Computed tomography of pulmonary veins: review of congenital and acquired pathologies.

Newer-generation CT scanners with ultrawide detectors or dual sources offer millisecond image acquisition times and significantly decreased radiation doses compared to historical cardiac CT and CT angiography. This technology is capable of nearly freezing cardiac and respiratory motion. As a result, CT is increasingly used for diagnosing and monitoring cardiac and vascular abnormalities in the pediatric population. CT is particularly useful in the setting of pulmonary vein evaluation because it offers evaluation of the entire pulmonary venous system and lung parenchyma. In this article we review a spectrum of congenital and acquired pulmonary venous abnormalities, including potential etiologies, CT imaging findings and important factors of preoperative planning. In addition, we discuss optimization of CT techniques for evaluating the pulmonary veins.

Severe COVID-19 initially presenting as mesenteric adenopathy.

Coronavirus disease 2019 (COVID-19) can present with abdominal pain in children and adults. Most imaging findings have been limited to characteristic lung findings, as well as one report of bowel-ischemia-related findings in adults. We report a case of COVID-19 in a healthy teenager who initially presented with isolated mesenteric adenopathy, typically a self-limited illness, which progressed to severe illness requiring intensive care before complete recovery. The boy tested negative for COVID-19 twice by polymerase chain reaction (PCR) from upper respiratory swabs before sputum PCR resulted positive. A high index of suspicion should be maintained for COVID-19 given the continued emergence of new manifestations of the disease.

Is biventricular vascular coupling a better indicator of ventriculo-ventricular interaction in congenital heart disease?

BACKGROUND: Ventriculo-ventricular interactions are known to exist, though not well quantified. We hypothesised that the ventricular-vascular coupling ratio assessed by cardiovascular MRI would provide insight into this relationship. We also sought to compare MRI-derived ventricular-vascular coupling ratio to echocardiography and patient outcomes. METHODS: Children with cardiac disease and biventricular physiology were included. Sanz's and Bullet methods were used to calculate ventricular-vascular coupling ratio by MRI and echocardiography, respectively. Subgroup analysis was performed for right and left heart diseases. Univariate and multivariate regressions were performed to determine associations with outcomes. RESULTS: A total of 55 patients (age 14.3 ± 2.5 years) were included. Biventricular ventricular-vascular coupling ratio by MRI correlated with each other (r = 0.41; p = 0.003), with respect to ventricle's ejection fraction (r = -0.76 to -0.88; p < 0.001) and other ventricle's ejection fraction (r = -0.42 to -0.47; p < 0.01). However, biventricular ejection fraction had only weak correlation with each other (r = 0.31; p = 0.02). Echo underestimated ventricular-vascular coupling ratio for the left ventricle (p < 0.001) with modest correlation to MRI-derived ventricular-vascular coupling ratio (r = 0.43; p = 0.002). There seems to be a weak correlation between uncoupled right ventricular-vascular coupling ratio with the need for intervention and performance on exercise testing (r = 0.33; p = 0.02). CONCLUSION: MRI-derived biventricular ventricular-vascular coupling ratio provides a better estimate of ventriculo-ventricular interaction in children and adolescents with CHD. These associations are stronger than traditional parameters and applicable to right and left heart conditions.

MRI change metrics of facioscapulohumeral muscular dystrophy: Stir and T1.

INTRODUCTION: MRI evaluation in facioscapulohumeral muscular dystrophy (FSHD) demonstrates fatty replacement and inflammation/edema in muscle. Our previous work demonstrated short T1 inversion recovery (STIR)-hyperintense (STIR+) signal in muscle 2 years before fatty replacement. We evaluated leg muscle STIR changes and fatty replacement within 14 months. METHODS: FSHD subjects received 2 MRI scans of thigh and calf over a 6.9- to 13.8-month interval. Quality of life measures were collected. One Radiologist rated muscle changes on a semi-quantitative scale. RESULTS: Fifteen subjects completed longitudinal imaging. Four STIR + muscles and 3 STIR-normal (STIR-) muscles were rated as progressing to fatty tissue over the study period. DISCUSSION: STIR + muscles with confluent regions of fat at baseline increased more in fat, while STIR- muscles had increases in septal-fat over the study period. These changes may reflect two phases of FSHD, demonstrating MRI sensitivity is weighted toward gross pathological phases of the disease. Muscle Nerve 57: 905-912, 2018.

Multimodality thoracic imaging of juvenile systemic sclerosis: emphasis on clinical correlation and high-resolution CT of pulmonary fibrosis.

OBJECTIVE. Juvenile systemic sclerosis is a rare multisystem autoimmune disorder characterized by vasculopathy and multiorgan fibrosis. Cardiopulmonary complications are the leading cause of morbidity and mortality. Although pulmonary fibrosis is the complication that is most common and well described, cardiovascular and esophageal involvement may also be observed. In this article, common thoracic findings in juvenile systemic sclerosis will be discussed. We will focus on chest CT, including CT findings of pulmonary fibrosis and associated grading methods, as well as cardiac MRI and esophageal imaging. CONCLUSION. Radiologists play a pivotal role in the initial diagnosis and follow-up evaluation of pediatric patients with systemic sclerosis. Treatment decisions and prognostic assessment are directly related to imaging findings along with clinical evaluation.

Pediatric ovarian torsion: a pictorial review.

Imaging is crucial in expediting the diagnosis and guiding definitive therapy in children with ovarian torsion. This article reviews the multimodality spectrum of imaging findings in pediatric ovarian torsion, focusing primarily on US appearances. We describe predisposing conditions that can lead to torsion, the pathological basis of the radiologic findings in ovarian torsion, and the common diagnostic pitfalls.

Liver and heart MR relaxometry in iron loading: reproducibility of three methods.

PURPOSE: To compare the derived T2* values and reproducibility of three methods used to assess iron-loading in heart and liver. MATERIALS AND METHODS: In 23 pediatric patients, liver and cardiac gradient-echo imaging datasets (within-exam repeated sequence pairs) were evaluated. Data analyses compared derived relaxation values (average of pairs) and coefficient of variation (reproducibility of pairs). RESULTS: T2* values showed differences across methods, with pixel-wise mean > average fit > pixel-wise median. Coefficient of variation was found to be lower (better) with pixel-wise median and average fit methods compared to the pixel-wise mean technique. Maximum coefficient of variation values were lowest for the pixel-wise median approach in both the heart and liver. CONCLUSION: Differences in derived T2* values between methods must be considered when comparing values to established magnetic resonance imaging (MRI)-biopsy formulas. The pixel-wise median and average fit methods demonstrate substantial benefits in reproducibility compared to the pixel-wise mean method. Since minimal variation in measurement is critical for patient care, median processing of relaxometry data may be preferable in both tissue types.

Right ventricular apical sequestration: demonstration of a rare variant of double-chambered right ventricle with MRI.

A 15-year-old boy sustained cardiac arrest and was ultimately found to have imaging characteristics consistent with a right ventricular apical sequestration, a sub-variety of double-chambered right ventricle. This is a unique report demonstrating the MRI findings of this rare variation.

Isolated Right Common Carotid Artery Arising from the Right Pulmonary Artery.

Isolated aortic arch vessels arising anomalously from the pulmonary arterial system are rare congenital anomalies. Case reports of isolated arch vessels are often associated with 22q11 deletion, CHARGE syndrome, or right aortic arch. Isolation of the carotid artery may lead to cerebral steal phenomenon and ischemia or to pulmonary overcirculation. The authors report what is, to their knowledge, the first case of isolated right common carotid artery arising from the right pulmonary artery, associated with 22q11 deletion, and describe the challenging multimodality image evaluation. Keywords: Congenital, Anatomy, Carotid Arteries © RSNA, 2022.

Limitations of using logarithmic transformation and linear fitting to estimate relaxation rates in iron-loaded liver.

BACKGROUND: MRI is being increasingly used to evaluate tissue relaxation in the setting of iron overload. Diagnostic accuracy is strongly dependent upon the acquisition and analysis methods employed. Typically, a multi-echo train of relaxation data is acquired, the resulting curve is fit using a non-linear (exponential) function, and the derived relaxation time is converted to iron concentration by a calibration formula derived from paired MRI-biopsy samples. A theoretically valid processing alternative is to fit a straight line to the relaxation data after logarithmic transformation (log-linear). This log-linear method is more computationally efficient, allowing a full relaxation map to be generated in near real time. This method is present on all scanner platforms and has been published for use in assessing iron concentration. These factors imply methodological validity. OBJECTIVE: To use in vivo and simulation data to show that log-linear fitting can generate highly erroneous relaxation results in iron-loaded tissues. MATERIALS AND METHODS: After IRB approval, exponential and linear fitting were compared in a cohort of 20 patients being evaluated for hepatic iron overload. Simulation analyses were performed to characterize the main factors impacting derived results. RESULTS: In human subjects, log-linear analyses demonstrated gross deviation from exponential results at a moderate relaxation shortening (T2* ~5 ms). Simulation analyses demonstrated that the discrepancy was caused by noise effects and additional signal components violating mono-exponential function shape. CONCLUSION: Log-linear processing results in increasingly erroneous estimation of T2* with iron-loading. Therefore, this method should not be employed for measurement of relaxation behavior in clinical samples.

Exploring the determinants of older adults' susceptibility to pedestrians' incidents.

Older pedestrians (65 years and above) are among the most vulnerable road users. As the number and proportion of older adults grows in many countries, and awareness of the benefits of active travel becomes increasingly evident, it behooves researchers to further investigate the safety of older pedestrians. This study contributes to the literature by examining the factors that influence older adults' susceptibility to pedestrian incidents (falls incidents and pedestrian-vehicle collisions). To this end, a sample of older adults living in the Greater Golden Horseshoe, South Ontario, Canada was surveyed. The data were analyzed using descriptive statistics, Confirmatory Factor Analysis (CFA) and Structural Equation Modeling (SEM), to identify several latent factors that are significantly associated with older adults' involvement in pedestrian incidents. The results revealed that the factors that affect older adults' susceptibility to pedestrian incidents are level of difficulty while walking, fear of falling, and crossing evaluation capability. In contrast, level of pedestrian confidence and level of risk-taking crossing behavior are not among the significant factors. It was also found that older pedestrians aged 65-75 years, males, and those who are still working had a greater probability to be involved in pedestrian incidents. These findings shed light on some key constraints of older pedestrians, and the extent to which each factor could improve their safety. This information, in turn, can be used by transportation authorities in prioritizing their plans, policies, and programs towards improving the safety and mobility of older pedestrians.

Combined endolymphatic and surgical treatment of a leaking central conducting lymphatic malformation in a neonate.

Lymphatic malformations are congenital alterations of normal embryonic lymphatic development. We present a case of a premature 7-week-old male with a large central conducting lymphatic malformation and significant abdominal chylorrhea. He was successfully treated with combined endolymphatic and surgical approaches. To the authors' knowledge, this is the first case to be described.

Congenital lung abnormalities: embryologic features, prenatal diagnosis, and postnatal radiologic-pathologic correlation.

Congenital lung abnormalities are being detected more frequently at routine high-resolution prenatal ultrasonography. The most commonly encountered anomalies include lung agenesis-hypoplasia complex (pulmonary underdevelopment), congenital pulmonary airway malformations, congenital lobar overinflation, bronchial atresia, bronchogenic cysts, congenital high airway obstruction syndrome, scimitar syndrome, and bronchopulmonary sequestration. Recognizing the antenatal and postnatal imaging features of these abnormalities is necessary for optimal prenatal counseling and appropriate peri- and postnatal management. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.306105508/-/DC1.

Fetal tumors: imaging features.

Although fetal tumors are rare, the prognostic and decision-making implications are substantial. The purpose of this pictorial essay is to highlight the most common tumors encountered during fetal imaging and to discuss the respective typical imaging findings. When appropriate, limited additional information regarding further considerations for patient care will be included.

ACR-SPR-STR Practice Parameter for the Performance of Cardiac Positron Emission Tomography - Computed Tomography (PET/CT) Imaging.

This clinical practice parameter has been developed collaboratively by the American College of Radiology (ACR), the Society for Pediatric Radiology (SPR), and the Society of Thoracic Radiology (STR). This document is intended to act as a guide for physicians performing and interpreting positron emission tomography-computed tomography (PET/CT) of cardiac diseases in adults and children. The primary value of cardiac PET/CT imaging include evaluation of perfusion, function, viability, inflammation, anatomy, and risk stratification for cardiac-related events such as myocardial infarction and death. Optimum utility of cardiac PET/CT is achieved when images are interpreted in conjunction with clinical information and laboratory data. Measurement of myocardial blood flow, coronary flow reserve and detection of balanced ischemia are significant advantages of cardiac PET perfusion studies. Increasingly cardiac PET/CT is used in diagnosis and treatment response assessment for cardiac sarcoidosis.

"Children are not small adults": avoiding common pitfalls of normal developmental variants in pediatric imaging.

Imaging of children is complicated with a vast array of normal variants, congenital or developmental disorders, and age-dependent differential considerations. We present imaging findings of several common anatomic variants as well as physiological and maturational processes that occur in children. We compare and contrast them with pathological entities so that the reader can successfully distinguish them when interpreting pediatric imaging examinations. The content has been accrued from the authors' collective experience at a tertiary-care pediatric hospital, teaching and consulting with radiology trainees and clinicians, as well as a comprehensive review of the literature, and is intended to represent a useful error prevention tool for radiologists interpreting pediatric studies.

Peer Review: Lessons Learned in A Pediatric Radiology Department.

The purpose of this article is to illustrate types of diagnostic errors and feedback given to radiologists, using cases to support and clarify these categories. A comment-enhanced peer review system may be leveraged to generate a comprehensive feedback categorization scheme. These include errors of observation, errors of interpretation, inadequate patient data gathering, errors of communication, interobserver variability, informational feedback, and compliments. Much of this feedback is captured through comments associated with interpretative agreements.

A cross sectional study of two independent cohorts identifies serum biomarkers for facioscapulohumeral muscular dystrophy (FSHD).

Measuring the severity and progression of facioscapulohumeral muscular dystrophy (FSHD) is particularly challenging because muscle weakness progresses over long periods of time and can be sporadic. Biomarkers are essential for measuring disease burden and testing treatment strategies. We utilized the sensitive, specific, high-throughput SomaLogic proteomics platform of 1129 proteins to identify proteins with levels that correlate with FSHD severity in a cross-sectional study of two independent cohorts. We discovered biomarkers that correlate with clinical severity and disease burden measured by magnetic resonance imaging. Sixty-eight proteins in the Rochester cohort (n = 48) and 51 proteins in the Seattle cohort (n = 30) had significantly different levels in FSHD-affected individuals when compared with controls (p-value ≤ .005). A subset of these varied by at least 1.5 fold and four biomarkers were significantly elevated in both cohorts. Levels of creatine kinase MM and MB isoforms, carbonic anhydrase III, and troponin I type 2 reliably predicted the disease state and correlated with disease severity. Other novel biomarkers were also discovered that may reveal mechanisms of disease pathology. Assessing the levels of these biomarkers during clinical trials may add significance to other measures of quantifying disease progression or regression.