New research supports incorporating whole-spine MRI into examination protocols for pediatric patients that present with suspected abusive head trauma (AHT).
Currently, most protocols for child abuse victims with AHT include a skeletal survey. But in recent years, cervical MRIs have been incorporated for the evaluation of additional ligament injuries or spinal subdural hematomas. These findings are more often related to abuse than accidental trauma, which has prompted many institutions to incorporate cervical MRIs into their AHT protocols.
"As pathognomonic injuries for AHT are lacking, the diagnosis is based on a combination of a detailed history, physical examination, and imaging findings that are inconsistent with accidental injuries or any underlying medical condition,” Boaz Karmazyn, MD, with the Department of Radiology and Imaging Sciences at Indiana University School of Medicine, and co-authors explained.
Though professional societies have supported its use, little research on how obtaining a whole-spine MRI on suspected AHT patients is available. The incidence of positive findings on the cervical MRIs of these patients prompted the American Academy of Pediatrics to suggest that whole-spine MRI should be considered, and groups like American College of Radiology and the Royal College of Radiology have followed suit.
To better understand how obtaining these MRIs on AHT patients might unveil additional abnormalities, researchers retrospectively examined 256 cases involving children less than 3-years-old. Out of those children, 148 underwent whole-spine MRI.
AHT was diagnosed in 53.4% of children who had whole-spine MRIs. Imaging revealed that 54 out of 148 kids had additional injuries. “Major findings,” which included subdural hematoma, epidural hematoma, ligamentous injury, and fractures, were found in 47 (31.8%) scans and prompted the doctors to recommend institutions implement whole-spine MRIs into protocols for pediatric AHT patients.
“While practice guidelines have recognized the role of cervical spine MRI in children with suspected AHT, our findings indicate a role for whole-spine MRI, rather than cervical spine MRI, in this setting,” the doctors concluded.
You can read the detailed research in the American Journal of Roentgenology.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She joined Innovate Healthcare in 2021 and has since put her unique expertise to use in her editorial role with Health Imaging.