Diagnostic Performance of Ultrafast Brain MRI for Evaluation of Abusive Head Trauma.
MR imaging with sedation is commonly used to detect intracranial traumatic pathology in the pediatric population. Our purpose was to compare nonsedated ultrafast MR imaging, noncontrast head CT, and standard MR imaging for the detection of intracranial trauma in patients with potential abusive head trauma.



A prospective study was performed in 24 pediatric patients who were evaluated for potential abusive head trauma. All patients received noncontrast head CT, ultrafast brain MR imaging without sedation, and standard MR imaging with general anesthesia or an immobilizer, sequentially. Two pediatric neuroradiologists independently reviewed each technique blinded to other modalities for intracranial trauma. We performed interreader agreement and consensus interpretation for standard MR imaging as the criterion standard. Diagnostic accuracy was calculated for ultrafast MR imaging, noncontrast head CT, and combined ultrafast MR imaging and noncontrast head CT.



Interreader agreement was moderate for ultrafast MR imaging (κ = 0.42), substantial for noncontrast head CT (κ = 0.63), and nearly perfect for standard MR imaging (κ = 0.86). Forty-two percent of patients had discrepancies between ultrafast MR imaging and standard MR imaging, which included detection of subarachnoid hemorrhage and subdural hemorrhage. Sensitivity, specificity, and positive and negative predictive values were obtained for any traumatic pathology for each examination: ultrafast MR imaging (50%, 100%, 100%, 31%), noncontrast head CT (25%, 100%, 100%, 21%), and a combination of ultrafast MR imaging and noncontrast head CT (60%, 100%, 100%, 33%). Ultrafast MR imaging was more sensitive than noncontrast head CT for the detection of intraparenchymal hemorrhage (P= .03), and the combination of ultrafast MR imaging and noncontrast head CT was more sensitive than noncontrast head CT alone for intracranial trauma (P= .02).



In abusive head trauma, ultrafast MR imaging, even combined with noncontrast head CT, demonstrated low sensitivity compared with standard MR imaging for intracranial traumatic pathology, which may limit its utility in this patient population.
From the Department of Radiology and Imaging Sciences (S.F.K., M.Y., N.S., C.L., L.G.N., C.Y.H.).
S F
0000-0001-7213-1761
SF
Kralik
From the Department of Radiology and Imaging Sciences (S.F.K., M.Y., N.S., C.L., L.G.N., C.Y.H.).
M
0000-0002-0545-1826
M
Yasrebi
From the Department of Radiology and Imaging Sciences (S.F.K., M.Y., N.S., C.L., L.G.N., C.Y.H.).
N
0000-0002-9129-9639
N
Supakul
From the Department of Radiology and Imaging Sciences (S.F.K., M.Y., N.S., C.L., L.G.N., C.Y.H.).
C
0000-0002-6146-7347
C
Lin
From the Department of Radiology and Imaging Sciences (S.F.K., M.Y., N.S., C.L., L.G.N., C.Y.H.).
L G
0000-0003-2532-6827
LG
Netter
Child Protective Program (R.A. Hicks, R.A. Hibbard).
R A
0000-0002-9348-9495
RA
Hicks
Child Protective Program (R.A. Hicks, R.A. Hibbard).
R A
0000-0002-2095-0762
RA
Hibbard
Departments of Neurological Surgery (L.L.A.).
L L
0000-0001-5085-6913
LL
Ackerman
Neurology (M.L.H.), Indiana University School of Medicine, Indianapolis, Indiana.
M L
0000-0002-1716-1113
ML
Harris
From the Department of Radiology and Imaging Sciences (S.F.K., M.Y., N.S., C.L., L.G.N., C.Y.H.) cyho@iupui.edu.
C Y
0000-0002-2358-1851
CY
Ho
D000768:Anesthesia, General; D002649:Child Abuse; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005260:Female; D015600:Glasgow Coma Scale; D006408:Hematoma, Subdural / Q000000981:diagnostic imaging; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D015588:Observer Variation; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed