Pediatric Radiology最新文献

Background: Ileocolic intussusception is the most common cause of bowel obstruction in young children. There is an ongoing debate about whether it is a middle-of-the-night emergency and if delays in intervention have a significant impact on outcome.

Objective: To determine the relationship between the time elapsed from diagnosis to pneumatic reduction and the success rate of the procedure.

Materials and methods: A retrospective study was performed on pediatric patients who underwent fluoroscopically guided pneumatic intussusception reduction during a 10-year period. Patients were categorized into groups according to the time elapsed between diagnosis and reduction with the following time intervals: ≤ 3 h, 3-6 h, and > 6 h. A chi-square test analyzed the association between the time elapsed from diagnosis to attempted reduction and the success rate.

Results: The study population consisted of 78 males and 38 females. Median age was 22.5 months (2-129 months). Median time elapsed between diagnosis and attempted reduction was 149 min (25-1389 min; IQR, 261 min). The overall success rate of pneumatic reduction was 85% (108/127, 95% CI 79-91%). The recurrence rate was 9.4% (95% CI 4.2-15%). Within the three intervals studied (0-3 h, 3-6 h, and more than 6 h), the success rates were 87% (61/70, 95% CI 77-93%), 80% (24/30, 95% CI 63-90%), and 85% (23/27, 95% CI 68-94%), respectively. The chi-square test yielded a statistic of 0.84 with a P-value of 0.66, indicating no significant correlation between the time elapsed from diagnosis to reduction and the success of the procedure.

Conclusion: There is no association between the time elapsed from ileocolic intussusception diagnosis to pneumatic reduction and the success of the procedure.

In addition to morphologic evaluation, cardiac computed tomography with a short scan time and a high spatial resolution may be performed to assess ventricular function in children with congenital heart disease, especially when cardiac magnetic resonance imaging is unavailable, inadequate, or contraindicated. Caution should be exercised over the computed tomography radiation dose because greater radiation doses are used to assess ventricular function than morphology. The three-dimensional threshold-based segmentation approach leads to higher accuracy and reproducibility of ventricular volumetry than the conventional approach, which frequently uses simplified contouring and two-dimensional disc summation. However, this approach is less frequently utilized in clinical practice than the conventional approach. Therefore, a step-by-step guide to cardiac computed tomography ventricular volumetry using three-dimensional threshold-based segmentation is presented for congenital heart disease.

Segmental spinal dysgenesis is a rare and complex congenital anomaly that affects the spinal cord. It is hypothesized to be a notochord malformation. Patients generally present with spastic paraparesis and a neurogenic bladder. It is characterized by focal spinal cord dysgenesis and kyphoscoliotic deformity. We present the case of a 2-year-old boy who presented to the outpatient department of our hospital with complaints of recurrent urinary tract infection and fever. On examination, he had bilateral clubfoot, kyphoscoliotic deformity, and paraparesis. Further examination by micturating cystourethrogram revealed bilateral grade V vesico-ureteric reflux. Cystoscopy ruled out a posterior urethral valve. Magnetic resonance imaging of the spine was conducted to evaluate any neurological cause, which revealed a high blunt ending of the spinal cord at the dorsal level 10, with the absence of spinal cord tissue between dorsal 10 and sacral 2 level. Bulky cord-like tissue was noted from the sacral 2-4 level. These findings were associated with a syrinx formation and multiple vertebral malformations. The patient was managed conservatively.

Non-contrast transperineal ultrasound is a valuable, non-invasive, and cost-effective imaging modality, particularly advantageous in pediatric populations. This painless procedure has a robust safety profile due to the absence of ionizing radiation, the lack of need for specialized equipment, and the avoidance of sedation. It can be performed as either an isolated examination or an adjunct to transabdominal ultrasound. Despite these benefits, its clinical application remains underutilized and unfamiliar to many practitioners. This technique plays a crucial role in the diagnosis of various pediatric conditions, including anorectal and genitourinary malformations (e.g., ectopic ureter, posterior urethral valves, Müllerian anomalies, and disorders of sex development), neoplastic processes affecting the genitourinary and anorectal systems (e.g., labial, vaginal, and urethral tumors), and perianal inflammatory diseases. This article provides a concise review of the embryological development of the genitourinary and anorectal systems, a description of normal male and female pelvic anatomy visualized via transperineal ultrasound, and an overview of the primary indications and associated findings of this technique in children.

Background: Non-invasive imaging methods for evaluating microstructural changes in patients with developmental dysplasia of the hip (DDH) are lacking.

Objective: To explore the feasibility of hip ultrasound radiomics to evaluate microstructural changes of the femoral head in patients with DDH.

Materials and methods: A retrospective analysis was conducted on 59 patients with DDH and 66 healthy controls who underwent hip ultrasound examination. We used three-dimensional (3D) Slicer software to obtain femoral head ultrasound radiomics features and compared them between the DDH and healthy control groups. A predictive model was established by using the maximum relevance minimum redundancy (mRMR) and least absolute shrinkage and selection operator (LASSO) methods. The receiver operating characteristic (ROC) curve was used to determine the performance of the model.

Results: There were significant differences (P < 0.05) in 69 ultrasound radiomics features of the femoral head between the patients with DDH and healthy controls. By using mRMR, 12 features were selected for further analysis via LASSO. We have successfully established a predictive model based on nine features. The area under the curve (AUC) of the model was 0.91 for the validation set.

Conclusion: We developed a predictive model based on ultrasound radiomics, and the model had good differential diagnostic efficacy in patients with DDH and healthy individuals.

Background: Photon-counting detector (PCD) CT allows for reduced intravenous iodinated contrast dosing with preserved or improved image quality across anatomical regions as compared to conventional energy-integrating detector (EID) CT in adults. However, there is limited evidence to support this in pediatric CT, particularly for pediatric chest CT.

Objective: To compare image quality of photon-counting detector (PCD) chest CT with energy-integrating detector (EID) CT at varying iodinated contrast doses in pediatric patients.

Methods and materials: This retrospective observational study included 60 contrast-enhanced chest CT studies in pediatric patients. The cohort included three groups: 20 PCD CT scans with a 1.5 mL/kg weight-based iodinated contrast dose, 20 EID CT scans with a 1.5 mL/kg dose, and 20 EID CT scans with a 2.0 mL/kg dose. Image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were assessed through region-of-interest measurement of Hounsfield units (HU) and standard deviation (SD). Assessed locations were the lung parenchyma, thoracic aorta, main pulmonary artery, left ventricle cavity, subcutaneous tissue, and pectoralis muscle. Blinded review by three pediatric radiologists assessed overall contrast enhancement, soft tissue delineation, and streak artifact from dense contrast using 5-point Likert scales (1 - excellent to 5 - non-diagnostic). Group comparisons were analyzed using Wilcoxon signed-rank, Chi-square, and Kruskal-Wallis tests.

Results: Twenty patients were included for each group (60 patients total). Compared to equivalent-contrast dose EID CT at 1.5 mL/kg, PCD CT showed higher left ventricle cavity SNR (21.6 [IQR 16.3-25.1] vs 16.2 [IQR 12.3-19.3], P = 0.05) and CNR (16.0 [IQR 11.3-19.5] vs 10.3 [8.8-13.7] P = 0.05), and lower image noise in pectoralis muscle (P = 0.04) and subcutaneous fat (P < 0.01). Furthermore, objective image quality on PCD CT demonstrated improvements in lung parenchyma noise, SNR, and CNR, as well as subcutaneous fat SNR and CNR (all P < 0.01) compared with both equivalent (1.5 mL/kg) and standard (2.0 mL/kg) contrast dosing in EID CT. No significant differences between PCD CT and EID CT were observed with other objective measures of image quality. Subjective assessments favored PCD CT for overall contrast enhancement to EID CT at equivalent (1.5 mL/kg) contrast dosing (median 1, IQR 1-1 vs median 2, IQR 1-5, P = 0.02) and soft tissue delineation compared with EID CT with higher (2.0 mL/kg) contrast dosing (median 1, IQR 1-2 vs median 2, IQR 1-2, P = 0.05).

Conclusion: Pediatric chest CT using photon-counting detector technology enables iodinated contrast dose reduction while preserving image quality compared with conventional EID CT at standard contrast doses.

Background: Osteosarcoma is the most common bone pediatric cancer, with the lung being the primary site of metastasis. A chest computed tomography scan (CT) is used to assess metastatic disease at diagnosis, classifying patients as localized or metastatic. Although there are radiological characteristics that suggest whether a lung nodule is metastatic, in daily practice, non-specific lesions on CT may complicate classification.

Objective: Our objective is to compare radiological findings with the histology of lung nodules deemed malignant by CT and to review current radiological criteria.

Materials and methods: A retrospective review was conducted of lung nodules in patients under 18 years old, diagnosed with osteosarcoma between 2014-2024 in a tertiary hospital. Radiological features, including calcification, size, shape, and location, were analyzed for their correlation with histological confirmation of metastasis.

Results: In 33 osteosarcoma patients, 116 nodules were identified as malignant by radiology. A total of 69% of patients had pulmonary nodules that met radiological criteria for malignancy during follow-up. All underwent surgical resection. Histology confirmed metastasis in 49% (57/116) of the nodules that were suspicious on CT. Only calcification showed a significant correlation with histological confirmation of metastasis.

Conclusions: CT imaging has an optimal sensitivity but low specificity for detecting lung metastases in osteosarcoma. However, we demonstrate that calcification is significantly correlated with histological confirmation of metastasis and may aid in confirming lung metastasis in osteosarcoma patients. Still, further studies are needed to refine radiological criteria to improve accuracy and reduce false positive rates.

Background: Ultrasound (US) enables clear visualization of the pancreaticobiliary junction within the pancreatic parenchyma. However, limited studies have evaluated its diagnostic utility for pancreaticobiliary maljunction in pediatrics.

Objective: To prospectively assess the diagnostic value of high-frequency ultrasonography for pancreaticobiliary maljunction in suspected pediatric patients.

Materials and methods: All suspected patients received detailed high-frequency US examination of the gallbladder wall, common bile duct, heterogeneous biliary echoes (including stones, sludge, and protein plugs), pancreatic duct, pancreaticobiliary junction, or common channel. Ultrasound characteristics were compared in patients with versus without pancreaticobiliary maljunction. The areas under receiver operating characteristic curves (AUCs) for different US characteristics in the diagnosis of pancreaticobiliary maljunction were calculated and compared.

Results: The study included 56 pediatric patients (male 19, female 37; median age 38.5 months, interquartile range 12-81). Pancreaticobiliary maljunction was present in 32 patients and absent in 24. High-frequency ultrasonography successfully depicted the pancreaticobiliary junction in 43 patients (76.8%). Higher sensitivities were observed in pancreatic duct dilation (88%) and common bile duct dilation (97%) compared to gallbladder wall thickening (78%) and heterogeneous biliary echoes (75%) for pancreaticobiliary maljunction identification, though specificities were suboptimal (21-63%). The full four-characteristic set achieved optimal results (AUC=0.872, sensitivity=84%, specificity=75%). The subset excluding common bile duct dilation maintained strong efficacy (AUC=0.860, sensitivity=81%, specificity=75%). Of note, among patients with the junction of pancreaticobiliary duct unclear, the common bile duct-excluded subset (thickened gallbladder wall, heterogeneous biliary echoes, pancreatic duct dilation) had a superior discrimination ability (AUC=0.931, sensitivity=100%, specificity=78%).

Conclusion: High-frequency ultrasonography enables direct pancreaticobiliary maljunction diagnosis in children via visualization of the abnormal common channel. When junctional anatomy is indeterminate, ultrasound characteristics-particularly thickened gallbladder wall, heterogeneous biliary echoes, and pancreatic duct dilation-serve as highly informative diagnostic indicators.