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The purpose of this article is to review the technique of fetal chest ultrasound screening evaluation, the diagnostic work-up in the presence of fetal mediastinal shift and which ultrasound imaging features to look for. The first step in evaluating the fetal thorax is to confirm situs. Then, a median sagittal line is drawn from a four-chamber view to assist in spatial orientation followed by echotexture analysis of the structures of the thorax in the presence of mediastinal shift. We propose a systematic approach based on the direction of the mediastinal shift and echogenicity of the compressing hemithorax. When the hemithorax contralateral to the mediastinal shift is enlarged, which is the most frequent situation, diaphragmatic hernia and macrocystic congenital cystic adenomatoid malformation are the most likely etiologies when the mass is heterogeneous. Microcystic congenital cystic adenomatoid malformation, sometimes associated with sequestration, is the most frequent etiology when the mass is homogeneous. When the hemithorax ipsilateral to the mediastinal shift is small, which is less frequent, and the contralateral hemithorax is homogeneously isoechoic, then a diagnosis of lung hypoplasia-agenesis-aplasia should be considered., (Copyright © 2011 Elsevier Masson SAS and Éditions françaises de radiologie. All rights reserved.)

Purpose: To compare image quality and radiation exposure from pediatric thoracic spine radiographs from two systems, one using a granular structure scintillator and another using a needle structure scintillator with 40% reduction of exposure., Patients and Methods: Randomized prospective study of 296 patients divided into 2 groups of 5 weight categories from 4 to 60 kg. Standard technique parameters are used for granular structure scintillators with dose reduction of 40% applied for needle structure scintillators based on results from a phantom study. Image quality based on detectability of 8 anatomical structures for both types of scintillators was assessed by 6 blinded radiologists. Exposure was expressed by DLP. Results underwent statistical analysis., Results: Overall, image quality was superior with corresponding dose reduction between 33-46% according to weight with needle structure scintillators. For the 4 lower weight categories, image quality was identical., Conclusion: With image quality at least equal, new needle structure scintillator units allow a dose reduction of about 40%.

Objective: Compare the irradiation delivered in conventional radiography and digital radiography by image intensifier during a scoliosis workup., Patients and Methods: Our prospective randomized study included 105 patients, all of whom were identified according to sociodemographic parameters as well as criteria evaluating the quality of the full front spinal x-ray at PA incidence. The entry dose at the scapula and the exit dose in interorbital, thyroid, mammary, and hypogastric projection was measured by thermoluminescent dosimeters., Results: The results of 71 girls and 28 boys, aged a mean 13.8 years with a mean weight of 47 kg were analyzed. At equal image quality, the entry dose was not significantly different between the two techniques; the mean exit dose reduction was 64% during digital acquisition. This reduction involved the interorbital (162%), mammary (43%), and thyroid (309%) regions. However, this system is more irradiating in the hypogastric region (34%)., Conclusion: The dosimetric evaluation of the different imaging techniques used to explore the entirety of the spine should be part of radiologists' quality standard used to document their work and their choices.

Diagnostic Radiology and Medical Imaging residents of French University Hospitals benefit from a wide array of learning tools. However, the professors' clinical workload, lack of sufficient proper formal training, lack of practical applicability of existing standards, and absence of rigorous assessment during the specialized training, reduce their very good quality formation to the level of accidental learning. This study originates from the need to apply a systemic planification of learning activities to the French residents' formal training curriculum, such as the one originally designed and applied within the Quebec educational system. This presentation also benefits from the recent introduction of the CanMEDS 2000 objectives by the Royal College of Physicians and Surgeons of Canada, in order to design an adapted version for the professional and academic activities of French radiologists. Needless to say this work will respect the outlined systematic planning of any learning activity: learning requirements, definition of learning objectives, selection of learning methods, assessment of the participants' achievement of these objectives, and evaluation of the learning activity itself.

Traumatic renal lesions have some particularities in the pediatric age group, especially for anatomic reasons. Imaging is very important for diagnosis and staging. Ultrasonography with Doppler is the first line examination performed in children and frequently allows initial diagnosis. From the Doppler-ultrasonographic results and the type of trauma, renal Computed Tomography (CT) is complementary performed. The association of these imaging techniques allows comprehensive work-up of traumatic renal lesions, and also of associated or pre-existing lesions. Conservative management is the rule in most cases. Interventional imaging techniques are sometimes used for therapeutic care of renal pedicular vascular lesions or lesions of the collecting system. Far from the traumatic event, imaging allows to follow up the morphologic and functional evolution of major renal lesions, in particular lesions of excretory renal ducts.

The use of high frequency (7-12 MHz) transducers on state of the art US units equipped with Doppler imaging provides excellent evaluation of the pediatric pancreas that compares to other cross-sectional imaging techniques. The availability of multidetector CT imaging reduces the need for sedation but requires additional review of the indications and protocols to avoid unnecessary radiation exposure. Evaluation of pancreatitis and tumors remains the main indication. Advances in MR imaging and MRCP has lead to very good results in children. Storage diseases of the pancreas can be diagnosed at MRI. The length of the examinations, the need for sedation and the limited spatial resolution remain the main pitfalls of MR imaging of the pancreas in pediatric patients.

Do advances in MR imaging and Computed Tomography have encroached upon the private territory of Ultrasound-Doppler imaging on paediatric practice? Do the enthusiasm promoted by the use of CT on non traumatic acute abdomen in adult has contaminated the indomitable village of paediatric radiologist? Undoubtfully, Ultrasound-Doppler stayed the first imaging modality to perform. However, the habits are less crystallised than a few years ago. The goal of this article is to describe the ultrasound findings and the potential indications for MRI or CT in the major non traumatic abdominal paediatric emergencies.

Purpose: To determine the MR imaging features of immature hemangiomas. To discuss the value of MR imaging compared to Doppler ultrasonography (US)., Materials and Methods: We performed a retrospective study of clinical, Doppler US and MRI data of 12 immature hemangiomas in 11 children. The mean age was 2 months and 21 days. The mean clinical follow up was 22 months and 7 days., Results: MRI was performed for non-diagnosed lesions (4 cases) or to further define lesion extension (8 cases). The lesions either involved the head and neck (8 cases) or the extremities (4 cases). At MR imaging, all immature hemangiomas corresponded to well defined homogeneous T2W hyperintense masses. On T1-weighted images, 11 immature hemangiomas were isointense with intense homogeneous enhancement. Eleven tumors contained linear low signal intensity flow voids. Ten lesions had superficial cutaneous and/or subcutaneous extension whereas 2 lesions had intra-muscular extension. At Doppler US, immature hemangiomas were highly vascularized masses, with well defined margins, often compressibles, homogeneous isoechoic or heterogeneous with nodular hypoechoic foci, relative to subcutaneous fat. A diagnosis of immature hemangioma was confirmed either by pathology (2 cases) or clinical follow up (10 cases)., Conclusion: In our study, the MR imaging features of immature hemangiomas were reproducible and similar to reports from the literature. MRI is a useful tool to better define the extent of immature hemangiomas, which can be difficult to assess at US. The sensitivity and specificity of MR imaging for this pathology remain to be defined.

Aim: To determine if teaching hospital imaging units are adequately staffed: how are the medical activities of radiologists distributed in such units?, Materials and Methods: A questionnaire was sent to all teaching hospital radiologists in June 2001. The questionnaire covered 7 areas, Results: Urgent cases represent, on average, 22% of patients. Imaging procedures are becoming more frequent (increase of 2 to 8% per year). The mean working week (excluding periods on duty and on call) is 48 hours per FTE radiologist. The mean time spent on teaching, expertise and organization is 10 hours per week. The mean working time per FTE radiologist is thus 58 h/week. The medical activity per FTE radiologist represents 530.240e., Conclusion: The workload of radiologists in teaching hospitals is extremely high, whatever the indicator used (time or activity), indicating major under-staffing.

Objectives: To standardize the ultrasound evaluation in congenital hip dysplasia according to the consensus meeting of 1991 in Paris. Detection of congenital anomalies is a daily pediatric challenge. The coronal plane at US of the hip is considered as the gold standard: its technique, its morphologic and dynamic results either normal or pathological, have been described. A standardized report and a simple terminology are proposed. 2. To explain the role of ultrasound, when performed in close collaboration with a pediatric orthopedic surgeon, for initial diagnosis and follow-up of anatomical anomalies. The role of arthrography and MR imaging will be discussed. 3. To describe the benefit of the ultrasound in cases of painful hip in children, including osteoarthritis, acute synovitis, osteochondritis. . . In these cases, the assessment of the hip is also done with radiographs, computer tomography, MR imaging and bone scan.

We report an uncommon presentation of Legionella pneumophila infection following a placentalblood transplantation in an immunodeficient child. The patient presented with lung nodules and liver abscesses. We discuss how a digestive contamination can be suspected.

We report three pediatric cases of infectious colitis that were misinterpreted on US examination as Crohn's disease. These colitis were limited to the left colon and presented with transmural hypoechoic thickening of the wall and homogenous hyperechoic appearance of the surrounding fat.

Renal US was prospectively performed in 124 madagascan children less than 1 year of age. Patients were examined in the prone position and maximum kidney length was measured in the longitudinal plane. These measurements and the height and weight of our patient population were compared to published tables. Kidney length and height and weight of our patient population were inferior to the previously published reference data and the growth curve of kidneys steeper than normative standards (p < 0.001). Because of the important variability in US measurement of kidney length it is not possible to definitely conclude that length and growth curve of kidneys in madagascan children are statistically different from those of the published normative standards.

We report an atypical presentation of Mycoplasma pneumoniae infection observed in a patient with primary hypogamma-globulinemia. Pulmonary miliary was combined with sternal and femoral osteomyelitis. These unusual CT findings could be explained by immunodeficiency with impaired antibody response.

The purpose of this study was to evaluate the attitude of French pediatric radiologists regarding the presence or absence of parents during pediatric imaging of their child. A mail survey was sent to the French members of the "Société Francophone de Radiologie Pédiatrique". We asked about the inclusion of parents during pediatric imaging procedures. They gave the reasons for their choice and stated if parental presence was helpful or not for the achievement of imaging procedures. Responses were received from 76% of those surveyed. Excluding vascular and interventional procedures, few respondents (13%) permit parents to be present for all types of examinations. One respondent excluded parents from every procedure. Others excluded parents from selected studies: plain films (18%), upper gastrointestinal series (33%), contrast enema (44%), retrograde (47%) and suprapubic (67%) voiding cystourethrography, intra-venous pyelography (45%), US (5%), CT (27%), MRI (25%). Regarding angiography, only 2% of the respondents allow parental presence. Every respondent performing interventional procedures did not accept parents in the interventional suite. When parents were present, they were close to their child (76%) and could help in his immobilization (47%). Most of the respondents (49%) thought parental presence to affect examination in a favorable way. The opposite opinion was supported by 25% of them. An equivocal response was given in 26% of the answers. Numerous reasons supported these responses, they could be classified according to the child and his illness, the parents, the radiologist and his team, the examination performed. Most pediatric radiologists in France allow parents to accompany their children during selected examinations. Radiologists vary in their perception of how parental presence affects the outcome of the pediatric imaging procedures.

Primary mediastino pulmonary tuberculosis in infancy is increasing in France. Bacteriological diagnosis is difficult. The aim of the study is to assess the value of chest radiograph and CTscan for diagnosis of tuberculosis. We studied 15 infants, 3 month old to 18 month old, between November 1990 and June 1992. On plain film, lymphadenopathies were present in 13 cases and parenchymal disease in 10 cases, parenchymal nodular densities in 6 cases and pleural effusion in one case, displacement of the trachea in 6 cases. We found CTscan to be useful in delineating the lymphadenopathies and parenchymal changes. In 2 cases lymphadenopathies and in 2 cases alveolar condensation were discovered on CTscan as plain film was normal. In all cases lymphadenopathies were present in CTscan, often in right side and in all cases, lymphadenopathies were hypodense with peripheral enhancement. In conclusion, the association of right paratracheal nodes with displacement of trachea and alveolar consolidation is common in tuberculosis in infants. These findings when seen on chest radiographs must lead to perform a CTscan and suggest the diagnosis.

Two cases of calcified thrombus of inferior vena cava in children are reported and the relevant literature reviewed. Although the physiopathology of this lesion is poorly understood and its detection is usually fortuitous, its presentation is univocal.

A 9-month-old infant presented with a multilocular pancreatic cystadenoma. Pathological features of this extremely rare lesion in children are outlined and the relevant literature reviewed. Diagnostic methods are analyzed, and emphasis placed on the difficulty of diagnosis of non-renal multicystic abdominal masses by ultrasound imaging in children.

Technical aspects and indications for the use of digital subtraction angiography of thorax in 109 children are discussed, and the interest of this exploratory method emphasized in chronic respiratory disease in children. Results obtained are compared with other investigations for screening of bronchopulmonary dysplasia. Although generally reliable for exploration of thoracic aorta anomalies (coarctation and abnormal vascular arch) it is considered to be incompletely effective for investigation of congenital heart disease.

About a case of striated and delayed nephrogram seen on a diabetic child, authors come back to the different etiologies. Among them, the tubular precipitation of Tamm-Horsfall protein seems to be given like on the right possibilities. Whatever is its etiology, the mechanism of striated appearance is always the same, being founded on the radiated disposal of the collecting ducts and on a tubular stasis beeing with iodine concentration.

Computed tomography and lateral plain films have been studied in 30 fractures of calcaneus. C.T. allows us to study in the same time the two feet, with low mobilisation. Two planes are mandatory: --one, along the long axis of the calcaneus, allows a good evaluation of calcaneo-cuboïd joint, of the quality of the bone structure and of the large fragments or comminution; --the other one (coronal in 18 cases of along the tuberosity in 16 cases) shows directly the subtalar joint lesions (impaction, joint incongruence) and plantar fracture line. This study conclude that CT is useful for the evaluation of the severity calcaneus fractures and for treatment selection because of a better evaluation of lesions.

High level ano-rectal anomalies were evaluated by Magnetic Resonance Imaging (MRI) in 15 patients. One neonate and two infants were evaluated preoperatively. Sagittal slices identified properly the blind rectal end in the 3 cases. Associated anomalies (tethered spinal cord, right ectopic kidney in 1 case, recto-urinary fistula in another case, upper excretory dilatation in 2 cases) were found during the same examination. In the post-operative period (12 cases), major data were obtained on axial transverse slices. When pulled-through intestine is outside the levator sling, re-do-surgery can be indicated. MRI appears as an accurate tool to assess these anomalies.

Predisposing factors in two children with urinary tract candidiasis included: neonatal period, uropathy with malformation, massive antibiotic therapy. Ultrasound images showed dilated excretory cavities of variable echo intensities and without posterior shadow cone. Diagnosis was confirmed by urine culture and a satisfactory outcome obtained by specific therapy and surgery for malformations.

The authors have tested different MR imaging sequences to detect hepatocellular carcinomas. The most performing is a spin-echo T2-weighted sequence with long TR (1800 or 2000 ms), and three echoes. The first echo, early at 40 ms, may allow an analysis of the vessels, later, at 80 and 120 ms, the two other echoes permit a better visualization of the tumor. With this type of sequence, the method's sensibility is excellent.