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Austin P Bell, Michael Hood, Asim F Choudhri, Jorge I Calzada; High specificity but low sensitivity of MRI for detection of retinal hemorrhages in non-accidental trauma. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5849.
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Dilated fundoscopic examination (DFE) is the gold standard for identifying retinal hemorrhages in suspected non-accidental trauma (NAT). Many NAT patients receive brain MRI examination, and ocular abnormalities are sometimes seen on various imaging sequences. Susceptibility weighted imaging (SWI) is a newer MRI technique that is very sensitive to blood products. We sought to determine the diagnostic performance of various MRI sequences as compared to DFE in identification of retinal hemorrhages.
This HIPAA compliant study was performed with IRB approval. A retrospective review of patients with DFE for suspected NAT was performed at a single institution. Patients with DFE and brain MRI performed at time of presentation were included. Multiple MRI sequences were evaluated in a blinded manner to determine whether there were signs of retinal hemorrhage.
40 patients (80 eyes) were identified that met inclusion criteria. Retinal hemorrhages were identified on DFE in 34 eyes (43%). T2 weighted MRI identified 6 retinal hemorrhages, and SWI identified 14 retinal hemorrhages. There were no false positives on MRI evaluation. The sensitivity of T2 images was 18%, and the sensitivity of SWI was 41%, and the specificity of both techniques was 100% in this study.
MRI has a low sensitivity but high specificity for detecting signs of retinal hemorrhages. Close attention to MRI is warranted to see if abnormalities are present, however the absence of ocular MRI abnormalities does not obviate the need for DFE.
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