Nonaccidental pediatric head injury

Diffusion-weighted imaging findings

Daniel Y. Suh, Patricia C. Davis, Katharine Hopkins, Nancy N. Fajman, Timothy B. Mapstone

Research output: Contribution to journalArticle

104 Citations (Scopus)

Abstract

OBJECTIVE: Diffusion-weighted imaging (DWI) reveals nonhemorrhagic posttraumatic infarction hours to days before conventional computed tomographic scanning or magnetic resonance imaging (MRI). We evaluated the diagnostic utility of DWI in children with nonaccidental head trauma. METHODS: The medical records and imaging examinations obtained between January 1998 and May 2000 for all children less than 2 years of age with presumed or suspected nonaccidental head injury were reviewed retrospectively. Twenty children who had undergone DWI within 5 days of presentation were included in the study. Computed tomographic scans, conventional MRI sequences, and DWI combined with apparent diffusion coefficient (ADC) maps were evaluated. RESULTS: Eleven girls and nine boys (median age, 5 mo) were studied. Eighteen children had presumed nonaccidental head trauma, and two children had suspected nonaccidental head trauma. Of the 18 children with presumed nonaccidental trauma, 16 (89%) demonstrated abnormalities on DWI/ADC, as compared with neither of the two children with suspected nonaccidental trauma. In 13 (81%) of 16 positive cases, DWI revealed more extensive brain injury than was demonstrated on conventional MRI sequences or showed injuries not observed on conventional MRI. DWI combined with ADC maps allowed better delineation of the extent of white matter injury. DWI/ADC abnormalities in the nonaccidental head-injured children were likely to involve posterior aspects of the cerebral hemispheres with relative sparing of the frontal and temporal poles. Severity on DWI correlated significantly with poor outcome (P <0.005). CONCLUSION: DWI has broad applications in the early detection of infarction in children with nonaccidental head injury and enhances the sensitivity of conventional MRI. In the patients in this study, early DWI provided an indicator of severity that was more complete than any other imaging modality. The use of DWI may help to identify children at high risk for poor outcome and to guide management decisions.

Original languageEnglish (US)
Pages (from-to)309-320
Number of pages12
JournalNeurosurgery
Volume49
Issue number2
DOIs
StatePublished - 2001
Externally publishedYes

Fingerprint

Craniocerebral Trauma
Pediatrics
Magnetic Resonance Imaging
Wounds and Injuries
Infarction
Diffusion Magnetic Resonance Imaging
Cerebrum
Diagnostic Imaging
Brain Injuries
Medical Records
Head

Keywords

  • Child abuse
  • Diffusion-weighted imaging
  • Magnetic resonance imaging
  • Traumatic brain injury

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Nonaccidental pediatric head injury : Diffusion-weighted imaging findings. / Suh, Daniel Y.; Davis, Patricia C.; Hopkins, Katharine; Fajman, Nancy N.; Mapstone, Timothy B.

In: Neurosurgery, Vol. 49, No. 2, 2001, p. 309-320.

Research output: Contribution to journalArticle

Suh, Daniel Y. ; Davis, Patricia C. ; Hopkins, Katharine ; Fajman, Nancy N. ; Mapstone, Timothy B. / Nonaccidental pediatric head injury : Diffusion-weighted imaging findings. In: Neurosurgery. 2001 ; Vol. 49, No. 2. pp. 309-320.
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abstract = "OBJECTIVE: Diffusion-weighted imaging (DWI) reveals nonhemorrhagic posttraumatic infarction hours to days before conventional computed tomographic scanning or magnetic resonance imaging (MRI). We evaluated the diagnostic utility of DWI in children with nonaccidental head trauma. METHODS: The medical records and imaging examinations obtained between January 1998 and May 2000 for all children less than 2 years of age with presumed or suspected nonaccidental head injury were reviewed retrospectively. Twenty children who had undergone DWI within 5 days of presentation were included in the study. Computed tomographic scans, conventional MRI sequences, and DWI combined with apparent diffusion coefficient (ADC) maps were evaluated. RESULTS: Eleven girls and nine boys (median age, 5 mo) were studied. Eighteen children had presumed nonaccidental head trauma, and two children had suspected nonaccidental head trauma. Of the 18 children with presumed nonaccidental trauma, 16 (89{\%}) demonstrated abnormalities on DWI/ADC, as compared with neither of the two children with suspected nonaccidental trauma. In 13 (81{\%}) of 16 positive cases, DWI revealed more extensive brain injury than was demonstrated on conventional MRI sequences or showed injuries not observed on conventional MRI. DWI combined with ADC maps allowed better delineation of the extent of white matter injury. DWI/ADC abnormalities in the nonaccidental head-injured children were likely to involve posterior aspects of the cerebral hemispheres with relative sparing of the frontal and temporal poles. Severity on DWI correlated significantly with poor outcome (P <0.005). CONCLUSION: DWI has broad applications in the early detection of infarction in children with nonaccidental head injury and enhances the sensitivity of conventional MRI. In the patients in this study, early DWI provided an indicator of severity that was more complete than any other imaging modality. The use of DWI may help to identify children at high risk for poor outcome and to guide management decisions.",
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