Three-Dimensional Computed Tomography Skull Reconstructions as an Aid to Child Abuse Evaluations

Area of Science:

• Radiology
• Pediatric Imaging
• Forensic Radiology

Background:

• Skull fractures in pediatric abuse cases are often subtle and difficult to detect on conventional radiographs and CT bone windows.
• Delayed diagnosis of abusive head trauma can lead to severe consequences, including further injury or death.

Observation:

• A retrospective review of 12 pediatric cases evaluated the utility of three-dimensional (3-D) CT reconstructions in identifying skull fractures.
• Radiologists assessed the ease and accuracy of interpreting findings from plain films, bone windows, and 3-D CT images.

Findings:

• Skull fractures were missed on initial review in 7 cases.
• 3-D CT reconstructions identified subtle fractures missed on conventional imaging, aiding in timely diagnosis and intervention.
• 3-D CT also helped differentiate true fractures from normal anatomical variants like sutural bones.

Implications:

• Three-dimensional CT reconstructions enhance the detection of pediatric skull fractures without increasing radiation exposure.
• This technique can facilitate earlier diagnosis of child abuse, enabling prompt protective interventions.
• 3-D CT aids in clarifying injury mechanisms and differentiating inflicted injuries from accidental trauma.