Pediatric Radiology (2018) 48:445 https://doi.org/10.1007/s00247-018-4075-2 LETTER TO THE EDITOR Reply to Reck-Burneo et al.: imaging anorectal and cloacal malformations 1 2 3 M. Luisa Lobo & Michael Riccabona & Lil-Sofie Ording Müller & On behalf of the European Society of Paediatric Radiology Abdominal Imaging Task Force Received: 31 December 2017 /Accepted: 5 January 2018 /Published online: 15 January 2018 Springer-Verlag GmbH Germany, part of Springer Nature 2018 Dear Editors, All anatomical structures, including the urethra, must be We thank Dr. Reck-Burneo and coauthors  for their interest identified and analysed. Furthermore, any potential fistulous in our recent article. We appreciate their valuable comments tracts must be delineated. Because of their erratic nature and and suggestions concerning our imaging recommendations unpredictable course, these tracts are better depicted, and eas- for patients with cloacal and anorectal malformations . ier for the surgeon to understand, on fluoroscopic studies. Our aim was to present imaging and procedural recommen- Volumetric images can be achieved if rotational three- dations based on consensus within the European Society of dimensional fluoroscopy equipment is available, as mentioned Paediatric Radiology (ESPR) Abdominal Imaging Task Force in Fig. 7 of our recommendations . and following public discussion at an ESPR meeting. We took For the colostogram, after filling the colon, it is essential to into account differences in viewpoints among various maintain pressure to allow filling of any potential fistula, as European centers/national societies. A comprehensive review also stated in Fig. 7 of our recommendations . Dynamic of imaging of cloacal and anorectal malformations was be- filling techniques also apply for magnetic resonance studies, yond our scope. although they may not be equally easily achieved for technical reasons and particularly in young children. We completely agree that a multidisciplinary team ap- proach is fundamental when treating patients with cloacal We also agree that presacral masses must be ruled out, and and anorectal malformations. Particularly for patients with this is part of the initial investigation of associated anomalies cloacal malformation who require highly specialised recon- starting with a detailed and complete ultrasound examination structive surgery, an individualised imaging approach of the entire abdominopelvic cavity and the spine. More ad- resulting from close collaboration between the paediatric im- vanced imaging such as computed tomography and magnetic aging and paediatric surgery teams (including all subspe- resonance imaging may follow depending on the sonographic cialties involved) is crucial, and these infants should be treated findings. in a dedicated paediatric centre. The above highlights how important it is for radiologists Classifications are helpful for the majority of conventional and surgeons to work together for a better understanding of cases, and we agree that the Krickenbeck classification is in- the imaging needs, technical restrictions and treatment options sufficient for the rarer and more complex cloacal anomalies. for these complicated congenital anomalies. References * M. Luisa Lobo firstname.lastname@example.org 1. Reck-Burneo CA, Vilanova-Sanchez A, Levitt RMA, Bates DG (2017) Imaging in anorectal and cloacal malformations. https://doi. org/10.1007/s00247-017-4040-5 Department of Radiology, Hospital de Santa Maria – CHLN, 2. Riccabona M, Lobo ML, Ording-Muller LS et al (2017) European University Hospital, Lisbon, Portugal Society of Paediatric Radiology abdominal imaging task force rec- Department of Radiology, Division of Pediatric Radiology, ommendations in paediatric uroradiology, part IX: imaging in University Hospital LKH Graz, Graz, Austria anorectal and cloacal malformation, imaging in childhood ovarian torsion, and efforts in standardising paediatric uroradiology terminol- Department of Radiology and Nuclear Medicine, ogy. Pediatr Radiol 47:1369–1380 Unit for Paediatric Radiology, Oslo University Hospital, Oslo, Norway
Pediatric Radiology – Springer Journals
Published: Jan 15, 2018
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