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Utility of three-dimensional and reformatted head computed tomography images in the evaluation of pediatric abusive head trauma

  • Child abuse imaging
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Abstract

Skull fractures are common in the pediatric population following head trauma and are estimated to occur post head trauma in 11% of children younger than 2 years. A skull fracture indicates potential underlying intracranial injury and might also help explain the mechanism of injury. Multiple primary and accessory sutures complicate the identification of non-depressed fractures in children younger than 2 years. Detection of linear skull fractures can be difficult on two-dimensional (2-D) CT and can be missed, particularly when the fracture is along the plane of image reconstruction. Knowledge of primary and accessory sutures as well as normal anatomical variants is of paramount importance in identifying pediatric skull fractures with a greater degree of confidence. Acute fractures appear as lucent cortical defects that do not have sclerotic borders, in contrast to sutures, which might demonstrate sclerotic margins. Three-dimensional (3-D) CT has increased sensitivity and specificity for detecting skull fractures and is essential in the evaluation of pediatric head CTs for distinguishing subtle fractures from sutural variants, especially in the setting of trauma. In this review, we present our experience of the use of 3-D reformats in head CT and its implications on the interpretation, especially in the setting of accidental or abusive head trauma.

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References

  1. Orman G, Wagner MW, Seeburg D et al (2015) Pediatric skull fracture diagnosis: should 3D CT reconstructions be added as routine imaging? J Neurosurg Pediatr 16:426–431

    Article  Google Scholar 

  2. Sim SY, Kim HG, Yoon SH et al (2017) Reappraisal of pediatric diastatic skull fractures in the 3-dimensional CT era: clinical characteristics and comparison of diagnostic accuracy of simple skull X-ray, 2-dimensional CT, and 3-dimensional CT. World Neurosurg 108:399–406

    Article  Google Scholar 

  3. O’Brien WT, Caré MM, Leach JL (2018) Pediatric emergencies: imaging of pediatric head trauma. Semin Ultrasound CT MRI 39:495–514

    Article  Google Scholar 

  4. Hsieh KL-C, Zimmerman RA, Kao HW, Chen C-Y (2015) Revisiting neuroimaging of abusive head trauma in infants and young children. AJR Am J Roentgenol 204:944–952

    Article  Google Scholar 

  5. Parisi MT, Wiester RT, Done SL et al (2015) Three-dimensional computed tomography skull reconstructions as an aid to child abuse evaluations. Pediatr Emerg Care 31:779–786

    Article  Google Scholar 

  6. Choudhary AK, Jha B, Boal DK, Dias M (2010) Occipital sutures and its variations: the value of 3D-CT and how to differentiate it from fractures using 3D-CT? [sic] Surg Radiol Anat 32:807–816

  7. Idriz S, Patel JH, Renani SA et al (2015) CT of normal developmental and variant anatomy of the pediatric skull: distinguishing trauma from normality. Radiographics 35:1585–1601

    Article  Google Scholar 

  8. Marti B, Sirinelli D, Maurin L, Carpentier E (2013) Wormian bones in a general paediatric population. Diagn Interv Imaging 94:428–432

    Article  CAS  Google Scholar 

  9. Shoja MM, Ramdhan R, Jensen CJ et al (2018) Embryology of the craniocervical junction and posterior cranial fossa, part I: development of the upper vertebrae and skull. Clin Anat 31:466–487

    Article  Google Scholar 

  10. Sanchez T, Stewart D, Walvick M, Swischuk L (2010) Skull fracture vs. accessory sutures: how can we tell the difference? Emerg Radiol 17:413–418

    Article  Google Scholar 

  11. Zacharia TT, Nguyen DTD (2010) Subtle pathology detection with multidetector row coronal and sagittal CT reformations in acute head trauma. Emerg Radiol 17:97–102

    Article  Google Scholar 

  12. Wei SC, Ulmer S, Lev MH et al (2010) Value of coronal reformations in the CT evaluation of acute head trauma. AJNR Am J Neuroradiol 31:334–339

    Article  CAS  Google Scholar 

  13. Kleinman PK, Spevak MR (1992) Soft tissue swelling and acute skull fractures. J Pediatr 121:737–739

    Article  CAS  Google Scholar 

  14. Erlichman DB, Blumfield E, Rajpathak S, Weiss A (2010) Association between linear skull fractures and intracranial hemorrhage in children with minor head trauma. Pediatr Radiol 40:1375–1379

    Article  Google Scholar 

  15. Choudhary AK, Servaes S, Slovis TL et al (2018) Consensus statement on abusive head trauma in infants and young children. Pediatr Radiol 48:1048–1065

    Article  Google Scholar 

  16. Kemp AM, Dunstan F, Harrison S et al (2008) Patterns of skeletal fractures in child abuse: systematic review. BMJ 337:859–862

    Article  Google Scholar 

  17. Kelly P, John S, Vincent AL et al (2015) Abusive head trauma and accidental head injury: a 20-year comparative study of referrals to a hospital child protection team. Arch Dis Child 100:1123–1130

    Article  Google Scholar 

  18. Bradford R, Choudhary AK, Dias MS (2013) Serial neuroimaging in infants with abusive head trauma: timing abusive injuries. J Neurosurg Pediatr 12:110–119

    Article  Google Scholar 

  19. Martin A, Paddock M, Johns CS et al (2020) Avoiding skull radiographs in infants with suspected inflicted injury who also undergo head CT: "a no-brainer?" Eur Radiol 30:1480–1487

    Article  Google Scholar 

  20. Culotta PA, Crowe JE, Tran QA et al (2017) Performance of computed tomography of the head to evaluate for skull fractures in infants with suspected non-accidental trauma. Pediatr Radiol 47:74–81

    Article  Google Scholar 

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Correspondence to Rangarajan Purushothaman.

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Dr. Choudhary is a medical expert for child abuse cases.

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Purushothaman, R., Desai, S., Jayappa, S. et al. Utility of three-dimensional and reformatted head computed tomography images in the evaluation of pediatric abusive head trauma. Pediatr Radiol 51, 927–938 (2021). https://doi.org/10.1007/s00247-021-05025-8

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  • DOI: https://doi.org/10.1007/s00247-021-05025-8

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