Value of postmortem thoracic CT over radiography in imaging of pediatric rib fractures

• Published in: Pediatric radiology 2011-06, Vol.41 (6), p.736-748
• Main Authors: Hong, Terence S., Reyes, Jeanette A., Moineddin, Rahim, Chiasson, David A., Berdon, Walter E., Babyn, Paul S.
• Format: Article
• Language: English
• Subjects: Battered Child Syndrome - diagnostic imaging; Child; Child Abuse - diagnosis; Child, Preschool; Female; Humans; Imaging; Infant, Newborn; Male; Medicine; Medicine & Public Health; Neuroradiology; Nuclear Medicine; Oncology; Original Article; Pediatrics; Radiography, Thoracic - methods; Radiology; Reproducibility of Results; Rib Fractures - diagnostic imaging; Sensitivity and Specificity; Tomography, X-Ray Computed - methods; Ultrasound; X-Ray Film
• ISSN: 0301-0449; 1432-1998
• DOI: 10.1007/s00247-010-1953-7

Background Studies have reported that thoracic CT may provide greater sensitivity compared with radiography in detection of pediatric rib fractures and fracture healing. The additional sensitivity afforded by thoracic CT may have medicolegal implications where abuse is suspected. Objective To determine the additional value of postmortem thoracic CT compared with radiography in detecting pediatric rib fractures, and fracture healing, using autopsy findings as a gold standard. Materials and methods We retrospectively reviewed 56 coroner’s cases with postmortem radiography and CT thoracic survey. All studies underwent primary interpretation by one or two radiologists. The study radiologist independently reviewed all images from 13 patients with positive findings on radiography, CT or autopsy. Sensitivity and specificity between observers and imaging modalities were compared. Results Primary interpretation: Fractures were recognized on radiography in 5/12 patients who had fractures found at autopsy, and on CT in 8/12 patients. In total, 29% (24/83) of fractures were reported on radiography, and 51% (52/101) of fractures were reported on CT. Study radiologist: Fractures were recognized on radiography in 7/12 patients who had fractures found at autopsy, and on CT in 11/12 patients. In total, 46% (38/83) of fractures were reported on radiography, and 85% (86/101) of fractures were reported on CT. Conclusion Postmortem thoracic CT provides greater sensitivity than radiography in detecting pediatric rib fractures, most notably in anterior and posterior fractures. However, the degree of improvement in sensitivity provided by CT might depend on observer experience.