Imaging of the Pediatric Cranial Sutures in Abusive Head Trauma

Pediatric skull fractures are frequently encountered in accidental and abusive head trauma and often involve cranial sutures. However, skull fracture association with cranial sutural widening, crossing, or contacting ≥2 cranial sutures can be seen more commonly with abusive head trauma. Knowledge of cranial sutures and associated variants is helpful for an accurate diagnosis. 3D head CT is a significant aid in the identification of skull fractures contacting and crossing cranial sutures. Growing literature supports the elimination of concurrent skull radiographs (often performed as required components of follow-up skeletal surveys). Ultrashort TE/zero TE MRI is an emerging new imaging technique to consider for assessing skull fractures to aid in evaluating pediatric abusive head trauma.

Learning Objective: To review skull fracture findings in abusive head trauma with attention paid to the cranial sutures (widening, crossing, or contacting ≥2 sutures).

To recognize normal cranial sutural variants.

To understand the role of CT versus radiographs in assessing skull fractures.

To discuss ultrashort TE/zero TE MRI as an emerging technique for imaging skull fractures in abusive head trauma.