Peter T. Evangelista MD, Presenter: Research Consultant, BioMimetic Therapeutics, Inc

W. Nathanael Holmes MD, Abstract Co-Author: Nothing to Disclose

Kathleen M. McCarten MD, Abstract Co-Author: Nothing to Disclose

Glenn A. Tung MD, Abstract Co-Author: Nothing to Disclose

Christine Barron MD, Abstract Co-Author: Nothing to Disclose

Daniel Arcuri, Abstract Co-Author: Nothing to Disclose

Carole Jenny, Abstract Co-Author: Nothing to Disclose

Amy P. Goldberg MD, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

To compare coronal, whole body-STIR (WB-STIR) with radiographic bone survey (RBS) for the evaluation of classic metaphyseal lesions (CML) in non-accidental trauma (NAT).

Between February 2003 and November 2007, WB-STIR and RBS were performed in children referred by Child Protection Services for suspected NAT. Coronal WB-STIR was performed in three anatomic stations on a 1.5T magnet using multiple surface coils: TR/TE/TI=9070/79/130; FOV, 200-300 mm; matrix, 230 x 384; slice length, 3 mm (gap, 0.3mm); Nex, 1-2; acq time, 5.5-7.4 minutes per station. All patients were sedated prior to MR imaging. Direct signs of CML on WB-STIR include a hypointense metaphyseal fracture line paralleling the physis and/or separating a triangular fragement at the periphery of the metaphysis. Indirect signs on WB-STIR include asymmetric peri-physeal hyperintense signal (PPHS) and subperiosteal edema extending from metaphysis to physis.

Imaging performed on 51 children (32 boys; 19 girls) of mean age 6.3 months (range, 1 week –37 months) with average interval of 2.4 days (range, 0-13) between RBS and WB-STIR. On RBS, 28 CML were demonstrated (distal tibia (n=7), distal femur (n=6), proximal tibia (n=5), distal radius (n=4), proximal femur (n=3), and distal ulna (n=3)). No CML were identified by direct signs on WB-STIR. 18 (64%) CML were identified by APPHS and 12 (43%) by subperiosteal edema extending from metaphysis to physis.  10 (36%) CML were not identified by either indirect sign. There were no false positive CML identified utilizing AHPPS.. There were 23 false positive CML identified ultilizing the subperiosteal edema sign. In 19 (83%) of these cases, there were associated long bone fractures and in one case it was associated with iatrogenic injury. In three (13%) of these cases there was no corresponding osseous injury detected on RBS.

Coronal WB-STIR has a sensitivity of 64% in identifying CML  No CML were detected by direct signs. The identification of APPHS on coronal WB-STIR has a 100% specificity in detecting CML. Subperiosteal edema extending from metaphysis to physis is a non-specific sign in detecting CML; however, its presence strongly suggests the presence of adjacent osseous injury.

Coronal WB-STIR should not replace RBS in the work-up of non-accidental trauma in children given its low sensitivity in detecting CML, a fracture of high specificity for inflicted injury.

Evangelista, P, Holmes, W, McCarten, K, Tung, G, Barron, C, Arcuri, D, Jenny, C, Goldberg, A, et al, , Coronal, Whole Body-STIR and the Problem of the Classic Metaphyseal Lesion in the Evaluation of Non-Accidental Trauma in Children.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6020925.html