Imaging the brain in non-accidental head trauma

Article Outline

• Copyright

Inflicted head injury remains a major cause of morbidity and mortality in children, and survivors may be left with significant neurologic disability. In this issue of The Journal, Sundgren et al in Michigan examine the roles of two imaging modalities—computed tomography (CT) and magnetic resonance imaging (MRI)—in the evaluation of 57 children with suspected non-accidental head injury.

In terms of making the diagnosis, both modalities work well; only one of the 47 children with both studies had an important finding by MRI which was not detected by CT. Similarly, CT was quite effective in identifying global ischemia in children who subsequently died from their injury.

On the other hand, there clearly is a role for MRI, in the authors' opinion. In some cases, it demonstrated that extra-axial blood was of differing ages, providing additional support to the diagnosis of inflicted injury. Additionally, MRI may identify some subtle parenchymal changes such as diffuse axonal injury, which may be markers for subsequent neurodevelopmental abnormalities.