Цель исследования: проанализировать последние исследования, относящиеся к вопросам применения компьютерной томографии (КТ) при черепно-мозговой травме (ЧМТ) у детей раннего возраста.Результаты. ЧМТ -одна из частых причин смерти и инвалидности у детей. Детская ЧМТ связана с рядом характеристик, отличающих ее от взрослых. Это обусловлено возрастными анатомо-физиологические различиями, зависящими от физического состояния ребенка и трудностями с неврологической оценкой у детей. Дети раннего возраста проявляют специфические патологические реакции на ЧМТ с четкими сопутствующими неврологическими проявлениями. В этом обзоре представлена важная информация о текущих аспектах использования КТ при всех видах изолированной тупой ЧМТ у детей в возрасте от рождения до 3 лет с учетом особенностей, соответствующих возрасту в условиях неотложной помощи. Хотя механизмы ЧМТ у раннего возраста аналогичны взрослым, визуальные проявления травм головы у детей имеют свои особенности из-за развивающегося мозга и свода черепа. Основная роль радиологаопределить и охарактеризовать тип и степень тяжести травмы головы, чтобы помочь правильному ведению пациента. Исходя из информации, полученной при КТ, зная механизм ЧМТ у младенцев и детей раннего возраста, радиологи играют ключевую роль как в диагностике, так и в выборе эффективного лечения и улучшении результатов лечения и исходов.Заключение. КТ головы с многоплановыми и 3D-реконструкциями в настоящее время заменила рентгенографию черепа при подозрения на ЧМТ и стала важнейшим диагностическим методом у пациентов с ЧМТ в условиях неотложной помощи. Рентгенограммы не добавляют дополнительной диагностической информации и могут быть исключены из исследования в случае проведения КТ с 3D-реконструкцией.

Aim of the study is to show the possibilities of multiplanar reformation and 3D reconstructions of computed tomography in the diagnosis of skull base fractures in young children. Materials and methods. In one thousand three hundred thirty four children under 3 years of age with traumatic brain injury (TBI) CT was performed on a 128-slice Philips Ingenuity CT scanner; in 707 (53%) in the first 6 hours, in 254 (19%) — after 6 hours, but during the first 24 hours, in 205 (15%) children within 3 days and in 168 (13%) children later on 3 days after injury. Scanning of the area of interest (head + cervical spine) was made with the maximum possible reduction in parameters to minimize the radiation dose. Contrast was not used in children from 0 to 3 years of age with TBI. Post-processing included isotropic multi-planar reformatted (MPR) and 3D images. Results. Of the 1334 children examined, 730 were boys and 604 were girls. In 448 (33.58%) children, fractures of the skull bones were diagnosed, in 366 (81.7%) of them, fractures were combined with intracranial injuries. Fractures of the skull base were in 83 (18.52%) of 448 children. In 65% (n = 54) of cases, basal fractures were combined with fractures of the temporal bones, 31.5% (n = 17) of these children had liquorrhea. Fractures of the anterior fossa (12% of the total number of fractures of the base of the skull) of the base of the skull or fronto-basal fractures were accompanied by additional fractures of the orbits and/or other bones of the facial skull in 56.6% of cases. Fractures of the middle cranial fossa were diagnosed in 54 (65%) children. Fractures of the posterior cranial fossa were found in 19 (23%) of 83 children. In addition to fractures of the bones of the base of the skull, 32 (38.6%) children were diagnosed with fractures of the bones of the vault and intracranial injuries. Conclusion. The use of multiplanar reformation and 3D reconstruction increased the sensitivity and specificity of diagnosing skull base fractures in children compared to conventional axial CT. The essential advantages of using 3D reconstruction are the availability of the technique, the absence of additional scanning time and radiation exposure.

Introduction. In MRI, the difference in sensitivity between tissues is used to obtain images weighted by the inhomogeneity of the magnetic field termed susceptibility-weighted imaging (SWI) and a high-resolution 3D radiofrequency gradient echo scan with full speed compensation is applied. The aim was to determine the features of lesions caused by traumatic brain injury in children using the SWI sequence. Materials and methods. 535 TBI children aged two months up to 18 years old (average age 9.58 ± 1.5) were studied. There were 325 boys (60.7%), 210 girls (39.3%). MRI was performed without and with intravenous contrast on a Phillips Achieva 3 T scanner with T1- and T2WI, 2D and 3D images, FLAIR, magnetic resonance angiography (TOF MRA), SWI, and DW/DTI, MRS and fMRI, SWI were used for visualization of DAI. Results. Patients included children with severe TBI - 178 (33.3%), moderate TBI - 172 (32.1%) and mild TBI - 185 (34.6%). Of the 535 injured children, 129 (24.1%) had MRI performed within the first 24 hours from the moment of injury, up to 48 hours - at 91 (17.0%), up to 72 hours - in 78 (14.6%) and up to 13 days - in 237 (44.3%). DAI foci at all degrees of TBI were detected in 422 (78.9%) children out of 535 children. Conclusion. SWI is a sensitive method for diagnosing brain lesions in TBI and significantly contributes to predicting outcomes in the early stages after trauma. The amount of brain lesions diagnosed by SWI correlates with the degree of injury according to the Glasgo Coma Scale. The study of the brain functional connections can inform about possible relationships between the localization of the SWI lesion and cognitive deficits, potentially providing an opportunity to use SWI in the hyperacute phase.