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Making MR Imaging Child's Play - Pediatric Neuroimaging Protocol, Guidelines and Procedure
Published on: July 30, 2009
Utility of a pediatric fast magnetic resonance imaging protocol as surveillance scanning for traumatic brain injury
Chelsea Shope1, Mohammed Alshareef2, Thomas Larrew2
11College of Medicine, Medical University of South Carolina; and.
Insights
A modified fast brain MRI protocol (t-fbMRI) is a safe and effective alternative to CT scans for diagnosing traumatic brain injuries (TBI) in children, reducing radiation exposure and improving diagnostic accuracy for intracranial hemorrhages.
Area of Science:
- Pediatric Radiology
- Neuroimaging
- Emergency Medicine
Background:
- Traumatic brain injury (TBI) is common in children, often diagnosed with CT scans.
- CT scans involve significant radiation exposure, a concern in pediatric patients.
- Fast brain MRI (fbMRI) is emerging as a rapid imaging technique.
Purpose of the Study:
- To evaluate a trauma-focused fbMRI (t-fbMRI) protocol as an alternative to CT for pediatric TBI.
- To assess if t-fbMRI can reduce radiation exposure while maintaining or improving diagnostic yield.
- To compare the diagnostic performance of t-fbMRI and CT in detecting various TBI-related injuries.
Main Methods:
- Retrospective review of pediatric patients who underwent t-fbMRI within 72 hours of a CT scan.
- Inclusion criteria: pediatric patients with TBI indications, scanned on 1.5- or 3-T MR scanners.
- Comparison of CT and t-fbMRI findings, with independent review by a neuroradiologist.
Main Results:
- t-fbMRI showed higher specificity, sensitivity, and negative predictive value than CT for most TBI pathologies, excluding skull fractures.
- 100% sensitivity for detecting extraaxial, intraventricular, and subarachnoid hemorrhage with t-fbMRI.
- 100% specificity for all intracranial hemorrhages detected by t-fbMRI.
Conclusions:
- t-fbMRI is a viable alternative to CT for pediatric TBI and intracranial hemorrhage surveillance.
- t-fbMRI effectively minimizes radiation exposure compared to traditional CT imaging.
- While less sensitive for isolated skull fractures, t-fbMRI is valuable for monitoring TBI pathologies.
Objective:
Traumatic brain injury (TBI) is a prevalent pediatric pathology in the modern emergency department. Computed tomography (CT) is utilized for detection of TBI and can result in cumulatively high radiation exposure. Recently, a fast brain magnetic resonance imaging (fbMRI) protocol has been employed for rapid imaging of hydrocephalus in pediatric patients. The authors investigate the utility of a modified trauma-focused fbMRI (t-fbMRI) protocol as an alternative to surveillance CT in the setting of acute TBI in pediatric patients, thus reducing radiation exposure while improving diagnostic yield.
Methods:
A retrospective review was performed at the authors' institution for all pediatric patients who had undergone t-fbMRI within 72 hours of an initial CT scan, using a 1.5- or 3-T MR scanner for trauma indications. Forty patients met the study inclusion criteria. The authors performed a comparison of findings on the reads of CT and fbMRI, and a board-certified neuroradiologist conducted an independent review of both modalities.
Results:
T-fbMRI outperformed CT in specificity, sensitivity, and negative predictive value for all injury pathologies measured, except for skull fractures. T-fbMRI demonstrated a sensitivity of 100% in the detection of extraaxial bleed, intraventricular hemorrhage, and subarachnoid hemorrhage and had a sensitivity of 78% or greater for epidural hematoma, subdural hematoma, and intraparenchymal hemorrhage. T-fbMRI yielded a specificity of 100% for all types of intracranial hemorrhages, with a corresponding negative predictive value that exceeded that for CT.
Conclusions:
In pediatric populations, the t-fbMRI protocol provides a valid alternative to CT in the surveillance of TBI and intracranial hemorrhage. Although not as sensitive in the detection of isolated skull fractures, t-fbMRI can be used to monitor pathologies implicated in TBI patients while minimizing radiation exposure from traditional surveillance imaging.
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