Dating fractures in infants.

AIM: To document the timing of the appearance of the radiological features of fracture healing in a group of infants in which the date of injury was known and to assess the degree of interobserver agreement. MATERIALS AND METHODS: Three paediatric radiologists independently assessed 161 images of 37 long bone fractures in 31 patients aged 0-44 months. The following features were assessed: soft-tissue swelling, subperiosteal new bone formation (SPNBF), definition of fracture line, presence or absence of callus, whether callus was well or ill defined, and the presence of endosteal callus. RESULTS: Agreement between observers was only moderate for all discriminators except SPNBF. SPNBF was invariably seen after 11 days but was uncommon before this time even in the very young. In one case SPNBF was seen at 4 days. CONCLUSION: With the exception of SPNBF, the criteria relied on to date fractures are either not reproducible or are poor discriminators of fracture age.

Radiological features of Meckel's diverticulum and its complications.

Meckel's diverticulum is the most common congenital abnormality of the small bowel. The majority of patients with this anomaly will remain asymptomatic; however, several complications may occur, including obstruction, intussusception, perforation, diverticulitis, and gastrointestinal haemorrhage. These complications may produce a variety of different clinical features and radiological appearances. The purpose of this article is to review the potential imaging manifestations of Meckel's diverticulum and its complications and discuss the advantages and disadvantages of the imaging techniques available.

Cervical spine injuries to children under 11: should we use radiography more selectively in their initial assessment?

OBJECTIVES: To assess the effectiveness of cervical spine radiography in injured children under 11 years old, and suggest improvements. METHODS: Retrospective survey of radiographs and accident and emergency records for children examined during a one year period in a large teaching hospital. RESULTS: No cervical spine fractures occurred in this age group during the year. The recorded clinical findings did not always justify radiography. CONCLUSIONS: Clinical examination appears undervalued by those assessing injured children and is poorly recorded. Radiography can be used more selectively. Initial assessment using a single lateral projection can be followed in doubtful cases by cross sectional imaging.

Improved ultrasound detection of renal scarring in children following urinary tract infection.

A system for defining renal scarring on ultrasound is proposed and compared with DMSA scintigraphy. Renal scarring was assessed with ultrasound in children following urinary tract infection (UTI) using the following criteria: (1) proximity of sinus echoes to cortical surface; (2) loss of pyramids; (3) irregularity of outline; (4) loss of definition of capsular echo; and (5) calyceal dilatation. Three hundred and thirty-nine consecutive ultrasound scans (US) and DMSA scintigrams, comprising 648 kidneys, were performed and reported blindly and the results were compared. Using DMSA scintigraphy as the gold standard, ultrasound had a positive predictive value of 93% and a negative predictive value of 95%. Ultrasound disagreed with DMSA scintigraphy in 5.2% of kidneys. On review of the cases of disagreement where arbitration was possible by comparison with other imaging, ultrasound was incorrect in 10 kidneys and DMSA was incorrect in 13. We conclude that the sensitivity in the ultrasound detection of renal scarring can be greatly improved using this method. If no scars were detected at ultrasound an alternative explanation for an abnormal DMSA scintigram should be sought.

Case report: benign urachal neoplasm.

Benign urachal neoplasms have been rarely reported. We describe a case of a large benign mesenchymal neoplasm (21 x 19 x 14 cm) arising from the urachus, with imaging by computed tomography and ultrasound.

A lethal skeletal dysplasia with generalised sclerosis and advanced skeletal maturation: Blomstrand chondrodysplasia?

The clinical and radiological features in a baby thought to have Blomstrand chondrodysplasia are presented. The hallmarks of this rare lethal disorder are an increase in bone density and advanced skeletal maturation. A high incidence of parental consanguinity is consistent with autosomal recessive inheritance.

Phosphor plate computed radiography: response to variation in mAs at fixed kVp in an animal model. Potential role in neonatal imaging.

Computed digital radiography offers a number of potential advantages over conventional film-screen imaging. To determine the applicability of these to portable neonatal examinations we performed a controlled prospective study comparing conventional 200 speed film-screen with a computed radiography unit in an animal model. Images acceptable for diagnostic purposes were obtained on the digital system over an exposure range many orders of magnitude greater than was possible on the film-screen system. Digital imaging offers potential for elimination of repeat examinations due to suboptimal exposure factors, and for reduction in radiation dose to the patient. We believe that computed digital radiography should be particularly suited to portable neonatal imaging.

Campomelic dysplasia associated with a de novo 2q;17q reciprocal translocation.

A phenotypically female fetus with campomelic dysplasia and a de novo reciprocal translocation, 46,XY,t(2;17) (q35;q23-24), is presented. This is the second case of campomelic dysplasia in which a rearrangement involving the long arm of chromosome 17 has been identified, indicating that this is likely to be the site of the campomelic dysplasia locus.

Comparison of computerized digital and film-screen radiography: response to variation in imaging kVp.

A controlled prospective study, in an animal model chosen to simulate portable neonatal radiography, was performed to compare the response of the Philips Computed Radiography (CR) system and conventional 200 speed film-screen (FS) to variation in imaging kVp. Acceptable images were obtained on the CR system over a very wide kVp range. In contrast the FS system produced acceptable images over a narrow kVp range. This ability suggests that the CR system should eliminate the need for repeat examinations in cases where a suboptimal kVp setting would have resulted in an unacceptable FS image. CR technology should therefore be ideally suited to portable radiography especially in situations where selection of correct exposure factors is difficult as in the neonatal nursery.

Precision of Larsen grading of radiographs in assessing progression of rheumatoid arthritis in individual patients.

A study was designed to evaluate observer variation in the assessment of radiographic deterioration of individual patients using the Larsen grading system. Radiographs of hands and feet of 52 patients were assessed by three observers. Each patient had paired films taken one year apart which were assessed together for change in score. To assess within-observer variation each set of films was read twice by all observers. The average progression was 11.6 (SD 9.0). Analysis of the source of variation showed the single observer replication SD to be 3.7 but that for different observers to be 5.5. This may be interpreted as indicating that to achieve 95% confidence of detecting a true change an increase in Larsen score of 8 is required if the same observer assesses or up to 11 if a different observer assesses.

Magnetic resonance differentiation of acute and chronic osteomyelitis in children.

A comparison has been made of the MRI findings of 17 studies in 16 patients with osteomyelitis: eight studies were performed in patients with acute osteomyelitis, six in chronic and three in healed osteomyelitis. Soft tissues, cortex and marrow were assessed in all patients. The best predictors of acute osteomyelitis were poorly defined soft tissue planes, absence of cortical thickening, and a poor interface between normal and diseased marrow. In contrast, chronic osteomyelitis was suggested by the presence of well-defined soft tissue abnormality, thickened cortex, and a relatively good interface between normal and diseased marrow. The appearance of osteomyelitis did not vary in different anatomic sites.

Pediatric digital chest imaging.

The Philips Computed Radiography system performs well with pediatric portable chest radiographs, handling the throughout of a busy intensive care service 24 hours a day. Images are excellent and routinely provide a conventional (unenhanced) image and an edge-enhanced image. Radiation dose is decreased by the lowered frequency of repeat examinations and the ability of the plates to respond to a much lower dose and still provide an adequate image. The high quality and uniform density of serial PCR portable radiographs greatly enhances diagnostic content of the films. Decreased resolution has not been a problem clinically. Image manipulation and electronic transfer to remote viewing stations appear to be helpful and are currently being evaluated further. The PCR system provides a marked improvement in pediatric portable chest radiology.

Digital imaging of the newborn chest.

The study reports initial experience on utilising an area plate digital imaging system to obtain portable radiographic images on newborn infants. Initial results suggest that the system is a practical alternative to conventional portable radiography with potential advantages of decreasing the number of retake films and also of decreasing radiation dose.