IMAGING OF CHILD-ABUSE

The use of imaging for the diagnosis of child abuse has advanced drama tically since Caffey's(3) initial descriptions of the association of u nexplained subdural hematomas and long-bone fractures in infants. Ln 1 953, Silverman(38) concluded that the skeletal injuries were the resul t of repetitive, nonaccidental trauma, and by 1962, Kempe et al(16) ha d coined the term battered child syndrome and presented radiographic s keletal manifestations of abuse. Much work has been done since then to delineate the imaging findings in skeletal and extraskeletal injuries of abused children. Although the awareness of child abuse and its ima ging characteristics has grown, the numbers of fatally injured childre n are increasing. At least 2000 children die annually in the United St ates as a result of physical abuse.(8) In addition, the proportion of serious injuries caused by abuse has increased significantly.(36) Chil dren under 1 year of age are particularly at risk.(10,31) Risk factors for abuse include low socioeconomic level, prematurity, physical hand icap, and low birthweight. Males, stepchildren, and twins are vulnerab le as well.(27,36) imaging studies provide the basis for a diagnosis o f abuse in many cases; awareness of the imaging patterns in abuse is e ssential for enhanced detection of these injuries as well as for a com plete understanding of the problem.