To compare objective and subjective parameters in image quality and radiation dose of two MDCTs (helical 64 detector CT vs. axial 256 detector CT) in paediatric lung CT. Radiation dose and image quality were compared between non-enhanced lung CT from a helical 64-slice multidetector CT (MDCT 1) and a 256-slice scanner (MDCT 2) with axial wide-cone acquisition and using deep learning image reconstruction. In 23 size-matched paediatric studies (age 2-18 years) from each scanner, the radiation exposure, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), image sharpness and delineation of small airways were assessed. Subjective image quality was rated by 6 paediatric radiologists. While MDCT 2 provided higher SNR and CNR, subjective image quality was not significantly different between studies from both scanners. Radiation exposure was lower in studies from MDCT 2 (CTDIvol 0.26 ± 0.14 mGy, effective dose 0.23 ± 0.11 mSv) than from MDCT 1 (CTDIvol 0.96 ± 0.52 mGy, effective dose 1.13 ± 0.58 mSv), p < 0.001. Despite lower radiation dose for the scout images, the relative scout-scan-ratio increased from 2.64 ± 1.42 % in MDCT 1 to 6.60 ± 5.03 % in MDCT 2 (p = 0.001). By using latest scanner technology effective radiation dose can be reduced to 0.1-0.3 mSv for lung CT in children without compromising image quality. Scout image dose increasingly accounts for substantial portions of the total scan dose and needs to be optimized. In children CT should be performed on state-of-the-art MDCT scanners with size-adapted exposure protocols and iterative reconstruction.

Sleep problems are frequently reported in infants treated with propranolol for infantile hemangiomas, possibly serving as a marker for a negative impact on central nervous system function. In this cohort study, we objectively investigate the sleep behavior of infants with infantile hemangiomas on propranolol compared to a healthy, untreated control group. Sleep of propranolol-treated infants and controls was investigated using ankle actigraphy and a 24-h diary for 7–10 days at ages 3 and 6 months. The main outcome measures were theNumber of Nighttime AwakeningsandSleep Efficiency. The main secondary outcome measures included24-hour Total Sleep, daytime sleep behavior, and parent-rated infant sleep quality and behavioral development based on the Brief Infant Sleep Questionnaire (BISQ) and the age-appropriate Ages-and-Stages Questionnaire (ASQ), respectively. Fifty-four term-born infants were included in each cohort. No group difference in any investigated parameter was seen at age 3 months. At age 6 months, the propranolol group exhibited a decrease inSleep Efficiencyand a trend towards an increasedNumber of Nighttime Awakeningscompared to the control group. Treated infants at 6 months also had shorter daytime waking periods.24-hour Total Sleepwas unaffected by propranolol. No negative impact of propranolol on subjective sleep quality and behavioral development was noted.Conclusion: Propranolol exerts a measurable yet mild impact on objectively assessed infants’ sleep measures. Behavioral developmental scores were unaffected. Our results support propranolol as first-line therapy for complicated infantile hemangiomas. What is Known:• Sleep disorders are frequently reported in infants with infantile hemangiomas treated with propranolol and often lead to treatment discontinuation.• Investigations of the sleep pattern in this patient group using objective measures are lacking. What is New:• The sleep pattern of propranolol-treated infants is assessed using actigraphy and a 24-h sleep diary and compared to healthy, untreated controls.• Propranolol leads to a decreased sleep efficiency at night and an increased demand of daytime sleep, yet effects are mild overall.

To explore the hypothesis that central venous stenosis/obstructions (CVS/O) in children are influenced by prior central venous access devices (CVADs) and are associated with future risk for thromboses. A convenience sample of 100 patients with abnormal venography (stenosis, collaterals, occlusions) documented during peripherally inserted central catheter (PICC) placements were identified from consecutive PICC placements (January 2008 to November 2012). The patients (41 males, 59 females, median age 2.7 years, median weight 11 kg) were categorized based on venographic presence (Group A, n = 53) or absence (Group B, n = 47) of visible connection to the superior vena cava. Each patient's CVAD history, before and after venography, was analyzed (until October 2016). Before venogram, Group B patients were associated with a higher number of previous CVADs, larger diameter devices, greater incidence of malposition, and more use of polyurethane catheters than Group A patients (P < .001). An ipsilateral PICC was successfully placed in 98% of Group A, compared to 32% of Group B (P < .001). After venogram, significantly more Doppler ultrasounds (DUS) were performed and thromboses diagnosed in Group B (57% and 36%) compared to Group A (21% and 8%) (P < .003; P = .001), respectively. Previous catheter characteristics influenced the severity of venographic changes of CVS/O (Group B). Group B was associated with more subsequent symptomatic thromboses. This information may assist parents and referring physicians to anticipate potential adverse sequelae from CVS/O on the child's venous health.

Fractures of carpal bones other than the scaphoid are rare in children. The aim of this study was to analyze results and identify risk factors for an unfavorable outcome. Children and adolescents up to the age of 16 years who sustained a carpal fracture other than in the scaphoid between 2004 and 2021 were reviewed in this single-center retrospective study. In a series of 209 children and adolescents with carpal fractures, 22 had fractures other than the scaphoid. Mean age was 13 years (range 8-16) years, with a total of 41 fractures, with highest incidences for the capitate (10), trapezium (6), triquetrum (4) and pisiform (4). Twenty-nine of these 41 fractures were missed on initial X-ray. Non-displaced fractures were treated with a short arm spica cast including the thumb. Four patients were operated on for displacement fracture or carpometacarpal subluxation. All fractures united, and patients returned to full activities. At the final consultation at a median 14 months (range 6-89) post-injury, all patients with non-displaced fractures were free of symptoms, with excellent Mayo Wrist Scores (MWS). However, three patients with operated trapezium fractures developed early radiological signs of osteoarthritis, two of them with residual pain and MWS rated only good. Non-displaced pediatric carpal fractures treated by forearm cast have excellent prognosis. Fractures of the trapezium with displacement or first carpometacarpal subluxation incur a risk of osteoarthritis despite anatomical reduction and internal fixation.

To evaluate the clinical and imaging outcome of aneurysmal bone cysts (ABCs) in children using percutaneous cryoablation as the sole treatment. This retrospective study included 7 children with a mean age of 8.7 years (range, 3.0-11.9 years) who underwent at least 1 cryoablation for ABC. Cryoablation needles were placed and guided by computed tomography (CT). Imaging follow-up and clinical examination were performed by radiography 1 and 6 months after the procedure and magnetic resonance (MR) imaging was performed 3 and 12 months after the procedure. Additional cryoablation was performed in case of MR imaging-detected recurrence. Data were analyzed by anatomical location, measurement of lesion volume, numbers of intralesional cysts, grade of mineralization (5-point Likert scale), pain (0 [none] to 4 [severe]), and grade of fluid-fluid levels (FFLs; 4-point Likert scale). Fourteen cryoablations were performed. Patients showed volume reduction, with 1 showing a complete response and 6 showing partial response. Following treatment, there was a substantial reduction in lesion volume compared with baseline, leading to a mean volume decrease of 81.9% (range, 66.8%-100%). The grade of mineralization (3.2 [SD ± 1.2] after therapy vs 1.1 [SD ± 0.3] at baseline), grade of FFL (1.6 [SD ± 0.5] after therapy vs 3.4 [SD ± 1.1] at baseline), and pain (0.29 [SD ± 0.4] after therapy vs 1.86 [SD ± 0.7] at baseline) significantly improved after therapy (all P < .05). One severe adverse event occurred. Cryoablation is an effective treatment option for ABC in children. Further research is needed to compare it with other techniques.