Imaging strategy for focal nodular hyperplasia in children: long-term experience from two specialist European centres.

BACKGROUND: Focal nodular hyperplasia (FNH) in children is a rare but benign tumour, which must be differentiated from malignant entities to avoid unnecessary treatment, leading to potential morbidity. OBJECTIVES: To provide data on imaging findings of these lesions with a suggested algorithm for diagnosis, sampling and follow-up. MATERIALS AND METHODS: This retrospective review evaluated imaging of all patients diagnosed with FNH in two tertiary referral centres in Europe between 1975 and 2018. RESULTS: One hundred and four patients with 137 tumours were reviewed. The mean age at presentation was 8.2 years. The median tumour size was 5 cm (range: 0.3-29 cm). Multiple lesions were seen in 16.3% of patients. The male-to-female ratio was 1:2. CONCLUSION: FNH with typical features on imaging can be safely followed up once the diagnosis has been established. The use of contrast-enhanced ultrasound and magnetic resonance imaging allows accurate characterisation in most cases. Histological sampling is only advised when there is diagnostic doubt. Atypical arterial enhancement of FNH should prompt the search for a congenital portosystemic shunt.

Current and future funding streams for paediatric postmortem imaging: European Society of Paediatric Radiology survey results.

BACKGROUND: Perinatal and childhood postmortem imaging has been accepted as a noninvasive alternative or adjunct to autopsy. However, the variation in funding models from institution to institution is a major factor prohibiting uniform provision of this service. OBJECTIVE: To describe current funding models employed in European and non-European institutions offering paediatric postmortem imaging services and to discuss the perceived barriers to future postmortem imaging service provision. MATERIALS AND METHODS: A web-based 16-question survey was distributed to members of the European Society of Paediatric Radiology (ESPR) and ESPR postmortem imaging task force over a 6-month period (March-August 2021). Survey questions related to the radiologic and autopsy services being offered and how each was funded within the respondent's institute. RESULTS: Eighteen individual responses were received (13/18, 72.2% from Europe). Only one-third of the institutions (6/18, 33.3%) have fully funded postmortem imaging services, with the remainder receiving partial (6/18, 33.3%) or no funding (5/18, 27.8%). Funding (full or partial) was more commonly available for forensic work (13/18, 72%), particularly where this was nationally provided. Where funding was not provided, the imaging and reporting costs were absorbed by the institute. CONCLUSION: Increased access is required for the expansion of postmortem imaging into routine clinical use. This can only be achieved with formal funding on a national level, potentially through health care commissioning and acknowledgement by health care policy makers and pathology services of the value the service provides following the death of a fetus or child. Funding should include the costs involved in training, equipment, reporting and image acquisition.

New image quality and dose reduction technique for pediatric digital radiography.

PURPOSE: The purpose of this study was to test a new post-processing and denoising engine for patient dose reduction while maintaining diagnostic image quality (IQ) in pediatric digital radiography (DR). MATERIALS AND METHODS: Pediatric DR images of the thorax, pelvis, abdomen and spine obtained in 174 patients (102 males, 72 females; mean age, 2±1.8 [SD] years; age range: 6 months-9 years) were retrieved. Artificial noise was added to the images to simulate acquisitions at 50%, 32% and 12.5% of the routine dose levels. A total of 696 images corresponding to four dose levels were post-processed using S-Vue™ and further blindly scored by three pediatric radiologists using a scoring grid of 4-6 criteria specifically defined per anatomical area. The mean score was assessed for each area and weight class (5-15 and 15-30kg) and compared across the simulated low dose images. Paired Wilcoxon test was used with a threshold difference of 0.5 (half a criterion) between scores to highlight a significant reduction in image quality. Inter-rater reliability was assessed using intraclass correlation coefficient (ICC). RESULTS: Only the 50% reduced dose images showed non-inferiority when compared to routine images for all of areas and weight classes (P<0.01). Very good inter-rater reliability of the overall scores was observed for the pelvis in the 5-15kg weight class (ICC=0.85) for images at full dose, 50% and 32% reduced dose. For the remaining areas (thorax, abdomen and spine) and weight classes, inter-rater reliability was moderate (ICC: 0.3-0.6). CONCLUSION: S-Vue™ post-processing software allows a two-fold radiation dose reduction while maintaining satisfactory IQ in pediatric DR.

Management of focal nodular hyperplasia of the liver: Experience of 50 pediatric patients in a tertiary center.

BACKGROUND: Focal nodular hyperplasia (FNH) is a rare benign hepatic lesion in children. No management guidelines for pediatric population exist because of limited evidence. OBJECTIVE: To review the experience of a large tertiary liver center, providing additional clinical data to help formulate management guidelines for FNH in the pediatric population. METHODS: We analyzed data of children <18 years diagnosed with FNH from 1996 to 2018 at our hospital, detailing management and long-term clinical outcome. RESULTS: 50 patients were identified. The median age was 10 years old (range 0.75-15.5 years old). The mean diameter of FNH was 5.9 cm (±3.1 cm). 10 patients had multiple lesions. First-line management: watchful waiting with serial checks (n = 37), surgery (n = 13). Of the watchful waiting patients, 10 required eventual second-line surgery. After a median follow-up of 4.7 years (range 0.5-20 years), 46 patients were asymptomatic, with no significant difference in clinical outcome (p = 0.962) between the two first-line management approaches. Lesions demonstrated growth in 13 cases: 5 of these required second-line surgery. In these patients, there was no significant difference in clinical outcome (p = 0.188) compared to nonoperative patients. Considering all surgically treated patients, there was no significant difference between first-line and second-line surgery for clinical outcome (p = 0.846), hospital stay (p = 0.410), complications (p = 0.510) and severe complications (p = 0.385). CONCLUSIONS: Our data support the hypothesis that watchful waiting is a safe initial approach to pediatric FNH management in patients with no major symptoms or complications. Surgery should be reserved for patients with diagnostic doubt, persistent symptoms and/or biological or significant anatomical abnormalities. FNH growth alone should not be considered as an indication for surgery. TYPE OF STUDY: Therapeutic study. LEVEL OF EVIDENCE: Level III.

The role of ultrasound as a problem-solving tool in the assessment of paediatric musculoskeletal injuries.

Musculoskeletal trauma in the paediatric population covers a wide range of injuries; although many overlap with their adult counterparts, others are exclusive to the immature skeletal system. Ultrasound is a versatile tool particularly suited to both the imaging of children and the dynamic assessment of musculoskeletal injuries. This pictorial review aims to discuss a range of injuries, focusing on those commonly encountered in children. We shall describe the muscle-tendon-bone complex and changes that occur with increasing skeletal maturity and how this affects the type of injury encountered.

18F-FDG PET-CT in paediatric oncology: established and emerging applications.

Accurate staging and response assessment is vital in the management of childhood malignancies. Fluorine-18 fluorodeoxyglucose positron emission tomography/CT (FDG PET-CT) provides complimentary anatomical and functional information. Oncological applications of FDG PET-CT are not as well-established within the paediatric population compared to adults. This article will comprehensively review established oncological PET-CT applications in paediatric oncology and provide an overview of emerging and future developments in this domain.