The Clinical Utility of Brain Magnetic Resonance Imaging in Children Hospitalized in a General Pediatric Department

Objective: To assess the benefit of brain magnetic resonance imaging (MRI) on the care of inpatient children. The clinical applicability and yield of brain MRI in the setting of an inpatient pediatric department has not been investigated.

Study design: A retrospective chart review of children who were not post-trauma or known neurosurgical patients who underwent brain MRI during their hospitalization in a general pediatric department over a 5-year period. Indications for and outcomes of the brain MRIs were analyzed, in addition to other clinical parameters.

Results: Of the 331 children who underwent brain MRI between 2014 and 2018, 148 (45%) had abnormal findings. High-risk headaches (P = .005) and focal seizures (P = .051) were significantly correlated with findings on brain MRI. Diagnostic and therapeutic yields were most significant in acute demyelinating events (P = .002), acute cerebrovascular disorders (P = .045), high-risk headaches when supported by neurologic and ophthalmologic findings (P < .001), focal seizures with evidence of multifocal epileptic activity on an electroencephalogram (P = .003), diplopia/strabismus and decrease in visual acuity when accompanied by cranial nerve palsy (P = .021), and optic nerve impairment (P = .023).

Conclusions: The contributions of a brain MRI in hospitalized children are pivotal in specific clinical situations. Brain MRIs should be considered in inpatient pediatric settings after a judicious decision-making process in order to optimize its diagnostic and therapeutic yield without compromising care.