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Arterial spin-labeling perfusion imaging of children with subdural hemorrhage: Perfusion abnormalities in abusive
Alex Mun-Ching Wong1, Chih-Hua Yeh1, Ho-Ling Liu2
1Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Keelung/Linkou, and Chang Gung University, Taiwan.
Insights
Children with abusive head trauma (AHT) show more brain perfusion abnormalities than other subdural hemorrhage (SDH) causes. Hypoperfusion in AHT patients may indicate poor neurological outcomes.
Area of Science:
- Pediatric neurology
- Neuroradiology
- Neuroimaging
Background:
- Perfusion abnormalities in pediatric subdural hemorrhage (SDH) are not well-characterized.
- Abusive head trauma (AHT) is a significant cause of SDH in infants.
Purpose of the Study:
- To investigate and compare brain perfusion abnormalities in children with SDH due to AHT versus other causes.
- To correlate imaging findings with neurological outcomes.
Main Methods:
- Retrospective review of perfusion MR studies in 12 infants with SDH (6 AHT+, 6 AHT-) and 21 controls.
- Utilized pseudo-continuous arterial spin-labeling (ASL) MRI.
- Developed a perfusion scoring system and calculated asymmetry indices (AI) for perfusion abnormalities.
Main Results:
- 83% of AHT+ patients exhibited perfusion abnormalities compared to 17% of AHT- patients.
- AHT+ group showed significantly higher perfusion scores than AHT- and control groups.
- Hypoperfused lesions in AHT+ patients had lower AI, while hyperperfused lesions had higher AI compared to controls. Poor outcomes (mortality, hemiparesis) were associated with hypoperfusion.
Conclusions:
- Abusive head trauma is associated with significantly increased brain perfusion abnormalities in pediatric SDH.
- Hypoperfusion on perfusion MRI may serve as an indicator of poor neurological outcomes in AHT.
Background And Purpose:
Perfusion abnormalities have not been well described in children with subdural hemorrhage (SDH). We investigated whether patients with abusive head trauma (AHT+) had more perfusion abnormalities than those without (AHT-).
Materials And Methods:
We reviewed the perfusion MR studies of 12 infants with SDH and 21 controls. The perfusion images were obtained using a pseudo-continuous arterial spin-labeling sequence with volumetric fast spin-echo readout. An MR perfusion scoring system (0-6 points) was devised to facilitate appraisal of the extent of abnormalities. An asymmetry index (AI) was calculated for each region of perfusion abnormality. Comparison of perfusion scores across the AHT+, AHT-, and control groups was performed. The AIs of the hypoperfused lesions and hyperperfused lesions in patients were separately compared with those of the controls. The neurological outcomes of the patients were associated with imaging abnormalities.
Results:
Perfusion abnormalities were found in five (83%) of six AHT+ patients and in one (17%) of six AHT- patients. The AHT+ group recorded a significantly higher perfusion score than did both the AHT- group and the controls. Four patients with hypoperfused lesions exhibited significantly lower AI (P=.002) than did the controls, and three patients with hyperperfused lesions had significantly higher AI (P=.006) than did the controls. Of the four patients with hypoperfused lesions, two expired and one experienced hemiparesis.
Conclusions:
Patients with AHT have higher perfusion abnormality scores than patients with other causes of SDH and controls. Moreover, hypoperfusion may suggest a poor clinical outcome.
