Laura Drubach MD, Presenter: Nothing to Disclose

Alice Newton MD, Abstract Co-Author: Nothing to Disclose

Stephen P. Laffin, Abstract Co-Author: Nothing to Disclose

Paul K. Kleinman MD, Abstract Co-Author: Nothing to Disclose

To evaluate the utility of 18F NaF PET bone scintigraphy as a complement to radiographic skeletal survey in the initial evaluation of suspected child abuse

Ten infants 3 weeks to 9 months of age (mean= 3.7 months) with suspected child abuse underwent a skeletal survey and a 18F NaF PET at the time of the initial work up. Skeletal surveys were performed according to ACR guidelines employing a high resolution CR system (Fuji Corporation, Stamford, CT, and U.S.A). Seven patients also underwent a follow up skeletal survey performed at an average of 19 days after the initial study. Fluorine-18 NaF PET of the whole body was acquired on a GE Advance Nxi PET scanner (GE Healthcare Technologies, Waukesha). The findings of the initial and follow up skeletal surveys were tabulated and compared to those of the 18F NaF PET

There were a total of 85 fractures detected by skeletal survey and 73 fractures detected by 18F NaF PET. Fluorine-18 NaF PET detected 7 of the 11 CMLs (classic metaphyseal fractures) diagnosed on skeletal survey. Two patients had a 18F NaF PET showing increased uptake in the distal tibia without correlative abnormality seen on skeletal survey. Fluorine-18 NaF PET detected all rib fractures seen on skeletal survey except for 2 rib fractures that showed mature callus formation on radiographs. Fluorine-18 NaF PET detected 1 rib and 4 costochondral fractures that were not evident on the initial skeletal survey. Fluorine-18 NaF PET substantiated 15 rib fractures, including costovertebral injuries that were equivocal on skeletal survey. Fluorine-18 NaF PET detected a pelvic fracture that was not visible on initial skeletal survey. Fluorine-18 NaF PET failed to show any abnormality in 3 of the 5 skull fractures detected on skeletal survey.

Fluorine-18 NaF PET showed a fracture detection rate similar to skeletal survey, and identified injuries not well documented on initial skeletal survey. Fluorine-18 NaF PET detected most CMLs, a highly specific inflicted injury that is not well assessed on 99mTc-MDP bone scans. Fluorine-18 NaF PET shows promise as a complement to the radiographic skeletal survey in the initial evaluation of suspected child abuse

Fluorine-18 NaF PET documents osseous injuries not evident or equivocal on skeletal survey and may complement radiography in the initial evaluation of suspected child abuse

Drubach, L, Newton, A, Laffin, S, Kleinman, P, Fluorine-18 NaF PET in the Detection of Skeletal Trauma in Suspected Child Abuse.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6012271.html