Susceptibility weighted imaging depicts retinal hemorrhages in abusive head trauma

Giulio Zuccoli,Ashok Panigrahy,Janet Squires,Ken K Nischal,Ellen Mitchell,Jennifer Wolford,Rachel P Berger,Lee Ann Lope,Anshul Haldipur,Dennis Willaman,Christin Sylvester

doi:10.1007/s00234-013-1180-7

Giulio Zuccoli, Ashok Panigrahy + Show 9 more

Open Access

https://doi.org/10.1007/s00234-013-1180-7

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Abstract

IntroductionThis study aims to evaluate the capability of magnetic resonance imaging (MRI) susceptibility weighted images (SWI) in depicting retinal hemorrhages (RH) in abusive head trauma (AHT) compared to the gold standard dilated fundus exam (DFE).MethodsThis is a retrospective, single institution, observational study on 28 patients with suspected AHT, who had a DFE and also underwent brain MRI-SWI as part of routine diagnostic protocol. Main outcome measures involved evaluation of patients to determine whether the RH could be identified on standard and high-resolution SWI sequences.ResultsOf the 21 subjects with RH on DFE, 13 (62 %) were identified by using a standard SWI sequence performed as part of brain MRI protocols. Of the 15 patients who also underwent an orbits SWI protocol, 12 (80 %) were positive for RH. None of the seven patients without RH on of DFE had RH on either standard or high-resolution SWI. Compared with DFE, the MRI standard protocol showed a sensitivity of 75 % which increased to 83 % for the orbits SWI protocol.ConclusionsOur study suggests the usefulness of a tailored high-resolution orbits protocol to detect RH in AHT.

Highlights

This study aims to evaluate the capability of magnetic resonance imaging (MRI) susceptibility weighted images (SWI) in depicting retinal hemorrhages (RH) in abusive head trauma (AHT) compared to the gold standard dilated fundus exam (DFE)
In the first few days after a severe traumatic brain injury (TBI), children may develop medical complications such as a coagulopathy or increased intracranial pressure. While these medical conditions do not cause the type of RH seen in children with AHT, whether or not they could cause a worsening of the RH is unknown, the issue is often raised in the legal setting [4]
The standard SWI protocol showed a sensitivity of 75 %, while the high-resolution orbits SWI protocol had a sensitivity of 83 %

Summary

Introduction

This study aims to evaluate the capability of magnetic resonance imaging (MRI) susceptibility weighted images (SWI) in depicting retinal hemorrhages (RH) in abusive head trauma (AHT) compared to the gold standard dilated fundus exam (DFE). Methods This is a retrospective, single institution, observational study on 28 patients with suspected AHT, who had a DFE and underwent brain MRI-SWI as part of routine. In the first few days after a severe TBI, children may develop medical complications such as a coagulopathy or increased intracranial pressure While these medical conditions do not cause the type of RH seen in children with AHT, whether or not they could cause a worsening of the RH is unknown, the issue is often raised in the legal setting [4]. An alternative method to identify RH could be very helpful

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