title: Minimizing Radiation Exposure in Evaluation of Pediatric Head Trauma: Use of Rapid MR Imaging.
abstract: OBJECTIVE
  With >473,000 annual emergency department visits for children with traumatic brain injuries in the United States, the risk of ionizing radiation exposure during CT examinations is a real concern. The purpose of this study was to assess the validity of rapid MR imaging to replace CT in the follow-up imaging of patients with head trauma.
  
  
  METHODS
  A retrospective review of 103 pediatric patients who underwent initial head CT and subsequent follow-up rapid MR imaging between January 2010 and July 2013 was performed. Patients had minor head injuries (Glasgow Coma Scale, >13) that required imaging. Initial head CT was performed, with follow-up rapid MR imaging completed within 48 hours. A board-certified neuroradiologist, blinded to patient information and scan parameters, then independently interpreted the randomized cases.
  
  
  RESULTS
  There was almost perfect agreement in the ability to detect extra-axial hemorrhage on rapid MR imaging and CT (κ = 0.84, P < .001). Evaluation of hemorrhagic contusion/intraparenchymal hemorrhage demonstrated a moderate level of agreement between MR imaging and CT (κ = 0.61, P < .001). The ability of MR imaging to detect a skull fracture also showed a substantial level of agreement with CT (κ = 0.71, P < .001). Detection of diffuse axonal injury demonstrated a slight level of agreement between MR imaging and CT (κ = 0.154, P = .04). However, the overall predictive agreement for the detection of an axonal injury was 91%.
  
  
  CONCLUSIONS
  Rapid MR imaging is a valid technique for detecting traumatic cranial injuries and an adequate examination for follow-up imaging in lieu of repeat CT.
authors.affiliation: From the Departments of Radiology (H.M., J.A., L.L.) MehtaH@wcmc.com.
authors.forename: H
authors.initials: H
authors.lastname: Mehta
authors.affiliation: From the Departments of Radiology (H.M., J.A., L.L.).
authors.forename: J
authors.initials: J
authors.lastname: Acharya
authors.affiliation: Neurosurgery (A.L.M., M.E.T., D.J.), New York Medical College, Valhalla, New York.
authors.forename: A L
authors.initials: AL
authors.lastname: Mohan
authors.affiliation: Neurosurgery (A.L.M., M.E.T., D.J.), New York Medical College, Valhalla, New York.
authors.forename: M E
authors.initials: ME
authors.lastname: Tobias
authors.affiliation: From the Departments of Radiology (H.M., J.A., L.L.).
authors.forename: L
authors.initials: L
authors.lastname: LeCompte
authors.affiliation: Neurosurgery (A.L.M., M.E.T., D.J.), New York Medical College, Valhalla, New York.
authors.forename: D
authors.initials: D
authors.lastname: Jeevan
mesh_terms: D000293:Adolescent; D001930:Brain Injuries / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D010372:Pediatrics / Q000379:methods; D000069079:Radiation Exposure / Q000517:prevention & control; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods