Cherie A. Colbert MD, Presenter: Nothing to Disclose

Barbara Ann Holshouser PhD, Abstract Co-Author: Nothing to Disclose

Gregory Aaen MD, Abstract Co-Author: Nothing to Disclose

Udo Oyoyo, Abstract Co-Author: Nothing to Disclose

Clare Sheridan MD, Abstract Co-Author: Nothing to Disclose

Daniel K. Kido MD, Abstract Co-Author: Nothing to Disclose

Stephen Ashwal MD, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

To determine whether the presence of intraparenchymal microhemorrhages (MH) seen on susceptibility weighted MRI sequences (SWI) is associated with severity of clinical outcome in pediatric victims of non-accidental trauma.

Retrospective analysis of 118 pediatric NAT victims was performed at Loma Linda University. Imaging data was collected based on review of finalized reports of head CTs and MRIs from neuroradiologists and pediatric radiologists. The imaging findings were dichotomized into presence (1) or absence (0) of extra axial hemorrhages, contusions and MH. Clinical data was collected by a pediatric child abuse specialist and a pediatric neurology fellow. Long-term clinical outcomes were based on Pediatric Cerebral Performance Category Scale (PCPCS). The clinical outcomes were then dichotomized (1-3 PCPCS = good outcome; 4-6 PCPCS = poor outcome). Inclusion criterion for statistical analysis was long-term follow-up of greater than or equal to 6 months. Student t-test, Chi squared analysis and logistic regression was utilized.

Of 118 analyzed non-accidental trauma victims, there were 97 patients evaluated with SWI. Of these, 26 patients (27%) were found to have MH (14 with 6 months or greater follow up). There were 71 patients without MH (34 patients with 6 months or greater follow up).  Patients with MH had a significantly lower GCS score than patients without MH (p=0.043). Patients with MH were 4.7 times more likely to have a poor outcome than patients without MH. Using logistic regression, predictive accuracy for those with poor outcome increased from 63.6% to 76.9% and for those with good outcome from 88.6% to 94.3% when presence of MH was added as a predictor along with age and initial GCS. Retinal hemorrhage, CT findings and other MRI findings were not significantly associated with 6 month outcome and did not improve outcome prediction above presence of MH when included separately in the logistic regression model.

 The presence of intraparenchymal microhemorrhages seen on SWI is associated with and is more helpful in improving prediction of long-term outcome in pediatric patients after NAT than findings on other radiologic studies.

Detection of MH with SWI improves long-term clinical outcome prediction for pediatric NAT victims compared to other radiologic findings.

Colbert, C, Holshouser, B, Aaen, G, Oyoyo, U, Sheridan, C, Kido, D, Ashwal, S, et al, , Prevalence of Microhemorrhage on Susceptibility-weighted Imaging and Correlation with Long-term Outcome in Pediatric Non-accidental Trauma (NAT) Victims.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6021995.html