CRANIAL MR-IMAGING AND CEREBRAL TC-99M HM-PAO-SPECT IN PATIENTS WITH SUBACUTE OR CHRONIC SEVERE CLOSED-HEAD INJURY AND NORMAL CT EXAMINATIONS

Eighteen patients in the subacute or chronic state following severe cl osed head injury with normal cranial CT scans were examined by MR and Tc-99m HM-PAO SPECT. Correlations were sought between these 2 imaging modalities and the clinical outcome, as defined by the Glasgow Outcome Scale (GOS) score. Both MR and SPECT revealed cerebral damage in all patients examined but structural and functional alterations did not co incide topographically in 64.9% of lesions. Nevertheless, complementar y injury patterns suggesting poor recovery were found; cortical contus ions and diffuse axonal injury (MR) in conjunction with cortical and t halamic hypoperfusion (SPECT) were noticed in 8 out of 12 patients wit h unfavorable outcome (GOS=III and IV). The synthesis of MR and SPECT information clearly enhanced the ability both to accurately assess pos ttraumatic brain damage and to improve patients' outcome pre predictio n.