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PURPOSE: To compare objective and subjective parameters in image quality and radiation dose of two MDCTs (helical 64 detector CT vs. axial 256 detector CT) in paediatric lung CT. METHODS: Radiation dose and image quality were compared between non-enhanced lung CT from a helical 64-slice multidetector CT (MDCT 1) and a 256-slice scanner (MDCT 2) with axial wide-cone acquisition and using deep learning image reconstruction. In 23 size-matched paediatric studies (age 2-18 years) from each scanner, the radiation exposure, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), image sharpness and delineation of small airways were assessed. Subjective image quality was rated by 6 paediatric radiologists. RESULTS: While MDCT 2 provided higher SNR and CNR, subjective image quality was not significantly different between studies from both scanners. Radiation exposure was lower in studies from MDCT 2 (CTDIvol 0.26 ± 0.14 mGy, effective dose 0.23 ± 0.11 mSv) than from MDCT 1 (CTDIvol 0.96 ± 0.52 mGy, effective dose 1.13 ± 0.58 mSv), p < 0.001. Despite lower radiation dose for the scout images, the relative scout-scan-ratio increased from 2.64 ± 1.42 % in MDCT 1 to 6.60 ± 5.03 % in MDCT 2 (p = 0.001). CONCLUSIONS: By using latest scanner technology effective radiation dose can be reduced to 0.1-0.3 mSv for lung CT in children without compromising image quality. Scout image dose increasingly accounts for substantial portions of the total scan dose and needs to be optimized. In children CT should be performed on state-of-the-art MDCT scanners with size-adapted exposure protocols and iterative reconstruction.
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Procesamiento de Imagen Asistido por Computador , Tomografía Computarizada Multidetector , Adolescente , Niño , Preescolar , Humanos , Pulmón/diagnóstico por imagen , Dosis de Radiación , Interpretación de Imagen Radiográfica Asistida por Computador , Relación Señal-RuidoRESUMEN
BACKGROUND: Malposition of intraosseous needles in pediatric patients is frequently reported. Incorrect needle length and penetration depth related to the puncture site and level are possible causes. AIMS: Aim of this study was to analyze anatomic dimensions of the proximal tibia in the pediatric population with respect to intraosseous needle placement and needle tip position. METHODS: Plain lower leg radiographs of children aged from birth to 16 years of age were analyzed. Pretibial tissue layer, cortical bone thickness, and the diameter of the medullary cavity were measured at two different puncture levels. Data were analyzed as descriptive statistics and by polynomial regression plots and set in context to commonly used EZ-IO® needle lengths of 15 and 25 mm. RESULTS: Radiographs from 190 patients (104 boys/86 girls) were included. When fully inserted to skin level, up to 10.5% of needles do not reach medullary cavity at one and 18.5% at two patient's fingerbreadths distal to tibial tuberosity. The opposite cortical wall is touched or penetrated in 16% and 25%, respectively. Up to 96% of too deep needle tip positions occur in children younger than 24 months, as do too superficial tip positions in 59%. CONCLUSIONS: Puncture level and needle length have a great influence on potential needle tip positions. Infants and toddlers are at highest risk for malpositioning. Due to relevant growth-related differences in tibial anatomy, an age-related and well-reflected approach is crucial to successfully establish intraosseous access.
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Infusiones Intraóseas , Tibia , Niño , Femenino , Humanos , Lactante , Pierna , Masculino , Agujas , Radiografía , Tibia/diagnóstico por imagenRESUMEN
BACKGROUND: The aim of this study was to obtain lower airway dimensions in children by means of computed tomography (CT). METHODS: Chest CT scans from 195 pediatric patients (118 boys/77 girls) aged 0.04-15.99 years were analyzed. Tracheal and bronchial lengths, anterior-posterior and lateral diameters, as well as cross-sectional area were assessed at the following levels: mid trachea, right proximal and distal bronchus, proximal bronchus intermedius, and left proximal and distal bronchus. Mediastinal angles of tracheal bifurcation were measured. Data were analyzed by means of linear and polynomial regression plots. RESULTS: The strongest correlations were found between tracheal and bronchial diameters and age as well as between tracheal and bronchial lengths and body length. All measured airway parameters correlated poorly to body weight. Bronchial angles revealed no association with patient's age, body length, or weight. CONCLUSION: This comprehensive anatomical database of lower airway dimensions demonstrates that tracheal and bronchial diameters correlate better to age, and that tracheal and bronchial length correlate better to body length. All measured airway parameters correlated poorly to body weight.
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Bronquios/anatomía & histología , Tomografía Computarizada por Rayos X/métodos , Tráquea/anatomía & histología , Adolescente , Pesos y Medidas Corporales/métodos , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Estudios RetrospectivosRESUMEN
AIMS: Prenatal myelomeningocele (MMC) repair has been proven to significantly reduce the need for hydrocephalus shunting and improve lower-extremity motor outcomes. The aim of this study was to evaluate the effect of prenatal MMC repair on the urological outcome. METHODS: All patients who underwent fetal MMC repair at our institution are followed prospectively. Assessments include medical history, renal and bladder ultrasound, voiding cystourethrogram and urodynamic study, need for clean intermittent catheterization (CIC) and anticholinergics, and the occurrence of urinary tract infections (UTI). RESULTS: Of the 30 patients who underwent prenatal MMC closure from December 2010 to December 2015, eight patients with a postnatal follow-up of at least 2 years were included in this study and compared with eight patients after postnatal MMC repair. The level of the bony spinal defect was similar in both groups. Urological evaluation at 2 years revealed normal bladder function in 50% after prenatal repair. Neurogenic bladder dysfunction requiring CIC and anticholinergic therapy was seen in 50% in the prenatal and in 100% in the postnatal group. Significant bladder wall thickening was found in 37.5% and 87.5%, respectively. Febrile UTIs occurred in 37.5% in the prenatal and 62.5% in the postnatal group during the observation period. CONCLUSIONS: Our data suggest a positive effect of prenatal MMC closure on lower urinary tract function. The long-term significance of these results remains unclear. Therefore, continued close monitoring of renal and bladder function are mandatory.
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Feto/cirugía , Riñón/fisiopatología , Meningomielocele/cirugía , Vejiga Urinaria/fisiopatología , Femenino , Humanos , Cateterismo Uretral Intermitente , Masculino , Meningomielocele/fisiopatología , Estudios Prospectivos , Resultado del Tratamiento , Infecciones Urinarias/fisiopatología , UrodinámicaRESUMEN
BACKGROUND: Emergency situations and conditions with impaired gastric emptying enhance the risk of perioperative pulmonary aspiration due to increased residual gastric contents volume (GCV). Gastric ultrasonographic (US) measurement of the gastric antral cross-sectional area (CSA) has been proposed to estimate preanesthetic GCV. However, only few healthy children and fasted pediatric patients have been investigated so far, predicting GCV with considerable imprecision. This study aimed to compare GCV assessed by US in different patient positions for measuring CSA, using magnetic resonance imaging (MRI) as reference, and to evaluate its potential as diagnostic test. METHODS: Healthy volunteer children were examined in a crossover design on 2 days. After baseline examination, they received a light breakfast, followed by 7 ml·kg-1 clear fluid after 2 or 4 h. Gastric emptying was examined with MRI over 4 or 6 h, respectively. US was performed immediately after MRI in right lateral decubital (RLD) and supine with upper body elevated (SUBE) positions. Correlation coefficients (Pearson R; 95%CI) between CSA and body weight corrected GCV (GCVw ) as determined by MRI volumetry were calculated. Data are presented as median (range). RESULTS: Eighteen children aged 9.8 (6.8-12.2) years had 72 US examinations completed. CSA was 401 (101-1311) mm2 and 271 (118-582) mm2 , and R between CSA and GCVw was 0.76 (0.76-1) and 0.57 (0.41-0.88) for the RLD and SUBE positions, respectively. The corresponding GCVw was 2.1 (0.1-13.8) ml·kg-1 . A linear regression model from RLD was similar to one previously derived. Bland-Altman analysis and ROC plots are presented. CONCLUSION: CSA correlated with GCVw in healthy children over a wide range of gastric filling, with the RLD position clearly superior to the SUBE position, confirming a previously derived formula. Although direct calculation of GCVw is imprecise, this technique has the potential to become a diagnostic risk assessment test.
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Contenido Digestivo/diagnóstico por imagen , Pruebas en el Punto de Atención , Cuidados Preoperatorios/métodos , Ultrasonografía/métodos , Niño , Estudios Cruzados , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: To test clinical findings associated with early temporomandibular joint (TMJ) arthritis in comparison to the current gold standard contrast enhanced magnetic resonance imaging (MRI) in children with juvenile idiopathic arthritis (JIA). METHODS: Seventy-six consecutive JIA patients were included in this study. Rheumatological and orthodontic examinations were performed blinded to MRI findings. Joint effusion and/or increased contrast enhancement of synovium or bone as well as TMJ deformity were assessed on MRI and compared to clinical findings. The maximal mouth opening capacity (MOC) of the JIA patients was compared to normative values obtained from a cohort of 20719 school children from Zürich, Switzerland. RESULTS: On MRI a total of 54/76 (71%) patients and 92/152 (61%) joints had signs of TMJ involvement. MRI showed enhancement in 85/152 (56%) and deformity in 39/152 (26%) joints. MOC, asymmetry and restriction in condylar translation showed significant correlation to TMJ enhancement and deformity, whereas antegonial notching was correlated with TMJ deformity only. When joints with deformity were excluded, enhancement alone did not show a significant correlation with any clinical factor. CONCLUSIONS: Clinical findings in affected TMJs are correlated with structural damage only. Therefore clinical assessment of TMJs does not allow to diagnose early arthritis accurately and will still depend on contrast enhanced MRI.
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Artritis Juvenil/complicaciones , Trastornos de la Articulación Temporomandibular/diagnóstico , Adolescente , Artritis Juvenil/patología , Niño , Preescolar , Femenino , Humanos , Lactante , Imagen por Resonancia Magnética/métodos , Masculino , Examen Físico , Articulación Temporomandibular/patología , Trastornos de la Articulación Temporomandibular/etiología , Trastornos de la Articulación Temporomandibular/patologíaRESUMEN
BACKGROUND: In about one-fifth of radiographs performed in neonates, no exact gastric feeding tube position can be defined. OBJECTIVES: To determine whether injection of air via feeding tube before taking radiographs improves radiological assessment of its position. METHODS: In the study group (n=153), air was injected via gastric feeding tube before taking a radiograph. The tube position on radiographs was compared with a blinded control group (n=381) with no injection of air. RESULTS: The definition of exact gastric tube position was possible in 95% of the study group compared with 78% in the control group (p<0.001). CONCLUSION: Injection of air before taking a radiograph significantly improves the definition of exact gastric feeding tube position in neonates.
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Nutrición Enteral , Neumorradiografía , Aire , Humanos , Recién Nacido , Errores Médicos/prevención & control , Estudios Prospectivos , Estómago/diagnóstico por imagenRESUMEN
In many paediatric cardiac units chest radiographs are performed routinely before discharge after cardiac surgery. These radiographs contribute to radiation exposure. To evaluate the diagnostic impact of routine chest X-rays before discharge in children undergoing open heart surgery and to analyze certain risk factors predicting pathologic findings. This was a prospective (6 months) single-centre observational clinical study. One hundred twenty-eight consecutive children undergoing heart surgery underwent biplane chest X-ray at a mean of 13 days after surgery. Pathologic findings on chest X-rays were defined as infiltrate, atelectasis, pleural effusion, pneumothorax, or signs of fluid overload. One hundred nine asymptomatic children were included in the final analysis. Risk factors, such as age, corrective versus palliative surgery, reoperation, sternotomy versus lateral thoracotomy, and relevant pulmonary events during postoperative paediatric intensive care unit (PICU) stay, were analysed. In only 5.5 % (6 of 109) of these asymptomatic patients were pathologic findings on routine chest X-ray before discharge found. In only three of these cases (50 %), subsequent noninvasive medical intervention (increasing diuretics) was needed. All six patients had relevant pulmonary events during their PICU stay. Risk factor analysis showed only pulmonary complications during PICU stay to be significantly associated (p = 0.005) with pathologic X-ray findings. Routine chest radiographs before discharge after cardiac surgery can be omitted in asymptomatic children with an uneventful and straightforward perioperative course. Chest radiographs before discharge are warrantable if pulmonary complications did occur during their PICU stay, as this is a risk factor for pathologic findings in chest X-rays before discharge.
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Procedimientos Quirúrgicos Cardíacos/efectos adversos , Complicaciones Posoperatorias/diagnóstico por imagen , Radiografía Torácica/métodos , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Alta del Paciente , Estudios Prospectivos , Factores de RiesgoRESUMEN
OBJECTIVES: To study the validity of both rheumatological and orthodontic examinations and ultrasound (US) as screening methods for early diagnosis of TMJ arthritis against the gold standard MRI. METHODS: Thirty consecutive juvenile idiopathic arthritis (JIA) patients were included in this pilot study. Rheumatological and orthodontic examinations as well as US were performed within 1 month of the MRI in a blinded fashion. Joint effusion and/or increased contrast enhancement of synovium or bone were considered signs of active arthritis on MRI. RESULTS: A total of 19/30 (63%) patients and 33/60 (55%) joints had signs of TMJ involvement on MRI. This was associated with condylar deformity in 9/19 (47%) patients and 15/33 (45%) joints. Rheumatological, orthodontic and US examinations correctly diagnosed 11 (58%), 9 (47%) and 6 (33%) patients, respectively, with active TMJ arthritis, but misdiagnosed 8 (42%), 10 (53%) and 12 (67%) patients, respectively, as having no signs of inflammation. The best predictor for active arthritis on MRI was a reduced maximum mouth opening. CONCLUSION: None of the methods tested was able to reliably predict the presence or absence of MRI-proven inflammation in the TMJ in our cohort of JIA patients. US was the least useful of all methods tested to exclude active TMJ arthritis.
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Artritis Juvenil/diagnóstico , Imagen por Resonancia Magnética , Trastornos de la Articulación Temporomandibular/diagnóstico , Articulación Temporomandibular/patología , Adolescente , Artritis Juvenil/diagnóstico por imagen , Distribución de Chi-Cuadrado , Niño , Preescolar , Diagnóstico Precoz , Femenino , Humanos , Lactante , Masculino , Ortodoncia , Examen Físico , Proyectos Piloto , Reumatología , Sensibilidad y Especificidad , Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , UltrasonografíaRESUMEN
OBJECTIVES: Accurate tube placement of orogastric and nasogastric feeding tubes in neonates is important to ensure safe and effective enteral feeding. Errors in placement and position of feeding tubes are described in literature, but there is little evidence of the exact prevalence of improperly placed tubes, especially in neonates. MATERIALS AND METHODS: To evaluate the prevalence of improperly placed feeding tubes, we reviewed 381 consecutive radiographs and defined the position of the feeding tubes. RESULTS: We found that in 41% of the placements, the optimal position of the feeding tubes was achieved, whereas overall 59% of the feeding tubes had been placed incorrectly. CONCLUSIONS: There is a need for both better rules to measure the distance between nose (lips) and the body of the stomach and improved methods to confirm correct tube position in neonates.
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Nutrición Enteral/instrumentación , Intubación Gastrointestinal/instrumentación , Errores Médicos , Nutrición Enteral/métodos , Esófago/diagnóstico por imagen , Femenino , Humanos , Recién Nacido , Intubación Gastrointestinal/métodos , Masculino , Radiografía , Estómago/diagnóstico por imagenRESUMEN
OBJECTIVE: To investigate efficacy and safety of enoxaparin for catheter-related arterial thrombosis in infants with congenital heart disease. DESIGN: Prospective observational study. SETTING: Pediatric Intensive Care and Cardiology Unit at the University Children's Hospital of Zurich. PATIENTS: A cohort of 32[Symbol: see text]infants aged 0-12[Symbol: see text]months treated with enoxaparin for catheter-related arterial thrombosis from 2002 to 2005. MEASUREMENTS: Dose requirements of enoxaparin, resolution of thrombosis by Doppler ultrasound, and bleeding complications. RESULTS: Catheter-related arterial thrombosis was located in the iliac/femoral arteries in 31 (97%) infants and aorta in 1 infant, and was related to indwelling catheters and cardiac catheterization in 17 (53%) and 15 (47%) cases, respectively. Newborns required increased doses of enoxaparin to achieve therapeutic anti-FXa levels (mean 1.62[Symbol: see text]mg/kg per dose) compared with infants aged 2-12 months (mean 1.12 mg/kg per dose; p=0.0002). Complete resolution of arterial thrombosis occurred in 29 (91%) infants at a mean of 23 days after initiation of enoxaparin therapy. Partial or no resolution was observed in 1 (3%) and 2 (6%) infants, respectively, at a mean follow-up time of 4.3 months. Bleeding complications occurred in 1 (3%) infant. CONCLUSION: Enoxaparin is efficient and safe for infants with congenital heart disease and catheter-related arterial thrombosis, possibly representing a valid alternative to the currently recommended unfractionated heparin.