Pediatric Radiology最新文献

Background: MRI provides adequate ovarian imaging to permit accurate measurement. More normative data for children and adolescents is needed as MRI is being used for evaluation of right lower quadrant pain that could be due to ovarian torsion.

Objective: To determine normative data for ovarian size by MRI using a rapid protocol for right lower quadrant pain.

Materials and methods: Retrospective evaluation of MRI examinations of girls obtained between 2013 and 2019 was performed including chart and image review. Normative data was determined by age.

Results: Mean patient age was 12.8 years (range 1-18 years). Six hundred forty-four scans were included in the study. Thirty-three ovaries contained cysts measuring greater than 3 cm and 8 additional ovaries were torsed. These ovaries were not included in the normal ovary measurements. Patients with known or suspected polycystic ovarian syndrome or torsion also were excluded. Ovarian volumes of normal-appearing ovaries are reported by patient age.

Conclusion: Normative data for girls and adolescents utilizing a rapid MRI protocol for right lower quadrant pain is provided for increased confidence in assessing ovarian size in girls on MRI.

Background: The survival rate of pediatric leukemia patients has remarkably increased. Early identification of cardiotoxicity associated with chemotherapy and the detection of prognostic factors are essential for effective patient management.

Objective: To evaluate the prognostic value of parameters assessed by cardiac magnetic resonance imaging (MRI) in pediatric patients with acute lymphoblastic leukemia (ALL).

Materials and methods: A total of 217 children diagnosed with ALL (study group) and 65 healthy (control group) were recruited for the study and underwent cardiac MRI. Follow-up was conducted after the cardiac MRI to monitor adverse clinical events and adverse cardiac events. Cox and Kaplan-Meier (K-M) analyses were used to investigate the predictive value of cardiac MRI parameters.

Results: All strain parameters including global radial strain, global circumferential strain, and global longitudinal strain were significantly lower in the study group compared to the control group. Global radial strain (hazard ratio (HR) = 0.89; 95% confidence interval (CI) 0.79-0.99) and global longitudinal strain (HR = 1.31; 95% CI 1.01-1.71) were indicators of adverse clinical outcomes (P < 0.05). Left ventricular remodeling index (LVRI, HR = 1.11; 95% CI 1.00-1.23) was the risk predictor for adverse cardiac events (P < 0.05). Patients with global longitudinal strain of < 18% had worse clinical outcomes (HR = 6.97, 95% CI 1.07-62.39, P = 0.04) and higher risk of adverse cardiac events (HR = 5.94, 95% CI 1.23-28.58, P = 0.03) compared with those with global longitudinal strain of ≥ 18%.

Conclusion: Cardiac MRI-derived parameters, including global longitudinal strain, global radial strain, and LVRI, are effective prognostic tools for predicting adverse events in children diagnosed with ALL who underwent chemotherapy with anthracyclines.

Abdominal and pelvic masses in infants present significant challenges for healthcare professionals and can be distressing for parents due to the wide spectrum of both benign and malignant conditions in this age group. This article concentrates on illustrating different types of abdominal and pelvic tumors, both benign and malignant, that occur in infants. It highlights the specific imaging characteristics of these tumors and covers non-neoplastic conditions that may appear similar on imaging. The aim is to aid radiologists in accurately diagnosing these conditions and distinguishing them from other differentials. By combining imaging results with clinical information, healthcare providers can timely identify and manage potentially concerning conditions, ultimately enhancing outcomes and the overall quality of life for affected infants and their families.

Background: Motion correction methods based on slice-to-volume registration (SVR) for fetal magnetic resonance imaging (MRI) allow reconstruction of three-dimensional (3-D) isotropic images of the fetal brain and body. However, all existing SVR methods are confined to research settings, which limits clinical integration. Furthermore, there have been no reported SVR solutions for low-field 0.55-T MRI.

Objective: Integration of automated SVR motion correction methods directly into fetal MRI scanning process via the Gadgetron framework to enable automated T2-weighted (T2W) 3-D fetal brain and body reconstruction in the low-field 0.55-T MRI scanner within the duration of the scan.

Materials and methods: A deep learning fully automated pipeline was developed for T2W 3-D rigid and deformable (D/SVR) reconstruction of the fetal brain and body of 0.55-T T2W datasets. Next, it was integrated into 0.55-T low-field MRI scanner environment via a Gadgetron workflow that enables launching of the reconstruction process directly during scanning in real-time.

Results: During prospective testing on 12 cases (22-40 weeks gestational age), the fetal brain and body reconstructions were available on average 6:42 ± 3:13 min after the acquisition of the final stack and could be assessed and archived on the scanner console during the ongoing fetal MRI scan. The output image data quality was rated as good to acceptable for interpretation. The retrospective testing of the pipeline on 83 0.55-T datasets demonstrated stable reconstruction quality for low-field MRI.

Conclusion: The proposed pipeline allows scanner-based prospective T2W 3-D motion correction for low-field 0.55-T fetal MRI via direct online integration into the scanner environment.

Background: Optimization of localizer radiograph and bolus tracking doses is necessary, as their dose proportion may increase with a decreasing diagnostic scan dose in pediatric cardiothoracic computed tomography (CT).

Objective: To evaluate the radiation dose proportions of the localizer radiograph and bolus tracking in low-dose pediatric cardiothoracic CT.

Materials and methods: For low-dose pediatric cardiothoracic CT, a posteroanterior localizer radiograph was acquired with 80 kV, and 35 mA or 20 mA in 852 infants (age<1 year). Propensity score matching was employed in comparing the 35 mA and 20 mA groups on dose proportion, over z-axis proportion, visibility of anatomic landmarks, and image noise. The over z-axis coverage proportion was correlated with the dose proportion of the localizer radiograph in both groups. Additionally, bolus tracking was performed in 1,015 children (≤2 years). The effects of the number of monitoring scan, dose-length product of the diagnostic scan, age, and water-equivalent area of the scanned patient body on the radiation dose proportion of bolus tracking were evaluated.

Results: The dose proportion of the localizer radiograph was significantly lower in the 20 mA group (2.5%, n = 94) than in the 35 mA group (6.5%, n = 94) (P < 0.001). While image noise was higher in the 20 mA group (2.1 Hounsfield units versus 1.0 Hounsfield units of the 35 mA-group, P < 0.001), all the anatomic landmarks remained visible in all cases. The over z-axis coverage proportion demonstrated high correlations with the dose proportion for both groups (R = 0.736, P < 0.001 for the 35 mA group and R = 0.660, P < 0.001 for the 20 mA group). The bolus tracking dose-length product proportion demonstrated the strongest positive correlation with the number of monitoring scans (R = 0.93, P < 0.001), while age, diagnostic scan dose-length product, and water-equivalent area showed weak negative correlations (R-values = -0.46~-0.50, P-values < 0.001).

Conclusions: In low-dose pediatric cardiothoracic CT, the dose proportion of the localizer radiograph can be substantially reduced with a low tube current setting while maintaining image quality. Additionally, minimization of the over z-axis coverage proportion merits attention. The number of monitoring scans is the most significant factor for increasing the radiation dose proportion of bolus tracking, especially in young ages.

Paediatric radiology is a fascinating and diverse field of medicine with many opportunities to gain expertise in a range of imaging modalities and body areas. Working with children makes imaging both rewarding and challenging, due to the wide range of patient ages encountered and the inherent variation in developmental needs. This requires a patient-focussed approach to manage their anxiety and ensure cooperation of the patient and their carers. Several approaches to dealing with children have been developed including recognising individual needs, empathising with the child and carers, and involving the use of play and a range of age-relevant preparation materials. All of these make the radiology imaging environment and encounter a more effective and collaborative process. The purpose of this manuscript is to present a practical guide to overcoming these challenges, by making the child the focus of their radiological examination.

Children are more sensitive to ionizing radiation than adults. Even though the risk is very low, exposure from radiological examinations can possibly cause them long-term side effects. Recent large epidemiological studies involving children and young adults have added evidence suggesting that even small doses of radiation, such as those from computed tomography scans, might slightly increase the risk of developing cancer later in life. Therefore, even though radiologic studies are essential for an accurate diagnosis and management of various conditions, it is crucial to minimize radiation exposure. This article addresses radiation protection for children in the medical use of ionizing radiation and it is set in the context of the European legislative framework regarding radiation protection. It advocates for a holistic approach to paediatric radiological tests. This approach includes the key principles of radiation protection, such as the justification of imaging procedures supported by referral guidelines, as well as the optimization of techniques (according to the ALARA principle) and effective communication with parents about the benefits and the risks of radiologic procedures. Protecting children from unnecessary radiation is not only a technical challenge, but also a moral obligation and a legal requirement.