The Role of Neuroimaging in the Evaluation of Abusive Head Trauma

Neuroimaging is an integral part of the work-up for children who may have experienced abusive head trauma (AHT). The initial exam is usually a head computed tomography (CT), which may be followed by magnetic resonance imaging (MRI) of the brain and/or spine, depending on clinical presentation and/or findings on head CT. Neuroimaging is important for both clinical care and prognosis, as well as the process of distinguishing AHT from accidental trauma. Brain CT and conventional MRI may provide evidence of more than one traumatic event. Diffusion-weighted and susceptibility-weighted imaging help with both acute clinical interventions and prognostication about neurodevelopmental outcomes. With more widespread use of spinal MRI, there is increased appreciation of the spectrum of clinically occult spinal soft tissue injuries associated with AHT. This review highlights clinical and radiologic findings in children evaluated for AHT and emphasizes the importance of a multidisciplinary evaluation.