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Kim PH, Hwang JY, Choi YH, Yoon HM, Lee CW. Safety of Gadoxetate Disodium for Hepatobiliary MRI in Children and Adolescents. Radiology 2024; 311:e232462. [PMID: 38860893 DOI: 10.1148/radiol.232462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
Background Despite a proven role in the characterization of liver lesions, use of the gadolinium-based contrast agent (GBCA) gadoxetate disodium at MRI is limited in children due to a lack of comparative safety data. Purpose To evaluate the safety of the GBCA gadoxetate disodium (a linear ionic hepatobiliary contrast agent [HBA]) in children and adolescents, compared with extracellular contrast agents (ECA). Materials and Methods A retrospective analysis was conducted in children and adolescents aged 18 years or younger who underwent HBA-enhanced MRI at one of three tertiary hospitals from January 2010 to December 2022. The incidence of GBCA-associated acute adverse events was compared between MRI examinations with a HBA and those with ECA. Severity was categorized according to American College of Radiology guidelines (mild, moderate, or severe). (a) Propensity score matching using multivariable logistic regression models and (b) inverse probability of treatment weighting analysis based on nine covariates (age, sex, asthma, allergic rhinitis, chronic urticaria or atopy, food allergy, drug allergy, premedication, and history of GBCA-associated adverse events) were used for confounder adjustment. Results A total of 1629 MRI examinations (ECA, n = 1256; HBA, n = 373) in 1079 patients were included (mean age, 8.6 years ± 6.5; 566 girls). The per-examination incidence of GBCA-associated acute adverse events showed no evidence of a difference, with rates of 0.9% (11 of 1256 examinations) for ECA and 1.3% (five of 373 examinations) for HBA (odds ratio [OR], 1.55 [95% CI: 0.54, 4.46]; P = .42). Acute adverse events were all mild with ECA, whereas with HBA, they were mild for four patients and moderate for one patient. There was no evidence of a difference in the incidence of acute adverse events, even in propensity score matching (OR, 1.33 [95% CI: 0.30, 5.96]; P = .71) and inverse probability of treatment weighting analysis (OR, 0.84 [95% CI: 0.25, 2.86]; P = .78). Conclusion Gadoxetate disodium showed no difference in acute adverse events compared with ECA in children and adolescents, with further large-scale pediatric studies required to confirm its safety. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Otero in this issue.
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Affiliation(s)
- Pyeong Hwa Kim
- From the Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (P.H.K., H.M.Y., C.W.L.); Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (J.Y.H., Y.H.C.); and Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, College of Medicine, Pusan National University, Yangsan, Republic of Korea (J.Y.H.)
| | - Jae-Yeon Hwang
- From the Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (P.H.K., H.M.Y., C.W.L.); Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (J.Y.H., Y.H.C.); and Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, College of Medicine, Pusan National University, Yangsan, Republic of Korea (J.Y.H.)
| | - Young Hun Choi
- From the Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (P.H.K., H.M.Y., C.W.L.); Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (J.Y.H., Y.H.C.); and Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, College of Medicine, Pusan National University, Yangsan, Republic of Korea (J.Y.H.)
| | - Hee Mang Yoon
- From the Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (P.H.K., H.M.Y., C.W.L.); Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (J.Y.H., Y.H.C.); and Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, College of Medicine, Pusan National University, Yangsan, Republic of Korea (J.Y.H.)
| | - Choong Wook Lee
- From the Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (P.H.K., H.M.Y., C.W.L.); Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (J.Y.H., Y.H.C.); and Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, College of Medicine, Pusan National University, Yangsan, Republic of Korea (J.Y.H.)
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Dong Y, Cekuolis A, Schreiber-Dietrich D, Augustiniene R, Schwarz S, Möller K, Nourkami-Tutdibi N, Chen S, Cao JY, Huang YL, Wang Y, Taut H, Grevelding L, Dietrich CF. Review on Pediatric Malignant Focal Liver Lesions with Imaging Evaluation: Part I. Diagnostics (Basel) 2023; 13:3568. [PMID: 38066809 PMCID: PMC10706220 DOI: 10.3390/diagnostics13233568] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/13/2023] [Accepted: 11/27/2023] [Indexed: 01/09/2024] Open
Abstract
Malignant focal liver lesions (FLLs) are commonly reported in adults but rarely seen in the pediatric population. Due to the rarity, the understanding of these diseases is still very limited. In children, most malignant FLLs are congenital. It is very important to choose appropriate imaging examination concerning various factors. This paper will outline common pediatric malignant FLLs, including hepatoblastoma, hepatocellular carcinoma, and cholangiocarcinoma and discuss them against the background of the latest knowledge on comparable/similar tumors in adults. Medical imaging features are of vital importance for the non-invasive diagnosis and follow-up of treatment of FLLs in pediatric patients. The use of CEUS in pediatric patients for characterizing those FLLs that remain indeterminate on conventional B mode ultrasounds may be an effective option in the future and has great potential to be integrated into imaging algorithms without the risk of exposure to ionizing radiation.
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Affiliation(s)
- Yi Dong
- Department of Ultrasound, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China; (Y.D.); (S.C.); (J.-Y.C.); (Y.-L.H.); (Y.W.)
| | - Andrius Cekuolis
- Ultrasound Section, Department of Pediatric Radiology, Radiology and Nuclear Medicine Centre, Vilnius University Hospital Santaros Klinikos, 08661 Vilnius, Lithuania; (A.C.); (R.A.)
| | | | - Rasa Augustiniene
- Ultrasound Section, Department of Pediatric Radiology, Radiology and Nuclear Medicine Centre, Vilnius University Hospital Santaros Klinikos, 08661 Vilnius, Lithuania; (A.C.); (R.A.)
| | - Simone Schwarz
- Department of Neonatology and Pediatric Intensive Care Medicine, Sana Kliniken Duisburg GmbH, 47055 Duisburg, Germany;
| | - Kathleen Möller
- Medical Department I/Gastroenterology, SANA Hospital Lichtenberg, 10365 Berlin, Germany;
| | - Nasenien Nourkami-Tutdibi
- Saarland University Medical Center, Hospital of General Pediatrics and Neonatology, 66421 Homburg, Germany;
| | - Sheng Chen
- Department of Ultrasound, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China; (Y.D.); (S.C.); (J.-Y.C.); (Y.-L.H.); (Y.W.)
| | - Jia-Ying Cao
- Department of Ultrasound, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China; (Y.D.); (S.C.); (J.-Y.C.); (Y.-L.H.); (Y.W.)
| | - Yun-Lin Huang
- Department of Ultrasound, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China; (Y.D.); (S.C.); (J.-Y.C.); (Y.-L.H.); (Y.W.)
| | - Ying Wang
- Department of Ultrasound, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China; (Y.D.); (S.C.); (J.-Y.C.); (Y.-L.H.); (Y.W.)
| | - Heike Taut
- Children’s Hospital, Universitätsklinikum Dresden, Technische Universität Dresden, 01069 Dresden, Germany;
| | - Lara Grevelding
- Department of Pediatrics, Division of Pneumology, Allergology, Infectious Diseases and Gastroenterology, University Hospital Frankfurt, Goethe University, 60323 Frankfurt, Germany
| | - Christoph F. Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, 3013 Bern, Switzerland
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Morin CE, Kolbe AB, Alazraki A, Chavhan GB, Gill A, Infante J, Khanna G, Nguyen HN, O'Neill AF, Rees MA, Sharma A, Squires JE, Squires JH, Syed AB, Tang ER, Towbin AJ, Schooler GR. Cancer Therapy-related Hepatic Injury in Children: Imaging Review from the Pediatric LI-RADS Working Group. Radiographics 2023; 43:e230007. [PMID: 37616168 DOI: 10.1148/rg.230007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
The liver is the primary organ for the metabolism of many chemotherapeutic agents. Treatment-induced liver injury is common in children undergoing cancer therapy. Hepatic injury occurs due to various mechanisms, including biochemical cytotoxicity, hepatic vascular injury, radiation-induced cytotoxicity, and direct hepatic injury through minimally invasive and invasive surgical treatments. Treatment-induced liver injury can be seen contemporaneous with therapy and months to years after therapy is complete. Patients can develop a combination of hepatic injuries manifesting during and after treatment. Acute toxic effects of cancer therapy in children include hepatitis, steatosis, steatohepatitis, cholestasis, hemosiderosis, and vascular injury. Longer-term effects of cancer therapy include hepatic fibrosis, chronic liver failure, and development of focal liver lesions. Quantitative imaging techniques can provide useful metrics for disease diagnosis and monitoring, especially in treatment-related diffuse liver injury such as hepatic steatosis and steatohepatitis, hepatic iron deposition, and hepatic fibrosis. Focal liver lesions, including those developing as a result of treatment-related vascular injury such as focal nodular hyperplasia-like lesions and hepatic perfusion anomalies, as well as hepatic infections occurring as a consequence of immune suppression, can be anxiety provoking and confused with recurrent malignancy or hepatic metastases, although there often are imaging features that help elucidate the correct diagnosis. Radiologic evaluation, in conjunction with clinical and biochemical screening, is integral to diagnosing and monitoring hepatic complications of cancer therapy in pediatric patients during therapy and after therapy completion for long-term surveillance. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material See the invited commentary by Ferraciolli and Gee in this issue.
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Affiliation(s)
- Cara E Morin
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - Amy B Kolbe
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - Adina Alazraki
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - Govind B Chavhan
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - Annie Gill
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - Juan Infante
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - Geetika Khanna
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - HaiThuy N Nguyen
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - Allison F O'Neill
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - Mitchell A Rees
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - Akshay Sharma
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - James E Squires
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - Judy H Squires
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - Ali B Syed
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - Elizabeth R Tang
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - Alexander J Towbin
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - Gary R Schooler
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
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Chavhan GB, Schooler GR, Tang ER, Squires JH, Rees MA, Nguyen HN, Morin CE, Kolbe AB, Khanna G, Infante JC, Alazraki AL, Towbin AJ. Optimizing Imaging of Pediatric Liver Lesions: Guidelines from the Pediatric LI-RADS Working Group. Radiographics 2022; 43:e220043. [DOI: 10.1148/rg.220043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Hojreh A, Ba-Ssalamah A, Lang C, Poetter-Lang S, Huber WD, Tamandl D. Influence of age on gadoxetic acid disodium-induced transient respiratory motion artifacts in pediatric liver MRI. PLoS One 2022; 17:e0264069. [PMID: 35235594 PMCID: PMC8890729 DOI: 10.1371/journal.pone.0264069] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 02/02/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Gd-EOB-DTPA-enhanced liver MRI is frequently compromised by transient severe motion artifacts (TSM) in the arterial phase, which limits image interpretation for the detection and differentiation of focal liver lesions and for the recognition of the arterial vasculature before and after liver transplantation. The purpose of this study was to investigate which patient factors affect TSM in children who undergo Gd-EOB-DTPA-enhanced liver MRI and whether younger children are affected as much as adolescents. METHODS One hundred and forty-eight patients (65 female, 83 male, 0.1-18.9 years old), who underwent 226 Gd-EOB-DTPA-enhanced MRIs were included retrospectively in this single-center study. The occurrence of TSM was assessed by three readers using a four-point Likert scale. The relation to age, gender, body mass index, indication for MRI, requirement for sedation, and MR repetition was investigated using uni- and multivariate logistic regression analysis. RESULTS In Gd-EOB-DTPA-enhanced MRIs, TSM occurred in 24 examinations (10.6%). Patients with TSM were significantly older than patients without TSM (median 14.3 years; range 10.1-18.1 vs. 12.4 years; range 0.1-18.9, p<0.001). TSM never appeared under sedation. Thirty of 50 scans in patients younger than 10 years were without sedation. TSM were not observed in non-sedated patients younger than 10 years of age (p = 0.028). In a logistic regression analysis, age remained the only cofactor independently associated with the occurrence of TSM (hazard ratio 9.152, p = 0.049). CONCLUSION TSM in Gd-EOB-DTPA-enhanced liver MRI do not appear in children under the age of 10 years.
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Affiliation(s)
- Azadeh Hojreh
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Ahmed Ba-Ssalamah
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Christian Lang
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
- Department of Anaesthesia, Emergency Medicine and Intensive Care, General Hospital Wiener Neustadt, Wiener Neustadt, Austria
| | - Sarah Poetter-Lang
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Wolf-Dietrich Huber
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Dietmar Tamandl
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
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Imaging for Staging of Pediatric Abdominal Tumors: An Update, From the AJR Special Series on Cancer Staging. AJR Am J Roentgenol 2021; 217:786-799. [PMID: 33825502 DOI: 10.2214/ajr.20.25310] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The three most common pediatric solid tumors of the abdomen are neuroblastoma, Wilms tumor, and hepatoblastoma. These embryonal tumors most commonly present in the first decade of life. Each tumor has unique imaging findings, including locoregional presentation and patterns of distant spread. Neuroblastoma, Wilms tumor, and hepatoblastoma have unique staging systems that rely heavily on imaging and influence surgical and oncologic management. The staging systems include image-defined risk factors for neuroblastoma, the Children's Oncology Group staging system for Wilms tumor, and the pretreatment extent of tumor system (PRETEXT) for hepatoblastoma. It is important for radiologists to be aware of these staging systems to optimize image acquisition and interpretation. This article provides a practical and clinically oriented approach to the role of imaging in the staging of these common embryonal tumors of childhood. The selection among imaging modalities, key findings for determining tumor stage, and the role of imaging in posttreatment response evaluation and surveil-lance are discussed. Recent updates to the relevant staging systems are highlighted with attention to imaging findings of particular prognostic importance. The information presented will help radiologists tailor the imaging approach to the individual patient and guide optimal oncologic management.
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Watson TA, Barber J, Woodley H. Paediatric gastrointestinal and hepatobiliary radiology: why do we need subspecialists, and what is new? Pediatr Radiol 2021; 51:554-569. [PMID: 33743039 DOI: 10.1007/s00247-020-04778-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/06/2020] [Accepted: 07/08/2020] [Indexed: 12/17/2022]
Abstract
We present the case for subspecialisation in paediatric gastrointestinal and hepato-pancreatico-biliary radiology. We frame the discussion around a number of questions: What is different about the paediatric patient and paediatric gastrointestinal system? What does the radiologist need to do differently? And finally, what can be translated from these subspecialty areas into everyday practice? We cover conditions that the sub-specialist might encounter, focusing on entities such as inflammatory bowel disease and hepatic vascular anomalies. We also highlight novel imaging techniques that are a focus of research in the subspecialties, including contrast-enhanced ultrasound, MRI motility, magnetisation transfer factor, and magnetic resonance elastography.
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Affiliation(s)
- Tom A Watson
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK.
| | - Joy Barber
- Department of Radiology, St. George's Hospital NHS Foundation Trust, London, UK
| | - Helen Woodley
- Department of Radiology, Leeds Teaching Hospital NHS Trust, Leeds, UK
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Lee SH, Hadipour-Lakmehsari S, Kim DH, Di Paola M, Kuzmanov U, Shah S, Lee JJH, Kislinger T, Sharma P, Oudit GY, Gramolini AO. Bioinformatic analysis of membrane and associated proteins in murine cardiomyocytes and human myocardium. Sci Data 2020; 7:425. [PMID: 33262348 PMCID: PMC7708497 DOI: 10.1038/s41597-020-00762-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 11/17/2020] [Indexed: 12/13/2022] Open
Abstract
In the current study we examined several proteomic- and RNA-Seq-based datasets of cardiac-enriched, cell-surface and membrane-associated proteins in human fetal and mouse neonatal ventricular cardiomyocytes. By integrating available microarray and tissue expression profiles with MGI phenotypic analysis, we identified 173 membrane-associated proteins that are cardiac-enriched, conserved amongst eukaryotic species, and have not yet been linked to a 'cardiac' Phenotype-Ontology. To highlight the utility of this dataset, we selected several proteins to investigate more carefully, including FAM162A, MCT1, and COX20, to show cardiac enrichment, subcellular distribution and expression patterns in disease. We performed three-dimensional confocal imaging analysis to validate subcellular localization and expression in adult mouse ventricular cardiomyocytes. FAM162A, MCT1, and COX20 were expressed differentially at the transcriptomic and proteomic levels in multiple models of mouse and human heart diseases and may represent potential diagnostic and therapeutic targets for human dilated and ischemic cardiomyopathies. Altogether, we believe this comprehensive cardiomyocyte membrane proteome dataset will prove instrumental to future investigations aimed at characterizing heart disease markers and/or therapeutic targets for heart failure.
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Affiliation(s)
- Shin-Haw Lee
- Translational Biology and Engineering Program, Ted Rogers Centre for Heart Research, Toronto, Ontario, M5G 1M1, Canada
- Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, M5S 1M8, Canada
| | - Sina Hadipour-Lakmehsari
- Translational Biology and Engineering Program, Ted Rogers Centre for Heart Research, Toronto, Ontario, M5G 1M1, Canada
- Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, M5S 1M8, Canada
| | - Da Hye Kim
- Translational Biology and Engineering Program, Ted Rogers Centre for Heart Research, Toronto, Ontario, M5G 1M1, Canada
- Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, M5S 1M8, Canada
| | - Michelle Di Paola
- Translational Biology and Engineering Program, Ted Rogers Centre for Heart Research, Toronto, Ontario, M5G 1M1, Canada
- Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, M5S 1M8, Canada
| | - Uros Kuzmanov
- Translational Biology and Engineering Program, Ted Rogers Centre for Heart Research, Toronto, Ontario, M5G 1M1, Canada
- Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, M5S 1M8, Canada
| | - Saumya Shah
- Department of Medicine, University of Alberta, Edmonton, Alberta, T6G 2R3, Canada
- Mazankowski Alberta Heart Institute, Edmonton, Alberta, T6G 2B7, Canada
| | - Joseph Jong-Hwan Lee
- Translational Biology and Engineering Program, Ted Rogers Centre for Heart Research, Toronto, Ontario, M5G 1M1, Canada
- Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, M5S 1M8, Canada
| | - Thomas Kislinger
- Princess Margaret Cancer Research Centre, Toronto, Ontario, M5G 1L8, Canada
- Department of Medical Biophysics, Faculty of Medicine, University of Toronto, Toronto, Ontario, M5G 1L7, Canada
| | - Parveen Sharma
- Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, M5S 1M8, Canada
- Department of Cardiovascular & Metabolic Medicine, University of Liverpool, Liverpool, L69 3GE, UK
| | - Gavin Y Oudit
- Department of Medicine, University of Alberta, Edmonton, Alberta, T6G 2R3, Canada
- Mazankowski Alberta Heart Institute, Edmonton, Alberta, T6G 2B7, Canada
| | - Anthony O Gramolini
- Translational Biology and Engineering Program, Ted Rogers Centre for Heart Research, Toronto, Ontario, M5G 1M1, Canada.
- Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, M5S 1M8, Canada.
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Hepatobiliary MRI Contrast Agents: Pattern Recognition Approach to Pediatric Focal Hepatic Lesions. AJR Am J Roentgenol 2020; 214:976-986. [DOI: 10.2214/ajr.19.22239] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Newly Developed Methods for Reducing Motion Artifacts in Pediatric Abdominal MRI: Tips and Pearls. AJR Am J Roentgenol 2020; 214:1042-1053. [PMID: 32023117 DOI: 10.2214/ajr.19.21987] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE. The purpose of this article is to review established and emerging methods for reducing motion artifacts in pediatric abdominal MRI. CONCLUSION. Clearly understanding the strengths and limitations of motion reduction methods can enable practitioners of pediatric abdominal MRI to select and combine the appropriate techniques and potentially reduce the need for sedation and anesthesia.
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Rate of gadoxetate disodium (Eovist®) induced transient respiratory motion in children and young adults. Abdom Radiol (NY) 2020; 45:101-106. [PMID: 31701191 DOI: 10.1007/s00261-019-02296-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Gadoxetate disodium (Eovist®, Bayer Healthcare, Wayne, NJ) is the preferred MR contrast agent for pediatric hepatobiliary imaging. A known limitation of this contrast agent is transient severe respiratory artifacts during arterial phase imaging, and some adult studies have raised caution against its use for evaluation of arterial enhancing lesions. The reported rate of transient severe breathing motion is 5-22% in adult studies. This study seeks to evaluate the frequency of transient severe respiratory motion secondary to gadoxetate disodium in a pediatric cohort. MATERIALS AND METHODS This is a retrospective, IRB-approved study with informed consent waiver. The radiology information system of a children's hospital was searched to identify all MRI studies performed with gadoxetate disodium during January 2016-June 2018. Two readers independently evaluated all phases of a dynamic liver protocol for respiratory motion artifact on a 5-point scale (1 none, 2 mild, 3 moderate, 4 severe-still diagnostic, 5 extreme-not diagnostic). Average scores of the 2 readers for each phase were used for analyses. Transient severe respiratory motion was defined as an increase in artifact score of ≥ 1.5 from pre-contrast to arterial phase that returned to < 3 in equilibrium phase of imaging. RESULTS The study cohort consisted of 140 cases (60% female), age range: 1 month-23 years (median 13 years). 102/140 scans were performed non-sedated. Mean respiratory motion score for each phase of scan for the entire cohort were pre-contrast: 2.23, arterial: 2.56, portal venous: 2.39, and equilibrium: 2.31. Transient severe respiratory motion was seen in 8 non-sedated cases and in 0 sedated cases. The rate of transient severe respiratory motion in a non-sedated pediatric cohort was estimated at 7.84% (8/102 cases). CONCLUSION The rate of transient severe respiratory motion in the non-sedated pediatric population is in the lower end of the range reported in adults. Transient severe respiratory motion is not observed in sedated patients.
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Surgical Management of Hepatoblastoma and Recent Advances. Cancers (Basel) 2019; 11:cancers11121944. [PMID: 31817219 PMCID: PMC6966548 DOI: 10.3390/cancers11121944] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 11/18/2019] [Accepted: 11/29/2019] [Indexed: 12/29/2022] Open
Abstract
Hepatoblastoma is the most common childhood liver malignancy. The management of hepatoblastoma requires multidisciplinary efforts. The five-year overall survival is approximately 80% in developed countries. Surgery remains the mainstay of treatment for hepatoblastoma, and meticulous techniques must be employed to ensure safe and effective local control surgeries. Additionally, there have been several advances from both pediatric and adult literature in the way liver tumor surgery is performed. In this review, we highlight important aspects of liver surgery for hepatoblastoma, the management of metastatic disease, and the most current technical advances in performing these procedures in a safe and effective manner.
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Ayyala RS, Anupindi SA, Gee MS, Trout AT, Callahan MJ. Intravenous gadolinium-based hepatocyte-specific contrast agents (HSCAs) for contrast-enhanced liver magnetic resonance imaging in pediatric patients: what the radiologist should know. Pediatr Radiol 2019; 49:1256-1268. [PMID: 31350632 DOI: 10.1007/s00247-019-04476-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/13/2019] [Accepted: 07/09/2019] [Indexed: 12/15/2022]
Abstract
Hepatocyte-specific contrast agents (HSCAs) are a group of intravenous gadolinium-based MRI contrast agents that can be used to characterize hepatobiliary pathology. The mechanism by which these agents are taken up by hepatocytes and partially excreted into the biliary tree improves characterization of hepatic lesions and biliary abnormalities relative to conventional extracellular gadolinium-based contrast agents (GBCAs). This manuscript presents an overview of HSCA use in pediatric patients with the intent to provide radiologists a guide for clinical use. We review available HSCAs and discuss dosing and age specifications for use in children. We also review various hepatic and biliary indications for HSCA use in children, with emphasis on the imaging characteristics distinct to HSCAs, as well as discussion of pitfalls one can encounter when imaging with HSCAs. Given the growing concern regarding gadolinium deposition in soft tissues and brain, we also discuss safety of HSCA use in children.
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Affiliation(s)
- Rama S Ayyala
- Department of Diagnostic Imaging, Rhode Island Hospital - Hasbro Children's Hospital, Warren Alpert Medical School of Brown University, 593 Eddy St., Providence, RI, 02903, USA.
| | - Sudha A Anupindi
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michael S Gee
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Respiratory motion in children and young adults undergoing liver magnetic resonance imaging with intravenous gadoxetate disodium contrast material. Pediatr Radiol 2019; 49:1171-1176. [PMID: 31203405 DOI: 10.1007/s00247-019-04437-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/29/2019] [Accepted: 05/21/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Gadoxetate disodium, utilized in hepatobiliary magnetic resonance (MR) imaging, has been associated with transient respiratory motion during the arterial phase in adults. OBJECTIVE The purpose of this study was to determine the presence and severity of this phenomenon in children imaged awake versus under general anesthesia. MATERIALS AND METHODS This retrospective cohort study was approved by the institutional review board; informed consent was waived. One hundred thirty exams of children ≤18 years old who underwent dynamic liver MR imaging with gadoxetate disodium between October 2010 and January 2018 were reviewed. Three pediatric radiologists scored respiratory motion artifacts on all imaging phases using a 5-point Likert scale. Differences in mean motion scores were assessed with analysis of variance and Tukey's multiple comparisons test, and multivariable regression was used to identify predictors of arterial phase motion in awake patients. RESULTS One hundred thirty patients (50% [n=65] female; mean age: 9.8±3.7 years, 48.5% [n=63] awake) were included. There were significant differences in mean motion scores between phases in the awake cohort (P<0.0001) but not in the general anesthesia cohort (P=0.051). In the awake cohort, arterial phase motion score (mean: 3.52±0.83) was significantly higher than mean motion score in all other phases (P≤0.0003). There were no significant patient-specific predictors of arterial phase motion score in the awake cohort. CONCLUSION Significantly increased arterial phase respiratory motion artifact in awake children undergoing dynamic liver MR imaging with gadoxetate disodium suggests that transient respiratory motion occurs in children. General anesthesia may suppress this phenomenon.
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Shet NS, Flynn JF, Maloney E, Iyer RS. Use of Eovist in Pediatric Patients: Pearls and Pitfalls. Curr Probl Diagn Radiol 2019; 49:266-274. [PMID: 31047739 DOI: 10.1067/j.cpradiol.2019.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 04/02/2019] [Indexed: 12/25/2022]
Abstract
Magnetic resonance imaging is excellent at characterizing pediatric hepatobiliary pathology. Noncontrast MRI is helpful due to T2 hyperintensity associated with bile, but contrast enhancement offers additional means of lesional characterization. In particular, hepatocyte-specific contrast agents such as gadoxetate disodium (Eovist) exhibit partial hepatobiliary excretion which may be leveraged in these contexts. In this review, we will discuss gadoxetate disodium usage, including a sample-imaging protocol, and demonstrate applications and limitations in the pediatric population.
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Affiliation(s)
- Narendra S Shet
- Division of Diagnostic Imaging and Radiology; Children's National Health System; Washington, DC.
| | - John F Flynn
- Division of Diagnostic Imaging and Radiology; Children's National Health System; Washington, DC
| | - Ezekiel Maloney
- Department of Radiology; Seattle Children's Hospital; Seattle, WA
| | - Ramesh S Iyer
- Department of Radiology; Seattle Children's Hospital; Seattle, WA
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Abstract
Alagille syndrome is associated with decreased bile ducts, cardiac abnormalities, vertebral body fusion defects, and a typical facies. While regenerative nodules and hepatocellular carcinoma have been described in these patients, hepatic adenoma has not. Herein, we present a patient with Alagille syndrome caused by a mutation in NOTCH2 with a hepatic adenoma. The clinical, imaging, and histologic features are discussed.
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Affiliation(s)
- M Cristina Pacheco
- 1 Department of Pathology, University of Washington, Seattle, Washington.,2 Department of Laboratories, Seattle Children's Hospital, Seattle, Washington
| | - Eric J Monroe
- 3 Department of Radiology, University of Washington, Seattle, Washington.,4 Department of Radiology, Seattle Children's Hospital, Seattle, Washington
| | - Simon P Horslen
- 5 Department of Pediatrics, University of Washington, Seattle, Washington.,6 Department of Gastroenterology and Hepatology, Seattle Children's Hospital, Seattle, Washington
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Masand PM. Magnetic resonance imaging features of common focal liver lesions in children. Pediatr Radiol 2018; 48:1234-1244. [PMID: 30078045 DOI: 10.1007/s00247-018-4218-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 07/06/2018] [Accepted: 07/17/2018] [Indexed: 12/29/2022]
Abstract
Magnetic resonance imaging (MRI) is commonly used to characterize focal liver masses in the pediatric population. MRI is the preferred modality because of its superior contrast resolution and utility for obtaining functional sequences such as diffusion-weighted imaging (DWI). MR exams performed with a hepatocyte-specific gadolinium-based contrast agent can characterize focal liver lesions, which helps in differentiating a common benign entity such as focal nodular hyperplasia from other liver pathology when the background liver is normal. The most common benign focal lesion is a hemangioma, and metastases followed by hepatoblastoma are the most common malignant lesions. This article can help radiologists become familiar with the pre- and post-contrast imaging features of common pediatric liver masses.
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Affiliation(s)
- Prakash M Masand
- Cardiovascular Imaging, Department of Pediatric Radiology, Texas Children's Hospital, 6701 Fannin St., Houston, TX, 77030, USA. .,Baylor College of Medicine, Houston, TX, USA.
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Koolwal J, Birkemeier KL, Zreik RT, Mattix KD. Pedunculated focal nodular hyperplasia in a healthy toddler. Proc (Bayl Univ Med Cent) 2018; 31:97-99. [PMID: 29686569 DOI: 10.1080/08998280.2017.1401845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Focal nodular hyperplasia (FNH) is a benign hepatic tumor rarely seen in pediatric patients, with most cases reported in school-aged children with a history of malignancy, liver disease, chemotherapy, or hematopoietic stem cell therapy. Despite having advanced radiographic imaging, diagnosing FNH before surgical resection can be difficult. We report a rare case of pedunculated FNH presenting as a large abdominal mass palpated on physical exam in a healthy 3-year-old girl with no history of malignancy or underlying liver disease. Ultrasound, computed tomography, and magnetic resonance imaging (MRI) did not demonstrate the typical imaging characteristics of FNH, because the mass was pedunculated with a poorly visualized central scar. Because approximately 75% of all primary hepatic tumors in this age group are malignant, this report also discusses the importance of adding hepatobiliary phase imaging with MRI to avoid, if possible, the need for biopsy or surgical resection of a benign hepatic tumor.
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Affiliation(s)
- Juhi Koolwal
- Texas A&M Health Science Center College of Medicine, Temple, Texas
| | - Krista L Birkemeier
- Department of Radiology, Baylor Scott & White McLane Children's Medical Center, Texas A&M University Health Sciences, Temple, Texas
| | - Riyam T Zreik
- Department of Pathology, Scott & White Medical Center, Temple, Texas
| | - Kelly D Mattix
- Department of Pediatric Surgery, Scott & White Medical Center, Temple, Texas
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Towbin AJ, Meyers RL, Woodley H, Miyazaki O, Weldon CB, Morland B, Hiyama E, Czauderna P, Roebuck DJ, Tiao GM. 2017 PRETEXT: radiologic staging system for primary hepatic malignancies of childhood revised for the Paediatric Hepatic International Tumour Trial (PHITT). Pediatr Radiol 2018; 48:536-554. [PMID: 29427028 DOI: 10.1007/s00247-018-4078-z] [Citation(s) in RCA: 145] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/01/2017] [Accepted: 01/11/2018] [Indexed: 02/07/2023]
Abstract
Imaging is crucial in the assessment of children with a primary hepatic malignancy. Since its inception in 1992, the PRETEXT (PRE-Treatment EXTent of tumor) system has become the primary method of risk stratification for hepatoblastoma and pediatric hepatocellular carcinoma in numerous cooperative group trials across the world. The PRETEXT system is made of two components: the PRETEXT group and the annotation factors. The PRETEXT group describes the extent of tumor within the liver while the annotation factors help to describe associated features such as vascular involvement (either portal vein or hepatic vein/inferior vena cava), extrahepatic disease, multifocality, tumor rupture and metastatic disease (to both the lungs and lymph nodes). This manuscript is written by members of the Children's Oncology Group (COG) in North America, the International Childhood Liver Tumors Strategy Group (SIOPEL) in Europe, and the Japanese Study Group for Pediatric Liver Tumor (JPLT; now part of the Japan Children's Cancer Group) and represents an international consensus update to the 2005 PRETEXT definitions. These definitions will be used in the forthcoming Trial to Pediatric Hepatic International Tumor Trial (PHITT).
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Affiliation(s)
- Alexander J Towbin
- Department of Radiology, Cincinnati Children's Hospital, 3333 Burnet Ave., MLC 5031, Cincinnati, OH, 45229, USA.
| | - Rebecka L Meyers
- Division of Pediatric Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA
| | - Helen Woodley
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Osamu Miyazaki
- Department of Radiology, National Center for Child Health and Development, Tokyo, Japan
| | - Christopher B Weldon
- Departments of Surgery and Oncology, Boston Children's Hospital/Dana Farber Cancer Institute, Boston, MA, USA
| | - Bruce Morland
- Department of Oncology, Birmingham Women's and Children's Hospital, Birmingham, UK
| | - Eiso Hiyama
- Department of Pediatric Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Piotr Czauderna
- Department of Surgery and Urology for Children and Adolescents, Medical University of Gdansk, Gdansk, Poland
| | - Derek J Roebuck
- Department of Radiology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Greg M Tiao
- Division of General and Thoracic Surgery, Cincinnati Children's Hospital, Cincinnati, OH, USA
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20
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Caro-Domínguez P, Gupta AA, Chavhan GB. Can diffusion-weighted imaging distinguish between benign and malignant pediatric liver tumors? Pediatr Radiol 2018; 48:85-93. [PMID: 28921384 DOI: 10.1007/s00247-017-3984-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 07/10/2017] [Accepted: 09/06/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND There are limited data on utility of diffusion-weighted imaging (DWI) in the evaluation of pediatric liver lesions. OBJECTIVE To determine whether qualitative and quantitative DWI can be used to differentiate benign and malignant pediatric liver lesions. MATERIALS AND METHODS We retrospectively reviewed MRIs in children with focal liver lesions to qualitatively evaluate lesions noting diffusion restriction, T2 shine-through, increased diffusion, hypointensity on DWI and apparent diffusion coefficient (ADC) maps, and intermediate signal on both, and to measure ADC values. Pathology confirmation or a combination of clinical, laboratory and imaging features, and follow-up was used to determine final diagnosis. RESULTS We included 112 focal hepatic lesions in 89 children (median age 11.5 years, 51 female), of which 92 lesions were benign and 20 malignant. Interobserver agreement was almost perfect for both qualitative (kappa 0.8735) and quantitative (intraclass correlation coefficient [ICC] 0.96) diffusion assessment. All malignant lesions showed diffusion restriction. Most benign lesions other than abscesses were not restricted. There was significant association of qualitative restriction with malignancy and non-restriction with benignancy (Fisher exact test P<0.0001). Mean normalized ADC values of malignant lesions (1.23x10-3 mm2/s) were lower than benign lesions (1.62x10-3 mm2/s; Student's t-test, P<0.015). However, there was significant overlap of ADC between benign and malignant lesions, with wide range for each diagnosis. Receiver operating characteristic (ROC) analysis revealed an area under the curve (AUC) of 0.63 for predicting malignancy using an ADC cut-off value of ≤1.20x10-3 mm2/s, yielding a sensitivity of 78% and a specificity of 54% for differentiating malignant from benign lesions. CONCLUSION Qualitative diffusion restriction in pediatric liver lesions is a good predictor of malignancy and can help to differentiate between benign and malignant lesions, in conjunction with conventional MR sequences. Even though malignant lesions demonstrated significantly lower ADC values than benign lesions, the use of quantitative diffusion remains limited in its utility for distinguishing them because of the significant overlap and wide ranges of ADC values.
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Affiliation(s)
- Pablo Caro-Domínguez
- Department of Diagnostic Imaging, The Hospital for Sick Children, Medical Imaging, University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada
| | - Abha A Gupta
- Department of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Govind B Chavhan
- Department of Diagnostic Imaging, The Hospital for Sick Children, Medical Imaging, University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada.
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21
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Ayyala RS, Anupindi SA, Callahan MJ. Practical use and pitfalls of hepatocyte-specific contrast agents (HSCAs) for pediatric hepatic and biliary magnetic resonance imaging. Abdom Radiol (NY) 2017; 42:502-520. [PMID: 27680015 DOI: 10.1007/s00261-016-0916-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Magnetic resonance imaging is commonly used to evaluate for hepatic and biliary pathology in the pediatric population. Recently, there has been increased use of hepatocyte-specific contrast agents (HSCAs), such as Gadoxetate disodium in children. Traditionally, HSCAs have been used to characterize focal liver lesions. However, these agents can also be used to problem solve specific hepatic or biliary diagnostic dilemmas. The purpose of this manuscript is to review the practical uses of HSCA in children with both hepatic and biliary indications, and review the corresponding imaging findings. We will highlight the diagnostic uses of HSCA in children, as well as pitfalls encountered.
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Affiliation(s)
- Rama S Ayyala
- Department of Pediatric Radiology, Columbia University Medical Center, Morgan Stanley Children's Hospital, 3959 Broadway, CHONY 3 N, New York, NY, 10032, USA.
| | - Sudha A Anupindi
- Department of Radiology, The Children's Hospital of Philadelphia, 34th Street and Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Michael J Callahan
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
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22
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Rapp JB, Bellah RD, Maya C, Pawel BR, Anupindi SA. Giant hepatic regenerative nodules in Alagille syndrome. Pediatr Radiol 2017; 47:197-204. [PMID: 27796468 DOI: 10.1007/s00247-016-3728-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 09/10/2016] [Accepted: 10/07/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Children with Alagille syndrome undergo surveillance radiologic examinations as they are at risk for developing cirrhosis and hepatocellular carcinoma. There is limited literature on the imaging of liver masses in Alagille syndrome. We report the ultrasound (US) and magnetic resonance imaging (MRI) appearances of incidental benign giant hepatic regenerative nodules in this population. OBJECTIVE To describe the imaging findings of giant regenerative nodules in patients with Alagille syndrome. MATERIALS AND METHODS A retrospective search of the hospital database was performed to find all cases of hepatic masses in patients with Alagille syndrome during a 10-year period. Imaging, clinical charts, laboratory data and available pathology were reviewed and analyzed and summarized for each patient. RESULTS Twenty of 45 patients with confirmed Alagille syndrome had imaging studies. Of those, we identified six with giant focal liver masses. All six patients had large central hepatic masses that were remarkably similar on US and MRI, in addition to having features of cirrhosis. In each case, the mass was located in hepatic segment VIII and imaging showed the mass splaying the main portal venous branches at the hepatic hilum, as well as smaller portal and hepatic venous branches coursing through them. On MRI, signal intensity of the mass was isointense to liver on T1-weighted sequences in four of six patients, but hyperintense on T1 in two of six patients. In all six cases, the mass was hypointense on T2- weighted sequences. The mass post-contrast was isointense to adjacent liver in all phases in five the cases. Five out of six patients had pathological correlation demonstrating preserved ductal architecture confirming the final diagnosis of a regenerative nodule. CONCLUSION Giant hepatic regenerative nodules with characteristic US and MR features can occur in patients with Alagille syndrome with underlying cirrhosis. Recognizing these lesions as benign giant hepatic regenerative nodules should, thereby, mitigate any need for intervention.
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Affiliation(s)
- Jordan B Rapp
- Department of Radiology, Temple University Hospital, Lewis Katz School of Medicine at Temple University, 3401 N. Broad St., Philadelphia, PA, 19140, USA.
| | - Richard D Bellah
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Carolina Maya
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Bruce R Pawel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sudha A Anupindi
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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23
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Chavhan GB, Shelmerdine S, Jhaveri K, Babyn PS. Liver MR Imaging in Children: Current Concepts and Technique. Radiographics 2016; 36:1517-32. [DOI: 10.1148/rg.2016160017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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24
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Use of Magnetic Resonance Imaging With Hepatobiliary-Specific Contrast Agent for Precise Localization of a Bile Duct Leak. J Pediatr Gastroenterol Nutr 2016; 63:e36. [PMID: 27548252 DOI: 10.1097/mpg.0000000000000531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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25
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Shelmerdine SC, Roebuck DJ, Towbin AJ, McHugh K. MRI of paediatric liver tumours: How we review and report. Cancer Imaging 2016; 16:21. [PMID: 27526937 PMCID: PMC4986178 DOI: 10.1186/s40644-016-0083-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 08/09/2016] [Indexed: 12/12/2022] Open
Abstract
Liver tumours are fortunately rare in children. Benign tumours such as haemangiomas and cystic mesenchymal hamartomas are typically seen in infancy, often before 6 months of age. After that age, malignant hepatic tumours increase in frequency. The differentiation of a malignant from benign lesion on imaging can often negate the need for biopsy. Ultrasound is currently the main screening tool for suspected liver pathology, and is ideally suited for evaluation of hepatic lesions in children due to their generally small size. With increasing research, public awareness and parental anxiety regarding radiation dosage from CT imaging, MRI is now unquestionably the modality of choice for further characterisation of hepatic mass lesions. Nevertheless the cost, length of imaging time and perceived complexity of a paediatric liver MR study can be intimidating to the general radiologist and referring clinician. This article outlines standard MR sequences utilised, reasons for their utilisation, types of mixed hepatocyte specific/extracellular contrast agents employed and imaging features that aid the interpretation of paediatric liver lesions. The two commonest paediatric liver malignancies, namely hepatoblastoma and hepatocellular carcinoma are described. Differentiation of primary hepatic malignancies with metastatic disease and mimickers of malignancy such as focal nodular hyperplasia (FNH) and hepatic adenomas are also featured in this review.. Imaging should aim to clarify the presence of a lesion, the likelihood of malignancy and potential for complete surgical resection. Reviewing and reporting the studies should address these issues in a systematic fashion whilst also commenting upon background liver parenchymal appearances. Clinical information and adequate patient preparation prior to MR imaging studies help enhance the diagnostic yield.
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Affiliation(s)
- Susan C Shelmerdine
- Department of Diagnostic Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
| | - Derek J Roebuck
- Department of Interventional Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Alexander J Towbin
- Department of Pediatric Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kieran McHugh
- Department of Diagnostic Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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26
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Merrow AC, Gupta A, Patel MN, Adams DM. 2014 Revised Classification of Vascular Lesions from the International Society for the Study of Vascular Anomalies: Radiologic-Pathologic Update. Radiographics 2016; 36:1494-516. [PMID: 27517361 DOI: 10.1148/rg.2016150197] [Citation(s) in RCA: 133] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Since the publication of the seminal work on the histology-based classification of vascular anomalies by Mulliken and Glowacki in 1982 and the subsequent adoption of an expanded and modified version in 1996 by the International Society for the Study of Vascular Anomalies, an increasing number of vascular lesions have been recognized as histologically distinct entities. Furthermore, there have been significant advances in detailing the behavior and underlying genetics of previously identified lesions. These developments have required restructuring and expansion of the classification scheme so that appropriate therapies may be studied and implemented in affected patients. The new classification retains the broad categories of neoplasms and malformations but now divides the tumor group into benign, locally aggressive or borderline, and malignant, with the malformation group being divided into simple, combined, those of major named vessels, and those associated with other anomalies. Additionally, a category has been created for lesions in which the histology and behavior do not yet allow clear separation into neoplasm or malformation (thus named "provisionally unclassified vascular anomalies"). The known clinical courses and imaging, histologic, and genetic findings of the most common and/or clinically relevant lesions in the newly adopted revised system are reviewed in this article. (©)RSNA, 2016.
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Affiliation(s)
- Arnold C Merrow
- From the Department of Radiology (A.C.M., M.N.P.) and Department of Pediatrics, Division of Pathology and Laboratory Medicine (A.G.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229; and Vascular Anomalies Center, Boston Children's Hospital, Boston, Mass (D.M.A.)
| | - Anita Gupta
- From the Department of Radiology (A.C.M., M.N.P.) and Department of Pediatrics, Division of Pathology and Laboratory Medicine (A.G.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229; and Vascular Anomalies Center, Boston Children's Hospital, Boston, Mass (D.M.A.)
| | - Manish N Patel
- From the Department of Radiology (A.C.M., M.N.P.) and Department of Pediatrics, Division of Pathology and Laboratory Medicine (A.G.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229; and Vascular Anomalies Center, Boston Children's Hospital, Boston, Mass (D.M.A.)
| | - Denise M Adams
- From the Department of Radiology (A.C.M., M.N.P.) and Department of Pediatrics, Division of Pathology and Laboratory Medicine (A.G.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229; and Vascular Anomalies Center, Boston Children's Hospital, Boston, Mass (D.M.A.)
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27
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Geller J, Kasahara M, Martinez M, Soresina A, Kashanian F, Endrikat J. Safety and Efficacy of Gadoxetate Disodium-Enhanced Liver MRI in Pediatric Patients Aged >2 Months to <18 Years-Results of a Retrospective, Multicenter Study. MAGNETIC RESONANCE INSIGHTS 2016; 9:21-8. [PMID: 27478381 PMCID: PMC4957604 DOI: 10.4137/mri.s39091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 04/11/2016] [Accepted: 04/11/2016] [Indexed: 01/28/2023]
Abstract
PURPOSE To assess the safety and efficacy of gadoxetate disodium–enhanced liver MR imaging in pediatric patients. MATERIAL AND METHODS Retrospective, multicenter study including pediatric patients aged >2 months to <18 years who underwent contrast-enhanced liver MRI due to focal liver lesions. A single intravenous bolus injection of 0.025 to 0.05 mmol/kg body weight of gadoxetate disodium was administered. Adverse events (AEs) up to 24 hours after injection were recorded and a one-year follow-up was conducted for all serious and unexpected AEs. Efficacy was defined based on the additional diagnostic information obtained from the combined (pre- and postcontrast) image sets as compared with the precontrast image sets by blinded reading. RESULTS A total of 52 patients for safety and 51 patients for efficacy analyses were evaluated. Twenty-two patients (42.3%) reported a total of 51 serious AEs (SAEs) and one AE after one year. No SAE or AE was related to gadoxetate disodium injection. Gadoxetate disodium–related effects on vital signs were not seen. Additional diagnostic information was obtained for 86.3% of patients. The three most improved efficacy variables were lesion-to-background contrast, lesion characterization, and improved border delineation in 78.4%, 76.5%, and 70.6% of patients, respectively. CONCLUSION Gadoxetate disodium in pediatric patients did not raise any clinically significant safety concern. Contrast enhancement provided additional clinically relevant information.
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Affiliation(s)
- James Geller
- Cincinnati Children's Hospital Medical Center, Cancer and Blood Diseases Institute, Ohio, USA
| | - Mureo Kasahara
- National Center for Child Health and Development, Organ Transplantation Center 2-10-1, Tokyo, Japan
| | - Mercedes Martinez
- Department of Pediatrics, Columbia University, Center for Liver Disease and Abdominal Organ Transplantation, New York Presbyterian, NY, USA
| | - Annarosa Soresina
- A.O. Spedali Civili di Brescia, Immunologia Pediatrica, Clinica Pediatrica Piazzale Spedali Civili, 1, Brescia, Italy
| | | | - Jan Endrikat
- Bayer Pharma AG, Berlin, Germany.; Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Homburg/Saar, Germany
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Pugmire BS, Towbin AJ. Magnetic resonance imaging of primary pediatric liver tumors. Pediatr Radiol 2016; 46:764-77. [PMID: 27229495 DOI: 10.1007/s00247-016-3612-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 02/28/2016] [Accepted: 03/15/2016] [Indexed: 12/31/2022]
Abstract
Although primary hepatic neoplasms are less common than other intra-abdominal tumors in children, these neoplasms are a significant source of morbidity and mortality in the pediatric population. MRI is increasingly relied upon in the diagnostic evaluation of these lesions, both before and after treatment, and familiarity with the MRI findings associated with these neoplasms is a must for pediatric radiologists. Advances in MRI technology, particularly the advent of hepatocyte-specific gadolinium-based MRI contrast agents, have allowed for accurate characterization of several types of hepatic neoplasms on the basis of imaging appearance. In this review, we provide an overview of the approach to imaging hepatic neoplasms in children using MRI, including a sample imaging protocol. We also discuss the relevant clinical features and MRI findings of the most clinically relevant entities, including their appearance on post-contrast imaging using hepatocyte-specific gadolinium-based MRI contrast agents.
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Affiliation(s)
- Brian S Pugmire
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC-5031, Cincinnati, OH, 45255, USA
| | - Alexander J Towbin
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC-5031, Cincinnati, OH, 45255, USA.
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29
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Smith EA, Dillman JR. Current role of body MRI in pediatric oncology. Pediatr Radiol 2016; 46:873-80. [PMID: 27229504 DOI: 10.1007/s00247-016-3560-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 12/06/2015] [Accepted: 01/21/2016] [Indexed: 12/18/2022]
Abstract
Magnetic resonance imaging (MRI) plays an important role in the imaging of children with non-central nervous system malignancies, and it is increasingly replacing or complementing CT in many cases. MRI has several advantages over CT, including superior contrast resolution as well as superior tissue characterization with the use of novel pulse sequences and functional or organ-specific contrast agents. In addition, the lack of ionizing radiation - an important consideration in children - allows for multiphase dynamic post-contrast imaging, which can be useful for lesion detection and characterization. Several challenges remain in the performance of MRI in pediatric oncology patients, including the frequent need for sedation or anesthesia in young children because of long imaging times, as well as the suboptimal imaging of the lungs in the evaluation for pulmonary metastatic disease. However, despite these challenges, with continued improvements in MRI image quality and the development of novel sequences, contrast agents and quantitative imaging techniques, MRI is expected to play an ever increasing role in the imaging of pediatric oncology patients.
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Affiliation(s)
- Ethan A Smith
- Department of Radiology, Section of Pediatric Radiology, University of Michigan Health System, C.S. Mott Children's Hospital, 1540 E. Hospital Drive, Ann Arbor, MI, 48109-4252, USA.
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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30
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Alqatie A, Mann E, Moineddin R, Kamath BM, Chavhan GB. Solitary liver lesions in children: interobserver agreement and accuracy of MRI diagnosis. Clin Imaging 2015; 39:442-8. [DOI: 10.1016/j.clinimag.2014.11.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 10/27/2014] [Accepted: 11/17/2014] [Indexed: 12/15/2022]
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The impact of hepatocyte phase imaging from infancy to young adulthood in patients with a known or suspected liver lesion. Pediatr Radiol 2015; 45:354-65. [PMID: 25246096 DOI: 10.1007/s00247-014-3160-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 07/21/2014] [Accepted: 08/15/2014] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Hepatocyte-specific contrast agents are used to help characterize liver lesions. However, there are no studies evaluating the utility of these agents in detecting or diagnosing pediatric liver lesions. The purpose of this study is to assess the impact of the hepatocyte phase of imaging on lesion detection, tumor staging and diagnostic confidence. MATERIALS AND METHODS All patients undergoing an MRI between September 2010 and August 2012 using gadoxetate disodium as the contrast agent were included in this study. Each exam was duplicated so that one copy contained all sequences, including the hepatocyte phase of imaging, and the other copy contained all sequences except the hepatocyte phase of imaging. One reviewer evaluated all exams in a blinded, random fashion. Data tracked included imaging diagnosis, confidence in diagnosis, number of lesions and PRETEXT grade. The imaging diagnosis was compared to histopathology, when available. Data were analyzed for the study population as well as the subset of patients diagnosed with focal nodular hyperplasia (FNH). RESULTS There were 112 patients (56 male; mean age: 9.25 years) included in this study. A total of 33 patients had a malignant tumor and the remainder had either a benign lesion or no lesion. The addition of the hepatocyte phase of imaging significantly improved the diagnostic confidence for all patients (P < 0.0001) as well as specifically for patients diagnosed with FNH (P = 0.003). In nearly a quarter of patients, the hepatocyte phase of imaging allowed the reviewer to detect additional lesions (P = 0.005). In the patients with a malignant tumor, the addition of the hepatocyte phase of imaging changed the PRETEXT grade in 7/30 patients although the results were not significant (P = 0.161). CONCLUSION The addition of the hepatocyte phase of imaging helps to improve lesion detection and increase the diagnostic confidence for all liver tumors, as well as for FNH in particular.
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32
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Towbin AJ. Pediatric tumours: liver tumours. Cancer Imaging 2014. [PMCID: PMC4242751 DOI: 10.1186/1470-7330-14-s1-o16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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33
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Chavhan GB, Mann E, Kamath BM, Babyn PS. Gadobenate-dimeglumine-enhanced magnetic resonance imaging for hepatic lesions in children. Pediatr Radiol 2014; 44:1266-74. [PMID: 24771094 DOI: 10.1007/s00247-014-2975-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Revised: 02/10/2014] [Accepted: 03/12/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Magnetic resonance imaging enhanced by hepatocyte-specific contrast media has been found useful to characterize liver lesions in adults and children. OBJECTIVE To present our experience with gadobenate dimeglumine (Gd-BOPTA)-enhanced MRI for evaluation of focal liver lesions in children. MATERIALS AND METHODS We retrospectively reviewed gadobenate-dimeglumine-enhanced MR images obtained for evaluation of suspected hepatic lesions in 30 children. Signal characteristics on various sequences including 45- to 60-min hepatobiliary phase images were noted by two radiologists. Chart review identified relevant clinical details including history of cancer treatment, available pathology and stability of lesion size on follow-up imaging. RESULTS Of the 30 children who had gadobenate-enhanced MRI, 26 showed focal lesions. Diagnoses in 26 children were focal nodular hyperplasia (FNH) in 15, hemangiomas in 3, regenerating nodules in 3, focal fatty infiltration in 2, indeterminate lesions in 3, and one patient each with adenomas, hepatoblastoma and metastasis. Two patients had multiple diagnoses. All FNH lesions (39), all regenerative nodules (19) and an indeterminate lesion were iso- or hyperintense on hepatobiliary-phase images while all other lesions (28) were hypointense to hepatic parenchyma. The average follow-up period was 21.7 months. CONCLUSION Our experience with gadobenate-enhanced MRI indicates potential utility of gadobenate in the evaluation of pediatric hepatic lesions in differentiating FNH and regenerating nodules from other lesions.
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Affiliation(s)
- Govind B Chavhan
- Department of Diagnostic Imaging, The Hospital for Sick Children and University of Toronto, 555 University Ave., Toronto, Canada, M5G 1X8,
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Do RKG, McErlean A, Ang CS, DeMatteo RP, Abou-Alfa GK. CT and MRI of primary and metastatic fibrolamellar carcinoma: a case series of 37 patients. Br J Radiol 2014; 87:20140024. [PMID: 24896196 DOI: 10.1259/bjr.20140024] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Fibrolamellar carcinoma (FLC) is a rare disease, with limited radiographic reported information. We assessed the imaging patterns of primary and metastatic FLC. METHODS CT and MR examinations of patients with FLC were retrospectively reviewed. Imaging features were assessed for primary and recurrent liver tumours, including dimension, enhancement characteristics, and presence or absence of central scars. Locations of nodal and extranodal metastases were also recorded. RESULTS Of 37 patients (18 males and 19 females; average age, 23.5 years) with FLC, 24 had imaging of their primary tumour; 13 had metastases at presentation and 7 developed metastases on follow-up. The remaining 13 patients had follow-up imaging of metastatic disease. Primary FLC had a mean diameter >11 cm, with central scars in ten (46%) patients. Most tumours enhanced heterogeneously (96%) and showed arterial enhancement (81%). On MRI, 62% of FLCs were hypointense on T1 weighted imaging and 54% were hyperintense on T2 weighted imaging. 13 patients (54%) had nodal metastases at presentation, mostly in the upper abdomen (92%) and commonly in the chest (38%). Extrahepatic metastases were most frequently pulmonary or peritoneal. Predominantly small and homogeneous intrahepatic recurrences were detected on follow-up in 15 patients. CONCLUSION FLC often presents as a large hepatic tumour with nodal and distant metastases. Thoracic adenopathy and lung metastases were frequently found in our series, suggesting the need for pre-operative and follow-up chest imaging. ADVANCES IN KNOWLEDGE Thoracic nodal and lung metastases are common in FLC; therefore, dedicated chest imaging should be part of the evaluation of a patient with FLC.
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Affiliation(s)
- R K G Do
- 1 Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Abstract
PURPOSE OF REVIEW To summarize the current standards and guidelines for the diagnosis and management of hepatoblastoma, a rare pediatric liver tumor. RECENT FINDINGS Hepatoblastoma is the most common malignant liver tumor in childhood. International collaborative efforts have led to uniform implementation of the pretreatment extent of disease (PRETEXT) staging system as a means to establish consensus classification and assess upfront resectability. Additionally, current histopathological classification, in light of more advanced molecular profiling and immunohistochemical techniques and integration of tumor biomarkers into risk stratification, is reviewed. Multimodal therapy is composed of chemotherapy and surgical intervention. Achievement of complete surgical resection plays a key role in successful treatment for hepatoblastoma. Overall, outcomes have greatly improved over the past four decades because of advances in chemotherapeutic agents and administration protocols as well as innovations of surgical approach, including the use of vascular exclusion, ultrasonic dissection techniques, and liver transplantation. Challenges remain in management of high-risk patients as well as patients with recurrent or metastatic disease. SUMMARY Eventually, a more individualized approach to treating the different types of the heterogeneous spectrum of hepatoblastoma, in terms of different chemotherapeutic protocols and timing as well as type and extent of surgery, may become the basis of successful treatment in the more complex or advanced types of hepatoblastoma.
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Abstract
Magnetic resonance imaging (MRI) is rich in diagnostic information but requires optimization for use in children. The main problems are motion artifacts and poor signal-to-noise ratio (SNR). SNR is proportional to voxel volume, which must therefore not be too small, however, usually needs to be reduced compared to adult imaging to account for the finer anatomy of the child. The use of multi-channel coils with element sizes appropriate for the anatomy of interest ensures optimal baseline SNR. Longer acquisition time increases SNR (with a square-root factor), but the flip-side is that this allows more motion artifacts. Attention to patient preparation and to techniques for motion artifact reduction is therefore crucial, and the most important principles are discussed. Low SNR may in part be compensated by optimizing the image contrast by weighting (tissue and lesions T1 and T2 may differ from adults) and by using contrast agents. It is also powerful to combine different image contrasts during postprocessing. The basic principles are discussed, followed by an example scan protocol.
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Affiliation(s)
- Øystein E Olsen
- Radiology Department, Great Ormond Street Hospital for
Children NHS Foundation Trust, London, UK
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Abstract
Refined stratification of disease is thought to result in better survival from childhood malignant disease while minimizing the adverse effects of anticancer therapies. There is a potential for magnetic resonance imaging (MRI) to contribute to such stratification by improved tissue characterization, anatomical depiction, staging, and assessment of early treatment response. Recent advances in pediatric MRI outside the central nervous system (CNS) are reviewed in this context. The focus is on new applications for conventional MRI and on clinical implementation of tissue-specific and quantitative techniques. This area is largely unexplored, and potential directions for research are indicated.
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Affiliation(s)
- Øystein E Olsen
- Radiology Department, Great Ormond Street Hospital for
Children NHS Foundation Trust, Great Ormond Street, London, UK
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Serai SD, Wallihan DB, Venkatesh SK, Ehman RL, Campbell KM, Sticka J, Marino BS, Podberesky DJ. Magnetic resonance elastography of the liver in patients status-post fontan procedure: feasibility and preliminary results. CONGENIT HEART DIS 2013; 9:7-14. [PMID: 24134059 DOI: 10.1111/chd.12144] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2013] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the feasibility of performing magnetic resonance elastography (MRE) as a screening tool for elevated liver stiffness in patients' status-post Fontan procedure. BACKGROUND With greater numbers of Fontan patients surviving far into adulthood, a factor increasingly affecting long-term prognosis is the presence of hepatic congestion and fibrosis. If detected early, steps can be taken to potentially slow or halt the progression of fibrosis. MRE is a relatively new, noninvasive imaging technique, which can quantitatively measure liver stiffness and provide an estimate of the extent of fibrosis. METHODS A retrospective study was conducted using MRE to evaluate liver stiffness in patients with a history of Fontan procedure. An MRE was performed in the same session as a clinical cardiac MRI. The liver was interrogated at four slice locations, and a mean liver stiffness value was calculated for each patient using postprocessing software. The medical records were reviewed for demographic and clinical characteristics. RESULTS During the time frame of this investigation, 17 MRE exams were performed on 16 patients. All patients had elevated liver stiffness values as defined by MRE standards. The median of the individual mean liver stiffness values was 5.1 kPa (range: 3.4-8.2 kPa). This range of liver stiffness elevation would suggest the presence of mild to severe fibrosis in a patient with standard cardiovascular anatomy. We found a significant trend toward higher liver stiffness values with greater duration of Fontan circulation (rs = 0.55, P = .02). CONCLUSION Our preliminary findings suggest that MRE is a feasible method for evaluating the liver in Fontan patients who are undergoing surveillance cardiac MRI. Further investigation with histologic correlation is needed to determine the contributions of hepatic congestion and fibrosis to the liver stiffness in this population.
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Affiliation(s)
- Suraj D Serai
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Abstract
Magnetic resonance (MR) imaging is an effective and noninvasive modality for evaluating hepatobiliary pathologic conditions. This article provides an up-to-date review of anatomy, indications, and imaging goals and protocols, including patient preparation, pulse sequences, and contrast agents used in pediatric MR hepatobiliary imaging. This article also highlights some of the common MR features of pediatric liver pathologic conditions, including tumors, congenital biliary ductal plate malformations, trauma, fibrosis, and infection.
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Is It Time for a Dedicated Pediatric MRI ACR Accreditation Program? J Am Coll Radiol 2013; 10:274-8. [DOI: 10.1016/j.jacr.2012.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 07/13/2012] [Indexed: 11/20/2022]
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Hegde SV, Dillman JR, Lopez MJ, Strouse PJ. Imaging of multifocal liver lesions in children and adolescents. Cancer Imaging 2013; 12:516-29. [PMID: 23400044 PMCID: PMC3569672 DOI: 10.1102/1470-7330.2012.0045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Multifocal liver lesions are encountered regularly in children and adolescents. By knowing the specific ultrasonographic, computed tomographic, and magnetic resonance imaging (MRI) features of benign and malignant pediatric liver lesions as well as the particular clinical setting, radiologists can frequently narrow the differential diagnosis and sometimes offer a definitive diagnosis. The purpose of this review article is to illustrate the imaging findings of numerous benign and malignant causes of multifocal liver lesions in the pediatric population.
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Affiliation(s)
- Shilpa V Hegde
- Section of Pediatric Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA
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Duigenan S, Anupindi SA, Nimkin K. Imaging of multifocal hepatic lesions in pediatric patients. Pediatr Radiol 2012; 42:1155-68; quiz 1285. [PMID: 22565297 DOI: 10.1007/s00247-012-2400-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 02/25/2012] [Accepted: 03/05/2012] [Indexed: 02/08/2023]
Abstract
Imaging plays a vital role in detection and characterization of multifocal liver lesions in children. Numerous causes for these lesions exist, including benign and malignant neoplasms, infectious lesions, and congenital and inflammatory conditions. The imaging spectrum of multifocal liver lesions in children is presented with emphasis on key imaging features, differential diagnoses and helpful relevant clinical features.
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Affiliation(s)
- Shauna Duigenan
- Division of Pediatric Radiology, Massachusetts General Hospital, Boston, MA, USA.
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Incidence and etiology of new liver lesions in pediatric patients previously treated for malignancy. AJR Am J Roentgenol 2012; 199:186-91. [PMID: 22733911 DOI: 10.2214/ajr.11.7690] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The purpose of this study was to retrospectively evaluate the time course, cause, and imaging characteristics of all new liver lesions in pediatric patients with a previously treated malignancy. MATERIALS AND METHODS Our hospital cancer registry was used to identify patients between 1980 and 2005 who met the following criteria: solid tumor, survival > 2 years after diagnosis, no liver lesions at a posttreatment baseline, and cross-sectional imaging follow-up of > 2 years. Final dictated reports of all cross-sectional imaging examinations including the abdomen were reviewed for any mention of new liver lesions. Positive reports were followed by consensus review of the images and clinical data. Patients were divided into three groups: those with suspected or proven focal nodular hyperplasia (FNH), those with suspected or proven metastases, and those with other lesions. An exact Wilcoxon test was used to evaluate the differences between the groups. RESULTS Of 967 patients who met the initial inclusion criteria, 273 had adequate follow-up to be included in the study. Forty-six patients (16.8%) developed new liver lesions during the study period, and 14 of those 46 were classified into the FNH group (30.4%) and seven were classified into the metastasis group (15.2%). A significant difference was found in the median time to the development of FNH versus metastasis and other lesions (FNH, 92.9 months; metastasis, 43.2 months; other lesions, 18.5 months; p < 0.0001). A significant difference was also seen in the median length of follow-up between the groups (FNH, 115.6 months; metastasis, 57 months; other lesions, 50.8 months; p = 0.002). The imaging features of the groups also differed. CONCLUSION The most common liver lesion encountered in pediatric patients previously treated for malignancy was FNH, which occurred farther from the time of diagnosis and had different imaging characteristics from both metastases and other liver lesions.
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Hepatoblastoma imaging with gadoxetate disodium-enhanced MRI--typical, atypical, pre- and post-treatment evaluation. Pediatr Radiol 2012; 42:859-66. [PMID: 22419052 DOI: 10.1007/s00247-012-2366-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 01/11/2012] [Accepted: 01/19/2012] [Indexed: 10/28/2022]
Abstract
Gadoxetate disodium (Gd-EOB-DTPA) is a hepatobiliary MRI contrast agent widely used in adults for characterization of liver tumors and increasingly used in children. Hepatoblastoma is the most common primary hepatic malignancy of childhood. In this review, we describe our experience with this agent both before and after initiating therapy in children with hepatoblastoma.
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Abstract
New options are available for the magnetic resonance imaging (MRI) assessment of pediatric hepatobiliary disease. This article describes the potential utility for MRI with contrast agents tailored for hepatobiliary imaging. MRI contrast agents that preferentially target the liver may be helpful in characterizing liver masses and bile duct abnormalities in select children. The imaging approach is noninvasive and relatively rapid to perform. It also provides anatomic and functional information and is a radiation-free alternative to other imaging strategies. This relatively new imaging procedure is placed in the context of more established imaging modalities. The pharmacokinetics, technical considerations, and potential applications of these hepatobiliary-specific contrast agents also are discussed.
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