Use of magnetic resonance imaging in severe pediatric traumatic brain injury: assessment of current practice

Abstract

OBJECTIVE There is no consensus on the optimal timing and specific brain MRI sequences in the evaluation and management of severe pediatric traumatic brain injury (TBI), and information on current practices is lacking. The authors performed a survey of MRI practices among sites participating in a multicenter study of severe pediatric TBI to provide information for designing future clinical trials using MRI to assess brain injury after severe pediatric TBI. METHODS Information on current imaging practices and resources was collected from 27 institutions participating in the Approaches and Decisions after Pediatric TBI Trial. Multiple-choice questions addressed the percentage of patients with TBI who have MRI studies, timing of MRI, MRI sequences used to investigate TBI, as well as the magnetic field strength of MR scanners used at the participating institutions and use of standardized MRI protocols for imaging after severe pediatric TBI. RESULTS Overall, the reported use of MRI in pediatric patients with severe TBI at participating sites was high, with 40% of sites indicating that they obtain MRI studies in > 95% of this patient population. Differences were observed in the frequency of MRI use between US and international sites, with the US sites obtaining MRI in a higher proportion of their pediatric patients with severe TBI (94% of US vs 44% of international sites reported MRI in at least 70% of patients with severe TBI). The reported timing and composition of MRI studies was highly variable across sites. Sixty percent of sites reported typically obtaining an MRI study within the first 7 days postinjury, with the remainder of responses distributed throughout the first 30-day postinjury period. Responses indicated that MRI sequences sensitive for diffuse axonal injury and ischemia are frequently obtained in patients with TBI, whereas perfusion imaging and spectroscopy techniques are less common. CONCLUSIONS Results from this survey suggest that despite the lack of consensus or guidelines, MRI is commonly obtained during the acute clinical setting after severe pediatric TBI. The variation in MRI practices highlights the need for additional studies to determine the utility, optimal timing, and composition of clinical MRI studies after TBI. The information in this survey describes current clinical MRI practices in children with severe TBI and identifies important challenges and objectives that should be considered when designing future studies.

Clinical guidelines for traumatic brain injuries in children and boys

“…Specifically, magnetic resonance imaging (MRI) special facilities improved diagnostic accuracy, and thus proper treatment selection, preventing of adverse side effects like post-traumatic seizures and other brain dysfunctions. 3 The incidence rate of pediatric TBI is not equal in various geographical areas, being significantly higher in low income countries. In accordance with the global statistics, more than 90% of injuries among pediatric population happens in low and middle income countries, ninety percent of these injuries being inadverted.…”

Necessity of Immediate MRI Imaging in the Acute Care of Severely Injured Patients

“…However, it was mostly performed in the centers within the first 7 days after trauma and not directly as part of the acute diagnostic workup. He also mentioned that there are currently no guidelines for the diagnostic use of MRI in severely injured pediatric patients [ 15 ]. Gordic et al were able to describe a positive benefit of MRI diagnostics in the diagnosis of traumatic splenic lacerations [ 16 ].…”

Addressing Key Clinical Care and Clinical Research Needs in Severe Pediatric Traumatic Brain Injury: Perspectives From a Focused International Conference

“…Although magnetic resonance imaging (MRI) does not expose children to ionizing radiation, conventional MRI requires the child to remain motionless for several minutes and usually requires anesthesia or sedation. MRI is typically reserved to detect lesions that may explain clinical symptoms, which remain unresolved despite initial CT, especially in the setting of diffuse axonal injury (DAI) ( 51 , 56 ). Compared with CT, MRI provides prognostic insights and identifies significantly more intra-parenchymal lesions in pTBI, particularly in children AHT.…”