MR Spectroscopy Head There have been few studies investigating spectroscopic changes in the brain of children with prior head trauma. Some preliminary data suggest there may be reduced N-acetyl aspartate metabolites in the corpus callosum in these children [50]. However, these studies are limited by patient selection and very small sample size, and the clinical relevance of these findings in children is unclear. MRI Head without IV Contrast with DTI There have been a few studies suggesting that post-traumatic microstructural changes in the white matter can be identified with diffusion-tensor imaging (DTI). However, these studies are usually in older adolescents and young adults, and the data remain limited by small sample sizes in select populations. There are little data regarding the routine use of this technique in children. MRI Functional (fMRI) Head without IV Contrast Some preliminary work suggests that changes in connectivity in pediatric patients may correlate with postconcussion symptoms [51,52]. However, studies are limited by small, select sample sizes, and there remains no strong literature to support the routine use of functional MRI (fMRI) in evaluation of post-traumatic head injury. Supporting Documents The evidence table, literature search, and appendix for this topic are available at https://acsearch. acr.org/list. The appendix includes the strength of evidence assessment and the final rating round tabulations for each recommendation. For additional information on the Appropriateness Criteria methodology and other supporting documents go to www. acr.org/ac. Appropriateness Category Names and Definitions Relative Radiation Level Information Potential adverse health effects associated with radiation exposure are an important factor to consider when selecting the appropriate imaging procedure. Because there is a wide range of radiation exposures associated with different diagnostic procedures, a relative radiation level (RRL) indication has been included for each imaging
Head Trauma Child PCAs. MR Spectroscopy Head There have been few studies investigating spectroscopic changes in the brain of children with prior head trauma. Some preliminary data suggest there may be reduced N-acetyl aspartate metabolites in the corpus callosum in these children [50]. However, these studies are limited by patient selection and very small sample size, and the clinical relevance of these findings in children is unclear. MRI Head without IV Contrast with DTI There have been a few studies suggesting that post-traumatic microstructural changes in the white matter can be identified with diffusion-tensor imaging (DTI). However, these studies are usually in older adolescents and young adults, and the data remain limited by small sample sizes in select populations. There are little data regarding the routine use of this technique in children. MRI Functional (fMRI) Head without IV Contrast Some preliminary work suggests that changes in connectivity in pediatric patients may correlate with postconcussion symptoms [51,52]. However, studies are limited by small, select sample sizes, and there remains no strong literature to support the routine use of functional MRI (fMRI) in evaluation of post-traumatic head injury. Supporting Documents The evidence table, literature search, and appendix for this topic are available at https://acsearch. acr.org/list. The appendix includes the strength of evidence assessment and the final rating round tabulations for each recommendation. For additional information on the Appropriateness Criteria methodology and other supporting documents go to www. acr.org/ac. Appropriateness Category Names and Definitions Relative Radiation Level Information Potential adverse health effects associated with radiation exposure are an important factor to consider when selecting the appropriate imaging procedure. Because there is a wide range of radiation exposures associated with different diagnostic procedures, a relative radiation level (RRL) indication has been included for each imaging