Fast MRI is feasible, accurate for pediatric head injury

  • Pediatrics

  • de Susan London
  • Clinical Essentials
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Takeaway

  • Among clinically stable young children being evaluated for possible traumatic brain injury (TBI), fast MRI was completed in nearly all those for whom it was attempted, and it yielded accurate results when compared with CT.

Why this matters

  • CT entails radiation exposure.

Key results

  • Fast MRI:
    • Consent was provided for 299 children,
    • Attempted in 225 (75%) of the consented children, and
    • Completed in 223 (99%) of the attempted children.
  • Median imaging time:
    • CT: 59 seconds.
    • Fast MRI: 365 seconds.
  • No children were sedated to facilitate fast MRI.
  • For detection of TBI using CT as comparator, fast MRI had:
    • 92.8% sensitivity.
    • 96.2% specificity.
  • Of the 8 cases missed by fast MRI:
    • 6 had isolated, linear, nondepressed skull fractures.
    • 2 had isolated subarachnoid hemorrhages.

Expert comment

  • In a Commentary, Brett Burstein, MDCM, PhD, MPH, and Christine Saint-Martin, MDCM, MSc, write: “Fast MRI may provide a radiation-sparing alternative to CT; however, the authors appropriately caution against the potential for increased unnecessary imaging for low-risk head injuries. Centers migrating toward this modality for neuroimaging children with head injuries should still use clinical judgment and highly sensitive, validated clinical decision rules when determining the need for any neuroimaging for head-injured children.”

Study design

  • Prospective cohort study among 299 children
  • Main outcomes:
    • Feasibility (completion rate).
    • Accuracy relative to CT.
  • Funding: Colorado Traumatic Brain Injury Trust Fund (MindSource); Colorado Clinical and Translational Sciences Institute.

Limitations

  • Study conducted at high-volume center with newer 3T scanners.
  • Image quality of CT scans varied.
  • Generalizability to clinically unstable children is unknown.
  • Injury features may have changed between CT and fast MRI scans.