Investigation of implementation status and usefulness of neuroimaging studies in children with febrile seizures

[Background and Objectives] Neuroimaging studies are usually not recommended for children with febrile seizures (FSs) during pediatric emergency room visits. The decision to perform neuroimaging studies on such patients depends on physicians' choices and interpretations of individual history and physical findings, and therefore may vary considerably among doctors and medical institutions. [Subjects and Methods] We retrospectively analyzed children treated for FSs at Okayama Medical Center during the period from April 2016 to July 2018, and examined the patients' current status and any abnormalities in neuroimaging studies. [Results] We identified 312 patients seen for FSs, aged 5 months to 13 years 8 months (median age 2 years; 199 boys, 113 girls); neuroimaging studies were performed in 131 cases (42.0%). Of these, 96 of the patients who underwent computed tomography (CT) scans showed no abnormality. Magnetic resonance imaging (MRI) was performed in 35 patients revealing structural abnormalities in four of them: one had a brain tumor, one had abusive head trauma (AHT), and two had acute encephalopathy. In addition, the patient with AHT and one with acute encephalopathy were further investigated using arterial spin labeling (ASL) to detect cerebral blood flow abnormalities. [Conclusions] The usefulness of CT is limited for children with FS, however, MRI should be considered in cases presenting with impaired consciousness.