These include children who had skeletal survey for suspected child abuse, children with neurological changes, and children with facial injuries raising concern for abuse. Multiplanar reformations and 3-D volume rendering of the skull increase sensitivity for fracture and intracranial hemorrhage [34,35]. MRI head without contrast Magnetic resonance imaging (MRI) is sensitive for the detection of small-volume extra-axial hemorrhage and for evolving parenchymal injury [36]. In addition to standard sequences, diffusion-weighted imaging and susceptibility-weighted imaging increase sensitivity for detection of parenchymal ischemia, diffuse axonal injury, and microhemorrhage and can provide prognostic information in AHT. The addition of contrast-enhanced MRI sequences can be used in select cases to improve evaluation of extra-axial collections [37] as it increases the sensitivity for the detection of membranes in subdural collections, a finding that indicates a chronic component [37]. Care must be taken when attempting to date subdural collections, however, as the imaging appearance depends not just on the age of blood products but also on the potential presence of cerebrospinal fluid accumulation in the subdural space through an arachnoid laceration (hematohygroma) [38]. Thrombosis of bridging veins in the subdural space also suggest abusive trauma [39,40]. The MRI should include T1- and T2-weighted imaging as well as T2 FLAIR and T2* (gradient-echo or susceptibility-weighted imaging) sequences. Diffusion-weighted sequences are required to indicate whether acute cerebral injury is present [36]. Susceptibility-weighted imaging may be useful in detection of blood products in the brain as well as retinal hemorrhages [41,42]. MRI is a particularly good choice to image children at high risk for AHT in the nonemergent setting but is a lengthy scan often requiring sedation, so it is typically not utilized in the emergent setting.
Suspected Physical Abuse Child. These include children who had skeletal survey for suspected child abuse, children with neurological changes, and children with facial injuries raising concern for abuse. Multiplanar reformations and 3-D volume rendering of the skull increase sensitivity for fracture and intracranial hemorrhage [34,35]. MRI head without contrast Magnetic resonance imaging (MRI) is sensitive for the detection of small-volume extra-axial hemorrhage and for evolving parenchymal injury [36]. In addition to standard sequences, diffusion-weighted imaging and susceptibility-weighted imaging increase sensitivity for detection of parenchymal ischemia, diffuse axonal injury, and microhemorrhage and can provide prognostic information in AHT. The addition of contrast-enhanced MRI sequences can be used in select cases to improve evaluation of extra-axial collections [37] as it increases the sensitivity for the detection of membranes in subdural collections, a finding that indicates a chronic component [37]. Care must be taken when attempting to date subdural collections, however, as the imaging appearance depends not just on the age of blood products but also on the potential presence of cerebrospinal fluid accumulation in the subdural space through an arachnoid laceration (hematohygroma) [38]. Thrombosis of bridging veins in the subdural space also suggest abusive trauma [39,40]. The MRI should include T1- and T2-weighted imaging as well as T2 FLAIR and T2* (gradient-echo or susceptibility-weighted imaging) sequences. Diffusion-weighted sequences are required to indicate whether acute cerebral injury is present [36]. Susceptibility-weighted imaging may be useful in detection of blood products in the brain as well as retinal hemorrhages [41,42]. MRI is a particularly good choice to image children at high risk for AHT in the nonemergent setting but is a lengthy scan often requiring sedation, so it is typically not utilized in the emergent setting.