Head trauma: comparison of MR and CT--experience in 100 patients

The results of CT and MR imaging were reviewed retrospectively and compared in 100 patients who experienced clinically significant head trauma. The findings were analyzed on the basis of several parameters in an attempt to establish objective clinical guidelines for the use of each diagnostic technique. CT remains the screening method of choice in evaluating acute severe head trauma; however, MR revealed additional clinically relevant findings in all four cases in which the patient's clinical symptoms were disproportionate to the CT findings. MR was equal or superior to CT in the evaluation of all patients with acute minor head trauma and in 94 of 95 patients examined in the subacute, chronic, or remote phase of injury, irrespective of the severity or pathologic nature of their injuries. All subacute contusions (21 lesions) and white-matter shearing lesions (18 cases) were demonstrated to particular advantage on MR compared with CT, as were all subdural hematomas (of 52 small subdural collections, 58% were detected only by MR). Although surgical management was not altered by the additional information provided by MR, the implications regarding the medical management and disposition of the patients with head trauma were significant.