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Dafpus 6. Imaging in Osteogenesis Imperfecta - Overview, Radiography, Computed Tomography
Dafpus 6. Imaging in Osteogenesis Imperfecta - Overview, Radiography, Computed Tomography
Thissiteisintendedforhealthcareprofessionals
ImaginginOsteogenesisImperfecta
Updated:Nov30,2015
Author:AnishKirpalani,MDChiefEditor:FelixSChew,MD,MBA,MEdmore...
OVERVIEW
Overview
Osteogenesisimperfecta(OI)isacommonheritabledisorderofcollagensynthesisthatresultsin
weakbonesthatareeasilyfracturedandareoftendeformed.Severaldistinctsubtypeshavebeen
identified,allofwhichleadtomicromelic(shortlimbed)dwarfismofvaryingdegree.Dependingon
severity,thebonefragilitymayleadtoperinataldeathorcauseseveredeformitiesthatpersistinto
adulthood.[1,2,3,4,5,6,7,8]
Thevariabilityofthemodesofinheritance,familyhistory,clinicalfeatures,andradiologicfindings
formsthebasisforthecurrentacceptedclassificationsystemofosteogenesisimperfecta,which
Sillenceetalfirstproposedin1979.TworadiographsdepictingtypeIdiseaseappearbelow.
FrontalradiographoftheleginapatientwithtypeIosteogenesisimperfecta(OI)showsevidenceofsevere
osteoporosis,overtubulationofboththetibiaandfibula,andahealingfractureofthetransversediaphysealof
thetibia.Alsonotethemultiplemetaphysealgrowthrecoverylinesaboutthekneeinthispatientwhowas
treatedwithpamidronate.
ViewMediaGallery
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Frontalradiographoftheforearmina17yearoldfemaleadolescentwithtypeIosteogenesisimperfecta(OI)
showsosteoporosis,bowingdeformitieswithovertubulationoftheradius,ahealedulnarfracture,andcallus
formationoverthedistalhumerus.Growthrecoverylinesarepresentinthedistalradius.
ViewMediaGallery
Typesofosteogenesisimperfecta
Bonefragilitywithmultiplefracturesandbonydeformitiesarethecommonhallmarkofalltypes.
IntypeIosteogenesisimperfecta,bonefragilityismild,andthereareminimalbonydeformities.
Approximately20%ofpatientshavekyphoscoliosis.
TypeIIisthemostsevereformofosteogenesisimperfecta.Theribsarethinandbeaded,thelong
bonesarecrumpled,thereislimitedcranialand/orfacialboneossification,andthelimbsareshort,
curved,andangulated.TypeIIdiseasecanbefurthersubdividedintotypesIIA,IIB,andIIConthe
basisoftheradiographicfeaturesofthelongbonesandribs(seeRadiographfordetails).
TypeIIIosteogenesisimperfectaisthenextmostsevereformaftertypeIIandisprobablytheform
thatisbestknowntoradiologistsandorthopedicsurgeons.Itshallmarkfeatureisseverebone
fragilityandosteopenia,whichisprogressivelydeforming.Multiplefracturesandprogressive
deformityaffectthelongbones,skull,andspineandareoftenpresentatbirth.Kyphoscoliosisis
common.Childrenwiththistypeofosteogenesisimperfectatendtohaveseveredwarfismcaused
byspinalcompressionfractures,limbdeformities,anddisruptionofgrowthplates.
TypeIVosteogenesisimperfectaisdistinguishedfromtypeIbytheslightlyincreased,althoughstill
variable,severityofbonefragility.Mildtomoderatebonydeformityofthelongbonesandspineis
presenttheincidenceoffractureisvariable.Basilarimpressionoftheskull,withconsequent
brainstemcompression,iscommon(reportedin70%ofpatients).
AtypeVcategoryhasbeenaddedtoincludepatientswithosteoporosisorinterosseous
membraneossificationoftheforearmsandlegs,aswellaspatientswhoarepronetothe
developmentofhypertrophiccalluses.[9,10,11]
SeeSpecialconcerns,below,foracontroversial,selflimitingvariantofosteogenesisimperfecta,
knownastemporarybrittlebonedisease.
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Preferredexamination
Thepreferredexaminationfortheinitialinvestigationofosteogenesisimperfectaisplain
radiography.Indeed,mostoftheimagingcharacteristicsofthisdiseaseareapparentonplain
radiographs.Prenatalultrasonographyplaysaroleinthediagnosisofosteogenesisimperfecta
thisconditionisoneofthemorecommonskeletaldysplasiasdetectedwithprenatal
ultrasonography.Mostcasesarefoundincidentallyonultrasonographicexaminationsperformed
forotherreasonstypicalincidentalfindingsincludefractures,decreasedcalvarialossification,or
calvariathatarecompressiblewithtransducerpressure.Mostcasesofosteogenesisimperfecta
thatarerecognizedinthiswayaretypeII,andthepatientshavenofamilyhistoryofthedisease.
Magneticresonanceimaging(MRI)playsanadjunctproblemsolvingroleinassessingfor
associatedcomplications,suchasbasilarinvagination.[12,13,14,15,16]
Differentialdiagnosisandotherproblemstobeconsidered
Becauseosteoporosisandmultiplefracturesarehallmarkfeaturesofosteogenesisimperfecta,
otherdisordersthatcausemultiplefracturesordecreasedbonemineralizationmaybeconsidered
inthedifferentialdiagnosis,suchaschildabuse,juvenileosteoporosis,steroidinduced
osteoporosis,Menkes(kinkyhair)syndrome,hypophosphatasia,batteredchildsyndrome
(syndromeX)andtemporarybrittlebonedisease.
Themultiplicityoffracturesseeninosteogenesisimperfectacommonlyraisesaconcernabout
childabusehowever,keyimaginghallmarkshelpdistinguishosteogenesisimperfectafromchild
abuse(ie,nonaccidentalinjury)(seeRadiograph).Becausetheradiologistplaysacentralrolein
distinguishingbetweenthese2entities,heorshemusthaveanunderstandingofthisdisease,its
geneticvariability,anditsimagingappearance.[9,17,18]
Specialconcerns
Someauthorshavesuggestedthatthereexistsaselflimitingvariantofosteogenesisimperfecta),
knownastemporarybrittlebonedisease,whichhasbeendescribedasafundamentaltransient
defectincollagenformationthatisassociatedwithmultiplefracturesininfantsyoungerthan6
months.Theradiologicandclinicalfeaturesofthisvariantarethesameasthosenotedincasesof
childabuse.Becausethereislittlescientificevidencetosupporttheexistenceofthisselflimiting
entity,controversyabouthowtodealwithcasesofpossiblechildabuseexistsinthemedicaland
legalcommunities.[19,20]
Radiography
Incasesofsuspectedosteogenesisimperfecta,postnatalradiographsshouldincludeviewsofthe
longbones,skull,chest,pelvis,andthoracolumbarspine.Theradiographicfeaturesarerelatedto
thetypeofosteogenesisimperfectaandtheseverityofdisease.Somefindings,however,maybe
seeninallsubtypes.
Generalradiographicfeaturesofosteogenesisimperfecta
Theradiologicsinequanonofosteogenesisimperfectaisgeneralizedosteoporosisofboththe
axialandappendicularskeleton.Milderformsofthisconditionresultinthin,overtubulated(gracile)
boneswiththincorticesandrelativelyfewfractures(seetheimagesbelow).Theshorttubular
bonesarealsoaffected,thoughtheyarelessfrequentlyfractured.Inaddition,radiographsofthe
skullinmilderformsofosteogenesisimperfectamayrevealnormalskulldevelopment.[14]
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FrontalradiographoftheleginapatientwithtypeIosteogenesisimperfecta(OI)showsevidenceofsevere
osteoporosis,overtubulationofboththetibiaandfibula,andahealingfractureofthetransversediaphysealof
thetibia.Alsonotethemultiplemetaphysealgrowthrecoverylinesaboutthekneeinthispatientwhowas
treatedwithpamidronate.
ViewMediaGallery
Frontalradiographoftheforearmina17yearoldfemaleadolescentwithtypeIosteogenesisimperfecta(OI)
showsosteoporosis,bowingdeformitieswithovertubulationoftheradius,ahealedulnarfracture,andcallus
formationoverthedistalhumerus.Growthrecoverylinesarepresentinthedistalradius.
ViewMediaGallery
Moresevereformsofosteogenesisimperfecta,suchastypesIIandIII,featurethickened,
shortenedlongboneswithmultiplefracturestheseformsareoftencomplicatedbyhyperplastic
callusformation(seethefollowingimage).Thecallusismostoftenfoundaroundthefemurandis
oftenlarge,appearingasadense,irregularmassarisingfromthecortexofbone.Thiscallusis
associatedwiththickenedperiosteum,anditspresencecausesotherdifferentialdiagnostic
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considerations,includingosteosarcoma,myositisossificans,chronicosteomyelitis,and
osteochondroma.
Healingfractureofthelefthumeraldiaphysiswithcallusformationinapatientwithosteogenesisimperfecta
(OI).
ViewMediaGallery
Moreover,withincreasingdiseaseseverity,theskulldemonstratespoormineralizationandmultiple
wormian,orintrasutural,bones(seetheimagesbelow).
LateralradiographoftheskullinayoungfemalepatientwithtypeIIIosteogenesisimperfecta(OI)
demonstratesmultiplewormianbones.
ViewMediaGallery
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Osteogenesisimperfecta(OI).Correspondinganteroposteriorradiographoftheskullinthesamepatientasin
thepreviousimagedemonstratesmultiplewormianbones.
ViewMediaGallery
Thechestmaybesmall.Multipleribfracturesareoftenfoundthesecancausetheribstobecome
broadanddeformed.Inaddition,spinalabnormalitiesinallsubtypesofosteogenesisimperfecta
includeplatyspondylyandscoliosis(seethesectiononTypeIIIspecificradiographicfeaturesof
osteogenesisimperfecta,below).
Recentadvancesinthetreatmentofosteogenesisimperfectawithbisphosphonateshaveresulted
inspecificimagingfindings.Cyclicalpamidronatetreatmentproducesscleroticgrowthrecovery
linesinthelongbones(seetheimagesbelow).Theamountofbonegrowthbetweendosesof
pamidronatemaybemeasuredbythedistancebetweenthesegrowthlines.
FrontalradiographoftheleginapatientwithtypeIosteogenesisimperfecta(OI)showsevidenceofsevere
osteoporosis,overtubulationofboththetibiaandfibula,andahealingfractureofthetransversediaphysealof
thetibia.Alsonotethemultiplemetaphysealgrowthrecoverylinesaboutthekneeinthispatientwhowas
treatedwithpamidronate.
ViewMediaGallery
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Frontalradiographofthepelvisina9yearoldgirlwithtypeIIIosteogenesisimperfecta(OI)andbilateral
healingfemoralfractures.Multiplegrowthrecoverylinesarepresentinthefemoralheadsbilaterallyafter
bisphosphonatetreatment.Scoliosisandsquarediliacbonesarealsodemonstrated.
ViewMediaGallery
Someradiographicfindingsaremorespecifictocertainsubtypesofosteogenesisimperfectathan
others.
TypeIIspecificradiographicfeaturesofosteogenesisimperfecta
TypeIIosteogenesisimperfectaisfurthercategorizedinto3subtypesonthebasisofradiologic
featuresofthelongbonesandribs.IntypesIIAandIIB,thelongbonesareshortandbroad
becauseofundermodelingthebonesarealsocrumpled.IntypeIIC,thelongbonesarethinner
(cylindrical)andlongerthanintheothersubtypes,althoughtheyarestillundermodeled.
TheribsintypeIIAareshortandbroadwithcontinuousbeading.IntypeIIB,beadingisabsentor
minimalanddiscontinuous.IntypeIIC,theribsarethinandbeaded.
TypeIIIspecificradiographicfeaturesofosteogenesisimperfecta
ScoliosisofthethoracolumbarspineisspecifictotypeIIIosteogenesisimperfecta:Asmanyas
25%ofpatientswithosteogenesisimperfectahavescoliosis,andtheassociationisevenhigherin
patientswithtypeIIIdisease(seetheimagebelow).MostaffectedpatientshaveanSshaped
scoliosis.
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FrontalradiographinapatientwithtypeIIIosteogenesisimperfecta(OI)withsevereSshapedscoliosisofthe
thoracolumbarspine.
ViewMediaGallery
Severeplatyspondylywithvertebralcompressionfracturesand"codfishvertebrae"aremore
commoninthistypeofosteogenesisimperfectathaninothertypes(seethefollowingimage).
Lateralspinalradiographina1yearoldboywithosteogenesisimperfecta(OI)demonstratesmultilevel,mild
platyspondyly.
ViewMediaGallery
"Popcorncalcifications"alsooccurcommonlyinthemetaphysealepiphysealregionoflongbones,
mostcommonlyatthekneeandankle.Thisresultsfromrepeatedmicrofracturesatthegrowth
plate.
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Softcraniofacialboneswithalarge,thincalvariumcausetriangularfacies.
TypeIVspecificradiographicfeaturesofosteogenesisimperfecta
RadiographicfindingsoftypeIVosteogenesisimperfectaaresimilartothegeneralfindingsand
findingsspecifictotypeIdisease.However,onefeaturethatismorecommonlyassociatedwith
typeIVthanothertypesisbasilarinvagination(impression),withorwithoutbrainstem
compression.Thismaybedetectedonplainradiographyoftheskullorcervicalspine.The
McGregorline,asthestraightlineconnectingtheuppersurfaceoftheposterioredgeofthehard
palatetothemostcaudalpointoftheoccipitalcurve,maybeusedtoassessforthiscomplication.
ProjectionofthetipoftheodontoidprocessabovetheMcGregorlinesuggeststhepresenceof
basilarinvagination(seetheCTscanandMRIimagesbelow).
Sagittallyreconstructedcomputedtomographyscanofthecervicalspineina16yearoldfemaleadolescent
withtypeIVosteogenesisimperfecta(OI).Thisimagedemonstratesmildbasilarinvagination,withthetipof
thedensabovetheMcGregorline(red).
ViewMediaGallery
MidlinesagittalT2weightedmagneticresonanceimagethroughthecervicalspineina16yearoldfemale
adolescentwithtypeIVosteogenesisimperfecta(OI).Thisimagedemonstratesmildstenosisattheforamen
magnum,causedbybasilarinvagination(effectivewidthofforamenmagnumdenotedbyredline).
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ViewMediaGallery
Thepresenceofalarge,thincraniumwithplatybasiaandcranialsettlingmayleadtothe
appearanceoftheTamO'Shanterskull.
Degreeofconfidence
Uponthedetectionofhallmarkbonefindingsofosteogenesisimperfectaonplainradiographs,the
diagnosismaybemadewithahighdegreeofconfidenceconfirmationwithotherimaging
modalitiesisnotneeded.
ComputedTomography
Currently,themajorroleofCTscanningisinadjunctiveproblemsolving.Thismodalitymaybe
usedtofurtherassessforbasilarimpression(seetheimagebelow)toevaluatethepetrousbone
fornarrowingofthemiddleearorotosclerosis,andtosupportbonemineraldensitometry(BMD)
(seeNuclearMedicine,below).[15]
Sagittallyreconstructedcomputedtomographyscanofthecervicalspineina16yearoldfemaleadolescent
withtypeIVosteogenesisimperfecta(OI).Thisimagedemonstratesmildbasilarinvagination,withthetipof
thedensabovetheMcGregorline(red).
ViewMediaGallery
ThefollowingisanMRIthroughthecervicalspineinthesamepatientasintheCTscanabove.
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MidlinesagittalT2weightedmagneticresonanceimagethroughthecervicalspineina16yearoldfemale
adolescentwithtypeIVosteogenesisimperfecta(OI).Thisimagedemonstratesmildstenosisattheforamen
magnum,causedbybasilarinvagination(effectivewidthofforamenmagnumdenotedbyredline).
ViewMediaGallery
MagneticResonanceImaging
ThemajorroleofMRIinosteogenesisimperfectaisinproblemsolving.MRIisalsousedtoimage
complicationsofthisdisease,suchasbasilarimpression.Althoughcervicalspinalradiographyand
CTscanning(seethefirstimagebelow)maydemonstratethisabnormalitywell,MRIhasthe
advantageofdetectingassociatedcompressionofthespinalcord(seethesecondimagebelow,
whichisfromthesamepatientasthatoftheCTscaninthefirstimage).[15]
Sagittallyreconstructedcomputedtomographyscanofthecervicalspineina16yearoldfemaleadolescent
withtypeIVosteogenesisimperfecta(OI).Thisimagedemonstratesmildbasilarinvagination,withthetipof
thedensabovetheMcGregorline(red).
ViewMediaGallery
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MidlinesagittalT2weightedmagneticresonanceimagethroughthecervicalspineina16yearoldfemale
adolescentwithtypeIVosteogenesisimperfecta(OI).Thisimagedemonstratesmildstenosisattheforamen
magnum,causedbybasilarinvagination(effectivewidthofforamenmagnumdenotedbyredline).
ViewMediaGallery
BasilarimpressionisfrequentlyassociatedwithtypeIVosteogenesisimperfecta.Inparticular,in
typeIVBdisease,theincidenceofneurologicsymptomsisincreased.Otherassociatedconditions
thatmaybeimagedbetterwithMRIthanwithplainradiographyincludesyringohydromyeliaand
communicatinghydrocephalus,especiallyiftheseconditionsdevelopafterfontanelleclosure.
Ultrasonography
Osteogenesisimperfectaisoneofthemostcommonskeletaldysplasiasdetectedonprenatal
ultrasonography.MostcasesinvolvetypeIIdiseaseandarefoundincidentally.
Firsttrimesterofpregnancy
Thediagnosisofosteogenesisimperfectamaybemadereliablybyweek17ofgestation.The
diagnosismaybemadebydetectingmorphologicabnormalitiesonultrasonogramsorbyanalyzing
collagensynthesizedbychorionicvilluscellsafterultrasonographyguidedchorionicvillus
sampling.
Secondtrimesterofpregnancy
Ultrasonographicfindingsofosteogenesisimperfectaduringthesecondtrimesterscanninginclude
decreasedechoesfromthecalvariumwithsupervisualized(tooeasilyseen)intracranialstructures
bowingandangulationofthelongbones,implyingplaticdeformitiesandfracturesdecreased
lengthofthelongbonesandmultipleribfractures.[21]
NuclearImaging
Bonemineraldensitometry(BMD)resultsmayconfirmtheseverityofosteoporosisinpatientswith
osteogenesisimperfectaitmayalsoconfirmthepresenceofdemineralizationinmildcasesoftype
IortypeIVdisease.
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CurrentlyacceptedBMDmeasurementtechniquesincludethefollowing:(1)corticalradialBMD
measuredbyuseofsinglephotonabsorptiometry(SPA)(2)BMDofthelumbarspine(inchildren
olderthan1y)andfemoralneck(inchildrenolderthan6y),inwhichBMDisobtainedbyuseof
dualenergyxrayabsorptiometry(DXA)and(3)lumbarspinalBMDmeasuredbymeansofCT
scanninginchildrenolderthan4years.
Degreeofconfidence
Thereareonlyafewreportedcasesinwhichbonemineraldensitometrymeasurementswere
madeinyoungchildrenwithosteogenesisimperfectaassuch,thereliabilityofthese
measurementsisunknown.
References
1.ByraP,ChillagS,PetitS.Osteogenesisimperfectaandaorticdissection.AmJMedSci.
2008Jul.336(1):702.[Medline].
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26(4):3949.[Medline].
3.BrusinJH.Osteogenesisimperfecta.RadiolTechnol.2008JulAug.79(6):53548.[Medline].
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9.GlorieuxFH,RauchF,PlotkinH,etal.TypeVosteogenesisimperfecta:anewformofbrittle
bonedisease.JBoneMinerRes.2000Sep.15(9):16508.[Medline].
10.KornblumM,StanitskiDF.Spinalmanifestationsofskeletaldysplasias.OrthopClinNorth
Am.1999Jul.30(3):50120.[Medline].
11.SillenceD.Osteogenesisimperfecta:anexpandingpanoramaofvariants.ClinOrthop.1981
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12.KirksDR,ed.MusculoskeletalSystem.PracticalPediatricImaging:DiagnosticRadiologyof
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13.TaybiH,LachmanRS.OsteogenesisImperfecta.RadiologyofSyndromes,Metabolic
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MediaGallery
FrontalradiographoftheleginapatientwithtypeIosteogenesisimperfecta(OI)shows
evidenceofsevereosteoporosis,overtubulationofboththetibiaandfibula,andahealing
fractureofthetransversediaphysealofthetibia.Alsonotethemultiplemetaphysealgrowth
recoverylinesaboutthekneeinthispatientwhowastreatedwithpamidronate.
Frontalradiographoftheforearmina17yearoldfemaleadolescentwithtypeIosteogenesis
imperfecta(OI)showsosteoporosis,bowingdeformitieswithovertubulationoftheradius,a
healedulnarfracture,andcallusformationoverthedistalhumerus.Growthrecoverylines
arepresentinthedistalradius.
Healingfractureofthelefthumeraldiaphysiswithcallusformationinapatientwith
osteogenesisimperfecta(OI).
LateralradiographoftheskullinayoungfemalepatientwithtypeIIIosteogenesisimperfecta
(OI)demonstratesmultiplewormianbones.
Osteogenesisimperfecta(OI).Correspondinganteroposteriorradiographoftheskullinthe
samepatientasinthepreviousimagedemonstratesmultiplewormianbones.
Frontalradiographofthepelvisina9yearoldgirlwithtypeIIIosteogenesisimperfecta(OI)
andbilateralhealingfemoralfractures.Multiplegrowthrecoverylinesarepresentinthe
femoralheadsbilaterallyafterbisphosphonatetreatment.Scoliosisandsquarediliacbones
arealsodemonstrated.
FrontalradiographinapatientwithtypeIIIosteogenesisimperfecta(OI)withsevereS
shapedscoliosisofthethoracolumbarspine.
Lateralspinalradiographina1yearoldboywithosteogenesisimperfecta(OI)demonstrates
multilevel,mildplatyspondyly.
Sagittallyreconstructedcomputedtomographyscanofthecervicalspineina16yearold
femaleadolescentwithtypeIVosteogenesisimperfecta(OI).Thisimagedemonstratesmild
basilarinvagination,withthetipofthedensabovetheMcGregorline(red).
MidlinesagittalT2weightedmagneticresonanceimagethroughthecervicalspineina16
yearoldfemaleadolescentwithtypeIVosteogenesisimperfecta(OI).Thisimage
demonstratesmildstenosisattheforamenmagnum,causedbybasilarinvagination(effective
widthofforamenmagnumdenotedbyredline).
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ContributorInformationandDisclosures
Author
AnishKirpalani,MDConsultingRadiologist,TexasRadiologyAssociates,LLP
AnishKirpalani,MDisamemberofthefollowingmedicalsocieties:AmericanRoentgenRay
Society,RadiologicalSocietyofNorthAmerica,InternationalSocietyforMagneticResonancein
Medicine,CanadianAssociationofRadiologists
Disclosure:Nothingtodisclose.
Coauthor(s)
PaulSBabyn,MDAssociateProfessor,DepartmentofMedicalImaging,UniversityofToronto
RadiologistinChief,DepartmentofDiagnosticImaging,TheHospitalforSickChildren
PaulSBabyn,MDisamemberofthefollowingmedicalsocieties:RadiologicalSocietyofNorth
America
Disclosure:Nothingtodisclose.
SpecialtyEditorBoard
BernardDCoombs,MB,ChB,PhDConsultingStaff,DepartmentofSpecialistRehabilitation
Services,HuttValleyDistrictHealthBoard,NewZealand
Disclosure:Nothingtodisclose.
MartaHernanzSchulman,MD,FAAP,FACRProfessor,RadiologyandRadiologicalSciences,
ProfessorofPediatrics,DepartmentofRadiology,ViceChairinPediatrics,MedicalDirector,
DiagnosticImaging,VanderbiltChildren'sHospital
MartaHernanzSchulman,MD,FAAP,FACRisamemberofthefollowingmedicalsocieties:
AmericanInstituteofUltrasoundinMedicine,AmericanRoentgenRaySociety
Disclosure:Nothingtodisclose.
ChiefEditor
FelixSChew,MD,MBA,MEdProfessor,DepartmentofRadiology,ViceChairmanforAcademic
Innovation,SectionHeadofMusculoskeletalRadiology,UniversityofWashingtonSchoolof
Medicine
FelixSChew,MD,MBA,MEdisamemberofthefollowingmedicalsocieties:AmericanRoentgen
RaySociety,AssociationofUniversityRadiologists,RadiologicalSocietyofNorthAmerica
Disclosure:Nothingtodisclose.
AdditionalContributors
HarrisLCohen,MD,FACRChairman,DepartmentofRadiology,ProfessorofRadiology,
Pediatrics,andObstetricsandGynecology,UniversityofTennesseeHealthScienceCenter
CollegeofMedicineRadiologistinChief,LeBonheurChildren'sHospitalEmeritusProfessorof
Radiology,TheSchoolofMedicineatStonyBrookUniversity
HarrisLCohen,MD,FACRisamemberofthefollowingmedicalsocieties:AmericanCollegeof
Radiology,AmericanInstituteofUltrasoundinMedicine,RadiologicalSocietyofNorthAmerica,
SocietyforPediatricRadiology,AssociationofProgramDirectorsinRadiology,Societyof
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RadiologistsinUltrasound
Disclosure:Nothingtodisclose.
http://emedicine.medscape.com/article/411919overview 16/16