MRIs reveal signs of brain injuries not seen in CT scans, researchers report

December 18, 2012 in Neuroscience

Hospital MRIs may be better at predicting long-term outcomes for people with mild traumatic brain injuries than CT scans, the standard technique for evaluating such injuries in the emergency room, according to a clinical trial led by researchers at the University of California, San Francisco (UCSF) and the San Francisco General Hospital and Trauma Center (SFGH).

Published this month in the journal , the study was led by UCSF neuroradiologist Esther Yuh, MD, PhD and followed 135 people treated for mild traumatic brain injuries over the past two years at one of three urban hospitals with level-one trauma centers: SFGH, the University of Pittsburgh Medical Center and University Medical Center Brackenridge in Austin, Texas as part of a study called NIH-funded TRACK-TBI (Transforming Research and Clinical Knowledge in Traumatic Brain Injury).

All 135 patients with mild traumatic brain injuries received CT scans when they were first admitted, and all were given MRIs about a week later. Most of them (99) had no detectable signs of injury on a , but more than a quarter (27/99) who had a "normal" CT scans also had detectable spots on their MRI scans called "focal lesions," which are signs of microscopic bleeding in the brain.

Spotting these focal lesions helped the doctors predict whether the patients were likely to suffer persistent neurological problems. About 15 percent of people who have mild traumatic brain injuries do suffer long-term neurological consequences, but doctors currently have no definitive way of predicting whether any one patient will or not.

"This work raises questions of how we're currently managing patients via CT scan," said senior author on the study Geoff Manley, MD, PhD, the chief of neurosurgery at SFGH and vice-chair of the Department of Neurological Surgery at UCSF. "Having a normal CT scan doesn't, in fact, say you're normal," he added.

Better Precision Tools Needed for Head Injuries, Doctors Say

At least 1.7 million Americans seek medical attention every year for acute head injuries, and three quarters of them have mild traumatic brain injuries – which generally do not involve skull fractures, comas or severe bleeding in the brain but have a variety of more mild symptoms, such as temporary loss of consciousness, vomiting or amnesia.

The U.S. Centers for Disease Control and Prevention (CDC) estimates that far more mild traumatic brain injuries may occur each year in the United States but the true number is unknown because only injuries severe enough to bring someone to an emergency room are counted.

Most of those who do show up at emergency rooms are treated and released without being admitted to the hospital. In general, most people with mild traumatic brain injuries recover fully, but about one in six go on to develop persistent, sometimes permanent disability.

The problem, Manley said, is that there is no way to tell which patients are going to have the poor long-term outcomes. Some socioeconomic indicators can help predict prolonged disability, but until now there have been no proven imaging features, or blood tests for predicting how well or how fast a patient will recover. Nor is there a consensus on how to treat mild traumatic brain injuries.

"The treatment's all over the place—if you're getting treatment at all," Manley said.

The new work is an important step towards defining a more quantitative way of assessing patients with mild traumatic brain injuries and developing more precision medical tools to detect, monitor and treat them, he added.

If doctors knew which patients were at risk of greater disabilities, they could be followed more closely. Being able to identify patients at risk of long-term consequences would also speed the development of new therapeutics because it would allow doctors to identify patients who would benefit the most from treatment and improve their ability to test potential new drugs in clinical trials.

More information: The article, "Magnetic Resonance Imaging Improves 3-Month Outcome Prediction in Mild Traumatic Brain Injury" by Esther l. Yuh, Pratik Mukherjee, Hester F. Lingsma, John K. Yue, Adam R. Ferguson, Wayne A. Gordon, Alex B. Valadka, David M. Schnyer, David O. Okonkwo, Andrew I. R. Maas, Geoffrey T. Manley and the TRACK-TBI Investigators was published online by the journal Annals of Neurology on December 7, 2012. See: dx.doi.org/10.1002/ana.23783

Journal reference: Annals of Neurology search and more info website

Provided by University of California, San Francisco search and more info website

not rated yet  

Rank not rated yet
Relevant PhysicsForums posts

More news stories

For combat veterans suffering from post-traumatic stress disorder, 'fear circuitry' in the brain never rests

Chronic trauma can inflict lasting damage to brain regions associated with fear and anxiety. Previous imaging studies of people with post-traumatic stress disorder, or PTSD, have shown that these brain regions can over-or ...

Neuroscience created May 18, 2013 | popularity 5 / 5 (1) | comments 0 | with audio podcast

Temporal processing in the olfactory system

The neural machinery underlying our olfactory sense continues to be an enigma for neuroscience. A recent review in Neuron seeks to expand traditional ideas about how neurons in the olfactory bulb might encode information about ...

Neuroscience created May 17, 2013 | popularity 4 / 5 (1) | comments 0 | with audio podcast report

Melon focus headband turns to Kickstarter for rollout plans

(Medical Xpress)—What if the quality of your work depends more on your focus on the piano keys or canvas or laptop than your musical or painting or computing skills? If target users can be convinced, they ...

Neuroscience created May 17, 2013 | popularity 3.7 / 5 (3) | comments 0 | with audio podcast weblog

Deep brain stimulation: A fix when the drugs don't work

Neurological disorders can have a devastating impact on the lives of sufferers and their families.

Neuroscience created May 17, 2013 | popularity 5 / 5 (1) | comments 0 | with audio podcast

Brain makes call on which ear is used for cell phone

If you're a left-brain thinker, chances are you use your right hand to hold your cell phone up to your right ear, according to a newly published study from Henry Ford Hospital in Detroit.

Neuroscience created May 16, 2013 | popularity 2 / 5 (2) | comments 0 | with audio podcast


New theory on genesis of osteoarthritis comes with successful therapy in mice

Scientists at Johns Hopkins have turned their view of osteoarthritis (OA) inside out. Literally. Instead of seeing the painful degenerative disease as a problem primarily of the cartilage that cushions joints, ...

Computational tool translates complex data into simplified 2-dimensional images

In their quest to learn more about the variability of cells between and within tissues, biomedical scientists have devised tools capable of simultaneously measuring dozens of characteristics of individual ...

Researchers identify a potential new risk for sleep apnea: Asthma

Researchers at the University of Wisconsin have identified a potential new risk factor for obstructive sleep apnea: asthma. Using data from the National Institutes of Health (Heart, Lung, and Blood Institute)-funded Wisconsin ...

Study finds that sleep apnea and Alzheimer's are linked

A new study looking at sleep-disordered breathing (SDB) and markers for Alzheimer's disease (AD) risk in cerebrospinal fluid (CSF) and neuroimaging adds to the growing body of research linking the two.

'Gap' for HIV vaccine efforts after latest setback

The hunt for an HIV vaccine has gobbled up $8 billion in the past decade, and the failure of the most recent efficacy trial has delivered yet another setback to 26 years of efforts.

Ginger compounds may be effective in treating asthma symptoms

Gourmands and foodies everywhere have long recognized ginger as a great way to add a little peppery zing to both sweet and savory dishes; now, a study from researchers at Columbia University shows purified components of the ...