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Imaging of the Central Nervous System in Suspected or Alleged Nonaccidental Injury, Including the Mimics

Barnes, Patrick D. MD; Krasnokutsky, Michael MD

Topics in Magnetic Resonance Imaging: February 2007 - Volume 18 - Issue 1 - p 53-74
doi: 10.1097/RMR.0b013e3180d0a455
Original Articles

Because of the widely acknowledged controversy in nonaccidental injury, the radiologist involved in such cases must be thoroughly familiar with the imaging, clinical, surgical, pathological, biomechanical, and forensic literature from all perspectives and with the principles of evidence-based medicine. Children with suspected nonaccidental injury versus accidental injury must not only receive protective evaluation but also require a timely and complete clinical and imaging workup to evaluate pattern of injury and timing issues and to consider the mimics of abuse. All imaging findings must be correlated with clinical findings (including current and past medical record) and with laboratory and pathological findings (eg, surgical, autopsy). The medical and imaging evidence, particularly when there is only central nervous system injury, cannot reliably diagnose intentional injury. Only the child protection investigation may provide the basis for inflicted injury in the context of supportive medical, imaging, biomechanical, or pathological findings.

From the Stanford University Medical Center, Stanford, CA.

Reprints: Patrick D. Barnes, MD, Departments of Radiology, Pediatric MRI and CT, Room 0511, Lucille Packard Children's Hospital, 725 Welch Road, Palo Alto, CA 94304 (e-mail:

© 2007 Lippincott Williams & Wilkins, Inc.