Feasibility and Accuracy of Fast MRI Versus CT for Traumatic Brain Injury in Young Children

Abstract

BACKGROUND: Computed tomography (CT) is commonly used for children when there is concern for traumatic brain injury (TBI) and is a significant source of ionizing radiation. Our objective was to determine the feasibility and accuracy of fast MRI (motion-tolerant MRI sequences performed without sedation) in young children. METHODS: In this prospective cohort study, we attempted fast MRI in children ,6 years old who had head CT performed and were seen in the emergency department of a single, level 1 pediatric trauma center. Fast MRI sequences included 3T axial and sagittal T2 single-shot turbo spin echo, axial T1 turbo field echo, axial fluid-attenuated inversion recovery, axial gradient echo, and axial diffusion-weighted single-shot turbo spin echo planar imaging. Feasibility was assessed by completion rate and imaging time. Fast MRI accuracy was measured against CT findings of TBI, including skull fracture, intracranial hemorrhage, or parenchymal injury. RESULTS: Among 299 participants, fast MRI was available and attempted in 225 (75%) and completed in 223 (99%). Median imaging time was 59 seconds (interquartile range 52-78) for CT and 365 seconds (interquartile range 340-392) for fast MRI. TBI was identified by CT in 111 (50%) participants, including 81 skull fractures, 27 subdural hematomas, 24 subarachnoid hemorrhages, and 35 other injuries. Fast MRI identified TBI in 103 of these (sensitivity 92.8%; 95% confidence interval 86.3-96.8), missing 6 participants with isolated skull fractures and 2 with subarachnoid hemorrhage. CONCLUSIONS: Fast MRI is feasible and accurate relative to CT in clinically stable children with concern for TBI.

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

“…Recent studies of scan times for similar qbMRI protocols found that patients reach the MR scanner from the ED within 30 minutes or order placement. 12,15 Our study showed that most qbMRI studies were obtained within ∼75 minutes of ordering, but many in less than 45 minutes. Cerebral edema/contusion reported use of qbMRI is for evaluation of potential CSF shunt failure in patients with hydrocephalus, who average 8.5 CT scans during childhood.…”

“…This study supports a growing literature describing the use of qbMRI for pediatric trauma indications. 15,17,18 However, our study was unique in a number of ways including a higher population of patients with clinically important traumatic brain injuries which is critical to ensure this imaging modality is identifying the patients at highest risk for morbidity and mortality, a primary outcome focused on clinically important traumatic brain injuries, broader age inclusion than past studies, and being a separate research institute and geographically removed from prior studies. One previous study of qbMRI for head trauma in children less than 6 years of age reported a 92.8% sensitivity for traumatic brain injury.…”

“…This was a prospective study of patients less than 15 cussing later in the course, they were followed by the study team. Any eligible patient and family who were approached but did not consent in the ED and subsequently underwent a qbMRI for clinical care were approached for consent at the later time.…”

Emergency department implementation of abbreviated magnetic resonance imaging for pediatric traumatic brain injury

“…There are limited publications reporting abbreviated brain MRI protocols in the ED and none modeling step-wise implementation for the evaluation of children presenting with head injury. 18 Specifics of the abbreviated brain MRI protocol used in this implementation project are provided in Table 2 with reference to the reasoning for sequence selection. To our knowledge, a single prior brain MRI protocol has been published regarding pediatric head injury evaluation in the ED; however, this protocol does not detail the sequences to an extent that we can perform a side-by-side comparison.…”

“…To our knowledge, a single prior brain MRI protocol has been published regarding pediatric head injury evaluation in the ED; however, this protocol does not detail the sequences to an extent that we can perform a side-by-side comparison. 18 However, abbreviated MRI implementation has been detailed in other settings and varying pathologies. 3,[29][30][31] Importantly, equipment, personnel, and financial resources for…”