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Pediatr Neurol. 2019 Dec 27. pii: S0887-8994(19)30997-X. doi: 10.1016/j.pediatrneurol.2019.12.007. [Epub ahead of print]

Rapid Sequence MRI Protocol in the Evaluation of Pediatric Brain Attacks.

Author information

1
Pediatric Resident, Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan. Electronic address: gdejong@dmc.org.
2
Division of Emergency Medicine, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, Michigan.
3
Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan.
4
Division of Neurology, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, Michigan.

Abstract

BACKGROUND:

The objective of our study was to evaluate the clinical utility of rapid sequence magnetic resonance imaging (MRI) utilizing diffusion-weighted imaging and fluid-attenuated inversion recovery sequences in children with acute ischemic strokes and nonstroke brain attacks.

METHODS:

We performed a retrospective chart review of patients aged one month to 25 years for whom a pediatric stroke clinical pathway was activated. Diffusion-weighted imaging and fluid-attenuated inversion recovery were obtained followed by a complete MRI. Imaging was interpreted by a pediatric radiologist and the study neurologist. We collected information regarding patient demographics, neuroimaging results, and final diagnosis.

RESULTS:

The Pediatric Stroke Clinical Pathway was activated for 59 patients of whom 52 were included for analysis. The majority of patients were female (n = 29, 55.8%) and African American (n = 32, 61.5%), with a median age of 12 years (interquartile range 9, 16). Six patients had an ischemic stroke. Seizures, migraines, and psychosomatic disorders (each with n = 7; 13.5%) were the most common nonstroke diagnoses. Diffusion-weighted imaging was more sensitive (100% [55.0% to 100%] versus 80 % [32% to 99%]) and specific (73.9% [68% to 74%] versus 37.2% [32% to 39%]) compared with fluid-attenuated inversion recovery in identification of an ischemic stroke. However, fluid-attenuated inversion recovery was useful in the identification of inflammatory and metabolic disorders.

CONCLUSION:

Rapid sequence MRI can be utilized as a screening imaging modality in children with suspected brain attacks in cases where there may be delays in obtaining full sequence brain imaging.

KEYWORDS:

Diffusion-weighted imaging; FLAIR; Fluid-attenuated inversion recovery; Magnetic resonance imaging; Pediatrics; Stroke; Stroke mimics

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