Silvera V Michelle, Danehy Amy R, Newton Alice W, Stamoulis Catherine, Carducci Chiara, Grant P Ellen, Wilson Celeste R, Kleinman Paul K
Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, 02115, Boston, MA, USA,
Pediatr Radiol. 2014 Dec;44 Suppl 4:S621-31. doi: 10.1007/s00247-014-3170-2. Epub 2014 Dec 14.
Retroclival collections are rare lesions reported almost exclusively in children and strongly associated with trauma. We examine the incidence and imaging characteristics of retroclival collections in young children with abusive head trauma. We conducted a database search to identify children with abusive head trauma ≤ 3 years of age with brain imaging performed between 2007 and 2013. Clinical data and brain images of 65 children were analyzed. Retroclival collections were identified in 21 of 65 (32%) children. Ten (48%) were subdural, 3 (14%) epidural, 2 (10%) both, and 6 (28%) indeterminate. Only 8 of 21 retroclival collections were identifiable on CT and most were low or intermediate in attenuation. Eighteen of 21 retroclival collections were identifiable on MRI: 3 followed cerebral spinal fluid in signal intensity and 15 were bloody/proteinaceous. Additionally, 2 retroclival collections demonstrated a fluid-fluid level and 2 enhanced in the 5 children who received contrast material. Sagittal T1-weighted images, sagittal fluid-sensitive sequences, and axial FLAIR (fluid-attenuated inversion recovery) images showed the retroclival collections best. Retroclival collections were significantly correlated with supratentorial and posterior fossa subdural hematomas and were not statistically correlated with skull fracture or parenchymal brain injury. Retroclival collections, previously considered rare lesions strongly associated with accidental injury, were commonly identified in this cohort of children with abusive head trauma, suggesting that retroclival collections are an important component of the imaging spectrum in abusive head trauma. Retroclival collections were better demonstrated on MRI than CT, were commonly identified in conjunction with intracranial subdural hematomas, and were not significantly correlated with the severity of brain injury or with skull fractures.
斜坡后间隙积液是一种罕见病变，几乎仅在儿童中报道，且与创伤密切相关。我们研究了遭受虐待性头部外伤的幼儿中斜坡后间隙积液的发生率及影像特征。我们进行了数据库检索，以确定2007年至2013年间接受脑部成像检查、年龄≤3岁的遭受虐待性头部外伤的儿童。分析了65名儿童的临床资料和脑部影像。65名儿童中有21名（32%）发现有斜坡后间隙积液。其中10名（48%）为硬膜下积液，3名（14%）为硬膜外积液，2名（10%）两者均有，6名（28%）情况不明。21例斜坡后间隙积液中只有8例在CT上可识别，且大多数密度较低或中等。21例斜坡后间隙积液中有18例在MRI上可识别：3例信号强度随脑脊液变化，15例为血性/含蛋白性。此外，在接受对比剂检查的5名儿童中，2例斜坡后间隙积液显示有液-液平面，2例有强化。矢状位T1加权像、矢状位液体敏感序列及轴位FLAIR（液体衰减反转恢复）像对斜坡后间隙积液显示最佳。斜坡后间隙积液与幕上及后颅窝硬膜下血肿显著相关，与颅骨骨折或脑实质损伤无统计学关联。斜坡后间隙积液此前被认为是与意外伤害密切相关的罕见病变，在这组遭受虐待性头部外伤的儿童中很常见，这表明斜坡后间隙积液是虐待性头部外伤影像谱的重要组成部分。斜坡后间隙积液在MRI上比CT显示更好，常与颅内硬膜下血肿同时出现，且与脑损伤严重程度或颅骨骨折无显著关联。
