Utility of Magnetic Resonance Findings in Elucidating Structural and Functional Brain Impairment in Traumatic Brain Injury

Fig. 31.1

Patient is a 20-year-old male admitted to the hospital for 30 ft. fall from oil rig. Patient was helicoptered in from the field and intubated due to low GCS 4–5. Presented with subarachnoid hemorrhage, brain laceration in the left frontal lobe, multiple skull fractures. After 3 years the patient showed cognitive decline, depression, bursts of anger, decreased capacity for planning, bad social interaction. Never returned to work. (a) Computed tomography in transverse view showing laceration and hematoma in left frontal lobe. (b) Magnetic resonance with susceptibility sequence depicts the frontal hemorrhage and blood deposits in the ventricles. (c) Hemosiderin deposits in microglia appear 3 years after first magnetic resonance in the susceptibility sequence. (d) Decreased cortical thickness (blue) in the frontal lobe in the same patient pinpointing Brodmann’s areas involved. (e) Diffusion tensor imaging performed in the same patient with decreased fractional anisotropy values in corpus callosum and inferior longitudinal fasciculus

Fig. 31.2

Resting-state functional magnetic resonance. (a) Functional connectivity. A seed was placed in the anterior cingulum. No connectivity with posterior cingulum and dorsal frontal cortex compared with normal in (c). (b) Z-test, patient compared to 20 normal individuals depicting decreased connectivity in the posterior cingulum. (d) Normal frsfMRI with seed in anterior cingulum. (e) Resting-state functional magnetic resonance. Compared to normal in (f), there is no connectivity with posterior cingulum, frontal cortex, angular cortex. (f) Z-test showing decreased connectivity in the patient’s anterior cingulum. (f, g) Magnetic resonance spectroscopy. Decreased n-acetyl aspartate in the frontal lobe. NAA is a marker for neurons, indicating decreased neuronal content in the frontal lobe. There is also an increase in myoinositol, a marker for glia. This correlates with increase in scarring and fibrillary content

Fig. 31.3

Autopsy in a patient who died from TBI. MR was obtained before death. Correlation of abnormal fractional anisotropy with pathology. Swollen and disrupted fibers in genu and splenium of corpus callosum correlate with fractional anisotropy (FA) abnormal values

Fig. 31.4

Autopsy case. Patient with encephalomalacia in frontal pole after surgery for resection of a meningioma. He sustained a seizure while driving. MR obtained before death. Correlation between abnormal cortical thickness (blue) and contusion demonstrated by pathology

Conclusions

Neuroimaging has increasingly become a vital tool for management of patients with head injury. While conventional CT and MR modalities offer rapid structural assessment ensuring prompt institution of surgical management for selective cases, functional modalities allow accurate prediction of overall functional and clinical outcomes in patients with TBI. With easy accessibility to MR technology, complex MR sequences entailing deeper insights into structural and functional impairments should routinely be employed in assessment of patients with TBI. MR imaging techniques additionally enhance our knowledge base relating to anatomic abnormalities and functional outcomes. Higher resolution scans, integration of digital software for data processing, and technical advancements offer a viable solution for automation in image processing and interpretation.

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