Imaging abusive head trauma: why use both computed tomography and magnetic resonance imaging?

Vázquez, Élida; Delgado, Ignacio; Sánchez‐Montáñez, Ángel; Fàbrega, Anna; Cano, P.; Martín, Nieves

doi:10.1007/s00247-014-3216-5

Cited by 48 publications

(22 citation statements)

References 49 publications

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“…Thus, CT can delay access to diagnostic neuroimaging and the initiation of appropriate therapy for potentially life‐threatening stroke mimics such as intracranial infection and raised intracranial pressure . Second, in the setting of nonaccidental injury, CT is less accurate than MRI in the estimation of shear injuries, hypoxic‐ischemic insults, and the timing of lesions . Third, the risk of cancer ionizing radiation related is inherent to CT: two standard brain CT scans performed per year over a period of 20 years, for example, for the evaluation of ventriculo‐peritoneal shunt function will result in one excess lifetime fatal cancer per 97 patients .…”

Section: Discussionmentioning

confidence: 99%

“…11 Second, in the setting of nonaccidental injury, CT is less accurate than MRI in the estimation of shear injuries, hypoxic-ischemic insults, and the timing of lesions. 12 Third, the risk of cancer ionizing radiation related is inherent to CT: two standard brain CT scans performed per year over a period of 20 years, for example, for the evaluation of ventriculoperitoneal shunt function will result in one excess lifetime fatal cancer per 97 patients. 5,13 Even utilizing low-dose brain CT scans will still result in one excess lifetime fatal cancer per 230 patients.…”

Section: Discussionmentioning

confidence: 99%

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Acute Brain Imaging in Children: Can MRI Replace CT as a Screening Tool?

Wagner

Kontzialis

Seeburg

et al. 2015

Journal of Neuroimaging

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Axial T2 screening can detect pediatric brain abnormalities with high sensitivity and specificity and can possibly replace CT as screening tool if the reading physician is aware of possible limitations/pitfalls. The level of experience influences sensitivity and specificity. Adding diffusion-weighted imaging and susceptibility-weighted imaging to a 3-dimensional T2-weighted sequence would most likely further increase sensitivity and specificity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Acute Brain Imaging in Children: Can MRI Replace CT as a Screening Tool?

Wagner

Kontzialis

Seeburg

et al. 2015

Journal of Neuroimaging

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“…7 A noncontrast head CT (nHCT) is usually the initial imaging study in suspected AHT due to high sensitivity for detection of acute hemorrhage and fracture, a high level of accessibility from the emergency department, and can be performed quickly and safely without the need for special monitoring equipment. 8,9 CT imaging disadvantages include ionizing radiation, particularly in children, and the reduced sensitivity in detecting microhemorrhages, axonal injury, and acute ischemia compared to MRI.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Performance of Ultrafast Brain MRI for Evaluation of Abusive Head Trauma

Kralik¹,

Yasrebi²,

Supakul³

et al. 2017

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: MRI with sedation is commonly used to detect intracranial traumatic pathology in the pediatric population. Our purpose is to compare nonsedated ultrafast MRI (ufMRI), non-contrast head CT (nHCT), and standard MRI (stMRI) for detection of intracranial trauma in patients with potential abusive head trauma (AHT). MATERIALS AND METHODS:A prospective study was performed in 24 pediatric patients who were evaluated for potential AHT. All patients received nHCT, ufMRI brain without sedation, and stMRI with general anesthesia or papoose, sequentially. Two pediatric neuroradiologists independently reviewed each modality blinded to other modalities for intracranial trauma. Inter-reader agreement was performed, and consensus interpretation for stMRI as the gold standard. Diagnostic accuracy was calculated for ufMRI, nHCT, and combined ufMRI with nHCT. RESULTS:Inter-reader agreement was moderate for ufMRI (k=0.42), substantial for nHCT (k=0.63), and nearly perfect for stMRI (k=0.86). 42% of patients had discrepancies between ufMRI and stMRI which included detection of subarachnoid hemorrhage, and subdural hemorrhage. Sensitivity, specificity, positive and negative predictive values were obtained for any traumatic pathology for each exam: UfMRI (50%, 100%, 100%, 31%), nHCT (25%, 100%, 100%, 21%) and combination of ufMRI with nHCT (60%, 100%, 100%, 33%). UfMRI was more sensitive than nHCT for detection of intraparenchymal hemorrhage (p=0.03), and the combination of ufMRI with nHCT was more sensitive than nHCT alone for intracranial trauma (p=0.02). CONCLUSION:In AHT, ufMRI, even combined with nHCT, demonstrated low sensitivity compared to stMRI for intracranial traumatic pathology which may limit its utility in this patient population.Abbreviations: AHT: abusive head trauma; GRE: gradient recalled echo; nHCT: non contrast head CT

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“…17 Multiple neuroimaging techniques may be necessary to diagnose the severity of the AHT and determine the timing of the injuries. 18 …”

Section: Aht Involves Multiple Mechanisms Of Injurymentioning

confidence: 99%

The Anesthesiologist’s Role in Treating Abusive Head Trauma

Lee

Brady

Deutsch

2016

Anesthesia &Amp; Analgesia

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Abusive head trauma (AHT) is the most common cause of severe traumatic brain injury (TBI) in infants and the leading cause of child abuse-related deaths. For reasons that remain unclear, mortality rates after moderate AHT rival those of severe non-intentional TBI. The developing brain’s vulnerability to injury may be partially responsible for the poor outcomes observed after AHT. AHT is mechanistically more complex than non-intentional TBI. The acute-on-chronic nature of the trauma along with synergistic injury mechanisms that include rapid rotation of the brain, diffuse axonal injury, blunt force trauma, and hypoxia-ischemia make AHT challenging to treat. The anesthesiologist must understand the complex injury mechanisms inherent to AHT, as well as the pediatric TBI treatment guidelines, in order to decrease the risk of persistent neurologic disability and death. In this review we discuss the epidemiology of AHT, differences between AHT and non-intentional TBI, the severe pediatric TBI treatment guidelines in the context of AHT, anesthetic considerations, as well as ethical and legal reporting requirements.

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Imaging abusive head trauma: why use both computed tomography and magnetic resonance imaging?

Cited by 48 publications

References 49 publications

Acute Brain Imaging in Children: Can MRI Replace CT as a Screening Tool?

Acute Brain Imaging in Children: Can MRI Replace CT as a Screening Tool?

Diagnostic Performance of Ultrafast Brain MRI for Evaluation of Abusive Head Trauma

The Anesthesiologist’s Role in Treating Abusive Head Trauma

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