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

BACKGROUND: 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. AIM: To evaluate the role of MRI in head injury patients with altered Glasgow Coma Scale (GCS) scores and normal CT findings. MATERIALS AND METHODS: 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. RESULTS: 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). CONCLUSION: MRI is an essential complementary modality in acute head injury with normal CT findings, improving diagnostic accuracy, prognostication, and clinical management.