Measurements in Pediatric Radiology

173 Pages·1991·4.736 MB·English

by  Holger Pettersson MD, PhD, Hans Ringertz MD, PhD (auth.)

Holger Pettersson and Hans Ringertz
Measurements in
Pediatric Radiology
With 35 Figures
Springer-Verlag
London Berlin Heidelberg New York
Paris Tokyo Hong Kong
Holger Pettersson, MD, PhD
Professor and Chairman,
Department of Radiology,
University Hospital,
S-221 Lund, Sweden
Hans Ringertz, MD, PhD
Professor and Chairman,
Department of Radiology,
Karolinska University Hospital,
S-104 Stockholm, Sweden
ISBN-13:978-1-4471-1846-6 e-ISBN-13:978-1-4471-1844-2
DOl: 10.1007/978-1-4471-1844-2
British Library Cataloguing in Publication Data
Pettersson, Holger 1942-
Measurements in pediatric radiology.
1. Children. Radiology
I. Title II. Ringertz, Hans 1939-
616.9200757
ISBN -13:978-1-4471-1846-6
Library of Congress Cataloging-in· Publication Data
Pettersson, Holger, 1942-
Measurements in pediatric radiology 1 by Holger Pettersson, Hans Ringertz.
p. em.
ISBN -13:978-1-4471-1846-6
1. Pediatric radiology. 2. Children-Anthropometry.
I. Ringertz, Hans. II. Title.
[DNLM: 1. Anthropometry-in infancy & childhood.
2. Anthropometry-methods. 3. Bone Density-in infancy & childhood.
4. Radiography-in infancy & childhood. WN 240 P485mj
RJ51.R3P48 1991
618.92'00757-dc20
DNLM/DLC
for Library of Congress 90-10455
CIP
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Preface
A thorough knowledge of normal radiological anatomy is necessary
for detection and evaluation of pathological changes. In pediatric
radiology, normal anatomy and normal proportions of anatomical
structures may differ considerably from the adult, and may vary
during growth. Therefore, in pediatric radiology there is a multitude
of measurements, that in the individual patient is important, but
that for the radiologist is not meaningful or even possible to keep
in mind. This holds true both for the experienced pediatric
radiologist, and for those who practise pediatric radiology only
occasionally. This volume is written for both categories.
In the literature, normal values are calculated and presented in
many different ways, that are not always easy to compare, or easy
to use in daily work. Therefore, we have revised and recalculated
the data given by authors, in order to present the statistical upper
and lower normal limits as between plus and minus two standard
deviations (± 2SD). This means that about 2% of a normal
population will be assessed as abnormally large and around 2%
abnormally small with respect to the parameter assessed. In this
way, the presentation throughout the book is uniform, and hopefully
easy to use. All figures have been redrawn and computed in an
attempt to make them as clear as possible.
A small format that can be updated has been intended in order
to ensure optimal clinical use. Our purpose is only to help to
differentiate between normal and abnormal, and not to make
available the whole differential diagnostic list. The measurements
chosen are those thought to be of most practical use in the daily
routine, but in some instances methods have been included that are
intendeq. more for research applications. Generally, only one method
is included for each parameter and modality, and we have tried to
make the choice of methods as objective as possible. In some
instances, additional methods for special cases are referred to in the
"background" and/or in the reference list.
It is our sincere hope that the present volume will be of value in
everyday clinical practice.
Lund and Stockholm Holger Pettersson
January 1991 Hans Ringertz
Contents
Section 1: The Skull
SKI Width of cranial sutures in neonates and infants
[radiography] ............ 2
SK2 Cranial growth/age [CT] . . . . . . . . . 5
SK3 Intracranial volume/age [radiography] 6
SK4 Volume of sella turcica/age [radiography]
Volume of sella turcica/height [radiography] 8
SKS Interorbital distance/age [radiography] . . 10
SK6 Length of the hard palate in the newborn
[radiography] .............. 11
SK7 Ventricular size at birth ratios [ultrasound] 12
SK8 Diameters of the lateral ventricle in pre term and
full-term infants [ultrasound] . . 14
SK9 Pituitary stalk diameter/age [CT] 16
Section 2: The Spine
SPI Transverse diameter of foramen occipitale
magnum/age [radiography] ....... . 20
SP2 Sagittal diameter of cervical spinal canal/age
[radiography]
Sagittal diameter of cervical spinal canal/height
[radiography] ............... . 22
SP3 Sagittal diameter of the cervical spinal canal in
infants [radiography] . . . . . . . . . . . . . 24
SP4 Sagittal diameter of the lumbar spinal canal/age
[radiography] ................ . 26
SPS Interpeduncular distance/age [radiography] . . . 28
SP6 Size of vertebral body and intervertebral disc/age
[radiography] ................ . 30
SP7 Spinal length at birth/gestational age [radiography] 32
SP8 Thoracic kyphosis/age [radiography] . . . .... 34
SP9 Diameter of the spinal cord [conventional
myelography] .............. 36
SPlO Diameter of the spinal cord [CT and myelography] . 38
Section 3: Pelvis and Hips
PHI Iliac angle and iliac index/age [radiography] 42
PH2 Acetabular angle/age [ radiography] . . . . . 44
PH3 Acetabular coverage of the femoral head/age
[radiography] .............. . 46
PH4 Femoral anteversion/age [CT] ...... . 48
PH5 Shaft/neck angle of the femur/age [radiography] 52
PH6 Appearance and size of femoral head/age
[radiography] ............. . 54
PH7 Angle measurements of the hip in infants
[ultrasound] . . . . . . . . . . . . . . . 56
Section 4: The Extremities
EXI Carpal length [radiography] 60
EX2 Carpal angle/age [radiography] . 64
EX3 Metacarpal index/age [radiography] 66
EX4 Metacarpophalangeal length/age [radiography] 69
EX5 Dimensions of distal femoral epiphysis
[radiography] 76
EX6 Tibiofemoral and metaphyseal-diaphyseal angle/age
[radiography] 78
EX7 Angle measurements of the foot/age [radiography] 80
EX8 Muscle cylinder ratio in infancy [radiography] 83
EX9 Limb bone length ratios/age [radiography] 84
EXIO Quadriceps muscle thickness and subcutaneous tissue
thickness/age [ultrasound] 86
Section 5: Bone Mineral Contents
BMI Cortical metacarpal thickness/age [radiography] 90
BM2 Cortical mass in neonates [radiography] 92
BM3 Quantitative spinal mineral analysis [CT] 94
BM4 Bone mineral content at birth [single photon
absorptiometry] 96
BM5 Bone mineral content/age [single photon
absorptiometry] 98
Section 6: The Respiratory Tract
RTl Adenoidal size/age [radiography] 100
RT2 Sagittal diameter of trachea in the newborn
[radiography]. . . . . . . . . . . . . . . 102
RT3 Transverse tracheal diameter/age [radiography] 103
RT4 Tracheal dimensions/age [CT] . . . . . . . . 104
RT5 Thymus dimensions/age [CT] . . . . . . . . . 106
RT6 The width of the paratracheal stripe [radiography] 108
Section 7: The Cardiovascular System
CVl Cardiac volume according to body surface area
[radiography] 110
CV2 Heart volume in the neonate/weight and age
[radiography1 114
CV3 Cardiothoracic ratio in newborn [radiography] 116
CV4 Left ventricular end diastolic diameter/weight
[sonography] 118
CV5 Diameter of pulmonary veins/height
[angiocardiography] 120
CV6 Diameter of the right descending pulmonary
artery/probability of shunt [radiography] 122
CV7 Diameter of the abdominal aorta at different
levels/body surface area [radiography] 124
Section 8: The Abdomen
ABI Liver size/height/age [radiography] 128
AB2 Size of liver and spleen/age and weight
[scintigraphy] .. . . 130
AB3 Size of liver and spleen/body weight and height
[ultrasound] . . . . 132
AB4 Size of gallbladder and biliary tract [ultrasound] 134
AB5 Width of common bile duct/age [cholangiography] 136
AB6 Muscle dimensions of the pylorus [ultrasound] 137
AB7 Diameter of gas filled bowel loops in infants
[radiography] ... . . 138
AB8 Diameter of small bowel/age [radiography] 140
AB9 Retrorectal soft tissue space [radiography] 141
Section 9: The Urinary Tract
UTl Renal length/Ll-L3 [radiography]
Renal parenchymal arealL1-L3 [radiography]
Renal parenchymal thicknesslL1-L3 [radiography] 144
UTI Renal length, area and parenchymal thickness: ratio
right/left kidney [radiography] . 148
UT3 Renal length/age [radiography] . . . . 150
UT4 Renal length/age [ultrasound] .... 152
UT5 Renal length in neonates [ultrasound] 154
UT6 Renal length/body weight in premature infants
[ultrasound] . . . . . . . . . . . . . . 155
UTI Renal volume/body weight [ultrasound] . . . . 156
UT8 Renal echogenicity/age [ultrasound] ..... 158
UT9 Skin-to-kidney distance/weight [eT (scintigraphy)] 160
UTlO Ureteral submucosal tunnel length/height
[u ltrasound]
Ureteral submucosal tunnel length/age [ultrasound] 162
UTl1 Ureteral diameter/Ll-L3 [radiography]
Ureteral diameter/age [radiography] . 166
UTl2 Bladder capacity/Ll-L3 [radiography]
Bladder proportions [radiography] . . 168
UTl3 Bladder wall thickness [ultrasound] . . 170
UTl4 Adrenal size/age: newborn [ultrasound] . 172
Appendices
Appendix I. Nomogram ..... . 177
Appendix II. Statistical considerations 179
SECTION 1
The Skull
SK1 Width of cranial sutures in neonates
and infants [radiography]
Referenced article:
Erasmie U, Ringertz H: Normal width of cranial sutures in the neonate and
infant. Acta Radiol [Diagn] 1976; 17:565.
Background:
In the neonate and infant, radiologically demonstrated widening of the sutures
is a generally appreciated and important sign of increased intracranial pressure.
The present method is based on the lateral view, which is easy to reproduce.
Material:
Lateral skull radiographs from 64 girls and 86 boys aged 0--60 days were
studied. All but 13 were considered to be mature at delivery. The lateral view
of the skull was obtained with the central beam centred over the midskull.
The film-focus distance was 90 cm. No correction for magnification was
performed.
Method of assessment:
Both coronal sutures were assessed at levels located at approximately one
third (C1 and C2) and two-thirds (C3 and C4) of their projected course
between the crown and the skull base (Figure SK1.1). In the same manner
the lambdoid sutures were estimated halfway between the calvarium and the
base of the skull (Ll and L2) (Figure SK1.l). The sum of these six
measurements, below named the sum of suture width, was used as one of the
parameters expressing the suture width (Table SK1.l). When the coronal
sutures appeared V -shaped, this feature was expressed as the difference
between the sums of the topnear and basal measurements of the sutures: (Cl
and C2) - (C3 and C4) (Table SK1.2).
Figure SK1.1. The sites of the measurements indicated on the lateral film of a child with increased
intracranial pressure. The projected course of the coronal suture is divided in three approximately
equal parts and the lambdoid suture in two. (After Erasmie and Ringertz 1976.)
2
Table SKl.l. The upper normal value (+2SD) for the sum of suture width (Cl + C2 + C3 + C4
+ L1 + L2) in neonates up to the age of 60 days. (After Erasmie and Ringertz 1976)
Upper normal value: 41mm
Table SK1.2. Upper normal value (+ 2 SD) for the V-shape (Cl + C2) - (C3 + C4)
of the sutures calculated in mm related to the sum of suture width (Cl + C2 + C3 +
C4 + L1 + L2) in neonates up to the age of 60 days. As an example the upper normal
V-shape in an infant with a sum of suture width of 36 mm will be 4.3 mm. (After
Erasmie and Ringertz 1976)
Sum of suture
width (mm) V-shape (mm)
20 4.8 4.8 4.8 4.8 4.8
25 4.8 4.7 4.7 4.7 4.7
30 4.7 4.6 4.6 4.6 4.5
35 4.4 4.3 4.1 3.8 3.4
40 2.9 2.0 0 0 0
References:
Biitzler H-O, Friedman G, Gawlich R: Plain film findings of the skull in hydrocephalus and
normal infants during the first months of life. Ann Radiol 1973; 16:245.
Schuster W, Tamae1a LA: Das Verhalten der Schadelnahte beim Neugeborenen und Saugling
unter physiologischen und pathologischen Bedingungen. Ann Radiol 1966; 9:232.
3