[Diagnostic imaging in non-accidental brain injuries]

Area of Science:

• Radiology
• Pediatric Imaging
• Forensic Medicine

Context:

• Nonaccidental injury (child abuse) diagnosis in infants presents challenges due to non-specific clinical findings and lack of external trauma signs.
• Radiologists play a crucial role in identifying radiologic indicators of abuse and correlating them with physical findings for accurate diagnosis.

Purpose:

• To outline the key radiologic findings indicative of nonaccidental injury in infants.
• To emphasize the importance of recognizing specific imaging patterns associated with abusive head trauma.
• To highlight MRI as the preferred modality for detecting cerebral lesions in nonaccidental injury.

Summary:

• Infants with nonaccidental injury often exhibit brain lesions disproportionate to the reported trauma, retinal hemorrhages, and characteristic fractures.
• Imaging findings in abusive head trauma include blunt impact, shaken, and whiplash shaken injuries.
• The combination of edema, cerebral swelling, hypoxic-ischemic injury, diffuse axonal injury, and subdural hematomas is highly suggestive of shaken infant syndrome.

Impact:

• Accurate radiologic diagnosis of nonaccidental injury is critical for timely intervention and improved long-term outcomes for abused infants.
• Understanding the pathophysiology and imaging characteristics of abusive head trauma aids in differentiating it from accidental injuries.
• Advanced imaging techniques like MRI enhance the detection and characterization of subtle cerebral injuries in nonaccidental injury cases.