Pediatric Central Nervous System Imaging of Nonaccidental Trauma: Beyond Subdural Hematomas
Pediatric Central Nervous System Imaging of Nonaccidental Trauma: Beyond Subdural Hematomas
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DOI：
10.1148/rg.2019180084
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发表时间：
2019-01-01
期刊：
影响因子：
5.5
通讯作者：
Alleman, Anthony M.
中科院分区：
文献类型：
--
作者：
Gunda, Divya;Cornwell, Benjamin O.;Alleman, Anthony M.
婴儿和2岁以下的儿童在非意外创伤后发生破坏性神经系统并发症的风险最大。虽然硬膜下血肿（SDH）是最常见的发现，往往足以引起虐待的怀疑，没有单一的伤害是虐待性头部创伤（AHT）的特征。相反，影像学和物理结果和临床表现的结合有助于确认AHT的诊断。熟悉的频谱的结果和正确识别的成像异常是重要的放射科医生，以促进治疗和患者从虐待的环境中删除。损伤通常是由于震动，包括过度屈曲，过度伸展和旋转力，以及不太常见的撞击创伤或两者的组合。婴儿头部、颈部和脊柱独特的关键解剖特征以及相关的生物力学力是造成缺氧缺血性损伤、桥静脉血栓形成、SDH、实质撕裂以及脊柱和视网膜损伤等实体的原因。虽然软膜下出血与AHT的关系尚未研究，但在遭受意外或创伤的非常年幼的婴儿中值得注意。头部CT和脑部及颈椎MRI的结合有助于准确诊断、适当管理和后续保护这些患者。(C)RSNA，2018年。
Infants and children under 2 years of age are at greatest risk for devastating neurologic complications following nonaccidental trauma. While a subdural hematoma (SDH) is the most common finding and is often enough to raise suspicion for abuse, no single injury is pathognomonic for abusive head trauma (AHT). Rather, the combination of imaging and physical findings and the clinical presentation help confirm the diagnosis of AHT. Familiarity with the spectrum of findings and proper identification of the imaging abnormalities is important for the radiologist to facilitate treatment and removal of the patient from the abusive environment. Injury is usually a result of shaking, which includes hyperflexion, hyperextension, and rotational forces, and less commonly impact trauma or a combination of both. Key anatomic features unique to the infant's head, neck, and spine and associated biomechanical forces are responsible for entities such as hypoxic ischemic injury, bridging vein thrombosis, SDH, parenchymal lacerations, and spinal and retinal injuries. Although the association of subpial hemorrhage with AHT has not been investigated, it warrants attention in very young infants who endure accidental or inflicted trauma. A combination of CT of the head and MRI of the brain and cervical spine aids in the accurate diagnosis, appropriate management, and subsequent protection of these patients. (C) RSNA, 2018.