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Shelmerdine SC, Davendralingam N, Langan D, Palm L, Mangham C, Arthurs OJ. Post-mortem skeletal survey (PMSS) versus post-mortem computed tomography (PMCT) for the detection of corner metaphyseal lesions (CML) in children. Eur Radiol 2024; 34:5561-5569. [PMID: 38459348 DOI: 10.1007/s00330-024-10679-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/02/2024] [Accepted: 02/13/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVES Corner metaphyseal lesions (CMLs) are specific for child abuse but challenging to detect on radiographs. The accuracy of CT for CML detection is unknown. Our aim was to compare diagnostic accuracy for CML detection on post-mortem skeletal surveys (PMSS, plain radiography) versus post-mortem CT (PMCT). METHODS A 10-year retrospective review was performed at a children's hospital for patients having PMSS, PMCT and histopathological correlation (reference standard) for suspected CMLs. Twenty-four radiologists independently reported the presence or absence of CMLs in all cases in a blinded randomised cross-over design across two rounds. Logistic regression models were used to compare accuracy between modalities. RESULTS Twenty CMLs were reviewed for each of the 10 subjects (200 metaphyses in all). Among them, 20 CMLs were confirmed by bone histopathology. Sensitivity for these CMLs was significantly higher for PMSS (69.6%, 95% CI 61.7 to 76.7) than PMCT (60.5%, 95% CI 51.9 to 68.6). Using PMSS for detection of CMLs would yield one extra correct diagnosis for every 11.1 (95% CI 6.6 to 37.0) fractured bones. In contrast, specificity was higher on PMCT (92.7%, 95% CI 90.3 to 94.5) than PMSS (90.5%, 95% CI 87.6 to 92.8) with an absolute difference of 2.2% (95% CI 1.0 to 3.4, p < 0.001). More fractures were reported collectively by readers on PMSS (785) than on PMCT (640). CONCLUSION PMSS remains preferable to PMCT for CML evaluation. Any investigation of suspected abuse or unexplained deaths should include radiographs of the limbs to exclude CMLs. CLINICAL RELEVANCE STATEMENT In order to avoid missing evidence that could indicate child abuse as a contributory cause for death in children, radiographs of the limbs should be performed to exclude CMLs, even if a PMCT is being acquired. KEY POINTS • Corner metaphyseal lesions (CMLs) are indicative for abuse, but challenging to detect. Skeletal surveys (i.e. radiographs) are standard practice; however, accuracy of CT is unknown. • Sensitivity for CML detection on radiographs is significantly higher than CT. • Investigation of unexplained paediatric deaths should include radiographs to exclude CMLs even if CT is also being performed.
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Affiliation(s)
- Susan Cheng Shelmerdine
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, WC1H 3JH, UK.
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, WC1N 1EH, UK.
- NIHR Great Ormond Street Hospital Biomedical Research Centre, 30 Guilford Street, Bloomsbury, London, WC1N 1EH, UK.
- Department of Clinical Radiology, St George's Hospital, London, UK.
| | - Natasha Davendralingam
- Department of Clinical Radiology, Bedfordshire Hospitals NHS Foundation Trust, Bedford, UK
| | - Dean Langan
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, WC1N 1EH, UK
| | - Liina Palm
- Department of Histopathology, Great Ormond Street Hospital for Children, London, WC1H 3JH, UK
| | - Chas Mangham
- University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Owen J Arthurs
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, WC1H 3JH, UK
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, WC1N 1EH, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, 30 Guilford Street, Bloomsbury, London, WC1N 1EH, UK
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Margerin M, Ducloyer M, Morel B, Delbreil A, Mergy-Laurent M, Tasu JP, Dumas V. Imaging of sudden unexpected death in infancy: a comprehensive nationwide French survey. Pediatr Radiol 2024; 54:1720-1728. [PMID: 39115697 DOI: 10.1007/s00247-024-06013-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 07/21/2024] [Accepted: 07/22/2024] [Indexed: 09/07/2024]
Abstract
RATIONALE AND OBJECTIVES Introduction of post-mortem imaging has helped improve sudden unexpected death in infancy (SUDI) management in Europe. French guidelines were issued in 2007 to homogenise SUDI investigations including imaging. The aim of this study was to evaluate current imaging management of SUDI in France. MATERIAL AND METHODS Between January 2022 and July 2022, all 35 SUDI French referral centres were invited to answer an e-mailed online survey including 29 questions divided into four different sections covering imaging practices for SUDI including radiology department organisation, imaging modalities performed, methods of reading, and current training resources. Partial responses were secondarily completed by a personal call to the SUDI imaging consultant. The current implementation of the 2007 recommendations was compared with a previous evaluation from 2015 and with current North American practices. RESULTS The participation rate of centres performing SUDI imaging was 100% (35/35). Imaging was systematically performed in 94.3% (33/35) of the centres: 74.3% (26/35) using radiography; 5.7% (2/35) using ultrasound; 94.3% (33/35) using computed tomography (CT), including 89% (31/35) whole-body CT and 5.7% (2/35) brain CT; and 20% (7/35) using magnetic resonance imaging (MRI). Two centres (5.7%, 2/35) did not systematically perform brain imaging. One (2.9%, 1/35) used ultrasound-guided biopsy. In comparison with 2015, rates of brain imaging increased by 25.4% (P=0.008). There was no significant difference in the number of forensic MRIs performed between France and North America (P=0.663). CONCLUSION Despite improvements since 2015, full compliance with French guidelines for SUDI investigations remains incomplete. The use of imaging, particularly CT and brain imaging, has increased. Further efforts are needed to standardise imaging practices for optimal SUDI investigations.
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Affiliation(s)
- Mathilde Margerin
- Department of Radiology, Poitiers University Medical Center, CHU Poitiers, 2 Rue de La Milétrie, 86000, Poitiers, France
| | - Mathilde Ducloyer
- Department of Forensic Medicine, Nantes University Medical Center, Nantes, France
| | - Baptiste Morel
- Department of Radiology, Tours University Medical Center, Tours, France
| | - Alexia Delbreil
- Department of Forensic Medicine, Poitiers University Medical Center, Poitiers, France
| | - Martine Mergy-Laurent
- Department of Radiology, Poitiers University Medical Center, CHU Poitiers, 2 Rue de La Milétrie, 86000, Poitiers, France
| | - Jean Pierre Tasu
- Department of Radiology, Poitiers University Medical Center, CHU Poitiers, 2 Rue de La Milétrie, 86000, Poitiers, France
- LaTIM, INSERM, UMR 1101, Bâtiment 1 CHRU Morvan - 2 Av. Foch, 29238, Brest, France
| | - Victor Dumas
- Department of Radiology, Poitiers University Medical Center, CHU Poitiers, 2 Rue de La Milétrie, 86000, Poitiers, France.
- LabCom I3M, DACTIM-MIS Team, LMA CNRS 7348, Poitiers University Medical Center, Poitiers, France.
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Shelmerdine SC, Arthurs OJ. How to report perinatal and paediatric postmortem CT. Insights Imaging 2024; 15:129. [PMID: 38816589 PMCID: PMC11139809 DOI: 10.1186/s13244-024-01698-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 04/13/2024] [Indexed: 06/01/2024] Open
Abstract
Postmortem CT (PMCT) has become increasingly accepted alongside skeletal surveys as a critical part of investigation in childhood deaths, either as part of a suite of non-invasive investigations through parental choice, or comprehensive evaluation in a forensic setting. Whilst CT image acquisition and protocols have been published and are relatively standardised, CT imaging reporting remains highly variable, largely dependent upon reporter experience and expertise. The main "risk" in PMCT is the over-interpretation of normal physiological changes on imaging as pathological, potentially leading to misdiagnosis or overdiagnosis of the disease. In this article, we present a pragmatic standardised reporting framework, developed over a decade of PMCT reporting in children in our institution, with examples of positive and negative findings, so that it may aid in the interpretation of PMCT images with those less experienced in paediatric findings and postmortem imaging. CRITICAL RELEVANCE STATEMENT: Standardised reporting using a common framework with a sound understanding of normal postmortem changes that occur in children are crucial in avoiding common reporting errors at postmortem CT. KEY POINTS: Familiarity with postmortem imaging is required for useful image reporting, and reporting standards vary. Understanding normal postmortem change from significant abnormalities requires training and experience. Following a template may remind reporters what to include and help improve performance.
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Affiliation(s)
- Susan C Shelmerdine
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.
- UCL Great Ormond Street Institute of Child Health, London, UK.
- Great Ormond Street Hospital NIHR Biomedical Research Centre, London, UK.
| | - Owen J Arthurs
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital NIHR Biomedical Research Centre, London, UK
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Edwards H, Shelmerdine SC, Arthurs OJ. Forensic post-mortem CT in children. Clin Radiol 2023; 78:839-847. [PMID: 37827594 DOI: 10.1016/j.crad.2023.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 03/30/2023] [Accepted: 06/02/2023] [Indexed: 10/14/2023]
Abstract
Post-mortem computed tomography (PMCT) imaging is gaining popularity and acceptance for use alongside forensic autopsies of children, predominantly to aid in the detection of traumatic injuries. Recent research on this topic has provided a breadth of new information regarding the appropriate usage, imaging guidance, and diagnostic accuracy for the identification of different paediatric pathologies. Additionally, advanced CT imaging techniques, such as PMCT angiography or ventilated PMCT, have been trialled, and post-mortem micro-CT is now being used in specialist centres for the assessment of subtle fractures in extracted bone specimens. Various image post-processing methods (e.g., three-dimensional printing from PMCT imaging data) are being used for the illustration of injuries in the medicolegal setting to a lay audience and provide another avenue for the future of forensic radiology research. In this review, the evidence-based principles and benefits of post-mortem imaging for forensic investigation in childhood deaths are presented, with a particular focus on PMCT and current practices. Variations in forensic imaging strategies around the world, published diagnostic accuracy rates, and expected normal post-mortem imaging findings are discussed, as well as potential future applications and research in this area.
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Affiliation(s)
- H Edwards
- Alder Hey Children's NHS Foundation Trust, Liverpool L12 2AP, UK
| | - S C Shelmerdine
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK; UCL Great Ormond Street Institute of Child Health, London, UK; NIHR Great Ormond Street Hospital Biomedical Research Centre, UK
| | - O J Arthurs
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK; UCL Great Ormond Street Institute of Child Health, London, UK; NIHR Great Ormond Street Hospital Biomedical Research Centre, UK.
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Henry MK, Egbe TI, White AM, Servaes S, Andronikou S, Scribano PV, Wood JN. Yield of Postmortem Skeletal Surveys in Infants Presenting to Emergency Care With Sudden and Unexpected Death. Pediatr Emerg Care 2023; 39:646-650. [PMID: 37590927 DOI: 10.1097/pec.0000000000003013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
OBJECTIVES Child abuse should be considered in cases of sudden unexpected infant death (SUID). Postmortem skeletal surveys (PM-SS) are recommended to evaluate for abusive fractures in SUID. Little is known about the yield of PM-SS among infants presenting to emergency care with SUID. Our objectives were to (1) describe the presentation and care of infants with SUID at a tertiary children's hospital emergency department and (2) report PM-SS use and findings. METHODS We performed a retrospective study of infants younger than 12 months with SUID presenting to an urban emergency department from 2007 to 2019. We describe their presentation and care, including PM-SS performance and findings, referrals to the medical examiner, and reports to child protective services (CPS). We assessed for associations between race, payer, and presentation with reports to CPS. RESULTS Of 73 infants with SUID, concern for unsafe sleep was documented in 45 (61.6%) and 71 (97.3%) underwent cardiopulmonary resuscitation by a medical professional. All 73 (100%) underwent PM-SS and were referred to the medical examiner. Twelve definite fractures (11 rib, 1 classic metaphyseal lesion) and 8 possible fractures (7 rib, 1 classic metaphyseal lesion) were identified among 6 (8.2%) infants. Forty-three (58.9%) were reported to CPS. There were no associations between race, payer, age, or history of unsafe sleep and CPS reports. CONCLUSIONS One in 12 cases of SUID had a possible and/or definite fracture identified on plain radiography. Multicenter studies are needed to compare yield across different postmortem imaging modalities and populations.
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Affiliation(s)
| | - Teniola I Egbe
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA
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Tan H, Xu H, Yu N, Yu Y, Duan H, Fan Q, Zhanyu T. The value of deep learning-based computer aided diagnostic system in improving diagnostic performance of rib fractures in acute blunt trauma. BMC Med Imaging 2023; 23:55. [PMID: 37055752 PMCID: PMC10099632 DOI: 10.1186/s12880-023-01012-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 04/04/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND To evaluate the value of a deep learning-based computer-aided diagnostic system (DL-CAD) in improving the diagnostic performance of acute rib fractures in patients with chest trauma. MATERIALS AND METHODS CT images of 214 patients with acute blunt chest trauma were retrospectively analyzed by two interns and two attending radiologists independently firstly and then with the assistance of a DL-CAD one month later, in a blinded and randomized manner. The consensusdiagnosis of fib fracture by another two senior thoracic radiologists was regarded as reference standard. The rib fracture diagnostic sensitivity, specificity, positive predictive value, diagnostic confidence and mean reading time with and without DL-CAD were calculated and compared. RESULTS There were 680 rib fracture lesions confirmed as reference standard among all patients. The diagnostic sensitivity and positive predictive value of interns weresignificantly improved from (68.82%, 84.50%) to (91.76%, 93.17%) with the assistance of DL-CAD, respectively. Diagnostic sensitivity and positive predictive value of attendings aided by DL-CAD (94.56%, 95.67%) or not aided (86.47%, 93.83%), respectively. In addition, when radiologists were assisted by DL-CAD, the mean reading time was significantly reduced, and diagnostic confidence was significantly enhanced. CONCLUSIONS DL-CAD improves the diagnostic performance of acute rib fracture in chest trauma patients, which increases the diagnostic confidence, sensitivity, and positive predictive value for radiologists. DL-CAD can advance the diagnostic consistency of radiologists with different experiences.
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Affiliation(s)
- Hui Tan
- Department of Radiology, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China
| | - Hui Xu
- Peter Boris Centre for Addiction Research, McMaster University & St. Joseph's Health Care Hamilton, 100 West 5th Street, Hamilton, ON, L8P 3R2, Canada.
| | - Nan Yu
- Department of Radiology, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China
| | - Yong Yu
- Department of Radiology, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China
| | - Haifeng Duan
- Department of Radiology, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China
| | - Qiuju Fan
- Department of Radiology, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China.
| | - Tian Zhanyu
- Institute of Medical Technology, Shaanxi University of Chinese Medicine, Xianyang, China
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Hongbiao S, Shaochun X, Xiang W, YuRun T, Yang L, Mingzi Z, Hua Y, Keyang Z, Chi-Cheng F, Qu F, Pengchen G, Yi X, Shiyuan L. Comparison and verification of two deep learning models for the detection of chest CT rib fractures. Acta Radiol 2023; 64:542-551. [PMID: 35300519 DOI: 10.1177/02841851221083519] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND A high false-positive rate remains a technical glitch hindering the broad spectrum of application of deep-learning-based diagnostic tools in routine radiological practice from assisting in diagnosing rib fractures. PURPOSE To examine the performance of two versions of deep-learning-based software tools in aiding radiologists in diagnosing rib fractures on chest computed tomography (CT) images. MATERIAL AND METHODS In total, 123 patients (708 rib fractures) were included in this retrospective study. Two groups of radiologists with different experience levels retrospectively reviewed images for rib fractures in the concurrent mode aided with RibFrac-High Sensitivity (HS) and RibFrac-High Precision (HP). We compared their diagnostic performance against the reference standard in terms of sensitivity and positive predictive value (PPV). RESULTS On a per-patient basis, RibFrac-HS exhibited a higher sensitivity compared with RibFrac-HP (mean difference=0.051, 95% CI=0.012-0.090; P = 0.011), whereas the latter significantly outperformed the former in terms of the PPV (mean difference=0.273, 95% CI=0.238-0.308; P < 0.0001). The use of RibFrac-HP significantly improved the junior and the senior groups' sensitivities respectively by 0.058 (95% CI=0.033-0.083; P < 0.0001) and 0.058 (95% CI=0.034-0.081; P < 0.0001), and decreased the diagnosis time by 206 s (95% CI=191-220; P < 0.0001) and 79 s (95% CI=67-92; P < 0.0001), respectively, when compared to no software assistance. CONCLUSION The sensitivity and efficiency of radiologists in identifying rib fractures can be improved by using RibFrac-HS and/or RibFrac-HP. With an added module for false-positive suppression, RibFrac-HP maintains the sensitivity and increases the PPV in fracture detection compared to Rib-Frac-HS.
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Affiliation(s)
- Sun Hongbiao
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai, PR China
| | - Xu Shaochun
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai, PR China
| | - Wang Xiang
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai, PR China
| | - Tang YuRun
- Company 13, College of Basic Medical Sciences, Naval Medical University, Shanghai, PR China
| | - Lu Yang
- Shanghai Aitrox Technology Corporation Limited, Shanghai, PR China
| | - Zhang Mingzi
- Shanghai Aitrox Technology Corporation Limited, Shanghai, PR China
| | - Yang Hua
- Shanghai Aitrox Technology Corporation Limited, Shanghai, PR China
| | - Zhao Keyang
- Shanghai Aitrox Technology Corporation Limited, Shanghai, PR China
| | - Fu Chi-Cheng
- Shanghai Aitrox Technology Corporation Limited, Shanghai, PR China
| | - Fang Qu
- Shanghai Aitrox Technology Corporation Limited, Shanghai, PR China
| | - Gu Pengchen
- Shanghai Aitrox Technology Corporation Limited, Shanghai, PR China
| | - Xiao Yi
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai, PR China
| | - Liu Shiyuan
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai, PR China
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Radiological detection of sharp force skeletal trauma: an evaluation of the sensitivity of Lodox in comparison to CT and X-ray. Int J Legal Med 2022; 136:1417-1430. [PMID: 35654876 DOI: 10.1007/s00414-022-02845-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 05/24/2022] [Indexed: 10/18/2022]
Abstract
Victims of violent crime often have evidence of sharp force trauma (SFT) which needs to be examined to accurately investigate these cases. The abilities of CTs, X-rays, and Lodox to detect skeletal SFT defects and the minimum number of impacts were assessed, as were their abilities to macroscopically interpret SFT with the aim of identifying the class of weapon used. Ten pigs were, post-mortem, stabbed using a kitchen knife on one side of the body and chopped using a panga on the other side. They were then scanned and macerated. The number of SFT defects, type of SFT, and minimum number of impacts identifiable osteologically were recorded, as well as when using each imaging modality. CTs were most sensitive for detecting stab and chop defects (56.7% and 78.3%, respectively) and the minimum number of impacts (82.8%), while X-rays were least sensitive (17.2% for stab wounds, 46.5% for chop marks, and 43.5% for impacts). Lodox detected 26.8% of stab defects, 59.3% of chop marks, and 58.4% of impacts. The type of SFT for more than 70.0% of identified defects was correctly classified using all methods, while only Lodox had moderate sensitivities for stab wounds (52.4%). When radiological assessments of skeletal SFT are required, CTs should be performed, but Lodox can be used as an alternative. However, dry bone analyses still produce the best results and should be performed whenever possible. Macroscopic interpretations of skeletal SFT to broadly determine the class of weapon used is possible radiologically.
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Garrett KS, Embertson RM, Hopper SA, Woodie JB, McQuerry KJ. Preoperative computed tomographic evaluation of neonatal foals with rib fractures. Vet Surg 2022; 51:816-826. [DOI: 10.1111/vsu.13817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 01/12/2022] [Accepted: 04/11/2022] [Indexed: 11/26/2022]
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Cinematic rendering of paediatric musculoskeletal pathologies: initial experiences with CT. Clin Radiol 2022; 77:274-282. [PMID: 35164928 DOI: 10.1016/j.crad.2022.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 01/06/2022] [Indexed: 11/22/2022]
Abstract
Cinematic rendering (CR) is a novel post-processing technique similar to volume rendering (VR), which allows for a more photorealistic imaging reconstruction by using a complex light modelling algorithm, incorporating information from multiple light paths and predicted photon scattering patterns. Several recent publications relating to adult imaging have argued that CR gives a better "realism" and "expressiveness" experience over VR techniques. CR has also been shown to improve visualisation of musculoskeletal and vascular anatomy compared with conventional CT viewing, and may help non-radiologists to understand complex patient anatomy. In this review, we provide an overview of how CR could be used in paediatric musculoskeletal imaging, particularly in complex diagnoses, surgical planning, and patient consent processes. We present a direct comparison of VR and CR reconstructions across a range of congenital and acquired musculoskeletal pathologies, highlighting potential advantages and areas for further research.
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Otjen JP, Menashe SJ, Romberg EK, Brown ECB, Iyer RS. Pearls and Pitfalls of Thoracic Manifestations of Abuse in Children. Semin Ultrasound CT MR 2022; 43:51-60. [PMID: 35164910 DOI: 10.1053/j.sult.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Child abuse is a broad term that includes, but is not limited to, physical or emotional harm, neglect, sexual abuse, and exploitation. In 2018 in the United States, there were nearly 700,000 victims of such maltreatment, of which 1700 children died. The majority of deaths occur in infants and toddlers under 3 years of age. While clinical signs and symptoms may raise suspicion for inflicted injury, such as bruising in young infants, imaging often plays a central role in identifying and characterizing nonaccidental trauma. The purpose of this article is to discuss the array of inflicted traumatic injuries to the thorax in children. Rib fractures are among the most common and telling features of physical abuse, especially in infants. The locations of such fractures and differences in appearance while healing will be presented, along with potential mimics and pitfalls. Less typical fractures seen in abuse will also be reviewed, including those of the sternum, clavicle, spine, and scapula. Finally, uncommon injuries to the lungs, heart and esophagus will also be considered.
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Affiliation(s)
- Jeffrey P Otjen
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
| | - Sarah J Menashe
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
| | - Erin K Romberg
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
| | - Emily C B Brown
- Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
| | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA.
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Liu C, Chen Z, Xu J, Wu G. Diagnostic value and limitations of CT in detecting rib fractures and analysis of missed rib fractures: a study based on early CT and follow-up CT as the reference standard. Clin Radiol 2022; 77:283-290. [DOI: 10.1016/j.crad.2022.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 01/06/2022] [Indexed: 11/17/2022]
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Ducloyer M, Carballeira-Alvarez A, Tuchtan L, Delteil C, Piercecchi-Marti MD, Gorincour G, Prodhomme O. Normal Post-mortem Imaging Findings in Foetuses and Children. FORENSIC IMAGING 2022. [DOI: 10.1007/978-3-030-83352-7_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Child Abuse, a Post-mortem Forensic Perspective. FORENSIC IMAGING 2022. [DOI: 10.1007/978-3-030-83352-7_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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15
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Doyle E, Dimmock M, Lee K, Ng J, Bassed R. A systematised literature review: Can low-dose whole-body computed tomography replace a radiographic skeletal survey when investigating paediatric non-accidental injury? FORENSIC IMAGING 2021. [DOI: 10.1016/j.fri.2021.200481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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16
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Pomeranz CB, Barrera CA, Servaes SE. Value of chest CT over skeletal surveys in detection of rib fractures in pediatric patients. Clin Imaging 2021; 82:103-109. [PMID: 34801840 DOI: 10.1016/j.clinimag.2021.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 10/25/2021] [Accepted: 11/10/2021] [Indexed: 11/03/2022]
Abstract
Recent literature has raised concerns about the sensitivity and accuracy of radiographs at diagnosing rib fractures. Studies have shown that chest computed tomography (CT) has far greater sensitivity at detecting rib fractures than radiographs. The purpose of this study was to evaluate the sensitivity of skeletal survey (SS) radiographs at diagnosis of rib fractures compared to CT in the pediatric population. This retrospective review included 57 patients who had undergone both a SS and a CT chest or CT chest/abdomen/pelvis within 30 days of each other for the indication of either non-accidental (NAT) or accidental trauma between 2009 and 2017. Images and reports were analyzed by a pediatric radiology fellow for presence/absence of fracture, evidence of healing and location of rib fracture, including rib level, location within the rib (anterior, lateral, and posterior), and side (right versus left). 225 rib fractures were identified in 25 patients on CT. 38 of those fractures were missed on the preceding SS, yielding a miss rate of 17%. Acute fractures were more likely to be missed than chronic or healing fractures (p ≤ 0.01). Location within the rib did not impact rib detection on radiographs. Left-sided rib fractures were not more common in NAT patients, compared to accidental trauma. SS miss approximately 17% of all rib fractures and CT is more sensitive modality in the detection of rib fractures, particularly acute rib fractures, regardless of location. Low-dose Chest CT could be a helpful modality in the work-up of NAT trauma.
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Affiliation(s)
- Christy B Pomeranz
- Department of Radiology, New York Presbyterian Hospital- Weill Cornell Medical School, New York, NY, United States of America.
| | - Christian A Barrera
- Department of Radiology, University of Pennsylvania School of Medicine and the Children's Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Sabah E Servaes
- Department of Radiology, University of Pennsylvania School of Medicine and the Children's Hospital of Philadelphia, Philadelphia, PA, United States of America
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17
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Pediatric rib pathologies: clinicoimaging scenarios and approach to diagnosis. Pediatr Radiol 2021; 51:1783-1797. [PMID: 34117521 DOI: 10.1007/s00247-021-05070-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 02/02/2021] [Accepted: 03/22/2021] [Indexed: 12/25/2022]
Abstract
Pathologies involving the ribs are diverse in nature, including entities specific to the pediatric population as well as shared pathologies with adults. These can be either localized within or adjacent to the rib, but may also cause rib alteration as a component of a systemic process. To better understand these disorders, we discuss several common rib pathologies in the context of their clinical presentation and pertinent imaging findings. In addition, we review the imaging modalities that may be used to evaluate the ribs. Encompassing both the clinical and imaging aspects of pediatric rib pathologies, this review aims to increase pediatric and musculoskeletal radiologists' awareness of the spectrum of disease and how to leverage a pattern-based approach.
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18
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Lawson M, Tully J, Ditchfield M, Kuganesan A, Badawy MK. Using Computed Tomography skeletal surveys to evaluate for occult bony injury in suspected non-accidental injury cases - A preliminary experience. J Med Imaging Radiat Oncol 2021; 66:41-48. [PMID: 34240551 DOI: 10.1111/1754-9485.13271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/19/2021] [Accepted: 06/01/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Michael Lawson
- Monash Health Imaging, Monash Health, Clayton, Victoria, Australia.,Centre for Medical and Radiation Physics, School of Physics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Joanna Tully
- Victorian Forensic Paediatric Medical Service, Monash Children's Hospital, Clayton, Victoria, Australia
| | - Michael Ditchfield
- Monash Health Imaging, Monash Health, Clayton, Victoria, Australia.,Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Ahilan Kuganesan
- Monash Health Imaging, Monash Health, Clayton, Victoria, Australia
| | - Mohamed K Badawy
- Monash Health Imaging, Monash Health, Clayton, Victoria, Australia.,Department of Medical Imaging and Radiation Sciences, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
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19
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Lawson M, Tully J, Ditchfield M, Metcalfe P, Qi Y, Kuganesan A, Badawy MK. A review of current imaging techniques used for the detection of occult bony fractures in young children suspected of sustaining non-accidental injury. J Med Imaging Radiat Oncol 2021; 66:68-78. [PMID: 34176229 DOI: 10.1111/1754-9485.13270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/01/2021] [Indexed: 11/30/2022]
Abstract
Non-accidental injuries remain a leading cause of preventable morbidity and mortality in young children. The accurate identification of the full spectrum of injuries in children presenting with suspected abuse is essential to ensure the appropriate protective intervention is taken. The identification of occult bone fractures in this cohort is important as it raises the level of concern about the mechanism of injury and maintaining the child's safety. Radiographic imaging remains the modality of choice for skeletal assessment; however, current studies report concerns regarding the ability of radiographs to detect certain fractures in the acute stage. As such, alternative modalities for the detection of fractures have been proposed. This article reviews the current literature regarding fracture detectability and radiation dose burden of imaging modalities currently used for the assessment of occult bony injury in young children in whom non-accidental injury is suspected.
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Affiliation(s)
- Michael Lawson
- Monash Imaging, Monash Health, Melbourne, Victoria, Australia.,Centre for Medical and Radiation Physics, School of Physics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Joanna Tully
- Victorian Forensic Paediatric Medical Service, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Michael Ditchfield
- Monash Imaging, Monash Health, Melbourne, Victoria, Australia.,Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Peter Metcalfe
- Centre for Medical and Radiation Physics, School of Physics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Yujin Qi
- Centre for Medical and Radiation Physics, School of Physics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | | | - Mohamed K Badawy
- Monash Imaging, Monash Health, Melbourne, Victoria, Australia.,Department of Medical Imaging and Radiation Sciences, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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20
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Harty MP, Gould SW, Harcke HT. Navigating the perils and pitfalls of pediatric forensic postmortem imaging in the United States. Pediatr Radiol 2021; 51:1051-1060. [PMID: 33999245 DOI: 10.1007/s00247-020-04833-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 05/28/2020] [Accepted: 08/27/2020] [Indexed: 02/06/2023]
Abstract
Postmortem CT is widely used in the general adult and military populations. It is used extensively in pediatric death investigations in Europe and Asia, but distinctive challenges are encountered when launching a postmortem imaging program in the United States. We describe the issues we have encountered specific to establishing a pediatric postmortem imaging service in this country and propose potential solutions.
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Affiliation(s)
- Mary P Harty
- Department of Medical Imaging, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA.
| | - Sharon W Gould
- Department of Medical Imaging, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Howard T Harcke
- Department of Medical Imaging, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA
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21
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Proisy M, Vivier PH, Morel B, Bruneau B, Sembely-Taveau C, Vacheresse S, Devillers A, Lecloirec J, Bodet-Milin C, Dubois M, Hamonic S, Bajeux E, Ganivet A, Adamsbaum C, Treguier C. Whole-body MR imaging in suspected physical child abuse: comparison with skeletal survey and bone scintigraphy findings from the PEDIMA prospective multicentre study. Eur Radiol 2021; 31:8069-8080. [PMID: 33912993 DOI: 10.1007/s00330-021-07896-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/26/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To assess the contribution of whole-body magnetic resonance imaging (WBMRI) and bone scintigraphy (BS) in addition to skeletal survey (SS) in detecting traumatic bone lesions and soft-tissue injuries in suspected child abuse. METHODS In this prospective, multicentre, diagnostic accuracy study, children less than 3 years of age with suspected physical abuse were recruited. Each child underwent SS, BS and WBMRI. A blinded first review was performed in consensus by five paediatric radiologists and three nuclear medicine physicians. A second review investigated discrepancies reported between the modalities using a consensus result of all modalities as the reference standard. We calculated the sensitivity, specificity and corresponding 95% confidence interval for each imaging modality (SS, WBMRI and BS) and for the combinations [SS + WBMRI] and [SS + BS]. RESULTS One hundred seventy children were included of which sixty-four had at least one lesion. In total, 146 lesions were included. The sensitivity and specificity of each examination were, respectively, as follows: 88.4% [95% CI, 82.0-93.1] and 99.7% [95% CI, 99.5-99.8] for the SS, 69.9% [95% CI, 61.7-77.2] and 99.5% [95% CI, 99.2-99.7] for WBMRI and 54.8% [95% CI, 46.4-63.0] and 99.7% [95% CI, 99.5-99.9] for BS. Sensitivity and specificity were, respectively, 95.9% [95% CI, 91.3-98.5] and 99.2% [95% CI, 98.9-99.4] for the combination SS + WBMRI and 95.2% [95% CI, 90.4-98.1] and 99.4% [95% CI, 99.2-99.6] for the combination SS + BS, with no statistically significant difference between them. CONCLUSION SS was the most sensitive independent imaging modality; however, the additional combination of either WBMRI or BS examinations offered an increased accuracy. KEY POINTS • SS in suspected infant abuse was the most sensitive independent imaging modality in this study, especially for detecting metaphyseal and rib lesions, and remains essential for evaluation. • The combination of either SS + BS or SS + WBMRI provides greater accuracy in diagnosing occult and equivocal bone injuries in the difficult setting of child abuse. • WBMRI is a free-radiation technique that allows additional diagnosis of soft-tissue and visceral injuries.
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Affiliation(s)
- Maïa Proisy
- Radiology Department, CHU Rennes, F-35200, Rennes, France.
| | - Pierre-Hugues Vivier
- Pediatric Radiology, service de Radiologie, Ramsay - Générale de Santé, University Hospital Charles Nicolle - Radiology, Hôpital Privé de l'Estuaire, 505 rue Irène Joliot Curie, 76620, Le Havre, France
| | | | | | | | | | - Anne Devillers
- Nuclear Medicine Department, CRLC Rennes, Rennes, France
| | - Joseph Lecloirec
- Nuclear Medicine Department, CRLC Henri Becquerel, Rouen, France
| | - Caroline Bodet-Milin
- CHU Nantes, Nuclear Medicine Department, Université de Nantes, CNRS, Inserm, CRCINA, Nantes, France
| | - Marine Dubois
- Radiology Department, CHU Rennes, F-35200, Rennes, France
| | - Stéphanie Hamonic
- Public Heatlh and Epidemiology Department, CHU Rennes, Rennes, France
| | - Emma Bajeux
- Public Heatlh and Epidemiology Department, CHU Rennes, Rennes, France
| | - Anne Ganivet
- Research and Innovation Department, CHU Rennes, Rennes, France
| | - Catherine Adamsbaum
- Pediatric Radiology Department, Hôpitaux Universitaires Paris-Sud, Bicêtre AP-HP, 94270, Le Kremlin-Bicêtre, France
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22
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Wulster K, Ortved K, Curtiss A, Richardson D. Response to Letter to the Editor: Validation of standing cone beam computed tomography for diagnosing subchondral fetlock pathology in the Thoroughbred racehorse. Equine Vet J 2021; 53:630-631. [PMID: 33834535 DOI: 10.1111/evj.13441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/11/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Kathryn Wulster
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania, Kennett Square, PA, USA
| | - Kyla Ortved
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania, Kennett Square, PA, USA
| | - Alexandra Curtiss
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania, Kennett Square, PA, USA
| | - Dean Richardson
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania, Kennett Square, PA, USA
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23
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Alzahrani NM, Jeanes A, Paddock M, Shuweihdi F, Offiah AC. The diagnostic performance of chest computed tomography in the detection of rib fractures in children investigated for suspected physical abuse: a systematic review and meta-analysis. Eur Radiol 2021; 31:7088-7097. [PMID: 33725188 PMCID: PMC8379101 DOI: 10.1007/s00330-021-07775-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/08/2021] [Accepted: 02/11/2021] [Indexed: 02/01/2023]
Abstract
Objectives To assess the diagnostic performance of chest CT in the detection of rib fractures in children investigated for suspected physical abuse (SPA). Methods Medline, Web of Science and Cochrane databases were searched from January 1980 to April 2020. The QUADAS-2 tool was used to assess the quality of the eligible English-only studies following which a formal narrative synthesis was constructed. Studies reporting true-positive, false-positive, true-negative, and false-negative results were included in the meta-analysis. Overall sensitivity and specificity of chest CT for rib fracture detection were calculated, irrespective of fracture location, and were pooled using a univariate random-effects meta-analysis. The diagnostic accuracy of specific locations along the rib arc (anterior, lateral or posterior) was assessed separately. Results Of 242 identified studies, 4 met the inclusion criteria. Of these, 2 were included in the meta-analysis. Chest CT identified 142 rib fractures compared to 79 detected by initial skeletal survey chest radiographs in live children with SPA. Post-mortem CT (PMCT) has low sensitivity (34%) but high specificity (99%) in the detection of rib fractures when compared to the autopsy reference standard. PMCT has low sensitivity (45%, 21% and 42%) but high specificity (99%, 97% and 99%) at anterior, lateral and posterior rib locations, respectively. Conclusions Chest CT detects more rib fractures than initial skeletal survey chest radiographs in live children with SPA. PMCT has low sensitivity but high specificity for detecting rib fractures in children investigated for SPA. Key Points • PMCT has low sensitivity (34%) but high specificity (99%) in the detection of rib fractures; extrapolation to CT in live children is difficult. • No studies have compared chest CT with the current accepted practice of initial and follow-up skeletal survey chest radiographs in the detection of rib fractures in live children investigated for SPA. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-07775-3.
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Affiliation(s)
- Nasser M Alzahrani
- Diagnostic Radiology Department, College of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia. .,Academic Unit of Child Health, Department of Oncology and Metabolism, University of Sheffield, Damer Street Building, Western Bank, Sheffield, S10 2TH, UK.
| | - Annmarie Jeanes
- Department of Paediatric Radiology, Leeds Children's Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX, UK
| | - Michael Paddock
- Academic Unit of Child Health, Department of Oncology and Metabolism, University of Sheffield, Damer Street Building, Western Bank, Sheffield, S10 2TH, UK.,Medical Imaging Department, Barnsley Hospital NHS Foundation Trust, Gawber Road, Barnsley, S75 2EP, UK
| | - Farag Shuweihdi
- Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9NL, UK
| | - Amaka C Offiah
- Academic Unit of Child Health, Department of Oncology and Metabolism, University of Sheffield, Damer Street Building, Western Bank, Sheffield, S10 2TH, UK.,Radiology Department, Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield, S10 2TH, UK
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24
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Spies AJ, Steyn M, Prince DN, Brits D. Can forensic anthropologists accurately detect skeletal trauma using radiological imaging? FORENSIC IMAGING 2021. [DOI: 10.1016/j.fri.2020.200424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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25
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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. [DOI: 10.1016/j.jflm.2020.102034] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/03/2020] [Accepted: 07/28/2020] [Indexed: 11/22/2022]
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26
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Paterson CR. Broken bones and irresponsible testimony? Am J Med Genet A 2019; 179:2333-2334. [DOI: 10.1002/ajmg.a.61349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 06/01/2019] [Accepted: 06/11/2019] [Indexed: 11/10/2022]
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27
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Mauf S, Held U, Gascho D, Baumeister R, Flach P, Nguyen-Kim TDL, Thali MJ, Jentzsch T. Flat chest projection in the detection and visualization of rib fractures: A cross-sectional study comparing curved and multiplanar reformation of computed tomography images in different reader groups. Forensic Sci Int 2019; 303:109942. [DOI: 10.1016/j.forsciint.2019.109942] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 08/07/2019] [Accepted: 08/26/2019] [Indexed: 11/28/2022]
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28
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Gould SW, Harty MP, Givler NE, Christensen TE, Curtin RN, Harcke HT. Pediatric postmortem computed tomography: initial experience at a children's hospital in the United States. Pediatr Radiol 2019; 49:1113-1129. [PMID: 31201439 DOI: 10.1007/s00247-019-04433-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/17/2019] [Accepted: 05/16/2019] [Indexed: 12/18/2022]
Abstract
Postmortem CT might provide valuable information in determining the cause of death and understanding disease processes, particularly when combined with traditional autopsy. Pediatric applications of postmortem imaging represent a new and rapidly growing field. We describe our experience in establishing a pediatric postmortem CT program and present a discussion of the distinct challenges in developing this type of program in the United States of America, where forensic practice varies from other countries. We give a brief overview of recent literature along with the common imaging findings on postmortem CT that can simulate antemortem pathology.
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Affiliation(s)
- Sharon W Gould
- Department of Medical Imaging, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA.
| | - M Patricia Harty
- Department of Medical Imaging, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Nicole E Givler
- Department of Medical Imaging, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Theresa E Christensen
- Department of Biomedical Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Riley N Curtin
- Department of Biomedical Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Howard T Harcke
- Department of Medical Imaging, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA
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29
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Shelmerdine S, Langan D, Sebire NJ, Arthurs O. Diagnostic accuracy of perinatal post-mortem ultrasound (PMUS): a systematic review. BMJ Paediatr Open 2019; 3:e000566. [PMID: 31799452 PMCID: PMC6863669 DOI: 10.1136/bmjpo-2019-000566] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/08/2019] [Accepted: 10/14/2019] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Ultrasound is ubiquitous in live paediatric imaging; however, its usage in post-mortem setting is less established. This systematic review aims to evaluate the diagnostic accuracy of paediatric post-mortem ultrasound (PMUS). DESIGN MEDLINE, Embase and Cochrane Library databases were queried for studies published between 1998 and 2018 assessing PMUS diagnostic accuracy rates in children<18 years old, using autopsy as reference standard. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies 2. A bivariate random-effects model was used to obtain combined mean estimates of sensitivity and specificity for different body systems. RESULTS Four studies were included, all relating to ultrasound for perinatal deaths. The mean diagnostic sensitivity and specificity for neurological abnormalities were 84.3% (95% CI: 70.8% to 92.2%) and 96.7% (95% CI: 86.5% to 99.3%); for cardiothoracic abnormalities 52.1% (95% CI: 27.6% to 75.5%,) and 96.6% (95% CI: 86.8% to 99.2%); and for abdominal abnormalities 78.4% (95% CI: 61.0% to 89.4%) and 97.3% (95% CI: 88.9% to 99.4%). Combining all body systems, the mean sensitivity and specificity were 73.3% (95% CI: 59.9% to 83.5%) and 96.6% (95% CI: 92.6% to 98.4%). CONCLUSIONS PMUS demonstrates a reasonable diagnostic accuracy, particularly for abdominal and neurological abnormalities, although cardiac anomalies were less readily identified. TRIAL REGISTRATION NUMBER CRD42018106968.
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Affiliation(s)
- Susan Shelmerdine
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK.,UCL GOSH ICH, London, UK
| | | | - Neil J Sebire
- UCL GOSH ICH, London, UK.,Department of Paediatric Pathology, Great Ormond Street Hospital for Children, London, UK
| | - Owen Arthurs
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK.,UCL GOSH ICH, London, UK
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30
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Feldman KW. Rib fractures: elusive, but important. THE LANCET. CHILD & ADOLESCENT HEALTH 2018; 2:769-770. [PMID: 30249542 DOI: 10.1016/s2352-4642(18)30282-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 08/23/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Kenneth W Feldman
- Children's Protection Program, Seattle Children's Hospital, and Department of Pediatrics, General Pediatric Division, University of Washington School of Medicine Seattle, WA 98105, USA.
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