High-resolution CT with histopathological correlates of the classic metaphyseal lesion of infant abuse
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The classic metaphyseal lesion (CML) is a common high specificity indicator of infant abuse and its imaging features have been correlated histopathologically in infant fatalities.
High-resolution CT imaging and histologic correlates were employed to (1) characterize the normal infant anatomy surrounding the chondro-osseous junction, and (2) confirm the 3-D model of the CML previously inferred from planar radiography and histopathology.
Materials and methods
Long bone specimens from 5 fatally abused infants, whose skeletal survey showed definite or suspected CMLs, were studied postmortem. After skeletal survey, selected specimens were resected and imaged with high-resolution digital radiography. They were then scanned with micro-CT (isotropic resolution of 45 μm3) or with high-resolution flat-panel CT (isotropic resolutions of 200 μm3). Visualization of the bony structures was carried out using image enhancement, segmentation and isosurface extraction, together with volume rendering and multiplanar reformatting. These findings were then correlated with histopathology.
Study of normal infant bone clarifies the 3-D morphology of the subperiosteal bone collar (SPBC) and the radiographic zone of provisional calcification (ZPC). Studies on specimens with CML confirm that this lesion is a fracture extending in a planar fashion through the metaphysis, separating a mineralized fragment. This disk-like mineralized fragment has two components: (1) a thick peripheral component encompassing the SPBC; and (2) a thin central component comprised predominantly of the radiologic ZPC. By manipulating the 3-D model, the varying appearances of the CML are displayed.
High-resolution CT coupled with histopathology provides elucidation of the morphology of the CML, a strong indicator of infant abuse. This new information may prove useful in assessing the biomechanical factors that produce this strong indicator of abusive assaults in infants.
KeywordsChild abuse Classic metaphyseal lesion Micro-CT High-resolution flat-panel CT Subperiosteal bone collar Zone of provisional calcification Infant
The authors would like to thank Nancy Drinan for her help in the preparation of the manuscript.
Conflicts of interest
- 4.Silverman F (1953) The roentgen manifestations of unrecognized skeletal trauma in infants. AJR Am J Roentgenol 69:413–427Google Scholar
- 8.Osier L, Marks S, Kleinman P (1993) Metaphyseal extensions of hypertrophied chondrocytes in abused infants indicate healing fractures. J Pediatr Orthoped 13:249–254Google Scholar
- 17.Ranvier L (1873) Quelques faits relatis au developpement du tissue osseux. Comtes Rend Acad Sci 77:1105Google Scholar
- 18.LaCroix P (1951) Origin of the perichondrial osseous ring. First example of a phenomenon of induction in skeletal development. The Organization of Bones (trans: Gilder S). Blakison, Philadelphia pp 90–97Google Scholar
- 21.Brighton C (1984) The growth plate. Orthop Clin N Am 15:571–595Google Scholar
- 25.Braden T (1993) Histophysiology of the growth plate and growth plate injuries. In: Smeak D, Bojrab J, Bloomberg M (eds) Disease mechanism in small animal surgery, 2nd edn. Lippincott Williams & Wilkins, Philadelphia, pp 1027–1041Google Scholar
- 28.Jerome C, Hoch B (2012) Skeletal system. In: Treuting P, Dintzis S (eds) Comparative anatomy and histology. Academic, Waltham, pp 53–70Google Scholar
- 33.Ham AW, Cormack DH (1979) Histology, 8th edn. Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
- 34.Maresh M (1955) Linear growth of long bones of extremities from infancy through adolescence. Am J Dis Child 89:725–742Google Scholar
- 35.Pavlov S, Petrov I (1992) Morphometric characteristics of bones of the extremities in newborn infants. Gegenbaurs Morphol Jahrb 117:145–161Google Scholar
- 38.McLean FC, Urist MR (1961) Bone. An introduction to the physiology of skeletal tissue, 2nd edn. University of Chicago Press, Chicago, p 24Google Scholar
- 41.Tsai A, McDonald AG, Rosenberg AE et al (2013) Discordant radiologic and histological dimensions of the zone of provisional calcification in fetal piglets. Pediatr Radiol 43:1606–1614Google Scholar