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Is there any value in performing magnetic resonance imaging in children with abnormal computerised tomography scans?

The following is a summary of the systematic review findings up to the date of our most recent literature search. If you have a specific clinical case, we strongly recommend you read all of the relevant references as cited and look for additional material published outside our search dates.

 

Results 1-8

  • Of 374 studies reviewed from the international literature, eight articles addressed this issue
  • Study design:
    • 1 cross-sectional
    • 7 case study / case series
  • Quality of studies:
    • Timing of magnetic resonance imaging (MRI) after computerised tomography scan (CT) varied (one day to six months)
    • Clinical indications for MRI varied
  • Age: ranging from 0-4 years

Analysis of included studies 2-5

  • Four studies were suitable for statistical analysis
  • 120/175 underwent additional MRI
  • In children with an abnormal brain CT, at least 20.5% (95% CI: 15.3 – 26.9) would have additional abnormalities detected by MRI 2-5. It is notable that the most recent study 3 had a lower rate of additional findings which may be due to the lower threshold for conducting MRI in children with suspected AHT

Additional findings

  • Further subdural haemorrhages (SDHs) not seen on the initial CT were the commonest additional finding 1,2,4-8
  • A recent study did not identify additional SDH, subarachoid haemorrhages (SAHs) or parenchymal haemorrhage but did note diffuse axonal injury and ischemia 3, as noted previously 4
  • These SDHs were found in occipital, posterior fossa, subtemporal, subfrontal, convexity and interhemispheric locations 1,2,4-8
  • Additional SAHs could be seen on MRI that had been missed on the initial CT 1,4,7
  • In 4/16 children MRI missed SAHs seen on CT 8
  • Cerebral contusions were identified more clearly on MRI than on CT 8
  • MRI gave additional information about the signal intensity of the SDHs 1,2,5
  • MRI demonstrated cranial shearing injury that was not apparent on CT 4,5,8
  • MRI was superior to CT at detecting parenchymal haemorrhages 4,5
  • The MRI contribued to the dating of SDHs 3

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References

  1. Chabrol B, Decarie JC, Fortin G. The role of cranial MRI in identifying patients suffering from child abuse and presenting with unexplained neurological findings. Child Abuse and Neglect. 1999;23(3):217-228 [Pubmed]
  2. Datta S, Stoodley N, Jayawant S, Renowden S, Kemp A. Neuroradiological aspects of subdural haemorrhages. Archives of Disease in Childhood. 2005;90(9):947-951 [Pubmed]
  3. Foerster BR, Petrou M, Lin D, Thurnher MM, Carlson MD, Strouse PJ, Sundgren PC. Neuroimaging evaluation of non-accidental head trauma with correlation to clinical outcomes: a review of 57 cases. Journal of Pediatrics. 2009;154(4):573-77. [Pubmed]

  4. Ghahreman A, Bhasin V, Chaseling R, Andrews B, Lang EW. Nonaccidental head injuries in children: a Sydney experience. Journal of Neurosurgery. 2005;103(3 suppl):213-218 [Pubmed]
  5. Hoskote A, Richards P, Anslow P, McShane T. Subdural haematoma and non-accidental head injury in children. Child's Nervous System. 2002;18(6-7):311-317 [Pubmed]
  6. Morad Y, Avni I, Benton SA, Berger RP, Byerley JS, Coffman K, Greeley CS, Gustavson EE, Levitt CJ, Lenane A, Topley J, Levin AV. Normal computerized tomography of brain in children with shaken baby syndrome. Journal of AAPOS: American Association for Pediatric Ophthalmology and Strabismus. 2004;8(5):445-450 [Pubmed]
  7. Morad Y, Avni I, Capra L, Case ME, Feldman K, Kodsi SR, Esernio-Jenssen D, Lukefahr JL, Levin AV. Shaken baby syndrome without intracranial hemorrhage on initial computed tomography. Journal of AAPOS: American Association for Pediatric Ophthalmology and Strabismus. 2004;8(6):521-527 [Pubmed]
  8. Sato Y, Yuh WT, Smith WL, Alexander RC, Kao SC, Ellerbroek CJ. Head injury in child abuse: evaluation with MR imaging. Radiology. 1989;173(3):653-657 [Pubmed]

 

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