Diagnostic performance of ultrafast brain MRI for evaluation of abusive head trauma

S. F. Kralik, M. Yasrebi, N. Supakul, C. Lin, L. G. Netter, Ralph Hicks, Roberta Hibbard, L. L. Ackerman, M. L. Harris, Chang Ho

Research output: Contribution to journalArticle

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Abstract

Background and Purpose: 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. MATERIALS AND METHODS: 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. RESULTS: 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: ultrafastMRimaging (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). CONCLUSIONS: 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.

Original languageEnglish (US)
Pages (from-to)807-813
Number of pages7
JournalAmerican Journal of Neuroradiology
Volume38
Issue number4
DOIs
StatePublished - Apr 1 2017

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Craniocerebral Trauma
Head
Brain
Pediatrics
Pathology
Wounds and Injuries
Subdural Hematoma
Subarachnoid Hemorrhage
Neuroimaging
General Anesthesia
Population
Prospective Studies
Hemorrhage
Sensitivity and Specificity

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

Cite this

Diagnostic performance of ultrafast brain MRI for evaluation of abusive head trauma. / Kralik, S. F.; Yasrebi, M.; Supakul, N.; Lin, C.; Netter, L. G.; Hicks, Ralph; Hibbard, Roberta; Ackerman, L. L.; Harris, M. L.; Ho, Chang.

In: American Journal of Neuroradiology, Vol. 38, No. 4, 01.04.2017, p. 807-813.

Research output: Contribution to journalArticle

Kralik, SF, Yasrebi, M, Supakul, N, Lin, C, Netter, LG, Hicks, R, Hibbard, R, Ackerman, LL, Harris, ML & Ho, C 2017, 'Diagnostic performance of ultrafast brain MRI for evaluation of abusive head trauma', American Journal of Neuroradiology, vol. 38, no. 4, pp. 807-813. https://doi.org/10.3174/ajnr.A5093
Kralik, S. F. ; Yasrebi, M. ; Supakul, N. ; Lin, C. ; Netter, L. G. ; Hicks, Ralph ; Hibbard, Roberta ; Ackerman, L. L. ; Harris, M. L. ; Ho, Chang. / Diagnostic performance of ultrafast brain MRI for evaluation of abusive head trauma. In: American Journal of Neuroradiology. 2017 ; Vol. 38, No. 4. pp. 807-813.
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AU - Netter, L. G.

AU - Hicks, Ralph

AU - Hibbard, Roberta

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N2 - Background and Purpose: 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. MATERIALS AND METHODS: 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. RESULTS: 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: ultrafastMRimaging (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). CONCLUSIONS: 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.

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