title: Pediatric skull fracture diagnosis: should 3D CT reconstructions be added as routine imaging?
abstract: OBJECTIVE
  The authors compared the efficacy of combining 2D+3D CT reconstructions with standard 2D CT images in the diagnosis of linear skull fractures in children with head trauma.
  
  
  METHODS
  This was a retrospective evaluation of consecutive head CT studies of children presenting with head trauma. Two experienced pediatric neuroradiologists in consensus created the standard of reference. Three readers independently evaluated the 2D CT images alone and then in combination with the 3D reconstructions for the diagnosis of linear skull fractures. Sensitivity and specificity in the diagnosis of linear skull fractures utilizing 2D and 2D+3D CT in combination were measured for children less than 2 years of age and for all children for analysis by the 3 readers.
  
  
  RESULTS
  Included in the study were 250 consecutive CT studies of 250 patients (167 boys and 83 girls). The mean age of the children was 7.82 years (range 4 days to 17.4 years). 2D+3D CT combined had a higher sensitivity and specificity (83.9% and 97.1%, respectively) compared with 2D alone (78.2% and 92.8%, respectively) with statistical significance for specificity (p < 0.05) in children less than 2 years of age. 2D+3D CT combined had a higher sensitivity and specificity (81.3% and 90.5%, respectively) compared with 2D alone (74.5% and 89.1%, respectively) with statistical significance for sensitivity (p < 0.05) in all children.
  
  
  CONCLUSIONS
  In this study, 2D+3D CT in combination showed increased sensitivity in the diagnosis of linear skull fractures in all children and increased specificity in children less than 2 years of age. In children less than 2 years of age, added confidence in the interpretation of fractures by distinguishing them from sutures may have a significant implication in the setting of nonaccidental trauma. Furthermore, 3D CT is available at no added cost, scan time, or radiation exposure, providing trainees and clinicians with limited experience an additional valuable tool for routine imaging of pediatric head trauma.
authors.affiliation: Section of Pediatric Neuroradiology, Division of Pediatric Radiology, and.
authors.forename: Gunes
authors.initials: G
authors.lastname: Orman
authors.affiliation: Section of Pediatric Neuroradiology, Division of Pediatric Radiology, and.
authors.forename: Matthias W
authors.initials: MW
authors.lastname: Wagner
authors.affiliation: Section of Pediatric Neuroradiology, Division of Pediatric Radiology, and.
authors.forename: Daniel
authors.initials: D
authors.lastname: Seeburg
authors.affiliation: Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science; and.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Zamora
authors.affiliation: Section of Pediatric Neuroradiology, Division of Pediatric Radiology, and.
authors.forename: Alexander
authors.initials: A
authors.lastname: Oshmyansky
authors.affiliation: Section of Pediatric Neuroradiology, Division of Pediatric Radiology, and.
authors.forename: Aylin
authors.initials: A
authors.lastname: Tekes
authors.affiliation: Section of Pediatric Neuroradiology, Division of Pediatric Radiology, and.
authors.forename: Andrea
authors.initials: A
authors.lastname: Poretti
authors.affiliation: Division of Pediatric Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: George I
authors.initials: GI
authors.lastname: Jallo
authors.affiliation: Section of Pediatric Neuroradiology, Division of Pediatric Radiology, and.
authors.forename: Thierry A G M
authors.initials: TA
authors.lastname: Huisman
authors.affiliation: Section of Pediatric Neuroradiology, Division of Pediatric Radiology, and.
authors.forename: Thangamadhan
authors.initials: T
authors.lastname: Bosemani
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003951:Diagnostic Errors; D003955:Diagnostic Tests, Routine; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods / Q000592:standards; D021621:Imaging, Three-Dimensional; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D061330:Multidetector Computed Tomography / Q000379:methods*; D064847:Multimodal Imaging; D015588:Observer Variation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012887:Skull Fractures / Q000175:diagnosis / Q000000981:diagnostic imaging*
keywords: MDCT = multidetector CT; MIP = maximum intensity projection; VR = volume rendered; children; computed tomography; head trauma; skull fracture