title: Should bone scintigraphy be used as a routine adjunct to skeletal survey in the imaging of non-accidental injury? A 10 year review of reports in a single centre.
abstract: OBJECTIVE
  To retrospectively analyse the bone scintigraphy (BS) and skeletal survey (SS) data to evaluate the role and limitations of BS in the diagnosis of non-accidental injury (NAI).
  
  
  METHODS
  All SS and BS performed over a 10 year period, for possible NAI, in children under 2 years old were retrospectively reviewed. Reports were compared in cases where both studies were performed and findings classified into one of three groups: (1) congruent: both reports agreed; (2) BS added confidence to the SS findings; (3) BS demonstrated a new finding. False-positive and false-negative rates for BS were calculated.
  
  
  RESULTS
  One hundred and sixty-six patients had both SS and BS. The findings were congruent in 74% of cases. BS added confidence to the SS findings in 8% and revealed a new abnormality in 4% of patients. BS demonstrated false-positive and -negative rates of 2% and 13%, respectively. Occult bony injury was detected in 12% of the 237 patients imaged.
  
  
  CONCLUSIONS
  When used as an adjunct to SS in the investigation of NAI, BS can aid the confidence of diagnosis or identify new findings in 12% of cases. In centres where nuclear medicine is readily available and there is appropriate expertise in paediatric BS, this modality provides a time-effective alternative to follow-up SS at 10-14 days.
authors.affiliation: Department of Radiology, Royal Gwent Hospital, Newport, Wales, UK. Electronic address: jonathan.bainbridge@wales.nhs.uk.
authors.forename: J K
authors.initials: JK
authors.lastname: Bainbridge
authors.affiliation: Department of Radiology, Royal Gwent Hospital, Newport, Wales, UK.
authors.forename: B M
authors.initials: BM
authors.lastname: Huey
authors.affiliation: Department of Radiology, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK.
authors.forename: S K
authors.initials: SK
authors.lastname: Harrison
mesh_terms: D001842:Bone and Bones / Q000000981:diagnostic imaging* / Q000293:injuries; D002649:Child Abuse / Q000175:diagnosis*; D050723:Fractures, Bone / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D010372:Pediatrics / Q000592:standards; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D012680:Sensitivity and Specificity