Multislice CT in Children

Donald P. Frush, M.D.
Division Of Pediatric Radiology, Duke University Medical Center

Computed tomography is an extremely important diagnostic tool. However, obtaining diagnostic information is extremely dependent on optimizing technique. CT in children can be quite complicated given the unique considerations found with the large variation in size (e.g., < 1.0 - > 100 kg) and the special needs children have. Each aspect of designing and performing pediatric CT will be discussed and organized by categories consisting of (1) patient preparation, (2) oral and IV contrast material, and (3) CT parameters.

Patient Preparation: Strategies to maximize the compliance of children will be addressed. Age specific breath hold strategies will be provided. Sedation can be a necessary component of pediatric CT and brief discussion of sedation, as well as alternative techniques (having parents present, swaddling, feeding infants, use of multidetector CT) will be provided. The benefits of fast multidetector CT for minimizing sedation needs will be emphasized.

Oral and Intravenous Contrast Material: Types, and amounts of oral contrast media will be presented, including alternates (water, other fluids) in children who often will not drink routine contrast material. Advantages and disadvantages (e.g., masking mucosal enhancement, mural abnormalities, aspiration risk particularly in the trauma setting, and artifacts) of oral contrast will also be discussed. Rectal contrast administration has a limited role and is not routine for any condition (including appendicitis) in our practice. Amounts, types, and techniques (manual bolus versus power injector; rates of administration; delays; use of bolus tracking software) of contrast administration which provide optimal enhancement of vessels and organs in children will also be presented. While conventional (slice-by slice) methods will be addressed, techniques of administration with helical CT will be emphasized.

CT Parameters: By attending to the indications, and size of the child, appropriate size-based scanning will provide maximum diagnostic information with minimum amount of radiation risk to the child. Size-based parameters will be presented and techniques to minimize radiation exposure, including a color-coded approach, will be reviewed.

FIGURES


Fig 1a - Excellent Contrast Neck Chest Abdomen Pelvis CT	Fig 1B – Excellent Contrast Neck Chest Abdomen Pelvis CT


Fig 2 – Normal CT Angiography 6 year old	Fig 3 – Abnormal Bowel Wall Enhancement

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Last Updated:
Tuesday, 04 January 2005