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Diffusion-weighted magnetic resonance imaging in Shaken Baby Syndrome
Valérie Biousse1, Daniel Y Suh, Nancy J Newman
1Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA. vbiouss@emory.edu
Insights
Diffusion-weighted MRI (DWIMRI) is crucial for diagnosing Shaken Baby Syndrome (SBS). Abnormal DWIMRI findings, including cerebral ischemia, aid in confirming SBS in infants and children.
Area of Science:
- Pediatric Radiology
- Neuroradiology
- Child Abuse Diagnosis
Background:
- Shaken Baby Syndrome (SBS) is a severe form of abusive head trauma in infants.
- Accurate diagnosis is critical for timely intervention and management.
- Conventional MRI may not always reveal subtle signs of injury.
Purpose of the Study:
- To evaluate the diagnostic utility of diffusion-weighted magnetic resonance imaging (DWIMRI) in children with suspected or confirmed Shaken Baby Syndrome (SBS).
- To assess the role of DWIMRI in identifying cerebral ischemia associated with SBS.
Main Methods:
- Retrospective case series of 26 infants and children (<2 years) with suspected or confirmed SBS.
- Inclusion criteria: ophthalmologist-documented ocular exam and brain MRI with DWI.
- Medical records and neuroimaging findings were reviewed.
Main Results:
- 18 of 26 patients had confirmed SBS; all had subdural hematomas.
- DWIMRI was abnormal in all 18 confirmed SBS cases, revealing lesions larger than conventional MRI in 13.
- DWIMRI findings suggested cerebral ischemia, a key factor in SBS pathogenesis.
Conclusions:
- DWIMRI is highly sensitive for detecting abnormalities in confirmed SBS.
- Abnormal DWIMRI findings, particularly cerebral ischemia, are integral to the diagnosis and understanding of SBS.
- DWIMRI aids in differentiating SBS from other causes of head injury.
Purpose:
To evaluate the role of diffusion-weighted magnetic resonance imaging (DWIMRI) in the diagnosis and management of children with suspected or confirmed Shaken Baby Syndrome (SBS).
Methods:
This was a retrospective interventional case series of all infants and children younger than 2 years of age admitted to a children's hospital. We retrospectively reviewed medical records and neuroimaging findings of all children younger than 2 years of age with confirmed or suspected SBS admitted to a children's hospital. Inclusion criteria were documented ocular examination by an ophthalmologist and a brain MRI with DWI. Twenty-six infants and children were included. Other children were excluded. Children with proven SBS were diagnosed with "confirmed SBS," while children in whom the diagnosis of SBS remained uncertain were diagnosed with "suspected SBS."
Results:
Twenty-six infants and children with mean age of 7.1 months (range, 6 weeks-24 months) were included, 18 with confirmed SBS. All 26 patients had a subdural hematoma, 10 had associated occult bone fractures, and 18 had retinal hemorrhages. Seven of the eight cases without retinal hemorrhages had isolated subdural hematoma without parenchymal brain lesions on both conventional MRI and DWIMRI. SBS was confirmed in only one case with a normal fundus. Among the 18 patients with retinal hemorrhages, SBS was confirmed in all but one case. All 18 patients with confirmed SBS had an abnormal DWIMRI. In 13 patients, DWI showed lesions that were larger than on conventional MRI. In patients with brain parenchymal lesions, the DWIMRI characteristics suggested cerebral ischemia, which appears to play a major role in SBS.
Conclusions:
In all patients with confirmed SBS, DWIMRI was abnormal and suggested diffuse or posterior cerebral ischemia, in addition to subdural hematomas in the pathogenesis of this disorder.