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Role of Susceptibility-Weighted Imaging in Detecting Retinal Hemorrhages in Children with Head Trauma

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Abstract

Purpose

This study was carried out to evaluate the utility of susceptibility-weighted imaging (SWI) in demonstrating retinal hemorrhages (RH) in pediatric head trauma.

Methods

Over a period of 7 years 67 children (age 0–4 years) with head trauma and MRI were included as either abusive head trauma (AHT) (n = 23), non-abusive head trauma (NAHT) (n = 38), or indeterminate (n = 6). Two pediatric neuroradiologists jointly reviewed the MR images for the presence of RH and sensitivity and specificity of SWI and T2WI were calculated.

Results

The dilated fundoscopic examination (DFE) was positive for RH in 18/23 (78.3%) of the AHT group, 5/38 (13.2%) in the NAHT group, and 4/6 (66.7%) in the indeterminate group. Regarding the SWI MRI findings, SWI was positive for RH in 13/23 (%56.5), while T2WI was positive in 6/23 (%26.1) of the AHT group. Based on utilizing DFE as a standard, the sensitivity and specificity of SWI in the detection of RH was 63% and 100%, respectively and 30% and 100%, respectively on T2WI.

Conclusion

Our results suggest that SWI is a useful diagnostic tool for detection of RH in pediatric head trauma in whom DFE is difficult to perform.

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Abbreviations

AHT:

Abusive head trauma

DFE:

Direct fundoscopic examination

MRI:

Magnetic resonance imaging

NAHT:

Nonabusive head trauma

RH:

Retinal hemorrhage

SWI:

Susceptibility-weighted imaging

T2WI:

T2-weighted imaging

TBI:

Traumatic brain injury

References

  1. Schutzman SA, Greenes DS. Pediatric minor head trauma. Ann Emerg Med. 2001;37:65–74.

    Article  CAS  Google Scholar 

  2. Chevignard MP, Lind K. Long-term outcome of abusive head trauma. Pediatr Radiol. 2014;44 Suppl 4:S548–58.

    Article  Google Scholar 

  3. Kivlin JD, Simons KB, Lazoritz S, Ruttum MS. Shaken baby syndrome. Ophthalmology. 2000;107:1246–54.

    Article  CAS  Google Scholar 

  4. Morad Y, Kim YM, Armstrong DC, Huyer D, Mian M, Levin AV. Correlation between retinal abnormalities and intracranial abnormalities in the shaken baby syndrome. Am J Ophthalmol. 2002;134:354–9.

    Article  Google Scholar 

  5. Levin AV. Retinal hemorrhage in abusive head trauma. Pediatrics. 2010;126:961–70.

    Article  Google Scholar 

  6. Maguire SA, Watts PO, Shaw AD, Holden S, Taylor RH, Watkins WJ, Mann MK, Tempest V, Kemp AM. Retinal haemorrhages and related findings in abusive and non-abusive head trauma: a systematic review. Eye (Lond). 2013;27:28–36.

    Article  CAS  Google Scholar 

  7. Jenny C, Hymel KP, Ritzen A, Reinert SE, Hay TC. Analysis of missed cases of abusive head trauma. JAMA. 1999;281:621–6.

    Article  CAS  Google Scholar 

  8. Colbert CA, Holshouser BA, Aaen GS, Sheridan C, Oyoyo U, Kido D, Ashwal S. Value of cerebral microhemorrhages detected with susceptibility-weighted MR Imaging for prediction of long-term outcome in children with nonaccidental trauma. Radiology. 2010;256:898–905.

    Article  Google Scholar 

  9. Zuccoli G, Panigrahy A, Haldipur A, Willaman D, Squires J, Wolford J, Sylvester C, Mitchell E, Lope LA, Nischal KK, Berger RP. Susceptibility weighted imaging depicts retinal hemorrhages in abusive head trauma. Neuroradiology. 2013;55:889–93.

    Article  Google Scholar 

  10. Thamburaj K, Soni A, Frasier LD, Tun KN, Weber SR, Dias MS. Susceptibility-weighted imaging of retinal hemorrhages in abusive head trauma. Pediatr Radiol. 2019;49:210–6.

    Article  Google Scholar 

  11. Polan RM, Poretti A, Scheller JM, Huisman TA, Bosemani T. Retinal hemorrhages in nonaccidental trauma: look at susceptibility-weighted imaging on pediatric MRI. Pediatr Neurol. 2015;52:464–5.

    Article  Google Scholar 

  12. Hwang M, Shin SS, Thimm MA, Ghodadra A, Sylvester CL, Nischal K, Panigrahy A, Zuccoli G. Apparent Diffusion Coefficient (ADC) of the vitreous humor and Susceptibility Weighted Imaging (SWI) of the retina in abused children with retinal hemorrhages. Clin Imaging. 2017;44:38–41.

    Article  Google Scholar 

  13. Binenbaum G, Mirza-George N, Christian CW, Forbes BJ. Odds of abuse associated with retinal hemorrhages in children suspected of child abuse. J AAPOS. 2009;13:268–72.

    Article  Google Scholar 

  14. Togioka BM, Arnold MA, Bathurst MA, Ziegfeld SM, Nabaweesi R, Colombani PM, Chang DC, Abdullah F. Retinal hemorrhages and shaken baby syndrome: an evidence-based review. J Emerg Med. 2009;37:98–106.

    Article  Google Scholar 

  15. Duhaime AC, Christian CW, Rorke LB, Zimmerman RA. Nonaccidental head injury in infants--the “shaken-baby syndrome”. N Engl J Med. 1998;338:1822–9.

    Article  CAS  Google Scholar 

  16. Levin AV. Retinal hemorrhages of crush head injury: learning from outliers. Arch Ophthalmol. 2006;124:1773–4.

    Article  Google Scholar 

  17. Beavers AJ, Stagner AM, Allbery SM, Lyden ER, Hejkal TW, Haney SB. MR detection of retinal hemorrhages: correlation with graded ophthalmologic exam. Pediatr Radiol. 2015;45:1363–71.

    Article  Google Scholar 

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Radiology, Division of Neuroradiology, University of Minnesota Medical Center, 420 Delaware ST SE, 55455, Minneapolis, MN, USA

    Mehmet Gencturk, Isa Cam, Yasemin Koksel & Alexander M. McKinney

Authors
  1. Mehmet Gencturk
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  2. Isa Cam
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  3. Yasemin Koksel
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  4. Alexander M. McKinney
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Contributions

All authors contributed to the study conception and design. Data collection was performed by Mehmet Gencturk and Yasemin Koksel. Data analysis was performed by Mehmet Gencturk, Yasemin Koksel and Alexander M. McKinney. The first draft of the manuscript was written by Mehmet Gencturk and Isa Cam, and all authors commented on previous versions of the manuscript. Alexander M. McKinney supervised the project and did the critical final version. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Mehmet Gencturk.

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Conflict of interest

M. Gencturk, I. Cam, Y. Koksel and A.M. McKinney declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was waived due to retrospective nature of the study.

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Gencturk, M., Cam, I., Koksel, Y. et al. Role of Susceptibility-Weighted Imaging in Detecting Retinal Hemorrhages in Children with Head Trauma. Clin Neuroradiol 31, 611–617 (2021). https://doi.org/10.1007/s00062-020-00939-6

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  • DOI: https://doi.org/10.1007/s00062-020-00939-6

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