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Acute identification of cranial burst fracture: comparison between CT and MR imaging findings
T S Ellis1, L G Vezina, D J Donahue
1Department of Neurosurgery, Children's National Medical Center, Washington, DC, USA.
Insights
Cranial burst fractures in infants can be misdiagnosed. Magnetic resonance (MR) imaging aids in the early detection of these severe skull fractures and associated brain injuries.
Area of Science:
- Pediatric Radiology
- Neuroradiology
- Trauma Imaging
Background:
- Scalp swelling in infants can mimic subgaleal hematoma.
- Cranial burst fractures involve dural laceration and cerebral extrusion.
- Both conditions may present with hemorrhagic shock.
Purpose of the Study:
- To improve early evaluation of infants with suspected cranial burst fractures.
- To highlight the utility of MR imaging in delineating the dural-cortical interface.
- To differentiate cranial burst fractures from simple subgaleal hematomas.
Main Methods:
- Retrospective study of seven infants (1-11 months) with cranial burst fractures.
- Initial imaging included skull radiography and CT.
- MR imaging was performed after resuscitation and stabilization.
Main Results:
- MR imaging findings were confirmed by surgery or autopsy in all seven infants.
- MR imaging accurately identified dural laceration and extracalvarial cerebral tissue.
- The dural-cortical interface, crucial for diagnosis, was clearly delineated.
Conclusions:
- MR imaging facilitates early diagnosis of cranial burst fractures.
- This technique is valuable for identifying acute cerebral extrusion associated with skull fractures.
- MR imaging improves diagnostic accuracy in pediatric head trauma.
Background And Purpose:
Scalp swelling associated with cranial burst fracture, a widely diastatic skull fracture of infants associated with dural laceration and acute cerebral extrusion, may be confused with that of a simple subgaleal hematoma. Both conditions can also be associated with hemorrhagic shock. We sought to improve the early evaluation of infants believed to have sustained cranial burst fracture by including MR imaging, since this study clearly delineates the dural-cortical interface, the site of injury.
Methods:
Seven infants aged 1 through 11 months who sustained cranial burst fractures, all initially imaged with skull radiography and CT, were studied or treated from 1992 through 1996. MR imaging was obtained after resuscitation and stabilization.
Results:
Surgery or autopsy confirmed MR findings (dural laceration and extracalvarial cerebral tissue) in all seven infants.
Conclusion:
MR imaging allows early diagnosis of skull fracture associated with acute cerebral extrusion.