Ultrasound is currently recommended as the first-line examination for abdominal symptoms in children. However, a pediatric radiologist is not always available on site, especially during on-call duty. ...This study was aimed at evaluating the reliability of an innovative 3-D virtual abdominal tele-ultrasonography in this context. A prospective study was conducted between December 2020 and May 2021 that recruited 103 children undergoing ultrasound for abdominal pain. Trauma cases were excluded. Four tridimensional acquisitions were performed with a Smart Sensor 3D device (Canon Medical Systems, Otawara, Japan). Each tele-ultrasonography was secondarily blindly reviewed by two radiologists (one senior and one resident) with Fusion software (Canon Medical Systems). Acceptance and quality of the acquisitions were evaluated on a Likert scale. Inter-rater reliability was quantified using Cohen's κ coefficient and intraclass correlation coefficient. The ultrasound examination was normal in 66 cases (64%), abnormal in 36 cases (35%) and inconclusive in 1 case (1%). The acquisitions were obtained without objections from the children, their parents or the operators in more than 95% of cases. The quality of the acquisitions was considered good to excellent in 84% and 70% of cases. The sensitivity of the senior radiologist and the resident was 86% and 84%, respectively; specificity was 95% and 92%, positive predictive value 92% and 86% and negative predictive value 92 and 91% when comparing the conclusions of the standard and the tele-ultrasound examinations. Cohen's κ coefficients of the diagnosis obtained with the standard and the tele-ultrasound examinations were 0.82 and 0.71, respectively. The inter-rater Cohen's κ coefficient was 0.84. The intraclass correlation coefficient between the standard abdominal examination and the 3-D tele-ultrasound reformatted images for the following quantitative variables on pathological cases was 0.99 (confidence interval: 0.98-0.99). Virtual abdominal tele-ultrasonography is a promising method in pediatric emergencies.
Purpose
Although lumbar spondylolysis is encountered in general population with an incidence estimated to be 3–10%, limited information is available for children. The aim of the study is to determine ...the prevalence of spondylolysis according to associated vertebral bony malformation and spinopelvic parameters in children under eight requiring CT evaluation for unrelated lumbar conditions.
Methods
Seven hundred and seventeen abdominal and pelvic multi-detector CT scans were obtained in patients under 8 years of age were reviewed. Two board certificated radiologists and two resident radiologists retrospectively evaluated CT scans for lumbar spondylolysis and associated malformations. Pelvic incidence and spondylolisthesis were reported.
Results
Our analysis included 717 CT scans in 532 children (259 girls and 273 boys). Twenty-five cases of spondylolysis were diagnosed (16 bilateral and 9 unilateral, 64 and 36%, respectively) in 14 boys (56%) and 11 girls (44%), associating with 12 grade I spondylolisthesis. The mean normal pelvic incidence was 45° (median 44°, SD 7°). The prevalence of spondylolysis was 1% in children under age 3 (
n
= 3 among 292 patients), 3.7% in children under age 6 (
n
= 17 among 454 patients) and 4.7% among the 532 patients. Unilateral spondylolysis was significantly associated with a spinal malformation (
p
= 0.04, Fisher’s exact test), with normal pelvic incidence. Half of the patients with bilateral spondylolysis had high pelvic incidence.
Conclusions
We observed a prevalence peak of unilateral spondylolysis in the context of a specific malformation in young infants under age 4 with normal pelvic incidence, and, then, a progressive increase in the prevalence of bilateral isolated spondylolysis.
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•Malformations, tumors, or traumatic pathologies inducing significant contrast or morphological abnormalities were easily diagnosed by radiologists.•Brain volume abnormalities were ...poorly detected by radiologists.•Widespread use of automated brain MRI segmentation would help better analyze normal and pathological brain development.
It can be challenging to depict brain volume abnormalities in the pediatric population on magnetic resonance imaging (MRI). The aim of the study was to evaluate the inter-radiologist reliability in brain MRI interpretation, including brain volume assessment and the efficiency of an automated brain segmentation.
We performed a single-center prospective study including 44 patients aged six months to five years recruited from the University Hospital, having a 1.5T brain MRI using a MP2RAGE sequence. All MRI were randomly and blindly reviewed by one junior and two senior pediatric radiologists. Inter-observer agreements were assessed using Fleiss’ kappa coefficient. Brain volumetry (total intracranial volume (TIV), brain parenchyma, and cerebrospinal fluid volumes) was estimated using the MorphoBox prototype. Clinical head circumference (HC) and z scores were reported. A Pearson correlation coefficient was calculated between brain volumes with HC.
Twenty-four brain MRI examinations were normal and twenty were pathological. Brain volume abnormalities were poorly detected by junior and senior radiologists: sensitivities 16.67% confidence interval 4.7–44.8, 33.33% 13–60 and 30.7% 12–58 and specificities 93.75% 79–98, 84.38% 68–93 and 77% 60–88, respectively. Brain volume apart, interobserver kappa coefficients were 0.93 between junior and seniors as well as between seniors. Brain volumes were significantly correlated with HC (P<0.0001). In patients with normal MRI, brain parenchyma volumes increased regularly with age. Low brain volume was easier to identify with automated quantification.
Brain volume was poorly appreciated by radiologists. The fully automated brain segmentation used can provide quantitative data to better diagnose, describe, and follow-up brain volume abnormalities.
Objectives
To assess the contribution of whole-body magnetic resonance imaging (WBMRI) and bone scintigraphy (BS) in addition to skeletal survey (SS) in detecting traumatic bone lesions and ...soft-tissue injuries in suspected child abuse.
Methods
In this prospective, multicentre, diagnostic accuracy study, children less than 3 years of age with suspected physical abuse were recruited. Each child underwent SS, BS and WBMRI. A blinded first review was performed in consensus by five paediatric radiologists and three nuclear medicine physicians. A second review investigated discrepancies reported between the modalities using a consensus result of all modalities as the reference standard. We calculated the sensitivity, specificity and corresponding 95% confidence interval for each imaging modality (SS, WBMRI and BS) and for the combinations SS + WBMRI and SS + BS.
Results
One hundred seventy children were included of which sixty-four had at least one lesion. In total, 146 lesions were included. The sensitivity and specificity of each examination were, respectively, as follows: 88.4% 95% CI, 82.0–93.1 and 99.7% 95% CI, 99.5–99.8 for the SS, 69.9% 95% CI, 61.7–77.2 and 99.5% 95% CI, 99.2–99.7 for WBMRI and 54.8% 95% CI, 46.4–63.0 and 99.7% 95% CI, 99.5–99.9 for BS. Sensitivity and specificity were, respectively, 95.9% 95% CI, 91.3–98.5 and 99.2% 95% CI, 98.9–99.4 for the combination SS + WBMRI and 95.2% 95% CI, 90.4–98.1 and 99.4% 95% CI, 99.2–99.6 for the combination SS + BS, with no statistically significant difference between them.
Conclusion
SS was the most sensitive independent imaging modality; however, the additional combination of either WBMRI or BS examinations offered an increased accuracy.
Key Points
•
SS in suspected infant abuse was the most sensitive independent imaging modality in this study, especially for detecting metaphyseal and rib lesions, and remains essential for evaluation.
•
The combination of either SS + BS or SS + WBMRI provides greater accuracy in diagnosing occult and equivocal bone injuries in the difficult setting of child abuse.
•
WBMRI is a free-radiation technique that allows additional diagnosis of soft-tissue and visceral injuries.
We present a case of a fetal dyshormonogenetic goiter diagnosed by ultrasound examination at 24 weeks of gestation, in a woman with no past history of thyroid disease or goitrogen treatment and with ...normal thyroid tests, including absence of auto-antibodies. In this situation, fetal goiter may only be associated with fetal hypothyroidism, therefore cord blood sampling was not performed but early treatment was initiated. Amniotic fluid instillation of thyroid hormone led to a rapid decrease in amniotic fluid volume and a clear reduction in thyroid goiter. However, fetal thyroid volume did not totally normalise, and cord blood analysis at birth showed elevated fetal TSH level. As prenatal treatment of fetal hypothyroidism remains controversial in euthyroid mothers, the main objective is to prevent obstetrical complications of large goiters. Therefore, in some selected cases with no maternal history of thyroid disease and normal thyroid function tests, cordocentesis is not necessary to confirm fetal thyroid status or to adjust fetal treatment.
Background
The aim of this preliminary study is to evaluate the results of T1-weighted dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) in pediatric patients at 1.5T, with a low ...peripheral intravenous gadoteric acid injection rate of 1 ml/s.
Materials and methods
Children with neurological symptoms were examined prospectively with conventional MRI and T1-weighted DCE MRI. An magnetic resonance perfusion analysis method was used to obtain time–concentration curves (persistent pattern, type-I; plateau pattern, type-II; washout pattern, type-III) and to calculate pharmacokinetic parameters. A total of two radiologists manually defined regions of interest (ROIs) in the part of the lesion exhibiting the greatest contrast enhancement and in the surrounding normal or contralateral tissue. Lesion/surrounding tissue or contralateral tissue pharmacokinetic parameter ratios were calculated. Tumors were categorized by grade (I–IV) using the World Health Organization (WHO) Grade. Mann–Whitney testing and receiver-operating characteristic (ROC) curves were performed.
Results
A total of nine boys and nine girls (mean age 10.5 years) were included. Lesions consisted of 10 brain tumors, 3 inflammatory lesions, 3 arteriovenous malformations and 2 strokes. We obtained analyzable concentration–time curves for all patients (6 type-I, 9 type-II, 3 type-III). Ktrans between tumor tissue and surrounding or contralateral tissue was significantly different (p = 0.034). Ktrans ratios were significantly different between grade I tumors and grade IV tumors (p = 0.027) and a Ktrans ratio value superior to 0.63 appeared to be discriminant to determine a grade IV of malignancy.
Conclusions
Our results confirm the feasibility of pediatric T1-weighted DCE MRI at 1.5T with a low injection rate, which could be of great value in differentiating brain tumor grades.
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