1
|
Ayyala RS, Dillman JR, Tkach JA, Trout AT. Rapid abdominopelvic MR imaging in the emergency department: establishing a program and addressing the challenges. Pediatr Radiol 2024:10.1007/s00247-024-06004-5. [PMID: 39042165 DOI: 10.1007/s00247-024-06004-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 07/09/2024] [Accepted: 07/10/2024] [Indexed: 07/24/2024]
Abstract
Utilization of magnetic resonance imaging (MRI) in the pediatric emergency room or urgent care setting for abdominopelvic indications has been increasing. The creation and implementation of rapid urgent MRI programs can have various challenges. The purpose of this article is to describe a framework for the creation of a rapid urgent abdominopelvic MRI program in the pediatric emergency room setting.
Collapse
Affiliation(s)
- Rama S Ayyala
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Avenue, Cincinnati, OH, 45229, USA.
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Avenue, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jean A Tkach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Avenue, Cincinnati, OH, 45229, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Avenue, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| |
Collapse
|
2
|
Gungor E, Haliloglu G, Yalnizoglu D, Oguz KK, Teksam O. Predictors of Clinically Important Neuroimaging Findings in Children Presenting Pediatric Emergency Department. Pediatr Emerg Care 2024; 40:474-479. [PMID: 38587067 DOI: 10.1097/pec.0000000000003203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
OBJECTIVE The aim of the study is to evaluate predictors of clinically important neuroimaging results, that is, computed tomography and magnetic resonance imaging in children in an academic pediatric emergency department (PED) from 2015 to 2019. METHODS This study was conducted in an academic PED. The patient's demographic and clinical characteristics of PED visits and neuroimaging findings requested at the PED were recorded for January 1, 2015, to December 31, 2019. In addition, descriptive statistics and logistic regression analyses were conducted. We described and determined the predictors of clinically important neuroimaging findings in children. RESULTS Clinically important neuroimaging findings were detected in patients with blurred vision ( P = 0.001), ataxia ( P = 0.003), unilateral weakness ( P = 0.004), and altered level of consciousness ( P = 0.026). Clinically important neuroimaging was found 9.4 times higher in patients with altered level of consciousness, 7.4 times higher in patients with focal weakness, 4.6 times higher in patients with blurred vision, and 3.5 times more in patients presenting with ataxia. CONCLUSIONS Advanced neuroimaging, especially for selected patients in PED, can improve the quality of health care for patients. On the other hand, irrelevant neuroimaging findings can lead physicians away from prompt diagnosis and accurate management. According to our study, advanced neuroimaging can be performed in the early period for both diagnosis and early treatment, especially in selected patients with ataxia, blurred vision, altered consciousness, and unilateral weakness. In other cases, clinicians may find more supporting evidence.
Collapse
Affiliation(s)
- Emre Gungor
- From the Division of Pediatric Emergency Medicine, Department of Pediatrics
| | | | | | - Kader Karli Oguz
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ozlem Teksam
- From the Division of Pediatric Emergency Medicine, Department of Pediatrics
| |
Collapse
|
3
|
Ata NA, Trout AT, Dillman JR, Tkach JA, Ayyala RS. Technical and Diagnostic Performance of Rapid MRI for Evaluation of Appendicitis in a Pediatric Emergency Department. Acad Radiol 2024; 31:1102-1110. [PMID: 37863782 DOI: 10.1016/j.acra.2023.09.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/22/2023] [Accepted: 09/24/2023] [Indexed: 10/22/2023]
Abstract
RATIONALE AND OBJECTIVES Rationale MRI is increasingly used for diagnosis of pediatric appendicitis in the emergency care setting. Scan and room time are important to optimize workflow, especially in situations with limited MRI availability and accessibility. To describe our process to optimize and implement a rapid, non-contrast, free-breathing MRI protocol for appendicitis and to characterize the accuracy for diagnosis. MATERIALS AND METHODS Initial MRI protocol implemented for suspected appendicitis included five respiratory-triggered axial and coronal single shot fast spin echo (SSFSE) and radial T2W sequences with and without fat suppression (FS). This protocol was reassessed based on image quality. Subsequently, the coronal and axial T2W SSFSE FS sequence were removed. A three-sequence exam comprised the rapid MRI appendicitis protocol used for the remainder of the study. All examinations were performed on a 1.5 T scanner. For all examinations, the following information was obtained: scan time, diagnosis of appendicitis (by radiology report), surgery and pathology reports, and alternative diagnoses documented in radiology reports. MRI examination scan durations were compared between the five-sequence and three-sequence protocols, with Mann-Whitney U test, and proportions of false diagnoses were compared to Fisher's exact test. RESULTS 216 examinations were performed; 21 and 195 performed with five- and three-sequence protocol, respectively. The median duration of the five-sequence protocol was 20 (16.9-23.5) minutes vs.11 (9.5-13) minutes for the three sequence protocol (p < 0.0001). The majority (n = 157, 80.5% of 195) of examinations were performed in a goal time of< 15 min. 23 examinations took longer than 20 min (n = 12, n = 11 for the three- and five-sequence protocols, respectively) were due to repeat sequences or addition of non-standard sequences (requested by interpreting radiologist). 27 (90%) of the 30 reported positive cases were confirmed by pathology. There were three false-positive diagnoses (all three-sequence protocol exams) and one false-negative diagnosis (five-sequence protocol exam). Alternative diagnoses, including pancreatitis, omental infarct, masses, and ovarian pathology, were made in 42 (19%) cases. CONCLUSION A three-sequence, non-contrast, free- breathing MRI examination can be performed in less than 15 min in the emergency department and has high diagnostic accuracy for acute appendicitis in children and young adults.
Collapse
Affiliation(s)
- Nadeen Abu Ata
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, Ohio, 45229, USA (N.A.A., A.T.T., J.R.D., J.A.T., R.S.A.); Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA (N.A.A., A.T.T., J.R.D., J.A.T., R.S.A.)
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, Ohio, 45229, USA (N.A.A., A.T.T., J.R.D., J.A.T., R.S.A.); Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA (N.A.A., A.T.T., J.R.D., J.A.T., R.S.A.); Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA (A.T.T.)
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, Ohio, 45229, USA (N.A.A., A.T.T., J.R.D., J.A.T., R.S.A.); Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA (N.A.A., A.T.T., J.R.D., J.A.T., R.S.A.)
| | - Jean A Tkach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, Ohio, 45229, USA (N.A.A., A.T.T., J.R.D., J.A.T., R.S.A.); Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA (N.A.A., A.T.T., J.R.D., J.A.T., R.S.A.)
| | - Rama S Ayyala
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, Ohio, 45229, USA (N.A.A., A.T.T., J.R.D., J.A.T., R.S.A.); Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA (N.A.A., A.T.T., J.R.D., J.A.T., R.S.A.).
| |
Collapse
|
4
|
Wang X, Fu K, Liu J, Xie H. Leveraging an efficient preparation method into magnetic resonance examinations of young children aged 3-6. Eur J Radiol 2024; 170:111256. [PMID: 38096742 DOI: 10.1016/j.ejrad.2023.111256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/15/2023] [Accepted: 12/05/2023] [Indexed: 01/16/2024]
Abstract
PURPOSE To evaluate the benefits of a multifaceted concept, ANMTE (Appropriate Number of children, appropriate learning Methods, appropriate adaptive Training, and appropriate Encouragement), proposed by our group, in improving the success rate, efficiency and image quality of Magnetic Resonance (MR) examinations for children from 3 to 6 years old. METHOD In this study, 150 participants were included from July 2019 to January 2023, including 50 non-sedated children in ANMTE group, 50 in the group with sedative, and 50 in the group with routine preparations. ANMTE refers to appropriate number of children, appropriate learning methods, appropriate adaptive training, and appropriate encouragement, developed by our group for MR examinations of children from 3 to 6 years old. Group differences in success rate, efficiency, and image quality were evaluated across the three groups using Kaplan-Meier, Log-rank and Chi-square test, respectively. RESULTS The rates of successful MR examinations were 44/50 (88 %), 45/50 (90 %), and 36/50 (72 %) for ANMTE group, the group with sedatives and the group with routine preparations, respectively (P = 0.03). Image quality of the 3 groups showed no significant group difference (P = 0.067). In terms of the median duration of MR examinations, ANMTE group was comparable to the group with sedative (both were about 10.0 min), but better than the group with routine preparations (16.5 min) (P = 0.024). CONCLUSION We demonstrated the feasibility of our comprehensive nursing method ANMTE in MR examinations of young children, similar to the group with sedative at the success rate and image quality as well as the durations of MR examinations. ANMTE has not only better efficiency but also higher safety as it does not require sedative, which could be promising in clinical routine MR examinations for young children aged 3-6 years old.
Collapse
Affiliation(s)
- Xueqin Wang
- Department of Radiology, Daping Hospital, Army Medical University (Army Medical Center of PLA), Chongqing, China.
| | - Kun Fu
- Department of Radiology, Daping Hospital, Army Medical University (Army Medical Center of PLA), Chongqing, China.
| | - Junling Liu
- Department of Radiology, Daping Hospital, Army Medical University (Army Medical Center of PLA), Chongqing, China.
| | - Huan Xie
- Department of Radiology, Daping Hospital, Army Medical University (Army Medical Center of PLA), Chongqing, China.
| |
Collapse
|
5
|
Cappellari AM, Bruschi G, Beretta GB, Molisso MT, Bertolozzi G. How Can Specialist Advice Influence the Neuroimaging Practice for Childhood Headache in Emergency Department? CHILDREN (BASEL, SWITZERLAND) 2023; 10:1837. [PMID: 38136039 PMCID: PMC10742139 DOI: 10.3390/children10121837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 12/24/2023]
Abstract
Differentiating between primary and secondary headaches can be challenging, especially in the emergency department (ED). Since symptoms alone are inadequate criteria for distinguishing between primary and secondary headaches, many children with headaches undergo neuroimaging investigations, such as brain CT and MRI. In various studies, the frequency of neuroimaging utilization is influenced by several factors, including teaching status, ownership, metropolitan area, insurance status, and ethnicity of patients. However, only a few studies have considered the role of specialist consultations in ordering neuroimaging studies on childhood headaches. We report the contributions of different specialists to the evaluation of children with headaches admitted to the ED and their influence on neuroimaging decisions. We retrospectively reviewed the medical reports of paediatric patients who presented with headaches to the paediatric ED of the Ospedale Maggiore Policlinico of Milano between January 2017 and January 2022. Overall, 890 children with headaches were evaluated (mean age: 10.0 years; range: 1 to 17 years). All patients were examined by the ED paediatricians, while specialist consultations were required for 261 patients, including 240 neurological (92.0%), 46 ophthalmological (17.6%), and 20 otorhinolaryngological (7.7%) consultations. Overall, 173 neuroimaging examinations were required, of which 51.4 and 48.6% were ordered by paediatricians and neurologists, respectively. In particular, paediatricians required 61.4% of brain CT scans, and neurologists required 92.0% of brain MRI scans. In conclusion, paediatricians were responsible for the management of most children with headaches admitted to the ED, while specialist consultations were required only in about a third of the cases. Although there was no significant difference in the number of neuroimaging studies ordered by specialists, brain CT scans were most often used by paediatricians, and MRI scans by neurologists.
Collapse
Affiliation(s)
- Alberto M. Cappellari
- Department of Neuroscience and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Gaia Bruschi
- Postgraduate School of Paediatrics, Università degli Studi di Milano, 20122 Milan, Italy; (G.B.); (G.B.B.)
| | - Gisella B. Beretta
- Postgraduate School of Paediatrics, Università degli Studi di Milano, 20122 Milan, Italy; (G.B.); (G.B.B.)
| | - Maria T. Molisso
- Department of Neuroscience and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Giuseppe Bertolozzi
- Pediatric Emergency Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| |
Collapse
|
6
|
Zanette B, Greer MLC, Moraes TJ, Ratjen F, Santyr G. The argument for utilising magnetic resonance imaging as a tool for monitoring lung structure and function in pediatric patients. Expert Rev Respir Med 2023; 17:527-538. [PMID: 37491192 DOI: 10.1080/17476348.2023.2241355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/06/2023] [Accepted: 07/24/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION Although historically challenging to perform in the lung, technological advancements have made Magnetic Resonance Imaging (MRI) increasingly applicable for pediatric pulmonary imaging. Furthermore, a wide array of functional imaging techniques has become available that may be leveraged alongside structural imaging for increasingly sensitive biomarkers, or as outcome measures in the evaluation of novel therapies. AREAS COVERED In this review, recent technical advancements and modern methodologies for structural and functional lung MRI are described. These include ultrashort echo time (UTE) MRI, free-breathing contrast agent-free, functional lung MRI, and hyperpolarized gas MRI, amongst other techniques. Specific examples of the application of these methods in children are provided, principally drawn from recent research in asthma, bronchopulmonary dysplasia, and cystic fibrosis. EXPERT OPINION Pediatric lung MRI is rapidly growing, and is well poised for clinical utilization, as well as continued research into early disease detection, disease processes, and novel treatments. Structure/function complementarity makes MRI especially attractive as a tool for increased adoption in the evaluation of pediatric lung disease. Looking toward the future, novel technologies, such as low-field MRI and artificial intelligence, mitigate some of the traditional drawbacks of lung MRI and will aid in improving access to MRI in general, potentially spurring increased adoption and demand for pulmonary MRI in children.
Collapse
Affiliation(s)
- Brandon Zanette
- Translational Medicine Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Mary-Louise C Greer
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Theo J Moraes
- Translational Medicine Program, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Felix Ratjen
- Translational Medicine Program, The Hospital for Sick Children, Toronto, ON, Canada
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Giles Santyr
- Translational Medicine Program, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
7
|
Ko TS, Catennacio E, Shin SS, Stern J, Massey SL, Kilbaugh TJ, Hwang M. Advanced Neuromonitoring Modalities on the Horizon: Detection and Management of Acute Brain Injury in Children. Neurocrit Care 2023; 38:791-811. [PMID: 36949362 PMCID: PMC10241718 DOI: 10.1007/s12028-023-01690-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 01/31/2023] [Indexed: 03/24/2023]
Abstract
Timely detection and monitoring of acute brain injury in children is essential to mitigate causes of injury and prevent secondary insults. Increasing survival in critically ill children has emphasized the importance of neuroprotective management strategies for long-term quality of life. In emergent and critical care settings, traditional neuroimaging modalities, such as computed tomography and magnetic resonance imaging (MRI), remain frontline diagnostic techniques to detect acute brain injury. Although detection of structural and anatomical abnormalities remains crucial, advanced MRI sequences assessing functional alterations in cerebral physiology provide unique diagnostic utility. Head ultrasound has emerged as a portable neuroimaging modality for point-of-care diagnosis via assessments of anatomical and perfusion abnormalities. Application of electroencephalography and near-infrared spectroscopy provides the opportunity for real-time detection and goal-directed management of neurological abnormalities at the bedside. In this review, we describe recent technological advancements in these neurodiagnostic modalities and elaborate on their current and potential utility in the detection and management of acute brain injury.
Collapse
Affiliation(s)
- Tiffany S Ko
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, USA.
| | - Eva Catennacio
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Samuel S Shin
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Joseph Stern
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, USA
| | - Shavonne L Massey
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Todd J Kilbaugh
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Misun Hwang
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, USA
| |
Collapse
|
8
|
Practice Patterns in Use of MRI for Appendicitis in the Emergency Department at Children's Hospitals: Results of a National Survey. AJR Am J Roentgenol 2023:1-2. [PMID: 36856304 DOI: 10.2214/ajr.23.29053] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
This study reports results of a national survey of Society of Chiefs of Radiology at Children's Hospital membership regarding use of MRI for appendicitis in the emergency department (ED); 39/100 surveyed individuals participated. A total of 21/39 institutions perform MRI for acute appendicitis in the ED; 17/21 institutions perform MRI only after an initial ultrasound. The number of MRI sequences ranges from three to seven. The estimated room time ranges from 8 to 30 minutes.
Collapse
|
9
|
Arnold TC, Freeman CW, Litt B, Stein JM. Low-field MRI: Clinical promise and challenges. J Magn Reson Imaging 2023; 57:25-44. [PMID: 36120962 PMCID: PMC9771987 DOI: 10.1002/jmri.28408] [Citation(s) in RCA: 60] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 02/03/2023] Open
Abstract
Modern MRI scanners have trended toward higher field strengths to maximize signal and resolution while minimizing scan time. However, high-field devices remain expensive to install and operate, making them scarce outside of high-income countries and major population centers. Low-field strength scanners have drawn renewed academic, industry, and philanthropic interest due to advantages that could dramatically increase imaging access, including lower cost and portability. Nevertheless, low-field MRI still faces inherent limitations in image quality that come with decreased signal. In this article, we review advantages and disadvantages of low-field MRI scanners, describe hardware and software innovations that accentuate advantages and mitigate disadvantages, and consider clinical applications for a new generation of low-field devices. In our review, we explore how these devices are being or could be used for high acuity brain imaging, outpatient neuroimaging, MRI-guided procedures, pediatric imaging, and musculoskeletal imaging. Challenges for their successful clinical translation include selecting and validating appropriate use cases, integrating with standards of care in high resource settings, expanding options with actionable information in low resource settings, and facilitating health care providers and clinical practice in new ways. By embracing both the promise and challenges of low-field MRI, clinicians and researchers have an opportunity to transform medical care for patients around the world. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 6.
Collapse
Affiliation(s)
- Thomas Campbell Arnold
- Department of Bioengineering, School of Engineering & Applied ScienceUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Center for Neuroengineering and TherapeuticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Colbey W. Freeman
- Department of Radiology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Brian Litt
- Center for Neuroengineering and TherapeuticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Neurology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Joel M. Stein
- Center for Neuroengineering and TherapeuticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Radiology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| |
Collapse
|
10
|
Added value of gadolinium-based contrast agents for magnetic resonance evaluation of adnexal torsion in girls. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:3868-3882. [PMID: 35978184 DOI: 10.1007/s00261-022-03642-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE Ultrasound is the first-line imaging modality to evaluate adnexa in girls with clinical suspicion of torsion. Patients with equivocal ultrasound findings can undergo MRI for better delineation of adnexal pathology. Here, we assess the utility of intravenous contrast in MRI evaluation of adnexal torsion in children. METHODS Two pediatric radiologists (R1, R2) retrospectively reviewed 198 pelvic MRI exams in 172 girls (median age 15 years). Each MRI was reviewed twice. The first review included pre-contrast images only. A second review, at least 1 month later, included both pre- and post-contrast images. Readers concluded if findings were suspicious for torsion or not. Readers' findings were compared to each other's and to surgical and MRI reports and clinical course. RESULTS 198 MRI exams yielded 354 evaluable ovaries. Surgical and pathological reports were available for 47 patients. 11 patients had adnexal torsion. Both readers accurately diagnosed acutely torsed ovaries during pre- and post-contrast reviews (n = 4). However, readers disagreed on torsed paraovarian cysts (n = 4) and chronically/intermittently torsed ovaries (n = 3). In 21 non-torsed ovaries that had lesions, one or both readers concluded that there were pre-contrast features of torsion. In this set with ovarian lesions, contrast helped readers to correctly conclude no torsion (R1 = 8, R2 = 6) more commonly than to incorrectly conclude torsion (1 each), improving post-contrast specificity for each reader. CONCLUSIONS Post-contrast sequences did not provide additional benefit in evaluating acutely torsed ovaries but helped in excluding torsion in patients with adnexal lesions. Therefore, contrast administration should be individualized, potentially reserved only for those with abnormal ultrasound or pre-contrast images.
Collapse
|
11
|
Wolfe C, Halsey-Nichols M, Ritter K, McCoin N. Abdominal Pain in the Emergency Department: How to Select the Correct Imaging for Diagnosis. Open Access Emerg Med 2022; 14:335-345. [PMID: 35899220 PMCID: PMC9309319 DOI: 10.2147/oaem.s342724] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/04/2022] [Indexed: 11/23/2022] Open
Abstract
Abdominal pain is a common presenting complaint in the emergency department, and utilization of diagnostic imaging is often a key tool in determining its etiology. Plain radiography has limited utility in this population. Computed tomography (CT) is the imaging modality of choice for undifferentiated abdominal pain. Ultrasound and magnetic resonance imaging may be helpful in specific scenarios, primarily in pediatrics and pregnancy, and offer the benefit of eliminating ionizing radiation risk of CT. Guidance for imaging selection is determined by location of pain, special patient considerations, and specific suspected etiologies. Expert guidance is offered by the American College of Radiology Appropriateness Criteria® which outlines imaging options based on location of pain.
Collapse
Affiliation(s)
- Carmen Wolfe
- Department of Emergency Medicine, TriStar Skyline Medical Center, Nashville, TN, USA
| | - Maglin Halsey-Nichols
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kathryn Ritter
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Nicole McCoin
- Department of Emergency Medicine, Ochsner Medical Center, New Orleans, LA, USA
| |
Collapse
|
12
|
AYDIN H, YAZICI S, ÖZDEN E, DEMİRPOLAT G. Retrospective features of cases with cranial magnetic resonance imaging. EGE TIP DERGISI 2022. [DOI: 10.19161/etd.1126762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: In this study, we aimed to reveal the diagnostic profiles of 0-18 years aged patients, for whom cranial magnetic resonance imaging is requested in outpatient settings, and to evaluate the cranial imaging results according to gender and age groups.
Materials and Methods: The files of patients aged 0-18 years who were requested cranial magnetic resonance imaging for various indications, between August 2019 and March 2021, in Balikesir University, Faculty of Medicine pediatric neurology and pediatric health and diseases outpatient clinics were reviewed retrospectively.
Age, gender, main complaint and neuroradiological imaging results were obtained from hospital records. Data were divided for three different age groups (0-6, 7-12, 13-18).
Results: Cranial magnetic resonance imaging of 313 cases were analyzed. The mean age of the patients was 9.35±4.89 (4 months-17 years) years. There were 164 (52.4%) boys and 149 (47.6%) girls. There were 82 (26.2%) cases in the 0-6 years age group, 104 (33.2%) in the 7-12 years age group and 127 (40.6%) in the 13-18 years age group. The most common reasons for requesting cranial magnetic resonance imaging were as; seizure/epilepsy in 106 (33.9%) cases, headache in 65 (20.8%) cases, and neuromotor retardation in 28 (8.9%) cases. While the cranial imaging of 200 (63.9%) cases was normal, the results of 113 (36.1%) cases were evaluated as abnormal. The most common abnormal findings were intracranial mass (2.5%), nonspecific white matter lesion (5.1%), intracranial cyst (5.7%), sinusitis (9.2%) and hydrocephalus/hydrancephaly (2.6%). When age groups were compared in terms of showing normal or abnormal cranial imaging findings, no statistically significant difference was found (p=0.73), but a statistically significant difference was found between the genders in the same respect (p=0.007).
Conclusion: Our study is important for including cranial MRI request indications and results in pediatric practice and it creating a diagnostic profile in these patients.
Collapse
Affiliation(s)
- Hilal AYDIN
- Balıkesir Üniversitesi Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Çocuk Nöroloji Bölümü, Balıkesir, Türkiye
| | - Selçuk YAZICI
- Balıkesir Ün vers tes Tıp Fakültes Çocuk Sağlığı ve Hastalıkları Ana l m Dalı, Çocuk Hastalıkları Bölümü, Balıkesir, Türkiye
| | - Ezgi ÖZDEN
- Balıkesir Ün vers tes Tıp Fakültes Çocuk Sağlığı ve Hastalıkları Ana l m Dalı, Çocuk Hastalıkları Bölümü, Balıkesir, Türkiye
| | - Gülen DEMİRPOLAT
- Balıkesir Üniversitesi Tıp Fakültesi Radyoloji Ana ilim Dalı, Balıkesir, Türkiye
| |
Collapse
|
13
|
Tajaldeen A, Kheiralla OAM, Alghamdi SS, Alsleem H, Al-Othman A, Abuelhia E, Aljondi R. Evaluation of Pediatric Imaging Modalities Practices of Radiologists and Technologists: A Survey-Based Study. J Multidiscip Healthc 2022; 15:443-453. [PMID: 35280855 PMCID: PMC8906869 DOI: 10.2147/jmdh.s351696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/17/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Abdulrahman Tajaldeen
- Department of Radiological Sciences, College of Applied Medical Science, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
- Correspondence: Abdulrahman Tajaldeen, Email
| | - Osama A Mabrouk Kheiralla
- Department of Radiological Sciences, College of Applied Medical Science, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Salem Saeed Alghamdi
- Department of Applied Radiologic Technology, College of Applied Medical Sciences, University of Jeddah, Jeddah, Saudi Arabia
| | - Haney Alsleem
- Department of Radiological Sciences, College of Applied Medical Science, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdullah Al-Othman
- Radiology Department, King Fahad University Hospital, Alkhobar, Saudi Arabia
| | - Elfatih Abuelhia
- Department of Radiological Sciences, College of Applied Medical Science, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Rowa Aljondi
- Department of Applied Radiologic Technology, College of Applied Medical Sciences, University of Jeddah, Jeddah, Saudi Arabia
| |
Collapse
|
14
|
Harrington SG, Jaimes C, Weagle KM, Greer MLC, Gee MS. Strategies to perform magnetic resonance imaging in infants and young children without sedation. Pediatr Radiol 2022; 52:374-381. [PMID: 33830290 PMCID: PMC8027290 DOI: 10.1007/s00247-021-05062-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/25/2021] [Accepted: 03/16/2021] [Indexed: 02/07/2023]
Abstract
Given the increasing use of MRI in the pediatric population, the need for sedation in MRI performed in young children is a topic of growing importance. Although sedation is generally tolerated well by children, the financial and operational impacts of anesthesia on MRI workflow, as well as potential adverse effects of anesthetic medications, highlight the need to perform MRI in children without sedation whenever possible. This review focuses on current techniques to facilitate non-sedation MRI in children, including exam preparation with MRI simulation; asleep but not sedated techniques; awake and relaxed techniques using certified child life specialists, animal-assisted therapy, a child-friendly environment and in-scan entertainment; and non-sedated MRI protocol modifications such as shorter scan time, prioritizing sequences, reducing motion artifact, noise reduction, limiting use of gadolinium, employing an open MRI and modifying protocols.
Collapse
Affiliation(s)
- Samantha G Harrington
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA.
| | | | - Kathryn M Weagle
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA
| | - Mary-Louise C Greer
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Michael S Gee
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA
| |
Collapse
|
15
|
Full-body MR imaging: a retrospective study on a novel diagnostic approach for children sustaining high-energy trauma. Eur J Trauma Emerg Surg 2021; 48:2165-2172. [PMID: 34279669 PMCID: PMC9192453 DOI: 10.1007/s00068-021-01736-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 06/23/2021] [Indexed: 11/04/2022]
Abstract
Purpose Severe accidents are the leading cause of long-term impairment and death in children. A common diagnostic procedure for children exposed to high-injury trauma is full-body contrast-enhanced CT (fbCT). However, the number of fbCT without detected injuries is relevant. In 2007, full-body MRI (fbMRI) was implemented as a diagnostic approach for children sustaining high-energy trauma. The aim of this cross-sectional retrospective study was to analyze fbMRI as a diagnostic tool for children after high-energy trauma focusing on feasibility, radiological findings, and limitations. Methods Diagnostics using fbMRI (from apex of the head to the pelvis) was performed if a child was stable and suffered a high-energy trauma in a Level I Trauma Center in Germany. 105 fbMRIs in patients exposed to high-energy trauma aged ≤ 16 years were performed between January 2007 and December 2018. Four fbMRIs were excluded as conducted for reasons other than trauma. Time between arrival in the emergency department and fbMRI, additional diagnostic procedures, injuries, and non-trauma related pathologies were analyzed. Results Mean time between arrival in the emergency department and fbMRI was 71 min (± SD 132 min). Two scans were discontinued and changed to a faster diagnostic procedure. 45% of children had additional X-rays and 11% CT scans. The MRIs showed intracranial abnormalities in 27%, extremities injuries in 26%, spinal injuries in 18%, pelvic, and thoracic injuries in 7% of the cases. Conclusion Overall fbMRI is a diagnostic alternative for hemodynamically stable, conscious children after high-energy trauma with the advantages of a radiation-free technique. However, MRI diagnostics take longer than CT scans. Prospective studies will be needed to identify the limiting factors of fbMRIs as primary diagnostic procedure compared to CT scans. Trial registration German Clinical Trials Register (DRKS; DRKS00017015). Level of evidence Case series, level of evidence V.
Collapse
|
16
|
Abstract
BACKGROUND. Anesthetic exposure in children may impact long-term neurocognitive outcomes. Therefore, minimizing pediatric MRI scan time in children under anesthesia and the associated anesthetic exposure is necessary. OBJECTIVE. The purpose of this study was to evaluate pediatric MRI scan time as a predictor of total propofol dose, considering imaging and clinical characteristics as covariates. METHODS. Electronic health records were retrospectively searched to identify MRI examinations performed from 2016 to 2019 in patients 0-18 years old who received propofol anesthetic. Brain; brain and spine; brain and abdomen; and brain, head, and neck MRI examinations were included. Demographic, clinical, and imaging data were extracted for each examination, including anesthesia maintenance phase time, MRI scan time, and normalized propofol dose. MRI scan time and propofol dose were compared between groups using a t test. A multiple linear regression with backward selection (threshold, p < .05) was used to evaluate MRI scan time as a predictor of total propofol dose, adjusting for sex, age, time between scan and study end, body part, American Society of Anesthesiologists (ASA) classification, diagnosis, magnet strength, and IV contrast medium administration as covariates. RESULTS. A total of 501 examinations performed in 426 patients (172 girls, 254 boys; mean age, 6.55 ± 4.59 [SD] years) were included. Single body part examinations were shorter than multiple body part examinations (mean, 52.7 ± 18.4 vs 89.3 ± 26.4 minutes) and required less propofol (mean, 17.7 ± 5.7 vs 26.1 ± 7.7 mg/kg; all p < .001). Among single body part examinations, a higher ASA classification, oncologic diagnosis, 1.5-T magnet, and IV contrast medium administration were associated with longer MRI scan times (all p ≤ .009) and higher propofol exposure (all p ≤ .005). In multivariable analysis, greater propofol exposure was predicted by MRI scan time (mean dose per minute of examination, 0.178 mg/kg; 95% CI, 0.155-0.200; p < .001), multiple body part examination (p = .04), and IV contrast medium administration (p = .048); lower exposure was predicted by 3-T magnet (p = .04). CONCLUSION. Anesthetic exposure during pediatric MRI can be quantified and predicted based on imaging and clinical variables. CLINICAL IMPACT. This study serves as a valuable baseline for future efforts to reduce anesthetic doses and scan times in pediatric MRI.
Collapse
|
17
|
Khaira G, Kurz JE. Rapid Brain MRI Use in a Pediatric Emergency Department. Pediatr Neurol Briefs 2020; 34:21. [PMID: 33354103 PMCID: PMC7747511 DOI: 10.15844/pedneurbriefs-34-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Investigators from the University of Pittsburgh (Department of Emergency Medicine and Division of Pediatric Radiology) and Feinberg School of Medicine (Division of Emergency Medicine) studied the rates of neuroimaging (rapid brain MRI [rMRI], head CT [HCT], and full MRI) before and after implementation of four rapid MRI protocols in their ED.
Collapse
Affiliation(s)
- Gurpreet Khaira
- Davee Pediatric Neurocritical Care Program, Division of Neurology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Jonathan E Kurz
- Davee Pediatric Neurocritical Care Program, Division of Neurology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| |
Collapse
|
18
|
Abstract
Emergent imaging of the brain is often required to diagnose and manage serious and life-threatening conditions for children presenting to the emergency department. In an effort to reduce children's exposure to ionizing radiation, the use of magnetic resonance imaging (MRI) as an alternative to computed tomography (CT) is increasing. In some conditions, an urgent MRI rather than CT is critical for making management decisions. The purpose of this review is to highlight 3 emergency medical conditions-acute stroke, traumatic brain injury, and hydrocephalus-in which timely MRI of the brain is required for diagnosis and management. Another aim will be to guide providers in determining when and what limited MRI sequences of the brain can be used in lieu of CT in these emergency medical conditions.
Collapse
|
19
|
Unenhanced MRI of the Abdomen and Pelvis in the Comprehensive Evaluation of Acute Atraumatic Abdominal Pain in Children. AJR Am J Roentgenol 2020; 215:1218-1228. [PMID: 32901563 DOI: 10.2214/ajr.19.22577] [Citation(s) in RCA: 5] [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
OBJECTIVE. The purpose of this study is to show the utility of rapid unenhanced MRI in the comprehensive assessment of acute atraumatic abdominal pain in children, including appendicitis and alternate diagnoses, and to review the MRI features of common acute abdominal and pelvic conditions in a large, single-institution cohort. CONCLUSION. Rapid unenhanced MRI is an excellent option for the initial, comprehensive evaluation of acute abdominal emergencies in pediatric patients because it can diagnose the full range of presenting abnormalities, including causes of abdominal pain warranting surgical and nonsurgical management.
Collapse
|
20
|
Shamir SB, Schwartz C, Morrone K, Taragin B, Liszewski MC. Acute Appendicitis in Pediatric Patients With Sickle Cell Disease: Lower Incidence, More Imaging, and More False-Positives. J Am Coll Radiol 2020; 18:257-264. [PMID: 33096090 DOI: 10.1016/j.jacr.2020.09.052] [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: 07/02/2020] [Revised: 09/09/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Patients with sickle cell disease (SCD) experience recurrent pain crises, which may mimic appendicitis. A prior study found a significantly lower rate of appendicitis in patients with SCD compared with national averages. We investigate the incidence of appendicitis and number of imaging studies for appendicitis in pediatric patients with SCD. METHODS Using a retrospective study design from a single institution, SCD and control cohorts were created. Inclusion criteria included age 0 to 21years and at least one follow-up appointment within 24 months. Length of observation was calculated from initial presentation to either inpatient admission for appendicitis or last clinic visit. Analysis of an SCD subgroup and a control subset (n = 1,596) was used to compare the number of imaging studies. Incidence rates of appendicitis and number of appendicitis studies were determined. Z-tests, binomial enumeration exact tests, and Fischer's exact tests were used. RESULTS The SCD cohort included 1,064 patients between January 1, 2001, to December 31, 2014, and the control cohort included 115,109 patients without SCD between January 1, 2011, and December 31, 2011. Incidence rate of appendicitis per 10,000 patient-years was significantly lower in the SCD group compared with controls (2.9 cases versus 10.7 cases per 10,000 patient-years; P = .044). Additionally, the SCD group received significantly more ultrasounds (148 versus 60 per 10,000 patient-years; P< .0001) and CTs (94 versus 27 per 10,000 patient-years; P< .0001) for appendicitis, which remained significant when controlling for race. Patients with SCD also received more false-positive scans. DISCUSSION Patients with SCD had a significantly lower incidence of appendicitis than controls, yet had a higher number of imaging tests performed for appendicitis. Appendicitis should be viewed as a less common cause of acute abdominal pain in SCD. This consideration should help guide imaging strategy.
Collapse
Affiliation(s)
- Stephanie B Shamir
- Montefiore Medical Center & Albert Einstein College of Medicine, Bronx, New York.
| | - Carly Schwartz
- Montefiore Medical Center & Albert Einstein College of Medicine, Bronx, New York
| | - Kerry Morrone
- Assistant Professor of Pediatrics, Director of the Pediatric Sickle Cell Program, Director of the Pediatric Hematology Oncology Fellowship Program, Division of Pediatric Hematology/Oncology and Cellular Therapy, The Children's Hospital at Montefiore and Montefiore Medical Center, Bronx, New York
| | - Benjamin Taragin
- Soroka University Medical Center, Beer Sheva, Israel; Ben-Gurion University, Beer Sheva, Israel
| | - Mark C Liszewski
- Montefiore Medical Center & Albert Einstein College of Medicine, Bronx, New York; Director of Outpatient Imaging, Montefiore Medical Center; Director, Division of Pediatric Radiology; Associate Program Director, Diagnostic Radiology Residency; Associate Professor of Radiology Departments of Radiology and Pediatrics, Montefiore Medical Center and The Children's Hospital at Montefiore Albert Einstein College of Medicine Bronx, New York
| |
Collapse
|
21
|
Tokatly Latzer I, Orbach R, Ben-Sira L, Mezad-Koursh D, Bachar Zipori A, Roth J, Constantini S, Fattal-Valevski A, Lubetzky R. The Clinical Utility of Inpatient Brain Magnetic Resonance Imaging in Children. J Child Neurol 2020; 35:744-752. [PMID: 32517554 DOI: 10.1177/0883073820931264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The clinical applicability and yield of brain magnetic resonance imaging (MRI) in the setting of an inpatient pediatric department has not been investigated. The authors performed a retrospective chart review of nontraumatic/nonneurosurgical children who underwent brain MRI during their hospitalization in a general pediatric department over a 5-year period. Of the 331 children who underwent brain MRI, 148 (45%) had abnormal findings. High-risk headaches and focal seizures were significantly correlated with findings on brain MRI. Diagnostic and therapeutic yields were most significant in acute demyelinating events, acute cerebrovascular disorders, high-risk headaches when supported by neurologic and ophthalmologic findings, focal seizures with evidence of multifocal epileptic activity on an electroencephalogram and ophthalmic complaints when accompanied by cranial nerve palsy and optic nerve impairment. Since the contributions of a brain MRI in hospitalized children is pivotal in specific clinical situations, a judicious decision-making process should be done before its scheduling, in order to optimize clinical care.
Collapse
Affiliation(s)
- Itay Tokatly Latzer
- Pediatric Neurology Institute, 108403Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, 26745Tel-Aviv University, Israel
| | - Rotem Orbach
- Pediatric Neurology Institute, 108403Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, 26745Tel-Aviv University, Israel
| | - Liat Ben-Sira
- Sackler School of Medicine, 26745Tel-Aviv University, Israel.,Pediatric Radiology Unit, 108403Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Daphna Mezad-Koursh
- Sackler School of Medicine, 26745Tel-Aviv University, Israel.,Pediatric Ophthalmology Unit, Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Anat Bachar Zipori
- Sackler School of Medicine, 26745Tel-Aviv University, Israel.,Pediatric Ophthalmology Unit, Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Jonathan Roth
- Sackler School of Medicine, 26745Tel-Aviv University, Israel.,Department of Pediatric Neurosurgery and 108403Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Shlomi Constantini
- Sackler School of Medicine, 26745Tel-Aviv University, Israel.,Department of Pediatric Neurosurgery and 108403Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Aviva Fattal-Valevski
- Pediatric Neurology Institute, 108403Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, 26745Tel-Aviv University, Israel.,These authors have contributed equally to this work
| | - Ronit Lubetzky
- Sackler School of Medicine, 26745Tel-Aviv University, Israel.,Department of Pediatrics, 108403Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel.,These authors have contributed equally to this work
| |
Collapse
|
22
|
Singhrao K, Fu J, Gao Y, Wu HH, Yang Y, Hu P, Lewis JH. A generalized system of tissue-mimicking materials for computed tomography and magnetic resonance imaging. ACTA ACUST UNITED AC 2020; 65:13NT01. [DOI: 10.1088/1361-6560/ab86d4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
23
|
Abstract
BACKGROUND Musculoskeletal infection is a major cause of morbidity in the pediatric population. Despite the canonical teaching that an irritable joint and signs of infection likely represent an infected joint space, recent evidence in the pediatric hip has demonstrated that alternative diagnoses are equally or more likely and that combinations of pathologies are common. The knee is the second most commonly infected joint in children, yet there remains a paucity of available data regarding the epidemiology and workup of the infected pediatric knee. The authors hypothesize that there is heterogeneity of pathologies, including combinations of pathologies, that presents as a potentially infected knee in a child. The authors aim to show the utility of magnetic resonance imaging and epidemiologic and laboratory markers in the workup of these patients. METHODS A retrospective review of all consults made to the pediatric orthopaedic surgery team at a single tertiary care center from September 2009 through December 2015 regarding a concern for potential knee infection was performed. Excluded from the study were patients with penetrating trauma, postoperative infection, open fracture, no C-reactive protein (CRP) within 24 hours of admission, sickle cell disease, an immunocompromised state, or chronic osteomyelitis. RESULTS A total of 120 patients were analyzed in this study. There was marked variability in pathologies. Patients with isolated osteomyelitis or osteomyelitis+septic arthritis were older, had an increased admission CRP, were more likely to be infected with Staphylococcus aureus, required an increased duration of antibiotics, and had an increased incidence of musculoskeletal complications than patients with isolated septic arthritis. CONCLUSIONS When considering a child with an irritable knee, a heterogeneity of potential underlying pathologies and combinations of pathologies are possible. Importantly, the age of the patient and CRP can guide a clinician when considering further workup. Older patients with a higher admission CRP value warrant an immediate magnetic resonance imaging, as they are likely to have osteomyelitis, which was associated with worse outcomes when compared with patients with isolated septic arthritis. LEVEL OF EVIDENCE Level III-retrospective research study.
Collapse
|
24
|
Young NM, Hoff SR, Ryan M. Impact of Cochlear Implant With Diametric Magnet on Imaging Access, Safety, and Clinical Care. Laryngoscope 2020; 131:E952-E956. [PMID: 32569426 PMCID: PMC7891447 DOI: 10.1002/lary.28854] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 05/14/2020] [Accepted: 05/26/2020] [Indexed: 11/24/2022]
Abstract
Objectives/Hypothesis Review safety and effectiveness of magnetic resonance imaging (MRI) of patients implanted with a cochlear implant (CI) containing a diametric magnet housed within the undersurface of the device. Study Design Retrospective chart review with additional review of MRI at a tertiary‐care children's hospital. Methods Seven patients with mean age of 8.4 years (range = 1.3–19 years) with a diametric magnet in situ during MRI. The intervention comprised one or more sessions of 1.5 T or 3.0 T MRI without a head wrap. The main outcome measures were the occurrence of magnet‐related complications including discomfort and magnet displacement, use of anesthesia or sedation, and clinical usefulness of MRI studies. Results Seven CI recipients underwent 17 episodes of 1.5 or 3.0 T MRI with an in situ diametric magnet. Thirteen of 17 (76%) MRI sessions were completed in awake patients. No patients had device‐related discomfort. No magnet‐related complications occurred. Thirteen of 14 (93%) brain studies were clinically useful despite artifacts. Conclusions The diametric magnet enabled MRI with magnet in situ without the discomfort or magnet displacement associated with removable axial magnets. The reduction in MRI magnet‐related complications occurred because torque is not directed perpendicular and outward from the plane of the magnet, and the magnet is securely contained within its housing. The design of this device increased access and reduced the need for sedation or anesthesia. Level of Evidence 4 Laryngoscope, 131:E952–E956, 2021
Collapse
Affiliation(s)
- Nancy M Young
- Division of Otolaryngology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A.,Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A.,Knowles Hearing Center, Department of Communication, Northwestern University, Evanston, Illinois, U.S.A
| | - Stephen R Hoff
- Division of Otolaryngology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A.,Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Maura Ryan
- Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A.,Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| |
Collapse
|
25
|
Ramgopal S, Karim SA, Subramanian S, Furtado AD, Marin JR. Rapid brain MRI protocols reduce head computerized tomography use in the pediatric emergency department. BMC Pediatr 2020; 20:14. [PMID: 31931764 PMCID: PMC6956479 DOI: 10.1186/s12887-020-1919-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 01/08/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rapid magnetic resonance imaging (MRI) protocols may be effective in the emergency department (ED) to evaluate nontraumatic neurologic complaints. We evaluate neuroimaging (rapid MRI [rMRI]), head computerized tomography [HCT], and full MRI) use following widespread implementation of rMRI protocols in a pediatric emergency department (ED). METHODS We conducted a retrospective study in a tertiary care pediatric ED of encounters with neuroimaging during two 9-month periods: one prior to (control period) and one after generalized availability of 4 rMRI protocols (rMRI period). The primary outcome was differences in neuroimaging rates between the two periods. Secondary outcomes included ED process measures, unsuccessful imaging, and undetected pathology, with full MRI within 14 days as the reference standard. RESULTS There were 1052 encounters with neuroimaging during the control and 1308 during the rMRI periods. Differences in neuroimaging between periods were 27.7% for rMRI (95% CI, 24.4, 31.0), - 21.5% for HCT (95% CI, - 25.5, - 17.5), and - 6.2% for full MRI (95% CI, - 9.3, - 3.1%.) Time to imaging (182 [IQR 138-255] versus 86 [IQR 52-137] minutes) as well as ED length of stay (396 [IQR 304-484] versus 257 [IQR 196-334] minutes) was longer for rMRI versus HCT (p < 0.01). Between the control and rMRI periods, there were differences in types of neuroimaging performed for patients with altered mental status, headache, seizure, shunt dysfunction, stroke, syncope, trauma, vomiting, infection, and other neurologic complaints (p < 0.05). rMRI studies were unsuccessful in 3.6% of studies versus 0.0% of HCTs (p < 0.01). The 22 unsuccessful rMRI studies were unsuccessful due to artifacts from dental hardware (n = 2) and patient motion (n = 20). None of the rMRI studies with full MRI follow-up imaging had undetected pathology; the false negative rate for the HCT exams was as high as 25%. CONCLUSIONS After routine ED use of 4 rMRI protocols, there was a more than 20% decrease in HCT use without missed diagnoses. Time to neuroimaging and length of stay were longer for rMRI than HCT, with higher rates of unsuccessful imaging. Despite these limitations, rMRI may be an alternative to HCT for nontraumatic complaints in the ED.
Collapse
Affiliation(s)
- Sriram Ramgopal
- Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, 225 E Chicago Ave, Box 62, Chicago, IL, 60611, USA.
| | - Sabrina A Karim
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Subramanian Subramanian
- Division of Pediatric Radiology, Children's Hospital of Pittsburgh, Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Andre D Furtado
- Division of Pediatric Radiology, Children's Hospital of Pittsburgh, Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jennifer R Marin
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| |
Collapse
|
26
|
Absolute neutrophil count as a diagnostic guide for the use of MRI in the workup of suspected appendicitis in children. J Pediatr Surg 2019; 54:1359-1364. [PMID: 30001891 DOI: 10.1016/j.jpedsurg.2018.06.021] [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: 04/03/2018] [Revised: 05/24/2018] [Accepted: 06/13/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND/PURPOSE To assess the additive value of magnetic resonance imaging (MRI) in the setting of an equivocal US (Eq-US) with or without an elevated absolute neutrophil count (ANC). METHODS Single-institution, retrospective review of children ages 5-18 years who presented to the ER with suspected appendicitis from 9/2015 to 8/2016. US, ANC, and MRI results were reviewed. Imaging was identified as positive/suspicious, normal, or equivocal and ANC <8000/mm3 was defined as normal. RESULTS 738 patients with a median age of 11 years (IQR 8-14) met inclusion criteria. US was equivocal in 61.4%. Among 304 (67.1%) patients with an Eq-US and normal ANC, only 5 (1.6%) had acute appendicitis. In contrast, 28 of 149 patients (18.8%) with Eq-US and elevated ANC had appendicitis. MRI was performed in 125 patients with Eq-US and was positive/suspicious in 2.9% (2/69) with normal ANC and 25.0% (14/56) with elevated ANC. MRI had 94.7% sensitivity and 100% specificity for acute appendicitis in patients with an Eq-US. CONCLUSIONS MRI has high sensitivity and specificity for diagnosing acute appendicitis in children. Patients with Eq-US plus a normal ANC have a very low likelihood of appendicitis and do not typically require further imaging. MRI may have utility for children with Eq-US and elevated ANC. LEVEL OF EVIDENCE Level III.
Collapse
|
27
|
Ayyala RS, Ahmed FS, Ruzal-Shapiro C, Taylor GA. Stressors contributing to burnout amongst pediatric radiologists: results from a survey of the Society for Pediatric Radiology. Pediatr Radiol 2019; 49:714-722. [PMID: 31069472 DOI: 10.1007/s00247-019-04370-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 02/04/2019] [Accepted: 02/21/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND A recent study showed a high prevalence of burnout in pediatric radiology. OBJECTIVE The purpose of this study is to evaluate potential stressors contributing to burnout in pediatric radiology. MATERIALS AND METHODS Society for Pediatric Radiology members received an invitation for an anonymous survey evaluating stressors contributing to burnout. Stressors evaluated included call burden, financial stress, work-life balance, health care evolution and job market changes, and radiology as a career choice. Additional questions regarding demographics were obtained. RESULTS The response rate was 460/1,453 (32%). The prevalence of emotional exhaustion was 66% (286/435), depersonalization was 61% (265/433) and perceived lack of personal accomplishment was 15% (67/436). In a backward selective logistic regression model, work-life imbalance and call burden were the only significant factors predicting higher emotional exhaustion (P<0.001). Using a similar model, work-life imbalance, call burden and decreased rate of reimbursement were significantly associated with higher probability of depersonalization (P=0.033, 0.0002 and 0.015, respectively). Emotional exhaustion and depersonalization were significantly associated with higher odds of a radiologist's wish to work in another medical specialty (P=0.011 and 0.002, respectively). CONCLUSION Key stressors contributing to burnout in pediatric radiology include work-life imbalance, pediatric call burden and a decreased rate of reimbursement. Burnout in pediatric radiology is a serious issue that needs to be addressed and prioritized on the individual and departmental/institutional levels and further investigated to develop effective interventions to mitigate it.
Collapse
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.
| | - Firas S Ahmed
- Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | - Carrie Ruzal-Shapiro
- Department of Radiology, Columbia University Medical Center, Morgan Stanley Children's Hospital, New York, NY, USA
| | - George A Taylor
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
28
|
Blumfield E, Swenson DW, Iyer RS, Stanescu AL. Gadolinium-based contrast agents - review of recent literature on magnetic resonance imaging signal intensity changes and tissue deposits, with emphasis on pediatric patients. Pediatr Radiol 2019; 49:448-457. [PMID: 30923876 DOI: 10.1007/s00247-018-4304-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/01/2018] [Accepted: 10/31/2018] [Indexed: 12/29/2022]
Abstract
Gadolinium has been used as a base for contrast agents in MRI for the last three decades. Numerous studies over the last 4 years have reported increased signal intensity in deep brain nuclei in non-contrast MRI images following gadolinium-based contrast agent (GBCA) administration. Pathology studies performed on adults and children, and rodent necropsy studies have also shown gadolinium deposition in brain and other tissues after GBCA administration. The purpose of this review was to summarize and discuss the knowledge gained from these reports and the relevance for imaging pediatric patients.
Collapse
Affiliation(s)
- Einat Blumfield
- Department of Radiology, Children's Hospital of Montefiore, Albert Einstein College of Medicine, 111E 210th St, Bronx, NY, 10461, USA.
| | - David W Swenson
- Department of Diagnostic Imaging, Alpert Medical School of Brown University, Rhode Island Hospital/Hasbro Children's Hospital, Providence, RI, USA
| | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - A Luana Stanescu
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| |
Collapse
|
29
|
Sarma A, Poussaint TY. Indications and Imaging Modality of Choice in Pediatric Headache. Neuroimaging Clin N Am 2019; 29:271-289. [PMID: 30926117 DOI: 10.1016/j.nic.2019.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pediatric headache is a common problem, with various underlying causes. Appropriate patient selection for neuroimaging is necessary to optimize the clinical evaluation. This review aims to provide a focused discussion of the clinical evaluation of children with headache, including published guidelines pertaining to neuroimaging, technical considerations for neuroimaging, and tailoring of examinations for specific clinical entities known to cause pediatric headache.
Collapse
Affiliation(s)
- Asha Sarma
- Department of Radiology, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital, 2200 Children's Way, Suite 1421, Nashville, TN 37232-9700, USA.
| | - Tina Young Poussaint
- Department of Radiology, Harvard Medical School, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02130, USA
| |
Collapse
|
30
|
Tsze DS, Ochs JB, Gonzalez AE, Dayan PS. Red flag findings in children with headaches: Prevalence and association with emergency department neuroimaging. Cephalalgia 2019; 39:185-196. [PMID: 29874930 PMCID: PMC10693908 DOI: 10.1177/0333102418781814] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
BACKGROUND Clinicians appear to obtain emergent neuroimaging for children with headaches based on the presence of red flag findings. However, little data exists regarding the prevalence of these findings in emergency department populations, and whether the identification of red flag findings is associated with potentially unnecessary emergency department neuroimaging. OBJECTIVES We aimed to determine the prevalence of red flag findings and their association with neuroimaging in otherwise healthy children presenting with headaches to the emergency department. Our secondary aim was to determine the prevalence of emergent intracranial abnormalities in this population. METHODS A prospective cohort study of otherwise healthy children 2-17 years of age presenting to an urban pediatric emergency department with non-traumatic headaches was undertaken. Emergency department physicians completed a standardized form to document headache descriptors and characteristics, associated symptoms, and physical and neurological exam findings. Children who did not receive emergency department neuroimaging received 4-month telephone follow-up. Outcomes included emergency department neuroimaging and the presence of emergent intracranial abnormalities. RESULTS We enrolled 224 patients; 197 (87.9%) had at least one red flag finding on history. Several red flag findings were reported by more than a third of children, including: Headache waking from sleep (34.8%); headache present with or soon after waking (39.7%); or headaches increasing in frequency, duration and severity (40%, 33.1%, and 46.3%). Thirty-three percent of children received emergency department neuroimaging. The prevalence of emergent intracranial abnormalities was 1% (95% CI 0.1, 3.6). Abnormal neurological exam, extreme pain intensity of presenting headache, vomiting, and positional symptoms were independently associated with emergency department neuroimaging. CONCLUSIONS Red flag findings are common in children presenting with headaches to the emergency department. The presence of red flag findings is associated with emergency department neuroimaging, although the risk of emergent intracranial abnormalities is low. Many children with headaches may be receiving unnecessary neuroimaging due to the high prevalence of non-specific red flag findings.
Collapse
Affiliation(s)
- Daniel S Tsze
- Division of Pediatric Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Julie B Ochs
- Division of Pediatric Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Ariana E Gonzalez
- Division of Pediatric Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Peter S Dayan
- Division of Pediatric Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| |
Collapse
|
31
|
Sum MY, Low K, Tang PH. General anesthesia / sedation requirement influences the way MRI brain scans are ordered in a tertiary pediatric hospital. J Magn Reson Imaging 2018; 49:e250-e255. [PMID: 30390374 DOI: 10.1002/jmri.26551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/06/2018] [Accepted: 10/09/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND MRI guidelines have been created to help clinicians order scans appropriately. Some scans in children are carried out under general anesthesia (GA) / sedation. PURPOSE To evaluate if the requirement for GA/sedation influences the way MRI brain scans are ordered. STUDY TYPE Retrospective. POPULATION Children with MRI brain scans in 2015 to 2017. FIELD STRENGTH 3T, 1.5T. ASSESSMENT Institutional Review Board approval for waiver of consent was obtained. Clinical MRI brain reports for children were classified into whether they conformed to the American College of Radiology (ACR) 2013 guidelines by research assistants under supervision of a pediatric radiologist. Scans were sorted into those with normal brains or abnormality. STATISTICAL TEST The statistical difference between groups was assessed using t-test for continuous variables and chi-square test for categorical variables with IBM SPSS 19. RESULTS Of the total 1893 MRI scans, 431 were performed under GA and six under sedation. Of the 431 cases performed under GA/sedation, 383 (87.6%) were ordered according to guidelines. Of the 1456 cases that did not require GA/sedation, 710 (48.8%) conformed to guidelines. The percentage of scans ordered according to guidelines was 38.8% higher in those who had scans performed under GA/sedation (P < 0.001). MRI scans were normal in 635 (58.0%) out of the 1093 cases ordered according to guidelines and normal in 638 (79.8%) out of the 800 cases that did not follow guidelines. Scans not ordered according to guidelines had higher proportion of normal scans (21.8%) compared with those ordered according to guidelines (P < 0.001). DATA CONCLUSION Higher adherence to imaging guidelines is seen in younger patients who were exposed to the risks of GA/sedation for the MRI. Scans not adhering to guidelines had a higher percentage of having no brain abnormality detected. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 6 J. Magn. Reson. Imaging 2019;49:e250-e255.
Collapse
Affiliation(s)
- Min Yi Sum
- Department of Diagnostic & Interventional Imaging, KK Women's and Children's Hospital, Singapore
| | - Kathy Low
- Department of Diagnostic & Interventional Imaging, KK Women's and Children's Hospital, Singapore
| | - Phua Hwee Tang
- Department of Diagnostic & Interventional Imaging, KK Women's and Children's Hospital, Singapore
| |
Collapse
|
32
|
The Critical Need for Pediatric and Juvenile Animal Research Addressing Gadolinium Retention in the Developing Body. Invest Radiol 2018; 54:72-75. [PMID: 30273280 DOI: 10.1097/rli.0000000000000516] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
33
|
Emergency Department Use of Neuroimaging in Children and Adolescents Presenting with Headache. J Pediatr 2018; 201:196-201. [PMID: 29908647 DOI: 10.1016/j.jpeds.2018.05.023] [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: 01/31/2018] [Revised: 04/19/2018] [Accepted: 05/15/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To evaluate emergency department use and outcomes of neuroimaging for headache in a free-standing children's hospital system. STUDY DESIGN We prospectively enrolled children aged 6-18 years who presented to the emergency department with a chief complaint of headache from September 2015 to September 2016. Standardized data collection was performed in real time, including telephone follow-up as needed, and imaging outcome was determined through a chart review. Using multivariable logistic regression, we estimated the associations between clinically important patient characteristics and neuroimaging. RESULTS Of 294 enrolled patients, 53 (18%) underwent neuroimaging (computed tomography or magnetic resonance imaging) and 2 (0.7%) had clinically important intracranial findings. Presenting with abnormal neurologic examination findings (OR, 11.55; 95% CI, 3.24-41.22), no history of similar headaches (OR, 2.13; 95% CI, 1.08-4.18), and white race (OR, 3.04; 95% CI, 1.51-6.12) were significantly associated with an increased odds of undergoing imaging in multivariable regression models. CONCLUSIONS Our observed emergency department imaging rate was 26.5 times higher than our positive result rate, suggesting there is room to decrease unnecessary neuroimaging. Associations for abnormal examination and new headache type are consistent with the American Academy of Neurology clinical imaging recommendations. The increased odds of imaging white patients suggests bias that should be addressed. The low rate of positive findings supports the need for an evidence-based clinical decision tool for neuroimaging in the acute care setting.
Collapse
|
34
|
Ohana O, Soffer S, Zimlichman E, Klang E. Overuse of CT and MRI in paediatric emergency departments. Br J Radiol 2018; 91:20170434. [PMID: 29271231 DOI: 10.1259/bjr.20170434] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The aim of this review is to survey CT and MRI overuse in the paediatric emergency department (ED) population. CT is one of the most important modalities employed in the ED. Not surprisingly, its high accuracy, rapid acquisition and availability have resulted in overuse. An obvious limitation of CT is ionizing radiation; in addition there are economic implications to overuse. Studies from the last two decades have shown increase in paediatric ED CT utilization in the first decade, reaching a plateau forming around 2008, followed by a decrease in the last decade. This decrease occurred in conjunction with campaigns raising awareness to the risks of radiation exposure. Although a trend of decrease in overuse have been observed, great variability has been shown across different facilities, as well as among physicians, with more pronounced overuse in non-teaching and non-children dedicated EDs. The leading types of paediatric ED CTs are head and abdominal scans. Decision rules, such as PECARN for head injury and the Alvarado score for abdominal pain, as well as using alternative imaging modalities, have been shown to reduce CT overuse in these two categories. MRI has the obvious benefit of avoiding radiation exposure, but the disadvantages of higher costs, less availability and less tolerability in younger children. Although anecdotally paediatric ED MRI usage has increased in recent years, only scarce reports have been published. In our opinion, there is need to conduct up-to-date studies covering paediatric CT and MRI overuse trends, usage variability and adherence to clinical protocols.
Collapse
Affiliation(s)
- Orly Ohana
- 1 Tel Aviv University, Sackler Faculty of Medicine , Tel Aviv , Israel
| | - Shelly Soffer
- 1 Tel Aviv University, Sackler Faculty of Medicine , Tel Aviv , Israel
| | - Eyal Zimlichman
- 1 Tel Aviv University, Sackler Faculty of Medicine , Tel Aviv , Israel.,2 The Chaim Sheba Medical Center, Tel Hashomer, Hospital Management , Ramat Gan , Israel
| | - Eyal Klang
- 1 Tel Aviv University, Sackler Faculty of Medicine , Tel Aviv , Israel.,3 Department of radiology, The Chaim Sheba Medical Center, Tel Hashomer , Ramat Gan , Israel
| |
Collapse
|
35
|
Pediatric Emergency MRI: What You Need to Know to Make It Through the Night. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0248-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
36
|
Case based simulation in MRI for suspected appendicitis in children. Clin Imaging 2017; 48:12-16. [PMID: 28963916 DOI: 10.1016/j.clinimag.2017.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 09/09/2017] [Accepted: 09/19/2017] [Indexed: 12/29/2022]
Abstract
PURPOSE To establish the effect on diagnostic confidence of a simulation setting, in which radiologists re-interpret anonymized pediatric MRI cases. MATERIALS In this IRB-approved study, participants completed surveys rating confidence before and after interpreting 10 MRI cases for suspected appendicitis in children. RESULTS 18 radiologists (4 faculty, 5 fellows, and 9 residents) correctly identified an average of 7.44 cases (range 5-9). Self-described confidence regarding technique and interpretation increased from 2.0 (SD 0.77) and 2.33 (SD 0.69) to 2.83 (SD 0.71) and 2.94 (SD 0.73), respectively. CONCLUSION Simulated interpretation of pediatric MRI in suspected appendicitis results in increased self-describe confidence without requiring additional capital/equipment expenses.
Collapse
|
37
|
Pelvic pain in the middle of the night: use of MRI for evaluation of pediatric female pathology in the emergent setting. Emerg Radiol 2017; 24:681-688. [PMID: 28547317 DOI: 10.1007/s10140-017-1520-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 05/18/2017] [Indexed: 01/27/2023]
Abstract
Acute pelvic pain in pediatric female patients is a common cause of emergency room visits. Imaging plays a crucial role in the clinical evaluation of these patients. Pelvic pain in female children can result from various pathologies. Ultrasound is the preferred first line imaging study; however, magnetic resonance imaging (MRI) is a helpful adjunct after hours, as it is available 24/7 in many institutions. Advantages of MRI include superior delineation of anatomy and higher tissue contrast resolution, particularly of the small pelvic structures. Given the lack of ionizing radiation, there is increasing use of MRI in children and adolescents, specifically in an emergent setting. In this pictorial review, we discuss pelvic MRI techniques and illustrate imaging findings of common etiologies of pelvic pain, emphasizing the advantages of MRI as an adjunct imaging modality.
Collapse
|