Acute Brain Imaging in Children: Can MRI Replace CT as a Screening Tool?

Wagner, Matthias; Kontzialis, Marinos; Seeburg, Daniel P.; Stern, Steven; Oshmyansky, Alexander; Poretti, Andrea; Huisman, Thierry A.G.M.

doi:10.1111/jon.12310

Cited by 13 publications

(14 citation statements)

References 18 publications

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“…[1][2][3][4][5][6] However, most studies have examined specific clinical conditions, thus only evaluating limited sequences. [7][8][9][10][11][12][13][14][15] Another fast technique, synthetic MR imaging, quantitatively approaches the absolute physical properties for single-scan, multiple-contrast generation with a total scan time of 4-5 minutes. [4][5][6]16,17 Routine clinical use of synthetic MR imaging is limited because it cannot produce DWI and T2*WI and provide inferior image quality in synthetic T2-FLAIR due to partial volume effects.…”

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confidence: 99%

Clinical Experience of 1-Minute Brain MRI Using a Multicontrast EPI Sequence in a Different Scan Environment

Ryu

Baek

Skare

et al. 2020

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: The long scan time of MR imaging is a major drawback limiting its clinical use in neuroimaging; therefore, we aimed to investigate the clinical feasibility of a 1-minute full-brain MR imaging using a multicontrast EPI sequence on a different MR imaging scanner than the ones previously reported. MATERIALS AND METHODS:We retrospectively reviewed the records of 146 patients who underwent a multicontrast EPI sequence, including T1-FLAIR, T2-FLAIR, T2WI, DWI, and T2*WI sequences. Two attending neuroradiologists assessed the image quality of each sequence to compare the multicontrast EPI sequence with routine MR imaging protocols. We used the Wilcoxon signed rank test and McNemar test to compare the 2 MR imaging protocols. RESULTS:The multicontrast EPI sequence generally showed sufficient image quality of .2 points using a 4-point assessment scale. Regarding image quality and susceptibility artifacts, there was no significant difference between the multicontrast EPI sequence DWI and routine DWI (P . .05), attesting to noninferiority of the multicontrast EPI, whereas there were significant differences in the other 4 sequences between the 2 MR imaging protocols. CONCLUSIONS:The multicontrast EPI sequence showed sufficient image quality for clinical use with a shorter scan time; however, it was limited by inferior image quality and frequent susceptibility artifacts compared with routine brain MR imaging. Therefore, the multicontrast EPI sequence cannot completely replace the routine MR imaging protocol at present; however, it may be a feasible option in specific clinical situations such as screening, time-critical diseases or for use with patients prone to motion.

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confidence: 99%

Clinical Experience of 1-Minute Brain MRI Using a Multicontrast EPI Sequence in a Different Scan Environment

Ryu

Baek

Skare

et al. 2020

AJNR Am J Neuroradiol

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“…21 In various studies, including at our institution, MR sequence choice was important to sensitivity. 15,22,23 In the present study, for example, addition of the T 2 This imaging modality has the potential to decrease the radiation risk that is often discussed with parents in the ED surrounding neuroimaging. This should not encourage providers to image more patients however.…”

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confidence: 94%

Can QuickBrain MRI replace CT as first‐line imaging for select pediatric head trauma?

et al. 2020

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Objective The current standard of care for initial neuroimaging in injured pediatric patients suspected of having traumatic brain injury is computed tomography (CT) that carries risks associated with radiation exposure. The primary objective of this trial was to evaluate the ability of a QuickBrain MRI (qbMRI) protocol to detect clinically important traumatic brain injuries in the emergency department (ED). The secondary objective of this trial was to compare qbMRI to CT in identifying radiographic traumatic brain injury. Methods This was a prospective study of trauma patients less than 15 years of age with suspected traumatic brain injury at a level 1 pediatric trauma center in Portland, Oregon between August 2017 and March 2019. All patients in whom a head CT was deemed clinically necessary were approached for enrollment to also obtain a qbMRI in the acute setting. Clinically important traumatic brain injury was defined as the need for neurological surgery procedure, intubation, pediatric intensive care unit stay greater than 24 hours, a total hospital length of stay greater than 48 hours, or death. Results A total of 73 patients underwent both CT and qbMRI. The median age was 4 years (interquartile range [IQR] = 1–10 years). Twenty‐two patients (30%) of patients had a clinically important traumatic brain injury, and of those, there were 2 deaths (9.1%). QbMRI acquisition time had a median of 4 minutes and 52 seconds (IQR = 3 minutes 49 seconds–5 minutes 47 seconds). QbMRI had sensitivity for detecting clinically important traumatic brain injury of 95% (95% confidence interval [CI] = 77%–99%). For any radiographic injury, qbMRI had a sensitivity of 89% (95% CI = 78%–94%). Conclusion Our results suggest that qbMRI has good sensitivity to detect clinically important traumatic brain injuries. Further multi‐institutional, prospective trials are warranted to either support or refute these findings.

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“…Efforts to speed up MRI include, for example, parallel imaging techniques . Moreover, ultrafast T 2 ‐weighted images have previously been evaluated as a nonionizing alternative to computed tomography for patients with shunt‐treated hydrocephalus, and T 2 ‐weighted imaging has been evaluated as a possible screening tool for pathology in children …”

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confidence: 99%

“…2,3 Moreover, ultrafast T 2 -weighted images have previously been evaluated as a nonionizing alternative to computed tomography for patients with shunt-treated hydrocephalus, 5 and T 2 -weighted imaging has been evaluated as a possible screening tool for pathology in children. 6 Another way to decrease the overall examination time has been to compute images from parametric maps of tissue properties using synthetic MRI and MRI fingerprinting (MRF), 4 thereby creating several MR contrasts 4,7-9 via postprocessing. The clinical utility of synthetic MRI, however, has been limited due to the relatively long acquisition times per slice and problems with T 2 -weighted fluid attenuated inversion recovery (T 2 -FLAIR) image quality and partial volume effect, sometimes mimicking pathology.…”

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confidence: 99%

Diagnostic performance of a new multicontrast one‐minute full brain exam (EPIMix) in neuroradiology: A prospective study

Delgado

Kits

Bystam

et al. 2019

Magnetic Resonance Imaging

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Background Clinical MRI protocols are time‐consuming; hence, new faster techniques are needed. One new fast multicontrast MRI technique, called echo planar image mix (EPIMix) (including contrasts T1‐FLAIR, T2‐weighted, diffusion‐weighted images [DWI], apparent diffusion coefficient [ADC], T2*‐weighted, and T2‐FLAIR images) needs to be tested. Purpose To assess if EPIMix has comparable diagnostic performance as routine clinical brain MRI. Study Type Prospective. Population A consecutive series of 103 patients' brain MRI (January 2018 to May 2018). Field Strength/Sequence 1.5 T or 3T. EPIMix and routine clinical protocol (clinical MRI included all or some of the contrasts T1‐FLAIR, T2‐weighted, DWI, T2*‐weighted, T2‐FLAIR, 3D‐FSE). Assessment Two neuroradiologists assessed EPIMix and clinical scans and categorized the images as abnormal or normal and described diagnosis, artifacts, diagnostic confidence image quality, and comparison of imaging time. Statistical Tests Pivot tables with diagnostic performance calculated by receiver operating characteristics (ROC) and the area under curve (AUC). Disease categorization and image quality measures were evaluated. The study protocol is published at http://clinicaltrials.gov NCT03338270. Results After exclusion of 21 patients, 82 patients had a routine clinical MRI with comparable contrasts to EPIMix and were evaluated. The diagnostic performance to categorize a full brain MRI investigation as abnormal or normal was comparable between EPIMix (AUC 0.99 (95% confidence interval [CI] 0.97–1.00) and 0.99 (95% CI 0.97–1.00)) and routine clinical MRI (n = 82). Sensitivity was 95% (95% CI 88–95) and 93% (95% CI 86–98), and specificity 100% (95% CI 97–100) and 100% (95% CI 90–100). Disease categorization was congruent between EPIMix and clinical routine MRI in 90% (reader 2) and 93% (reader 1). Image quality was generally rated lower for EPIMix (P < 0.001). Imaging time was 78 seconds for EPIMix and for the same contrasts 12 minutes 29 seconds for conventional 3T MRI. Data Conclusion EPIMix has comparable diagnostic performance (disease identification and categorization) for most patients investigated in clinical routine. Level of Evidence 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:1824–1833.

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Acute Brain Imaging in Children: Can MRI Replace CT as a Screening Tool?

Cited by 13 publications

References 18 publications

Clinical Experience of 1-Minute Brain MRI Using a Multicontrast EPI Sequence in a Different Scan Environment

Clinical Experience of 1-Minute Brain MRI Using a Multicontrast EPI Sequence in a Different Scan Environment

Can QuickBrain MRI replace CT as first‐line imaging for select pediatric head trauma?

Diagnostic performance of a new multicontrast one‐minute full brain exam (EPIMix) in neuroradiology: A prospective study

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