Child's Nervous System

, Volume 34, Issue 7, pp 1345–1352 | Cite as

MRI in mild pediatric traumatic brain injury: diagnostic overkill or useful tool?

  • Gesa Cohrs
  • Monika Huhndorf
  • Nils Niemczyk
  • Lukas J. Volz
  • Alexander Bernsmeier
  • Ash Singhal
  • Naomi Larsen
  • Michael Synowitz
  • Friederike Knerlich-Lukoschus
Original Paper



Magnetic resonance imaging (MRI) is a sensitive imaging tool which lacks the burden of ionizing radiation. It is not established as primary diagnostic tool in traumatic brain injury (TBI). The purpose of this study was to evaluate the usefulness of MRI as initial imaging modality in the emergency management of mild pediatric TBI.


Children (0–18 years, sub-divided in four age-groups) with mild TBI who received MRI in the emergency department were identified. Clinical characteristics and trauma mechanisms were evaluated retrospectively. Univariate and multivariate logistic regression analyses were used to identify clinical factors that might be indicative for trauma sequelae on MRI scans.


An institutional case series of 569 patients (322 male/247 female; age < 18years; (GCS ≥ 13), who received MRI for mild TBI, was analyzed. Multi-sequence imaging (including T2, T2*, FLAIR, and diffusion-weighted sequences) was feasible without sedation in 96.8% of cases (sedation, 1.8%; general anesthesia, 1.4%). MRI revealed trauma-associated findings in 13% of all cases; incidental findings were detected in 4.7%. In our cohort, GCS deterioration, scalp hematoma, clinical signs of skull base fractures, and horseback riding accidents were related to structural trauma sequelae on MRI.


MRI is a practical primary imaging tool for evaluating children with mild TBI in the emergency department. The presented analyses demonstrated that in our institution, MRI imaging is performed frequently in the emergency department. It resulted mostly in normal findings. This may reflect uneasiness of when to perform imaging in mild TBI and appears retrospectively as an “overdo.” There are clinical factors that are more likely associated with MRI-positive findings. Their reliability has to be evaluated in prospective studies in order to formulate further decision rules of when to perform MRI imaging or not.


Imaging Children Head injury Alternative imaging 



Blood-oxygen-level dependent


Confidence interval


Computed tomography


Diffuse axonal injury


Diffusion-weighted imaging


Epidural hematoma


Fluid attenuation inversion recovery


Glasgow Coma Scale


Magnetic resonance imaging


Odds ratio


Subarachnoid hemorrhage


Subdural hematoma


Short-tau inversion recovery


Traumatic brain injury


Compliance with ethical standards

Conflict of interest

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Gesa Cohrs
    • 1
  • Monika Huhndorf
    • 2
  • Nils Niemczyk
    • 1
  • Lukas J. Volz
    • 3
  • Alexander Bernsmeier
    • 4
  • Ash Singhal
    • 5
  • Naomi Larsen
    • 2
  • Michael Synowitz
    • 1
  • Friederike Knerlich-Lukoschus
    • 1
    • 6
  1. 1.Department of NeurosurgeryUniversity Medical Center Schleswig-Holstein (UKSH)KielGermany
  2. 2.Department of NeuroradiologyUniversity Medical Center Schleswig-Holstein (UKSH)KielGermany
  3. 3.Department of NeurologyUniversity Hospital CologneCologneGermany
  4. 4.Department of General, Visceral-, Thoracic-, Transplantation- and Pediatric SurgeryUniversity Medical Center Schleswig-Holstein (UKSH)KielGermany
  5. 5.Division of Pediatric Neurosurgery, Department of SurgeryUniversity of British Columbia and BC Children’s HospitalVancouverCanada
  6. 6.Asklepios Klinik Sankt Augustin, Department of Pediatric NeurosurgerySankt AugustinGermany

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