{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T13:37:06Z","timestamp":1783777026367,"version":"3.55.0"},"reference-count":19,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["PED"],"published-print":{"date-parts":[[2015,5]]},"abstract":"\nOBJECT<\/jats:title>\nTraumatic head injury (THI) is a highly prevalent condition in the United States, and concern regarding excess radiation-related cancer mortality has placed focus on limiting the use of CT in the evaluation of pediatric patients with THI. Given the success of rapid-acquisition MRI in the evaluation of ventriculoperitoneal shunt malfunction in pediatric patient populations, this study sought to evaluate the sensitivity of MRI in the setting of acute THI.<\/jats:p><\/jats:sec>\n\nMETHODS<\/jats:title>\nMedical records of 574 pediatric admissions for THI to a Level 1 trauma center over a 10-year period were retrospectively reviewed to identify patients who underwent both CT and MRI examinations of the head within a 5-day period. Thirty-five patients were found, and diagnostic images were available for 30 patients. De-identified images were reviewed by a neuroradiologist for presence of any injury, intracranial hemorrhage, diffuse axonal injury (DAI), and skull fracture. Radiology reports were used to calculate interrater reliability scores. Baseline demographics and concordance analysis was performed with Stata version 13.<\/jats:p><\/jats:sec>\n\nRESULTS<\/jats:title>\nThe mean age of the 30-patient cohort was 8.5 \u00b1 6.7 years, and 63.3% were male. The mean Injury Severity Score was 13.7 \u00b1 9.2, and the mean Glasgow Coma Scale score was 9 \u00b1 5.7. Radiology reports noted 150 abnormal findings. CT scanning missed findings in 12 patients; the missed findings included DAI (n = 5), subarachnoid hemorrhage (n = 6), small subdural hematomas (n = 6), cerebral contusions (n = 3), and an encephalocele. The CT scan was negative in 3 patients whose subsequent MRI revealed findings. MRI missed findings in 13 patients; missed findings included skull fracture (n = 5), small subdural hematomas (n = 4), cerebral contusions (n = 3), subarachnoid hemorrhage (n = 3), and DAI (n = 1). MRI was negative in 1 patient whose preceding CT scan was read as positive for injury. Although MRI more frequently reported intracranial findings than CT scanning, there was no statistically significant difference between CT and MRI in the detection of any intracranial injury (p = 0.63), DAI (p = 0.22), or intracranial hemorrhage (p = 0.25). CT scanning tended to more frequently identify skull fractures than MRI (p = 0.06).<\/jats:p><\/jats:sec>\n\nCONCLUSIONS<\/jats:title>\nMRI may be as sensitive as CT scanning in the detection of THI, DAI, and intracranial hemorrhage, but missed skull fractures in 5 of 13 patients. MRI may be a useful alternative to CT scanning in select stable patients with mild THI who warrant neuroimaging by clinical decision rules.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2014.10.peds14128","type":"journal-article","created":{"date-parts":[[2015,2,20]],"date-time":"2015-02-20T15:35:45Z","timestamp":1424446545000},"page":"529-534","source":"Crossref","is-referenced-by-count":44,"title":["Magnetic resonance imaging as an alternative to computed tomography in select patients with traumatic brain injury: a retrospective comparison"],"prefix":"10.3171","volume":"15","author":[{"given":"Marie","family":"Roguski","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brent","family":"Morel","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"},{"name":"Tufts University School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Sweeney","sequence":"additional","affiliation":[{"name":"General Surgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordan","family":"Talan","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"},{"name":"Tufts University School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leslie","family":"Rideout","sequence":"additional","affiliation":[{"name":"General Surgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ron I.","family":"Riesenburger","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neel","family":"Madan","sequence":"additional","affiliation":[{"name":"Radiology, Tufts Medical Center, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Hwang","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-peds14128","series-title":"Arch Pediatr Adolesc Med","doi-asserted-by":"publisher","first-page":"439","DOI":"10.1001\/archpedi.162.5.439","article-title":"A clinical decision rule for cranial computed tomography in minor pediatric head trauma","volume":"162","author":"Atabaki","year":"2008"},{"key":"b2-peds14128","series-title":"J Neurotrauma","doi-asserted-by":"publisher","first-page":"915","DOI":"10.1089\/neu.2010.1712","article-title":"Detecting traumatic brain lesions in children: CT versus MRI versus susceptibility weighted imaging (SWI)","volume":"28","author":"Beauchamp","year":"2011"},{"key":"b3-peds14128","series-title":"Ann Emerg Med","doi-asserted-by":"publisher","first-page":"486","DOI":"10.1016\/j.annemergmed.2013.02.018","article-title":"Emergency department computed tomography utilization in the United States and Canada","volume":"62","author":"Berdahl","year":"2013"},{"key":"b4-peds14128","series-title":"AJR Am J Roentgenol","doi-asserted-by":"publisher","first-page":"289","DOI":"10.2214\/ajr.176.2.1760289","article-title":"Estimated risks of radiation-induced fatal cancer from pediatric CT","volume":"176","author":"Brenner","year":"2001"},{"key":"b5-peds14128","series-title":"J Trauma","first-page":"838","article-title":"Diffuse axonal injury in patients with head injuries: an epidemiologic and prognosis study of 124 cases","volume":"71","author":"Chelly","year":"2011"},{"key":"b6-peds14128","series-title":"Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations and Deaths 2002\u20132006","author":"Faul","year":"2010"},{"key":"b7-peds14128","series-title":"J Pediatr","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1016\/j.jpeds.2012.07.018","article-title":"Pediatric traumatic brain injury and radiation risks: a clinical decision analysis","volume":"162","author":"Hennelly","year":"2013"},{"key":"b8-peds14128","series-title":"Lancet","doi-asserted-by":"publisher","first-page":"1160","DOI":"10.1016\/S0140-6736(09)61558-0","article-title":"Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study","volume":"374","author":"Kuppermann","year":"2009"},{"key":"b9-peds14128","series-title":"Radiology","doi-asserted-by":"publisher","first-page":"793","DOI":"10.1148\/radiol.11101939","article-title":"Rising use of CT in child visits to the emergency department in the United States, 1995\u20132008","volume":"259","author":"Larson","year":"2011"},{"key":"b10-peds14128","series-title":"JAMA Pediatr","doi-asserted-by":"publisher","first-page":"700","DOI":"10.1001\/jamapediatrics.2013.311","article-title":"The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk","volume":"167","author":"Miglioretti","year":"2013"},{"key":"b11-peds14128","series-title":"World Neurosurg","doi-asserted-by":"publisher","first-page":"e307","DOI":"10.1016\/j.wneu.2012.10.066","article-title":"Rapid sequence magnetic resonance imaging in the assessment of children with hydrocephalus","volume":"80","author":"O'Neill","year":"2013"},{"key":"b12-peds14128","series-title":"CMAJ","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1503\/cmaj.091421","article-title":"CATCH: a clinical decision rule for the use of computed tomography in children with minor head injury","volume":"182","author":"Osmond","year":"2010"},{"key":"b13-peds14128","series-title":"Lancet","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1016\/S0140-6736(12)60815-0","article-title":"Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study","volume":"380","author":"Pearce","year":"2012"},{"key":"b14-peds14128","series-title":"Pediatr Radiol","doi-asserted-by":"publisher","first-page":"971","DOI":"10.1007\/s00247-011-2032-4","article-title":"External validation of the New Orleans Criteria (NOC), the Canadian CT Head Rule (CCHR) and the National Emergency X-Radiography Utilization Study II (NEXUS II) for CT scanning in pediatric patients with minor head injury in a non-trauma center","volume":"41","author":"Schachar","year":"2011"},{"key":"b15-peds14128","series-title":"Arch Dis Child","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1136\/archdischild-2013-305004","article-title":"Pediatric Emergency Care Applied Research Network head injury clinical prediction rules are reliable in practice","volume":"99","author":"Schonfeld","year":"2014"},{"key":"b16-peds14128","series-title":"Pediatr Neurol","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1016\/j.pediatrneurol.2007.01.003","article-title":"Multimodality comparison of neuroimaging in pediatric traumatic brain injury","volume":"36","author":"Sigmund","year":"2007"},{"key":"b17-peds14128","series-title":"Arch Intern Med","doi-asserted-by":"publisher","first-page":"2078","DOI":"10.1001\/archinternmed.2009.427","article-title":"Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer","volume":"169","author":"Smith-Bindman","year":"2009"},{"key":"b18-peds14128","series-title":"Ann Neurol","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1002\/1531-8249(199907)46:1<70::AID-ANA11>3.0.CO;2-L","article-title":"Computed tomography and magnetic resonance imaging in mild to moderate head injury: early and late imaging related to outcome","volume":"46","author":"van der Naalt","year":"1999"},{"key":"b19-peds14128","series-title":"Ann Neurol","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1002\/ana.23783","article-title":"Magnetic resonance imaging improves 3-month outcome prediction in mild traumatic brain injury","volume":"73","author":"Yuh","year":"2013"}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/15\/5\/article-p529.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/15\/5\/article-p529.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/15\/5\/article-p529.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T20:03:11Z","timestamp":1681588991000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/15\/5\/article-p529.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,5]]},"references-count":19,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3171\/2014.10.peds14128","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,5]]}}}