Pediatric Radiology最新文献

A life-threatening chylothorax developed in a female neonate after corrective surgery of d-transposition of the great arteries complicated by extensive postoperative thrombosis of the superior vena cava distribution, including at the thoracic duct-venous junction. Emergent percutaneous catheter intervention for thrombus aspiration and transluminal angioplasty was required. Despite therapeutic heparinization, thrombosis persisted. Curative image-guided treatment was twofold: first, the occluded thoracic duct was punctured under ultrasound guidance; then, the thrombus at the thoracic duct-venous junction was mobilized using the Seldinger-technique. Additionally, a venous catheter was placed with the tip at the thoracic duct-venous junction, and local low-dose thrombolysis was administered. This case shows that it is possible to percutaneously access the thoracic duct by direct puncture in a neonate with ultrasound guidance.

Background: Pediatric rotator cuff (RTC) injuries are uncommon, yet supraspinatus tendon (SST) signal alterations on T2-weighted imaging are frequently observed.

Objective: To compare rates of SST signal alterations on shoulder MRIs of adolescents who are considered low- and high-risk for RTC injury.

Materials and methods: We retrospectively reviewed non-arthrogram shoulder MRI reports in 12-17-year-old patients at a large tertiary children's hospital (01/2010-09/2024). We identified a low-risk patient cohort who lacked (a) clinical concern for RTC pathology, (b) athletic history associated with RTC injuries, (c) recent trauma, or (d) prior shoulder intervention. We also identified an age- and sex-matched high-risk patient cohort who had clinical concern for RTC pathology. Two experienced pediatric radiologists independently and blindly reviewed the shoulder MRIs in a random order from these cohorts. SST was evaluated using coronal oblique fat-suppressed T2-weighted sequences. Logistic regression models were developed to investigate differences between cohorts.

Results: Both low- and high-risk cohorts included 26 patients (14 males). Their median (inter-quartile range) ages were 14.0 (2.0) years and 14.5 (3.0) years, respectively. In the low-risk cohort, SST signal alterations were identified in 23 (88.5%) and 22 (84.6%) patients by readers 1 and 2, respectively. In the high-risk group, SST signal alterations were identified in 24 (92.3%) and 23 (88.5%) patients by readers 1 and 2, respectively. Overall inter-reader agreement was substantial (Cohen's kappa=0.63). There was no statistical difference in the SST signal alteration grades between the low- and high-risk cohorts (P≥0.07).

Conclusion: SST signal alterations are common in adolescent shoulder MRIs regardless of the clinical concern for RTC injury.

Background: Necrotizing enterocolitis (NEC) remains a highly morbid disease for preterm infants. The use of adjunct abdominal ultrasonography improves the evaluation of early or uncertain cases of NEC. No institutions have reported implementing a standardized adjunct abdominal ultrasound guideline and universally adopting adjunct abdominal ultrasound in routine neonatal practice for the evaluation of NEC.

Objective: To determine if a standardized, adjunct abdominal ultrasound guideline for diagnosing NEC is feasible and beneficial for the routine detection of pathologic abdominal findings in NEC.

Materials and methods: This retrospective study was conducted in an 82-bed level IV academic neonatal intensive care unit from February 2023-April 2024. Unit guidelines were updated in February 2023 to recommend the addition of an adjunct abdominal ultrasound to evaluate NEC universally at the time of initial evaluation. Imaging data was abstracted from a post-implementation observation period of 15 months. Implementation feasibility was assessed. Sonographic findings consistent with NEC were described after implementing standardized sonography protocols.

Results: Adjunct abdominal ultrasound was performed in 22 of 23 cases (96%) of NEC following guideline implementation. Twenty ultrasounds (90%) had at least one finding suggestive of NEC, and 12 (55%) had multiple findings suggestive of NEC. Seven ultrasounds (32%) showed findings of NEC in cases with unremarkable initial abdominal radiographs. Two NEC cases had radiographic findings without abdominal ultrasound findings. The sensitivity of abdominal ultrasound for NEC was 0.91. In 59% of cases, abdominal ultrasound findings resulted in a higher modified Bell's stage when compared to initial abdominal radiograph findings.

Conclusion: Implementing a standardized adjunct abdominal ultrasound guideline to assist with the initial diagnostic evaluation of NEC is feasible and may aid in diagnosis of NEC.

Sturge-Weber syndrome (SWS) is a rare congenital neurocutaneous disorder caused by somatic mutations in the GNAQ gene, resulting in capillary-venous malformations involving the brain, skin, and eyes. Neurological involvement arises from impaired cortical venous drainage and progressive venous congestion, which can lead to irreversible brain injury characterized by hypoperfusion, gliosis, atrophy, and calcifications. Seizures commonly develop before the age of 2, underscoring the importance of early recognition. Magnetic resonance imaging (MRI) plays a central role in evaluating cerebral involvement in SWS. Although conventional MRI is widely used to identify late-stage features like pial-arachnoid enhancement and cortical atrophy, it also holds potential for detecting early changes when interpreted within the appropriate clinical context. Advanced MRI techniques, including susceptibility-weighted imaging and arterial spin labeling perfusion, provide enhanced sensitivity for identifying early perfusion disturbances and venous anomalies, offering important insights into the progressive pathophysiology of the disease. This review highlights the complementary roles of conventional and advanced MRI techniques in detecting early and evolving imaging features of SWS, pairing imaging findings with its underlying pathophysiology, to support timely diagnosis.

Transabdominal pelvic ultrasound plays a pivotal role in the evaluation of pediatric gynecologic pathology, such as Müllerian anomalies and intrauterine device (IUD) malposition. The diagnostic value of this examination can be significantly increased by adding three-dimensional (3D) images, which offer true coronal reconstructions and enhance anatomic detail. Increasing the yield of the examination has the potential to spare the patient discomfort, time, and/or cost. This pictorial essay explores the applications of this widely available, but underutilized, tool while providing embryologic context and pathologic background for some of the most consequential diagnoses radiologists must recognize.

Background: Phase-resolved functional lung (PREFUL) MRI offers a more accessible alternative to hyperpolarized ¹²⁹Xe MRI (Xe-MRI) for monitoring treatment response in pediatric cystic fibrosis (CF), but longitudinal comparisons are limited.

Objective: To assess longitudinal lung function changes following elexacaftor/tezacaftor/ivacaftor (ETI) treatment initiation in CF children using PREFUL MRI, in comparison with Xe-MRI and pulmonary function tests (PFTs).

Materials and methods: PREFUL MRI, Xe-MRI, and PFTs were performed in 14 CF patients (median [IQR] age 15 [14-16.5] years old) at baseline and 1 month, 6 months, 12 months, and 24 months following initiation of ETI treatment. Ventilation and defect percentage (VDP) was derived from PREFUL MRI (regional ventilation VDP, VDP_RVent; regional-flow volume loop cross-correlation VDP, VDP_CC; and the combination of VDP_RVent and VDP_CC, VDP_combined) and Xe-MRI (VDP_Xe) maps. Perfusion defect percentage (QDP) was derived from normalized perfusion maps and, with VDP_combined, determined the percentage of healthy ventilation-perfusion matching (VQM). Significance of 1-month treatment changes was determined using the Wilcoxon-signed rank test and was correlated between metrics using Spearman ranked correlation.

Results: All PREFUL measures significantly improved (P < 0.01) 1-month post-treatment in agreement with changes in Xe-MRI VDP and PFTs (P < 0.03). The absolute change in VDP_CC and VDP_combined significantly correlated with VDP_Xe (r ≥ 0.62, P < 0.02), unlike VDP_RVent (P = 0.35). The change in QDP did not correlate with any metric (P > 0.10). PREFUL MRI and Xe-MRI measures showed minimal changes 1 to 24 months post-treatment (median changes = -2.3% to 1.4%), in agreement with PFTs.

Conclusion: PREFUL MRI detects longitudinal treatment-related changes in pulmonary ventilation and perfusion in CF children post ETI.

Background: Radiography is routinely used to evaluate the pediatric and young adult pelvis and hips. Unfortunately, the 2D nature of this imaging modality is insufficient in accurately depicting and evaluating complex 3D anatomical structures. In contrast, computed tomography (CT) provides exquisite details of 3D anatomy, typically at the expense of a higher radiation dose. Recent studies have suggested that ultra-low-dose CT (ULDCT) with tin filtration may overcome this diagnostic imaging dilemma by offering high-quality CT images with reduced radiation exposure.

Objective: To compare patient-specific radiation exposure of diagnostic-quality hip ULDCTs and pelvic radiographs and thereby validate an optimized clinical protocol for hip ULDCT imaging in pediatric and young adult patients.

Materials and methods: We retrospectively searched the image archive at our large tertiary children's hospital for hip CTs and anteroposterior (AP) pelvic radiographs performed within 6 months of each other (Dec 2023 - May 2024). The inclusion criteria were (1) hip CTs performed in accordance with our established ULDCT imaging protocol and (2) AP pelvic radiographs acquired in accordance with the American College of Radiology (ACR) guidelines. To calculate the effective doses of the pelvic radiographs and hip CTs, we used the National Cancer Institute dosimetry system for Radiography and Fluoroscopy (NCIRF) and Computed Tomography (NCICT), respectively. A paired two-tailed t-test was used to compare the effective doses of the hip CTs and AP pelvic radiographs.

Results: The study cohort included 29 patients (9 males, 20 females), stratified into the pediatric group (<18 years, n=17), young adult group (18-30 years, n=12), and entire cohort, with mean ages of 10.7 (SD, 6.0), 22.3 (SD, 3.7), and 15.5 (SD, 6.9) years, respectively. The average effective doses from ULDCT were 0.33 mSv (pediatric), 0.23 mSv (young adult), and 0.29 mSv (entire cohort), not significantly different from AP pelvic radiograph doses of 0.26, 0.29, and 0.27 mSv, respectively. In contrast, cumulative radiographic doses were significantly higher at 0.73 mSv, 0.76 mSv, and 0.74 mSv.

Conclusion: ULDCT is a clinically feasible approach for pediatric and young adult hip imaging, offering diagnostic-quality CT images with substantially reduced radiation exposure (at a radiation dose level comparable to that of a single AP pelvic radiograph).

Upper urinary tract abnormalities are commonly encountered on fetal imaging. While ultrasound (US) remains the primary imaging modality for evaluation of the fetal kidneys, magnetic resonance imaging (MRI) can play a significant complementary role in the diagnosis and management of these patients with upper urinary tract abnormalities. This paper will review the most common prenatal pathologies encountered in the kidneys, including urinary tract dilatation (UTD), renal agenesis, renal ectopia, multicystic dysplastic kidney (MCDK), and other cystic renal diseases, and will include a discussion of when and why fetal MRI should be considered in these diagnoses. Images from prenatal US and fetal MRI examinations will be included.