Use Whole-spine MRI in Cases of Suspected Child Abuse

Whole-spine MRI commonly demonstrates isolated thoracolumbar injuries in children with suspected abusive head trauma and therefore should be used rather than C-spine, according to an article published in the American Journal of Roentgenology.

The study included 256 children (170 boys, 86 girls; mean age, 5.9 months) who, from January 2019 to December 2020, underwent skeletal survey and head MRI for suspected child abuse. Children with suspected abusive head trauma also underwent whole-spine MRI, per institutional protocol. Diagnoses for abusive head trauma were established via clinical record review, as well as injuries described in skeletal survey, head MRI, and head CT (if performed) reports.

“When performing spine MRI in children with suspected abusive head trauma, whole-spine MRI rather than cervical spine MRI may be warranted, to avoid missing isolated thoracolumbar injuries,” clarified first author Boaz Karmazyn, MD,  from Indiana University School of Medicine, Riley Hospital for Children.

Of the 148 total children with suspected abusive head trauma who underwent whole-spine MRI, 23.0% of examinations demonstrated injuries localized to the thoracolumbar spine. Injuries were localized to the thoracolumbar spine in 51.1% of examinations with major findings: subdural hematoma, epidural hematoma, ligamentous injury, or fracture not identified by skeletal survey.

“This study represents the largest reported series to our knowledge of children with suspected abusive head trauma who were evaluated by whole-spine MRI,” added the study authors.