RESUMEN
The physis, or growth plate, is the primary structure responsible for longitudinal growth of the long bones. Diffusion tensor imaging (DTI) is a technique that depicts the anisotropic motion of water molecules, or diffusion. When diffusion is limited by cellular membranes, information on tissue microstructure can be acquired. Tractography, the visual display of the direction and magnitude of water diffusion, provides qualitative visualization of complex cellular architecture as well as quantitative diffusion metrics that appear to indirectly reflect physeal activity. In the growing bones, DTI depicts the columns of cartilage and new bone in the physeal-metaphyseal complex. In this "How I do It", we will highlight the value of DTI as a clinical tool by presenting DTI tractography of the physeal-metaphyseal complex of children and adolescents during normal growth, illustrating variation in qualitative and quantitative tractography metrics with age and skeletal location. In addition, we will present tractography from patients with physeal dysfunction caused by growth hormone deficiency and physeal injury due to trauma, chemotherapy, and radiation therapy. Furthermore, we will delineate our process, or "DTI pipeline," from image acquisition to data interpretation.
Asunto(s)
Imagen de Difusión Tensora , Placa de Crecimiento , Niño , Adolescente , Humanos , Imagen de Difusión Tensora/métodos , Placa de Crecimiento/diagnóstico por imagen , Huesos , Anisotropía , AguaRESUMEN
BACKGROUND: Two-point modified Dixon (mDixon) turbo spin-echo (TSE) sequence provides an efficient, robust method of fat suppression. In one mDixon acquisition, four image types can be generated: water-only, fat-only, in-phase and opposed-phase images. OBJECTIVE: To determine whether PD mDixon TSE water-only and, by proxy, PD in-phase images generated by one acquisition can replace two conventional PD TSE sequences with and without fat suppression in routine clinical MR examination of the knee. MATERIALS AND METHODS: This is a retrospective study of 50 consecutive pediatric knee MR examinations. PD mDixon TSE water-only and PD fat-saturated TSE sequences (acquired in the sagittal plane with identical spatial resolution) were reviewed independently by two pediatric radiologists for homogeneity of fat suppression and detection of intra-articular pathology. Thirteen of the 50 patients underwent arthroscopy, and we used the arthroscopic results as a reference standard for the proton-density fat-saturated and proton-density mDixon results. We used the Kruskal-Wallis rank test to assess difference in fat suppression between the proton-density mDixon and proton-density fat-saturated techniques. We used kappa statistics to compare the agreement of detection of intra-articular pathology between readers and techniques. We also calculated sensitivity, specificity and accuracy between arthroscopy and MR interpretations. RESULTS: Proton-density mDixon water-only imaging showed significant improvement with the fat suppression compared with proton-density fat-saturated sequence (P=0.02). Each observer demonstrated near-perfect agreement between both techniques for detecting meniscal and ligamentous pathology and fair to substantial agreement for bone contusions, and chondral and osteochondral lesions. CONCLUSION: Two-point mDixon water-only imaging can replace conventional proton-density fat-saturated sequence. When same-plane proton-density fat-saturated and non-fat-saturated sequences are required, proton-density water-only and proton-density in-phase image types acquired in the same acquisition shorten the overall examination time while maintaining excellent intra-articular lesion conspicuity.
Asunto(s)
Traumatismos de la Rodilla/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Adolescente , Artroscopía , Niño , Femenino , Humanos , Aumento de la Imagen/métodos , Interpretación de Imagen Asistida por Computador/métodos , Masculino , Estudios RetrospectivosRESUMEN
BACKGROUND: Pancreatic neuroendocrine tumors are not included in the diagnostic criteria for tuberous sclerosis complex, although an association has been described. OBJECTIVE: To investigate the association of pancreatic neuroendocrine tumor in children and young adults with tuberous sclerosis complex and define MRI characteristics of the tumor. MATERIALS AND METHODS: We retrospectively evaluated the abdominal MRI scans of 55 children and young adults with tuberous sclerosis complex for the presence of a pancreatic mass. The scans were performed over a period of 7 years to monitor renal pathology. We obtained each patient's clinical history and treatment protocol from the hospital's electronic medical records. RESULTS: A solid pancreatic mass was identified in 5/55 (9%, 95% confidence interval [CI] 3-20%) patients (4 male) with a mean age of 12.6 years. Four of the lesions were located in the pancreatic tail and one in the pancreatic body. All of the lesions were solid, ovoid and well demarcated, with a mean diameter of 3.1 cm. The masses uniformly demonstrated T1 and T2 prolongation, but their diffusion behavior and post-contrast enhancement varied. The two surgically resected lesions were synaptophysin (+) non-functional pancreatic neuroendocrine tumors on pathology. Two of the patients who did not have surgery were treated with everolimus; one of the lesions has shown interval decrease in size and the other has remained stable. CONCLUSION: Pancreatic tumor is relatively common in children and young adults with tuberous sclerosis complex.
Asunto(s)
Imagen por Resonancia Magnética/métodos , Tumores Neuroendocrinos/diagnóstico por imagen , Tumores Neuroendocrinos/etiología , Neoplasias Pancreáticas/diagnóstico por imagen , Neoplasias Pancreáticas/etiología , Esclerosis Tuberosa/complicaciones , Adolescente , Niño , Preescolar , Terapia Combinada , Medios de Contraste , Femenino , Humanos , Masculino , Tumores Neuroendocrinos/terapia , Neoplasias Pancreáticas/terapia , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE/HYPOTHESIS: Standard chest radiographs are a poor diagnostic tool for pediatric foreign body aspiration. Machine learning may improve upon the diagnostic capabilities of chest radiographs. The objective is to develop a machine learning algorithm that improves the diagnostic capabilities of chest radiographs in pediatric foreign body aspiration. METHOD: This retrospective, diagnostic study included a retrospective chart review of patients with a potential diagnosis of FBA from 2010 to 2020. Frontal view chest radiographs were extracted, processed, and uploaded to Google AutoML Vision. The developed algorithm was then evaluated against a pediatric radiologist. RESULTS: The study selected 566 patients who were presented with a suspected diagnosis of foreign body aspiration. One thousand six hundred and eighty eight chest radiograph images were collected. The sensitivity and specificity of the radiologist interpretation were 50.6% (43.1-58.0) and 88.7% (85.3-91.5), respectively. The sensitivity and specificity of the algorithm were 66.7% (43.0-85.4) and 95.3% (90.6-98.1), respectively. The precision and recall of the algorithm were both 91.8% with an AuPRC of 98.3%. CONCLUSION: Chest radiograph analysis augmented with machine learning can diagnose foreign body aspiration in pediatric patients at a level similar to a read performed by a pediatric radiologist despite only using single-view, fixed images. Overall, this study highlights the potential and capabilities of machine learning in diagnosing conditions with a wide range of clinical presentations. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:3807-3814, 2024.
Asunto(s)
Cuerpos Extraños , Aprendizaje Automático , Radiografía Torácica , Sensibilidad y Especificidad , Humanos , Cuerpos Extraños/diagnóstico por imagen , Estudios Retrospectivos , Radiografía Torácica/métodos , Niño , Preescolar , Femenino , Masculino , Lactante , Algoritmos , Aspiración Respiratoria/diagnóstico por imagen , Aspiración Respiratoria/diagnóstico , AdolescenteRESUMEN
Subcutaneous granuloma annulare (SGA) is a rarely reported subtype of granuloma annulare that occurs almost exclusively in children. The etiology of these lesions is unknown, although a possible relationship to insulin-dependent diabetes mellitus (IDDM) has been proposed in the literature. Here we present an unusual case of SGA on the right forearm in a 3-year-old girl. Unlike the typical lesions noted on the extremities, on magnetic resonance imaging her lesions involved the subcutaneous tissue and adjacent muscles in multiple locations. Histopathologically, the case was consistent with SGA but was unusual in its distribution involving multiple muscles, a finding that has not been previously reported. Weeks after incisional biopsy, she was readmitted with diabetic ketoacidosis (DKA) secondary to IDDM. After treatment of her DKA and control of her glycemia, the forearm SGA vanished, which supported the pathologic diagnosis and alleviated our concerns secondary to the unusual distribution.
Asunto(s)
Diabetes Mellitus Tipo 1/diagnóstico , Granuloma Anular/diagnóstico , Biopsia/métodos , Glucemia/análisis , Preescolar , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 1/patología , Cetoacidosis Diabética/patología , Femenino , Antebrazo/patología , Granuloma Anular/patología , Humanos , Imagen por Resonancia Magnética , Tejido Subcutáneo/patologíaRESUMEN
BACKGROUND: Osteonecrosis of the femoral head is a common complication in patients with sickle cell disease, and collapse of the femoral head occurs in 90% of patients within five years after the diagnosis of the osteonecrosis. However, the efficacy of hip core decompression to prevent the progression of osteonecrosis in these patients is still controversial. METHODS: In a prospective multicenter study, we evaluated the safety of hip core decompression and compared the results of decompression and physical therapy with those of physical therapy alone for the treatment of osteonecrosis of the femoral head in patients with sickle cell disease. Forty-six patients (forty-six hips) with sickle cell disease and Steinberg Stage-I, II, or III osteonecrosis of the femoral head were randomized to one of two treatment arms: (1) hip core decompression followed by a physical therapy program or (2) a physical therapy program alone. Eight patients withdrew from the study, leaving thirty-eight who participated. RESULTS: Seventeen patients (seventeen hips) underwent decompression combined with physical therapy, and no intraoperative or immediate postoperative complications occurred. Twenty-one patients (twenty-one hips) were treated with physical therapy alone. After a mean of three years, the hip survival rate was 82% in the group treated with decompression and physical therapy and 86% in the group treated with physical therapy alone. According to a modification of the Harris hip score, the mean clinical improvement was 18.1 points for the patients treated with hip core decompression and physical therapy compared with 15.7 points for those treated with physical therapy alone. With the numbers studied, the differences were not significant. CONCLUSIONS: In this randomized prospective study, physical therapy alone appeared to be as effective as hip core decompression followed by physical therapy in improving hip function and postponing the need for additional surgical intervention at a mean of three years after treatment.
Asunto(s)
Anemia de Células Falciformes/epidemiología , Descompresión Quirúrgica , Necrosis de la Cabeza Femoral/epidemiología , Necrosis de la Cabeza Femoral/terapia , Cuello Femoral/cirugía , Modalidades de Fisioterapia , Adulto , Artroplastia de Reemplazo de Cadera , Terapia Combinada , Comorbilidad , Femenino , Necrosis de la Cabeza Femoral/cirugía , Estudios de Seguimiento , Humanos , Masculino , Prevalencia , Estudios Prospectivos , Resultado del Tratamiento , Soporte de PesoRESUMEN
Renal sonography is a routine step in the evaluation of new onset renal failure. When renal masses are discovered in this setting, functional imaging may be critical. We report a case of bilateral renal masses in a girl with urinary tract infection and renal insufficiency found to have vesicoureteral reflux. Renal scintigraphy revealed these masses to be the only remaining functional renal tissue, preventing potentially harmful resection.
Asunto(s)
Renografía por Radioisótopo/métodos , Insuficiencia Renal/complicaciones , Insuficiencia Renal/diagnóstico por imagen , Infecciones Urinarias/complicaciones , Infecciones Urinarias/diagnóstico , Reflujo Vesicoureteral/diagnóstico por imagen , Niño , Diagnóstico Diferencial , Femenino , HumanosRESUMEN
OBJECTIVE: The purpose of this study was to describe the radiographic features and etiology of the "diaphanous" (translucent) diaphragm. This sign, which, to our knowledge, has not previously been described, is a transient phenomenon seen on chest radiographs, after surgical patch repair of congenital diaphragmatic hernia. CONCLUSION: The diaphanous diaphragm is a consequence of air trapped in the porous polytetrafluoroethylene graft that creates an intragraft radiolucency apparent on postoperative chest radiographs obtained within the first 24 hr. This radiolucency is transient and gradually disappears over the first few postoperative days as the air is replaced by granulation tissue. This sign should be recognized and not mistaken for a persistent pneumothorax after repair of a congenital diaphragmatic hernia.
Asunto(s)
Diafragma/diagnóstico por imagen , Hernias Diafragmáticas Congénitas , Neumotórax/diagnóstico por imagen , Politetrafluoroetileno , Complicaciones Posoperatorias/diagnóstico por imagen , Implantación de Prótesis , Diagnóstico Diferencial , Femenino , Tejido de Granulación/diagnóstico por imagen , Hernia Diafragmática/diagnóstico por imagen , Hernia Diafragmática/cirugía , Humanos , Recién Nacido , Masculino , Radiografía , Estudios Retrospectivos , Cicatrización de Heridas/fisiologíaRESUMEN
OBJECTIVE: Chest radiographs (CXRs) are routinely obtained at many institutions in all pediatric patients following thoracostomy tube removal to search for pneumothorax (PTX). To aid in evaluating the necessity of this practice, this study investigates whether clinical signs and symptoms may be a sensitive predictor of PTX in such patients. MATERIALS AND METHODS: Reports from CXRs obtained following chest tube removal in all pediatric patients (374 patients) who underwent cardiac surgery with chest tube placement over 1 year were reviewed. For cases with reported PTX, the PTX was quantified and chart review was performed to assess whether signs and symptoms of PTX preceded the CXR result. RESULTS: Fifty-one of 374 children (13.6%) had a radiographically defined PTX within 6 h after thoracostomy tube removal. The PTX was large (>40%) in 2 children, moderate (20-40%) in 5 children, and small (<20%) in 44 children. Symptoms (dyspnea, tachypnea, respiratory distress) or signs (increased oxygen requirement, worsening arterial blood gas and/or hypotension) of respiratory distress were present at the time of the initial CXR in six of seven patients, who later underwent a major clinical intervention, and in one patient who did not. Major clinical interventions were performed in all patients with a large PTX, four of five patients with a moderate PTX, and one patient with a small PTX that later enlarged. CONCLUSIONS: Clinical signs and symptoms identified nearly all patients with significant pneumothoraces. Future prospective investigations may examine reserving chest radiography following chest tube removal for select groups, such as symptomatic patients or those with tenuous cardiovascular status.