Pediatric Radiology最新文献

Background: Some children with inflammatory bowel disease (IBD) have hepatobiliary and/or pancreatic manifestations of the disease. The frequency of related imaging abnormalities at IBD diagnosis is unknown.

Objective: To identify and quantify hepatobiliary and pancreatic findings on baseline magnetic resonance enterography (MRE) examinations in children with newly diagnosed IBD.

Materials and methods: Children <18 years of age diagnosed with IBD between August 2022 and April 2024 who underwent MRE within 90 days of diagnosis were included. Three radiologists retrospectively reviewed the MREs, reported the presence of intrahepatic biliary dilation, and measured maximum extrahepatic bile and pancreatic duct diameters and pancreas:spleen T1 signal intensity ratios (SIR). Pancreatic volume was calculated from axial T2 images using an open-source segmentation tool (PaNSegNet).

Results: A total of 111 children were included: 77% (n=86) with Crohn disease; 22% (n=24) with ulcerative colitis; 1% (n=1) with IBD-unspecified. The mean age at diagnosis was 13.7 years (range, 5.3-17.9 years); 61% (n=43) were male. Subjective intrahepatic biliary dilation by reviewer consensus was present in 11% (n=12). Extrahepatic biliary dilation was present in 6% (n=7). Pancreatic duct dilation was present in 2% (n=2). Low pancreas:spleen T1 SIR (<1.4 at 1.5 T, <1.3 at 3 T) was present in 14% (n=16). Pancreatic volume was <5th percentile in 6% (n=5) and >95th percentile in 13% (n=14).

Conclusions: Imaging findings potentially associated with autoimmune-related hepatobiliary or pancreatic disease are present in 2-14% on baseline MR enterography examinations in children with newly diagnosed inflammatory bowel disease. While infrequent, radiologists should be attentive to these findings of multisystem disease.

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.

Pulled elbow, colloquially named nursemaid's elbow, is an injury that results from annular ligament displacement and interposition between the radial head and capitellum. There is a paucity of literature describing the sonographic findings of pulled elbow. Given that this condition is primarily diagnosed clinically, radiographs are typically only obtained when there is concern for fracture. Sonographic evaluation is most useful in cases when attempted reduction is unsuccessful and radiographs are negative for fracture. This review describes the essential pathoanatomy needed for accurate sonographic diagnosis, which has previously been described with cadaveric research and a small number of case reports.

Medication-induced lung disease is rare in children but can be associated with considerable morbidity and mortality and can alter treatment regimens for children with a variety of conditions. Medication-induced lung disease tends to occur in association with certain categories of medication and tends to manifest as one of several patterns of lung disease on CT. We review classes of medications associated with medication-induced lung disease, clinical diagnosis and management of the condition including the role of the radiologist, and CT patterns of disease to enable the radiologist to more fully contribute to multidisciplinary diagnosis and potentially be the first to recognize and suggest the possibility of this condition.

Background: Many children are born without prenatal determination of gestational age (GA). Postnatal determinations are limited. Fetal GA determination using transcerebellar diameter measurements is reliable for fetuses. We wanted to see if transcerebellar diameters obtained on neonatal head ultrasound exams could help GA determination in newborns and whether such measurements conformed to similar GA determinations in fetuses.

Objective: Our goal was to determine if neonatal GA can be estimated by measuring transcerebellar diameter via a transmastoid approach using fetal charts as the gold standard. If true, one could develop a neonatal chart for GA determination by transcerebellar diameter.

Materials and methods: Transmastoid views are a routine part of our neonatal intensive care unit neurosonograms. A retrospective analysis of transcerebellar diameters of neonates (1 day to 21 days old) born between 22 weeks and 40 weeks corrected GA was performed. Cases with congenital anomalies, intraventricular hemorrhage, or other neurosonographic abnormalities were excluded. Neonatal GA was determined by early antenatal crown rump lengths. We calculated transcerebellar mean and standard deviation for each prenatally determined GA week. GA was determined from fetal charts, both for subsets of neonates evaluated at less than or equal to (≤) 10 days of life and for those examined at ≤21 days of life. Statistical analysis using linear regression demonstrated no differences in GA determined by neonatal transcerebellar diameter compared to fetal charts (our gold standard).

Results: We evaluated 1,260 neurosonograms. Of these, 589 cases were excluded. A total of 671 exams were of neonates ≤21 days old; 530 of those were examined at ≤10 days of life. There were no significant differences between GA determined by fetal charts and our neonatal transcerebellar diameters, whether from the ≤21-day (P=0.15) or the younger ≤10-day group (P=0.87).

Conclusion: Neonatal GA estimation by transmastoid fontanelle measurements of cerebellar width appears as reliable as the accepted antenatal transcerebellar measurements of fetuses. Our proposed neonatal chart will hopefully aid reliable estimation of GA in neonates, improving patient care among neonates with unknown maternal last menstrual period.

Background: In vivo placental volume derived from magnetic resonance imaging (MRI) is a novel imaging tool to evaluate the placenta during pregnancy, as the placenta is difficult to access throughout gestation. There is a paucity of established standardized normative raw values and Z-scores for in vivo placental volume based on MRI.

Objective: To establish normative references for in vivo placental MRI-based volumes derived from a large cohort of healthy pregnant women carrying healthy fetuses throughout gestation.

Materials and methods: Healthy pregnant women with healthy singleton pregnancies greater than 16 weeks gestation were enrolled in a longitudinal, prospective observational study. In total, 313 placental MRIs were analyzed from 209 pregnant women. In-vivo placentas were manually segmented to derive volumes and Z-scores. Means, standard deviations, and percentiles for normative reference raw values were calculated using weekly gestational age (GA) bins. Placental volume Z-scores were calculated based on 2-week GA bins using means and standard deviations.

Results: Normative reference placental volumes from 209 subjects (313 scans) with median GA 31.43 [8.86] weeks are presented in weekly and bi-weekly GA bins. Using 2-week GA intervals, 95% of placental volume Z-scores were within ±2 standard deviations of the population mean.

Conclusion: This data provides established normative in vivo raw and Z-score values derived from placental MRI. The value of accessing the placenta in vivo through MRI has become increasingly recognized, as the importance of the placenta in fetal and postnatal health is now more widely known. Establishing normative reference values for the in vivo placenta throughout gestation benefits both the clinical and scientific communities.

This report presents the prenatal imaging findings and short-term clinical outcome of a rare case of fetal cerebral sinovenous thrombosis, along with a brief review of the literature. A 31-year-old pregnant Afghan woman at 34 weeks of gestation (gravida 3, para 0, abortion 2) presented to the hospital with complaints of decreased fetal movement. Fetal cranial ultrasonography revealed a thick-walled, avascular, hypoechoic, mass-like lesion (17×18×18 mm) extending from the left foramen of Monro to the superior aspect of the thalamus and displacing the body of the left lateral ventricle. Fetal cranial magnetic resonance imaging (MRI) suggested subacute hemorrhage and demonstrated hyperintensity in the left transverse venous sinus, indicative of thrombosis. Serial follow-up revealed stability of the lesion; however, at 36 weeks, an emergency cesarean section was performed due to fetal distress. Postnatal cranial MRI and magnetic resonance venography (MRV) confirmed left transverse venous sinus thrombosis with subacute hemorrhage. The newborn received enoxaparin therapy for 3 months, remained clinically stable, and had no neurological deficits at the 4-month follow-up. Fetal intracranial hemorrhage has a broad differential diagnosis, and accurate identification of the underlying etiology is critical for prognosis and management. Fetal cerebral sinovenous thrombosis should be considered in the differential diagnosis when mass-like hemorrhagic lesions are detected on prenatal imaging. While short-term outcomes may be favorable in the absence of additional cranial pathology, the long-term prognosis remains uncertain.

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.