Imaging Modality |
Advantages |
Disadvantages |
Skeletal Survey |
Gold standard investigation in detecting skeletal injuries of abuse. High quality images can help uncover undetected fractures and skeletal survey is a highly valuable modality in patients under 2 years of age and patients unable to communicate their injuries |
Radiation exposure is one of the primary disadvantages of this imaging modality. Additionally, it needs to be supported by a follow up survey. It has limited utility in detecting nondisplaced fractures, and rib fractures. it is also technically demanding and appropriate immobilization of the patient is important. |
Follow-up Survey |
It can identify new undetected fractures such as rib fractures and Classic metaphyseal lesions (CML). It can also visualize nondisplaced fractures due to healing changes |
Time is of utmost importance for a follow-up survey and safety of the patient needs to be ensured in between surveys. Excessive radiation exposure, inefficient utilization of financial and healthcare resources are also some its other drawbacks. Additionally, fractures may heal and become undetectable |
Radionuclide Bone Scans |
It is an efficient replacement for a follow-up survey and is more sensitive than a skeletal survey in detecting rib fractures, acromion fractures, and fractures of the spine. It can appropriately complement a skeletal survey. |
Isolated use is not recommended in cases of suspected physical abuse. Limited utility in detecting skull fractures and CMLs. It is also technically demanding and radiation exposure is one of its primary drawbacks. Additionally, it can be falsely negative in the first 72 hours. It cannot additionally be used to date fractures. Not cost effective. Require sedation |
Computed Tomography |
Computed Tomography (CT) Scan of chest can detect rib and vertebral fractures. CT Chest has lower radiation exposure compared to a four-view chest radiograph. Contrast is not required unless visceral trauma is suspected. It is also indicated in patients with suspected THI-CM/AHT regardless of neurological signs. It can identify skull fractures, hemorrhages, soft tissue swellings in acute presentation. It is more sensitive than MRI in detecting acute intracranial hemorrhages. It is the investigation of choice in children with neurological findings. It can detect lesions requiring emergency intervention. Sedation is not required. |
Contrast may need to be used particularly in cases of suspected visceral injuries; therefore, it is contraindicated in patients of renal failure and those in shock. |
Magnetic Resonance Imaging (MRI) |
Important in non-acute cases of inflicted head trauma. It is the most important imaging technique to comprehensively assess intracranial lesions. Whole body MRI (WBMRI) can also detect soft tissue injuries |
It has limitations in acute setting. WBMRI is not recommended in the evaluation of skeletal injuries |
Ultrasonography |
Increased sensitivity for the detection of subcortical tears. It is a bedside imaging technique. It can help differentiate between various types of extra-axial fluids. It is additionally effective in detection of transphyseal and rib fractures when radiographic findings are negative. It can also pick up CMLs |
It should not be performed as an isolated modality in cases of head injury. It cannot detect common lesions that a CT scan can detect, cannot detect several acute intracranial injuries including small subdural hemorrhages |