Normal radiological -values-& ultrasound

Normal radiological -values-& ultrasound
https://radiopaedia.org/articles/normal-radiological-reference-values?lang=us

http://www.radiologyassistant.nl/en/p5a3056eebe646/normal-values-ultrasound.html

A list of normal radiological reference values is as follows:
https://radiopaedia.org/articles/normal-radiological-reference-values?lang=us

adrenal gland: <1 cm thick, 4-6 cm length

aorta: <3 cm diameter**

appendix: on CT <6 mm caliber**

atlantodental distance
adults: <3 mm
children: <5 mm
azygous vein: on erect chest x-ray <10 mm diameter

(bladder wall: <3 mm (well-distended state **

Boehler angle: 20-40o
capitolunate angle: <30o
carinal angle: <60-70o

colon:**
lumen: <5 cm
wall: <3 mm

common bile duct**
less than 7mm and add 1 mm for each decade over age of 60 years
up to 10 mm postcholecystectomy

(diaphragm (right dome is usually higher than left**
difference between right and left: <3 cm

endometrial thickness**
premenopausal: 3-15 mm
postmenopausal: <6 mm

(esophagus wall: <3 mm (with distended lumen**

(gallbladder wall: <3 mm (well-distended**

heart (cardiothoracic ratio): <0.55**
Cardiac size can be estimated by measuring the maximum diameter of the heart and comparing it to the maximum diameter of the thorax; this is the cardiothoracic ratio (CTR). The CTR is normally less than 50%, but that is a crude estimate of cardiac size.

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[rtl] [/rtl]

inferior vena cava: <28 mm**

internal carotid artery:
peak systolic velocity (PSV): <125 cm/s
end diastolic velocity (EDV): <40 cm/s

kidneys : 8-10 cm x 4-6 cm**

liver span: <15 cm**

lymph nodes**
mediastinal: <10mm in short axis
retrocrural: <6mm in short axis

ovarian follicle: <2.5-3 cm**

ovaries: volume**
premenopausal: <18 cc
postmenopausal: <8 cc

paraspinal lines:
left: <10 mm wide
right: <3 mm wide
paratracheal stripe: <5 mm

pancreatic duct**
head: 3.5 mm
body: 2.5 mm
tail: 1.5 mm

portal vein: <13 mm diameter**

(prevertebral soft tissue thickness (lateral c-spine x-ray
seven mm at C2
two cm at C7
easiest way to remember is "7 at 2 and 2 at 7"

prostate volume: <25-30 cc**

pulmonary artery
descending branch of right pulmonary artery
less than 16 mm in males
less than 15 mm in females
main pulmonary artery: <29 mm

rectum: wall thickness <5 mm**

scapholunate angle: 30-60o

small bowel**
lumen: <3 cm
wall: <3 mm

spleen: <12 cm**
splenic vein: <10 mm diameter**

testis**
vein: <2 mm diameter*
size: <5 x 3 x 3 cm / volume: 12.5-19 cc*

thyroid: <2 cm anteroposterior dimension**

trachea**
chest x-ray:
less than 25 mm in males
less than 21 mm in females

ureter: 30-34 cm long, 2-8 mm diameter**

uterus**
prepubescent: length ≤3 cm, diameter ~1 cm*
nulliparous: length ≤8 cm, diameter ~8 cm*
multiparous: length ≤9.5 cm, diameter ~5.5 cm*
postmenopausal: length ≤6 cm, diameter ~2 cm*
uterine cervix: diameter <3 cm*

Sonographic values in obstetrics and gynecology
https://radiopaedia.org/articles/sonographic-values-in-obstetrics-and-gynaecology?lang=us

Obstetric and gynecological ultrasound is rampant (unchecked - uncontrolled) with numerous cut off values. Some of these get revised over the years. The following list is a useful aid to refer to and revise.

1 mm
rate of increase of a mean sac diameter per day in early pregnancy

2 mm
generally accepted value for a thickness for a significant fetal pericardial effusion*
generally accepted thickness for a decidual reaction for an early pregnancy*
generally accepted thickness of an intertwin membrane in order differentiate a MCDA from a DCDA pregnancy*

2.5 mm
(considered by some as the upper limit for a normal nuchal translucency (others take it as 3 mm
traditional single cut off lower limit value for a nasal bone length below which it is considered as a hypoplastic nasal bone

3 mm
(considered by some as the upper limit for a normal nuchal translucency (others take is as 2.5mm*
considered by many as the *upper limit of seperation between the choroid and the medial wall of the ventricles in or to support the diagnosis of a mild fetal ventriculomegaly

4 mm
considered by some as the *lower limit for an endometrial thickness below which is interpreted as endometrial atrophy
considered by many as the *upper limit for a fetal renal pelvic diameter in the second trimester beyond which it is taken as fetal renal pelvic dilatation

5 mm
depth of invasive component for cervical cancer to be upgraded from stage Ia to stage Ib*
accepted upper limit for an endometrial thickness in a post menopausal patient*
cconsidered by many as the *upper of the thickness of fetal subcutanous tissues beyond which it is interpreted as fetal anasarca
upper size limit of microcysts in a type III CPAM*
accepted *upper limit for an endometrial thickness following a DC/STOP procedure beyond which the diagnosis of retained products of conception should be considered
considered by some as *a mininum size difference between a gestational sac over the size of the fetal pole for a healthy pregnancy

6 mm
considered by many as the upper limit for a nuchal thickness*
maximal *CRL beyond which a fetal heart rate should be seen for a viable pregnancy under current ASUM criteria

7 mm
recently revised RCOG recommendation for *CRL beyond which a fetal heart beat should be seen (ASUM criteria in
(process of revision
width of invasive component for cervical cancer to be upgraded from stage Ia to stage Ib*

8 mm
maximal gestational sac diameter *(MSD) on a transvaginal scan beyond which a yolk sac should be seen for a viable pregnancy

ten mm = 1 cm
upper limit for the accepted width of *normal fetal ventricles beyond which it is considered as mild fetal ventriculomegaly
considered by some as a *upper limit for a simple appearing anechoic ovarian cyst beyond which sonographic follow up required in a post menopausal patient
upper limit for the diameter of the *cisterna magna beyond which it is considered as a mega cisterna magna

twelve mm = 1.2 cm
accepted by many as the upper limit for a junctional zone in MRI above which is concerning for adenomyosis

fifteen mm = 1.5 cm
upper limit for the accepted width of normal fetal ventricles in mild fetal ventriculomegaly beyond which it is considered as fetal hydrocephalus

sixteen mm = 1.6 cm
considered by some as the upper limit of normal for gestational sac diameter (MSD) on a transvaginal scan scan beyond which a fetal pole should be seen for viable pregnancy: some consider this as 20 mm

twenty mm = 2 cm
considered by some as the *upper limit of normal for gestational sac diameter (MSD) on a transvaginal scan scan beyond which a fetal pole should be seen for viable pregnancy: some consider this as 20 mm
(current ASUM criteria)
considered by some as the *upper limit of normal for gestational sac diameter (MSD) on a transvaginal scan scan
(beyond which a fetal pole should be seen for viable pregnancy (current ASUM criteria
considered by some as the *upper limit of size for a gestational sac (MSD) on a transabdominal scan beyond which a yolk sac should be visible
minimum depth of amniotic fluid pocket below which it is reported as oligohydramnios*
accepted by many as the *minimum distance between the placental edge and the internal cervical os below which it is classified as a low lying placenta
size of peritoneal deposits in ovarian cancer which differentiates stage IIIb from stage IIIc*

twenty five mm = 2.5 cm
upper limit for *mean sac diameter on a trans-abdominal scan beyond which a yolk sac should be seen for viable pregnancy
recently revised RCOG recommendation for upper limit *MSD beyond which a fetal pole should be seen (ASUM
(criteria in process of revision
accepted lower limit for a cervical length up to ~24 weeks below cervical incompetence is considered*

thirty mm = 3 cm
considered by many as the *upper limit for a ovarian cyst or paraovarian cyst in a premenopausal patient beyond which it should be mentioned on a radiology report

thirty five mm = 3.5 cm
considered by some as the lower limit length of the umbilical cord to be considered as a short umbilical cord*

fourty mm = 4 cm
considered by many as the *maximal placental thickness at any gestation beyond which is it taken as placentomegaly

fourty five mm = 4.5 cm
often accepted as the lower limit for a CRL in order for a nuchal translucency to be valid*

fifty mm = 5 cm
considered by some as the upper limit for a *ovarian cyst or paraovarian cyst in a premenopausal patient beyond which sonographic follow is recommended

seventy mm = 7 cm
considered by many as upper limit for a *simple appearing ovarian cyst or paraovarian cyst beyond which MRI is recommended for full evaluation
considered by many as upper limit for the umbilical cord length beyond which it is taken as a long umbilical cord*

eighty mm = 8 cm
maximum depth of amniotic fluid pocket. > 8 cm is indicative of polyhydramnios

eighty four mm = 8.4 cm
often accepted as the upper limit for a CRL in order for a nuchal translucency to be valid

This is an overview of normal values of ultrasound examinations in neonates and children.

http://www.radiologyassistant.nl/en/p5a3056eebe646/normal-values-ultrasound.html

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Causes of enlargement of adrenal glands:

Congenital Adrenal Hyperplasia
Adrenal Hemorrhage
Adrenal Neuroblastoma

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(The length (L) of the gland is defined as the maximum cephalocaudal dimension (either coronal or sagital plane
The width is defined as the maximum thickness of one of the limbs.

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Ultrasonographic anteroposterior measurement of the appendix.
Casues of enlarged appendix:

Appendicitis
Cystic fibrosis
Lymphoid hypertrophy (Immune deficiency, viral enteritis)
Intraluminal gas, mucus of faeces
Mucocele

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The bladder volume was calculated first by measuring the maximum length (L) of the urinary bladder on the longitudinal scan, which was obtained from the neck to the fundus of the bladder.
Depth (D) was measured, perpendicular to the first plane at the level of the maximum area, in the midline from the anterior to posterior mucosal surface of the bladder.
The width (W) was taken perpendicular to D at its mid-point.
Bladder volume as presented in the table was recalculated from the data in this study using the equation for an ellipsoïd: L×D×W (in centimetres) x 0.523.

Causes of bladder wall thickening:

cystitis
dysfunctional voiding
urethral valves

The bladder wall thickness was measured from a zoomed image of the transverse plane of the voided bladder at 3 points: anterolaterally, laterally and posterolaterally (figure). The mean was taken for these three measurements.
The bladder wall thickness depends on the degree of filling of the bladder and its capacity.
(Therefore the bladder wall thickness is expressed as the bladder volume wall thickness index (BVWI

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Ultrasonographic measurement of wall thickness of terminal ileum in a 12-year-old boy with cystic fibrosis.
Causes of small bowel wall thickening:

Henoch Schönlein Purpura
Crohn's disease
Lymphoma

Causes of colon wall thickening:

Inflammatory bowel disease (IBD)
Hemolytic Uremic syndrome
Pseudomembranous colitis

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Transverse ultrasonographic image of common bile duct and surrounding anatomy

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Materials and method
One hundred and seventy-three consecutive children, referred for abdominal ultrasonography not related to hepato-biliary pathology, were included in this study (100 boys and 73 girls), age range 1 day - 13 years (median age 5.0
(years
The diameter of the common bile duct was ≤ 3.3 mm in all patients

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Materials and method
Ultrasonographic gallbladder volume assessment (length x width x height x 0,52) was performed in 50 preterm (mean GA 31.7 ± 2.5 weeks and mean birth weight 1556 ± 441 g) and 46 term infants (mean GA 38.3 ± 1.2 weeks 3253 ± 440 g).
Data were collected soon after delivery and at 6-h fasting, and at the age of 5-7 days at 3-h and 6-h fastening following regular milk feeding.
Causes of small gallbladder:

Biliary atresia
Fatty meal

This is an overview of normal values of ultrasound examinations in neonates and children.

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Ultrasonographic measurement of the length of a neonatal kidney.
Note the increased echogenicity of the renal parenchyma compared to liver parenchyma.
This is normal at this age.

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Children

Materials and method
Two hundred and three patients were included in this ultrasonography study.
Patients were excluded if they had a history of malignancy, use of steroids, upper urinary tract abnormality, VUR greater than grade I, urological surgery or if sonography of the kidney was regarded as abnormal.
On average the left kidney was 1.9 mm larger than the right kidney.
Causes of enlarged kidneys:

Duplicated collecting system
Nephritis (Infectious and non-infectious)
Leukemia and Lymphoma
ARPKCD

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ultrasonorphic measurement of the length of the kidney

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Kidney volume

Material and method
A total of 3376 children were recruited in this ultrasonographic study.
Kidney volume was calculated using the ellipsoid formula as Length x Width x Depth x 0.523.
In this study, the total renal volume was obtained by adding together both kidney volumes but without mentioning the separate values for the left and right kidney.
The values in the table were obtained by dividing the total renal volume by two.

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Ultrasonographic measurement of the length, width an depth of a kidney.
Kidney volume is calculated using the ellipsoid formula as Length x Width x Depth x 0.523.

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Thickness of the wall of the collecting system

Material and Methods
Ultrasonographic study of 48 renal collecting systems in 24 healthy children (age range 3 days to 12.6 years).
The collecting system could be identified in all kidneys and its wall thickness varied between 0 (not visible) and 0.8 mm.
Thickening of the wall ≥ 1mm is be considered as abnormal.
Causes of wall thickening:

urinary tract infection
intermittent dilatation (e.g. vesicoureteric reflux)
dilatation in the recent past.

This is an overview of normal values of ultrasound examinations in neonates and children.

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raniocaudal dimension of the liver on the midclavicular line was measured with ultrasonography (figure).
Causes of hepatomegaly

Leukemia
Storage diseases
neonatal) Hepatitis)

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US study in 261 healthy newborn infants. Craniocaudal dimension of the liver on the midclavicular line was determined with ultrasonography.

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Materials and method
In this retrospective study in 61 children (36 boys and 25 girls, mean age 10.7 years, range 1.1-17.3 years) who underwent non-contrast abdominal CT examination for evaluation of suspected or known renal stones abdominal lymph node size was evaluated.
It is assumed that these CT findings can be extrapolated to ultrasonography.
Enlarged mesenteric lymph nodes (short axis > 5 mm) were found in 33 (54%) of the 61 children.
The majority of the enlarged mesenteric lymph nodes were found in the right lower quadrant (88%).
Based on their findings the authors state that: using a short-axis diameter of >8 mm might be a more appropriate definition for mesenteric lymphadenopathy in children.
False-positive rate for enlarged mesenteric lymph nodes with varying lymph node threshold size is seen in the table.

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Pathologically enlarged lymph nodes:

Intestinal lymphoma
Lymphogenic metastasis
Specific enteritis (e.g. TBC)

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Material and Method
Ultrasonographic measurement of uterine and ovarian volume was performed in 178 healthy girls.
Causes of enlarged ovaries:

Precocious puberty
Ovarian torsion
Polycystic ovarian disease
Teratoma/dermoid

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Ovarian volume is calculated using the formula:

Length x Width x Height x 0.523.

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Materials and method
Two hundred and seventy-three patients (differentiation in sex not mentioned) were included in this retrospective ultrasonography study.
The maximum anteroposterior (AP) diameters of the head, body and tail of the pancreas were measured on transverse/oblique images.
(Echogenicity was low in 27 (10%), isoechoic in 145 (53%) and high in 101 (37%

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The maximum anteroposterior (AP) diameters of the head, body and tail of the pancreas were measured on transverse/oblique images.
Causes of enlargement of the pancreas:

Traumatic pancreatitis
Viral pancreatitis
Drug-induced pancreatitis

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The portal vein is visualized in the longitudinal axis from the splenomesenteric junction to the liver hilum.
The greatest anteroposterior diameter is measured at the site where the hepatic artery crosses the portal vein.

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Preterm and term babies
Material and methods
US study in 261 healthy newborn infants. Craniocaudal dimension of the spleen was determined with ultrasonography.

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Children
Materials and method
These ultrasonography studies comprised of 512 healthy children - 238 boys and 274 girls - with ages ranging from 1 day (full-term neonate) to 17 years and 96 premature infants with gestational ages from 25-35 weeks.
None of the children had a problem that could affect spleen size.
Ultrasonography was performed using standard probes matched for age.

Causes of splenomegaly:
Portal hypertension
Leukemia
(Systemic infections (e.g. EBV or CMV
(Hematologic disease (e.g. spherocystosis or thalassemia
Storage diseases

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The measurement of spleen length is the optically maximal distance -ideally at the hilum - on the longitudinal
(coronal view between the most superomedial and the most inferolateral points (figure

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Materials and method
A total of 344 boys from different ethnic backgrounds were studied.
There were no differences between ethnic groups or between right and left testicle.

Causes of enlargement of the testis:
Leukemia
Precocious puberty
Testicular torsion
Epididymo-orchitis

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Testicular volume was calculated using the formula:

Length x Width x Height x 0.523.

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Material and methods
US study in 100 English newborn infants in the first week of life, a subset of iodine sufficient European children from a study of 5709 children, aged 6-15 years 1 and a subset of German children from a study of 252 children aged 2-4 years 2 [1-3].
The thyroid volume was the sum of the volumes of both lobes.
The volume of the isthmus was not included.

Causes of enlargement of thyroid gland:
Thyroiditis (Hashimoto, Graves)
Multinodular goiter

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(The volume of a thyroid lobe is calculated by the formula of an ellipsoid (length x width x height x 0,52

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