Department of Radiology, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland.
Department of Pediatric Orthopedic Surgery, University of Turku and Turku University Hospital, Turku, Finland.
Childs Nerv Syst. 2024 May;40(5):1435-1441. doi: 10.1007/s00381-024-06298-8. Epub 2024 Jan 27.
Imaging is the gold standard in diagnosing traumatic brain injury, but unnecessary scans should be avoided, especially in children and adolescents. Clinical decision-making rules often help to distinguish the patients who need imaging, but if spinal trauma is suspected, concomitant brain imaging is often conducted. Whether the co-occurrence of brain and spine injuries is high enough to justify head imaging in patients without symptoms suggesting brain injury is unknown.
This study aims to assess the diagnostic yield of brain MRI in pediatric patients with suspected or confirmed accidental spinal trauma but no potential brain injury symptoms.
We retrospectively reviewed the medical and imaging data of pediatric patients (under 18 years old) who have undergone concomitant MRI of the brain and spine because of acute spinal trauma in our emergency radiology department over a period of 8 years. We compared the brain MRI findings in patients with and without symptoms suggesting brain injury and contrasted spine and brain MRI findings.
Of 179 patients (mean age 11.7 years, range 0-17), 137 had symptoms or clinical findings suggesting brain injury, and 42 did not. None of the patients without potential brain injury symptoms had traumatic findings in brain MRI. This finding also applied to patients with high-energy trauma (n = 47) and was unrelated to spinal MRI findings.
Pediatric accidental trauma patients with suspected or confirmed spine trauma but no symptoms or clinical findings suggesting brain injury seem not to benefit from brain imaging.
影像学检查是诊断创伤性脑损伤的金标准，但应避免不必要的扫描，尤其是在儿童和青少年中。临床决策规则通常有助于区分需要进行影像学检查的患者，但如果怀疑存在脊髓创伤，通常会同时进行脑部成像。同时存在脑和脊柱损伤的发生率是否高到足以证明没有提示脑损伤症状的患者需要进行头部成像尚不清楚。
本研究旨在评估疑似或确诊意外脊髓创伤但无潜在脑损伤症状的儿科患者行脑部 MRI 的诊断收益。
我们回顾性分析了在过去 8 年中，因急性脊髓创伤在我院急诊放射科同时行脑部和脊柱 MRI 的儿科患者（年龄<18 岁）的病历和影像学资料。我们比较了有和无提示脑损伤症状的患者的脑部 MRI 结果，并对比了脊柱和脑部 MRI 结果。
在 179 例患者中（平均年龄 11.7 岁，范围 0-17 岁），137 例有提示脑损伤的症状或临床发现，42 例无。无脑损伤症状的患者脑部 MRI 未见创伤性表现。这一发现也适用于高能创伤患者（n=47），且与脊柱 MRI 结果无关。
疑似或确诊脊柱创伤但无提示脑损伤的症状或临床发现的意外创伤患儿似乎无需进行脑部成像。
