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. Head Trauma-Child Variant 4: Child. Moderate or severe acute blunt head trauma (GCS less than or equal to 13). Excluding suspected abusive head trauma. Initial imaging. Radiography Skull Not all skull fractures are evident by radiographs, and up to 50% of intracranial injuries in children occur in the absence of fracture [2,33]. Therefore, radiographs are not sufficient to evaluate for traumatic injury [9]. CT Head Moderate and severe head injury is typically associated with post-traumatic mental status changes. Despite the lower incidence and fewer numbers of studies addressing more significant injury in children, there is little debate regarding the need for imaging because of the greater incidence of intracranial injury in patients with decreased GCS [36]. CT has the advantage of rapid acquisition and excellent sensitivity for traumatic injuries, such as herniation or hemorrhage, which benefit from prompt intervention. CTA Head Imaging for vascular injury is primarily guided by clinical suspicion or imaging findings, such as fracture through the skull base or vascular channels. Most literature regarding vascular injury in the pediatric population is confined to small series, and the true incidence and natural history of these injuries in children remains uncertain [19]. However, vascular imaging should be considered in patients with evidence of arterial stroke by examination or by imaging as well as those with fractures extending through the skull base or vascular channels, which are typically encountered in higher impact traumas [37,38]. CTA provides high spatial resolution and rapid assessment for vascular injuries.
Head Trauma Child PCAs. 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. Head Trauma-Child Variant 4: Child. Moderate or severe acute blunt head trauma (GCS less than or equal to 13). Excluding suspected abusive head trauma. Initial imaging. Radiography Skull Not all skull fractures are evident by radiographs, and up to 50% of intracranial injuries in children occur in the absence of fracture [2,33]. Therefore, radiographs are not sufficient to evaluate for traumatic injury [9]. CT Head Moderate and severe head injury is typically associated with post-traumatic mental status changes. Despite the lower incidence and fewer numbers of studies addressing more significant injury in children, there is little debate regarding the need for imaging because of the greater incidence of intracranial injury in patients with decreased GCS [36]. CT has the advantage of rapid acquisition and excellent sensitivity for traumatic injuries, such as herniation or hemorrhage, which benefit from prompt intervention. CTA Head Imaging for vascular injury is primarily guided by clinical suspicion or imaging findings, such as fracture through the skull base or vascular channels. Most literature regarding vascular injury in the pediatric population is confined to small series, and the true incidence and natural history of these injuries in children remains uncertain [19]. However, vascular imaging should be considered in patients with evidence of arterial stroke by examination or by imaging as well as those with fractures extending through the skull base or vascular channels, which are typically encountered in higher impact traumas [37,38]. CTA provides high spatial resolution and rapid assessment for vascular injuries.