In Vivo Demonstration of Traumatic Rupture of the Bridging Veins in Abusive Head Trauma

• Published in: Pediatric neurology Vol. 72; pp. 31 - 35
• Main Authors: Zuccoli, Giulio, MD, Khan, Abdullah S, Panigrahy, Ashok, MD, Tamber, Mandeep S., MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2017
• Subjects: abusive head trauma; bridging vein thrombosis; Cerebral Veins - diagnostic imaging; Child Abuse; Craniocerebral Trauma - complications; Craniocerebral Trauma - diagnostic imaging; Female; Humans; Infant; Magnetic Resonance Imaging - methods; Male; Neurology; Pediatrics; Retrospective Studies; susceptibility-weighted imaging; Venous Thrombosis - diagnostic imaging; Venous Thrombosis - etiology; Abusive head trauma; bridging vein thrombosis; susceptibility-weighted imaging; pediatrics; abusive head trauma
• ISSN: 0887-8994; 1873-5150
• DOI: 10.1016/j.pediatrneurol.2017.04.003

Abstract Objective In victims of abusive head trauma (AHT), bridging vein thrombosis (BVT) is a common finding depicted on MR imaging. We aimed to evaluate the utility of high-resolution coronal susceptibility weighted imaging (SWI) in depicting BVT, and to verify the appearance of BVT on axial SWI. We additionally looked at the presence of correlations between BVT or bridging vein deformation and other MR imaging findings usually described in association with AHT. Methods 17 patients with a diagnosis of AHT 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 BVT on axial versus high-resolution coronal SWI was determined. Results Of 11 patients identified with thrombosis on axial SWI, high-resolution coronal SWI verified BVT in 4 cases (36%). The previously reported “tadpole sign” on axial images did not predict BVT on coronal SWI [OR=0.3 (0.02, 5.01), p=0.538]. Volumetric coronal SWI disclosed additional irregularities of the bridging veins’ walls, which was associated with the presence of subdural hematoma on MR imaging (p=0.03), suggesting traumatic injury. Conclusion Coronal SWI confirmed thrombosis of the bridging veins being 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.