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Fenn JS, Lorde N, Ward JM, Borovickova I. Hypophosphatasia. J Clin Pathol 2021; 74:635-640. [PMID: 33931563 DOI: 10.1136/jclinpath-2021-207426] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 11/04/2022]
Abstract
Hypophosphatasia (HPP) is a group of inherited disorders characterised by the impaired mineralisation of bones and/or teeth and low serum alkaline phosphatase (ALP) activity. It is caused by a mutation in the ALPL gene encoding the tissue-non-specific isoenzyme of ALP (TNSALP) resulting in a loss of function. The disease is highly heterogenous in its clinical expression ranging from stillbirth without mineralised bone to the mild form of late adult onset with symptoms and signs such as musculoskeletal pain, arthropathy, lower-extremity fractures, premature loss of teeth or an incidental finding of reduced serum ALP activity. A classification based on the age at diagnosis and the presence or absence of bone symptoms was historically used: perinatal, prenatal benign, infantile, childhood, adult and odontohypophosphatasia. These subtypes are known to have overlapping signs and complications. Three forms of HPP distinguishable by their genetic characteristics have been described: severe, moderate and mild. Severe forms of HPP (perinatal and infantile severe) are recessively inherited, whereas moderate HPP may be dominantly or recessively inherited. The biochemical hallmark of HPP is persistently low serum ALP for age and increase in natural substrates of TNSALP, pyridoxal 5'-phosphate and phosphoethanolamine supported by radiological findings. The diagnosis is confirmed by ALPL sequencing. A multidisciplinary team of experts is essential for the effective management. Calcium restriction is recommended in infants/children to manage hypercalcaemia. A targeted enzyme replacement therapy for HPP has become available and correct diagnosis is crucial to allow early treatment.
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Affiliation(s)
- Jonathan Samuel Fenn
- Black Country Pathology Services, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Nathan Lorde
- Department of Clinical Chemistry, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - John Martin Ward
- Department of Radiology, McGill University Health Center, Montreal, Québec, Canada
| | - Ingrid Borovickova
- Department of Biochemical Genetics, Children's Health Ireland at Temple Street, Dublin, Ireland
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Orman G, Masand PM, Kukreja KU, Acosta AA, Guillerman RP, Jadhav SP. Diagnostic sensitivity and specificity of CT angiography for renal artery stenosis in children. Pediatr Radiol 2021; 51:419-426. [PMID: 33151345 DOI: 10.1007/s00247-020-04852-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/14/2020] [Accepted: 09/10/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Children with suspected renal artery stenosis (RAS) are screened with renal Doppler ultrasonography or computed tomography (CT) angiography/magnetic resonance (MR) angiography depending on institutional preference. CT angiography produces images with superior resolution, allowing higher quality multiplanar two-dimensional reformats and three-dimensional reconstructions. However, there is a paucity of data in the literature regarding the utility and diagnostic performance of renal CT angiography in pediatric RAS. OBJECTIVE The objective of this study is to retrospectively review our experience with renal CT angiography in the diagnosis of pediatric RAS relative to digital subtraction angiography (DSA) as the reference standard. MATERIALS AND METHODS All patients 0-18 years of age who underwent CT angiography for evaluation of RAS as a cause of hypertension between January 2012 and May 2019 were identified for the study. A total of 131 patients were identified, 23 of whom had DSA correlation. RESULTS Twenty-three patients (17 boys, 6 girls) with a mean age of 6 years 3 months (range: 3 months to 14 years 7 months) were included in this study. Of the 59 renal arteries studied by DSA, 22 were abnormal on CT angiography and 20 were abnormal on DSA. Of the 59 renal arteries, CT angiography was true positive in 18 and true negative in 35. The sensitivity and specificity of CT angiography for RAS diagnosis were 90.0% and 89.7%, respectively. CT angiography identified all cases of main RAS. CONCLUSION Renal CT angiography has a high sensitivity and specificity for pediatric RAS diagnosis in patients referred for DSA.
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Affiliation(s)
- Gunes Orman
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, 6701 Fannin Street, Suite 470, Houston, TX, 77030, USA.
| | - Prakash M Masand
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, 6701 Fannin Street, Suite 470, Houston, TX, 77030, USA
| | - Kamlesh U Kukreja
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, 6701 Fannin Street, Suite 470, Houston, TX, 77030, USA
| | - Alisa A Acosta
- Renal Section, Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, TX, USA
| | - R Paul Guillerman
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, 6701 Fannin Street, Suite 470, Houston, TX, 77030, USA
| | - Siddharth P Jadhav
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, 6701 Fannin Street, Suite 470, Houston, TX, 77030, USA
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Offiah AC, Vockley J, Munns CF, Murotsuki J. Differential diagnosis of perinatal hypophosphatasia: radiologic perspectives. Pediatr Radiol 2019; 49:3-22. [PMID: 30284005 PMCID: PMC6313373 DOI: 10.1007/s00247-018-4239-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 06/25/2018] [Accepted: 08/14/2018] [Indexed: 01/13/2023]
Abstract
Perinatal hypophosphatasia (HPP) is a rare, potentially life-threatening, inherited, systemic metabolic bone disease that can be difficult to recognize in utero and postnatally. Diagnosis is challenging because of the large number of skeletal dysplasias with overlapping clinical features. This review focuses on the role of fetal and neonatal imaging modalities in the differential diagnosis of perinatal HPP from other skeletal dysplasias (e.g., osteogenesis imperfecta, campomelic dysplasia, achondrogenesis subtypes, hypochondrogenesis, cleidocranial dysplasia). Perinatal HPP is associated with a broad spectrum of imaging findings that are characteristic of but do not occur in all cases of HPP and are not unique to HPP, such as shortening, bowing and angulation of the long bones, and slender, poorly ossified ribs and metaphyseal lucencies. Conversely, absent ossification of whole bones is characteristic of severe lethal HPP and is associated with very few other conditions. Certain features may help distinguish HPP from other skeletal dysplasias, such as sites of angulation of long bones, patterns of hypomineralization, and metaphyseal characteristics. In utero recognition of HPP allows for the assembly and preparation of a multidisciplinary care team before delivery and provides additional time to devise treatment strategies.
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Affiliation(s)
- Amaka C Offiah
- Academic Unit of Child Health, Sheffield Children's NHS Foundation Trust, University of Sheffield, Western Bank, Sheffield, S10 2TH, UK.
| | - Jerry Vockley
- School of Medicine and Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Craig F Munns
- The Children's Hospital at Westmead, Westmead, NSW, Australia
- Sydney Medical School, The University of Sydney, University of Sydney NSW, Sydney, Australia
| | - Jun Murotsuki
- Aoba Ward, Miyagi Children's Hospital, Sendai, Miyagi Prefecture, Japan
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Hou Q, Gao W, Zhong Y, Sun A, Wang Q, Hu L, Wang J. Diagnostic Accuracy of Three-dimensional Turbo Field Echo Magnetic Resonance Imaging Sequence in Pediatric Tracheobronchial Anomalies with Congenital Heart Disease. Sci Rep 2018; 8:2529. [PMID: 29416073 PMCID: PMC5803237 DOI: 10.1038/s41598-018-20892-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 01/23/2018] [Indexed: 12/29/2022] Open
Abstract
Tracheobronchial anomalies are common in congenital heart disease (CHD), including tracheobronchial stenosis, tracheal bronchus, cardiac bronchus, and bronchial isomerism, which can cause varying degrees of respiratory illness. It is necessary to assess tracheobronchial anomalies and make a preoperative airway evaluation. Multi-slice computed tomography (MSCT) and cardiac magnetic resonance imaging (MRI) are the most effective noninvasive modalities for the diagnosis of CHD and the associated tracheobronchial anomalies. However, MSCT remains an ionizing procedure despite using low dose protocols. The aim of this study was to evaluate diagnostic accuracy of tracheobronchial anomalies in patients with CHD using three-dimensional turbo field echo(3D-TFE) magnetic resonance imaging sequence for preoperative airway evaluation. The results indicated that 3D-TFE provided better image quality as compared to that of 3D-balanced turbo field echo (3D-bTFE), and it can clearly demonstrated the tracheobronchial tree and tracheobronchial anomalies in CHD. This study confirms the clinical value of 3D-TFE in diagnosing tracheobronchial anomalies and supply helpful tracheobronchial information for preoperative strategies and postoperative follow-up.
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Affiliation(s)
- QiaoRu Hou
- Diagnostic imaging Center of Shanghai Children's Medical Center affiliated with Shanghai Jiao Tong University Medical School, Shanghai, China
| | - Wei Gao
- Department of Pediatric Cardiology of Shanghai Children's Medical Center affiliated with Shanghai Jiao Tong University Medical School, Shanghai, China
| | - YuMin Zhong
- Diagnostic imaging Center of Shanghai Children's Medical Center affiliated with Shanghai Jiao Tong University Medical School, Shanghai, China.
| | - AiMin Sun
- Diagnostic imaging Center of Shanghai Children's Medical Center affiliated with Shanghai Jiao Tong University Medical School, Shanghai, China
| | - Qian Wang
- Diagnostic imaging Center of Shanghai Children's Medical Center affiliated with Shanghai Jiao Tong University Medical School, Shanghai, China
| | - LiWei Hu
- Diagnostic imaging Center of Shanghai Children's Medical Center affiliated with Shanghai Jiao Tong University Medical School, Shanghai, China
| | - JingLei Wang
- Diagnostic imaging Center of Shanghai Children's Medical Center affiliated with Shanghai Jiao Tong University Medical School, Shanghai, China
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Winslow J, Zhang Y, Samei E. A method for characterizing and matching CT image quality across CT scanners from different manufacturers. Med Phys 2017; 44:5705-5717. [DOI: 10.1002/mp.12554] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 08/03/2017] [Accepted: 08/07/2017] [Indexed: 11/09/2022] Open
Affiliation(s)
- James Winslow
- Clinical Imaging Physics Group; Department of Radiology; Duke University Medical Center; Durham NC 27705 USA
| | - Yakun Zhang
- Clinical Imaging Physics Group; Department of Radiology; Duke University Medical Center; Durham NC 27705 USA
| | - Ehsan Samei
- Clinical Imaging Physics Group; Carl E. Ravin Advanced Imaging Laboratories; Department of Radiology; Duke University Medical Center; Durham NC 27705 USA
- Departments of Physics, Electrical and Computer Engineering, and Biomedical Engineering; Medical Physics Graduate Program; Duke University; Durham NC 27705 USA
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Colleran GC, Callahan MJ, Paltiel HJ, Nelson CP, Cilento BG, Baum MA, Chow JS. Imaging in the diagnosis of pediatric urolithiasis. Pediatr Radiol 2017; 47:5-16. [PMID: 27815617 DOI: 10.1007/s00247-016-3702-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 06/28/2016] [Accepted: 09/01/2016] [Indexed: 12/31/2022]
Abstract
Pediatric urolithiasis is an important and increasingly prevalent cause of pediatric morbidity and hospital admission. Ultrasound (US) is the recommended primary imaging modality for suspected urolithiasis in children. There is, however, widespread use of CT as a first-line study for abdominal pain in many institutions involved in pediatric care. The objective of this review is to outline state-of-the-art imaging modalities and methods for diagnosing urolithiasis in children. The pediatric radiologist plays a key role in ensuring that the appropriate imaging modality is performed in the setting of suspected pediatric urolithiasis. Our proposed imaging algorithm starts with US, and describes the optimal technique and indications for the use of CT. We emphasize the importance of improved communication with a greater collaborative approach between pediatric and general radiology departments so children undergo the appropriate imaging evaluation.
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Affiliation(s)
- Gabrielle C Colleran
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02116, USA.
| | - Michael J Callahan
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02116, USA
| | - Harriet J Paltiel
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02116, USA
| | - Caleb P Nelson
- Department of Urology, Boston Children's Hospital, Boston, MA, USA
| | | | - Michelle A Baum
- Department of Nephrology, Boston Children's Hospital, Boston, MA, USA
| | - Jeanne S Chow
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02116, USA
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Sorensen C, Gach P, Pico H, Hugues N, Dabadie A, Desvignes C, Bourlière B, Aschero A, Colavolpe N, Petit P, Gorincour G. Cardiac CT or MRI in pediatric practice: Which one to choose? Diagn Interv Imaging 2016; 97:513-7. [DOI: 10.1016/j.diii.2016.02.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 01/30/2016] [Accepted: 02/02/2016] [Indexed: 11/24/2022]
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Rosolen A, Perkins SL, Pinkerton CR, Guillerman RP, Sandlund JT, Patte C, Reiter A, Cairo MS. Revised International Pediatric Non-Hodgkin Lymphoma Staging System. J Clin Oncol 2015; 33:2112-8. [PMID: 25940716 DOI: 10.1200/jco.2014.59.7203] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Treatment and prognosis of pediatric non-Hodgkin lymphoma (NHL) have improved dramatically in the last 30 years. However, the St Jude NHL staging classification for pediatric NHL was developed more than 35 years ago. The most recent Lugano lymphoma staging classification focused on adult lymphoma. Furthermore, major limitations of the current pediatric NHL staging classification include lack of consideration of new distinct pediatric NHL histologic entities; absence of recognition of frequent skin, bone, kidney, ovarian, and other organ involvement; and lack of newer precise methods to detect bone marrow and CNS involvement, minimal disease quantification, and highly sensitive imaging technologies. METHODS An international multidisciplinary expert panel convened in Frankfurt, Germany, in 2009 at the Third International Childhood, Adolescent and Young Adult NHL Symposium to develop a revised international pediatric NHL staging system (IPNHLSS), addressing limitations of the current pediatric NHL staging system and creating a revised classification. Evidence-based disease distribution and behavior were reviewed from multiple pediatric cooperative group NHL studies. RESULTS A revised IPNHLSS was developed incorporating new histologic entities, extranodal dissemination, improved diagnostic methods, and advanced imaging technology. CONCLUSION This revised IPNHLSS will facilitate more precise staging for children and adolescents with NHL and facilitate comparisons of efficacy across different treatment strategies, various institutions, multicenter trials, and cooperative groups by allowing for reproducible pediatric-based staging at diagnosis and relapse.
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Affiliation(s)
- Angelo Rosolen
- Angelo Rosolen, University of Padova, Padova, Italy; Sherrie L. Perkins, University of Utah Health Sciences Center, Salt Lake City, UT; C. Ross Pinkerton, University of Queensland, Brisbane, Queensland, Australia; R. Paul Guillerman, Texas Children's Hospital, Houston, TX; John T. Sandlund, St Jude Children's Research Hospital, Memphis, TN; Catherine Patte, Institut Gustave Roussy, Paris, France; Alfred Reiter, Justus-Liebig University of Giessen, Giessen, Germany; and Mitchell S. Cairo, New York Medical College, Valhalla, NY
| | - Sherrie L Perkins
- Angelo Rosolen, University of Padova, Padova, Italy; Sherrie L. Perkins, University of Utah Health Sciences Center, Salt Lake City, UT; C. Ross Pinkerton, University of Queensland, Brisbane, Queensland, Australia; R. Paul Guillerman, Texas Children's Hospital, Houston, TX; John T. Sandlund, St Jude Children's Research Hospital, Memphis, TN; Catherine Patte, Institut Gustave Roussy, Paris, France; Alfred Reiter, Justus-Liebig University of Giessen, Giessen, Germany; and Mitchell S. Cairo, New York Medical College, Valhalla, NY
| | - C Ross Pinkerton
- Angelo Rosolen, University of Padova, Padova, Italy; Sherrie L. Perkins, University of Utah Health Sciences Center, Salt Lake City, UT; C. Ross Pinkerton, University of Queensland, Brisbane, Queensland, Australia; R. Paul Guillerman, Texas Children's Hospital, Houston, TX; John T. Sandlund, St Jude Children's Research Hospital, Memphis, TN; Catherine Patte, Institut Gustave Roussy, Paris, France; Alfred Reiter, Justus-Liebig University of Giessen, Giessen, Germany; and Mitchell S. Cairo, New York Medical College, Valhalla, NY
| | - R Paul Guillerman
- Angelo Rosolen, University of Padova, Padova, Italy; Sherrie L. Perkins, University of Utah Health Sciences Center, Salt Lake City, UT; C. Ross Pinkerton, University of Queensland, Brisbane, Queensland, Australia; R. Paul Guillerman, Texas Children's Hospital, Houston, TX; John T. Sandlund, St Jude Children's Research Hospital, Memphis, TN; Catherine Patte, Institut Gustave Roussy, Paris, France; Alfred Reiter, Justus-Liebig University of Giessen, Giessen, Germany; and Mitchell S. Cairo, New York Medical College, Valhalla, NY
| | - John T Sandlund
- Angelo Rosolen, University of Padova, Padova, Italy; Sherrie L. Perkins, University of Utah Health Sciences Center, Salt Lake City, UT; C. Ross Pinkerton, University of Queensland, Brisbane, Queensland, Australia; R. Paul Guillerman, Texas Children's Hospital, Houston, TX; John T. Sandlund, St Jude Children's Research Hospital, Memphis, TN; Catherine Patte, Institut Gustave Roussy, Paris, France; Alfred Reiter, Justus-Liebig University of Giessen, Giessen, Germany; and Mitchell S. Cairo, New York Medical College, Valhalla, NY
| | - Catherine Patte
- Angelo Rosolen, University of Padova, Padova, Italy; Sherrie L. Perkins, University of Utah Health Sciences Center, Salt Lake City, UT; C. Ross Pinkerton, University of Queensland, Brisbane, Queensland, Australia; R. Paul Guillerman, Texas Children's Hospital, Houston, TX; John T. Sandlund, St Jude Children's Research Hospital, Memphis, TN; Catherine Patte, Institut Gustave Roussy, Paris, France; Alfred Reiter, Justus-Liebig University of Giessen, Giessen, Germany; and Mitchell S. Cairo, New York Medical College, Valhalla, NY
| | - Alfred Reiter
- Angelo Rosolen, University of Padova, Padova, Italy; Sherrie L. Perkins, University of Utah Health Sciences Center, Salt Lake City, UT; C. Ross Pinkerton, University of Queensland, Brisbane, Queensland, Australia; R. Paul Guillerman, Texas Children's Hospital, Houston, TX; John T. Sandlund, St Jude Children's Research Hospital, Memphis, TN; Catherine Patte, Institut Gustave Roussy, Paris, France; Alfred Reiter, Justus-Liebig University of Giessen, Giessen, Germany; and Mitchell S. Cairo, New York Medical College, Valhalla, NY
| | - Mitchell S Cairo
- Angelo Rosolen, University of Padova, Padova, Italy; Sherrie L. Perkins, University of Utah Health Sciences Center, Salt Lake City, UT; C. Ross Pinkerton, University of Queensland, Brisbane, Queensland, Australia; R. Paul Guillerman, Texas Children's Hospital, Houston, TX; John T. Sandlund, St Jude Children's Research Hospital, Memphis, TN; Catherine Patte, Institut Gustave Roussy, Paris, France; Alfred Reiter, Justus-Liebig University of Giessen, Giessen, Germany; and Mitchell S. Cairo, New York Medical College, Valhalla, NY.
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Miyazaki O, Sawai H, Murotsuki J, Nishimura G, Horiuchi T. Nationwide radiation dose survey of computed tomography for fetal skeletal dysplasias. Pediatr Radiol 2014; 44:971-9. [PMID: 24737001 DOI: 10.1007/s00247-014-2916-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 11/20/2013] [Accepted: 01/30/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recently, computed tomography (CT) has been used to diagnose fetal skeletal dysplasia. However, no surveys have been conducted to determine the radiation exposure dose and the diagnostic reference level (DRL). OBJECTIVE To collect CT dose index volume (CTDIvol) and dose length product (DLP) data from domestic hospitals implementing fetal skeletal 3-D CT and to establish DRLs for Japan. MATERIALS AND METHODS Scan data of 125 cases of 20 protocols from 16 hospitals were analyzed. The minimum, first-quartile, median, third-quartile and maximum values of CTDIvol and DLP were determined. The time-dependent change in radiation dose setting in hospitals with three or more cases with scans was also examined. RESULTS The minimum, first-quartile, median, third-quartile and maximum CTDIvol values were 2.1, 3.7, 7.7, 11.3 and 23.1 mGy, respectively, and these values for DLP were 69.0, 122.3, 276.8, 382.6 and 1025.6 mGy·cm, respectively. Six of the 12 institutions reduced the dose setting during the implementation period. CONCLUSIONS The DRLs of CTDIvol and DLP for fetal CT were 11.3 mGy and 382.6 mGy·cm, respectively. Institutions implementing fetal CT should use these established DRLs as the standard and make an effort to reduce radiation exposure by voluntarily decreasing the dose.
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Affiliation(s)
- Osamu Miyazaki
- Department of Radiology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan,
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Badve CA, K MM, Iyer RS, Ishak GE, Khanna PC. Craniosynostosis: imaging review and primer on computed tomography. Pediatr Radiol 2013; 43:728-42; quiz 725-7. [PMID: 23636536 DOI: 10.1007/s00247-013-2673-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 02/05/2013] [Accepted: 02/07/2013] [Indexed: 12/29/2022]
Abstract
Craniosynostosis is encountered in the pediatric population in isolated or syndromic forms. The resulting deformity depends on the number and type of sutures involved and, in multi-sutural synostosis, the order of suture fusion. Primary craniosynostosis needs to be differentiated from the secondary variety and positional or deformational mimics. Syndromic craniosynostoses are associated with other craniofacial deformities. Evaluation with 3-D CT plays an important role in accurate diagnosis and management; however, implementation of appropriate CT techniques is essential to limit the radiation burden in these children. In this article, the authors briefly review the classification, embryopathogenesis and epidemiology and describe in detail the radiologic appearance and differential diagnoses of craniosynostosis.
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Affiliation(s)
- Chaitra A Badve
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA.
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12
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Davis JS, Ryan ML, Fields JM, Neville HL, Perez EA, Sola JE. Use of CT enterography for the diagnosis of lower gastrointestinal bleeding in pediatric patients. J Pediatr Surg 2013; 48:681-4. [PMID: 23480934 DOI: 10.1016/j.jpedsurg.2013.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 01/02/2013] [Accepted: 01/02/2013] [Indexed: 11/16/2022]
Abstract
Diagnosis of lower gastrointestinal bleeding (LGIB) represents a significant diagnostic and therapeutic challenge for any physician. While CT enterography (CTE) has been applied in adults with occult LGIB, its use in children has been limited to evaluation of Crohn's disease. We reviewed 6 patients ages 4-15 who underwent CTE for LGIB at a tertiary pediatric institution. In sum, CTE appears to be a valuable tool for localizing the source of LGIB prior to surgical or endoscopic intervention. However, rapid lesion identification must be weighed against the increased radiation exposure and patient discomfort due to bowel distention associated with this diagnostic technique.
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Affiliation(s)
- James S Davis
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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Tricarico F, Hlavacek AM, Schoepf UJ, Ebersberger U, Nance JW, Vliegenthart R, Cho YJ, Spears JR, Secchi F, Savino G, Marano R, Schoenberg SO, Bonomo L, Apfaltrer P. Cardiovascular CT angiography in neonates and children: Image quality and potential for radiation dose reduction with iterative image reconstruction techniques. Eur Radiol 2012. [DOI: 10.1007/s00330-012-2734-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Solomon JB, Christianson O, Samei E. Quantitative comparison of noise texture across CT scanners from different manufacturers. Med Phys 2012; 39:6048-55. [DOI: 10.1118/1.4752209] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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15
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Rathore N, Eissa HM, Margolin JF, Liu H, Wu MF, Horton T, Kamdar K, Dreyer Z, Steuber P, Rabin KR, Redell M, Allen CE, McClain KL, Guillerman RP, Bollard CM. Pediatric Hodgkin lymphoma: are we over-scanning our patients? Pediatr Hematol Oncol 2012; 29:415-23. [PMID: 22632168 PMCID: PMC3685486 DOI: 10.3109/08880018.2012.684198] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Despite the favorable outcome of most pediatric patients with Hodgkin lymphoma (HL), there is rising concern about risks of carcinogenesis from both diagnostic and therapeutic radiation exposure for patients treated on study protocols. Although previous studies have investigated radiation exposure during treatment, radiation from post-treatment surveillance imaging may also increase the likelihood of secondary malignancies. All diagnostic imaging examinations involving ionizing radiation exposure performed for surveillance following completion of therapy were recorded for 99 consecutive pediatric patients diagnosed with HL from 2000 to 2010. Cumulative radiation dosage from these examinations and the frequency of relapse detection by these examinations were recorded. In the first 2 years following completion of therapy, patients in remission received a median of 11 examinations (range 0-26). Only 13 of 99 patients relapsed, 11 within 5 months of treatment completion. No relapse was detected by 1- or 2-view chest radiographs (n = 38 and 296, respectively), abdomen/pelvis computed tomography (CT) scans (n = 211), or positron emission tomography (PET) scans alone (n = 11). However, 10/391 (2.6%) of chest CT scans, 4/364 (1.1%) of neck CT scans, and 3/47 (6.4%) of PET/CT scans detected relapsed disease. Thus, only 17 scans (1.3%) detected relapse in a total of 1358 scans. Mean radiation dosages were 31.97 mSv for Stage 1, 37.76 mSv for Stage 2, 48.08 mSv for Stage 3, and 51.35 mSv for Stage 4 HL. Approximately 1% of surveillance imaging examinations identified relapsed disease. Given the very low rate of relapse detection by surveillance imaging stipulated by current protocols for pediatric HL patients, the financial burden of the tests themselves, the high cure rate, and risks of second malignancy from ionizing radiation exposure, modification of the surveillance strategy is recommended.
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Affiliation(s)
- N Rathore
- Texas Children's Cancer Center and Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas 77030, USA
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Prenatal diagnosis of fetal skeletal dysplasia with 3D CT. Pediatr Radiol 2012; 42:842-52. [PMID: 22532233 DOI: 10.1007/s00247-012-2381-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2011] [Revised: 11/23/2011] [Accepted: 01/16/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Clinical use of 3D CT for fetal skeletal malformations is controversial. OBJECTIVE The purpose of this study was to evaluate the efficacy of fetal 3D CT using three protocols with different radiation doses and through comparing findings between fetal CT and conventional postnatal radiographic skeletal survey. MATERIALS AND METHODS Seventeen fetuses underwent CT for suspected skeletal dysplasia. A relay of three CT protocols with stepwise dose-reduction were used over the study period. The concordance between the CT diagnosis and the final diagnosis was assessed. Ninety-three radiological findings identifiable on radiographs were compared with CT. RESULTS Fetal CT provided the correct diagnosis in all 17 fetuses, the detectability rate of cardinal findings was 93.5 %. In 59 % of the fetuses an US-based diagnosis was changed prenatally due to CT findings. The estimated fetal radiation dose in the final protocol was 3.4 mSv (50 %) of the initial protocol, and this dose reduction did not result in degraded image quality. CONCLUSION The capability of fetal CT to delineate the skeleton was almost the same as that of postnatal skeletal survey. The perinatal management was altered due to these more specific CT findings, which aided in counseling and in the management of the pregnancy.
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