MATERIALS AND METHODS. We retrospectively compared chest ultrasound and chest CT in 19 children (nine girls and 10 boys; age range, 8 months–17 years) admitted with complicated pneumonia and parapneumonic effusion between December 2006 and January 2009. Images were evaluated for effusion, loculation, fibrin strands, parenchymal consolidation, necrosis, and abscess. In the subset of patients who underwent surgical management, imaging findings were correlated with operative findings.

RESULTS. Eighteen of 19 patients had an effusion on both chest ultrasound and chest CT. The findings of effusion loculation as well as parenchymal consolidation and necrosis or abscess were similar between the two techniques. Chest ultrasound was better able to visualize fibrin strands within the effusions. Of the 14 patients who underwent video-assisted thoracoscopy, five had surgically proven parenchymal abscess or necrosis. Preoperatively, chest ultrasound was able to show parenchymal abscess or necrosis in four patients, whereas chest CT was able to show parenchymal abscess or necrosis in three.

CONCLUSION. In our series, chest ultrasound and chest CT were similar in their ability to detect loculated effusion and lung necrosis or abscess resulting from complicated pneumonia. Chest CT did not provide any additional clinically useful information that was not also seen on chest ultrasound. We suggest that the imaging workup of complicated pediatric pneumonia include chest radiography and chest ultrasound, reserving chest CT for cases in which the chest ultrasound is technically limited or discrepant with the clinical findings.

CONCLUSION. We found that all children in our experience with occult or subtle SH type II fractures of the distal femur have posterior periosteal disruption and other MRI findings to indicate a hyperextension mechanism of injury. Direct indicators of fracture may be inconspicuous, and the presence of posterior periosteal disruption is a clue that should prompt a search for other features of this serious pediatric injury, which may be followed by limb shortening or angular deformity.

CONCLUSION. MRI may show proximal femoral abnormalities before radiography in the setting of Legg-Calvé-Perthes disease, allowing appropriate diagnosis and prompt treatment. MRI can also assess for revascularization, healing, and multiple complications.

MATERIALS AND METHODS. Study group patients (n = 43) underwent at least two two-view abdominal radiographic series within 48 hours of surgical intervention for suspected NEC complications. Control group patients (n = 86) were patients with suspected NEC who did not undergo surgery for suspected NEC complications. DAAS scores were assigned by two pediatric radiologists with 20 and 6 years' experience.

RESULTS. The initial radiographs of 26 of 43 (60.5%) patients in the study group showed fixed bowel loops (10/43, 23.3%), highly probable or definite pneumatosis (9/43, 20.9%), or portal venous gas (7/43, 16.3%). These findings had progressed to pneumoperitoneum on the follow-up series in 20 (46.5%) study group patients. Among the control group, three patients (3.5%) had highly probable or definite pneumatosis, and none had fixed bowel loops, portal venous gas, or pneumoperitoneum. Patients with higher DAAS scores were more likely to undergo surgical intervention than patients with lower scores (odds ratio, 1.69; 95% CI, 1.40–2.03). A receiver operating characteristic curve analysis showed good overall performance (c statistic = 0.83) for predicting eventual surgical intervention in the study group with higher DAAS scores.

CONCLUSION. The DAAS provides a standardized 10-point radiographic scale that increases with disease severity when using need for surgical intervention as a surrogate for severe NEC. For every 1-point increase in the DAAS score, patients were statistically significantly more likely to have severe disease as measured by need for surgical intervention.

MATERIALS AND METHODS. A search of the hospital information system was conducted to identify the cases of pediatric patients with clinically suspected or known interstitial lung disease who underwent 16-MDCT of the chest with both volumetric and axial HRCT acquisitions (both 1.25-mm slice thickness) from March 2005 to July 2008. Two pediatric radiologists reviewed the images for the presence of motion artifacts at three anatomic levels (upper, middle, and lower lung zones). Motion artifacts were given numerical grades representing no artifact to severe artifact, and the paired Student's t test was used to compare the scores for the two acquisition methods. A total motion score for each acquisition was calculated by summing the scores for each of the three lung zones, and the scores for the two imaging methods were compared. Correlation between degree of motion artifact and age was evaluated. Effective radiation doses were estimated for volumetric and axial CT acquisitions.

RESULTS. The study population consisted of 54 children (28 boys, 26 girls; mean age, 11.7 ± 3.8 years; range, 5–18 years; eight inpatients, 46 outpatients) who underwent a total of 54 MDCT chest studies with volumetric and axial HRCT acquisitions. Motion artifact scores were higher for axial than for volumetric HRCT images of the upper (1.2 vs 1.0), middle (1.6 vs 1.2), and lower (2.2 vs 1.5) lung zones (p < 0.05 at each level). The total motion score of the axial HRCT images (mean, 5; range, 1–9) was higher than that of the volumetric HRCT images (mean, 3.6; range, 1–8) (p < 0.05). Younger age correlated with higher motion artifact score on axial HRCT images (r = –0.36, p < 0.01), whereas no correlation was found between age and motion artifact score on volumetric HRCT images (r = –0.12, p = 0.38). The effective radiation doses were 0.57 mSv for axial HRCT acquisition and 7.6 mSv for volumetric acquisition. The addition of axial acquisition increased the total radiation dose of the MDCT examination 7.1%.

CONCLUSION. At CT of pediatric patients, reconstructed HRCT images from volumetric MDCT acquisition have significantly less motion artifact than images obtained with traditional axial acquisition.

CONCLUSION. Although inflammatory myofibroblastic tumors occur in various sites and the imaging characteristics are variable, tumors showed different imaging patterns that were dependent on the site at which the tumor had originated.