Using fast MRI to assess brain injuries

Computed tomography (CT) scans are often used when treating children for traumatic brain injury, but the exposure to ionizing radiation may give a clinician pause in cases that are extremely subtle. A new study published in Pediatrics looked at whether fast magnetic resonance imaging (MRI) scans, meaning motion-tolerant MRI sequences done without sedation) was accurate and feasible in young children.

The researchers attempted fast MRI scans with children aged <6 years old who had a head CT performed and had been examined in the emergency department of a single, level 1 pediatric trauma center. The fast MRI sequence included 3T axial and sagittal T2 single-shot turbo spin echo, axial T1 turbo field echo, axial fluid-attenuated inversion recovery, axial gradient echo, and axial diffusion-weighted single-shot turbo spin echo planar imaging. Feasibility was determined by completion rate and imaging time. Accuracy of fast MRI versus CT was measured for findings of traumatic brain injury, which included intracranial hemorrhage, parenchymal injury, and skull fracture.

Of the 299 potential study participants, a fast MRI was available and attempted in 225 children and completed in 223 children. The median image time was 59 seconds for the CT scan (interquartile range 52–78) and 365 seconds (interquartile range 340–392) for fast MRI. A CT scan identified traumatic brain injury in 111 children, which included 81 skull fractures, 27 subdural hematomas, 24 subarachnoid hemorrhages, and 35 other injuries. Fast MRI scans identified traumatic brain injuries in 103 children (sensitivity 92.8%; 95% confidence interval 86.3–96.8). It missed a 2 children with subarachnoid hemorrhage and 6 children with isolated skull fractures.

Researchers concluded that when compared to CT, fast MRI was feasible and accurate in clinically stable children who presented with a traumatic brain injury concern.