Skip to main content
Top
Published in: Pediatric Radiology 5/2013

01-05-2013 | Original Article

Three-dimensional skull models as a problem-solving tool in suspected child abuse

Authors: Sanjay P. Prabhu, Alice W. Newton, Jeannette M. Perez-Rossello, Paul K. Kleinman

Published in: Pediatric Radiology | Issue 5/2013

Login to get access

Abstract

Background

The value of 3-D skull models in evaluation of young children with suspected child abuse is not known.

Objective

The purpose of this study was to assess the value of 3-D skull models as a problem-solving tool in children younger than 2 years.

Materials and methods

We performed a retrospective study on 73 children (ages 0–24 months) seen by a child protection team (CPT) who were undergoing head CT between August 2007 and July 2009.

Results

Of the 73 children, volume-rendered 3-D models were obtained in 26 (35.6%). Three-dimensional models changed initial CT interpretation in nine instances (34.6%). Findings thought to be fractures were confirmed as normal variants in four children. Depressed fractures were correctly shown to be ping-pong fractures in two cases. In one case, an uncertain finding was confirmed as a fracture, and an additional contralateral fracture was identified in one child. A fracture seen on skull radiographs but not seen on axial CT images was identified on the 3-D model in one case. Changes in interpretation led to modification in management in five children.

Conclusion

Use of 3-D skull models can be a problem-solving tool when there is discordance among the CT reading, subsequent radiographic investigations and clinical evaluation.
Literature
1.
go back to reference Tung GA, Kumar M, Richardson RC et al (2006) Comparison of accidental and nonaccidental traumatic head injury in children on noncontrast computed tomography. Pediatrics 118:626–633PubMedCrossRef Tung GA, Kumar M, Richardson RC et al (2006) Comparison of accidental and nonaccidental traumatic head injury in children on noncontrast computed tomography. Pediatrics 118:626–633PubMedCrossRef
2.
go back to reference Foerster BR, Petrou M, Lin D et al (2009) Neuroimaging evaluation of non-accidental head trauma with correlation to clinical outcomes: a review of 57 cases. J Pediatr 154:573–577PubMedCrossRef Foerster BR, Petrou M, Lin D et al (2009) Neuroimaging evaluation of non-accidental head trauma with correlation to clinical outcomes: a review of 57 cases. J Pediatr 154:573–577PubMedCrossRef
3.
go back to reference Kemp AM, Butler A, Morris S et al (2006) Which radiological investigations should be performed to identify fractures in suspected child abuse? Clin Radiol 61:723–736PubMedCrossRef Kemp AM, Butler A, Morris S et al (2006) Which radiological investigations should be performed to identify fractures in suspected child abuse? Clin Radiol 61:723–736PubMedCrossRef
4.
go back to reference Medina LS (2000) Three-dimensional CT maximum intensity projections of the calvaria: a new approach for diagnosis of craniosynostosis and fractures. Am J Neuroradiol 21:1951–1954PubMed Medina LS (2000) Three-dimensional CT maximum intensity projections of the calvaria: a new approach for diagnosis of craniosynostosis and fractures. Am J Neuroradiol 21:1951–1954PubMed
5.
go back to reference Mulroy MH, Loyd AM, Frush DP et al (2012) Evaluation of pediatric skull fracture imaging techniques. Forensic Sci Int 214:167–172PubMed Mulroy MH, Loyd AM, Frush DP et al (2012) Evaluation of pediatric skull fracture imaging techniques. Forensic Sci Int 214:167–172PubMed
6.
go back to reference Choudhary AK, Jha B, Boal DK et al (2010) Occipital sutures and its variations: the value of 3D-CT and how to differentiate it from fractures using 3D-CT? Surg Radiol Anat 32:807–816PubMedCrossRef Choudhary AK, Jha B, Boal DK et al (2010) Occipital sutures and its variations: the value of 3D-CT and how to differentiate it from fractures using 3D-CT? Surg Radiol Anat 32:807–816PubMedCrossRef
7.
go back to reference Section of Radiology, American Academy of Pediatrics (2009) Diagnostic imaging of child abuse. Pediatrics 123:1430–1435CrossRef Section of Radiology, American Academy of Pediatrics (2009) Diagnostic imaging of child abuse. Pediatrics 123:1430–1435CrossRef
8.
go back to reference Perez-Rossello JM, Connolly SA, Newton AW et al (2010) Whole-body MRI in suspected infant abuse. Am J Roentgenol 195:744–750CrossRef Perez-Rossello JM, Connolly SA, Newton AW et al (2010) Whole-body MRI in suspected infant abuse. Am J Roentgenol 195:744–750CrossRef
9.
go back to reference Wei SC, Ulmer S, Lev MH et al (2010) Value of coronal reformations in the CT evaluation of acute head trauma. Am J Neuroradiol 31:334–339PubMedCrossRef Wei SC, Ulmer S, Lev MH et al (2010) Value of coronal reformations in the CT evaluation of acute head trauma. Am J Neuroradiol 31:334–339PubMedCrossRef
10.
go back to reference Zacharia TT, Nguyen DT (2010) Subtle pathology detection with multidetector row coronal and sagittal CT reformations in acute head trauma. Emerg Radiol 17:97–102PubMedCrossRef Zacharia TT, Nguyen DT (2010) Subtle pathology detection with multidetector row coronal and sagittal CT reformations in acute head trauma. Emerg Radiol 17:97–102PubMedCrossRef
11.
go back to reference Arnholz D, Hymel KP, Hay TC et al (1998) Bilateral pediatric skull fractures: accident or abuse? J Trauma 45:172–174PubMedCrossRef Arnholz D, Hymel KP, Hay TC et al (1998) Bilateral pediatric skull fractures: accident or abuse? J Trauma 45:172–174PubMedCrossRef
12.
go back to reference Kleinman PK, Barnes PD (1998) Diagnostic imaging of child abuse, 2nd edn. Mosby, St. Louis Kleinman PK, Barnes PD (1998) Diagnostic imaging of child abuse, 2nd edn. Mosby, St. Louis
14.
go back to reference Prabhu SP, Young-Poussaint T (2010) Pediatric central nervous system emergencies. Neuroimaging Clin N Am 20:663–683PubMedCrossRef Prabhu SP, Young-Poussaint T (2010) Pediatric central nervous system emergencies. Neuroimaging Clin N Am 20:663–683PubMedCrossRef
15.
go back to reference White KS (1996) Invited article: helical/spiral CT scanning: a pediatric radiology perspective. Pediatr Radiol 26:5–14PubMedCrossRef White KS (1996) Invited article: helical/spiral CT scanning: a pediatric radiology perspective. Pediatr Radiol 26:5–14PubMedCrossRef
17.
go back to reference Tzedakis A, Perisinakis K, Raissaki M et al (2006) The effect of z overscanning on radiation burden of pediatric patients undergoing head CT with multidetector scanners: a Monte Carlo study. Med Phys 33:2472–2478PubMedCrossRef Tzedakis A, Perisinakis K, Raissaki M et al (2006) The effect of z overscanning on radiation burden of pediatric patients undergoing head CT with multidetector scanners: a Monte Carlo study. Med Phys 33:2472–2478PubMedCrossRef
18.
go back to reference Halpin SF (2004) Brain imaging using multislice CT: a personal perspective. Br J Radiol 77:S20–S26PubMedCrossRef Halpin SF (2004) Brain imaging using multislice CT: a personal perspective. Br J Radiol 77:S20–S26PubMedCrossRef
19.
go back to reference Abdeen N, Chakraborty S, Nguyen T et al (2010) Comparison of image quality and lens dose in helical and sequentially acquired head CT. Clin Radiol 65:868–873PubMedCrossRef Abdeen N, Chakraborty S, Nguyen T et al (2010) Comparison of image quality and lens dose in helical and sequentially acquired head CT. Clin Radiol 65:868–873PubMedCrossRef
20.
go back to reference Schilham A, van der Molen AJ, Prokop M et al (2010) Overranging at multisection CT: an underestimated source of excess radiation exposure. Radiographics 30:1057–1067PubMedCrossRef Schilham A, van der Molen AJ, Prokop M et al (2010) Overranging at multisection CT: an underestimated source of excess radiation exposure. Radiographics 30:1057–1067PubMedCrossRef
21.
go back to reference Bushberg JT (2012) The essential physics of medical imaging, 3rd edn. Wolters Kluwer Health/Lippincott Williams & Wilkins, Philadelphia Bushberg JT (2012) The essential physics of medical imaging, 3rd edn. Wolters Kluwer Health/Lippincott Williams & Wilkins, Philadelphia
22.
go back to reference Strauss KJ, Goske MJ, Kaste SC et al (2010) Image gently: ten steps you can take to optimize image quality and lower CT dose for pediatric patients. Am J Roentgenol 194:868–873CrossRef Strauss KJ, Goske MJ, Kaste SC et al (2010) Image gently: ten steps you can take to optimize image quality and lower CT dose for pediatric patients. Am J Roentgenol 194:868–873CrossRef
23.
go back to reference Philipp MO, Kubin K, Mang T et al (2003) Three-dimensional volume rendering of multidetector-row CT data: applicable for emergency radiology. Eur J Radiol 48:33–38PubMedCrossRef Philipp MO, Kubin K, Mang T et al (2003) Three-dimensional volume rendering of multidetector-row CT data: applicable for emergency radiology. Eur J Radiol 48:33–38PubMedCrossRef
24.
go back to reference Fishman EK, Ney DR (1993) Advanced computer applications in radiology: clinical applications. Radiographics 13:463–475PubMed Fishman EK, Ney DR (1993) Advanced computer applications in radiology: clinical applications. Radiographics 13:463–475PubMed
25.
go back to reference Kuszyk BS, Heath DG, Bliss DF et al (1996) Skeletal 3-D CT: advantages of volume rendering over surface rendering. Skeletal Radiol 25:207–214PubMedCrossRef Kuszyk BS, Heath DG, Bliss DF et al (1996) Skeletal 3-D CT: advantages of volume rendering over surface rendering. Skeletal Radiol 25:207–214PubMedCrossRef
Metadata
Title
Three-dimensional skull models as a problem-solving tool in suspected child abuse
Authors
Sanjay P. Prabhu
Alice W. Newton
Jeannette M. Perez-Rossello
Paul K. Kleinman
Publication date
01-05-2013
Publisher
Springer-Verlag
Published in
Pediatric Radiology / Issue 5/2013
Print ISSN: 0301-0449
Electronic ISSN: 1432-1998
DOI
https://doi.org/10.1007/s00247-012-2546-4

Other articles of this Issue 5/2013

Pediatric Radiology 5/2013 Go to the issue