Pediatric Radiology最新文献

Background: Low birth weight and preterm infants may have higher risks of poor health. As the key brain region for learning and memory, normal development of the hippocampus is crucial for the cognitive abilities of preterm infants.

Objective: This study aimed to analyze hippocampal glutamate (Glu) levels and morphometric changes in preterm infants at term-equivalent age (TEA) with different birth weights.

Materials and methods: Eighty-seven infants (23 full-term infants and 64 preterm infants) born between 2023 and 2025, underwent magnetic resonance imaging (MRI) at TEA. Glutamate chemical exchange saturation transfer (GluCEST) MRI and 3D-SPACE were used to assess hippocampal Glu levels and morphometric changes. The preterm cohort was categorized by birth weight: preterm infants born at extremely and very low birth weight (Group 1), preterm infants born at low birth weight (Group 2) and preterm infants born at normal birth weight (Group 3). Full-term infants born at normal birth weight (Group 4) were included as controls.

Results: Group 1 exhibited elevated Glu levels, Group 2 showed intermediate Glu levels. In infants with normal birth weight, preterm at TEA have higher glutamate levels than full-term infants. No differences were observed in the bilateral hippocampal Glu levels within each group. The bilateral hippocampal volume, surface area, and long diameter in Group 1 were all significantly smaller than those in Group 3. Morphological analysis revealed rightward hippocampal asymmetry in all preterm groups.

Conclusion: Birth weight significantly influences hippocampal glutamate levels and morphology in preterm infants. These findings offer new insights into the metabolic variations in preterm neurodevelopment.

Background: Abnormal diffusion tensor imaging (DTI) metrics have been reported both near and distant from non-hemorrhagic punctate white matter lesions, suggesting abnormal brain connectivity.

Objective: To evaluate the effect of non-hemorrhagic punctate white matter lesions on both structural and functional brain connectivity in preterm infants.

Materials and methods: DTI and resting-state functional magnetic resonance imaging (rs-fMRI) data acquired around term-equivalent age were analyzed using graph theory in nine preterm infants with non-hemorrhagic punctate white matter lesions (gestational age: mean±SD, 31.5 weeks±2.5 weeks) and nine gestational age-matched controls (mean, 31.4 weeks±2.5 weeks).

Results: Both groups exhibited modularity, small-world topology, and rich-club organization. Compared with controls, infants with non-hemorrhagic punctate white matter lesions showed increased diffusion efficiency (0.0098±0.0003 vs. 0.0093±0.0003, P=0.03) in functional connectivity. In structural connectivity, the non-hemorrhagic punctate white matter lesions group demonstrated (a) increased betweenness centrality in the opercular part of the right inferior frontal gyrus (227.3±93.9 vs. 164.9±3.2, P<0.01); (b) increased characteristic path length in the left superior parietal lobe (48.7±3.1 vs. 46.9±3.1, P<0.01), left inferior parietal lobe (53.0±3.3 vs. 50.8±3.5, P<0.01), and right angular gyrus (61.1±4.3 vs. 55.8±4.3, P<0.01); and (c) increased participation coefficient in the inferior temporal gyrus (0.14±0.20 vs. 0.03±0.09, P<0.01).

Conclusions: In preterm infants, non-hemorrhagic punctate white matter lesions appear to disrupt modularity in functional networks and structural connectivity in the dorsal visual stream, with compensatory changes in the ventral stream. They are also associated with increased structural connectivity in regions linked to risk aversion.

Background: Radiographers play a crucial role in ensuring the safe and effective delivery of iodinated contrast media in pediatric CT imaging. However, practice variability across institutions, such as differences in contrast medium dosing protocols, injection techniques, and timing of image acquisition, raises concerns about consistency, patient safety, and diagnostic quality.  OBJECTIVE: To examine the range of real-world practices in pediatric iodinated contrast medium administration, focusing on protocol adherence and variations in technique.  MATERIALS AND METHODS: An international cross-sectional survey was conducted among 103 CT radiographers. The online questionnaire assessed demographic data, clinical practices, protocol modification behaviors, and institutional procedures. Data were collected over 9 weeks and analyzed using descriptive and comparative statistics to identify trends and practice variability.

Results: The findings revealed considerable variability in iodinated contrast medium administration practices, including differences in injection rates, contrast volumes, catheter gauge selection, and use of saline flush techniques. Although 93.2% of participants reported confidence in modifying contrast protocols, knowledge assessments showed that 75.7% of radiographers scored in the "Poor" category, with no participants achieving an "Excellent" score. Additionally, many respondents reported relying on experience-based practices rather than standardized institutional guidelines, contributing to inconsistent contrast delivery approaches. No significant associations were found between demographic factors and reported practices, suggesting variability exists across all levels of education and experience.

Conclusion: The study highlights inconsistencies in pediatric iodinated contrast medium delivery practices among CT radiographers, emphasizing the need for standardized protocols and structured training programs. Addressing these inconsistencies is crucial for improving diagnostic quality, patient safety, and promoting consistency in best practices across clinical settings.

While horseshoe kidneys are the most common renal fusion anomaly, various complex variant anatomies exist. One rare form is the retroaortic retrocaval reverse horseshoe kidney, where the upper poles fuse posterior to both the aorta and inferior vena cava. These intricate renal anomalies increase complication risk and complicate surgical interventions. We report a 3-year-old boy diagnosed with a retroaortic retrocaval reverse horseshoe kidney during a spinal deformity evaluation. This case is one of few instances of this specific variant documented in the literature and is the first to be associated with type 1 diastematomyelia and tethered cord.

Background: Bone age assessment is essential in evaluating pediatric growth disorders. Artificial intelligence (AI) systems offer potential improvements in accuracy and reproducibility compared to traditional methods.

Objective: To compare the performance of a commercially available artificial intelligence-based software (BoneView BoneAge, Gleamer, Paris, France) against two human-assessed methods-the Greulich-Pyle (GP) atlas and Tanner-Whitehouse version 2 (TW2)-in a pediatric population.

Materials and methods: This proof-of-concept study included 203 pediatric patients (mean age, 9.0 years; range, 2.0-17.0 years) who underwent hand and wrist radiographs for suspected endocrine or growth-related conditions. After excluding technically inadequate images, 157 cases were analyzed using AI and GP-assessed methods. A subset of 35 patients was also evaluated using the TW2 method by a pediatric endocrinologist. Performance was measured using mean absolute error (MAE), root mean square error (RMSE), bias, and Pearson's correlation coefficient, using chronological age as reference.

Results: The AI model achieved a MAE of 1.38 years, comparable to the radiologist's GP-based estimate (MAE, 1.30 years), and superior to TW2 (MAE, 2.86 years). RMSE values were 1.75 years, 1.80 years, and 3.88 years, respectively. AI showed minimal bias (-0.05 years), while TW2-based assessments systematically underestimated bone age (bias, -2.63 years). Strong correlations with chronological age were observed for AI (r=0.857) and GP (r=0.894), but not for TW2 (r=0.490).

Conclusion: BoneView demonstrated comparable accuracy to radiologist-assessed GP method and outperformed TW2 assessments in this cohort. AI-based systems may enhance consistency in pediatric bone age estimation but require careful validation, especially in ethnically diverse populations.

Purpose: Lymphoma is a significant pediatric cancer, following acute leukemia and malignant brain tumors. Traditional diagnostic and staging methods, such as biopsies and the Ann Arbor system, may have limitations in accuracy and invasiveness. This systematic review aims to critically evaluate the utility of fluorine-18 fluorodeoxyglucose-positron emission tomography ([¹⁸F]FDG-PET), positron emission tomography/computed tomography (PET/CT), and positron emission tomography/magnetic resonance imaging (PET/MRI) in improving non-invasive staging, treatment response evaluation, and prognostic values in pediatric lymphoma.

Method: A systematic search of PubMed, Scopus, and Web of Science was conducted (2011-2024) using keywords related to pediatric lymphoma and PET. Data were extracted on study design, demographics, imaging protocols, tracer dosing, and quantitative PET parameters.

Results: Thirty-one studies met the eligibility criteria. Quantitative analysis primarily relied on the standardized uptake value (SUV), with additional use of metabolic tumor volume and total lesion glycolysis. Across diagnostic, staging, and follow-up phases, [¹⁸F]FDG-PET (alone or combined with CT/MRI) consistently showed higher sensitivity and the negative predictive value (NPV) (>70%) than conventional imaging, though the positive predictive value remained moderate (<50%). PET/CT provided more reliable prognostic value than PET alone or MRI. At follow-up, PET/MRI demonstrated better positive predictive value (PPV) than conventional imaging, which showed limited utility.

Conclusion: [¹⁸F]FDG-PET combined with CT or MRI enhances diagnostic accuracy and staging of pediatric lymphoma by improving the detection of nodal and extranodal disease. PET's ability to reveal early metabolic changes supports timely assessment of treatment response and may reduce the need for invasive bone marrow biopsies. Nonetheless, concerns about radiation exposure, limited MRI coverage, and variable predictive value highlight the need for cautious application in children. Advanced parameters such as metabolic tumor volume and total lesion glycolysis offer additional prognostic potential, but further standardization and prospective validation are required. Overall, PET represents a promising, less invasive tool for staging and follow-up, with the potential to improve both diagnostic precision and patient outcomes.

Clinical trial number: Not applicable.

Pulmonary nodules are commonly encountered in pediatric patients. While metastases make up the majority of malignant pulmonary nodules found in children, nodules are also frequently identified in healthy children. Currently, there are no definitive nodule features to differentiate benign from malignant nodules, and there are no guidelines for incidental nodule follow-up in children similar in scope to the 2017 Fleischner Society Guidelines for adults. In this review, we discuss the epidemiology, histology, and imaging findings of pulmonary nodules found in healthy children, pulmonary metastases, primary pediatric lung cancer, and other causes of pulmonary nodules in children. We also explore current applications of artificial intelligence for the evaluation of pediatric pulmonary nodules.

Background: Intussusception, a serious condition where the intestine folds in on itself, is a leading cause of bowel obstructions in children. The global standard of care has shifted towards non-surgical procedures as a first response. However, evidence supporting the effectiveness and safety of this approach specifically within Sub-Saharan Africa has been scarce and disjointed. Our research systematically gathered and analyzed the existing data from the region to provide a clearer assessment.

Methods: We searched PubMed, Scopus, Web of Science, African Journals Online, and Google Scholar from inception (earliest date covered by each database) to March 2025 for studies reporting outcomes of non-operative reduction in children with intussusception in Sub-Saharan Africa. Eligible studies focused primarily on non-operative reduction with clearly reported outcomes. Data were extracted independently by two reviewers, and study quality was assessed using the Newcastle-Ottawa Scale. Meta-analyses were performed using random-effects models for sex distribution and treatment outcomes, while complications, recurrence, and mortality were synthesized narratively. Certainty of evidence was evaluated using the GRADE framework.

Results: Nine studies including 536 patients met the inclusion criteria. The pooled male prevalence was 67% (95%CI 60-74%), and the mean age ranged from 2.8 months to 21 months. The overall success rate of non-operative reduction was 78% (95%CI 71-86%; I² = 78.6%), while the failure rate was 22%. Success rates were higher in studies published after 2022 (≥81.6%) compared to earlier reports (≤73.1%). The pooled perforation rate was 3% (95%CI 0-6%), with a single procedure-related mortality reported. Recurrence occurred in 7% (95%CI 3-12%) of patients. Delayed presentation, pathological lead points, and absent Doppler flow were consistent predictors of failure. Certainty of evidence was moderate for sex prevalence, low for success/failure, and low to very low for complications, recurrence, and mortality.

Conclusion: Non-operative reduction of pediatric intussusception in Sub-Saharan Africa is effective and safe, with outcomes improving in recent years, particularly with ultrasound guidance. Delayed presentation remains the major barrier to success. Expanding access to imaging, strengthening referral systems, and standardizing reporting are essential to improve outcomes and evidence quality in the region.

Cardiomyopathies are rare diseases in children but are the primary indication for heart transplantation in this age group. Various causes of paediatric cardiomyopathies, ranging from gene-mediated to underlying infection or systemic disease, result in a wide spectrum of clinical presentations and imaging manifestations. Over the years, the classification and terminology of cardiomyopathy have evolved in children and are currently primarily based on the imaging phenotype (dilated, hypertrophic, and restrictive) and then subdivided based on pathogenesis, organ involvement, genetic or familial inheritance pattern, and aetiology. Dilated and hypertrophic cardiomyopathies are more common than non-compaction, restrictive, and arrhythmogenic cardiomyopathies. Echocardiography remains the first-line modality for functional and structural cardiac assessment. However, cardiac magnetic resonance imaging enhances diagnostic accuracy, provides serial cardiac functional evaluation and tissue characterization, and facilitates individual risk stratification and management in patients with heterogeneous phenotypes. This review provides an overview of paediatric cardiomyopathies with a focus on magnetic resonance imaging indications, technique, and key imaging findings that influence management decision-making.