Diagnostic performance of radiography and whole-spine MRI for detecting vertebral fractures in suspected child abuse.
Magnetic Resonance Imaging missed one-quarter to one-third of abusive spine fractures used alone
Diagnostic performance of radiography and whole-spine MRI for detecting vertebral fractures in suspected child abuse.
Spine fractures in child abuse are rare, reported in 0.1% to 2.7%, but increase to 10% when additional fractures are detected on skeletal surveys.
To assess the accuracy of radiograph and whole- spine Magnetic Resonance Imaging in detecting spine fractures in suspected non-accidental trauma and to identify the strengths and limitations of each modality.
In this IRB approved 8-years retrospective study (2015-2022), we included children with reported spine fractures who underwent both skeletal survey radiographs and whole-spine Magnetic Resonance Imaging within seven days.
whole-spine Magnetic Resonance Imaging alone correctly identified three-quarters of true fractures
Most fractures (81.8%) were in the thoracic spine, especially T2-T3 and T8-T10.
The interobserver agreement was weak for radiography (kappa 0.53; 0.26-0.81) and for whole-spine Magnetic Resonance Imaging (kappa 0.59; 0.34-0.85).
Limbus variation was found in 6/65 children (9.2%) at the level of L1-L3.
Both radiography and whole-spine Magnetic Resonance Imaging have high specificity in diagnosing spine fractures, but each has limited sensitivity when used alone.
Diagnosis of a fracture is best achieved by evaluation of both imaging modalities. Radiologists should also be aware of limbus vertebra in the lumbar spine that can mimic a compression fracture.
Raw data for this study is not publicly available to preserve individuals' privacy.