Pediatric Radiology最新文献

Background: The rising prevalence of paediatric liver disease, including metabolic dysfunction- associated steatotic liver disease, highlights the need for reliable, non-invasive diagnostic tools. Advanced ultrasound techniques such as shear wave elastography (SWE), shear wave dispersion (SWD), and attenuation imaging (ATI) offer promising alternatives to biopsy or magnetic resonance imaging, but normative paediatric values remain limited.

Objective: This study aimed to establish age-specific reference values for SWE, SWD, and ATI in healthy children and to assess potential influencing factors such as age, sex, body mass index (BMI), and fasting duration.

Materials and methods: In this retrospective study, 264 children (135 female, median age 11.5 years) without known liver disease were selected from a cohort of 734. Each child underwent liver ultrasound using a standardized protocol with five ATI and ten SWE/SWD measurements. Only high-quality data were included. Statistical analyses examined correlations between imaging parameters and patient characteristics.

Results: The median ATI was 0.54 dB/cm/MHz [interquartile range (IQR):0.50-0.58], SWE was 1.24 m/s (IQR:1.14-1.33) and SWD was 11.70 (m/s)/kHz (IQR:10.84-12.13). ATI and SWD values showed significant negative correlations with age (P < 0.001 and P = 0.0048, respectively). SWD also correlated negatively with BMI z-score (P < 0.001) and was significantly lower in females (P = 0.001). SWE showed only a weak positive correlation with measurement depth (P = 0.0261). Fasting duration had no significant impact on any measurement.

Conclusion: This study provides reference values for SWE, SWD, and ATI in children. Age and sex influence SWD and ATI values, underscoring the importance of age-specific interpretation in paediatric liver ultrasound.

Fetal caecal volvulus is an extremely rare entity, scarcely reported in antenatal imaging literature. Early diagnosis and prompt surgical intervention are crucial to prevent bowel necrosis, fetal demise and post-natal complications. We present a rare case of fetal caecal volvulus at 34 weeks of gestational age, diagnosed on antenatal ultrasound and fetal magnetic resonance imaging mimicking a heterogenous cystic intra-abdominal mass and confirmed on post-natal surgery. To our knowledge, caecal volvulus has never been reported in existing fetal imaging literature. This case highlights the importance of antenatal imaging in differentiating abdominal masses and detecting rare gastrointestinal emergencies in utero.

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.