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The objective of the study was to determine the intraobserver agreement, confidence level, and efficiency in interpretation of soft-copy (workstation) versus hard-copy (laser-printed film) sonograms of the cranium.Cranial sonograms of 100 premature infants were randomly reviewed twice on both soft-copy and hard-copy images by three observers and were graded for hemorrhage using a five-level scale. The kappa statistic was calculated to measure intraobserver agreement. Differences in agreement were tested for statistical significance with a test for marginal homogeneity. Observers rated their confidence in interpretation using a six-point ordinal scale. Total viewing time was recorded, and videotaped sessions were analyzed for image handling time (opening each case, closing each case, and selecting the next case) and interpretation time.For soft copy versus hard copy, the mean kappa value was .73; for hard-copy 1 versus hard-copy 2, .71; and for soft-copy 1 versus soft-copy 2, .65. None of these differences was statistically significant (p.05). The mean confidence score was the same for soft copy (5.3) and hard copy (5.3). On average, the observers needed 24 min longer to review 100 studies on soft copy than on hard copy. Opening and closing times for soft copy were significantly faster than for hard copy (p = .0001); however, case selection for soft copy, which was not needed for hard copy, took 4.69-9.09 sec per case. Extrapolated to 100 cases, case selection accounted for 8-15 min of viewing time.Radiologist agreement and confidence in the interpretation of cranial sonograms for hemorrhage was the same for soft copy and hard copy. However, viewing times were longer for soft copy. Elimination of inefficiency in case selection could improve image-handling time.

The 4p- syndrome results from a structural deficiency in chromosome 4. The clinical and radiologic findings in three patients with the 4p- syndrome are presented. Clinical, genetic, and radiologic findings in other reported cases are summarized. A widened interpubic distance with underdevelopment of the bony pelvis and deficiencies in ossification of the cervical spine are prominent radiologic features in our cases. Taken separately, these findings have limited differential diagnostic possibilities which are briefly discussed. The combination of these findings with characteristic clinical abnormalities is very suggestive of the 4p- syndrome and should prompt karyotyping for confirmation.

Pelvic pneumography was performed in 150 children, including those with precocious puberty, suspected pelvic masses, abdominal pain, virilization, ambiguous genitalia, gonadal dysgenesis, Stein-Leventhal syndrome, amenorrhea, and contralateral inguinal hernia detection. Pneumography proved safe, accurate, and easy to perform. However, advances in sonography have limited the use of pneumography primarily to the investigation of infant intersex problems and confirmation of idiopathic precocious puberty in the infant or very young girl.

Twenty-one infants and children with ovarian teratomas are reported. Calcification or ossification occurred in 68%, a higher figure than quoted in prior series. Teeth were recognized in 29% of these. A lucent fat-containing mass was appreciated in only two patients. In younger children the tumor was more frequently abdominal rather than pelvic. In two patients the tumor was malignant. A patient with an amputated freely mobile teratoma is reported in detail and the differential diagnosis of mobile abdominal calcifications discussed.

Seven patients with left-sided congenital diaphragmatic hernias at ages of 2--20 months are reported and five are described in detail. Radiographic findings were classic in one patient, but simulated inflammatory chest disease in two patients, gastric volvulus in three patients, and a pneumothorax in one patient. These misleading appearances if not recognized can lead to incorrect radiographic interpretation and in some cases inappropriate treatment.

Five children with intrathoracic metastases from Wilms tumor are presented. In two patients pneumothoraces developed, and in one patient pneumonitis developed secondary to a primary intrabronchial metastasis. Two other patients had paraspinal widening from metastases to paraaortic or posterior mediastinal lymph nodes. These are extremely rare complications of metastatic Wilms tumor.

Twenty-two patients with Henoch-Schonlein syndrome are reviewed, and four unusual cases are reported in detail. Henoch-Schonlein syndrome represents a diagnostic problem when abdominal manifestations precede cutaneous lesions and suggest a surgical abdomen. Unusual radiographic features such as changes in the small bowel identical to Crohn disease or colonic involvement may further obscure the diagnosis. Intussusception and rarely bowel obstruction may complicate the clinical course. The spectrum of clinical and radiographic findings is described to increase the awareness of the radiologist to the possibility of the diagnosis of Henoch-Schonlein syndrome.

Analysis of airway radiographs of 20 children with proven acute epiglottitis revealed that five (25%) had, in addition to supraglottic edema, localized subglottic edema radiographically indistinguishable from that seen in croup. In all five patients the etiologic organism was Hemophilus influenzae type B.

Cysto-Conray II 17.2% (81 mg l/ml), diluted Cysto-Conray 10% (47 mg l/ml), and Hypaque-Cysto 10% (47 mg l/ml) produced no histologic effects on rat bladders. Simulated ureters in water phantoms were well shown with lower concentrations of cystographic solutions including those of 5% (24 mg l/ml). In clinical studies there was little difference between Cysto-Conray II 17.2% and Hypaque-Cysto 10% for delineating refluxing ureters, bladder margins, and the urethra. Intraluminal filling defects in dog bladders were demonstrated best with cystographic concentrations of less than 10% (47 mg l/ml).