Jonathan Bainbridge MBCHB, BSC, Presenter: Nothing to Disclose

Brian Huey MBBCh, Abstract Co-Author: Nothing to Disclose

Rhian Isaac MBBCh, Abstract Co-Author: Nothing to Disclose

Sara Harrison MBBCH, Abstract Co-Author: Nothing to Disclose

Guidelines advise skeletal survey (SS) as the primary imaging investigation for non-accidental injury (NAI) in children under 2 years old. Bone scintigraphy (BS) can be used as a complementary investigation but there is little recent literature evaluating this. Our institution has used BS as an adjunct to SS in investigation of NAI for most of the last 10 years. This study retrospectively analyses the BS and SS data to evaluate the role and limitations of BS in the diagnosis of NAI.

Reports were reviewed of all SS and BS performed between November 2000 and October 2010 for possible NAI in children under 2 years old. The 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 findings on SS (3) BS demonstrated a new finding. False positive and false negative rates for BS were assessed and reviewed.

In total 237 SS and 173 BS were eligible for inclusion. 166 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, these cases are discussed. Occult bony injury was detected in 12% of the 237 patients imaged.

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 full or limited skeletal survey at 10-14 days. This creates safety and management problems for care of the child during this period. BS avoids this wait as it can be performed at the same time as the SS enabling radiological evaluation for NAI to be completed more efficiently and effectively.

Bone scintigraphy is a useful adjunct to skeletal survey in the investigation of NAI, adding confidence to the diagnosis or identifying new findings in 12% of cases.

Bainbridge, J, Huey, B, Isaac, R, Harrison, S, Should Bone Scintigraphy Be Used as a Routine Adjunct to Skeletal Survey in the Imaging of NAI?.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11001253.html