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The Importance of 3T MR Imaging

6 December 2023   |   Gyrus Group

Jenny is a 25-year-old architect, who was hit by a car while cycling training for a triathlon. She was wearing a helmet. She had sustained significant orthopaedic injuries, and at the scene was noted by the paramedics to be repetitive and agitated. By the time she had arrived at hospital she had had Morphine, but was considered alert and orientated, she had visible signs of a head injury. Her day of injury CT head scan showed bruising outside the skull, but no skull fracture or bleeding in or around the brain.

Jenny had undergone significant physical rehabilitation, and as she returned to work, she had ongoing problems with headaches and fatigue. She noted that she was making errors in the workplace and felt that her thought processes were now slower than they used to be. She felt not as sharp at her job and had a negative performance review for the first time.

Some 18 months after the injury, her solicitor instructed a neurologist as part of the Gyrus Group team. They noted the above clinical features, and that her memories began after some hours after the injury in the emergency department. The treating doctors have not considered there being a significant brain injury. Given ongoing issues of fatigue, headaches, cognitive symptoms, the expert considered there may be a significant organic brain injury.

With our partnership with Aston University, we undertook a 3T MRI scan specifically looking for the detection of blood products. The scan detected evidence of small bleeds in the frontal lobes. This could only have been explained by the injury.

The imaging here helped Jenny understand that she had had a significant traumatic brain injury. It informed the case manager, who was then able to focus on brain injury rehabilitation as part of the recovery. It allowed the neurological expert to understand the severity of the injury, influencing their views about the organic nature of the symptoms reported, and also on epilepsy risk.

As part of the claim, a neuropsychologist and a psychiatrist were instructed as part of the Gyrus Group team.

Jenny had an excellent outcome, she realised through her cognitive symptoms fatigue, that she would be best to taking reasonable adaptations for lifestyle and adapted her working hours to better manage her symptoms. Jenny was now supported at work.

The highest quality MRI imaging is vital, particularly in injuries such as this, where there has been evidence of a brain injury but normal CT scanning. Commonly, there is not a consideration of a head injury by the treating doctors at the time. CT scan remains the appropriate investigation at the time of any injury as they detect skull fractures and blood, MRI imaging is better at detecting subtle features of brain injury. It remains important in cases such as this to use MR imaging, 3T in strength, which has the appropriate protocols to look for blood products and diffuse axonal injury, as interpreted by an experienced neuroradiologist.

These services are all offered at Gyrus who have a special collaboration with Aston University to deliver these services.

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