1. 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 Hospital Little Rock, Arkansas

2.  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

3.  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

4.  Materials and Methods  95 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

5.  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 magnet  Sequences included sagittal T1W, axial PD or FLAIR, T2W and GE images in all cases  27/40 (68%) had DW imaging  3/40 (7.5%) had MRA  None had spectroscopy

6. 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)

7.  Results  30/40 (75%) had SDH  15/40 (38%) had CIC  9/40 (23%) had PH  3/40 (8%) had EDH

8.  Results  In all cases CT and MR both detected EDH, SDH and PH  In 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)

9.  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)

10.  3 year old with seizures

11.  1 ½ year old with seizures

12.  3 ½ year old with nausea and vomiting

13.  Unresponsive 2 year old

14.  Conclusion  Although 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