Evaluating a novel MR imaging biomarker for retinal hemorrhage

Dilated fundus examination is the clinical reference standard for retinal hemorrhage diagnosis. Obtaining a timely examination may be challenging in emergent and inpatient settings, and retinal hemorrhage may go undetected. An imaging biomarker is therefore desirable.

To evaluate the frequency of ringlets of hyperintensity in orbital fat on axial fat-suppressed T2-weighted fast spin echo MR images in children with ophthalmologically-confirmed retinal hemorrhage and in a comparison group of children with benign macrocrania.

This retrospective single-center study included cases aged > 6 weeks- < 3 years with ophthalmologist-confirmed retinal hemorrhage from 07/2011-12/2019 who underwent full brain MR imaging and reference patients aged > 6 weeks- < 3 years with benign macrocrania who underwent brain MR imaging during the same period. Images were reviewed by two pediatric neuroradiologists blinded to patient group; a subset was randomly selected for duplicate reads. Descriptive data were tabulated for each reviewer and adjudicated results.

After adjudication, ringlets were observed in at least one eye in 67/70 retinal hemorrhage cases (96%) and 3/74 benign macrocrania patients (4%; P < 0.0001). Similar results were observed upon stratification by presence of visible retinal hemorrhage on imaging, and by magnet strength. Intrarater reliability and interrater reliability were high (all κ ≥ 0.86), with concordance rates ≥ 93% across duplicate reads.

Ringlets of hyperintensity are present at high frequency in children with confirmed retinal hemorrhage and are neither an MR imaging artifact, nor a normal developmental finding in infants and young children. As such, they may aid in retinal hemorrhage detection following abusive head trauma.