ArticlePediatric radiology2014
High-resolution CT with histopathological correlates of the classic metaphyseal lesion of infant abuse.
Article in Pediatric radiology, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 21 papers, 1 of them a synthesis that pooled it.
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Who cites it
21 citing papers in PubMed, 1 synthesis or guideline pooled it, 58 citations in OpenAlex.
- Comparing imaging modalities and healing criteria for the estimation of fracture age: a systematic review.International journal of legal medicine · 2026Pooled it
- Postmortem CT: Applications in Clinical and Forensic Medicine.Radiographics : a review publication of the Radiological Society of North America, Inc · 2025Review
- Improving the radiographic image analysis of the classic metaphyseal lesion via conditional diffusion models.Medical image analysis · 2024Article
- Deep generative model of the distal tibial classic metaphyseal lesion in infants: assessment of synthetic images.Radiology advances · 2024Article
- Machine learning to identify distal tibial classic metaphyseal lesions of infant abuse: a pilot study.Pediatric radiology · 2022Article
- Evolving forensic controversies in child abuse imaging.Pediatric radiology · 2021Review
- Using micro-computed tomography to examine the larynx in cases of suspected strangulation-a comparison of case findings and control images.International journal of legal medicine · 2020Article
- Accuracy of ultrasound in the diagnosis of classic metaphyseal lesions using radiographs as the gold standard.Pediatric radiology · 2020Article
- Establishing signs for acute and healing phases of distal tibial classic metaphyseal lesions.Pediatric radiology · 2020Article
- Describing pediatric fractures in the era of ICD-10.Pediatric radiology · 2020Review
- It's time to recognize the perichondrium.Pediatric radiology · 2020Review
- Prevalence of metaphyseal injury and its mimickers in otherwise healthy children under two years of age.Pediatric radiology · 2019Article
- Subperiosteal new bone formation with the distal tibial classic metaphyseal lesion: prevalence on radiographic skeletal surveys.Pediatric radiology · 2019Article
- Brief Review on Metabolic Bone Disease.Academic forensic pathology · 2018Review
- The distal tibial classic metaphyseal lesion: medial versus lateral cortical injury.Pediatric radiology · 2018Article
- Biomechanics of the classic metaphyseal lesion: finite element analysis.Pediatric radiology · 2017Article
- Growth recovery lines are more common in infants at high vs. low risk for abuse.Pediatric radiology · 2016Article
- The etiology and significance of fractures in infants and young children: a critical multidisciplinary review.Pediatric radiology · 2016Review
- Imaging of skeletal injuries associated with abusive head trauma.Pediatric radiology · 2014Review
- The metaphyseal collar is also present until later childhood and at birth.Pediatric radiology · 2014Article
Corrections and comments
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- Erratum issued
Authors and funding
5 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe classic metaphyseal lesion (CML) is a common high specificity indicator of infant abuse and its imaging features have been correlated histopathologically in infant fatalities.
objectiveHigh-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
methodsLong 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 μm(3)) or with high-resolution flat-panel CT (isotropic resolutions of 200 μm(3)). 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.
resultsStudy 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.
conclusionHigh-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.
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