Keywords:
Paediatric, Musculoskeletal bone, Forensic / Necropsy studies, CT, Medico-legal issues, Forensics, Pathology, Trauma
Authors:
A. Paterson, P. Ingram, C. Thornton; Belfast/UK
DOI:
10.1594/ecr2011/C-1587
Methods and Materials
This was a prospective study.
Between September 2008 and October 2010,
26 children underwent initial skeletal survey imaging per the recommendations of the 2008 joint RCR/RCPCH working group document,
for either alleged or suspected NAI. Included in the study group were children classified initially as "sudden unexpected death of an infant" (SUDI),
as it is policy within the Province of Northern Ireland to manage the latter group of patients as suspected NAI victims until pathology proves otherwise.
All of the children either presented to hospital dead or died in the two week interval period before follow up chest radiographs could be obtained to look for healing rib fractures.
In addition to the standard imaging protocol,
all children had a post-mortem CT chest examination to look for both acute and healing rib fractures.
The CT examinations were reviewed in the axial plane,
with multiplanar reformatted (MPR) images being constructed for all patients,
and 3D-volume rendered (3D VR) images being constructed for those patients in whom fractures were identified.
All of the imaging investigations were reviewed by a single experienced paediatric radiologist and the results were conveyed to the pathology department.
The reporting radiologist was not blinded to the clinical information available on the radiology request forms.
Abnormal ribs were resected at autopsy and examined microscopically.
The results of the autopsies were cross-referenced with both the radiographic and CT examination results.