16个月大的男婴，孕28周出生，出现不明原因的面部烧伤:同时有不明原因的肋骨、肱骨和胫骨骨折，三次颅骨骨折，严重急性缺氧脑损伤伴小脑幕疝，脑半球间镰和天幕硬膜下血肿。被诊断为虐待性头部创伤的儿童。A.全脊柱MRI的矢状STIR图像显示颈韧带水肿，与韧带损伤一致(箭头)，硬膜外血肿沿胸椎延伸(箭头)，与T4至T7压缩性骨折相关(矩形)。胸腰椎孤立的硬膜外血肿。B.胸椎侧位片临床解释为阴性脊柱骨折。C. L4轴位梯度回忆t2加权MR图像显示后部血肿清除硬膜外脂肪，与硬膜外血肿一致(箭头)。
January 12, 2022 —According to an article in ARRS’ American Journal of Roentgenology (AJR),whole-spineMRIcommonly demonstrates isolated thoracolumbar injuries in children with suspected abusive head trauma.
“When performing spine MRI in children with suspected abusive head trauma, whole-spine MRI rather than cervical spine MRI may be warranted, to avoid missing isolated thoracolumbar injuries,” clarified first authorBoaz Karmazynfrom Indiana University School of Medicine,Riley Hospital for Children.
Karmazyn和团队的回顾性研究包括256名儿童(170名男孩，86名女孩;mean age, 5.9 months) who, from January 2019 to December 2020, underwent skeletal survey and head MRI for suspectedchild abuse. Children with suspected abusive head trauma also underwent whole-spine MRI, per institutional protocol. Diagnoses for abusive head trauma were established via clinical record review, as well as injuries described in skeletal survey, head MRI, and head CT (if performed) reports.
He also had unexplained rib, humerus, and tibial fractures, three skull fractures, severe acute hypoxic brain injury with transtentorial herniation, and intracranial subdural hematoma in interhemispheric falx and tentorium. Child diagnosed with abusive head trauma. A. Sagittal STIR image from whole-spine MRI demonstrates edema in nuchal ligament consistent with ligamentous injury (arrow) and epidural hematoma extending along thoracic spine (arrowhead), associated with compression fractures from T4 to T7 (rectangle). Epidural hematoma isolated to thoracolumbar spine. B. Lateral radiograph of thoracic spine clinically interpreted as negative for spine fracture. C. Axial gradient-recalled echo T2-weighted MR image at L4 demonstrates posterior hematoma obliterating epidural fat, consistent with epidural hematoma (arrow).
Of the 148 total children with suspected abusive head trauma who underwent whole-spine MRI, 23.0% of examinations demonstrated injuries localized to the thoracolumbar spine. Injuries were localized to the thoracolumbar spine in 51.1% of examinations with major findings: subdural hematoma, epidural hematoma, ligamentous injury, or fracture not identified by skeletal survey.
“This study represents the largest reported series to our knowledge of children with suspected abusive head trauma who were evaluated by whole-spine MRI,”added the authors of this AJR article.
An electronic supplement to this AJR article is availablehere.
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