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The authors set out to determine the maximum level of statistical iterative reconstruction that can be used to establish dose-reduced head CT protocols in a primarily pediatric population while maintaining similar appearance and level of image noise in the reconstructed image. Dose-reduced head protocols using an adaptive statistical iterative reconstruction were compared for image quality with the original filtered back-projection reconstructed protocols in a phantom and CT dose index and image noise magnitude were assessed in 737 pre- and post-dose-reduced examinations. Implementation of 40% and 60% adaptive statistical iterative reconstruction led to an average reduction in the volume CT dose index of 43% for brain, 41% for orbit, 30% for maxilla, 43% for sinus, and 42% for temporal bone protocols for patients between 1 month and 26 years of age, while improving the contrast-to-noise ratio of low-contrast soft-tissue targets.

The authors evaluated the clinical records and neuroimaging of patients with spontaneous intracranial hypotension from September 2005 to August 2014. Patients with classic spontaneous intracranial hypotension (n = 33) were compared with those with intracranial hypotension with atypical clinical presentation (n = 8). There was no significant difference in dural enhancement, subdural hematomas, or cerebellar tonsil herniation. Patients with atypical spontaneous intracranial hypotension had significantly more elongated anteroposterior midbrain diameter compared with those with classic spontaneous intracranial hypotension, and shortened pontomammillary distance. In this population, patients with atypical spontaneous intracranial hypotension showed a more chronic syndrome compared with classic spontaneous intracranial hypotension, more severe brain sagging, lower rates of clinical response, and frequent relapses.