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Whole-body MR imaging in suspected physical child abuse: comparison with skeletal survey and bone scintigraphy findings from the PEDIMA prospective multicentre study

  • Paediatric
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Abstract

Objectives

To assess the contribution of whole-body magnetic resonance imaging (WBMRI) and bone scintigraphy (BS) in addition to skeletal survey (SS) in detecting traumatic bone lesions and soft-tissue injuries in suspected child abuse.

Methods

In this prospective, multicentre, diagnostic accuracy study, children less than 3 years of age with suspected physical abuse were recruited. Each child underwent SS, BS and WBMRI. A blinded first review was performed in consensus by five paediatric radiologists and three nuclear medicine physicians. A second review investigated discrepancies reported between the modalities using a consensus result of all modalities as the reference standard. We calculated the sensitivity, specificity and corresponding 95% confidence interval for each imaging modality (SS, WBMRI and BS) and for the combinations [SS + WBMRI] and [SS + BS].

Results

One hundred seventy children were included of which sixty-four had at least one lesion. In total, 146 lesions were included. The sensitivity and specificity of each examination were, respectively, as follows: 88.4% [95% CI, 82.0–93.1] and 99.7% [95% CI, 99.5–99.8] for the SS, 69.9% [95% CI, 61.7–77.2] and 99.5% [95% CI, 99.2–99.7] for WBMRI and 54.8% [95% CI, 46.4–63.0] and 99.7% [95% CI, 99.5–99.9] for BS. Sensitivity and specificity were, respectively, 95.9% [95% CI, 91.3–98.5] and 99.2% [95% CI, 98.9–99.4] for the combination SS + WBMRI and 95.2% [95% CI, 90.4–98.1] and 99.4% [95% CI, 99.2–99.6] for the combination SS + BS, with no statistically significant difference between them.

Conclusion

SS was the most sensitive independent imaging modality; however, the additional combination of either WBMRI or BS examinations offered an increased accuracy.

Key Points

• SS in suspected infant abuse was the most sensitive independent imaging modality in this study, especially for detecting metaphyseal and rib lesions, and remains essential for evaluation.

• The combination of either SS + BS or SS + WBMRI provides greater accuracy in diagnosing occult and equivocal bone injuries in the difficult setting of child abuse.

• WBMRI is a free-radiation technique that allows additional diagnosis of soft-tissue and visceral injuries.

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Abbreviations

BS:

Bone scintigraphy

CML :

Classic metaphyseal lesion

FN:

False negative

FP:

False positive

FUSS:

Follow-up skeletal survey

NPV:

Negative predictive value

PEDIMA:

PEDiatric Imaging of Abuse

PPV:

Positive predictive value

SS:

Skeletal survey

SPNBF:

Sub-periosteal new bone formation

STIR:

Short tau inversion recovery

TE:

Echo time

TP:

True positive

TR:

Repetition time

WBMRI:

Whole-body magnetic resonance imaging

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Acknowledgement

The PEDIMA Collaborative Study group includes the following: Lydie Abalea (Department of Pediatrics and Emergency Medicine, CHU Brest), Séverine Croly-Labourdette (Department of Pediatrics and Emergency Medicine, CHU Brest), Phong Dam Hieu (Department of Neurosurgery, CHU Brest), Murielle Dobrzynski (Pediatric Intensive Care Unit, CHU Brest), Bertrand Fenoll (Department of Pediatric Surgery, CHU Brest), Pierre Forlodou (Department of Pediatric Radiology, CHU Brest), Christiane Le Bot (Department of Pediatrics, CHU Brest), Jérémie Lefranc (Department of Pediatrics, CHU Brest), Mélanie Lesoeur (Department of Pediatric Radiology, CHU Brest), Philippe Meriot (Department of Pediatric Radiology, CHU Brest), Sylviane Peudenier (Department of Pediatrics, CHU Brest), Solène Querellou (Department of Nuclear Medicine, CHU Brest), Pierre-Yves Salaun (Department of Nuclear Medicine, CHU Brest), Pierre Olivier (Department of Nuclear Medicine, CHU Nancy), Laurent Martrille (Department of Forensic Medicine, CHU Nancy), Anne Borsa-Dorion (Department of Pediatrics and Emergency Medicine, CHU Nancy), Marie-Agnès Galloy (Department of Pediatric Radiology, CHU Nancy), Laurence Mainard-Simard (Department of Pediatric Radiology, CHU Nancy), Emmanuel Raffo (Department of Pediatrics, CHU Nancy), Sylvie Cavare-Vigneron (Department of Pediatrics and Emergency Medicine, CHU Nancy), Michel Claudon (Department of Pediatric Radiology, CHU Nancy), Olivier Klein (Department of Neurosurgery, CHU Nancy), Emmanuelle Schmitt (Department of Pediatric Radiology, CHU Nancy), Serge Le Tacon (Pediatric Intensive Care Unit, CHU Nancy), Olivier Morel (Department of Nuclear Medicine, CHU Nancy), Lucie Lapp (Department of Pediatrics and Emergency Medicine, CHU Nancy), Françoise Bodéré-Kraeber (Department of Nuclear Medicine, CHU Nantes), Caroline Bodet-Milin (Department of Nuclear Medicine, CHU Nantes), Juliette Fleury (Department of Pediatrics, CHU Nantes), Loïc Geffroy (Department of Pediatric Surgery, CHU Nantes), Sophie Hamel (Department of Pediatric Surgery, CHU Nantes), Antoine Hamel (Department of Pediatric Surgery, CHU Nantes), Thomas Lefrançois (Department of Pediatric Radiology,CHU Nantes), Marie-Pierre Longis (Department of Pediatric Surgery, CHU Nantes), Emmanuelle Mayrargue (Department of Pediatric Surgery, CHU Nantes), Georges Picherot (Department of Pediatrics, CHU Nantes), Marie-Pierre Quéré (Department of Pediatric Radiology, CHU Nantes), Jean-Christophe Rozé (Pediatric Intensive Care Unit, CHU Nantes), Nathalie Vabres (Department of Pediatrics, CHU Nantes), Renaud Bouvet (Department of Forensic Medicine, CHU Rennes), Mariannick Le Gueut (Department of Forensic Medicine, CHU Rennes), Laurent Riffaud (Department of Neurosurgery, CHU Rennes), Martine Balençon (Department of Pediatrics, CHU Rennes), Pierre Bétrémieux (Pediatric Intensive Care Unit, CHU Rennes), Bertrand Bruneau (Department of Pediatric Radiology, CHU Rennes), Madeleine Chapuis (Department of Pediatric Surgery, CHU Rennes), Véronique Chasle (Department of Pediatrics and Emergency Medicine, CHU Rennes), Alain Dabadie (Department of Pediatrics, CHU Rennes), Léna Damaj (Department of Pediatrics, CHU Rennes), Pierre Darnault (Department of Pediatric Radiology, CHU Rennes), François De La Brière (Department of Anesthesiology, CHU Rennes), Séverine Delahaye (Pediatric Intensive Care Unit, CHU Rennes), Régis Duvauferrier (Department of Pediatric Radiology, CHU Rennes), Céline Farges (Department of Pediatrics and Emergency Medicine, CHU Rennes), Bernard Fraisse (Department of Pediatric Surgery, CHU Rennes), Théophile Gaillot (Pediatric Intensive Care Unit, CHU Rennes), Maryse Gardin (Department of Anesthesiology, CHU, Rennes), Cécile Gauvrit (Department of Anesthesiology, CHU Rennes), Marie-Aline Guitteny (Department of Pediatrics and Emergency Medicine, CHU Rennes), Sylvette Marleix (Department of Pediatric Surgery, CHU Rennes), Silvia Napuri (Department of Pediatrics, CHU Rennes), Michel Roussey (Department of Pediatrics, CHU Rennes), Céline Rozel (Department of Pediatric Radiology, CHU Rennes), Olivier Tirel (Pediatric Intensive Care Unit, CHU, Rennes), Catherine Tréguier (Department of Pediatric Radiology, CHU Rennes), Catherine Vignaud (Department of Anesthesiology, CHU Rennes), Philippe Violas (Department of Pediatric Surgery, CHU Rennes), Eric Wodey (Department of Anesthesiology, CHU Rennes), Marion Pierre (Department of Pediatrics and Emergency Medicine, CHU Rennes), Patrick Pladys (Department of Pediatrics, CHU Rennes), Saad Abu-Amara (Department of Pediatric Surgery, CHU Rouen), Bruno Bachy (Department of Pediatric Surgery, CHU Rouen), Marie Brasseur-Daudruy (Department of Pediatric Radiology, CHU Rouen), Jean-Nicolas Dacher (Department of Radiology, CHU, Rouen), Pascal Delmon (Department of Anesthesiology, CHU Rouen), Joël Lechevallier Amara (Department of Pediatric Surgery, CHU,Rouen), Bénédicte Lerebours (Department of Pediatrics, CHU Rouen), Julien Leroux (Department of Pediatric Surgery, CHU, Rouen), François Proust (Department of Neurosurgery, CHU Rouen), Sophie Rigal (Department of Pediatrics and Emergency Medicine CHU Rouen), Pierre-Hugues Vivier (Department of Pediatric Radiology, CHU Rouen), Jean-Louis Baulieu (Department of Nuclear Medicine, CHU Tours), Yann Venel (Department of Nuclear Medicine, CHU Tours), Elodie Carpentier (Department of Pediatric Radiology, CHU Tours), Alain Chantepie (Department of Pediatrics, CHU Tours), Julie Chantreuil (Intensive Care Unit, CHU Tours), Mathieu Come (Department of Pediatrics and Emergency Medicine, CHU Tours), Benoît De Courtivron (Department of Pediatric Surgery, CHU Tours), François Labarthe (Department of Pediatrics, CHU Tours), Yves Marot (Department of Pediatrics and Emergency Medicine, CHU Tours), Myriam Pepin-Donat (Department of Pediatrics and Emergency Medicine, CHU Tours), Catherine Sembely-Taveau (Department of Pediatric Radiology, CHU Tours), Dominique Sirinelli (Department of Pediatric Radiology, CHU Tours), Nadine Travers (Department of Neurosurgery, CHU Tours), Annie Urvois-Grangé (Department of Pediatrics, CHU Tours), Patrick O’Byrne (Department of Forensic Medicine, CHU Tours), Antoine Listrat (Department of Neurosurgery, CHU Tours), Anne Devillers (Department of Nuclear Medicine, CRLC Rennes), Marie-Luce Barge-Galerne (Department of Nuclear Medicine, CRLC Rennes), Joseph Le Cloirec (Department of Nuclear Medicine, CRLC Rouen), Pierre Vera (Department of Nuclear Medicine, CRLC Rouen), Catherine Adamsbaum (Department of Pediatric Radiology, CHU Kremlin Bicêtre) Isabelle Koné-Paut (Department of Pediatrics, CHU Kremlin Bicêtre), Kumaran Deiva (Department of Pediatrics, CHU Kremlin Bicêtre), Philippe Chaumet-Riffaud (Department of Nuclear Medicine, CHU Kremlin Bicêtre), Gilles Grimon (Department of Nuclear Medicine, CHU Kremlin Bicêtre), Frédérique Archambaud (Department of Nuclear Medicine, CHU Kremlin Bicêtre), Ferielle Zenkhri (Department of Pediatrics and Emergency Medicine, CHU Kremlin Bicêtre), Caroline Galeotti (Department of Pediatrics, CHU Kremlin Bicêtre), Nancy Sevette-Béchard (Department of Pediatric Radiology, CHU Montpellier), Olivier Prodhomme (Department of Pediatric Radiology, CHU Montpellier), Céline Leconte (Department of Forensic Medicine, CHU Montpellier), Armelle Haquet (Department of Pediatrics and Emergency Medicine, CHU Montpellier), Aurélie Bourdon (Department of Nuclear Medicine, CHU Montpellier), Mélanie Sainmont (Department of Nuclear Medicine, CHU Montpellier), Loïc De Pontual (Department of Pediatrics, CHU Bondy), Nicolas Sellier (Department of Pediatric Radiology, CHU, Bondy), Thanh-Van Trieu (Department of Pediatrics and Emergency Medicine, CHU Bondy), and Claire De Labriolle-Vaylet (Department of Nuclear Medicine, CHU Trousseau Paris). We thank our radiologist, nuclear medicine physicians and technicians colleagues who helped during the research study; pediatricians with dedicated training in abuse from all the centers for patient inclusion in the study; colleagues of the Public Health and Epidemiology Department for the statistical study and management of images; and Tracey Westcott for English languge editing.

Funding

This study has received funding from the French Ministry for Health as part of its interregional PHRC (grant number API11/R/051). The funder of the study had no role in study design, data collection, data analysis, data interpretation or writing of the report.

Author information

Authors and Affiliations

  1. Radiology Department, CHU Rennes, F-35200, Rennes, France

    Maïa Proisy, Bertrand Bruneau, Solène Vacheresse, Marine Dubois & Catherine Treguier

  2. Pediatric Radiology, service de Radiologie, Ramsay - Générale de Santé, University Hospital Charles Nicolle - Radiology, Hôpital Privé de l’Estuaire, 505 rue Irène Joliot Curie, 76620, Le Havre, France

    Pierre-Hugues Vivier

  3. Radiology Department, CHU Tours, Tours, France

    Baptiste Morel & Catherine Sembely-Taveau

  4. Nuclear Medicine Department, CRLC Rennes, Rennes, France

    Anne Devillers

  5. Nuclear Medicine Department, CRLC Henri Becquerel, Rouen, France

    Joseph Lecloirec

  6. CHU Nantes, Nuclear Medicine Department, Université de Nantes, CNRS, Inserm, CRCINA, Nantes, France

    Caroline Bodet-Milin

  7. Public Heatlh and Epidemiology Department, CHU Rennes, Rennes, France

    Stéphanie Hamonic & Emma Bajeux

  8. Research and Innovation Department, CHU Rennes, Rennes, France

    Anne Ganivet

  9. Pediatric Radiology Department, Hôpitaux Universitaires Paris-Sud, Bicêtre AP-HP, 94270, Le Kremlin-Bicêtre, France

    Catherine Adamsbaum

Authors
  1. Maïa Proisy
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  2. Pierre-Hugues Vivier
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  3. Baptiste Morel
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  4. Bertrand Bruneau
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  5. Catherine Sembely-Taveau
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  6. Solène Vacheresse
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  7. Anne Devillers
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  8. Joseph Lecloirec
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  9. Caroline Bodet-Milin
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  10. Marine Dubois
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  11. Stéphanie Hamonic
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  12. Emma Bajeux
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  13. Anne Ganivet
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  14. Catherine Adamsbaum
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  15. Catherine Treguier
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Consortia

on behalf of the PEDIMA study research group

  • Lydie Abalea
  • , Séverine Croly-Labourdette
  • , Phong Dam Hieu
  • , Murielle Dobrzynski
  • , Bertrand Fenoll
  • , Pierre Forlodou
  • , Christiane Le Bot
  • , Jérémie Lefranc
  • , Mélanie Lesoeur
  • , Philippe Meriot
  • , Sylviane Peudenier
  • , Solène Querello
  • , Pierre-Yves Salaun
  • , Pierre Olivier
  • , Laurent Martrille
  • , Anne Borsa-Dorion
  • , Marie-Agnès Galloy
  • , Laurence Mainard-Simard
  • , Emmanuel Raffo
  • , Sylvie Cavare-Vigneron
  • , Michel Claudon
  • , Olivier Klein
  • , Emmanuelle Schmitt
  • , Serge Le Tacon
  • , Olivier Morel
  • , Lucie Lapp
  • , Françoise Bodéré-Kraeber
  • , Caroline Milin
  • , Juliette Fleury
  • , Loïc Geffroy
  • , Sophie Hamel
  • , Antoine Hamel
  • , Thomas Lefrançois
  • , Marie-Pierre Longis
  • , Emmanuelle Mayrargue
  • , Georges Picherot
  • , Marie-Pierre Quéré
  • , Jean-Christophe Rozé
  • , Nathalie Vabres
  • , Renaud Bouvet
  • , Mariannick Le Gueut
  • , Laurent Riffaud
  • , Martine Balençon
  • , Pierre Bétrémieux
  • , Madeleine Chapuis
  • , Véronique Chasle
  • , Alain Dabadie
  • , Léna Damaj
  • , Pierre Darnault
  • , François De La Brière
  • , Séverine Delahaye
  • , Régis Duvauferrier
  • , Céline Farges
  • , Bernard Fraisse
  • , Théophile Gaillot
  • , Maryse Gardin
  • , Cécile Gauvrit
  • , Marie-Aline Guitteny
  • , Sylvette Marleix
  • , Silvia Napuri
  • , Michel Roussey
  • , Céline Rozel
  • , Olivier Tirel
  • , Catherine Tréguier
  • , Catherine Vignaud
  • , Philippe Violas
  • , Eric Wodey
  • , Marion Pierre
  • , Patrick Pladys
  • , Saad Abu-Amara
  • , Bruno Bachy
  • , Marie Brasseur-Daudruy
  • , Jean-Nicolas Dacher
  • , Pascal Delmon
  • , Joël Lechevallier Amara
  • , Bénédicte Lerebours
  • , Julien Leroux
  • , François Proust
  • , Sophie Rigal
  • , Pierre-Hugues Vivier
  • , Jean-Louis Baulieu
  • , Yann Venel
  • , Elodie Carpentier
  • , Alain Chantepie
  • , Julie Chantreuil
  • , Mathieu Come
  • , Benoît De Courtivron
  • , François Labarthe
  • , Yves Marot
  • , Myriam Pepin Donat
  • , Dominique Sirinelli
  • , Nadine Travers
  • , Annie Urvois-Grangé
  • , Patrick O’Byrne
  • , Antoine Listrat
  • , Marie-Luce Barge-Galerne
  • , Joseph Le Cloirec
  • , Pierre Vera
  • , Isabelle Koné-Paut
  • , Kumaran Deiva
  • , Philippe Chaumet-Riffaud
  • , Gilles Grimon
  • , Frédérique Archambaud
  • , Ferielle Zenkhri
  • , Caroline Galeotti
  • , Nancy Sevette Béchard
  • , Olivier Prodhomme
  • , Céline Leconte
  • , Armelle Haquet
  • , Aurélie Bourdon
  • , Mélanie Sainmont
  • , Loïc De Pontual
  • , Nicolas Sellier
  • , Thanh-Van Trieu
  •  & Claire De Labriolle-Vaylet

Corresponding author

Correspondence to Maïa Proisy.

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Guarantor

The scientific guarantor of this publication is Dr Catherine Treguier.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Dr. Emma Bajeux and Stephanie Hamonic kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Prospective

• Diagnostic or prognostic study

• Multicentre study

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Study group members are listed at the end of the article.

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Proisy, M., Vivier, PH., Morel, B. et al. Whole-body MR imaging in suspected physical child abuse: comparison with skeletal survey and bone scintigraphy findings from the PEDIMA prospective multicentre study. Eur Radiol 31, 8069–8080 (2021). https://doi.org/10.1007/s00330-021-07896-9

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