· Traumatic brain injury (TBI) is recognized as a
major cause of morbidity and mortality, in all walks of life - whether related
to accidents, non-accidental trauma, athletic activity, or military service.
· Susceptibility-Weighted Imaging (SWI) is an
extremely sensitive technique for detecting small hemorrhages in the brain,
particularly after trauma.
Physicians and scientists interested in using SWI for evaluating
traumatic brain injury.
The goal of this presentation is to highlight the benefits of using SWI
in assessing patients with TBI, whether acute or chronic, as well as discuss
the prognostic value of information acquired by SWI.
By many reports, TBI affects approximately 1.7 million individuals in
the U.S. per year (up to 600 per 100,000 people per year), although the actual
number is likely more than doubled because many cases of mild TBI are
frequently not reported. The WHO estimates a worldwide incidence of 100-300 per
100,000 per year, although many believe the actual number is up to six times
higher, again largely due to the lack of inclusion of mild TBI cases, in some
reports accounting for up to 95% of all TBI cases. Although TBI is a leading cause of death in
individuals under 45 years of age, it has an even greater impact on long-term
morbidity and disability. This is becoming more evident in the military
population as well as sports-related concussion/TBI. Standardization of TBI evaluation remains elusive,
but increasing awareness of advanced imaging methods is helping to improve the
assessment of individuals, and aid in their management. SWI is more readily
available on most clinical MRI platforms, and easily improves detection of
injured brain.
TBI evaluation is moving away from the traditional practice of simply relying
on CT to determine if urgent neurosurgical intervention is required in the
acute setting, to identify mass-occupying hematomas or severe brain swelling.
MRI is being used more frequently to evaluate subtler areas of tissue injury, which
can significantly impact the patient’s outcome. SWI is extremely useful for
detecting small hemorrhages that are usually missed by CT and conventional MRI.
These small hemorrhages may be quite extensive or be located in critical brain
regions, and can serve as biomarkers of injury or help predict neurologic and
neuropsychological outcomes. Quantitative SWI (QSM, SWIM) can also provide
additional information such as measuring iron deposition after chronic TBI, or
used to quantify lesions for comparison or follow-up purposes.
SWI is most useful in moderate and severe TBI assessment, where
hemorrhages are more likely to be present. Microhemorrhages are less often
found in mild TBI, in which case other advanced imaging modalities may be more
helpful, such as DTI for determining the integrity of white matter tracts. In
the adult population, microhemorrhages can also be found in the setting of
chronic hypertension and amyloid angiopathy, which should be taken into
consideration. The appearance of microhemorrhages can also be artificially
created by post-processing techniques, which may also be problematic in mild
TBI cases.
SWI can provide important information regarding areas of injured brain.
However, it is best used in conjunction with other advanced MR imaging
modalities that complement the evaluation, including MR spectroscopy (MRS),
Diffusion Tensor Imaging (DTI), resting state functional MRI (fMRI) and MR
perfusion/permeability imaging.
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