Value of postmortem thoracic CT over radiography in imaging of pediatric rib fractures.
BACKGROUND
Studies have reported that thoracic CT may provide greater sensitivity compared with radiography in detection of pediatric rib fractures and fracture healing. The additional sensitivity afforded by thoracic CT may have medicolegal implications where abuse is suspected.


OBJECTIVE
To determine the additional value of postmortem thoracic CT compared with radiography in detecting pediatric rib fractures, and fracture healing, using autopsy findings as a gold standard.


METHODS
We retrospectively reviewed 56 coroner's cases with postmortem radiography and CT thoracic survey. All studies underwent primary interpretation by one or two radiologists. The study radiologist independently reviewed all images from 13 patients with positive findings on radiography, CT or autopsy. Sensitivity and specificity between observers and imaging modalities were compared.


RESULTS
Primary interpretation: Fractures were recognized on radiography in 5/12 patients who had fractures found at autopsy, and on CT in 8/12 patients. In total, 29% (24/83) of fractures were reported on radiography, and 51% (52/101) of fractures were reported on CT. Study radiologist: Fractures were recognized on radiography in 7/12 patients who had fractures found at autopsy, and on CT in 11/12 patients. In total, 46% (38/83) of fractures were reported on radiography, and 85% (86/101) of fractures were reported on CT.


CONCLUSIONS
Postmortem thoracic CT provides greater sensitivity than radiography in detecting pediatric rib fractures, most notably in anterior and posterior fractures. However, the degree of improvement in sensitivity provided by CT might depend on observer experience.
Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada.
Terence S
TS
Hong
Jeanette A
JA
Reyes
Rahim
R
Moineddin
David A
DA
Chiasson
Walter E
WE
Berdon
Paul S
PS
Babyn
D001497:Battered Child Syndrome / Q000000981:diagnostic imaging*; D002648:Child; D002649:Child Abuse / Q000175:diagnosis*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D013902:Radiography, Thoracic / Q000379:methods*; D015203:Reproducibility of Results; D012253:Rib Fractures / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014962:X-Ray Film
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