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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.
Insights
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.
Background And Purpose:
Traumatic brain injury (TBI) is a frequent indication for neuroimaging in young children. Head CT is widely available and fast, but it exposes children to ionizing radiation. Routine MRI avoids radiation but is longer and frequently requires sedation. Fast MRI without sedation is increasingly used instead of head CT in young children with head trauma, but the intracranial findings it may miss relative to routine MRI are not well defined.
Materials And Methods:
We retrospectively studied children 6 years of age or younger who underwent fast brain MRI for evaluation of TBI and subsequent routine brain MRI within 7 days from 2014 through 2024. Reports were abstracted for traumatic intracranial findings. To address selection bias of the paired cohort, we also identified children who underwent fast MRI as their initial neuroimaging study for evaluation of TBI who did not undergo a subsequent routine MRI within 7 days. We reviewed any return emergency department or inpatient visits within 1 year of the initial fast MRI for evidence of a missed traumatic brain injury.
Results:
The selected paired cohort included 69 children; 68 had traumatic intracranial findings on routine MRI. Fast MRI detected at least one traumatic intracranial abnormality in all 68 routine-MRI-positive cases. Compared with routine MRI, fast MRI was less sensitive for SAH (18/24, 75.0%) and parenchymal injury (20/31, 64.5%). Among 2471 children with an initially negative fast MRI, 1,122 re-presented to the emergency department or inpatient setting within one year. Four had traumatic findings on follow-up neuroimaging, all attributed to new trauma rather than delayed recognition.
Conclusions:
In this selected cohort, fast MRI detected traumatic brain injury consistently, while selected components were apparent only on routine MRI. Fast MRI may serve as an initial screening and triage examination in hemodynamically stable children when skull fracture detection or complete forensic characterization is not needed.
