Showing posts with label imaging. Show all posts
Showing posts with label imaging. Show all posts

Tuesday, July 29, 2014

A Ray of Hope: Sensitivity of Limited vs. Total Follow-up Skeletal Survey

By: Lewis First, MD, MS; Editor-in-Chief 

Photo by Craig Breil via Flickr
There is no question that a child who has been allegedly abused warrants a follow-up skeletal survey—but do all the bones need to be radiated for a second time or can a more limited  approach be taken that will not miss fractures not appearing on a preliminary survey?

Hansen et al. (doi: 10.1542/peds.2013-4024) have addressed this concern through a retrospective review of medical records from five institutions in children under 2 years of age who had a full skeletal survey when initially suspected for child abuse. They then looked at whether a limited view follow-up skeletal survey, in which the spine and pelvis are spared in the absence of findings on the first survey, was performed instead.

The results, though retrospective, suggest there is value and less radiation in considering a limited view protocol. But to convince yourself, read this study and decide if it will result in less radiation in your patients who require follow-up skeletal views for alleged abuse.

Related Reading:

Friday, July 11, 2014

Which Colonoscopy Cleanout Preparation Works Best in Children?

By: Lewis First, MD, MS -- Editor-in-Chief

Photo by cheryl via Flickr
Preparing a child’s bowel for a colonoscopy is easier said than done, since available bowel preparation solutions often don’t taste good, require children to consume a high volume of the solution, and necessitate compliance with tricky dietary restrictions.

Multiple preparations for colonoscopy do exist, but have not been compared with each other for efficacy, safety, tolerability and acceptance—at least not until Di Nardo et al. (doi: 10.1542/peds.2014-0131) performed a randomized controlled trial using four different bowel preparation methods.

The study does a nice job of coming clean with some useful results that will flush out what you need to know and consider using (if you’re not using them already) the next time you need to have one of your patients undergo colonoscopy.

Related Reading: 

Tuesday, June 3, 2014

CT or Rapid MRI for Diagnosing a Ventricular Shunt Malfunction: Which Would You Choose?

By: Lewis First, MD, MS

Given the concerns of radiation exposure from CT scans that have been written about in our journal and others, it is great to see other modalities like rapid MRI come on the scene to offer imaging alternatives. One situation where this is occurring is in the diagnosing of a ventricular shunt malfunction.

Photo by Aimun AB Jamjoom 
via Wikimedia Commons
Cerebrospinal fluid ventricular shunts, implanted surgically, are the preferred method for treating pediatric hydrocephalus. But, whether due to mechanical obstruction, over-drainage or equipment failure, malfunctions are commonplace and frequently require imaging to evaluate the potential malfunction. This frequent need to image and use of cranial CT can expose children with ventricular shunts to a large cumulative dose of ionizing radiation. But is rapid MRI accurate enough, compared to CT, to help avoid excess CT scans?

Boyle et al. (doi: 10.1542/peds. 2013-3739) performed a retrospective cohort study of almost 300 children and teens under 21 years of age seen in the emergency department with a possible shunt malfunction to determine the non-inferiority of the accuracy of rapid cranial MRI when compared to CT. The results are worth reading about and may change your approach or your discussion with your local pediatric emergency specialists as to what imaging to recommend.

This study will likely get some nice exposure once it is officially published next month (just not radiation exposure). Check it out and learn more.

Related Reading:

Tuesday, May 27, 2014

Best Imaging Strategy for Evaluation of Neonatal Encephalopathy via the Vermont Oxford Network

By: Lewis First, MD, MS

You don’t have to read far into a journal table of contents nowadays (ours included) to often find studies showing the risks of computed tomography (CT) radiation in children—especially if there are same or better ways to get the information needed besides CT scans that come with increased risk of radiation to the brain. Nowhere is this more of a concern than in our smallest high-risk infants and their immature brains that need to be examined in the setting of a known or suspected disorder such as neonatal encephalopathy.

Photo by denver kid via Flickr
Fortunately, Barnette et al. (doi: 10.1542/peds. 2013-4247), with the help of the large number of babies enrolled in the Vermont Oxford Network (VON), looked at imaging modalities used in the first three days of life in more than 4,000 infants over 36 weeks gestation and/or treated by therapeutic hypothermia to determine the modality, timing and neuroimaging results obtained by CT, ultrasound and MRI. While CT could show hemorrhage and deep brain structural abnormalities better than ultrasound, ultrasound still had a role in screening for problems with backup from MRI, perhaps shifting CT out of the first line imaging strategy if you haven’t shifted it already.

To get a much better handle on the robustness and import of the findings shared in this study, Dr. Donald Frush (doi: 10.1542/peds. 2014-0733) has written a commentary to accompany this study that should not be missed. Scan, or better yet read, this study carefully and learn more.

If you do take care of high risk newborns with potential encephalopathy, what imaging strategy do you use—and would this study change what you are currently doing? Share your thoughts with us by responding to the blog, sending us an e-letter, or posting your thoughts via our Facebook page or Twitter.

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Thursday, March 6, 2014

Imaging for Appendicitis: US/MRI vs CT—Which Is Better?

Although the CT scan had previously been thought to be the gold standard for imaging someone with suspected appendicitis, the role of ultrasound (US) followed by magnetic resonance imaging (MRI) has been gaining in popularity. So which does a better job?

Photo by Liz West via Flickr
Aspelund et al. (doi: 10.1542/peds.2013-2128) explored this issue by retrospectively reviewing pediatric patients over a 4 year period during which CT was preferred for the first two years (2008-2010) and
ultrasound/MRI for the latter two years. Positive imaging for suspected appendicitis, negative appendectomy rates, perforation rates, and time to antibiotics were studied among other outcome parameters. As to the results, well, you’ll need to read the study to find out, but we think you’ll be on the (cutting) edge of your seats as you learn how each of these imaging modalities performed.

How are you diagnosing appendicitis? We still feel the history and physical can be very sensitive diagnostic tools when performed well—but what do you think? Do you find yourself needing to image your suspected appendicitis patients, or do you send them right to the pediatric surgeon for an operation? If you do image your patients, what do you find as your preferred imaging technique of choice? Would that change as a result of this study?

Let us know by sharing your thoughts via our blog, Facebook or Twitter, or by submitting an eLetter on the Pediatrics website.

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