Emergency radiologic evaluation of the pediatric cervical spine can be challenging because of the confusing appearance of synchondroses, normal anatomic variants, and injuries that are unique to children. Cervical spine injuries in children are usually seen in the upper cervical region owing to the unique biomechanics and anatomy of the pediatric cervical spine. Knowledge of the normal embryologic development and anatomy of the cervical spine is important to avoid mistaking synchondroses for fractures in the setting of trauma. Familiarity with anatomic variants is also important for correct image interpretation. These variants include pseudosubluxation, absence of cervical lordosis, wedging of the C3 vertebra, widening of the predental space, prevertebral soft-tissue widening, intervertebral widening, and "pseudo-Jefferson fracture." In addition, familiarity with mechanisms of injury and appropriate imaging modalities will aid in the correct interpretation of radiologic images of the pediatric cervical spine.

The retrospective nature of the study prevents precise definition of the clinical characteristics and selection criteria for diagnostic examinations that may contribute to the management of children with suspected acute appendicitis. It was designed, however, to reflect the diagnostic approach and management of these patients, under the care of many decision makers and interpreters of imaging examinations, prevalent today in most hospital-based clinical practices. It is suggested that imaging increases diagnostic accuracy in difficult cases, but it might be one of the factors increasing the rate of perforations.

The purpose of this study was to determine the reliability of the splenic index (SI) in children with Hodgkin's disease (HD). Seventeen patients who underwent staging laparotomy for HD were included in this study. Pretreatment computed tomography scans of these patients were reviewed retrospectively to determine the SI. The specificity, sensitivity, positive and negative predictive values, and accuracy of the SI were calculated. The sensitivity and specificity of the SI were 50% and 66%, respectively. The SI alone accurately identified or ruled out involvement with HD in 10 of 17 patients. Positive and negative predictive values of the SI were 57% and 60%, respectively. Even with the use of the SI, computed tomography alone remains unreliable to determine splenic involvement in children with HD. Additional imaging studies, especially fluorodeoxyglucose positron emission tomography, may improve the clinical staging of HD.