MRI Brain Imaging in Assessment of Pediatric Head Trauma

T is the leading cause of death in children over the age of one, and traumatic brain injury (TBI) is the leading cause of death and disability due to trauma, accounting for 70% of fatal injuries.1 In the United States, every year there are 3,000 deaths, 50,000 hospitalizations and 675,000 emergency room (ER) visits related to blunt head trauma.1 TBI is a major public health and socio-economic problem throughout the world, especially among children and young adults.2 Even in patients who do not have any recognizable initial clinical manifestations, it can still have devastating long-term consequences on neurocognitive function and psychosocial behavior, if untreated. The use of computed tomography (CT) has increased in recent years, thus enabling early identification of TBI. Accordingly, many recent studies have shown an association between lifetime risk of developing cancer and ionizing radiation from CT exams. This lifetime risk of cancer is higher in young children when compared to adults.3,4 Though CT has remained the mainstay imaging modality used in the initial evaluation of pediatric head injury, faster magnetic resonance imaging (MRI) techniques have proven to be more sensitive in identifying subtle findings of brain injury. Specifically, MRI has been used in differentiating subacute and chronic brain injury, and identifying the extent of encephalopathy, reactive gliosis, and hemorrhage related ABSTRACT Purpose Though computed tomography (CT) has been the mainstay imaging modality used in the initial evaluation of pediatric head injury, newer magnetic resonance imaging (MRI) techniques have proven to be more sensitive in identifying subtle findings of brain injury. Specifically, MRI has been used in differentiating subacute and chronic brain injury, and identifying the extent of encephalopathy, reactive gliosis, and hemorrhage related to the insult. In this literature review, we intend to present the current information about the use and benefits of MR in evaluating pediatric head trauma. Methods Literature search was done from Medline and PubMed for all peer-reviewed manuscripts from January 1990 and December 2018 using several keywords. The preceding searches included pediatric head trauma, pediatric TBI, imaging in head trauma, MRI in head trauma evaluation, and long-term effects of pediatric head trauma. After careful analysis, the most important points were chosen and summarized in this review. Results MRI has greater sensitivity in the detection of most types of head injuries, in comparison to CT – except skull fractures. Conclusions In the setting of head trauma, MRI provides an imaging modality with a unique ability to provide additional clinical information compared to CT examination.