Abstract
While computerized tomography (CT) urography has been a mainstay for the imaging of the genitourinary (GU) tract in adults, it has been used less frequently in children due to concerns for the radiation dosages and the differing disease processes. Plain x-ray imaging, ultrasonography, voiding cystourethrography (VCUG), nuclear scintigraphy, and magnetic resonance (MR) urography continue to be the most commonly utilized diagnostic imaging methods for assessment of the pediatric genitourinary tract. However, as CT techniques have become more refined and the associated radiation dosages have continued to decrease, the use of CT urography in children appears to be expanding as well.
Common indications for CT urography in children include the evaluation of urinary tract stones, tumors, urinary tract infections/inflammation, trauma, and hydronephrosis. In addition, the use of CT urography has been used to delineate anatomic variations associated with GU anomalies that are unable to be adequately assessed by the other modalities. Although functional assessment of the kidneys is possible with CT urography, its usage in children continues to be low due to the relatively high radiation dosages and because of MR urography’s ability to evaluate the anatomy in a radiation-free manner. However, there remain a small number of infants and children who cannot be safely sedated for MR urography where CT urography may be a good alternative due to its excellent spatial resolution and short scan time requirements. In general, CT urography protocols in infants and children are based on body mass index, age, and weight to calculate contrast amounts and radiation dosages that are as low as possible in adherence to the “As Low As Reasonably Achievable” (ALARA) principles and “Image Gently” guidelines and the minimal use of multi-series imaging [1].
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Shah NB, Platt SL. ALARA: is there a cause for alarm? Reducing radiation risks from computed tomography scanning in children. Curr Opin Pediatr. 2008;20(3):243–7. PubMed PMID: 18475090. Epub 2008/05/14. eng.
Yu L, Bruesewitz MR, Thomas KB, Fletcher JG, Kofler JM, McCollough CH. Optimal tube potential for radiation dose reduction in pediatric CT: principles, clinical implementations, and pitfalls. Radiographics. 2011;31(3):835–48. PubMed PMID: 21571660. Epub 2011/05/17. eng.
Dougeni E, Faulkner K, Panayiotakis G. A review of patient dose and optimisation methods in adult and paediatric CT scanning. Eur J Radiol. 2012;81(4):e665–83. PubMed PMID: 21684099. Epub 2011/06/21. eng.
Nievelstein RA, van Dam IM, van der Molen AJ. Multidetector CT in children: current concepts and dose reduction strategies. Pediatr Radiol. 2010;40(8):1324–44. PubMed PMID: 20535463. Pubmed Central PMCID: 2895901.
Karmazyn B, Frush DP, Applegate KE, Maxfield C, Cohen MD, Jones RP. CT with a computer-simulated dose reduction technique for detection of pediatric nephroureterolithiasis: comparison of standard and reduced radiation doses. AJR Am J Roentgenol. 2009;192(1):143–9. PubMed PMID: 19098193.
Afschrift M, Nachtegaele P, Van Rattinghe R, Praet M, Voet D, Vanhaesebrouck P, et al. Nephrocalcinosis demonstrated by ultrasound and CT. Pediatr Radiol. 1983;13(1):42–3. PubMed PMID: 6844054.
Maturen KE, Blane CE, Strouse PJ. Computed tomographic diagnosis of unsuspected pyelonephritis in children. Can Assoc Radiol J. 2002;53(5):279–83.
Peng Y, Jia L, Sun N, Li J, Fu L, Zeng J, et al. Assessment of cystic renal masses in children: comparison of multislice computed tomography and ultrasound imaging using the Bosniak classification system. Eur J Radiol. 2010;75(3):287–92. PubMed PMID: 20594787.
Beier UH, John E, Lumpaopong A, Co JG, Jelnin V, Benedetti E, et al. Electron-beam CT as a diagnostic modality in pediatric nephrology and renal transplant surgery. Pediatr Nephrol. 2006;21(5):677–82. PubMed PMID: 16520947.
Lubahn JD, Cost NG, Kwon J, Powell JA, Yang M, Granberg CF, et al. Correlation between preoperative staging computerized tomography and pathological findings after nodal sampling in children with Wilms tumor. J Urol. 2012;188(4 Suppl):1500–4. PubMed PMID: 22910268.
Guillerman RP, Voss SD, Parker BR. Leukemia and lymphoma. Radiol Clin North Am. 2011;49(4):767–97, vii. PubMed PMID: 21807173.
Kim JK, Park SY, Shon JH, Cho KS. Angiomyolipoma with minimal fat: differentiation from renal cell carcinoma at biphasic helical CT. Radiology. 2004;230(3):677–84. PubMed PMID: 14990834.
Chaudry G, Perez-Atayde AR, Ngan BY, Gundogan M, Daneman A. Imaging of congenital mesoblastic nephroma with pathological correlation. Pediatr Radiol. 2009;39(10):1080–6. PubMed PMID: 19629463.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2014 Springer Science+Business Media New York
About this chapter
Cite this chapter
Kaminsky, C.K., Yuh, B., Koh, C.J. (2014). Principles of Computerized Tomography (CT). In: Palmer, L., Palmer, J. (eds) Pediatric and Adolescent Urologic Imaging. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8654-1_3
Download citation
DOI: https://doi.org/10.1007/978-1-4614-8654-1_3
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4614-8653-4
Online ISBN: 978-1-4614-8654-1
eBook Packages: MedicineMedicine (R0)