MRIs Are Better Than CT Scans at Diagnosing Brain Injuries

It is not unusual for a person to be diagnosed with a traumatic brain injury days or weeks after an emergency room visit.  Many clients ask “how can this happen?”  The answer is easily explained when one understands the typical technology currently used in the average emergency room of a U.S. hospital. When a scan is needed, many emergency rooms will use a CT scan rather than an MRI.  CT scans are not currently as sensitive at detecting ischemic injury in the brain as an MRI is. CT scans are a specialized kind of x-ray. Ischemic injury in the brain occurs when blood supply to the brain is restricted causing damage to related brain matter. While this is not a perfect analogy, imagine the difference between an x-ray being able to detect a broken bone versus a ruptured spleen.  The x-ray is simply not as sensitive to pick up the ruptured spleen.
As stated in the publications surrounding the revisions to guidelines from the American Academy of Neurology “while CT scans are currently the standard test used to diagnose stroke, the Academy’s guideline found that MRI scans are better at detecting ischemic/stroke damage compared to CT scans.”  The majority of strokes, causing traumatic brain injuries, are ischemic, caused by lack of blood flow in the brain usually due to a blockage or a blood clot. CT scans are a specialized kind of x-ray taken of the brain while the MRI uses magnets and radio waves that show clear images of brain tissue. A diffusion MRI measures molecular water motion in the tissue. The MRI shows where the water diffusion is restricted and therefore better shows where the brain damage has occurred.
The Academy of Neurology considers a diffusion MRI more useful than a CT scan for diagnosing acute ischemic injury to the brain within twelve hours of the onset of symptoms.  In a large study among stroke victims, stroke victims were accurately detected 83% of the time by an MRI versus an accurate prediction of the injury only 26% of the time through the use of a CT scan.

            The guidelines from the American Academy of Neurology were formed, in part,  based on the work of Dr. Peter Schellinger with the Johannes Wesling Clinical Center in Minden, Germany.  The findings further indicated that specific types of MRI scans can help reveal how severe the brain injuries are and help find the acute lesions earlier.  “This is important” Dr. Schellinger said, “because the research suggests finding lesions early may lead to better health outcomes.”  According to Dr. Schellinger, the studies are clear that emergency rooms should use MRIs more frequently in cases involving traumatic brain injuries including stokes.  The American Academy of Neurology guidelines give doctors clear direction in using the MRI first. CT scans are not outdated, in fact they are still used first when a person needs an emergency injection of drug therapy, also known as intravenous thrombolytic therapy to break up blood clots in order to avoid delays in starting this treatment if an MRI is not immediately available.

            Brain injuries are permanent and significant injuries.  Often, a brain injury survivor does not realize the full extent of the injuries until weeks or months later as they discover limitations secondary to the brain injury which the brain previously handled without problem.

            North Carolina based attorneys at Fisher Stark work to understand the current science on brain injuries, traumatic brain injury recovery, therapies and modalities to assist their clients to reach maximum medical improvement and protect their rights under law. The unique nature of a brain injury requires brain injury attorneys to be both an attorney and a counselor of law.  If you have questions please feel free to contact the Asheville attorneys at Fisher Stark P.A. as they will be glad to answer your questions and assist you as they are able.