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Is there any value in performing diffusion weighted / susceptibility weighted imaging in addition to standard magnetic resonance imaging?

The following is a summary of the systematic review findings up to the date of our most recent literature search. If you have a specific clinical case, we strongly recommend you read all of the relevant references as cited and look for additional material published outside our search dates.

 

Results 1-5

  • Study design:
    • 4 case series
    • 1 case-control 1
  • Age: ranging from 0-22 months

 Analysis of included studies

  • Diffusion weighted imaging (DWI) demonstrated additional findings that were not apparent on conventional magnetic resonance imaging (MRI) 2-5
  • DWI revealed more extensive brain injury 5
  • DWI with apparent diffusion coefficient (ADC) mapping allowed better delineation of the extent of white matter injury 5
  • The severity of injury on DWI correlated with prognosis 5
  • DWI identified restricted diffusion of cortical and subcortical areas in addition to subdural haemorrhage 2-4
  • Diffuse cortical infarction and early subacute phase hypoxic ischaemic encephalopathy (HIE) shown on DWI 2-4
  • These were found to correlate with later poor prognosis 2-4
  • Susceptibility-weighted MR imaging demonstrated brain micro-haemorrhages and intra-parenchymal brain micro-haemorrhages which were significantly more common amongst children with poorer outcome than those with good outcome, predictive accuracy of 92.5%. N.B the SW-images may have been confounded by previous undocumented trauma or induced foci of germinal matrix haemorrhage 1

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References

  1. Colbert CA, Holshouser BA, Aaen GS, Sheridan C, Oyoyo U, Kido D, Ashwal S. Value of cerebral microhemorrhages detected with susceptibility-weighted MR Imaging for prediction of long-term outcome in children with nonaccidental trauma. Radiology. 2010;256(3):898-905 [Pubmed]

  2. Dan B, Damry N, Fonteyne C, Jissendi P, Ziereisen F, Christophe C. Repeated diffusion-weighted magnetic resonance imaging in infantile non-haemorrhagic, non-accidental brain injury. Developmental Medicine and Child Neurology. 2008;50(1):78-80 [Pubmed citation only]
  3. Küker W, Schöning M, Krägeloh-Mann I, Nägele T. Shaken baby syndrome. Imaging methods for the recognition of a severe form of infant maltreatment [German]. Monatsschrift Kinderheilkunde. 2006;154(7):659-668 [Abstract from Springer]
  4. McKinney AM, Thompson LR, Truwitt CL, Velders S, Karagulle A, Kiragu A. Unilateral hypoxic-ischemic injury in young children from abusive head trauma, lacking craniocervical vascular dissection or cord injury. Pediatric Radiology. 2008;38(2):164-174 [Pubmed]
  5. Suh DY, Davis PC, Hopkins KL, Fajman NN, Mapstone TB. Nonaccidental pediatric head injury: diffusion-weighted imaging findings. Neurosurgery. 2001;49(2):309-318, discussion 318-320 [Pubmed]

 

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