Investigative Guidelines

• In the acutely injured patient with significant neurological impairment, CT remains the primary screening method.
  
  
• If available, MRI is the method of choice for the detection of intracranial injuries, particularly those associated with shaking-induced trauma.
  
  
• If evidence of child abuse is being sought and the CT scan is negative (shows no evidence of injury), an MRI scan should be strongly considered if available. Even when the findings of the CT scan are positive, MRI may be advisable to portray the injury fully.
  
  
• When the patient's clinical symptoms indicate more substantial injury than that shown by CT, an MRI examination should also be performed.
  
  
• In patients who are more clinically stable, MRI is superior to CT in the screening of subacute or chronic head injury and should be the primary imaging technique whenever possible.
  
  
• When an MRI examination shows significant intracranial injuries such as subdural hematoma, cortical contusion, and shearing injury (tearing of brain tissue) that are out of proportion to the history of injury given by the caretakers, the MRI findings should be considered to indicate child abuse, and appropriate evaluation of the social situation should be undertaken.
  
  
• Obtaining the most thorough diagnostic imaging assessment possible requires advance preparation of the caretakers who accompany the child to the radiology department. The reason for the diagnostic study (e.g., to identify other injuries or underlying conditions) should be explained, and the caretakers should know what to expect.
  
  
• Achievement of adequate studies in young children may require restraint or sedation and, in cases of skeletal surveys, numerous exposures. Excessive apprehension, hostility, and resistance on the part of the child usually will result in an inadequate examination. The technician performing the study should have experience in working with young children.
  
  
• Clinical personnel should treat the caretakers in a professional and nonjudgmental manner.
  
  
• Caretakers' questions regarding either the reasons for the study or the results should be directed to the referring physician.
  
  
• Imaging examinations must be viewed in the context of other clinical findings. The implications of the examinations are best addressed by physicians and other healthcare workers familiar with the family and skilled in these sensitive interactions.
  
  
• A single view of the entire infant ("babygram") is inadequate.