Arterial spin-labeling perfusion imaging of children with subdural hemorrhage: Perfusion abnormalities in abusive head trauma

Alex Mun Ching Wong, Chih Hua Yeh, Ho Ling Liu, Tai Wei Wu, Kuang Lin Lin, Huei Shyong Wang, Cheng Hong Toh*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

23 Scopus citations

Abstract

Background and purpose Perfusion abnormalities have not been well described in children with subdural hemorrhage (SDH). We investigated whether patients with abusive head trauma (AHT+) had more perfusion abnormalities than those without (AHT−). Materials and methods We reviewed the perfusion MR studies of 12 infants with SDH and 21 controls. The perfusion images were obtained using a pseudo-continuous arterial spin-labeling sequence with volumetric fast spin-echo readout. An MR perfusion scoring system (0–6 points) was devised to facilitate appraisal of the extent of abnormalities. An asymmetry index (AI) was calculated for each region of perfusion abnormality. Comparison of perfusion scores across the AHT+, AHT−, and control groups was performed. The AIs of the hypoperfused lesions and hyperperfused lesions in patients were separately compared with those of the controls. The neurological outcomes of the patients were associated with imaging abnormalities. Results Perfusion abnormalities were found in five (83%) of six AHT+ patients and in one (17%) of six AHT− patients. The AHT+ group recorded a significantly higher perfusion score than did both the AHT− group and the controls. Four patients with hypoperfused lesions exhibited significantly lower AI (P = .002) than did the controls, and three patients with hyperperfused lesions had significantly higher AI (P = .006) than did the controls. Of the four patients with hypoperfused lesions, two expired and one experienced hemiparesis. Conclusions Patients with AHT have higher perfusion abnormality scores than patients with other causes of SDH and controls. Moreover, hypoperfusion may suggest a poor clinical outcome.

Original languageEnglish
Pages (from-to)281-287
Number of pages7
JournalJournal of Neuroradiology
Volume44
Issue number4
DOIs
StatePublished - 07 2017

Bibliographical note

Publisher Copyright:
© 2017 Elsevier Masson SAS

Keywords

  • Abusive head trauma
  • Arterial spin-labeling perfusion imaging
  • Subdural hemorrhage

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