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Unravelling neuroinflammation in abusive head trauma with radiotracer imaging

  • Child abuse imaging
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Abstract

Abusive head trauma (AHT) is a leading cause of mortality and morbidity in child abuse, with a mortality rate of approximately 25%. In survivors, the prognosis remains dismal, with high prevalence of cerebral palsy, epilepsy and neuropsychiatric disorders. Early and accurate diagnosis of AHT is challenging, both clinically and radiologically, with up to one-third of cases missed on initial examination. Moreover, most of the management in AHT is supportive, reflective of the lack of clear understanding of specific pathogenic mechanisms underlying secondary insult, with approaches targeted toward decreasing intracranial hypertension and reducing cerebral metabolism, cell death and excitotoxicity. Multiple studies have elucidated the role of pro- and anti-inflammatory cytokines and chemokines with upregulation/recruitment of microglia/macrophages, oligodendrocytes and astrocytes in severe traumatic brain injury (TBI). In addition, recent studies in animal models of AHT have demonstrated significant upregulation of microglia, with a potential role of inflammatory cascade contributing to secondary insult. Despite the histological and biochemical evidence, there is a significant dearth of specific imaging approaches to identify this neuroinflammation in AHT. The primary motivation for development of such imaging approaches stems from the need to therapeutically target neuroinflammation and establish its utility in monitoring and prognostication. In the present paper, we discuss the available data suggesting the potential role of neuroinflammation in AHT and role of radiotracer imaging in aiding diagnosis and patient management.

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Authors and Affiliations

  1. Department of Medical Imaging, Nemours Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA

    Rahul M. Nikam, Vinay V. Kandula & Lauren W. Averill

  2. Katzin Diagnostic & Research PET/MR Center, Nemours Alfred I. duPont Hospital for Children, Wilmington, DE, USA

    Rahul M. Nikam, Xuyi Yue, Bishnuhari Paudyal & Sigrid A. Langhans

  3. Department of Radiology, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA

    Arabinda K. Choudhary

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  1. Rahul M. Nikam
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Correspondence to Rahul M. Nikam.

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Dr. Choudhary is a medical expert in child abuse cases.

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Nikam, R.M., Yue, X., Kandula, V.V. et al. Unravelling neuroinflammation in abusive head trauma with radiotracer imaging. Pediatr Radiol 51, 966–970 (2021). https://doi.org/10.1007/s00247-021-04995-z

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