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Rapid-sequence MRI for evaluation of pediatric traumatic brain injury: a systematic review
Brice A Kessler1, Jo Ling Goh2, Hengameh B Pajer3
11Department of Neurosurgery and.
Objective:
Rapid-sequence MRI (RSMRI) of the brain is a limited-sequence MRI protocol that eliminates ionizing radiation exposure and reduces imaging time. This systematic review sought to examine studies of clinical RSMRI use for pediatric traumatic brain injury (TBI) and to evaluate various RSMRI protocols used, including their reported accuracy as well as clinical and systems-based limitations to implementation.
Methods:
PubMed, EMBASE, and Web of Science databases were searched, and clinical articles reporting the use of a limited brain MRI protocol in the setting of pediatric head trauma were identified.
Results:
Of the 1639 articles initially identified and reviewed, 13 studies were included. An additional article that was in press at the time was provided by its authors. The average RSMRI study completion time was variable, spanning from 1 minute to 16 minutes. RSMRI with "blood-sensitive" sequences was more sensitive for detection of hemorrhage compared with head CT (HCT), but less sensitive for detection of skull fractures. Compared with standard MRI, RSMRI had decreased sensitivity for all evidence of trauma.
Conclusions:
Protocols and uses of RSMRI for pediatric TBI were variable among the included studies. While traumatic pathology missed by RSMRI, such as small hemorrhages and linear, nondisplaced skull fractures, was frequently described as clinically insignificant, in some cases these findings may be prognostically and/or forensically significant. Institutions should integrate RSMRI into pediatric TBI management judiciously, relying on clinical context and institutional capabilities.
Insights
Rapid-sequence MRI (RSMRI) offers a radiation-free alternative for pediatric traumatic brain injury (TBI) assessment. While effective for hemorrhage detection, it shows lower sensitivity for skull fractures compared to standard imaging.
Area of Science:
- Radiology
- Pediatric Imaging
- Neuroimaging
Background:
- Rapid-sequence MRI (RSMRI) is a streamlined MRI protocol designed to minimize radiation exposure and shorten scan times.
- Its application in pediatric traumatic brain injury (TBI) warrants systematic evaluation.
Purpose of the Study:
- To systematically review clinical studies on RSMRI for pediatric TBI.
- To assess the accuracy and limitations of various RSMRI protocols in this population.
Main Methods:
- A comprehensive search of PubMed, EMBASE, and Web of Science databases was conducted.
- Clinical articles detailing the use of limited brain MRI for pediatric head trauma were identified and reviewed.
Main Results:
- Thirteen studies were included, with completion times ranging from 1 to 16 minutes.
- RSMRI with blood-sensitive sequences demonstrated higher sensitivity for hemorrhage than head CT but lower sensitivity for skull fractures.
- Compared to standard MRI, RSMRI showed decreased sensitivity for overall trauma detection.
Conclusions:
- RSMRI protocols and applications for pediatric TBI are inconsistent.
- Missed findings like subtle hemorrhages or fractures, though often deemed clinically insignificant, may have prognostic or forensic implications.
- Judicious integration of RSMRI into pediatric TBI management, considering clinical context and institutional resources, is recommended.
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