Three-dimensional skull models as a problem-solving tool in suspected child abuse

Pediatr Radiol. 2013 Mar;43(5):575-81. doi: 10.1007/s00247-012-2546-4. Epub 2012 Nov 25.


Background: The value of 3-D skull models in evaluation of young children with suspected child abuse is not known.

Objective: The purpose of this study was to assess the value of 3-D skull models as a problem-solving tool in children younger than 2 years.

Materials and methods: We performed a retrospective study on 73 children (ages 0-24 months) seen by a child protection team (CPT) who were undergoing head CT between August 2007 and July 2009.

Results: Of the 73 children, volume-rendered 3-D models were obtained in 26 (35.6%). Three-dimensional models changed initial CT interpretation in nine instances (34.6%). Findings thought to be fractures were confirmed as normal variants in four children. Depressed fractures were correctly shown to be ping-pong fractures in two cases. In one case, an uncertain finding was confirmed as a fracture, and an additional contralateral fracture was identified in one child. A fracture seen on skull radiographs but not seen on axial CT images was identified on the 3-D model in one case. Changes in interpretation led to modification in management in five children.

Conclusion: Use of 3-D skull models can be a problem-solving tool when there is discordance among the CT reading, subsequent radiographic investigations and clinical evaluation.

MeSH terms

  • Child Abuse / diagnosis*
  • Child Abuse / prevention & control
  • Computer Simulation
  • Diagnosis, Differential
  • Female
  • Humans
  • Imaging, Three-Dimensional / methods*
  • Infant
  • Infant, Newborn
  • Male
  • Models, Anatomic*
  • Problem Solving*
  • Radiographic Image Interpretation, Computer-Assisted / methods*
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Skull Fractures / diagnostic imaging*
  • Ultrasonography