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Rapid-sequence MRI for evaluation of pediatric traumatic brain injury: a systematic review
Journal of Neurosurgery: Pediatrics ( IF 1.9 ) Pub Date : 2021-06-25 , DOI: 10.3171/2021.2.peds20852
Brice A. Kessler 1 , Jo Ling Goh 2 , Hengameh B. Pajer 3 , Anthony M. Asher 4 , Weston T. Northam 1 , Sheng-Che Hung 5, 6 , Nathan R. Selden 2 , Carolyn S. Quinsey 1
Affiliation  

OBJECTIVE

Rapid-sequence MRI (RSMRI) of the brain is a limited-sequence MRI protocol that eliminates ionizing radiation exposure and reduces imaging time. This systematic review sought to examine studies of clinical RSMRI use for pediatric traumatic brain injury (TBI) and to evaluate various RSMRI protocols used, including their reported accuracy as well as clinical and systems-based limitations to implementation.

METHODS

PubMed, EMBASE, and Web of Science databases were searched, and clinical articles reporting the use of a limited brain MRI protocol in the setting of pediatric head trauma were identified.

RESULTS

Of the 1639 articles initially identified and reviewed, 13 studies were included. An additional article that was in press at the time was provided by its authors. The average RSMRI study completion time was variable, spanning from 1 minute to 16 minutes. RSMRI with “blood-sensitive” sequences was more sensitive for detection of hemorrhage compared with head CT (HCT), but less sensitive for detection of skull fractures. Compared with standard MRI, RSMRI had decreased sensitivity for all evidence of trauma.

CONCLUSIONS

Protocols and uses of RSMRI for pediatric TBI were variable among the included studies. While traumatic pathology missed by RSMRI, such as small hemorrhages and linear, nondisplaced skull fractures, was frequently described as clinically insignificant, in some cases these findings may be prognostically and/or forensically significant. Institutions should integrate RSMRI into pediatric TBI management judiciously, relying on clinical context and institutional capabilities.



中文翻译:

用于评估小儿创伤性脑损伤的快速序列 MRI:系统评价

客观的

大脑的快速序列 MRI (RSMRI) 是一种有限序列 MRI 协议,可消除电离辐射暴露并减少成像时间。本系统评价旨在检查临床 RSMRI 用于小儿创伤性脑损伤 (TBI) 的研究,并评估所使用的各种 RSMRI 协议,包括其报告的准确性以及临床和基于系统的实施限制。

方法

搜索了 PubMed、EMBASE 和 Web of Science 数据库,并确定了报告在小儿头部外伤情况下使用有限脑部 MRI 协议的临床文章。

结果

在最初确定和审查的 1639 篇文章中,纳入了 13 项研究。当时正在出版的另一篇文章由其作者提供。RSMRI 研究的平均完成时间是可变的,从 1 分钟到 16 分钟不等。与头部 CT (HCT) 相比,具有“血液敏感”序列的 RSMRI 对出血检测更敏感,但对颅骨骨折检测不太敏感。与标准 MRI 相比,RSMRI 对所有创伤证据的敏感性降低。

结论

在纳入的研究中,RSMRI 治疗儿科 TBI 的方案和用途各不相同。虽然 RSMRI 遗漏的创伤病理,例如小出血和线性、无移位的颅骨骨折,经常被描述为临床上无意义的,但在某些情况下,这些发现可能具有预后和/或法医意义。机构应根据临床背景和机构能力,明智地将 RSMRI 整合到儿科 TBI 管理中。

更新日期:2021-09-01
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