Using Computed Tomography skeletal surveys to evaluate for occult bony injury in suspected non-accidental injury cases - A preliminary experience.
child abuse
computed tomography
non-accidental injury
occult bony injury
radiology
Journal
Journal of medical imaging and radiation oncology
ISSN: 1754-9485
Titre abrégé: J Med Imaging Radiat Oncol
Pays: Australia
ID NLM: 101469340
Informations de publication
Date de publication:
Feb 2022
Feb 2022
Historique:
revised:
19
04
2021
received:
17
01
2021
accepted:
01
06
2021
pubmed:
10
7
2021
medline:
4
2
2022
entrez:
9
7
2021
Statut:
ppublish
Résumé
This case series summarises our institution's preliminary experience of using computed tomography skeletal surveys (CT-SS) for the assessment of infants with suspected non-accidental injury (NAI) who were unable to undergo radiographic skeletal surveys (SS). This paper describes our experience using CT-SS in terms of radiation doses achieved, occult bony injury detection and forensic utility. Ten infants aged between two weeks and ten months underwent a CT-SS. The results of the CT-SS were compared with concurrent imaging results where available. Radiation doses from imaging procedures were calculated for each patient. Six infants had abnormalities identified on CT-SS. Two patients had both an ante-mortem CT-SS and post-mortem imaging. All fractures identified on alternate imaging modalities were visible on at least one CT-SS reconstruction. The radiation dose associated with CT-SS imaging ranged from 0.73 to 1.46mSv. The radiation dose received by the ten infants in this study was greater than the two skeletal survey approach but was less than the dose received during a bone scintigraphy examination, sometimes used to assess for occult bony injury in this setting. While CT-SS imaging results could not be compared with those obtained with current contemporaneous gold standard imaging techniques, CT-SS identified all fractures observed on the radiographic images where performed. CT-SS also identified additional rib fractures in two patients. Our preliminary findings indicate the need for future prospective studies to clarify the ability of CT-SS to detect metaphyseal fractures reliably.
Identifiants
pubmed: 34240551
doi: 10.1111/1754-9485.13271
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
41-48Informations de copyright
© 2021 The Royal Australian and New Zealand College of Radiologists.
Références
Australian Institute of Health and Welfare. Child Protection Australia 2017-18. Australian Institute of Health and Welfare, Canberra, 2019.
Barlow KM, Minns RA. Annual incidence of shaken impact syndrome in young children. Lancet 2000; 356: 1571-2.
Fluke JD, Shusterman GR, Hollinshead DM, Yuan Y-YT. Longitudinal analysis of repeated child abuse reporting and victimization: Multistate analysis of associated factors. Child Maltreat 2008; 13: 76-88.
Rao R, Browne D, Lunt B, Perry D, Reed P, Kelly P. Radiation doses in diagnostic imaging for suspected physical abuse. Arch Dis Child 2019; 104: 863-8.
Alzen G, Benz-Bohm G. Radiation protection in pediatric radiology. Dtsch Arztebl Int. 2011; 108: 407.
The Royal College of Radiologists. The Radiological Investigation of Suspected Physical Abuse in Children. The Royal College of Radiologists, London, 2018.
Drubach LA, Johnston PR, Newton AW, Perez-Rossello JM, Grant FD, Kleinman PK. Skeletal trauma in child abuse: detection with 18F-NaF PET. Radiology 2010; 255: 173-81.
Berger RP, Panigrahy A, Gottschalk S, Sheetz M. Effective radiation dose in a skeletal survey performed for suspected child abuse. J Pediatr 2016; 171: 310-2.
Wootton-Gorges SL, Soares BP, Alazraki AL et al. ACR appropriateness criteria® suspected physical abuse-child. J Am Coll Radiol 2017; 14: S338-S349.
Harlan SR, Nixon GW, Campbell KA, Hansen K, Prince JS. Follow-up skeletal surveys for nonaccidental trauma: can a more limited survey be performed? Pediatr Radiol 2009; 39: 962-8.
Bainbridge JK, Huey BM, Harrison SK. Should bone scintigraphy be used as a routine adjunct to skeletal survey in the imaging of non-accidental injury? A 10 year review of reports in a single centre. Clin Radiol 2015; 70: e83-e89.
Chuang Y-W, Hsu C-C, Chang C-C et al. Multiple bony injuries on bone scan in a case of unsuspected child abuse. Case Rep Med 2017; 2017: 1-4.
Stauss J, Hahn K, Mann M, De Palma D. Guidelines for paediatric bone scanning with 99m Tc-labelled radiopharmaceuticals and 18 F-fluoride. Eur J Nucl Med Mol Imaging 2010; 37: 1621-8.
Greer M-LC. Whole-body magnetic resonance imaging: techniques and non-oncologic indications. Pediatr Radiol 2018; 48: 1348-63.
Wootton-Gorges SL, Stein-Wexler R, Walton JW, Rosas AJ, Coulter KP, Rogers KK. Comparison of computed tomography and chest radiography in the detection of rib fractures in abused infants. Child Abuse Negl 2008; 32: 659-63.
Sanchez TR, Grasparil AD, Chaudhari R, Coulter KP, Wootton-Gorges SL. Characteristics of Rib fractures in child abuse - The role of low-dose chest computed tomography. Pediatr Emerg Care 2018; 34: 81-3.
Shelmerdine SC, Langan D, Hutchinson JC et al. Chest radiographs versus CT for the detection of rib fractures in children (DRIFT): a diagnostic accuracy observational study. Lancet Child Adolesc Heal 2018; 2: 802-11.
Sanchez TR, Lee JS, Coulter KP, Seibert JA, Stein-Wexler R. CT of the chest in suspected child abuse using submillisievert radiation dose. Pediatr Radiol 2015; 45: 1072-6.
Martin A, Paddock M, Johns CS et al. Avoiding skull radiographs in infants with suspected inflicted injury who also undergo head CT: “a no-brainer?”. Eur Radiol 2020; 30: 1480-7.
Horn BD, Crisci K, Krug M, Pizzutillo PD, MacEwen GD. Radiologic evaluation of juvenile Tillaux fractures of the distal tibia. J Pediatr Orthop 2001; 21: 162-4.
Kleinman PK. Diagnostic Imaging of Child Abuse. Cambridge University Press, Cambridge, 2015.
Proisy M, Marchand AJ, Loget P et al. Whole-body post-mortem computed tomography compared with autopsy in the investigation of unexpected death in infants and children. Eur Radiol 2013; 23: 1711-9.
Lee C, Kim KP, Bolch WE, Moroz BE, Folio L. NCICT: a computational solution to estimate organ doses for pediatric and adult patients undergoing CT scans. J Radiol Prot 2015; 35: 891.
Tapiovaara M, Siiskonen T. PCXMC: A Monte Carlo programfor calculating patient doses in medical x-ray examinations. STUK-A231; 2008: 44
Spies AJ, Steyn M, Bussy E, Brits D. Forensic imaging: The sensitivities of various imaging modalities in detecting skeletal trauma in simulated cases of child abuse using a pig model. J Forensic Leg Med 2020; 76: 102034.
Mandelstam SA, Cook D, Fitzgerald M, Ditchfield MR. Complementary use of radiological skeletal survey and bone scintigraphy in detection of bony injuries in suspected child abuse. Arch Dis Child 2003; 88: 387-90.
Esser M, Hess S, Teufel M et al. Radiation dose optimization in pediatric chest CT: major indicators of dose exposure in 1695 CT scans over seven years. Röfo 2018; 190: 1131-40.
Karmazyn B, Marine MB, Wanner MR, Sağlam D, Jennings SG, Hibbard RA. Establishing signs for acute and healing phases of distal tibial classic metaphyseal lesions. Pediatr Radiol 2020; 50: 715-25.
Karmazyn B, Wanner MR, Marine MB, Tilmans L, Jennings SG, Hibbard RA. The added value of a second read by pediatric radiologists for outside skeletal surveys. Pediatr Radiol 2019; 49: 203-9.