The Value of Radionuclide Bone Scanning in the Early Recognition of Deliberate Child Abuse

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Abstract
Children (44) suspected of having been abused underwent Tc-99m diphosphonate bone imaging at the time of initial presentation for treatment of trauma or burns. Twenty-six had negative scans. These patients never showed X-ray evidence of skeletal injury although 10 were abuse victims. Skull fractures (2) were found on X-ray examination when the scan was normal. Initial roentgenograms confirmed the presence of bone injury in 11 children with positive scans. Of 7 children with positive scans and normal initial X-rays, 5 developed bone or periosteal lesions visible on later X-ray studies. Of the remaining 2 children, 1 was lost to further study and the other had a history suggesting a prior injury which might have healed sufficiently to yield normal X-rays. In the study of children suspected of having been physically abused, the skull should be X-rayed and a bone scan performed. The scan can identify which additional bony areas to study roentgenographically on the day of 1st medical encounter, and which areas to re-study should the initial roentgenograms appear normal. Bone scanning, using Tc-99m diphosphonate is more sensitive than the roentgenographic skeletal survey in detecting early evidence of bone or periosteal injury. The evidence thus obtained is useful for protecting children from further abuse, either by court action or, more commonly, by effective counselling after the abuser''s denial has been overcome.

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