Beyond the scan: quick MRI's emergence in pediatric emergency care

Computed tomography (CT) remains the dominant neuroimaging modality in the pediatric emergency department despite growing awareness of the risks associated with cumulative ionizing radiation exposure. Advances in rapid MRI have renewed interest in quick brain MRI (qbMRI) as a feasible, radiation-free alternative. This manuscript explores emerging strategies to reduce unnecessary CT utilization, expand MRI accessibility, and synthesize growing evidence supporting the use of qbMRI across a range of pediatric emergency indications.

Recent literature demonstrates that qbMRI offers significant reductions in radiation exposure with comparable diagnostic performance to CT for the evaluation of hydrocephalus and cerebrospinal fluid shunt malfunction. Studies also highlight its value in selected traumatic brain injuries, abusive head trauma screening, and nontraumatic neurologic emergencies; notably for pediatric stroke, where diffusion-weighted qbMRI shows superior sensitivity to CT. Quality improvement data highlight the successful integration of qbMRI protocols that produce substantial decreases in CT utilization while sustaining diagnostic accuracy.

QbMRI increasingly represents a safer neuroimaging strategy compared to CT. While CT remains essential for detecting acute intracranial hemorrhage and skull fractures, qbMRI can meaningfully reduce radiation exposure in appropriately selected patients. Ongoing technological advances, such as improved fracture detection; along with targeted implementation efforts, are likely to further expand its role in pediatric emergency neuroimaging.