Nonaccidental Pediatric Head Injury: Diffusion-weighted Imaging Findings
Nonaccidental Pediatric Head Injury: Diffusion-weighted Imaging Findings
复制标题
非意外小儿头部损伤：弥散加权成像结果
作者：
D. Y. Suh;P. Davis;K. Hopkins;N. Fajman;T. Mapstone
目的 弥散加权成像 (DWI) 在传统计算机断层扫描或磁共振成像 (MRI) 之前数小时至数天揭示非出血性创伤后梗塞。我们评估了 DWI 对非意外头部外伤儿童的诊断效用。方法对1998年1月至2000年5月期间所有疑似非意外性头部损伤的2岁以下儿童的病历和影像学检查进行回顾性分析。该研究纳入了 20 名在就诊后 5 天内接受过 DWI 的儿童。对计算机断层扫描、常规 MRI 序列以及 DWI 与表观扩散系数 (ADC) 图相结合进行了评估。结果 对 11 名女孩和 9 名男孩（中位年龄 5 个月）进行了研究。十八名儿童被推定为非意外头部外伤，两名儿童疑似非意外头部外伤。在 18 名疑似非意外创伤的儿童中，有 16 名 (89%) 在 DWI/ADC 上表现出异常，而两名疑似非意外创伤的儿童均未出现异常。在 16 例阳性病例中，有 13 例 (81%) 的 DWI 显示比传统 MRI 序列显示的更广泛的脑损伤，或显示传统 MRI 未观察到的损伤。 DWI 与 ADC 图相结合可以更好地描绘白质损伤的程度。非意外头部受伤儿童的 DWI/ADC 异常可能涉及大脑半球的后部，而额叶和颞极相对较少。 DWI 的严重程度与不良结果显着相关（P < 0.005）。结论 DWI 在非意外性颅脑损伤儿童梗死的早期检测中具有广泛的应用，并提高了常规 MRI 的敏感性。在本研究的患者中，早期 DWI 提供了比任何其他成像方式更完整的严重程度指标。 DWI 的使用可能有助于识别预后不良的高风险儿童并指导管理决策。
OBJECTIVEDiffusion-weighted imaging (DWI) reveals nonhemorrhagic posttraumatic infarction hours to days before conventional computed tomographic scanning or magnetic resonance imaging (MRI). We evaluated the diagnostic utility of DWI in children with nonaccidental head trauma. METHODSThe medical records and imaging examinations obtained between January 1998 and May 2000 for all children less than 2 years of age with presumed or suspected nonaccidental head injury were reviewed retrospectively. Twenty children who had undergone DWI within 5 days of presentation were included in the study. Computed tomographic scans, conventional MRI sequences, and DWI combined with apparent diffusion coefficient (ADC) maps were evaluated. RESULTSEleven girls and nine boys (median age, 5 mo) were studied. Eighteen children had presumed nonaccidental head trauma, and two children had suspected nonaccidental head trauma. Of the 18 children with presumed nonaccidental trauma, 16 (89%) demonstrated abnormalities on DWI/ADC, as compared with neither of the two children with suspected nonaccidental trauma. In 13 (81%) of 16 positive cases, DWI revealed more extensive brain injury than was demonstrated on conventional MRI sequences or showed injuries not observed on conventional MRI. DWI combined with ADC maps allowed better delineation of the extent of white matter injury. DWI/ADC abnormalities in the nonaccidental head-injured children were likely to involve posterior aspects of the cerebral hemispheres, with relative sparing of the frontal and temporal poles. Severity on DWI correlated significantly with poor outcome (P < 0.005). CONCLUSIONDWI has broad applications in the early detection of infarction in children with nonaccidental head injury and enhances the sensitivity of conventional MRI. In the patients in this study, early DWI provided an indicator of severity that was more complete than any other imaging modality. The use of DWI may help to identify children at high risk for poor outcome and to guide management decisions.
登录
查看更多内容
影响因子：
8.3
作者：
WELCH, KMA;WINDHAM, J;LEVINE, SR
通讯作者：
LEVINE, SR
影响因子：
2.9
作者：
Rivers, CS;Wardlaw, JM
通讯作者：
Wardlaw, JM
影响因子：
4.1
作者：
Duhaime, AC;Margulies, SS;Raghupathi, R
通讯作者：
Raghupathi, R
影响因子：
0.7
作者：
David P. Adelson;B. Clyde;P. Kochanek;S. Wisniewski;D. Marion;H. Yonas
通讯作者：
David P. Adelson;B. Clyde;P. Kochanek;S. Wisniewski;D. Marion;H. Yonas
用于评估创伤性脑损伤的新磁共振成像技术。
DOI：
10.1089/neu.1995.12.573
发表时间：
1995
期刊：
Journal of neurotrauma.
影响因子：
--
作者：
Smith,DH;Meaney,DF;Lenkinski,RE;Alsop,DC;Grossman,R;Kimura,H;McIntosh,TK;Gennarelli,TA
通讯作者：
Gennarelli,TA