Purpose or Case Report: The purpose of this poster is to review the imaging findings of spinal fractures in children evaluated for child abuse on radiography, CT, and MRI, and differentiate fractures from vertebral body variations.
Methods & Materials: All skeletal surveys, CT scans, and spine MRI studies with a diagnosis of spinal fractures at our institution from 2014 to 2023 were identified. Representative cases of spinal fractures in non-accidental trauma demonstrated on radiography, CT, and MRI will be shown, in addition to some variations that can mimic fractures.
Results: The most common location of spinal fractures was in the thoracic spine, while cervical spine fractures were rare. Overlapping ribs in lateral thoracic radiographs create a challenge for diagnosing thoracic spinal fractures. Wedge fractures are the most common type of fractures.
Sclerosis on radiography and CT and absence of bone marrow edema on MRI can be seen in healing fractures. CT has better spatial resolution than MRI, and therefore chronic fractures may only be identified on CT. In young infants, deformed vertebra or decreased vertebral height on radiography may be related to variations in ossification rather than a fracture, with vertebral bodies appearing normal on MRI.
Conclusions: Diagnosis of a spine fracture in child abuse can be a challenge and requires understanding of the advantages and limitations of each imaging modality. Increased sclerosis on radiography and CT and absence of bone marrow edema on MRI can be seen in chronic fractures. Some fractures, especially if chronic, may be identified only on CT due to its better spatial resolution compared to MRI. MRI best depicts cartilaginous structures and can differentiate between a fracture and variation in vertebral body ossification.