Implementation of a brain injury screen MRI for infants at risk for abusive head trauma

Abstract

Background

Head computed tomography (CT) is the current standard of care for evaluating infants at high risk of abusive head trauma.

Objective

To both assess the feasibility of using a previously developed magnetic resonance imaging (MRI) brain injury screen (MRBRscreen) in the acute care setting in place of head CT to identify intracranial hemorrhage in high-risk infants and to compare the accuracy of a rapid imaging pulse sequence (single-shot T2 fast spin echo [ssT2FSE]) to a conventional pulse sequence (conventional T2 fast spin echo [conT2FSE]).

Materials and methods

This was a quality improvement initiative to evaluate infants <12 months of age who were screened for intracranial hemorrhage using an MRBRscreen as part of clinical care. The MRBRscreen included axial conT2FSE, axial gradient recalled echo, coronal T1-weighted inversion recovery, axial diffusion-weighted image and an axial ssT2FSE. A comparison of ssT2FSE to conT2FSE with respect to lesion detection was also performed.

Results

Of 158 subjects, the MRBRscreen was able to be completed in 155 (98%); 9% (14/155) were abnormal. Ninety-four percent (137/145) of subjects underwent only an MRBRscreen and avoided both radiation from head CT and sedation from MRI. The axial ssT2FSE and conT2FSE results were congruent 99% of the time.

Conclusion

An MRBRscreen in place of a head CT is feasible and potentially could decrease head CT use by more than 90% in this population. Using a rapid ssT2FSE in place of a conT2FSE can reduce total scan time without losing lesion detection. If an MRBRscreen is readily available, physicians’ threshold to perform neuroimaging may be lowered and lead to earlier detection of abusive head trauma.

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Acknowledgments

The authors would like to thank Tom Sutcavage, who pulled the data, and Julia Wallace and Eleanor Zinn, who assisted with data cleaning and provided administrative assistance.

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Correspondence to Rachel P. Berger.

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Berger, R.P., Furtado, A.D., Flom, L.L. et al. Implementation of a brain injury screen MRI for infants at risk for abusive head trauma. Pediatr Radiol 50, 75–82 (2020). https://doi.org/10.1007/s00247-019-04506-1

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Keywords

  • Abusive head trauma
  • Brain
  • Child abuse
  • Computed tomography
  • Infants
  • Magnetic resonance imaging
  • Screening