Rapid Sequence MRI Protocol in the Evaluation of Pediatric Brain Attacks.

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.