Pediatric Radiology最新文献

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.

Background: Mitral annular disjunction is an increasingly recognized structural abnormality associated with myocardial remodeling. While related functional and structural alterations have been well documented in adults, data on pediatric mitral annular disjunction remain scarce.

Objective: To assess early myocardial structural and functional changes in pediatric patients with mitral annular disjunction using cardiac magnetic resonance (CMR) feature-tracking strain and parametric mapping.

Materials and methods: In this retrospective study, 32 pediatric patients with mitral annular disjunction confirmed by CMR and 16 age- and sex-matched controls with normal CMR findings were included. Cine imaging, late gadolinium enhancement, native T1 mapping, extracellular volume, and CMR strain analysis were performed. Holter monitoring data were evaluated for ventricular ectopy.

Results: Patients with mitral annular disjunction demonstrated significantly reduced global, mean basal, and segmental basal radial, circumferential, longitudinal strain values compared to controls. Also, native T1 and extracellular volume were significantly higher in the mitral annular disjunction group. Late gadolinium enhancement was present in 21.9% of patients with mitral annular disjunction. Ventricular ectopy was observed in 48.3%, with no significant association with late gadolinium enhancement. Subgroup analysis showed longer mitral annular disjunction distances, more frequent systolic curling, late gadolinium enhancement, and ventricular ectopy in patients with mitral annular disjunction and mitral valve prolapse, compared to those with isolated mitral annular disjunction.

Conclusion: Pediatric mitral annular disjunction is associated with early myocardial alterations, including impaired deformation, elevated native T1, and extracellular volume. These findings suggest that subclinical myocardial remodeling may begin in childhood, and CMR is valuable in detecting these subtle changes.

This review examines the application of advanced imaging technologies in pediatric cardiology, focusing on enhancing the visualization of cardiovascular anatomy in congenital heart disease (CHD). It provides an overview of key factors for adopting these tools in clinical practice, such as software options, cost considerations, and resource requirements across healthcare settings, from small, resource-limited centers to larger institutions. Emphasizing the importance of multidisciplinary collaboration, the paper highlights the roles of pediatric radiologists, cardiologists, engineers, and physicians with expertise in computer-aided design (CAD) for effective implementation. The review covers a range of imaging tools, from low-cost virtual reality, mixed reality, and three-dimensional (3D) printing to more advanced technologies, and explores their clinical applications in CHD. Through a literature analysis, the paper offers practical insights to help integrate and optimize these technologies, aiming to improve diagnostic accuracy and patient care.

Background: Diffusion magnetic resonance imaging has emerged as an opportunity to explore brain white matter fiber tracts (WMFTs) through 3D digital reconstruction. This method could be useful in investigating the relationship between positional plagiocephaly and developmental problems; however, this has not been fully explored.

Objective: Evaluate WMFTs of healthy infants in two age groups with a range of positional plagiocephaly from normal to severe.

Materials and methods: This exploratory study, conducted at a free-standing, quaternary pediatric hospital in the Northeastern United States, utilized an existing database of healthy infants' MRIs obtained between 1 month and 4 months of age. MRIs were included if deemed good quality and had complete T1- and diffusion-weighted sequences and excluded if there were measurement disagreements or MRI data processing problems. Positional plagiocephaly severity was calculated using the Cranial Vault Asymmetry Index (CVAI). A repeated-measures regression model was constructed to assess the association of positional plagiocephaly severity with WMFTs fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD).

Results: Median age of 18 infants was 64.5 (IQR 71) days at the time of MRI. FA had a negative association with CVAI overall (β±SE=-0.53±0.51% per unit CVAI, P=0.32) and in both age groups. MD and RD had a positive association with CVAI overall (β±SE=1.31±0.46% per unit CVAI, P=0.013; β±SE=1.54±0.54% per unit CVAI, P=0.012) and in both age groups and all pathways.

Conclusion: As the severity of positional plagiocephaly increases, differences in WMFT formation are observed, suggesting the need for longitudinal studies with cognitive and behavioral assessments.

Cranial fasciitis is a rare pediatric skull tumor with a challenging radiological diagnosis, particularly when it arises in unusual locations or presents with atypical features. We report a case of cranial fasciitis originating from the ethmoid bone in a 17-month-old girl, presenting as isolated facial asymmetry instead of the usual scalp mass. Cross-sectional and metabolic imaging demonstrated an aggressive-appearing ethmoid sinus mass mimicking rhabdomyosarcoma, with extensive bone destruction and intracranial extension. The patient underwent complete surgical resection of the lesion. This report emphasizes the need to consider cranial fasciitis in the differential diagnosis of any aggressive-appearing skull mass in childhood, and underscores the importance of recognizing the wide anatomical and clinical spectrum of the lesion.