It may aid by detecting bony injury that is occult, equivocal, or subtle on plain radiographs, but it requires venipuncture and often requires sedation. CT head and MRI head There are varying opinions on how to image suspected abuse victims who show no evidence suggesting intracranial injury. Although skull radiographs may detect fractures associated with intracranial pathology, they do not provide adequate screening, since significant traumatic intracranial pathology may occur in the absence of skull fractures [58,59]. Children, especially those <12 months of age, may have significant intracranial injury without signs or symptoms of head injury or retinal hemorrhage [60-62]. Unenhanced CT of the head is the examination of choice for initial evaluation for intracranial injury in child abuse [33]. MRI is a good choice to image children for abusive head injury in the nonemergent setting. A study of abused children without clinical suspicion of intracranial injury showed that 11 (29%) of the 51 children had positive neuroimaging including subdural hematoma, epidural hematoma, or cerebral edema; most of them had negative skeletal surveys and no retinal hemorrhage. Eight of the 11 children were <12 months of age [60]. In another prospective study of infants <6 months of age evaluated for possible physical abuse, the presence of apparently isolated bruises (seen in 146 children) at presentation correlated with new injury on neuroimaging in 40 children (27%) [50]. In yet another study [61], 37% of children <2 years of age with high-risk criteria (defined as rib fractures, multiple fractures, facial injury, or <6 months of age) and without overt signs of head injury who underwent head CT or MRI had occult head injury; nearly all with occult head injury were <1 year of age. Intracranial injury is also associated with spinal trauma seen on skeletal survey [18].
Suspected Physical Abuse Child. It may aid by detecting bony injury that is occult, equivocal, or subtle on plain radiographs, but it requires venipuncture and often requires sedation. CT head and MRI head There are varying opinions on how to image suspected abuse victims who show no evidence suggesting intracranial injury. Although skull radiographs may detect fractures associated with intracranial pathology, they do not provide adequate screening, since significant traumatic intracranial pathology may occur in the absence of skull fractures [58,59]. Children, especially those <12 months of age, may have significant intracranial injury without signs or symptoms of head injury or retinal hemorrhage [60-62]. Unenhanced CT of the head is the examination of choice for initial evaluation for intracranial injury in child abuse [33]. MRI is a good choice to image children for abusive head injury in the nonemergent setting. A study of abused children without clinical suspicion of intracranial injury showed that 11 (29%) of the 51 children had positive neuroimaging including subdural hematoma, epidural hematoma, or cerebral edema; most of them had negative skeletal surveys and no retinal hemorrhage. Eight of the 11 children were <12 months of age [60]. In another prospective study of infants <6 months of age evaluated for possible physical abuse, the presence of apparently isolated bruises (seen in 146 children) at presentation correlated with new injury on neuroimaging in 40 children (27%) [50]. In yet another study [61], 37% of children <2 years of age with high-risk criteria (defined as rib fractures, multiple fractures, facial injury, or <6 months of age) and without overt signs of head injury who underwent head CT or MRI had occult head injury; nearly all with occult head injury were <1 year of age. Intracranial injury is also associated with spinal trauma seen on skeletal survey [18].