MRI characteristics and perioperative changes in serum hs-CRP, NSE, and MMP-2 levels in patients with acute closed craniocerebral injury

Objective This study aimed to explore the magnetic resonance imaging (MRI) features in patients with ACCI, alongside the clinical relevance of perioperative fluctuations in serum levels of high-sensitivity C-reactive protein (hs-CRP), neuron-specific enolase (NSE), and matrix metalloproteinase-2 (MMP-2). Methods A retrospective analysis was conducted on clinical data from 118 patients diagnosed with ACCI (three subgroups: mild group with 46 cases, moderate group with 55 cases, and severe group with 17 cases). A total of 60 healthy volunteers were enrolled as the health control group (HC group). All enrolled patients received MRI scanning upon hospital admission to characterize imaging findings. The blood samples were collected to quantify serum concentrations of hs-CRP, NSE, and MMP-2. During follow-up, patient outcomes were assessed using the Glasgow Outcome Scale (GOS). Results MRI revealed cerebral contusions/lacerations in 81% (96/118), intracranial hemorrhage in 73% (86/118), perilesional edema in 68% (80/118), and midline shift in 42% (50/118). The ACCI group exhibited markedly higher serum hs-CRP, NSE, and MMP-2 concentrations relative to the HC group, with statistical significance ( P < 0.05). Furthermore, these biomarker levels showed a stepwise elevation in accordance with injury severity, with the most pronounced increases observed in the severe group, followed by the moderate group, and the lowest values noted in the mild group (all comparisons yielded P < 0.05). According to multivariate analysis identified GCS score (OR = 1.431, 95% CI: 1.025-1.850), MRI abnormalities (OR = 2.129, 95% CI: 1.353-3.095), hs-CRP (OR = 1.890, 95% CI: 1.144-2.673), NSE (OR = 2.037, 95% CI: 1.670-2.591), and MMP-2 (OR = 3.455, 95% CI: 1.873-4.886) as independent predictors of poor prognosis ( P < 0.05). The predictive capacity for poor outcomes, as evaluated by ROC curve analysis, was substantial for GCS score and each of the three serum biomarkers individually. Conclusion The combination of MRI imaging features with serum levels of hs-CRP, NSE, and MMP-2 can comprehensively reflect the injury severity and prognosis of ACCI patients, providing significant reference value for early clinical risk assessment and treatment decisions.