title: QuickBrain MRI for the detection of acute pediatric traumatic brain injury.
abstract: OBJECTIVE The current gold-standard imaging modality for pediatric traumatic brain injury (TBI) is CT, but it confers risks associated with ionizing radiation. QuickBrain MRI (qbMRI) is a rapid brain MRI protocol that has been studied in the setting of hydrocephalus, but its ability to detect traumatic injuries is unknown. METHODS The authors performed a retrospective cohort study of pediatric patients with TBI who were undergoing evaluation at a single Level I trauma center between February 2010 and December 2013. Patients who underwent CT imaging of the head and qbMRI during their acute hospitalization were included. Images were reviewed independently by 2 neuroradiology fellows blinded to patient identifiers. Image review consisted of identifying traumatic mass lesions and their intracranial compartment and the presence or absence of midline shift. CT imaging was used as the reference against which qbMRI was measured. RESULTS A total of 54 patients met the inclusion criteria; the median patient age was 3.24 years, 65% were male, and 74% were noted to have a Glasgow Coma Scale score of 14 or greater. The sensitivity and specificity of qbMRI to detect any lesion were 85% (95% CI 73%-93%) and 100% (95% CI 61%-100%), respectively; the sensitivity increased to 100% (95% CI 89%-100%) for clinically important TBIs as previously defined. The mean interval between CT and qbMRI was 27.5 hours, and approximately half of the images were obtained within 12 hours. CONCLUSIONS In this retrospective pilot study, qbMRI demonstrated reasonable sensitivity and specificity for detecting a lesion or injury seen with neuroimaging (radiographic TBI) and clinically important acute pediatric TBI.
authors.affiliation: Department of Emergency Medicine, Center for Policy and Research in Emergency Medicine.
authors.forename: David C
authors.initials: DC
authors.lastname: Sheridan
authors.affiliation: Department of Emergency Medicine, Center for Policy and Research in Emergency Medicine.
authors.forename: Craig D
authors.initials: CD
authors.lastname: Newgard
authors.affiliation: Department of Neurological Surgery, Division of Pediatric Neurosurgery, and.
authors.forename: Nathan R
authors.initials: NR
authors.lastname: Selden
authors.affiliation: Department of Surgery, Division of Pediatric Surgery, Oregon Health & Science University, Portland, Oregon.
authors.forename: Mubeen A
authors.initials: MA
authors.lastname: Jafri
authors.affiliation: Department of Emergency Medicine, Center for Policy and Research in Emergency Medicine.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Hansen
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging*; D000070642:Brain Injuries, Traumatic / Q000000981:diagnostic imaging* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D005260:Female; D015600:Glasgow Coma Scale; D006760:Hospitalization; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D010865:Pilot Projects; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers
keywords: ED = emergency department; GCS = Glasgow Coma Scale; GRE = gradient echo; LOS = length of stay; PICU = pediatric intensive care unit; TBI = traumatic brain injury; child; ciTBI = clinically important traumatic brain injury; imaging; qbMRI = QuickBrain MRI; trauma