Department of Neurosurgery, Medical School, University of Ioannina, P.O. Box 103, Neohoropoulo, Ioannina, 45500, Greece.
Pediatr Radiol. 2013 Jul;43(7):777-84. doi: 10.1007/s00247-013-2692-3. Epub 2013 May 23.
Headache is a common complaint in children, one that gives rise to considerable parental concern and fear of the presence of a space-occupying lesion. The evaluation and diagnosis of headache is very challenging for paediatricians, and neuroimaging by means of CT or MRI is often requested as part of the investigation. CT exposes children to radiation, while MRI is costly and sometimes requires sedation or general anaesthesia, especially in children younger than 6 years. This review of the literature on the value of neuroimaging in children with headache showed that the rate of pathological findings is generally low. Imaging findings that led to a change in patient management were in almost all cases reported in children with abnormal signs on neurological examination. Neuroimaging should be limited to children with a suspicious clinical history, abnormal neurological findings or other physical signs suggestive of intracranial pathology. Well-designed prospective studies are needed to better define the clinical findings that warrant neuroimaging in children with headache.
头痛是儿童常见的主诉之一，这会引起家长的极大关注和担忧，担心是否存在占位性病变。儿科医生在评估和诊断头痛方面面临着巨大的挑战，经常要求进行 CT 或 MRI 等神经影像学检查。CT 会使儿童暴露在辐射下，而 MRI 则较为昂贵，且有时需要镇静或全身麻醉，尤其是对于 6 岁以下的儿童。本文对头痛儿童神经影像学价值的文献进行了回顾，结果显示，病理发现的发生率通常较低。在几乎所有情况下，改变患者管理的影像学发现都是在有神经系统检查异常体征的儿童中报告的。神经影像学检查应仅限于有可疑临床病史、异常神经系统发现或其他提示颅内病变的体格检查的儿童。需要进行精心设计的前瞻性研究，以更好地确定需要对头痛儿童进行神经影像学检查的临床发现。
