European Radiology

, Volume 15, Issue 3, pp 569–581 | Cite as

New developments in the neuroradiological diagnosis of craniocerebral trauma

  • P. M. Parizel
  • J. W. Van Goethem
  • Ö. Özsarlak
  • M. Maes
  • C. D. Phillips


Accurate radiographic diagnosis is a cornerstone of the clinical management and outcome prediction of the head-injured patient. New technological advances, such as multi-detector computed tomography (MDCT) scanning and diffusion-weighted magnetic resonance imaging (MRI) have influenced imaging strategy. In this article we review the impact of these developments on the neuroradiological diagnosis of acute head injury. In the acute phase, multi-detector CT has supplanted plain X-ray films of the skull as the initial imaging study of choice. MRI, including fluid-attenuated inversion recovery, gradient echo T2* and diffusion-weighted sequences, is useful in determining the severity of acute brain tissue injury and may help to predict outcome. The role of MRI in showing diffuse axonal injuries is emphasized. We review the different patterns of primary and secondary extra-axial and intra-axial traumatic brain lesions and integrate new insights. Assessment of intracranial hypertension and cerebral herniation are of major clinical importance in patient management. We discuss the issue of pediatric brain trauma and stress the importance of MRI in non-accidental injury. In summary, new developments in imaging technology have advanced our understanding of the pathophysiology of brain trauma and contribute to improving the survival of patients with craniocerebral injuries.


Head trauma Diffusion-weighted imaging Multi-detector CT 


  1. 1.
    Marion DW (1998) Head and spinal cord injury. Neurol Clin 16:485–502Google Scholar
  2. 2.
    Teasdale GM (1995) Head injury. J Neurol Neurosurg Psychiatry 58:526–539Google Scholar
  3. 3.
    Sklar EM (2000) What more can MR imaging teach us about brain injury? (editorial). Am J Neuroradiol 21:808–809Google Scholar
  4. 4.
    Gean AD (1994) Imaging of head trauma. Raven, New YorkGoogle Scholar
  5. 5.
    Gentry LR (2002) Magnetic resonance imaging of the brain and spine, 3rd edn. Lippincott–Raven, Philadelphia, pp 1059–1098 (chapter 20)Google Scholar
  6. 6.
    Mirvis SE, Shanmuganathan K (1994) Trauma radiology. Part IV. Imaging of acute craniocerebral trauma. J Intensive Care Med 9:305–315Google Scholar
  7. 7.
    Parizel PM, Phillips CD (2004) Neuroradiological diagnosis of craniocerebral and spinal trauma: current concepts. In: von Schulthess GK, Zollikofer CL (eds) Diseases of the brain, head and neck spine (36th International Diagnostic Course in Davos IDKD 2004). Springer, Milan, pp 60–72Google Scholar
  8. 8.
    The Society of British Neurological Surgeons (1998) Guidelines for the initial management of head injuries: recommendations form the Society of British Neurological Surgeons. Br J Neurosurg 12:349–352Google Scholar
  9. 9.
    York JE, Gokaslan, ZL, Grossman RG (1999) Trauma of the nervous system. Curr Pract Med 2:773–782Google Scholar
  10. 10.
    Gean AD, Kates RS, Lee S (1995) Neuroimaging in head injury. New Horizons 3:549–561Google Scholar
  11. 11.
    Borg J, Holm L, Cassidy JD, Peloso PM, Carroll LJ, von Holst H, Ericson K; WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury (2004) Diagnostic procedures in mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. J Rehabil Med 43 [Suppl]:61–75Google Scholar
  12. 12.
    Mittl RL, Grossman RI, Hiehle JF, Hurst RW, Kauder DR, Gennarelli TA, Alburger GW (1994) Prevalence of MR evidence of diffuse axonal injury in patients with mild head injury and normal head CT findings. Am J Neuroradiol 15:1583–1589PubMedGoogle Scholar
  13. 13.
    Murray JG, Gean AD, Evans SJ (1996) Imaging of acute head injury. Semin Ultrasound CT MR 173:185–205Google Scholar
  14. 14.
    Heidemann RM, Ozsarlak O, Parizel PM, Michiels J, Kiefer B, Jellus V, Muller M, Breuer F, Blaimer M, Griswold MA, Jakob PM (2003) A brief review of parallel magnetic resonance imaging. Eur Radiol 13:2323–2337CrossRefPubMedGoogle Scholar
  15. 15.
    Scheid R, Preul C, Gruber O, Wiggins C, von Cramon DY (2003) Diffuse axonal injury associated with chronic traumatic brain injury: evidence from T2*-weighted gradient-echo imaging at 3 T. Am J Neuroradiol 24:1049–1056Google Scholar
  16. 16.
    Ashikaga R, Araki Y, Ishida O (1997) MRI of head injury using FLAIR. Neuroradiology 39:239–242Google Scholar
  17. 17.
    Campbell BG, Zimmerman RD (1998) Emergency magnetic resonance of the brain. Top Magn Reson Imaging 9:208–227Google Scholar
  18. 18.
    Lin DD, Filippi CG, Steever AB, Zimmerman RD (2001) Detection of intracranial hemorrhage: comparison between gradient-echo images and b(0) images obtained from diffusion-weighted echo-planar sequences. Am J Neuroradiol 22:1275–1281Google Scholar
  19. 19.
    Parizel PM, Makkat S, Van Miert E, Van Goethem JW, van den Hauwe L, De Schepper AM (2001) Intracranial hemorrhage: principles of CT and MRI interpretation. Eur Radiol 11:1770–1783CrossRefGoogle Scholar
  20. 20.
    Parizel PM, Ozsarlak, Van Goethem JW, van den Hauwe L, Dillen C, Verlooy J, Cosyns P, De Schepper AM (1998) Imaging findings in diffuse axonal injury after closed head trauma. Eur Radiol 8:960–960CrossRefPubMedGoogle Scholar
  21. 21.
    Schaefer PW (2001) Applications of DWI in clinical neurology. J Neurol Sci 186 [Suppl 1]:S25–S35Google Scholar
  22. 22.
    Liu AY, Maldjian JA, Bagley LJ, Sinson GP, Grossman RI (1999) Traumatic brain injury: diffusion-weighted MR imaging findings. Am J Neuroradiol 20:1636–1641Google Scholar
  23. 23.
    Hergan K, Schaefer PW, Sorensen AG, Gonzalez RG, Huisman TA (2002) Diffusion-weighted MRI in diffuse axonal injury of the brain. Eur Radiol 12:2536–2541Google Scholar
  24. 24.
    Huisman TA, Sorensen AG, Hergan K, Gonzalez RG, Schaefer PW (2003) Diffusion-weighted imaging for the evaluation of diffuse axonal injury in closed head injury. J Comput Assist Tomogr 27:5–11Google Scholar
  25. 25.
    Huisman TA (2003) Diffusion-weighted imaging: basic concepts and application in cerebral stroke and head trauma. Eur Radiol 13:2283–2297CrossRefPubMedGoogle Scholar
  26. 26.
    Huisman TA, Schwamm LH, Schaefer PW, Koroshetz WJ, Shetty-Alva N, Ozsunar Y, Wu O, Sorensen AG (2004) Diffusion tensor imaging as potential biomarker of white matter injury in diffuse axonal injury. Am J Neuroradiol 25:370–376Google Scholar
  27. 27.
    Parizel PM, Makkat S, Jorens PG, Ozsarlak O, Cras P, Van Goethem JW, van den Hauwe L, Verlooy J, De Schepper AM (2002) Brainstem hemorrhage in descending transtentorial herniation (Duret hemorrhage). Intensive Care Med 28:85–88Google Scholar
  28. 28.
    Zimmerman RA, Bilaniuk LT (1982) Computed tomographic staging of traumatic epidural bleeding. Radiology 144:809–812Google Scholar
  29. 29.
    Wilms G, Marchal G, Geusens E, Raaijmakers C, Van Calenbergh F, Goffin J, Plets C (1992) Isodense subdural haematomas on CT: MRI findings. Neuroradiology 34:497–499Google Scholar
  30. 30.
    Iplikcioglu AC, Akkas O, Sungur R (1991) Ossified chronic subdural hematoma: case report. J Trauma 31:272–295Google Scholar
  31. 31.
    Hashimoto N, Sakakibara T, Yamamoto K, Fujimoto M, Yamaki T (1992) Two fluid–blood density levels in chronic subdural hematoma. Case report. J Neurosurg 77:310–321Google Scholar
  32. 32.
    Parizel G (1973) Life-threatening arrhythmias in subarachnoid hemorrhage. Angiology 24:17–21Google Scholar
  33. 33.
    Bakshi R, Kamran S, Kinkel PR, Bates VE, Mechtler LL, Janardhan V, Belani SL, Kinkel WR (1999) Fluid-attenuated inversion-recovery MR imaging in acute and subacute cerebral intraventricular hemorrhage. Am J Neuroradiol 20:629–636Google Scholar
  34. 34.
    Lobato RD, Gomez PA, Alday R, Rivas JJ, Dominguez J, Cabrera A, Turanzas FS, Benitez A, Rivero B (1997) Sequential computerized tomography changes and related final outcome in severe head injury patients. Acta Neurochir (Wien) 139:385–391Google Scholar
  35. 35.
    Besenski N (2002) Traumatic injuries: imaging of head injuries. Eur Radiol 12:1237–1252CrossRefPubMedGoogle Scholar
  36. 36.
    Gentry LR, Godersky JC, Thompson B (1988) MR imaging of head trauma: review of the distribution and radiopathologic features of traumatic lesions. Am J Roentgenol 150:663–672Google Scholar
  37. 37.
    Gentry LR, Thompson B, Godersky JC (1988) Trauma to the corpus callosum: MR features. Am J Neuroradiol 9:1129–1138PubMedGoogle Scholar
  38. 38.
    Gentry LR, Godersky JC, Thompson BH (1989) Traumatic brain stem injury: MR imaging. Radiology 171:177–187Google Scholar
  39. 39.
    Server A, Dullerud R, Haakonsen M, Nakstad PH, Johnsen UL, Magnaes B (2001) Post-traumatic cerebral infarction. Neuroimaging findings, etiology and outcome. Acta Radiol 42:254–260Google Scholar
  40. 40.
    Parizel PM, Demey HE, Veeckmans G, Verstreken F, Cras P, Jorens PG, De Schepper AM (2001) Early diagnosis of cerebral fat embolism syndrome by diffusion-weighted MRI (starfield pattern). Stroke 32:2942–2944Google Scholar
  41. 41.
    Poussaint TY, Moeller KK (2002) Imaging of pediatric head trauma. Neuroimaging Clin N Am 12:271–294Google Scholar
  42. 42.
    Han BK, Towbin RB, De Courten-Myers G, McLaurin RL, Ball WS Jr (1990) Reversal sign on CT: effect of anoxic/ischemic cerebral injury in children. Am J Roentgenol 154:361–368Google Scholar
  43. 43.
    Demaerel P, Casteels I, Wilms G (2002) Cranial imaging in child abuse. Eur Radiol 12:849–857CrossRefGoogle Scholar
  44. 44.
    Blumenthal I (2002) Shaken baby syndrome. Postgrad Med J 78:732–735Google Scholar
  45. 45.
    Parizel PM, Ceulemans B, Laridon A, Ozsarlak O, Van Goethem JW, Jorens PG (2003) Cortical hypoxic–ischemic brain damage in shaken-baby (shaken impact) syndrome: value of diffusion-weighted MRI. Pediatr Radiol 33:868–871Google Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • P. M. Parizel
    • 1
  • J. W. Van Goethem
    • 1
    • 2
  • Ö. Özsarlak
    • 1
    • 2
  • M. Maes
    • 1
  • C. D. Phillips
    • 1
    • 2
  1. 1.Department of RadiologyUniversity of AntwerpAntwerpBelgium
  2. 2.Department of RadiologyUniversity of Virginia Health SystemCharlottesvilleUSA

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