Postconceptual Neonatal Dating by Transmastoid Ultrasound of Transcerebellar Diameter-Comparison to Crown Rump Length Measurement: A Proof of Concept Paper.

OBJECTIVES: Transcerebellar diameter (TCD) has been utilized prenatally as a tool to estimate gestational age (GA) when fetal growth aberrations are suspected. Traditionally, first trimester ultrasound (1TUS) has been the gold standard of dating a pregnancy in spontaneous pregnancies. We sought to determine if neonatal TCD measurement was as accurate as 1TUS in the estimation of postconceptual gestational age (PCGA). METHODS: A retrospective cohort from a registry of high-quality transmastoid views of consecutive patients from July 2019 to November 2020, delivered from 24 to 34 weeks GA, and with a 1TUS were included. The reference PCGA was the sum of the GA at delivery by 1TUS and day of life. The PCGA by TCD was calculated from Chang et al for GA by TCD. Reference and experimental values were compared by correlation, agreement within 7 days, and Bland-Altman analysis. RESULTS: Of the 154 individual patients in the registry of high-quality transmastoid views during the study period, 62 met inclusion and exclusion criteria. PCGA by 1TUS and TCD were highly correlated (r = 0.86, P < .001; κ = 47% agreement within 7 days of PCGA). The bias of PCGA by TCD was 4.6 days earlier than the PCGA by 1TUS (95% confidence interval of agreement: -29.2, 20). CONCLUSIONS: PCGA estimation by neonatal transmastoid TCD was highly correlated with that of 1TUS. It generally underestimates GA by 4.6 days. This relationship warrants further investigation to determine if this method of estimating PCGA in undated gestations is generalizable.

ChatGPT and the Future of Journal Reviews: A Feasibility Study.

The increasing volume of research submissions to academic journals poses a significant challenge for traditional peer-review processes. To address this issue, this study explores the potential of employing ChatGPT, an advanced large language model (LLM), developed by OpenAI, as an artificial intelligence (AI) reviewer for academic journals. By leveraging the vast knowledge and natural language processing capabilities of ChatGPT, we hypothesize it may be possible to enhance the efficiency, consistency, and quality of the peer-review process. This research investigated key aspects of integrating ChatGPT into the journal review workflow. We compared the critical analysis of ChatGPT, acting as an AI reviewer, to human reviews for a single published article. Our methodological framework involved subjecting ChatGPT to an intricate examination, wherein its evaluative acumen was juxtaposed against human-authored reviews of a singular published article. As this is a feasibility study, one article was reviewed, which was a case report on scurvy. The entire article was used as an input into ChatGPT and commanded it to "Please perform a review of the following article and give points for revision." Since this was a case report with a limited word count the entire article could fit in one chat box. The output by ChatGPT was then compared with the comments by human reviewers. Key performance metrics, including precision and overall agreement, were judiciously and subjectively measured to portray the efficacy of ChatGPT as an AI reviewer in comparison to its human counterparts. The outcomes of this rigorous analysis unveiled compelling evidence regarding ChatGPT's performance as an AI reviewer. We demonstrated that ChatGPT's critical analyses aligned with those of human reviewers, as evidenced by the inter-rater agreement. Notably, ChatGPT exhibited commendable capability in identifying methodological flaws, articulating insightful feedback on theoretical frameworks, and gauging the overall contribution of the articles to their respective fields. While the integration of ChatGPT showcased immense promise, certain challenges and caveats surfaced. For example, ambiguities might present with complex research articles, leading to nuanced discrepancies between AI and human reviews. Also figures and images cannot be reviewed by ChatGPT. Lengthy articles need to be reviewed in parts by ChatGPT as the entire article will not fit in one chat/response. The benefits consist of reduction in time needed by journals to review the articles submitted to them, as well as an AI assistant to give a different perspective about the research papers other than the human reviewers. In conclusion, this research contributes a groundbreaking foundation for incorporating ChatGPT into the pantheon of journal reviewers. The delineated guidelines distill key insights into operationalizing ChatGPT as a proficient reviewer within academic journal frameworks, paving the way for a more efficient and insightful review process.

Scurvy in A Malnourished Child: Atypical Imaging Findings.

Scurvy, a disease caused by a severe lack of vitamin C in the diet, is most often associated with 17th-century sailors. Its 21st-century manifestation is a disease of the poor, sick, and those living in remote rural neighborhoods in which fresh, nutritious food is hard to come by. It is caused by a deficiency of Vitamin C and is rare in the United States. We describe the radiographic and MRI findings of a case of scurvy in a child with Noonan syndrome who is a "picky eater". MRI is rarely performed in scurvy as its radiographic findings are generally well known and sufficient for a diagnosis. However, due to the rarity of the disease in the US, MRI features of scurvy have been described in only a few case reports, to date. The rarity of this disease also causes scurvy to be kept lower, if at all in the differential diagnosis list.

Fetal imaging of congenital lung lesions with postnatal correlation.

Congenital lung lesions are a rare group of developmental pulmonary abnormalities that are often first identified prenatally on routine second-trimester US. Congenital pulmonary airway malformation (CPAM) is the most common anomaly while others include bronchopulmonary sequestration, congenital lobar overinflation, bronchogenic cyst and bronchial atresia. Clinical presentation is highly variable, ranging from apparent in utero resolution to severe mass effect with resultant hydrops fetalis and fetal demise. Differentiation among these lesions can be challenging because overlapping imaging features are often present. The roles of the radiologist are to identify key imaging findings that help in diagnosing congenital lung lesions and to recognize any ominous features that might require prenatal or perinatal intervention. High-resolution US and complementary rapid-acquisition fetal MRI provide valuable information necessary for lesion characterization. Postnatal US and CT angiography are helpful for lesion evaluation and for possible surgical planning. This article reviews the embryology of the lungs, the normal prenatal imaging appearance of the thorax and its contents, and the prenatal and neonatal imaging characteristics, prognosis and management of various congenital lung lesions.

Pearls and Pitfalls of Pediatric Scrotal Imaging.

Ultrasonography (US) is the primary imaging modality for the evaluation of pediatric scrotal disease. The ability to obtain exceptional anatomical detail and testicular perfusion information without ionizing radiation makes it the essential tool for evaluating scrotal pain and palpable masses. Challenges arise in both the performance and interpretation of scrotal US in the child. Optimizing imaging parameters and recognizing key differentiating US features help minimize misinterpretations that can lead to poor patient outcomes. Key pearls and pitfalls in pediatric scrotal ultrasound methods and diagnoses are reviewed. Knowledge of what is normal for the various ages of childhood from neonate through adolescence is necessary for accurate US analysis. Imaging evaluation of key causes of the acute painful scrotum including testicular appendage torsion, epididymitis, and testicular torsion are discussed. Sonographic features for the diagnosis of benign and malignant scrotal masses, microlithiasis, and cryptorchidism are reviewed.

Contrast-enhanced ultrasound of the kidneys and adrenals in children.

Pediatric applications of contrast-enhanced ultrasound (CEUS) are growing. Evaluation of the kidneys and adrenal glands in children using intravenous administration of US contrast agents, however, is still an off-label indication. Pediatric CEUS applications for kidneys are similar to those in adults, including ischemic disorders, pseudo- versus real tumors, indeterminate lesions, complex cystic lesions, complicated pyelonephritis, and abscesses. CEUS applications for evaluation of adrenal glands in children are limited, mainly focusing on the assessment and follow-up of adrenal trauma and the differentiation between an adrenal hemorrhage and a mass. This review addresses the current experience in pediatric CEUS of the kidneys and adrenal glands. By extrapolating the established knowledge for US contrast evaluations in the adult kidney to the pediatric context we can note opportunities for CEUS clinical use in children.

Medical Student Ultrasound Education: The Radiology Chair Weighs In.

ABSTRACT: To assess the radiology department chairs' opinions concerning current status and plans for teaching ultrasound to medical students, the American College Taskforce on Radiology Ultrasound Education, commissioned by the American College of Radiology, distributed a survey to 142 radiology chairs and a medical school dean subgroup.The response rate was 30% (42/142), and 76% indicated ultrasound was currently part of the medical student curriculum. In preclinical years, radiology involvement was only 6.4%. During clinical years, radiology led ultrasound education with 51.7% in general and 82.9% in elective rotations. Regarding actual content, top 4 results were evenly distributed between learning hands-on scanning (81.1%), diagnostic use of ultrasound (75.7%), anatomy/pathology (75.7%), and ultrasound guidance for procedures (54.0%). Educational leaders in preclinical courses were emergency medicine (72.7%) followed by radiology (45.4%) physicians. During clinical years, leaders were radiology (52.6%) and emergency medicine (47.4%) physicians. Most chairs stated that knowledge of diagnostic ultrasound should be mandatory (76.2%), stressing the importance of teaching the diagnostic capabilities and uses of ultrasound as the primary goal (78.8%). Perceived barriers to implementation were evenly distributed between lack of space in the curriculum (55.6%), lack of faculty (48.2%), lack of resources (44.4%), and lack of institutional support (40.7%). The American College Taskforce on Radiology Ultrasound Education survey shows that radiology's role in ultrasound undergraduate education occurs almost exclusively during clinical years, and the chairs voice a desire to improve upon this role. Barriers include both intradepartmental (faculty and resources) and institutional (curricular) factors.

Determining the impact of body mass index on ultrasound accuracy for diagnosing appendicitis: Is it less useful in obese children?

BACKGROUND: Ultrasonography (US) is the preferred imaging for suspected pediatric appendicitis. We hypothesize that children with elevated Body-Mass-Index-for-age percentile (BMIP) may be more likely to have an inaccurate or equivocal (IE) US. METHODS: After IRB approval, a four-year review was performed on pediatric patients evaluated for appendicitis by US. The CDC BMIP Calculator was used. IE subgroups were analyzed together for comparison against the accurate group. RESULTS: 1059 patients were included: median age 11.3 years (IQR: 8.2, 14.6), 506 (47.8%) males. Median BMIP was 65.9 (IQR: 33.9, 89.6). US accurately diagnosed 857 (80.9%), incorrectly diagnosed 76 (7.2%), 126 (11.9%) were equivocal. Overall sensitivity was 0.85, specificity 0.96, PPV 0.93 and NPV 0.91. Obese children (BMIP ≥95%), had higher odds of IE US (OR: 1.86, 95% CI: 1.28, 2.70; p = 0.001). When analyzed by sex, risk increased in obese males (OR: 2.55, 95% CI:1.53, 4.24; p = 0.0003) but normalized in obese females (OR: 1.30, 95% CI:0.74, 2.28; p = 0.35). CONCLUSIONS: An elevated BMIP may increase difficulty in visualizing the appendix, resulting in inaccurate or equivocal findings. This risk is seen specifically in obese males. If US findings do not correlate with clinical assessment in obese children with abdominal pain, further evaluation may be warranted.

Virtual endoluminal aortic root views determined at coronary CT angiography - an important tool for improving anomalous coronary artery visualization and surgical planning.

Anomalous origin of the coronary arteries, though uncommon, is of great clinical concern. It can be the cause of sudden cardiac death and abnormal cardiac hemodynamics. Advances in electrocardiographically (ECG)-gated multi-detector CT have increased diagnostic accuracy in detecting anomalous origin of coronary arteries and their interarterial and intramural courses. Recent advances in multi-detector CT image processing software have allowed the creation of virtual endoluminal views of the aortic root and improved assessment of the intramural course (the length and relationship to the intercoronary commissure) of the coronary artery, which is of considerable surgical importance. We review our experience with virtual endoluminal imaging in our first 19 cases of interarterial coronary artery anomalies (17 cases of interarterial with intramural segment and 2 cases of purely interarterial course) diagnosed preoperatively and proven surgically.

Neonatal Head Ultrasound: A Review and Update-Part 2: The Term Neonate and Analysis of Brain Anomalies.

Neonatal head ultrasound has a key role in triaging neonates with antenatal imaging or postnatal clinical concerns. This article will discuss key features of various intracranial pathologies of concern in term infants. It will also illustrate various congenital malformations.

Neonatal Head Ultrasound: A Review and Update-Part 1: Techniques and Evaluation of the Premature Neonate.

Ultrasound of the infant brain has proven to be an important diagnostic tool in the evaluation of neonatal brain morphology and pathology since its introduction in the late 1970s and early 1980s. It is a relatively inexpensive examination that can be performed in the isolette in the neonatal intensive care unit. There is no radiation exposure and no need for sedation. This article will discuss gray scale and Doppler techniques and findings in normal head ultrasounds of premature neonates. It will discuss intracranial pathologies noted in such neonates and their neurodevelopmental outcome.

Vaginal Anatomy on MRI: New Information Obtained Using Distention.

OBJECTIVES: To demonstrate and confirm the presence of three anatomic zones of the vagina (a superficial sphincteric zone; a central wedge shaped transition zone; and a deep, expanded forniceal zone) using pelvic magnetic resonance imaging with contrast distention of the vagina. METHODS: A total of 107 consecutive female pelvic magnetic resonance imaging scans using vaginal contrast distention were retrospectively reviewed. The images were observed for the three-zone configuration. Anteroposterior and transverse diameter measurements were taken in the proximal, mid, and distal sphincteric, transition, and forniceal zones. Means and standard deviations were calculated at each site. Adjacent sites were compared using paired t tests. RESULTS: The three-zone configuration was observed in all of the cases but one. Statistically significant increases and decreases of mean anteroposterior diameters occurred at all levels expected by visual observation. CONCLUSIONS: The three-zone configuration of the distended vagina was confirmed by this study. The configuration of the vagina is more complex than has been reported previously. This configuration may facilitate parturition and may be useful in the design of intravaginal devices.

Twenty-Five Diagnoses on Midline Images of the Brain: From Fetus to Child to Adult.

Midsagittal images of the brain provide a wealth of anatomic information and may show abnormalities that are pathognomonic for particular diagnoses. Using an anatomy-based approach, the authors identify pertinent anatomic structures to serve as a checklist when evaluating these structures. Subregions evaluated include the corpus callosum, pituitary gland and sellar region, pineal gland and pineal region, brainstem, and cerebellum. The authors present 25 conditions with characteristic identifiable abnormalities at midsagittal imaging. Midsagittal views from multiple imaging modalities are shown, including computed tomography, ultrasonography, and magnetic resonance (MR) imaging. Standard MR imaging sequences are shown, as well as fetal MR and sagittal diffusion-weighted images. To demonstrate these conditions, fetal, neonatal, childhood, adolescent, and young adulthood images are reviewed. The differentiation of normal variants is guided by the understanding of anatomy and pathology. When a specific diagnosis is not possible, the authors present information to evaluate differential considerations and discuss when follow-up imaging may be indicated. The authors hope each case will clarify a pertinent differential diagnosis, appropriately guide patient management, and improve understanding of normal anatomy and identification of pathologic entities. It is in these hopes that the authors have presented a checklist of pertinent anatomy and pathologic entities that can build on existing search patterns. Improved confidence and accuracy in the evaluation of midsagittal images will benefit physicians and patients. ©RSNA, 2018.

Elucidation of Renal Scars in Children With Vesicoureteral Reflux Using Contrast-Enhanced Ultrasound: A Pilot Study.

INTRODUCTION: Vesicoureteral reflux is a common disorder in children but can result in kidney scarring following acute pyelonephritis. The gold standard diagnostic to detect renal scars in children is 99mTc-dimercaptosuccinic acid (DMSA) scintigraphy. DMSA has a number of limitations including radiation exposure, need for sedation, and radiotracer supply shortages. Contrast-enhanced ultrasound (CEUS) is a technique whereby biocompatible microspheres of inert gas are administered i.v. that reflect ultrasonography sound waves and do not involve radiation. Because the contrast agent is rapidly cleared, contrast images must be obtained within minutes of administration. CEUS has been used in a variety of organ systems, but its use in pediatric kidney diseases is limited. METHODS: In this study, we performed CEUS in 7 children with documented renal scars by radiographic imaging consistent with reflux nephropathy. RESULTS: In all subjects, CEUS detected all previously known radiologic abnormalities as well as detecting new areas of hypoenhancing renal parenchyma. None of the patients experienced any serious adverse events. DISCUSSION: This study represents the first report of using CEUS to characterize renal scars in children with reflux nephropathy. We conclude that CEUS is a highly sensitive, rapid, and cost-effective diagnostic imaging modality for detecting and monitoring renal scars in children with vesicoureteral reflux.

Pediatric Ovarian Torsion: Spectrum of Imaging Findings.

The accurate diagnosis of ovarian torsion is imperative, as loss of the ovary can have long-term consequences in terms of fertility. However, a nonspecific clinical presentation in conjunction with a highly variable imaging appearance makes the diagnosis of ovarian torsion challenging. This is complicated even further in the pediatric population, as these patients cannot always articulate their symptoms or provide an adequate medical history. Therefore, imaging has a critical role in the diagnosis of ovarian torsion in pediatric patients. Common imaging findings of ovarian torsion in the prepubescent and adolescent populations include asymmetric enlargement of the ovary, peripheral location of ovarian follicles, and midline location of the ovary. A coexistent mass within the ovary may or may not be present. Antenatal torsion also can occur and may be discovered at routine or specific imaging of the fetus or postnatal imaging of the neonate. Imaging findings in the perinatal population that may suggest torsion include a cystic mass with a fluid-debris level and a complex, multiseptated mass. This article reviews ovarian torsion throughout the pediatric years-from the fetal period through adolescence. It reviews the clinical presentation and imaging findings of this abnormality while describing the relevant anatomy, embryologic features, and pathophysiology. Ovarian torsion may be variable in appearance owing to the age and degree of torsion, which is seen early as a large ovary with peripheral follicles and later, once necrosis has ensued, as a complex cystic mass. ©RSNA, 2017.

Neurosonography: Assessing the Premature Infant.

Neurosonography has proven to be helpful in neonatal brain diagnosis. Premature infants are at great risk for intraventricular hemorrhage and periventricular leukomalacia, key abnormalities affecting developmental outcome. Here we discuss technique, anatomy, variants and key points for diagnosis.

"Lying-Down" Adrenal Sign: There Are Exceptions to the Rule Among Fetuses and Neonates.

A linear-shaped or "lying-down" adrenal gland is a sign often seen with the absence of the kidney in the renal fossa due to renal agenesis, renal ectopia, or horseshoe kidney. It is theorized that the presence of the kidney in the normal location within the renal fossa is important for the formation of the normal triangular inverted V or Y adrenal shape. There are exceptions to this rule whereby a kidney is missing from the renal fossa, yet a normal adrenal shape is present. This series looked at 18 cases of an empty renal fossa in fetal, neonatal, and pediatric patients and recorded the shape of the adrenal gland. Nine cases (50%) appropriately showed the linear or lying-down adrenal gland; 6 (33%) showed an exception to the rule, with a normally shaped adrenal gland; and 3 (17%) showed a pseudo exception in which the adrenal gland was linear but blended with the diaphragmatic crus to simulate a triangular adrenal gland. The sonographic characteristics of the crus are different from those of the adrenal gland; thus, this pseudo exception can be avoided by careful inspection. Because the absence of the kidney is often a difficult diagnosis, the lying-down adrenal gland sign can be a helpful secondary sign for confirming that a kidney is absent or ectopic in position and not within the renal bed.

Excessive Bright Echoes Sign for Hypertrophic Pyloric Stenosis Suggest the Diagnosis: Gastric Pneumatosis and Portal Venous Gas in Infants Suggest HPS.

We describe a new finding, the "excessive bright echoes" sign, for the diagnosis of hypertrophic pyloric stenosis (HPS). Portal venous gas and gastric wall pneumatosis were noted in 4 vomiting infants proven to have HPS. Portal venous gas can be concerning for ischemic bowel. Gastric wall pneumatosis can be seen in association with necrotizing enterocolitis and has been associated with increased gastric pressure from severe, usually proximal, bowel obstruction. Our HPS cases had prominent bright punctate echoes on sonography of the liver, portal vein lumen, and gastric wall. Knowledge of this excessive bright echoes sign suggests the need for sonography of the antropyloric area. One should consider HPS as a differential diagnostic possibility when the combination of bright echoes within the liver parenchyma, consistent with portal venous gas, and bright echoes in the gastric wall, consistent with gastric pneumatosis, are seen.