non-accidental cerebral injury (naci)
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Contribution of cranial MR in combination with CT in the initial
evaluation of infants and children with non-accidental
cerebral injury (NACI): Correlation with presence of
retinal hemorrhages (RH)Kilpadikar, Anil*, Worthington, T.**, Jones, J.G.**,
Glasier, C.M***University of Arkansas for Medical Sciences
**Arkansas Children’s HospitalLittle Rock, Arkansas
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Non-accidental Cerebral Injury (NACI)
NACI is the leading cause of death (USA) in children under 2 years of age
In children less than 1 year old, 95% of all serious head injuries and 64% of all head injuries result from maltreatment
Outcome of infants suffering NACI is considerably worse than for those of the same age who have sustained ACI
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Purpose Retrospectively study a large group of
infants and children with documented NACI who had cranial CT, MR and ophthalmologic exam as part of an initial evaluation in order to determine:
Added utility of acute cranial MR, if any Significance of retinal hemorrhage for
prediction of severity of cerebral injury
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Materials and Methods95 consecutive infants and children age
newborn to 4 years admitted from 1999-2003 with documented NACI were reviewed
40 children in this group who had concurrent CT and MR near the time of admission were included in the study
CT exams were performed on the day of admission without contrast or sedation
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Materials and Methods MR was performed within an average of
51 hrs. of the admission CT (range 0-12 days)
MR performed on a 1.5T magnetSequences included sagittal T1W, axial
PD or FLAIR, T2W and GE images in all cases
27/40 (68%) had DW imaging3/40 (7.5%) had MRANone had spectroscopy
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• Materials and Methods Patient records, CT and MR reports
were reviewed retrospectively with specific attention to EDH, SDH, parenchymal hemorrhage (PH), cerebral ischemic change (CIC) and retinal hemorrhage (RH)
Presence of RH was correlated with severity of cerebral injury
Maximum cerebral injury score of 3 included presence of SDH or EDH (1point), PH (1point) and CIC (1 point)
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Results30/40 (75%) had SDH15/40 (38%) had CIC 9/40 (23%) had PH 3/40 (8%) had EDH
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Results In all cases CT and MR both
detected EDH, SDH and PHIn patients with CIC, CT was
positive in 7/15 (47%) and MR positive in 15/15 (100%) cases, which is statistically significant (p<0.05)
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Results 18/40 patients with RH had a
higher cerebral injury score (1.72) than 22/40 patients without RH (0.85), which is statistically significant (p<0.05)
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3 year old with seizures
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1 ½ year old with seizures
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3 ½ year old with nausea and vomiting
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Unresponsive 2 year old
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ConclusionAlthough CT and MR each detected all
cases of EDH, SDH and PH, MR detected over twice as many cases of CIC as compared to CT, a statistically significant finding indicating added value for the MR examination in acute setting
Presence of RH was associated with a statistically significant increase in severity of cerebral injury