Grasso S N, Keller M S
Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT 06520-8042, USA.
Curr Opin Pediatr. 1998 Jun;10(3):299-302. doi: 10.1097/00008480-199806000-00013.
In the head and neck, the futility of skull radiography is again reemphasized as a poorer predictor of intracranial injury than is a neurologic examination, though controversy continues as to which neurologic criteria should be the ones leading to a cranial computed tomography scan. Understanding the anatomic variations in the radiography of the cervical spine in small infants and children can help avoid overdiagnosis in this group and can obviate the need for additional unwarranted computed tomography studies and undue clinical concern. Magnetic resonance imaging can show anatomically exquisite portrayals of growing skull fractures for neurosurgical planning, but its routine use for imaging the cervical cord in shaken, abused infants without clinical abnormality appears unwarranted. Within the chest, the radiograph remains a highly accurate and low cost cornerstone in traumatized patients. The use of ultrasound imaging to detect pleural fluid is being investigated and has been found to be accurate but cannot compare to all of the information gleaned from the radiograph. The pericardium is clearly an exception. Abdominal trauma in children is triaged vastly differently from that of adults. Imaging of adults looks for signs to diagnose significant bleeding and need for operation, while pediatric trauma imaging has its greatest effect in reducing the intensity of care. Administration of oral contrast has not been very effective in aiding diagnosis of hollow visceral perforations and is being used less in blunt abdominal trauma computed tomography. Children with microscopic hematuria and no evidence of multiple system trauma seem to be helped little by imaging. The utility of finding and extracting subcutaneous foreign material, usually in extremities, by ultrasound imaging remains controversial. Experience, equipment, and effort all seem to play a role.
在头颈部，颅骨X线摄影的无用性再次被强调，因为与神经学检查相比，它对颅内损伤的预测能力较差，尽管对于哪些神经学标准应作为进行头颅计算机断层扫描的依据仍存在争议。了解小婴儿和儿童颈椎X线摄影中的解剖变异有助于避免对该群体的过度诊断，避免不必要的计算机断层扫描检查以及不必要的临床担忧。磁共振成像可以为神经外科手术规划精确显示生长性颅骨骨折的解剖结构，但对于无临床异常的受摇晃、虐待婴儿的颈髓进行常规成像似乎并无必要。在胸部，X线片仍然是创伤患者高度准确且低成本的基石。利用超声成像检测胸腔积液正在研究中，并且已发现其准确，但无法与从X线片中获得的所有信息相比。心包显然是个例外。儿童腹部创伤的分类与成人有很大不同。成人的影像学检查寻找诊断严重出血和手术必要性的体征，而儿科创伤影像学在降低护理强度方面效果最佳。口服造影剂在辅助诊断中空脏器穿孔方面效果不佳，在钝性腹部创伤计算机断层扫描中使用较少。有镜下血尿且无多系统创伤证据的儿童通过影像学检查似乎获益不大。利用超声成像发现并取出通常位于四肢的皮下异物的实用性仍存在争议。经验、设备和努力似乎都起作用。
