Contribution of cranial MR in combination with Ct in the：在与CT结合头颅MR贡献

ContributionofcranialMRincombinationwithCTintheinitialevaluationofinfantsandchildrenwithnon-accidentalcerebralinjury(NACI):Correlationwithpresenceofretinalhemorrhages(RH)

Kilpadikar,Anil*,Worthington,T.**,Jones,J.G.**,Glasier,C.M**

*UniversityofArkansasforMedicalSciences

**ArkansasChildren’sHospital

LittleRock,ArkansasNon-accidentalCerebralInjury(NACI)NACIistheleadingcauseofdeath(USA)inchildrenunder2yearsofageInchildrenlessthan1yearold,95%ofallseriousheadinjuriesand64%ofallheadinjuriesresultfrommaltreatmentOutcomeofinfantssufferingNACIisconsiderablyworsethanforthoseofthesameagewhohavesustainedACIPurposeRetrospectivelystudyalargegroupofinfantsandchildrenwithdocumentedNACIwhohadcranialCT,MRandophthalmologicexamaspartofaninitialevaluationinordertodetermine:AddedutilityofacutecranialMR,ifanySignificanceofretinalhemorrhageforpredictionofseverityofcerebralinjuryMaterialsandMethods95consecutiveinfantsandchildrenagenewbornto4yearsadmittedfrom1999-2003withdocumentedNACIwerereviewed40childreninthisgroupwhohadconcurrentCTandMRnearthetimeofadmissionwereincludedinthestudyCTexamswereperformedonthedayofadmissionwithoutcontrastorsedationMaterialsandMethods

MRwasperformedwithinanaverageof51hrs.oftheadmissionCT(range0-12days)MRperformedona1.5TmagnetSequencesincludedsagittalT1W,axialPDorFLAIR,T2WandGEimagesinallcases27/40(68%)hadDWimaging3/40(7.5%)hadMRANonehadspectroscopyMaterialsandMethods

Patientrecords,CTandMRreportswerereviewedretrospectivelywithspecificattentiontoEDH,SDH,parenchymalhemorrhage(PH),cerebralischemicchange(CIC)andretinalhemorrhage(RH)PresenceofRHwascorrelatedwithseverityofcerebralinjuryMaximumcerebralinjuryscoreof3includedpresenceofSDHorEDH(1point),PH(1point)andCIC(1point)

Results30/40(75%)hadSDH15/40(38%)hadCIC9/40(23%)hadPH3/40(8%)hadEDHResults

InallcasesCTandMRbothdetectedEDH,SDHandPHInpatientswithCIC,CTwaspositivein7/15(47%)andMRpositivein15/15(100%)cases,whichisstatisticallysignificant(p<0.05)

Results

18/40patientswithRHhadahighercerebralinjuryscore(1.72)than22/40patientswithoutRH(0.85),whichisstatisticallysignificant(p<0.05)3yearoldwithseizures1½yearoldwithseizures3½yearoldwithnauseaandvomitingUnresponsive2yearoldConclusionAlthoughCTandMReachdetectedallcasesofEDH,SDHandPH,MRdetectedovertwiceasmanycasesofCICascomparedtoCT,astatisticallysignificantfindingindicatingaddedvaluefo