Pediatric Radiology最新文献

Acute otomastoiditis is a common pediatric infection that may rarely lead to severe intracranial complications. The frequency of otomastoiditis, and even more so the frequency of intracranial complications, significantly increased after the end of the coronavirus disease 19 pandemic. We report a 14-month-old boy with bilateral otomastoiditis complicated by extensive venous sinus thrombosis, petrous apicitis, and progressive infectious arteritis of the cavernous internal carotid artery. Serial magnetic resonance imaging and magnetic resonance angiography demonstrated interval internal carotid artery narrowing with vessel wall enhancement, subsequent arterial occlusion, and focal ischemic injury. Despite these findings, the patient remained neurologically intact and showed radiologic improvement at follow-up. This case highlights a rare arterial complication of pediatric otomastoiditis and underscores the importance of comprehensive and serial vascular imaging for early detection, differentiation from extrinsic compression, and guidance of multidisciplinary management.

Most prenatal/neonatal pulmonary masses are non-neoplastic congenital bronchopulmonary malformations. However, both benign and malignant primary pulmonary neoplasms do occur. While rare, these neoplasms can be difficult to differentiate from one another, as well as from other congenital and some acquired pulmonary lesions, including occasional mediastinal and chest wall masses. Misdiagnosis or delayed identification of a pulmonary neoplasm can result in incorrect or delayed management decisions and therapy, adversely affecting outcomes. Atypical timing of presentation, rapid growth, and unusual or heterogeneous imaging appearance should raise suspicion for a neoplastic lesion. There are some diagnostic and ultrasound, computed tomography, and magnetic resonance imaging features that help to differentiate these lesions, along with several useful genetic or biological identifying markers. This review will discuss and illustrate the clinical and imaging features of neonatal pulmonary neoplasms, as well as some of the conditions that are differential considerations.

Background: Quantitative susceptibility mapping (QSM) is an advanced magnetic resonance imaging (MRI) technique that quantifies tissue magnetic susceptibility, offering non-invasive insights into brain microstructure, including iron content and myelination. While extensively applied in adult neuroimaging, its use in pediatric populations is rapidly expanding.

Purpose: This systematic review aims to provide a comprehensive overview of QSM applications in pediatric brain imaging, highlighting methodological advancements, diagnostic potential, and current limitations.

Methods: A systematic literature search was performed using PubMed and Google Scholar up to April 2025. Inclusion criteria were original research articles written in English, involving only pediatric populations (0-17 years) and employing QSM in brain imaging. Twenty studies met eligibility criteria and were analyzed in terms of acquisition protocols, post-processing methods, study objectives, and main findings.

Results: A systematic search on PubMed and Google Scholar found 54 QSM brain studies in children; after exclusions, 20 original research papers qualified for review and were quality-checked using Quality Assessment of Diagnostic Accuracy Studies version-2 (QUADAS-2). Most studies were recent (85% in the last 5 years), in Asia (55%, with China 35%), and used 3-tesla (T) MRI (80%). Typical imaging parameters: 8 echoes (TE=40 ms), slice thickness=2-2.5 mm, matrix often 256×256; Laplacian was the main phase-unwrapping method and variable-kernel sophisticated harmonic artifact reduction for phase data (VSHARP) the dominant background-field removal. Study aims clustered into improved detection, microstructural analysis, normative comparisons, clinical correlations, developmental patterns, and pathology tracking.

Conclusion: QSM emerges as a valuable tool in pediatric neuroimaging, offering quantitative biomarkers for brain development, disease monitoring, and potential clinical translation. Despite promising results, challenges remain, including motion artifacts, lack of normative pediatric data, and methodological heterogeneity. Future research should focus on longitudinal designs, standardization of protocols, and integration with complementary imaging modalities. With further refinement, QSM has the potential to become an integral component of pediatric neuroradiological assessment.

Background: Carpal tunnel syndrome is rare in the paediatric population but is frequently associated with mucopolysaccharidosis. Owing to nonspecific symptoms and limited reliability of clinical examination, early diagnosis of carpal tunnel syndrome in patients with mucopolysaccharidosis remains challenging. Advanced ultrasonographic techniques may enable objective and early detection.

Objective: To evaluate the diagnostic performance of ultra-microangiography and shear wave elastography for the early detection of carpal tunnel syndrome in pediatric patients with mucopolysaccharidosis and to investigate their potential contribution to existing diagnostic protocols.

Materials and methods: This cross-sectional study included 44 individuals (mean age, 11.6±4.8 years), comprising 22 pediatric patients with genetically confirmed mucopolysaccharidosis and 22 age- and sex-matched healthy controls. The mucopolysaccharidosis group was further divided into carpal tunnel syndrome-negative (n=16) and carpal tunnel syndrome-negative (n=6) subgroups based on electromyography. Median nerve cross-sectional area, vascular index obtained by ultra-microangiography, and stiffness values measured by shear wave elastography (expressed in kilopascals) were evaluated bilaterally. Diagnostic performance was assessed using receiver operating characteristic analysis.

Results: Significant differences were observed among control, carpal tunnel syndrome-negative mucopolysaccharidosis, and carpal tunnel syndrome-positive mucopolysaccharidosis groups for median nerve cross-sectional area, vascular index, and stiffness values (all P<0.001). These parameters demonstrated high diagnostic performance in distinguishing mucopolysaccharidosis patients from healthy controls, with area under the curve values ranging from 0.853 to 1.000. Among mucopolysaccharidosis patients, these parameters also demonstrated high accuracy in differentiating carpal tunnel syndrome-positive from carpal tunnel syndrome-negative individuals (AUC, 0.891-0.984), with sensitivity ranging from 83.3% to 100% and specificity from 87.5% to 93.7%.

Conclusion: Our findings suggest that ultra-microangiography and shear wave elastography may provide complementary quantitative information for the evaluation of early median nerve changes in pediatric patients with mucopolysaccharidosis, although further studies are required to validate the clinical utility of shear wave elastography in peripheral nerves.

Acute musculoskeletal infection is a common pediatric emergency that requires early diagnosis and management, without which adverse sequelae can include functional impairment, limb deformities, persistent infection, progression to sepsis, and mortality. Magnetic resonance imaging (MRI) is the gold standard for diagnosis. In recent years, there has been growing interest in the use of rapid MRI protocols for acute pediatric musculoskeletal infection, with benefits including quicker scan times with decreased need for sedation and contrast. In the present study, we discuss key considerations, practical challenges, and clinical applications of rapid musculoskeletal MRI in children. We also include various case examples of rapid MRI scans with a practical guide for interpretation to be used by the practicing radiologist. Rapid MRI protocols ultimately present a powerful diagnostic tool that can condense the workup of patients being evaluated for acute musculoskeletal infection, and their incorporation into hospital systems should continue to be investigated.

Background: Focused abbreviated survey technique (FAST) brain magnetic resonance imaging (MRI) (i.e., sedation-free abbreviated MRI) is progressively being implemented in the daily clinical practice of multiple pediatric institutions for neuroimaging assessment of children presenting with neurological disorders.

Objective: To survey current awareness, imaging practices, and perception of members of the European Society of Pediatric Radiology (ESPR) regarding pediatric FAST brain MRI.

Materials and methods: A survey consisting of seven questions related to FAST brain MRI was distributed electronically to all ESPR members.

Results: A total of 64 responses from 27 different countries (17 of which were European) were received, corresponding to a 4% response rate. Among responders, 68% were full-time pediatric radiologists and the great majority (94%) were aware of current clinical use of FAST brain MRI in the pediatric setting. Moreover, 83% already apply this imaging approach in daily work activity, more commonly for a few years (85%). The most cited advantage for adopting this imaging approach was radiation risk reduction (95%). Major reported obstacles to routine implementation were technical/human resource limitations (63%), potential medicolegal implications (55%), and lower image quality reducing diagnostic accuracy (53%). Diverse protocols are used, including utilization of inhouse/custom developed solutions (68%) or one of multiple commercially available/published protocols (17%), or both (15%). Near all participants (97%) expressed desire for formal consensus recommendations from the ESPR on the topic.

Conclusion: Despite widespread knowledge and high clinical adoption rate of pediatric FAST brain MRI among participants, clinical indications/protocols remain variable and some barriers persist in the daily practice, highlighting the need for evidence-based consensus-driven guidelines.

Background: In pediatric abusive head trauma (AHT), retinal hemorrhages are a key diagnostic feature. Detection by fundoscopy may be delayed or limited, whereas magnetic resonance imaging (MRI) enables non-invasive, objective assessment on routine brain sequences.

Objective: To evaluate the diagnostic utility of different MRI sequences-particularly susceptibility-weighted imaging (SWI), T2*-weighted (T2*w), and morphological sequences-in detecting retinal hemorrhages in AHT.

Materials and methods: In this retrospective multicenter study (2006-2015), 57 well-documented AHT cases from three German institutions were analyzed. A subgroup consisted of "confession cases." MRI scans were reviewed for retinal hemorrhages across SWI, T2*w, T1-weighted, T2-weighted (T2w), and fluid-attenuated inversion recovery (FLAIR) sequences by blinded expert readers. Fundoscopy results served as the gold standard. Sensitivities were calculated for each sequence, and "confession" versus "non-confession" cases were compared.

Results: Fundoscopy detected retinal hemorrhages in 44 of 56 evaluable cases (78.6%). MRI identified retinal hemorrhages most frequently on gradient recalled echo sequences, with SWI showing higher sensitivity compared to T2*w (76.9% vs. 47.8%). T2w imaging showed markedly lower sensitivity (30.3%) but detected retinal hemorrhages on one eye missed on T2*w imaging in two cases. In three cases, MRI detected retinal hemorrhages not reported on fundoscopy. No statistically significant differences were found between "confession" and "non-confession" cases across all parameters considered (P>0.05).

Conclusion: MRI-particularly SWI and, to a lesser extent, T2*w imaging-may offer a useful tool of detecting retinal hemorrhages in AHT when fundoscopy is limited. T2w imaging may provide complementary information in selected cases.

RAD-AID International is a non-profit organization improving radiology healthcare in medically underserved regions of the world through sustained partnerships and programmatic efforts targeting education, medical imaging technology advancement, and economic development. This paper examines the global landscape of pediatric radiology, emphasizing the significant disparities in low-resource areas. It details RAD-AID's holistic strategy to customize programs according to local needs and enhance pediatric radiology through education, equipment, and technology. It also discusses the challenges and future directions for expanding pediatric radiology services, highlighting the importance of sustainability and the active involvement of local stakeholders.