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Patel PA, Muñoz FG. Interventional oncology in children: Where are we now? J Med Imaging Radiat Oncol 2024. [PMID: 38874327 DOI: 10.1111/1754-9485.13719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 05/22/2024] [Indexed: 06/15/2024]
Abstract
Paediatric Interventional Oncology (IO) lags behind adult IO due to a scarcity of specific outcome data. The suboptimal way to evolve this field is relying heavily on adult experiences. The distinct tumour types prevalent in children, such as extracranial germ cell tumours, sarcomas, and neuroblastoma, differ strongly from those found in adults, presenting a completely different biological behaviour. Compounding this challenge, paediatric interventional radiology often employs adapted or off-label techniques, potentially compromising optimal outcomes. This review outlines the present indications for interventional radiology in paediatric cancer, from biopsy to supportive care, including complication management. It emphasises the role of locoregional approaches, and explores the status of common paediatric oncological diseases, highlighting areas where IO has made progress identifying potential opportunities for future advancements in this evolving field.
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Affiliation(s)
- Premal Amrishkumar Patel
- Interventional Radiology, Radiology Department, Great Ormond Street Hospital for Children, London, UK
- Developmental Biology and Cancer Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Fernando Gómez Muñoz
- Interventional Radiology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Interventional Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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Cooke-Barber J, Brungardt JG, Sorger M, Pressey JG, Turpin B, Nagarajan R, Szabo S, Sorger J, Johnson N, Dasgupta R. Pediatric and Young Adult Image-Guided Percutaneous Bone Biopsy-A New Standard of Care? Ann Surg Oncol 2023; 30:3658-3665. [PMID: 36658249 DOI: 10.1245/s10434-023-13097-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/29/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND There are no consensus guidelines regarding the use of percutaneous needle biopsy for the diagnosis of soft tissue and bone tumors. The aim of this study was to understand the efficacy of image-guided percutaneous biopsy for pediatric patients with soft tissue and bony masses, the role of intraoperative image guidance, and diagnostic accuracy. PATIENTS AND METHODS A retrospective institutional chart review was performed on patients who underwent percutaneous biopsy of soft tissue or bone tumors between 2007 and 2017. Data collected included preoperative imaging, type of biopsy, demographics, insurance status, number of samples taken, and pathologic results. RESULTS One hundred forty-one children and young adults underwent 169 biopsies. Female patients received 48.2% of biopsies. The mean age was 14.3 ± 7.0 years. Core needle biopsies made up 89.4% of procedures, while 10.6% were fine needle aspirate. The mean number of samples per patient was 3.6 ± 2.5. All patients had imaging guidance, with computed tomography used in 44.7% of patients, 9.9% using fluoroscopy, 7.1% using ultrasound for guidance, and 53 (37.6%) patients had more than one modality. Diagnostic specimens were obtained in 97.9% of biopsies. The most common overall pathology was osteoid osteoma. The most common malignant tumors were osteosarcoma and Ewing's sarcoma. CONCLUSION Image-guided percutaneous biopsy is a safe and effective method of obtaining accurate tissue samples in children and young adults with soft tissue or bone masses. LEVEL OF EVIDENCE Level 4-Study of diagnostic test.
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Affiliation(s)
- Jo Cooke-Barber
- Department of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Joseph G Brungardt
- Department of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Michael Sorger
- Department of Orthopedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Joseph G Pressey
- Department of Oncology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Brian Turpin
- Department of Oncology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Rajaram Nagarajan
- Department of Oncology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Sara Szabo
- Department of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Joel Sorger
- Department of Orthopedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Neil Johnson
- Division of Interventional Radiology, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Roshni Dasgupta
- Department of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
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Kurian J, Loganathan A, Jacob T, Matthew L, Moses V, Nidugala Keshava S, Priscilla A. Efficacy of core needle biopsy in the diagnosis of pediatric extracranial solid malignancies: A 10-year study. J Indian Assoc Pediatr Surg 2022; 27:60-64. [PMID: 35261515 PMCID: PMC8853597 DOI: 10.4103/jiaps.jiaps_319_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/26/2020] [Accepted: 02/04/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction: Core needle biopsies of solid masses in children are a minimally invasive technique. It guides to a definitive diagnosis and facilitates management. Aims and Objectives: To determine the accuracy, sensitivity, and specificity of core needle biopsies in diagnosing pediatric solid masses. Materials and Methods: A retrospective analysis of 430 children, who underwent core needle biopsy for solid masses between January 2007 and December 2016 at CMC Vellore, was done. Results: Retroperitoneal and intra-abdominal masses constituted 66% of cases. Real-time image guidance was used in 44% of cases. An accurate diagnosis was obtained in 93.6% of cases, while results did not correlate with the final diagnosis in 3.4%. Three percent had inadequate or necrotic tissue. None of the children had postprocedure complications. Conclusion: Core needle biopsies serve as good diagnostic modality, with minimal risks, in making a conclusive diagnosis and deciding on the line of management.
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Hirvonen M, Sinikumpu JJ, Tervonen O, Sequeiros RB. Magnetic resonance imaging-guided biopsies in children. Acta Radiol Open 2021; 10:20584601211053846. [PMID: 34868661 PMCID: PMC8638078 DOI: 10.1177/20584601211053846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 09/28/2021] [Indexed: 12/13/2022] Open
Abstract
Background Magnetic resonance imaging (MRI) is used far less as an imaging-guided method
for percutaneous biopsies than computed tomography (CT) and ultrasound (US),
despite its imaging benefits, particularly in children. Purpose To evaluate the feasibility, accuracy and safety of MRI-guided biopsies in
paediatric patient population. Material and Methods The retrospective study included 57 consecutive paediatric patients
(<18 years old). A percutaneous core needle biopsy (PCNB) or trephine
biopsy was performed in 53 cases, and an additional fine-needle aspiration
biopsy (FNAB) in 26 cases. In 4 cases, a stand-alone FNAB was taken.
Biopsies were performed with 0.23 T open and 1.5 T closed MRI scanners.
Statistical methods used for confidence intervals and
p-values were Wilson score method and chi-square test. Results The overall diagnostic accuracy of histologic biopsy was 0.94, with
sensitivity 0.82, specificity 1.00, positive predictive value (PPV) 1.00 and
negative predictive value (NPV) 0.92. In histological bone biopsies,
diagnostic accuracy was 0.96, with sensitivity 0.86, specificity 1.00, PPV
1.00 and NPV 0.94. The FNAB sample diagnosis was associated with the
histological diagnosis in 79% of cases. There were no major primary
complications and only a few late complications. After biopsy, 83% of the
children were ambulatory in 6 h. Anti-inflammatory drugs and paracetamol
provided satisfactory pain relief in 96% of the patients after biopsy. Most
outpatients (71%) were discharged from hospital either on the same day or
1 day later. Conclusion MRI is a technically feasible, accurate and safe guidance tool for performing
percutaneous biopsies in children.
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Affiliation(s)
- Mika Hirvonen
- Department of Radiology, Oulu University Hospital, Oulu, Finland
| | - Juha-Jaakko Sinikumpu
- Department of Paediatric Surgery and Orthopaedics, PEDEGO Research Center, Oulu University Hospital and Oulu University, Oulu, Finland
| | - Osmo Tervonen
- Department of Radiology, Oulu University Hospital, Oulu, Finland
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Serati L, Morosi C, Barretta F, Collini P, Calareso G, Chiaravalli S, Spreafico F, Luksch R, Ferrari A, Massimino M, Marchianò A. Diagnostic yield and accuracy of image-guided percutaneous core needle biopsy of paediatric solid tumours: An experience from Italy. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2021. [DOI: 10.1016/j.phoj.2020.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Ultrasound-Guided Core Biopsy for Tissue Diagnosis in Pediatric Oncology: 16-Year Experience With 597 Biopsies. AJR Am J Roentgenol 2021; 216:1066-1073. [PMID: 33566633 DOI: 10.2214/ajr.20.23196] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE. Percutaneous imaging-guided core needle biopsies (CNBs) for cancer diagnosis in pediatric patients are gaining interest because of their availability, lower rate of complications, and high diagnostic power compared with traditional surgical biopsies. Nevertheless, their precise role in the diagnostic algorithm of pediatric oncology is still unknown. The purpose of this study was to report our accumulated 16-year experience with CNB; discuss the availability, safety, and diagnostic accuracy of the procedure and the adequacy of ancillary testing; and compare our findings with the available literature. MATERIALS AND METHODS. Pediatric ultrasound-guided CNBs performed in our hospital between November 2003 and December 2019 were retrospectively studied. Data collection included demographics, clinical and procedural parameters, complications, and final diagnosis. RESULTS. A total of 597 biopsies were performed in 531 patients (132 performed in known oncologic patients and 465 performed to establish diagnosis). The median time between the biopsy request and the procedure was 1 day. Of 432 biopsies performed in patients with malignancies, 12 (2.8%) had false-negative results. In 165 cases of benign pathologic findings, all had true-negative results. Ancillary testing was adequate in all malignant cases. Overall sensitivity, specificity, and accuracy rates were 97.2%, 100%, and 98.0%, respectively. Five biopsies (0.8%) resulted in complications, including one major bleed and one track seeding. CONCLUSION. Our experience shows that ultrasound-guided CNB for suspected malignancy in pediatric patients has a high safety profile, availability, and accuracy rate compared with surgical biopsy. Our fast-track strategy enables early initiation of designated therapy and has the potential to become the procedure of choice.
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Rhee DS, Rodeberg DA, Baertschiger RM, Aldrink JH, Lautz TB, Grant C, Meyers RL, Tracy ET, Christison-Lagay ER, Glick RD, Mattei P, Dasgupta R. Update on pediatric rhabdomyosarcoma: A report from the APSA Cancer Committee. J Pediatr Surg 2020; 55:1987-1995. [PMID: 32674846 DOI: 10.1016/j.jpedsurg.2020.06.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/31/2020] [Accepted: 06/09/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND/PURPOSE Rhabdomyosarcoma is the most common soft tissue sarcoma in children and young adults and requires multimodality treatment. The purpose of this review is to present an update on risk stratification as well as surgical and medical management strategies in pediatric rhabdomyosarcoma. METHODS A comprehensive review of the current literature on pediatric rhabdomyosarcoma, including the most recent Children's Oncology Group studies and several international collaboratives, was performed by the authors and key findings were summarized in the manuscript. RESULTS FOXO1 fusion status is a stronger prognostic factor than histology and is now used for risk stratification in treatment protocols. For assessment of regional nodal involvement, FDG-PET-CT shows poor sensitivity and specificity to detect histologically confirmed nodal metastasis. Thus, surgical assessment of regional lymph nodes is required for rhabdomyosarcoma of the extremities or trunk as well as paratesticular rhabdomyosarcoma in patients ≥10 years of age, although adherence to surgical guidelines remains poor. Hemiscrotectomy performed for scrotal violation in paratesticular rhabdomyosarcoma has not shown an improvement in event free survival and is not recommended. CONCLUSIONS Surgical and medical treatment strategies for rhabdomyosarcoma in children continue to evolve. This review provides current evidence-based treatment standards with an emphasis on surgical care. TYPE OF STUDY Review. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Daniel S Rhee
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - David A Rodeberg
- Division of Pediatric Surgery, Department of Surgery, East Carolina University, Greenville, NC
| | - Reto M Baertschiger
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON
| | - Jennifer H Aldrink
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Timothy B Lautz
- Division of Pediatric Surgery, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL
| | - Christa Grant
- Division of Pediatric Surgery, Penn State Children's Hospital, Hershey, PA
| | - Rebecka L Meyers
- Division of Pediatric Surgery, University of Utah, Primary Children's Hospital, Salt Lake City, UT
| | - Elisabeth T Tracy
- Division of Pediatric Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Emily R Christison-Lagay
- Division of Pediatric Surgery, Department of Surgery, Yale University School of Medicine, Yale New Haven Children's Hospital, New Haven, CT
| | - Richard D Glick
- Division of Pediatric Surgery, Zucker School of Medicine at Hofstra/Northwell, Cohen Children's Medical Center, New Hyde Park, NY
| | - Peter Mattei
- Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Campagna G, Rosenfeld E, Foster J, Vasudevan S, Nuchtern J, Kim E, Commander S, Naik-Mathuria B. Evolving biopsy techniques for the diagnosis of neuroblastoma in children. J Pediatr Surg 2018; 53:2235-2239. [PMID: 29753525 DOI: 10.1016/j.jpedsurg.2018.04.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/09/2018] [Accepted: 04/08/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND/PURPOSE To compare the adequacy and safety of percutaneous core needle biopsy and surgical wedge biopsy of neuroblastoma in children. METHODS A retrospective review of patients who underwent biopsy for intermediate- or high-risk neuroblastoma at our institution between 2011 and 2015 was performed (recent cohort). Procedure details and outcomes were collected and analyzed using descriptive statistics and Wilcoxon rank tests; P < 0.05 was considered significant. Published data from 2002 to 2010 were compared (historic cohort). RESULTS Since 2011, percutaneous, ultrasound-guided, core needle biopsy has been more commonly utilized (47% (16/34) recent vs. 25% (7/28) historic; P = 0.07), and the number of core needle samples increased from median 7 (historic) to 25 (recent). Complications decreased (21% (7/34) recent vs. 64% (18/28) historic; P < 0.01). Biopsy adequacy in the recent cohort was similar (94% percutaneous vs. 89% surgical; P = 1.00), which is improved from the historic cohort (71% percutaneous vs. 100% surgical; P = 0.06). Larger tumors were more likely to have a percutaneous biopsy (82 ± 37 cm percutaneous vs. 47 ± 29 cm surgical; P = 0.04). CONCLUSIONS When multiple cores are obtained, percutaneous core needle biopsy is adequate for complete tissue diagnosis of neuroblastoma and can be safely performed. This can be considered as an alternative to open surgical biopsy. TYPE OF STUDY Treatment Study. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | - Eric Rosenfeld
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Jennifer Foster
- Department of Pediatric Hematology-Oncology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Sanjeev Vasudevan
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Jed Nuchtern
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Eugene Kim
- Department of Pediatric Surgery, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Sarah Commander
- School of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Bindi Naik-Mathuria
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
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Metz T, Heider A, Vellody R, Jarboe MD, Gemmete JJ, Grove JJ, Smith EA, Mody R, Newman EA, Dillman JR. Image-guided percutaneous core needle biopsy of soft-tissue masses in the pediatric population. Pediatr Radiol 2016; 46:1173-8. [PMID: 26914937 DOI: 10.1007/s00247-016-3571-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 01/14/2016] [Accepted: 02/04/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND A paucity of literature describes the use of imaged-guided percutaneous core needle biopsy for the diagnosis and characterization of pediatric soft-tissue masses and lesions. OBJECTIVE To retrospectively determine whether image-guided percutaneous core needle biopsy is adequate for diagnosing and characterizing benign and malignant pediatric soft-tissue masses and lesions. MATERIALS AND METHODS We identified children (≤18 years old) who underwent US- or CT-guided percutaneous core needle biopsy of a soft-tissue mass or other lesion between January 2012 and March 2014. Using medical records, we documented the following data: age and gender, site of the mass or lesion, size and number of biopsy specimens, whether the biopsy procedure was diagnostic, whether sufficient tissue was obtained for necessary ancillary testing (e.g., cytogenetic evaluation), and whether there was a procedural complication within 1 week. RESULTS One hundred eight soft-tissue masses or lesions were biopsied under imaging guidance in 84 children; 39 (46%) were girls. Mean age ± standard deviation (SD) was 12.1 ± 5.1 years (range 6 months to 18 years). Of these procedures, 105/108 (97%) were diagnostic; 82/108 (76%) were US-guided; 87/108 (81%) were performed using a 17-gauge introducer needle/18-gauge biopsy instrument. The mean number ± SD of core needle biopsy specimens obtained was 8.9 ± 5.0. For newly diagnosed malignancies, adequate tissue was obtained for ancillary testing in 28/30 (93%) masses. One minor complication was documented. CONCLUSION Image-guided percutaneous core needle biopsy of pediatric soft-tissue masses is safe, has a high diagnostic rate, and provides sufficient tissue for ancillary testing.
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Affiliation(s)
- Terrence Metz
- Department of Radiology, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA
| | - Amer Heider
- Department of Pathology, C.S. Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI, USA
| | - Ranjith Vellody
- Department of Radiology, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Marcus D Jarboe
- Section of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI, USA.,Department of Radiology, C.S. Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI, USA
| | - Joseph J Gemmete
- Department of Radiology, C.S. Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI, USA
| | - Jason J Grove
- Department of Radiology, C.S. Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI, USA
| | - Ethan A Smith
- Department of Radiology, C.S. Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI, USA
| | - Rajen Mody
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, C.S. Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI, USA
| | - Erika A Newman
- Section of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI, USA
| | - Jonathan R Dillman
- Department of Radiology,Cincinnati Children's Hospital Medical Center,, University of Cincinnati College of Medicine, 3333 Burnet Ave., ML 5031, Cincinnati, OH, 45229-3039, USA.
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