Novel in vivo depiction of optic nerves hemorrhages in child abuse: a 3D-SWI pilot study

Abstract

Purpose Until now, the diagnosis of optic nerves hemorrhages in abusive head trauma (AHT) has been obtained only in the postmortem setting. The aim of the IRB-approved study was to assess the presence of optic nerves hemorrhages in AHT patients using 3D-SWI. Methods Thirteen children with a final confirmed multidisciplinary diagnosis of AHT underwent coronal and axial 3D-SWI imaging of the orbits. The presence of optic nerve sheath (ONS) hemorrhages was defined by thickening and marked 3D-SWI hypointensity of the ONS, resulting in mass effect upon the CSF space. Optic nerve (ON) hemorrhages were defined by areas of susceptibility artifacts in the ON parenchyma. Superficial siderosis was defined by susceptibility artifact coating the ON. Furthermore, data about post-traumatic deformity of the ONS at the head of the optic nerve were collected. Results The average age of the population was 7.9 ± 5.9 months old. The average GCS was 11.8 ± 4.5. The male to female ratio was 7:6. ONS hemorrhages were identified in 69.2% of cases. Superficial siderosis and ON hemorrhages were identified in 38.5 and 76.9% of cases, respectively. 3D-SWI also depicted traumatic deformity of the ONS at the level of the optic nerve head in 10 cases (76.9%). No statistical correlations were identified between RetCam findings and 3D-SWI findings or GCS and ON hemorrhages. Conclusion This research shows that dedicated MRI with volumetric SWI of the orbits can depict hemorrhages in the ON, ONS, and ONS injury, in AHT victims.

New Insights into the Diagnosis and Age Determination of Retinal Hemorrhages from Abusive Head Trauma: A Systematic Review

“…Decisive progress, therefore, could be identified in the performance of targeted radiological investigations that, in a cephalic or total-body visualization context, allow the simultaneous search for bone fractures or brain parenchymal lesions. At present, the best method for studying the retina and its appendages (in particular the ON) is represented by MRI performed with specific protocols, i.e., GRE T2-w and 3D-SWI [80,96].…”

“…Subsequently, 123 articles were excluded because they did not meet the inclusion criteria. Finally, 16 articles were included for qualitative analysis [71,78,[87][88][89][90][91][92][93][94][95][96][97][98][99][100] (Figure 1).…”

“…Despite two articles [87,88] being written in German, all of the considered papers presented abstracts written in English. From a structural point of view, six of them consist of case reports or case series associated with a brief literature review [71,87,88,[91][92][93]; two articles consist of reviews of the scientific knowledge available at the time of writing [78,98]; one is a technical note of the author [90]; and the seven remaining are original articles, all statistically validated [89,[94][95][96][97]99,100].…”

“…Except for the review articles, the remaining works account for a complete cohort of 296 infant victims of AHT within the age range from 10 days (0 months) to 1041 days (34.7 months). Different methodologies were pursued among the considered works; clinical examination of alive subjects was executed by means of ophthalmoscopy or a combination of RETcam and OCT [87,88,90,92,97,99]; imaging techniques were employed by means of Magnetic Resonance Imaging (MRI) with different time-weights (3D-SWI, coronal T2-w, T1-w, and axial GRE T2-w protocols) [78,96]; forensic autopsies permitted the direct observation of macroscopic pathologic alterations of the eye and periorbital soft tissues [71,88,98]; and histopathological investigations were based on traditional H&E staining [71,88,91,94,95,98,100], histochemical iron-specific and PAS stains [91,94,95,100], and immunohistochemical reactants (β-APP, ubiquitin, GFAP, Glycophorin A, Nestin, CD44, and collagen type IX) [89,98,100]. The main characteristics of the selected articles are summarized in Table 3.…”

“…At the vitreal level, on the other hand, an uneven visualization of the lesion pattern represents a useful tool for monitoring the intracavitary hemorrhagic spread and hypothesizing its topographic origin. However, the ocular plane is not the only area of interest in the field of ophthalmological diagnostics of AHT; the optic nerve, similar to the retina, is an extremely useful area of investigation and, in this regard, Zuccoli [96] was the first to apply MRI with the 3D-SWI technique to sagittal and coronal planes to the orbits of patients recovered at his own institution. In this way, it was possible to observe the presence of ONSH through the detection of ONS thickening/3D-SWI hypointensity and by the observation of mass effect lesions at the level of the CSF space.…”