Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Traumatic Spinal Cord Injury: Acute Spinal Cord Injury and Prognosis

1.3A.1 Introduction Prior to the 1980s a diagnosis of trauma to the spinal cord was largely inferred based on either X-rays showing misalignment of the spinal column or myelography whereby interruption of the flow of contrast medium in the cerebral spinal fluid (CSF) space indicated impingement of the spinal cord. With the widespread adoption of MRI came the visualization of the spinal cord itself, and along…

Inflammatory Demyelinating Diseases

1.2.1 Introduction The spinal cord is a common site of involvement in inflammatory demyelinating diseases of the central nervous system (CNS). The most common such disease, multiple sclerosis, is the leading cause of nontraumatic disability in young adults, with an enormous socioeconomic impact. Neuromyelitis optica (NMO), an increasingly recognized and recently redefined condition, also has prominent and very characteristic spinal cord involvement, which is typically much…

Rationale for Quantitative MRI of the Human Spinal Cord and Clinical Applications

1.1.1 Introduction Neuroaxonal injury of the spinal cord occurs in a broad spectrum of clinically and pathologically heterogeneous neurodegenerative diseases, typically with serious clinical consequences for patients. Typically, the clinical syndrome produced by injury to the spinal cord includes weakness or paralysis of the limbs and trunk, with sensory disturbance and dysfunction of the gastrointestinal and genitourinary sphincters. The spinal cord is therefore an important region…

Imaging of Back Pain

Acknowledgments I acknowledge Brad Hoehne, Radiology Digital Imaging Specialist (Nationwide Children’s Hospital), for preparation of figures. Back pain is common in children and tends to increase with age, especially in the early teen years. Although back pain can be the presenting symptom of serious pathology, such as infection or neoplasm, recent studies have shown lower rates of identifiable disease in children with back pain. A nonpathological…

Neonatal Spine Imaging

In the neonatal period the most frequently encountered spinal pathologies are of developmental nature. Spinal tumors or infections are exquisitely rare in neonates. Spinal trauma may occasionally be encountered and typically result from a complicated/traumatic delivery. This chapter will consequently focus on spinal malformations. The development of the spinal canal and its contents is highly complex and involves multiple “programmed” anatomic and functional developmental and maturational…

Imaging of the Pediatric Cervical Spine

The most common indication for pediatric cervical spine (C-spine) imaging is trauma. Although cervical spinal injuries are rare in children, the result can be devastating. The role of the radiologist is crucial in the early detection of cervical spinal injury (CSI) that may require immediate clinical attention. Imaging interpretation of the C-spine is particularly challenging and requires a thorough knowledge of its unique anatomic characteristics as…

Pediatric Head and Neck Masses

Evaluation of pediatric head and neck masses can be challenging because the anatomy is complex and the diseases that affect the head and neck are numerous. Grouping head and neck lesions into broad categories based on anatomic location and suspected type of lesion, whether it is solid or cystic, can greatly facilitate a practical approach to imaging. For small, superficial lesions in the neck, ultrasound is…

Approach to Lateral Neck Radiographs

Approach to the Lateral Neck Radiograph The lateral neck radiograph is a relatively inexpensive, readily available, and easy-to-perform examination that is very useful for the evaluation of suspected abnormalities in the upper aerodigestive tract. In the emergency setting the lateral neck radiograph is commonly obtained to evaluate for abnormalities causing acute respiratory distress or dysphagia. The examination also can be useful in the workup of chronic…

Pediatric Head CT

Introduction Neuroradiological imaging of the pediatric patient has undergone tremendous change since the late 2000s. Although the use of magnetic resonance imaging (MRI) is on the rise, in part because of concerns over exposing children to medical radiation, there is still an important role for pediatric head computed tomography (CT), which provides fast imaging, often without the need for sedation. CT therefore remains an important tool…

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…