Culotta Paige A, Crowe James E, Tran Quynh-Anh, Jones Jeremy Y, Mehollin-Ray Amy R, Tran H Brandon, Donaruma-Kwoh Marcella, Dodge Cristina T, Camp Elizabeth A, Cruz Andrea T
Section of Public Health Pediatrics, Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin St., Suite A2275, Houston, TX, 77030, USA.
The Edward B. Singleton, MD, Department of Pediatric Radiology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
Pediatr Radiol. 2017 Jan;47(1):74-81. doi: 10.1007/s00247-016-3707-7. Epub 2016 Oct 15.
Young children with suspected abusive head trauma often receive skull radiographs to evaluate for fractures as well as computed tomography (CT) of the head to assess for intracranial injury. Using a CT as the primary modality to evaluate both fracture and intracranial injury could reduce exposure to radiation without sacrificing performance.
To evaluate the sensitivity of CT head with (3-D) reconstruction compared to skull radiographs to identify skull fractures in children with suspected abusive head trauma.
This was a retrospective (2013-2014) cross-sectional study of infants evaluated for abusive head trauma via both skull radiographs and CT with 3-D reconstruction. The reference standard was skull radiography. All studies were read by pediatric radiologists and neuroradiologists, with ten percent read by a second radiologist to evaluate for interobserver reliability.
One hundred seventy-seven children (47% female; mean/median age: 5 months) were included. Sixty-two (35%) had skull fractures by radiography. CT with 3-D reconstruction was 97% sensitive (95% confidence interval [CI]: 89-100%) and 94% specific (CI: 87-97%) for skull fracture. There was no significant difference between plain radiographs and 3-D CT scan results (P-value = 0.18). Kappa was 1 (P-value <0.001) between radiologist readings of CTs and 0.77 (P = 0.001) for skull radiographs.
CT with 3-D reconstruction is equivalent to skull radiographs in identifying skull fractures. When a head CT is indicated, skull radiographs add little diagnostic value.
疑似虐待性头部外伤的幼儿常接受颅骨X光片检查以评估是否骨折，同时进行头部计算机断层扫描（CT）以评估颅内损伤。将CT作为评估骨折和颅内损伤的主要方式可减少辐射暴露且不影响诊断效果。
评估与颅骨X光片相比，CT三维（3-D）重建对疑似虐待性头部外伤儿童颅骨骨折的诊断敏感性。
这是一项回顾性（2013 - 2014年）横断面研究，纳入通过颅骨X光片和CT三维重建评估虐待性头部外伤的婴儿。参考标准为颅骨X光片。所有研究均由儿科放射科医生和神经放射科医生阅片，10%的研究由另一位放射科医生阅片以评估观察者间的可靠性。
纳入177名儿童（47%为女性；平均/中位年龄：5个月）。62名（35%）经X光片检查发现颅骨骨折。CT三维重建对颅骨骨折的敏感性为97%（95%置信区间[CI]：89 - 100%），特异性为94%（CI：87 - 97%）。平片与三维CT扫描结果之间无显著差异（P值 = 0.18）。CT阅片者间的Kappa值为1（P值 < 0.001），颅骨X光片阅片者间的Kappa值为0.77（P = 0.001）。
CT三维重建在识别颅骨骨折方面与颅骨X光片等效。当需要进行头部CT检查时，颅骨X光片的诊断价值不大。
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