Study Shows Fast MRIs Effectively Detect Traumatic Brain Injury in Children
Annually, throughout the US, Traumatic Brain Injury (TBI) in children results in more than 1.5 million emergency room visits, with up to 70 percent of these children being exposed to ionized radiation while undergoing computed tomography (CT) scans. This exposure to ionized radiation during CT scans prompted a group of researchers from the University of Colorado School of Medicine (CU SOM) to find a safer option for the detection of traumatic brain injury in children. The CU SOM researchers conducted a study to determine if a form of MRI (magnetic resonance imaging) could be used instead of a CT scan for accurately diagnosing TBI. Specifically, these researchers wanted to know if a fast MRI could replace the computed tomography scan.
Children Are at a Greater Risk of Experiencing the Negative Side Effects of Radiation
While radiation exposure can have negative consequences for people of all ages, the risk to children is greater because their tissues are still growing. These growing tissues are more vulnerable to the effects of radiation. Furthermore, children’s neurologic exams are less reliable and since children are at the beginning of their lives, they have a longer period of time for harmful mutations to accumulate.
Fast MRIs Are Commonly Used for Children with Shunted Hydrocephalus
Children who have shunted hydrocephalus have been undergoing the fast MRI procedure for some time. The fast MRI procedure eliminates ionized radiation exposure and offers a motion-tolerant protocol that does not require the use of sedation. Despite being a regular protocol for children with shunted hydrocephalus, fast MRI procedures have yet to be validated for use in children with a TBI. This critical gap led to the investigators measuring the diagnostic utility and feasibility of substituting a fast MRI for the gold standard CT scan which is typically used for children with TBI. The study, Fast MRI for Young Children with Traumatic Brain Injury, concentrated on children with traumatic brain injury who were under 6 years of age.
The Study: Fast MRI for Young Children with Traumatic Brain Injury
The study began on June 2, 2015, and its completion date was June 4, 2018. This study aimed to determine if the fast MRI could correctly identify radiographically apparent traumatic brain injury that had already been discovered with a CT scan.
There were 225 children who participated in this study. All patients were under the age of 6 when they began their participation in the study. Each participant had visited a Level 1, pediatric trauma center’s emergency department. While receiving emergency medical care, each study participant underwent a head CT scan.
The children enrolled in this study received a fast MRI scan after having their head CT scan, ideally, researchers wanted the fast MRIs to be performed within the 24-hour timeframe following the head CT.
Two of the three pediatric radiologists independently interpreted the fast MRIs. These radiologists were denied access to the other imaging and clinical results as well as to the patient’s initial clinical interpretations.
The fast MRI’s accuracy was to be established by the presence of a radiographically apparent traumatic brain injury: The researchers used the results of the participant’s earlier head CT scan as the criterion standard.
A successful completion of the fast MRI occurred in 99 percent of the participants. The head CT scans median imaging time was 59 seconds, whereas, the fast MRI scans was 365 seconds. A traumatic brain injury was identified by the computed tomography scan in 111 of the children. Meanwhile, the fast MRI identified 103 TBIs (of the 111), thus, offering a sensitivity of 92.8 percent.
The researchers determined that a fast MRI is a plausible alternative to the computed tomography scan for the evaluation of children who have TBI. These findings are reported in, Feasibility and Accuracy of Fast MRI vs. CT for TBI in Young Children, which is published in the Oct. 1, 2019, Volume 144, Issue 4, of Pediatrics.
Lead author Daniel Lindberg, MD, who is the associate professor of emergency medicine at CU SOM, stated, “We found that fast MRI is a reasonable alternative to CT. Nearly all (99 percent) of fast MRIs were completed successfully, with accuracy that was similar to CT, while avoiding the harms of radiation exposure.” In the same statement, Lindberg said, “While we believe our findings reveal a feasible alternative to CTs in pediatric specialty centers, further study is necessary to test the results in other settings.”