Pediatric Radiology最新文献

Background: Infant MRI is limited by motion and the frequent reliance on general anesthesia (GA), which suppresses motion but increases procedural risk, resource use, and turnover time. A sedation-free alternative is the feed-and-wrap (FW) technique-natural sleep supported by swaddling and noise control-which avoids anesthesia but can be limited by motion and variable success. Deep-learning (DL)-based image reconstruction shortens acquisitions and improves image quality, potentially strengthening the FW pathway (DL-FW) by reducing scan time and repeat sequences.

Objective: Our study aimed to investigate whether, compared with GA, DL-FW reduces MRI turnover time in infants younger than 4 months.

Materials and methods: In this single-center retrospective study, we included consecutive infants aged ≤4 months who underwent brain MRI during the study period and met predefined criteria. Infants underwent either DL-FW or GA according to institutional practice. The primary endpoint was the turnover time of the MRI room, defined as the interval from the starting point to the end of the procedure. Times are summarized as median (IQR) and mean±SD; groups were compared using a two-sided Mann-Whitney U test (α=0.05). The between-group shift was estimated with the Hodges-Lehmann (HL) estimator and 95% confidence interval (CI).

Results: Forty-eight infants were analyzed (DL-FW n=22; GA n=26). Turnover time was shorter with DL-FW (23 min [21-27], mean±SD 26.8±11.3, range 14-52) versus GA (30 min [27-38], 32.6±9.8, 19-58), and the difference was significant (U=166; z= - 2.48; P=0.013). The HL estimator indicated that the GA turnover time exceeded that of DL-FW by 6 min (95% CI 2-11), corresponding to a 7-min reduction in group medians (~23% relative to GA). No data were missing.

Conclusion: In infants aged ≤4 months, a DL-FW pathway with an infant MRI stabilizer was associated with significantly shorter MRI room turnover time than GA was, supporting the use of DL-FW as an anesthesia-sparing approach that may improve workflow and safety.

Background: Temporal bone computed tomography (CT) is essential for evaluating ear diseases but requires awareness of normal variations to avoid misdiagnosis. The cochlear cleft, seen as pericochlear CT hypoattenuation, reflects incomplete endochondral ossification and mainly occurs in children. Although a normal variant, it can mimic conditions such as otosclerosis. Data on its prevalence and extent in children, especially in relation to hearing status and other temporal bone findings, remain limited.

Objective: The aim of our study is to evaluate the overall prevalence of cochlear clefts in children and to determine their clinical significance.

Materials and methods: A total of 404 temporal bone CTs without pathologies were reviewed retrospectively by two neuroradiologists. The prevalence and the extent (mild, moderate, or extensive) of pericochlear CT hypoattenuation, representing the cochlear cleft, were recorded, and their correlation with clinical findings was evaluated.

Results: Among 404 CTs examined, cochlear clefts were observed in 135 cases (33.4%). The presence of cochlear clefts was independently associated with a younger age group (0-4 years old, P-value <0.001), but not with other parameters such as sex, hearing loss status, inner ear anomalies, or other temporal bone pathologies.

Conclusion: Cochlear clefts are an anatomical variation that is prevalently associated with younger age. Thus, pericochlear CT hypoattenuation in young children should be interpreted with caution, as it can be caused either by cochlear clefts (an anatomical variation) or by pathologies. Radiologists should be aware of and recognize cochlear clefts to avoid unnecessary medical or surgical interventions.

Abdominal compartment syndrome is a life-threatening condition caused by elevated intra-abdominal pressure, leading to impaired organ perfusion and dysfunction. In pediatric patients-especially neonates-diagnosis is challenging due to non-specific signs and limited clinical awareness. Pediatric abdominal compartment syndrome remains underrepresented in the literature, with few published cases and no standardized guidelines for diagnosis or management in this age group. We report the case of a premature newborn from a twin pregnancy who developed abdominal compartment syndrome following surgical repair of an omphalocele, emphasizing the value of ultrasound as an effective tool for the diagnosis and monitoring of abdominal compartment syndrome. This report contributes to the limited evidence available, highlighting the need for vigilance in similar high-risk scenarios, as early recognition and timely intervention are crucial to prevent irreversible damage.

Non-Hodgkin lymphomas (NHL) are a heterogeneous group of lymphoid malignancies, whose subtypes vary regarding radiological presentation, clinical course, and prognosis. Imaging plays a major role in initial diagnosis, staging, assessment of treatment response, and complications. Early diagnosis and treatment of paediatric NHL are crucial, due to the highly aggressive nature of the majority of subtypes in paediatric patients. Unlike adults, low-grade lymphomas are seldomly seen in children. Initial correct diagnosis can be challenging given the predominantly extranodal origin with subsequent overlap with other diseases. In this pictorial review, we describe the imaging features at presentation of the most common NHL subtypes in children. We highlight certain characteristics that can support clinical decision-making, especially relevant in scenarios that require prompt management. Furthermore, the recently introduced classification and staging criteria are briefly discussed.

Background: Talocalcaneal coalition is highly prevalent but diagnostically challenging due to the subtalar joint's complex anatomy, leading to frequent oversights on conventional radiographs. Existing signs rely primarily on lateral views, with variable sensitivity.

Objective: To introduce and validate the "gorilla lip" sign on non-weight-bearing anteroposterior (AP) radiographs as a complementary diagnostic marker for talocalcaneal coalition.

Materials and methods: In this retrospective study, non-weight-bearing AP ankle radiographs of 30 talocalcaneal coalition-confirmed feet (positive group) and 33 normal feet (negative group) from children aged ≤17 years were analyzed. The "gorilla lip" sign was defined by sustentaculum tali abnormalities: (1) osseous protuberance ≥50% medial malleolus height, (2) narrowed and rough articular surface, or (3) absent joint space. Three blinded observers independently assessed randomized images twice (2-month interval). Sensitivity, specificity, likelihood ratios, and inter-/intraobserver reliability were calculated.

Results: Across two evaluations by three observers, sensitivity ranged from 77-93%, and specificity ranged from 85-100%. Positive likelihood ratios were ranging from 5.28 to infinite, indicating a high probability of talocalcaneal coalition when the sign is present, while low negative likelihood ratios (ranging from 0.07 to 0.24) suggest its absence is a strong indicator to rule out talocalcaneal coalition. The sign showed good interobserver reliability (Fleiss kappa, 0.65-0.70) and good to excellent intraobserver reliability (kappa, 0.67-0.87).

Conclusions: The "gorilla lip" sign is a highly sensitive, specific, and reproducible radiographic marker for diagnosing talocalcaneal coalition on non-weight-bearing AP ankle radiographs. Its application can complement traditional lateral view signs, enhancing diagnostic confidence and potentially reducing unnecessary examinations prompted by misdiagnosis.

Background: Low birth weight and preterm infants may have higher risks of poor health. As the key brain region for learning and memory, normal development of the hippocampus is crucial for the cognitive abilities of preterm infants.

Objective: This study aimed to analyze hippocampal glutamate (Glu) levels and morphometric changes in preterm infants at term-equivalent age (TEA) with different birth weights.

Materials and methods: Eighty-seven infants (23 full-term infants and 64 preterm infants) born between 2023 and 2025, underwent magnetic resonance imaging (MRI) at TEA. Glutamate chemical exchange saturation transfer (GluCEST) MRI and 3D-SPACE were used to assess hippocampal Glu levels and morphometric changes. The preterm cohort was categorized by birth weight: preterm infants born at extremely and very low birth weight (Group 1), preterm infants born at low birth weight (Group 2) and preterm infants born at normal birth weight (Group 3). Full-term infants born at normal birth weight (Group 4) were included as controls.

Results: Group 1 exhibited elevated Glu levels, Group 2 showed intermediate Glu levels. In infants with normal birth weight, preterm at TEA have higher glutamate levels than full-term infants. No differences were observed in the bilateral hippocampal Glu levels within each group. The bilateral hippocampal volume, surface area, and long diameter in Group 1 were all significantly smaller than those in Group 3. Morphological analysis revealed rightward hippocampal asymmetry in all preterm groups.

Conclusion: Birth weight significantly influences hippocampal glutamate levels and morphology in preterm infants. These findings offer new insights into the metabolic variations in preterm neurodevelopment.

Background: Abnormal diffusion tensor imaging (DTI) metrics have been reported both near and distant from non-hemorrhagic punctate white matter lesions, suggesting abnormal brain connectivity.

Objective: To evaluate the effect of non-hemorrhagic punctate white matter lesions on both structural and functional brain connectivity in preterm infants.

Materials and methods: DTI and resting-state functional magnetic resonance imaging (rs-fMRI) data acquired around term-equivalent age were analyzed using graph theory in nine preterm infants with non-hemorrhagic punctate white matter lesions (gestational age: mean±SD, 31.5 weeks±2.5 weeks) and nine gestational age-matched controls (mean, 31.4 weeks±2.5 weeks).

Results: Both groups exhibited modularity, small-world topology, and rich-club organization. Compared with controls, infants with non-hemorrhagic punctate white matter lesions showed increased diffusion efficiency (0.0098±0.0003 vs. 0.0093±0.0003, P=0.03) in functional connectivity. In structural connectivity, the non-hemorrhagic punctate white matter lesions group demonstrated (a) increased betweenness centrality in the opercular part of the right inferior frontal gyrus (227.3±93.9 vs. 164.9±3.2, P<0.01); (b) increased characteristic path length in the left superior parietal lobe (48.7±3.1 vs. 46.9±3.1, P<0.01), left inferior parietal lobe (53.0±3.3 vs. 50.8±3.5, P<0.01), and right angular gyrus (61.1±4.3 vs. 55.8±4.3, P<0.01); and (c) increased participation coefficient in the inferior temporal gyrus (0.14±0.20 vs. 0.03±0.09, P<0.01).

Conclusions: In preterm infants, non-hemorrhagic punctate white matter lesions appear to disrupt modularity in functional networks and structural connectivity in the dorsal visual stream, with compensatory changes in the ventral stream. They are also associated with increased structural connectivity in regions linked to risk aversion.

Background: Radiographers play a crucial role in ensuring the safe and effective delivery of iodinated contrast media in pediatric CT imaging. However, practice variability across institutions, such as differences in contrast medium dosing protocols, injection techniques, and timing of image acquisition, raises concerns about consistency, patient safety, and diagnostic quality.  OBJECTIVE: To examine the range of real-world practices in pediatric iodinated contrast medium administration, focusing on protocol adherence and variations in technique.  MATERIALS AND METHODS: An international cross-sectional survey was conducted among 103 CT radiographers. The online questionnaire assessed demographic data, clinical practices, protocol modification behaviors, and institutional procedures. Data were collected over 9 weeks and analyzed using descriptive and comparative statistics to identify trends and practice variability.

Results: The findings revealed considerable variability in iodinated contrast medium administration practices, including differences in injection rates, contrast volumes, catheter gauge selection, and use of saline flush techniques. Although 93.2% of participants reported confidence in modifying contrast protocols, knowledge assessments showed that 75.7% of radiographers scored in the "Poor" category, with no participants achieving an "Excellent" score. Additionally, many respondents reported relying on experience-based practices rather than standardized institutional guidelines, contributing to inconsistent contrast delivery approaches. No significant associations were found between demographic factors and reported practices, suggesting variability exists across all levels of education and experience.

Conclusion: The study highlights inconsistencies in pediatric iodinated contrast medium delivery practices among CT radiographers, emphasizing the need for standardized protocols and structured training programs. Addressing these inconsistencies is crucial for improving diagnostic quality, patient safety, and promoting consistency in best practices across clinical settings.