Abelian Khoren,  Kaleem Musa,  Mclennan Kerrie,  Edwards Harriet

Final Pr. ID: Poster #: EDU-100

Abusive head trauma (AHT) is the leading cause of death in cases of physical child abuse. It primarily affects infants under two years of age, with the highest incidence in those younger than six months. Mortality may reach 30%, and approximately half of survivors suffer long-term neurological disability. Early and accurate differentiation of AHT from other causes of brain injury is therefore essential for safeguarding and appropriate management.
We present six cases of bilateral and three cases of unilateral intracranial haemorrhage in infants and children under the age of two years with confirmed child abuse. Of these, five had associated spinal injuries, two had associated retinal haemorrhages and features of hypoxic–ischaemic injury, and one had a skull fracture.
Using illustrations and findings from each case, we aim to (1) revisit abusive head trauma guidelines and imaging recommendations in both America and Europe, (2) the varied patterns of clinical presentation, and (3) outline the associated neuroimaging features which, either in isolation or in combination, can favour a shaking mechanism of injury rather than an isolated impact injury, as is more commonly seen in accidental head trauma. (4) We shall highlight how clinical outcomes can vary between cases due to factors such as cerebral ischaemia and raised intracranial pressure, (5) consider the importance of additional findings on spinal imaging and skeletal surveys, and (6) discuss the medicolegal implications of abusive head trauma.
After review, both the paediatric and general radiologist will have increased knowledge and confidence to raise suspicion to the paediatrician of potential abusive head trauma and suggest the correct next imaging steps to protect our vulnerable patients when presented with these neuroimaging findings. Read More

Authors:  Abelian Khoren , Kaleem Musa , Mclennan Kerrie , Edwards Harriet

Keywords:  Abusive Head Trauma, Intracranial Hemorrhage, Child Abuse

Abelian Khoren,  Kaleem Musa,  Mclennan Kerrie,  Edwards Harriet

Final Pr. ID: Poster #: SCI-063

Abusive head trauma (AHT) is the leading cause of death in physical child abuse, predominantly affecting infants under two years. Early recognition of injury patterns inconsistent with reported mechanisms is critical for safeguarding and clinical management. This study reviewed neuroimaging findings in children under two presenting with head injury or altered neurological behaviour, focusing on the distribution and laterality of intracranial haemorrhage. Read More

Authors:  Abelian Khoren , Kaleem Musa , Mclennan Kerrie , Edwards Harriet

Keywords:  Abusive Head Trauma, Intracranial Hemorrhage, Child Abuse

Thompson Matthew,  Davis Joseph,  Thompson Atalie,  Hull Nathan,  Schooler Gary

Final Pr. ID: Poster #: SCI-055

The purpose of this study is to determine whether a decrease in hematocrit is predictive of an intracranial hemorrhage (ICH) on neonatal head ultrasound (HUS). Read More

Authors:  Thompson Matthew , Davis Joseph , Thompson Atalie , Hull Nathan , Schooler Gary

Keywords:  intracranial hemorrhage, head ultrasound, hematocrit

Arceo Salvador,  Christopher Ross,  Milla Sarah,  Riedesel Erica

Final Pr. ID: Paper #: 165

Head trauma is a significant cause of morbidity and mortality in pediatrics. Non-contrast Head CT is the accepted gold standard imaging study to evaluate for suspected acute intracranial hemorrhage (ICH), however small acute extra-axial hemorrhage may be easily missed due to size and similar density to the bony calvarium. In Dual Energy CT (DECT), materials within the body such as bone/calcium and hemorrhage can be more easily discriminated based on differential attenuation at high and low peak voltage image acquisitions. This allows for advanced post-processing including automated bone removal which has been shown to improved visualization of acute ICH in the adult radiology literature, but has not yet been described in pediatrics. We report a retrospective review of DECT with automated bone removal for detection of acute ICH in the pediatric population. Read More

Authors:  Arceo Salvador , Christopher Ross , Milla Sarah , Riedesel Erica

Keywords:  Dual Energy, Trauma, Intracranial Hemorrhage

Sahu Asutosh,  Prabhu Sanjay

Final Pr. ID: Poster #: EDU-086

Purpose
Post-hemorrhagic ventricular dilatation (PHVD) is a common sequela of severe neonatal intraventricular hemorrhage (IVH), often necessitating cerebrospinal fluid (CSF) shunt placement. Despite advances in shunt technology and neonatal neurosurgical care, shunt malfunction remains a leading cause of morbidity and repeat surgical intervention in this population.
After reviewing this exhibit, participants will be able to:
1. Describe the pathophysiologic mechanisms and imaging manifestations of shunt failure following neonatal intraventricular hemorrhage.
2. Apply a structured, multimodality diagnostic algorithm integrating ultrasound, MR ventricular check examinations, and rapid MRI techniques for shunt assessment.
3. Recognize imaging considerations for programmable and nonprogrammable shunt valves and identify key features predicting recurrent or multiloculated hydrocephalus.
Content Organization
- Pathophysiologic mechanisms unique to the post-IVH brain—including septations and ependymal scarring, predispose to both mechanical and functional shunt failure. Common causes include proximal or distal obstruction, valve dysfunction, and secondary complications such as infection or pseudocyst formation.
- Multimodality examples (ultrasound, MRI, CT) are used to illustrate key imaging findings and subtle differentiating features.
- A stepwise diagnostic algorithm is presented, beginning with cranial ultrasound in newborns and younger infants, followed by rapid-sequence MRI (single-shot T2, 3D DRIVE/CISS) for ventricular morphology and catheter assessment, with CT reserved for problem solving. Phase-contrast MRI assists in evaluating CSF flow and shunt patency.
- Programmable and non-programmable shunt valves are reviewed, highlighting imaging appearance, verification techniques, and implications for longitudinal surveillance. Recommended imaging intervals and markers of evolving multiloculated hydrocephalus are summarized.
Conclusion
Early, accurate recognition of shunt malfunction after neonatal IVH depends on understanding its imaging signatures and etiologies. This exhibit provides a step-by-step, multimodality algorithm, anchored in rapid MRI vent checks and informed by shunt hardware variability with illustrative cases to guide pediatric radiologists in assessment and follow-up, and to support coordinated care with neurosurgery and neonatology. Read More

Authors:  Sahu Asutosh , Prabhu Sanjay

Keywords:  Intracranial Hemorrhage, Shunts

Sahu Asutosh,  Prabhu Sanjay

Final Pr. ID: Poster #: EDU-091

Background:
The germinal matrix (GM) is a transient, highly vascular zone that involutes between 24–34 weeks’ postmenstrual age. In extremely preterm infants (≈22–28 weeks), maturational changes in size, echogenicity, and symmetry can mimic or mask hemorrhage, leading to grading variability and inconsistent follow-up.
Purpose:
To present a developmentally tuned, imaging atlas enabling radiologists to distinguish physiologic GM maturation from germinal matrix hemorrhage (GMH) using standardized cranial ultrasound (US) and MRI techniques and terminology.
Educational Objectives
1. Summarize GM anatomy, vascular “hot spots,” and week-by-week involution.
2. Standardize US across anterior, posterior, and mastoid windows for optimal assessment of the caudothalamic groove and posterior fossa.
3. Specify age-related normal variants vs hemorrhage on US and MRI (T1/T2, SWI, DWI), with key sequence-specific pitfalls.
4. Provide a concise measurement/reporting lexicon to improve reproducibility and inter-reader agreement.
Content Highlights:
- Anatomy & Maturation Map: Caudothalamic groove, subependymal region, ganglionic eminence; gestational-week echogenicity charts.
- Acquisition Essentials: Minimal-variance US (required planes, cine sweeps, gain/depth); a 12–15-minute, sedation-sparing MRI set (3D T2, axial T2/T1, DWI/ADC, SWI) with neonatal parameter tips.
- US Pattern Library: Early symmetric subependymal echogenicity; benign choroid plexus prominence; venous plexus near the foramen of Monro; beam-angle/anisotropy effects that simulate clot.
- MRI Pattern Library: Age-appropriate T1/T2 at the caudothalamic notch; SWI venous blooming vs microbleed; diffusion pitfalls along the ventricular wall.
- Mimics & Traps: Choroid plexus lobulations, mineralizing vasculopathy speckles, dependent ventricular debris, partial-volume at the groove, posterior fossa venous plexus on mastoid views.
- Consistency Toolkit: Correct caliper placement for ventricular indices; elements (location, side, extent, confidence).
Conclusion
Germinal matrix appearance is gestation-dependent; interpretations must be age-calibrated. Meticulous acquisition, appropriate window selection and optimized probe technique, including routine posterior/mastoid views reduces posterior fossa misses. Sequence-aware MRI reading (3D T2, SWI, DWI) limits venous and anisotropy misclassification. Standardized terminology and measurements improve report clarity, interobserver agreement, and reliability of follow-up imaging. Read More

Authors:  Sahu Asutosh , Prabhu Sanjay

Keywords:  Intracranial Hemorrhage, Ultrasound and MRI