Radiology Department, Paris Descartes University, St Vincent de Paul Hospital, AP-HP 82 Avenue Denfert Rochereau, 75674 Paris Cedex 14, France.
Pediatr Radiol. 2010 Jun;40(6):932-8. doi: 10.1007/s00247-010-1591-0. Epub 2010 Apr 30.
Child abuse is a controversial problem of special concern. Recent reports have focused on the broad variability of reporting to child protection services. Radiologists play a key role in the early diagnosis and imaging of suspected inflicted injury. Imaging must be performed and then interpreted with rigour.The aims of this review are: To review the recent recommended guidelines for imaging in cases of suspicion of abuse. These include a highly detailed complete skeletal survey with centered views, whilst brain CT and/or MRI are mandatory in children younger than 2 years. The use of abdominal imaging is debatable if the child has no symptoms. All siblings younger than 2 years should be assessed in the same way while the diagnosis of abuse is investigated. Body MRI is an interesting modality that remains a "work-in-progress". To highlight that dating of both brain and skeletal injuries is imprecise. The main point is, however, to determine if the pattern is of "age-different" lesions. This not only provides a strong argument for the diagnosis of abuse, but also indicates repetitive violence with a high risk for further injury and death. To remember that the medical perspective is to protect the child. Thus, radiologists must communicate clearly the suspicion of abuse and the degree of certainty to clinicians to aid reporting or hospitalization.
儿童虐待是一个备受关注的有争议问题。最近的报告集中在向儿童保护服务机构报告的广泛可变性上。放射科医生在疑似虐待所致伤害的早期诊断和影像学检查中发挥着关键作用。必须进行影像学检查，并严格进行解读。本综述的目的是：回顾最近关于疑似虐待病例影像学检查的建议指南。这些指南包括高度详细的全面骨骼调查，并进行中心视图，而对于 2 岁以下的儿童，脑 CT 和/或 MRI 是强制性的。如果儿童没有症状，则腹部影像学的使用存在争议。在调查虐待的诊断时，所有 2 岁以下的兄弟姐妹都应采用相同的方式进行评估。身体 MRI 是一种有趣的模式，仍在不断发展中。需要强调的是，脑和骨骼损伤的年龄确定并不精确。最重要的是，要确定损伤模式是否为“年龄不同”的病变。这不仅为虐待的诊断提供了强有力的证据，还表明存在重复暴力行为，儿童面临更高的进一步受伤和死亡风险。要记住，医学观点是保护儿童。因此，放射科医生必须向临床医生清晰地传达对虐待的怀疑和确定性程度，以协助报告或住院治疗。
