Pediatric Radiology (PEDIATR RADIOL )

Publisher: Springer Verlag


Official Journal of the European Society of Pediatric Radiology and The Society for Pediatric Radiology Pediatric Radiology informs its readers of new findings and progress in all areas of pediatric imaging and in related fields. This is achieved by a blend of original papers complemented by reviews that set out the present state of knowledge in a particular area of the specialty or summarize specific topics in which discussion has led to clear conclusions. Advances in technology methodology apparatus and auxiliary equipment are presented and modifications of standard techniques are described.

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    Pediatric radiology
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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Congenital malformations of the nose can be associated with a variety of syndromes, including solitary median maxillary central incisor syndrome, CHARGE syndrome, Bosma syndrome, median cleft face syndrome, PHACES association, Bartsocas-Papas syndrome, Binder syndrome, duplication of the pituitary gland-plus syndrome and syndromic craniosynsotosis (e.g., Apert and Crouzon syndromes) among other craniofacial syndromes. Imaging with CT and MRI plays an important role in characterizing the nasal anomalies as well as the associated brain and cerebrovascular lesions, which can be explained by the intimate developmental relationship between the face and intracranial structures, as well as certain gene mutations. These conditions have characteristic imaging findings, which are reviewed in this article.
    Pediatric Radiology 01/2015;
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    ABSTRACT: Background Radiographic bone age determination is part of the routine evaluation of suspected growth disorders. Simplicity and low cost are its major advantages, but although the effective dose of ionizing radiation is low, it should be taken into consideration given its cumulative effect. Objectives To assess the chronological ultrasonographic emergence of the ossification centers of the hand and wrist. Materials and methods Cross-sectional study of healthy patients ages 1 to 24 months (n = 498) from Buenos Aires, Argentina. All patients underwent ultrasonographic evaluation of the left hand and wrist to identify the different bone nuclei; a subgroup of infants had their nuclei measured (n = 228). Results Girls showed an earlier emergence of the evaluated nuclei and a trend to a greater size than age-matched boys. Size-for-age relation showed linear increase. Carpal bones (capitate and hamate) were the first to appear, as early as from the first 3 months of life, an age gap not thoroughly present on the radiographic atlas developed by Greulich and Pyle. The distal epiphysis of the radius and the second metacarpophalangeal joint (index finger) followed in order of emergence. The proximal epiphysis of the first metacarpal bone (thumb) was the last to emerge and was infrequently found on boys at age 24 months. Overall, these findings are in accordance with the radiographic atlas. An ultrasonography atlas of the left hand and wrist was outlined for girls and boys. Conclusion Conventional ultrasonography allows proper identification of the ossification centers of the hand and wrist and may become an innocuous follow-up tool for patients with growth disorders.
    Pediatric Radiology 01/2015;
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    ABSTRACT: The kidneys are the most commonly injured genitourinary organ in children following blunt abdominal trauma. Though the retroperitoneal location affords the kidneys some protection from the forces experienced in blunt abdominal trauma, the kidneys are at greater risk of injury when a disease process exposes them from their normal shielded location. In such cases, the injuries may appear to be disproportionate in relation to the severity of the trauma history, confusing the imaging findings. Recognition of both the underlying disease process as well as the manifestations of acute trauma is important; therefore, we present a pictorial essay of traumatized kidneys in children with pre-existing renal abnormalities.
    Pediatric Radiology 01/2015; 45(1):118-23.
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    ABSTRACT: Due to advances in cardiac surgery, survival of patients with congenital heart disease has increased considerably during the past decades. Many of these patients require repeated cardiovascular magnetic resonance imaging to assess cardiac anatomy and function. In the past decade, technological advances have enabled faster and more robust cardiovascular magnetic resonance with improved image quality and spatial as well as temporal resolution. This review aims to provide an overview of advances in cardiovascular magnetic resonance hardware and acquisition techniques relevant to both pediatric and adult patients with congenital heart disease and discusses the techniques used to assess function, anatomy, flow and tissue characterization.
    Pediatric Radiology 01/2015; 45(1):5-19.
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    ABSTRACT: MRI is an important additional tool in the diagnostic work-up of children with congenital heart disease. This review aims to summarise the role MRI has in this patient population. Echocardiography remains the main diagnostic tool in congenital heart disease. In specific situations, MRI is used for anatomical imaging of congenital heart disease. This includes detailed assessment of intracardiac anatomy with 2-D and 3-D sequences. MRI is particularly useful for assessment of retrosternal structures in the heart and for imaging large vessel anatomy. Functional assessment includes assessment of ventricular function using 2-D cine techniques. Of particular interest in congenital heart disease is assessment of right and single ventricular function. Two-dimensional and newer 3-D techniques to quantify flow in these patients are or will soon become an integral part of quantification of shunt size, valve function and complex flow patterns in large vessels. More advanced uses of MRI include imaging of cardiovascular function during stress and tissue characterisation of the myocardium. Techniques used for this purpose need further validation before they can become part of the daily routine of MRI assessment of congenital heart disease.
    Pediatric Radiology 01/2015; 45(1).
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    ABSTRACT: In the early days of cardiac surgery, the pretreatment multidisciplinary discussion involved a presentation of the case history and diagnostic imaging by the clinical cardiologist. At this time, most, if not all, cardiac imaging techniques were in the hands of the cardiologist. If the radiologist made a report, this was done relatively late in the clinical process and only concerned the perioperative radiographs. In recent years, multidisciplinary decision-making in the context of a Heart Team has gained an increasingly important role in the process of decision-making with regard to the available therapy options in individual patients. Nevertheless, the concept of the Heart Team is still evolving. The minimal requirements for the Heart Team include the presence of the attending cardiologist, an interventional cardiologist and a cardiac surgeon. Those members of the Heart Team should be aware of the local possibilities, should correctly make conclusions about the available data and should put this information into the clinical context and preference of the patient. In addition, in areas where expertise in cardiac imaging such as CT and MRI is relevant, this would explicitly require expertise of the Heart Team in these specific areas, most often by involving a radiologist, to provide the optimal joint treatment strategy recommendation.
    Pediatric Radiology 01/2015; 45(1):27-31.
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    ABSTRACT: “Measure what is measurable, and make measurable what is not so.” It was the 17th century when Galileo Galilei, father of the scientific method, made this well-known statement. With this sentence, Galilei told us to avoid subjective, qualitative evaluations of the world around us. Rather, he advised to make our observations as objective as possible, independent from the observer. He first recognized that human beings greatly differ from one another and that, in the evaluation of a given entity, a spectrum of opinions is inevitable. In an era in which technical instruments were far to come, such a situation made the science of nature very unscientific.In medicine, the uncertainty recognized by Galilei was further formalized by Alexander Pope, who in 1732 wondered “Who shall decide when doctors disagree?” This question must have been a very common one in Pope’s day, because medical practice at that time was based largely on tradition and opinion, not science. Regarding the evaluation of ...
    Pediatric Radiology 01/2015; 45(1):32-4.
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    ABSTRACT: This article questions the scientific justification of ingrained radiologic practices exemplified by size measurements of childhood solid tumours. This is approached by a critical review of staging systems from a selection of paediatric oncological treatment protocols. Local staging remains size-dependent for some tumour types. The consequent stage assignment can significantly influence treatment intensity. Still, the protocols tend not to give precise guidance on how to perform scans and standardise measurements. Also, they do not estimate or account for the inevitable variability in measurements. Counts and measurements of lung nodules are, within some tumour groups, used for diagnosis of metastatic disease. There is, however, no evidence that nodule size is a useful discriminator of benign and malignant lung nodules. The efficacy of imaging depends chiefly on observations being precise, accurate and valid for the desired diagnostic purpose. Because measurements without estimates of their errors are meaningless, studies of variability dependent on tumour shape and location, imaging device and observer need to be encouraged. Reproducible observations make good candidates for staging parameters if they have prognostic validity and at the same time show little covariation with (thereby adding new information to) the existing staging system. The lack of scientific rigour has made the validity of size measurement very difficult to assess. Action is needed, the most important being radiologists' active contribution in development of oncological staging systems, attention to standardisation, knowledge about errors in measurement and protection against undue influence of such errors in the staging of the individual child.
    Pediatric Radiology 01/2015; 45(1):35-41.
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    ABSTRACT: Background: Performing micturating cystourethrography (MCUG) in young children with recurrent urinary tract infection is controversial with discrepancy among the major guidelines. Objective: Previous studies have shown that a normal dimercaptosuccinic acid (DMSA) scintigraphy may avoid the need of performing MCUG for detecting vesicoureteric reflux in children with first febrile UTI. However, the role of DMSA for ruling out vesicoureteric reflux in children with recurrent urinary tract infections has not been studied. Materials and methods: Approval from institutional ethical review committee was sought and the requirement of informed consent was waived. A total of 50 children under the age of 10 years with recurrent urinary tract infections underwent MCUG scan within 3 months of DMSA scan from January 2011 to September 2012 at our institution. Diagnosis of recurrent urinary tract infections and grading of VUR was according to previously established standards. Abnormalities on DMSA scan – scarring, hydronephrosis and reduced differential renal function – were compared with presence of vesicoureteric reflux on MCUG. Results: High-grade vesicoureteric reflux was noted on MCUG in 22 (44%) cases. The findings on DMSA included hydronephrosis and scarring in 25 (50%) and 25 (50%) cases, respectively. Abnormalities on DMSA scan for detecting the presence of high-grade vesicoureteric reflux on MCUG examination had sensitivity, specificity, positive and negative predictive values of 95.45%, 35.71%, 53.85% and 90.91%, respectively. The positive and negative likelihood ratios were 1.48 and 0.13 respectively. Conclusion: DMSA scan had high overall sensitivity and negative predictive value with a low negative likelihood ratio for ruling out high-grade VUR on MCUG, which may obviate the need of invasive MCUG along with its associated drawbacks.
    Pediatric Radiology 01/2015; 45(1):62-68.
  • Pediatric Radiology 12/2014;
  • Pediatric Radiology 12/2014;
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    ABSTRACT: Concavity in the central portion of the distal humerus is referred to as fishtail deformity. This entity is a rare complication of distal humeral fractures in children. The purpose of this study is to describe imaging features of post-traumatic fishtail deformity and discuss the pathophysiology. We conducted a retrospective analysis of seven cases of fishtail deformity after distal humeral fractures. Seven children ages 7-14 years (five boys, two girls) presented with elbow pain and history of distal humeral fracture. Four of the seven children had limited range of motion. Five children had prior grade 3 supracondylar fracture treated with closed reduction and percutaneous pinning. One child had a medial condylar fracture and another had a lateral condylar fracture; both had been treated with conservative casting. All children had radiographs, five had CT and three had MRI. All children had a concave central defect in the distal humerus. Other imaging features included joint space narrowing with osteophytes and subchondral cystic changes in four children, synovitis in one, hypertrophy or subluxation of the radial head in three and proximal migration of the ulna in two. Fishtail deformity of the distal humerus is a rare complication of distal humeral fractures in children. This entity is infrequently reported in the radiology literature. Awareness of the classic imaging features can result in earlier diagnosis and appropriate treatment.
    Pediatric Radiology 12/2014;
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    ABSTRACT: Background Thyroid cancer is the most common endocrine malignancy with relatively good prognosis in children. However, unlike adults, children usually present with more advanced disease and have a higher local recurrence and distant metastases. Thus surveillance for recurrence is a major goal of long-term follow-up. Objective This retrospective study evaluates the diagnostic value of ultrasound (US) imaging in the post-therapy surveillance of children with differentiated thyroid cancer. Materials and methods We reviewed the charts of 54 children (40 girls; mean age 14.3 ± 3.6 years) with differentiated thyroid cancer treated with total or near-total thyroidectomy. Forty children (29 girls and 11 boys) who had routine follow-up US examinations (112 studies) were included for the evaluation of US accuracy in the follow-up of pediatric differentiated thyroid cancer. Histopathology, stimulated thyroglobulin determination, post-therapy whole-body iodine scan and clinical follow-up were used as the standards of reference. Results Mean period of follow-up was 34 months. The frequency of recurrence was 42% (17/40). Seventeen percent of the children had lung metastases either at presentation or on follow-up. In all cases of lung metastases, stimulated thyroglobulin level was greater than 10 ng/ml. The sensitivity was 85.7%, specificity 89.4%, negative predictive value 94.4% and positive predictive value 75% for US in detecting loco-regional recurrence in follow-up studies of pediatric differentiated thyroid cancer. In 17.3% (18/104) of studies, the results of stimulated thyroglobulin and US were discordant. Conclusion US showed very good sensitivity and specificity and a high negative predictive value for evaluation of loco-regional involvement in follow-up of pediatric differentiated thyroid cancer. Diagnostic whole-body iodine scan is indicated when serum anti-thyroglobulin Ab is high, or in cases of discordant findings between US and stimulated thyroglobulin levels, or when stimulated thyroglobulin levels are >10 ng/ml (to evaluate for lung metastasis).
    Pediatric Radiology 12/2014;
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    ABSTRACT: This essay depicts some of the diagnostic errors identified in a large academic pediatric imaging department during a 13-year period. Our aim is to illustrate potential situations in which errors are more likely to occur and more likely to cause harm, and to share our difficult cases so other radiologists might learn without having to experience those situations themselves.
    Pediatric Radiology 12/2014;
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    ABSTRACT: Error is a constant companion in any human endeavor where knowledge and skill play a role. Research on skilled performance in recent decades has shown that people make mistakes on a continual basis, regardless of education level [1].Interestingly, cognitive psychologists have found that professionals typically are not wired to understand this. Although everyone seems to agree with the generality that “nobody is perfect,” in the absence of data-driven feedback on performance, professionals tend to believe that their performance is excellent; the less the feedback, the greater their overconfidence [2].Given this, it should come as no surprise not only that error occurs on a regular basis in radiology but also that radiologists tend to be surprised when they learn this — especially radiologists who do not receive regular feedback about their performance.Of course, radiology is far from the first field of professionals to come to the unpleasant realization that mistakes happen more often t ...
    Pediatric Radiology 12/2014;
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    ABSTRACT: There is heterogeneity in how pediatric voiding cystourethrography (VCUG) is performed. Some institutions, including our own, obtain a radiographic scout image prior to contrast agent instillation. To demonstrate that the radiographic scout image does not augment VCUG interpretation or contribute management-changing information but nonetheless carries a non-negligible effective dose. We evaluated 181 children who underwent VCUG in 2012, with an age breakdown of less than 1 year (56 children), 1-5 years (66 children), 6-10 years (43 children) and 11-18 years (16 children), with a mean age of 4.0 years. We investigated patient demographics, clinical indication for the examination, scout image findings and estimated effective radiation dose, as well as overall exam findings and impression. No clinically significant or management-changing findings were present on scout images, and no radiopaque urinary tract calculi or concerning incidental finding was identified. Scout image estimated effective radiation dose averaged 0.09 mSv in children younger than 1 y, 0.09 mSv in children age 1-5, 0.13 mSv in children age 6-10 and 0.18 mSv in children age 11-18. Total fluoroscopy time per examination averaged 36.7 s (range 34.8-39.6 s for all age group averages). Evaluation of known or suspected vesicoureteral reflux (VUR) and urinary tract infection (UTI) were the most common clinical indications, stated in 40.9% and 37.0% of exams, respectively. Although the estimated effective dose is low for VCUG radiographic scout images, this step did not augment VCUG interpretation or contribute management-changing information. This step should be omitted or substituted to further reduce dose in pediatric VCUG.
    Pediatric Radiology 12/2014;
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    ABSTRACT: Background Living donor liver transplantation in children often results in venous complications, leading to portal hypertension. Spleen stiffness measurements have been recently proposed as a new, noninvasive parameter for portal hypertension in cirrhotic patients. Objective To evaluate the diagnostic value of spleen stiffness measurements by acoustic radiation force impulse (ARFI) imaging in diagnosing venous complications after pediatric living donor liver transplantation. Materials and methods We prospectively enrolled 69 patients after pediatric living donor liver transplantation using a left-side liver allograft. Around the time of the protocol liver biopsy examination, spleen stiffness measurements by ARFI imaging were performed via the left intercostal space at the center of the spleen parenchyma and repeated five times. Imaging examinations around the time of the spleen stiffness measurements were retrospectively reviewed. Regarding venous complications, significant portal and hepatic venous stenosis was defined as >50% stenosis on multiphasic computed tomography. Results After post hoc exclusion, 62 patients were studied. Portal and hepatic venous stenosis was identified in three and two patients, respectively. The median spleen stiffness values were 2.70 and 4.00 m/s in patients without and with venous complications, respectively (P Conclusion Spleen stiffness measurements by ARFI imaging might provide a useful quantitative index for venous complications after pediatric living donor liver transplantation.
    Pediatric Radiology 12/2014;