Showing papers in "Pediatric Radiology in 2004"
TL;DR: Current concepts and some controversial issues related to management of intussusception are highlighted, including patient selection for attempted enema reduction, the advantages and disadvantages of each technique, complications, the value of delayed, repeated reduction attempts, the role of imaging after attempted enEMA reduction, and recurrence of int Mussusception.
Abstract: Children with symptomatic ileocolic or ileo-ileocolic intussusceptions can be successfully managed in one of a number of different ways. The nonoperative enema reduction technique has major advantages over surgical reduction and high success rates can be achieved using pneumatic or hydrostatic reduction techniques under fluoroscopic or sonographic guidance. This article highlights current concepts and some controversial issues related to management of intussusception, including patient selection for attempted enema reduction, the advantages and disadvantages of each technique, complications, the value of delayed, repeated reduction attempts, the role of imaging after attempted enema reduction, and recurrence of intussusception.
209 citations
TL;DR: In this essay, the radiologic findings of malrotation and volvulus are reviewed and illustrated with particular attention to the child with equivocal imaging findings.
Abstract: Malrotation with volvulus is one of the true surgical emergencies of childhood. Prompt radiological diagnosis is often paramount to achieving a good outcome. An understanding of the normal and anomalous development of the midgut provides a basis for understanding the pathophysiology and the clinical presentation of malrotation and malrotation complicated by volvulus. In this essay, the radiologic findings of malrotation and volvulus are reviewed and illustrated with particular attention to the child with equivocal imaging findings.
204 citations
TL;DR: Practical guidelines are provided for the accurate radiological classification of intra-thoracic TB in children less than 15 years of age based on the underlying disease and the principles of pathological disease progression.
Abstract: One of the obstacles in discussing childhood tuberculosis (TB) is the lack of standard descriptive terminology to classify the diverse spectrum of disease. Accurate disease classification is important, because the correct identification of the specific disease entity has definite prognostic significance. Accurate classification will also improve study outcome definitions and facilitate scientific communication. The aim of this paper is to provide practical guidelines for the accurate radiological classification of intra-thoracic TB in children less than 15 years of age. The proposed radiological classification is based on the underlying disease and the principles of pathological disease progression. The hope is that the proposed classification will clarify concepts and stimulate discussion that may lead to future consensus.
187 citations
TL;DR: The imaging findings of skeletal tuberculosis in children are presented to present the modality of choice in evaluating early marrow involvement and soft-tissue extension of the lesion.
Abstract: The objective of this review is to present the imaging findings of skeletal tuberculosis in children. The incidence of tuberculosis is increasing and skeletal tuberculosis accounts for 10-20% of all extra-pulmonary cases. The most common manifestations of skeletal tuberculosis in children are spondylitis, arthritis and osteomyelitis. Tuberculous spondylitis involves the intervertebral disc only late in the disease. Subligamentous spread of the infection may lead to multiple levels of vertebral body involvement that may either be continuous or skipped. Extension of the disease into the paravertebral or extra-dural space may occur. Tuberculous arthritis usually occurs as a result of metaphyseal spread to the joint. Tuberculous osteomyelitis may appear as cystic, well-defined lesions, infiltrative lesions or spina ventosa. The latter is a term used to describe a form of tuberculous osteomyelitis where underlying bone destruction, overlying periosteal reaction and fusiform expansion of the bone results in cyst-like cavities with diaphyseal expansion. Radiographs are still the mainstay of evaluation of patients with bony lesions. Ultrasonography can detect soft-tissue extension of the bony lesions and guide drainage or biopsy procedures. CT accurately demonstrates bony sclerosis and destruction, especially in areas difficult to assess on radiographs such as the posterior elements of the vertebral body. MRI is the modality of choice in evaluating early marrow involvement and soft-tissue extension of the lesion.
175 citations
TL;DR: This approach covers both aspects of fetal CNS disorders: isolated and complex malformations and cerebral lesions arising from the impaired integrity of the feto-placental unit.
Abstract: The development of ultrafast sequences has led to a significant improvement in fetal MRI. Imaging protocols have to be adjusted to the rapidly developing fetal central nervous system (CNS) and to the clinical question. Sequence parameters must be changed to cope with the respective developmental stage, to produce images free from motion artefacts and to provide optimum visualization of the region and focus of interest. In contrast to postnatal studies, every suspect fetal CNS abnormality requires examination of the whole fetus and the extrafetal intrauterine structures including the uterus. This approach covers both aspects of fetal CNS disorders: isolated and complex malformations and cerebral lesions arising from the impaired integrity of the feto-placental unit.
161 citations
TL;DR: Those intussusceptions with an identifiable cause including pathologic lead point, those due to gastrojejunostomy or other feeding tubes, and those that are seen in the postoperative period as well as those that may be asymptomatic or may reduce spontaneously are discussed.
Abstract: In the previous two parts of this review on intussusception, the diagnosis and management of symptomatic, "idiopathic" ileocolic and ileoileocolic intussusceptions, which are considered to result from hyperplasia of lymphoid tissue in the distal ileum, were discussed. In this third part, those intussusceptions with an identifiable cause including pathologic lead point, those due to gastrojejunostomy or other feeding tubes, and those that are seen in the postoperative period as well as those that may be asymptomatic or may reduce spontaneously (usually limited to the small bowel) are discussed.
133 citations
TL;DR: Lymphadenopathy was common, but only 46 patients had lymph nodes greater than 1 cm, and enhancement was ‘ghost-like’ rather than discreet ring enhancing with a low-density centre.
Abstract: Background
The diagnosis of primary pulmonary tuberculosis (PTB) in children relies heavily on the radiographic demonstration of mediastinal lymphadenopathy. Plain radiographs may be unreliable and CT is the current ‘gold standard’ for demonstrating this. Only two previous studies have described the CT findings of mediastinal adenopathy exclusively in children.
115 citations
TL;DR: This paper takes a different approach to analyzing posterior fossa cysts based on the pathology of the cyst wall and the embryology of the hindbrain, choroid plexus, and meninges.
Abstract: Posterior fossa cysts are frequently identified on MR studies. This paper takes a different approach to analyzing these cysts based on the pathology of the cyst wall and the embryology of the hindbrain, choroid plexus, and meninges. The type of cyst depends on the histologic components of the cyst wall. Frequent types of posterior fossa cysts are arachnoid, Blake's pouch, and cysts associated with Dandy Walker malformation. All of these cysts may mimic the others in terms of position of the torcula, vermian abnormalities, and mass effect on the cerebellum and occipital bone. A clue to the nature of the cyst may be the position of the choroid plexus in the fourth ventricle; normal in arachnoid cyst, absent in Dandy Walker malformation, and displaced into the superior cyst wall in Blake's pouch. When the cyst wall histology is not known, it is suggested to use a descriptive term such as "retrocerebellar cyst".
110 citations
TL;DR: The pre-contrast hyperdensity may be detectable by a computer program that will facilitate diagnosis, and may also be modified to detect abnormal enhancement, which is a very specific sign for TBM in children.
Abstract: Background: Although CT scanning is used widely for making the diagnosis and detecting the complications of tuberculous meningitis (TBM) in children, the radiological features are considered non-specific CT is particularly suggestive of the diagnosis when there is a combination of basal enhancement, hydrocephalus and infarction, and even then the diagnosis may be in doubt In this paper we introduce a new CT feature for making the diagnosis of TBM, namely, hyperdensity in the basal cisterns on non-contrast scans, and we assess which of the recognized CT features is most sensitive and specific Objective: To determine the sensitivity and specificity of the presence of high-density exudates in the basal cisterns (on non-contrast CT) and basal enhancement (on contrast-enhanced CT) for the diagnosis of TBM in children, and to correlate these with the complications of infarction and hydrocephalus Materials and methods: Retrospective review of CT scans with readers blinded to the diagnosis, which was based on a definitive culture of cerebrospinal fluid (CSF) for TBM or other bacteria Computer-aided conversion of hard-copy film density to Hounsfield units was employed as well as a density threshold technique for determining abnormally high densities Results: The most specific feature for TBM is hyperdensity in the basal cisterns prior to IV contrast medium administration (100%) The most sensitive feature of TBM is basal enhancement (89%) A combination of features (hydrocephalus, infarction and basal enhancement) is as specific as pre-contrast hyperdensity, but has a lower sensitivity (41%) There were statistically significant differences in the presence of hydrocephalus (p=00016), infarcts (P=00014), basal enhancement (P<00001) and pre-contrast density (P<00001) between the negative and positive TBM patient groups The presence of granulomas was not statistically significant between the two groups (P=044) Conclusions: The presence of high density within the basal cisterns on non-contrast CT scans is a very specific sign for TBM in children This will enhance diagnostic confidence, allow early institution of therapy and could reduce expenditure on contrast medium, scan time and radiation exposure With the use of threshold techniques we believe that the pre-contrast hyperdensity may be detectable by a computer program that will facilitate diagnosis, and may also be modified to detect abnormal enhancement Basal enhancement is a sensitive sign for the diagnosis of TBM and should be sought after contrast medium administration when no hyperdensity is seen in the basal cisterns or when this finding needs to be confirmed The CT scan feature of hyperdense exudates on pre-contrast scans should be added to the inclusion criteria for the diagnosis of TBM in children
107 citations
TL;DR: The linear, no-threshold model is currently the best estimate of risk from radiation exposure with no level below which radiation is safe, but future needs include better documentation of the dose the patient receives, dose-based research on the radiation risk, and accreditation in CR and digital radiography for public assurance.
Abstract: The linear, no-threshold model is currently the best estimate of risk from radiation exposure with no level below which radiation is safe. Plain-film radiography has a much lower patient dose than CT or fluoroscopy. With the advent of computed radiography (CR) the dose to patients is higher than screen-film radiography and overexposure is quite common. Task-oriented adjustment of technique, commonly used in CT, is rarely used in CR. Exposure reduction is important in CR as research indicates an increased risk of childhood acute lymphocytic leukemia from plain-film studies and an increased risk of fatal breast cancer from scoliosis series. Future needs include better documentation of the dose the patient receives, dose-based research on the radiation risk, and accreditation in CR and digital radiography for public assurance.
95 citations
TL;DR: Ongoing prospective studies of PET in pediatric patients will increase understanding about the optimal use of this modality in children with cancer and define the characteristics of FDG-avid nonmalignant conditions that may be problematic in the interpretation of tumor activity.
Abstract: Advances in diagnostic imaging technology, especially functional imaging modalities like positron emission tomography (PET), have significantly influenced the staging and treatment approaches used for pediatric Hodgkin's lymphoma. Today, the majority of children and adolescents diagnosed with Hodgkin's lymphoma will be cured following treatment with non-cross-resistant combination chemotherapy alone or in combination with low-dose, involved-field radiation. This success produced a greater appreciation of long-term complications related to radiation, chemotherapy, and surgical staging that prompted significant changes in staging and treatment protocols for children and adolescents with Hodgkin's lymphoma. Contemporary treatment for pediatric Hodgkin's lymphoma uses a risk-adapted approach that reduces the number of combination chemotherapy cycles and radiation treatment fields and doses for patients with localized favorable disease presentation. Advances in diagnostic imaging technology have played a critical role in the development of these risk-adapted treatment regimens. The introduction of computed tomography (CT) provided an accurate and non-invasive modality to define nodal involvement below the diaphragm that motivated the change from surgical to clinical staging. The introduction of functional imaging modalities, like positron emission tomography (PET) scanning, provided the means to correlate tumor activity with anatomic features generated by CT and modify treatment based on tumor response. For centers with access to this modality, PET imaging plays an important role in staging, evaluating tumor response, planning radiation treatment fields, and monitoring after completion of therapy for pediatric Hodgkin's lymphoma. This trend will likely increase in the future as a result of PET's superior sensitivity in correlating sites of tumor activity compared to other available functional imaging modalities. Ongoing prospective studies of PET in pediatric patients will increase understanding about the optimal use of this modality in children with cancer and define the characteristics of FDG-avid nonmalignant conditions that may be problematic in the interpretation of tumor activity.
TL;DR: This review aims to guide the reader through the modern imaging techniques useful for diagnosing TB of the thorax, central nervous system and abdomen in children.
Abstract: Tuberculosis (TB) can affect any organ in the body Children are a high-risk group for contracting the disease and pose a constant challenge to clinicians with regard to making a definitive diagnosis Radiologists are playing a more active role in diagnosing TB, and armed with more accurate diagnostic investigations such as CT and MRI, they must face the cost implications as well as technical limitations This review aims to guide the reader through the modern imaging techniques useful for diagnosing TB of the thorax, central nervous system and abdomen in children The more specific features of each modality in the particular anatomical regions are highlighted
TL;DR: This review focuses on imaging of osteosarcoma and Ewing’s sarcoma of the long bones in children during preoperative neoadjuvant chemotherapy to find new early prognostic criteria.
Abstract: This review focuses on imaging of osteosarcoma and Ewing's sarcoma of the long bones in children during preoperative neoadjuvant chemotherapy. Morphological criteria on plain films and conventional static MRI are insufficiently correlated with histological response. We review the contribution of dynamic MRI, diffusion-weighted MR and nuclear medicine (18FDG-PET) to monitor tumoural necrosis. MRI is currently the best method to evaluate local extension prior to tumour resection, especially to assess the feasibility of conservative surgery. Quantitative models in dynamic MRI and 18FDG-PET are currently being developed in order to find new early prognostic criteria, but for the time being, treatment protocols are still based on the gold standard of histological response.
TL;DR: In order to examine the risk that CR and DR pose in pediatric radiography and the potential for dose reduction, the SPR organized a second ALARA Conference, attended by 77 pediatric radiologists, medical physicists, radiologic technologists, imaging scientists, and engineers.
Abstract: ALARA, an acronym for as low as reasonably achievable, is a philosophy of radiation-dose management. As the SPR continues to promote ALARA in pediatric CT, we have begun to examine other imaging modalities where the potential for dose reduction exists. Computed radiography (CR) and digital radiography (DR) are acquisition systems that replace conventional screen-film (SF) systems for projection radiography. In conventional radiography, the amount of radiation needed to produce an acceptable image is specific to the SF system and chemical processing conditions. In CR and DR, the acquisition process is separated from the display process, allowing these systems to produce acceptable images over a wide range of exposures. Unfortunately, the disconnection of acquisition from display also introduces the potential for systematic overexposure. In order to examine the risk that CR and DR pose in pediatric radiography and the potential for dose reduction, the SPR organized a second ALARA Conference. The conference, held in Houston, Texas, February 28, 2004 and was attended by 77 pediatric radiologists, medical physicists, radiologic technologists, imaging scientists, and engineers. The conference was made possible by unrestricted grants from 6 CR and DR manufacturers. The faculty consisted of four academic speakers, five industry speakers, and a speaker from the Food and Drug Administration. The industry speakers were provided a list of questions in order to focus their lectures on specific features of their products that were relevant to dose management in pediatric radiography.
TL;DR: Comparing the various MRI findings, a haemorrhagic component within an acute lesion was the most reliable parameter predicting residual pathologic findings on follow-up imaging.
Abstract: Background: Central nervous system (CNS) involvement is a common complication in haemolytic uraemic syndrome (HUS). Various imaging findings have been described, mostly as case reports. Although there are a few retrospective studies on larger patient groups there is no report that focuses on MRI. Objective: To analyse the CT and MRI studies of patients with neurological complications of HUS, to describe the typical imaging findings, and to evaluate their predictive character with regard to follow-up examinations and clinical outcome. Materials and methods: Of 57 patients with clinically proven HUS who were referred to our hospital between 1995 and 2003, 17 had signs of serious CNS involvement and 10 underwent neuroimaging. Nine MRI and seven CT studies were performed in the acute phase and five MRI and two CT studies were done for follow-up. Results: In six patients, pathological imaging findings were seen on CT or MRI performed in the acute phase of the disease whereas CT and MRI scans were completely normal in four patients. All patients with positive imaging findings had pathological changes within the basal ganglia. Additional findings were seen in the thalami (n=2), cerebellum (n=2) and brain stem (n=1). On follow-up imaging performed in five cases, the pathological imaging findings had resolved completely in two and partially in three patients. All patients had a good neurological outcome. Comparing the various MRI findings, a haemorrhagic component within an acute lesion was the most reliable parameter predicting residual pathologic findings on follow-up imaging. Conclusions: Basal ganglia involvement is a typical finding in patients with neurological complications of HUS. Even in patients with severe CNS involvement on acute imaging studies, prognosis was favourable for clinical outcome and resolution of pathological imaging findings.
TL;DR: A second-generation US contrast medium such as SonoVue, if available, should be the first choice as the dose required for one examination is much lower and consequently significant reduction of contrast agent cost is possible.
Abstract: Background: Contrast-enhanced voiding urosonography (VUS) is largely accepted both for the diagnosis and follow-up of vesicoureteric reflux (VUR) in children. Objective: To evaluate the usefulness of contrast-enhanced second-harmonic VUS in the diagnosis and grading of VUR, using a second-generation contrast agent. Materials and methods: Eighty consecutive children were prospectively studied with contrast-enhanced second-harmonic VUS. All children received a second-generation contrast medium, constituted by phospholipid-stabilized microbubbles of sulphur-hexafluoride (SonoVue, Bracco, Milan, Italy). US monitoring of the bladder, of the retrovesical space and of the kidneys was performed using, alternatively, both tissue-harmonic and contrast-harmonic modes. In those young boys where VUR was depicted at VUS, examination was completed with transperineal, sagittal urethral exploration during micturition. VUR was graded in five steps and diagnoses were compared with voiding cystourethrography (VCUG). Results: VUR was diagnosed in 52 reno-ureteral units with VUS. In 49 of these reno-ureteral units, VCUG confirmed the presence of VUR. In comparison to VUS, sensitivity and negative predictive value of VCUG were inferior. The grade of VUR detected at VUS was higher than that detected at VCUG in three units. In no case was the grade of VUR detected at VCUG higher than the one detected at VUS. The differences between VUS and VCUG in grading VUR were statistically significant (p=0.02). Imaging of the normal posterior urethra was skilfully demonstrated with US in 15 young boys with VUR. No statistically significant differences were found between tissue-harmonic and contrast-harmonic mode (p=0.102). Conclusions: Contrast-enhanced second-harmonic VUS is a sensitive and easy technique for the evaluation of VUR. A second-generation US contrast medium such as SonoVue, if available, should be the first choice as the dose required for one examination is much lower and consequently significant reduction of contrast agent cost is possible.
TL;DR: The Haller index, a quantitative measurement ofchest-wall configuration, demonstrates significant age- and gender-related variability, and should be considered when evaluating the patient with suspected chest-wall deformity.
Abstract: Purpose
The Haller index is an accepted CT method for evaluating thoracic dimensions in patients with pectus excavatum. The purpose of this study is to establish age- and gender-related norms for the Haller index in childhood.
TL;DR: The predictive value of blood flow parameters for prediction of intestinal motility revealed high sensitivity and specificity by the first postnatal day, 2 or 3 days before development of clinical signs of intestinal dysmotility.
Abstract: Background
Blood flow parameters in the superior mesenteric artery (SMA) change with vasoconstriction or vasodilatation of the intestinal vascular bed. In cases of severe growth retardation as a result of haemodynamic disturbances, the blood flow changes persist into postnatal life.
TL;DR: There is significant correlation between cephalometric data and AHI score severity in children with OSAS, and the institution of early and effective therapy of adenotonsillar hypertrophy in childrenWith OSAS is clearly mandates.
Abstract: Background
Cephalometry is useful as a screening test for anatomical abnormalities in patients with obstructive sleep apnoea syndrome (OSAS).
TL;DR: A variety of countermeasures for managing radiation doses in pediatric CR and DR examinations are examined, including use of derived exposure indicators, modifications of imaging practice, and development of more efficient radiographic detectors.
Abstract: Uncoupling of display from acquisition in computed radiography (CR) and digital radiography (DR) introduces the potential for systematic overexposure without necessarily compromising image quality. Although the magnitude of radiation doses in general radiography is low compared to computed tomography and fluoroscopy, the dose to the patient is more critical in pediatric examinations than in adults, because of the greater radiosensitivity of children. This manuscript examines a variety of countermeasures for managing radiation doses in pediatric CR and DR examinations, including use of derived exposure indicators, modifications of imaging practice, and development of more efficient radiographic detectors.
TL;DR: Cross-sectional imaging with sonography and computed tomography have proven useful for the evaluation of suspected acute appendicitis in children and improved patient outcomes including decreased negative laparotomy and perforation rates.
Abstract: Acute appendicitis is the most common condition presenting with right lower quadrant pain requiring acute surgical intervention in childhood. The clinical diagnosis of acute appendicitis is often not straightforward and can be challenging. Approximately one-third of children with the condition have atypical clinical findings and are initially managed non-operatively. Complications usually result from perforation and include abscess formation, peritonitis, sepsis, bowel obstruction and death. Cross-sectional imaging with sonography and computed tomography (CT) have proven useful for the evaluation of suspected acute appendicitis in children. The principal advantages of sonography are its lower cost, lack of ionizing radiation, and ability to precisely delineate gynecologic disease. The principal advantages of CT are its operator independency with resultant higher diagnostic accuracy, enhanced delineation of disease extent in perforated appendicitis, and improved patient outcomes including decreased negative laparotomy and perforation rates.
TL;DR: Comparison enema delineation of the transition zone in HD needs to be regarded with caution, especially true in long-segment disease, where knowledge of the extent of aganglionic bowel is most crucial to surgical planning.
Abstract: Background: Knowledge of the extent of aganglionic bowel is important for preoperative planning of trans-anal surgery in patients with Hirschsprung’s disease (HD) Objective: To evaluate the accuracy of the transition zone, as identified by contrast enema study, for identifying the extent of aganglionic bowel Materials and methods: A total of 32 patients with preoperative contrast enema studies and pathologic identification of aganglionic extent were reviewed Two pediatric radiologists independently reviewed the contrast enema studies The radiographic transition zone was compared to the pathological extent of aganglionic bowel Results: Radiologist agreement of the site of transition zone on contrast enema was 906% The concordance between the radiographic transition zone and pathologic extent of aganglionic bowel was 625% The subgroup of patients with long-segment HD revealed a concordance of only 25% Conclusion: Contrast enema delineation of the transition zone in HD needs to be regarded with caution This is especially true in long-segment disease, where knowledge of the extent of aganglionic bowel is most crucial to surgical planning
TL;DR: Different concepts must be introduced for a better understanding of the tradeoffs encountered when dealing with digital radiography and ALARA.
Abstract: Image quality takes on different perspectives and meanings when associated with the concept of as low as reasonably achievable (ALARA), which is chiefly focused on radiation dose delivered as a result of a medical imaging procedure. ALARA is important because of the increased radiosensitivity of children to ionizing radiation and the desire to keep the radiation dose low. By the same token, however, image quality is also important because of the need to provide the necessary information in a radiograph in order to make an accurate diagnosis. Thus, there are tradeoffs to be considered between image quality and radiation dose, which is the main topic of this article. ALARA does not necessarily mean the lowest radiation dose, nor, when implemented, does it result in the least desirable radiographic images. With the recent widespread implementation of digital radiographic detectors and displays, a new level of flexibility and complexity confronts the technologist, physicist, and radiologist in optimizing the pediatric radiography exam. This is due to the separation of the acquisition, display, and archiving events that were previously combined by the screen-film detector, which allows for compensation for under- and overexposures, image processing, and on-line image manipulation. As explained in the article, different concepts must be introduced for a better understanding of the tradeoffs encountered when dealing with digital radiography and ALARA. In addition, there are many instances during the image acquisition/display/interpretation process in which image quality and associated dose can be compromised. This requires continuous diligence to quality control and feedback mechanisms to verify that the goals of image quality, dose and ALARA are achieved.
TL;DR: This review focuses on the optimum use of fetal MRI as an additional imaging tool to sonographic data in posterior fossa (PF) abnormalities in the second and third trimesters of gestation.
Abstract: This review focuses on the optimum use of fetal MRI as an additional imaging tool to sonographic data in posterior fossa (PF) abnormalities in the second and third trimesters of gestation. We have chosen three particular situations to demonstrate the value of MRI as a complementary investigation to US: (1) the pattern of increased fluid-filled space of the PF, (2) decreased cerebellar sonographic biometry and (3) the diagnosis of focal echogenic lesions of the cerebellum. For increased fluid-filled space of the PF and decreased cerebellar sonographic biometry, a practical approach is proposed, largely based on prenatal imaging, especially MRI.
TL;DR: A comprehensive literature review of various aspects of theVCUG is undertaken in order to determine the best way to perform the VCUG in modern paediatric radiology practice.
Abstract: The voiding cystourethrogram (VCUG) examination is a difficult investigation to perform and is a stressful experience for patients and their parents, as well as for the radiologists, technicians and paediatric radiology nurses involved in the examination. Despite the VCUG being one of the most commonly performed fluoroscopic procedures in paediatric radiology practice, there is no general consensus as to the best way to perform this investigation. This is particularly concerning when one considers the potentially high gonadal radiation dose children may receive. Because of this, we have undertaken a comprehensive literature review of various aspects of the test in order to determine the best way to perform the VCUG in modern paediatric radiology practice.
TL;DR: This review article aims at summarizing the data regarding fetal and neonatal hydronephrosis, at correlating controversial data with the differences in the practice of obstetrical sonography from one country to another, and at presenting their own criteria for fetal renal collecting system dilatation along with their own guidelines of postnatal investigation.
Abstract: This review article aims at summarizing the data regarding fetal and neonatal hydronephrosis, at correlating controversial data with the differences in the practice of obstetrical sonography from one country to another, and finally, at presenting our own criteria for fetal renal collecting system dilatation along with our own guidelines of postnatal investigation.
TL;DR: The aim of this review is to emphasize the role of fetal MR in the evaluation of the supratentorial space and the advantages of MRI compared to US in three fields of application: cerebral biometry, sulcation and cerebral parenchyma.
Abstract: The aim of this review is to emphasize the role of fetal MR in the evaluation of the supratentorial space. The advantages of MRI compared to US are stressed in three fields of application: cerebral biometry, sulcation and cerebral parenchyma. In each field, normal data are displayed and MR applications with patterns of the main pathologies are briefly described.
TL;DR: With the exception of myositis ossificans, magnetic resonance (MR) imaging has largely replaced the use of computed tomography and is used to delineate the extent of a lesion, to evaluate response to therapy, and to monitor postoperative complications.
Abstract: The evaluation of a soft tissue mass in a child should proceed with a differential diagnosis in mind, based on the clinical history, age of the child, and location of the abnormality. Small, superficial masses can be initially evaluated with sonography. More extensive or deep lesions usually require cross-sectional imaging. With the exception of myositis ossificans, magnetic resonance (MR) imaging has largely replaced the use of computed tomography. MR imaging is used to delineate the extent of a lesion, to evaluate response to therapy, and to monitor postoperative complications. There is great overlap in the MR imaging characteristics of benign and malignant lesions, making tissue sampling imperative for diagnosis.
TL;DR: Junior residents perform as well as staff radiologists in screening US for suspected intussusception and have gained both the respect and confidence of the paediatricians.
Abstract: Ultrasonography is an important tool in the screening and diagnosis of patients with suspected intussusception. To retrospectively evaluate the accuracy and performance of junior residents and compare it to that of senior residents and staff radiologists. Between January 1999 and February 2003, 151 patients with suspected intussusception underwent screening US. The mean age of the patients was 13.8 months. Patients were divided into three groups according to examiner: staff radiologist, senior resident or junior resident. Sixty-five patients had both US and air enema. Forty-four patients had a positive US result; 37 (84%) were true positive and 7 (16%) were false positive. Twenty-one patients had a negative US result; 18 (86%) were true negative and 3 (14%) were false negative. Eighty-six patients underwent screening US only and were then kept under observation in the emergency room. They were all diagnosed as having a non-surgical condition. The total accuracy rate was 93%, sensitivity was 84%, specificity was 97%, positive predictive value was 93% and negative predictive value was 94%. Accuracy rate, sensitivity and specificity were 92%, 85% and 98% for staff radiologists, 94%, 75% and 96% for senior residents and 95%, 83% and 97% for junior residents, respectively. Junior residents perform as well as staff radiologists in screening US for suspected intussusception and have gained both the respect and confidence of the paediatricians.
TL;DR: Cross-sectional imaging evaluation with CT and MRI should include axial and coronal images of the paranasal sinuses and, where appropriate, the orbits and brain (with attention to the cavernous sinus).
Abstract: Acute paranasal sinus infection in children is often diagnosed clinically without the need for radiographic confirmation. Most cases have a favorable outcome following appropriate antibiotic therapy. A small percentage of cases where symptoms and signs are persistent or severe will require emergent imaging to rule out complications related to local spread of disease intraorbitally or intracranially. A strong index of suspicion is required in such cases, and cross-sectional imaging evaluation with CT and MRI should include axial and coronal images of the paranasal sinuses and, where appropriate, the orbits and brain (with attention to the cavernous sinus). There is no role for plain radiography in the evaluation of the complications of acute sinusitis in the pediatric patient.