Radiology Department, CHU Rennes, F-35200, Rennes, France.
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.
Eur Radiol. 2021 Nov;31(11):8069-8080. doi: 10.1007/s00330-021-07896-9. Epub 2021 Apr 29.
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.
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].
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.
SS was the most sensitive independent imaging modality; however, the additional combination of either WBMRI or BS examinations offered an increased accuracy.
• 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.
评估全身磁共振成像（WBMRI）和骨闪烁扫描（BS）在疑似儿童虐待中除骨骼检查（SS）之外对创伤性骨损伤和软组织损伤的检测贡献。
在这项前瞻性、多中心、诊断准确性研究中，招募了年龄小于 3 岁的疑似身体虐待的儿童。每个孩子都接受了 SS、BS 和 WBMRI 检查。由五名儿科放射科医生和三名核医学医师进行了盲法共识第一回顾。第二回顾调查了各模态之间报告的差异，并使用所有模态的共识结果作为参考标准。我们计算了每个成像模态（SS、WBMRI 和 BS）以及组合 [SS + WBMRI] 和 [SS + BS] 的敏感性、特异性和相应的 95%置信区间。
共纳入 170 名儿童，其中 64 名至少有一处病变。总共包括 146 处病变。各项检查的敏感性和特异性分别为：SS 为 88.4%[95%CI，82.0-93.1]和 99.7%[95%CI，99.5-99.8]，WBMRI 为 69.9%[95%CI，61.7-77.2]和 99.5%[95%CI，99.2-99.7]，BS 为 54.8%[95%CI，46.4-63.0]和 99.7%[95%CI，99.5-99.9]。SS + WBMRI 组合的敏感性和特异性分别为 95.9%[95%CI，91.3-98.5]和 99.2%[95%CI，98.9-99.4]，SS + BS 组合的敏感性和特异性分别为 95.2%[95%CI，90.4-98.1]和 99.4%[95%CI，99.2-99.6]，两者之间无统计学差异。
SS 是最敏感的独立成像方式；然而，附加的 WBMRI 或 BS 检查的组合提供了更高的准确性。
在本研究中，SS 是疑似婴儿虐待中最敏感的独立成像方式，尤其是对检测干骺端和肋骨病变，仍然是评估的基础。
在儿童虐待的困难情况下，SS + BS 或 SS + WBMRI 的组合可提高隐匿性和可疑性骨损伤的诊断准确性。
WBMRI 是一种自由辐射技术，可额外诊断软组织和内脏损伤。
