Pediatric Radiology最新文献

Background: Workload among pediatric radiologists is rising, driven by staff shortages, case complexity, and call demands. Higher imaging volumes are linked to diagnostic errors and job dissatisfaction, affecting patient care and radiologists' retention and recruitment. Technological advances may have increased the number of images generated per study, contributing a hidden workload not captured by study counts alone.

Objective: To determine the increase in the number of images per study in pediatric ultrasound (US), computed tomography (CT), and magnetic resonance (MR) at a pediatric tertiary care hospital between 2004 and 2023.

Materials and methods: A single-center retrospective review was conducted on the number of images acquired in select US, CT, and MR studies for patients under 18 years during the week of June 1-7, from 2004 to 2023. Trends were assessed with linear regression, with statistical significance at a P-value of <0.05.

Results: A total of 1,751 studies were reviewed and 749,152 total images were analyzed. The average number of US images per study increased from 38.67 to 165.24, MR from 185.62 to 1,292.00, and CT from 42.53 to 266.00. Regression analysis indicated statistically significant increases in all modalities: US by 7.41 images per year, MR by 51.60, and CT by 22.27 (P<0.0001 for all). Stratification based on study subtype was also performed.

Conclusion: The number of images per study has significantly increased over the two decades, adding hidden strain on pediatric radiologists' workload. Imaging protocols should be reviewed to optimize the number of acquired images without losing diagnostic accuracy.

Neuroleukemiosis, leukemic infiltration of the peripheral nerves, is exceedingly rare. We report a child with neuroleukemiosis affecting multiple peripheral nerves, presenting 2 months after stem cell transplant for acute myeloid leukemia. We discuss this unusual entity and highlight the ultrasonographic and magnetic resonance imaging findings that facilitated biopsy confirmation. Recognition of this entity is critical as it may be the sole sign of primary disease or relapse.

We report a case of a 16-year-old girl with cholelithiasis in the accessory gallbladder of an accessory liver. A parenchymal cyst was also present in the accessory liver. The accessory lobe of the liver is a rare congenital anomaly with supernumerary liver lobes caused by hyperplasia of the hepatic diverticulum in early fetal life. The presence of an accessory gallbladder is scarce. To our knowledge, this case is the first reported with cholelithiasis in the only gallbladder of the patient located in the accessory liver. This case reiterates the importance of familiarity of radiologists with this congenital anomaly, accessory liver and gallbladder, which may also lead to complications.

Background: Classic metaphyseal lesions (CMLs) are considered specific for child abuse, but the reliability of radiologists in distinguishing CMLs from metaphyseal variations is unclear.

Objective: To evaluate the diagnostic performance of pediatric and adult emergency radiologists in differentiating CMLs from metaphyseal variations in the knees.

Materials and methods: We retrospectively reviewed distal femur and proximal tibia radiographs in children under 1 year of age who underwent skeletal surveys for suspected child abuse. A consensus diagnosis for CMLs and metaphyseal variations-serving as the ground truth-was established by two pediatric radiologists. The CML group comprised children diagnosed with abuse and confirmed CMLs. The metaphyseal variation group included children not diagnosed with abuse, who exhibited metaphyseal variations and had either no fractures or only an isolated skull fracture. Radiographs were trimmed to exclude other injuries. Four pediatric and four adult radiologists reviewed anonymized studies and categorized each case as CML, metaphyseal variation, normal, or indeterminate, with confidence levels (high, moderate, low). We analyzed diagnoses with moderate or high confidence. Interobserver agreement was assessed using kappa statistics.

Results: There were 44 children with CMLs (10 initial, 7 follow-up, 27 initial and follow-up) and 22 with metaphyseal variations (10 initial, 7 follow-up, 5 initial and follow-up). Metaphyseal fragmentation was the most common variation, identified in 249 of 344 femurs (72.4%, 95% CI 67.3-77.0%) and 60 of 69 tibias (87.0%, 76.7-93.9%). Fragmentations were most frequently located in the posterior or medial metaphysis, or both, in 238 of 249 femurs (95.6%, 92.2-97.8%) and 60 of 69 tibias (87.0%, 76.7-93.9%). In the CML group, 33 of 114 initial CML diagnoses (28.9%, 20.8-38.2%) were read on follow-up as either metaphyseal variation (n = 17) or normal (n = 16). In contrast, in the metaphyseal variation group, only one follow-up case was diagnosed as a CML; the remainder were diagnosed on follow-up as metaphyseal variation (n = 24). Diagnostic performance for CML demonstrated high specificity (90.9%, 85.6-94.7%) and positive predictive value (95.6%, 93.0-97.5%), with moderate accuracy (79.3%, 75.9-82.4%), sensitivity (74.9%, 70.8-78.8%), and negative predictive value (57.6%, 51.5-63.5%). Interobserver agreement was substantial, with a mean kappa of 0.61 (range 0.45-0.84).

Conclusion: Radiologists demonstrated substantial agreement and high specificity in distinguishing CMLs from metaphyseal variations. Metaphyseal fragmentation was the most common variation and was uncommonly diagnosed as CML on follow-up.

Background: Skeletal abnormalities are important to recognize in the workup of physical child abuse. Normal variants can simulate child abuse and cause incorrect diagnosis and management. An osseous protuberance of the proximal medial tibial metaphysis, "the tibial bump," is a normal variant that is important to recognize.

Objective: To determine the prevalence of a tibial bump in infants undergoing a skeletal survey for a child abuse evaluation.

Materials and methods: A retrospective study of initial and follow-up child abuse skeletal surveys at a tertiary center was conducted to assess for the presence of a tibial bump on the proximal medial tibial metaphysis. The presence or absence of fracture healing changes around the tibial bump was recorded.

Results: Twenty of two hundred sixty cases showed a tibial bump on the initial skeletal survey, estimating a prevalence of 7.7%. Fourteen of these twenty cases (70%) demonstrated a persistent tibial bump unchanged in appearance on the follow-up skeletal survey. None of the tibial bumps demonstrated findings of a healing fracture on the initial or follow-up skeletal survey. In cases with a tibial bump present, 10 (50%) were bilateral and 10 were unilateral (50%). The mean (median) age of a child with a tibial bump was 3.5 (2.9) months with a range from 1 to 8 months, and there was a statistically significant association between age and the presence of a bump, supporting that this is a finding of infancy (P = 0.04).

Conclusion: A tibial bump on the proximal medial tibial metaphysis was a relatively common finding in infants undergoing workup for child abuse and not radiographically consistent with a fracture. It is a normal variant and should not be confused with a traumatic finding.