258. Utility of a Trauma-dedicated Magnetic Resonance (MR) Protocol in Work-up for Traumatic Brain Injury

Authors: Mohammed Alshareef, MD; Chelsea Shope, BS; Maria Spampinato, MD; Eskandari Ramin, MD, MS (Charleston, SC)

Introduction:

Traumatic brain injury (TBI) is a common type of injury  seen frequently in emergency department. Most TBIs are evaluated using computer tomography (CT) imaging, a modality that can result in cumulatively high radiation exposure in pediatric patients. Recently, the fast brain magnetic resonance imaging (fbMRI) protocol has been utilized for rapid and targeted imaging for sequential imaging of hydrocephalus in the pediatric population. We investigate the role of a modified trauma-dedicated fbMRI protocol with additional sequences in non-hydrocephalus indications, including TBI.

Methods:

A retrospective review was performed in our institution for all pediatric patients who underwent CT scan and subsequently a trauma MRI within 72 hours. All trauma MRIs were performed on either a 1.5 or 3T MR scanner. Exclusion criteria consisted of hydrocephalus, procedures performed or presence of documented change in neurologic exam between the CT and MRI scans, and imaging done outside of the 72 hours window. 40 patients fit the criteria for imaging. We performed a comparison of findings on the reads of CT and MRI and the time to final reports.

Results:

All patients included in the study had a trauma MRI with a CT comparison. Imaging reports revealed a higher rate of detection for intraparenchymal hemorrhages (IPH), subdural and epidural hematoma, and stroke in MRI compared to CT. the rate of false negative was higher in Skull fractures without underlying hematoma were missed on more MRIs compared to CT.

Conclusion:

The modified, trauma MRI protocol provides a valid alternative to CT in detection of intracranial hemorrhages and stroke in the pediatric population. Although not as sensitive in detection of isolated skull fractures, the trauma MRI protocol can screen most pathologies implicated in acute decline in TBI while minimizing radiation exposure from repeat CT imaging.