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Black bone MRI with 3D reconstruction for the detection of skull fractures in children with suspected abusive head trauma

  • Paediatric Neuroradiology
  • Published:
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Abstract

Purpose

The purpose of this study was to determine the accuracy of “black bone” (BB) MRI for the detection of skull fractures in children with potential abusive head trauma.

Methods

A total of 34 pediatric patients were evaluated for potential abusive head trauma. All patients had both a non-contrast head CT (HCT) with multiplanar reformatted images and 3D volumetric reformatted images where available (gold standard) for fracture diagnosis and BB of the head with multiplanar reformatted images and 3D volumetric images. BB was performed using an ultrashort TE pointwise encoding time reduction with radial acquisition (PETRA) sequence at 1.5 T or 3 T. BB datasets were post-processed and 3D images created using Fovia’s High Definition Volume Rendering® software. Two board-certified pediatric neuroradiologists independently reviewed the HCT and BB imaging, blinded to the findings from the other modality.

Results

Median patient age was 4 months (range 1.2–30 months). A total of 20 skull fractures in six patients (18% incidence of skull fractures) were detected on HCT. BB demonstrated 83% sensitivity (95%[CI] 36–99%), 100% specificity (95%[CI] 88–100%), 100% PPV (95%[CI] 46–100%), 97% NPV (95%[CI] 82–99%), and 97% accuracy (95%[CI] 85–99%) for diagnosis of a skull fracture. BB detected 95% (19/20) of the skull fractures detected by CT.

Conclusion

A black bone MRI sequence may provide high sensitivity and specificity for detection of skull fractures in pediatric patients with abusive head trauma.

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Abbreviations

UTE:

Ultrashort TE

PETRA:

Pointwise encoding time reduction with radial acquisition

HCT:

Head CT

AHT:

Abusive head trauma

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Authors and Affiliations

  1. Department of Radiology, Texas Children’s Hospital, 6701 Fannin St, Suite 470, Houston, TX, USA

    Stephen F. Kralik

  2. Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 714 N. Senate Avenue, Indianapolis, IN, USA

    Nucharin Supakul, Isaac C. Wu, Rupa Radhakrishnan & Chang Y. Ho

  3. Department of Radiology, Addenbrooke’s Hospital, University of Cambridge, Hills Road, Cambridge, CB2 0QQ, UK

    Gaspar Delso & Karen A. Eley

Authors
  1. Stephen F. Kralik
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  2. Nucharin Supakul
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  3. Isaac C. Wu
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  4. Gaspar Delso
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  5. Rupa Radhakrishnan
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  6. Chang Y. Ho
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  7. Karen A. Eley
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Corresponding author

Correspondence to Stephen F. Kralik.

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Funding

No funding was received for this study.

Conflict of interest

GD is employed by GE Healthcare.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of retrospective study formal consent is not required.

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Kralik, S.F., Supakul, N., Wu, I.C. et al. Black bone MRI with 3D reconstruction for the detection of skull fractures in children with suspected abusive head trauma. Neuroradiology 61, 81–87 (2019). https://doi.org/10.1007/s00234-018-2127-9

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  • DOI: https://doi.org/10.1007/s00234-018-2127-9

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