Imaging Evidence and Recommendations for Traumatic Brain Injury: Conventional Neuroimaging Techniques
Abstract: Imaging plays an essential role in identifying intracranial injury in patients with TBI. The goals of imaging include: (1) detecting injuries that may require immediate surgical or procedural intervention: (2) detecting injuries that may benefit from early medical therapy or vigilant neurologic supervision, and: (3) determining the prognosis of patients to tailor rehabilitative therapy or help with family counseling and discharge planning. In this article, the authors perform a review of the evidence on the utility of various imaging techniques in patients presenting with TBI to provide guidance for evidence-based, clinical imaging protocols.
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Imaging Evidence and Recommendations for Traumatic Brain Injury: Advanced Neuro- and Neurovascular Imaging Techniques
Abstract: Neuroimaging plays a critical role in the evaluation of patients with TBI, with NCCT as the first-line of imaging for patients with TBI and MR imaging being recommended in specific settings. Advanced neuroimaging techniques, including MR imaging DTI, blood oxygen level\Ndependent fMRI, MR spectroscopy, perfusion imaging, PET/SPECT, and magnetoencephalography, are of particular interest in identifying further injury in patients with TBI when conventional NCCT and MR imaging findings are normal, as well as for prognostication in patients with persistent symptoms. These advanced neuroimaging techniques are currently under investigation in an attempt to optimize them and substantiate their clinical relevance in individual patients.
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When referring physicians and radiologists needed to select the most appropriate imaging procedure for the case at hand, there was a lack of digestible, synthesized content that summarized the latest in evidence-based research. After identifying this gap in the information and education products available to the TBI clinical community, the ACR’s Head Injury Institute (HII) convened a working committee of over 25 leading neuroradiologists, neurologists and other experts to perform a review of the evidence on the utility of various imaging techniques in patients presenting with TBI to provide guidance for evidence-based, clinical imaging protocols.
The HII is pleased to announce that many months and hundreds of hours of work by this dedicated team has culminated in the publication of a peer-reviewed article in the Journal of the American College of Radiology (JACR) and a companion article in the American Journal of Neuroradiology (AJNR).
The intent of the JACR article is to suggest practical imaging recommendations for patients presenting with TBI across different practice settings and to simultaneously provide the rationale and background evidence supporting their use. These recommendations should ultimately assist referring physicians faced with the task of ordering appropriate imaging tests in particular patients with TBI for whom they are providing care. These recommendations should also help radiologists advise their clinical colleagues on appropriate imaging utilization for patients with TBI.
The intent of the AJNR article is to assess the current evidence and determine the currently appropriateness of advanced neuroimaging techniques to these same needs for TBI imaging. It is the HII’s intention that these twin publications be used by a wide variety of TBI stakeholders, including:
• Emergency medicine physicians
• Other referring physicians, including internists and rehabilitative medicine physicians
In the spirit of patient-centered medicine, it is also our hope that patients and their caregivers who are proactively involved in making health care decisions will avail themselves of these articles and share them with their clinical teams.
Since the science and supporting published evidence for TBI-related imaging continues to advance at a steady clip, it is the HII’s intention that these will be living documents. To this end, the HII plans to reconvene this working group on an as-needed basis to update the background analysis work and publish updated versions of these papers.