Imaging abusive head trauma: why use both computed tomography and magnetic resonance imaging?
Imaging abusive head trauma: why use both computed tomography and magnetic resonance imaging?
复制标题
对虐待性头部外伤进行成像：为什么同时使用计算机断层扫描和磁共振成像？
作者：
É. Vázquez;I. Delgado;Á. Sánchez;A. Fábrega;P. Cano;N. Martin
虐待头部创伤是虐待儿童案件中死亡的主要原因。大多数受害者是1岁以下的婴儿，平均年龄在3至8个月之间，尽管这些伤害可以在5岁以下的儿童中看到。许多受害者有以前的虐待史，诊断往往被推迟。神经影像学检查通常对确立虐待性头部创伤的诊断至关重要，因为它在37%的病例中发现了隐匿性损伤。几种成像模式被认为与虐待性头部创伤特别相关。硬膜下血肿的存在，尤其是在多个位置，如半球间区域，凸面上方和后颅窝，与虐待性头部创伤显著相关。虽然CT是推荐的怀疑虐待性头部创伤的一线成像方式，早期MRI越来越多地与CT一起使用，因为它提供了更好的估计剪切损伤，缺氧缺血性损伤和病变的时间。本文提出了一个审查的使用和临床适应症的最相关的神经影像学模式的诊断虐待性头部创伤，强调更新和更敏感的技术，可能是有用的，以更好地表征性质和演变的伤害。
Abusive head trauma is the leading cause of death in child abuse cases. The majority of victims are infants younger than 1 year old, with the average age between 3 and 8 months, although these injuries can be seen in children up to 5 years old. Many victims have a history of previous abuse and the diagnosis is frequently delayed. Neuroimaging is often crucial for establishing the diagnosis of abusive head trauma as it detects occult injury in 37% of cases. Several imaging patterns are considered to be particularly associated with abusive head trauma. The presence of subdural hematoma, especially in multiple locations, such as the interhemispheric region, over the convexity and in the posterior fossa, is significantly associated with abusive head trauma. Although CT is the recommended first-line imaging modality for suspected abusive head trauma, early MRI is increasingly used alongside CT because it provides a better estimation of shear injuries, hypoxic-ischemic insult and the timing of lesions. This article presents a review of the use and clinical indications of the most pertinent neuroimaging modalities for the diagnosis of abusive head trauma, emphasizing the newer and more sensitive techniques that may be useful to better characterize the nature and evolution of the injury.