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Clinical Issue: The diagnostics of physical child abuse are usually performed by a multidisciplinary team and frequently represent a clinical challenge. Radiological expertise is particularly important for the recognition of abusive injuries to the skeletal system and the central nervous system. The aim of the article is to give an overview of red flags of child abuse in radiological imaging., Imaging Methods: For the diagnostics of child abuse, conventional projection radiography of the skeletal system as well as computed tomography (CT) and magnetic resonance imaging (MRI) of the head are especially relevant. There is insufficient evidence with respect to sonography., Conclusion: Radiological imaging plays a key role for recognizing physical child abuse. Radiological red flags of child abuse can be crucial for making the diagnosis., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Clinical Problem: Congenital anomalies of the kidney and urinary tract (CAKUT) are very common findings in fetal diagnostics. Their effects range from variants without pathological significance to pronounced functional impairment with the need for renal replacement therapy in childhood. Sometimes the genital organs are also affected. The aim of the article is to provide an overview of embryology and examples of key findings., Imaging Procedures: In the fetal period, magnetic resonance imaging (MRI) is used, while postnatally, sonography with the option of contrast-enhanced micturition urosonography (MUS, ceVUS) dominates imaging in pediatric radiology, supplemented in individual cases by fluoroscopy (micturition cysturethrography) and MRI. Quantitative methods for assessing kidney function and excretion (MAG3 scintigraphy, functional MR urography) are essential when planning further therapeutic procedures, especially in obstructive uropathies., Conclusion: Imaging plays an essential role in the assessment of abnormalities of the kidneys and urinary tract both pre- and postnatally. Knowledge of embryology facilitates anatomical understanding and assessment of pathologies., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

The ultrasound (US) examination is the most important imaging procedure in the clinical care of children with chronic kidney disease, the assessment before kidney transplantation and in the acute and chronic phase after successful kidney transplantation. In trained hands, particularly with experience in Doppler sonography, US ensures that vascular complications, such as occlusions, thrombosis, stenosis as well as non-vascular complications, e.g., urinary tract dilatation, abscesses, hematomas, urine leaks or lymphoceles, are cost-effectively and rapidly diagnosed at any time. For the diagnosis of acute rejection, the US signs in the intraindividual course are only suggestive, but not specific. The gold standard for the diagnosis of acute rejection is a kidney biopsy. In these cases, US serves to exclude other causes. The use of multimodal techniques, various Doppler techniques and microvascular procedures, such as superb microvascular imaging (SMI) or B‑flow and contrast-enhanced ultrasonography (CEUS), optimizes the imaging in the context of transplantations in children. Magnetic resonance imaging with diffusion-weighed imaging (DWI), magnetic resonance angiography (MRA) and magnetic resonance urography (MRU) as well as functional MRU (fMRU) performed with the administration of gadolinium-containing contrast agents, are part of the extended diagnostics and possibly necessary for surgical planning in the early phase after kidney transplantation and for long-term assessment after transplantation. Excretory urography is associated with ionizing radiation and intravenous administration of iodine-containing contrast medium and is obsolete in children. Computed tomography (CT) using age-adapted and weight-adapted dose protocols is an alternative in emergencies if MRI is not available., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)