Department of Radiology, Children's Hospital Boston and Harvard Medical School, 300 Longwood Ave., Boston, MA 02115, USA.
AJR Am J Roentgenol. 2010 Sep;195(3):744-50. doi: 10.2214/AJR.09.3364.
The purpose of our study was to examine the utility of whole-body MRI (WB-MRI) in the detection of skeletal and soft-tissue injuries in suspected infant abuse.
Twenty-one infants (0-12 months) underwent WB-MRI for evaluation of suspected child abuse. WB-MRI at 1.5 T was performed using coronal and sagittal STIR sequences within 5 days of initial skeletal survey. Follow-up skeletal survey was performed in 16 cases. The "truth" was determined by integrating the initial and follow-up skeletal surveys, where available, into a summary of skeletal injuries (summary skeletal survey). Statistics included analysis of counts and proportions, concordance rate, sensitivity, and specificity.
Summary skeletal survey and WB-MRI identified 167 fractures or areas of skeletal signal abnormality: 46 (27.5%) by both techniques, 68 (40.7%) by summary skeletal survey only, and 53 (31.7%) by WB-MRI only. WB-MRI had high specificity (95%) but low sensitivity (40%) for identifying fractures or signal abnormalities compared with summary skeletal survey. Thirty-seven classic metaphyseal lesions or metaphyseal signal abnormalities were identified: 11 (29.7%) by both techniques, 24 (64.8%) by summary skeletal survey only, and two (5.4%) by WB-MRI only. WB-MRI had very low sensitivity (31%) for identifying signal abnormality where classic metaphyseal lesions were seen with skeletal survey. WB-MRI had low sensitivity (57%) for identifying signal abnormality in areas where rib fractures were seen on skeletal survey. WB-MRI identified soft-tissue injuries such as muscle edema and joint effusions that, in some cases, led to identifying additional fractures.
WB-MRI is insensitive in the detection of classic metaphyseal lesions and rib fractures, high specificity indicators of infant abuse. WB-MRI cannot replace the skeletal survey but may complement it by identifying soft-tissue abnormalities.
本研究旨在探讨全身磁共振成像（WB-MRI）在疑似婴儿虐待所致骨骼和软组织损伤中的应用价值。
21 例（0-12 个月）婴儿因疑似虐待接受 WB-MRI 检查。在初始骨骼检查后 5 天内，使用冠状位和矢状位 STIR 序列在 1.5T 上进行 WB-MRI。16 例进行了后续骨骼检查。“真相”通过将初始和后续骨骼检查（如有）整合到骨骼损伤总结（骨骼总结检查）中确定。统计分析包括计数和比例分析、一致性率、敏感性和特异性。
骨骼总结检查和 WB-MRI 共发现 167 处骨折或骨骼信号异常部位：两种方法均发现 46 处（27.5%），骨骼总结检查仅发现 68 处（40.7%），WB-MRI 仅发现 53 处（31.7%）。与骨骼总结检查相比，WB-MRI 识别骨折或信号异常的特异性（95%）高，但敏感性（40%）低。共发现 37 处经典干骺端病变或干骺端信号异常：两种方法均发现 11 处（29.7%），骨骼总结检查仅发现 24 处（64.8%），WB-MRI 仅发现 2 处（5.4%）。骨骼总结检查发现经典干骺端病变时，WB-MRI 识别信号异常的敏感性（31%）非常低。骨骼总结检查发现肋骨骨折时，WB-MRI 识别信号异常的敏感性（57%）较低。WB-MRI 还可识别肌肉水肿和关节积液等软组织损伤，在某些情况下，这有助于识别其他骨折。
WB-MRI 在检测经典干骺端病变和肋骨骨折方面不敏感，而这是婴儿虐待的高度特异性指标。WB-MRI 不能替代骨骼检查，但可以通过识别软组织异常来补充骨骼检查。
