The Role of Neuroimaging in the Diagnosis, Treatment, and Prognosis of Traumatic Brain Injury in Children

Abstract

Neuroimaging is a central pillar in the diagnosis, management, prognostication, and research of pediatric traumatic brain injury (TBI). Head computed tomography (CT) is the most readily available and rapid method of acute neuroimaging in emergency departments and it has been viewed as the diagnostic standard. However, concern about excessive and unnecessary radiation exposure in children has led to the development of clinical prediction rules with a goal of limiting excessive CT imaging in children with blunt head trauma. There is a trend toward increased use of structural magnetic resonance imaging (MRI) including tailored rapid techniques, in both acute and follow-up imaging in children. Where available, MRI is more sensitive for parenchymal injury than CT and may fulfill the dual goal of decreasing radiation exposure and increasing the yield of more subtle parenchymal trauma. In the current era of TBI management, the diagnosis and treatment of TBI is driven increasingly by neuroimaging. The ability of neuroimaging to provide multidimensional information, specifically, pathoanatomic classification of injuries, as well as important data on injury evolution over time, is increasingly relied upon to match appropriate treatments to the pathophysiology specific to a given injury profile. When combined with premorbid, acute clinical, biomarker, and genetic data, the hope is that multidimensional characterization of injury will improve current management of children with TBIs as well as stratify patients more effectively for clinical trials in the future.