Skip to main content

Advertisement

SpringerLink
Log in

MR detection of retinal hemorrhages: correlation with graded ophthalmologic exam

  • Original Article
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

Abstract

Background

Dilated fundoscopic exam is considered the gold standard for detecting retinal hemorrhage, but expertise in obtaining this exam is not always immediately available. MRI can detect retinal hemorrhages, but correlation of the grade or severity of retinal hemorrhage on dilated fundoscopic exam with retinal hemorrhage visibility on MRI has not been described.

Objective

To determine the value of standard brain protocol MRI in detecting retinal hemorrhage and to determine whether there is any correlation with MR detection of retinal hemorrhage and the dilated fundoscopic exam grade of hemorrhage.

Materials and methods

We conducted a retrospective chart review of 77 children <2 years old who were seen for head trauma from April 2007 to July 2013 and had both brain MRI and dilated fundoscopic exam or retinal camera images. A staff pediatric radiologist and radiology resident reviewed the MR images. Retinal hemorrhages were graded by a chief ophthalmology resident on a 12-point scale based on the retinal hemorrhage type, size, location and extent as seen on review of retinal camera images and detailed reports by ophthalmologists. Higher scores indicated increased severity of retinal hemorrhages.

Results

There was a statistically significant difference in the median grade of retinal hemorrhage examination between children who had retinal hemorrhage detected on MRI and children who did not have retinal hemorrhage detected on MRI (P = 0.02). When examination grade was categorized as low-grade (1–4), moderate-grade (5–8) or high-grade (>8) hemorrhage, there was a statistically significant association between exam grade and diagnosis based on MRI (P = 0.008). For example, only 14% of children with low-grade retinal hemorrhages were identified on MRI compared to 76% of children with high-grade hemorrhages. MR detection of retinal hemorrhage demonstrated a sensitivity of 61%, specificity of 100%, positive predictive value of 100% and negative predictive value of 63%. Retinal hemorrhage was best seen on the gradient recalled echo (GRE) sequences.

Conclusion

MRI using routine brain protocol demonstrated 61% sensitivity and 100% specificity in detecting retinal hemorrhage. High-grade hemorrhage was more often detected on MRI than low-grade hemorrhage, 76% vs. 14%. GRE images were the most sensitive for detection of retinal hemorrhages. A dilated fundoscopic exam can be difficult to obtain in infancy, especially in critically ill or non-sedated children. MRI is a useful modality for added documentation of retinal hemorrhage and can be used as an alternative exam when ophthalmologic expertise or retinal camera images are unavailable. Additionally, identification of retinal hemorrhage on MRI can raise the possibility of abuse in children presenting with nonspecific findings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Gordy C, Kuns B (2013) Pediatric abusive head trauma. Nurs Clin N Am 48:193–201

    Article  Google Scholar 

  2. Kivlin J (1999) A 12-year ophthalmologic experience with the shaken baby syndrome at a regional children’s hospital. Trans Am Ophthalmol Soc 97:545–581

    CAS  PubMed Central  PubMed  Google Scholar 

  3. Kivlin J (2001) Manifestations of the shaken baby syndrome. Curr Opin Ophthalmol 12:158–163

    Article  CAS  PubMed  Google Scholar 

  4. Emerson M, Pieramici D, Stoessel K et al (2001) Incidence and rate of disappearance of retinal hemorrhage in newborns. Am Acad Ophthalmol 108:36–39

    CAS  Google Scholar 

  5. Agrawal S, Peters M, Adams G et al (2012) Prevalence of retinal hemorrhages in critically ill children. Pediatrics 129:1388–1396

    Article  Google Scholar 

  6. Vinchon M, Defoort-Dhellemmes S, Desurmont M et al (2005) Accidental and nonaccidental head injuries in infants: a prospective study. J Neurosurg Pediatr 102:380–384

    Article  Google Scholar 

  7. Binenbaum G, Mirza-George N, Christian C et al (2009) Odds of abuse associated with retinal hemorrhages in children suspected of abuse. J AAPOS 13:268–272

    Article  PubMed Central  PubMed  Google Scholar 

  8. Togioka B, Arnold A, Bathurst M et al (2009) Retinal hemorrhages and shaken baby syndrome: an evidence-based review. J Emerg Med 37:98–106

    Article  PubMed  Google Scholar 

  9. Jenny C, Hymel K, Ritzen A et al (1999) Analysis of missed cases of abusive head trauma. JAMA 282:621–626

    Article  Google Scholar 

  10. Altinok D, Saleem S, Zhang Z et al (2009) MR imaging findings of retinal hemorrhage in a case of nonaccidental trauma. Pediatr Radiol 39:290–292

    Article  PubMed  Google Scholar 

  11. Zuccoli G, Panigrahy A, Haldipur A et al (2013) Susceptibility weighted imaging depicts retinal hemorrhages in abusive head trauma. Neuroradiology 55:889–893

    Article  PubMed Central  PubMed  Google Scholar 

  12. Maguire S, Watts P, Shaw A et al (2013) Retinal hemorrhages and related findings in abusive and non-abusive head trauma: a systematic review. Eye 27:28–36

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  13. King W, MacKay M, Sirnick A (2003) Shaken baby syndrome in Canada: clinical characteristics and outcomes of hospital cases. JAMC 168:155–159

    Google Scholar 

Download references

Conflicts of interest

None

Author information

Authors and Affiliations

  1. Department of Radiology, University of Nebraska Medical Center, Omaha, NE, 68198-1045, USA

    Angela J. Beavers & Sandra M. Allbery

  2. Department of Radiology, Children’s Hospital and Medical Center, Nebraska Medical Center, Omaha, NE, USA

    Angela J. Beavers & Sandra M. Allbery

  3. Department of Ophthalmology, University of Nebraska Medical Center, Omaha, NE, USA

    Anna M. Stagner & Thomas W. Hejkal

  4. Department of Ophthalmology, Children’s Hospital and Medical Center, Omaha, NE, USA

    Anna M. Stagner & Thomas W. Hejkal

  5. College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA

    Elizabeth R. Lyden

  6. Department of Pediatrics, Children’s Hospital and Medical Center, Omaha, NE, USA

    Suzanne B. Haney

  7. Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, USA

    Suzanne B. Haney

Authors
  1. Angela J. Beavers
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anna M. Stagner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sandra M. Allbery
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elizabeth R. Lyden
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Thomas W. Hejkal
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Suzanne B. Haney
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Angela J. Beavers.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Beavers, A.J., Stagner, A.M., Allbery, S.M. et al. MR detection of retinal hemorrhages: correlation with graded ophthalmologic exam. Pediatr Radiol 45, 1363–1371 (2015). https://doi.org/10.1007/s00247-015-3312-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-015-3312-1

Keywords

Search

Navigation