Comparison of computed tomography and chest radiography in the detection of rib fractures in abused infants.
OBJECTIVE
Chest radiographs (CXR) are the standard method for evaluating rib fractures in abused infants. Computed tomography (CT) is a sensitive method to detect rib fractures. The purpose of this study was to compare CT and CXR in the evaluation of rib fractures in abused infants.


METHODS
This retrospective study included all 12 abused infants identified from 1999 to 2004 who had rib fractures and both CXR and CT (8 abdomen CTs, 4 chest CTs). CT exams had been performed for clinical indications, and were obtained within one day of the CXR. Studies were reviewed by two pediatric radiologists to determine the number, locations, and approximate ages of the rib fractures. A total of 225 ribs were completely (192) or partially (33) seen by CT, and the matched ribs on CXR were used for the analysis.


RESULTS
The mean patient age was 2.5 months (1.2-5.6), with seven females and five males. While 131 fractures were visualized by CT, only 79 were seen by CXR (p<.001). One patient had fractures only seen by CT. There were significantly (p<.05) more early subacute (24 vs. 4), subacute (47 vs. 26), and old fractures (4 vs. 0) seen by CT than by CXR. Anterior (42 vs. 11), anterolateral (21 vs. 12), posterolateral (9 vs. 3) and posterior (39 vs. 24) fractures were better seen by CT than by CXR (p<.01). Bilateral fractures were detected more often by CT (11) than by CXR (6).


CONCLUSIONS
While this study group is small, these findings suggest that CT is better than CXR in visualizing rib fractures in abused infants.
Department of Radiology, University of California, Davis Medical Center and UC Davis Children's Hospital, 4860 Y Street, Sacramento, CA 95817, USA.
Sandra L
SL
Wootton-Gorges
Rebecca
R
Stein-Wexler
John W
JW
Walton
Angela J
AJ
Rosas
Kevin P
KP
Coulter
Kristen K
KK
Rogers
D001497:Battered Child Syndrome / Q000000981:diagnostic imaging*; D002649:Child Abuse / Q000175:diagnosis*; D005260:Female; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D007223:Infant; D008297:Male; D009104:Multiple Trauma / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D012253:Rib Fractures / Q000000981:diagnostic imaging*; D012272:Ribs / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed