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

Fellows’ Journal Club

Editor’s Comment

This study is a retrospective review of 103 pediatric patients who underwent initial head CT and subsequent follow-up rapid MR imaging between January 2010 and July 2013. Patients had minor head injuries that required imaging. There was almost perfect agreement in the ability to detect extra-axial hemorrhage on rapid MR imaging and CT (kappa = 0.84). Evaluation of hemorrhagic contusion/hemorrhage demonstrated a moderate level of agreement between MR imaging and CT (kappa = 0.61). The authors conclude that rapid MRI is an adequate imaging technique for the follow-up of pediatric patients with minor head trauma.

Abstract

Figure from Mehta et al -- Fellows' Journal Club
An 8-year-old child who fell from a bike. Initial noncontrast head CT shows a left epidural hemorrhage (A). Follow-up rMRI axial T2 TSE shows interval-increased size of the left epidural hemorrhage (B). Follow-up rMRI axial T2 TSE shows interval craniotomy and evacuation of the left epidural hemorrhage (C).

BACKGROUND AND PURPOSE

With >473,000 annual emergency department visits for children with traumatic brain injuries in the United States, the risk of ionizing radiation exposure during CT examinations is a real concern. The purpose of this study was to assess the validity of rapid MR imaging to replace CT in the follow-up imaging of patients with head trauma.

MATERIALS AND METHODS

A retrospective review of 103 pediatric patients who underwent initial head CT and subsequent follow-up rapid MR imaging between January 2010 and July 2013 was performed. Patients had minor head injuries (Glasgow Coma Scale, >13) that required imaging. Initial head CT was performed, with follow-up rapid MR imaging completed within 48 hours. A board-certified neuroradiologist, blinded to patient information and scan parameters, then independently interpreted the randomized cases.

RESULTS

There was almost perfect agreement in the ability to detect extra-axial hemorrhage on rapid MR imaging and CT (κ = 0.84, P < .001). Evaluation of hemorrhagic contusion/intraparenchymal hemorrhage demonstrated a moderate level of agreement between MR imaging and CT (κ = 0.61, P < .001). The ability of MR imaging to detect a skull fracture also showed a substantial level of agreement with CT (κ = 0.71, P < .001). Detection of diffuse axonal injury demonstrated a slight level of agreement between MR imaging and CT (κ = 0.154, P = .04). However, the overall predictive agreement for the detection of an axonal injury was 91%.

CONCLUSIONS

Rapid MR imaging is a valid technique for detecting traumatic cranial injuries and an adequate examination for follow-up imaging in lieu of repeat CT.

Read this article: http://bit.ly/RadExposure-PedsHeadTrauma

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