Brain MRI Protocol for Post-Concussion Syndrome

Rationale for MRI Without Contrast

• The American College of Radiology recommends brain MRI without IV contrast as the initial imaging protocol for patients with post-concussion syndrome, as it is more sensitive than CT for detecting subtle findings such as microbleeds, white matter lesions, focal encephalomalacia, and traumatic axonal injury 1
• The American College of Radiology states that contrast administration is not necessary for the initial evaluation of post-concussion syndrome, as there is no relevant literature supporting the routine use of contrast-enhanced brain MRI for this condition 2

Clinical Context and Expectations

• The American College of Radiology suggests that the primary value of MRI in post-concussion syndrome is diagnostic exclusion, rather than confirmation, and that normal conventional MRI does not exclude the diagnosis of post-concussion syndrome 3

When Contrast May Be Considered

• The American College of Radiology recommends considering contrast MRI if initial non-contrast MRI reveals unexpected findings requiring further characterization, or if there is clinical suspicion for alternative diagnoses such as infection, neoplasm, or inflammatory conditions 1

Common Pitfalls to Avoid

• The American College of Radiology advises against routine contrast administration, as it adds cost, time, and potential contrast-related risks without established benefit for typical post-concussion syndrome evaluation 2