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Hughes ECM, Rosenbaum DG, Branson HM, Tshuma M, Marie E, Frayn CS, Rajani H, Gerrie SK. Imaging approach to pediatric calvarial bulges. Pediatr Radiol 2024; 54:1603-1617. [PMID: 38940907 DOI: 10.1007/s00247-024-05967-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/23/2024] [Accepted: 05/29/2024] [Indexed: 06/29/2024]
Abstract
Palpable calvarial lesions in children may require multi-modality imaging for adequate characterization due to non-specific clinical features. Causative lesions range from benign incidental lesions to highly aggressive pathologies. While tissue sampling may be required for some lesions, others have a typical imaging appearance, and an informed imaging approach facilitates diagnosis. This review illustrates imaging findings of common and clinically important focal pediatric calvarial bulges to aid the radiologist in narrowing the differential diagnosis and directing appropriate referral. We focus on birth-related lesions, congenital abnormalities, and modeling disturbances (i.e., those that produce a change in calvarial contour early in development), normal variants, and neoplastic lesions with their mimics.
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Affiliation(s)
- Emily C M Hughes
- Department of Radiology, BC Children's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada.
- Department of Radiology, University of British Columbia, Vancouver, Canada.
- Department of Radiology, University Hospitals Dorset NHS Foundation Trust, Poole, UK.
| | - Daniel G Rosenbaum
- Department of Radiology, BC Children's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Helen M Branson
- Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Toronto, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Makabongwe Tshuma
- Department of Radiology, BC Children's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Eman Marie
- Department of Diagnostic Imaging, McMaster Children's Hospital, McMaster University, Hamilton, Canada
| | - Cassidy S Frayn
- Department of Radiology, BC Children's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Heena Rajani
- Department of Radiology, BC Children's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Samantha K Gerrie
- Department of Radiology, BC Children's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- Department of Radiology, University of British Columbia, Vancouver, Canada
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Linkugel AD, Anstadt EE, Hauptman J, Ettinger RE. Pediatric Cranial Vault Pathology. Oral Maxillofac Surg Clin North Am 2024; 36:343-353. [PMID: 38782678 DOI: 10.1016/j.coms.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
A wide variety of diagnoses can be approached with a common framework for diagnosis, extirpation, and reconstruction of pediatric cranial vault pathologies. Durability of reconstruction is critical for the range of pediatric patients from infancy to adolescence. Rigid reconstruction, preferably with autologous tissue when possible, promotes brain protection and satisfactory aesthetic outcome. Careful planning can allow for immediate definitive reconstruction of defects without need for further surgical intervention.
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Affiliation(s)
- Andrew D Linkugel
- Division of Plastic Surgery, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA; Craniofacial Center, Seattle Children's Hospital, 4800 Sand Point Way Northeast, Seattle, WA 98105, USA
| | - Erin E Anstadt
- Division of Plastic Surgery, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA; Craniofacial Center, Seattle Children's Hospital, 4800 Sand Point Way Northeast, Seattle, WA 98105, USA
| | - Jason Hauptman
- Craniofacial Center, Seattle Children's Hospital, 4800 Sand Point Way Northeast, Seattle, WA 98105, USA; Department of Neurosurgery, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Russell E Ettinger
- Division of Plastic Surgery, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA; Craniofacial Center, Seattle Children's Hospital, 4800 Sand Point Way Northeast, Seattle, WA 98105, USA.
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3
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Alsalek S, Christian EA, Esfahani DR. Ultrasound as a standalone tool for the management of pediatric calvarial dermoid cysts. Childs Nerv Syst 2024:10.1007/s00381-024-06521-6. [PMID: 38951208 DOI: 10.1007/s00381-024-06521-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 06/21/2024] [Indexed: 07/03/2024]
Abstract
PURPOSE Calvarial dermoid and epidermoid cysts are benign lesions common in pediatric neurosurgery. Diagnosis is primarily clinical, with frequent but inconsistent use of imaging. Dermoids have been shown to possess distinct sonographic features, but ultrasound (US) remains underutilized in their management. The purpose of this study is to investigate the independent reliability of US in managing pediatric calvarial dermoids and distinguishing them from other calvarial lesions. METHODS A retrospective review of consecutive patients ≤ 21 years of age with surgically resected calvarial masses between 2017-2024 was performed. Demographic, clinical, and imaging data were analyzed. Pearson chi-squared tests were used for comparison of categorical variables and a binomial linear model was generated controlling for age, lesion tenderness, growth, and suture location. RESULTS Fifty-nine patients with 61 lesions (31 in females; median age 13 months) were included. Dermoids were more common in younger patients (median age 12 months), along suture lines, and were less likely to present with tenderness (p < 0.001) or rapid growth (p = 0.003). Ultrasound was used in 83% of cases and was the sole imaging modality in 33%. On multivariate analysis, suture location was a significant positive predictor of a dermoid diagnosis (OR = 8.08, 95% CI = 1.67-44.18), while rapid growth was a significant negative predictor (OR = 0.08, 95% CI = 0.003-0.80). CONCLUSION Ultrasound presents a sensitive and reliable method for the evaluation of most pediatric calvarial lesions, especially dermoid cysts, and warrants being part of standard workup. With appropriate patient selection, US obviates the need for additional imaging in pediatric patients.
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Affiliation(s)
- Samir Alsalek
- Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA, USA
| | - Eisha A Christian
- Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA, USA
- Department of Pediatric Neurosurgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Darian R Esfahani
- Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA, USA.
- Department of Pediatric Neurosurgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA.
- Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, 4700 Sunset Blvd, Los Angeles, CA, 90027, USA.
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Marchiori S, Cousin F, Papadopoulos I, Bernard C, Thys M, De Prijck B, Pirotte M, Donneau AF, Hustinx R, Caers J, Withofs N. Prognostic value of visual IMPeTUs criteria and metabolic tumor burden at baseline [ 18F]FDG PET/CT in patients with newly diagnosed multiple myeloma. EJNMMI Res 2024; 14:51. [PMID: 38806885 PMCID: PMC11133264 DOI: 10.1186/s13550-024-01113-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 05/22/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND 2-[18F]fluoro-2-deoxy-D-glucose ([18F]FDG) positron emission tomography combined with low-dose computed tomography (PET/CT) can be used at diagnosis to identify myeloma-defining events and also provides prognostic factors. The aim of this study was to assess the prognostic significance of baseline [18F]FDG PET/CT visual IMPeTUs (Italian myeloma criteria for PET Use)-based parameters and/or total metabolic tumor volume (TMTV) in a single-center population of patients with newly diagnosed multiple myeloma (NDMM) eligible for transplantation. METHODS Patients with MM who underwent a baseline [18F]FDG PET/CT were retrospectively selected from a large internal database of the University Hospital of Liege (Liege, Belgium). Initially, all PET/CT images were visually analyzed using IMPeTUs criteria, followed by delineation of TMTV using a semi-automatic lesion delineation workflow, including [18F]FDG-positive MM focal lesions (FL) with an absolute SUV threshold set at 4.0. In a first step, to ensure PET/CT scans accurate reporting, the agreement between two nuclear medicine physicians with distinct experience was assessed. In the second step, univariable and multivariable analyses were conducted to determine the prognostic significance of [18F]FDG PET/CT parameters on progression free survival (PFS) and overall survival (OS), respectively. RESULTS A total of 40 patients with NDMM were included in the study. The observers agreement in the analysis [18F]FDG PET/CT images was substantial for the presence of spine FL, extra spine FL, at least one fracture and paramedullary disease (Cohen's kappa 0.79, 0.87, 0.75 and 0.64, respectively). For the presence of skull FL and extramedullary disease the agreement was moderate (Cohen's kappa 0.56 and 0.53, respectively). Among [18F]FDG PET/CT parameters, a high number of delineated volumes of interest (VOI) using the SUV4.0 threshold was the only independent prognostic factor associated with PFS [HR (95% CI): 1.03 (1.004-1.05), P = 0.019] while a high number of FL (n > 10; F group 4) was the only independent prognostic factor associated with OS [HR (95% CI): 19.10 (1.90-191.95), P = 0.01]. CONCLUSION Our work confirms the reproducibility IMPeTUs criteria. Furthermore, it demonstrates that a high number of FL (n > 10; IMPeTUs F group 4), reflecting a high [18F]FDG-avid tumor burden, is an independent prognostic factor for OS. The prognostic value of the TMTV delineated using a SUV4.0 threshold was not significant. Nevertheless, the count of delineated [18F]FDG-avid lesions VOI using a SUV4.0 threshold was an independent prognostic factor for PFS.
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Affiliation(s)
- Silvano Marchiori
- Division of Nuclear Medicine and Oncological Imaging, Department of Medical Physics, CHU of Liege, Liège, Belgium.
| | - François Cousin
- Division of Nuclear Medicine and Oncological Imaging, Department of Medical Physics, CHU of Liege, Liège, Belgium
| | - Iraklis Papadopoulos
- Biostatistics and Research Methods Center (B-STAT), University of Liege, Liège, Belgium
| | - Claire Bernard
- Division of Nuclear Medicine and Oncological Imaging, Department of Medical Physics, CHU of Liege, Liège, Belgium
| | - Marie Thys
- Medico-Economic Information Department / Data Analysis, CHU of Liège, Liège, Belgium
| | | | | | | | - Roland Hustinx
- Division of Nuclear Medicine and Oncological Imaging, Department of Medical Physics, CHU of Liege, Liège, Belgium
- GIGA-CRC in Vivo Imaging, University of Liege, Liège, Belgium
| | - Jo Caers
- Department of Hematology, CHU de Liège, Liège, Belgium
- Laboratory of Hematology, GIGA I3, University of Liège, Liège, Belgium
| | - Nadia Withofs
- Division of Nuclear Medicine and Oncological Imaging, Department of Medical Physics, CHU of Liege, Liège, Belgium
- GIGA-CRC in Vivo Imaging, University of Liege, Liège, Belgium
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Wang W, Patel J. Imaging of congenital anomalies and defects of the skull base and calvarium. Br J Radiol 2024; 97:902-912. [PMID: 38478401 PMCID: PMC11075995 DOI: 10.1093/bjr/tqae042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/05/2023] [Accepted: 02/19/2024] [Indexed: 05/09/2024] Open
Abstract
Congenital anomalies and defects of the skull base and calvarium encompass a broad and complex spectrum of pathologies. The clinical presentation is highly variable, and these anomalies may be discovered incidentally in asymptomatic individuals. Radiological assessment plays a pivotal role in precisely characterizing these abnormalities, facilitating the diagnostic process, and assisting in any preoperative preparation.
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Affiliation(s)
- Wen Wang
- Radiology Department, University of Florida College of Medicine—Jacksonville, Jacksonville, FL 32209, United States
| | - Jeet Patel
- Radiology Department, University of Florida College of Medicine—Jacksonville, Jacksonville, FL 32209, United States
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Owosho AA, Aguirre SE, Dayo AF, Omolehinwa TT, Shintaku WH. Radiographic Orofacial Findings of Systemic Diseases. Dent Clin North Am 2024; 68:409-427. [PMID: 38417998 DOI: 10.1016/j.cden.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
This article discusses the orofacial clinicoradiographic features of systemic diseases that manifest in the orofacial region. The systemic diseases discussed are grouped into the following: autoimmune diseases, endocrine diseases, bone diseases, hematologic diseases, syndromes, and malignancies. The radiographic manifestation ranges from radiolucent bony destruction, increased bone density, calcification, thinning of cortical plate, loss of trabeculation, missing teeth, and supernumerary teeth. It is imperative for clinicians to be cognizant of these findings, as they may be the first manifestation of these systemic diseases.
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Affiliation(s)
- Adepitan A Owosho
- Department of Diagnostic Sciences, College of Dentistry, The University of Tennessee Health Science Center, Memphis, TN, USA.
| | - Sarah E Aguirre
- Department of Diagnostic Sciences, College of Dentistry, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Adeyinka F Dayo
- Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, PA, USA
| | - Temitope T Omolehinwa
- Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, PA, USA
| | - Werner H Shintaku
- Department of Diagnostic Sciences, College of Dentistry, The University of Tennessee Health Science Center, Memphis, TN, USA
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McDermott T, Amarneh M, Sato Y, Watal P, Charmi V, Fuortes M, Faruqui S, Sato TS. Pediatric focal calvarial lesions: an illustrated review. Pediatr Radiol 2023; 53:2699-2711. [PMID: 37964037 DOI: 10.1007/s00247-023-05795-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 11/16/2023]
Abstract
Focal skull lesions in children can be diagnostically challenging with a wide variety of potential etiologies. Understanding the diverse pathologies and recognizing their associated clinical and imaging characteristics is crucial for accurate diagnosis and appropriate treatment planning. We review pertinent anatomy of the scalp and calvarium and review different pathologies that can present with focal skull lesions in pediatric patients. These include neoplastic, non-neoplastic tumor-like, congenital, post traumatic, and vascular-associated etiologies. We review the key clinical and imaging features associated with these pathologies and present teaching points to help make the correct diagnosis. It is important for radiologists to be aware of the common and rare etiologies of skull lesions as well as the clinical and imaging characteristics which can be used to develop an accurate differential to ensure a timely diagnosis and initiate appropriate management.
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Affiliation(s)
- Tyler McDermott
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Mohammad Amarneh
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Yutaka Sato
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Pankaj Watal
- Department of Radiology, Nemours Children's Health, Orlando, FL, USA
| | - Vijapura Charmi
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Michaelangelo Fuortes
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Sami Faruqui
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - T Shawn Sato
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
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Benson JC, Hamilton-Cave M, Carr CM, Lane JI. Prevalence of intra-osseous veins and venous lakes in the posterior skull base on 3T MRI. Neuroradiol J 2023; 36:702-706. [PMID: 37382936 PMCID: PMC10649541 DOI: 10.1177/19714009231187350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Intra-osseous vessels are normal anatomic structures in the calvarium and skull base. On imaging, these structures-particularly venous lakes-can mimic pathologic abnormalities. This study sought to assess the prevalence of veins and lakes in the skull base on MRI. MATERIALS AND METHODS A retrospective review was completed of consecutive patients that underwent contrast-enhanced MRI imaging of the internal auditory canals. The clivus, jugular tubercles, and basio-occiput were assessed for the presence of both intra-osseous veins (serpentine and/or branching vessels) and venous lakes (well-circumscribed round or oval enhancing structures). Vessels in the adjacent synchondroses major foramina were excluded. Three board-certified neuroradiologists performed independent blinded reviews, with discrepancies agreed upon by consensus. RESULTS 96 patients were included in this cohort (58.3% female). Mean age was 58.4 years (range = 19-85). At least one intra-osseous vessel was identified in 71 (74.0%) patients. 67 (70.0%) had at least one skull base vein, and 14 (14.6%) had at least one venous lake. Both vessel subtypes were observed in 8.3% of patients. Vessels were more commonly observed in women, though this did not reach statistical threshold (p = 0.56). Age was not associated with the presence of vessels (0.59) or vessel location (p values ranged from 0.44-0.84). CONCLUSIONS Intra-osseous skull base veins and venous lakes are relatively common findings on MRI. Both vascular structures should be considered normal anatomy, and care should be taken to not confuse these for pathologic entities.
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Affiliation(s)
- John C Benson
- Department of Radiology, Mayo Clinic, Rochester, MN USA
| | | | - Carrie M Carr
- Department of Radiology, Mayo Clinic, Rochester, MN USA
| | - John I Lane
- Department of Radiology, Mayo Clinic, Rochester, MN USA
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Sarma A, Martin D, Pruthi S, Jones R, Little SB. Imaging the Cerebral Veins in Pediatric Patients: Beyond Dural Venous Sinus Thrombosis. Radiographics 2023; 43:e220129. [PMID: 36656758 DOI: 10.1148/rg.220129] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The range of intracranial venous anomalies in children differs from that in adults. As a commonly encountered highly morbid disease, sinovenous thrombosis has been discussed extensively in the literature, and the associated imaging considerations are similar in pediatric and adult patients. The authors shift the focus to less frequently discussed cerebral venous diseases in pediatric patients. First, the practical embryology pertinent to malformations, syndromes, and variants such as vein of Galen aneurysmal malformation, Sturge-Weber syndrome, and developmental venous anomalies are discussed. Second, anatomic considerations that are applicable to neuroimaging in pediatric patients with cerebral venous anomalies are reviewed. In the discussion of anatomy, special attention is given to the medullary venous system that serves the cerebral white matter, superficial cortical veins (tributaries of the dural venous sinuses), and bridging veins, which carry blood from the superficial cortical veins through the potential subdural space into the dural venous sinuses. Third, the selection of imaging modalities (US, CT and CT venography, and MRI) is addressed, and various MR venographic pulse sequences (time-of-flight, phase-contrast, and contrast-enhanced sequences) are compared. Finally, a broad variety of congenital and acquired superficial and deep venous diseases in children are reviewed, with emphasis on less frequently discussed entities involving the medullary (eg, deep medullary venous engorgement and thrombosis, periventricular hemorrhagic venous infarction due to germinal matrix hemorrhage), cortical (eg, cortical venous thrombosis), and bridging (eg, acute and chronic manifestations of injury in abusive head trauma) veins, as well as the deep veins and dural venous sinuses (eg, varix). © RSNA, 2023 Quiz questions for this article are available through the Online Learning Center. Online supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article.
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Affiliation(s)
- Asha Sarma
- From the Department of Radiology, Vanderbilt University Medical Center, Monroe Carell Jr Children's Hospital, 2200 Children's Way, Nashville, TN 37323 (A.S., D.M., S.P.); and Department of Radiology, Children's Healthcare of Atlanta, Emory University, Atlanta, GA (R.J., S.B.L.)
| | - Dann Martin
- From the Department of Radiology, Vanderbilt University Medical Center, Monroe Carell Jr Children's Hospital, 2200 Children's Way, Nashville, TN 37323 (A.S., D.M., S.P.); and Department of Radiology, Children's Healthcare of Atlanta, Emory University, Atlanta, GA (R.J., S.B.L.)
| | - Sumit Pruthi
- From the Department of Radiology, Vanderbilt University Medical Center, Monroe Carell Jr Children's Hospital, 2200 Children's Way, Nashville, TN 37323 (A.S., D.M., S.P.); and Department of Radiology, Children's Healthcare of Atlanta, Emory University, Atlanta, GA (R.J., S.B.L.)
| | - Richard Jones
- From the Department of Radiology, Vanderbilt University Medical Center, Monroe Carell Jr Children's Hospital, 2200 Children's Way, Nashville, TN 37323 (A.S., D.M., S.P.); and Department of Radiology, Children's Healthcare of Atlanta, Emory University, Atlanta, GA (R.J., S.B.L.)
| | - Stephen B Little
- From the Department of Radiology, Vanderbilt University Medical Center, Monroe Carell Jr Children's Hospital, 2200 Children's Way, Nashville, TN 37323 (A.S., D.M., S.P.); and Department of Radiology, Children's Healthcare of Atlanta, Emory University, Atlanta, GA (R.J., S.B.L.)
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William Whitehouse R, Ahmad G, Kirwadi A, Matthew Howard J. Imaging of Chronic Kidney Disease-Mineral and Bone Disorder. Radiol Clin North Am 2022; 60:547-559. [PMID: 35672088 DOI: 10.1016/j.rcl.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The characteristic radiological appearances of metabolic bone and soft tissue diseases in chronic renal failure are described and illustrated in the context of advancing understanding of the complex metabolic changes that occur in chronic kidney disease and its management.
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Affiliation(s)
| | - Gulraiz Ahmad
- Department of Radiology, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
| | - Anand Kirwadi
- Department of Radiology, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
| | - James Matthew Howard
- Department of Radiology, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
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