Purpose The CT examination is first tool to detect brain ICH or skull bone fracture. But the skull fontanel and suture is developing in infant and child,

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Purpose The CT examination is first tool to detect brain ICH or skull bone fracture. But the skull fontanel and suture is developing in infant and child, led to difficult diagnose skull bone fracture. In our case, we provide bone window with MPR and 3D image to distinguish fracture lesion. Material and Methods The Infant or child with head injury suspected brain ICH clinically received brain CT examination. Before performing the CT examination, we have to communicate with family members, that must let the infant or child be quiet in scanning to avoid repeat scan and increase radiation dose, and give the patient lead skirt to protection gonad. With the use of 64 slice MDCT(Brilliance; PHILIPS) and CT protocol: collimation 16*0.625 mm, tube rotation time of 0.75sec, pitch of 0.563, table speed of 0.75mm/sec, 200–230 mAs, and 120 kVp. Raw data reconstruction included soft and bone window image. Results With the helical scan and different post-processing image, the skull bone structure and lesion can be well detected and characterized. The image of infant and child skull bone would be presented. Conclusion MPR & 3D image is a simple method to help diagnose skull bone fracture or suture in infant and child. Therefore, our radiology department formulated the brain CT image at infant or child must extra include axial, coronal, sagittal bone window and VR image to provide clinical diagnose rapid. Keywords : MDCT, fontanel, skull suture Department of Radiology, Ditmanson Medical Foundation Chia-Yi Christian Hospital Ru-Lin Yeh Lateral view Superior view  Fig 1. The skull of infant anatomy  Fig 3. The normal skull of three-month-old infant in CT images D AB D C EF SS CS LS SqS CS LS SS A-C: axial, coronal, sagittal bone window images. D-E: Volume rendering images. The CT images showed the normally skull fontanel and suture in an infant. CS: coronal suture, FS: frontal suture, SS: sagittal suture, LS: lambdoid suture, SqS: squamous suture. A B C D E F  Fig 4. The fracture skull of two-years-old child in CT images A: axial soft window image showed epidural hematoma in left temporo-parietal lobe. B -D: axial, coronal, sagittal bone window images showed fracture of left parietal bone (not easy to see). E-F: Volume rendering images showed fracture of left parietal bone (easy to see). A-C: axial, coronal, sagittal bone window images. D-E: Volume rendering images. The CT images showed the normally skull fontanel and suture in an infant. CS: coronal suture, FS: frontal suture, SS: sagittal suture, LS: lambdoid suture, SqS: squamous suture, AF: anterior fontanel, PF: posterior fontanel.  Fig 2. The normal skull of two-day-old infant in CT images A CBA DE F CS FS SS AF LS SqS AF PF SS E A B C DF E  Fig 4. The fracture skull of twenty-five-day-old infant in CT images A: axial soft window image showed right of skull small subarachnoid hematoma and scalp hematoma. B-D: axial, coronal, sagittal bone window images showed fracture of right parietal bone. E-F: Volume rendering images showed right skull fracture of parietal and frontal bone.