To do or not to do? Magnetic resonance imaging in mild traumatic brain injury

Clinical quantification of mild traumatic brain injury (MTBI) patients shou ld be based on Glasgow coma scale (GCS) score, duration of loss of consciou sness (LOC) and post-traumatic amnesia (PTA). In addition, a short practica ble neuropsychological test might be useful in detecting minor memory and a ttentional deficits. MRI appears to be the most sensitive imaging method fo r assessing MTBI so far, but information regarding a visualized lesion is n ot usually utilized in the classification of MTBI. Magnetic resonance imagi ng (MRI) should, therefore, play a major role in any MTBI classification sc heme. An appropriate MRI protocol has to be chosen using at least T-1 weigh ted, T-2 weighted, proton density and gradient-echo (GRE) sequence images, all in at least two planes, in order to detect and classify all lesions pre cisely. Owing to the fact that acute lesions may be missed, it is advisable to perform MRI in the first 2 weeks following trauma. Further research is necessary to clarify the relationship between chronic symptoms after MTBI a nd MRI abnormalities. It may, thus, be possible to provide optimal strategi es for emergency department management, to define a group of patients with a need for acute and rehabilitative intervention after MTBI, and to predict their outcome.