MR detection of retinal hemorrhages: correlation with graded ophthalmologic exam

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• 作者：Angela J. Beavers ; Anna M. Stagner ; Sandra M. Allbery…
• 关键词：Abusive head trauma ; Child ; Graded dilated fundoscopic examination ; Infant ; Magnetic resonance imaging ; Retinal hemorrhage
• 刊名：Pediatric Radiology
• 出版年：2015
• 出版时间：August 2015
• 年：2015
• 卷：45
• 期：9
• 页码：1363-1371
• 全文大小：6,065 KB
• 参考文献：1.Gordy C, Kuns B (2013) Pediatric abusive head trauma. Nurs Clin N Am 48:193-01View Article
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  5.Agrawal S, Peters M, Adams G et al (2012) Prevalence of retinal hemorrhages in critically ill children. Pediatrics 129:1388-396View Article
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  7.Binenbaum G, Mirza-George N, Christian C et al (2009) Odds of abuse associated with retinal hemorrhages in children suspected of abuse. J AAPOS 13:268-72PubMed Central PubMed View Article
  8.Togioka B, Arnold A, Bathurst M et al (2009) Retinal hemorrhages and shaken baby syndrome: an evidence-based review. J Emerg Med 37:98-06PubMed View Article
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  11.Zuccoli G, Panigrahy A, Haldipur A et al (2013) Susceptibility weighted imaging depicts retinal hemorrhages in abusive head trauma. Neuroradiology 55:889-93PubMed Central PubMed View Article
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• 作者单位：Angela J. Beavers (1) (2)
  Anna M. Stagner (3) (4)
  Sandra M. Allbery (1) (2)
  Elizabeth R. Lyden (5)
  Thomas W. Hejkal (3) (4)
  Suzanne B. Haney (6) (7)
  
  1. Department of Radiology, University of Nebraska Medical Center, Omaha, NE, 68198-1045, USA
  2. Department of Radiology, Children’s Hospital and Medical Center, Nebraska Medical Center, Omaha, NE, USA
  3. Department of Ophthalmology, University of Nebraska Medical Center, Omaha, NE, USA
  4. Department of Ophthalmology, Children’s Hospital and Medical Center, Omaha, NE, USA
  5. College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
  6. Department of Pediatrics, Children’s Hospital and Medical Center, Omaha, NE, USA
  7. Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, USA
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Imaging and Radiology
  Pediatrics
  Neuroradiology
  Nuclear Medicine
  Ultrasound
  Oncology
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1432-1998

文摘

Background Dilated fundoscopic exam is considered the gold standard for detecting retinal hemorrhage, but expertise in obtaining this exam is not always immediately available. MRI can detect retinal hemorrhages, but correlation of the grade or severity of retinal hemorrhage on dilated fundoscopic exam with retinal hemorrhage visibility on MRI has not been described. Objective To determine the value of standard brain protocol MRI in detecting retinal hemorrhage and to determine whether there is any correlation with MR detection of retinal hemorrhage and the dilated fundoscopic exam grade of hemorrhage. Materials and methods We conducted a retrospective chart review of 77 children <2?years old who were seen for head trauma from April 2007 to July 2013 and had both brain MRI and dilated fundoscopic exam or retinal camera images. A staff pediatric radiologist and radiology resident reviewed the MR images. Retinal hemorrhages were graded by a chief ophthalmology resident on a 12-point scale based on the retinal hemorrhage type, size, location and extent as seen on review of retinal camera images and detailed reports by ophthalmologists. Higher scores indicated increased severity of retinal hemorrhages. Results There was a statistically significant difference in the median grade of retinal hemorrhage examination between children who had retinal hemorrhage detected on MRI and children who did not have retinal hemorrhage detected on MRI (P--.02). When examination grade was categorized as low-grade (1-), moderate-grade (5-) or high-grade (>8) hemorrhage, there was a statistically significant association between exam grade and diagnosis based on MRI (P--.008). For example, only 14% of children with low-grade retinal hemorrhages were identified on MRI compared to 76% of children with high-grade hemorrhages. MR detection of retinal hemorrhage demonstrated a sensitivity of 61%, specificity of 100%, positive predictive value of 100% and negative predictive value of 63%. Retinal hemorrhage was best seen on the gradient recalled echo (GRE) sequences. Conclusion MRI using routine brain protocol demonstrated 61% sensitivity and 100% specificity in detecting retinal hemorrhage. High-grade hemorrhage was more often detected on MRI than low-grade hemorrhage, 76% vs. 14%. GRE images were the most sensitive for detection of retinal hemorrhages. A dilated fundoscopic exam can be difficult to obtain in infancy, especially in critically ill or non-sedated children. MRI is a useful modality for added documentation of retinal hemorrhage and can be used as an alternative exam when ophthalmologic expertise or retinal camera images are unavailable. Additionally, identification of retinal hemorrhage on MRI can raise the possibility of abuse in children presenting with nonspecific findings.