Improving quality of life and symptom experience in patients with metastatic breast cancer: A systematic review of supportive care interventions.

OBJECTIVE: The prognosis for individuals with metastatic breast cancer (MBC) has improved in recent decades. This expanding cohort has unique psychological and psychosocial needs, yet targeted supportive care interventions are underdeveloped. This systematic review seeks to summarise the available evidence on the effectiveness of supportive care interventions in improving quality of life and symptom experience of individuals living with MBC so that services can be developed to address the unmet needs of this cohort in future. METHODS: Academic Search Complete, CINAHL, ERIC, Medline and SocINDEX were searched for publications investigating the effect of supportive care interventions specifically targeted at addressing the quality of life or symptom experience of individuals living with MBC. Three reviewers independently screened and selected studies. Quality appraisal and assessed risk of bias were carried out. RESULTS: The search yielded 1972 citations. Thirteen studies met the inclusion criteria. Interventions included psychological (n = 3), end of life discussion and preparation (n = 2), physical activity (n = 4), lifestyle (n = 2), and medication self-management support (n = 2). Three studies reported significant improvement in quality of life, two of which reported improved symptom experience in at least one symptom. Three further physical activity interventions showed improvement in at least one of the symptoms investigated. CONCLUSION: Studies reporting a statistically significant effect on quality of life and improved symptom experience were extremely heterogenous. We can tentatively suggest that multimodal and frequently administered interventions are effective, with physical activity interventions positively impacting on symptom experience, however further research is required.

Meta-Analysis of the Use of Head Impulse Test and Head Impulse Test with Direction Changing Nystagmus and Test of Skew Deviation in the Diagnosis of Peripheral Vertigo and Stroke.

INTRODUCTION: The head impulse test (HIT) and HIT combined with direction-changing Nystagmus-Test of Skew deviation (HINTS) have been proposed as bedside tests to differentiate between peripheral and central causes of vertigo in the emergency department (ED). We conducted a meta-analysis of the HIT and HINTS tests to diagnose peripheral vertigo (PV) and central vertigo. METHODS: Pubmed, Google Scholar, EmBase, and articles references published in English up to July 2021 were searched for keywords "vertigo" or "acute vestibular syndrome" or "dizziness" and "head impulse" and "stroke." The bivariate method for meta-analysis was used to calculate positive (PLR) and negative likelihood ratios (NLR) and summary receiver operating characteristics area under the curve (AUC). RESULTS: A total of 11 studies were included analysing both HIT (8 studies, N = 417) and HINTS (6 studies, N = 405). HIT and HINTS were performed within 24 h in 4 of 11 studies. PLR and NLR for HIT in PV was 4.85 (95% CI: 2.83-8.08) and 0.19 (95% CI: 0.12-0.29, I2 63.25%), respectively. The AUC for HIT the diagnosis of PV and stroke was 0.90 and 0.92, respectively. PLR and NLR for a negative HIT in stroke was 5.85 (95% CI: 3.07-10.6) and 0.17 (95% CI: 0.08-0.30), respectively. PLR and NLR for peripheral HINTS pattern for PV was 17.3 (95% CI: 8.38-32.1) and 0.15 (95% CI: 0.07-0.26), respectively. PLR and NLR for central HINTS pattern for stroke: 5.61 (95% CI: 4.19-7.7) and 0.06 (95% CI: 0.03-0.12). In all included studies, HIT and HINTS exams were administered by neurology residents or neurology specialists with additional neuro-otology or neuro-ophthalmology subspeciality experience, and two studies included ED physicians. Raters reported high degree of bias and high concern regarding applicability in most domains of the quality assessment of diagnostic accuracy studies (QUADAS-2) tool. Meta-regression did not demonstrate a statistically significant effect of publication year, time to test, and type of assessor on sensitivity or false positive rate. CONCLUSION: The HIT and HINTS exams appear to be moderately good discriminators of central and PV. However, in most papers, the tests were administered by neurologists and were evaluated beyond 24 h, which may limit utility in the ED setting.

Improving the detection of ventricular shunt disruption using volume-rendered three-dimensional head computed tomography.

Hydrocephalus is the most common neurosurgical disorder in children, and cerebrospinal fluid (CSF) diversion with shunt placement is the most commonly performed pediatric neurosurgical procedure. CT is frequently used to evaluate children with suspected CSF shunt malfunction to assess change in ventricular size. Moreover, careful review of the CT images is important to confirm the integrity of the imaged portions of the shunt system. Subtle shunt disruptions can be missed on multiplanar two-dimensional (2-D) CT images, especially when the disruption lies in the plane of imaging. The use of volume-rendered CT images enables radiologists to view the extracranial shunt tubing within the field of view as a three-dimensional (3-D) object. This allows for a rapid and intuitive method of assessing the integrity of the extracranial shunt tubing. The purpose of this pictorial essay is to discuss how volume-rendered CT images can be generated to evaluate CSF shunts in the pediatric population and to provide several examples of their utility in diagnosing shunt disruption. We also address the potential pitfalls of this technique and ways to avoid them.

Practical Imaging Strategies for Intussusception in Children.

OBJECTIVE. Intussusception is the most common cause of intestinal obstruction in young children. Radiology has a key role in its diagnosis and treatment. This systematic review summarizes the currently available evidence for best practices in radiologic management of pediatric intussusception. CONCLUSION. High diagnostic accuracy and lack of ionizing radiation make ultrasound (US) the preferred imaging modality for diagnosing intussusception. For intussusception reduction, fluoroscopy-guided pneumatic enema and US-guided hydrostatic enema are equally dependable and safe techniques. The areas that warrant further research in this field include the efficacy and safety of the US-guided pneumatic enema, potential benefits of sedation and general anesthesia for the reduction procedure, and the optimal management of intussusceptions potentially involving pathologic lead points.

Pediatric SARS, H1N1, MERS, EVALI, and Now Coronavirus Disease (COVID-19) Pneumonia: What Radiologists Need to Know.

OBJECTIVE. The purpose of this article is to review new pediatric lung disorders-including disorders that have occurred in recent years years such as severe acute respiratory syndrome (SARS), swine-origin influenza A (H1N1), Middle East respiratory syndrome (MERS), e-cigarette or vaping product use-associated lung injury (EVALI), and coronavirus disease (COVID-19) pneumonia-to enhance understanding of the characteristic imaging findings. CONCLUSION. Although the clinical symptoms of SARS, H1N1, MERS, EVALI, and COVID-19 pneumonia in pediatric patients may be nonspecific, some characteristic imaging findings have emerged or are currently emerging. It is essential for radiologists to have a clear understanding of the characteristic imaging appearances of these lung disorders in pediatric patients to ensure optimal patient care.

Dual-Energy CT of Pediatric Abdominal Oncology Imaging: Private Tour of New Applications of CT Technology.

OBJECTIVE. Dual-energy CT is gaining increasing recognition as a valuable diagnostic tool for assessing abdominal neoplasms. Nevertheless, much of the literature has focused on its use in adults. This review article illustrates specific tools available with dual-energy CT in the evaluation of pediatric abdominal neoplasms. Additionally, common imaging artifacts and pitfalls in dual-energy CT of the pediatric abdomen are outlined. CONCLUSION. Dual-energy CT can augment diagnostic yield in the imaging evaluation of pediatric abdominal neoplasms.

Practical administration of intravenous contrast media in children: screening, prophylaxis, administration and treatment of adverse reactions.

Administration of intravenous contrast media to children is a routine practice at many clinical imaging centers, that can involve special considerations. In this paper, we provide practical information to facilitate optimal performance and oversight of this task. We provide targeted screening questions that can help to identify high-risk pediatric patients for both iodine-based and gadolinium-based intravenous contrast media administration. These include children at risk for allergic-like reactions, thyroid dysfunction, contrast-induced nephropathy, and nephrogenic systemic fibrosis. We make recommendations for addressing "yes" responses to screening questions using risk stratification schema that are specific to children. We also present criteria for selecting children for premedication prior to intravenous contrast administration, and suggest pediatric regimens. Additionally, we discuss practical nuances of intravenous contrast media administration to children and provide a quick-reference table of appropriate treatments with pediatric dosages for adverse contrast reactions.

Neonatal Bowel Disorders: Practical Imaging Algorithm for Trainees and General Radiologists.

OBJECTIVE: Neonatal bowel disorders require prompt and accurate diagnosis to avoid potential morbidity and mortality. Symptoms such as feeding intolerance, emesis, or failure to pass meconium may prompt a radiologic evaluation. CONCLUSION: We discuss the most common neonatal bowel disorders and present a practical imaging algorithm for trainees and general radiologists.

Control of bacterial exoelectrogenesis by c-AMP-GMP.

Major changes in bacterial physiology including biofilm and spore formation involve signaling by the cyclic dinucleotides c-di-GMP and c-di-AMP. Recently, another second messenger dinucleotide, c-AMP-GMP, was found to control chemotaxis and colonization by Vibrio cholerae. We have identified a superregulon of genes controlled by c-AMP-GMP in numerous Deltaproteobacteria, including Geobacter species that use extracellular insoluble metal oxides as terminal electron acceptors. This exoelectrogenic process has been studied for its possible utility in energy production and bioremediation. Many genes involved in adhesion, pilin formation, and others that are important for exoelectrogenesis are controlled by members of a variant riboswitch class that selectively bind c-AMP-GMP. These RNAs constitute, to our knowledge, the first known specific receptors for c-AMP-GMP and reveal that this molecule is used by many bacteria to control specialized physiological processes.

Intraoperative Doppler sonogram in pediatric liver transplants: a pictorial review of intraoperative and early postoperative complications.

A spectrum of vascular complications can be seen in pediatric liver transplant patients, including occlusion and hemodynamically significant narrowing of the vessels that provide inflow to or outflow from the graft. Intraoperative Doppler ultrasound (US) has the potential benefit of identifying vascular complications in pediatric liver transplant patients prior to abdominal closure. Importantly, intraoperative Doppler US can be used as a problem-solving tool in situations such as position-dependent kinking of the portal or hepatic veins, or in suspected vasospasm of the hepatic artery. Furthermore, this technique can be used for real-time reassessment after surgical correction of vascular complications. This pictorial review of intraoperative Doppler US in pediatric liver transplant patients illustrates normal findings and common vascular complications, including examples after surgical correction, in the perioperative period.

Vertical expandable prosthetic titanium rib (VEPTR): a review of indications, normal radiographic appearance and complications.

Vertical expandable prosthetic titanium rib (VEPTR) is increasingly used in the treatment of thoracic insufficiency, idiopathic and neuromuscular scoliosis and chest wall defects in children. In contrast to spinal fusion surgery, the VEPTR allows for growth while stabilizing the deformity. We illustrate the common indications and normal radiographic appearance of the three common configurations of VEPTR (cradle-to-cradle assembly, cradle with lumbar extension assembly, cradle-to-ala hook assembly). There is a relatively high rate of reported complications with VEPTR in the literature. We discuss the potential complications of VEPTR, including infection, rib fracture, dislodged hardware and neurological injury, with an emphasis on imaging diagnosis.

Relationships of pediatric anthropometrics for CT protocol selection.

OBJECTIVE: Determining the optimal CT technique to minimize patient radiation exposure while maintaining diagnostic utility requires patient-specific protocols that are based on patient characteristics. This work develops relationships between different anthropometrics and CT image noise to determine appropriate protocol classification schemes. MATERIALS AND METHODS: We measured the image noise in 387 CT examinations of pediatric patients (222 boys, 165 girls) of the chest, abdomen, and pelvis and generated mathematic relationships between image noise and patient lateral and anteroposterior dimensions, age, and weight. RESULTS: At the chest level, lateral distance (ld) across the body is strongly correlated with weight (ld = 0.23 × weight + 16.77; R(2) = 0.93) and is less well correlated with age (ld = 1.10 × age + 17.13; R(2) = 0.84). Similar trends were found for anteroposterior dimensions and at the abdomen level. Across all studies, when acquisition-specific parameters are factored out of the noise, the log of image noise was highly correlated with lateral distance (R(2) = 0.72) and weight (R(2) = 0.72) and was less correlated with age (R(2) = 0.62). Following first-order relationships of image noise and scanner technique, plots were formed to show techniques that could achieve matched noise across the pediatric population. CONCLUSION: Patient lateral distance and weight are essentially equally effective metrics to base maximum technique settings for pediatric patient-specific protocols. These metrics can also be used to help categorize appropriate reference levels for CT technique and size-specific dose estimates across the pediatric population.

The utility of adding expiratory or decubitus chest radiographs to the radiographic evaluation of suspected pediatric airway foreign bodies.

STUDY OBJECTIVE: This study aimed to compare test characteristics of standard (lateral and posteroanterior or anteroposterior) chest radiographs with and without special views (expiratory or bilateral decubitus) in the emergency department evaluation of children with suspected airway foreign bodies. METHODS: From 1997 to 2008, 328 patients with a suspected airway foreign body had standard and special view chest radiographs: 192 with left and right decubitus views, 133 with expiratory views, and 3 with both. Patients were excluded for cardiorespiratory disease, chest wall deformity, visible airway foreign bodies on standard views, or spontaneously expelled airway foreign bodies. After blinded radiologist review, standard plus special view test characteristics were compared to standard views. RESULTS: Nine upper airway and 70 tracheobronchial airway foreign bodies were identified by direct visualization or bronchoscopy, and the remainder were ruled out by bronchoscopy (50 patients) or clinically (199 patients). The sensitivity and specificity of the radiographs were, respectively, decubitus cohort, standard views, 56% and 79% and standard+decubitus views, 56% and 64%; expiratory radiograph cohort, standard views, 33% and 70% and standard+expiratory views, 62% and 72%. For standard plus decubitus views versus standard views alone, the relative sensitivity was 1.0 (0.56/0.56; 95% confidence interval [CI] 0.81 to 1.23) and the relative 1-specificity was 1.76 (0.36/0.21; 95% CI 1.3 to 2.37). For standard plus expiratory views versus standard views alone, the relative sensitivity was 1.87 (0.62/0.33; 95% CI 1.23 to 2.83) and the relative 1-specificity was 0.93 (0.28/0.3; 95% CI 0.6 to 1.44). CONCLUSION: The addition of decubitus to standard views increases false positives without increasing true positives and lacks clinical benefit. The addition of expiratory to standard views increases true positives without increasing false positives, but test accuracy remains low and the clinical benefit is uncertain.

Imaging of pediatric renal transplants and their complications: a pictorial review.

Renal transplantation is the treatment of choice for end-stage renal disease in children. As a technically demanding surgery with complex medical management, it is associated with a number of complications. Anatomic imaging including ultrasonography with color and spectral Doppler and functional assessment with renal perfusion scintigraphy are complementary for the detection and characterization of posttransplant complications. Complications can be characterized by the time of appearance after transplantation (immediate, early, or late) or the anatomic site of origin (perinephric, vascular, urologic, or renal parenchymal). Perinephric fluid collections include hematomas and seromas, abscesses, lymphoceles, and urinomas. Noninfected collections frequently resolve spontaneously but should be monitored to exclude progression. Vascular complications are more prevalent in pediatric patients because of the small vessel caliber and include vascular thrombosis and stenosis. Arteriovenous fistulas and pseudoaneurysms can complicate biopsy and are typically transient. Common urologic complications include urine leak and urinary tract obstruction. Renal perfusion scintigraphy can be invaluable in elucidating the nature of such complications. Renal parenchymal abnormalities include acute tubular necrosis, rejection, and toxic effects of medication. Imaging features of renal parenchymal abnormalities can overlap, and the primary role of imaging is to exclude alternative causes of renal dysfunction. Renal and nonrenal mass lesions are more common in immunosuppressed patients after transplantation. Familiarity with the normal imaging appearance of the renal allograft and the appearances of common complications facilitates accurate diagnosis and timely treatment, with the ultimate goal of increasing graft survival. This goal is particularly crucial in children, given their greater number of projected life years.

Safety essentials: acute reactions to iodinated contrast media.

The objectives of this article are to review the diagnosis and management of acute nonrenal reactions to iodinated contrast media. We will begin by discussing the types of contrast media and their correlative rates of reaction. The mechanism of contrast reactions, predisposing risk factors, and preventative measures will then be discussed. The remainder of the article will review the assessment of potential reactions, initial management, and treatment algorithms for specific reactions.

Interactive Web-based learning module on CT of the temporal bone: anatomy and pathology.

An interactive Web-based learning module on the temporal bone has been developed. It shows normal temporal bone anatomy in four imaging planes: axial, coronal, and parallel and perpendicular to the long axis of the petrous bone. After reviewing the normal anatomy, users should be able to identify key imaging features of pathologic conditions of the temporal bone. Children with congenital abnormalities of the temporal bone may present with conductive or sensorineural hearing loss or both and may have a genetic syndrome. Acute otitis media is the most common infection of the temporal bone and is most prevalent among children. Although imaging is unnecessary in uncomplicated otitis media, it is important for evaluation of infectious complications. Classically, temporal bone fractures were described as longitudinal or transverse with respect to the long axis of the petrous bone. However, it is increasingly recognized that many fractures have both longitudinal and transverse components. Patients with temporal bone fractures may have conductive or sensorineural hearing loss in addition to other complications. The most common tumor of the temporal bone at the cerebellopontine angle is the vestibular schwannoma. Paraganglioma is the second most common tumor of the temporal bone and the most common tumor of the middle ear. Supplemental material available at http://uwmsk.org/temporalbone/atlas.html.

Neonatal skeletal dysplasias.

Skeletal dysplasias are a large diverse group of disorders characterized by abnormal bone and cartilage growth. Approximately one-quarter of them are considered lethal in the perinatal period. This paper will review the components of the skeletal survey, the primary imaging tool for diagnosing dysplasias postnatally, emphasizing the use of an organized approach and appropriate descriptive terminology. Several illustrative cases of lethal and nonlethal dysplasias will be shown, with additional discussion of commonly associated genetic mutations and classification systems.

Usual and unusual causes of pediatric gastric outlet obstruction.

Gastric outlet obstruction in children encompasses a spectrum of disorders that extends beyond hypertrophic pyloric stenosis. Each condition can result in the clinical syndrome of persistent nonbilious vomiting, which can progress to dehydration and electrolyte imbalances. This paper reviews the spectrum of both the common and uncommon entities that cause partial or complete gastric outlet obstruction and their imaging appearances. The correct diagnosis of those with gastric outlet obstruction can be achieved by combining clinical presentation with appropriate imaging, leading to optimal and timely patient management.

Interactive, computer-based pediatric chest atlas.

OBJECTIVES: The authors created a computer-based, interactive atlas of pediatric chest radiographs to facilitate (1) understanding of normal variants and (2) interpretation of pediatric chest radiographs in the acute setting. METHODS: Seventy-three normal pediatric chest radiographs were selected for inclusion in the atlas by consensus after review by 3 pediatric radiologists. Sixteen abnormal pediatric chest radiographs showing a variety of abnormalities (infection, malignancy, congenital abnormalities, foreign body, and acquired disease), as well as 4 normal adult chest radiographs, were also included in the atlas. Images for the atlas were derived from Digital Imaging and Communications in Medicine-compliant data. The atlas software was written in C# and offers features of a picture archiving and communication system viewer. In addition, the atlas offers annotated series that describe particular radiographic features of normal variants and disease. RESULTS: The digital, interactive pediatric chest atlas displays normal chest radiographs of children aged 7 days to 17.8 years, as well as 4 normal adult chest radiographs and 16 abnormal pediatric chest radiographs. The digital interactive format of the atlas allows for (1) easy manipulation of atlas cases and (2) direct comparison between normal atlas cases and provided abnormal cases, as well as (3) the potential for direct comparison with images displayed on an institution's picture archiving and communication system. The atlas is available for free download at http://www.seattlechildrens.org/radiologyeducation/pediatric-chest. CONCLUSIONS: Improved interpretation of pediatric chest radiographs in the acute setting may be facilitated by a comprehensive, computer-based, pediatric chest atlas.

Pediatric Abdominal Masses: Imaging Guidelines and Recommendations.

Pediatric abdominal masses are commonly encountered in the pediatric population, with a broad differential diagnosis that encompasses benign and malignant entities. The primary role of abdominal imaging in the setting of a suspected pediatric abdominal mass is to establish its presence, as nonneoplastic entities can mimic an abdominal mass, and to identify characteristic imaging features that narrow the differential diagnosis. In the setting of a neoplasm, various imaging modalities play an important role to characterize the mass, stage extent of disease, and assist in presurgical planning. The purpose of this article is to discuss a practical imaging algorithm for suspected pediatric abdominal masses and to describe typical radiological findings of the commonly encountered abdominal masses in neonates and children with emphasis on imaging guidelines and recommendations.