Arterial spin-labeling perfusion imaging of children with subdural hemorrhage: Perfusion abnormalities in abusive head trauma

Background and purpose Perfusion abnormalities have not been well described in children with subdural hemorrhage (SDH). We investigated whether patients with abusive head trauma (AHT+) had more perfusion abnormalities than those without (AHT−). Materials and methods We reviewed the perfusion MR studies of 12 infants with SDH and 21 controls. The perfusion images were obtained using a pseudo-continuous arterial spin-labeling sequence with volumetric fast spin-echo readout. An MR perfusion scoring system (0–6 points) was devised to facilitate appraisal of the extent of abnormalities. An asymmetry index (AI) was calculated for each region of perfusion abnormality. Comparison of perfusion scores across the AHT+, AHT−, and control groups was performed. The AIs of the hypoperfused lesions and hyperperfused lesions in patients were separately compared with those of the controls. The neurological outcomes of the patients were associated with imaging abnormalities. Results Perfusion abnormalities were found in five (83%) of six AHT+ patients and in one (17%) of six AHT− patients. The AHT+ group recorded a significantly higher perfusion score than did both the AHT− group and the controls. Four patients with hypoperfused lesions exhibited significantly lower AI (P = .002) than did the controls, and three patients with hyperperfused lesions had significantly higher AI (P = .006) than did the controls. Of the four patients with hypoperfused lesions, two expired and one experienced hemiparesis. Conclusions Patients with AHT have higher perfusion abnormality scores than patients with other causes of SDH and controls. Moreover, hypoperfusion may suggest a poor clinical outcome.