title: Limitations of T2*-Gradient Recalled-Echo and Susceptibility-Weighted Imaging in Characterizing Chronic Subdural Hemorrhage in Infant Survivors of Abusive Head Trauma.
abstract: A possible misconception among radiologists is that chronic subdural hemorrhage should show some degree of blooming on T2*-gradient recalled-echo or susceptibility-weighted sequences such as SWI and susceptibility-weighted angiography, which is not necessarily true. We present 5 cases of chronic subdural hemorrhages in infants, demonstrating intensity near or greater than that of CSF with variable amounts of hemosiderin staining along the neomembranes. We review the physiology and MR imaging physics behind the appearance of a chronic subdural hemorrhage, highlighting that the absence of a BBB can allow hemosiderin to be completely removed from the subdural compartment. Finally, we stress the importance of reviewing all multiplanar sequences for the presence of neomembranes, which can be quite subtle in the absence of hemosiderin staining and are critical for making the diagnosis of chronic subdural hemorrhage.
authors.affiliation: From the Department of Radiology (J.A.C., U.A.R.), University of Utah Hospital, Salt Lake City, Utah jcramer10@gmail.com.
authors.forename: J A
authors.identifier: 0000-0003-0350-184X
authors.initials: JA
authors.lastname: Cramer
authors.affiliation: From the Department of Radiology (J.A.C., U.A.R.), University of Utah Hospital, Salt Lake City, Utah.
authors.forename: U A
authors.identifier: 0000-0002-0408-9749
authors.initials: UA
authors.lastname: Rassner
authors.affiliation: Department of Radiology (G.L.H.), Primary Children's Hospital, Salt Lake City, Utah.
authors.forename: G L
authors.identifier: 0000-0003-1727-0683
authors.initials: GL
authors.lastname: Hedlund
mesh_terms: D001812:Blood-Brain Barrier / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D002649:Child Abuse; D006259:Craniocerebral Trauma / Q000134:cerebrospinal fluid / Q000000981:diagnostic imaging*; D017352:Echo-Planar Imaging; D005260:Female; D020200:Hematoma, Subdural, Chronic / Q000134:cerebrospinal fluid / Q000000981:diagnostic imaging; D006485:Hemosiderin / Q000378:metabolism; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D017741:Survivors
chemical_list: D006485:Hemosiderin