Abdominal CT In Children Research Articles

Performance evaluation of two iterative reconstruction algorithms, MBIR and ASIR, in low radiation dose and low contrast dose abdominal CT in children.

The adverse effect of low-dose CT on image quality may be mitigated using iterative reconstructions. The purpose of this study was to evaluate the performance of the full model-based iterative reconstruction (MBIR) and adaptive statistical reconstruction (ASIR) algorithms in low radiation dose and low contrast dose abdominal contrast-enhanced CT (CECT) in children. A total of 59 children (32 males and 27 females) undergoing low radiation dose (100kVp) and low contrast dose (270 mgI/ml) abdominal CECT were enrolled. The median age was 4.0years (ranging from 0.3 to 13years). The raw data were reconstructed with MBIR, ASIR and filtered back-projection (FBP) algorithms into 6 groups (MBIR, 100%ASIR, 80%ASIR, 60%ASIR, 40%ASIR and FBP). The CT numbers, standard deviations, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of liver, pancreas, kidney and abdominal aorta were measured. Two radiologists independently evaluated the subjective image quality including the overall image noise and structure display ability on a 4-point scale with 3 being clinically acceptable. The measurements among the reconstruction groups were compared using one-way ANOVA. The overall image noise score and display ability were 4.00 ± 0.00 and 4.00 ± 0.00 with MBIR and 3.27 ± 0.33 and 3.25 ± 0.43 with ASIR100%, respectively, which met the diagnostic requirement; other reconstructions couldn't meet the diagnostic requirements. Compared with FBP images, the noise of MBIR images was reduced by 62.86-65.73% for the respective organs (F = 48.15-80.47, P < 0.05), and CNR increased by 151.38-170.69% (F = 22.94-38.02, P < 0.05). MBIR or ASIR100% improves the image quality of low radiation dose and contrast dose abdominal CT in children to meet the diagnostic requirements, and MBIR has the best performance.

Administration of enteric contrast material before abdominal CT in children: current practices and controversies

Administration of enteric contrast material before abdominal CT in children: current practices and controversies

Mesenteric lymph nodes in children: what is normal?

Enlarged mesenteric lymph nodes (MLN) are frequently seen in children with abdominal pain and, in the absence of other disorders, have been attributed to primary mesenteric lymphadenitis. To evaluate the prevalence of enlarged MLN (short axis>or=5 mm) as detected by abdominal CT in children with a low likelihood for mesenteric lymphadenopathy. During a 14-month period, we identified all non-contrast abdominal CT examinations performed at a tertiary care pediatric hospital for evaluation of suspected or known renal stones. Two radiologists reviewed the examinations and recognized all enlarged MLN, measured the short-axis diameter, and noted the quadrant location. Sixty-one children were identified who met entry criteria; mean age was 10.7 years (range 1.1-17.3 years). Enlarged MLN were found in 33 (54%) of the 61 children; the largest enlarged MLN was most frequently in the right lower quadrant (RLQ) (29 of 33, 88%). Seventeen of the 61 children (28%) had three or more enlarged MLN; all were in the RLQ. The largest short-axis diameter measured was 10 mm. MLN with a short-axis diameter of >5-10 mm are commonly found on abdominal CT examination of children with a low likelihood for mesenteric lymphadenopathy and should be considered a non-specific finding. A short-axis diameter of 8 mm might better define the upper limit of normal mesenteric lymph node size in children.

Significance of ‘blush’ on computed tomography scan in children with liver injury

Background/Purpose: The aim of this study was to determine if the presence of “blush” (an indication of active bleeding) on abdominal CT in children with blunt liver injury adversely affected their clinical outcome as has been reported in adults. Methods: The authors reviewed the records of 105 children ages 1 to 16 years with blunt liver injury seen on admission IV contrast CT seen over a 6-year period. Demographic characteristics measured were age, mechanism of injury, and injury severity score (ISS). Clinical outcomes included ICU stay, hospital length of stay (LOS), transfusion requirement (milliliters per kilogram), operations performed, and mortality rate. CT scans were evaluated retrospectively by a radiologist blinded to prior reports, for a “blush” and grade of liver injury. No patient underwent arterial embolization. The authors eliminated children with grade I-II injuries (30 patients), because only one had a blush, and analyzed the 75 patients with severe liver injuries (grades III-V). Those patients without a blush (n = 53) seen on CT were the control group, whereas patients with a blush (n = 22) were the study group. Data were analyzed using the Fisher's Exact and Mann-Whitney U test. The level of significance was set at.05. Results: Patients with a blush had a significantly larger transfusion requirement (17.3 ± 30.5 mL/kg v 5.0 ± 10.9 mL/kg; P =.02) and mortality rate (23% v 4%; P =.02), but the ISS also was significantly greater (25.8 ± 14.5 v 17.5 ± 12.2; P =.019). All other data were similar between the 2 groups. Conclusions: Children with a blush seen on abdominal CT after blunt liver injury have higher transfusion requirements and greater risk of mortality than those without blush. Mortality is primarily related to the severity of their other injuries. J Pediatr Surg 38:363-366. Copyright 2003, Elsevier Science (USA). All rights reserved.

Is administration of enteric contrast material safe before abdominal CT in children who require sedation? Experience with chloral hydrate and pentobarbital.

It has been common practice to administer enteric contrast material in preparation for abdominal CT in children who require sedation to be examined. At some institutions, the practice of administering an anesthetic or enteric contrast material before sedation is being challenged because it violates the "nothing by mouth" status that is otherwise strictly enforced before sedation. Our purpose was to review our safety record in administering enteric contrast material for CT before sedation. Radiology reports, medical records, and department incident reports were reviewed for the past 5 years from all patients who required sedation for abdominal CT. Patient age and sex, type of sedation, and complications (defined as vomiting with aspiration) related to enteric contrast material before the sedation were recorded. For routine oral contrast material, diluted Hypaque (meglumine diatrizoate) was administered in an age-based amount 1-2 hr before scanning. For sedation, depending on the patient's age, either oral chloral hydrate (70-100 mg/kg) or IV pentobarbital (3 mg/kg with repeated doses of up to 7 mg/kg) was used. Three hundred sixty-seven patients who received oral contrast material before sedation for abdominal CT were identified (200 boys, 167 girls; age range, 1 month-19 years; mean age, 2.9 years). Chloral hydrate was used in 30 patients and IV pentobarbital in 337 patients. No complications related to the administration of oral contrast material before sedation were identified. The practice of administering oral contrast material in children before sedation for abdominal CT appears to be safe when using the sedation drugs and protocols in place at our institution. Further study of the safety of this practice should be undertaken.

Abdominal CT in Children

Abdominal CT in Children

Abdominal CT in children with neurologic impairment following blunt trauma: G.A. Taylor and M.R. Eichelberger. Ann Surg 210:229–233, (August), 1989

Abdominal CT in children with neurologic impairment following blunt trauma: G.A. Taylor and M.R. Eichelberger. Ann Surg 210:229–233, (August), 1989

Abdominal CT in children with neurologic impairment following blunt trauma. Abdominal CT in comatose children.

This paper examines the role of neurologic impairment as an indication for CT examination of the abdomen in children after blunt trauma. The clinical information and abdominal CT examinations of 482 consecutive children were reviewed prospectively for indications for abdominal CT and presence and severity of abdominal and chest injury. Children were divided into two groups determined by Glasgow Coma Scale (GCS): GCS less than 8, and greater than or equal to 8. The prevalence and severity of thoracoabdominal injury were higher in the neurologically impaired group. These children had a higher frequency of abdominal injury (GCS less than 8, 25 of 90 patients (27.8%) vs. GCS greater than or equal to 8, 70 of 392 patients (17.8%); p = 0.047 by Chi square test), injury to multiple abdominal organs (16.7% vs. 4.8%; p = 0.0002), chest injury (32.2% vs. 0.09%; p = 0.0001), and combined chest and abdominal injury (18.9% vs. 4.6%; p = 0.0001). In addition, the mortality rate in children with a GCS less than 8 was significantly higher (GCS less than 8, 24% vs. GCS greater than or equal to 8, 0.26%; p = 0.0001). Eleven children had a GCS less than 8 as the only indication for abdominal CT examination. All 11 children had a normal CT of the abdomen. Every child with abdominal injury on CT scan had specific abdominal signs suggestive of underlying injury. Three neurologically impaired children required abdominal surgery (3.3%) vs. 14 of 369 (3.8%) children with a GCS greater than or equal to 8; p = NS). We conclude that children with severe neurologic impairment are at higher risk for intraabdominal injury than those without coma, but that neurologic impairment without abdominal signs is a low-yield indication for abdominal CT examination. Abdominal CT scan should be reserved for children in whom there is a high clinical index of suspicion of significant abdominal trauma based on physical examination and the mechanism of injury.