Zuccoli G, Khan AS, Panigrahy A, Tamber MS. In Vivo
Demonstration of Traumatic Rupture of the Bridging Veins in Abusive Head Trauma.
Pediatr Neurol. 2017 Apr 8. pii: S0887-8994(17)30120-0. doi:
10.1016/j.pediatrneurol.2017.04.003. [Epub ahead of print]
Abstract
OBJECTIVE:
In victims of abusive head trauma, bridging vein thrombosis
is a common finding on magnetic resonance imaging. We aimed to evaluate the
utility of high-resolution coronal susceptibility-weighted imaging (SWI) in
depicting bridging vein thrombosis as well as to verify the morphology of the
bridging vein thrombosis on axial SWI. We additionally analyzed the
correlations between bridging vein thrombosis or bridging vein deformation and
other magnetic resonance imaging findings that often occur in association with
abusive head trauma.
METHODS:
Seventeen patients with abusive head trauma were
retrospectively evaluated for the presence of thrombosis on axial SWI. The
affected veins were localized on coronal SWI, and the strength of association
between the presence of bridging vein thrombosis on axial versus
high-resolution coronal SWI was determined.
RESULTS:
Of 11 patients identified with thrombosis on axial SWI,
high-resolution coronal SWI verified bridging vein thrombosis in four
individuals (36%). The previously reported "tadpole sign" on axial
images did not predict bridging vein thrombosis on coronal SWI (odds ratio =
0.3 [0.02, 5.01], P = 0.538). Volumetric coronal SWI disclosed additional irregularities
of the bridging vein walls which was associated with the presence of subdural
hematoma on magnetic resonance imaging (P = 0.03), suggesting traumatic injury.
CONCLUSION:
Coronal SWI confirmed thrombosis of the bridging veins only
in a minority of cases. Diffusely irregular contours of the veins observed on
high-resolution coronal SWI was a major finding in our study. Disruption of the
normal anatomy of the bridging veins in abusive head trauma further supports
the traumatic nature of the disease.
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