In recent years, limited rapid MRI techniques have been investigated as a means to evaluate pediatric head trauma without the need for sedation. Preliminary data suggest variations of this method may be helpful in following known intracranial hemorrhage documented by CT, but the sensitivity of rapid MRI in lieu of CT remains uncertain [28-31]. Contrast-enhanced sequences are generally not indicated unless there is a concern for infection, such as from penetrating injury or fractures involving the sinuses. MRA Head MRA can evaluate the intracranial vasculature and can be performed in conjunction with MRI when vascular injury is clinically suspected. However, as with standard MRI, it may be difficult to perform emergently. MRA can be performed without IV contrast using time-of-flight sequences, although IV contrast may be helpful for clarification in some instances, particularly when imaging is limited by tortuosity or flow artifact. Arteriography Cerebral Conventional cerebral angiography remains the definitive diagnostic test for vascular injury and can demonstrate subtle abnormalities that may be occult on either CTA or MRA. However, because of the invasive procedure and need for sedation, conventional angiography should be reserved for problem solving in cases with uncertain noninvasive imaging and high clinical suspicion of injury. Variant 6: Child. Chronic blunt head trauma with new or progressive cognitive or neurologic deficits. Excluding suspected abusive head trauma and post-traumatic seizure. Postconcussion symptoms are common after head injury. In mild traumatic cases, imaging in the chronic setting is usually negative, and in cases in which more severe trauma or prior intracranial injury has occurred, imaging in the chronic period rarely reveals additional actionable changes [45-47]. CT Head There are little data regarding the use of CT in children in the chronic post-traumatic setting.
Head Trauma Child PCAs. In recent years, limited rapid MRI techniques have been investigated as a means to evaluate pediatric head trauma without the need for sedation. Preliminary data suggest variations of this method may be helpful in following known intracranial hemorrhage documented by CT, but the sensitivity of rapid MRI in lieu of CT remains uncertain [28-31]. Contrast-enhanced sequences are generally not indicated unless there is a concern for infection, such as from penetrating injury or fractures involving the sinuses. MRA Head MRA can evaluate the intracranial vasculature and can be performed in conjunction with MRI when vascular injury is clinically suspected. However, as with standard MRI, it may be difficult to perform emergently. MRA can be performed without IV contrast using time-of-flight sequences, although IV contrast may be helpful for clarification in some instances, particularly when imaging is limited by tortuosity or flow artifact. Arteriography Cerebral Conventional cerebral angiography remains the definitive diagnostic test for vascular injury and can demonstrate subtle abnormalities that may be occult on either CTA or MRA. However, because of the invasive procedure and need for sedation, conventional angiography should be reserved for problem solving in cases with uncertain noninvasive imaging and high clinical suspicion of injury. Variant 6: Child. Chronic blunt head trauma with new or progressive cognitive or neurologic deficits. Excluding suspected abusive head trauma and post-traumatic seizure. Postconcussion symptoms are common after head injury. In mild traumatic cases, imaging in the chronic setting is usually negative, and in cases in which more severe trauma or prior intracranial injury has occurred, imaging in the chronic period rarely reveals additional actionable changes [45-47]. CT Head There are little data regarding the use of CT in children in the chronic post-traumatic setting.