Discussion & Conclusions

Inflicted head injury is the most common cause of traumatic death in infancy, however history is often unreliable and physical exam may be unrevealing. Diagnostic imaging therefore plays a crucial role in identifying potential patterns of abuse. Although no single imaging finding is specific for abuse, no other medical condition fully mimics all the features of non-accidental injury in infants and children. As radiologists we have a vital role to play in identifying those imaging findings that can suggest abuse. Our index of suspicion should be high since failure to identify potential patterns of abuse portends grave consequences for the child who will invariably be returned to a high risk environment (fig 9). In this presentation we have attempted to demonstrate the common and some less common patterns of nonaccidental head injury which have been significantly enhanced since the introduction of MR imaging. Despite all the technological advances, however, imaging of nonaccidental injury continues to be a challenge. Some forms of injury like intermittent suffocation and asphyxiation may present with little or no morphological changes on imaging. MR spectroscopy, however, holds promise for the future by aiding in the identification of biochemical changes that may predate and morphological findings. This may help identify children who are subject to subclinical forms of repetitive abuse before a fatality occurs.

Infarction
Fig 9. 2-year-old female who initially presented with se izure. Axial T1-weighted image (fig 9a) shows a small right SDH (arrows). Axia l flair image (fig 9b) shows a small amount of SAH (arrows). DWI was normal. Child injury survey(not shown) at the time was also normal. A month later the child returned with a history of a fall which resulted in a right tibia/fibula fracture. A repeat MR exam shows multiple areas of subacute infarction on T1, flair and DWI (fig 9d, e & f).

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