High-resolution CT of pediatric lung disease
Section snippets
INDICATIONS
The most common indications for pediatric HRCT are listed in Table 1. Virtually any time a child has a pulmonary parenchymal abnormality requiring CT, a relatively thin-slice technique should be used in combination with the edge-enhancing algorithm. For some conditions, such as metastatic disease, all of both lungs need to be imaged. For other conditions, such as an anomaly or localized mass, it may be possible to restrict the examination to the region of interest to limit radiation to the
Image Quality
Four components impact on the quality of HRCT images in children: (1) motion, (2) lung volume, (3) patient size, and (4) CT technical factors. Technique should be chosen after consideration of the first three factors. Although technique is the primary determinant of dose, it has the least impact on image quality.
Motion. The greatest impediment to obtaining high-quality CT studies in children is respiratory and gross body motion. In children who cannot follow instructions, typically those under
Electron Beam CT
Electron beam CT allows routine use of a 0.1-second scan time that is short enough to stop respiratory motion artifact. Drawbacks include spatial resolution inferior to that of helical scanners and the lack of widespread availability of EBCT.
Stop Ventilation Technique
HRCT in young children is limited both by patient motion and by an inability to obtain inspiratory and expiratory images. The stop ventilation technique uses conscious sedation and mask ventilation to provide motion-free images at inspiration and expiration.
Airways
Investigation of diseases of the pediatric airways is perhaps the most important use of HRCT because this group of diseases is so common in children. HRCT signs of diseases involving the airways are listed in Table 2. Diseases primarily affecting the bronchi are diagnosed by finding bronchial wall thickening or bronchiectasis. The abnormalities can range from subtle and equivocal to grossly obvious. Minimal bronchial wall thickening, whether caused by infection, infiltration, or edema, can be
DISORDERS ASSOCIATED WITH PULMONARY NODULES OR SMALL MASSES
Pulmonary nodules can be classified in a number of ways: by attenuation that may be ground-glass, soft tissue, calcific, or air-containing; by size; or by location (Table 7). It can be difficult to determine if a CT image showing too many dots is caused by multiple small nodules, vessels, or CLOs. Using a slightly thicker slice (3 to 5 mm) allows easier recognition of vessels. Nodules tend to be diffuse and CLOs tend to be localized, associated with bronchial wall thickening, and possess a
FATAL NEONATAL LUNG DISORDERS
Surfactant B deficiency has been identified as a cause of congenital pulmonary alveolar proteinosis.95 This condition presents at birth with radiographic findings similar to respiratory distress syndrome. The CT appearance in two cases was similar to that described in the adult form of alveolar proteinosis described previously with diffuse GGO and marked septal thickening (Fig. 17).61a This disease also is usually fatal unless lung transplantation is performed. A second rare neonatal condition
SUMMARY
High-resolution CT in children remains a technically challenging procedure, both to perform optimally and to interpret correctly. Although much remains to be learned about its optimal application, it is apparent that often confusing or nonspecific chest radiographs are clarified and a much clearer understanding is being gained about the diagnosis and evolution of both common and unusual pediatric lung diseases. As new therapies become available for these disorders, and CT becomes faster and
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2009, Pediatric Clinics of North AmericaCitation Excerpt :Plain chest radiographs and high-resolution computed thomography (HRCT) are commonly used in the evaluation of children suspected of aspiration. Although not diagnostic tests for aspiration, they are useful indicators of lung injury and may also document disease progression or resolution over time.26,27 On radiographs, CLA typically presents as hyperaeration, peribronchial thickening, subsegmental or segmental infiltrates, and atelectasis.
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2009, Pediatric Radiology, Third Edition