Magnetic resonance imaging improves 3-month outcome prediction in mild traumatic brain injury

Ann Neurol. 2013 Feb;73(2):224-35. doi: 10.1002/ana.23783. Epub 2012 Dec 7.


Objective: To determine the clinical relevance, if any, of traumatic intracranial findings on early head computed tomography (CT) and brain magnetic resonance imaging (MRI) to 3-month outcome in mild traumatic brain injury (MTBI).

Methods: One hundred thirty-five MTBI patients evaluated for acute head injury in emergency departments of 3 LEVEL I trauma centers were enrolled prospectively. In addition to admission head CT, early brain MRI was performed 12 ± 3.9 days after injury. Univariate and multivariate logistic regression were used to assess for demographic, clinical, socioeconomic, CT, and MRI features that were predictive of Extended Glasgow Outcome Scale (GOS-E) at 3 months postinjury.

Results: Twenty-seven percent of MTBI patients with normal admission head CT had abnormal early brain MRI. CT evidence of subarachnoid hemorrhage was associated with a multivariate odds ratio of 3.5 (p = 0.01) for poorer 3-month outcome, after adjusting for demographic, clinical, and socioeconomic factors. One or more brain contusions on MRI, and ≥4 foci of hemorrhagic axonal injury on MRI, were each independently associated with poorer 3-month outcome, with multivariate odds ratios of 4.5 (p = 0.01) and 3.2 (p = 0.03), respectively, after adjusting for head CT findings and demographic, clinical, and socioeconomic factors.

Interpretation: In this prospective multicenter observational study, the clinical relevance of abnormal findings on early brain imaging after MTBI is demonstrated. The addition of early CT and MRI markers to a prognostic model based on previously known demographic, clinical, and socioeconomic predictors resulted in a >2-fold increase in the explained variance in 3-month GOS-E.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Brain Injuries / diagnostic imaging*
  • Brain Injuries / epidemiology
  • Brain Injuries / pathology*
  • Female
  • Humans
  • Logistic Models
  • Magnetic Resonance Imaging / standards*
  • Magnetic Resonance Imaging / statistics & numerical data*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Practice Guidelines as Topic
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • ROC Curve
  • Risk Factors
  • Tomography, X-Ray Computed / standards*
  • Tomography, X-Ray Computed / statistics & numerical data
  • Trauma Centers
  • Trauma Severity Indices
  • Young Adult