Multimodality comparison of neuroimaging in pediatric traumatic brain injury.
Traumatic brain injury is a common cause of death and disability in children; early neuroimaging has assumed an increasingly important role in evaluating the extent and severity of injury. Several imaging methods were assessed in a study of 40 children with traumatic brain injury: computed tomography (CT), T(2)-weighted magnetic resonance imaging (MRI), fluid-attenuated inversion recovery (FLAIR) MRI, and susceptibility-weighted imaging (SWI) MRI to determine which were most valuable in predicting 6-12 month outcomes as classified by the Pediatric Cerebral Performance Category Scale score. Patients were subdivided into three groups: (1) normal, (2) mild disability, and (3) moderate/severe disability/persistent vegetative state. T(2), FLAIR, and SWI showed no significant difference in lesion volume between normal and mild outcome groups, but did indicate significant differences between normal and poor and between mild and poor outcome groups. Computed tomography revealed no significant differences in lesion volume between any groups. The findings suggest that T(2), FLAIR, and SWI MRI sequences provide a more accurate assessment of injury severity and detection of outcome-influencing lesions than does CT in pediatric traumatic brain injury patients. Although CT was inconsistent at lesion detection/outcome prediction, it remains an essential part of the acute traumatic brain injury work-up to assess the need for neurosurgic intervention.
Sigmund
Geoffrey A
GA
Loma Linda University School of Medicine, Loma Linda, California 92354, USA.
Tong
Karen A
KA
Nickerson
Joshua P
JP
Wall
Christopher J
CJ
Oyoyo
Udo
U
Ashwal
Stephen
S
D000208:Acute Disease; D000293:Adolescent; D001930:Brain Injuries / Q000000981:diagnostic imaging* / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D004185:Disability Evaluation; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D020127:Recovery of Function; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D015599:Trauma Severity Indices