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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

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Imaging Children Head injury Alternative imaging 

Abbreviations

BOLD

Blood-oxygen-level dependent

CI

Confidence interval

CT

Computed tomography

DAI

Diffuse axonal injury

DWI

Diffusion-weighted imaging

EDH

Epidural hematoma

FLAIR

Fluid attenuation inversion recovery

GCS

Glasgow Coma Scale

MRI

Magnetic resonance imaging

OR

Odds ratio

SAH

Subarachnoid hemorrhage

SDH

Subdural hematoma

STIR

Short-tau inversion recovery

TBI

Traumatic brain injury

Notes

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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