Understanding the Pathology of Homicidal Pediatric Blunt Neurotrauma through Correlation of Advanced Magnetic Resonance Images with Histopathology

As submitted by the proposer:

In the United States, approximately one third of children who are victims of abusive head injury die - and those who survive have worse neurological outcomes compared to children who survive accidental head injuries.

Current forensic pathology practice relies on autopsy examination with comprehensive neuropathological examination for the diagnosis of fatal non-penetrating blunt head injury. Although considered the gold standard for forensic pathology, neuropathologic examination may be limited, particularly in the evaluation of traumatic axonal injury. The use of advanced magnetic resonance (MR) imaging may facilitate the forensic examination of brains, allowing the pathologist to target specific regions that may not be macroscopically visible during examination.

In order to evaluate whether MR imaging supplements the neuropathologic evaluation of traumatic brain injury in homicidal pediatric blunt head trauma, we plan to compare standard routine neuropathologic examination to findings detected on advanced MR. We plan to perform advanced MR (including SWI and DTI) using a 7 Tesla scanner, on ex vivo formalin-fixed brains, removed at the time of forensic autopsy, on children ages birth to 15 years, who died as a result of abusive head injury (non-penetrating).

Prior to imaging, each brain will be placed in a plastic holder that is unique to the brain’s morphology. Each brain will undergo advanced MR, with interpretation rendered by a neuroradiologist. Each brain will then be examined by a forensic neuropathologist, who will document abnormalities, sample standard regions, as well as macroscopically abnormal regions, and sample additional regions of injury identified by the neuroradiologist.

Histologic correlation will be performed, comparing microscopic findings of the standard set of sampling to the regions detected by neuroradiology. If the differences detected are statistically significant, our study would suggest that advanced MR can provide valuable diagnostic information to the forensic pathologist, detecting areas of injury that might otherwise be overlooked for standard neuropathologic examination.

Data will be analyzed using GraphPad PRISM 7.0 software. Imaging parameters will be assessed per region and compared between control and injury groups using the student’s t-test. Additionally, groups may be divided into severity and time of injury for each region of interest, using a one-way ANOVA.

Note: This project contains a research and/or development component, as defined in applicable law, and complies with Part 200 Uniform Requirements - 2 CFR 200.210(a)(14).

ca/ncf