Contribution of cranial MR in combination with CT in the initial

evaluation of infants and children with non-accidental

cerebral injury (NACI): Correlation with presence of

retinal hemorrhages (RH)Kilpadikar, Anil*, Worthington, T.**, Jones, J.G.**,

Glasier, C.M***University of Arkansas for Medical Sciences

**Arkansas Children’s HospitalLittle Rock, Arkansas

Non-accidental Cerebral Injury (NACI)

NACI is the leading cause of death (USA) in children under 2 years of age

In children less than 1 year old, 95% of all serious head injuries and 64% of all head injuries result from maltreatment

Outcome of infants suffering NACI is considerably worse than for those of the same age who have sustained ACI

Purpose Retrospectively study a large group of

infants and children with documented NACI who had cranial CT, MR and ophthalmologic exam as part of an initial evaluation in order to determine:

Added utility of acute cranial MR, if any Significance of retinal hemorrhage for

prediction of severity of cerebral injury

Materials and Methods95 consecutive infants and children age

newborn to 4 years admitted from 1999-2003 with documented NACI were reviewed

40 children in this group who had concurrent CT and MR near the time of admission were included in the study

CT exams were performed on the day of admission without contrast or sedation

Materials and Methods MR was performed within an average of

51 hrs. of the admission CT (range 0-12 days)

MR performed on a 1.5T magnetSequences included sagittal T1W, axial

PD or FLAIR, T2W and GE images in all cases

27/40 (68%) had DW imaging3/40 (7.5%) had MRANone had spectroscopy

• Materials and Methods Patient records, CT and MR reports

were reviewed retrospectively with specific attention to EDH, SDH, parenchymal hemorrhage (PH), cerebral ischemic change (CIC) and retinal hemorrhage (RH)

Presence of RH was correlated with severity of cerebral injury

Maximum cerebral injury score of 3 included presence of SDH or EDH (1point), PH (1point) and CIC (1 point)

Results30/40 (75%) had SDH15/40 (38%) had CIC 9/40 (23%) had PH 3/40 (8%) had EDH

Results In all cases CT and MR both

detected EDH, SDH and PHIn patients with CIC, CT was

positive in 7/15 (47%) and MR positive in 15/15 (100%) cases, which is statistically significant (p<0.05)

Results 18/40 patients with RH had a

higher cerebral injury score (1.72) than 22/40 patients without RH (0.85), which is statistically significant (p<0.05)

3 year old with seizures

1 ½ year old with seizures

3 ½ year old with nausea and vomiting

Unresponsive 2 year old

ConclusionAlthough CT and MR each detected all

cases of EDH, SDH and PH, MR detected over twice as many cases of CIC as compared to CT, a statistically significant finding indicating added value for the MR examination in acute setting

Presence of RH was associated with a statistically significant increase in severity of cerebral injury