Utility of balanced steady-state field precession sequence in the evaluation of retinal and subdural hemorrhages in patients with abusive head trauma

Pediatr Radiol. 2023 Aug;53(9):1842-1853. doi: 10.1007/s00247-023-05614-9. Epub 2023 Apr 20.


Abusive head trauma is the leading cause of physical child abuse deaths in children under 5 years of age in the United States. To evaluate suspected child abuse, radiologic studies are typically the first to identify hallmark findings of abusive head trauma including intracranial hemorrhage, cerebral edema, and ischemic injury. Prompt evaluation and diagnosis are necessary as findings may change rapidly. Current imaging recommendations include brain magnetic resonance imaging with the addition of a susceptibility weighted imaging (SWI) sequence which can detect additional findings that suggest abusive head trauma including cortical venous injury and retinal hemorrhages. However, SWI is limited due to blooming artifacts and artifacts from the adjacent skull vault or retroorbital fat, which can affect the evaluation of retinal, subdural, and subarachnoid hemorrhages. This work explores the utility of the high-resolution, heavily T2 weighted balanced steady-state field precession (bSSFP) sequence to identify and characterize retinal hemorrhage and cerebral cortical venous injury in children with abusive head trauma. The bSSFP sequence provides distinct anatomical images to improve the identification of retinal hemorrhage and cortical venous injury.

Keywords: Abusive head trauma; Child abuse; Cortical venous injury; Magnetic resonance imaging; Retinal hemorrhage; Subdural hemorrhage.

MeSH terms

  • Brain Injuries*
  • Child
  • Child Abuse* / diagnosis
  • Child, Preschool
  • Craniocerebral Trauma* / complications
  • Craniocerebral Trauma* / diagnostic imaging
  • Hematoma, Subdural / diagnostic imaging
  • Humans
  • Infant
  • Retinal Hemorrhage / diagnostic imaging
  • Retinal Hemorrhage / etiology
  • Retrospective Studies