Given these studies, clinicians should have a relatively low threshold for performing either CT (emergent setting and more sensitive for detection of nondisplaced fractures) or MRI of the head in children with suspected abuse. In summary, there is no strong evidence to recommend universal screening with neuroimaging. However, clinicians should have low threshold for performing head CT or MRI in young children with suspected child abuse. Variant 2: Suspected physical abuse. Child >24 months of age. Neurological or visceral injuries not clinically suspected. Initial imaging evaluation. X-ray area of interest Children >2 years of age are often able to verbalize the area(s) of injury or pain during clinical examination. Thus, initial imaging should focus on the areas of clinical concern. Tc-99m bone scan whole body Bone scintigraphy is a complementary/adjunctive examination for detecting bone injuries. It may aid by detecting bony injury that is occult, equivocal, or subtle on plain radiographs, but the study requires venipuncture and often requires sedation. CT head and MRI head Unenhanced CT of the head is the examination of choice for acute evaluation for intracranial injury in child abuse [33]. However, there is no strong evidence to recommend universal screening with neuroimaging in the absence of clinical suspicion for AHT. This is particularly true in older children where the neurological examination is typically more reliable, except for children with chronic disabilities. MRI is a good choice to image children for abusive head injury in the nonemergent setting. MRI is useful in the detection of small-volume extra-axial hemorrhage and for evolving parenchymal injury [36]. Diffusion-weighted imaging and susceptibility-weighted imaging increase the sensitivity for detection of parenchymal ischemia, diffuse axonal injury, and microhemorrhage. The addition of contrast-enhanced MRI sequences can be utilized in select cases to improve evaluation of extra-axial fluid collections.
Suspected Physical Abuse Child. Given these studies, clinicians should have a relatively low threshold for performing either CT (emergent setting and more sensitive for detection of nondisplaced fractures) or MRI of the head in children with suspected abuse. In summary, there is no strong evidence to recommend universal screening with neuroimaging. However, clinicians should have low threshold for performing head CT or MRI in young children with suspected child abuse. Variant 2: Suspected physical abuse. Child >24 months of age. Neurological or visceral injuries not clinically suspected. Initial imaging evaluation. X-ray area of interest Children >2 years of age are often able to verbalize the area(s) of injury or pain during clinical examination. Thus, initial imaging should focus on the areas of clinical concern. Tc-99m bone scan whole body Bone scintigraphy is a complementary/adjunctive examination for detecting bone injuries. It may aid by detecting bony injury that is occult, equivocal, or subtle on plain radiographs, but the study requires venipuncture and often requires sedation. CT head and MRI head Unenhanced CT of the head is the examination of choice for acute evaluation for intracranial injury in child abuse [33]. However, there is no strong evidence to recommend universal screening with neuroimaging in the absence of clinical suspicion for AHT. This is particularly true in older children where the neurological examination is typically more reliable, except for children with chronic disabilities. MRI is a good choice to image children for abusive head injury in the nonemergent setting. MRI is useful in the detection of small-volume extra-axial hemorrhage and for evolving parenchymal injury [36]. Diffusion-weighted imaging and susceptibility-weighted imaging increase the sensitivity for detection of parenchymal ischemia, diffuse axonal injury, and microhemorrhage. The addition of contrast-enhanced MRI sequences can be utilized in select cases to improve evaluation of extra-axial fluid collections.