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Paediatric multi-detector row chest CT: what you really need to know.

Young C, Xie C, Owens CM - Insights Imaging (2012)

Bottom Line: Paediatric imaging technique/protocol together with radiation dose reduction is discussed in detail.However, users must be vigilant in their imaging techniques to minimise radiation burden, whilst maintaining good image quality.Main Messages • CT examinations should be clinically justified by the referring clinician and radiologist. • MDCT is invaluable for evaluating the central airway, mediastinal structures and lung parenchyma. • MDCT is more sensitive than plain radiographs in detection of structural changes within the lungs.

View Article: PubMed Central - PubMed

Affiliation: Cardio-thoracic Unit, Great Ormond Street Hospital for Children NHS Trust, London, WC1N, 3JH, UK, carolyn.young16@yahoo.co.uk.

ABSTRACT

Background: The emergence of multi-detector row CT (MDCT) has established and extended the role of CT especially in paediatric chest imaging. This has altered the way in which data is acquired and is perceived as the 'gold standard' in the detection of certain chest pathologies. The range of available post-processing tools provide alternative ways in which CT images can be manipulated for review and interpretation in order to enhance diagnostic accuracy.

Methodology: Paediatric imaging technique/protocol together with radiation dose reduction is discussed in detail. The use of different post-processing tools to best demonstrate the wide range of important congenital anomalies and thoracic pathologies is outlined and presented pictorially.

Conclusion: MDCT with its isotropic resolution and fast imaging acquisition times reduces the need for invasive diagnostic investigations. However, users must be vigilant in their imaging techniques to minimise radiation burden, whilst maintaining good image quality. Main Messages • CT examinations should be clinically justified by the referring clinician and radiologist. • MDCT is invaluable for evaluating the central airway, mediastinal structures and lung parenchyma. • MDCT is more sensitive than plain radiographs in detection of structural changes within the lungs.

No MeSH data available.


Related in: MedlinePlus

Type 1 CPAM consists of a large cyst with multiple smaller cysts seen on the coronal MinIP image (a) causing mass effect with distortion to the remainder of the right lung parenchyma with mediastinal shift seen on the air bronchogram (b). Scanning parameters: 80 kV, 60 eff mAs, 60 ref mAs, 0.87 CTDIvol, 16 DLP. Type 2 CPAM with multiple cystic lesions in the right lower lobe is better defined on the coronal MinIP image (c) than on the MPR image (d). Scanning parameters: 80 kV, 51 eff mAs, 60 ref mAs, 0.76 CTDIvol, 12 DLP. Type 3 CPAM axial images (e, f) show an area of consolidation with adjacent region of hyperinflation. There is tubular lucency seen within this apical segment of the right lower lobe with air-trapping within the lesion as shown on the MinIP image (g). Scanning parameters: 80 kV, 60 eff mAs, 60 ref mAs, 0.90 CTDIvol, 18 DLP
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Fig7: Type 1 CPAM consists of a large cyst with multiple smaller cysts seen on the coronal MinIP image (a) causing mass effect with distortion to the remainder of the right lung parenchyma with mediastinal shift seen on the air bronchogram (b). Scanning parameters: 80 kV, 60 eff mAs, 60 ref mAs, 0.87 CTDIvol, 16 DLP. Type 2 CPAM with multiple cystic lesions in the right lower lobe is better defined on the coronal MinIP image (c) than on the MPR image (d). Scanning parameters: 80 kV, 51 eff mAs, 60 ref mAs, 0.76 CTDIvol, 12 DLP. Type 3 CPAM axial images (e, f) show an area of consolidation with adjacent region of hyperinflation. There is tubular lucency seen within this apical segment of the right lower lobe with air-trapping within the lesion as shown on the MinIP image (g). Scanning parameters: 80 kV, 60 eff mAs, 60 ref mAs, 0.90 CTDIvol, 18 DLP

Mentions: Congenital pulmonary airway malformation (CPAM) is characterised by proliferation of distal bronchioles with resultant suppression of alveolar formation. Previously known as CCAM (congenital cystic adenomatoid malformation), CPAM is now the favoured descriptive term, as the lesion can be either ‘solid’ or ‘cystic’ in appearance [28, 29]. There are four types of CPAM (Stocker classification): Type 1 involves macroscopic cysts greater than 2 cm, whilst type 2 presents with smaller cysts under 1 cm. Type 3 is composed of solid ‘adenomatoid’ tissue, and type 4 presents with very large cysts causing mass effect with lobar expansion and mediastinal shift, as shown in Fig. 7a–g. CPAMs communicate with the tracheobronchial tree but do not have a systemic arterial supply, although hybrid lesions do exist that consist of both CPAM and pulmonary sequestration [30]. The abnormality is seen on prenatal ultrasound as a cystic or solid mixed lesion. Postnatal imaging includes chest radiograph and chest MDCT to further define and classify the lesion to assess whether surgical excision is necessary.Fig. 7


Paediatric multi-detector row chest CT: what you really need to know.

Young C, Xie C, Owens CM - Insights Imaging (2012)

Type 1 CPAM consists of a large cyst with multiple smaller cysts seen on the coronal MinIP image (a) causing mass effect with distortion to the remainder of the right lung parenchyma with mediastinal shift seen on the air bronchogram (b). Scanning parameters: 80 kV, 60 eff mAs, 60 ref mAs, 0.87 CTDIvol, 16 DLP. Type 2 CPAM with multiple cystic lesions in the right lower lobe is better defined on the coronal MinIP image (c) than on the MPR image (d). Scanning parameters: 80 kV, 51 eff mAs, 60 ref mAs, 0.76 CTDIvol, 12 DLP. Type 3 CPAM axial images (e, f) show an area of consolidation with adjacent region of hyperinflation. There is tubular lucency seen within this apical segment of the right lower lobe with air-trapping within the lesion as shown on the MinIP image (g). Scanning parameters: 80 kV, 60 eff mAs, 60 ref mAs, 0.90 CTDIvol, 18 DLP
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Related In: Results  -  Collection

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Fig7: Type 1 CPAM consists of a large cyst with multiple smaller cysts seen on the coronal MinIP image (a) causing mass effect with distortion to the remainder of the right lung parenchyma with mediastinal shift seen on the air bronchogram (b). Scanning parameters: 80 kV, 60 eff mAs, 60 ref mAs, 0.87 CTDIvol, 16 DLP. Type 2 CPAM with multiple cystic lesions in the right lower lobe is better defined on the coronal MinIP image (c) than on the MPR image (d). Scanning parameters: 80 kV, 51 eff mAs, 60 ref mAs, 0.76 CTDIvol, 12 DLP. Type 3 CPAM axial images (e, f) show an area of consolidation with adjacent region of hyperinflation. There is tubular lucency seen within this apical segment of the right lower lobe with air-trapping within the lesion as shown on the MinIP image (g). Scanning parameters: 80 kV, 60 eff mAs, 60 ref mAs, 0.90 CTDIvol, 18 DLP
Mentions: Congenital pulmonary airway malformation (CPAM) is characterised by proliferation of distal bronchioles with resultant suppression of alveolar formation. Previously known as CCAM (congenital cystic adenomatoid malformation), CPAM is now the favoured descriptive term, as the lesion can be either ‘solid’ or ‘cystic’ in appearance [28, 29]. There are four types of CPAM (Stocker classification): Type 1 involves macroscopic cysts greater than 2 cm, whilst type 2 presents with smaller cysts under 1 cm. Type 3 is composed of solid ‘adenomatoid’ tissue, and type 4 presents with very large cysts causing mass effect with lobar expansion and mediastinal shift, as shown in Fig. 7a–g. CPAMs communicate with the tracheobronchial tree but do not have a systemic arterial supply, although hybrid lesions do exist that consist of both CPAM and pulmonary sequestration [30]. The abnormality is seen on prenatal ultrasound as a cystic or solid mixed lesion. Postnatal imaging includes chest radiograph and chest MDCT to further define and classify the lesion to assess whether surgical excision is necessary.Fig. 7

Bottom Line: Paediatric imaging technique/protocol together with radiation dose reduction is discussed in detail.However, users must be vigilant in their imaging techniques to minimise radiation burden, whilst maintaining good image quality.Main Messages • CT examinations should be clinically justified by the referring clinician and radiologist. • MDCT is invaluable for evaluating the central airway, mediastinal structures and lung parenchyma. • MDCT is more sensitive than plain radiographs in detection of structural changes within the lungs.

View Article: PubMed Central - PubMed

Affiliation: Cardio-thoracic Unit, Great Ormond Street Hospital for Children NHS Trust, London, WC1N, 3JH, UK, carolyn.young16@yahoo.co.uk.

ABSTRACT

Background: The emergence of multi-detector row CT (MDCT) has established and extended the role of CT especially in paediatric chest imaging. This has altered the way in which data is acquired and is perceived as the 'gold standard' in the detection of certain chest pathologies. The range of available post-processing tools provide alternative ways in which CT images can be manipulated for review and interpretation in order to enhance diagnostic accuracy.

Methodology: Paediatric imaging technique/protocol together with radiation dose reduction is discussed in detail. The use of different post-processing tools to best demonstrate the wide range of important congenital anomalies and thoracic pathologies is outlined and presented pictorially.

Conclusion: MDCT with its isotropic resolution and fast imaging acquisition times reduces the need for invasive diagnostic investigations. However, users must be vigilant in their imaging techniques to minimise radiation burden, whilst maintaining good image quality. Main Messages • CT examinations should be clinically justified by the referring clinician and radiologist. • MDCT is invaluable for evaluating the central airway, mediastinal structures and lung parenchyma. • MDCT is more sensitive than plain radiographs in detection of structural changes within the lungs.

No MeSH data available.


Related in: MedlinePlus