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Updated: Aug 6, 2025
Making MR Imaging Child's Play - Pediatric Neuroimaging Protocol, Guidelines and Procedure
Published on: July 30, 2009
Neuroimaging to diagnose central nervous system tumours in children
Insights
Pediatric CNS tumors present with common symptoms like headache and vomiting. Early brain imaging is crucial, with the HeadSmart initiative offering guidance to reduce diagnostic delays in children.
Area of Science:
- Pediatric Neurology
- Neuro-oncology
- Diagnostic Imaging
Background:
- Common childhood symptoms like headache and vomiting can indicate serious central nervous system (CNS) tumors.
- Hesitancy exists regarding radiation exposure from CT scans and sedation for MRI in children.
- Delayed diagnosis of pediatric CNS tumors is a significant clinical challenge.
Purpose of the Study:
- To determine optimal timing for radiologic head imaging in children presenting with common symptoms that may signify a CNS tumor.
- To advocate for the adoption of established guidelines to expedite the diagnosis of pediatric CNS tumors.
Main Methods:
- Review of clinical presentation of pediatric CNS tumors.
- Evaluation of diagnostic imaging modalities (CT and MRI) and their associated risks.
- Analysis of the HeadSmart initiative's guidelines for brain imaging.
Main Results:
- Central nervous system tumors lack specific diagnostic features, leading to diagnostic delays.
- Symptoms of increased intracranial pressure are common due to infratentorial tumors.
- The HeadSmart initiative recommends brain imaging within 4 weeks for persistent symptoms.
Conclusions:
- Implementing the HeadSmart criteria in Canada can reduce diagnostic delays for pediatric CNS tumors.
- A detailed history, physical examination, and timely imaging are essential for early detection.
- Computed tomography may be a practical first-line imaging option for children requiring urgent evaluation.
Question:
Headache, vomiting, lethargy, and seizures are common symptoms in healthy children with benign viral illnesses, but they are also signs that could represent a central nervous system (CNS) tumour. Primary care providers and guardians are hesitant to expose children to radiation associated with computed tomography scans or take on risks associated with the sedation frequently needed for magnetic resonance imaging. When should primary care providers order radiologic head imaging for children with common symptoms to identify those with a CNS tumour?
Answer:
Central nervous system tumours have no pathognomonic features, which often results in delays in diagnosis. Owing to the high prevalence of infratentorial tumours, children commonly present with symptoms of increased intracranial pressure, making a detailed history and a comprehensive physical examination, including ophthalmoscopy for papilledema, especially important. Magnetic resonance imaging is the criterion standard test but it may take time to access, and young children may need sedation. Hence, computed tomography may be a preferable first option.The HeadSmart initiative in the United Kingdom provides guidance to obtain brain imaging within 4 weeks of onset of persistent symptoms that are associated with CNS tumours. We advocate applying the same criteria in Canada in order to reduce delay in diagnosis of CNS tumours in children.
