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Whole-body PET/MRI of Pediatric Patients: The Details That Matter
Published on: December 19, 2017
Full-body MR imaging: a retrospective study on a novel diagnostic approach for children sustaining high-energy trauma
Johanna Ludwig1,2, Peter Heumann3, Denis Gümbel3,4
1Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Trauma Hospital Berlin, Warener Straße 7, 12683, Berlin, Germany. mail@johannaludwig.com.
Insights
Full-body MRI (fbMRI) offers a radiation-free diagnostic alternative for stable pediatric trauma patients. While feasible, fbMRI requires longer scan times than CT, necessitating further research for optimal use in high-energy trauma cases.
Area of Science:
- Pediatric Radiology
- Emergency Medicine
- Diagnostic Imaging
Background:
- Severe trauma in children can lead to long-term impairment and death.
- Contrast-enhanced computed tomography (CT) is a common diagnostic tool but often reveals no injuries.
- Full-body MRI (fbMRI) was introduced in 2007 as an alternative diagnostic approach.
Purpose of the Study:
- To evaluate full-body MRI (fbMRI) in children after high-energy trauma.
- To analyze the feasibility, radiological findings, and limitations of fbMRI.
- To compare fbMRI with conventional diagnostic methods.
Main Methods:
- A retrospective cross-sectional study of 105 pediatric patients (≤16 years) undergoing fbMRI.
- Patients were hemodynamically stable with high-energy trauma at a Level I Trauma Center.
- Data collected included time to scan, additional procedures, and identified injuries.
Main Results:
- The mean time from arrival to fbMRI was 71 minutes.
- 2 fbMRIs were discontinued; 45% of patients had additional X-rays, 11% had CT scans.
- Intracranial abnormalities (27%), extremity injuries (26%), and spinal injuries (18%) were the most common findings.
Conclusions:
- fbMRI is a viable radiation-free diagnostic option for stable pediatric trauma patients.
- fbMRI has longer scan times compared to CT scans.
- Further prospective studies are needed to determine fbMRI's role as a primary diagnostic tool.
Purpose:
Severe accidents are the leading cause of long-term impairment and death in children. A common diagnostic procedure for children exposed to high-injury trauma is full-body contrast-enhanced CT (fbCT). However, the number of fbCT without detected injuries is relevant. In 2007, full-body MRI (fbMRI) was implemented as a diagnostic approach for children sustaining high-energy trauma. The aim of this cross-sectional retrospective study was to analyze fbMRI as a diagnostic tool for children after high-energy trauma focusing on feasibility, radiological findings, and limitations.
Methods:
Diagnostics using fbMRI (from apex of the head to the pelvis) was performed if a child was stable and suffered a high-energy trauma in a Level I Trauma Center in Germany. 105 fbMRIs in patients exposed to high-energy trauma aged ≤ 16 years were performed between January 2007 and December 2018. Four fbMRIs were excluded as conducted for reasons other than trauma. Time between arrival in the emergency department and fbMRI, additional diagnostic procedures, injuries, and non-trauma related pathologies were analyzed.
Results:
Mean time between arrival in the emergency department and fbMRI was 71 min (± SD 132 min). Two scans were discontinued and changed to a faster diagnostic procedure. 45% of children had additional X-rays and 11% CT scans. The MRIs showed intracranial abnormalities in 27%, extremities injuries in 26%, spinal injuries in 18%, pelvic, and thoracic injuries in 7% of the cases.
Conclusion:
Overall fbMRI is a diagnostic alternative for hemodynamically stable, conscious children after high-energy trauma with the advantages of a radiation-free technique. However, MRI diagnostics take longer than CT scans. Prospective studies will be needed to identify the limiting factors of fbMRIs as primary diagnostic procedure compared to CT scans.
Trial Registration:
German Clinical Trials Register (DRKS; DRKS00017015).
Level Of Evidence:
Case series, level of evidence V.
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