Rapid MRI Screening for Pediatric Headache?

Written by Clay Smith

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A fast MRI for children with persistent or recurrent headache was feasible and detected sinusitis in many patients and an intracranial mass in one child.

Why does this matter?
For many years, my hospital has used rapid sequence, T2-only MRI to evaluate patients for potential VP shunt malformation. Fast MRI has been studied for pediatric TBI and found to be feasible and accurate. Would it work for non-shunted patients with headache to detect major intracranial pathology without radiation exposure?

Fast MRI for headache
This was a prospective study including 105 children ≤12 years old with persistent or recurrent headache of unclear etiology (not trauma related, no known intracranial pathology, with normal exam). A single-shot T2 axial sequence was obtained. Average time for MRI was 75 seconds; none required sedation, and all studies were successful. Parents were consented to clearly explain that this was only a screening test.

Ages ranged from 2 months to 12 years; median 6.1 years. 82 studies were normal (78%). 17 had sinusitis. 2 had mastoiditis. 1 had an ethmoidal mass. 1 had an arachnoid cyst. 1 had asymmetric white matter changes. 1 had a cerebellar mass causing hydrocephalus.

The study was done from 2013-2015. Imaging may have changed since then, so be sure you’re taking advantage of the latest imaging technological advances. A fast MRI is not the same as a complete study, and parents may not understand this nuance and need for follow up.

Source
The Use of Rapid Sequence Magnetic Resonance Imaging of the Brain as a Screening Tool for the Detection of Gross Intracranial Pathology in Children Presenting to the Emergency Department With a Chief Complaint of Persistent or Recurrent Headaches. Pediatr Emerg Care. 2021 Oct 1;37(10):e660-e663. doi: 10.1097/PEC.0000000000002089.

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