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The following is a summary of the systematic review findings up to the date of our most recent literature search. If you have a specific clinical case, we strongly recommend you read all of the relevant references as cited and look for additional material published outside our search dates.


Since 2007, no studies meeting our inclusion criteria have compared the value of Skeletal Survey versus Radionuclide Imaging


  • Of the 540 studies reviewed, 17 studies compared skeletal survey (SS) and radionuclide imaging (RNI) 1-17 
  • Study design:
    • 14 case study / case series 1,3-10,12,14-17 
    • 3 cross-sectional 2,11,13 
  • Age range: 0 – 16 years
  • Gender: data not analysed by gender
  • No study addressed radiological investigations of disabled children
  • No study addressed the influence of ethnicity and socio-economic group


Details of included studies

  • Total data: eight large studies compared the diagnostic yield in 509 children who had both investigations 3,6,7,9,11,13,14,16
    • RNI was performed between 24 and 96 hours of the SS
    • The number of images included in SS varied between studies. The detail was poorly described. No study included oblique views of the ribs
    • All studies, with the exception of Pickett et al 14, confirmed that using either investigation in isolation would miss some fractures
  • Nine small studies highlight additional findings on RNI not identified on SS 1,2,4,5,8,10,12,15,17
    • Five cases had RNI findings confirmed on repeat plain films 12,15,17
    • Smith describes costo-vertebral fractures seen on RNI but NOT SS 15
  • Five studies showed that RNI was more sensitive, overall, at identifying bony abnormalities than SS 3,6,7,11,16
  • Two studies stated that SS had the greatest sensitivity 9,14
  • RNI had a higher level of diagnostic significance over SS, excluding skull fractures 4,6,8,16,17
  • RNI was better at identifying individual fractures than SS 5,7,11
  • SS identifies metaphyseal fractures and skull fractures significantly better than RNI 9
  • No significant difference in the diagnostic specificity for rib fractures between either modality  9
  • Combining all other fracture types, RNI was better than SS  9
  • RNI had an increased sensitivity in detecting soft tissue as well as bone trauma 3
  • Neither SS or RNI is as good as the two investigations combined 6,7,9,11,16
  • RNI predominately missed skull, metaphyseal and epiphyseal fractures whereas skeletal survey commonly missed rib fractures 6,7,9-11,16

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  1. Ablin DS, Greenspan A, Reinhart MA. Pelvic injuries in child abuse. Pediatric Radiology. 1992;22(6):454-457 [Pubmed]
  2. Cadzow SP, Armstrong KL. Rib fractures in infants: red alert! The clinical features, investigations and child protection outcomes. Journal of Paediatrics and Child Health. 2000;36(4):322-326 [Pubmed]
  3. Conway JJ, Collins M, Tanz RR, Radkowski MA, Anandappa E, Hernandez R, Freeman EL. The role of bone scintigraphy in detecting child abuse. Seminars in Nuclear Medicine. 1993;23(4):321-333 [Pubmed]
  4. Curcoy Barcenilla AI, Trenchs Sainz de la Maza V, Pou Fernandez J. [Utility of bone scintigraphy in the differential diagnosis of child maltreatment] [Spanish]. Anales de Pediatria. 2006;65(1):83-84 [Pubmed]
  5. Frye TR, Shores RM, Slovis TL, Young LW, Helfer RE. Radiological case of the month. Child abuse. American Journal of Diseases of Children. 1984;138(3):323-324 [Pubmed]
  6. Haase GM, Ortiz VN, Sfakianakis GN, Morse TS. The value of radionuclide bone scanning in the early recognition of deliberate child abuse. Journal of Trauma. 1980;20(10):873-875 [Pubmed citation only]
  7. Jaudes PK. Comparison of radiography and radionuclide bone scanning in the detection of child abuse. Pediatrics. 1984;73(2):166-168 [Pubmed]
  8. Kleinhans E, Kentrup H, Alzen G, Skopnik H, Bull U. [Falsch-negatives skelett-szintigramm bei einer biparietalen schadelfraktur beim "Battered Child"-Syndrom] [German] Falsely negative bone scintigram in a case of a Battered-Child Syndrome with biparietal skull fractures. Nuklearmedizin (Stuttg) 1993;32(4):206-207 [Pubmed]
  9. Mandelstam SA, Cook D, Fitzgerald M, Ditchfield MR. Complementary use of radiological skeletal survey and bone scintigraphy in detection of bony injuries in suspected child abuse. Archives of Disease in Childhood 2003;88(5):387-390 [Pubmed]
  10. Merten DF, Kirks DR, Ruderman RJ. Occult humeral epiphyseal fracture in battered infants. Pediatric Radiology. 1981;10(3):151-154 [Pubmed]
  11. Merten DF, Radlowski MA, Leonidas JC. The abused child: a radiological reappraisal. Radiology. 1983;146(2):377-381 [Pubmed]
  12. Nimkin K, Spevak MR, Kleinman PK. Fractures of the hands and feet in child abuse: imaging and pathological features. Radiology. 1997;203(1):233-236 [Pubmed]
  13. Olesen T, Egeblad M, Dige-Petersen H, Ahlgren P, Nielsen AM, Vesterdal J. Somatic manifestations in children suspected of having been maltreated. Acta Paediatrica Scandinavica. 1988;77(1):154-160 [Pubmed]
  14. Pickett WJ, Faleski EJ, Chacko A, Jarrett RV. Comparison of radiographic and radionuclide skeletal surveys in battered children. Southern Medical Journal. 1983;76(2):207-212 [Pubmed]
  15. Smith FW, Gilday DL, Ash JM, Green MD. Unsuspected costo-vertebral fractures demonstrated by bone scanning in the child abuse syndrome. Pediatric Radiology. 1980;10(2):103-106 [Pubmed]
  16. Sty JR, Starshak RJ. The role of bone scintigraphy in the evaluation of the suspected abused child. Radiology. 1983;146(2):369-375 [Pubmed]
  17. Williams G, Treves ST. A second radiographic skeletal survey for child abuse triggered by bone scintigraphy found positive after the initial survey was called negative. Clinical Nuclear Medicine. 2007;32(1):29-31 [Pubmed]


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