AIM: Caffey: Section 3: Pediatric Neuroradiology

Question 1

The following form the three portions of the skull, except:
a. Neurocranium
b. Face
c. Base
d. Orbit

Answer 1

d. Orbit

Question 2

The following are true regarding the anatomy of the skull, except:
a. The neurocranium is composed of the membranous portions of the occipital, parietal, frontal, and temporal bones, and is bounded inferiorly by the base of the skull, which includes the sphenoid and ethmoid bones
b. The face is between the glabella and chin.
c. Routine skull radiographs include the frontal projection, Towne view of the occipital bone, and the lateral view. Submentovertical, Waters, and Caldwell (posteroanterior 15 degrees) views may be added for specific indications.
d. All of the above are true

Answer 2

b. The face is between the glabella and chin.

Question 3

The following are indications for plain film examination of the skull, except:
a. Mild trauma
b. Syndrome evaluation
c. Cephalhematoma
d. Metastatic workup for small round cell tumor

Answer 3

a. Mild trauma

Question 4

Tagged as a “possible” indication for plain film examination of the skull
a. Sinusitis evalution
b. Initial evaluation in facial trauma
c. “Bump”
d. Foreign body (initial test)

Answer 4

b. Initial evaluation in facial trauma

The radiation dose (with the thyroid and lens being the most sensitive structures) varies with the view obtained and the age of the patient. Best practice skin doses for a lateral skull range from 0.09 mGy in the first year of life to 0.46 mGy in a 10- to 15-year- old child

Com- puted tomography (CT) and magnetic resonance imaging (MRI) are used for evaluation of intracranial contents, facial structures, craniosynostosis, and trauma.

Question 5

Most radiosensitive structures in the head and neck region:
a. Thyroid
b. Lens
c. Lips
c. A and B only

Answer 5

c. A and B only

Question 6

The following are false regarding the neonatal and infant skull, except:
a. The six major fontanelles are located at the four corners of the parietal bones—two in the skull midline and two pairs on each side
b. Obliteration of the sutures does not begin until the first to second decades
c. Accessory fontanelles may occur in several locations but usually are in the coronal suture.
d. The sutures and the skull base synchondroses are prominent in newborns but diminish in width during the first to second months.

Answer 6

a. The six major fontanelles are located at the four corners of the parietal bones—two in the skull midline and two pairs on each side

b. SECOND to THIRD decades
c. SAGITTAL
d. SECOND to THIRD

Question 7

Early tooth calciication is seen in the what fetal month?
a. Fourth
b. Fifth
c. Sixth
d. Seventh

Answer 7

b. Fifth

Question 8

The following statements are true, except:
a. During infancy, the neurocranium is larger relative to the face.
b. The angle between the body of the neonatal mandible and the ramus in lateral projection is about 160 degrees; the bodies are separated by a midline cartilaginous symphysis mentalis
c. Around the 15th year, the skull attains its definitive size.
d. Most of the postnatal skull growth occurs during the first 2 years of life, after which most of the features of the adult skull are present.

Answer 8

c. Around the 15th year, the skull attains its deinitive size.

20th

Question 9

Intrasutural, or wormian, bones occur most frequently along WHAT SUTURE?

Answer 9

Lambdoid suture

Question 10

This wormian bone results from division of the supraoccipital portion of the occipital bone into two parts by the mendosal suture, with the superior part arising from membranous bone and the inferior part from cartilage continuous with the supracondylar basiocciput.

Answer 10

Interparietal or Inca bone

Question 11

In Towne projection this suture is seen as a midline longitudinal lucency in the occipital squamosa in pediatric patients, which resulted from failure of fusion mediad of its lateral paired ossiication centers, and can be mistaken for a fracture line

Answer 11

Cerebellar synchondrosis

Median cerebellar suture

Question 12

It is the an outward bulge of the occipital squamosa just above the torcular Herophili in a newborn

Answer 12

Bathrocephaly

Question 13

The only treatable condition in which wormian bones may be present

Answer 13

Hypothyroidism (cretinism)

Question 14

The following statements are true, except:
a. The outer table portion of the suture may be deeply serrated when the inner table portion is practically a straight line and may be erroneously interpreted as a fracture
b. Persistence of the metopic suture may simulate a vertical occipital bone fracture in anteroposterior, caudally angulated radiographs
c. The frontal crest on the internal surface of the frontal squamosa in the midsagittal plane may be sufficiently prominent to simulate calciication of the falx cerebri
d. All of the above are true

Answer 14

d. All of the above are true

Question 15

Identify

Answer 15

Question 16

Re: Venous and arterial grooves

Compared with the venous grooves, the arterial grooves tend to taper more. The most constant of these channels is the ____, which courses upward and backward from the pterion

Answer 16

Middle meningeal artery

Question 17

These are areas of diminished calvarial density separated by strips of normal density, and are formed by localized pressure of pulsating brain on the inner table of the neurocranium

Answer 17

Convolutional (Digital) Markings

Question 17

Often the groove for the bregmatic vein is a conspicuous strip of hypodensity on one or both lateral calvarial walls; this groove, also called ____

Answer 17

Sphenoparietal sinus

Question 18

Identify the structure represented by the sharply defined calvarial impression pointed by the arrows

Answer 18

Pacchionian granulation

Question 19

Identify

Answer 19

Enlarged parietal foramina

About 60% of skulls show small defects (parietal foramina) in the superior posterior angles of the parietal bones through which emissary veins penetrate. The veins communicate with the sagittal sinus internally and occipital vein tributaries externally.

NTK:
Large parietal foramina have been recognized as an inherited trait ever since Goldsmith found them in 56 members of the Catlin family, giving rise to the term “Catlin mark.” They may persist throughout life, although they tend to become smaller or disappear leaving focal sclerotic residua.

Question 20

Identify c and f

Answer 20

c. SOF
f. Ethmoid bulla

Question 21

Identify e and f

Answer 21

e. Superior cruciate ridge
f. Inferior cruciate ridge

Question 22

Identify 1 and 4

Answer 22

1. Zygomatic arch
2. Greater wing of the sphenoid

Question 23

The frontal sinuses are not suficiently developed for radiographic identiication until what age?

Answer 23

6 years of age

Question 24

Ethmoid cells are usually complete by what age?

Answer 24

12 years of age

Question 25

Period by which frontal sinuses attain their adult size and maxillary sinuses are considered mature

Answer 25

Puberty

Question 26

The following are true about the ethmoid sinuses, except:
a. Three anatomic variants of ethmoid cells are found: Agger nasi, Haller, and Onodi cells
b. They usually form two groups: anterior and posterior
c. The ethmoid cells often extend into the turbinates, crista galli, and neighboring frontal, maxillary, sphenoid, and palate bones.
d. They are present at birth, expand rapidly during the irst 5 years, expand less quickly until about 8 years, and typically are complete by age 12 years.

Answer 26

b. They usually form two groups: anterior and posterior

They usually form three groups: anterior, middle, and posterior

Question 27

In general, radiographs are unnecessary for the diagnosis of paranasal sinus disease, particularly in children less than ____

Answer 27

6 years

In older children, a single Waters view may prove useful