Search

Anorectal and cloacal malformations are a broad mix of congenital abnormalities related to the distal rectum and anus. Confusion exists between all the forms in this large and heterogeneous group. The spectrum includes everything from anal stenosis, ventral anus, anal atresia (with and without fistula) and the full spectrum of cloacal malformations. Imaging in these conditions is done through the whole armamentarium of radiologic modalities, with very different imaging strategies seen across the centres where these conditions are managed. In 2017, the European Society of Paediatric Radiology (ESPR) abdominal imaging task force issued recommendations on the imaging algorithm and standards for imaging anorectal malformations. This was followed by further letters and clarifications together with an active multispecialty session on the different imaging modalities for anorectal malformations at the 2018 ESPR meeting in Berlin. Through this paper, the abdominal task force updates its guidelines and recommended imaging algorithm for anorectal malformations.Other Information Published in: Pediatric Radiology License: https://creativecommons.org/licenses/by/4.0See article on publisher's website: http://dx.doi.org/10.1007/s00247-022-05395-7

Objectives Female genital malformations may be present in the form of individual entities, they may involve neighboring organs or they may occur in the context of complex syndromes. Given the anatomical structures of the vulva, vagina, uterus and uterine appendages, the clinical picture of malformations varies greatly. Methods This S2k-guideline was developed by representative members from different medical specialties and professions as part of the guidelines program of the DGGG, SGGG and OEGGG. The recommendations and statements were developed and voted on using a structured consensus process with neutral moderation. Recommendations This guideline is the first comprehensive summary of female genital malformations from infancy to adulthood which covers clinical examinations, diagnostic workups and treatment options. Additional chapters have been included on complex urogenital malformations, vascular malformations, psychosomatic care, and tumor risk.

When discussing imaging of the paediatric urogenital (UG) system, the basic rational of any imaging should be reconsidered and remembered: imaging should only be used if it has an impact on diagnosis, treatment, further management and/or patient outcome. Particularly, in paediatrics the imaging modality should be selected considering the specifi c paediatric needs and diseases: imaging should try to avoid ionising radiation whenever possible, the least invasive procedure applicable for the individual query should be selected (e.g., try to avoid catheterism if possible, reduce examinations that need sedation, etc.), and any imaging that does not impact management should be avoided. Furthermore, the recommended imaging method should be easily accessible and available. Another basic comment on imaging in children: children are not small adults, therefore state-of-the-art imaging of infants and children requires dedicated techniques (equipment, transducer, fi ltering...) as well as age-adapted investigation protocols (ultrasound, CT, MR, etc.). This means that everyone who deals with children needs to have not only the adequate equipment available, but also has undergone dedicated training in paediatric imaging.

Imaging plays a crucial role in evaluating newborns and infants with cloacal and urogenital malformations. Contrast-enhanced genitosonography (ceGS) and contrast-enhanced colosonography (ceCS) are sensitive and radiation-free alternatives to fluoroscopic genitography and colography for diagnosis and surgical planning. These imaging techniques are performed by instilling a US contrast agent into specific body cavities to define the genitourinary and colorectal anatomy. This review article presents the experience with ceGS and ceCS applications in children, focusing on the background, examination technique, and interpretation of imaging findings, as well as strengths and weaknesses compared to conventional techniques.

Introduction Novel dedicated extremity cone beam computed tomography (CBCT) devices, recently introduced to the market, raised attention as a possible alternative in advanced diagnostic pediatric trauma imaging, today usually performed by multidetector computed tomography (MDCT). This work aimed to compare image quality and radiation dose of CBCT and MDCT. Materials and methods Fifty-four CBCT-MDCT examination pairs, containing nine MDCTs acquired in parallel prospectively and 45 MDCTs matched in retrospect, were included in this study. Image quality was analyzed semi-objectively by measuring noise, contrast-to-noise ratio (CNR), and signal-to-noise ratios (SNR) and subjectively by performing image impression ratings. CT dose records were readout. Results Image noise was significantly lower in CBCT compared with MDCT, both semi-objectively and subjectively (both p p = 0.001). Motion artifacts were infrequently, but exclusively observed in CBCT. CT dose index (CTDIvol) was substantially lower in CBCT (p Conclusion Dedicated extremity CBCT could be an alternative low-dose modality in the diagnostic pathway of pediatric fractures. At lower doses compared with MDCT and commonly affected by beam hardening artifacts, semi-objective CBCT image quality parameters were generally better than in MDCT.

Das Strategiepapier der GPR zeigt Entwicklungsmöglichkeiten der Kinder- und Jugendradiologie als Querschnittsfach zwischen der Radiologie und der konservativen und operativen Kinder- und Jugendmedizin auf. Zitierweise

Contrast-enhanced ultrasonography (US) has become an important supplementary tool in many clinical applications in children. Contrast-enhanced voiding urosonography and intravenous US contrast agents have proved useful in routine clinical practice. Other applications of intracavitary contrast-enhanced US, particularly in children, have not been widely investigated but could serve as a practical and radiation-free problem-solver in several clinical settings. Intracavitary contrast-enhanced US is a real-time imaging modality similar to fluoroscopy with iodinated contrast agent. The US contrast agent solution is administered into physiological or non-physiological body cavities. There is no definitive list of established indications for intracavitary US contrast agent application. However, intracavitary contrast-enhanced US can be used for many clinical applications. It offers excellent real-time spatial resolution and allows for a more accurate delineation of the cavity anatomy, including the internal architecture of complex collections and possible communications within the cavity or with the surrounding structures through fistulous tracts. It can provide valuable information related to the insertion of catheters and tubes, and identify related complications such as confirming the position and patency of a catheter and identifying causes for drainage dysfunction or leakage. Patency of the ureter and biliary ducts can be evaluated, too. US contrast agent solution can be administered orally or a via nasogastric tube, or as an enema to evaluate the gastrointestinal tract. In this review we present potential clinical applications and procedural and dose recommendations regarding intracavitary contrast-enhanced ultrasonography.

Since Francis Fontan first introduced the eponymous technique, the Fontan procedure, this type of surgical palliation has allowed thousands of children affected by specific heart malformations to reach adulthood. Nevertheless, abdominal, thoracic, lymphatic and neurologic complications are the price that is paid by these patients. Our review focuses on Fontan-associated liver disease; the purpose is to summarize the current understanding of its physiopathology, the aim of follow-up and the specific radiologic follow-up performed in Europe. Finally, we as members of the Abdominal Task Force of the European Society of Paediatric Radiology propose a consensus-based imaging follow-up algorithm.

Contrast-enhanced ultrasound (CEUS) and diffusion-weighted imaging (DWI) are safe, repeatable imaging techniques. The aim of this paper is to discuss the advantages, technical factors and possible clinical applications of these imaging tools in focal renal lesions in children.

Background: Justification of imaging investigations is important, particularly in pediatrics underwent investigation using a relatively higher radiation such as CT, due to the higher radiation sensitivity of children. Objective: To assess the difference of viewpoints between pediatric physicians and pediatric radiologists on the appropriateness of pediatric CT utilization in a tertiary-care university hospital with limited MR capacity. Methods: Pediatric medical records of head CT, chest CT, and abdominal CT were retrospectively reviewed in consecutive date of the examination until having 100 head CTs and 100 body CTs with complete clinical and imaging information. The physicians and the radiologists were asked to suggest the imaging modality of choice for each patient according to the given data, regardless of the hospital’s limitation. If the suggested modality of choice was not CT, the CT request would be considered as “inappropriate”. They additionally scored the CT appropriateness, firstly using individual judgement, and secondly using the ACR Appropriateness Criteria. Both scoring methods used the same rating scale from 1 to 9; score 1-3 was considered “inappropriate”. Results: From the viewpoint of the physicians and radiologists, the number of inappropriate CT request was 20% and 54% according to “the modality of choice”, 2.5% and 17% according to “individual judgement”, 12% and 22% according to the “ACR Appropriateness Criteria”. The main difference was not from no indication for imaging but from the selected modality of imaging. The radiologists suggested 52% of head CTs and 64% of abdominal CTs could have been replaced by MRI if available. Conclusion: There are ten-percent disagreement on appropriateness of pediatric CT request between physicians and the radiologists when using the same guidelines and considering the hospital limitation.

There are many errors and pitfalls that are commonly encountered during ultrasound examinations. In normal ultrasound, pitfalls may arise from anatomic or physiologic variants of pediatric anatomy, settings, artifacts, patient conditions, operator misunderstanding, or inexperienced performance. In limited field and point-of-care ultrasound, common errors are usually due to limited access, misdiagnosis as a result of wrong timing, unsuitable patient conditions, limited transducer options, satisfaction of search, and unfamiliarity with pediatric sonography. Knowledge of these pitfalls helps improve a physician's performance and diagnosis.

Zusammenfassung Hintergrund Kindliche Lebertumoren sind relativ selten, aber die Kenntnisse über ihre bildgebende Diagnostik nicht weniger wichtig. Fragestellung Häufigkeit und Bildmorphologie benigner und maligner Raumforderungen der Leber im Kindesalter. Material und Methode Aufbereitung der einschlägigen Originalarbeiten, Übersichtsarbeiten und Expertenempfehlungen betreffend die Bildgebung kindlicher Lebertumoren. Ergebnisse Die häufigsten bösartigen Lebertumoren sind das meist bei Kleinkindern auftretende Hepatoblastom sowie in manchen Regionen auch das hepatozelluläre Karzinom. Ihre Bildmorphologie ist im Gegensatz zu manchen benignen Raumforderungen, wie beispielsweise der fokalen nodulären Hyperplasie, simplen Zysten oder Steatosearealen, wenig charakteristisch. Radiologisch kommen üblicherweise die Sonographie und die Magnetresonanztomographie (MRT) zum Einsatz. Beide Methoden profitieren von einer intravenösen Kontrastmittelgabe. Schlussfolgerung Kindliche Lebertumoren weisen ein breites morphologisches Spektrum auf. Manche Entitäten lassen sich mittels Bildgebung charakterisieren, manche benötigen eine multimodale Bildgebung oder eine histologische Begutachtung. Neben den bildmorphologischen Kriterien spielen insbesondere auch Alter, Laborparameter und Anamnese eine wichtige Rolle in der Diagnosefindung.

Objectives Female genital malformations may take the form of individual entities, they may involve neighboring organs or they may occur in the context of complex syndromes. Given the anatomical structures of the vulva, vagina, uterus and adnexa, the clinical picture of malformations may vary greatly. Depending on the extent of the malformation, organs of the urinary system or associated malformations may also be involved.Methods This S2k-guideline was developed by representative members from different medical specialties and professions as part of the guidelines program of the DGGG, SGGG and OEGGG. The recommendations and statements were developed using a structured consensus process with neutral moderation and voted on.Recommendations The guideline is the first comprehensive presentation of the symptoms, diagnosis and treatment options for female genital malformations. Additional chapters on classifications and transition were included.

We aim to present a practical approach to imaging in suspected biliary atresia, an inflammatory cholangiopathy of infancy resulting in progressive fibrosis and obliteration of extrahepatic and intrahepatic bile ducts. Left untreated or with failure of the Kasai procedure, biliary atresia progresses to biliary cirrhosis, end-stage liver failure and death within the first years of life. Differentiating biliary atresia from other nonsurgical causes of neonatal cholestasis is difficult as there is no single method for diagnosing biliary atresia and clinical, laboratory and imaging features of this disease overlap with those of other causes of neonatal cholestasis. In this second part, we discuss the roles of magnetic resonance (MR) cholecystopancreatography, hepatobiliary scintigraphy, percutaneous biopsy and percutaneous cholecysto-cholangiography. Among imaging techniques, ultrasound (US) signs have a high specificity, although a normal US examination does not rule out biliary atresia. Other imaging techniques with direct opacification of the biliary tree combined with percutaneous liver biopsy have roles in equivocal cases. MR cholecystopancreatography and hepatobiliary scintigraphy are not useful for the diagnosis of biliary atresia. We propose a decisional flowchart for biliary atresia diagnosis based on US signs, including elastography, percutaneous cholecysto-cholangiography or endoscopic retrograde cholangiopancreatography and liver biopsy.

We present a practical approach to imaging in suspected biliary atresia, an inflammatory cholangiopathy of infancy resulting in progressive fibrosis and obliteration of extrahepatic and intrahepatic bile ducts. Left untreated or with failure of the Kasai procedure, biliary atresia progresses towards biliary cirrhosis, end-stage liver failure and death by age 3. Differentiation of biliary atresia from other nonsurgical causes of neonatal cholestasis is challenging because there is no single method for diagnosing biliary atresia, and clinical, laboratory and imaging features of this disease overlap with those of other causes of neonatal cholestasis. Concerning imaging, our systematic literature review shows that ultrasonography is the main tool for pre- and neonatal diagnosis. Key prenatal features, when present, are non-visualisation of the gallbladder, cyst in the liver hilum, heterotaxy syndrome and irregular gallbladder walls. Postnatal imaging features have a very high specificity when present, but a variable sensitivity. Triangular cord sign and abnormal gallbladder have the highest sensitivity and specificity. The presence of macro- or microcyst or polysplenia syndrome is highly specific but less sensitive. The diameter of the hepatic artery and hepatic subcapsular flow are less reliable. When present in the context of acholic stools, dilated intrahepatic bile ducts rule out biliary atresia. Importantly, a normal US exam does not rule out biliary atresia. Signs of chronic hepatopathy and portal hypertension (portosystemic derivations such as patent ductus venosus, recanalised umbilical vein, splenomegaly and ascites) should be actively identified for - but are not specific for - biliary atresia.

Das Strategiepapier der GPR zeigt Entwicklungsmöglichkeiten der Kinder- und Jugendradiologie als Querschnittsfach zwischen der Radiologie und der konservativen und operativen Kinder- und Jugendmedizin auf. ZITIERWEISE: · Mentzel H, von Kalle T, Antoch G et al. Challenges in Pediatric Radiology – Strategies of the board of the German speaking Society of Pediatric Radiology. Fortschr Röntgenstr 2020; 192: 531 – 536.

Common applications including indications, techniques and findings of US in the paediatric musculoskeletal system and small parts are listed.

Important and commonly used normal values in paediatric US are listed. However, this is not a complete list.

Various methods on how to perform hip US for developmental hip dysplasia (DSD) are described and the respective findings illustrated, additionally other applications of US in paediatric hip conditions such as for assessing hip effusion.

As the vertebrae are not yet completely ossified in early childhood, the spinal canal and its content is nicely visible by US in neonates (and infants). The respective US technique and normal as well as typical pathological findings are described and illustrated.

The basics and all common application of paediatric and particularly neonatal neurosonography are presented, furthermore more sophisticated and advanced applications are addressed.

Graphs and illustrations as well as some remarks on measurements in diagnostic paediatric ultrasound.

Short overview of US methods as necessary for understanding diagnostic US. Additionally, the various options, artefacts, how to perform an investigation, biological effects or documentation needs are addressed.

Most important non-invasive tool for evaluation of the child’s cardiovascular system provides exact morphological diagnosis and enables hemodynamic assessment in most cases – often avoiding invasive diagnostic heart catheterisation.

Overview of Doppler Sonography and 3D/4DUS. Additionally, various specific artefacts or restrictions and some respective typical applications of those methods are described.

The basics and most common entities encountered on paediatric abdominal US are outlined excluding the bowel and the urogenital tract (see separate dedicated chapters).

The sonographic imaging of peripheral nerves in childhood is described, particularly focusing on normal findings and findings after nerve trauma or in tumous such as neuroma or neurofibroma.

To briefly address imaging algorithms for common queries in paediatrics, where US plays a key role, particularly focusing on the abdomen including also urogenital tract diseases and chest.

All somewhat invasive techniques, i.e. biopsies, punctures, drainages, foreign body removal, voiding urosonography, sonographic enema, US guidance for catheter placement, and similar procedures are addressed. Additionally, US for follow-up is addressed.

The various options of limited field of view or focused US as often used in point-of-care US (POCUS) as a first orientation in addition to the basic clinical exam; furthermore, FAST and RUSH applications in childhood will be briefly addressed.

The chapter addresses besides procedural details the potential of US in most paediatric urogenital conditions such as postnatal imaging in foetal urinary tract dilatation, urinary tract infection, haematuria, failure to grow, suspicion of VUR, obstructive uropathy, renal failure, enuresis, micturition problems, urolithiasis, involvement in systemic or syndromic disease, high blood pressure, trauma, tumour, nephritic and nephrotic syndrome, renal transplantation, pre−/postoperatively, etc.

Very early onset inflammatory bowel disease (VEO-IBD) is defined as disease presenting before the age of 6. These children require a tailored imaging approach because conventional imaging studies can be difficult to perform at such a young age. Unlike inflammatory bowel disease in older children and adults, colonic disease predominates in VEO-IBD, and small-bowel disease is rare. Distinguishing Crohn disease from ulcerative colitis is challenging both clinically and on histology. Radiology offers the greatest utility for detecting small-bowel disease because it helps to distinguish the two main disease entities and guide clinical management. Small-bowel ultrasound is recommended as the first-line investigation because it requires relatively little preparation, is readily available and is generally well tolerated in young children. We present these recommendations, based on the current evidence for radiologic management in this group, and propose an imaging algorithm for investigating VEO-IBD.