Search

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Significant changes can be expected in modern pediatric radiology. New imaging techniques are progressively added to basic modalities like Xrays and ultrasound. This essay summarizes recent advances and technical innovations in pediatric radiology, which are supposed to gain further importance in the future. Thus, CT dose reduction techniques including artificial intelligence as well as advances in the fields of magnetic resonance and molecular imaging are presented. KEY POINTS:   · Technical innovations will lead to significant changes in pediatric radiology.. · CT dose reduction is crucial for pediatric patient collectives.. · New MR-techniques will lower the need for sedation and contrast media application.. · Functional MR-imaging might gain further importance in patients with chronic lung disease.. · Molecular imaging enables detection, characterization and quantification of molecular processes in tumors.. CITATION FORMAT: · Staatz G, Daldrup-Link HE, Herrmann J et al. From Xrays to PET/MR, and then? - Future imaging in pediatric radiology. Fortschr Röntgenstr 2019; 191: 357 - 366., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (© Georg Thieme Verlag KG Stuttgart · New York.)

Disability is a condition or function that is judged to be significantly impairing relative to the usual standard of an individual or group. The spectrum of musculoskeletal disabilities in children is immense and varied. Musculoskeletal disabilities are congenital or acquired; they affect a child partially or generally and can occur as a permanent or transient disability.Although injuries still represent a major concern for children and adolescents worldwide, studies focusing on injuries in physically disabled children are lacking. To detect musculoskeletal injuries, radiographs are frequently required. In disabled children the radiographic findings can detect the skeletal injury but also can present special radiographic findings of the underlying disease.This review offers an overview of different musculoskeletal disabilities and their related injuries as well as characteristic findings on radiographs., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

An avulsion fracture occurs when the growth plate of an apophysis is injured due to a sudden and forceful contraction of the attaching musculotendinous unit. Usually it is adolescents who sustain these injuries, and a significant male preponderance has been found. Even though apophyseal fractures have been described in a variety of locations, the apophyses of the pelvis and hip are more prone to these injuries. Due to their rarity, avulsion fractures of the pelvis are often misdiagnosed. Additionally, patients can present late, and other pathologies are suspected initially. In most acute cases conservative treatment is successful. However, some cases require operative intervention. To plan an optimal treatment regimen, it is important to be familiar with the typical pathomechanism, the typical clinical findings, and the most commonly applied imaging modalities of these injures. The present review analyzes the currently available literature on the most frequently encountered apophyseal injuries of the pelvis in adolescent patients. Some case examples are also presented., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

In the last few decades, sports injuries in pediatric and adolescent athletes have increased dramatically, with ∼ 38 million young athletes participating in organized sports annually in the United States. Starting at the age of 2 years, an increase of the incidence of knee injuries until adulthood with a peak at 6 and at 13 years of age has been observed. Due to a physiologic laxity of the ligaments, ligament injuries are uncommon in these patients, but they are getting more frequent. In the growing knee, open physis are the points of minor resistance. Therefore apophyseal injuries of the pediatric knee are more common. Diagnostics and treatment of ligament injuries of the pediatric and adolescent knees are challenging. This article presents an overview of ligament injuries in the pediatric and adolescent knee, their diagnostic work-up, and their treatment in the growing patient., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Traumatic brain injury (TBI) is the consequence of external forces that traumatically injure the brain. Closed head injury is common in children and is estimated to result in 650,000 to 1 million emergency department visits annually with approximately 7,400 deaths in the United States. Mild TBI is the most common form of closed head injury and constitutes 80 to 90% of all the TBI. Cranial computed tomography (cCT) is performed in usually more than 50% of the patients, thus, resulting in an extreme overuse with the inherent risk for inducing malignancies. The purpose of this article is to review current approaches, recommendations, and guidelines on pediatric head trauma with special emphasis on cCT. Therefore, after an overview on classification and TBI scores, diagnostic imaging, and management rules for clinical important TBI, as well as own experience including remarks on cCT technique will be discussed., (Georg Thieme Verlag KG Stuttgart · New York.)

During the last years the indications of Cardiac Magnetic Resonance Imaging (CMRI) have been continuously expanded. However, the acceptance of the method by cardiologists and radiologists does not correlate with respect to the diagnostic potential. Several factors, such as expensive equipment, relatively long examination times, high technical know how and lack of remuneration, limit the application of CMRI in everyday clinical practice. Furthermore, doctors tend to apply more conventional, well established diagnostic procedures, the access to the method is still limited and there exist difficulties in the interdisciplinary collaboration. The interdisciplinary Austrian approach to Cardiac Imaging is aimed to improve the aforementioned problems and to support the implementation of CMRI in the diagnostic tree of cardiac diseases thus enabling a cost efficient management of patients in cardiology., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Ovarian tumors are rare in the pediatric age group and thus diagnostic and treatment strategies are heterogeneous. This study aims to evaluate ovarian tumors with a focus on age at presentation, imaging characteristics, diagnostic strategy, tumor presentation and management., Methods: Data was collected retrospectively from patients admitted between 1991 and 2008 for the evaluation and therapy of ovarian tumors., Results: Twenty-five patients were identified with neoplastic ovarian lesions (mean age 10.7 years). Sixteen patients (64%) underwent surgery for benign and 9 (36%) for malignant tumors. Benign tumors (n=16) had a mean diameter of 10.7 cm and mean age at presentation was 9.6 years compared to a diameter of 18.6 cm and 12.3 years in the malignant group (n=9). Elevated tumor markers were observed in 3 (12.5%) benign tumors and in 7 (77.8%) malignant tumors. In preoperative ultrasound investigation, cyst formation was identified in 4 benign tumors and solid tumor mass in 2 malignant tumors. A minimally invasive surgical approach was chosen in two patients, while open surgery was opted for in the rest., Conclusion: Cyst formation, small tumor size and younger age at presentation were characteristic of benign tumors. Malignant tumors often presented with elevated tumor markers, a larger size and a solid consistency. Diagnostic dilemmas remain for both tumor groups due to the different tumor types and the heterogeneity of presentation.

Aim: (67)Ga citrate has been used long and successfully to diagnose and stage sarcoidosis. (18)F-fluorodeoxyglucose ((18)F-FDG) has been suggested as a positron emission tomography (PET) tracer for sarcoidosis imaging. This study aimed to analyze possible advantages of (18)F-FDG-PET over (67)Ga citrate scintigraphy during the primary assessment of patients with sarcoidosis., Patients and Methods: Twenty-four patients (11 men, 13 women, aged 52 years +/-12.4) with histologically proven sarcoidosis were investigated with (18)F-FDG and (67)Ga citrate. Equipment included a full-ring PET scanner (ECAT EXACT HR+, Siemens/CTI, Knoxville TN, USA) and a double-headed gamma camera (ECAM, Siemens, Illinois, USA) for scintigraphy. The mean time difference between the two studies was 6.5 days (range: 5-8 days)., Results: There was a significant difference in the detection of pulmonary and nonpulmonary sarcoidosis lesions between planar (67)Ga citrate scans and (18)F-FDG-PET images (<0.0021). A total of 64 lesions were detected with (67)Ga citrate scans in the thorax and elsewhere with a mean of 2.6 lesions (4%) per patient, while 85 lesions were found with (18)F-FDG-PET, with a mean of 3.5 lesions (4.1%) per patient. There was complete agreement between (18)F-FDG and (67)Ga citrate in thoracic manifestations in four (16.6%) patients, and in non-thoracic manifestations in five (20.8%) patients. The interobserver variability showed a kappa value of 0.79., Conclusion: (67)Ga citrate and (18)F-FDG are useful tracers for diagnostic evaluation of thoracic sarcoidosis. (18)F-FDG seems to be more suitable for imaging the mediastinum, the bi-hilar lymph nodes, the posterior regions of the lungs and non-thoracic lesions. Further prospective studies are needed to clarify the role of both tracers in early diagnosis and staging of sarcoidosis, and to resolve questions concerning medical treatment and follow-up.

Aim: We addressed the feasibility of FDG-PET to differentiate between viability and non-viability in the immediate postoperative assessment of flaps (autologous microvascular anastomosed pedicled flaps) in oro-maxillo-facial surgery., Methods: 3-7 days after surgery, FDG-PET was done in 38 patients who had received flaps for re-construction of the mandible after partial resection. The studies were done on a dedicated full ring PET-scanner (ECAT EXACT HR+, Siemens/CTI). Acquisition started between 60 and 80 min post injection. The findings of the soft tissue component of the flaps were grouped using a three point scale: (I) no defect, (II) small defects, (III) one large defect. The results of PET were compared with the clinical course for at least 3 months., Results: "No defect" on the FDG-PET study identified vi-ability of the flap and predicted normal clinical follow-up (22/38 patients). "Small defects" visualized areas of decreased perfusion and decreased glucose metabolism indicating risk of non-viability (13/38 patients); adapt-ing the postsurgical management led to delayed but uncomplicated healing of the flaps in these patients. "One large defect" demonstrated early necrosis of the flap (3/38 patients). After removal and replacement of this necrotic portion of the flap the second FDG-PET scan of these 3 patients demonstrated the uncomplicated post-operative healing., Conclusion: FDG-PET facilitated the assessment of viability and non viability of flaps in the immediate postsurgical period, and demonstrated the usefulness of FDG-PET for postoperative care and prognosis.

At the Department of Pediatric Surgery in Graz, 31 boys and 23 girls were operated on for congenital diaphragmatic hernia (CDH) from 1978 to 1994. In 49 patients the defect was on the left, in five on the right side. In 46 cases, the hernia was diagnosed within the first week of life; in eight children at a later date. 19 children (35%) died. 25 of the 35 survivors (71%) came to a follow-up examination on average 9.4 (1-17) years after the operation. 24 h pH-monitoring or manometry and Upper G.I. series revealed pathological gastroesophageal reflux (GER) in 16 patients. Nine children were treated conservatively; in seven patients an antireflux procedure was performed. A thoracic position of the stomach or left liver lobe, presence of a hernial sac, gestational age, prenatal diagnosis, use of a patch or severity of lung hypoplasia did not significantly influence the incidence of GER. In three patients, a hiatal hernia was found. The motility of the diaphragm was documented with M-mode sonography (n = 18); a restricted motility could be demonstrated in five patients. GER is very common in patients after repair of CDH. We recommend long-term follow-up with special interest in respect of GER.