Is there a role for magnetic resonance imaging in the evaluation of non-traumatic intraparenchymal haemorrhage in children?

BACKGROUND

In contrast to adults, intraparenchymal haemorrhage (IPH) is at least as common as ischaemic stroke in children. There is often uncertainty about the most appropriate modality for imaging in the acute stage.

OBJECTIVE

To examine the diagnostic value of MRI and MR angiography (MRA) in the detection of underlying pathology in children with non-traumatic IPH.

MATERIALS AND METHODS

A retrospective review was conducted of children with IPH from January 1997 to March 2003. After exclusion of patients with traumatic IPH or previously diagnosed vascular malformation, aneurysm, or brain tumour, 50 children were identified. Case notes and imaging studies were reviewed.

RESULTS

An underlying lesion was demonstrated with MR in two-thirds of children (25/38) with IPH. A vascular lesion was the commonest cause, followed by tumour. Three children had false-negative MR scans.

CONCLUSION

MR is a valuable non-invasive imaging modality for detection of both vascular and non-vascular causes of paediatric IPH. The high rate of the latter in childhood makes incorporation of MR into paediatric IPH imaging protocols especially important. Clinical guidelines regarding the optimum sequence of investigations in non-traumatic IPH would be helpful to standardize practice and enable critical appraisal.