Essentials of Head Trauma Imaging

Head trauma is a common indication for neuroimaging in the emergency room. CT is the modality of first choice, as it is quick, safe, and effective in evaluating for life-threatening intracranial hemorrhage and mass effect. CT is also best for evaluating for skull fractures, which may alter management and lead to further imaging studies. MRI is reserved for selected patients, particularly when the clinical exam does not match the CT imaging findings, such as in diffuse axonal injury. Emergency room physicians and radiologists, particularly those in training, would benefit from a consistent approach and search pattern for evaluating head trauma. We offer a comprehensive “outside-to-inside” approach to head trauma imaging, discussing not only common findings but also subtle “should not miss” findings and their clinical correlation.