ACR-SPR-STR Practice Parameter for the Performance of Cardiac Positron Emission Tomography - Computed Tomography (PET/CT) Imaging.

This clinical practice parameter has been developed collaboratively by the American College of Radiology (ACR), the Society for Pediatric Radiology (SPR), and the Society of Thoracic Radiology (STR). This document is intended to act as a guide for physicians performing and interpreting positron emission tomography-computed tomography (PET/CT) of cardiac diseases in adults and children. The primary value of cardiac PET/CT imaging include evaluation of perfusion, function, viability, inflammation, anatomy, and risk stratification for cardiac-related events such as myocardial infarction and death.

Prevalence of non-cardiovascular findings on CT angiography in children with congenital heart disease.

Background: CT angiography is gaining broader acceptance in the evaluation of children with known or suspected congenital heart disease. These studies include non-cardiovascular structures such as the mediastinum, lung parenchyma and upper abdominal organs. It is important to inspect all these structures for potential abnormalities that might be clinically important and, in some cases, may impact care plans.

Vascular lesions--congenital, acquired, and iatrogenic: imaging in the neonate.

The imaging of vasculitis, vasculopathies, and other vascular disorders in neonates presents unique challenges compared with the vascular imaging of older children or adults. These challenges include small-caliber vessels, the need for sedation or anesthesia, a high rate of vasospasm, higher respiratory rates, and a greater susceptibility to long-term effects of ionizing radiation. Duplex ultrasound (US) is typically the first-line imaging modality; in most cases, US provides key diagnostic information necessary for guiding initial management.

Cumulative exposure to medical radiation for children requiring surgery for congenital heart disease.

Objective: To describe cumulative radiation exposure in a large single-center cohort of children with congenital heart disease (CHD) and identify risk factors for greater exposure.

Study Design: A detailed medical radiation exposure history was collected retrospectively for patients aged <18 years who underwent surgery for CHD between January 1, 2001, and July 22, 2009. Cumulative per patient exposure was quantified as the effective dose in millisieverts (mSv) and annualized (mSv/year).

Associations between routine coronary computed tomographic angiography and reduced unnecessary hospital admissions, length of stay, recidivism rates, and invasive coronary angiography in the emergency department triage of chest pain.

Objectives: This study was designed to assess the effects on resource utilization of routine coronary computed tomographic angiography (CCTA) in triaging chest pain patients in the emergency department (ED).

Background: The routine use of CCTA for ED evaluation of chest pain is feasible and safe.

Methods: We conducted a retrospective multivariate analysis of data from two risk-matched cohorts of 894 ED patients presenting with chest pain to assess the impact of CCTA versus standard evaluation on admissions rate, length of stay, major adverse cardiovascular event rates, recidivism rates, and downstream resource utilization.

The role of CT angiography in the evaluation of pediatric renovascular hypertension.

Historically, the evaluation of renovascular hypertension has been accomplished by US, renal scintigraphy and digital subtraction angiography. Based on its high accuracy reported in adults renal CT angiography (CTA) with pediatric-appropriate low radiation dose techniques has become an important tool in the workup of renovascular hypertension in children. Renal CTA has several advantages over more conventional imaging modalities, including rapid and non-invasive acquisition, high resolution and easy reproducibility.

Impact of clinical history on chest radiograph interpretation.

Background: The inclusion of clinical information may have unrecognized influence in the interpretation of diagnostic testing.

Objective: The objective of the study was to determine the impact of clinical history on chest radiograph interpretation in the diagnosis of pneumonia.

Design: Prospective case-based study.

Advances in uroradiologic imaging in children.

Diagnostic imaging of pediatric urologic disorders is continuously changing as technologic advances are made. Although the backbone of pediatric urologic imaging has been ultrasound, voiding cystourethrography, and radionuclide scintigraphy, newer and advanced modalities are becoming increasingly important. This article discusses the techniques and clinical applications of three such imaging modalities as they pertain to pediatric urologic disorders: (1) MR urography; (2) advanced ultrasound (harmonic imaging, three-dimensional, and voiding urosonography); and (3) CT angiography.

Variability in the interpretation of chest radiographs for the diagnosis of pneumonia in children.

Background: Although chest radiography is commonly used to establish the diagnosis of pneumonia in children, the reliability of radiographic findings among radiologists is not well described.

Objective: We sought to evaluate the inter-rater and intra-rater reliability of radiographic features commonly described by radiologists in childhood pneumonia.

Methods: Prospective case-based study.

Congenital thoracic vascular anomalies: evaluation with state-of-the-art MR imaging and MDCT.

Congenital thoracic vascular anomalies include embryologic developmental disorders of the thoracic aorta, aortic arch branch arteries, pulmonary arteries, thoracic systemic veins, and pulmonary veins. Diagnostic evaluation of these anomalies in pediatric patients has evolved with innovations in diagnostic imaging technology. State-of-the-art magnetic resonance (MR) imaging, MR angiography multidetector-row computed tomographic (MDCT) angiography, and advanced postprocessing visualization techniques offer accurate and reliable high-resolution two-dimensional and three-dimensional noninvasive anatomic displays for interpretation and clinical management of congenital thoracic vascular anomalies.

Pediatric computed tomographic angiography: imaging the cardiovascular system gently.

Whether congenital or acquired, timely recognition and management of disease is imperative, as hemodynamic alterations in blood flow, tissue perfusion, and cellular oxygenation can have profound effects on organ function, growth and development, and quality of life for the pediatric patient. Ensuring safe computed tomographic angiography (CTA) practice and "gentle" pediatric imaging requires the cardiovascular imager to have sound understanding of CTA advantages, limitations, and appropriate indications as well as strong working knowledge of acquisition principles and image post processing. From this vantage point, CTA can be used as a useful adjunct along with the other modalities.

Upper extremity computed tomographic angiography: state of the art technique and applications in 2010.

From technical and interpretative perspectives, upper extremity computed tomographic angiography (CTA) is one of the more challenging vascular CTA applications. Synchronizing the relatively large scan coverage with a single bolus of contrast medium requires precise selection of acquisition and contrast delivery parameters. To avoid multiple acquisitions and minimize radiation exposure and contrast medium volume, it is important to have fundamental knowledge on how to select these parameters.

Pediatric urologic advanced imaging: techniques and applications.

Diagnostic imaging of pediatric urologic disorders is continuously changing as technological advances are made. Although the backbone of pediatric urologic imaging has been ultrasound (US), voiding cystourethrography (VCUG), and radionuclide scintigraphy, newer and advanced modalities are increasingly becoming important. The aim of this review is to discuss the techniques and clinical applications of 3 such imaging modalities as they pertain to pediatric urologic disorders: MR urography, advanced US (harmonic imaging, 3D, voiding urosonography), and CT angiography.

Pediatric advanced imaging and informatics: state of the art.

Pediatric imaging has been at the forefront of radiology innovation since the days of Roentgen. In the past 2 decades, evolving computer technology and sophisticated software algorithms have rapidly advanced how pediatric radiologic examinations are acquired and displayed, interpreted and communicated, and stored and retrieved. Cost-effective use of this state of the art technology requires fundamental knowledge of the modalities, workstations, and informatics that guide advanced pediatric imaging in the current digital era.

Current imaging of prenatally diagnosed congenital lung lesions.

Congenital lung lesions refer to a spectrum of pulmonary developmental anomalies including, but not limited to, bronchial atresia, congenital pulmonary airway malformation (formerly known as congenital cystic adenomatoid malformation) and bronchopulmonary sequestration. These anomalies comprise about 90% of the anomalies seen in clinical practice. The advent of prenatal sonography and, more recently, fetal magnetic resonance imaging has changed our understanding and practice in the evaluation of congenital lung lesions.

Vascular involvement in tuberous sclerosis.

Vascular involvement in tuberous sclerosis (TS) is rare. Central and peripheral aneurysms and large and medium size arterial stenotic-occlusive disease have been reported in patients with TS. We present here three pediatric patients with TS and severe vascular abnormalities, followed by a review of the literature.

A case report of rapid progressive coarctation and severe middle aortic syndrome in an infant with Williams syndrome.

Williams syndrome is a genetic disorder caused by multiple contiguous gene deletions in chromosome 7. Presentation in early life is most often a result of luminal stenosis of right- and left-sided arterial vasculature. We report the case of a newborn infant who had a rapidly progressing diffuse form of arteriopathy that required two surgeries and one percutaneous balloon dilation within the first 2 months of her life.

CT angiography in pediatric extremity trauma: preoperative evaluation prior to reconstructive surgery.

Computed tomographic angiography (CTA) is a noninvasive modality for evaluating the vascular system and planning treatment strategies. The goal of this study was to validate the clinical utility of CTA in assessment of suspected pediatric extremity traumatic vascular injury, prior to emergent and delayed reconstructive surgery. A retrospective review was performed of all operative patients under 18 years of age who underwent multidetector-row CTA for evaluation of suspected extremity vascular injury.

A prospective observational study of IVC filters in pediatric patients.

Background: The use of inferior vena cava (IVC) filters to prevent pulmonary embolism (PE) has increased with the advent of retrievable filters (Crowther: Am J Med 120: S13-S17, 2007). Both permanent and retrievable filters have been used in the pediatric population, though reports describing such patients and their outcomes are limited.

Procedure: Our center has established a longitudinal prospective cohort study of consecutive patients with acute venous thromboembolism (VTE) at our pediatric tertiary care institution.

CT angiography effectively evaluates extremity vascular trauma.

Traditionally, conventional arteriography is the diagnostic modality of choice to evaluate for arterial injury. Recent technological advances have resulted in multidetector, fine resolution computed tomographic angiography (CTA). This study examines CTA for evaluation of extremity vascular trauma compared with conventional arteriography.

Identification, imaging, functional assessment and management of congenital coronary arterial abnormalities in children.

The coronary arteries, the vessels through which both substrate and oxygen are provided to the cardiac muscle, normally arise from paired stems, right and left, each arising from a separate and distinct sinus of the aortic valve. The right coronary artery runs through the right atrioventricular groove, terminating in the majority of instances in the inferior interventricular groove. The main stem of the left coronary artery bifurcates into the anterior descending, or interventricular, and the circumflex branches.

Portosystemic pressure gradient during transjugular intrahepatic portosystemic shunt with Viatorr stent graft: what is the critical low threshold to avoid medically uncontrolled low pressure gradient related complications?

Background: Inappropriately decreased portosystemic pressure gradient (PSG) during transjugular intrahepatic portosystemic shunt (TIPS) can cause fatal complications but the critical low threshold of PSG is still not clear. The aim of the present study was to evaluate the critical low threshold of PSG during TIPS.

Methods: Sixty-six patients with cirrhosis who successfully underwent de novo TIPS with Viatorr stent grafts were studied.