放射科医生帮助鉴别儿童虐待

2003年仅仅在美国，就有大约906000儿童成为被忽视或者虐待的牺牲品，而放射科医生在帮助此类所谓虐待案件法庭程序终结的过程中，发挥着关键作用。

根据肯塔基大学医学中心研究人员的结果，可以使用放射学以及其它影像扫描方法来发现许多虐待事件的迹象。该医学中心已经收集来自肯塔基大学医学中心的许多案例，组织了一次互动式展览，来帮助放射科医生准确地诊断儿童虐待事件。

肯塔基大学的Andrea Walker指出，在还不能走路的儿童，如果放射科医生在愈合不同阶段发现骨折，在长骨末端发现骨折（这通常发生在儿童被摇晃的情况之下），背部肋骨骨折，长骨骨折，应当引起高度重视。而且可以使用核磁共振扫描来鉴别反复出血，核磁共振波谱检查能够检测升高的乳酸水平，这通常发生在低氧损害（氧气丧失或者缺乏）的情况之下。

Walder博士说：“另外一方面，有些疾病可能会被误认为虐待。例如，代谢性骨骼疾病，例如成骨不全，会在放射学检查的时候表现为反复骨折，这可以在儿童虐待的时候发生。但是如果我们重新核实，会发现所有骨骼都不正常，我们就可以十分自信的说这个孩子正遭受疾病而不是虐待的折磨。所谓的儿童虐待事件常常在法庭终结，而放射科医生在这类事件中扮演重要角色因为放射检查是客观证据。这类检查必须仔细应对。”

2005年5月新奥尔良美国伦琴射线学会年会上展示了该研究结果的电子展示。

Radiologists Help Identify Child Abuse
 
In the United States alone, approximately 906,000 children were victims of neglect or abuse in 2003, and radiologists are playing a crucial role when these cases of alleged abuse end up in court proceedings.

There are a host of indicators of abuse that can be seen using radiography and other imaging methods, according to researchers at the University of Kentucky Medical Center (Lexington, KY, USA), who have comprised an interactive exhibit of cases from the University of Kentucky Medical Center to help radiologists accurately diagnose child abuse.

A red flag should appear when a radiologist discovers fractures in different stages of healing, fractures at the very end of the long bones (which can occur when a child has been shaken), posterior rib fractures, and long-bone fractures in children who are not walking, said Andrea Walker, DO, from the University of Kentucky. Furthermore, magnetic resonance imaging (MRI) of the brain can identify repeated hemorrhages, and MR spectroscopy can detect increased lactate levels, which are found in hypoxic (loss or reduction of oxygen) injuries.

“On the other hand, there are a number of diseases and disorders that could potentially be mistaken for abuse,” said Dr. Walker. “For example, metabolic bone diseases, such as osteogenesis imperfecta, can show up on a radiologic examination as multiple fractures, which can also be seen in abuse. However, if we take a second look, and see that all the bones are abnormal, we can be confident that the child suffers from a disease rather than abuse. Cases of alleged child abuse often end up in the courtroom and the radiologist is a critical component of the case because radiographs are objective data. It is crucial to be well informed.”

The electronic exhibit was displayed at the annual meeting of the American Roentgen Ray Society in New Orleans in May 2005.