| Background: The relationship between severity of traumatic brain injury (TBI) and outcome (prognosis) is markedly importance either theory or clinical practice. Estimation of prognosis Closed head injury is very difficult, with damage of diffuse and local. The assessment of prognosis of TBI during the long recovery period is far more difficult with many variable factors, while the extent of TBI in the short time is easy predict. Both Computed tomography(CT) and Magnetic resonance imaging(MRI) have been used to identify abnormalities in patients following TBI.Objective: 1) To compare characteristic of acute closed TBI by using MRI and CT. 2) To investigate the relationship of the results of MRI's measurement and prognosis of acute closed TBI, especial damaged position and extent of acute closed TBI. 3) To evaluate the significance of brainstem injury by using MRI in patients with severe acute closed TBI (GCS< 8).Methods: 61 patients (men: 55, female: 6) with traumatic brain injury (TBI) were chosen, which their age ranged from 15 to 70 years with a mean age of 42 years. The clinical material included the general material, hisyory, mechanism of injury, clinical manifestations, image findings. Initial neurological status of patient was evaluated using the Glasgow Coma Scale (GCS). Initial GCS scores of patient ranged from 3 to 15. According to the extent of head trauma, patients were divided into two groups: severe traumatic brain injury (sTBI, GCS < 8, n=28 patients) and moderate to mild traumatic brain injury (mTBI; GCS > 8, n=33 patients). CT scan on admission wasperformed together with MRI studies within 1 to 39 days after trauma (mean, 14 days). MRI was performed using a Sigma Excite with 1.5 Tesla magnetic field strength. With MRI and CT techniques, the damaged position and extent of patients with acute closed TBI were identified. The study was finished by followed up for 6 months.Statistical analysis: The results of sTBI and mTBI groups were analyzed and assessed using Glasgow Outcome Score (GOS) respectively. Patients with sTBI were divided into two groups by (GOS), including favorable group (GOS 4-5) and unfavorable group (GOS 2-3). The favorable group was involved in patients with or without mild disability, while The unfavorable outcome group included patients who were severely disabled , in a vegetative state.. Meantime, the results in mTBI group were assessed by the extended GOS, the depth of lesions was coded as absent (0), cortical (1), subcortical (2), cortical/subcortical (3).Results:1. mTBI groupOutcome assessed with the extended GOS revealed good recovery (30%, 10/33 patients),mild complaints and disturbances not interfering with daily activities or work (45%, 15/33 patients), and moderate disability (24%, 8/33 patients ). None of the patients was severely disabled. With CT scanning, pieces of 25 intracranial lesions in 23/33 patients were found. With early MRI scanning, pieces of 44 intracranial lesions in 29/33 patients were identified (P < 0.01). Intracranial lesions located predominantly in the frontal and temporal regions. Abnormal patients with MRI showed poor prognosis. We also found that only lesion in the frontal regions was signification. There were evidentlycorrelation between quantity and depth of lesion.2. sTBI group28 patients (30 men, female:2) were included in this study. CT scans on admission was performed together with MRI scans within 1 day to 39 days after injury. Injury of the brainstem was detected by using MRI. The results showed that 16 cases were lesion of brainstem, and 12 patients not. Patients were divided into the lesion group (n=16) and the non-lesion group. The results revealed that brainstem lesions patients were worse prognosis than those of non-lesions group, with initial GCS (4.81 ± 1.47 vs 6.17 ±0.39), duration of coma (3.69 ± 3.75 days vs 9.71 ± 4.71 days), and GOS (3.25± 0.19 vs 4.25 ± 0.18). Outcome assessed with GOS revealed good recovery (18%, 5 patients), moderate disability (39%, 11 patients), .severe disability (36%, 10 patients )...
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