Pediatric emergency medicine trisk 1151 1151

small hemorrhage may not be detected by CT, and in such cases, blood in the
cerebrospinal fluid (CSF) is the only diagnostic finding. However, this is an
uncommon situation in the pediatric population.
As with laboratory testing, few children with headaches who come to the ED
will require an emergent imaging study. A child with a ventricular shunt may
require a shunt series in addition to CT or MRI. Likewise, sinus radiographs are
rarely indicated in pediatric patients because the diagnosis is almost always made
on clinical grounds. Occasionally, a child with multiple episodes of an apparent
sinus infection will require a CT scan of the sinuses, but this is normally done as
an outpatient. However, it should be noted that the Image Gently campaign has
changed the landscape of pediatric imaging. Utilizing radiation-free imaging
modalities, such as ultrasound and MRI, is encouraged when possible. As a result,
MRI usage in the pediatric population has increased. Scheinfeld et al. looked at
MRI usage trends over a 5-year period and found an increased utilization rate.
This was especially true for neuroimaging, particularly children with headaches.
The two imaging modalities that are most widely used clinically to obtain
detailed information about intracranial abnormalities are CT and MRI, each of
which has advantages and disadvantages. CT is more readily available on an
emergent basis (many EDs have a dedicated scanner). Scanning time is also much
shorter for CT, and the potentially unstable patient can be more easily observed
and monitored. These characteristics make CT the test of choice to evaluate
patients at risk for problems such as intracranial hemorrhage, head trauma,
cerebral edema, hydrocephalus, and herniation syndrome. Recent advances in
MRI approaches have reduced the time needed for some MRI scans. For example,
1-minute ultrafast brain MRI technology is now being developed and utilized.
Researchers are also looking at using MRI to replace CT as a screening tool,
including those with traumatic brain injury, stroke, and identification of skull
fractures in cases of potential abusive head trauma. It is possible, and highly
probable, that within the next decade MRI will replace CT as a screening tool for
brain imaging in children. CT does not offer the quality of image resolution
provided by MRI. Smaller lesions, particularly those of the posterior fossa and

brainstem, are more reliably detected by MRI. This is true even when the CT scan
is performed using contrast material. Consequently, MRI is superior for children
suspected of having a brain tumor who have a normal neurologic examination and
no signs of elevated ICP. If these patients have a normal head CT scan in the ED,
they will likely also require an outpatient MRI. Such duplication of testing is
costly, time consuming, and usually unwarranted. While the use of MRI in the
acute management of stroke has led to a substantial increase in overall scanning