Imaging Detects Child Abuse Fractures With High Sensitivity

PET imaging shows higher sensitivity in overall detection of fractures than skeletal survey

TUESDAY, March 30 (HealthDay News) -- Positron emission tomography (PET) imaging is likely more sensitive than a skeletal survey in identifying fractures due to child abuse, according to a study in the April issue of Radiology.

Laura A. Drubach, M.D., of Children's Hospital Boston, and colleagues reviewed baseline skeletal survey and fluorine 18-labeled sodium fluoride (18F-NaF) PET data in 22 children under 2 years of age suspected of having been abused. Fourteen children also underwent a follow-up skeletal survey.

At baseline, the researchers identified 156 fractures by skeletal survey and 200 fractures by PET. Compared with children who had both a baseline and follow-up skeletal survey, PET had a higher sensitivity than the baseline skeletal survey in detecting all fractures (85 versus 72 percent), thoracic fractures (ribs, sternum, clavicle and scapula; 92 versus 68 percent), and posterior rib fractures (93 versus 73 percent). In contrast, the baseline skeletal survey was more sensitive than PET in detecting classic metaphyseal lesions (defined as a series of microfractures across the metaphysis; 80 versus 67 percent).

"18F-NaF PET had greater sensitivity in the overall detection of fractures related to child abuse than did baseline skeletal survey," the authors write. "Because of the lower sensitivity of PET in the detection of classic metaphyseal lesions, a characteristic fracture in child abuse, initial radiographic evaluation remains necessary."

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