- Email: [email protected]
Imaging neonates—Special paediatric edition 2006
European Journal of Radiology 60 (2006) 131–132
Editorial
Imaging neonates—Special paediatric edition 2006
Children – and in particular babies – are our future, in many aspects: they are the next generation who carry on mankind, our traditions and cultures. They will further develop and expand our knowledge and techniques, and will help making life better on this planet. All future economy will heavily rely on them. They will eventually finance our retirement plans and guarantee our safe future within a friendly social environment, and they will treat us when we are old and sick. Entering life may be difficult or even dangerous. Lots have been undertaken to reduce perinatal mortality and morbidity. Screening programs during pregnancy have been established to early detect and potentially treat various foetal and neonatal conditions in order to reduce long term sequalae. They are constantly improved, quality management programs try to ensure a high level of these measures. When a baby is born, and health problems arise, imaging is often necessary and even essential, as babies not only show very unspecific clinical symptoms, but additionally cannot communicate in a way we understand easily. Not only severe conditions that partially occur during or immediately after birth may be present and need reliable, readily available and efficient imaging diagnostics in order to prevent sequalae. Many other queries – particularly deriving from intrauterine screening – have to be properly addressed and answered in order to early recognise, confirm and classify, and then treat pathologies that otherwise may cause significant harm and suffering to the neonate and its family. Imaging has changed: new methods such as MRI have been introduced that widened imaging potential and significantly changed imaging algorithms. Other methods such as ultrasound have undergone refinements and technical developments that lead to new potential and enlarged role of these methods. And some methods such as IVU or VCUG have lost much of their importance or are applied more reluctantly. Furthermore, treatment methods and strategies have changed as well. All these aspects need to be considered when confronted with queries for imaging in neonates. As children – and babies in particular – are different and not just small adults, with different physiology, anatomy, proportions, metabolism, diseases, immunological response, clinical manifestation, healing process, laboratory values, radiation sensitivity and different treatment needs, imaging and imaging 0720-048X/$ – see front matter © 2006 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ejrad.2006.07.020
algorithms must be adapted to these needs and thus differ significantly from standard adult radiology. For example, while CT is a major imaging player in many adult conditions, it has a rather restricted role in neonates, whereas ultrasound is used less in adults, but plays a dominant role in imaging neonates. This dedicated paediatric EJR issue tries to address these aspects and to elude on some of the specific demands and conditions in imaging neonates. It does not give a complete overview of all potential conditions, detailed discussion of rare diseases or research projects. It does not try to imitate a syllabus on paediatric radiology in this age group. This issue shall try to present the most common and important conditions in neonates and their respective imaging needs and appearances, with regard to new imaging modalities and potential. It tries to provide some basic pathophysiologic and embryologic background indispensable for understanding and properly interpreting the findings on imaging. It should give a basic and general overview offering some useful information for daily routine for general radiologists without direct access to dedicated tertiary neonatal or paediatric care and radiology institutions. It cannot and will not replace experience in planning, selecting, performing or reading an investigation. It shall help those who intermittently have to deal with these conditions to improve their diagnostic knowledge, and offer an update on new developments in imaging neonates. And it should indicate that many conditions ought to be referred to a dedicated paediatric radiology institution for definite diagnosis—once properly recognised, after initial stabilisation. Children – and in particular babies – are our future. They are rewarding—a smile of a successfully treated baby can make your day. And imaging neonates properly is a long-term investment: they will be healthier and (probably) happier than without your help, even if they will not remember. It is an investment into the future, not only the future of these babies who still have all of their life ahead of them (and its your responsibility not to impair their potential and perspectives), but also into the societies’ and mankinds’ future. And it promises to be very efficacious, as early diagnosis by adapted and harmless imaging and proper treatment may help to reduce long-term costs. But not the money should be our primary motivation; the health of the neonates and children, the happiness of their families, and the trustful smile of the babies should be our primary reward that encourages us to constantly
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Editorial / European Journal of Radiology 60 (2006) 131–132
provide proper and age adapted imaging also for all neonates entrusted to us. As the same we want for us applies also and particularly to neonates: the best (imagine and equipment and expertise) is just enough.
Michael Riccabona ∗ LKH Graz, University Hospital, Division of Paediatric Radiology, Department of Radiology, Auenbruggerplatz, 8036 Graz, Austria ∗ Tel.:
+43 316 385 84205; fax: +43 316 385 4299. E-mail address: [email protected] 10 July 2006
Editorial
Imaging neonates—Special paediatric edition 2006
Children – and in particular babies – are our future, in many aspects: they are the next generation who carry on mankind, our traditions and cultures. They will further develop and expand our knowledge and techniques, and will help making life better on this planet. All future economy will heavily rely on them. They will eventually finance our retirement plans and guarantee our safe future within a friendly social environment, and they will treat us when we are old and sick. Entering life may be difficult or even dangerous. Lots have been undertaken to reduce perinatal mortality and morbidity. Screening programs during pregnancy have been established to early detect and potentially treat various foetal and neonatal conditions in order to reduce long term sequalae. They are constantly improved, quality management programs try to ensure a high level of these measures. When a baby is born, and health problems arise, imaging is often necessary and even essential, as babies not only show very unspecific clinical symptoms, but additionally cannot communicate in a way we understand easily. Not only severe conditions that partially occur during or immediately after birth may be present and need reliable, readily available and efficient imaging diagnostics in order to prevent sequalae. Many other queries – particularly deriving from intrauterine screening – have to be properly addressed and answered in order to early recognise, confirm and classify, and then treat pathologies that otherwise may cause significant harm and suffering to the neonate and its family. Imaging has changed: new methods such as MRI have been introduced that widened imaging potential and significantly changed imaging algorithms. Other methods such as ultrasound have undergone refinements and technical developments that lead to new potential and enlarged role of these methods. And some methods such as IVU or VCUG have lost much of their importance or are applied more reluctantly. Furthermore, treatment methods and strategies have changed as well. All these aspects need to be considered when confronted with queries for imaging in neonates. As children – and babies in particular – are different and not just small adults, with different physiology, anatomy, proportions, metabolism, diseases, immunological response, clinical manifestation, healing process, laboratory values, radiation sensitivity and different treatment needs, imaging and imaging 0720-048X/$ – see front matter © 2006 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ejrad.2006.07.020
algorithms must be adapted to these needs and thus differ significantly from standard adult radiology. For example, while CT is a major imaging player in many adult conditions, it has a rather restricted role in neonates, whereas ultrasound is used less in adults, but plays a dominant role in imaging neonates. This dedicated paediatric EJR issue tries to address these aspects and to elude on some of the specific demands and conditions in imaging neonates. It does not give a complete overview of all potential conditions, detailed discussion of rare diseases or research projects. It does not try to imitate a syllabus on paediatric radiology in this age group. This issue shall try to present the most common and important conditions in neonates and their respective imaging needs and appearances, with regard to new imaging modalities and potential. It tries to provide some basic pathophysiologic and embryologic background indispensable for understanding and properly interpreting the findings on imaging. It should give a basic and general overview offering some useful information for daily routine for general radiologists without direct access to dedicated tertiary neonatal or paediatric care and radiology institutions. It cannot and will not replace experience in planning, selecting, performing or reading an investigation. It shall help those who intermittently have to deal with these conditions to improve their diagnostic knowledge, and offer an update on new developments in imaging neonates. And it should indicate that many conditions ought to be referred to a dedicated paediatric radiology institution for definite diagnosis—once properly recognised, after initial stabilisation. Children – and in particular babies – are our future. They are rewarding—a smile of a successfully treated baby can make your day. And imaging neonates properly is a long-term investment: they will be healthier and (probably) happier than without your help, even if they will not remember. It is an investment into the future, not only the future of these babies who still have all of their life ahead of them (and its your responsibility not to impair their potential and perspectives), but also into the societies’ and mankinds’ future. And it promises to be very efficacious, as early diagnosis by adapted and harmless imaging and proper treatment may help to reduce long-term costs. But not the money should be our primary motivation; the health of the neonates and children, the happiness of their families, and the trustful smile of the babies should be our primary reward that encourages us to constantly
132
Editorial / European Journal of Radiology 60 (2006) 131–132
provide proper and age adapted imaging also for all neonates entrusted to us. As the same we want for us applies also and particularly to neonates: the best (imagine and equipment and expertise) is just enough.
Michael Riccabona ∗ LKH Graz, University Hospital, Division of Paediatric Radiology, Department of Radiology, Auenbruggerplatz, 8036 Graz, Austria ∗ Tel.:
+43 316 385 84205; fax: +43 316 385 4299. E-mail address: [email protected] 10 July 2006