Acute identification of cranial burst fracture: Comparison between CT and MR imaging findings

BACKGROUND AND PURPOSE: Scalp swelling associated with cranial burst fractu re, a widely diastatic skull fracture of infants associated with dural lace ration and acute cerebral extrusion, may be confused with that of a simple subgaleal hematoma. Both conditions can also be associated with hemorrhagic shock. We sought to improve the early evaluation of infants believed to ha ve sustained cranial burst fracture by including MR imaging, since this stu dy clearly delineates the dural-cortical interface, the site of injury. METHODS: Seven infants aged 1 through 11 months who sustained cranial burst fractures, all initially imaged with skull radiography and CT, were studie d or treated from 1992 through 1996, MR imaging was obtained after resuscit ation and stabilization. RESULTS: Surgery or autopsy confirmed MR findings (dural laceration and ext racalvarial cerebral tissue) in all seven infants. CONCLUSION: MR imaging allows early diagnosis of skull fracture associated with acute cerebral extrusion.