MRI Findings in Pediatric Abusive Head Trauma: A Review

Area of Science:

• Pediatric Radiology
• Child Abuse Pediatrics
• Forensic Pathology

Background:

• Abusive head trauma (AHT) is a leading cause of death and severe injury in young children.
• Diagnosing AHT presents significant clinical and radiological challenges, including unreliability of history and lack of pathognomonic imaging signs.

Purpose of the Study:

• To highlight the diagnostic challenges in identifying abusive head trauma (AHT) in infants and young children.
• To review typical and less common magnetic resonance imaging (MRI) findings associated with AHT.

Main Methods:

• Review of recent literature on neuroimaging findings in abusive head trauma (AHT).
• Focus on magnetic resonance imaging (MRI) characteristics, including subdural hemorrhage and less common signs like the "lollipop sign" and "tadpole sign."
• Emphasis on integrating imaging findings with clinical information and mechanism of injury for diagnosis.

Main Results:

• Subdural hemorrhage is the most frequent neuroimaging finding in AHT.
• Less common but significant MRI findings include parenchymal lacerations, subpial hemorrhage, cranio-cervical junction injuries (e.g., retroclival hematomas), and diffuse hypoxic brain injury.
• Specific signs like the "lollipop sign" and "tadpole sign" are noted in the literature.

Conclusions:

• Abusive head trauma (AHT) diagnosis is multifactorial, requiring a synthesis of clinical history, physical examination, and neuroimaging.
• Radiologists' familiarity with a broader spectrum of MRI findings, beyond subdural hematomas, can improve the recognition and diagnosis of AHT.
• Improved recognition of AHT is critical for child protection and reducing morbidity and mortality.