Pediatric Head Imaging Guidelines

Evicore’s pediatric head imaging guidelines approve MRI as the preferred advanced modality and define specific indications for MRI, CT (limited to trauma/acute/hemorrhage/bony/hydrocephalus or MRI‑contraindicated cases), MRA/CTA, cranial ultrasound, and selected nuclear studies (including limited MRS for neonatal HIE and specified metabolic disorders, with fMRI/FDG‑PET supported only for presurgical mapping), while excluding routine screening of asymptomatic children and deeming most MRS/fMRI/PET uses investigational outside the listed indications. Requests must document active clinical signs/symptoms with a detailed history and neurologic exam, appropriate labs/basic imaging and specialist or surgical‑planning documentation (e.g., headache red flags, intractable epilepsy for presurgical imaging), justify repeat studies by progression or management impact, and provide specific test results or PET/CT unavailability when applicable.

"Advanced imaging of the head is only indicated in individuals who have documented active clinical signs or symptoms of disease involving the head."