E-Book, Englisch, 666 Seiten
Medina / Altmann / Applegate Evidence-Based Imaging in Pediatrics
1. Auflage 2010
ISBN: 978-1-4419-0922-0
Verlag: Springer
Format: PDF
Kopierschutz: 1 - PDF Watermark
Improving the Quality of Imaging in Patient Care
E-Book, Englisch, 666 Seiten
ISBN: 978-1-4419-0922-0
Verlag: Springer
Format: PDF
Kopierschutz: 1 - PDF Watermark
This practical book is ideal for readers who want to rapidly determine the appropriate imaging for pediatric patients. The text provides a concise and accessible summary of the literature on how and when to use imaging studies. Chapters address the essentials, such as cost-effectiveness, and are written in collaboration by renowned specialists in the fields of pediatrics and pediatric radiology. Topics cover common clinical scenarios in neuroimaging and musculoskeletal, chest, and abdominal imaging. Each imaging recommendation is presented along with the supporting data and the strength of the evidence.
Autoren/Hrsg.
Weitere Infos & Material
1;Foreword;6
2;Preface;10
3;Contents;12
4;Contributors;16
5;Part I Principles, Methodology, and Radiation Risk;22
5.1;1 Principles of Evidence-Based Imaging;23
5.1.1;What Is Evidence-Based Imaging?;23
5.1.2;The Evidence-Based Imaging Process;25
5.1.2.1;Formulating the Clinical Question;25
5.1.2.2;Identifying the Medical Literature;25
5.1.2.3;Assessing the Literature;26
5.1.2.3.1;What Are the Types of Clinical Studies?;26
5.1.2.3.2;What Is the Diagnostic Performance of a Test: Sensitivity, Specificity, and Receiver Operating Characteristic (ROC) Curve?;27
5.1.2.3.3;What Are Cost-Effectiveness and Cost-Utility Studies?;29
5.1.2.4;Types of Economic Analyses in Medicine;29
5.1.2.5;Summarizing the Data;31
5.1.2.6;Applying the Evidence;31
5.1.3;How to Use This Book;34
5.1.4;Take-Home Appendix 1: Equations;34
5.1.5;Take-Home Appendix 2: Summary of Bayes Theorem;35
5.1.6;References;36
5.2;2 Critically Assessing the Literature: Understanding Error and Bias;37
5.2.1;What Are Error and Bias?;37
5.2.2;What Is Random Error?;38
5.2.2.1;Type I Error;38
5.2.2.2;Confidence Intervals;38
5.2.2.3;Type II Error;39
5.2.2.4;Power Analysis;39
5.2.3;What Is Bias?;40
5.2.4;What Are the Inherent Biases in Screening?;41
5.2.5;Qualitative Literature Summary;43
5.2.6;Conclusion;44
5.2.7;References;44
5.3;3 Radiation Risk from Medical Imaging in Children;45
5.3.1;Definition and Pathophysiology;46
5.3.1.1;Radiation Terminology;46
5.3.1.2;Radiation Mechanisms of Effect;46
5.3.1.3;Types of Biological Effects;46
5.3.1.4;Radiation Doses in Medical Imaging;47
5.3.2;Epidemiology and Medical Utilization of Ionizing Radiation;47
5.3.2.1;Increased Dose from Medical Imaging;48
5.3.2.2;Increased Use of CT Scans;48
5.3.2.3;Assessing Risk Versus Benefit when Using Medical Imaging in Children;48
5.3.3;Overall Cost to Society;49
5.3.4;Goals;49
5.3.5;Methodology;49
5.3.6;Discussion of Issues;49
5.3.7;Is There a Cancer Risk from Low-Level Radiation Used in Medical Imaging? What Are the Uncertainties in the Data?;49
5.3.7.1;Cancer Risk and Radiation Following Diagnostic Medical Imaging;50
5.3.7.2;CT Scan and Risk;50
5.3.7.3;Assumptions in Estimating Radiation Risks;50
5.3.7.4;Increased Radiosensitivity in Children;51
5.3.7.5;Nonfatal Cancers;51
5.3.7.6;Additional Confounders in Risk Estimation;51
5.3.7.7;Radiation Doses from Medical Imaging and Uncertainty in Cancer Risks;51
5.3.8;What Is the Estimated Risk From a Single Chest X-Ray in a Child?;52
5.3.9;What Is the Estimated Risk from a Single Abdominal CT Scan in a Child?;52
5.3.9.1;The Changing Landscaping of Radiation Dose for Medical Imaging;52
5.3.9.2;Lowering CT Dose in Children;53
5.3.10;Understanding Benefit Versus Risk of Imaging Tests in Well-Indicated Studies Versus Those That Have Very Low Probability of Disease;53
5.3.10.1;The Example of CT in Children with Headache;53
5.3.11;How Should I Communicate Radiation Risk from Imaging to Parents and Patients?;53
5.3.12;Special Situation: Increased Cancer Risk Following Therapeutic Medical Radiation;54
5.3.13;Take-Home Tables and Figures;55
5.3.14;Future Research;55
5.3.15;References;58
6;Part II Neuroimaging;60
6.1;4 Imaging in the Evaluation of Children with Suspected Craniosynostosis;61
6.1.1;Definition and Pathophysiology;62
6.1.2;Epidemiology;62
6.1.3;Overall Cost to Society;62
6.1.4;Goals;62
6.1.5;Methodology;63
6.1.6;Discussion of Issues;63
6.1.7;I. What Is the Role of Imaging in the Diagnosis of Craniosynostosis?;63
6.1.8;II. What Is the Cost and Cost-Effectiveness of Imaging in Children with Suspected Craniosynostosis?;64
6.1.9;III. Is Imaging Required When the Clinical Diagnosis Has Clearly Been Made?;65
6.1.10;IV. How Often and What Intracranial Abnormalities Are Seen in Craniosynostosis?;66
6.1.11;V. What Is the Role of Imaging in the Prenatal Diagnosis of Craniosynostosis?;66
6.1.12;Take Home Figures and Tables;67
6.1.13;Imaging Case Studies;68
6.1.14;Suggested Imaging Protocol for Craniosynostosis;69
6.1.14.1;Plain Radiographs;69
6.1.14.2;CT;69
6.1.15;Future Research;69
6.1.16;References;70
6.2;5 Sickle Cell Disease and Stroke;71
6.2.1;Definition, Pathophysiology, and Clinical Presentation;72
6.2.2;Epidemiology;73
6.2.2.1;Epidemiology of Stroke;73
6.2.2.2;Risk of Stroke;74
6.2.2.3;Epidemiology of Recurrent Stroke;74
6.2.2.4;Epidemiology of Silent Infarcts Diagnosed by MRI;74
6.2.3;Overall Cost to Society;74
6.2.3.1;Cost of Screening;75
6.2.3.2;Cost-Effectiveness Analysis;75
6.2.4;Goals;75
6.2.5;Methodology;75
6.2.6;Discussion of Issues;76
6.2.7;I. What Is the Role of Neuroimaging in Acute Stroke in Children with Sickle Cell Disease?;76
6.2.8;II. What Is the Role of Neuroimaging in Children with Sickle Cell Disease at Risk of Their First Stroke?;77
6.2.9;III. What Is the Role of Neuroimaging in Prevention of Recurrent Ischemic Stroke in Children with Sickle Cell Disease?;78
6.2.10;IV. Are There Neuroimaging Criteria That Indicate That Blood Transfusions Can Be Safely Halted?;79
6.2.11;V. What Is the Role of Neuroimaging in Hemorrhagic Stroke in Children with SCD?;79
6.2.12;Take Home Figures and Tables;80
6.2.13;Imaging Case Studies;83
6.2.13.1;Case 1;83
6.2.14;Suggested Imaging Protocol for Sickle Cell Disease and Stroke;84
6.2.15;Future Research;84
6.2.16;References;84
6.3;6 Imaging of Hypoxic-Ischemic Encephalopathy in the Full-Term Neonate;88
6.3.1;Definition and Pathophysiology;89
6.3.2;Epidemiology;89
6.3.3;Overall Cost to Society;90
6.3.4;Goals;90
6.3.5;Methodology;90
6.3.6;Discussion of Issues;91
6.3.7;I. What Are the Clinical Features of Neonatal HIE?;91
6.3.8;II. What Is the Optimal Time and What Are the Ideal MRI Sequences to Image Neonatal HIE?;91
6.3.9;III. Why Should Infants with Neonatal Encephalopathy Be Imaged?;93
6.3.10;IV. Does the Pattern of Brain Injury on MR Help Predict Outcome in Neonatal HIE?;94
6.3.11;V. Does Cooling Alter the Pattern of Brain Injury?;95
6.3.12;Take Home Tables;95
6.3.13;Imaging Case Studies;96
6.3.13.1;Case 1;96
6.3.14;Suggested Imaging Protocols for HIE in the Full-Term Neonate;97
6.3.15;Future Research;98
6.3.16; References;98
6.4;7 Evidence-Based Neuroimaging for Traumatic Brain Injury in Children;101
6.4.1;Definition and Pathophysiology;102
6.4.2;Epidemiology;103
6.4.3;Overall Cost to Society;103
6.4.4;Goals;103
6.4.5;Methodology;103
6.4.6;Discussion of Issues;104
6.4.7;I. Which Pediatric Patients with Head Injury Should Undergo Imaging in the Acute Setting?;104
6.4.8;II. What Is the Sensitivity and Specificity of Imaging for Injury Requiring Immediate Treatment/Surgery?;105
6.4.9;III. What Is the Overall Sensitivity and Specificity of Imaging in the Diagnosis and Prognosis of Children with Head Trauma?;105
6.4.10;IV. What Is the Role of Advanced Imaging (Functional MRI, MR Spectroscopy, Diffusion Imaging, SPECT, and PET) in Children with TBI?;108
6.4.11;Take Home Figures and Tables;110
6.4.12;Imaging Case Studies;113
6.4.12.1;Case 1: Example of MR Imaging for Traumatic Brain Injury (TBI);113
6.4.12.2;Case 2: Example of MR Spectroscopy;115
6.4.13;Suggested Protocols for Acute TBI Imaging;116
6.4.13.1;CT;116
6.4.13.2;MR;116
6.4.14;Future Research;116
6.4.15;References;116
6.5;8 Imaging of Brain Neoplasm;119
6.5.1;Definition and Pathophysiology;120
6.5.1.1;Definition of Brain Cancer;120
6.5.1.2;Unique Challenges of Brain Cancer;120
6.5.2;Epidemiology;120
6.5.3;Overall Cost to Society;121
6.5.4;Goals;121
6.5.5;Methodology;121
6.5.6;Discussion of Issues;122
6.5.7;I. Who Should Undergo Imaging to Exclude Pediatric Brain Cancer?;122
6.5.8;II. What Is the Appropriate Imaging in Subjects at Risk for Pediatric Brain Cancer?;123
6.5.8.1;Special Case: How Can a Tumor Be Differentiated from a Tumor-Mimicking Lesion?;124
6.5.9;III. What Is the Role of Proton Magnetic Resonance Spectroscopy (MRS) in the Diagnosis and Follow-Up of Brain Neoplasms?;125
6.5.10;IV. Can Imaging Be Used to Differentiate Post-treatment Necrosis from Residual/Recurrent Tumor?;126
6.5.11;V. What Is the Added Value of Functional MRI (fMRI) in the Surgical Planning of Patients with Suspected Brain Neoplasm or Focal Brain Lesions?;126
6.5.12;Take Home Tables;126
6.5.13;Imaging Case Studies;128
6.5.13.1;Case 1;128
6.5.13.2;Case 2;129
6.5.14;Suggested Imaging Protocols for Brain Neoplasms;129
6.5.15;Future Research;129
6.5.16;References;129
6.6;9 Children with Headache: Evidence-Based Role of Neuroimaging;131
6.6.1;Definition and Pathophysiology;132
6.6.2;Epidemiology;132
6.6.3;Overall Cost to Society;132
6.6.4;Goals;132
6.6.5;Methodology;133
6.6.6;Discussion of Issues;133
6.6.7;I. When Is Neuroimaging Appropriate in Children with Headache?;133
6.6.8;II. What Is the Sensitivity and Specificity of CT and MR Imaging for Space-Occupying Lesions?;134
6.6.9;III. What Is the Sensitivity and Specificity of CT and MRI Imaging of Patients with Headache and Subarachnoid Hemorrhage Suspected of Having an Intracranial Aneurysm?;134
6.6.10;IV. What Is the Role of Advance Imaging Techniques in Primary Headache Disorders?;135
6.6.11;V. What Is the Cost-Effectiveness of Neuroimaging in Patients with Headache?;136
6.6.12;Take Home Tables and Figures;137
6.6.12.1;Case 1: Colloid Cyst;138
6.6.12.2;Case 2: Chiari I;138
6.6.12.3;Case 3: Brain Stem Infiltrative Glial Neoplasm;139
6.6.13;Suggested Imaging Protocols for Headaches;140
6.6.13.1;CT Imaging;140
6.6.13.2;MR Imaging;140
6.6.14;Future Research;140
6.6.15; References;140
6.7;10 Pediatric Neuroimaging of Seizures;142
6.7.1;Definition and Pathophysiology;143
6.7.2;Epidemiology;143
6.7.2.1;Prevalence and Incidence;144
6.7.3;Overall Cost to Society;144
6.7.4;Goals;145
6.7.5;Methodology;145
6.7.6;Discussion of Issues;145
6.7.7;I. What Is the Likelihood of having an Abnormal Structural Finding in Neuroimaging in First Unprovoked Seizure or Newly Diagnosed Epilepsy in Infancy and Childhood?;145
6.7.8;II. Can Neuroimaging Predict Future Seizures or Patient Outcomes?;147
6.7.9;III. Is Neuroimaging Justified in Patients with First Febrile Seizures?;148
6.7.10;IV. What Is the Probability of Finding Structural Abnormalities in Neuroimaging Performed in Children with Temporal Lobe Epilepsy (TLE)?;148
6.7.11;V. What Is the Role of Functional MRI in Patients Who Are Candidates for Epilepsy Surgery?;149
6.7.12;VI. What Is the Role of Nuclear Medicine in Children with TLE Seizures?;150
6.7.13;Take Home Figures;150
6.7.14;Imaging Case Studies;153
6.7.14.1;Case 1;153
6.7.14.2;Case 2;154
6.7.15;Suggested Imaging Protocols for Seizures;154
6.7.15.1;CT Scan Brain Protocol for the Study of First Seizure;154
6.7.15.2;MRI of the Brain for the Workup of Epilepsy and Non-febrile Seizures;154
6.7.16;Future Research;154
6.7.17;References;154
6.8;11 Diagnosis and Management of Acute and Chronic Sinusitis in Children;156
6.8.1;Definition and Pathophysiology;157
6.8.2;Epidemiology;157
6.8.3;Overall Cost to Society;158
6.8.4;Goals;158
6.8.5;Methodology: Medline and PubMed;159
6.8.6;Discussion of Issues;159
6.8.7;I. Is There a Role for Imaging in the Initial Diagnosis of Uncomplicated Acute Bacterial Sinusitis in Children?;159
6.8.8;II. What Is the Diagnostic Performance of Sinus Radiography and Sinus CT in Acute Bacterial Sinusitis? What Diagnostic Criteria Should We Use for Acute Sinusitis?;160
6.8.9;III. When Are Imaging Studies Indicated for the Diagnosis and the Management of Children with Sinusitis?;162
6.8.10;IV. What Is the Most Cost-Effective Strategy for the Diagnosis and the Management of Patients with Acute Sinusitis?;163
6.8.11;V. What Is the Role of Imaging in Children with Chronic Sinusitis?;164
6.8.12;VI. Special Situation: What Is the Role of Imaging in Immunocompromised Children?;165
6.8.13;Take Home Figures and Tables;166
6.8.14;Imaging Case Studies;170
6.8.15;Suggested Imaging Protocols for Children Clinically Suspected of Acute Sinusitis;172
6.8.15.1;Sinus Radiographs;172
6.8.15.2;Low-Dose Screening Sinus CT;172
6.8.15.3;MRI;172
6.8.16;Future Research;172
6.8.17;References;172
6.9;12 Imaging of Nonaccidental Head Injury;175
6.9.1;Definition and Pathophysiology;176
6.9.2;Epidemiology;176
6.9.3;Overall Cost to Society;177
6.9.4;Goals;177
6.9.5;Methodology;177
6.9.6;Discussion of Issues;177
6.9.7;I. What Are the Clinical Findings that Raise Suspicion of NAHI to Direct Further Imaging?;177
6.9.8;II. Can Imaging Help to Predict NAHI?;178
6.9.9;III. Can CT and MR Imaging Help to Determine Timing of Injury?;180
6.9.10;IV. What Is the Sensitivity and Specificity of CT and MRI?;181
6.9.11;V. How Should the Newer MR Imaging Techniques Be Used?;181
6.9.12;Take Home Tables;183
6.9.13;Imaging Case Studies;183
6.9.13.1;Case 1;184
6.9.13.2;Case 2;184
6.9.14;Suggested Imaging Protocols for Nonaccidental Head Injury;185
6.9.15;Future Research;185
6.9.16;References;185
7;Part III Musculoskeletal Imaging;189
7.1;13 Evidence-Based Imaging in Non-CNS Nonaccidental Injury;190
7.1.1;Definition and Pathophysiology;191
7.1.2;Epidemiology;191
7.1.3;Overall Cost to Society;192
7.1.3.1;Direct Costs;192
7.1.3.2;Indirect Costs;192
7.1.4;Goals;192
7.1.5;Methodology;193
7.1.6;Discussion of Issues;193
7.1.7;I. What Are the Radiological Findings in Skeletal Nonaccidental Injury?;193
7.1.8;II. What Is the Preferred Imaging Modality for the Diagnosis of Nonaccidental Skeletal Injury?;194
7.1.9;III. What Is the Role of Repeat Surveys in Skeletal Nonaccidental Injury?;196
7.1.10;IV. What Is the Role of Sibling Screening with Skeletal Survey?;197
7.1.11;V. What Is the Role of Postmortem Imaging?;197
7.1.12;VI. How Well Can We Date Fractures?;197
7.1.13;VII. What Is the Role of Imaging in Abdominal Trauma in NAI?;198
7.1.14;Take Home Tables;199
7.1.15;Imaging Case Studies;199
7.1.15.1;Case 1;200
7.1.15.2;Case 2;201
7.1.16;Suggested Imaging Protocols for Non-CNS Nonaccidental Injury;201
7.1.17;Future Research;202
7.1.18;References;202
7.2;14 Imaging of Spine Disorders in Children: Dysraphism and Scoliosis;205
7.2.1;Spinal Dysraphism;205
7.2.2;Scoliosis;205
7.2.3;Definition and Pathophysiology;206
7.2.3.1;Spinal Dysraphism;206
7.2.3.2;Scoliosis;206
7.2.3.3;Conus Medullaris Position;207
7.2.4;Epidemiology;207
7.2.4.1;Spinal Dysraphism;207
7.2.4.2;Scoliosis;207
7.2.5;Goals;208
7.2.5.1;Spinal Dysraphism;208
7.2.5.2;Scoliosis;208
7.2.6;Methodology;208
7.2.7;Discussion of Issues in Spinal Dysraphism;208
7.2.8;I. How Accurate Is Imaging in Occult Spinal Dysraphism?;208
7.2.9;II. What Are the Clinical Predictors of Occult Spinal Dysraphism (OSD)?;208
7.2.10;III. What Are the Natural History and Role of Surgical Intervention in Occult Spinal Dysraphism?;209
7.2.11;IV. What Is the Cost-Effectiveness of Imaging in Children with Occult Spinal Dysraphism?;209
7.2.12;Discussion of Issues in Scoliosis;210
7.2.13;I. How Should the Radiographic Evaluation of Scoliosis Be Performed?;210
7.2.14;II. What Radiation-Induced Complications Result from Radiographic Monitoring of Scoliosis?;211
7.2.15;III. What Is the Role of Magnetic Resonance Imaging in Idiopathic Scoliosis?;211
7.2.16;Take Home Figures and Tables;213
7.2.16.1;How Should Physicians Evaluate Newborns with Suspected Occult Spinal Dysraphism?;213
7.2.16.2;How Should Scoliosis Be Evaluated?;215
7.2.17;Imaging Case Studies;215
7.2.17.1;Case 1: Spinal Dysraphism;215
7.2.17.2;Case 2: Scoliosis;216
7.2.18;Suggested Imaging protocols for Spinal Dysraphism and Scoliosis;217
7.2.18.1;Spinal Dysraphism;217
7.2.18.1.1;Spinal Ultrasound;217
7.2.18.1.2;Entire Spine MRI;217
7.2.18.2;Scoliosis;217
7.2.18.2.1;Scoliosis Radiographs;217
7.2.18.2.2;Entire Spine MRI;217
7.2.19;Future Research;217
7.2.20;References;218
7.3;15 Imaging of the Spine for Traumatic and Nontraumatic Etiologies;220
7.3.1;Definition and Pathophysiology;221
7.3.2;Epidemiology;221
7.3.3;Overall Cost to Society;221
7.3.4;Goals;221
7.3.5;Methodology;222
7.3.6;Discussion of Issues;222
7.3.7;I. Who Should Undergo Imaging of the Cervical Spine Following Trauma?;222
7.3.8;II. Who Should Undergo Imaging of the Thoracic and Lumbar Spine Following Trauma?;223
7.3.9;III. Who Should Undergo Imaging for Nontraumatic Back Pain?;223
7.3.10;IV. Special Case: Spondylolysis;224
7.3.11;Take Home Figures and Tables;225
7.3.12;Imaging Case Studies;225
7.3.12.1;Case 1;226
7.3.12.2;Case 2;226
7.3.13;Future Research;227
7.3.14;References;227
7.4;16 Imaging for Early Assessment of Peripheral Joints in Juvenile Idiopathic Arthritis;229
7.4.1;Definition and Pathophysiology;230
7.4.2;Epidemiology;230
7.4.3;Overall Cost to Society;231
7.4.4;Clinical and Laboratory Predictors;231
7.4.5;Goals;231
7.4.6;Methodology;232
7.4.7;Discussion of Issues;232
7.4.8;I. What Is the Diagnostic Performance of Radiography in JIA?;232
7.4.9;II. What Is the Diagnostic Performance of US and MRI in JIA?;232
7.4.10;III. Can US and/or MRI (Diagnostic Tests) Accurately Detect Synovial Hypertrophy in JIA Children?;233
7.4.11;IV. Can Cross-Sectional Imaging Modalities (US and/or MRI) Accurately Demonstrate Evidence of Cartilage Degeneration?;235
7.4.12;V. Is There an Association Between Imaging (US or/and MRI) Evidence of Cartilage Degeneration and Clinical Response to Treatment?;237
7.4.13;VI. What Is the Diagnostic Accuracy of Peripheral Quantitative Ultrasound (QUS) and Peripheral Computed Tomography (pQCT) to Detect Bone Changes in Children with JIA?;238
7.4.14;Take Home Figures and Tables;240
7.4.15;Imaging Case Studies;247
7.4.15.1;Case 1;248
7.4.15.2;Case 2;249
7.4.15.3;Case 3;250
7.4.16;Suggested Imaging Protocols for Juvenile Idiopathic Arthritis;250
7.4.16.1;Ultrasound;250
7.4.16.2;MRI;251
7.4.16.2.1;Large Joints (Knees, Ankles, Elbows, Shoulders);251
7.4.16.2.2;Small Joints (Wrists, Hands, Feet);251
7.4.17;Future Research;251
7.4.18;Appendix;251
7.4.19;References;252
7.5;17 Imaging of Hematogenous Osteomyelitis and Septic Arthritis in Children;254
7.5.1;Definition and Pathophysiology;255
7.5.2;Epidemiology;255
7.5.3;Overall Cost to Society;256
7.5.4;Goals;256
7.5.5;Methodology;256
7.5.6;Discussion of Issues;256
7.5.7;I. What Is the Diagnostic Performance of the Different Imaging Studies in Acute Hematogenous Osteomyelitis (AHOM)?;256
7.5.8;II. What Is the Diagnostic Performance of the Different Imaging Studies in the Evaluation of Subperiosteal and Soft Tissue Abscesses Associated with Acute Hematogenous Osteomyelitis?;258
7.5.9;III. What Is the Diagnostic Performance of the Different Imaging Studies in Chronic Osteomyelitis?;258
7.5.10;IV. What Is the Diagnostic Performance of the Different Imaging Studies in Septic Hip Arthritis?;259
7.5.11;Take Home Figure;260
7.5.11.1;What Are the Roles of the Imaging Modalities in the Evaluation of Acute Osteomyelitis and Septic Arthritis?;260
7.5.12;Imaging Case Studies;262
7.5.12.1;Case 1;262
7.5.12.2;Case 2;263
7.5.12.3;Case 3;264
7.5.12.4;Case 4;265
7.5.13;Suggested Imaging Protocols for Hematogenous Osteomyelitis and Septic Arthritis in Children;265
7.5.13.1;Radiography;265
7.5.13.2;Radionuclide Bone Scintigraphy;265
7.5.13.3;MRI;265
7.5.13.4;Ultrasound;265
7.5.14;Future Research;265
7.5.15;References;266
7.6;18 Imaging of Pediatric Bone Tumors: Osteosarcoma and Ewing Sarcoma;268
7.6.1;Definition and Pathophysiology;269
7.6.2;Epidemiology;269
7.6.3;Overall Cost to Society;270
7.6.4;Goals;270
7.6.5;Methodology;270
7.6.6;Discussion of Issues;270
7.6.7;I. What Is the Recommended Imaging Approach for Evaluation of Suspected Bone Tumors?;271
7.6.8;II. What Is the Best Imaging Modality for Local Staging of Pediatric Bone Sarcomas?;271
7.6.9;III. Do Imaging Findings of the Primary Tumor Have Prognostic Significance?;272
7.6.10;IV. What Is the Frequency of Skip Bone Metastases and What Is the Best Imaging Modality to Detect Them?;273
7.6.11;V. What Imaging Studies Should Be Performed for Staging of Pediatric Bone Sarcomas?;273
7.6.12;VI. What Is the Best Imaging Method to Assess Response to Chemotherapy?;274
7.6.13;VII. What Is the Appropriate Imaging Protocol for Posttreatment Surveillance of These Malignancies?;276
7.6.14;Take Home Tables;276
7.6.15;Imaging Case Studies;278
7.6.15.1;Case 1;278
7.6.15.2;Case 2;279
7.6.16;Suggested Imaging Protocols for Osteosarcoma and Ewings Sarcoma;279
7.6.16.1;Osteosarcoma Imaging Evaluation at Baseline;279
7.6.16.1.1;Anatomic Imaging;279
7.6.16.1.2;Functional Imaging;279
7.6.16.2;OS Baseline After Surgery;279
7.6.16.3;OS Surveillance During Chemotherapy;279
7.6.16.4;OS Surveillance After Chemotherapy;279
7.6.16.5;ES Imaging Evaluation at Baseline;280
7.6.16.5.1;Anatomic Imaging;280
7.6.16.5.2;Functional Imaging;280
7.6.16.6;ES Baseline After Surgery;280
7.6.16.7;ES Surveillance During Chemotherapy;280
7.6.16.8;ES Surveillance After Chemotherapy;280
7.6.17;Future Research;280
7.6.18;References;280
7.7;19 Imaging for Knee and Shoulder Injuries;283
7.7.1;Issues in Imaging the Pediatric Knee;283
7.7.1.1;Issues in Imaging Children with Acute Shoulder Injury;283
7.7.2;Definition and Pathophysiology;284
7.7.2.1;The Knee;284
7.7.2.1.1;Osteochondritis Dissecans;284
7.7.2.1.2;Discoid Lateral Meniscus;285
7.7.2.2;The Shoulder;285
7.7.3;Epidemiology;285
7.7.3.1;Acute Knee Trauma;285
7.7.3.1.1;Osteochondritis Dissecans;286
7.7.3.1.2;Discoid Lateral Meniscus;286
7.7.3.2;Acute Shoulder Trauma;286
7.7.4;Overall Cost to Society;286
7.7.4.1;The Knee;286
7.7.4.2;The Shoulder;286
7.7.5;Goals;286
7.7.5.1;The Knee;287
7.7.5.2;The Shoulder;287
7.7.6;Methodology;287
7.7.7;Discussion of Issues: Knee;287
7.7.8;I. What Is the Role of Radiographs in Children with an Acute Knee Injury and Possible Fracture?;287
7.7.9;II. When Should MRI Be Used in Children with Suspected Meniscal, Ligamentous, or Articular Cartilage Injuries?;288
7.7.10;III. What Is the Role of Imaging in the Evaluation of Osteochondritis Dissecans?;290
7.7.11;IV. What Is the Role of Imaging in the Evaluation of Discoid Lateral Meniscus?;291
7.7.12;Discussion of Issues: Shoulder;292
7.7.13;I. When Is Radiography Indicated for Children with Acute Shoulder Trauma?;292
7.7.14;II. What Is the Role of MRI in Shoulder Dislocation?;294
7.7.15;Take Home Tables;295
7.7.16;Imaging Case Studies;297
7.7.16.1;Case 1;297
7.7.16.2;Case 2;298
7.7.16.3;Case 3;298
7.7.17;Suggested Imaging Protocol for the Knee and the Shoulder;298
7.7.17.1; The Knee ;298
7.7.17.1.1;Radiography;299
7.7.17.1.2;MRI;299
7.7.17.2;The Shoulder;299
7.7.17.2.1;Radiography;299
7.7.18;Future Research;299
7.7.18.1;The Knee;299
7.7.18.2;The Shoulder;299
7.7.19;References;299
7.8;20 Developmental Dysplasia of the Hip;302
7.8.1;Definition and Pathophysiology;303
7.8.2;Epidemiology;303
7.8.3;Overall Cost to Society;303
7.8.4;Goals;304
7.8.5;Methodology;304
7.8.6;Discussion of Issues;304
7.8.7;I. What Are the Clinical Findings of DDH and How Effective Are Clinicians at Detecting Them?;304
7.8.8;II. What Is the Natural History of Undetected DDH?;305
7.8.9;III. How Accurate Is US Imaging in Depicting Hip Anatomy and DDH?;306
7.8.10;IV. How Effective Is Imaging in the Diagnosis and Treatment of DDH?;307
7.8.11;V. Is There a Case for US Screening in Newborns to Detect DDH?;309
7.8.12;Take Home Figures and Tables;310
7.8.13;Imaging Case Studies;313
7.8.13.1;Case 1;313
7.8.13.2;Case 2;314
7.8.14;Suggested Imaging Protocols for Developmental Dysplasia of the Hip;314
7.8.14.1;Screening for DDH;314
7.8.15;Future Research;314
7.8.16;References;314
7.9;21 Slipped Capital Femoral Epiphysis;317
7.9.1;Definition and Pathophysiology;317
7.9.2;Epidemiology;318
7.9.3;Overall Cost to Society;318
7.9.4;Goals;318
7.9.5;Methodology;319
7.9.6;Discussion of Issues;319
7.9.7;I. What Is the Diagnostic Performance of Radiographs in the Initial Diagnosis of Slipped Capital Femoral Epiphysis?;319
7.9.8;II. What Is the Diagnostic Performance of Magnetic Resonance Imaging in the Initial Diagnosis of Slipped Capital Femoral Epiphysis?;319
7.9.9;III. What Is the Diagnostic Performance of Ultrasound Imaging in the Diagnosis of Slipped Capital Femoral Epiphysis?;320
7.9.10;IV. What Is the Role of CT in Preoperative Planning?;320
7.9.11;V. What Is the Imaging Method of Choice in Suspected Avascular Necrosis Associated with the Treatment of Slipped Capital Femoral Epiphysis?;320
7.9.12;Take Home Tables;321
7.9.13;Case Imaging Studies;322
7.9.13.1;Case 1;322
7.9.14;Suggested Imaging Protocols for Slipped Capital Femoral Epiphysis;323
7.9.14.1;Radiographs;323
7.9.14.2;CT;323
7.9.14.3;MRI and Nuclear Medicine;323
7.9.15;Future Research;323
7.9.16;References;323
7.10;22 Imaging of Legg–Calvé–PerthesDisease in Children;324
7.10.1;Definition and Pathophysiology;325
7.10.2;Epidemiology;325
7.10.3;Overall Cost to Society;325
7.10.4;Goals;326
7.10.5;Methodology;326
7.10.6;Discussion of Issues;326
7.10.7;I. What Is the Role of Imagingin the Diagnosis of Legg–Calvé–Perthes Disease?;327
7.10.8;II. Can Plain Radiographs Establish the Prognosis of the Disease?;327
7.10.9;III. Is MRI the Best Imaging Modality to Determine the Extent of Disease and Establish Important Predictors in LeggCalvPerthes?;328
7.10.10;IV. Can Patterns of Healing and Reperfusion Assessed by Scintigraphy, US, or MRI Predict the Ultimate Outcome of the Disease?;329
7.10.11;Take Home Figures and Tables;330
7.10.12;Imaging Case Studies;331
7.10.12.1;Case 1;331
7.10.12.2;Case 2;331
7.10.13;Suggested Imaging Protocol for LeggCalvPerthes Disease in Children;331
7.10.14;Future Research;331
7.10.15;References;332
7.11;23 Fractures of the Ankle;334
7.11.1;Definition and Pathophysiology;335
7.11.2;Epidemiology;335
7.11.3;Overall Cost to Society;335
7.11.4;Goals;335
7.11.5;Methodology;335
7.11.6;Discussion of Issues;336
7.11.7;I. What Are the Clinical Indications for Obtaining the Ankle X-ray Series Following Trauma in a Child?;336
7.11.8;II. What Is the Diagnostic Performance of Computed Tomography in the Investigation of Ankle Fractures in Children?;336
7.11.9;III. What Is the Diagnostic Performance of Magnetic Resonance Imaging in the Investigation of Ankle Injuries in Children?;337
7.11.10;IV. What Is the Diagnostic Performance of Ultrasound in the Investigation of Ankle Injuries in Children?;337
7.11.11;Take Home Tables;338
7.11.12;Imaging Case Studies;339
7.11.12.1;Case 1;339
7.11.12.2;Case 2;340
7.11.13;Suggested Imaging Protocol for Fractures of the Ankle;341
7.11.13.1;Radiographs;341
7.11.13.2;CT and MRI;341
7.11.14;Future Research;341
7.11.15;References;341
8;Part IV Chest Imaging;342
8.1;24 Evidence-Based Approach to Imaging of Congenital Heart Disease;343
8.1.1;Introduction, Pathophysiology, and Definitions;344
8.1.2;Epidemiology;344
8.1.3;Overall Cost to Society;345
8.1.4;Goals;345
8.1.5;Methodology;345
8.1.6;Discussion of Issues;346
8.1.7;I. What Is the Role of Conventional Chest Radiography in Initial Diagnosis of CHD?;346
8.1.8;II. What Is the Role of Routine Daily Chest Radiography in the Pediatric Cardiac Intensive Care Unit and in the Immediate Post-operative Period for CHD?;347
8.1.9;Pediatric Studies;347
8.1.10;III. How Does MRI Compare with Echocardiography in Evaluating RV Size and Function in CHD?;347
8.1.11;IV. Can MRI Determine Clinical Outcome and Timing of Pulmonary Valve Replacement in Repaired Tetralogy of Fallot?;349
8.1.12;MRI Predictors of Adverse Clinical Outcome in Repaired Tetralogy of Fallot;349
8.1.13;Timing of Pulmonary Valve Replacement;350
8.1.14;V. Can MRI Replace Routine Cardiac Catheterization in the Evaluation of Patients Undergoing Single-Ventricle Repair?;350
8.1.15;VI. What Is the Role of CT in CHD?;351
8.1.16;Take Home Tables;352
8.1.17;Imaging Case Studies;354
8.1.17.1;Case 1;355
8.1.17.2;Case 2;356
8.1.17.3;Case 3;357
8.1.17.4;Case 4;358
8.1.17.5;Case 5;359
8.1.18;Suggested Protocols for Imaging of Congenital Heart Disease;359
8.1.18.1;MRI Protocol for Repaired Tetralogy of Fallot;359
8.1.18.2;MRI Protocol for Patients Undergoing Single-Ventricle Repair Prior to Superior and Total Cavopulmonary Connection;360
8.1.19;Future Research;360
8.1.20;References;360
8.2;25 Congenital Disease of the Aortic Arch: Coarctation and Arch Anomalies;363
8.2.1;Definition;364
8.2.1.1;Thoracic Aorta Coarctation;364
8.2.1.2;Vascular Ring;365
8.2.1.3;Pulmonary Sling;366
8.2.2;Epidemiology;366
8.2.2.1;Coarctation;366
8.2.2.2;Aortic Arch Anomaly;366
8.2.3;Overall Cost to Society;367
8.2.4;Goals;368
8.2.5;Methodology;368
8.2.6;Discussion of Issues;369
8.2.7;I. Which Clinical Symptoms and Signs May Suggest the Presence of Coarctation or an Aortic Arch Anomaly?;369
8.2.7.1;Coarctation;369
8.2.7.2;Aortic Arch Anomaly;370
8.2.8;II. What Is the Natural History of Thoracic Aorta Coarctation and Aortic Arch Anomalies?;370
8.2.8.1;Coarctation;370
8.2.8.2;Aortic Arch Anomaly;372
8.2.9;III. What Are the Diagnostic Performances of Imaging Modalities Used to Evaluate Suspected Coarctation and Aortic Arch Anomalies?;372
8.2.9.1;Coarctation;372
8.2.9.2;Aortic Arch Anomaly;374
8.2.10;Take Home Figures;376
8.2.11;What Is the Diagnostic Imaging Workflow for Suspected Thoracic Aorta Coarctation?;376
8.2.12;What Is the Diagnostic Imaging Workflow for a Suspected Aortic Arch Anomaly?;377
8.2.13;Take Home Tables;378
8.2.14;Imaging Case Studies;379
8.2.14.1;Case 1;379
8.2.14.2;Case 2;380
8.2.15;Suggested Imaging Protocols for Coarctation and Arch Anomalies;381
8.2.15.1;Plain Radiograph;381
8.2.15.2;Esophagram;381
8.2.15.3;MRI;381
8.2.15.4;CTA;381
8.2.15.5;Echocardiogram;381
8.2.16;Future Research;381
8.2.17;References;381
8.3;26 Imaging Evaluation of Mediastinal Masses in Infants and Children;384
8.3.1;Definition and Pathophysiology;385
8.3.2;Epidemiology;386
8.3.3;Overall Cost to Society;386
8.3.4;Goals;386
8.3.5;Methodology;387
8.3.6;Discussion of Issues;387
8.3.7;I. What Are the Clinical Findings that Raise Suspicion for Possible Mediastinal Masses in Infants and Children?;387
8.3.8;II. What Is the Diagnostic Performance of the Major Methods to Image Infants and Children with Mediastinal Masses?;388
8.3.9;III. Which Imaging Approach Is Most Appropriate in Differentiating Normal Thymus from Abnormal Anterior Mediastinal Masses in Infants?;390
8.3.10;IV. Which Imaging Modality Is Best Equipped to Evaluate Anterior Mediastinal Masses in Infants and Children?;391
8.3.11;V. Which Imaging Modality Is Most Appropriate for Evaluating Middle Mediastinal Masses in Infants and Children?;392
8.3.12;VI. What Is the Recommended Imaging Modality for Evaluating Neurogenic Tumors in the Posterior Mediastinum in Infants and Children?;393
8.3.13;VII. What Is the Role of PET in the Management of Childhood Lymphomas?;394
8.3.14;Take Home Figures;395
8.3.14.1;What Are the Various Roles of the Principal Imaging Modalities in Evaluating Mediastinal Masses in Infants and Children?;395
8.3.15;Take Home Tables;396
8.3.16;Imaging Case Studies;398
8.3.16.1;Case 1;398
8.3.16.2;Case 2;398
8.3.17;Suggested Imaging Protocols;399
8.3.17.1;Plain Radiographs;399
8.3.17.2;Ultrasound;399
8.3.17.3;CT;399
8.3.17.4;MRI;399
8.3.17.5;PET;399
8.3.18;Future Research;399
8.3.19;References;400
8.4;27 Imaging of Chest Infections in Children;403
8.4.1;Definition and Pathophysiology;404
8.4.1.1;Pleural Effusion and Empyema;404
8.4.1.2;Lung Abscess;405
8.4.2;Epidemiology;405
8.4.3;Overall Cost to Society;405
8.4.4;Goals;406
8.4.5;Methodology;406
8.4.6;Discussion of Issues;406
8.4.7;I. What Are the Clinical Presentation and Predictors of Chest Infections in Children, and Which Findings Raise the Suspicion for Complications?;406
8.4.7.1;Viral Versus Bacterial Pneumonia;407
8.4.8;II. When Are Chest Radiographs Useful in Children with Suspected Pneumonia?;407
8.4.9;III. How Does Chest Radiography Compare to Cross-Sectional Imaging in the Evaluation of Chest Infections in Children? When Is Chest CT Indicated?;408
8.4.10;IV. What Is the Role and Diagnostic Performance of Imaging Studies (Radiography, Ultrasound, and CT) for Treatment Planning of Complicated Pneumonia with Empyema and Parapneumonic Effusions?;410
8.4.11;V. What Are the Relative Roles of Imaging in Medical Therapy, Minimally Invasive Intervention such as Thoracotomy or Thoracentesis, and Surgical Treatment for Pneumonia Complicated by Pleural Involvement?;411
8.4.12;Take Home Tables and Figures;412
8.4.13;Case Imaging Studies;418
8.4.13.1;Case 1;418
8.4.14;Suggested Imaging Protocols;419
8.4.14.1;Radiography;419
8.4.14.2;Ultrasound;419
8.4.14.3;Chest CT;419
8.4.15;Future Research;419
8.4.16;References;419
8.5;28 Imaging of Asthma in Children;421
8.5.1;Definition and Pathophysiology;422
8.5.2;Epidemiology;423
8.5.2.1;Asthma Attack Prevalence;423
8.5.2.2;Lifetime Asthma Diagnosis;423
8.5.3;Overall Cost to Society;424
8.5.4;Methodology;424
8.5.5;Discussion of Issues;425
8.5.6;I. Are Chest Radiographs Indicated in Patients with Acute Asthma?;425
8.5.7;II. What Are the Radiographic Findings of Importance in Uncomplicated Versus Complicated Asthma?;426
8.5.8;III. What Is the Role of CT in Patients with Asthma?;428
8.5.9;Take Home Tables;430
8.5.10;Imaging Case Studies;431
8.5.10.1;Case 1;431
8.5.10.2;Case 2;431
8.5.11;Suggested Protocol for Imaging for Asthma in Children;432
8.5.11.1;Chest Radiograph;432
8.5.11.2;HRCT;432
8.5.12;Future Research;432
8.5.13;References;432
9;Part V Abdominal Imaging;434
9.1;29 Imaging of Clinically Suspected Malrotation in Children;435
9.1.1;Definition and Pathophysiology;436
9.1.2;Epidemiology;436
9.1.3;Overall Cost to Society;437
9.1.4;Goals;437
9.1.5;Methodology;437
9.1.6;Discussion of Issues;437
9.1.7;I. What Are the Clinical Predictors of Malrotation and Volvulus?;437
9.1.8;II. Who Should Undergo Imaging? What Is the Diagnostic Performance of Imaging in the Diagnosis or Exclusion of Malrotation?;438
9.1.8.1;Abdominal Radiographs;438
9.1.8.2;UGI Series;438
9.1.8.3;Contrast Enema;439
9.1.8.4;Cross-Sectional Imaging (US, CT, and MR);439
9.1.8.5;Volvulus: Diagnostic Performance of UGI, Sonography, and CT;439
9.1.9;III. How Should the UGI Series Be Performed? What Imaging Is Appropriate in Indeterminate Cases?;439
9.1.9.1;What Imaging Is Appropriate in Indeterminate UGI Cases?;440
9.1.10;IV. Special Situation: The Older Child (at Low Risk?);441
9.1.11;V. Special Situation: The Infant or Child with Heterotaxy Syndrome;441
9.1.12;Take Home Tables;442
9.1.13;Imaging Case Studies;444
9.1.13.1;Cases 1 and 2;444
9.1.14;Suggested Imaging Protocol for Clinically Suspected Malrotation in Children;445
9.1.15;Future Research;445
9.1.16;References;445
9.2;30 Imaging of Infantile Hypertrophic Pyloric Stenosis (IHPS);447
9.2.1;Definition, Clinical Presentation, and Pathophysiology;448
9.2.2;Epidemiology;448
9.2.3;Overall Cost to Society;449
9.2.4;Goals;449
9.2.5;Methodology;449
9.2.6;Discussion of Issues;450
9.2.7;I. What Are the Clinical Findings that Raise the Suspicion for IHPS and Direct Further Investigation?;450
9.2.8;II. What Is the Diagnostic Performance of the Clinical and Imaging Examinations in IHPS?;450
9.2.9;III. Is There a Role for Follow-Up Imaging in IHPS?;453
9.2.10;IV. What Is the Natural History of IHPS and Patient Outcome with Medical Therapy Versus Surgical Therapy?;454
9.2.11;Take Home Figures and Tables;455
9.2.12;Imaging Case Studies;456
9.2.12.1;Case 1;456
9.2.12.2;Case 2;456
9.2.13;Future Research;456
9.2.14;References;456
9.3;31 Intussusception in Children: Diagnostic Imaging and Treatment;458
9.3.1;Definition and Pathophysiology;459
9.3.2;Epidemiology;459
9.3.2.1;Rotavirus Vaccine;460
9.3.3;Overall Cost to Society;460
9.3.4;Goals;460
9.3.5;Methodology;460
9.3.6;Discussion of Issues;460
9.3.7;I. What Are the Clinical Predictors of Intussusception? What Are the Clinical Predictors of Reducibility and Bowel Necrosis? Who Should Undergo Imaging?;461
9.3.8;II. Which Imaging Studies Should Be Performed?;461
9.3.9;III. How Should Therapeutic Enema Be Performed?;463
9.3.9.1;Air Versus Liquid Enema;463
9.3.9.2;The Rule of Threes;464
9.3.9.3;Radiation Dose;464
9.3.9.4;Alternative Enema Approaches;465
9.3.9.5;Fluoroscopy Versus Sonography;465
9.3.9.6;Delayed Repeat Enema;465
9.3.10;Where Should Patients Be Treated?;465
9.3.10.1;What Are the Complications of Enema Therapy?;465
9.3.10.2;What Are the Surgical Management and Complications?;466
9.3.10.3;Cost-Effectiveness Analysis;466
9.3.11;IV. What Is Appropriate Management in Recurrent Cases?;466
9.3.12;V. Special Case: Intussusception Limited to the Small Bowel;467
9.3.13;VI. Special Case: Intussusception with a Known Lead Point Mass;467
9.3.14;Take Home Tables;468
9.3.15;Imaging Case Study;469
9.3.15.1;Case 1;469
9.3.16;Suggested Imaging Protocol for Intussusception in Children;470
9.3.16.1;Ultrasound for Clinically Suspected Intussusception;470
9.3.16.2;Air Enema for Reduction;470
9.3.17;Future Research Studies;470
9.3.18;References;470
9.4;32 Imaging of Appendicitis in Pediatric Patients;473
9.4.1;Definition and Pathophysiology;474
9.4.2;Epidemiology;474
9.4.3;Overall Cost to Society;474
9.4.4;Goals;474
9.4.5;Methodology;474
9.4.6;Discussion of Issues;475
9.4.7;I. What Is the Accuracy of Imaging for Diagnosing Acute Appendicitis in Children?;475
9.4.8;II. In Which Cases of Suspected Pediatric Appendicitis Is Imaging Indicated?;477
9.4.9;III. What Is the Effect of Imaging on the Rate of Negative Appendectomy in Pediatric Patients with Suspected Appendicitis?;478
9.4.10;IV. What Is the Role of Imaging in Managing Pediatric Perforated Appendicitis?;479
9.4.11;V. What Is the Effect of Imaging Pediatric Patients with Suspected Appendicitis on Health-Care Costs?;480
9.4.12;Take Home Tables;481
9.4.13;Imaging Case Studies;482
9.4.13.1;Case 1;482
9.4.13.2;Case 2;483
9.4.14;Suggested Imaging Protocols for Suspected Appendicitis;483
9.4.15;Future Research;483
9.4.16;References;483
9.5;33 Imaging of Inflammatory Bowel Disease in Children;485
9.5.1;Definition and Pathophysiology;486
9.5.2;Epidemiology and Diagnosis;486
9.5.3;Overall Cost to Society;487
9.5.4;Goals;487
9.5.5;Methodology;487
9.5.6;Discussion of Issues;488
9.5.7;I. What Are the Important Clinical Predictors of IBD?;488
9.5.7.1;Laboratory Markers;488
9.5.7.2;Children Under Age 5 Years;488
9.5.8;II. What Is the Diagnostic Performance of Current Endoscopic Techniques in the Evaluation of Patients with IBD: Lower, Upper Endoscopies and Wireless Capsule Endoscopy (WCE)?;488
9.5.9;III. What Is the Diagnostic Performance of Current Imaging Modalities in Evaluating IBD of the Small Bowel (Small Bowel Follow-Through, CT, MR, US, Enteroclysis)?;490
9.5.10;IV. Complications of IBD (Intra-abdominal Abscess, Intestinal Fistulae, Strictures and Small Bowel Obstruction, Primary Sclerosing Cholangitis [PSC]): Which Imaging Should Be Performed and What Is Its Diagnostic Performance?;493
9.5.11;V. What Are the Most Important Imaging Features That Lead to Surgery in a Child with Crohns Disease and Ulcerative Colitis?;494
9.5.11.1;Role of Conventional Barium Fluoroscopy and Multidetector CT;495
9.5.11.2;Role of Enteroclysis (CT/MR) and Enterography (CT/MR);495
9.5.12;VI. What Are the Role and Risk of Repeat Imaging in Monitoring IBD Response to Treatment?;496
9.5.13;VII. Special Situation: Which Imaging Modality Provides the Best Performance for the Evaluation of Perianal/Perirectal Disease in Crohns Disease?;497
9.5.14;Take Home Tables and Figures;497
9.5.15;Imaging Case Studies;500
9.5.15.1;Case 1;500
9.5.15.2;Case 2;501
9.5.15.3;Case 3;502
9.5.16;Suggested Imaging Protocols for Inflammatory Bowel Disease in Children;502
9.5.16.1;Definition of Imaging Techniques;502
9.5.16.1.1;Upper gastrointestinal study with SBFT;502
9.5.16.2;General IBD Algorithm;502
9.5.16.3;Clinical and Imaging Pathways for CD and UC;503
9.5.17;Future Research;503
9.5.18;References;503
9.6;34 Pediatric Abdominal Tumors: Neuroblastoma;506
9.6.1;Definition and Pathophysiology;507
9.6.2;Epidemiology;507
9.6.3;Overall Cost to Society;508
9.6.4;Goals;508
9.6.5;Methodology;508
9.6.6;Discussion of Issues;508
9.6.7;I. What Are the Clinical Findings that Raise the Suspicion for Neuroblastoma?;508
9.6.8;II. What Is the Diagnostic Performance of the Different Imaging Studies in the Assessment of the Primary Tumor Mass in Patients with Neuroblastoma?;509
9.6.9;III. What Are the Essential Features that Need to Be Assessed by Imaging Studies in Patients with Neuroblastoma for Surgical Planning and Staging?;509
9.6.10;IV. What Is the Diagnostic Performance of the Different Imaging Studies in the Detection of Regional Disease in Patients with Neuroblastoma?;510
9.6.11;V. What Is the Diagnostic Performance of the Different Imaging Studies in the Detection of Distant Metastases in Patients with Neuroblastoma?;510
9.6.12;VI. Special Situations: The Child Who Presents with Opsoclonus-Myoclonus Syndrome or Intractable Watery Diarrhea;512
9.6.13;Take Home Figures and Tables;512
9.6.14;What Are the Roles of the Imaging Modalities in the Evaluation of Wilms Tumor?;512
9.6.15;Imaging Case Studies;513
9.6.15.1;Case 1;514
9.6.15.2;Case 2;515
9.6.15.3;Case 3;516
9.6.15.4;Case 4;517
9.6.15.5;Case 5;518
9.6.15.6;Case 6;518
9.6.15.7;Case 7;519
9.6.16;Suggested Imaging Protocols for Pediatric Neuroblastoma;519
9.6.16.1;Ultrasound;519
9.6.16.2;Chest Radiography;519
9.6.16.3;CT;519
9.6.16.4;MRI;519
9.6.16.5;99mTc Bone Scintigraphy;520
9.6.16.6;123I-MIBG Scintigraphy ;520
9.6.17;Future Research;520
9.6.18;References;520
9.7;35 Pediatric Abdominal Tumors: Wilms Tumor;522
9.7.1;Definition and Pathophysiology;523
9.7.2;Epidemiology;523
9.7.3;Overall Cost to Society;524
9.7.4;Goals;524
9.7.5;Methodology;524
9.7.6;Discussion of Issues;524
9.7.7;I. What Are the Clinical Findings That Raise the Suspicion for Wilms Tumor?;524
9.7.8;II. What Is the Diagnostic Performance of the Different Imaging Studies in the Detection of the Primary Tumor Mass in Patients with Wilms Tumor?;525
9.7.9;III. What Are the Essential Features That Need to be Assessed on Imaging Studies in Patients with Wilms Tumor for Surgical Planning or Staging?;525
9.7.10;IV. What Is the Diagnostic Performance of the Different Imaging Studies in the Detection of Regional Disease in Patients with Wilms Tumor?;526
9.7.11;V. What Is the Diagnostic Performance of the Different Imaging Studies in the Detection of Distant Disease in Patients with Wilms Tumor?;527
9.7.12;VI. Is Screening Indicated in Children at Higher Risk of Wilms Tumor?;527
9.7.13;VII. What Is the Role of Imaging for Follow-Up of Wilms Tumor at the End of Treatment?;528
9.7.14;Take Home Figures and Tables;528
9.7.14.1;What Are the Roles of the Imaging Modalities in the Evaluation of Wilms Tumor?;528
9.7.15;Imaging Case Studies;530
9.7.15.1;Case 1;530
9.7.15.2;Case 2;531
9.7.15.3;Case 3;532
9.7.15.4;Case 4;532
9.7.15.5;Case 5;532
9.7.15.6;Case 6;533
9.7.16;Suggested Imaging Protocols for Wilms Tumor;533
9.7.16.1;Ultrasound;533
9.7.16.2;CT;533
9.7.16.3;MRI;533
9.7.17;Future Research;533
9.7.18;References;533
9.8;36 Imaging of Blunt Trauma to the Pediatric Torso;535
9.8.1;Definition and Pathophysiology;536
9.8.2;Epidemiology;536
9.8.3;Overall Cost to Society;536
9.8.4;Goals;536
9.8.5;Methodology;536
9.8.6;Discussion of Issues;536
9.8.7;I. What Are the Priorities in Caring for Pediatric Victims of Trauma? What Are the Goals for Diagnostic Testing Relative to These Priorities?;536
9.8.7.1;Cost-Effectiveness Analysis;537
9.8.8;II. Among Pediatric Victims of Trauma, Who Needs to Be Imaged? What Are the Clinical Indications Warranting Diagnostic Imaging?;537
9.8.8.1;Cost-Effectiveness Analysis;538
9.8.9;III. Which Pediatric Victims of Trauma Should Undergo Multiphase CT and Follow-Up Imaging?;538
9.8.9.1;Cost-Effectiveness Analysis;539
9.8.10;IV. How Should Children with Trauma Be Imaged? What Are the Performance Characteristics of Available Imaging Modalities?;539
9.8.10.1;Thorax;539
9.8.10.1.1;Aorta and Great Vessels;539
9.8.10.1.2;Chest Wall;540
9.8.10.1.3;Pleura and Lung;540
9.8.10.1.4;Aerodigestive Tract;540
9.8.10.1.5;Diaphragm;540
9.8.10.2;Abdomen and Pelvis (Table 36.3);540
9.8.10.2.1;Imaging Modalities;540
9.8.10.2.2;Liver;541
9.8.10.2.3;Spleen;541
9.8.10.2.4;Pancreas;541
9.8.10.2.5;Kidneys and Ureters;541
9.8.10.3;Hollow Viscus;541
9.8.10.3.1;Stomach;541
9.8.10.3.2;Duodenum;542
9.8.10.3.3;Small Bowel, Colon, and Mesentery;542
9.8.10.3.4;Urinary Bladder and Urethra;542
9.8.10.3.5;Vascular;542
9.8.10.4;Cost-Effectiveness Analysis;542
9.8.11;V. Special Issue: What Are the Blind Spots in Imaging? How Can These Blind Spots Be Addressed?;543
9.8.12;Take Home Tables;543
9.8.13;Imaging Case Studies;545
9.8.13.1;Case 1;545
9.8.13.2;Case 2;546
9.8.13.3;Case 3;546
9.8.14;Suggested Imaging Protocols for Blunt Trauma to the Pediatric Torso;546
9.8.14.1;Abdominal and Pelvic CT;546
9.8.14.2;FAST;546
9.8.15;Future Research;546
9.8.16;References;547
9.9;37 Imaging of Nephrolithiasis and Urinary Tract Calculi in Children;550
9.9.1;Definition, Pathophysiology, and Epidemiology;551
9.9.2;Overall Cost to Society;551
9.9.3;Goals;551
9.9.4;Methodology;551
9.9.5;Discussion of Issues;552
9.9.6;I. What Are the Clinical Findings That Raise the Suspicion for Urolithiasis?;552
9.9.7;II. What Is the Diagnostic Performance of the Different Imaging Studies in Nephrolithiasis and Urinary Tract Calculi in the Pediatric Population?;552
9.9.7.1;Special Case: Bladder Calculi;555
9.9.8;III. What Is the Natural History of Nephrolithiasis and Urinary Tract Calculi and What Are the Roles of Medical Therapy Versus Extracorporeal Shock Wave Lithotripsy (ESWL) or Surgical Management?;555
9.9.9;IV. Special Case: Will the Stone Pass on Its Own?;555
9.9.10;V. What Is the Role of Repeat Imaging in Children with Known Stone? In Children with Recurrent Symptoms (Suggesting Obstructing Stone)?;556
9.9.11;Take Home Tables and Figures;556
9.9.11.1;What Are the Roles of the Imaging Modalities in the Evaluation of Urolithiasis?;556
9.9.12;Imaging Case Studies;557
9.9.12.1;Case 1;557
9.9.12.2;Case 2;558
9.9.12.3;Case 3;558
9.9.12.4;Case 4;559
9.9.13;Suggested Imaging Protocols Nephrolithiasis and Urinary Tract Calculi in Children;559
9.9.13.1;Plain Radiograph;559
9.9.13.2;Ultrasound;559
9.9.13.3;MDCT;559
9.9.13.4;MRI;559
9.9.14;Future Research;559
9.9.15;References;559
9.10;38 Urinary Tract Infection in Infants and Children;564
9.10.1;Definitions and Pathophysiology;565
9.10.2;Epidemiology;566
9.10.3;Overall Cost to Society;566
9.10.4;Goals;566
9.10.5;Methodology;567
9.10.6;Discussion of Issues;567
9.10.7;I. What Is Known About the Natural History of Urinary Tract Infections in Infants and Children?;567
9.10.8;II. What Can Imaging Reveal in the Setting of UTI?;568
9.10.9;III. What Are Reasonable Imaging Strategies When Caring for a Male Infant or Child with a History of a Febrile Urinary Tract Infection?;570
9.10.10;IV. What Are Reasonable Imaging Strategies When Caring for a Female Infant or Child with a History of a Febrile Urinary Tract Infection?;570
9.10.11;V. Special Case: Postnatal Management of Fetal Hydronephrosis;571
9.10.12;Take Home Tables and Figures;572
9.10.13;Imaging Case Studies;578
9.10.13.1;Case 1;578
9.10.13.2;Case 2;579
9.10.13.3;Case 3;580
9.10.13.4;Case 4;582
9.10.13.5;Case 5;583
9.10.14;Suggested Imaging Protocols for Urinary Tract Infections in Infants and Children;584
9.10.15;Future Research;584
9.10.16;References;584
9.11;39 Imaging of Female Children and Adolescents with Abdominopelvic Pain Caused by Gynecological Pathologies;588
9.11.1;Definition;589
9.11.2;Pathology and Epidemiology;589
9.11.2.1;Congenital Anomalies;589
9.11.2.2;Endometriosis;589
9.11.2.3;Pelvic Inflammatory Disease;590
9.11.2.4;Adnexal Torsion;590
9.11.2.5;Abdominopelvic Mass;590
9.11.2.6;Pregnancy;591
9.11.3;Overall Cost to Society;591
9.11.3.1;Pelvic Inflammatory Disease;591
9.11.3.2;Endometriosis;591
9.11.4;Goals;592
9.11.5;Methodology;592
9.11.6;Discussion of Issues;592
9.11.7;I. What Is the Diagnostic Performance of the Different Imaging Studies for the Diagnosis or Exclusion of Ovarian Torsion?;592
9.11.8;II. What Is the Best Imaging Technique for the Diagnosis of PID?;593
9.11.9;III. What Is the Best Imaging Technique for the Diagnosis of Endometriosis?;593
9.11.10;IV. What Is the Best Technique for the Diagnosis of an Ectopic Pregnancy?;593
9.11.11;Take Home Tables;594
9.11.12;Imaging Case Studies;595
9.11.12.1;Case 1;595
9.11.12.2;Case 2;595
9.11.13;Suggested Imaging Protocols;596
9.11.13.1;Plain Radiographs;596
9.11.13.2;Ultrasound;596
9.11.13.3;MDCT;596
9.11.13.4;MRI;596
9.11.14;Future Research;596
9.11.15;References;596
9.12;40 Imaging of Boys with an Acute Scrotum: Differentiation of Testicular Torsion from Other Causes;598
9.12.1;Definition and Pathophysiology;599
9.12.2;Epidemiology;599
9.12.3;Overall Cost to Society;599
9.12.4;Goals;600
9.12.5;Methodology;600
9.12.6;Discussion of Issues;600
9.12.7;I. What Are the Clinical Findings That Raise the Suspicion of Testicular Torsion in Children with Acute Scrotal Pain?;600
9.12.8;II. What Is the Diagnostic Performance of the Different Imaging Studies in Children with Acute Scrotal Pain?;600
9.12.9;III. In Cases of Testicular Torsion, Is Manual Reduction Required?;602
9.12.10;Take Home Figures and Tables;602
9.12.11;Imaging Case Studies;604
9.12.11.1;Case 1;604
9.12.12;Suggested Imaging Protocols for Acute Scrotum;605
9.12.12.1;Ultrasound;605
9.12.12.2;Manual Detorsion;605
9.12.13;Future Research;605
9.12.14;References;605
10;Part VI Prenatal Imaging;608
10.1;41 Imaging of Fetal Anomalies;609
10.1.1;Definition and Pathophysiology;610
10.1.2;Epidemiology;610
10.1.3;Overall Cost to Society;610
10.1.4;Goals;611
10.1.5;Methodology;611
10.1.6;Discussion of Issues;611
10.1.7;I. Does Early Fetal Imaging (Before 24 Weeks Gestation) Improve Maternal or Fetal Outcome?;611
10.1.8;II. Does Third Trimester Fetal Imaging Improve Maternal or Fetal Outcome?;613
10.1.9;III. Is US Safe for Imaging the Fetus?;614
10.1.10;IV. Is MRI Safe for Imaging the Fetus?;615
10.1.11;V. What Is the Diagnostic Performance of US and MRI in the Assessment of Fetal Anomalies?;616
10.1.12;VI. What Is the Role of MR Imaging in the Evaluation of the Fetus?;618
10.1.13;Take Home Tables;618
10.1.14;Imaging Case Studies;620
10.1.14.1;Case 1;620
10.1.14.2;Case 2;620
10.1.14.3;Case 3;621
10.1.14.4;Case 4;622
10.1.15;Suggested Imaging Protocols for Fetal Anomalies;622
10.1.15.1;Ultrasound;622
10.1.15.2;MRI;622
10.1.16;Future Research;623
10.1.17;References;623
11;Index;626
