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.
J Med Imaging Radiat Oncol. 2022 Feb;66(1):41-48. doi: 10.1111/1754-9485.13271. Epub 2021 Jul 9.
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.
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.
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.
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.
本病例系列总结了我们机构在无法进行放射性骨骼扫描（SS）的情况下，使用计算机断层扫描骨骼扫描（CT-SS）评估疑似非故意损伤（NAI）婴儿的初步经验。本文描述了我们在辐射剂量、隐匿性骨损伤检测和法医学应用方面使用 CT-SS 的经验。
10 名年龄在两周至十个月之间的婴儿接受了 CT-SS。将 CT-SS 的结果与同期的影像学结果进行比较。为每位患者计算了影像学检查的辐射剂量。
6 名婴儿的 CT-SS 发现异常。2 名患者均进行了生前 CT-SS 和死后影像学检查。所有在其他影像学检查中发现的骨折在至少一个 CT-SS 重建中均可见。CT-SS 成像的辐射剂量范围为 0.73 至 1.46mSv。
本研究中 10 名婴儿接受的辐射剂量大于两种骨骼扫描方法，但小于在该环境下用于评估隐匿性骨损伤的骨闪烁扫描检查所接受的剂量。虽然无法将 CT-SS 成像结果与当前同期的金标准成像技术的结果进行比较，但 CT-SS 确实识别了所有在进行放射性骨骼扫描时观察到的骨折。CT-SS 还在两名患者中发现了额外的肋骨骨折。我们的初步研究结果表明，需要进行未来的前瞻性研究以明确 CT-SS 可靠检测干骺端骨折的能力。
