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Fetal CNS MRI

Since first being performed in 1986, fetal MRI has rapidly become a standard of care for the secondary evaluation of fetal abnormalities involving the central nervous system (CNS) and thoracic and abdominopelvic cavities. Fetal MRI is most commonly performed for the evaluation of the fetal CNS when prenatal ultrasound demonstrates an abnormality. This chapter will provide an overview of fetal MRI by addressing foundations of fetal…

Fetal Body MRI

Why Fetal Body Magnetic Resonance Imaging? Imaging is an essential component of the evaluation and care of the developing fetus. Ultrasound remains the core screening modality because of its availability, safety profile, and low cost. Standard of care includes a complete anatomy scan during the second trimester to assess for appropriate development. When anomalies are identified, ultrasound is critical in the assessment of fetal well-being, including…

Dose Optimization and Risk Management in Pediatric CT

The radiologist’s most obvious “product” is the interpretation rendered for an imaging study. Although this visible document is a key component of the radiologist’s job, it is only one of many responsibilities under the modern radiologist’s purview. Many radiologists also oversee departmental practice functions, including, but not limited to, licensing and certification requirements, regulatory compliance, quality improvement, patient and staff safety, equipment purchasing and maintenance, patient…

Child Abuse (Radiology)

Background Among the first to identify issues related to child abuse, Dr. John Caffey studied and published results in 1946 detailing multiple unexplained long-bone fractures of apparent traumatic origin in infants with chronic subdural hematomas. His work is cited in the landmark 1962 article, “The Battered-Child Syndrome,” by Dr. C. Henry Kempe et al. Kempe and colleagues (1962) stated that “the physician’s duty and responsibility to the…

Abusive Head and Spinal Trauma

This chapter will review the basics of abusive head and spinal trauma, focus on common questions that arise when interpreting imaging studies of children with inflicted injuries of the central nervous system, and discuss the pros and cons of various imaging approaches. This chapter is written in a question-and-answer format. Abusive Head Trauma Demographics, Clinical Presentation, and Outcomes What Is Abusive Head Trauma? Various definitions of…

Imaging of the Neonate: Term Infant

Encountering a neonatal imaging study may be an unsettling experience to radiologists who do not interpret them routinely. Normal structures often appear different from those of the adult or older child. Moreover, many differential diagnoses and disease processes are unique to the term neonate. In reality, however, there are a limited number of likely diagnoses that need to be considered for each imaging finding compared with…

Imaging of the Neonate: Preterm Infant

Preterm birth is birth before 37 weeks’ gestational age. The incidence of preterm birth is approximately 1 in 10 births in the United States. The imaging of a preterm infant is not uncommon, and especially in the neonatal period, the radiologist plays a crucial role in the diagnosis of common complications related to preterm birth. Through a system-based approach, this chapter will review key imaging diagnoses…

MSK Trauma

Whether the history is motor vehicle accident, fall from monkey bars, or sports-related injury, musculoskeletal trauma is one of the most common reasons for emergency department visits. Knowledge of the developing bone anatomy and specific pediatric fractures leads to appropriate diagnosis and treatment. Common Musculoskeletal Trauma Imaging Techniques Plain Radiographs Multiorthogonal radiographs of the bones are a mainstay of trauma evaluation and are often the first…

Approach to Pediatric Soft Tissue Masses

Why Imaging? Pediatric patients with soft tissue musculoskeletal masses encompass a wide array of pathology that ranges from benign fatty masses and self-involuting vascular tumors all the way to aggressive malignant lesions that require a multidisciplinary approach and staging before intervention is performed. Anesthesia and surgical procedures in children for histological diagnosis before imaging is performed is not without risk both in the short term from…

Vascular Malformations

Vascular malformations arise from disorganized angiogenesis and manifest as congenital abnormalities that may be isolated events or associated with syndromes. The International Society for the Study of Vascular Anomalies (ISSVA) recognizes vascular malformations as a separate entity from vascular tumors and classifies vascular malformations into four major groups: simple, combined, anomalies of major vessels, and those associated with other vascular anomalies. Vascular tumors, including infantile hemangioma,…

Imaging Approach to Pediatric Bone Lesions

“Knowledge is power…knowledge is safety…knowledge is happiness.” —Thomas Jefferson Bone lesions are a frequently encountered diagnostic challenge faced by radiologists in the evaluation of pediatric and adolescent patients. Up to 42% of all bone lesions are detected in the first two decades of life, including benign and malignant neoplasms. Nine percent of bone lesions occur in the first decade of life, and approximately 33% in the…

Approach to Pediatric Elbow

The elbow is complex in its multiple articulations, which allow for flexion and extension, as well as supination and pronation. Imaging of the pediatric elbow is deceptively simple: two conventional radiographic orthogonal views are all that is required to diagnose most pediatric elbow fractures. The challenge lays in the radiographic interpretation of a joint with evolving ossification whose appearance changes significantly as the child’s skeleton matures.…

Approach to Pediatric Foot

The pediatric foot can be complex, from both clinical and imaging perspectives. Acquired and congenital diseases can affect the foot, especially during early childhood development. Because radiographs are often first line in imaging, having an appreciation for the normal appearance of the developing foot and, similarly, what can go wrong, is paramount. Laying the Groundwork Technique When imaging the foot, weight-bearing views (or simulated weight-bearing views…

Skeletal Dysplasias

Skeletal dysplasias are bone and cartilage disorders that result in abnormal skeletal development and often, short stature. Skeletal dysplasias and syndromes with bony involvement are not uncommonly seen in pediatric populations. The differential diagnosis of dysplasias includes more than 450 heritable disorders. Early and accurate diagnosis of skeletal dysplasia/syndrome is essential to determining prognosis, receiving appropriate treatment and management of associated complications, and obtaining referral to…

Imaging the Limping Child

The observation that a child has a limp is not a diagnosis, but rather a manifestation of an underlying problem. A limping child has altered gait, which may or may not also be antalgic. This is a commonly encountered phenomenon in pediatric medicine, and ~4% of all pediatric patient visits are related to acute onset of limp or refusal to ambulate. The causes of limp in…

Pelvic Pain

Pelvic pain in a preadolescent or adolescent girl can be a diagnostic challenge. Ovarian causes, including torsion of the ovary, ovarian cysts, and paraovarian cysts, must be distinguished from nonovarian diagnoses, such as appendicitis, renal calculi, urinary tract infection, and even intussusception in younger children. Because ovarian or fallopian tube torsion are emergent situations, rapid diagnosis is key. What Imaging Modality Is Best to Assess Pelvic…

Imaging Approach to Urinary Tract Dilation

Acknowledgments I am grateful to Robert Lebowitz, Rhonda Johnson, and Jane Choura for their invaluable help in preparing this chapter and, always, for their friendship. Key point: Distinguishing normal from pathological causes of urinary tract dilation (UTD) is one of the most important topics in pediatric uroradiology. Most etiologies of UTD in children are congenital. Understanding UTD is one of the primary indications for radiological evaluation…

Scrotal Pain and Swelling

When a child presents with scrotal pain and swelling, the most important determination is between surgical and nonsurgical causes of the symptoms. This often cannot be differentiated with certainty from the physical examination and clinical history. Imaging can, therefore, be crucial to management. The term acute scrotum refers to sudden-onset scrotal pain, erythema, and/or swelling. The most common causes of acute scrotum are torsion of the…

Abdominal Masses in Children

Abdominal masses in children present with variable symptoms, including abdominal pain, abdominal distention, and palpable mass on physical examination. Palpable abdominal masses are a common presenting problem on pediatric outpatient services. Although many pediatric patients ultimately have benign causes for their palpable abdominal masses, such as constipation (in fact, up to 3% of all pediatric outpatient visits are thought to be secondary to constipation), there is…

Pediatric Abdominal Pain

In pediatrics, one of the most common presenting symptoms to the pediatrician or emergency department is abdominal pain. It is a source of much consternation for parents and is often an extrapolated symptom by the parent based on how the child is behaving. Nearly one-fourth of patients younger than 15 years will have seen a physician for this problem. Abdominal pain may be defined as any…