title: Age determination of subdural hematomas with CT and MRI: a systematic review.
abstract: OBJECTIVE
  To systematically review the literature on dating subdural hematomas (SDHs) on CT and MRI scans.
  
  
  METHODS
  We performed a systematic review in MEDLINE, EMBASE and Cochrane to search for articles that described the appearance of SDHs on CT or MRI in relation to time between trauma and scanning. Two researchers independently screened the articles, assessed methodological quality and performed data extraction. Medians with interquartile ranges were calculated. Differences were tested with a Mann-Whitney U or Kruskal-Wallis H test.
  
  
  RESULTS
  We included 22 studies describing 973 SDHs on CT and 4 studies describing 83 SDHs on MRI. Data from 17 studies (413 SDHs) could be pooled. There were significant differences between time intervals for the different densities on CT (p<0.001). Time interval differed significantly between children and adults for iso- and hypodensity (p=0.000) and hyperdensity (p=0.046). Time interval did not differ significantly between abused and non-abused children. On MRI, time intervals for different signal intensities on T1 and T2 did not differ significantly (p=0.108 and p=0.194, respectively).
  
  
  CONCLUSIONS
  Most time intervals of the different appearances of SDHs on CT and MRI are broad and overlapping. Therefore CT or MRI findings cannot be used to accurately date SDHs.
authors.affiliation: Section of Forensic Pediatrics, Department of Forensic Medicine, Netherlands Forensic Institute, PO Box 24044, 2490 AA The Hague, The Netherlands; Department of Radiology, Academic Medical Center/Emma Children's Hospital, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Electronic address: t.sieswerda@amc.nl.
authors.forename: Tessa
authors.initials: T
authors.lastname: Sieswerda-Hoogendoorn
authors.affiliation: Faculty of Medicine, University of Amsterdam, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Electronic address: f.a.postema@amc.nl.
authors.forename: Floor A M
authors.initials: FAM
authors.lastname: Postema
authors.affiliation: Department of Neurosurgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Electronic address: d.verbaan@amc.nl.
authors.forename: Dagmar
authors.initials: D
authors.lastname: Verbaan
authors.affiliation: Department of Radiology, Academic Medical Center/Emma Children's Hospital, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Electronic address: c.b.majoie@amc.nl.
authors.forename: Charles B
authors.initials: CB
authors.lastname: Majoie
authors.affiliation: Section of Forensic Pediatrics, Department of Forensic Medicine, Netherlands Forensic Institute, PO Box 24044, 2490 AA The Hague, The Netherlands; Department of Radiology, Academic Medical Center/Emma Children's Hospital, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Electronic address: r.r.vanrijn@amc.nl.
authors.forename: Rick R
authors.initials: RR
authors.lastname: van Rijn
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002649:Child Abuse / Q000175:diagnosis* / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003951:Diagnostic Errors; D005260:Female; D006408:Hematoma, Subdural / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008297:Male; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*
keywords: Age determination; Hematoma, Subdural; Magnetic resonance imaging; Tomography, X-ray computed