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What neuroimaging should be performed in children in whom inflicted brain injury (iBI) is suspected? A systematic review

Kemp, Alison Mary, Rajaram, S., Mann, Mala K., Tempest, Vanessa, Farewell, Daniel, Gawne-Cain, M. L., Jaspan, T. and Maguire, Sabine Ann 2009. What neuroimaging should be performed in children in whom inflicted brain injury (iBI) is suspected? A systematic review. Clinical Radiology 64 (5) , pp. 473-483. 10.1016/j.crad.2008.11.011

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Abstract

Aims To investigate the optimal neuroradiological investigation strategy to identify inflicted brain injury (iBI). Materials and methods A systematic review of studies published between 1970–2008 in any language was conducted, searching 20 databases and four websites, using over 100 keywords/phrases, supplemented by hand-searching of references. All studies underwent two independent reviews (with disagreements adjudicated by a third reviewer) by trained reviewers from paediatrics, paediatric neuroradiology and related disciplines, using standardized critical appraisal tools, and strict inclusion/exclusion criteria. We included primary studies that evaluated the diagnostic yield of magnetic resonance imaging (MRI), in addition to initial computed tomography (CT), or follow-up CT or ultrasound in children with suspected iBI. Results Of the 320 studies reviewed, 18 met the inclusion criteria, reflecting data on 367 children with iBI and 12 were published since 1998. When an MRI was conducted in addition to an abnormal early CT examination, additional information was found in 25% (95% CI: 18.3–33.16%) of children. The additional findings included further subdural haematoma, subarachnoid haemorrhage, shearing injury, ischaemia, and infarction; it also contributed to dating of injuries. Diffusion-weighted imaging (DWI) further enhanced the delineation of ischaemic changes, and assisted in prognosis. Repeat CT studies varied in timing and quality, and none were compared to the addition of an early MRI/DWI. Conclusions In an acutely ill child, the optimal imaging strategy involves initial CT, followed by early MRI and DWI if early CT examination is abnormal, or there are ongoing clinical concerns. The role of repeat CT imaging, if early MRI is performed, is unclear, as is the place for MRI/DWI if initial CT examination is normal in an otherwise well child.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Information Services
Medicine
Subjects: R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
R Medicine > RJ Pediatrics
Publisher: Elsevier
ISSN: 0009-9260
Last Modified: 07 Jul 2019 23:25
URI: http://orca.cf.ac.uk/id/eprint/24415

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