MR venography utilizing unenhanced 2-dimensional time-of-flight technique can be used to assess patency of the dural venous sinuses and deep venous system. Neuroimaging should not be performed as a screening examination in all children but should be used for further evaluation of all abnormal initial examinations and in cases of clinical suspicion [36]. The clinician should have a relatively low threshold for performing either CT (emergent setting) or MRI of the head (nonemergent setting), especially in children under 1 year of age [60,61]. MRI cervical spine MRI of the cervical spine should be strongly considered at the time of MRI brain imaging, as unsuspected spinal injuries may be demonstrated in >36% of cases [44]. Cervical spine injury, particularly at the craniocervical junction, is highly associated with bilateral hypoxic-ischemic injury. Most cervical spine injury detected by MRI in abused infants is ligamentous. MRI complete spine MRI of the entire spine may show thoracolumbar SDH, most commonly from redistribution of blood products; however, it rarely results in cord compression or alters clinical management. An MRI of the total spine should be reserved for cases where the distinction between abusive and accidental trauma is not clear, since thoracolumbar SDH is more commonly seen with abusive trauma [43]. Variant 4: Child. Suspected physical abuse. Suspected thoracic or abdominopelvic injuries (eg, abdominal skin bruises, distension, tenderness, or elevated liver or pancreatic enzymes). Initial imaging evaluation. X-ray skeletal survey As most children with thoracic or abdominopelvic injury from child abuse have polytrauma [69], skeletal survey is recommended in all children 24 months of age or younger and should be considered in older children. 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.
Suspected Physical Abuse Child. MR venography utilizing unenhanced 2-dimensional time-of-flight technique can be used to assess patency of the dural venous sinuses and deep venous system. Neuroimaging should not be performed as a screening examination in all children but should be used for further evaluation of all abnormal initial examinations and in cases of clinical suspicion [36]. The clinician should have a relatively low threshold for performing either CT (emergent setting) or MRI of the head (nonemergent setting), especially in children under 1 year of age [60,61]. MRI cervical spine MRI of the cervical spine should be strongly considered at the time of MRI brain imaging, as unsuspected spinal injuries may be demonstrated in >36% of cases [44]. Cervical spine injury, particularly at the craniocervical junction, is highly associated with bilateral hypoxic-ischemic injury. Most cervical spine injury detected by MRI in abused infants is ligamentous. MRI complete spine MRI of the entire spine may show thoracolumbar SDH, most commonly from redistribution of blood products; however, it rarely results in cord compression or alters clinical management. An MRI of the total spine should be reserved for cases where the distinction between abusive and accidental trauma is not clear, since thoracolumbar SDH is more commonly seen with abusive trauma [43]. Variant 4: Child. Suspected physical abuse. Suspected thoracic or abdominopelvic injuries (eg, abdominal skin bruises, distension, tenderness, or elevated liver or pancreatic enzymes). Initial imaging evaluation. X-ray skeletal survey As most children with thoracic or abdominopelvic injury from child abuse have polytrauma [69], skeletal survey is recommended in all children 24 months of age or younger and should be considered in older children. 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.