Pediatric urinary tract infection: imaging techniques with special reference to voiding cystoerethrography

Urinary tract infection (UTI) is the second most common infection in childhood. Large hospital-based pediatric series report an incidence of 3-5%. Dickinson prospectively determined that 1.7/1000 boys and 3.1/1 000 girls annually present with a UTI. This corresponds to about 780 girls and 430 boys per million population aged 0-14 years. Under age 6 years, a UTI furthermore is an indicator of an anatomic and/or functional urinary tract disorder in 35-50% of these patients. Vesicoureteral reflux (VUR) is present in 30-35% of these, but is present in 85% of children with evidence of renal scarring.4•5 This scarring, in turn, is responsible for 20-40% of end-stage renal failure in patients under 40 years of age. From these figures it can be estimated that the risk for hypertension or renal failure after a first, laboratory and clinically proven (index) UTI is about 1% for boys and 0.5% for girls. The imaging evaluation of these children has a dual purpose. On the one hand, it is intended to establish that the kidneys, bladder and urethra are normal, so that subsequent UTis can be treated by a 10 day course of antibiotics without risking renal damage. This affords the opportunity to make sure that normal kidneys remain normal. On the other hand, appropriate imaging is intended to a) identify and grade the severity of VUR, b) to define the extent of renal scarring and to c) determine the site of obstruction, if any. This allows for minimizing renal damage.8 Early identification of these abnormalities, the anatomic basis of which will be discussed later, thus offers the prospect of preventive medicine and sound advice to the clinician regarding antibiotic (for lower grades of VUR) or surgical (for higher grades of VUR and obstructive etiologies) therapeutic measures. The available imaging modalities (VCUG, EU, US, Urodynamics and Radionuclides) all have different capabilities and limitations and should not be used indiscriminately as some employ ionizing radiation, others are invasive, uncomfortable and expensive

Chest gossypiboma after coronary surgery.

Contains fulltext : 53275.pdf (publisher's version ) (Open Access

Emergency department radiology: reality or luxury? An international comparison.

Contains fulltext : 88729.pdf (publisher's version ) (Closed access)Changes in society and developments within emergency care affect imaging in the emergency department. It is clear that radiologists have to be pro-active to even survive. High quality service is the goal, and if we are to add value to the diagnostic (and therapeutic) chain of healthcare, sub-specialization is the key, and, although specifically patient-oriented and not organ-based, emergency and trauma imaging is well suited for that. The development of emergency radiology in Europe and the United States is compared with emphasis on how different healthcare systems and medical cultures affect the utilization of Acute Care imaging.1 april 201

From the RSNA refresher courses: US of the rotator cuff: pitfalls, limitations, and artifacts.

Contains fulltext : 50296.pdf (publisher's version ) (Closed access)High-resolution ultrasonography (US) has gained increasing popularity as a diagnostic tool for assessment of the soft tissues in shoulder impingement syndrome. US is a powerful and accurate method for diagnosis of rotator cuff tears and other rotator cuff abnormalities, provided the examiner has a detailed knowledge of shoulder anatomy, uses a standardized examination technique, and has a thorough understanding of the potential pitfalls, limitations, and artifacts. False-positive sonographic findings of rotator cuff tears can be caused by the technique (anisotropy, transducer positioning, acoustic shadowing by the deltoid septum), by the anatomy (rotator cuff interval, supraspinatus-infraspinatus interface, musculotendinous junction, fibrocartilaginous insertion), or by disease (criteria for diagnosis of rotator cuff tears, tendon inhomogeneity, acoustic shadowing by scar tissue or calcification, rotator cuff thinning). False-negative sonographic findings of rotator cuff tears can be caused by the technique (transducer frequency, suboptimal focusing, imaging protocol, transducer handling), by the anatomy (nondiastasis of the ruptured tendon fibers, posttraumatic obscuration of landmarks), by disease (tendinosis, calcifications, synovial proliferation, granulation or scar tissue, bursal thickening, massive rotator cuff tears), or by patient factors (obesity, muscularity, limited shoulder motion)

Prevalence of testicular adrenal rest tumours in male children with congenital adrenal hyperplasia due to 21-hydroxylase deficiency.

Contains fulltext : 53373.pdf (publisher's version ) (Open Access)OBJECTIVE: Testicular adrenal rest tumours (TART) are a well-known complication in adult male patients with congenital adrenal hyperplasia (CAH), with a reported prevalence of up to 94%. In adulthood, the tumours are associated with gonadal dysfunction most probably due to longstanding obstruction of the seminiferous tubules. The aim of our study was to determine the presence of TART and their influence on gonadal function in childhood. DESIGN: Retrospective study. PATIENTS AND METHODS: Scrotal ultrasound was performed in 34 children with CAH due to 21-hydroxylase deficiency who were between 2 and 18 years old. FSH, LH, testosterone and inhibin B concentrations were measured in serum of 27 patients. RESULTS: TART were detected by ultrasound in 8 out of 34 (24%) children. In two of them, bilateral tumours were found. All lesions were located in the rete testis. Seven patients had the salt-wasting type of CAH; one patient had the simple virilising type of CAH. Mean tumour size was 4.1 mm (range 2-8 mm). In none of the patients were the tumours palpable. Two children with TART were between 5 and 10 years old, the other six children were above 10 years old. In all children with TART, LH, FSH, testosterone and inhibin B levels were similar to the patients without TART. CONCLUSION: TART can be found in CAH children before the age of 10 years. The absence of gonadal dysfunction in our group of children suggests that gonadal dysfunction as frequently reported in adult CAH patients with TART develops after childhood

The role of imaging studies in pancreatic injury due to blunt abdominal trauma in children.

Contains fulltext : 49792.pdf (publisher's version ) (Closed access)BACKGROUND: The role imaging studies play in the choice of treatment in traumatic pancreas damage remains unclear. This study was performed to gain insight into the role of radiological studies in children 16 years of age or younger admitted to our hospital with pancreatic damage due to a blunt abdominal trauma. METHOD: Retrospectively, the radiological as well as patient clinical records were reviewed of all children admitted to our hospital between 1975 and 2003 with a pancreatic lesion due to blunt abdominal trauma. RESULTS: Thirty-four children with ages ranging from 3 to 14 years old were admitted with traumatic pancreas damage. Initially 33 children were treated conservatively for the pancreatic damage and only one had immediate surgery of the pancreas with a Roux-y pancreaticojejunostomy. Five other children had immediate surgery for other reasons. Overall, five children proved to have a pancreas transection on CT scans or during laparotomy. One child had a pancreas hematoma and 28 a pancreas contusion. In total 15 children developed a pseudocyst (44%), nine of which resolved spontaneously while six were treated by intervention. None of the children had residual morbidity, and there were no deaths. Considering the pancreas, the 11 available CT's were re-evaluated by two radiologists independently. Grade 3 pancreas damage (distal transection of the pancreatic duct) was diagnosed in five patients by radiologist A and four patients by radiologist B (80% match); Grade 1 was diagnosed in, respectively six and one patients (15% match). An US was performed on 19 children with 82 follow-up examinations, mostly for follow-up of the pseudocysts. CONCLUSION: Traumatic pancreas damage is a rare and difficult diagnosis. There is no straightforward answer for diagnostic imaging in blunt abdominal trauma in children. The diagnostic relevance of CT is limited. CT in combination with MRCP may be a better option for exclusion of pancreatic duct lesions

Pervasive access to images and data--the use of computing grids and mobile/wireless devices across healthcare enterprises.

Contains fulltext : 51535.pdf (publisher's version ) (Closed access)Emerging technologies are transforming the workflows in healthcare enterprises. Computing grids and handheld mobile/wireless devices are providing clinicians with enterprise-wide access to all patient data and analysis tools on a pervasive basis. In this paper, emerging technologies are presented that provide computing grids and streaming-based access to image and data management functions, and system architectures that enable pervasive computing on a cost-effective basis. Finally, the implications of such technologies are investigated regarding the positive impacts on clinical workflows

Current imaging concepts in pediatric osteomyelitis

Contains fulltext : 57287.pdf (publisher's version ) (Closed access

[Feasibility of MRI imaging in patients with breast cancer],[Feasibility of MRI imaging in patients with breast cancer]

Item does not contain fulltextThree women aged 45, 37 and 56 underwent MRI imaging of the breast for: breast-cancer screening, pre-operative staging and for monitoring the response on chemotherapy. Breast cancer at an early stage for which breast-saving surgery was possible was discovered in the first woman. In the second woman, the tumour was larger than was seen with mammography or ultrasound and other tumour sites were seen, leading to a more extensive treatment plan. In the year thereafter no metastases were found. In the third woman the response to chemotherapy was monitored. 8 months after therapy she appeared to have skeletal metastases. Mammography and ultrasound are the most commonly used modalities in breast imaging. Over the past few years MRI has been making an increasingly large contribution to the screening, staging and follow-up of patients with breast cancer. MRI can be an important supplementary study but its exact role still needs to be defined