http://pediatrics.aappublications.org:80 This feed contains articles for Pediatrics Subject Collection "Radiology" Pediatrics http://pediatrics.aappublications.org:80 http://pediatrics.aappublications.org:80/cgi/content/short/124/1/e145?rss=1 CONTEXT: Given radiation- and sedation-associated risks, there is uncertainty about which children with head trauma should receive cranial computed tomography (CT) scanning. A high-quality and high-performing clinical prediction rule may reduce this uncertainty. OBJECTIVE: To systematically review the quality and performance of published clinical prediction rules for intracranial injury in children with head injury. METHODS: Medline and Embase were searched in December 2008. Studies were selected if they included clinical prediction rules involving children aged 0 to 18 years with a history of head injury. Prediction-rule quality was assessed by using 14 previously published items. Prediction-rule performance was evaluated by rule sensitivity and the predicted frequency of CT scanning if the rule was used. RESULTS: A total of 3357 titles and abstracts were assessed, and 8 clinical prediction rules were identified. For all studies, the rule derivations were reported; no study validated a rule in a separate population or assessed its impact in actual practice. The rules differed considerably in population, predictors, outcomes, methodologic quality, and performance. Five of the rules were applicable to children of all ages and severities of trauma. Two of these were high quality ([≥]11 of 14 quality items) and had high performance (lower confidence limits for sensitivity >0.95 and required [≤]56% to undergo CT). Four of the 8 rules were applicable to children with minor head injury (Glasgow coma score [≥]13). One of these had high quality (11 of 14 quality items) and high performance (lower confidence limit for sensitivity = 0.94 and required 13% to undergo CT). Four of the 8 rules were applicable to young children, but none exhibited adequate quality or performance. CONCLUSIONS: Eight clinical prediction-rule derivation studies were identified. They varied considerably in population, methodologic quality, and performance. Future efforts should be directed toward validating rules with high quality and performance in other populations and deriving a high-quality, high-performance rule for young children. Maguire, J. L. Boutis, K. Uleryk, E. M. Laupacis, A. Parkin, P. C. 2009-07-01 doi:10.1542/peds.2009-0075 Should a Head-Injured Child Receive a Head CT Scan? A Systematic Review of Clinical Prediction Rules American Academy of Pediatrics 1 124 154 145 2009-07-01 REVIEW ARTICLE http://pediatrics.aappublications.org:80/cgi/content/short/118/6/e1779?rss=1 OBJECTIVE. The purpose of this work was to assess the frequency of clinically relevant findings from plain films of infants evaluated for torticollis. PATIENTS AND METHODS. After institutional review board approval, radiology records were searched for infants 0 to 12 months of age who underwent plain film study for torticollis or "head tilt." Infants evaluated for trauma or Down syndrome were excluded. All of the studies were reviewed, demographic data was recorded, and any additional imaging studies were examined. RESULTS. A total of 502 patients (189 girls and 313 boys) were identified with an average age of 0.37 {+/-} 0.2 years. Head tilt was to the left in two thirds of patients. Ten patients had abnormal findings reported. Six of these proved normal on subsequent studies (3 suspected occipital-C1 fusions, 2 suspected cervical fusions, and 1 suspected hemivertebra). Four patients had true bony vertebral abnormalities including absent left C7 pedicle, multiple fusion anomalies from C4 to T2, C3 hemivertebra and thoracic spine anomalies, and C4 hypoplasia. This last patient had abnormal kyphosis on physical examination and demonstrated instability with dynamic testing. Twenty-five additional patients with normal plain films underwent spine computed tomography or magnetic resonance imaging; all were normal. CONCLUSIONS. The true-positive yield of plain films in nontraumatic infant torticollis was low (4 of 502). There were more false-positive than true-positive results. A common rationale for imaging is to exclude craniocervical or other unstable abnormalities that might contraindicate physical therapy, seen in only 1 of the 502 cases. Close physical examination could safely eliminate most patients sent for radiography. Snyder, E. M. Coley, B. D. 2006-12-01 doi:10.1542/peds.2006-1624 Limited Value of Plain Radiographs in Infant Torticollis American Academy of Pediatrics 6 118 1784 1779 2006-12-01 ARTICLES http://pediatrics.aappublications.org:80/cgi/content/short/peds.2006-1624v1?rss=1 OBJECTIVE.: The purpose of this work was to assess the frequency of clinically relevant findings from plain films of infants evaluated for torticollis. PATIENTS AND METHODS.: After institutional review board approval, radiology records were searched for infants 0 to 12 months of age who underwent plain film study for torticollis or "head tilt." Infants evaluated for trauma or Down syndrome were excluded. All of the studies were reviewed, demographic data was recorded, and any additional imaging studies were examined. RESULTS.: A total of 502 patients (189 girls and 313 boys) were identified with an average age of 0.37 {+/-} 0.2 years. Head tilt was to the left in two thirds of patients. Ten patients had abnormal findings reported. Six of these proved normal on subsequent studies (3 suspected occipital-C1 fusions, 2 suspected cervical fusions, and 1 suspected hemivertebra). Four patients had true bony vertebral abnormalities including absent left C7 pedicle, multiple fusion anomalies from C4 to T2, C3 hemivertebra and thoracic spine anomalies, and C4 hypoplasia. This last patient had abnormal kyphosis on physical examination and demonstrated instability with dynamic testing. Twenty-five additional patients with normal plain films underwent spine computed tomography or magnetic resonance imaging; all were normal. CONCLUSIONS.: The true-positive yield of plain films in nontraumatic infant torticollis was low (4 of 502). There were more false-positive than true-positive results. A common rationale for imaging is to exclude craniocervical or other unstable abnormalities that might contraindicate physical therapy, seen in only 1 of the 502 cases. Close physical examination could safely eliminate most patients sent for radiography. Snyder, E. M. Coley, B. D. 2006-11-20 doi:10.1542/peds.2006-1624 Limited Value of Plain Radiographs in Infant Torticollis American Academy of Pediatrics 2006 0 1784 200616241 2006-11-20 ARTICLES http://pediatrics.aappublications.org:80/cgi/content/short/118/2/626?rss=1 OBJECTIVE. Mixed-density convexity subdural hematoma and interhemispheric subdural hematoma suggest nonaccidental head injury. The purpose of this retrospective observational study is to investigate subdural hematoma on noncontrast computed tomography in infants with nonaccidental head injury and to compare these findings in infants with accidental head trauma for whom the date of injury was known. PATIENTS AND METHODS. Two blinded, independent observers retrospectively reviewed computed tomography scans with subdural hematoma performed on the day of presentation on 9 infant victims of nonaccidental head injury (mean age: 6.8 months; range: 1-25 months) and on 38 infants (mean age: 4.8 months; range: newborn to 34 months) with accidental head trauma (birth-related: 19; short fall: 17; motor vehicle accident: 2). RESULTS. Homogeneous hyperdense subdural hematoma was significantly more common in children with accidental head trauma (28 of 38 [74%]; nonaccidental head trauma: 3 of 9 [33%]), whereas mixed-density subdural hematoma was significantly more common in cases of nonaccidental head injury (6 of 9 [67%]; accidental head trauma: 7 of 38 [18%]). Twenty-two (79%) subdural hematomas were homogeneously hyperdense on noncontrast computed tomography performed within two days of accidental head trauma, one (4%) was homogeneous and isodense compared to brain tissue, one (4%) was homogeneous and hypodense, and four (14%) were mixed-density. There was no statistically significant difference in the proportion of interhemispheric subdural hematoma, epidural hematoma, calvarial fracture, brain contusion, or subarachnoid hemorrhage. CONCLUSIONS. Homogeneous hyperdense subdural hematoma is more frequent in cases of accidental head trauma; mixed-density subdural hematoma is more frequent in cases of nonaccidental head injury but may be observed within 48 hours of accidental head trauma. Interhemispheric subdural hematoma is not specific for inflicted head injury. Tung, G. A. Kumar, M. Richardson, R. C. Jenny, C. Brown, W. D. 2006-08-01 doi:10.1542/peds.2006-0130 Comparison of Accidental and Nonaccidental Traumatic Head Injury in Children on Noncontrast Computed Tomography American Academy of Pediatrics 2 118 633 626 2006-08-01 ARTICLES http://pediatrics.aappublications.org:80/cgi/content/short/118/1/23?rss=1 OBJECTIVE. MRI studies have shown that preterm infants with brain injury have altered brain tissue volumes. Investigation of preterm infants without brain injury offers the opportunity to define the influence of early birth on brain development and provide normative data to assess effects of adverse conditions on the preterm brain. In this study, we investigated serial MRI of low-risk preterm infants with the aim to identify regions of altered brain development. METHODS. Twenty-three preterm infants appropriate for gestational age without magnetic resonance-visible brain injury underwent MRI twice at 32 and at 42 weeks' postmenstrual age. Fifteen term infants were scanned 2 weeks after birth. Brain tissue classification and parcellation were conducted to allow comparison of regional brain tissue volumes. Longitudinal brain growth was assessed from preterm infants' serial scans. RESULTS. At 42 weeks' postmenstrual age, gray matter volumes were not different between preterm and term infants. Myelinated white matter was decreased, as were unmyelinated white matter volumes in the region including the central gyri. The gray matter proportion of the brain parenchyma constituted 30% and 37% at 32 and 42 weeks' postmenstrual age, respectively. CONCLUSIONS. This MRI study of preterm infants appropriate for gestational age and without brain injury establishes the influence of early birth on brain development. No decreased cortical gray matter volumes were found, which is in contrast to findings in preterm infants with brain injury. Moderately decreased white matter volumes suggest an adverse influence of early birth on white matter development. We identified a sharp increase in cortical gray matter volume in preterm infants' serial data, which may correspond to a critical period for cortical development. Mewes, A. U.J. Huppi, P. S. Als, H. Rybicki, F. J. Inder, T. E. McAnulty, G. B. Mulkern, R. V. Robertson, R. L. Rivkin, M. J. Warfield, S. K. 2006-07-01 doi:10.1542/peds.2005-2675 Regional Brain Development in Serial Magnetic Resonance Imaging of Low-Risk Preterm Infants American Academy of Pediatrics 1 118 33 23 2006-07-01 ARTICLES http://pediatrics.aappublications.org:80/cgi/content/short/117/6/2119?rss=1 OBJECTIVE. Sturge-Weber syndrome is characterized by leptomeningeal angiomatosis and a facial naevus that is usually unilateral. Magnetic resonance imaging is the cornerstone of confirming the disease and judging the extent of the abnormalities. It has been shown, however, that brain perfusion abnormalities on nuclear medicine imaging often are more extensive than the abnormal leptomeningeal enhancement on magnetic resonance. In this article, we assess the utility of magnetic resonance perfusion in demonstrating perfusion abnormalities in pediatric cases of Sturge-Weber syndrome. METHODS. Magnetic resonance perfusion studies were performed on 7 consecutive children who presented to our department with clinically suspected Sturge-Weber syndrome. The extent of time to peak abnormality on dynamic gadolinium bolus magnetic resonance perfusion imaging was compared with the extent of leptomeningeal enhancement and the presence of venous abnormalities. RESULTS. Good magnetic resonance perfusion data were obtained in all 7 cases. Perfusion abnormalities were closely anatomically related to meningeal enhancement on postcontrast T1-weighted imaging. However, perfusion abnormalities were found consistently in the vicinity of developmental venous anomalies that were present in 4 of 7 cases. In 1 child, there was a perfusion deficit in the cerebellar lobe contralateral to the leptomeningeal angiomatosis, consistent with crossed cerebellar diaschisis. CONCLUSIONS. Magnetic resonance perfusion is a sensitive indicator of perfusion abnormalities in Sturge-Weber syndrome and can be performed easily at the same time as the diagnostic scan. Magnetic resonance perfusion imaging therefore is useful in the assessment of this disease. This approach has the extra advantage of correlating the perfusion abnormalities with the high-resolution imaging that is provided from magnetic resonance imaging. Evans, A. L. Widjaja, E. Connolly, D. J. A. Griffiths, P. D. 2006-06-01 doi:10.1542/peds.2005-1815 Cerebral Perfusion Abnormalities in Children With Sturge-Weber Syndrome Shown by Dynamic Contrast Bolus Magnetic Resonance Perfusion Imaging American Academy of Pediatrics 6 117 2125 2119 2006-06-01 ARTICLES http://pediatrics.aappublications.org:80/cgi/content/short/117/3/e413?rss=1 OBJECTIVE. As the number of diagnostic imaging studies performed has increased, the demand for sedation in support of these radiologic tests has also increased. Our objectives were to (1) assess the safety and efficacy of a radiology sedation service that is staffed exclusively by pediatric emergency medicine (PEM) physicians, (2) determine the frequency and the type of commonly performed pediatric imaging studies that require procedural sedation, and (3) assess the average duration of procedural sedation for commonly performed radiologic studies. METHODS. We conducted a retrospective observational study of patient encounters in 2004 involving procedural sedation to facilitate diagnostic imaging. We are a university-affiliated group of PEM physicians that provide a radiology sedation service during weekdays at a freestanding urban children's hospital. RESULTS. The sedation service participated in 1285 patient encounters during the study period. Deep sedation was provided to 1027 patients. Moderate sedation was administered to 258 patients. Procedural sedation times for the most frequently performed imaging studies ranged from 5 to 183 minutes. Agents that were used to provide deep sedation were pentobarbital (with midazolam, fentanyl, or both) in 65% of cases, propofol in 31%, and ketamine (with or without midazolam) in 4%. Moderate sedation was achieved with chloral hydrate in 86% and oral diazepam in 14% of the cases. A total of 99.1% of the imaging studies were completed successfully. Six imaging studies were aborted because of failed sedation or occurrence of adverse event. Five patients who were deemed high risk on their presedation evaluation were referred electively for general anesthesia. CONCLUSIONS. Our data suggest that a dedicated sedation team in support of diagnostic imaging services, staffed exclusively by PEM physicians, can be a successful clinical enterprise. The service consumes significant resources and physician time. Pershad, J. Gilmore, B. 2006-03-01 doi:10.1542/peds.2005-1385 Successful Implementation of a Radiology Sedation Service Staffed Exclusively by Pediatric Emergency Physicians American Academy of Pediatrics 3 117 422 413 2006-03-01 ARTICLES http://pediatrics.aappublications.org:80/cgi/content/short/117/2/376?rss=1 Objective. Diffuse excessive high signal intensity (DEHSI) is observed in the majority of preterm infants at term-equivalent age on conventional MRI, and diffusion-weighted imaging has shown that apparent diffusion coefficient values are elevated in the white matter (WM) in DEHSI. Our aim was to obtain diffusion tensor imaging on preterm infants at term-equivalent age and term control infants to test the hypothesis that radial diffusivity was significantly different in the WM in preterm infants with DEHSI compared with both preterm infants with normal-appearing WM on conventional MRI and term control infants. Methods. Diffusion tensor imaging was obtained on 38 preterm infants at term-equivalent age and 8 term control infants. Values for axial ({lambda}1) and radial [({lambda}2 + {lambda}3)/2] diffusivity were calculated in regions of interest positioned in the central WM at the level of the centrum semiovale, frontal WM, posterior periventricular WM, occipital WM, anterior and posterior portions of the posterior limb of the internal capsule, and the genu and splenium of the corpus callosum. Results. Radial diffusivity was elevated significantly in the posterior portion of the posterior limb of the internal capsule and the splenium of the corpus callosum, and both axial and radial diffusivity were elevated significantly in the WM at the level of the centrum semiovale, the frontal WM, the periventricular WM, and the occipital WM in preterm infants with DEHSI compared with preterm infants with normal-appearing WM and term control infants. There was no significant difference between term control infants and preterm infants with normal-appearing WM in any region studied. Conclusions. These findings suggest that DEHSI represents an oligodendrocyte and/or axonal abnormality that is widespread throughout the cerebral WM. Counsell, S. J. Shen, Y. Boardman, J. P. Larkman, D. J. Kapellou, O. Ward, P. Allsop, J. M. Cowan, F. M. Hajnal, J. V. Edwards, A. D. Rutherford, M. A. 2006-02-01 doi:10.1542/peds.2005-0820 Axial and Radial Diffusivity in Preterm Infants Who Have Diffuse White Matter Changes on Magnetic Resonance Imaging at Term-Equivalent Age American Academy of Pediatrics 2 117 386 376 2006-02-01 ARTICLES http://pediatrics.aappublications.org:80/cgi/content/short/113/2/e150?rss=1 Background. Magnetic resonance (MR) imaging of the neonate is important clinically, because this group of patients often has complex and multiple problems due to prematurity and developmental abnormalities. MR imaging usually involves moving neonates away from their controlled environment to the scanner. Objective. In this study we present the results of our initial experience with an MR-compatible incubator used on a 1.5-T system. Methods. Seven neonates were imaged at 1.5 T without sedation or anesthesia. Images were obtained by using single-shot fast spin echo, 3-dimensional Fourier transfer gradient echo, and diffusion-weighted sequences. In 4 cases, time-of-flight angiography was performed. Results. All 7 neonates were stable throughout the scan time (10-21 minutes). Experienced observers graded the images for quality, and all were graded excellent or good. In no case was the image quality poor. Conclusion. Neonates can be imaged safely by using an MR-compatible incubator and fast image sequences. This method should allow neonates to be imaged by MR in sites at which a dedicated neonatal MR scanner is not available. Whitby, E. H. Griffiths, P. D. Lonneker-Lammers, T. Srinivasan, R. Connolly, D. J.A. Capener, D. Paley, M. N.J. 2004-02-01 doi:10.1542/peds.113.2.e150 Ultrafast Magnetic Resonance Imaging of the Neonate in a Magnetic Resonance-Compatible Incubator With a Built-in Coil American Academy of Pediatrics 2 113 152 150 2004-02-01 ELECTRONIC ARTICLE http://pediatrics.aappublications.org:80/cgi/content/short/112/4/971?rss=1 It is apparent that without extrapolation or animal experimentation, low-dose radiation has a small but statistically significant individual risk of excessive cancer over a child's lifetime.1-3 This data was recently published as part of the ongoing, >50-year study of the survivors of the atomic bomb that cost $500 million. The kind of radiation and doses these individuals were exposed to is similar to that from computed tomography (CT) (Fig 1). The total body effect of the A-bomb versus the more localized effect of medical radiation makes little difference on the outcome. Figure 2 is an explanation of terminology of the radiation doses used. There is clearly an overlap between the CT doses currently used and the low doses that the atomic bomb survivors received. ... Slovis, T. L. 2003-10-01 doi:10.1542/peds.112.4.971 Children, Computed Tomography Radiation Dose, and the As Low As Reasonably Achievable (ALARA) Concept American Academy of Pediatrics 4 112 972 971 2003-10-01 COMMENTARIES