대한영상의학회지 (Journal of the Korean Society of Radiology)

  • 제81권4호
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  • Pages.832-851
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  • 2020
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  • 1738-2637(pISSN)
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  • 2951-0805(eISSN)
대한영상의학회 (The Korean Society of Radiology)
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신체적 학대를 받은 아동의 진단적 영상

Diagnostic Imaging for Physical Abuse in Children

  • 전태연 (성균관대학교 삼성서울병원 영상의학과) ;
  • 유소영 (성균관대학교 삼성서울병원 영상의학과) ;
  • 어홍 (성균관대학교 삼성서울병원 영상의학과) ;
  • 김지혜 (성균관대학교 삼성서울병원 영상의학과)
  • Tae Yeon Jeon (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • So-Young Yoo (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Hong Eo (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Ji Hye Kim (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 투고 : 2020.04.21
  • 심사 : 2020.07.03
  • 발행 : 2020.07.01
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⟨ 이전 논문 다음 논문 ⟩

초록

신체적 학대로 인한 손상은 소아에서 이환율과 사망률의 중요한 원인이 된다. 특히, 1세 이하의 영아가 신체적 학대의 위험이 높다. 신체적 학대가 의심되는 경우 영상의학과 의사의 역할은 매우 중요한데 학대가 의심되는 영상의학적 소견을 찾고 다른 질환과의 감별을 통해 신속하고 정확한 진단을 내려야 한다. 본 논문에서는 신체적 학대를 받은 아동에서 흔히 보일 수 있는 특징적인 손상인 골절, 머리 손상, 척추 손상, 흉부와 복부의 손상 등의 여러 영상의학적 소견을 설명하고 이러한 손상이 유발되는 생체 역학적 힘의 기전에 대해 알아보고자 한다.

Physical abuse is a significant cause of morbidity and mortality in the pediatric population. Young children, particularly in the first year of life, are most vulnerable to physical abuse. To evaluate suspected physical abuse, radiologists play a vital role by detecting radiological findings suggestive of physical abuse and differentiating them from other pathologies. This review focuses on radiologic findings, including those for fractures, abusive head trauma, spinal injury, and thoracoabdominal injury, commonly discovered in physically abused children, with special emphasis on biomechanical forces that produce injuries.

키워드

과제정보

The authors thank Dr. Hye-Kyung Yoon (Human Medical Imaging & Intervention Center, Seoul, Korea) for providing figures of classic metaphyseal lesion and Dr. Kyoung Ja Lim (Hallym University College of Medicine, Kangdong Seong-Sim Hospital, Seoul, Korea) for providing figures of pancreas injury.

참고문헌

  1. Ministry of Health & Welfare, National Child Protection Agency. 2017 child abuse & neglect Korea. Available at. http://korea1391.go.kr/new/bbs/board.php?bo_table=report&wr_id=9870&page=1. Published 2018. Accessed Feb 20, 2020
  2. Berkowitz CD. Physical abuse of children. N Engl J Med 2017;376:1659-1666 https://doi.org/10.1056/NEJMcp1701446
  3. Duhaime AC, Christian CW, Rorke LB, Zimmerman RA. Nonaccidental head injury in infants--the "shaken-baby syndrome." N Engl J Med 1998;338:1822-1829 https://doi.org/10.1056/NEJM199806183382507
  4. US Department of Health and Human Services, Administration for Children and Families, Children's Bureau. Child maltreatment 2018. Available at. https://www.acf.hhs.gov/sites/default/files/cb/cm2018.pdf. Published 2018. Accessed Feb 20, 2020
  5. Keenan HT, Runyan DK, Marshall SW, Nocera MA, Merten DF, Sinal SH. A population-based study of inflicted traumatic brain injury in young children. JAMA 2003;290:621-626 https://doi.org/10.1001/jama.290.5.621
  6. Kemp AM, Butler A, Morris S, Mann M, Kemp KW, Rolfe K, et al. Which radiological investigations should be performed to identify fractures in suspected child abuse? Clin Radiol 2006;61:723-736 https://doi.org/10.1016/j.crad.2006.03.017
  7. Expert Panel on Pediatric Imaging; Wootton-Gorges SL, Soares BP, Alazraki AL, Anupindi SA, Blount JP, Booth TN, et al. ACR Appropriateness Criteria® suspected physical abuse-child. J Am Coll Radiol 2017;14:S338-S349 https://doi.org/10.1016/j.jacr.2017.01.036
  8. Wood JN, Fakeye O, Feudtner C, Mondestin V, Localio R, Rubin DM. Development of guidelines for skeletal survey in young children with fractures. Pediatrics 2014;134:45-53 https://doi.org/10.1542/peds.2013-3242
  9. American College of Radiology. ACR-SPR practice parameter for skeletal surveys in children. Available at. https://www.acr.org/-/media/ACR/Files/Practice-Parameters/Skeletal-Survey.pdf. Published 2016. Accessed Feb 20, 2020
  10. Bennett BL, Chua MS, Care M, Kachelmeyer A, Mahabee-Gittens M. Retrospective review to determine the utility of follow-up skeletal surveys in child abuse evaluations when the initial skeletal survey is normal. BMC Res Notes 2011;4:354
  11. Phillips KL, Bastin ST, Davies-Payne D, Browne D, Bird HL, Craw S, et al. Radiographic skeletal survey for non-accidental injury: systematic review and development of a national New Zealand protocol. J Med Imaging Radiat Oncol 2015;59:54-65 https://doi.org/10.1111/1754-9485.12271
  12. Karmazyn B, Lewis ME, Jennings SG, Hibbard RA, Hicks RA. The prevalence of uncommon fractures on skeletal surveys performed to evaluate for suspected abuse in 930 children: should practice guidelines change? AJR Am J Roentgenol 2011;197:W159-163 https://doi.org/10.2214/AJR.10.5733
  13. O'Connor JF, Cohen J. Diagnostic imaging of child abuse. 2nd ed. St Louis: Mosby 1998:168-177
  14. Duffy SO, Squires J, Fromkin JB, Berger RP. Use of skeletal surveys to evaluate for physical abuse: analysis of 703 consecutive skeletal surveys. Pediatrics 2011;127:e47-52 https://doi.org/10.1542/peds.2010-0298
  15. Hansen KK, Keeshin BR, Flaherty E, Newton A, Passmore S, Prince J, et al. Sensitivity of the limited view follow-up skeletal survey. Pediatrics 2014;134:242-248 https://doi.org/10.1542/peds.2013-4024
  16. Conway JJ, Collins M, Tanz RR, Radkowski MA, Anandappa E, Hernandez R, et al. The role of bone scintigraphy in detecting child abuse. Semin Nucl Med 1993;23:321-333 https://doi.org/10.1016/S0001-2998(05)80111-4
  17. Caffey J. Some traumatic lesions in growing bones other than fractures and dislocations: clinical and radiological features: The Mackenzie Davidson Memorial Lecture. Br J Radiol 1957;30:225-238 https://doi.org/10.1259/0007-1285-30-353-225
  18. Kleinman PK, Marks SC, Blackbourne B. The metaphyseal lesion in abused infants: a radiologic-histopathologic study. AJR Am J Roentgenol 1986;146:895-905 https://doi.org/10.2214/ajr.146.5.895
  19. Kleinman PK, Marks SC Jr, Richmond JM, Blackbourne BD. Inflicted skeletal injury: a postmortem radiologic-histopathologic study in 31 infants. AJR Am J Roentgenol 1995;165:647-650 https://doi.org/10.2214/ajr.165.3.7645487
  20. King J, Diefendorf D, Apthorp J, Negrete VF, Carlson M. Analysis of 429 fractures in 189 battered children. J Pediatr Orthop 1988;8:585-589
  21. Adamsbaum C, De Boissieu P, Teglas JP, Rey-Salmon C. Classic metaphyseal lesions among victims of abuse. J Pediatr 2019;209:154-159.e2 https://doi.org/10.1016/j.jpeds.2019.02.013
  22. Kleinman PK. Problems in the diagnosis of metaphyseal fractures. Pediatr Radiol 2008;38 Suppl 3:S388-394 https://doi.org/10.1007/s00247-008-0845-6
  23. Lonergan GJ, Baker AM, Morey MK, Boos SC. From the archives of the AFIP. Child abuse: radiologic-pathologic correlation. Radiographics 2003;23:811-845 https://doi.org/10.1148/rg.234035030
  24. Kemp AM, Dunstan F, Harrison S, Morris S, Mann M, Rolfe K, et al. Patterns of skeletal fractures in child abuse: systematic review. Version 2. BMJ 2008;337:a1518
  25. Barsness KA, Cha ES, Bensard DD, Calkins CM, Partrick DA, Karrer FM, et al. The positive predictive value of rib fractures as an indicator of nonaccidental trauma in children. J Trauma 2003;54:1107-1110 https://doi.org/10.1097/01.TA.0000068992.01030.A8
  26. Kleinman PK, Schlesinger AE. Mechanical factors associated with posterior rib fractures: laboratory and case studies. Pediatr Radiol 1997;27:87-91 https://doi.org/10.1007/s002470050073
  27. Hsieh KL, Zimmerman RA, Kao HW, Chen CY. Revisiting neuroimaging of abusive head trauma in infants and young children. AJR Am J Roentgenol 2015;204:944-952 https://doi.org/10.2214/AJR.14.13228
  28. Donahue DJ, Sanford RA, Muhlbauer MS, Chadduck WM. Cranial burst fracture in infants: acute recognition and management. Childs Nerv Syst 1995;11:692-697 https://doi.org/10.1007/BF00262233
  29. Arnholz D, Hymel KP, Hay TC, Jenny C. Bilateral pediatric skull fractures: accident or abuse? J Trauma 1998;45:172-174 https://doi.org/10.1097/00005373-199807000-00039
  30. Barkovich AJ, Raybaud C. Pediatric neuroimaging. 5th ed. Philadelphia: Lippincott Williams & Wilkins 2011:273-278
  31. Islam O, Soboleski D, Symons S, Davidson LK, Ashworth MA, Babyn P. Development and duration of radiographic signs of bone healing in children. AJR Am J Roentgenol 2000;175:75-78 https://doi.org/10.2214/ajr.175.1.1750075
  32. Perez-Rossello JM, Feldman HA, Kleinman PK, Connolly SA, Fair RA, Myers RM, et al. Rachitic changes, demineralization, and fracture risk in healthy infants and toddlers with vitamin D deficiency. Radiology 2012;262:234-241 https://doi.org/10.1148/radiol.11110358
  33. Cheung MS, Glorieux FH. Osteogenesis Imperfecta: update on presentation and management. Rev Endocr Metab Disord 2008;9:153-160 https://doi.org/10.1007/s11154-008-9074-4
  34. Wittschieber D, Karger B, Pfeiffer H, Hahnemann ML. Understanding subdural collections in pediatric abusive head trauma. AJNR Am J Neuroradiol 2019;40:388-395
  35. Wright JN. CNS injuries in abusive head trauma. AJR Am J Roentgenol 2017;208:991-1001 https://doi.org/10.2214/AJR.16.17602
  36. Gerber P, Coffman K. Nonaccidental head trauma in infants. Childs Nerv Syst 2007;23:499-507 https://doi.org/10.1007/s00381-006-0267-4
  37. Bandak FA. Shaken baby syndrome: a biomechanics analysis of injury mechanisms. Forensic Sci Int 2005;151:71-79 https://doi.org/10.1016/j.forsciint.2005.02.033
  38. Caffey J. The whiplash shaken infant syndrome: manual shaking by the extremities with whiplash-induced intracranial and intraocular bleedings, linked with residual permanent brain damage and mental retardation. Pediatrics 1974;54:396-403 https://doi.org/10.1542/peds.54.4.396
  39. Elder JE, Taylor RG, Klug GL. Retinal haemorrhage in accidental head trauma in childhood. J Paediatr Child Health 1991;27:286-289 https://doi.org/10.1111/j.1440-1754.1991.tb02539.x
  40. Duhaime AC, Gennarelli TA, Thibault LE, Bruce DA, Margulies SS, Wiser R. The shaken baby syndrome. A clinical, pathological, and biomechanical study. J Neurosurg 1987;66:409-415 https://doi.org/10.3171/jns.1987.66.3.0409
  41. Hadley MN, Sonntag VK, Rekate HL, Murphy A. The infant whiplash-shake injury syndrome: a clinical and pathological study. Neurosurgery 1989;24:536-540 https://doi.org/10.1227/00006123-198904000-00008
  42. Aryan HE, Ghosheh FR, Jandial R, Levy ML. Retinal hemorrhage and pediatric brain injury: etiology and review of the literature. J Clin Neurosci 2005;12:624-631 https://doi.org/10.1016/j.jocn.2005.05.005
  43. Section on Radiology; American Academy of Pediatrics. Diagnostic imaging of child abuse. Pediatrics 2009;123:1430-1435 https://doi.org/10.1542/peds.2009-0558
  44. Mankad K, Chhabda S, Lim W, Oztekin O, Reddy N, Chong WK, et al. The neuroimaging mimics of abusive head trauma. Eur J Paediatr Neurol 2019;23:19-30 https://doi.org/10.1016/j.ejpn.2018.11.006
  45. Orman G, Kralik SF, Meoded A, Desai N, Risen S, Huisman TAGM. MRI findings in pediatric abusive head trauma: a review. J Neuroimaging 2020;30:15-27 https://doi.org/10.1111/jon.12670
  46. Ashwal S, Wycliffe ND, Holshouser BA. Advanced neuroimaging in children with nonaccidental trauma. Dev Neurosci 2010;32:343-360 https://doi.org/10.1159/000316801
  47. Choudhary AK, Servaes S, Slovis TL, Palusci VJ, Hedlund GL, Narang SK, et al. Consensus statement on abusive head trauma in infants and young children. Pediatr Radiol 2018;48:1048-1065 https://doi.org/10.1007/s00247-018-4149-1
  48. Palifka LA, Frasier LD, Metzger RR, Hedlund GL. Parenchymal brain laceration as a predictor of abusive head trauma. AJNR Am J Neuroradiol 2016;37:163-168 https://doi.org/10.3174/ajnr.A4519
  49. Kemp A, Cowley L, Maguire S. Spinal injuries in abusive head trauma: patterns and recommendations. Pediatr Radiol 2014;44 Suppl 4:S604-612 https://doi.org/10.1007/s00247-014-3066-1
  50. Rabbitt AL, Kelly TG, Yan K, Zhang J, Bretl DA, Quijano CV. Characteristics associated with spine injury on magnetic resonance imaging in children evaluated for abusive head trauma. Pediatr Radiol 2020;50:83-97 https://doi.org/10.1007/s00247-019-04517-y
  51. Choudhary AK, Ishak R, Zacharia TT, Dias MS. Imaging of spinal injury in abusive head trauma: a retrospective study. Pediatr Radiol 2014;44:1130-1140 https://doi.org/10.1007/s00247-014-2959-3
  52. Trokel M, Discala C, Terrin NC, Sege RD. Patient and injury characteristics in abusive abdominal injuries. Pediatr Emerg Care 2006;22:700-704 https://doi.org/10.1097/01.pec.0000238734.76413.d0