Utility of a pediatric fast magnetic resonance imaging protocol as surveillance scanning for traumatic brain injury

View More View Less
  • 1 College of Medicine, Medical University of South Carolina; and
  • 2 Departments of Neurosurgery and
  • 3 Radiology, Medical University of South Carolina, Charleston, South Carolina
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

OBJECTIVE

Traumatic brain injury (TBI) is a prevalent pediatric pathology in the modern emergency department. Computed tomography (CT) is utilized for detection of TBI and can result in cumulatively high radiation exposure. Recently, a fast brain magnetic resonance imaging (fbMRI) protocol has been employed for rapid imaging of hydrocephalus in pediatric patients. The authors investigate the utility of a modified trauma-focused fbMRI (t-fbMRI) protocol as an alternative to surveillance CT in the setting of acute TBI in pediatric patients, thus reducing radiation exposure while improving diagnostic yield.

METHODS

A retrospective review was performed at the authors’ institution for all pediatric patients who had undergone t-fbMRI within 72 hours of an initial CT scan, using a 1.5- or 3-T MR scanner for trauma indications. Forty patients met the study inclusion criteria. The authors performed a comparison of findings on the reads of CT and fbMRI, and a board-certified neuroradiologist conducted an independent review of both modalities.

RESULTS

T-fbMRI outperformed CT in specificity, sensitivity, and negative predictive value for all injury pathologies measured, except for skull fractures. T-fbMRI demonstrated a sensitivity of 100% in the detection of extraaxial bleed, intraventricular hemorrhage, and subarachnoid hemorrhage and had a sensitivity of 78% or greater for epidural hematoma, subdural hematoma, and intraparenchymal hemorrhage. T-fbMRI yielded a specificity of 100% for all types of intracranial hemorrhages, with a corresponding negative predictive value that exceeded that for CT.

CONCLUSIONS

In pediatric populations, the t-fbMRI protocol provides a valid alternative to CT in the surveillance of TBI and intracranial hemorrhage. Although not as sensitive in the detection of isolated skull fractures, t-fbMRI can be used to monitor pathologies implicated in TBI patients while minimizing radiation exposure from traditional surveillance imaging.

ABBREVIATIONS ADC = apparent diffusion coefficient; CT = computed tomography; DWI = diffusion-weighted imaging; EDH = epidural hematoma; GCS = Glasgow Coma Scale; GRE = gradient echo; HASTE = half-Fourier acquisition single-shot turbo spin echo; IPH = intraparenchymal hemorrhage; IVH = intraventricular hemorrhage; MRI = magnetic resonance imaging; NPV = negative predictive value; PPV = positive predictive value; SAH = subarachnoid hemorrhage; SDH = subdural hematoma; TBI = traumatic brain injury; t-fbMRI = trauma-focused fast brain MRI.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Correspondence Ramin Eskandari: Medical University of South Carolina, Charleston, SC. eskandar@musc.edu.

INCLUDE WHEN CITING Published online February 5, 2021; DOI: 10.3171/2020.8.PEDS20496.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Faul M, Xu L, Wald MM, Coronado VG. Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations and Deaths 2002–2006. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2010:75.

    • Search Google Scholar
    • Export Citation
  • 2

    Schneier AJ, Shields BJ, Hostetler SG, Incidence of pediatric traumatic brain injury and associated hospital resource utilization in the United States. Pediatrics. 2006;118(2):483492.

    • Search Google Scholar
    • Export Citation
  • 3

    Stanley RM, Bonsu BK, Zhao W, US estimates of hospitalized children with severe traumatic brain injury: implications for clinical trials. Pediatrics. 2012;129(1):e24e30.

    • Search Google Scholar
    • Export Citation
  • 4

    Vavilala MS, King MA, Yang JT, The Pediatric Guideline Adherence and Outcomes (PEGASUS) programme in severe traumatic brain injury: a single-centre hybrid implementation and effectiveness study. Lancet Child Adolesc Health. 2019;3(1):2334.

    • Search Google Scholar
    • Export Citation
  • 5

    Stevens RD, Shoykhet M, Cadena R. Emergency neurological life support: intracranial hypertension and herniation. Neurocrit Care. 2015;23(2)(suppl 2):S76S82.

    • Search Google Scholar
    • Export Citation
  • 6

    Pickering A, Harnan S, Fitzgerald P, Clinical decision rules for children with minor head injury: a systematic review. Arch Dis Child. 2011;96(5):414421.

    • Search Google Scholar
    • Export Citation
  • 7

    Pearce MS, Salotti JA, Little MP, Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet. 2012;380(9840):499505.

    • Search Google Scholar
    • Export Citation
  • 8

    Brenner D, Elliston C, Hall E, Berdon W. Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol. 2001;176(2):289296.

    • Search Google Scholar
    • Export Citation
  • 9

    Young AMH, Guilfoyle MR, Donnelly J, Multimodality neuromonitoring in severe pediatric traumatic brain injury. Pediatr Res. 2018;83(1-1):4149.

    • Search Google Scholar
    • Export Citation
  • 10

    Greenberg JK, Jeffe DB, Carpenter CR, North American survey on the post-neuroimaging management of children with mild head injuries. J Neurosurg Pediatr. 2018;23(2):227235.

    • Search Google Scholar
    • Export Citation
  • 11

    Wintermark M, Sanelli PC, Anzai Y, Imaging evidence and recommendations for traumatic brain injury: conventional neuroimaging techniques. J Am Coll Radiol. 2015;12(2):e1e14.

    • Search Google Scholar
    • Export Citation
  • 12

    Filippi C, Sanelli P. Pediatric traumatic brain injury: common data elements to inform diagnosis, neuroimaging, and outcome metrics. J Pediatr Neuroradiol. 2016;5(1):3237.

    • Search Google Scholar
    • Export Citation
  • 13

    Argyropoulou MI, Alexiou GA, Xydis VG, Pediatric minor head injury imaging practices: results from an ESPR survey. Neuroradiology. 2020;62(2):251255.

    • Search Google Scholar
    • Export Citation
  • 14

    Mendoza D, Kadom N, Palasis S, Use of conventional and advanced MRI techniques in accidental pediatric traumatic brain injury. J Pediatr Neuroradiol. 2016;5(1):2025.

    • Search Google Scholar
    • Export Citation
  • 15

    Malviya S, Voepel-Lewis T, Eldevik OP, Sedation and general anaesthesia in children undergoing MRI and CT: adverse events and outcomes. Br J Anaesth. 2000;84(6):743748.

    • Search Google Scholar
    • Export Citation
  • 16

    Flick RP, Katusic SK, Colligan RC, Cognitive and behavioral outcomes after early exposure to anesthesia and surgery. Pediatrics. 2011;128(5):e1053e1061.

    • Search Google Scholar
    • Export Citation
  • 17

    O’Leary JD, Janus M, Duku E, Influence of surgical procedures and general anesthesia on child development before primary school entry among matched sibling pairs. JAMA Pediatr. 2019;173(1):2936.

    • Search Google Scholar
    • Export Citation
  • 18

    Mehta H, Acharya J, Mohan AL, Minimizing radiation exposure in evaluation of pediatric head trauma: use of rapid MR imaging. AJNR Am J Neuroradiol. 2016;37(1):1118.

    • Search Google Scholar
    • Export Citation
  • 19

    Kabakus IM, Spampinato MV, Knipfing M, Fast brain magnetic resonance imaging with half-Fourier acquisition with single-shot turbo spin echo sequence in detection of intracranial hemorrhage and skull fracture in general pediatric patients: preliminary results. Pediatr Emerg Care. 2019.

    • Search Google Scholar
    • Export Citation
  • 20

    Lindberg DM, Stence NV, Grubenhoff JA, Feasibility and accuracy of fast MRI versus CT for traumatic brain injury in young children. Pediatrics. 2019;144(4):e20190419.

    • Search Google Scholar
    • Export Citation
  • 21

    Greenes DS, Schutzman SA. Clinical significance of scalp abnormalities in asymptomatic head-injured infants. Pediatr Emerg Care. 2001;17(2):8892.

    • Search Google Scholar
    • Export Citation
  • 22

    Kuppermann N, Holmes JF, Dayan PS, Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet. 2009;374(9696):11601170.

    • Search Google Scholar
    • Export Citation
  • 23

    Osmond MH, Klassen TP, Wells GA, CATCH: a clinical decision rule for the use of computed tomography in children with minor head injury. CMAJ. 2010;182(4):341348.

    • Search Google Scholar
    • Export Citation
  • 24

    Dunning J, Daly JP, Lomas JP, Derivation of the children’s head injury algorithm for the prediction of important clinical events decision rule for head injury in children. Arch Dis Child. 2006;91(11):885891.

    • Search Google Scholar
    • Export Citation
  • 25

    Lyttle MD, Crowe L, Oakley E, Comparing CATCH, CHALICE and PECARN clinical decision rules for paediatric head injuries. Emerg Med J. 2012;29(10):785794.

    • Search Google Scholar
    • Export Citation
  • 26

    Sheridan DC, Newgard CD, Selden NR, QuickBrain MRI for the detection of acute pediatric traumatic brain injury. J Neurosurg Pediatr. 2017;19(2):259264.

    • Search Google Scholar
    • Export Citation
  • 27

    Currie S, Saleem N, Straiton JA, Imaging assessment of traumatic brain injury. Postgrad Med J. 2016;92(1083):4150.

  • 28

    Young JY, Duhaime AC, Caruso PA, Rincon SP. Comparison of non-sedated brain MRI and CT for the detection of acute traumatic injury in children 6 years of age or less. Emerg Radiol. 2016;23(4):325331.

    • Search Google Scholar
    • Export Citation
  • 29

    Dremmen MHG, Wagner MW, Bosemani T, Does the addition of a “black bone” sequence to a fast multisequence trauma MR protocol allow MRI to replace CT after traumatic brain injury in children? AJNR Am J Neuroradiol. 2017;38(11):21872192.

    • Search Google Scholar
    • Export Citation
  • 30

    Flom L, Fromkin J, Panigrahy A, Development of a screening MRI for infants at risk for abusive head trauma. Pediatr Radiol. 2016;46(4):519526.

    • Search Google Scholar
    • Export Citation
  • 31

    Kralik SF, Yasrebi M, Supakul N, Diagnostic performance of ultrafast brain MRI for evaluation of abusive head trauma. AJNR Am J Neuroradiol. 2017;38(4):807813.

    • Search Google Scholar
    • Export Citation
  • 32

    Ryan ME, Jaju A, Ciolino JD, Alden T. Rapid MRI evaluation of acute intracranial hemorrhage in pediatric head trauma. Neuroradiology. 2016;58(8):793799.

    • Search Google Scholar
    • Export Citation
  • 33

    Wang ML, Li WB. Cognitive impairment after traumatic brain injury: the role of MRI and possible pathological basis. J Neurol Sci. 2016;370:244250.

    • Search Google Scholar
    • Export Citation
  • 34

    Roguski M, Morel B, Sweeney M, Magnetic resonance imaging as an alternative to computed tomography in select patients with traumatic brain injury: a retrospective comparison. J Neurosurg Pediatr. 2015;15(5):529534.

    • Search Google Scholar
    • Export Citation
  • 35

    Atzema C, Mower WR, Hoffman JR, Prevalence and prognosis of traumatic intraventricular hemorrhage in patients with blunt head trauma. J Trauma. 2006;60(5):10101017.

    • Search Google Scholar
    • Export Citation
  • 36

    Rocchi G, Caroli E, Raco A, Traumatic epidural hematoma in children. J Child Neurol. 2005;20(7):569572.

Metrics

All Time Past Year Past 30 Days
Abstract Views 78 78 78
Full Text Views 30 30 30
PDF Downloads 21 21 21
EPUB Downloads 0 0 0