Pediatric radiology
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Pediatric radiology · Jan 2012
Case Reports'Benign' ovarian teratoma and N-methyl-D-aspartate receptor (NMDAR) encephalitis in a child.
N-methyl-D-aspartate receptor (NMDAR) encephalitis is a life-threatening paraneoplastic neuropsychiatric encephalitis that predominantly affects young women and has a strong association with ovarian teratomas. Removal of the ovarian teratomas improves the prognosis and decreases the risk of recurrence. We present an 11-year-old girl with NMDAR encephalitis with small bilateral teratomas not initially appreciated on abdominal CT or pelvic MRI. ⋯ In NMDAR encephalitis, the ovarian teratomas can be very small, particularly in children, and easily missed on cross-sectional imaging. Awareness of the association of NMDAR encephalitis and ovarian teratomas will improve the diagnostic accuracy and imaging interpretation. Periodic sonography and MRI might be warranted in children if the initial study is negative.
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Pediatric radiology · Nov 2011
ReviewPaediatric MRI under sedation: is it necessary? What is the evidence for the alternatives?
To achieve diagnostic images during MRI examinations, small children need to lie still to avoid movement artefact. To reduce patient motion, obviate the need for voluntary immobilisation or breath-holding and therefore obtain high-quality images, MRI of infants is frequently carried out under sedation or general anaesthesia, but this is not without risk and expense. However, many other techniques are available for preparing children for MRI, which have not been fully evaluated. ⋯ Lastly, we discuss several factors that will influence the choice of imaging preparation, including patient factors, imaging factors and service provision. The choice of approach to paediatric MRI is multi-factorial, with limited scientific evidence for many of the current approaches. These considerations may enable others to image children using MRI under different circumstances.
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Pediatric radiology · Sep 2011
ReviewAdvances in CT technology and application to pediatric imaging.
The use of imaging in both hospital and non-hospital settings has expanded to more than 70 million CT procedures in the United States per year, with nearly 10% of procedures performed on children. The availability of multiple-row detector CT (MDCT) systems has played a large part in the wider usage of CT. This rapid increase in CT utilization combined with an increasing concern with regard to radiation exposure and associated risk demands the need for optimization of MDCT protocols. This manuscript will briefly discuss how technology has changed in regard to MDCT protocols, helping to reduce radiation dose in CT, especially in pediatric imaging.
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Greater than 10% of diagnostic imaging studies performed in developed countries are CT examinations. In the United States, as many as 60 million CT studies are performed each year, up to 7 million of which are performed in pediatric patients. ⋯ This can be achieved by utilizing imaging studies that do not require the use of ionizing radiation, thus decreasing the number of CT studies performed. If a CT study is indicated, the delivered dose should be optimized to use the lowest possible dose level while still answering the clinical question.
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Pediatric radiology · Sep 2011
ReviewThe appropriate use of CT: quality improvement and clinical decision-making in pediatric emergency medicine.
An increasing number of patients presenting to a shrinking number of hospital emergency departments has contributed to challenges to providing high-quality care, specifically care that is safe, efficient and effective. These challenges are magnified by trends in CT utilization with uncertain implications for care delivery. ⋯ Strategies for minimizing CT utilization in managing appendicitis, traumatic brain injury and cervical spine injuries are described. Clinical scores, clinical decision rules and evidence-based guidelines can assist the clinician in providing high-quality care through effective utilization of CT.