Pediatric Radiology最新文献

Background: In pediatric magnetic resonance imaging (MRI), reducing the rate of non-diagnostic scans due to artifacts and shortening acquisition time are crucial not only for economic reasons but also to minimize sedation or general anesthesia.

Objective: Enabling faster and motion-robust MRI of the brain in infants and children using a novel, enhanced compressed sensing (CS) algorithm in combination with a turbo-spin-echo T2-weighted sequence utilizing the PROPELLER-technique (periodically rotated overlapping parallel lines with enhanced reconstruction; T2_{PROPELLER CS}).

Materials and methods: This prospective study included 31 patients (8.0 ± 4.7 years, 15 males) undergoing a clinically indicated MRI examination of the brain on a 3-T scanner. The T2_{PROPELLER CS} sequence was compared to a conventional, CS-accelerated Cartesian turbo-spin-echo T2-weighted sequence (T2_{Cartesian CS}). Apparent contrast-to-noise ratio (aCNR) and signal-to-noise ratio (aSNR) were calculated. Three blinded radiologists independently rated both sequences twice qualitatively on a 5-point Likert-scale from 1-5 (non-diagnostic-excellent) for artifacts, image sharpness, basal ganglia delineation, lesion conspicuity, and overall image quality. Statistical analysis was performed using the Wilcoxon signed-rank test and paired sample t test. Intra- and interrater reliability of qualitative image assessment was evaluated by computing Krippendorff's $\alpha$ reliability estimates.

Results: The average acquisition time of the T2_{PROPELLER CS} (189 ± 27 s) was 31% shorter than that of the T2_{Cartesian CS} sequence (273 ± 21 s; P < 0.001). aCNR (7.7 ± 4.6 vs. 6.2 ± 2.8; P = 0.004) and aSNR (24.8 ± 9.7 vs. 18.8 ± 5.5; P < 0.001) were higher for the T2_{Cartesian CS} compared to the T2_{PROPELLER CS} sequence. The T2_{PROPELLER CS} sequence significantly reduced (motion-)artifacts (P < 0.001) and increased image sharpness (P < 0.001), basal ganglia delineation (P<0.001), lesion conspicuity (raters 1 and 2, P < 0.001; rater 3, P = 0.004), and overall image quality (P < 0.001). Metal artifacts were prominent in both sequences, though slightly more pronounced in the T2_{PROPELLER CS} sequence.

Conclusion: The T2_{PROPELLER CS} sequence enables faster and motion-robust imaging of the brain in infants and children, reducing the rate of non-diagnostic scans and potentially allowing sedation or general anesthesia to be minimized in the future.

Ectoparasites affect the skin, causing different clinical manifestations through direct mechanical damage, blood consumption, pathogen transmission, hypersensitivity reactions, or toxin inoculation. Dermatological ultrasound is the imaging modality of choice to evaluate these superficial lesions, detecting submillimetric alterations in a non-invasive and innocuous way. This review helps the radiologist describe the imaging findings of lesions caused by mosquitoes, myiasis, bees, spiders, and scorpions, with suggestive ultrasound patterns.

Hydatid disease, caused by the larval stages of Echinococcus species, poses a significant public health challenge, especially in resource-limited cattle-producing areas of South America. The number of cases in children under the age of 15 is nearly 16% of the total cases in South America according to the latest report of the Pan American Health Organization (PAHO). The presentation of the disease depends on the anatomic location and correlates with the parasitic life stage. The liver is the most commonly affected organ in children, followed by the lungs, kidney, bone, and brain. The classification of hydatid cysts varies based on the parasite's stage, from purely cystic lesions to solid masses. The radiological approach varies by cyst location. Clinically, hydatid disease symptoms are nonspecific and organ-dependent, with imaging playing a crucial role in diagnosis. Complications include cyst rupture and superinfection, with potential severe consequences. This pictorial essay aims to illustrate the manifestations of hydatid cysts in an endemic population and highlight atypical signs for radiologists evaluating pediatric cysts in endemic regions.

Background: Quantified small bowel motility assessment using cine magnetic resonance enterography (MRE) has shown promise as a biomarker in adult inflammatory bowel disease. Whether quantified motility corresponds to treatment response in paediatric inflammatory bowel disease is unknown.

Objective: To test whether changes in motility reflect response.

Materials and methods: Local ethics approval was granted for this single-institution, retrospective study. All children < 18 years with confirmed inflammatory bowel disease, who had more than one MRE between Jan 2011-Jan 2022, were included. Simplified MaRIA (sMaRIA) and motility index (quantified motility) at all terminal ileum and diseased non-terminal ileum segments were independently assessed by two radiologists each with ≥ 9 years' experience. Change in (Δ) motility index was compared to clinical (gastroenterologist physician's global assessment) and consensus radiological reference standard (response = decrease in sMaRIA of more than or equal to 2 points) in responders versus non-responders using the Mann-Whitney test. Sensitivity and specificity of Δ motility index more than zero were compared to decrease in sMaRIA of 2 or more points for identifying clinical response.

Results: Of 64 children aged 5-16, 21 out of 64 (33%) were responders, 37 out of 64 (58%) were non-responders and 6 out of 64 (9%) had inactive disease according to clinical reference standard. Δ Motility index by both radiologists was higher in responders (+ 16, + 39) than non-responders (-43, -44), P = 0.04, P = 0.01 each radiologist, respectively. Motility index was more sensitive (57% versus 24%), but less specific (67% versus 93%) than sMaRIA in identifying clinical response.

Conclusion: Motility index on cine MRE corresponds to clinical response, and is more sensitive at detecting response compared to sMaRIA in paediatric inflammatory bowel disease.

Artificial intelligence (AI) is increasingly recognized for its transformative potential in radiology; yet, its application in pediatric radiology is relatively limited when compared to the whole of radiology. This manuscript introduces pediatric radiologists to essential AI concepts, including topics such as use case, data science, machine learning, deep learning, natural language processing, and generative AI as well as basics of AI training and validating. We outline the unique challenges of applying AI in pediatric imaging, such as data scarcity and distinct clinical characteristics, and discuss the current uses of AI in pediatric radiology, including both image interpretive and non-interpretive tasks. With this overview, we aim to equip pediatric radiologists with the foundational knowledge needed to engage with AI tools and inspire further exploration and innovation in the field.

Posterior fossa anomalies are less common in prenatal diagnosis than midline anomalies or ventricular dilatations. However, they constitute an important entity, combining neurological disorders as well as normal variants that should be recognized in prenatal diagnosis because of the genetic implications and neurodevelopmental outcome of some of these conditions. Here we present some of the main imaging features enabling prenatal diagnosis of posterior fossa anomalies in a context of constantly evolving classifications, resulting from advances in genetics and neuroimaging.

Osteoarticular tuberculosis (TB) is an uncommon form of extrapulmonary TB that has the potential to damage joints and bones, generating long-term impairment. Mainly, the initial diagnosis of osteoarticular TB relies on clinical findings and imaging. When required, imaging can aim for less invasive tissue or fluid sampling for pathology, microbiology, and molecular biology analysis. Most TB diagnosis tests have variable and frequently poor sensitivities; however, bone biopsy samples have demonstrated a high percentage of culture positivity. Clinical and imaging findings of osteoarticular TB often mimic other processes, such as rheumatoid arthritis or chronic recurrent multifocal osteomyelitis. When the infection affects the growth plates, angular deformities and extremity length discrepancies can arise. Unfortunately, several osteoarticular TB cases are detected late due to the nonspecific nature of clinical symptoms and non-characteristic imaging findings. This article reviews the most common and atypical osteoarticular TB imaging presentations to increase awareness of osteoarticular TB.