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<meta name="DC.Title" content="Limitations of T2*–Gradient Recalled-Echo and Susceptibility-Weighted Imaging in Characterizing Chronic Subdural Hemorrhage in Infant Survivors of Abusive Head Trauma" />
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<meta name="DC.Description" content="SUMMARY: A possible misconception among radiologists is that chronic subdural hemorrhage should show some degree of blooming on T2*–gradient recalled-echo or susceptibility-weighted sequences such as SWI and susceptibility-weighted angiography, which is not necessarily true. We present 5 cases of chronic subdural hemorrhages in infants, demonstrating intensity near or greater than that of CSF with variable amounts of hemosiderin staining along the neomembranes. We review the physiology and MR imaging physics behind the appearance of a chronic subdural hemorrhage, highlighting that the absence of a BBB can allow hemosiderin to be completely removed from the subdural compartment. Finally, we stress the importance of reviewing all multiplanar sequences for the presence of neomembranes, which can be quite subtle in the absence of hemosiderin staining and are critical for making the diagnosis of chronic subdural hemorrhage.

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&lt;p&gt;A possible misconception among radiologists is that chronic subdural hemorrhage should show some degree of blooming on T2*–gradient recalled-echo or susceptibility-weighted sequences such as SWI and susceptibility-weighted angiography, which is not necessarily true. We present 5 cases of chronic subdural hemorrhages in infants, demonstrating intensity near or greater than that of CSF with variable amounts of hemosiderin staining along the neomembranes. We review the physiology and MR imaging physics behind the appearance of a chronic subdural hemorrhage, highlighting that the absence of a BBB can allow hemosiderin to be completely removed from the subdural compartment. Finally, we stress the importance of reviewing all multiplanar sequences for the presence of neomembranes, which can be quite subtle in the absence of hemosiderin staining and are critical for making the diagnosis of chronic subdural hemorrhage.&lt;/p&gt;" />
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<meta name="twitter:description" content="SUMMARY: A possible misconception among radiologists is that chronic subdural hemorrhage should show some degree of blooming on T2*–gradient recalled-echo or susceptibility-weighted sequences such as SWI and susceptibility-weighted angiography, which is not necessarily true. We present 5 cases of chronic subdural hemorrhages in infants, demonstrating intensity near or greater than that of CSF with variable amounts of hemosiderin staining along the neomembranes. We review the physiology and MR imaging physics behind the appearance of a chronic subdural hemorrhage, highlighting that the absence of a BBB can allow hemosiderin to be completely removed from the subdural compartment. Finally, we stress the importance of reviewing all multiplanar sequences for the presence of neomembranes, which can be quite subtle in the absence of hemosiderin staining and are critical for making the diagnosis of chronic subdural hemorrhage.

GRE
:   gradient recalled-echo
cSDH
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SDH
:   subdural hemorrhage
SDHy
:   subdural hygroma
SWAN
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GRE
:   gradient recalled-echo
cSDH
:   chronic subdural hemorrhage
SDH
:   subdural hemorrhage
SDHy
:   subdural hygroma
SWAN
:   susceptibility-weighted angiography" />
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      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">PEDIATRICS</span></span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">Limitations of T2*–Gradient Recalled-Echo and Susceptibility-Weighted Imaging in Characterizing Chronic Subdural Hemorrhage in Infant Survivors of Abusive Head Trauma</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">J.A. Cramer</span>, <span class="highwire-citation-author" data-delta="1">U.A. Rassner</span> and <span class="highwire-citation-author" data-delta="2">G.L. Hedlund</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">September 2016,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">37 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(9) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1752-1756; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A4769 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-14557--61327711734" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">J.A. Cramer </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (J.A.C., U.A.R.), University of Utah Hospital, Salt Lake City, Utah</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.A.%2BCramer%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Cramer%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AJ.A.%2BCramer%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0003-0350-184X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J.A. Cramer</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">U.A. Rassner </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (J.A.C., U.A.R.), University of Utah Hospital, Salt Lake City, Utah</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=U.A.%2BRassner%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Rassner%20U&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AU.A.%2BRassner%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-0408-9749" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for U.A. Rassner</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">G.L. Hedlund </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Department of Radiology (G.L.H.), Primary Children's Hospital, Salt Lake City, Utah.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=G.L.%2BHedlund%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Hedlund%20G&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AG.L.%2BHedlund%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0003-1727-0683" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for G.L. Hedlund</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" xmlns:xhtml="http://www.w3.org/1999/xhtml" class="section ref-list" id="ref-list-1"><h2 class="">References</h2><ol class="cit-list ref-use-labels"><li><span class="ref-label">1.</span><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1. in text" id="ref-1">↵</a><div class="cit ref-cit ref-journal" id="cit-37.9.1752.1" data-doi="10.1148/radiology.189.1.8372185"><div class="cit-metadata"><ol class="cit-auth-list"><li>
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</li><li><span class="cit-auth"><span class="cit-name-surname">Hedlund</span>  <span class="cit-name-given-names">GL</span></span></li></ol><cite>. <span class="cit-article-title">Subdural hemorrhage in abusive head trauma: imaging challenges and controversies</span>. <abbr class="cit-jnl-abbrev">Am Osteopath Coll Radiol</abbr> <span class="cit-pub-date">2012</span>;<span class="cit-vol">1</span>:<span class="cit-fpage">23</span>–<span class="cit-lpage">30</span></cite></div><div class="cit-extra"></div></div></li><li><span class="ref-label">9.</span><a class="rev-xref-ref" href="#xref-ref-9-1" title="View reference 9. in text" id="ref-9">↵</a><div class="cit ref-cit ref-journal" id="cit-37.9.1752.9" data-doi="10.3171/2013.4.PEDS12596"><div class="cit-metadata"><ol class="cit-auth-list"><li>
</li><li><span class="cit-auth"><span class="cit-name-surname">Bradford</span>  <span class="cit-name-given-names">R</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Choudhary</span>  <span class="cit-name-given-names">AK</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Dias</span>  <span class="cit-name-given-names">MS</span></span></li></ol><cite>. <span class="cit-article-title">Serial neuroimaging in infants with abusive head trauma: timing abusive injuries</span>. <abbr class="cit-jnl-abbrev">J Neurosurg Pediatr</abbr> <span class="cit-pub-date">2013</span>;<span class="cit-vol">12</span>:<span class="cit-fpage">110</span>–<span class="cit-lpage">19</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.3171/2013.4.PEDS12596</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>23799250</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.3171/2013.4.PEDS12596&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=23799250&amp;link_type=MED&amp;atom=%2Fajnr%2F37%2F9%2F1752.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">10.</span><a class="rev-xref-ref" href="#xref-ref-10-1" title="View reference 10. in text" id="ref-10">↵</a><div class="cit ref-cit ref-journal" id="cit-37.9.1752.10" data-doi="10.3109/02688699409002947"><div class="cit-metadata"><ol class="cit-auth-list"><li>
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 37</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 9 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Sep 2016 </div></div>
      
      
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      <div class="highwire-cite-title">Limitations of T2*–Gradient Recalled-Echo and Susceptibility-Weighted Imaging in Characterizing Chronic Subdural Hemorrhage in Infant Survivors of Abusive Head Trauma</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">J.A.</span> <span class="nlm-surname">Cramer</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">U.A.</span> <span class="nlm-surname">Rassner</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">G.L.</span> <span class="nlm-surname">Hedlund</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Sep 2016, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">37 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(9) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1752-1756; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A4769 </span></div>
  
  
  
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      <div class="highwire-cite-title">Limitations of T2*–Gradient Recalled-Echo and Susceptibility-Weighted Imaging in Characterizing Chronic Subdural Hemorrhage in Infant Survivors of Abusive Head Trauma</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">J.A.</span> <span class="nlm-surname">Cramer</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">U.A.</span> <span class="nlm-surname">Rassner</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">G.L.</span> <span class="nlm-surname">Hedlund</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Sep 2016, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">37 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(9) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1752-1756; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A4769 </span></div>
  
  
  
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