Table Of ContentMichael Riccabona
I
Thieme
I
Thieme
Pediatric Imaging Essentials
Radiography, Ultrasound, CT,
and MRI in Neonates and Children
Michael Riccabona, MD
Professor
Department of Radiology
Division of Pediatric Radiology
Graz University Hospital
Graz, Austria
With contributions by
Ingmar Gassner, Gabriele Hahn, Wolfgang Hirsch,
Marcus Hoermann, Thekla von Kalle, Kathrin Maurer,
Heimo Nemec, Gerald Paertan, Brigitte Povysil,
Ianina Scheer, jens-Peter Schenk, Gisela Schweigmann,
Maria Sinzig, Erich Sorantin, Gundula Staatz,
Peter Waibel, Doris Zebedin
633 illustrations
Thieme
Stuttgart · New York
IV
Ubrary ofC ongress catalogtng-in-PubUcacwn Data Important note: Medicine is an ever-changing science un
dergoing continual development. Research and clinical ex
Trainer Kinderradiologie. English. perience are continually expanding our knowledge, in par
Pediatric imaging essentials : radiography, ultrasound, ticular our knowledge of proper treatment and drug
cr. and MRI in neonates and children I (edited by) Michael therapy. Insofar as this book mentions any dosage or appli
Ricc.abona ; with contributions by Ingrnar Gassner, Gabriele cation. readers may rest assured that the authors, editors,
Hahn. Wolfgang Hirsch, Marcus Hoermann, Thekla vonKaJie, and publishers have made every effort to ensure that such
Kathrin Maurer, Heimo Nemer, Gerald Paertm. Brigitte references are in accordance with tne state of knowledge at
Povysil Janina Scheer, ]ens-Peter Schenk. Gisela Schweig the time of production of tne book.
mann, Maria Sin zig, Erich Sorantin. GunduJa Staatz,
Peter Waibel, Doris Zebedin. Nevertheless. this does not involve, imply, or express any
p.;an. guarantee or responsibility on the part of the publishers in
"This book is an authorized translation of the German respect to any dos.age instructions and forms ofa pplications
edition entided Trainer Kinderradiologie published and stated in the book. Every user Is requested to examine care·
copyrighted 2010 by Georg Thieme Verlag, Stuttgart." fully the manufacturers' leaflets accompanying each drug
Includes bibliographical references and index. and to check. if necessaxy in consultation with a physician
ISBN 978-3-13-166191-3 (paperback)- or specialist, whether the dosage schedules mentioned
ISBN 978-3-13-166211-8 (e-ISBN} therein or the contraindications stated by the manufacturers
I. Riccabona, M. (Michael), editor ofc ompilation. II. Title. differ from the statements made in the present book. Such
(DNIM: 1. Diagnosticlmaging-methods.2. Adolesamt. examination is partiatlarly important with drugs that are
3. Child. 4. Infant. WN 2401 either rarely used or have been newly released on the mar
Rj51D5 ket. Every dosage schedule or every form ofa pplication used
618.92'00754-dc23 2013030053 is entirely at the user's own risk and responsibility. The au
thors and publishers request every user to report to the pub
lishers any discrepancies or inaccuracies noticed. Ife rrors in
This book is an authorized translation oft he German edition this work are found after publication, errata will be posted at
published and copyrighted 2010 by Georg Thieme Verlag, www.thieme.com on the product description page.
Stuttgart. Title oft he Gennan edition: Trainer Kinder
cr
radiologie. ROntgen. Ultraschall, und MI« im
Neugeborenen-und Kindesalter
Translator: Terry C. Telger, Fort Worth. TX. USA
Illustrator: Andrea Sclmitzler,lnnsbruck. Austria
C 2014 Georg Thieme Verlag KG, Some of the product names, patents, and registered designs
Rlldigerstrasse 14, 70469 Stuttgart, Gennany referred to in this book are in fact registered trademarks or
http://www.thieme.de proprietary names even though specific reference to this fact
Thieme Medica] Publishers, Inc., 333 Seventh Avenue, is not always made in the text. Therefore, the appearance of a
New York, NY 10001, USA name without designation as proprietary is not to be con
http:/Jwww.thieme.com strued as a representation by the publisher that it is in the
public domain.
Cover design: Thieme Publishing Group
Cover graphics: Martina Berge, Erbach, Gennany This book. including all parts thereof, is legally protected by
'J.Ypesetting by Ziegler und Miiller, Kirchentellinsfurt. copyright. Any use, exploitation, or commercialization out
Gennany side the narrow limits set by copyright legislation. without
Printed in Olina by Asia Pacific Offset the publisher's consent, is illegal and liable to prosecution.
This applies in particular to photostat reproduction. copying,
ISBN 978-3-13-166191-3 mimeographing, preparation of microfilms, and electronic
data processing and storage.
Also available as e-book:
eiSBN 978-3-13-166211-8
v
Contributors
Ingmar Gassner, MD Gerald Paertan, MD
Medical University of Innsbruck Department of Radiology
Department of Radiology Donauspital, Social Medical Center East
Division of Pediatric Radiology Vienna, Austria
Innsbruck, Austria
Brigitte Povysil. MD
Gabriele Hahn, MD Department of Diagnostic Radiology
Department of Diagnostic Radiology Unz Regional Women's and Children's Hospital
Carl Gustav Carus University Hospital Unz, Austria
Dresden University ofTechnology
Dresden, Germany Michael Riccabona, MD
Professor
Franz Wolfgang Hirsch, MD Department of Radiology
Professor Clinical Division of Pediatric Radiology
Department of Pediatric Radiology Graz University Hospital
University of Leipzig Graz, Austria
Leipzig, Germany
Ianina Scheer, MD
Marcus Hoermann, MD Zurich Children's Hospital
Professor University Children's Hospital
City Diagnostic Center Bellaria Zurich, Switzerland
Vienna, Austria
]ens-Peter Schenk, MD
Thekla von Kalle, MD Heidelberg University Medical Center
Department of Radiology of Olga Hospital Division of Pediatric Radiology
Stuttgart Medical Center Angelika Lautenschlager Hospital
Stuttgart, Germany Heidelberg, Germany
Kathrin Maurer, MD Gisela Schweigmann, MD
Medical University of lnnsbruck Medical University of Innsbruck
Department of Radiology Department of Radiology
Pediatric Radiology Division of Pediatric Radiology
Innsbruck, Austria Innsbruck, Austria
Heimo Nemec, MD Maria Sinzig, MD
Department of Radiology and Pediatric Radiology Klagenfurt Regional Hospital
Salzburg Regional Hospital Department of Diagnostic
University Hospital Paracelsius and Interventional Radiology
Private Medical University Division of Pediatric Radiology
Salzburg, Austria Klagenfurt. Austria
VI Contributors
Erich Sorantin, MD Peter Waibel, MD
Professor East Swiss Children's Hospital
Department of Radiology Department of Radiology
Clinical Division of Pediatric Radiology St. Gallen, SWitzerland
Graz University Hospital
Graz, Austria Doris Zebedin, MD
Department of Radiology
Gundula Staatz, MD Clinical Division of Pediatric Radiology
Professor Graz University Hospital
Instructor, Division of Pediatric Radiology Graz, Austria
Department of Diagnostic
and lnterventional Radiology
Mainz University Hospital
Mainz, Germany
VII
Preface
The role and importance of diagnostic imaging are requires substantive knowledge in adapting proto
changing. While more and more imaging studies cols and equipment to ensure consistent, high
are being requested-with a constantly growing quality results for pediatric patients. It is obvious
workload of individual examinations-some radiol in this context that while pediatric radiology is
ogy (sub)specialties are facing increasing staff functionally a branch of pediatrics, the laws regu
shortages, making state-of-the-art services for all, lating the occupational and training aspects of pe
particularly pediatric patients, difficult in some lo diatric radiology make it more closely allied to the
calities and countries. This development raises con field of radiology in general. Although children are
cern, especially as diagnostic imaging studies are less socially powerful than other groups, they are
becoming a central hub for prevention, (pre)clinical the future ofo ur society, and we must strive to pro
diagnosis, treatment planning and monitoring, and vide universally accessible imaging tools and proto
follow-up in a more individualized approach to cols available "24/7" throughout the year that are
medicine, which is the way of the future. With this appropriate to their needs, just as we would for
new role of diagnostic imaging, comprehensive any other segment of society.
knowledge and expert skills in all imaging modali Imaging procedures should always have a valid
ties are becoming an essential requirement for all indication and sound rationale that justifies every
(pediatric) radiologists. In addition, there is a grow single investigation, especially in children. Actions
ing desire within other specialties to implement in pediatric radiology should have an impact on di
imaging procedures. This threat to radiology can agnostic confidence, patient management, long
probably be met most effectively by giving focused term outcome, and on public health whenever pos
attention to all aspects necessary for a particular sible. The nature and application of all imaging mo
subspecialty and by interdisciplinary cooperation, dalities, the various imaging algorithms, and the in
which ensures that all clinically relevant aspects terpretation of findings must conform to the
are addressed with optimal professional skill in or special requirements of children, notably their
der to avoid any bias that might be engendered by greater radiation risk.
being too closely involved, clinically. This approach This textbook seeks to address these needs by
can best be achieved by a profoundly educated ra summarizing essential knowledge in the subspeci
diologist performing the studies-in pediatric radi alty of pediatric radiology, conveying this informa
ology this means, in particular, that the high radia tion as clearly and concisely as possible, thus also
tion sensitivity of children needs to be specifically helping students prepare for certification exams.
addressed. Essential points are reinforced by ending each
Soon, in response to growing economic pres chapter with concise case reports that illustrate
sures, only a few centers will be able to provide ter typical clinical questions and findings in children.
tiary care for children. These centers must also be These brief reports are also meant to highlight rele
able to guarantee training and continuing educa vant aspects ofg ood practice in pediatric radiology,
tion in the subspecialty of pediatric radiology. Be such as the different roles of specific imaging mo
cause many children are seen in office settings and dalities (especially ultrasound) compared to adult
primary care facilities, a sound basic knowledge radiology, the special importance of radiation pro
and good working skills in pediatric imaging have tection (especially in modality selection and dose
cr
become an essential part of specialty training in ra adaptation, as when defining protocols), and a
diology. Equipment and resource-sharing with familiarity with child-specific diseases and clinical
"adult radiology" continue to be important, which questions.
VIII Preface
As imaging algorithms and indications for cer And though imaging should be performed cost ef
tain studies vary with differing health care systems fectively, financial success can never be accepted
(more or less inpatient care, different billing sys as the primary goal of any pediatric radiology activ
tems, other medico-legal requirements, etc.), none ity. These beliefs are becoming more and more im
of such aspects are included or recommended here. portant; and some countries and institutions might
By the very nature of the book and its authors, the well benefit from reconsidering and redefining
treatment of some aspects may reflect the habitual their use of imaging, potentially also resulting in a
use of practitioners in Austria, Germany, and Swit significant reduction of imaging studies, which
zerland. However, great efforts have been made to would not only better serve the patient, but also
ward the goals of relevance and applicability across may contribute to relieve economic burden on
continents, in particular to North America, and to health care systems.
cater to the respective and specific needs of pedia I hope that my readers will enjoy this exposition
tric radiology in all countries. Still, for many rea of pediatric imaging. In addition I want to express
sons, not all aspects of imaging could be addressed. my sincere thanks to all those who made this book
But it is important to remember that diagnostic possible, especially the staff at Thieme Medical
imaging should always primarily serve the patient/ Publishers, my dedicated coauthors, and everyone
child, and should be performed at lowest possible who helped out in any way. I am grateful for valua
invasiveness and (radiation) burden. Even though ble suggestions from colleagues and technologists,
certain medicolegal and financial requirements and I extend special thanks to our young, motivat
must be kept in mind, diagnostic imaging should ing patients, and to my partner Barbara for her
not primarily address (legal) needs and (financial) patience and support
interests of lawyers or hospital administrations. Michael Riccabona, MD
