1 Department of Radiology and Imaging Sciences, Emory University School of Medicine, 201 Dowman Dr, Atlanta, GA 30322.
2 Emory University School of Medicine, Atlanta, GA.
AJR Am J Roentgenol. 2018 Jan;210(1):8-17. doi: 10.2214/AJR.17.18561. Epub 2017 Sep 12.
Headache in children is a common symptom and often is worrisome for clinicians and parents because of the breadth of possible underlying significant abnormalities, including meningitis, brain neoplasms, and intracranial hemorrhage. For this reason, many children with headaches undergo neuroimaging. Most neuroimaging studies performed of children with headaches have normal findings but may lead to significant downstream effects, including unnecessary exposure to ionizing radiation or sedation, as well as unnecessary cost to the health care system. In this article, we review the current evidence and discuss the role of neuroimaging in the diagnosis and management of pediatric headaches, with a special focus on tools that may aid in increasing the rate of positive findings, such as classification systems, algorithms, and red flag criteria.
Many tools exist that can help in improving the appropriateness of neuroimaging in pediatric headache. The main issues that remain to be addressed include scientific proof of safety and validity of these tools and clarity regarding the risks, benefits, and cost-effectiveness of CT versus MRI in various clinical settings and scenarios.
儿童头痛是一种常见症状，由于可能存在广泛的潜在严重异常，包括脑膜炎、脑肿瘤和颅内出血，因此常令临床医生和家长感到担忧。出于这个原因，许多头痛的儿童接受神经影像学检查。虽然大多数针对头痛儿童进行的神经影像学研究结果正常，但可能会产生重大的下游影响，包括不必要的电离辐射或镇静暴露，以及对医疗保健系统造成不必要的费用。在本文中，我们回顾了现有证据，并讨论了神经影像学在儿科头痛的诊断和管理中的作用，特别关注可能有助于提高阳性发现率的工具，如分类系统、算法和危险信号标准。
许多工具可以帮助提高儿科头痛神经影像学检查的适当性。仍需解决的主要问题包括这些工具的安全性和有效性的科学证据，以及在各种临床环境和情况下 CT 与 MRI 的风险、益处和成本效益的明确性。
