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Magnetic Resonance Imaging Findings in Infants with Severe Traumatic Brain Injury and Associations with Abusive Head
Nikki Miller Ferguson1, Susan Rebsamen2, Aaron S Field2
1Department of Pediatrics, Virginia Commonwealth University, Richmond, VA 23298, USA.
Insights
Magnetic resonance imaging (MRI) reveals that ischemia is the most common injury in infants with severe traumatic brain injury (TBI). This finding, particularly when affecting multiple brain regions, is significantly associated with abusive head trauma (AHT).
Area of Science:
- Pediatric Neurology
- Neuroimaging
- Traumatic Brain Injury Research
Background:
- Young children with severe traumatic brain injury (TBI) are often excluded from research.
- Magnetic resonance imaging (MRI) is increasingly used to detect brain injuries and edema in infants.
Purpose of the Study:
- To assess MRI findings in infants with severe TBI.
- To determine the association between MRI findings and injury mechanisms, including abusive head trauma (AHT).
Main Methods:
- MRI scans from infants (< 2 years) with severe TBI were analyzed.
- Data were coded using NIH/NINDS Common Data Elements (CDEs).
- Children were classified based on the likelihood of AHT.
Main Results:
- Ischemia was the most frequent MRI finding (70%), followed by contusion (57%) and diffuse axonal injury (DAI) (44.4%).
- Ischemia was significantly associated with AHT (p=0.001) and inflicted injury (p=0.0003).
- Ischemia in >4 brain regions predicted AHT.
Conclusions:
- Ischemia is the predominant intracerebral injury on MRI in infants with severe TBI.
- MRI findings, especially widespread ischemia, can help identify AHT in infants.
- Further research is needed to understand TBI mechanisms in young children.
Abstract:
Young children with severe traumatic brain injury (TBI) have frequently been excluded from studies due to age and/or mechanism of injury. Magnetic resonance imaging (MRI) is now frequently being utilized to detect parenchymal injuries and early cerebral edema. We sought to assess MRI findings in infants with severe TBI, and to determine the association between specific MRI findings and mechanisms of injury, including abusive head trauma (AHT). MRI scans performed within the first 30 days after injury were collected and coded according to NIH/NINDS Common Data Elements (CDEs) for Neuroimaging in subjects age < 2 years old with severe TBI enrolled in the Approaches and Decisions in Acute Pediatric Traumatic Brain Injury Trial. Demographics and injury characteristics were analyzed. A total of 81 children were included from ADAPT sites with MRI scans. Median age was 0.77 years and 57% were male. Most common MRI finding was ischemia, present in 57/81 subjects (70%), in a median of 7 brain regions per subject. Contusion 46/81 (57%) and diffuse axonal injury (DAI) 36/81 (44.4%) subjects followed. Children were dichotomized based on likelihood of AHT with 43/81 subjects classified as AHT. Ischemia was found to be significantly associated with AHT (p = 0.001) and “inflicted” injury mechanism (p = 0.0003). In conclusion, the most common intracerebral injury seen on MRI of infants with severe TBI was ischemia, followed by contusion and DAI. Ischemia was associated with AHT, and ischemia affecting > 4 brain regions was predictive of AHT.
