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Type:
Educational Exhibit
Keywords:
Education, MR-Diffusion/Perfusion, MR, CT, Trauma, Paediatric
Authors:
F. C. Sarioglu, H. Sahin, Y. Pekcevik, O. Oztekin, O. Sarioglu; Izmir/TR
DOI:
10.1594/ecr2016/C-1022
Background
Trauma is one of the most common cause of child deaths.
In many countries,
vehicle accident and falling are the most common causes of head trauma in pediatric population,
in addition,
drowning is also a cause of traumatic brain injury.
Nonaccidental trauma or child abuse also occurs in infants and it may be difficult to diagnose initially.
Due to the some anatomical and physiological differences,
the effects of trauma in children can be different when compared with adults.
Fundamental differences are these,
the pediatric skull is thinner and more pliable,
the size of the head relative to the body is also large,
the neck musculature is often less developed and the cervical ligaments and joints are more flexible when compared with adults (1).
Furthermore,
cerebral blood flow (CBF) is higher during development and declines with maturation and a phase of maximal synaptogenesis is closely related with CBF (1).
So,
traumatic brain injury (TBI) may cause arrest in the neurological development process. Physical,
cognitive and behavioral system disabilities may occur.
IMAGING TECHNIQUE:
- The role of neuroimaging becomes important in early detection of traumatic brain injuries and prevention of secondary posttraumatic complications.
- Skull radiography remains limited in traumatic patients.
- CT scanning: Most useful imaging study for patients with head trauma.
CT advantages are demonstration of mass effect,
ventricular size and configuration,
bone injuries,
and acute hemorrhage (2).
In addition,
CT scanning is quick and cheap.
However,
there are some disadvantages.
Limitations of CT scan in traumatic patients are following (3):
- small and nonhemorrhagic lesions (diffuse axonal injury)
- some hemorrhagic lesions (located in posterior fossa,
infratemporal and subfrontal region)
- vascular injury
- increased intracranial pressure or cerebral edema
- hypoxic-ischemic brain injury
- fracture line which is parallel to the section plane (multiplanar CT 3D bony reconstruction should be used)
- patients with severe anemia (acute hemorrhage may not be seen hyperdense)
- MR imaging (MRI): MRI is sensitive for detecting and characterizing subacute and chronic brain injuries.
MRI is superior to CT for establishing nonhemorrhagic primary lesions and secondary effects of trauma such as edema and hypoxic-ischemic brain injury.
MRI is better than CT in determining the brainstem,
basal ganglia and thalamic traumatic lesions.
T2-weighted (T2-W) gradient echo sequences or susceptibility weighted images (SWI) reveal small microbleeds (4).
Diffusion weighted imaging (DWI) is useful for detection of traumatic hypoxic brain injury and acute infarction associated with head injury.
Fluid-attenuated inversion recovery (FLAIR) images are sensitive for depicting subarachnoid hemorrhage.
- Traumatic head injury divides into two main groups:
Primary lesions;
- Skull fracture
- Epidural,
subdural and subarachnoid hemorrhage
- Diffuse axonal injury
- Contusion
- Traumatic vascular lesions
Secondary lesions:
- Diffuse cerebral edema
- Traumatic hypoxic-ischemic brain injury and cortical laminar necrosis
- Leptomeningeal cyst
- Herniation
- CSF leakage
- Encephalomalacia and atrophy