Magnetic resonance imaging-based detection of retinal hemorrhages in a multicenter cohort of abusive head trauma

TL;DR

This study explores how MRI, especially SWI sequences, can detect retinal hemorrhages in abusive head trauma when fundoscopy is not sufficient.

Contribution

The study evaluates the diagnostic utility of various MRI sequences for detecting retinal hemorrhages in abusive head trauma.

Findings

SWI showed higher sensitivity (76.9%) compared to T2*w (47.8%) in detecting retinal hemorrhages.

MRI detected retinal hemorrhages not reported by fundoscopy in three cases.

T2w imaging provided complementary information in selected cases.

Abstract

In pediatric abusive head trauma (AHT), retinal hemorrhages are a key diagnostic feature. Detection by fundoscopy may be delayed or limited, whereas magnetic resonance imaging (MRI) enables non-invasive, objective assessment on routine brain sequences.

To evaluate the diagnostic utility of different MRI sequences—particularly susceptibility-weighted imaging (SWI), T2*-weighted (T2*w), and morphological sequences—in detecting retinal hemorrhages in AHT.

In this retrospective multicenter study (2006–2015), 57 well-documented AHT cases from three German institutions were analyzed. A subgroup consisted of “confession cases.” MRI scans were reviewed for retinal hemorrhages across SWI, T2*w, T1-weighted, T2-weighted (T2w), and fluid-attenuated inversion recovery (FLAIR) sequences by blinded expert readers. Fundoscopy results served as the gold standard. Sensitivities were calculated for each sequence, and “confession” versus “non-confession” cases were compared.

Fundoscopy detected retinal hemorrhages in 44 of 56 evaluable cases (78.6%). MRI identified retinal hemorrhages most frequently on gradient recalled echo sequences, with SWI showing higher sensitivity compared to T2*w (76.9% vs. 47.8%). T2w imaging showed markedly lower sensitivity (30.3%) but detected retinal hemorrhages on one eye missed on T2*w imaging in two cases. In three cases, MRI detected retinal hemorrhages not reported on fundoscopy. No statistically significant differences were found between “confession” and “non-confession” cases across all parameters considered (P>0.05).

MRI—particularly SWI and, to a lesser extent, T2*w imaging—may offer a useful tool of detecting retinal hemorrhages in AHT when fundoscopy is limited. T2w imaging may provide complementary information in selected cases.

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