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  • The role of pediatric radiologists and radiographers: a different future from the past
    Pediatr. Radiol. (IF 2.022) Pub Date : 2020-01-02
    Graciano Paulo

    The author of this paper reflects on the reality of pediatric radiology practice and pinpoints several constraints identified in the literature, constraints that limit the development of the role of pediatric radiologists and radiographers and therefore compromise the quality of medical imaging care delivered to the children. There is a need to build a pediatric imaging family of dedicated radiographers and radiologists at every hospital that has a radiology department. This strategy could improve the quality of the 350 million pediatric imaging procedures performed every year.

    更新日期:2020-01-17
  • Computer-aided diagnosis for World Health Organization-defined chest radiograph primary-endpoint pneumonia in children
    Pediatr. Radiol. (IF 2.022) Pub Date : 2020-01-13
    Nasreen Mahomed, Bram van Ginneken, Rick H. H. M. Philipsen, Jaime Melendez, David P. Moore, Halvani Moodley, Tanusha Sewchuran, Denny Mathew, Shabir A. Madhi

    The chest radiograph is the most common imaging modality to assess childhood pneumonia. It has been used in epidemiological and vaccine efficacy/effectiveness studies on childhood pneumonia.

    更新日期:2020-01-13
  • Pediatric multiple sclerosis: from clinical basis to imaging spectrum and differential diagnosis
    Pediatr. Radiol. (IF 2.022) Pub Date : 2020-01-10
    Igor G. Padilha, Ana P. A. Fonseca, Ana L. M. Pettengill, Diego C. Fragoso, Felipe T. Pacheco, Renato H. Nunes, Antonio C. M. Maia, Antônio J. da Rocha

    Abstract Pediatric multiple sclerosis (MS) deserves special attention because of its impact on cognitive function and development. Although knowledge regarding pediatric MS has rapidly increased, understanding the peculiarities of this population remains crucial for disease management. There is limited expertise about the efficacy and safety of current disease-modifying agents. Although pathophysiology is not entirely understood, some risk factors and immunological features have been described and are discussed herein. While the revised International Pediatric MS Study Group diagnostic criteria have improved the accuracy of diagnosis, the recently revised McDonald criteria also offer some new insights into the pediatric population. It is fundamental that radiologists have strong knowledge about the vast spectrum of demyelinating disorders that can occur in childhood to ensure appropriate diagnosis and provide early treatment.

    更新日期:2020-01-11
  • Characteristics of rib fractures in young abused children
    Pediatr. Radiol. (IF 2.022) Pub Date : 2020-01-10
    Stevan Kriss, Angela Thompson, Gina Bertocci, Melissa Currie, Vesna Martich

    The presumed mechanism of rib fractures in abuse is violent grasping of the torso causing anterior–posterior chest compression. We hypothesized an asymmetrical distribution of rib fractures in abused infants given the greater incidence of right-hand dominance within the general population.

    更新日期:2020-01-11
  • Cochlear–facial dehiscence in a pediatric patient
    Pediatr. Radiol. (IF 2.022) Pub Date : 2020-01-08
    Dionysios J. Koroulakis, Brian K. Reilly, Matthew T. Whitehead

    Abstract Temporal bone dehiscence is an infrequent but clinically important phenomenon. Cochlear–facial dehiscence, the rarest type, has been described only in adults. We report cochlear–facial dehiscence in a child. Knowledge of this entity is imperative for radiologists searching for anatomical markers of inner ear pathology and for cochlear implant planning.

    更新日期:2020-01-08
  • Describing pediatric fractures in the era of ICD-10
    Pediatr. Radiol. (IF 2.022) Pub Date : 2020-01-08
    Tal Laor, Roger Cornwall

    Childhood fractures are extremely common. The recent trend is to direct certain fracture care from orthopedic specialists to primary care clinicians. However, to confirm an appropriate level of treatment, the initial diagnosis must be accurate, the description precise, and the communication between those caring for the child consistent. This review illustrates descriptors used at one institution that are based on terminology consensually created between radiologists and orthopedic surgeons for common pediatric fracture types and their displacement, and that satisfy the expanded and detailed International Statistical Classification of Diseases and Related Health Problems (ICD)-10 requirements for successful coding.

    更新日期:2020-01-08
  • E-cigarette, or vaping, product use-associated lung injury in adolescents: a review of imaging features
    Pediatr. Radiol. (IF 2.022) Pub Date : 2020-01-02
    Pooja D. Thakrar, Kevin P. Boyd, Craig P. Swanson, Eric Wideburg, Sachin S. Kumbhar

    There has been a recent increase in recognition of lung disease related to the use of electronic cigarettes (called “vaping”). These patients present with acute respiratory illness following exposure to vaporized cannabis or nicotine products and sometimes require hospitalization and intensive care. We describe the imaging findings of this disease entity in the pediatric population.

    更新日期:2020-01-04
  • Correlation of clinical and chest radiograph findings in pediatric submersion cases
    Pediatr. Radiol. (IF 2.022) Pub Date : 2020-01-02
    Brandon J. Ho, James E. Crowe, Scott R. Dorfman, Elizabeth A. Camp, Shabana Yusuf, Rohit P. Shenoi

    Abstract Background Submersion injuries are a leading cause of injury death in children in the United States. The clinical course of a submersion patient varies depending on the presence of anoxic brain injury and acute respiratory failure. Objective We studied changes in clinical findings and chest radiograph findings and determined the sensitivity/specificity of the presenting chest radiograph in predicting clinical improvement within the first 24 h in pediatric submersion cases. Materials and methods We conducted a cross-sectional study of pediatric submersion patients through age 18 years treated at a children’s hospital from 2010 to 2013. We reviewed demographics, comorbidities, prehospital/hospital course and chest radiographic findings. Clinical improvement occurred when a child demonstrated normal vital signs and mentation. We compared radiographic findings among children based on clinical improvement up to 24 h post submersion. Using odds ratios, we calculated associations between radiographic findings and clinical improvement. We studied the sensitivity/specificity of the presenting chest radiograph in predicting clinical improvement within 24 h. Results One hundred forty-two of 262 (54%) patients had initial chest radiographs; 41% had follow-up radiographs. The odds of an abnormal initial chest radiograph were 4 times higher in children with respiratory distress or abnormal mentation at emergency department (ED) presentation compared to children without these findings (odds ratio [OR]=4.83; 95% confidence interval [CI]=2.1–10.85; P<0.001). Improvement in radiographic findings occurred in 85% of children within 24 h. Children with an abnormal initial chest radiograph were 87% less likely to improve clinically by 24 h (P<0.001). A presenting chest radiograph that was normal or with mild pulmonary edema/atelectasis predicted clinical improvement within 24 h (sensitivity 95%, specificity 57%). Conclusion Most chest radiographic findings improve in pediatric submersion patients who recover within the first 24 h. An initial chest radiograph that is normal or with mild pulmonary edema/atelectasis satisfactorily predicts clinical improvement by 24 h post submersion.

    更新日期:2020-01-04
  • Retraction Note to: Radiographic characteristics that delineate abusive from accidental skull fractures, including the significance of fracture extension to sutures
    Pediatr. Radiol. (IF 2.022) Pub Date : 2019-12-06
    Spencer Kriss, Gina Bertocci, Melissa Currie, Angela Thompson, Vesna Kriss

    The authors have retracted the abstract #029 “Radiographic characteristics that delineate abusive from accidental skull fractures, including the significance of fracture extension to sutures”.

    更新日期:2020-01-04
  • Hypothalamic hamartomas and inner ear diverticula with X-linked stapes gusher syndrome - new associations?
    Pediatr. Radiol. (IF 2.022) Pub Date : 2019-08-22
    Emily A. Anderson, Can Özütemiz, Bradley S. Miller, Timothy J. Moss, David R. Nascene

    X-linked stapes gusher syndrome is a genetic form of deafness with distinct radiographic features on temporal bone CT. Hypothalamic hamartoma is a congenital glioneuronal anomaly of the hypothalamus. We report a potential association between these two rare anomalies that, to our knowledge, has not been reported. Two brothers presented with sensorineural hearing loss and almost identical inner ear and hypothalamic abnormalities, consistent with a diagnosis of X-linked stapes gusher syndrome and hypothalamic hamartoma. Genetic testing revealed identical mutations in the POU3F4 gene associated with X-linked stapes gusher syndrome. Furthermore, multiple vestibular diverticula were seen in both brothers, which have also not been reported with X-linked stapes gusher syndrome. This case suggests that POU3F4 mediated X-linked stapes gusher syndrome may also lead to multiple vestibular diverticula and hypothalamic hamartoma and, therefore, brain magnetic resonance imaging (MRI) could be considered in patients presenting with these inner ear findings.

    更新日期:2020-01-04
  • Atlanto-occipital ligament calcification: a novel imaging finding in pediatric rotational vertebral artery occlusion
    Pediatr. Radiol. (IF 2.022) Pub Date : 2019-09-11
    Nathan T. Cohen, Dana B. Harrar, Yaser A. Diab, Monica S. Pearl, Jonathan G. Murnick

    We describe a 2-year-old girl with bow hunter syndrome complicated by vertebral artery dissection and multiple ischemic infarcts. Pediatric bow hunter syndrome is a rare and likely under-recognized disorder. Interestingly, our patient had atlanto-occipital ligament calcification on CT scan, an imaging finding that has not been reported in association with bow hunter syndrome and one that might help increase recognition of this dynamic disorder of the posterior circulation.

    更新日期:2020-01-04
  • Prenatal imaging of anorectal malformations — 10-year experience at a tertiary center in Switzerland
    Pediatr. Radiol. (IF 2.022) Pub Date : 2019-09-03
    Lysiane Rohrer, Yvan Vial, Carole Gengler, Estelle Tenisch, Leonor Alamo

    Anorectal malformation is a spectrum of congenital defects of the distal bowel, mostly diagnosed at birth.

    更新日期:2020-01-04
  • An image processing algorithm to aid diagnosis of mesial temporal sclerosis in children: a case-control study
    Pediatr. Radiol. (IF 2.022) Pub Date : 2019-10-02
    Benjamin S. Strnad, Hilary L. P. Orlowski, Matthew S. Parsons, Amber Salter, Sonika Dahiya, Aseem Sharma

    Mesial temporal sclerosis (MTS) is an important cause of intractable epilepsy. Early and accurate diagnosis of MTS is essential to providing curative and life-changing therapy but can be challenging in children in whom the impact of diagnosis is particularly high. Magnetic resonance imaging (MRI) plays an important role in the diagnosis of MTS, and image processing of MRI is a recently studied strategy to improve its accuracy.

    更新日期:2020-01-04
  • Diagnostic accuracy of 3-T lung magnetic resonance imaging in human immunodeficiency virus-positive children
    Pediatr. Radiol. (IF 2.022) Pub Date : 2019-09-13
    Pratyaksha Rana, Kushaljit Singh Sodhi, Anmol Bhatia, Akshay Kumar Saxena, Deepti Suri, Surjit Singh

    Abstract Background More than 70% of human immunodeficiency virus (HIV)-positive children sustain respiratory diseases in their lifetime. Imaging plays an important role in establishing early and correct diagnosis. Objective To evaluate the diagnostic accuracy of 3-Tesla (T) thorax MRI in HIV-positive children, using chest CT as the gold standard. Materials and methods We included 25 children with confirmed HIV-positive status and pulmonary complaints who were referred for chest CT. All children had 3-T thorax MRI using T2-W turbo spin-echo sequence, steady-state free precession gradient echo sequence, T2-W turbo spin-echo MultiVane XD sequence, and T1-weighted modified Dixon sequences. We evaluated the images for various pulmonary and mediastinal findings and calculated the sensitivity and specificity of 3-T thoracic MRI. Results Sensitivity of 3-T MRI was 100% for detecting nodules >4 mm (95% confidence interval [CI] 66.3–100%), pleural effusion (CI 29.2–100%) and lymphadenopathy (CI 81.5–100%). It demonstrated a specificity of 100% for nodules >4 mm (CI 79.4–100%), pleural effusion (CI 84.6–100%) and lymphadenopathy (CI 59–100%). For consolidation/collapse, sensitivity and specificity were 93.8% (CI 69.8–99.8%) and 88.9% (CI 51.8–99.7%), respectively. The sensitivity and specificity for detecting bronchiectasis were 75% (CI 42.8–94.5%) and 100% (CI 75.3–100%), respectively, while for ground-glass opacity, sensitivity and specificity were 75% (CI 34.9–96.8%) and 94.1% (CI 71.3–99.9%), respectively. Nodules <4 mm were not well detected on MRI, with sensitivity of 35% (CI 15.4–59.2%). Conclusion Thoracic MRI at 3 T demonstrates a high sensitivity and specificity for detecting nodules >4 mm, effusion and lymphadenopathy in HIV-positive children.

    更新日期:2020-01-04
  • Altered 4-D magnetic resonance imaging flow characteristics in complex congenital aortic arch repair
    Pediatr. Radiol. (IF 2.022) Pub Date : 2019-08-31
    Lajja P. Desai, Haben Berhane, Nazia Husain, Joshua D. Robinson, Cynthia K. Rigsby, Michael Markl

    Abstract Background Interrupted aortic arch (IAA) is a rare but severe congenital abnormality often associated with bicuspid aortic valve (BAV). Complex re-interventions are often needed despite surgical advances, but the impact of aortic hemodynamics in repaired patients is unknown. Objective Investigate effect of IAA repairs on aortic hemodynamics, wall shear stress and flow derangements via 4-D flow MRI. Materials and methods We retrospectively analyzed age- and gender-matched cohorts (IAA [n=6], BAV alone [n=6], controls [n=6]) undergoing cardiac MRI including 4-D flow. Aortic dimensions were measured from standard MR angiography. We quantified peak systolic velocities, regurgitant fractions and wall shear stress in the ascending aorta (AAo), transverse arch and descending aorta (DAo) from 4-D flow, and we graded helix/vortex flow patterns from 3-D blood flow visualization. Results Children and young adults with IAA had a wide range of arch dimensions, peak systolic velocities, regurgitant fractions and flow grades. Peak transverse arch systolic velocities were higher in patients with IAA versus controls (P=0.02). Flow derangements in the AAo were found in patients with IAA (median grade=2, 5/6 patients, P=0.04) and BAV (median grade=3, 5/6 patients, P=0.03) versus controls. Flow derangements in the DAo were only seen in patients with IAA (median grade=1, 5/6 patients, P=0.04), and 5/6 people with IAA had helical flow in head and neck vessels. Wall shear stress was increased in people with IAA along the superior transverse arch and proximal DAo versus controls (P=0.02). Conclusion Complex congenital aortic arch repairs can change aortic hemodynamics. Associated cardiac defects can further alter findings. Studies are warranted to investigate clinical implications in larger cohorts.

    更新日期:2020-01-04
  • Impact on child and parent anxiety level of a teddy bear-scale mock magnetic resonance scanner
    Pediatr. Radiol. (IF 2.022) Pub Date : 2019-09-09
    Baptiste Morel, Frederic Andersson, Muriel Samalbide, Gauthier Binninger, Elodie Carpentier, Dominique Sirinelli, Jean-Philippe Cottier

    Abstract Background Pediatric magnetic resonance imaging (MRI) can be stressful. Mock MR scanners have been proven to be effective in avoiding the use of general anesthesia. Objectives We prospectively evaluated the impact of a teddy bear-scale model of a mock MR scanner on the anxiety experienced by parents and their children during MRI without general anesthesia . Materials and methods A 1-year prospective study before and after the installation of a mock scanner in a Pediatric Radiology Department of a university hospital. Anxiety levels were self-estimated by children ages 4 to 16 years and by the parents with a visual analogue scale (from 0, completely relaxed, to 100, extremely stressed) at three moments: in the waiting room, in the preparation room after an explanation by the MRI technologists, and at the issue of the MR acquisition images. Two groups were tested: one with a mock MR scanner, the other without. Analysis of variance (ANOVA) and Fisher exact tests were performed. Motion artifacts were studied. Results Ninety-one children and their parents were included. The median age was 8 years (standard deviation [SD]=2). In the post mock period, the ambiance of the preparation room was considered by children as significantly more relaxing in 50% vs. 20% (P=0.004) and the anxiety level of children was significantly lower after the explanation, particularly in girls, but unchanged for their parents. The anxiety levels at the end of the examination were significantly lower for parents. The motion artifacts rate was lower (1.7% vs. 4.7%, P=0.04). Conclusion A mock scanner was an efficient tool to improve efficiency of the explanation and to decrease anxiety in children and motion artifacts in pediatric MRI.

    更新日期:2020-01-04
  • A new imaging entity consistent with partial ectopic posterior pituitary gland: report of six cases
    Pediatr. Radiol. (IF 2.022) Pub Date : 2019-08-30
    Marina Ybarra, Rawan Hafiz, Marie-Eve Robinson, Julia Elisabeth von Oettingen, Helen Bui, Christine Saint-Martin

    Abnormal posterior pituitary development including ectopic location has been associated with endocrine manifestations of anterior pituitary dysfunction.

    更新日期:2020-01-04
  • 18F-2-fluoro-2-deoxyglucose uptake in white adipose tissue on pediatric oncologic positron emission tomography (PET)/computed tomography (CT).
    Pediatr. Radiol. (IF 2.022) Pub Date : null
    Ka Kit Wong,Laura K Sedig,David A Bloom,Raymond J Hutchinson,Barry L Shulkin

    BACKGROUND Altered biodistribution of [F-18]2-fluoro-2-deoxyglucose (FDG) is sometimes encountered in pediatric patients undergoing chemotherapy for lymphoma on post-induction positron emission tomography (PET) imaging. A characteristic pattern of increased FDG uptake in white adipose tissue can be seen, particularly in the buccal regions, body wall and gluteal regions, with a shift of radiotracer away from the blood pool and liver. This altered biodistribution has been attributed to effects of corticosteroids in pediatric and adult patients and is important to recognize because of its potential for limiting the diagnostic quality of the PET scan and interfering with therapeutic response assessment. OBJECTIVE In contrast to the well-known metabolically active brown fat seen on up to one-third of pediatric PET scans, white fat is usually non-metabolically active. We sought to determine the incidence of altered distribution of FDG in subcutaneous white adipose tissue in pediatric patients undergoing PET imaging and to assess the association with corticosteroid use. MATERIALS AND METHODS We reviewed the medical records and imaging for four children in whom altered biodistribution in white adipose tissue was present on post-induction FDG PET/CT, identified during routine clinical practice. All four were receiving corticosteroids as part of their chemotherapy. We then retrospectively reviewed oncology FDG PET/CT scans over a 2-year period (1,361 scans in 689 patients) to determine the incidence of uptake in white fat by qualitative visual assessment. In the children identified with altered biodistribution, we measured maximum standard uptake value (SUVmax) and mean standard uptake value (SUVmean) in areas of subcutaneous white fat, the buccal regions, body wall or gluteal soft-tissue regions, liver and blood pool. We reviewed all medical records, including medication lists. We summarize the relevant clinical and imaging findings of 13 pediatric patients, including the 4 index patients. RESULTS We determined the incidence of FDG uptake in white fat to be rare, found in 9 of 1,361 (0.6%) PET scans performed for pediatric cancer evaluation. FDG uptake was increased in subcutaneous adipose tissue, particularly in the buccal regions, body wall and gluteal regions, with a shift of radiotracer away from the blood pool and liver. The degree of increased uptake in peripheral white fat varied from marked to mild, and the biodistribution was distinct from that of brown adipose tissue. Children with this altered biodistribution were uniformly receiving corticosteroids as part of induction treatment for their cancer, and these findings were only identified on post-induction PET/CT. Follow-up PET/CT documented resolution of this effect after treatment with corticosteroids ceased. CONCLUSION Our findings support the current understanding that characteristic uptake of FDG in white adipose tissue is mediated by corticosteroid effect. Although this altered biodistribution is rare (<1% of PET scans) it could impair the diagnostic quality of the scan, affecting image interpretation, and should be recognized when present.

    更新日期:2019-11-01
  • Fetal magnetic resonance imaging of skeletal dysplasias.
    Pediatr. Radiol. (IF 2.022) Pub Date : null
    Leah A Gilligan,Maria A Calvo-Garcia,K Nicole Weaver,Beth M Kline-Fath

    BACKGROUND Fetal magnetic resonance imaging (MRI) is obtained for prenatal diagnosis and prognostication of skeletal dysplasias; however, related literature is limited. OBJECTIVE The purpose of this study was to define the utility of fetal MRI for skeletal dysplasias and to report MRI findings associated with specific diagnoses. MATERIALS AND METHODS This retrospective study was approved by the institutional review board; informed consent was waived. Women referred for suspected fetal skeletal dysplasia who underwent MRI between January 2003 and December 2018 were included. Definitive diagnoses were determined by genetic testing, autopsy, physical examination and/or postnatal/postmortem imaging. Fetal MRI examinations and reports were reviewed. Descriptive statistics were used to summarize imaging findings. RESULTS Eighty-nine women were referred for fetal MRI for possible skeletal dysplasia. Forty-three (48%) were determined to have a diagnosis other than skeletal dysplasia and nine were excluded for lack of specific skeletal dysplasia diagnosis. Thirty-seven cases of skeletal dysplasia with available fetal MRI and specific diagnosis were included for analysis. Diagnoses included achondrogenesis (n=2), achondroplasia (n=5), Boomerang dysplasia (n=1), campomelic dysplasia (n=2), Jeune syndrome (n=1), Kniest dysplasia (n=1), osteogenesis imperfecta (n=15) and thanatophoric dysplasia (n=10). A specific skeletal dysplasia diagnosis was mentioned in 17/37 (46%) of MRI imaging reports and correct for 14/17 (82%). MRI findings were reported for each specific skeletal dysplasia diagnosis. CONCLUSION Fetal MRI is a useful diagnostic tool for skeletal dyplasias and excluded the diagnosis in nearly half of referred pregnancies. In addition to providing fetal lung volumes, fetal MRI demonstrates findings of the brain in achondroplasia and thanatophoric dysplasia, of the spine in achondroplasia and achondrogenesis, of the calvarium in osteogenesis imperfecta and thanatophoric dysplasia, and of the cartilage in Kniest dysplasia.

    更新日期:2019-11-01
  • European Society of Paediatric Radiology abdominal imaging task force: recommendations for contrast-enhanced ultrasound and diffusion-weighted imaging in focal renal lesions in children.
    Pediatr. Radiol. (IF 2.022) Pub Date : null
    M Beatrice Damasio,Lil-Sofie Ording Müller,Thomas A Augdal,Fred E Avni,Luca Basso,Costanza Bruno,Damjana Ključevšek,Annemieke S Littooij,Stéphanie Franchi-Abella,Luisa M Lobo,Hans-Joachim Mentzel,Marcello Napolitano,Aikaterini Ntoulia,Michael Riccabona,Samuel Stafrace,M Magdalena M Woźniak,Philippe Petit

    Contrast-enhanced ultrasound (CEUS) and diffusion-weighted imaging (DWI) are safe, repeatable imaging techniques. The aim of this paper is to discuss the advantages, technical factors and possible clinical applications of these imaging tools in focal renal lesions in children.

    更新日期:2019-11-01
  • Cyst-like lesions following fracture in a child - sonographic appearances.
    Pediatr. Radiol. (IF 2.022) Pub Date : null
    Jennifer Allali,Clément Escalard,Frédérique Belloy,Marie Blouet

    Cyst-like lesions are a rare radiologic presentation following fractures in children. We report the case of a 3-year-old boy having three cyst-like lesions after a buckle fracture of his left radius that was diagnosed with digital radiography and CT scan. We also describe the lesions' ultrasonographic appearance, which has not been addressed in other studies. The keys to diagnosis depend on the clinical context and the radiologic appearance. The cyst-like lesions occur several weeks after a non-displaced fracture in an asymptomatic child. The radiologic appearance shows small, well-defined lucent lesions located near the fracture site, in the subperiosteal space and bone callus. Ultrasonography can be useful to confirm the subperiosteal location and to exclude adjacent soft-tissue abnormalities. In cases requiring further clarity, MRI can be performed to identify the fatty content and exclude osteomyelitis.

    更新日期:2019-11-01
  • Subdural hemorrhage rebleeding in abused children: frequency, associations and clinical presentation.
    Pediatr. Radiol. (IF 2.022) Pub Date : 2019-11-21
    Jason N Wright,Timothy J Feyma,Gisele E Ishak,Sergey Abeshaus,James B Metz,Emily C B Brown,Seth D Friedman,Samuel R Browd,Kenneth W Feldman

    BACKGROUND Limited documentation exists about how frequently radiologically visible rebleeding occurs with abusive subdural hemorrhages (SDH). Likewise, little is known about rebleeding predispositions and associated symptoms. OBJECTIVE To describe the frequency of subdural rebleeding after abusive head trauma (AHT), its predispositions and clinical presentation. MATERIALS AND METHODS We evaluated children with SDHs from AHT who were reimaged within a year of their initial hospitalization, retrospectively reviewing clinical details and imaging. We used the available CT and MR images. We then performed simple descriptive and comparative statistics. RESULTS Fifty-four of 85 reimaged children (63.5%) with AHT-SDH rebled. No child had new trauma, radiologic evidence of new parenchymal injury or acute neurologic symptoms from rebleeding. From the initial presentation, macrocephaly was associated with subsequent rebleeding. Greater subdural depth, macrocephaly, ventriculomegaly and brain atrophy at follow-up were associated with rebleeding. No other radiologic findings at initial presentation or follow-up predicted rebleeding risk, although pre-existing brain atrophy at initial admission and initial chronic SDHs barely missed significance. Impact injuries, retinal hemorrhages and clinical indices of initial injury severity were not associated with rebleeding. All rebleeding occurred within chronic SDHs; no new bridging vein rupture was identified. The mean time until rebleeding was recognized was 12 weeks; no child had rebleeding after 49 weeks. CONCLUSION Subdural rebleeding is common and occurs in children who have brain atrophy, ventriculomegaly, macrocephaly and deep SDHs at rebleed. It usually occurs in the early months post-injury. All children with rebleeds were neurologically asymptomatic and lacked histories or clinical or radiologic findings of new trauma. Bleeds did not occur outside of chronic SDHs. We estimate the maximum predicted frequency of non-traumatic SDH rebleeding accompanied by acute neurological symptoms in children with a prior abusive SDH is 3.5%.

    更新日期:2019-11-01
  • 更新日期:2019-11-01
  • Impact of a fast free-breathing 3-T abdominal MRI protocol on improving scan time and image quality for pediatric patients with tuberous sclerosis complex.
    Pediatr. Radiol. (IF 2.022) Pub Date : 2019-09-06
    Rene Balza,Camilo Jaimes,Seretha Risacher,Heather I Gale,Jessica Mahoney,Keith Heberlein,John E Kirsch,Erik S Shank,Michael S Gee

    BACKGROUND Magnetic resonance imaging (MRI) of the abdomen can be especially challenging in pediatric patients because of image quality degradation from respiratory motion. Abdominal MR protocols tailored for free-breathing children can potentially improve diagnostic image quality and reduce scan time. OBJECTIVE To evaluate the performance of a free-breathing 3-T MRI protocol for renal evaluation in pediatric patients with tuberous sclerosis complex (TSC). MATERIALS AND METHODS A single institution, Institutional Review Board-approved, retrospective database query identified pediatric TSC patients who underwent a free-breathing 3-T MR abdominal protocol including radial and respiratory-triggered pulse sequences and who also had a prior abdominal MRI on the same scanner using a traditional MR protocol utilizing signal averaging and Cartesian k-space sampling. Scan times and use of sedation were recorded. MR image quality was compared between the two protocols using a semiquantitative score for overall image quality and sharpness. RESULTS Forty abdominal MRI studies in 20 patients were evaluated. The mean scan time of the fast free-breathing protocol was significantly lower (mean: 42.5±9.8 min) compared with the traditional protocol (58.7±11.7 min; P=<0.001). Image sharpness was significantly improved for radial T2-weighted and T1-weighted triggered Dixon and radial T1-weighted fat-suppressed post-contrast images in the free-breathing protocol, while image quality was significantly higher on radial and Dixon T1-weighted sequences. CONCLUSION A free-breathing abdominal MR protocol in pediatric TSC patients decreases scan time and improves image quality and should be considered more widely for abdominal MRI in children.

    更新日期:2019-11-01
  • 2-D magnetic resonance spectroscopic imaging of the pediatric brain using compressed sensing.
    Pediatr. Radiol. (IF 2.022) Pub Date : 2019-08-30
    Rohini Vidya Shankar,Houchun H Hu,Nutandev Bikkamane Jayadev,John C Chang,Vikram D Kodibagkar

    BACKGROUND Magnetic resonance spectroscopic imaging helps to determine abnormal brain tissue conditions by evaluating metabolite concentrations. Although a powerful technique, it is underutilized in routine clinical studies because of its long scan times. OBJECTIVE In this study, we evaluated the feasibility of scan time reduction in metabolic imaging using compressed-sensing-based MR spectroscopic imaging in pediatric patients undergoing routine brain exams. MATERIALS AND METHODS We retrospectively evaluated compressed-sensing reconstructions in MR spectroscopic imaging datasets from 20 pediatric patients (11 males, 9 females; average age: 5.4±4.5 years; age range: 3 days to 16 years). We performed retrospective under-sampling of the MR spectroscopic imaging datasets to simulate accelerations of 2-, 3-, 4-, 5-, 7- and 10-fold, with subsequent reconstructions in MATLAB. Metabolite maps of N-acetylaspartate, creatine, choline and lactate (where applicable) were quantitatively evaluated in terms of the root-mean-square error (RMSE), peak amplitudes and total scan time. We used the two-tailed paired t-test along with linear regression analysis to statistically compare the compressed-sensing reconstructions at each acceleration with the fully sampled reference dataset. RESULTS High fidelity was maintained in the compressed-sensing MR spectroscopic imaging reconstructions from 50% to 80% under-sampling, with the RMSE not exceeding 3% in any dataset. Metabolite intensities and ratios evaluated on a voxel-by-voxel basis showed no statistically significant differences and mean metabolite intensities showed high correlation compared to the fully sampled reference dataset up to an acceleration factor of 5. CONCLUSION Compressed-sensing MR spectroscopic imaging has the potential to reduce MR spectroscopic imaging scan times for pediatric patients, with negligible information loss.

    更新日期:2019-11-01
  • Ultrasonography with the colonic segment-approach for colonic polyps in children.
    Pediatr. Radiol. (IF 2.022) Pub Date : 2019-08-24
    Yu Wang,Xiao Man Wang,Li Qun Jia

    BACKGROUND Ultrasonography (US) has been widely applied and has validated efficacy in the diagnosis of colonic polyps in children. However, little attention has been paid to improving the detection rate of polyps, optimizing the ultrasonic examination process and reducing misdiagnosis. OBJECTIVE To investigate the diagnostic performance of the colonic segment-approach by US in the diagnosis of colonic polyps in pediatric patients. MATERIALS AND METHODS One hundred fifty-nine patients who were going to have a colonoscopy from September 2014 to August 2016 were enrolled in this study. All patients received US before colonoscopy. In a preliminary study, 50 patients were chosen to determine the interobserver agreement, with half of the cases with and half of the cases without a colonic segment-approach. The other 109 patients were examined by both approaches. The sensitivity and the specificity of each approach were compared based on the outcome of colonoscopy as the gold criteria. RESULTS The interobserver agreement was high (0.816 for the non-segmental approach, 0.754 for the colonic segment-approach). The diagnostic sensitivity of the colonic segment-approach was higher than that of the traditional approach (82.1% vs. 57.7%, P<0.05) with 89.3% vs. 64.2% detection rate of colonic polyps in the descending colon, 81.8% vs. 60.6% in the sigmoid colon, and 81.3% vs. 43.8% in the rectum, respectively. The specificity of both methods was 100% (95% confidence interval: 86.3%-100%). CONCLUSION The US colonic segment-approach can improve diagnostic sensitivity for colonic polyps as a convenient method with no special requirement for equipment and examination conditions.

    更新日期:2019-11-01
  • Dual-source computed tomography coronary artery imaging in children.
    Pediatr. Radiol. (IF 2.022) Pub Date : 2019-08-24
    Aurelio Secinaro,Davide Curione,Kristian Havmand Mortensen,Teresa Pia Santangelo,Paolo Ciancarella,Carmela Napolitano,Alessia Del Pasqua,Andrew Mayall Taylor,Paolo Ciliberti

    Computed tomography (CT) has a well-established diagnostic role in the assessment of coronary arteries in adults. However, its application in a pediatric setting is still limited and often impaired by several technical issues, such as high heart rates, poor patient cooperation, and radiation dose exposure. Nonetheless, CT is becoming crucial in the noninvasive approach of children affected by coronary abnormalities and congenital heart disease. In some circumstances, CT might be preferred to other noninvasive techniques such as echocardiography and MRI for its lack of acoustic window influence, shorter acquisition time, and high spatial resolution. The introduction of dual-source CT has expanded the role of CT in the evaluation of pediatric cardiovascular anatomy and pathology. Furthermore, technical advances in the optimization of low-dose protocols represent an attractive innovation. Dual-source CT can play a key role in several clinical settings in children, namely in the evaluation of children with suspected congenital coronary artery anomalies, both isolated and in association with congenital heart disease. Moreover, it can be used to assess acquired coronary artery abnormalities, as in children with Kawasaki disease and after surgical manipulation, especially in case of transposition of the great arteries treated with arterial switch operation and in case of coronary re-implantation.

    更新日期:2019-11-01
  • Ultrasound detection of crystal gel ball ingestion in children.
    Pediatr. Radiol. (IF 2.022) Pub Date : 2019-08-24
    Xiaoman Wang,Yawei Dong,Xiaoxia Peng,Liqun Jia

    更新日期:2019-11-01
  • Normal sonographic renal length measurements in an Australian pediatric population.
    Pediatr. Radiol. (IF 2.022) Pub Date : 2019-08-21
    Peter R Coombs,Ilona Lavender,Michelle Y Z Leung,Jessica C Woods,Eldho Paul,Nathalie Webb,Michael Ditchfield

    BACKGROUND Reference charts depicting normal growth are important for the sonographic assessment of the pediatric kidney. Limited charts are available for clinical use in an Australian population. OBJECTIVE To retrospectively collate sonographic renal length measurements in a cohort of low-risk Australian children aged newborn to 16 years to produce a reference table and comparison with other published charts. MATERIALS AND METHODS We identified consecutive pediatric patients who were at low risk for renal disease and had renal lengths measured. After exclusions, we included 941 renal lengths (male 490, female 451). We used linear regression to estimate the relationship of renal length with age, gender and side. We calculated percentile values of renal length according to age categories. RESULTS No statistically significant differences in mean renal length were observed between males and females, or for left and right kidneys. We tabulated reference data and provide them in a reference chart (1-, 2.5-, 5-, 10-, 50-, 90-, 97.5- and 99-percentiles). CONCLUSION We calculated new reference ranges for pediatric renal length using a larger cohort than previously published, from a population with diverse ethnicity.

    更新日期:2019-11-01
  • Association between ventricular shunt catheter calcifications and the development of shunt fracture.
    Pediatr. Radiol. (IF 2.022) Pub Date : 2019-08-20
    M Azfar Siddiqui,Anna K Hardy,Philippe A Mercier,Shannon G Farmakis

    BACKGROUND Calcifications along ventricular catheters have been associated with shunt fractures although it is unknown whether their development predicts whether and when the shunts will fracture. OBJECTIVE To determine whether extracranial calcifications found on a radiographic shunt series predicts whether a patient will experience a shunt catheter fracture or complication. MATERIALS AND METHODS A retrospective review was performed of pediatric patients with a ventricular shunt placed before 18 years of age and radiographic shunt series. Two thousand, six hundred and thirty shunt series in 523 patients (301 male) were reviewed to identify the development of calcifications around the catheter and fracture. Fifty-one patients were excluded for preexisting calcifications with shunt fracture. (48) Absence of shunt (2) or age (1). Analysis included descriptive statistics, odds ratio and chi-square test results. RESULTS Four hundred seventy-two patients were included. Of the 59 shunts in 58 patients that developed calcifications, 23 went on to fracture (39%). Forty shunts without calcification in 37 patients developed fractures. There is a significant positive association between calcification and fracture (Χ2=39.1, P<0.01). It is 6.12 times more likely that a fractured shunt had calcifications compared to a non-fractured shunt having calcifications. Calcifications appeared within an average of 9 years, 10 months (range: 4-14 years) after shunt insertion. Shunt fractures occurred within an average of 5 years, 2 months (range: 6 months-9 years) after the appearance of calcifications with a median patient age of 14.6 years. Nearly all fractures were at or adjacent to the calcifications, most commonly in the neck (17/23; 73.9%). CONCLUSION Shunt calcification represents a significant risk for catheter fracture in the pediatric population. Early intervention or closer interval follow-up may be indicated in those found to have calcifications.

    更新日期:2019-11-01
  • Shear wave elastography correlates with liver fibrosis scores in pediatric patients with liver disease.
    Pediatr. Radiol. (IF 2.022) Pub Date : 2019-08-17
    Shannon G Farmakis,Paula M Buchanan,Miguel A Guzman,Anna K Hardy,Ajay K Jain,Jeffrey H Teckman

    BACKGROUND While liver biopsy remains the gold standard, given the procedure risks and sampling errors, there is a need for reliable noninvasive biomarkers of hepatic fibrosis. OBJECTIVE Determine the accuracy of two-dimensional shear wave elastography (2-D SWE) in predicting the histological severity of liver fibrosis in pediatric patients with known or suspected liver disease. MATERIALS AND METHODS Subjects 0-18 years old with known or suspected liver disease and liver biopsy within 30 days (n=70) were included. Comparisons by 2-D SWE were made to a control group (n=79). Two-dimensional SWE was performed using the GE LOGIQ E9 system. Liver biopsy specimens were scored according to METAVIR and Ishak scoring systems using Spearman's Rho correlation. Receiver operator characteristic (ROC) analysis, Kruskal-Wallis and Mann-Whitney U tests were conducted. RESULTS Control group median 2-D SWE measurements were lower than in subjects with any degree of liver fibrosis (P<0.001). Those with METAVIR F0 and Ishak 0 scores had significantly lower median 2-D SWE measurements (1.35 m/s; 1.36 m/s) than those with more advanced liver disease (F1-F3: 1.49-1.62 m/s; 1-4: 1.45-1.63 m/s) (P<0.05 for all), whereas the 2-D SWE in the higher scores were similar. Results did not differ between METAVIR and Ishak scores for any degree of fibrosis. Fibrosis scores moderately correlated with median 2-D SWE measurements (rs=0.43). The area under the curve for F1 compared to combined control/F0 was 0.89 (95% confidence interval [CI] 0.83-0.95; P<0.001) with sensitivity of 94.6% and specificity of 78.6%. Results for Ishak score 1 were similar. The ideal cutoff value for identifying fibrosis was determined to be 1.29 m/s. CONCLUSION The liver 2-D SWE measurements correlated with the histological liver fibrosis scores, regardless of the histopathological scoring system, although 2-D SWE was better at identifying patients with early fibrosis, not at distinguishing among the individual fibrosis levels. Two-dimensional SWE using the GE LOGIQ US system is useful for identifying pediatric patients at risk for liver fibrosis.

    更新日期:2019-11-01
  • A multifactorial severity score for left congenital diaphragmatic hernia in a high-risk population using fetal magnetic resonance imaging.
    Pediatr. Radiol. (IF 2.022) Pub Date : 2019-08-16
    Brandon P Brown,Michael T Clark,Rachel L Wise,Lava R Timsina,Thomas A Reher,Robert J Vandewalle,Joshua J Brown,Zoe M Saenz,Brian W Gray

    BACKGROUND Adverse outcomes for infants born with left congenital diaphragmatic hernia (CDH) have been correlated with fetal imaging findings. OBJECTIVE We sought to corroborate these correlations in a high-risk cohort and describe a predictive mortality algorithm combining multiple imaging biomarkers for use in prenatal counseling. MATERIALS AND METHODS We reviewed fetal MRI examinations at our institution from 2004 to 2016 demonstrating left-side CDH. MRI findings, hospital course and outcomes were recorded and analyzed using bivariate and multivariable analysis. We generated a receiver operating curve (ROC) to determine a cut-off relation for mortality. Finally, we created a predictive mortality calculator. RESULTS Of 41 fetuses included in this high-risk cohort, 41% survived. Per bivariate analysis, observed-to-expected total fetal lung volume (P=0.007), intrathoracic position of the stomach (P=0.049), and extracorporeal membrane oxygenation (ECMO) requirement (P<0.001) were significantly associated with infant mortality. Youden J statistic optimized the ROC for mortality at 24% observed-to-expected total fetal lung volume (sensitivity 64%, specificity 82%, area under the curve 0.72). On multivariable analysis, observed-to-expected total fetal lung volume ± 24% was predictive of mortality (adjusted odds ratio, 95% confidence interval: 0.09 [0.02, 0.55]; P=0.008). We derived a novel mortality prediction calculator from this analysis. CONCLUSION In this high-risk cohort, decreased observed-to-expected total fetal lung volume and stomach herniation were significantly associated with mortality. The novel predictive mortality calculator utilizes information from fetal MR imaging and provides prognostic information for health care providers. Creation of similar predictive tools by other institutions, using their distinct populations, might prove useful in family counseling, especially where there are discordant imaging findings.

    更新日期:2019-11-01
  • Effects of an MRI Try Without program on patient access.
    Pediatr. Radiol. (IF 2.022) Pub Date : 2019-08-09
    Barbra S Rudder,Sara J Easley,Amie L Robinson,Janelle R Noel-MacDonnell,David B Nielsen

    BACKGROUND Pediatric patients are often sedated for magnetic resonance imaging (MRI) scans to ensure images are of diagnostic quality. However, access time for MRIs requiring sedation is often long due to high patient volumes and limited sedation resources. OBJECTIVE This study examined the effectiveness of an MRI Try Without sedation program to decrease the wait time for obtaining an MRI while simultaneously ensuring diagnostic-quality images. MATERIALS AND METHODS A retrospective chart review was performed on subjects who utilized the MRI Try Without program from April 2014 through June 2015 at a dedicated pediatric institution. Child life specialist preparations and access time (i.e. time from exam ordered to exam completed) were recorded in each patient's electronic medical record. MRI images were evaluated for image quality by a pediatric neuroradiologist. RESULTS A total of 134 patients participated in the MRI Try Without program (mean age: 6.9±1.7 years), all of whom received interventions from a child life specialist. The average number of days between when the order was placed and when the MRI was completed using the MRI Try Without program was 15.4±18.5 days, while the third-available appointment for sedation/anesthesia was 46.2 days (standard deviation [SD]±15.7 days). Nearly all patients received a "good" or "very good" image quality determination (87.3%) and only 5 (3.8%) patients were recommended for repeat examination for diagnostic-quality images. CONCLUSION Utilization of an MRI Try Without sedation program, with child life specialist interventions, decreased the wait time for obtaining an MRI while still providing diagnostic-quality images.

    更新日期:2019-11-01
  • Prenatal evaluation of the Sakoda complex.
    Pediatr. Radiol. (IF 2.022) Pub Date : 2019-08-07
    Usha D Nagaraj,Rohitha Moudgal,Robert J Hopkin,Charu Venkatesan,Beth M Kline-Fath

    Sakoda complex is a rare but distinct combination of birth defects consisting of a basal cephalocele, agenesis of the corpus callosum, and midline cleft lip/palate. It has been reported in association with ophthalmologic abnormalities, cognitive deficits and severe epilepsy. Here we describe both prenatal and postnatal MRI findings of a classic case of Sakoda complex in a child with characteristic findings on fetal MRI; prenatal findings have not been described in the literature. Diagnosis of this entity has important implications for prenatal counseling and perinatal management, as is demonstrated in this case.

    更新日期:2019-11-01
  • Classic metaphyseal lesion of distal tibia following footling breech delivery.
    Pediatr. Radiol. (IF 2.022) Pub Date : 2019-08-06
    Gloria S Lee,Sosamma T Methratta,Lori D Frasier

    Classic metaphyseal lesions associated with childbirth are rare. We report a distal tibial metaphyseal fracture following a difficult breech delivery. Classic metaphyseal fractures are considered highly specific injuries associated with non-accidental trauma. This case depicts a classic metaphyseal lesion sustained during footling breech extraction in an urgent delivery. The traction and torque placed on the distal extremities during this difficult delivery suggest a potential mechanism for this injury.

    更新日期:2019-11-01
  • Prevalence of pituitary cysts in children using modern magnetic resonance imaging techniques.
    Pediatr. Radiol. (IF 2.022) Pub Date : 2019-07-29
    Eman S Mahdi,Ryan Logan Webb,Matthew T Whitehead

    BACKGROUND Pituitary pars intermedia/Rathke cleft cysts or cyst-like structures are commonly encountered in children undergoing brain magnetic resonance imaging (MRI), especially when examinations include thin-section, high-resolution sequences. OBJECTIVE To determine the prevalence of pituitary cystic lesions in children at our institution using modern MRI technique, to assess for associated endocrinopathy and to address the need for follow-up. MATERIALS AND METHODS We retrospectively reviewed 232 consecutive 1.5- and 3-T brain MRIs in children ages 0-18 years (mean: 8.3±5.3 years). We evaluated 3-D volumetric T1 spoiled gradient echo (SPGR) and axial T2-weighted sequences. Pituitary glands were evaluated for the presence, size and signal characteristics of cysts. Cyst volumes were measured in three orthogonal planes. Endocrine abnormalities were documented from the medical record. RESULTS Pituitary cysts were present in 57.7% of children (n=134), with a mean linear measurement of 3.6±1.17 mm (range: 0.4 to 12.3 mm). The overwhelming majority of cysts were hyopointense on T1-W images (n=121, 90%) and isointense on T2-W images relative to the adenohypophysis (n=106, 79%). T1 hyperintense and T2 hypointense signals were present in a minority, 6.7% and 8%, respectively. Most cysts were occult on post-contrast T1-W images (n=24, 77%). Endocrine abnormalities were present in 2/134 (1.5%) of children with cysts (these were unrelated to the pituitary gland) versus 1/98 (1%) children without cysts (P=0.7). CONCLUSION More often than not, pituitary cysts/cyst-like structures can be found incidentally in children using modern MRI techniques. Follow-up is not typically required if there are no associated symptoms or excessive size.

    更新日期:2019-11-01
  • Diagnostic performance of standardized ultrasound protocol for detecting perforation in pediatric appendicitis.
    Pediatr. Radiol. (IF 2.022) Pub Date : 2019-07-26
    Erica L Riedesel,Blake C Weber,Matthew W Shore,Randi S Cartmill,Daniel J Ostlie,Charles M Leys,Kara G Gill,Jonathan E Kohler

    BACKGROUND Recent clinical trials in adults and children have shown that uncomplicated acute appendicitis can be successfully treated with antibiotics alone. As treatment strategies for acute appendicitis diverge, accurate preoperative diagnosis of complicated appendicitis and appendiceal perforation has become increasingly important for clinical decision-making. OBJECTIVE To examine diagnostic performance of ultrasound for detecting perforated appendicitis in a single institution using a standardized technique. MATERIALS AND METHODS In this retrospective single-center study we evaluated 113 ultrasounds from pediatric patients who underwent appendectomy between November 2014 and December 2015. All ultrasounds were performed using a standardized US protocol including still and cine images of all four abdominal quadrants, with more targeted evaluation of the right lower quadrant (RLQ) using graded compression technique. We compared US findings to intraoperative diagnosis of non-perforated or perforated acute appendicitis. RESULTS The standardized image protocol generated a reproducible set of ultrasound images in all cases. The most common primary appendiceal finding on US in perforated appendicitis was appendix wall thickening >3 mm (54%, 171/314) and most common secondary finding was echogenic mesenteric fat (75%, 237/314). Thinning of the appendix wall and loculated fluid collection in the right lower quadrant were both highly specific (>90%) for perforation. CONCLUSION The diagnostic performance of ultrasound using a standardized US technique was similar to that reported in prior studies for detecting perforated appendicitis. Despite low sensitivity, individual ultrasound findings and overall diagnostic impression of "evidence of appendix perforation" remain highly specific.

    更新日期:2019-11-01
  • Quantification of skeletal muscle mass: sarcopenia as a marker of overall health in children and adults.
    Pediatr. Radiol. (IF 2.022) Pub Date : null
    Leah A Gilligan,Alexander J Towbin,Jonathan R Dillman,Elanchezhian Somasundaram,Andrew T Trout

    Sarcopenia is defined as the loss of muscle mass or function and has been associated with increased morbidity and mortality in a variety of diseased populations. Sarcopenia results from a higher rate of muscle protein degradation compared to protein synthesis and is an important marker of metabolic status related to nutrition and physical activity. The diagnosis of sarcopenia is accomplished by clinical assessment demonstrating decreased muscle function and radiographic confirmation of decreased muscle mass, via dual X-ray absorptiometry, bioelectric impedance or cross-sectional imaging with CT or MRI. However, normative data for skeletal muscle mass are lacking, especially for children and young adults. Additionally, studies of skeletal muscle mass by cross-sectional imaging in children are scarce. Here, we review the concept of sarcopenia with an emphasis on its relevance in the pediatric population.

    更新日期:2019-11-01
  • Improved diagnostic confidence and accuracy of pediatric elbow fractures with digital tomosynthesis.
    Pediatr. Radiol. (IF 2.022) Pub Date : null
    Matthew A Zapala,Kristin Livingston,Danial Bokhari,Andrew S Phelps,Jesse L Courtier,Collin Ma,Youngho Seo,John D MacKenzie

    BACKGROUND Pediatric elbow fractures are common but remain challenging to accurately diagnose. Digital tomosynthesis is a technique that has shown promise in difficult adult fracture patterns but has not been formally studied in the pediatric population. OBJECTIVE To assess the added value of digital tomosynthesis on the detection and diagnostic confidence of pediatric elbow fractures. MATERIALS AND METHODS A retrospective study was performed between January 2016 and December 2017 in pediatric patients (≤18 years) to assess the ability of conventional elbow radiographs and digital tomosynthesis to detect elbow fractures. One hundred twenty-one pediatric patients with concern for pediatric elbow trauma (64 males, 57 females; mean age: 8.1 years, range: 1 year to 17 years) were imaged with both conventional elbow radiographs and digital tomosynthesis. Two blinded pediatric radiologists identified fractures and indicated their diagnostic confidence. Observer agreement was assessed with Cohen's Kappa coefficient and a nonparametric Wilcoxon rank sum test was used to compare the degree of diagnostic confidence between standard radiographs alone and standard radiographs with digital tomosynthesis. McNemar's test was used to assess the difference in the rate of fracture detection between the two methods and sensitivity, specificity, precision, accuracy and diagnostic odds ratios were calculated. RESULTS Compared with standard radiographs alone, standard radiographs with digital tomosynthesis improved inter-rater agreement, sensitivity, specificity, accuracy, precision and the diagnostic odds ratio for fracture detection and increased diagnostic confidence (Rater 1: P=0.01, Rater 2: P=0.003). CONCLUSION The addition of digital tomosynthesis with conventional elbow radiographs improves diagnostic confidence and performance for the detection of pediatric elbow fractures.

    更新日期:2019-11-01
  • 更新日期:2019-11-01
  • The heart of pediatric radiology.
    Pediatr. Radiol. (IF 2.022) Pub Date : 2019-08-16
    Richard B Gunderman

    更新日期:2019-11-01
  • Pancreatic pseudocyst drainage in children by image-guided cystogastrostomy and stent insertion.
    Pediatr. Radiol. (IF 2.022) Pub Date : 2019-07-26
    Premal A Patel,Craig Gibson,Kishore S Minhas,Sam Stuart,Paolo De Coppi,Derek J Roebuck

    BACKGROUND Endoscopic ultrasound is seldom available at paediatric centres; therefore drainage of pancreatic pseudocysts in children has traditionally been achieved by surgery. OBJECTIVE This study assessed the feasibility and safety of performing image-guided internal drainage of pancreatic pseudocysts with a flanged self-expanding covered nitinol pancreatic pseudocyst drainage stent. MATERIALS AND METHODS We conducted a retrospective case note review of children undergoing image-guided cystogastrostomy at two paediatric hospitals. Percutaneous access to the stomach was achieved via an existing gastrostomy tract or image-guided formation of a new tract. Under combined ultrasound, fluoroscopic or cone-beam CT guidance the pancreatic pseudocysts were punctured through the posterior wall of the stomach. A self-expanding covered nitinol stent was deployed to create a cystogastrostomy opening. RESULTS Image-guided cystogastrostomy was performed in 6 children (4 male; median age 6 years, range 46 months to 15 years; median weight 18 kg, range 13.8-47 kg). Two children had prior failed attempts at surgical or endoscopic drainage. Median maximum cyst diameter was 11.5 cm (range 4.7-15.5 cm) pre-procedure. Technical success was 100%. There were no complications. There was complete pseudocyst resolution in five children and a small (2.1-cm) residual pseudocyst in one. Pseudocyst-related symptoms resolved in all children. CONCLUSION Pancreatic pseudocyst drainage can be successfully performed in children by image-guided placement of a cystogastrostomy stent. In this cohort of six children there were no complications.

    更新日期:2019-11-01
  • Diagnostic yield and safety of ultrasound-guided bowel mass biopsies in children.
    Pediatr. Radiol. (IF 2.022) Pub Date : 2019-07-16
    Kishore Minhas,Derek J Roebuck,Alex Barnacle,Paolo De Coppi,Neil Sebire,Premal A Patel

    BACKGROUND Traditionally, ultrasound (US)-guided bowel mass biopsies are avoided in favour of endoscopic or surgical biopsies. However, endoscopy cannot easily reach lesions between the duodenojejunal flexure and the terminal ileum and lesions not involving the mucosa may not be accessible via an endoscopic route. OBJECTIVE The aim of this study was to report our technique and to assess the diagnostic accuracy and safety of US-guided biopsy of bowel masses in children. MATERIALS AND METHODS We conducted a 14-year retrospective review of US-guided bowel mass biopsies at a single paediatric hospital. RESULTS Twenty US-guided bowel mass biopsies were performed in 19 patients (median age: 6 years and 6 months, range: 22 months-17 years, median weight: 22 kg, range: 10.2-48.4 kg). For 14 biopsies, there was no other lesion that could potentially be biopsied. A percutaneous coaxial technique was used for 19 biopsies and a transanal non-coaxial biopsy was performed in 1. A median of 9 (range: 2-15) cores of tissue was obtained at each biopsy. The technical success rate and adequacy of diagnostic yield were 100%. The most common diagnosis was lymphoma, which occurred in 16 biopsies. Three biopsies contained mucosa. There was one complication out of 20 biopsies (5%, 95% confidence interval 0-15%): a self-limiting, post biopsy pyrexia. Nineteen procedures were accompanied by a bone marrow aspirate and/or trephine within 2 weeks of the bowel biopsy, only one of which was diagnostic. CONCLUSION US-guided bowel mass biopsy can be performed safely in children, with a high diagnostic yield and low complication rate.

    更新日期:2019-11-01
  • Correction to: Magnetic resonance imaging of sacroiliitis in children: frequency of findings and interobserver reliability.
    Pediatr. Radiol. (IF 2.022) Pub Date : 2018-08-01
    Katharine E Orr,Savvas Andronikou,Marc James Bramham,Izidora Holjar-Erlic,Flavia Menegotto,Athimalaipet V Ramanan

    The original version of this article contained an error. Under the heading 'Limitations', the sentence 'Another limitation was the decision to exclude one reader from interobserver analysis.

    更新日期:2019-11-01
  • Correction to: community-acquired pneumonia in children - a changing spectrum of disease.
    Pediatr. Radiol. (IF 2.022) Pub Date : 2017-11-08
    David M le Roux,Heather J Zar

    The published version of this article unfortunately contained an error. Corresponding author information included only the mailing address but not the affiliations. Full corresponding author information is given below. The publisher apologizes.

    更新日期:2019-11-01
  • Nathan Thorne Griscom, MD (1931-2019).
    Pediatr. Radiol. (IF 2.022) Pub Date : null
    George A Taylor,Carlo Buonomo,Michael J Callahan

    更新日期:2019-11-01
  • Altered regional myocardial velocities by tissue phase mapping and feature tracking in pediatric patients with hypertrophic cardiomyopathy.
    Pediatr. Radiol. (IF 2.022) Pub Date : 2019-10-30
    Arleen Li,Alexander Ruh,Haben Berhane,Joshua D Robinson,Michael Markl,Cynthia K Rigsby

    BACKGROUND Hypertrophic cardiomyopathy (HCM) is associated with heart failure, atrial fibrillation and sudden death. Reduced myocardial function has been reported in HCM despite normal left ventricular (LV) ejection fraction. Additionally, LV fibrosis is associated with elevated T1 and might be an outcome predictor. OBJECTIVE To systematically compare tissue phase mapping and feature tracking for assessing regional LV function in children and young adults with HCM and pediatric controls, and to evaluate structure-function relationships among myocardial velocities, LV wall thickness and myocardial T1. MATERIALS AND METHODS Seventeen pediatric patients with HCM and 21 age-matched controls underwent cardiac MRI including standard cine imaging, tissue phase mapping (two-dimensional cine phase contrast with three-directional velocity encoding), and modified Look-Locker inversion recovery to calculate native global LV T1. Maximum LV wall thickness was measured on cine images. LV radial, circumferential and long-axis myocardial velocity time courses, as well as global and segmental systolic and diastolic peak velocities, were quantified from tissue phase mapping and feature tracking. RESULTS Both tissue phase mapping and feature tracking detected significantly decreased global and segmental diastolic radial and long-axis peak velocities (by 12-51%, P<0.001-0.05) in pediatric patients with HCM vs. controls. Feature tracking peak velocities were lower than directly measured tissue phase mapping velocities (mean bias = 0.3-2.9 cm/s). Diastolic global peak velocities correlated moderately with global T1 (r = -0.57 to -0.72, P<0.01) and maximum wall thickness (r = -0.37 to -0.61, P<0.05). CONCLUSION Both tissue phase mapping and feature tracking detected myocardial velocity changes in children and young adults with HCM vs. controls. Associations between impaired diastolic LV velocities and elevated T1 indicate structure-function relationships in HCM.

    更新日期:2019-11-01
  • Supine versus prone positioning for ultrasound evaluation of postnatal urinary tract dilation in children.
    Pediatr. Radiol. (IF 2.022) Pub Date : null
    Juan S Calle-Toro,Carolina L Maya,Yocabel Gorfu,Emily Dunn,Kassa Darge,Susan J Back

    BACKGROUND Ultrasound (US) is used in the initial evaluation and surveillance of urinary tract dilation in children. Urinary tract dilation is diagnosed in 1-2% of all pregnancies during routine prenatal sonography with technological advances in US imaging. Urinary tract dilation classification systems, including the 2014 multidisciplinary consensus, assess anterior-posterior renal pelvic diameter and calyceal dilation. There is no consensus regarding optimal patient positioning - supine versus prone - during US assessment of urinary tract dilation. OBJECTIVE We performed this study to determine whether there is a significant difference in the measurement of the anterior-posterior renal pelvic diameter, presence of calyceal dilation, or resulting urinary tract dilation consensus score obtained between supine and prone positions. MATERIALS AND METHODS Two raters retrospectively reviewed renal bladder US exams of children with urinary tract dilation of one or both kidneys. We included technically adequate US examinations of orthotopic kidneys that were imaged in both supine and prone positions; we excluded children with renal anomalies or prior surgery. Anterior-posterior renal pelvic diameter measurements as well as central and peripheral calyceal dilation were documented in both supine and prone positions. A postnatal urinary tract dilation consensus score was assigned to each kidney based only on these features. RESULTS Urinary tract dilation in either the supine or prone position was performed in 146 kidneys (69 right, 77 left) in 89 children. Median age was 0.26 years (interquartile ratio [IQR] 0.08-0.61 years). Female-to-male ratio was 1:3 (21/89). The interclass correlations of the anterior-posterior renal pelvic diameter were 0.88 and 0.87 in the supine and prone positions, respectively, without significant differences (P=0.1). When comparing all kidneys together, the mean anterior-posterior renal pelvic diameter was 7.1 mm (95% confidence interval [CI] 6.4-7.8) in supine and 7.9 (95% CI 7.1-8.7) in prone, with a mean difference between the measurements of 0.83 mm (95% CI 0.3-1.4; P=0.16). Central calyceal and peripheral calyceal dilation were more commonly found in the prone position versus the supine position in both kidneys. Central calyceal dilation was observed in 15 cases in the prone but not in the supine position. In one kidney, it was seen only in the supine but not in the prone position. Overall the urinary tract dilation score differed between positions in 10.3% (15/146) of cases, most of them (14/15) with a higher score in prone compared to the supine position. CONCLUSION Scanning in prone position tends to more frequently show calyceal dilation and a greater size of the anterior-posterior renal pelvic diameter, resulting in higher urinary tract dilation classification scores, with almost perfect interobserver agreement.

    更新日期:2019-11-01
  • Delayed diagnosis of posterior ankle impingement in pediatric and adolescent patients: does radiology play a role?
    Pediatr. Radiol. (IF 2.022) Pub Date : 2019-11-11
    Indranil Kushare,Matthew G Ditzler,Siddharth P Jadhav

    BACKGROUND Posterior ankle impingement syndrome (PAIS) results from the pinching of anatomical structures in the posterior part of the ankle. OBJECTIVE To identify the possible role of imaging in the delayed diagnosis of PAIS and identify key findings on imaging to suggest PAIS in pediatric and adolescent patients. MATERIALS AND METHODS Data were collected prospectively in patients younger than 18 years of age who underwent arthroscopy after being diagnosed with PAIS. Imaging was reviewed retrospectively by two radiologists, compared with findings in literature and an age-matched control group, and correlated with arthroscopic findings. Pre- and postsurgical Visual Analogue Scale (VAS) pain and American Orthopedic Foot Ankle Society (AOFAS) ankle-hindfoot scores were noted. RESULTS Thirty-eight patients (20 females, 18 males), 51 ankles, with an average age of 12.9 years had an average 18-month delay in diagnosis. Twenty-seven of the 38 (73%) patients had previously seen multiple medical providers and were given multiple misdiagnoses. Radiographs were reported normal in 34/47 (72%) ankles. Thirty patients had magnetic resonance imaging (MRI) and findings included the presence of an os trigonum/Stieda process (94%) with associated osseous edema (69%), flexor hallucis longus (FHL) tenosynovitis (16%), and edema in Kager's fat pad (63%). Although individual findings were noted, the impression in the MRI reports in 16/32 (50%) did not mention PAIS as the likely diagnosis. There was a significant difference in the MRI findings of ankle impingement in the patient population when compared to the control group. Surgery was indicated after conservative treatment failed. All 51 ankles had a PAIS diagnosis confirmed during arthroscopy. At an average follow-up of 10.2 months, there was improvement of VAS pain (7.0 to 1.1) and AOFAS ankle-hindfoot scores (65.1 to 93.5). CONCLUSION PAIS as a diagnosis is commonly delayed clinically in young patients with radiologic misinterpretation being a contributing factor. Increased awareness about this condition is needed among radiologists and physicians treating young athletes.

    更新日期:2019-11-01
  • The perineal midsagittal view in male fetuses - pivotal for assessing genitourinary disorders.
    Pediatr. Radiol. (IF 2.022) Pub Date : 2019-11-11
    Juliette Garel,Eléonore Blondiaux,Valeria Della Valle,Lucie Guilbaud,Farah Khachab,Jean-Marie Jouannic,Hubert Ducou le Pointe,Catherine Garel

    A wide range of genitourinary pathologies can be diagnosed in utero, from a simple vesicoureteral reflux to a more complex disorder of sexual differentiation. The prognosis and neonatal management of these conditions differ significantly. Evaluation of the fetal perineal anatomy is paramount to making the right diagnosis. The aim of this pictorial essay is to show sonographers how to acquire a perineal midsagittal view in a male fetus, and to demonstrate how this specific view allows assessment of the urethra and penis, to differentiate various genitourinary pathologies.

    更新日期:2019-11-01
  • T1ρ-mapping for assessing knee joint cartilage in children with juvenile idiopathic arthritis - feasibility and repeatability.
    Pediatr. Radiol. (IF 2.022) Pub Date : 2019-11-11
    Anouk M Barendregt,Valentina Mazzoli,J Merlijn van den Berg,Taco W Kuijpers,Mario Maas,Aart J Nederveen,Robert Hemke

    BACKGROUND Ongoing arthritis in children with juvenile idiopathic arthritis (JIA) can result in cartilage damage. OBJECTIVE To study the feasibility and repeatability of T1ρ for assessing knee cartilage in JIA and also to describe T1ρ values and study correlation between T1ρ and conventional MRI scores for disease activity. MATERIALS AND METHODS Thirteen children with JIA or suspected JIA underwent 3-tesla (T) knee MRI that included conventional sequences and a T1ρ sequence. Segmentation of knee cartilage was carried out on T1ρ images. We used intraclass correlation coefficient to study the repeatability of segmentation in a subset of five children. We used the juvenile arthritis MRI scoring system to discriminate inflamed from non-inflamed knees. The Mann-Whitney U and Spearman correlation compared T1ρ between children with and without arthritis on MRI and correlated T1ρ with the juvenile arthritis MRI score. RESULTS All children successfully completed the MRI examination. No images were excluded because of poor quality. Repeatability of T1ρ measurement had an intraclass correlation coefficient (ICC) of 0.99 (P<0.001). We observed no structural cartilage damage and found no differences in T1ρ between children with (n=7) and without (n=6) inflamed knees (37.8 ms vs. 31.7 ms, P=0.20). However, we observed a moderate correlation between T1ρ values and the juvenile arthritis MRI synovitis score (r=0.59, P=0.04). CONCLUSION This pilot study suggests that T1ρ is a feasible and repeatable quantitative imaging technique in children. T1ρ values were associated with the juvenile arthritis MRI synovitis score.

    更新日期:2019-11-01
  • Imaging of developmental dysplasia of the hip: ultrasound, radiography and magnetic resonance imaging.
    Pediatr. Radiol. (IF 2.022) Pub Date : 2019-11-07
    Christian A Barrera,Sara A Cohen,Wudbhav N Sankar,Victor M Ho-Fung,Raymond W Sze,Jie C Nguyen

    Developmental dysplasia of the hip (DDH) describes a broad spectrum of developmental abnormalities of the hip joint that are traditionally diagnosed during infancy. Because the development of the hip joint is a dynamic process, optimal treatment depends not only on the severity of the dysplasia, but also on the age of the child. Various imaging modalities are routinely used to confirm suspected diagnosis, to assess severity, and to monitor treatment response. For infants younger than 4 months, screening hip ultrasound (US) is recommended only for those with risk factors, equivocal or positive exam findings, whereas for infants older than 4-6 months, pelvis radiography is preferred. Following surgical hip reduction, magnetic resonance (MR) imaging is preferred over computed tomography (CT) because MR can not only confirm concentric hip joint reduction, but also identify the presence of soft-tissue barriers to reduction and any unexpected postoperative complications. The routine use of contrast-enhanced MR remains controversial because of the relative paucity of well-powered and validated literature. The main objectives of this article are to review the normal and abnormal developmental anatomy of the hip joint, to discuss the rationale behind the current recommendations on the most appropriate selection of imaging modalities for screening and diagnosis, and to review routine and uncommon findings that can be identified on post-reduction MR, using an evidence-based approach. A basic understanding of the physiology and the pathophysiology can help ensure the selection of optimal imaging modality and reduce equivocal diagnoses that can lead to unnecessary treatment.

    更新日期:2019-11-01
  • Impingement syndromes of the ankle and hindfoot.
    Pediatr. Radiol. (IF 2.022) Pub Date : 2019-11-07
    Andrew M Zbojniewicz

    Ankle impingement refers to a chronic painful mechanical limitation of ankle motion caused by soft-tissue or osseous abnormality affecting the tibiotalar joint or extraarticular soft tissues. Impingement can be associated with a prior single traumatic event or repetitive microtrauma, often in an adolescent with anatomical predisposition. Impingement syndromes at the tibiotalar joint can be subdivided into anterior, anterolateral, anteromedial, posterior or posteromedial. Extraarticular impingement can consist of talocalcaneal or subfibular impingement. Impingement syndromes are just one possible etiology of persistent ankle pain, and although the diagnosis is often made or suspected clinically, the radiologist might be the first person to raise the possibility of the diagnosis or be called upon to provide support for the clinically suspected diagnosis. In this article I review the etiology, imaging findings and current treatment associated with these conditions.

    更新日期:2019-11-01
  • The borderline dysplastic hip: when and how is it abnormal?
    Pediatr. Radiol. (IF 2.022) Pub Date : 2019-11-07
    Sarah D Bixby,Michael B Millis

    Borderline acetabular dysplasia refers to mildly sub-normal patterns of acetabular shape and coverage that might predispose children to mechanical dysfunction and instability. Borderline dysplasia generally includes children with a lateral center edge angle (CEA) of 18-24°. Some children with borderline radiographic measurements have normal joint mechanics and function while others benefit from acetabular reorienting surgery. Although radiographic findings of borderline dysplasia might suggest instability, the ultimate diagnosis is based on history and physical exam in addition to imaging. Children with borderline acetabular dysplasia sometimes benefit from other cross-sectional imaging studies such as MR imaging to evaluate for secondary evidence of instability, including damage along the acetabular rim, or labral degeneration and hypertrophy. CT is also helpful for depiction of 3-D acetabular morphology for preoperative assessment and planning. Pediatric radiologists are often the first to identify borderline or mild dysplasia on radiographs. It is imperative that pediatric radiologists serve as effective consultants and offer appropriate recommendations as part of a cohesive multidisciplinary approach to this complex patient population.

    更新日期:2019-11-01
  • Management of pediatric foot deformities: an imaging review.
    Pediatr. Radiol. (IF 2.022) Pub Date : 2019-11-07
    Matthew J Winfeld,Brittany E Winfeld

    Abnormalities of foot alignment can be a cause of significant morbidity in children, and some require complex surgical intervention to improve functionality and decrease pain. Imaging plays a key role in management decisions. We address some of the most common surgical strategies for selected diagnoses including pes planus, congenital vertical talus, pes cavus, and clubfoot, with a focus on imaging findings.

    更新日期:2019-11-01
  • Digital tomosynthesis of the pediatric elbow.
    Pediatr. Radiol. (IF 2.022) Pub Date : 2019-11-07
    Matthew A Zapala,Kristin Livingston,Andrew S Phelps,John D MacKenzie

    Imaging pediatric elbow trauma in the acute setting remains diagnostically challenging given difficult patient positioning, multiple ossification centers of the pediatric elbow, overlapping structures, and complex joint anatomy. Digital tomosynthesis is a technique where the X-ray source travels across a limited arc angle, obtaining a series of low-dose exposures that are in turn digitally reconstructed to produce high in-plane resolution at a relatively low overall radiation dose. Digital tomosynthesis is now more commonly integrated into standard radiographic machines and offers a new and exciting way to assess the pediatric elbow. In this review article we discuss the clinical applications of digital tomosynthesis in pediatric elbow trauma along with challenges related to technique, patient positioning and artifacts.

    更新日期:2019-11-01
  • Magnetic resonance imaging of elbow injuries in children.
    Pediatr. Radiol. (IF 2.022) Pub Date : 2019-11-07
    Nancy A Chauvin,Cristy N Gustas-French

    Evaluating elbow injuries is challenging because of the complex anatomy of the joint. In children, injury patterns depend on the sports-specific mechanism as well as the stage of skeletal maturity. This article reviews the anatomy of the elbow and common injury patterns seen in children, with an emphasis on MRI and the throwing athlete. Imaging pitfalls specific to children are described.

    更新日期:2019-11-01
  • Normal development imaging pitfalls and injuries in the pediatric shoulder.
    Pediatr. Radiol. (IF 2.022) Pub Date : 2019-11-07
    Jonathan Zember,Pedro Vega,Ignacio Rossi,Zehava Sadka Rosenberg

    The skeletal maturation of the shoulder has been well documented on radiographic and cadaveric studies. Recent increased use of MRI has provided increased understanding of the soft-tissue and osseous changes that occur during development. Thus recognizing normal maturation, imaging manifestations and pitfalls is crucial when evaluating the pediatric shoulder joint. At birth, the humeral diaphysis, midportion of the clavicle, and the body of the scapula are ossified, while the remainder of the bones of the shoulder are composed of non-ossified cartilaginous precursors. During growth, cartilaginous apophyses and epiphyses of the shoulder develop numerous secondary ossification centers, which fuse with the primary ossification centers to form the complete bony components of the shoulder. Additionally changes in the morphology of the growth plates as well as marrow signal occur in an organized manner. This paper affords the reader with an understanding of the normal development of three major components of skeletal maturation in the shoulder: ossification centers, growth plates and marrow signal. These topics are further subdivided into the glenoid, proximal humerus and acromioclavicular joint. We also provide a focus on distinguishing normal anatomy from imaging pitfalls related to skeletal maturation.

    更新日期:2019-11-01
  • Imaging of osteochondrosis.
    Pediatr. Radiol. (IF 2.022) Pub Date : 2019-11-07
    Elizabeth Yuan West,Diego Jaramillo

    Osteochondrosis is an abnormality of the epiphyses or epiphyseal equivalents (round bones and apophyses) during later stages of endochondral ossification. This process of abnormal endochondral ossification can occur at various locations throughout the body. The pathogenesis of osteochondrosis is under active investigation. In humans, the process of abnormal endochondral ossification has been attributed to a combination of vascular insult and trauma. Although the proposed etiology of osteochondrosis varies based on body part affected, the overall process is defined by necrosis, revascularization and repair. As such, common radiologic findings include those of osseous destruction and associated inflammation. The purpose of this review is to discuss the current understanding of osteochondroses as a disease entity and explore imaging features of osteochondroses throughout the body.

    更新日期:2019-11-01
  • Physeal bridges: causes, diagnosis, characterization and post-treatment imaging.
    Pediatr. Radiol. (IF 2.022) Pub Date : 2019-11-07
    Arthur B Meyers

    The cartilaginous primary physis, or growth plate, at the end of long bones in children allows for longitudinal bone growth. A variety of insults to the physis can lead to physeal bridge formation, which in turn can lead to limb-shortening and angular deformities. This paper begins with a description of the causes, risk factors and mechanisms by which bridges form. Then it reviews the use of imaging in the diagnosis and characterization of bridges and in the evaluation of treatment and post-treatment complications. It is important for radiologists taking care of children to be aware of the indirect and direct imaging findings of physeal bridges to aid in their diagnosis, to be able to characterize bridges as part of preoperative planning, and to know the imaging finding of post-resection complications.

    更新日期:2019-11-01
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