Pediatric Radiology最新文献

Background: Repeated full-spine radiography for scoliosis follow-up in children results in increased radiation exposure, especially to anterior radiosensitive organs. Optimizing projection direction and beam filtration is essential for dose reduction.

Objective: To quantitatively evaluate the age-dependent effects of anteroposterior (AP) and posteroanterior (PA) projections, with and without a 0.1-mm copper filter, on organ and effective doses in pediatric full-spine radiography.

Materials and methods: Monte Carlo simulations were performed using the Particle and Heavy Ion Transport code System with 5-, 10-, and 15-year-old female hybrid phantoms. Full-spine radiography from the first cervical vertebra to both femoral heads was modeled under AP and PA conditions, with or without copper filtration. Organ doses were calculated, with active bone marrow and bone surface evaluated using the "International Commission on Radiological Protection Publication 116" dose response functions. Percentage depth dose analysis was performed to assess the effect of body thickness.

Results: PA projection markedly reduced doses to anterior radiosensitive organs, with maximum reductions of approximately 93% for the breast (AP/PA ratio 14) and over 80% for the thyroid. Copper filtration provided additional reductions of 15-19% in AP and 5-6% in PA. In contrast, dose increases were observed in posterior and deep-seated organs such as the kidneys and active bone marrow. Effective dose was reduced by about half with PA and further decreased with copper filtration.

Conclusion: PA projection and copper filtration are effective strategies for reducing radiation exposure to anterior radiosensitive organs and lowering effective dose in pediatric full-spine radiography. However, dose increases in deep-seated organs were also observed, highlighting the need for protocol optimization according to patient age and organ location.

Anyone who has visited a radiology department in another continent, country, or even city has likely noticed subtle differences in how things are done compared to their own department. Many procedures become so ingrained in daily practice that we rarely stop to question whether they are truly supported by evidence. One such procedure is intussusception reduction. In this paper, we review the literature, examine the best reduction technique and the risks associated with general anaesthesia and sedation, and offer the Abdominal Task Force's opinion on this common but very variable procedure, based on the current available literature.

Artificial intelligence (AI) is being increasingly utilized in various aspects by the radiology department. With an ever-increasing burden on the healthcare system, particularly in emergency units, the need to incorporate AI in patient triage and workflow optimization cannot be overstated. Machine learning (ML)-based algorithms form the core of AI-based software, aiding healthcare professionals at nearly every step in delivering appropriate patient care. Regarding the radiology section of the hospital, AI-based algorithms have proven exceptionally useful in assisting radiologists and technicians with image acquisition. From accurate clinical referrals to scheduling computed tomography/magnetic resonance imaging scan appointments, from ensuring the lowest radiation exposure to offering timely follow-up reminders, ML-based software has indeed revolutionized the concept of modern image acquisition, especially in the pediatric radiology section. Although the implementation of these algorithms is swift, several technical challenges and the limited availability of pediatric datasets preclude their widespread use. The utility of multimodal pediatric datasets, which combine imaging, genomics, and clinical data, for comprehensive AI triage models can help AI systems evolve toward greater adaptability and integration, resulting in enhanced efficiency, reduced turnaround times, and improved patient outcomes in pediatric radiology departments in the future. In this article, we highlight and review the utility of AI and machine learning-based algorithms in efficiently aiding triage and streamlining the workflow in the pediatric radiology section, thereby ensuring an overall improvement in the departmental workflow.

Pediatric cardiovascular imaging plays an important role in the diagnosis, monitoring, and management of congenital and acquired heart diseases. Although echocardiography remains the most widely used modality in pediatric cardiology, cross-sectional imaging techniques such as cardiac magnetic resonance imaging (MRI) and computed tomography (CT) provide complementary anatomic and functional information. However, time-consuming diagnostic processes and patient-specific characteristics remain major limitations to early and precise diagnosis, as well as optimal clinical outcomes. With technological advancements, artificial intelligence (AI) has been increasingly integrated into cardiovascular magnetic resonance imaging (MRI) and computed tomography (CT) to enhance image acquisition, segmentation, interpretation, and diagnosis, and to facilitate predictive modeling of clinical outcomes. This review summarizes current and emerging AI applications in pediatric cardiovascular MRI and CT, emphasizing workflow optimization, diagnostic automation, and quantitative analysis. Emerging frontiers include multimodal data integration for risk stratification, clinical decision-making support, digital twin models, three-dimensional virtual modeling, and the application of computational fluid dynamics, as well as the potential of AI to improve access to care in low-resource settings.

Background: Synovial-joint abnormalities in children can be caused by different conditions, including autoimmune arthritis, infection, and neoplasm. An ultrasound-guided biopsy targeting the synovial membrane can aid in determining the etiology when the cause is unclear.

Objective: To determine the diagnostic performance, findings, and outcomes of ultrasound-guided joint biopsy in children.

Materials and method: This is a retrospective study on patients who underwent ultrasound-guided joint biopsy from May 2000 to December 2024. Patient demographics, clinical information, imaging, procedure details, pathology findings, adverse events, and clinical outcomes were collected and reviewed.

Results: Thirty-one patients (25 females) with a mean age of 10.2 years underwent 34 biopsies. Presenting symptoms were pain (33/34), mobility issues (33/34), and swelling (20/34). Effusion (19/28), joint capsule thickening (24/28), and contrast enhancement (20/28) were the most common MRI findings, while joint capsule thickening (29/29) and effusion (19/29) were the most frequent ultrasound findings. The most common joints biopsied were the hip (16/34), knee (9/34), and ankle (4/34). Core needle biopsy was performed in all cases. The mean number of passes was 4.5 (SD 1.8), obtaining a mean of 4.1 cores (SD 1.9). Biopsy was diagnostic in 20/34 (59% [CI 41-76%]) joints, and only one patient required surgical biopsy. Synovitis was the most common diagnosis (14/34), followed by pigmented villonodular synovitis (2/34). No major adverse events were observed.

Conclusion: Ultrasound-guided joint biopsy in children has moderate diagnostic performance; however, it can be clinically impactful, even when non-diagnostic, helping in joint disease management, potentially preventing surgery, with low adverse event incidence.

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.

Background: Requests for secondary interpretation of imaging examinations adds clinical work and generates additional charges.

Objective: To understand the impact of secondary interpretations of pediatric nuclear medicine examinations at a quaternary academic center.

Materials and methods: In this IRB approved study, we retrospectively reviewed nuclear medicine examinations submitted for secondary interpretation by a pediatric radiologist with a nuclear medicine focus at our institution between 08/2019 and 08/2024. A single reviewer compared the primary and secondary reports to identify discrepancies that would likely impact clinical management, and discrepancies were confirmed by additional reviewers. Pediatric hematology/oncology faculty (n=29) and fellows (n=18) at our institution were surveyed to understand requests for, and the impact of, secondary interpretations. Results are summarized with descriptive statistics.

Results: Three hundred fifty-eight examinations (median patient age=8 years) were included, 237 were ¹⁸F-FDG PET body scans, 97 were ¹²³I-MIBG scans, and 24 were other examinations. Secondary interpretations yielded meaningful changes in 17% (60/358). Of these, 20% (12/60) changed from negative/normal to positive, 20% (12/60) changed from positive to negative/normal, and 57% (34/60) included additional positive findings/diagnoses. Sixteen survey responses (34%; n=16/47 response rate) were received, with providers indicating that secondary interpretations were clinically useful even when they agreed with the primary impression.

Conclusion: Secondary interpretation of pediatric nuclear medicine examinations by pediatric radiologists with nuclear medicine focus resulted in changes that have potential impact on clinical management in 17% of cases. Secondary interpretations completely changed the impression regarding the presence or absence of malignant disease in 40% of these cases. Referring providers identified benefit in secondary interpretations even when they confirmed the primary impression.