Neuroimaging of Pediatric Inflicted Injury

Abstract

Head imaging plays an essential role in the workup of an unstable child who presents with signs and symptoms of intracranial injury. Head imaging is important not only for detecting any potential neurosurgical emergency or need for immediate intervention but also in assessing for additional acute or remote intracranial injuries, particularly in children in whom there is a strong suspicion of child abuse. In addition to assisting in directing patient treatment plans, central nervous system (CNS) imaging is also important in aiding investigators in documenting as fully as possible the presence, extent, and timing of injury and to provide objective evidence of inflicted injury to prosecutors. Imaging provides essential data concerning the condition of the brain and spine in the living child, often immediately following the injury – data that cannot be acquired in the postmortem state. Computed tomography (CT) and magnetic resonance imaging (MRI) scans are the main imaging modalities used clinically for detecting intracranial injury. Recent technological advances in neuroimaging have greatly enhanced our ability to identify subtle injuries that may have immediate and long-term consequences. Newer functional neuroimaging techniques (such as perfusion imaging, diffusion tractography, and MR spectroscopy) may lead to an improved understanding of the pathophysiology of nonaccidental intracranial trauma. This chapter will describe in detail each technique and give specific examples relevant to the neuroimaging of inflicted head injury.