Arterial spin-labeling perfusion imaging of children with subdural hemorrhage: Perfusion abnormalities in abusive head trauma - 22/03/17

Doi : 10.1016/j.neurad.2017.02.003

Alex Mun-Ching Wong ^a, Chih-Hua Yeh ^a, Ho-Ling Liu ^b, Tai-Wei Wu ^c, Kuang-Lin Lin ^d, Huei-Shyong Wang ^d, Cheng-Hong Toh ^a,^⁎
^a Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Keelung/Linkou, and Chang Gung University, Taiwan
^b Department of Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
^c Division of Neonatal Medicine, Department of Pediatrics, Center for Fetal and Neonatal Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
^d Division of Pediatric Neurology, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung University, Linkou, Taiwan

^⁎Corresponding author at: Department of Medical Imaging and Intervention, Chang-Gung Memorial Hospital, 5 Fu-Hsing Street, Tao Yuan 333, Taiwan. Tel.: +886 33281200x2575; fax: +886 33971936.Department of Medical Imaging and Intervention, Chang-Gung Memorial Hospital5 Fu-Hsing StreetTao Yuan 333Taiwan

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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.

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Keywords : Abusive head trauma, Arterial spin-labeling perfusion imaging, Subdural hemorrhage