Reply: SPR Child Abuse Committee Response Regarding Classic Metaphyseal Lesion

In response to Brown et al. [1], who wrote on behalf of the Child Abuse Committee of the Society of Pediatric Radiology, we agree that the radiologic diagnosis of abuse should be based on reliable evidence. Our article [2] made two points: first, that the evidence for classic metaphyseal lesions (CMLs) as traumatic lesions is weak and second, that CMLs closely resemble the abnormalities seen in rickets, particularly the healing stages. We are not the first to point out that the evidence that CMLs are indicators of abuse is weak [3]; nor are we the first to suggest that CMLs can resemble healing rickets, which was pointed out in 2008 [4].