Pediatric Radiology最新文献

The after-hours period presents unique challenges for pediatric radiologists. These stem from the higher percentage of high acuity/emergent studies, limited staffing, and the adverse effects of non-traditional hours on radiologists' health and performance. This article describes the current landscape of after-hours pediatric radiology coverage, workflow, and staffing challenges, and reviews the impact that disruptions in circadian rhythm can have on health and performance.

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.

Background: Extensive cervicofacial lymphatic malformations can compromise the neonatal airway. Fetal magnetic resonance imaging (MRI) is useful in airway assessment but it is not known how well the fetal MRI findings correspond to postnatal MRI.

Objective: To describe and compare fetal and postnatal MRI findings of patients who required tracheostomy in the neonatal period due to large cervicofacial lymphatic malformations. To examine the usefulness of the tracheoesophageal displacement index (TEDI) in cervicofacial lymphatic malformation patients.

Materials and methods: A single-institution, retrospective case series of patients who had been tracheostomized due to cervicofacial lymphatic malformations and had undergone at least one fetal MRI between 2007-2024. The anatomical areas involved and airway effects in fetal and postnatal MRIs were assessed. The TEDI was measured for 40 fetuses imaged for reasons other than a cervical or upper thoracic mass for comparison.

Results: A total of six fetuses were identified. Marked retropharyngeal extension was present in 5/6 cases. Third-trimester fetal MRI corresponded well with postnatal MRI findings. Patients with prenatal intralesional hemorrhage continued to have postnatal intralesional bleeding. TEDI values became abnormally elevated (>12) in the third trimester in fetuses with a tracheostomy requirement postnatally.

Conclusion: Fetal MRI is a valuable tool for anticipating neonatal airway obstruction in cervicofacial lymphatic malformations. Retropharyngeal extension of the malformation and a TEDI >12 in fetal MRI should alert to the possibility of significant airway compromise postnatally.

Artificial intelligence (AI) has potential to revolutionize radiology, yet current solutions and guidelines are predominantly focused on adult populations, often overlooking the specific requirements of children. This is important because children differ significantly from adults in terms of physiology, developmental stages, and clinical needs, necessitating tailored approaches for the safe and effective integration of AI tools. This multi-society position statement systematically addresses four critical pillars of AI adoption: (1) regulation and purchasing, (2) implementation and integration, (3) interpretation and post-market surveillance, and (4) education. We propose pediatric-specific safety ratings, inclusion of datasets from diverse pediatric populations, quantifiable transparency metrics, and explainability of models to mitigate biases and ensure AI systems are appropriate for use in children. Risk assessment, dataset diversity, transparency, and cybersecurity are important steps in regulation and purchasing. For successful implementation, a phased strategy is recommended, involving early pilot testing, stakeholder engagement, and comprehensive post-market surveillance with continuous monitoring of defined performance benchmarks. Clear protocols for managing discrepancies and adverse incident reporting are essential to maintain trust and safety. Moreover, we emphasize the need for foundational AI literacy courses for all healthcare professionals which include pediatric safety considerations, alongside specialized training for those directly involved in pediatric imaging. Public and patient engagement is crucial to foster understanding and acceptance of AI in pediatric radiology. Ultimately, we advocate for a child-centered framework for AI integration, ensuring that the distinct needs of children are prioritized and that their safety, accuracy, and overall well-being are safeguarded.

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: Intussusception, a serious condition where the intestine folds in on itself, is a leading cause of bowel obstructions in children. The global standard of care has shifted towards non-surgical procedures as a first response. However, evidence supporting the effectiveness and safety of this approach specifically within Sub-Saharan Africa has been scarce and disjointed. Our research systematically gathered and analyzed the existing data from the region to provide a clearer assessment.

Methods: We searched PubMed, Scopus, Web of Science, African Journals Online, and Google Scholar from inception (earliest date covered by each database) to March 2025 for studies reporting outcomes of non-operative reduction in children with intussusception in Sub-Saharan Africa. Eligible studies focused primarily on non-operative reduction with clearly reported outcomes. Data were extracted independently by two reviewers, and study quality was assessed using the Newcastle-Ottawa Scale. Meta-analyses were performed using random-effects models for sex distribution and treatment outcomes, while complications, recurrence, and mortality were synthesized narratively. Certainty of evidence was evaluated using the GRADE framework.

Results: Nine studies including 536 patients met the inclusion criteria. The pooled male prevalence was 67% (95%CI 60-74%), and the mean age ranged from 2.8 months to 21 months. The overall success rate of non-operative reduction was 78% (95%CI 71-86%; I² = 78.6%), while the failure rate was 22%. Success rates were higher in studies published after 2022 (≥81.6%) compared to earlier reports (≤73.1%). The pooled perforation rate was 3% (95%CI 0-6%), with a single procedure-related mortality reported. Recurrence occurred in 7% (95%CI 3-12%) of patients. Delayed presentation, pathological lead points, and absent Doppler flow were consistent predictors of failure. Certainty of evidence was moderate for sex prevalence, low for success/failure, and low to very low for complications, recurrence, and mortality.

Conclusion: Non-operative reduction of pediatric intussusception in Sub-Saharan Africa is effective and safe, with outcomes improving in recent years, particularly with ultrasound guidance. Delayed presentation remains the major barrier to success. Expanding access to imaging, strengthening referral systems, and standardizing reporting are essential to improve outcomes and evidence quality in the region.

The increasing integration of artificial intelligence (AI) into radiology practice presents both opportunities and challenges for the education of future radiologists. This review critically examines the interplay between AI, the theory of deliberate practice, and radiology training. Deliberate practice, defined by focused, goal-directed activities with immediate feedback and opportunities for refinement, has been shown to be superior to traditional volume- and experience-based learning models in developing clinical expertise. AI integration risks attenuating essential learning processes by reducing primary interpretation opportunities, fostering automation bias, and promoting over-reliance on "black box" algorithms. However, AI also offers a powerful educational adjunct through precision learning, curating personalised learning experiences based on individual needs. AI can identify diagnostic errors in real time and enhance feedback mechanisms, aligning with deliberate practice principles. We argue that AI must be deliberately incorporated into radiology training to safeguard and enhance the development of diagnostic expertise. We also consider the impact AI will have on the role of the future radiologist and the importance and challenges of acquiring the necessary non-interpretative skills. We propose evidence-based recommendations for the integration of AI into residency programmes, emphasising the need for AI literacy, preservation of exposure to normal imaging findings, maintenance of primary interpretation skills, and structured feedback. We contend that thoughtful application of AI technologies offers the potential to optimise deliberate practice, accelerate skill acquisition, and ensure that future radiologists are equipped not only to work alongside AI but to surpass its limitations with superior clinical judgment and expertise.

Twin pregnancies are at increased risk of perinatal morbidity and mortality. Ultrasound imaging is a critical component of twin management, allowing earlier identification and management of potential complications. Ultrasound for twin gestations should begin in the first trimester, and the timing of follow-up scans is based on the chorionicity and amnionicity of the gestation. In dichorionic twins, ultrasound can detect discordant malformations, discordant growth, and increased risk for preterm delivery. In monochorionic twins, ultrasound not only allows similar surveillance as for dichorionic twins but also monitors for evidence of twin-twin transfusion syndrome (TTTS), twin anemia polycythemia sequence (TAPS), selective fetal growth restriction (sFGR), and twin reversed arterial perfusion (TRAP) sequence that may require in utero surgical intervention.

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.

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.