Radiology: NaF PET imaging detects skeletal trauma in child abuse cases

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18F-Sodium Fluoride (NaF) PET had greater sensitivity in the overall detection of fractures related to child abuse than did baseline skeletal survey and was superior in the detection of rib fractures in particular, according to a study published in the April issue of Radiology.

Laura A. Drubach, MD, from the department of radiology at Children’s Hospital and Harvard Medical School in Boston, and colleagues reviewed the baseline skeletal survey and PET images obtained in 22 patients younger than two years between September 2007 and January 2009. Fourteen patients also underwent follow-up skeletal survey.

A pediatric radiologist blindly interpreted the initial obtained skeletal survey images. A second pediatric radiologist interpreted the follow-up skeletal survey images, in conjunction with the baseline survey images and rendered a final interpretation for the 14 patients in whom both baseline and follow-up skeletal survey data were available, which served as the reference standard.

The researchers detected a total of 156 fractures at baseline skeletal survey, and 200 fractures were detected with PET.

“PET had sensitivities of 85 percent for the detection of all fractures, 92 percent for the detection of thoracic fractures (ribs, sternum, clavicle and scapula), 93 percent for the detection of posterior rib fractures, and 67 percent for the detection of classic metaphyseal lesions (CMLs),” wrote Drubach and colleagues.

The investigators found that baseline skeletal survey had sensitivities of 72 percent for the detection of all fractures, 68 percent for the detection of thoracic fractures, 73 percent for the detection of posterior rib fractures and 80 percent for the detection of CMLs.

Because of the lower sensitivity of PET in the detection of CMLs, initial radiographic evaluation remains necessary, said Drubach and colleagues. However, because CMLs are distinct injuries in infants, PET scanning shows promise as the sole global skeletal assessment tool in children older than 12 months.

Drubach and colleagues concluded that the image contrast from the high tracer extraction with 18 F-NaF PET, as well as the intrinsically high sensitivity and high spatial resolution of 18 F-NaF PET technology, makes it an attractive choice for the evaluation of child abuse.