Apparent diffusion coefficient values predict outcomes of abusive head trauma

Tanoue, Koji; Aida, Noriko

doi:10.1111/apa.12281

Cited by 15 publications

(8 citation statements)

References 27 publications

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“…[12][13][14][15][16] Brain MRI findings have correlated with poor outcomes associated with findings on diffusion-weighted imaging (DWI) and susceptibility-weighted imaging (SWI) in AHT; however, disadvantages of MRI continue to include the need for sedation in children, and compatible monitoring equipment. [17][18][19][20][21][22] Although there is greater accessibility of CT compared to MRI, the availability of MRI is relatively high and imaging techniques that allow neuroimaging in potential AHT patients without sedation would be valuable particularly given the potential adverse effects of sedation on the developing brain. 23,24 A potential solution for diagnostic quality brain MRI without sedation in AHT is the use of ultrafast MRI sequences, also termed fast MRI, quick MRI, or rapid 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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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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“…However, the exact mechanism of injury in AHT is often unknown and may be the result of a combination of forces. [9][10][11][12] In reality, there are often overlapping findings as well as unclear clinical presentations and history that result in nonrecognized or subjective interpretations of cases. Furthermore, resulting parenchymal damage is often multifactorial.…”

Section: Introductionmentioning

confidence: 99%

Pediatric Abusive Head Trauma: Review of Standard Imaging Evaluation and Typical Findings

et al. 2017

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Evaluation of abusive head trauma (AHT) in children is an ongoing diagnostic challenge, as there are currently no standard criteria or objective tests for differentiating AHT from accidental trauma. The use of neuroradiologic imaging has an increasingly important role in identifying AHT and often involves a combination of skull radiographs, computerized tomography (CT), and conventional magnetic resonance imaging (MRI) with diffusion-weighted imaging, susceptibility-weighted imaging, and occasionally magnetic resonance spectroscopy. Development of more advanced imaging techniques includes diffusion tensor imaging and arterial spin labeling. MRI may provide insight into different mechanisms of injury and long-term impacts of AHT. A better understanding of the available imaging modalities, typical findings, and their respective contribution to an accurate diagnosis can help guide physicians, other health care providers, as well as law enforcement in the evaluation of children with suspected AHT.

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“…In addition to retroclival collections, other posterior fossa abnormalities were identified, such as subdural hematomas along the occipital squama, a common finding in children with abusive head trauma, as well as cerebellar parenchymal injury, which is less commonly observed in these children and associated with poor neurodevelopmental outcomes [40]. Retroclival collections were significantly correlated with posterior fossa subdural hematomas but not with parenchymal injury of the cerebellum.…”

Section: Discussionmentioning

confidence: 98%

Retroclival collections associated with abusive head trauma in children

et al. 2014

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Retroclival collections are rare lesions reported almost exclusively in children and strongly associated with trauma. We examine the incidence and imaging characteristics of retroclival collections in young children with abusive head trauma. We conducted a database search to identify children with abusive head trauma ≤ 3 years of age with brain imaging performed between 2007 and 2013. Clinical data and brain images of 65 children were analyzed. Retroclival collections were identified in 21 of 65 (32%) children. Ten (48%) were subdural, 3 (14%) epidural, 2 (10%) both, and 6 (28%) indeterminate. Only 8 of 21 retroclival collections were identifiable on CT and most were low or intermediate in attenuation. Eighteen of 21 retroclival collections were identifiable on MRI: 3 followed cerebral spinal fluid in signal intensity and 15 were bloody/proteinaceous. Additionally, 2 retroclival collections demonstrated a fluid-fluid level and 2 enhanced in the 5 children who received contrast material. Sagittal T1-weighted images, sagittal fluid-sensitive sequences, and axial FLAIR (fluid-attenuated inversion recovery) images showed the retroclival collections best. Retroclival collections were significantly correlated with supratentorial and posterior fossa subdural hematomas and were not statistically correlated with skull fracture or parenchymal brain injury. Retroclival collections, previously considered rare lesions strongly associated with accidental injury, were commonly identified in this cohort of children with abusive head trauma, suggesting that retroclival collections are an important component of the imaging spectrum in abusive head trauma. Retroclival collections were better demonstrated on MRI than CT, were commonly identified in conjunction with intracranial subdural hematomas, and were not significantly correlated with the severity of brain injury or with skull fractures.

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Apparent diffusion coefficient values predict outcomes of abusive head trauma

Abstract: Apparent diffusion coefficient values during the acute phase of AHT were significantly associated with poor long-term neurodevelopmental outcomes.

Cited by 15 publications

References 27 publications

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

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

Pediatric Abusive Head Trauma: Review of Standard Imaging Evaluation and Typical Findings

Retroclival collections associated with abusive head trauma in children

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