Pediatric radiology Research Papers - Academia.edu (original) (raw)

Background Rickets affects young infants and toddlers. However, there is a paucity of literature regarding the types of fractures that occur in rachitic patients. Objective To evaluate the age of patients at which radiographically evident... more

Background Rickets affects young infants and toddlers. However, there is a paucity of literature regarding the types of fractures that occur in rachitic patients. Objective To evaluate the age of patients at which radiographically evident rickets occurs, and to characterize the age incidence and fractures that are observed in infants and toddlers with radiographically evident rickets. Materials and methods A retrospective study of children younger than 24 months was performed. Clinical data and radiographs were reviewed. Radiographs obtained within 1 month of the diagnosis were evaluated for the presence or absence of osteopenia, presence or absence of fraying–cupping, and presence and characterization of fractures. Results After exclusion criteria were applied, 45 children were included in the study. Children with rickets evident by radiograph were in the age range of 2–24 months. Fractures were present in 17.5% of the study group, exclusively in mobile infants and toddlers. Fracture types included transverse long bone fractures, anterior and anterior-lateral rib fractures, and metaphyseal fractures. All fractures occurred exclusively in patients with severe, overtly evident rickets. Conclusion Fractures occur in older infants and toddlers with overt rickets and can be seen by radiograph. Fractures do not resemble high-risk non-accidental trauma fractures.

Radiologists play a key role in the recognition of child abuse. In the last century, radiologists pioneered the identification of nonaccidental injuries, including fractures and brain injury, and together with colleagues in paediatrics... more

Radiologists play a key role in the recognition of child abuse. In the last century, radiologists pioneered the identification of nonaccidental injuries, including fractures and brain injury, and together with colleagues in paediatrics advocated the protection of children from abuse. Prevalence studies in many countries have revealed the widespread and hidden nature of child maltreatment. New and complex forms of abuse, e.g. fabricated or induced illness, have been recognized. Physical abuse affects 7-9% of children in the UK, although fewer suffer the severe or life-threatening injuries seen by radiologists. A high index of suspicion of nonaccidental trauma is required where known patterns of injury or inconsistencies of presentation and history are detected. In many cases the diagnosis is readily made, although some cases remain contentious or controversial and consume much clinical time and energy. Differences of view between doctors are tested in the courts. Adverse publicity has made this work unpopular in the UK. Knowledge of the differential diagnosis of unexplained or apparent injury is essential for accurate diagnosis, vital where errors in either direction can be disastrous. New UK radiological guidelines will assist radiologists in achieving best evidence-based practice.

Background The arterial vascularity of the hip has been investigated in normal infants using duplex Doppler sonography. This study addressed the differences in hip vascularity in infants with respect to gender and acetabular morphology.... more

Background The arterial vascularity of the hip has been investigated in normal infants using duplex Doppler sonography. This study addressed the differences in hip vascularity in infants with respect to gender and acetabular morphology. Objective To determine whether there is a relationship between the resistive index of the vessels of the femoral chondroepiphysis and the alpha angle in normal infant hips and in those with developmental dysplasia of the hip. Materials and methods We studied 76 hips (38 patients) with gray-scale and power Doppler US. The patients were referred because of a possible abnormal clinical hip examination or had risk factors for developmental dysplasia of the hip. The infants ranged in age from 1 day to 6 weeks. There were 13 boys and 25 girls. Gray-scale images were initially performed in the coronal and transverse planes to evaluate acetabular morphology, alpha angle and position of the femoral chondroepiphysis relative to the acetabulum. The hips were then examined with power Doppler US, in both sagittal and transverse planes, to identify arterial vessels within the femoral epiphysis. Resistive indices were then recorded from the spectral analysis in each vessel identified. Each examination was performed by one of five pediatric radiologists. Mixed model regression was used to assess the relationship between resistive index and alpha angle, age and gender. Results Of the 76 hips, 34 had an alpha angle of 60° or greater and were classified as normal, 26 had an alpha angle between 50° and 59° and were classified as immature, and 13 had an alpha angle of less than 50° and were either subluxed or dislocated at the time of examination. At least two vessels were documented in each femoral epiphysis except in three hips, in which no vessels could be documented because of technical factors. There was a statistically significant linear relationship between the alpha angle and resistive index, such that the resistive index tended to rise with increasing alpha angle (P=0.0022). In addition, female infants had a significantly higher average resistive index than the average resistive index in male infants with the same alpha angle (P=0.0005). Conclusion There is a direct linear relationship between alpha angle and resistive index in the infant hip. Female infants have a higher average resistive index than male infants. We believe that these results might serve as a model for predicting an infant hip at risk of ischemia. In addition, the fact that lower resistive indices of the femoral epiphysis are associated with acetabular dysplasia might help explain the documented low incidence of avascular necrosis in untreated hip dysplasia.

The diagnosis of subtle slipped capital femoral epiphysis (SCFE), for example in the contralateral asymptomatic hip, may require use of an exactly defined and reproducible lateral view where the slipping angle can be measured. To test a... more

The diagnosis of subtle slipped capital femoral epiphysis (SCFE), for example in the contralateral asymptomatic hip, may require use of an exactly defined and reproducible lateral view where the slipping angle can be measured. To test a simplified geometrical method and compare it to the conventional method (AP and frogleg views). The two methods were compared in 95 normal children 9-14 years old and 100 children 9-20 years old with SCFE. The slipping angle (SA) measurements had very high reproducibility, and the new method was diagnostically superior to the conventional method ( P<0.05). An exactly defined and reproducible lateral view is recommended for the X-ray diagnosis of SCFE. Nontraumatic SCFE appears to be bilateral in all cases.

Salivary gland lesions are uncommon in children and may be related to the parotid, submandibular or sublingual glands. Inflammatory lesions are the most common cause of salivary gland abnormalities in children and can be due to acute... more

Salivary gland lesions are uncommon in children and may be related to the parotid, submandibular or sublingual glands. Inflammatory lesions are the most common cause of salivary gland abnormalities in children and can be due to acute viral, acute suppurative, or recurrent acute or chronic inflammation. Intraparotid lymphadenitis may also occur, as in cat-scratch disease or in other causes of cervical lymphadenitis. Salivary gland neoplasms are rare in children, and most of them are benign including mainly hemangioma, pleomorphic adenoma, or lymphangioma. Other lesions, such as sialolithiasis, mucocele, or ranula, may also be seen. Ultrasonography should be the initial imaging study used for the examination of salivary gland lesions in children, given the fact that most of such lesions are benign and are shown up clearly by sonography. In most cases, this technique permits the differentiation of intraglandular and extraglandular lesions, and may suggest the correct diagnosis. The entire lesion could not be totally depicted by US however, and other imaging techniques such as CT or MRI may be necessary. Vascular lesions can be demonstrated more clearly through the use of color Doppler imaging. Some of the lesions may appear similar, and clinical correlation is important for the differential diagnosis. This article discusses the sonographic appearance and clinical manifestations of the spectrum of salivary gland abnormalities that may occur in children.

Hydrocephalus is a common neurological disorder in children and the result of a variety of causes. However, with the advancement of imaging modalities, particularly MRI, previously reported rarer causes of hydrocephalus in children are... more

Hydrocephalus is a common neurological disorder in children and the result of a variety of causes. However, with the advancement of imaging modalities, particularly MRI, previously reported rarer causes of hydrocephalus in children are now being more readily appreciated. We report an 11-year-old boy with diffuse villous hyperplasia of the choroid plexus. He had a ventriculo-peritoneal (VP) shunt in-situ and a prior diagnosis from infancy of congenital aqueduct stenosis as the cause of his hydrocephalus. His current presentation was with further shunt dysfunction. CT and MRI demonstrated enlarged choroid plexuses but did not confirm aqueduct stenosis. CSF overproduction was demonstrated from the externalized ventricular drain. The enlarged choroid plexuses were surgically resected and histology confirmed choroid plexus hyperplasia. Identification of choroid plexus hyperplasia is important since the neurosurgical management of hydrocephalus is not VP shunt insertion, but resection of the hyperplastic choroid plexus.

Digital radiography systems based on flat-panel detectors have been introduced into clinical practice in the past few years. The high detective quantum efficiency of these detectors allows the radiation dose to be reduced while... more

Digital radiography systems based on flat-panel detectors have been introduced into clinical practice in the past few years. The high detective quantum efficiency of these detectors allows the radiation dose to be reduced while maintaining image quality, an issue particularly significant for pediatric radiography. Another important aspect for dose optimization and monitoring is the integration of the detector into a computer-controlled x-ray examination system. This enables full control and complete reporting of all dose-relevant exposure parameters, including the determination of the exposure indicator and the patient dose (kerma-area product). In this paper the implementation of these principles in the Philips Digital Diagnost DR system is described and their relevance for pediatric applications is discussed.

PURPOSE: The aim of this study was to investigate the image quality preferences among radiographers and radiologists. The radiographers&#x27; preferences are mainly related to technical parameters, whereas radiologists assess image... more

PURPOSE: The aim of this study was to investigate the image quality preferences among radiographers and radiologists. The radiographers&#x27; preferences are mainly related to technical parameters, whereas radiologists assess image quality based on diagnostic ...

Raccoon roundworm encephalitis is a rare but devastating infection characterized by progressive neurological decline despite attempted therapy. Patients present with deteriorating neurological function, eosinophilia, and history of pica... more

Raccoon roundworm encephalitis is a rare but devastating infection characterized by progressive neurological decline despite attempted therapy. Patients present with deteriorating neurological function, eosinophilia, and history of pica or geophagia resulting in ingestion of the parasite. Neuroimaging studies demonstrate nonspecific findings of progressive white matter inflammation and cortical atrophy.