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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

Maïa Proisy 1 Pierre-Hugues Vivier 2 Baptiste Morel 3 Bertrand Bruneau 1 Catherine Sembely-Taveau 3 Solène Vacheresse 1 Anne Devillers 4 Joseph Lecloirec 5 Caroline Bodet-Milin 6 Marine Dubois 1 Stéphanie Hamonic 7 Emma Bajeux 7 Anne Ganivet 7 Catherine Adamsbaum 8 Catherine Treguier 1 Lydie Abalea Séverine Croly-Labourdette Phong Dam Hieu Murielle Dobrzynski Bertrand Fenoll Pierre Forlodou Christiane Le Bot Jérémie Lefranc Mélanie Lesoeur Philippe Mériot Sylviane Peudenier Solène Querello Pierre yves Salaun Pierre Olivier Laurent Martrille 9, 10 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 Bodere-Kraeber Caroline Milin Juliette Fleury Loïc Geffroy Sophie Hamel Thomas Lefrancois 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 Regis 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 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 Francois Proust Sophie Rigal Jean-Louis Baulieu yann Venel Carpentier Elodie Alain Chantepie Julie Chantreuil Mathieu Come Benoit de Courtivron François Labarthe yves Marot Myriam Pepin-Donat Dominique Sirinelli Nadine Travers Annie Urvois-Grange Patrick O'Byrne Antoine Listrat Marie-Luce Barge-Galern Joseph Le Cloirec Pierre Vera I. Kone-Paut Kumaran Deiva Philippe Chaumet-Riffaud Gilles Grimon Frederique Archambaud Ferielle Zenkhri Caroline Galeotti Nancy Sevette-Béchard Olivier Prodhomme Céline Leconte Armelle Haquet Aurélie Bourdon 9, 11 Mélanie Sainmont Loic De-Pontual Nicolas Sellier Thanh-Van Trieu Claire de Labriolle-Vaylet 
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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https://www.hal.inserm.fr/inserm-03214574
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Submitted on : Sunday, May 2, 2021 - 8:14:49 AM
Last modification on : Saturday, May 21, 2022 - 4:00:27 AM

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Maïa Proisy, Pierre-Hugues Vivier, Baptiste Morel, Bertrand Bruneau, Catherine Sembely-Taveau, 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. European Radiology, Springer Verlag, 2021, Online ahead of print. ⟨10.1007/s00330-021-07896-9⟩. ⟨inserm-03214574⟩

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