Pediatric skull fracture diagnosis: should 3D CT reconstructions be added as routine imaging?

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>The authors compared the efficacy of combining 2D+3D CT reconstructions with standard 2D CT images in the diagnosis of linear skull fractures in children with head trauma.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>This was a retrospective evaluation of consecutive head CT studies of children presenting with head trauma. Two experienced pediatric neuroradiologists in consensus created the standard of reference. Three readers independently evaluated the 2D CT images alone and then in combination with the 3D reconstructions for the diagnosis of linear skull fractures. Sensitivity and specificity in the diagnosis of linear skull fractures utilizing 2D and 2D+3D CT in combination were measured for children less than 2 years of age and for all children for analysis by the 3 readers.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Included in the study were 250 consecutive CT studies of 250 patients (167 boys and 83 girls). The mean age of the children was 7.82 years (range 4 days to 17.4 years). 2D+3D CT combined had a higher sensitivity and specificity (83.9% and 97.1%, respectively) compared with 2D alone (78.2% and 92.8%, respectively) with statistical significance for specificity (p &lt; 0.05) in children less than 2 years of age. 2D+3D CT combined had a higher sensitivity and specificity (81.3% and 90.5%, respectively) compared with 2D alone (74.5% and 89.1%, respectively) with statistical significance for sensitivity (p &lt; 0.05) in all children.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>In this study, 2D+3D CT in combination showed increased sensitivity in the diagnosis of linear skull fractures in all children and increased specificity in children less than 2 years of age. In children less than 2 years of age, added confidence in the interpretation of fractures by distinguishing them from sutures may have a significant implication in the setting of nonaccidental trauma. Furthermore, 3D CT is available at no added cost, scan time, or radiation exposure, providing trainees and clinicians with limited experience an additional valuable tool for routine imaging of pediatric head trauma.</jats:p></jats:sec>

Pediatric Traumatic Brain Injury: Characteristic Features, Diagnosis, and Management

“…In a recent report, 2D+3D computed tomography (CT) in combination were shown to have high sensitivity in the diagnosis of linear skull fractures in all children and increased specificity in children less than 2 years of age, with concurrent intracranial lesions being detected in 15%–30% of these cases. 12) Hospitalization is not necessary for many children with non-displaced skull fractures but patients with mental status changes, additional injuries, or those suspected to be cases of AHT may require hospitalization. 13) …”

Can three-dimensional reformatted computed tomography scans be useful to avoid misdiagnoses of skull fractures in pediatric emergency cases?

“…In routine clinical practice, head computerized tomography (CT) is a sensitive measure to diagnose post-traumatic skull fractures (7). In some circumstances, two dimensional (2-D) CT images cannot be sufficient to demonstrate subtle or linear fractures in the axial plane on images (8). Skull fractures may occur in linear, depressed, diastatic, or basilar (skull base) fashion, and linear fractures constitute approximately 75% of all fractures (7,8).…”

“…In some circumstances, two dimensional (2-D) CT images cannot be sufficient to demonstrate subtle or linear fractures in the axial plane on images (8). Skull fractures may occur in linear, depressed, diastatic, or basilar (skull base) fashion, and linear fractures constitute approximately 75% of all fractures (7,8). Intracranial injury is a significant cause of mortality and morbidity in children (9).…”

“…Intracranial injury is a significant cause of mortality and morbidity in children (9). Since a skull fracture may be a critical indicator of an intracranial injury; timely and accurate establishment of the diagnosis is crucial (8,9).…”

Usefulness of 3‐D computed tomography for diagnosis of abusive head trauma

“…Orman et al . retrospectively evaluated consecutive head CT of pediatric head trauma and concluded that the combination of 2‐D and 3‐D CT had higher sensitivity in the diagnosis of all pediatric linear skull fractures and increased specificity in children <2 years old . Approximately 75% of all skull fractures are linear fractures .…”