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Fast MRI for Pediatric Traumatic Brain Injury: What Findings Are Missed Compared with Routine MRI?
William K Canty1, Daniel M Lindberg2, Ilana Neuberger2
1From the University of Colorado School of Medicine, Aurora (W.K.C.), CO, USA; Kempe Center for the Prevention and Treatment of Child Abuse & Neglect (D.M.L.), Department of Emergency Medicine (D.M.L.), Radiology (I.N., J.M., C.W., L.F., M.N.-M., S.M., D.M.M., N.V.S.), University of Colorado School of Medicine, Aurora, CO, USA and Children's Hospital Colorado (I.N., J.M., C.W., L.F., M.N.-M., S.M., D.M.M., N.V.S.), Aurora, CO, USA. william.2.canty@cuanschutz.edu.
Fast MRI is a reliable tool for detecting traumatic brain injury (TBI) in children, though routine MRI may reveal subtle findings like subarachnoid hemorrhage. Fast MRI can be a useful initial screening for pediatric TBI.
Area of Science:
- Pediatric Radiology
- Neuroimaging
- Traumatic Brain Injury
Background:
- Traumatic brain injury (TBI) is common in young children, necessitating neuroimaging.
- Head CT uses ionizing radiation, while routine MRI is time-consuming and often requires sedation.
- Fast MRI offers a radiation-free alternative to CT but its ability to detect all findings compared to routine MRI is unclear.
Purpose of the Study:
- To evaluate the diagnostic performance of fast MRI compared to routine MRI in detecting intracranial findings in pediatric TBI.
- To assess the potential for missed diagnoses with fast MRI in young children with head trauma.
Main Methods:
- Retrospective study of children aged 6 years or younger with TBI who underwent both fast and routine brain MRI within 7 days.
- Analysis of neuroimaging reports for traumatic intracranial findings.
- Evaluation of children with initial negative fast MRI for subsequent emergency department visits or hospitalizations within 1 year to identify missed injuries.
Main Results:
- In a paired cohort, fast MRI detected traumatic abnormalities in all cases positive on routine MRI.
- Fast MRI showed lower sensitivity for subarachnoid hemorrhage (SAH) (75%) and parenchymal injury (64.5%) compared to routine MRI.
- Among 2471 children with negative fast MRI, only 4 had follow-up neuroimaging findings, attributed to new trauma.
Conclusions:
- Fast MRI consistently detects TBI in children but may miss certain findings visible on routine MRI.
- Fast MRI can serve as an initial screening tool for hemodynamically stable children with TBI, especially when skull fracture detection or detailed forensic assessment is not critical.
