Abstract
PurposeThe diagnosis of abusive head trauma (AHT) is complex and neuroimaging plays a crucial role. Our goal was to determine whether non-neuroradiologists with standard neuroradiology knowledge perform as well as neuroradiologists with experience in pediatric neuroimaging in interpreting MRI in cases of presumptive AHT (pAHT).MethodsTwenty children were retrospectively evaluated. Patients had been diagnosed with pAHT (6 patients), non-abusive head trauma-NAHT (5 patients), metabolic diseases (3 patients), and benign enlargement of the subarachnoid spaces (BESS) (6 patients). The MRI was assessed blindly, i.e., no clinical history was given to the 3 non-neuroradiologists and 3 neuroradiologists from 2 different institutions.ResultsBlindly, neuroradiologists demonstrated higher levels of sensitivity and positive predictive value in the diagnosis of pAHT (89%) than non-neuroradiologists (50%). Neuroradiologists chose correctly pAHT as the most probable diagnosis 16 out of 18 times; in contrast, non-neuroradiologists only chose 9 out of 18 times. In our series, the foremost important misdiagnosis for pAHT was NAHT (neuroradiologists twice and non-neuroradiologists 5 times). Only victims of motor vehicle accidents were blindly misdiagnosed as pAHT. No usual household NAHT was not misdiagnosed as pAHT. Neuroradiologists correctly ruled out pAHT in all cases of metabolic diseases and BESS.ConclusionMRI in cases of suspected AHT should be evaluated by neuroradiologists with experience in pediatric neuroimaging. Neuroradiologists looked beyond the subdural hemorrhage (SDH) and were more precise in the assessment of pAHT and its differential diagnosis than non-neuroradiologists were. It seems that non-neuroradiologists mainly assess whether or not a pAHT is present depending on the presence or absence of SDH.
Highlights
The published review of the literature on “abusive head trauma” (AHT) in infants by the Swedish Agency for HealthLP and MBB Divided First AuthorshipTechnology and Assessment of Social Services (SBU) [1] triggered an intense discussion on this issue
Neuroradiologists showed a strong agreement in their case assessments (Graphic 1a) and more often chose correctly presumed AHT (pAHT) as the most probable diagnosis
The task force for child abuse from the pediatric radiology society suggests that when children younger than 2 years of age with benign enlargement of the subarachnoid spaces (BESS) present with subdural collections, further evaluation should be performed to exclude traumatic cause, including AHT. It appears that non-neuroradiologists assess whether or not a pAHT is present mostly depending on “the presence of subdural hematomas.”
Summary
The published review of the literature on “abusive head trauma” (AHT) in infants by the Swedish Agency for Health. Technology and Assessment of Social Services (SBU) [1] triggered an intense discussion on this issue. The main conclusion of the report was that there is insufficient scientific evidence on which to assess the diagnostic accuracy of the “triad” (encephalopathy, subdural hemorrhage (SDH), and retinal hemorrhage) in identifying traumatic shaking (very low-quality evidence). The diagnosis of presumed AHT (pAHT) is complex and should always be the result of an extensive multidisciplinary approach. Even though there are controversies; the main way for a radiologist to blindly assess pAHT is to evaluate the presence of the classical “triad” on magnetic resonance imaging (MRI): SDH, retinal hemorrhage (if possible), and parenchymal
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