Susceptibility-weighted imaging of retinal hemorrhages in abusive head trauma

Research output: Contribution to journalArticle

Abstract

Background: Retinal hemorrhages are one of the most important supportive evidences for abusive head trauma (AHT). Susceptibility-weighted imaging (SWI) is highly suited to identify various forms of intracranial hemorrhage in AHT. However its utility in imaging retinal hemorrhage is not well established. Objective: SWI is a sensitive sequence for identifying retinal hemorrhage on MRI. Materials and methods: In this retrospective analysis, 26 consecutive infants and young children with a suspected admission diagnosis of AHT underwent indirect ophthalmoscopy and brain MRI protocol for AHT along with SWI. Brain susceptibility-weighted images of 14 age-matched children were used as controls. For detecting retinal hemorrhage, susceptibility-weighted images of patients and controls were reviewed randomly and independently by two neuroradiologists who were blinded to the history and ophthalmology findings. A pediatric ophthalmologist graded the indirect ophthalmoscopy images. Results: A diagnosis of AHT was confirmed in all 26 cases from a multidisciplinary meeting. Indirect ophthalmoscopy images were available in 21 cases. Ophthalmoscopy was positive for retinal hemorrhage in the right eye in 18 cases (85.7%) and in the left eye in 16 cases (76.2%). On SWI, retinal hemorrhage was identified in the right eye in 9/21 cases (42.8%) and in the left eye in 8/21 cases (38.1%) of AHT. Analysis of SWI in 21 cases of AHT demonstrated a sensitivity of 50%, specificity of 100%, positive predictive value of 100% and negative predictive value of 32% for detecting retinal hemorrhage. Conclusion: SWI is moderately sensitive and highly specific for identifying retinal hemorrhage in AHT. Further studies are needed to identify steps to improve the efficiency of SWI in detecting retinal hemorrhage.

Original languageEnglish (US)
Pages (from-to)210-216
Number of pages7
JournalPediatric Radiology
Volume49
Issue number2
DOIs
StatePublished - Feb 7 2019

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Retinal Hemorrhage
Craniocerebral Trauma
Ophthalmoscopy
Intracranial Hemorrhages
Brain
Ophthalmology
History
Pediatrics
Sensitivity and Specificity

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Radiology Nuclear Medicine and imaging

Cite this

@article{bac0a31c21694afb9e071ce85de8a2cf,
title = "Susceptibility-weighted imaging of retinal hemorrhages in abusive head trauma",
abstract = "Background: Retinal hemorrhages are one of the most important supportive evidences for abusive head trauma (AHT). Susceptibility-weighted imaging (SWI) is highly suited to identify various forms of intracranial hemorrhage in AHT. However its utility in imaging retinal hemorrhage is not well established. Objective: SWI is a sensitive sequence for identifying retinal hemorrhage on MRI. Materials and methods: In this retrospective analysis, 26 consecutive infants and young children with a suspected admission diagnosis of AHT underwent indirect ophthalmoscopy and brain MRI protocol for AHT along with SWI. Brain susceptibility-weighted images of 14 age-matched children were used as controls. For detecting retinal hemorrhage, susceptibility-weighted images of patients and controls were reviewed randomly and independently by two neuroradiologists who were blinded to the history and ophthalmology findings. A pediatric ophthalmologist graded the indirect ophthalmoscopy images. Results: A diagnosis of AHT was confirmed in all 26 cases from a multidisciplinary meeting. Indirect ophthalmoscopy images were available in 21 cases. Ophthalmoscopy was positive for retinal hemorrhage in the right eye in 18 cases (85.7{\%}) and in the left eye in 16 cases (76.2{\%}). On SWI, retinal hemorrhage was identified in the right eye in 9/21 cases (42.8{\%}) and in the left eye in 8/21 cases (38.1{\%}) of AHT. Analysis of SWI in 21 cases of AHT demonstrated a sensitivity of 50{\%}, specificity of 100{\%}, positive predictive value of 100{\%} and negative predictive value of 32{\%} for detecting retinal hemorrhage. Conclusion: SWI is moderately sensitive and highly specific for identifying retinal hemorrhage in AHT. Further studies are needed to identify steps to improve the efficiency of SWI in detecting retinal hemorrhage.",
author = "Krishnamoorthy Thamburaj and Ajay Soni and Lori Frasier and Tun, {Kyaw N.} and Weber, {Sarah R.} and Mark Dias",
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Susceptibility-weighted imaging of retinal hemorrhages in abusive head trauma. / Thamburaj, Krishnamoorthy; Soni, Ajay; Frasier, Lori; Tun, Kyaw N.; Weber, Sarah R.; Dias, Mark.

In: Pediatric Radiology, Vol. 49, No. 2, 07.02.2019, p. 210-216.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Susceptibility-weighted imaging of retinal hemorrhages in abusive head trauma

AU - Thamburaj, Krishnamoorthy

AU - Soni, Ajay

AU - Frasier, Lori

AU - Tun, Kyaw N.

AU - Weber, Sarah R.

AU - Dias, Mark

PY - 2019/2/7

Y1 - 2019/2/7

N2 - Background: Retinal hemorrhages are one of the most important supportive evidences for abusive head trauma (AHT). Susceptibility-weighted imaging (SWI) is highly suited to identify various forms of intracranial hemorrhage in AHT. However its utility in imaging retinal hemorrhage is not well established. Objective: SWI is a sensitive sequence for identifying retinal hemorrhage on MRI. Materials and methods: In this retrospective analysis, 26 consecutive infants and young children with a suspected admission diagnosis of AHT underwent indirect ophthalmoscopy and brain MRI protocol for AHT along with SWI. Brain susceptibility-weighted images of 14 age-matched children were used as controls. For detecting retinal hemorrhage, susceptibility-weighted images of patients and controls were reviewed randomly and independently by two neuroradiologists who were blinded to the history and ophthalmology findings. A pediatric ophthalmologist graded the indirect ophthalmoscopy images. Results: A diagnosis of AHT was confirmed in all 26 cases from a multidisciplinary meeting. Indirect ophthalmoscopy images were available in 21 cases. Ophthalmoscopy was positive for retinal hemorrhage in the right eye in 18 cases (85.7%) and in the left eye in 16 cases (76.2%). On SWI, retinal hemorrhage was identified in the right eye in 9/21 cases (42.8%) and in the left eye in 8/21 cases (38.1%) of AHT. Analysis of SWI in 21 cases of AHT demonstrated a sensitivity of 50%, specificity of 100%, positive predictive value of 100% and negative predictive value of 32% for detecting retinal hemorrhage. Conclusion: SWI is moderately sensitive and highly specific for identifying retinal hemorrhage in AHT. Further studies are needed to identify steps to improve the efficiency of SWI in detecting retinal hemorrhage.

AB - Background: Retinal hemorrhages are one of the most important supportive evidences for abusive head trauma (AHT). Susceptibility-weighted imaging (SWI) is highly suited to identify various forms of intracranial hemorrhage in AHT. However its utility in imaging retinal hemorrhage is not well established. Objective: SWI is a sensitive sequence for identifying retinal hemorrhage on MRI. Materials and methods: In this retrospective analysis, 26 consecutive infants and young children with a suspected admission diagnosis of AHT underwent indirect ophthalmoscopy and brain MRI protocol for AHT along with SWI. Brain susceptibility-weighted images of 14 age-matched children were used as controls. For detecting retinal hemorrhage, susceptibility-weighted images of patients and controls were reviewed randomly and independently by two neuroradiologists who were blinded to the history and ophthalmology findings. A pediatric ophthalmologist graded the indirect ophthalmoscopy images. Results: A diagnosis of AHT was confirmed in all 26 cases from a multidisciplinary meeting. Indirect ophthalmoscopy images were available in 21 cases. Ophthalmoscopy was positive for retinal hemorrhage in the right eye in 18 cases (85.7%) and in the left eye in 16 cases (76.2%). On SWI, retinal hemorrhage was identified in the right eye in 9/21 cases (42.8%) and in the left eye in 8/21 cases (38.1%) of AHT. Analysis of SWI in 21 cases of AHT demonstrated a sensitivity of 50%, specificity of 100%, positive predictive value of 100% and negative predictive value of 32% for detecting retinal hemorrhage. Conclusion: SWI is moderately sensitive and highly specific for identifying retinal hemorrhage in AHT. Further studies are needed to identify steps to improve the efficiency of SWI in detecting retinal hemorrhage.

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