Minimizing Radiation Exposure in Evaluation of Pediatric Head Trauma: Use of Rapid MR Imaging

Mehta, Hasit; Acharya, Jay; Mohan, Avinash; Tobias, Michael; LeCompte, L.; Jeevan, Dhruve

doi:10.3174/ajnr.a4464

Cited by 42 publications

(34 citation statements)

References 34 publications

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“…35 Recently, an ufMRI protocol incorporating sequences in addition to T2 sequences have been reported in pediatric trauma patients. 36 This study did not compare findings to a standard MRI (stMRI) and included a wider age range of pediatric patients such that the value of ufMRI in pediatric abusive head trauma remain uncertain. 36 Therefore, the purpose of our study was to evaluate an ufMRI brain protocol performed without sedation for feasibility in terms of scanning time and diagnostic value as well as diagnostic accuracy compared to nHCT and stMRI brain for the detection of intracranial traumatic pathology in patients with suspected AHT.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Performance of Ultrafast Brain MRI for Evaluation of Abusive Head Trauma

Kralik¹,

Yasrebi²,

Supakul³

et al. 2017

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: MRI with sedation is commonly used to detect intracranial traumatic pathology in the pediatric population. Our purpose is to compare nonsedated ultrafast MRI (ufMRI), non-contrast head CT (nHCT), and standard MRI (stMRI) for detection of intracranial trauma in patients with potential abusive head trauma (AHT). MATERIALS AND METHODS:A prospective study was performed in 24 pediatric patients who were evaluated for potential AHT. All patients received nHCT, ufMRI brain without sedation, and stMRI with general anesthesia or papoose, sequentially. Two pediatric neuroradiologists independently reviewed each modality blinded to other modalities for intracranial trauma. Inter-reader agreement was performed, and consensus interpretation for stMRI as the gold standard. Diagnostic accuracy was calculated for ufMRI, nHCT, and combined ufMRI with nHCT. RESULTS:Inter-reader agreement was moderate for ufMRI (k=0.42), substantial for nHCT (k=0.63), and nearly perfect for stMRI (k=0.86). 42% of patients had discrepancies between ufMRI and stMRI which included detection of subarachnoid hemorrhage, and subdural hemorrhage. Sensitivity, specificity, positive and negative predictive values were obtained for any traumatic pathology for each exam: UfMRI (50%, 100%, 100%, 31%), nHCT (25%, 100%, 100%, 21%) and combination of ufMRI with nHCT (60%, 100%, 100%, 33%). UfMRI was more sensitive than nHCT for detection of intraparenchymal hemorrhage (p=0.03), and the combination of ufMRI with nHCT was more sensitive than nHCT alone for intracranial trauma (p=0.02). CONCLUSION:In AHT, ufMRI, even combined with nHCT, demonstrated low sensitivity compared to stMRI for intracranial traumatic pathology which may limit its utility in this patient population.Abbreviations: AHT: abusive head trauma; GRE: gradient recalled echo; nHCT: non contrast head CT

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Section: Introductionmentioning

confidence: 99%

Diagnostic Performance of Ultrafast Brain MRI for Evaluation of Abusive Head Trauma

Kralik¹,

Yasrebi²,

Supakul³

et al. 2017

AJNR Am J Neuroradiol

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“…Ultrasound may accurately diagnose paediatric skull fractures; its innocuousness and cost-effectiveness in comparison with CT makes it a good choice in this situation [19,20]. Rapid MRI is a valid technique for detecting traumatic cranial injuries and an adequate examination for follow-up imaging in lieu of repeat CT [21]. Therefore, in future clinical work, we should consider ultrasound and rapid MRI for the detection of traumatic cranial injuries because of its innocuousness and cost-effectiveness.…”

Section: Discussionmentioning

confidence: 99%

Traumatic skull fractures in children and adolescents: A retrospective observational study

Wang

Zhou

et al. 2018

Injury

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“…Furthermore, Mehta et al used rapid MR imaging techniques in acute pediatric TBI patients and concluded that the protocol was valid in detecting acute traumatic intracranial injuries. 28 Their protocol was acquired in 2.5 to 3 minutes and none of the patients in their study required sedation. Rapid MRI techniques with a total protocol duration of 3 to 4 minutes have also been used in patients with pediatric TBI and no clinically important findings were missed using this modality when compared with non-contrast CT. 29 The sequences used in this study were T2 half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequences in three planes (40 seconds each) and susceptibility weighted images (2 minutes).…”

Section: The Evolving Role Of Mri In Acute Pediatric Tbimentioning

confidence: 99%

“…3). 8,28 MRI generally incurs higher cost compared with CT and may require more specialized training for optimal interpretation.…”

Section: The Evolving Role Of Mri In Acute Pediatric Tbimentioning

confidence: 99%

Use of Conventional and Advanced MRI Techniques in Accidental Pediatric Traumatic Brain Injury

Mendoza

Kadom

Palasis

et al. 2016

J Pediatr Neuroradiol

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Traumatic brain injury (TBI) has a complex and dynamic pathophysiology, and neuroimaging plays a critical role in its evaluation in the acute, subacute, and chronic settings. Here, we describe technical advancements in magnetic resonance (MR) imaging techniques that promote use of MRI for acute TBI in children to avoid radiation exposure. We also discuss the value of using advanced MR imaging techniques for research in children with TBI.

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Minimizing Radiation Exposure in Evaluation of Pediatric Head Trauma: Use of Rapid MR Imaging

Cited by 42 publications

References 34 publications

Diagnostic Performance of Ultrafast Brain MRI for Evaluation of Abusive Head Trauma

Diagnostic Performance of Ultrafast Brain MRI for Evaluation of Abusive Head Trauma

Traumatic skull fractures in children and adolescents: A retrospective observational study

Use of Conventional and Advanced MRI Techniques in Accidental Pediatric Traumatic Brain Injury

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