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Temporal development of subdural collections in infants with confessed abusive head trauma: a forensic neuroimaging
Maria Hahnemann1, Bernd Karger2, Alexander Radbruch3
1Department of Diagnostic and Interventional Neuroradiology and Pediatric Neuroradiology, University Hospital Bonn, University of Bonn, Bonn, Germany. maria.hahnemann@ukbonn.de.
Insights
Estimating injury age in pediatric abusive head trauma (AHT) is crucial. This study provides reference data on subdural collection imaging, identifying early (tadpole sign) and late (membrane formation) indicators for forensic analysis.
Area of Science:
- Forensic Radiology
- Pediatric Traumatology
- Neuroradiology
Background:
- Estimating injury age in pediatric abusive head trauma (AHT) is critical for legal proceedings.
- Subdural collections (SDCs) are common in AHT, but their temporal imaging development is not well-established.
- Reliable age-diagnostic data for SDCs is sparse, hindering expert opinions.
Purpose of the Study:
- To describe the temporal evolution of imaging features in subdural collections (SDCs) in pediatric abusive head trauma (AHT).
- To establish novel age-diagnostic reference data for SDCs in forensic-radiological assessments.
- To aid in the identification of perpetrators by refining injury age estimation.
Main Methods:
- Multi-center, 10-year study analyzing serial neuroimaging (CT and MRI) of 13 confirmed AHT cases.
- Detailed analysis of SDC imaging parameters, including appearance, entities, components, and associated findings.
- Correlation of imaging findings with precisely known trauma time points based on perpetrator confessions.
Main Results:
- Hyperdense SDCs on CT observed up to 9 days post-injury (p.i.).
- CSF-like SDCs and the 'tadpole sign' on CT/MRI identified as early as 3 hours p.i.
- Subdural membrane formation observed as a late finding, from day 283 p.i.; heterogeneous subdural hematohygroma dominant between 3 hours and 22 days p.i.
Conclusions:
- Specific subdural imaging findings can aid in estimating injury age in pediatric AHT.
- Subdural membrane formation is a late indicator, while the tadpole sign is an early phenomenon.
- Sediment analysis of SDCs shows potential for age-diagnostic value, unlike the supernatant.
Objectives:
Estimating the age of injury in pediatric abusive head trauma (AHT) is a challenging task but potentially valuable for the identification of perpetrators. The aims of the study are (1) to describe the temporal development of different imaging features of subdural collections (SDCs), and (2) to provide novel age-diagnostic reference data for forensic-radiological expert reports.
Methods:
Using a multi-center approach and a 10-year study period, serial neuroimaging studies of 13 comprehensively investigated AHT cases (8 CT and 26 MRI scans) were analyzed regarding several subdural imaging parameters (SDC appearances, entities, components, and associated findings). Due to confessions by perpetrators, the time points of the trauma were presumed unique and known in all cases facilitating correlation of imaging findings with time.
Results:
Hyperdense SDCs in CT were found up to 9 d post-injury (p.i.), CSF-like SDCs in CT or MRI as early as from the 3rd hour p.i., and subdural membrane formation as late as from day 283. The heterogeneous variant of the subdural hematohygroma was observed to be the dominant SDC entity between 3 h and 22 d p.i. The tadpole sign was detected in MRI between 3 h and 46 d p.i.
Conclusion:
Certain subdural imaging findings may be helpful for estimating the age of injury in AHT. Subdural membrane formation is demonstrated to be a late finding and the tadpole sign is an early phenomenon p.i. The data corroborated that the sediment but not the supernatant has the potential for being valuable for age-diagnostic aspects.
Key Points:
Question Reliable evidence-based data on the development of SDCs is sparse but required for expert opinions on pediatric AHT. Findings Reference data on the evolution of the imaging appearance of SDCs and associated phenomena in confirmed cases of AHT are provided. Clinical relevance As there is a great need for estimating the age of injury in criminal and civil proceedings, many clinical radiologists are confronted with the diagnostic and forensic aspects of AHT that are addressed in the present study.
