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Imaging abusive head trauma: why use both computed tomography and magnetic resonance imaging?

  • Special Issue: Abusive Head Trauma
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Pediatric Radiology Aims and scope Submit manuscript

Abstract

Abusive head trauma is the leading cause of death in child abuse cases. The majority of victims are infants younger than 1 year old, with the average age between 3 and 8 months, although these injuries can be seen in children up to 5 years old. Many victims have a history of previous abuse and the diagnosis is frequently delayed. Neuroimaging is often crucial for establishing the diagnosis of abusive head trauma as it detects occult injury in 37% of cases. Several imaging patterns are considered to be particularly associated with abusive head trauma. The presence of subdural hematoma, especially in multiple locations, such as the interhemispheric region, over the convexity and in the posterior fossa, is significantly associated with abusive head trauma. Although CT is the recommended first-line imaging modality for suspected abusive head trauma, early MRI is increasingly used alongside CT because it provides a better estimation of shear injuries, hypoxic-ischemic insult and the timing of lesions. This article presents a review of the use and clinical indications of the most pertinent neuroimaging modalities for the diagnosis of abusive head trauma, emphasizing the newer and more sensitive techniques that may be useful to better characterize the nature and evolution of the injury.

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Acknowledgments

We thank Celine Cavallo for English language support

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Authors and Affiliations

  1. Pediatric Radiology Department, Hospital Universitario Vall d’Hebron, UAB, Psg. Vall d’Hebron, 112-119, 08035, Barcelona, Spain

    Elida Vázquez, Ignacio Delgado & Angel Sánchez-Montañez

  2. Department of Pediatrics, Hospital Universitario Vall d’Hebron, UAB, Barcelona, Spain

    Anna Fábrega

  3. Pediatric Neurosurgery, Hospital Universitario Vall d’Hebron, UAB, Barcelona, Spain

    Paola Cano

  4. Pediatric Ophthalmology, Hospital Universitario Vall d’Hebron, UAB, Barcelona, Spain

    Nieves Martín

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  1. Elida Vázquez
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  2. Ignacio Delgado
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  3. Angel Sánchez-Montañez
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  4. Anna Fábrega
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  5. Paola Cano
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  6. Nieves Martín
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Correspondence to Elida Vázquez.

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Vázquez, E., Delgado, I., Sánchez-Montañez, A. et al. Imaging abusive head trauma: why use both computed tomography and magnetic resonance imaging?. Pediatr Radiol 44 (Suppl 4), 589–603 (2014). https://doi.org/10.1007/s00247-014-3216-5

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  • DOI: https://doi.org/10.1007/s00247-014-3216-5

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