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MRI and Mild TBI

I recently reviewed an interesting article in the annals of Neurology entitled: “Magnetic Resonance Imaging improves three-month outcome prediction in mild traumatic brain injury.”  Ann Neurol 2012; 00:000-000. 
The article authored, by Geoffrey T. Manley, M.D. Ph.D. and colleagues, sought to determine the clinical relevance, if any, of traumatic intracranial findings on early head computed tomography (CT) and brain magnetic resonance imaging (MRI) to three-month outcome in mild traumatic brain injury.  The authors evaluated 135 mild TBI patients for acute head injury in the emergency departments of three level one trauma centers.  All patients underwent admission head CT, early brain MRI, which were performed 12 plus or minus 3.9 days after injury. 
The results of the study found that 27% of mild TBI patients with normal admission head CT had abnormal early brain MRI.  The authors in the abstract concluded “in this perspective multi center observational study, the clinical relevance of abnormal findings on early brain imaging after MTBI is demonstrated.  The addition of early CT and MRI markers to a prognostic model based on previously known demographic, clinical and socioeconomic predictors resulted in a greater than 2-fold increase in the explained variance in 3-month extended Glasgow Outcome Scale (GOS-E). 
From a neuro-law perspective, the authors make an important statement in their discussion, finding “there is also growing recognition that current classifications schemes for TBI based on Glasgow Coma Scale are severely limited, with small mean affect sizes in long-term impairment potentially obscuring differences among diverse groups of TBI patients with very different prognoses.  
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