Does the Addition of a "Black Bone" Sequence to a Fast Multisequence Trauma MR Protocol Allow MRI to Replace CT after
M H G Dremmen1,2, M W Wagner3,4, T Bosemani3
1From the Section of Pediatric Neuroradiology (M.H.G.D., M.W.W., T.B., A.T., D.A., E.D., B.P.S., T.A.G.M.H.), Division of Pediatric Radiology and Pediatric Neuroradiology, Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, Maryland m.dremmen@erasmusmc.nl.
Background And Purpose:
Head CT is the current neuroimaging tool of choice in acute evaluation of pediatric head trauma. The potential cancer risks of CT-related ionizing radiation should limit its use in children. We evaluated the role of MR imaging, including a "black bone" sequence, compared with CT in detecting skull fractures and intracranial hemorrhages in children with acute head trauma.
Materials And Methods:
We performed a retrospective evaluation of 2D head CT and brain MR imaging studies including the black bone sequence of children with head trauma. Two experienced pediatric neuroradiologists in consensus created the standard of reference. Another pediatric neuroradiologist blinded to the diagnosis evaluated brain MR images and head CT images in 2 separate sessions. The presence of skull fractures and intracranial posttraumatic hemorrhages was evaluated. We calculated the sensitivity and specificity of CT and MR imaging with the black bone sequence in the diagnosis of skull fractures and intracranial hemorrhages.
Results:
Twenty-eight children (24 boys; mean age, 4.89 years; range, 0-15.5 years) with head trauma were included. MR imaging with the black bone sequence revealed lower sensitivity (66.7% versus 100%) and specificity (87.5% versus 100%) in identifying skull fractures. Four of 6 incorrectly interpreted black bone MR imaging studies showed cranial sutures being misinterpreted as skull fractures and vice versa.
Conclusions:
Our preliminary results show that brain MR imaging complemented by a black bone sequence is a promising nonionizing alternative to head CT for the assessment of skull fractures in children. However, accuracy in the detection of linear fractures in young children and fractures of aerated bone remains limited.
Insights
Magnetic resonance imaging (MRI) with a black bone sequence shows promise as a non-ionizing alternative for detecting skull fractures and intracranial hemorrhages in pediatric head trauma. However, its accuracy for linear fractures and fractures in aerated bone requires further investigation.
Area of Science:
- Pediatric Neuroradiology
- Medical Imaging
- Radiology
Background:
- Computed tomography (CT) is standard for pediatric head trauma, but carries cancer risks from ionizing radiation.
- Limiting radiation exposure in children is crucial.
- Magnetic resonance imaging (MRI) offers a non-ionizing alternative.
Purpose of the Study:
- To evaluate MRI, including a "black bone" sequence, against CT for detecting skull fractures and intracranial hemorrhages in pediatric head trauma.
- To compare the diagnostic accuracy of CT and MRI for these injuries.
Main Methods:
- Retrospective review of 2D head CT and brain MRI studies (including black bone sequence) in children with head trauma.
- Consensus reference standard established by two pediatric neuroradiologists.
- Independent blinded evaluation of CT and MRI by a third pediatric neuroradiologist.
Main Results:
- MRI with black bone sequence demonstrated lower sensitivity (66.7%) and specificity (87.5%) for skull fractures compared to CT (100% for both).
- Four cases showed misinterpretation of cranial sutures as fractures or vice versa on black bone MRI.
- The study included 28 children (24 boys, mean age 4.89 years).
Conclusions:
- Brain MRI with a black bone sequence is a potential non-ionizing alternative to CT for pediatric head trauma assessment.
- Accuracy for detecting linear fractures in young children and fractures in aerated bone remains limited.
- Further research is needed to optimize MRI techniques for pediatric skull fracture detection.
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