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

Kralik, Stephen F.; Yasrebi, Mona; Supakul, Nucharin; Lin, Chen; Netter, Lynn; Hicks, Ralph A.; Hibbard, Roberta A.; Ackerman, Laurie L.; Harris, Mandy L.; Ho, Chang Yueh

doi:10.3174/ajnr.a5093

Cited by 41 publications

(16 citation statements)

References 35 publications

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“…Lastly, we chose to focus on fracture detection rather than evaluate additional intracranial trauma findings because previous reports have demonstrated superiority of MRI compared to CT in pediatric patients. [16,24] Nevertheless, based on the results of our study, BB imaging with 3D reconstruction is a promising tool to detect calvarial fractures in young children with suspected abusive head trauma. Further refinement in technique and improvements in the processing pipeline of the BB images could facilitate its use in other conditions currently requiring CT imaging for assessment of bone detail.…”

Section: Discussionmentioning

confidence: 82%

Black bone MRI with 3D reconstruction for the detection of skull fractures in children with suspected abusive head trauma

Kralik

Supakul

et al. 2018

Neuroradiology

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Dear Neuroradiology Editors, I am pleased to submit for review on behalf of myself and my co-authors the following original research paper titled "Black Bone MRI with 3D reconstruction for the Detection of Skull Fractures in Children with Suspected Abusive Head Trauma." Black bone MRI sequences are newer MRI sequences which have been developed for imaging of the bone with MRI. The purpose for this original research was to compare a black bone MRI sequence to head CT for detection of skull fractures in pediatric patients with possible abusive head trauma.

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Section: Discussionmentioning

confidence: 82%

Black bone MRI with 3D reconstruction for the detection of skull fractures in children with suspected abusive head trauma

Kralik

Supakul

et al. 2018

Neuroradiology

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“…In addition to the limitation in radiation exposure from HCT use, these data support potentially limiting subsequent full MRI imaging, particularly given the need for sedation in some cases, and the cost associated with such imaging. The benefit of rMRI for shunt dysfunction has been previously investigated [7][8][9][10], as has the use of rMRI as a screening tool for nonaccidental trauma [12,13]. Few Table 4 Neuroimaging performed in the control and rMRI periods for those complaints with significant differences between the time periods.…”

Section: Discussionmentioning

confidence: 99%

“…Rapid-sequence magnetic resonance imaging of the brain (rMRI) has gained acceptance as an alternative to HCT in children because of the speed of image acquisition. Previous studies highlight experiences with rMRI protocols for a single indication, including ventricular shunt malfunction [6][7][8][9][10], stroke [11], and abusive head trauma [12,13]. These studies demonstrate a role for rMRI as a radiation-sparing alternative to HCT.…”

Section: Introductionmentioning

confidence: 94%

Rapid brain MRI protocols reduce head computerized tomography use in the pediatric emergency department

et al. 2020

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Background: Rapid magnetic resonance imaging (MRI) protocols may be effective in the emergency department (ED) to evaluate nontraumatic neurologic complaints. We evaluate neuroimaging (rapid MRI [rMRI]), head computerized tomography [HCT], and full MRI) use following widespread implementation of rMRI protocols in a pediatric emergency department (ED). Methods:We conducted a retrospective study in a tertiary care pediatric ED of encounters with neuroimaging during two 9-month periods: one prior to (control period) and one after generalized availability of 4 rMRI protocols (rMRI period). The primary outcome was differences in neuroimaging rates between the two periods. Secondary outcomes included ED process measures, unsuccessful imaging, and undetected pathology, with full MRI within 14 days as the reference standard.Results: There were 1052 encounters with neuroimaging during the control and 1308 during the rMRI periods. Differences in neuroimaging between periods were 27.7% for rMRI (95% CI, 24.4, 31.0), − 21.5% for HCT (95% CI, − 25.5, − 17.5), and − 6.2% for full MRI (95% CI, − 9.3, − 3.1%.) Time to imaging (182 [IQR 138-255] versus 86 [IQR 52-137] minutes) as well as ED length of stay (396 [IQR 304-484] versus 257 [IQR 196-334] minutes) was longer for rMRI versus HCT (p < 0.01). Between the control and rMRI periods, there were differences in types of neuroimaging performed for patients with altered mental status, headache, seizure, shunt dysfunction, stroke, syncope, trauma, vomiting, infection, and other neurologic complaints (p < 0.05). rMRI studies were unsuccessful in 3.6% of studies versus 0.0% of HCTs (p < 0.01). The 22 unsuccessful rMRI studies were unsuccessful due to artifacts from dental hardware (n = 2) and patient motion (n = 20). None of the rMRI studies with full MRI follow-up imaging had undetected pathology; the false negative rate for the HCT exams was as high as 25%.Conclusions: After routine ED use of 4 rMRI protocols, there was a more than 20% decrease in HCT use without missed diagnoses. Time to neuroimaging and length of stay were longer for rMRI than HCT, with higher rates of unsuccessful imaging. Despite these limitations, rMRI may be an alternative to HCT for nontraumatic complaints in the ED.

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“…[1][2][3][4][5][6] However, most studies have examined specific clinical conditions, thus only evaluating limited sequences. [7][8][9][10][11][12][13][14][15] Another fast technique, synthetic MR imaging, quantitatively approaches the absolute physical properties for single-scan, multiple-contrast generation with a total scan time of 4-5 minutes. [4][5][6]16,17 Routine clinical use of synthetic MR imaging is limited because it cannot produce DWI and T2*WI and provide inferior image quality in synthetic T2-FLAIR due to partial volume effects.…”

mentioning

confidence: 99%

Clinical Experience of 1-Minute Brain MRI Using a Multicontrast EPI Sequence in a Different Scan Environment

Ryu

Baek

Skare

et al. 2020

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: The long scan time of MR imaging is a major drawback limiting its clinical use in neuroimaging; therefore, we aimed to investigate the clinical feasibility of a 1-minute full-brain MR imaging using a multicontrast EPI sequence on a different MR imaging scanner than the ones previously reported. MATERIALS AND METHODS:We retrospectively reviewed the records of 146 patients who underwent a multicontrast EPI sequence, including T1-FLAIR, T2-FLAIR, T2WI, DWI, and T2*WI sequences. Two attending neuroradiologists assessed the image quality of each sequence to compare the multicontrast EPI sequence with routine MR imaging protocols. We used the Wilcoxon signed rank test and McNemar test to compare the 2 MR imaging protocols. RESULTS:The multicontrast EPI sequence generally showed sufficient image quality of .2 points using a 4-point assessment scale. Regarding image quality and susceptibility artifacts, there was no significant difference between the multicontrast EPI sequence DWI and routine DWI (P . .05), attesting to noninferiority of the multicontrast EPI, whereas there were significant differences in the other 4 sequences between the 2 MR imaging protocols. CONCLUSIONS:The multicontrast EPI sequence showed sufficient image quality for clinical use with a shorter scan time; however, it was limited by inferior image quality and frequent susceptibility artifacts compared with routine brain MR imaging. Therefore, the multicontrast EPI sequence cannot completely replace the routine MR imaging protocol at present; however, it may be a feasible option in specific clinical situations such as screening, time-critical diseases or for use with patients prone to motion.

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

Cited by 41 publications

References 35 publications

Black bone MRI with 3D reconstruction for the detection of skull fractures in children with suspected abusive head trauma

Black bone MRI with 3D reconstruction for the detection of skull fractures in children with suspected abusive head trauma

Rapid brain MRI protocols reduce head computerized tomography use in the pediatric emergency department

Clinical Experience of 1-Minute Brain MRI Using a Multicontrast EPI Sequence in a Different Scan Environment

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