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

BACKGROUND AND PURPOSE Scalp swelling associated with cranial burst fracture, a widely diastatic skull fracture of infants associated with dural laceration 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 have sustained cranial burst fracture by including MR imaging, since this study 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 studied or treated from 1992 through 1996. MR imaging was obtained after resuscitation and stabilization. RESULTS Surgery or autopsy confirmed MR findings (dural laceration and extracalvarial cerebral tissue) in all seven infants. CONCLUSION MR imaging allows early diagnosis of skull fracture associated with acute cerebral extrusion.