, Volume 61, Issue 1, pp 81–87 | Cite as

Black bone MRI with 3D reconstruction for the detection of skull fractures in children with suspected abusive head trauma

  • Stephen F. KralikEmail author
  • Nucharin Supakul
  • Isaac C. Wu
  • Gaspar Delso
  • Rupa Radhakrishnan
  • Chang Y. Ho
  • Karen A. Eley
Paediatric Neuroradiology



The purpose of this study was to determine the accuracy of “black bone” (BB) MRI for the detection of skull fractures in children with potential abusive head trauma.


A total of 34 pediatric patients were evaluated for potential abusive head trauma. All patients had both a non-contrast head CT (HCT) with multiplanar reformatted images and 3D volumetric reformatted images where available (gold standard) for fracture diagnosis and BB of the head with multiplanar reformatted images and 3D volumetric images. BB was performed using an ultrashort TE pointwise encoding time reduction with radial acquisition (PETRA) sequence at 1.5 T or 3 T. BB datasets were post-processed and 3D images created using Fovia’s High Definition Volume Rendering® software. Two board-certified pediatric neuroradiologists independently reviewed the HCT and BB imaging, blinded to the findings from the other modality.


Median patient age was 4 months (range 1.2–30 months). A total of 20 skull fractures in six patients (18% incidence of skull fractures) were detected on HCT. BB demonstrated 83% sensitivity (95%[CI] 36–99%), 100% specificity (95%[CI] 88–100%), 100% PPV (95%[CI] 46–100%), 97% NPV (95%[CI] 82–99%), and 97% accuracy (95%[CI] 85–99%) for diagnosis of a skull fracture. BB detected 95% (19/20) of the skull fractures detected by CT.


A black bone MRI sequence may provide high sensitivity and specificity for detection of skull fractures in pediatric patients with abusive head trauma.


Abusive head trauma MRI CT 



Ultrashort TE


Pointwise encoding time reduction with radial acquisition


Head CT


Abusive head trauma


Compliance with ethical standards


No funding was received for this study.

Conflict of interest

GD is employed by GE Healthcare.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of retrospective study formal consent is not required.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Stephen F. Kralik
    • 1
    Email author
  • Nucharin Supakul
    • 2
  • Isaac C. Wu
    • 2
  • Gaspar Delso
    • 3
  • Rupa Radhakrishnan
    • 2
  • Chang Y. Ho
    • 2
  • Karen A. Eley
    • 3
  1. 1.Department of RadiologyTexas Children’s HospitalHoustonUSA
  2. 2.Department of Radiology and Imaging SciencesIndiana University School of MedicineIndianapolisUSA
  3. 3.Department of Radiology, Addenbrooke’s HospitalUniversity of CambridgeCambridgeUK

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