Essential Measurements in Pediatric Musculoskeletal Imaging

Description:
This practical guide presents an up-to-date, comprehensive yet concise collection of the most frequently used measurements in musculoskeletal studies carried out in children and adolescents through the different radiological modalities.The book covers the measurements applied on various anatomical regions in a succinct and easy-to-use structure, with additional chapters dedicated to specific techniques and focused evaluations. It provides radiological images, informative drawings, and diagrams to describe each measurement and explain its applications and role in specific diseases. Also, the book identifies potential difficulties regarding positioning and techniques and offers tips to avoid misinterpretation.The book is a handy reference for everyday use and helps practitioners evaluate pediatric musculoskeletal studies by providing precise instructions on how to perform accurate measurements and interpret them to obtain an accurate diagnosis.

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Preface

The practice of pediatric musculoskeletal radiology relies on the adequate knowledge of anatomy, physiology, pathology, and background genetics of the child and adolescent, but also, like any other discipline of pediatric imaging, on a good dose of training and experience. Complex, challenging, and atypical cases abound in pediatric imaging, while robust guidelines, appropriateness criteria, and studies on large populations are notoriously limited or absent.

The greatest challenge for radiologists and health professionals involved in pediatric musculoskeletal imaging is to combine expertise with modern evidence-based approaches.

In the context of evidence-based medicine, the focus of imaging is shifting from simple description towards quantification, with measurements becoming more important to make the diagnosis and distinguish the normal from the pathological.

In pediatrics, most measurements change over time and are dependent on development and gender. Besides, the peak of puberty is different in boys and girls, so single reference values are not sufficient, and instead normative values for patient groups are necessary for an accurate diagnosis.

It is important to highlight that common measurements used in adults may not be validated for the pediatric population. Performing searches and contrasting evidence on measurements that have been validated for children may be an arduous task in the context of increasing reporting volumes, interrupting normal workflow.

For this reason, this text summarizes, in a comprehensive but easy to refer way, the measurements that are most commonly used in clinical practice and have been validated in pediatric populations. Examples are presented on real diagnostic images to allow the most practical demonstration.

Beyond measurements, some normal developmental appearances and variants of anatomical structures are discussed, when the correct interpretation of the images depends on the presence of these.

In some cases, measurements that have not been validated in children but are used in clinical practice in pediatrics are included in the text, with an appropriate note to interpret the measurements with caution.

There is the expectation that this book will serve as a valid tool to speed up diagnosis and optimize assessment, potentially reducing unnecessary diagnostic steps that may involve radiation in children.

It is humbly hoped by the editors and authors that this book will find a place among the desktop texts that colleagues can refer to frequently and with confidence.

Table of contents :
Foreword
Preface
Acknowledgments
Contents
In-Utero
Introduction: Prenatal Ultrasound
Development
Imaging Workup When a Skeletal Dysplasia Is Suspected in Utero (Prenatal Ultrasound)
Assessment of Characteristics of Long Bones
Bone Length
Bone Shape
Echogenicity
Evaluation of Hands and Feet
Evaluation of Fetal Movements
Evaluation of the Fetal Head
Abdominal Circumference
Evaluation of the Fetal Thorax
Determination of Lethality
Imaging Workup When a Skeletal Dysplasia Is Suspected Postnatally (Radiographs)
Specific Considerations
References
Skull
Introduction
Sutures
Suture Closure (Table 1)
Fontanelles
Closure Timeline of the Fontanelles (Table 2)
Skull Layers
Craniosynostosis
Non-syndromic Craniosynostosis (Table 3)
Scaphocephaly (or Dolichocephaly)
Trigonocephaly
Plagiocephaly
Brachycephaly
Oxycephaly (Acrocephaly)
Syndromic Craniosynostosis
Craniocervical Junction
Skull Base Craniometry
Odontoid Process
Basilar Invagination (Congenital): Atlantoaxial Impaction
Basilar Impression (Acquired)
Chiari I (Arnold-Chiari) Malformation
References
Spine
Spine
Cervical Spine
Basilar Invagination/Impression
Atlanto-Occipital Junction
Atlanto-Dens Interval (ADI)
Posterior Atlanto-Dens Relationship
Posterior Cervical Line/Posterior Line of Swischuk
Prevertebral Soft Tissue Assessment
Spinal Canal Size
Vertebral Body Height
Thoracolumbar Spine
Thoracic Kyphosis
Modified Cobb Angle
Sagittal Balance
C7 Plumb Line
Scoliosis
Infantile Idiopathic Scoliosis
Juvenile Idiopathic Scoliosis
Cobb Angle
Coronal Balance
Lumbar Spinal Canal Dimensions
References
Shoulder
Introduction
Proximal Humerus and Glenohumeral Joint
Humeral Metaphyseal Stripe
Glenoid Version
Acromioclavicular Joint and Coracoclavicular Ligament
References
Elbow
Introduction
Technique and Quality Assessment
Ossification Centers
The Anterior Humeral Line (AHL)
The Anterior Coronoid Line
Shaft Condylar Angle (SCA)
Lateral Capitellohumeral Angle (LCHA)
The Radiocapitellar Line
Humeral and Ulnar Shaft Lines
The Carrying Angle
Baumann’s Angle
Medial Epicondyle-Epiphyseal (MEE) Angle
References
Wrist
Introduction
Scapholunate and Capitolunate Angle Measurements
Ulnar Variance
Radial Height
Radial Inclination
Volar Tilt
Cartilage Thickness
Epiphyseal Overload
Juvenile Arthritis (JIA)
Skeletal Age
References
Hand
Introduction
Skeletal Development of the Hand
Carpal Bone Ossification
Determination of Skeletal Maturity
Carpal Angle
Carpal Height
Scapholunate Distance
Carpal Instability
Metacarpal Index
Metacarpal Sign
Brachydactyly
Joint Fluid
Tendon Pathology
Paediatric Trigger Thumb
Carpal Tunnel
References
Hip and Pelvis
Introduction
Developmental Dysplasia (DDH)
Hip Acetabular Angle
Acetabular Coverage of the Femoral Head
US Alpha-Beta Angle
Medial Joint Space (Teardrop Distance)
Shenton’s Line
Perkin’s Line
Lateral Center-Edge Angle (Wiberg)
Vertical-Center-Anterior Angle
Tönnis Angle
Pubofemoral Distance
Femoral Head-Neck-Shaft Angle
Slipped Capital Femoral Epiphysis (SCFE)
Klein’s Line
Southwick’s Method
Femoroacetabular Impingement (FAI)
Anterior Offset Distance
Alpha Angle
Acetabular Anteversion
Lines: Arcuate/Acetabular Roof-Teardrop
Pelvic Tilt
Pubic Symphyseal Width
References
Knee
Introduction
Tibiofemoral Joint
Varus–Valgus
Metadiaphyseal Angle
Tibial Torsion
Intercondylar Notch
ACL Angles
PCL Angles
ACL Grafts
Discoid Meniscus
Patellofemoral Joint
Trochlear Dysplasia/Patellar Maltracking
Trochlear Angle (Sulcus Angle)
Radiographs
Ultrasound
MRI
Lateral Trochlear Inclination
Trochlear Depth
Radiographs
US/CT/MRI
Trochlear Facet Ratio
Tibial Tuberosity to Trochlear Groove Distance (TT- TG)
Patellar Position Assessment
Vertical Position
Koshino and Sugimoto
Insall-Salvati
Horizontal Position
References
Ankle and Foot
Introduction
Ankle
Lateral Distal Tibial Angle
Anterior Distal Tibial Angle
Total Clear Space
Tibiofibular Overlap
Medial Clear Space
Talocrural Angle
Foot
Hindfoot
Midtalar Line
Midcalcaneal Line
Lateral Tibiocalcaneal Angle
Talocalcaneal Angle
Talo-Horizontal Angle
Calcaneal-Horizontal Angle
Meary Method
Djian Method
Saltzman and El-Khoury Distance
Lamm Angle
Bohler Angle
Gissane Angle
Midfoot
Ultrasound Measurements
Lateral Tarsal Joint Surface Angles
Lateral Talar-First Metatarsal or Meary Angle
Djian-Annonier Angle
Lateral Calcaneus-Fifth Metatarsal Angle
Lateral Calcaneus-First Metatarsal or Hibbs Angle
Forefoot
Metatarsal Index
Morton’s Method
Hardy and Clapham’s Method
Metatarsal Depth Angle
Metatarsus Adductus Angle
Modified Metatarsus Adductus Angle or Engel’s Method
Angle Between Calcaneus and Second Metatarsal
AP Talar-First Metatarsal Angle
AP Calcaneal-Fifth Metatarsal Angle
Hallux Valgus Angle
References
Body Composition
Introduction
DXA
MRI
References
EOS Imaging
Introduction
Spine and Pelvis
Pelvic Measurements
Pelvic Incidence (PI)
Sacral Slope (SS)
Pelvic Tilt (PT)
Pelvic Obliquity (PO)
Axial Rotation of the Pelvis (ARP)
Spine Measurements
Vertebral Numbering
Coronal Balance
C7-Central Sacral Line (CSL)
Cobb Angle
Lateral Flexion (Bending) Radiographs
In-Brace Measurements
Sagittal Balance
Sagittal Vertical Axis (SVA) and CAM Plumb Line
Spino-Sacral Angle (SSA)
T9 Tilt or T9 Sagittal Offset
Thoracic Kyphosis (TK) and Lumbar Lordosis (LL)
3D Images
Lower Limb Measurements
References