A Review of Imaging Modalities in Paediatric Traumatic Brain Injury: Evaluating Diagnostic Accuracy and Clinical Outcomes: Cross Sectional Study
Authors: Aleid Abdulsalam Mohammed , Al Omireen Razan Mohammed , Enani Mohmmed Jamal , Alharbi Raghad Awadh , Alsubaie Ohoud Faisal , Aljibreen Amal Fahad , Aldehailan Marwa Salman , Alawad Fatema Hani , Alsarar Abdullah Ali , Almalki Sami Fadhel 
Published: January 2025

Abstract

Background:
Traumatic brain injury (TBI) in children is still a major concern amongst healthcare worldwide as it causes raised morbidity and mortality rate. Identification of TBI cases is therefore paramount in treatment with diagnostic imaging techniques such as the computed tomography (CT) and magnetic resonance imaging (MRI) amongst others. However, deciding between the two methods has been a challenge since radiation exposure by CT and the limitation of MRI, which include longer time for scan and most importantly, need for use of sedation amongst children. This review aims at analysing and comparing accuracy of CT and MRI in diagnosing paediatric TBI; the effects of the two MRI scans on prognosis and the contribution of the two scans in management decision-making. Furthermore, the views on safety issues connected with radiation in CT as well as whether the modern MRI methods can improve the diagnostic potential without safety issues are also discussed.

Methods:
A literature search using the PubMed, Scopus and Google Scholar databases was done with terms such as ‘point of care’, ‘clinical decision support’, ‘decision support system’ was used with an emphasis on articles published in the past 15 years. Article titles used were ‘paediatric traumatic brain injury’, ‘CT in paediatric TBI’, ‘MRI in paediatric TBI’ and ‘diagnostic accuracy of imaging in TBI’. The review of articles involved only patients aged between 0 and 18 years diagnosed with TBI through CT or MRI that provided data on diagnostic accuracy, clinical management and safety considerations.

Results:
CT is used in the management of acute TBI because it is fast and widely available, especially for instance in emergency situations. MRI, however, has the advantages of producing higher sensitivity in identification of diffuse axonal injuries and less evident pathologies of the brain that may not be identified in a CT. However, MRI has limitations such as long time to perform a scan, is expensive and requires administration of sedatives to children making it less suitable for use in the acute care settings. Third, despite its effectiveness, CT exposes the patient to radiation that increases his/her chances of getting cancer especial if the patient is a child. Newer techniques in MRI have emerged which enhance the capacity of diagnosis of paediatric TBI and its further management and prognosis; these are the diffusion tensor imaging and susceptibility-weighted imaging.

Conclusions:
CT and MRI should both be used in the evaluation of paediatric TBI because they each provide information that the other cannot. CT scan has remained the primary imaging modality in the acute setting because of the speed in availability and to assess the critical lesions, whereas MRI offers a detailed examination of TBI important in the post-acute phase. This review is helpful in establishing possible guidelines that will help in the use of these imaging techniques in paediatric TBI that will enhance the detection of the injury without exposing the patients to additional harm. More investigation is, therefore, required to standardise the techniques and protocols that improve the efficiency of imaging procedures for therapeutic processes, while avoiding adverse effects such as radiation hazards.