title: Three-dimensional skull models as a problem-solving tool in suspected child abuse.
abstract: BACKGROUND
  The value of 3-D skull models in evaluation of young children with suspected child abuse is not known.
  
  
  OBJECTIVE
  The purpose of this study was to assess the value of 3-D skull models as a problem-solving tool in children younger than 2 years.
  
  
  METHODS
  We performed a retrospective study on 73 children (ages 0-24 months) seen by a child protection team (CPT) who were undergoing head CT between August 2007 and July 2009.
  
  
  RESULTS
  Of the 73 children, volume-rendered 3-D models were obtained in 26 (35.6%). Three-dimensional models changed initial CT interpretation in nine instances (34.6%). Findings thought to be fractures were confirmed as normal variants in four children. Depressed fractures were correctly shown to be ping-pong fractures in two cases. In one case, an uncertain finding was confirmed as a fracture, and an additional contralateral fracture was identified in one child. A fracture seen on skull radiographs but not seen on axial CT images was identified on the 3-D model in one case. Changes in interpretation led to modification in management in five children.
  
  
  CONCLUSIONS
  Use of 3-D skull models can be a problem-solving tool when there is discordance among the CT reading, subsequent radiographic investigations and clinical evaluation.
authors.affiliation: Department of Radiology, Harvard Medical School, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, USA. sanjay.prabhu@childrens.harvard.edu
authors.forename: Sanjay P
authors.initials: SP
authors.lastname: Prabhu
authors.forename: Alice W
authors.initials: AW
authors.lastname: Newton
authors.forename: Jeannette M
authors.initials: JM
authors.lastname: Perez-Rossello
authors.forename: Paul K
authors.initials: PK
authors.lastname: Kleinman
mesh_terms: D002649:Child Abuse / Q000175:diagnosis* / Q000517:prevention & control; D003198:Computer Simulation; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008953:Models, Anatomic; D011340:Problem Solving; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012887:Skull Fractures / Q000000981:diagnostic imaging*; D014463:Ultrasonography