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

Abstract

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.

Risk of Traumatic Brain Injuries in Infants Younger than 3 Months With Minor Blunt Head Trauma

“…28 Rapid MRI performed without sedation has high sensitivity in detecting traumatic brain injuries in children but has not been evaluated specifically in young infants. 29,30 Although our sample size did not allow us to precisely determine the risk of clinically important traumatic brain injury and traumatic brain injury on CT in infants with specific isolated PECARN rule findings (eg, solely having a severe mechanism of injury), prior data suggest that individual PECARN rule findings have somewhat different risk profiles for traumatic brain injury. In the cohort of children <2 years old in the PECARN data set, clinically important traumatic brain injuries occurred in 0.3%, 0.2%, 0%, and 0.6% of those with an isolated severe mechanism of injury, isolated parental report of acting abnormally, isolated history of vomiting, and isolated history of loss of consciousness, respectively.…”

Elective one-minute full brain multi-contrast MRI versus brain CT in pediatric patients: a prospective feasibility study

“…Despite the scheduling of clinical CT examinations after two weeks from referral, the clinical question in a majority of patients, as stated in the referral, was “brain tumor?”. Previous studies have investigated the clinical feasibility of fast MRI methods in pediatric patients with hydrocephalus [ 15 , 16 ], acute arterial ischemic stroke [ 17 ], traumatic brain injury [ 18 ], and non-traumatic pediatric emergency [ 19 ], while others have evaluated the diagnostic image quality of fast brain MRI [ 20 – 22 ] and fast spine MRI [ 23 ]. In accordance with the results from these previous studies, EPIMix performed well in a clinical situation, showing comparable diagnostic performance to CT in pediatric patients.…”

Rapid T2∗‐weighted MRI using multishot EPI with retrospective motion and phase correction in the emergency department

“…3D acquisition is often preferred to 2D acquisition due to its higher SNR, contiguous slice coverage, and other benefits in specific applications such as 3D $$$ {\mathrm{T}}_2^{\ast } $$$–GRE 30 . Although the long scan time needed for 3D acquisition can be shortened with parallel imaging or compressed sensing, 2D $$$ {\mathrm{T}}_2^{\ast } $$$–GRE is still widely used clinically for ED or pediatric MRI, 31–36 in part because conventional 3D Cartesian GRE is prone to motion artifacts, which are further exacerbated in a challenging patient population. Therefore, 2D $$$ {\mathrm{T}}_2^{\ast } $$$–GRE is still preferred in our institute's preferred ED brain protocol, although we have adopted 3D GRE‐SWI for use in other patients.…”