Whole-Body MR Imaging in Suspected Physical Child Abuse: Comparison With Skeletal Survey and Bone Scintigraphy Findings From the PEDIMA Prospective Multicenter Study

Background: A skeletal survey (SS) of high technical quality is the standard method of investigation for identifying bone injuries in suspected physical child abuse worldwide. We aimed to assess the contribution of Whole-Body Magnetic Resonance Imaging (WBMRI) and BS in addition to SS in detecting traumatic bone lesions and soft-tissue injuries. Methods: PEDIMA is a prospective, multicenter, diagnostic accuracy study. Eligible children were less than three years of age and suspected of non-accidental injury. Each child underwent SS, BS and WBMRI. A blinded first review was jointly conducted by five paediatric radiologists and three nuclear medicine physicians. A second review investigated the discrepancies, in full knowledge of the results of all the imaging modalities in order to reach a consensus 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]. Findings: 170 children under three years old were included. Sixty-four children had at least one lesion for a total of 146 lesions. The sensitivity and specificity of each examination was, 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 significant difference between them. Interpretation: SS is still the most sensitive imaging modality, but the combined examinations offer greater accuracy and WBMRI is emerging as a new imaging strategy that could influence a change of practice. Funding:  French Ministry for Health as part of its interregional PHRC. Declaration of Interests: We declare no competing interests. Ethics Approval Statement: The local ethics committees approved the protocol and all children’s parents gave written informed consent before enrolment in the study.