Multifocal Signal Loss at Bridging Veins on Susceptibility-Weighted Imaging in Abusive Head Trauma.
Identifying abusive head trauma (AHT) in infants is difficult because often there are no externally visible injuries and symptoms are nonspecific. The radiological finding that usually raises suspicion of AHT--especially when found with retinal hemorrhage and inappropriate history--is subdural hematoma (SDH). In addition to that, bridging vein thrombosis, assessed by imaging or autopsy, has been reported as a sign of the traumatic cause of SDH. Here we present two cases of AHT-associated SDH in infants, in which multifocal signal loss at bridging veins was present on susceptibility-weighted imaging without signs of venous infarction. As susceptibility-weighted imaging has been reported to be more sensitive for blood products than gradient-echo T2-weighted imaging, we propose that it might help to identify clot formation on injured bridging veins and therefore increase the sensitivity of imaging studies for a traumatic cause of SDH, helping to identify AHT that is considered to be caused by violent shaking.
Department of Neuroradiology, Saarland University Hospital, Kirrberger Str., 66424, Homburg, Germany, umut.yilmaz@uks.eu.
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U
Yilmaz
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Körner
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S
Meyer
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W
Reith
D002550:Cerebral Veins / Q000293:injuries* / Q000473:pathology*; D002649:Child Abuse / Q000175:diagnosis*; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging; D004292:Dominance, Cerebral / Q000502:physiology; D005260:Female; D005625:Frontal Lobe / Q000098:blood supply / Q000473:pathology; D016489:Head Injuries, Closed / Q000175:diagnosis*; D020199:Hematoma, Subdural, Acute / Q000175:diagnosis*; D006801:Humans; D007089:Image Enhancement; D007091:Image Processing, Computer-Assisted; D007223:Infant; D020767:Intracranial Thrombosis / Q000175:diagnosis*; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D010296:Parietal Lobe / Q000098:blood supply / Q000473:pathology; D012166:Retinal Hemorrhage / Q000175:diagnosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D038642:Shaken Baby Syndrome / Q000175:diagnosis; D013346:Subarachnoid Space / Q000473:pathology; D020246:Venous Thrombosis / Q000175:diagnosis*