Imaging of Vesicoureteral Reflux: Expert Panel Narrative Review.

Vesicoureteral reflux (VUR) is a common congenital anomaly of the urinary tract that can present with collecting system dilation or as a febrile infection. VUR can lead to permanent renal sequelae requiring surgery but can also spontaneously resolve without complication. Therefore, recognizing patient populations who warrant imaging for screening, confirmation, or ongoing surveillance for VUR is important, as is avoiding overdiagnosis.

Prevalence of intrarenal reflux in pediatric patients on contrast-enhanced voiding urosonography.

Background: Intrarenal reflux may be seen with vesicoureteral reflux (VUR) when contrast from the pelvocalyceal system extends into tubules in the parenchyma. Because intrarenal reflux has been associated with scarring, detecting intrarenal reflux may influence management to avoid renal damage.

Objective: Our objective was to evaluate the prevalence of intrarenal reflux identified on contrast-enhanced voiding urosonography (ceVUS) and its association with sex, age, grade of VUR, location in kidney and stage of bladder filling or voiding.

Assessment of distal ureteral and ureterovesical junction visualization on contrast-enhanced voiding urosonography.

Background: Contrast-enhanced voiding urosonography (CEVUS) uses intravesically administered microbubble contrast to detect vesicoureteral reflux (VUR) and urethral anomalies with ultrasound. Multiple studies have suggested CEVUS can replace voiding cystourethrogram (VCUG) as a radiation-free alternative. Analysis of the ureterovesical junction and ureters on VCUG documenting the ureterovesical junction position, ureteral duplication, periureteral diverticula and ureteroceles is important as anatomical variations may affect management and surgical approach.

Physeal separation in pediatric osteomyelitis.

In children, acute osteomyelitis, an infection of the bone, is most commonly hematogeneous in origin. Osteomyelitis is most often diagnosed with magnetic resonance imaging (MRI) and findings may include marrow signal changes on T1 and T2, with abnormal enhancement after gadolinium. Imaging helps detect any associated intraosseous or subperiosteal abscesses, which may require orthopedic drainage.

Evaluation of a pediatric fluoroscopy training module to improve performance of upper gastrointestinal procedures in neonates with bilious emesis.

Background: Life-threatening midgut volvulus usually occurs in infants with malrotation and requires rapid diagnosis and surgical treatment to prevent bowel necrosis and death. However, because of the low frequency of upper gastrointestinal studies performed in infants younger than 1 month, many diagnostic radiology residents finish their residency training having limited or no opportunity to perform or observe an upper gastrointestinal (GI) series for evaluation of bilious emesis in a neonate.

Objective: To determine whether adding simulated upper GI series on neonates with bilious emesis to the curriculum improves residents' skill and accuracy in diagnosing midgut volvulus.

Upper gastrointestinal fluoroscopic simulator for neonates with bilious emesis.

Prompt diagnosis of malrotation and midgut volvulus in infants with bilious emesis is critical. However because of the limited frequency of pediatric upper gastrointestinal (UGI) fluoroscopic procedures in neonates, many diagnostic radiology residents complete their training never having seen or performed a UGI on a baby for evaluation of malrotation and midgut volvulus. A UGI simulation model for infants with bilious emesis was created to supplement the hands-on fluoroscopic experience of residents in training.

Utility of the computed tomography severity index (Balthazar score) in children with acute pancreatitis.

Background: Previous studies in children with acute pancreatitis have demonstrated that clinical scoring systems such as the Ranson, modified Glasgow, and pediatric acute pancreatitis scores are of value in predicting severity of the disease. The aim of this study was to determine the predictive value of the computed tomography severity index (CTSI or Balthazar score) in pediatric patients.

Methods: All children (≤ 18 years) admitted to our institution with acute pancreatitis from 2000 through 2009 were reviewed.

A rare case of thymoma in a 15-month-old girl.

We report a case of thymoma in a 15-month-old girl successfully treated with thymectomy. This case is unique due to the very young age of the child and a family history of thymoma in the father, who was treated with resection at age 10. Radiographic and CT findings mimicked thymic hyperplasia, and highlight the difficulty of distinguishing between these two conditions, since the latter is more common in children.

Evaluation of pediatric bone lesions.

The radiologist is commonly confronted with bone lesions in children. Knowledge of the age of the patient, the lesion location, and various imaging characteristics are all important in making an accurate diagnosis, and determining benign from malignant etiologies should be a primary goal. Various imaging features seen on cross-sectional imaging, including marrow edema, periosteal reaction patterns, and fluid-fluid levels, are discussed.

Anatomical location of the bifurcation of the sciatic nerve in the posterior thigh in infants and children: a formula derived from MRI imaging for nerve localization.

Background And Objectives: Sciatic nerve block is performed at the popliteal fossa for various surgical procedures in infants and children. The aim of this study is to review magnetic resonance imaging scans in children of various ages to assess the location of the division of the nerve in the posterior thigh.

Methods: After Institutional Review Board approval was obtained, measurements of the bifurcation of the sciatic nerve in the posterior thigh were recorded from magnetic resonance images that were previously obtained in children of various ages.

MRI characterization of the glenohumeral joint in Apert syndrome.

The features of craniosynostosis, facial dysmorphism, and distal extremity syndactyly in Apert syndrome are well known. However, there have been limited descriptions of the associated glenohumeral joint findings. We report the radiographic and MRI abnormalities of the glenohumeral joints in a 10-month-old girl with Apert syndrome.

Safety and efficacy of pressure-limited power injection of iodinated contrast medium through central lines in children.

Objective: The purpose of this study was to evaluate the safety and efficacy of pressure-limited power injection of contrast medium through central lines for pediatric body CT examinations.

Subjects And Methods: All patients with a central line who were referred for body CT examinations requiring an i.v.

Umbilical artery catheter use complicated by pseudoaneurysm of the aorta.

We report a case of a large aortic mycotic pseudoaneurysm in a premature infant, a rare but serious complication associated with sepsis and umbilical artery catheter (UAC) use. Sonography is an appropriate first-line imaging modality for detection of aortic pseudoaneurysms. Increased awareness of this rare complication may lead to earlier diagnosis in the high-risk premature infant with a history of a UAC and sepsis.