QuickBrain MRI for the detection of acute pediatric traumatic brain injury

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>The current gold-standard imaging modality for pediatric traumatic brain injury (TBI) is CT, but it confers risks associated with ionizing radiation. QuickBrain MRI (qbMRI) is a rapid brain MRI protocol that has been studied in the setting of hydrocephalus, but its ability to detect traumatic injuries is unknown.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>The authors performed a retrospective cohort study of pediatric patients with TBI who were undergoing evaluation at a single Level I trauma center between February 2010 and December 2013. Patients who underwent CT imaging of the head and qbMRI during their acute hospitalization were included. Images were reviewed independently by 2 neuroradiology fellows blinded to patient identifiers. Image review consisted of identifying traumatic mass lesions and their intracranial compartment and the presence or absence of midline shift. CT imaging was used as the reference against which qbMRI was measured.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>A total of 54 patients met the inclusion criteria; the median patient age was 3.24 years, 65% were male, and 74% were noted to have a Glasgow Coma Scale score of 14 or greater. The sensitivity and specificity of qbMRI to detect any lesion were 85% (95% CI 73%–93%) and 100% (95% CI 61%–100%), respectively; the sensitivity increased to 100% (95% CI 89%–100%) for clinically important TBIs as previously defined. The mean interval between CT and qbMRI was 27.5 hours, and approximately half of the images were obtained within 12 hours.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>In this retrospective pilot study, qbMRI demonstrated reasonable sensitivity and specificity for detecting a lesion or injury seen with neuroimaging (radiographic TBI) and clinically important acute pediatric TBI.</jats:p></jats:sec>

Treating childhood traumatic brain injury with autologous stem cell therapy

“…Similarly, symptoms of brain damage including TBI may not be apparent until the child begins to develop and mature behaviorally and cognitively. A current effective method for diagnosing neonatal TBI acutely is computer tomography (CT) scanning, however, doctors are often hesitant to submit the newborn to CT due to the risks associated with ionizing radiation [49]. As a result of the limited diagnosing ability, stem cell therapy may not feasible as an acute treatment.…”

“…To make acute stem cell therapy effective, a method of diagnoses must be developed that does not harm the neonate. A possible area of development is in highly sensitive imaging technologies, such as quickbrain MRI, which removes the radiation concern [49–51]. …”

Rapid magnetic resonance imaging screening for abusive head trauma

“…A few small studies have suggested that rapid MRI can be used to detect clinically significant intracranial injury that would require neurosurgical intervention, but the sensitivity for trace extra-axial hemorrhages of a few millimeters in width has been questioned. In one study of 54 children by Sheridan et al [6], rapid brain MRI demonstrated 85% sensitivity for all intracranial traumatic injuries, with small extraaxial hemorrhages missed in 4 children. At our institution, we previously evaluated 102 hemorrhages in children and demonstrated an overall sensitivity of 86% for subdural or epidural hemorrhages with rapid MRI [7].…”

Think A-Head Campaign of Image Gently: Shared Decision-Making in Pediatric Head Trauma

“…MR imaging is not established for routine use in acute pediatric brain trauma yet, though several studies have validated the ability of MR imaging to detect relevant pathology and have shown the feasibility of rapid MR imaging protocols. [6][7][8] The use of radiographs in minor pediatric head trauma is controversial. In patients with linear skull fractures on radiographs and who are asymptomatic, there may still be small intracranial hemorrhages, but these would not require neurosurgical intervention.…”