Source:

Prabhu
A
,
Newton
A
,
Perez-Rossello
J
, et al
.
Three-dimensional skull models as a problem-solving tool in suspected child abuse
.
Pediatr Radiol.
2013
;
43
(
5
):
575
581
; doi:
https://doi.org/10.1007/s00247-012-2546-4

Investigators at Boston Children’s Hospital retrospectively reviewed the imaging workups of children ≤2 years old with suspected child abuse to assess the utility of volume-rendered 3D models created from head CTs. Eligible cases were children evaluated for possible abuse by the Child Protection Team who underwent noncontrast axial head CT between August 2007 and July 2009. The investigators reviewed cases where 3D reconstructions from the head CTs had been ordered at the request of the radiologist, and collected information on clinical history, clinical findings, the initial reviewing radiologist report, and the skull series which was part of the patient’s skeletal survey. The final interpretation based on the 3D reconstructions was performed by the mandated reporter. The main study outcome was the difference between the initial radiologic report based upon the routine CT images and the final report which also included 3D skull reconstruction.

The eligible cases consisted of 73 children (43 boys) whose ages ranged from 13 days to 23 months (mean 10.5 months). In 26 of the children (36%), volume-rendered 3D models had been ordered after review of the original CT images. The review of the 3D skull reconstructions altered the initial CT interpretation in 9 of these 26 children (35%), because the reconstructions provided better analysis of the calvaria. In 5 of these 9 children, the change in interpretations led to modifications in management.

The authors conclude that 3D skull models can be useful in young children with suspected nonaccidental head trauma.

Dr Cohen has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

A number of AAP Grand Rounds reviews have discussed ways of decreasing or avoiding patient radiation dosages while maintaining the ability to make key diagnoses using alternative modalities to CT, especially ultrasound and MRI (see AAP Grand Rounds, January 2010;23[1]:5 and September 2012;28[3]:27). Despite concerns regarding overexposure to radiation when CT is used imprudently, CT is an excellent diagnostic tool. Advances in multislice technology and iterative image reconstructions have markedly reduced exposures to radiation. With no additional radiation exposure, 2D and 3D reconstruction software allow use of the basic information obtained on routine scanning to see anatomy with better resolution and perspicuity. Even more than the fact that the additional images are accomplished free of any new radiation “cost”, the improved images allow quicker and more confident diagnoses, obviating the need for repeat examinations to clear up confusion on the initial examination.

The current study highlights the use of 3D reconstructions of the skull to reinforce diagnoses of nonaccidental or other trauma or to reduce concerns about trauma when a skull variant is accurately identified. This has implications not only in decreasing radiation costs,...

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