Advantages of MRI for lesion detection in pediatric traumatic brain injury
A retrospective analysis of over 100 children admitted to the emergency department of Phoenix Children’s Hospital with traumatic brain injury (TBI) suggests that MRI imaging may provide more clinically relevant information relating to lesion detection.
The findings of the retrospective study published in the February 2015 issue of Hospital Pediatrics suggest that patients suspected of abusive head trauma may benefit more from a MRI exam instead of a CT exam. Lead author Dr. Sandra D.W. Buttram of the division of critical care medicine and colleagues discovered that MRI imaging detected nearly four times as many intraparenchymal lesions (43%) as compared with CT imaging (11%). This is particularly important in view of the fact that within the past decade cases of abusive head trauma in young children five years of age and younger has more than doubled, from 13.7 to 28.9 per 100,000.
The researchers also determined that nearly three times as many intraparencheymal lesions were detected by MRI (44%) compared to CT (15%). The study cohort insisted of a group of 105 patients from infancy to age 21 admitted to the hospital’s pediatric trauma center during a 36 month long time period between 2008 and 2010. All of the patients first had a CT exam, followed by a MRI scan within 14 days, with a median interval of one day. Seventy-eight percent were diagnosed with mild traumatic brain injury. Eight of the patients had a normal CT scan. However, their subsequent MRI scan revealed abnormal lesions for six patients.
While CT is the preferred modality for acute evaluaion of traumatic brain injury in emergency departments because it is readily available, does not require sedation, and can be completed quickly, the authors suggest MRI be considered more often. At Phoenix Children’s Hospital, the protocol for ordering a follow-up MRI is ordered when lesions are discovered or the patient has symptoms that warrant additional imaging.
“In the absence of contraindications, MRI is optimal for broader identification of elsions without exposure to ionizing radiation,” they wrote. They recommend additional studies to determine the prognostic value of identify intraparenchymal lesions by MRI.
Reference
- Buttram SD, Garcia-Filion P, Miller J, et al. Computed tomography vs. magnetic resonance imaging for identifying acute lesions in pediatric traumatic brain injury. Hosp.Pediatr. 2015 Feb;5(2):79-84. doi: 10.1542/hpeds.2014-0094.