Role of Magnetic Resonance Imaging in Acute Head Injury Patients with Normal Computed Tomography Brain Findings

Traumatic brain injury (TBI) is a major cause of morbidity and mortality. Computed tomography (CT) is the first-line imaging modality in acute head injury; however, patients with altered neurological status may show normal CT findings. Magnetic resonance imaging (MRI), with superior soft-tissue contrast, can detect subtle intracranial injuries missed on CT.

To evaluate the role of MRI in head injury patients with altered Glasgow Coma Scale (GCS) scores and normal CT findings.

This hospital-based cross-sectional study was conducted in the Department of Radiology, Aarupadai Veedu Medical College and Hospital, Puducherry, from November 2023 to May 2024. Ninety-two patients aged 18-60 years with acute traumatic head injury, altered GCS, and normal CT brain findings were included. MRI was performed using a 1.5-T scanner with T1 Weighted Imaging (T1W), T2 Weighted Imaging (T2W), T2 Fluid Attenuated Inversion Recovery (T2-FLAIR), Diffusion Weighted Imaging (DWI), and Susceptibility Weighted Imaging (SWI) sequences. MRI findings were correlated with GCS scores. Data were analyzed using descriptive statistics and Chi-square test, with P < 0.05 considered significant.

MRI detected small contusions (81.5%), edema (80.4%), thin SDH (60.9%), microhemorrhages (48.9%), nonhemorrhagic DAI (46.7%), hemorrhagic DAI (34.8%), brainstem injury (41.3%), and thin SAH (28.3%). Hemorrhagic DAI, nonhemorrhagic DAI, microhemorrhages, and edema showed significant association with GCS scores (P < 0.05).

MRI is an essential complementary modality in acute head injury with normal CT findings, improving diagnostic accuracy, prognostication, and clinical management.