Objective The notion that osteogenesis imperfecta (OI) predisposes children to metaphyseal fractures is controversial. This review aimed to ascertain the prevalence of metaphyseal fractures in children with OI less than 2 years of age.Materials and methods Medline, CINAHL and Web of Science were searched for studies reporting metaphyseal fractures in children with OI less than 2 years of age. Articles not retrievable, not published in English, or where ‘metaphyseal’ fracture was not defined/illustrated, were excluded. Article quality was independently assessed using the Critical Appraisal Skills Programme and Case Reports tools.Results Of 298 retrieved abstracts, 82 were duplicates: 216 articles were screened by title and abstract, excluding 186. Hand search of the remaining 30 articles identified two further articles. Only four articles were included: (1) 4/41 children with OI aged between 1 day and 3 years with ‘metaphyseal’ fractures; (2) a case series including a 16-month-old boy with three ‘metaphyseal’ fractures. Abuse concerns remained despite a type IV OI diagnosis (not genetically confirmed); (3) a 7-month-old girl with two ‘corner’ fractures suspected to have OI and to have been abused; and (4) a pair of siblings with ‘metaphyseal’ fractures and type XI OI (FKBP10 mutation).Conclusions There is limited evidence that OI predisposes infants and young children to metaphyseal fractures. The two diagnoses are not mutually exclusive and until further large studies are conducted, physical abuse should always be considered in infants and young children with metaphyseal fractures, even in those with confirmed OI.

Cranial ultrasound is a critical screening tool in the detection of cerebral abnormalities in term neonates and infants, and is complementary to other imaging modalities. This pictorial review illustrates the diverse central nervous system pathologies which can affect the term neonatal and infantile brain, including vascular abnormalities (hypoxic ischaemic injury, perinatal arterial ischaemic stroke, cerebral sinovenous thrombosis, vein of Galen aneurysmal malformations, subpial haemorrhage, and dural sinus malformations); infections (congenital (cytomegalovirus and toxoplasmosis) and bacterial meningoencephalitis); genetic disorders and malformations (callosal agenesis, tuberous sclerosis, developmental megalencephaly, lissencephaly-pachygyria, and grey matter heterotopia); tumours (choroid plexus papilloma, atypical teratoid/rhabdoid tumour, and desmoplastic infantile glioma) and trauma (birth-related, inflicted injury). Each condition is explored with a focus on its sonographic characteristics—some have rarely, if ever, been described on ultrasound. Through this case review, we illustrate various pathologies affecting the term neonatal and infantile brain, including vascular lesions, infection, genetic disorders/malformations, tumours and trauma: some of these pathologies have rarely, if ever, been described on CUS.

BACKGROUND:Computed tomography (CT) of the chest has proven promising in improving rib fracture detection in children with suspected physical abuse (SPA). However, concerns regarding relatively higher radiation exposure make it less desirable in routine clinical practice. OBJECTIVE:To investigate the effect of varying CT scanning parameters (tube voltage and current) on radiation dose, image quality and diagnostic performance (i.e., sensitivity and specificity), and to optimize chest CT scanning parameters for the detection of acute rib fractures in infants with SPA. METHODS:Following traumatic induction of rib fractures, five rabbits underwent post-mortem CT scanning at two centres using combinations of tube voltage (80 and 100 kV) with progressive 10 % reduction in tube current (mA) until 10 mA was reached. Two pediatric radiologists, blinded to the scan parameters, independently assessed subjective image quality using a 5-point Likert scale and recorded presence of acute undisplaced rib fractures. Linear regression between the readers' scores for image quality and effective dose (ED) was used to determine the imaging parameters providing the lowest ED with acceptable diagnostic image quality. RESULTS:There was moderate agreement between readers for image noise (Centre 1, kappa (k) = 0.5; Centre 2, k = 0.45) and sharpness (Centre 1, k = 0.59; Centre 2, k = 0.55). The parameters with acceptable diagnostic image quality at Centre 1 were 80 kV/30 mA with an ED of 0.32 mSv and sensitivity and specificity of 93.5 % and 99.4 %, respectively, and at Centre 2 80 kV/40 mA with ED of 0.2 mSv and sensitivity and specificity of 84.3 % and 99.1 %, respectively, approaching the combined ED for initial and follow-up skeletal survey chest radiographs performed for SPA (0.14 mSv). CONCLUSION:Low-dose CT (with ED approaching that of chest radiographs performed for SPA) may provide images of sufficient diagnostic quality to confidently diagnose rib fractures. Studies in children with SPA are required.

Cranial ultrasound is an invaluable tool in assessing neonatal brain anatomy and pathology. It is accessible, relatively quick, inexpensive, safe, portable and generally well-tolerated. This pictorial review focuses on the use of cranial ultrasound in evaluating the premature brain. We illustrate the different grades of intraventricular haemorrhage, the most common sequela of prematurity, its evolution and potential complications, as well as periventricular leukomalacia. Anatomical variants and benign findings that mimic preterm brain injury are also discussed. CRITICAL RELEVANCE STATEMENT: Cranial US is an invaluable tool for assessing neonatal brain anatomy and pathology and can be used in preterm infants to diagnose, monitor and assess for complications of intraventricular haemorrhage and periventricular leukomalacia. KEY POINTS: Cranial US (CUS) is an invaluable tool for assessing the neonatal brain and has many advantages over MRI. CUS can detect intraventricular haemorrhage and periventricular leukomalacia, the most important sequelae of prematurity. Knowledge of optimal CUS technique, normal anatomy, and variants/benign sonographic findings that mimic pathology is crucial to avoid misdiagnosis and unnecessary concern.

The European Society of Paediatric Radiology (ESPR) awards prizes for outstanding work presented at their annual scientific meetings. The proportion of ESPR prize-winning abstracts to journal publications is not known. Contextualising abstract-to-publication proportions by evaluating publication experience can yield valuable insights and actionable outcomes to support researchers in overcoming barriers to journal publication. To assess the abstract-to-publication proportion of prize-winning ESPR abstracts and prize-winning authors’ experience of publishing in Pediatric Radiology, the affiliated journal of the ESPR and other specialist international paediatric radiology societies. PubMed was searched for titles of ESPR prize-winning abstracts from 1977 (the year of first award) up to and including 2021, where the presenter was either first or co-author, and the article was published 2 years before or after the presentation year. If not found, a general internet search was performed. Titles of all retrieved articles were evaluated for inclusion. A survey was distributed to all ESPR prize winners to better understand their experiences around journal submission. Over 44 years, 108 prizes were awarded. The prize-winning abstract-to-publication proportion was significantly higher (59.3

[This corrects the article DOI: 10.1016/j.radcr.2023.10.075.].

Extraskeletal myxoid chondrosarcoma (EMC) is a malignant cartilage neoplasm usually encountered in the proximal extremities. We report the case of a 58-year-old male who presented initially with a 3-month history of cough. Initial staging demonstrated a right upper lobe mass with bilateral pulmonary nodules and moderate tracer uptake in the right lung mass and right groin on positron emission tomography imaging. Endobronchial ultrasound biopsy confirmed a histological diagnosis of EMC for which the patient underwent right upper lobe wedge resection. Pelvic MRI revealed a peripherally enhancing juxta-articular lesion within the region of the right obturator externus bursa, which was thought initially to represent either a ganglion or paralabral cyst. However, ultrasound-guided biopsy yielded identical histology to the resected lung mass leading to the diagnosis of primary EMC in the right groin with pulmonary metastases. The patient underwent surgical excision of the right groin mass with no local recurrence on the surveillance computed tomography at 5, 12, and 18 months but eventual disease recurrence in the right groin and further progression of the pulmonary metastases at 29 months. We emphasize that the contrast enhancement pattern of EMC can mimic a benign cystic lesion, in particular, when in a juxta-articular location, which has the potential to mislead radiologists and delay diagnosis and definitive treatment.

BACKGROUND: The impact of sedation on the quality of initial skeletal surveys performed for suspected physical abuse in children is not known. OBJECTIVE: To assess whether sedation influenced the number of, reason for and effective dose of repeat radiographs obtained as part of initial skeletal surveys, and their mean examination times. MATERIALS AND METHODS: One hundred consecutive antemortem initial skeletal survey examinations performed for suspected physical abuse in children <2 years were retrieved from two tertiary paediatric hospitals: Centre 1, where sedation is not used for initial skeletal survey imaging; and Centre 2, where sedation is used routinely. RESULTS: In total, 4055 radiographic projections were performed, of which 93 (2.3%) were repeats. Comparing centres, there was a significant difference in the total number of repeats (P=0.001) P =0.001) and the number of repeats in children aged <12 months (P=0.008). P =0.008). Mean examination times were significantly shorter in unsedated children (P=0.005), P =0.005), even after outliers were excluded (P=0.002). P =0.002). There was no significant difference between the number of routine projections (P=0.587), P =0.587), incompletely imaged body parts (P=0.254), P =0.254), rotation/suboptimal positioning (P=0.527), P =0.527), repeats in children aged >12 months (P=0.089), P =0.089), routine projections in children aged <12 months (P=0.6 P =0.6 42) or >12 months (P=0.979) P =0.979) or the effective doses of repeats (P=0.286). P =0.286). CONCLUSION: There were fewer repeat projections in sedated children and those aged <12 months but examination times were significantly longer. There was no difference in the effective doses of repeated projections. The routine use of sedation is not supported when performing skeletal survey imaging if the primary considerations are reducing radiation dose and examination time.

This second roundtable discussion was convened at the 56th European Society of Paediatric Radiology (ESPR) 2022 Annual Meeting in Marseille, France, to discuss controversial aspects of imaging in child abuse. The following topics were discussed:Fracture dating-the published literature is broadly similar with respect to the identification of the radiographic stages of bony healing. The non-expert/general radiologist is encouraged to use broad descriptors of fracture healing (acute, healing or old) within their reports, rather than attempting to date fractures. The more experienced/expert radiologist, who may provide a timeframe/range to assist the courts, should be aware that any published timeframes are not absolute and that recent research indicates that the rate of healing may differ according to the bone affected and the age of the patient.Whole spine imaging in suspected abusive head trauma-this is recommended to enable a complete assessment of the neuraxis when abusive head trauma is suspected or diagnosed, particularly in the presence of intracranial and cervical subdural haemorrhage and cervical ligamentous injury.Cranial imaging in suspected physical abuse-both computed tomography (CT) and magnetic resonance imaging (MRI) remain complimentary depending on the clinical context in which they are used with CT remaining first-line in the assessment of children with (suspected abusive) head trauma prior to an early MRI. MRI is superior in its assessment of parenchymal injury and may be employed as first-line in age appropriate asymptomatic siblings of a child with suspected physical abuse.

Palpable cervical lymph nodes are common in children and are a frequent reason for presentation to both primary and secondary care. Enlarged lymph nodes are most commonly the result of self-limiting infection, and in children, are rarely the first indicator of a malignant process. This article presents an evidenced-based approach to evaluating these patients.