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Updated: Dec 27, 2025
Making MR Imaging Child's Play - Pediatric Neuroimaging Protocol, Guidelines and Procedure
Published on: July 30, 2009
Rapid Sequence MRI Protocol in the Evaluation of Pediatric Brain Attacks
Gracia De Jong1, Nirupama Kannikeswaran2, Amy DeLaroche2
1Pediatric Resident, Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan.
Insights
Rapid sequence magnetic resonance imaging (MRI) is a useful screening tool for pediatric brain attacks. Diffusion-weighted imaging is more sensitive and specific for ischemic stroke than fluid-attenuated inversion recovery.
Area of Science:
- Pediatric Neurology
- Neuroradiology
- Emergency Medicine
Background:
- Pediatric acute ischemic stroke and nonstroke brain attacks require prompt diagnosis.
- Rapid sequence MRI offers a potential solution for timely evaluation.
Purpose of the Study:
- To assess the clinical utility of rapid sequence MRI in children with suspected acute ischemic stroke or nonstroke brain attacks.
- To compare the diagnostic performance of diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) sequences.
Main Methods:
- Retrospective chart review of pediatric patients (1 month to 25 years) with activated stroke pathway.
- Acquisition of DWI and FLAIR sequences followed by complete MRI.
- Interpretation by a pediatric radiologist and neurologist; data collection on demographics, imaging, and diagnosis.
Main Results:
- 52 patients analyzed; majority were female and African American, median age 12 years.
- Six patients had ischemic stroke; seizures, migraines, and psychosomatic disorders were common nonstroke diagnoses.
- DWI demonstrated higher sensitivity (100%) and specificity (73.9%) for ischemic stroke compared to FLAIR (80% and 37.2%). FLAIR aided in identifying inflammatory and metabolic disorders.
Conclusions:
- Rapid sequence MRI is a valuable screening tool for pediatric brain attacks when full imaging is delayed.
- DWI is superior to FLAIR for detecting ischemic stroke in this population.
- FLAIR has utility in diagnosing other neurological conditions.
Background:
The objective of our study was to evaluate the clinical utility of rapid sequence magnetic resonance imaging (MRI) utilizing diffusion-weighted imaging and fluid-attenuated inversion recovery sequences in children with acute ischemic strokes and nonstroke brain attacks.
Methods:
We performed a retrospective chart review of patients aged one month to 25 years for whom a pediatric stroke clinical pathway was activated. Diffusion-weighted imaging and fluid-attenuated inversion recovery were obtained followed by a complete MRI. Imaging was interpreted by a pediatric radiologist and the study neurologist. We collected information regarding patient demographics, neuroimaging results, and final diagnosis.
Results:
The Pediatric Stroke Clinical Pathway was activated for 59 patients of whom 52 were included for analysis. The majority of patients were female (n = 29, 55.8%) and African American (n = 32, 61.5%), with a median age of 12 years (interquartile range 9, 16). Six patients had an ischemic stroke. Seizures, migraines, and psychosomatic disorders (each with n = 7; 13.5%) were the most common nonstroke diagnoses. Diffusion-weighted imaging was more sensitive (100% [55.0% to 100%] versus 80 % [32% to 99%]) and specific (73.9% [68% to 74%] versus 37.2% [32% to 39%]) compared with fluid-attenuated inversion recovery in identification of an ischemic stroke. However, fluid-attenuated inversion recovery was useful in the identification of inflammatory and metabolic disorders.
Conclusion:
Rapid sequence MRI can be utilized as a screening imaging modality in children with suspected brain attacks in cases where there may be delays in obtaining full sequence brain imaging.
