Rapid-sequence MRI for evaluation of pediatric traumatic brain injury: a systematic review

View More View Less
  • 1 Department of Neurosurgery and
  • | 2 Division of Neuroradiology, Department of Radiology,
  • | 3 University of North Carolina School of Medicine and
  • | 4 Biomedical Research Imaging Center, University of North Carolina, Chapel Hill;
  • | 5 Campbell University School of Osteopathic Medicine, Buies Creek, North Carolina and
  • | 6 Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
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

Rapid-sequence MRI (RSMRI) of the brain is a limited-sequence MRI protocol that eliminates ionizing radiation exposure and reduces imaging time. This systematic review sought to examine studies of clinical RSMRI use for pediatric traumatic brain injury (TBI) and to evaluate various RSMRI protocols used, including their reported accuracy as well as clinical and systems-based limitations to implementation.

METHODS

PubMed, EMBASE, and Web of Science databases were searched, and clinical articles reporting the use of a limited brain MRI protocol in the setting of pediatric head trauma were identified.

RESULTS

Of the 1639 articles initially identified and reviewed, 13 studies were included. An additional article that was in press at the time was provided by its authors. The average RSMRI study completion time was variable, spanning from 1 minute to 16 minutes. RSMRI with “blood-sensitive” sequences was more sensitive for detection of hemorrhage compared with head CT (HCT), but less sensitive for detection of skull fractures. Compared with standard MRI, RSMRI had decreased sensitivity for all evidence of trauma.

CONCLUSIONS

Protocols and uses of RSMRI for pediatric TBI were variable among the included studies. While traumatic pathology missed by RSMRI, such as small hemorrhages and linear, nondisplaced skull fractures, was frequently described as clinically insignificant, in some cases these findings may be prognostically and/or forensically significant. Institutions should integrate RSMRI into pediatric TBI management judiciously, relying on clinical context and institutional capabilities.

ABBREVIATIONS

DAI = diffuse axonal injury; DWI = diffusion-weighted imaging; ED = emergency department; EDH = epidural hematoma; EPI = echo-planar imaging; GRE = gradient echo; HASTE = half-Fourier acquisition single-shot turbo spin echo; HCT = head CT; IPH = intraparenchymal hemorrhage; PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses; QUADAS-2 = revised Quality of Assessment of Diagnostic Accuracy; RSMRI = rapid-sequence MRI; SAH = subarachnoid hemorrhage; SDH = subdural hemorrhage; SSFSE = single-shot fast spin echo; SSHTSE = single-shot turbo spin echo; SWI = susceptibility-weighted imaging; TBI = traumatic brain injury.

Illustration from Seaman et al. (pp 260–267). Copyright Jane Whitney. Published with permission.

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 Carolyn S. Quinsey: University of North Carolina, Chapel Hill, NC. carolyn_quinsey@med.unc.edu.

INCLUDE WHEN CITING Published online June 25, 2021; DOI: 10.3171/2021.2.PEDS20852.

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

    Babl FE, Borland ML, Phillips N, et al. Accuracy of PECARN, CATCH, and CHALICE head injury decision rules in children: a prospective cohort study. Lancet. 2017;389(10087):23932402.

    • Search Google Scholar
    • Export Citation
  • 2

    Kuppermann N, Holmes JF, Dayan PS, et al. 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
  • 3

    Osmond MH, Klassen TP, Wells GA, et al. 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
  • 4

    Pfeifer CM. Rapid-sequence MRI of the brain: a distinct imaging study. AJNR Am J Neuroradiol. 2018;39(8):E93E94.

  • 5

    Thompson EM, Baird LC, Selden NR. Results of a North American survey of rapid-sequence MRI utilization to evaluate cerebral ventricles in children. J Neurosurg Pediatr. 2014;13(6):636640.

    • Search Google Scholar
    • Export Citation
  • 6

    Iskandar BJ, Sansone JM, Medow J, Rowley HA. The use of quick-brain magnetic resonance imaging in the evaluation of shunt-treated hydrocephalus. J Neurosurg. 2004;101 (2)(suppl):147151.

    • Search Google Scholar
    • Export Citation
  • 7

    Ashley WW Jr, McKinstry RC, Leonard JR, et al. Use of rapid-sequence magnetic resonance imaging for evaluation of hydrocephalus in children. J Neurosurg. 2005;103 (2)(suppl):124130.

    • 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

    Miglioretti DL, Johnson E, Williams A, et al. The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk. JAMA Pediatr. 2013;167(8):700707.

    • Search Google Scholar
    • Export Citation
  • 10

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

    • Search Google Scholar
    • Export Citation
  • 11

    O’Leary JD, Janus M, Duku E, et al. 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
  • 12

    Mehta H, Acharya J, Mohan AL, et 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
  • 13

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

    • Search Google Scholar
    • Export Citation
  • 14

    ACR appropriateness criteria. American College of Radiology. Accessed March 1, 2021. https://www.acr.org/Clinical-Resources/ACR-Appropriateness-Criteria

    • Search Google Scholar
    • Export Citation
  • 15

    Performance measures. American College of Radiology. Accessed March 1, 2021. https://www.acr.org/Practice-Management-Quality-Informatics/Performance-Measures

    • Search Google Scholar
    • Export Citation
  • 16

    Whiting PF, Rutjes AWS, Westwood ME, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011;155(8):529536.

    • Search Google Scholar
    • Export Citation
  • 17

    McInnes MDF, Bossuyt PMM. Pitfalls of systematic reviews and meta-analyses in imaging research. Radiology. 2015;277(1):1321.

  • 18

    Sheridan DC, Pettersson D, Newgard CD, et al. Can QuickBrain MRI replace CT as first-line imaging for select pediatric head trauma? J Am Coll Emerg Physicians Open. 2020;1(5):965973.

    • Search Google Scholar
    • Export Citation
  • 19

    Berger RP, Furtado AD, Flom LL, et al. Implementation of a brain injury screen MRI for infants at risk for abusive head trauma. Pediatr Radiol. 2020;50(1):7582.

    • Search Google Scholar
    • Export Citation
  • 20

    Ramgopal S, Karim SA, Subramanian S, et al. Rapid brain MRI protocols reduce head computerized tomography use in the pediatric emergency department. BMC Pediatr. 2020;20(1):14.

    • Search Google Scholar
    • Export Citation
  • 21

    Kabakus IM, Spampinato MV, Knipfing M, et al. 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. Published online December 3 2019. doi:https://doi.org/10.1097/PEC.0000000000001949

    • Search Google Scholar
    • Export Citation
  • 22

    Lindberg DM, Stence NV, Grubenhoff JA, et al. 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
  • 23

    Dremmen MHG, Wagner MW, Bosemani T, et al. 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
  • 24

    Kralik SF, Yasrebi M, Supakul N, et al. 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
  • 25

    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
  • 26

    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
  • 27

    Cohen AR, Caruso P, Duhaime AC, Klig JE. Feasibility of “rapid” magnetic resonance imaging in pediatric acute head injury. Am J Emerg Med. 2015;33(7):887890.

    • Search Google Scholar
    • Export Citation
  • 28

    Missios S, Quebada PB, Forero JA, et al. Quick-brain magnetic resonance imaging for nonhydrocephalus indications. J Neurosurg Pediatr. 2008;2(6):438444.

    • Search Google Scholar
    • Export Citation
  • 29

    Yue EL, Meckler GD, Fleischman RJ, et al. Test characteristics of quick brain MRI for shunt evaluation in children: an alternative modality to avoid radiation. J Neurosurg Pediatr. 2015;15(4):420426.

    • Search Google Scholar
    • Export Citation
  • 30

    DeFlorio RM, Shah CC. Techniques that decrease or eliminate ionizing radiation for evaluation of ventricular shunts in children with hydrocephalus. Semin Ultrasound CT MR. 2014;35(4):365373.

    • Search Google Scholar
    • Export Citation
  • 31

    Beauchamp MH, Ditchfield M, Babl FE, et al. Detecting traumatic brain lesions in children: CT versus MRI versus susceptibility weighted imaging (SWI). J Neurotrauma. 2011;28(6):915927.

    • Search Google Scholar
    • Export Citation
  • 32

    Tao JJ, Zhang WJ, Wang D, et al. Susceptibility weighted imaging in the evaluation of hemorrhagic diffuse axonal injury. Neural Regen Res. 2015;10(11):18791881.

    • Search Google Scholar
    • Export Citation
  • 33

    Tong KA, Ashwal S, Holshouser BA, et al. Hemorrhagic shearing lesions in children and adolescents with posttraumatic diffuse axonal injury: improved detection and initial results. Radiology. 2003;227(2):332339.

    • Search Google Scholar
    • Export Citation
  • 34

    Northam W, Chandran A, Quinsey C, et al. Pediatric nonoperative skull fractures: delayed complications and factors associated with clinic and imaging utilization. J Neurosurg Pediatr. 2019;24(5):489497.

    • Search Google Scholar
    • Export Citation
  • 35

    Kralik SF, Supakul N, Wu IC, et al. Black bone MRI with 3D reconstruction for the detection of skull fractures in children with suspected abusive head trauma. Neuroradiology. 2019;61(1):8187.

    • Search Google Scholar
    • Export Citation
  • 36

    Wade SL, Zhang N, Yeates KO, et al. Social environmental moderators of long-term functional outcomes of early childhood brain injury. JAMA Pediatr. 2016;170(4):343349.

    • Search Google Scholar
    • Export Citation
  • 37

    Keenan HT, Presson AP, Clark AE, et al. Longitudinal developmental outcomes after traumatic brain injury in young children: are infants more vulnerable than toddlers? J Neurotrauma. 2019;36(2):282292.

    • Search Google Scholar
    • Export Citation
  • 38

    Galloway NR, Tong KA, Ashwal S, et al. Diffusion-weighted imaging improves outcome prediction in pediatric traumatic brain injury. J Neurotrauma. 2008;25(10):11531162.

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 140 140 140
Full Text Views 36 36 36
PDF Downloads 52 52 52
EPUB Downloads 0 0 0