Abusive Head Trauma: Dr Felice D’Arco Shares His Specialist Radiology Expertise

Dr Felice D’Arco, Consultant Paediatric Neuroradiologist at Great Ormond Street Hospital, presented at the European Society of Paediatric Radiology (ESPR) 2024 Annual Meeting in Seville, delivering a specialist session on the imaging of abusive head trauma and the practical challenges clinicians face when interpreting complex paediatric neuroimaging.

His presentation explored one of the most difficult areas of paediatric radiology: distinguishing accidental injury from findings that may raise concern for non-accidental trauma, while avoiding conclusions based on imaging features considered in isolation.

Drawing on his specialist neuroradiology experience, Dr D’Arco examined imaging protocols, differential diagnosis, common interpretative pitfalls and the importance of placing radiological findings within the wider clinical context.

The Radiologist’s Role in Suspected Abusive Head Trauma

Abusive head trauma can present with a complex combination of neurological and radiological findings.

Imaging may therefore play a central role in identifying intracranial injury, assessing its extent and helping the wider clinical team understand whether the pattern of findings is consistent with the history provided.

Dr D’Arco’s presentation highlighted the importance of a structured and evidence-led radiological approach.

Rather than treating any single imaging feature as diagnostic in itself, the radiologist must consider the complete pattern of abnormalities, their distribution, their likely timing and how they relate to the broader clinical picture.

This becomes particularly important where the distinction between accidental and non-accidental injury may have significant clinical and legal consequences.

Choosing the Appropriate Imaging Approach

The investigation of suspected abusive head trauma may involve more than one imaging modality.

CT can be important in the acute setting, particularly where rapid identification of intracranial haemorrhage or other significant injury is required.

MRI can provide additional detail about the brain and surrounding structures and may help characterise injuries that are less apparent on initial imaging.

Dr D’Arco’s session addressed the importance of appropriate imaging protocols and ensuring that investigations are designed to answer the relevant clinical questions.

The quality and completeness of the imaging pathway can materially affect the conclusions that can subsequently be drawn from the radiological evidence.

Distinguishing Accidental From Non-Accidental Injury

One of the most challenging aspects of abusive head trauma imaging is determining the significance of the abnormalities identified.

Subdural haemorrhage, cerebral injury and other findings can arise in different clinical circumstances, meaning interpretation requires considerably more than recognising that an abnormality is present.

Dr D’Arco explored the importance of differential diagnosis and the need to consider whether alternative explanations are supported by the imaging and clinical evidence.

The mechanism described, the child's age and developmental stage, the distribution of injury and associated clinical findings may all contribute to the radiological assessment.

This careful distinction is particularly important in cases where imaging interpretation may later be scrutinised in a medico-legal setting.

Avoiding Radiological Misinterpretation

Complex paediatric imaging also carries a risk of overinterpretation.

Dr D’Arco highlighted the importance of recognising imaging appearances that may mimic traumatic injury or be incorrectly attributed to a particular mechanism.

For the radiologist, this requires familiarity not only with traumatic pathology but also with normal developmental appearances, anatomical variants and conditions that can produce similar findings.

A robust opinion should therefore explain both what the imaging demonstrates and what it cannot reliably establish on its own.

That distinction is essential when radiological findings form part of a wider multidisciplinary or medico-legal investigation.

The Importance of Clinical Context

Imaging does not exist in isolation.

The significance of a radiological finding may depend heavily on the child's presentation, clinical history, examination findings and other investigations.

Dr D’Arco’s presentation reinforced the importance of integrating those sources of evidence while remaining clear about the limits of radiological expertise.

The radiologist’s role is to provide a specialist interpretation of the imaging evidence rather than to make unsupported assumptions about events outside that evidence.

This ability to define both the strength and the limitations of an opinion is especially important in sensitive and disputed cases.

Communicating Complex Radiological Evidence

Abusive head trauma cases may involve clinicians from multiple specialties alongside safeguarding professionals and, in some cases, legal teams.

Radiological findings therefore need to be communicated clearly.

Technical terminology, areas of uncertainty and differential diagnoses must be explained in a way that allows other professionals to understand both the significance of the imaging and any limitations in interpretation.

Dr D’Arco’s presentation demonstrated the value of specialist paediatric neuroradiology expertise in translating complex imaging into a clear, structured and clinically meaningful opinion.

Specialist Expertise in Paediatric Neuroradiology

As a Consultant Paediatric Neuroradiologist at Great Ormond Street Hospital, Dr D’Arco works within a highly specialised area of imaging involving complex neurological conditions in children.

His presentation at ESPR 2024 provided an opportunity to share his expertise with fellow radiologists and explore the practical challenges involved in assessing suspected abusive head trauma in real-world clinical practice.

His approach emphasises careful imaging analysis, appropriate differential diagnosis and a clear understanding of the boundaries of radiological interpretation — all of which are particularly important when imaging evidence may later be subject to detailed medico-legal scrutiny.

Dr Felice D’Arco is a member of Ardent Expert Chambers. View his full member profile to learn more about his specialist expertise and medico-legal practice.