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Radiologists play key role in child abuse cases: Electronic exhibit outlines signs of abuse

An estimated 906,000 children were victims of abuse or neglect in 2003 (the latest year statistics are available), and radiologists are playing a key role when these cases and cases of alleged abuse end up in court.

There are a number of indications of abuse that can be seen using radiography and other imaging techniques, said Andrea Walker, DO, who, along with her mentor Vesna Kriss, MD, has put together an interactive exhibit of cases from the University of Kentucky Medical Center designed to help radiologists confidently diagnose child abuse.

A red flag should go up when a radiologist finds fractures in different stages of healing, posterior rib fractures, fractures at the very end of the long bones (which can occur when a child has been shaken) and long bone fractures in children who are not walking, said Dr. Walker. In addition, MR imaging of the brain can detect repeated hemorrhages and MR spectroscopy can detected elevated lactate levels, which are found in hypoxic (loss or reduction of oxygen) injuries.

"On the other hand, there are a number of diseases and disorders that could potentially be mistaken for abuse," said Dr. Walker. "For example, metabolic bone diseases, such as osteogenesis imperfecta, can show up on a radiologic examination as multiple fractures, which can also be seen in abuse. However, if we take a second look, and see that all the bones are abnormal, we can be confident that the child suffers from a disease rather than abuse," she said.

"Cases of alleged child abuse often end up in the courtroom and the radiologist is a critical component of the case because radiographs are objective data. It is crucial to be well informed," Dr. Walker said.

The electronic exhibit will be on display at the American Roentgen Ray Society Annual Meeting in New Orleans beginning May 16.


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