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Anna Stagner, Angela Beavers, Sandra Allbery, Elizabeth Lyden, Suzanne Haney, Thomas Hejkal; MRI Detection of Retinal Hemorrhages: Correlation with Graded Ophthalmologic Exam. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5843.
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Determine the ability of standard brain protocol magnetic resonance imaging (MR) to detect intraretinal, preretinal, or vitreous hemorrhage (RH) and determine if there is correlation with MR detection of RH and the dilated fundoscopic exam (DFE) severity grade of the hemorrhage.
A retrospective chart review was conducted of 51 patients < 2 years old who were seen for head trauma, often non-accidental, from 5/2008 to 5/2013 and had both brain MR and DFE. MRs were reviewed by a staff pediatric radiologist and resident looking for presence of retinal hemorrhage. DFEs were graded by the chief ophthalmology resident on a 12-point scale (higher scores indicating increased severity) based on type, size, location, and extent of hemorrhage (J AAPOS. 2009 13(3):268-272). Fundus photos were available for grading the DFE for 40 patients; a grade was calculated for the remaining exams based on detailed reports by the retinal specialist who initially examined the patient. Statistical analysis was done using Fisher’s exact test and Wilcoxon Rank Sum test with P<0.05 considered statistically significant.
There was a statistically significant difference in the median grade of RH on DFE between patients who had RH detected on MR and those who did not (p=0.0012). When exam grade was grouped by severity 0-4, 5-8 and >8, there was a significant association between DFE grade and detection of RH based on MR (p=0.0003). Only 4% of patients with an exam grade of 0-4 were classified as having RH on MR compared to 79% who had an exam grade >8. In patients with only intraretinal hemorrhages, MR did not detect any RH. MRI was 61% sensitive and 100% specific for detection of RH. Positive predictive value (PV) was 100% and negative PV 22%. RH was best seen on the MR fast field echo (FFE) and T2 sequences.
Since MR detection of RH was shown to be highly specific and MR findings of RH correlate with the severity of RH, MR may be a useful adjunct in the evaluation of patients for suspected non-accidental trauma, especially when ophthalmologic expertise may be initially unavailable. Given that orbital MR protocols have much thinner cuts through the globe, adding this sequence at the time of brain imaging my increase the sensitivity of MR for detecting RH.
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