ABSTRACT
Computed tomography (CT) is a valuable examination in children, but the lifetime cancer mortality attributed to CT radiation in children is an order of magnitude higher than in adults. Therefore, it is important that radiologists and referring clinicians ensure that parents are fully informed of the radiation risks, the appropriateness of the examination is considered and imaging protocols are tailored to reduce the radiation burden.
Subject(s)
Informed Consent , Neoplasms, Radiation-Induced/etiology , Tomography Scanners, X-Ray Computed/adverse effects , Adult , Child , Humans , Informed Consent/standards , Parents , Risk FactorsABSTRACT
OBJECTIVE: Failure of a kidney to grow satisfactorily in childhood is evidence of renal disease. Because kidneys may enlarge during an episode of acute pyelonephritis, concomitant renal length measurements cannot be used as baselines for growth assessment. This study was designed to determine the degree of renal enlargement in children with acute pyelonephritis and the time the enlargement takes to resolve after treatment is started to find the optimum time for obtaining baseline measurements. SUBJECTS AND METHODS: In a cohort study, 180 children younger than 5 years old with their first proven acute urinary tract infection, with or without pyelonephritis, had renal scintigraphy and sonography within 15 days of starting treatment. The presence of cortical defects on scintigrams indicated pyelonephritis. The lengths of kidneys with and without scintigraphic defects (i.e., with and without pyelonephritis) were compared, adjusting for age and sex, and the length of kidneys with defects was related to time elapsed between the start of treatment and sonography. RESULTS: Ninety-nine kidneys (28%) in 77 children (43%) had scintigraphic defects. Kidneys with defects were an average of 3.2 mm longer than kidneys without defects. Length and time interval between treatment and sonography in kidneys with defects correlated negatively, with mean length approaching that of kidneys without defects by 10-11 days. CONCLUSION: Kidneys with acute pyelonephritis initially increase in length but return to normal on average by the 11th day of treatment. If poor renal growth is used as an indication of renal disease, sonography should be delayed or repeated at least 2 weeks after the start of treatment to determine the length of the uninflamed kidney.
Subject(s)
Kidney/diagnostic imaging , Kidney/growth & development , Pyelonephritis/diagnostic imaging , Acute Disease , Analysis of Variance , Child, Preschool , Cohort Studies , Dilatation, Pathologic/diagnostic imaging , Female , Gluconates , Humans , Infant , Kidney/pathology , Male , Organotechnetium Compounds , Prospective Studies , Radionuclide Imaging , Regression Analysis , Succimer , Technetium Tc 99m Dimercaptosuccinic Acid , Time Factors , UltrasonographySubject(s)
Brain Death/diagnosis , Angiography, Digital Subtraction , Blood Flow Velocity , Brain Death/physiopathology , Cerebral Angiography , Cerebrovascular Circulation , Echoencephalography , Electroencephalography , Humans , Infant , Infant, Newborn , Radionuclide Angiography , Tomography, X-Ray ComputedABSTRACT
As one treatment option for pineal region tumours is based on the accurate prediction of histology by CT, the scans of 11 children with biopsy proven pineal region tumours were reviewed, and poor correlation found with the "classical" appearances previously described. Accurate diagnosis and appropriate treatment are best achieved when CT is combined with serum tumour markers, CSF cytology and tumour biopsy/debulking/resection.
Subject(s)
Brain Neoplasms/diagnostic imaging , Neuroblastoma/diagnostic imaging , Pineal Gland/diagnostic imaging , Pinealoma/diagnostic imaging , Teratoma/diagnostic imaging , Adolescent , Child , Female , Humans , Male , Tomography, X-Ray ComputedABSTRACT
Unlike gray-scale sonography, color Doppler ultrasonography allows reliable visualization of the ureteric jet phenomenon. A study was undertaken to determine whether any measurable parameter predicts the presence of vesicoureteric reflux. Measurements of mean urine jet velocity, longitudinal angle, transverse angle, and distance of the origin of the jet from the midline of the bladder were obtained on 31 infants and children (62 ureters) with a proved urinary tract infection. Of these measurements, only the distance of the ureteric orifice from the midline of the bladder was found to correlate with vesicoureteric reflux (mean distance in the reflux group, 10.25 mm +/- 2.40 (standard deviation [SD]); in the nonreflux group, 7.98 mm +/- 2.40 [P = .004]). The authors conclude that the more laterally positioned the ureteric orifice, the more likely it is to reflux. Color Doppler ultrasound measurement of the laterality of the ureteric orifice may be useful for predicting which children with a urinary tract infection would benefit from voiding cystourethrography.
