Current issues and controversies surrounding spine imaging and the significance of spinal subdural hemorrhage in suspected abusive head trauma

Canty, Katherine W.; Feldman, Kenneth W.; Bartnik-Olson, Brenda; Choudhary, Arabinda K.; Shiroishi, Mark S.; Brink, Farah W.; Caré, Marguerite M.; Crichton, Kristin G.; Haney, Suzanne B.; Kissoon, N; Metz, James B; Northrop, Sarah; Otjen, Jeffrey P.; Wright, Jason N.

doi:10.1007/s00247-022-05534-0

Cited by 5 publications

(5 citation statements)

References 14 publications

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“…We require a larger pool of evidence to draw statistically significant associations between injurious spinal findings and abusive head trauma to be able to confidently exclude the circularity argument. The accumulation and review of current evidence are encouraging [32]. In the published literature, there is a high percentage of spinal subdural haemorrhage in cases of abusive head trauma which is Fig.…”

Section: Did We Miss a Finding That May Help Establish Or Refute A Di...mentioning

confidence: 91%

“…The need for, and the extent of, spinal imaging in abusive head trauma is further complicated by the variable availability of magnetic resonance imaging (MRI) and other related resources, such as sedation services, which are not uniform across centres which image children (including specialist paediatric institutions and general hospitals which also image adults) [32]. We discuss justifying full spinal imaging and the implications of potential spinal findings in children investigated for suspected abusive head trauma.…”

Section: Why and In Which Scenarios Should Whole Spine Imaging Be Per...mentioning

confidence: 99%

“…Reviewing the previous roundtable paper from 2001 [2], it would appear that our understanding of the mechanism of injury in abusive head trauma has not changed significantly. The need for, and extent of, spinal imaging and the significance of the imaging findings in the context of abusive head trauma have been recently emphasised [30,31] with existing controversies summarised by Canty et al [32] and published subsequent to the ESPR 2022 roundtable discussion.…”

Section: Why and In Which Scenarios Should Whole Spine Imaging Be Per...mentioning

confidence: 99%

“…In summary, imaging of the whole spine is recommended to enable a comprehensive evaluation of the neuraxis in the context of abusive head trauma [32]. Further studies are needed to understand the frequency and importance of these findings and their relationship to both abusive head trauma and accidental trauma.…”

Section: Considering the Above Scenario What Findings Will Be Missed ...mentioning

confidence: 99%

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Controversial aspects of imaging in child abuse: a second roundtable discussion from the ESPR child abuse taskforce

Paddock

Choudhary²,

Jeanes³

et al. 2023

Pediatr Radiol

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This second roundtable discussion was convened at the 56th European Society of Paediatric Radiology (ESPR) 2022 Annual Meeting in Marseille, France, to discuss controversial aspects of imaging in child abuse. The following topics were discussed: Fracture dating—the published literature is broadly similar with respect to the identification of the radiographic stages of bony healing. The non-expert/general radiologist is encouraged to use broad descriptors of fracture healing (acute, healing or old) within their reports, rather than attempting to date fractures. The more experienced/expert radiologist, who may provide a timeframe/range to assist the courts, should be aware that any published timeframes are not absolute and that recent research indicates that the rate of healing may differ according to the bone affected and the age of the patient. Whole spine imaging in suspected abusive head trauma—this is recommended to enable a complete assessment of the neuraxis when abusive head trauma is suspected or diagnosed, particularly in the presence of intracranial and cervical subdural haemorrhage and cervical ligamentous injury. Cranial imaging in suspected physical abuse—both computed tomography (CT) and magnetic resonance imaging (MRI) remain complimentary depending on the clinical context in which they are used with CT remaining first-line in the assessment of children with (suspected abusive) head trauma prior to an early MRI. MRI is superior in its assessment of parenchymal injury and may be employed as first-line in age appropriate asymptomatic siblings of a child with suspected physical abuse.

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Section: Did We Miss a Finding That May Help Establish Or Refute A Di...mentioning

confidence: 91%

Section: Why and In Which Scenarios Should Whole Spine Imaging Be Per...mentioning

confidence: 99%

Section: Why and In Which Scenarios Should Whole Spine Imaging Be Per...mentioning

confidence: 99%

Section: Considering the Above Scenario What Findings Will Be Missed ...mentioning

confidence: 99%

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Controversial aspects of imaging in child abuse: a second roundtable discussion from the ESPR child abuse taskforce

Paddock

Choudhary²,

Jeanes³

et al. 2023

Pediatr Radiol

Self Cite

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“…Pathologies seen on MR imaging include ligamentous injury at the craniocervical junction in up to 78% and spinal subdural hemorrhages in up to 68% of patients being evaluated for non-accidental trauma [ 32 ]. It has therefore been advocated to include total spinal MRI in the work-up for non-accidental trauma patients [ 33 , 34 ].…”

Section: Resultsmentioning

confidence: 99%

Diagnostic Excellence in Pediatric Spine Imaging: Using Contextualized Imaging Protocols

Kadom,

Reddy,

Cooper

et al. 2023

Diagnostics

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Abusive spinal injury: imaging and updates

Derinkuyu,

Caré,

Makoroff

et al. 2024

Pediatr Radiol

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Child physical abuse has significant morbidity and mortality in the pediatric population. There is growing evidence that abusive spinal injury has been under-recognized, changing historical perceptions that these injuries are relatively uncommon. Increased utilization of MRI has been pivotal in recognizing that most abusive spinal injuries involve the soft tissues and ligaments or manifest as intrathecal blood products, which are often undetectable by radiography or CT. Detecting spinal injury in the work-up of non-accidental trauma improves management for abused children and their siblings (defined as siblings or other household members). This review highlights key points in the imaging literature of abusive spinal injury, describes typical patterns of injury, and addresses appropriate imaging practice for work-up. Graphical Abstract

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Current issues and controversies surrounding spine imaging and the significance of spinal subdural hemorrhage in suspected abusive head trauma

Cited by 5 publications

References 14 publications

Controversial aspects of imaging in child abuse: a second roundtable discussion from the ESPR child abuse taskforce

Controversial aspects of imaging in child abuse: a second roundtable discussion from the ESPR child abuse taskforce

Diagnostic Excellence in Pediatric Spine Imaging: Using Contextualized Imaging Protocols

Abusive spinal injury: imaging and updates

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