MRI for Pediatric Appendicitis in an Adult-Focused General Hospital: A Clinical Effectiveness Study-Challenges and Lessons Learned.

OBJECTIVE: The objective of our study was to determine the feasibility and accuracy of MRI for pediatric appendicitis in an adult-predominant general hospital setting where non-pediatric-trained radiologists routinely interpret the studies. MATERIALS AND METHODS: MRI was performed in pediatric patients with equivocal ultrasound (US) findings and persistent clinical concern for appendicitis. Neither IV contrast material nor a sedative was administered. Our MRI protocol evolved early during the study period, quickly settling on three sequences (total scanning time, 11 minutes). The clinical reference standard for statistical analysis was appendicitis diagnosed on operative or pathology report; 95% Clopper-Pearson CIs were calculated. RESULTS: Between 2012 and 2016, 528 pediatric patients (mean age, 9.9 years; age range, 1-17 years) underwent MRI after US evaluation yielded equivocal findings: 10.4% (55/528) of patients were found to have surgically proven or pathologically proven appendicitis. Sensitivity and specificity of MRI for appendicitis were 96.4% and 98.9%, respectively. Positive and negative predictive values were 91.2% and 99.6%. A normal appendix and abnormalities not involving the appendix were identified on MRI in 21.6% (114/528) of patients. CONCLUSION: Our data show that unenhanced MRI for suspected appendicitis in pediatric patients is clinically effective when performed in a nonpediatric hospital setting with nonpediatric radiologists, emergency physicians, and surgeons.

A Primary Parotid Mucosa-Associated Lymphoid Tissue Non-Hodgkin Lymphoma in a Patient With Sjogren Syndrome.

The salivary gland tumors are rare entities and the majority of these are benign. However, there are some entities such as prior neck radiation, certain infections, and systemic diseases which should raise the clinical suspicion for a malignant lesion. Patients with Sjogren syndrome are at increased risk for a salivary gland neoplasm, specifically non-Hodgkin lymphoma. While clinical findings play an important role in the initial workup, imaging plays a critical role in the diagnosis and management. This case describes a patient with Sjogren syndrome who presented with a left face mass where imaging was able to confidently diagnose her with a suspicious parotid neoplasm with lymphoma as the favored diagnosis. After histological evaluation, she was diagnosed with primary parotid mucosa-associated lymphoid tissue (MALT) non-Hodgkin lymphoma after which she went on to non-operative management.

Predicting outcomes of steady-state ¹³C isotope tracing experiments using Monte Carlo sampling.

BACKGROUND: Carbon-13 (13C) analysis is a commonly used method for estimating reaction rates in biochemical networks. The choice of carbon labeling pattern is an important consideration when designing these experiments. We present a novel Monte Carlo algorithm for finding the optimal substrate input label for a particular experimental objective (flux or flux ratio). Unlike previous work, this method does not require assumption of the flux distribution beforehand. RESULTS: Using a large E. coli isotopomer model, different commercially available substrate labeling patterns were tested computationally for their ability to determine reaction fluxes. The choice of optimal labeled substrate was found to be dependent upon the desired experimental objective. Many commercially available labels are predicted to be outperformed by complex labeling patterns. Based on Monte Carlo Sampling, the dimensionality of experimental data was found to be considerably less than anticipated, suggesting that effectiveness of 13C experiments for determining reaction fluxes across a large-scale metabolic network is less than previously believed. CONCLUSIONS: While 13C analysis is a useful tool in systems biology, high redundancy in measurements limits the information that can be obtained from each experiment. It is however possible to compute potential limitations before an experiment is run and predict whether, and to what degree, the rate of each reaction can be resolved.