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Steinborn M, Huf V. Chronic non-bacterial osteomyelitis (CNO) in childhood and adolescence - a disease with many faces. ROFO-FORTSCHR RONTG 2024; 196:243-252. [PMID: 37699432 DOI: 10.1055/a-2143-7564] [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] [Indexed: 09/14/2023]
Abstract
BACKGROUND Chronic non-bacterial osteomyelitis (CNO) is a chronic inflammatory skeletal disease that affects particularly children and adolescents and is often diagnosed with a delay. With whole-body MRI, early diagnosis of this disease is possible in many cases. Since children and adolescents frequently present with non-specific complaints for outpatient radiological diagnosis, every radiologist should have basic knowledge of this complex clinical picture. MATERIALS In this review the basics and current findings regarding the disease are discussed. Unusual courses are also presented. RESULTS AND CONCLUSION With knowledge of the radiographic and MR tomographic characteristics of the mostly multifocal bone lesions, the diagnosis of CNO can be reliably made in many cases. In particular, the early use of whole-body MRI plays an important role. Thus, therapeutic delays and resulting complications and the number of unnecessary biopsies for diagnosis can be reduced.
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Affiliation(s)
- Marc Steinborn
- Institut für Diagnostische und Interventionelle Radiologie und Kinderradiologie, Klinikum Schwabing, München Klinik gGmbH, München, Germany
| | - Veronika Huf
- Institut für Diagnostische und Interventionelle Radiologie und Kinderradiologie, Klinikum Schwabing, München Klinik gGmbH, München, Germany
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2
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Scruggs M, Pateva I. Multifocal osteomyelitis in a child with sickle cell disease and review of the literature regarding best diagnostic approach. Clin Case Rep 2023; 11:e7288. [PMID: 37405047 PMCID: PMC10315443 DOI: 10.1002/ccr3.7288] [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: 10/26/2022] [Revised: 03/16/2023] [Accepted: 04/15/2023] [Indexed: 07/06/2023] Open
Abstract
Key Clinical Message In patients with sickle cell disease, we must be more cognizant of the possibility of multifocal osteomyelitis. Diagnosis can be challenging in this patient population as the symptoms mimic vaso-occlusive crisis. There is no gold standard in imaging. Abstract Osteomyelitis occurs more frequently in children with sickle cell disease. Diagnosis is challenging as it mimics vaso-occlusive crises, a common manifestation of sickle cell disease. We present a case of a 22-month-old girl with sickle cell disease and multifocal osteomyelitis. We review the literature on the utility of diagnostic imaging.
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Affiliation(s)
- Megan Scruggs
- Department of PediatricsRainbow Babies and Children's HospitalClevelandOhioUSA
| | - Irina Pateva
- Division of Hematology and Oncology, Department of PediatricsRainbow Babies and Children's HospitalClevelandOhioUSA
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Frush DP, Callahan MJ, Coley BD, Nadel HR, Guillerman RP. Comparison of the different imaging modalities used to image pediatric oncology patients: A COG diagnostic imaging committee/SPR oncology committee white paper. Pediatr Blood Cancer 2023; 70 Suppl 4:e30298. [PMID: 37025033 PMCID: PMC10652359 DOI: 10.1002/pbc.30298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 04/08/2023]
Abstract
Diagnostic imaging is essential in the diagnosis and management, including surveillance, of known or suspected cancer in children. The independent and combined roles of the various modalities, consisting of radiography, fluoroscopy, ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), and nuclear medicine (NM), are both prescribed through protocols but also function in caring for complications that may occur during or subsequent to treatment such as infection, bleeding, or organ compromise. Use of a specific imaging modality may be based on situational circumstances such as a brain CT or MR for a new onset seizure, chest CT for respiratory signs or symptoms, or US for gross hematuria. However, in many situations, there are competing choices that do not easily lend themselves to a formulaic approach as options; these situations depend on the contributions of a variety of factors based on a combination of the clinical scenario and the strengths and limitations of the imaging modalities. Therefore, an improved understanding of the potential influence of the imaging decision pathways in pediatric cancer care can come from comparison among the individual diagnostic imaging modalities. The purpose of the following material to is to provide such a comparison. To do this, pediatric imaging content experts for the individual modalities of radiography and fluoroscopy, US, CT, MRI, and NM will discuss the individual modality strengths and limitations.
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Affiliation(s)
- Donald P. Frush
- Department of Radiology, Box 3808, Duke University Medical Center, Durham, NC 27710
| | - Michael J. Callahan
- Department of Radiology, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115
| | - Brian D. Coley
- Division of Radiology and Medical Imaging, 3333 Burnet Avenue MLC 15017., Children’s Hospital Medical Center, Cincinnati, OH 45229
| | - Helen R. Nadel
- Pediatric Radiology, Lucile Packard Children’s Hospital at Stanford, Stanford University School of Medicine, 725 Welch Rd, MC 5913, Palo Alto, CA 94304
| | - R. Paul Guillerman
- Department of Radiology, Texas Children’s Hospital, 6701 Fannin Street, Suite 470, Houston, TX 77030
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4
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Le Cam S, de Boissieu P, Teglas JP, Merzoug V, Mannes I, Adamsbaum C. Analysis of whole-body MRI artifacts in a pediatric population with a special emphasis on the effect of hands position. Diagn Interv Imaging 2023; 104:153-159. [PMID: 36274050 DOI: 10.1016/j.diii.2022.10.002] [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: 06/17/2022] [Revised: 09/28/2022] [Accepted: 10/04/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The purpose of this retrospective study was to determine the prevalence of artifacts on whole-body (WB) magnetic resonance imaging (MRI) examination in pediatric patients and identify their causes. MATERIALS AND METHODS A total of 107 pediatric patients who underwent a total of 107 WB-MRI examinations, including short-tau inversion recovery (STIR) and T1-weighted sequences, were included. There were 62 girls and 45 boys with a mean age of 11 ± 3 (SD) years (age range: 2-16 years). WB-MRI examinations were analyzed for the presence of artifacts on STIR and T1-weighted sequences. Artifacts were further assigned to one of eight categories (motion, partial volume, cross-talk, phase sampling, susceptibility, equipment, noise, and "other") and 19 anatomical sites by a 4-year resident. Prevalence of artifacts were analyzed especially according to hands position during the examination for the upper limbs and patients' age. Age was expressed as a binary variable using median age (10 years) as the cut-off value. All qualitative variables were compared using chi-square test. RESULTS A total of 3436 artifacts were found. The STIR sequences showed more "noise" artifacts (93/1038; 8.96%) and more "cross-talk" (102/1038; 9.83%) artifacts than T1-weighted sequences (12/1038 [1.16%] and 7/1038 [0.67%], respectively) (P < 0.001 for both). T1-weighted sequences showed more "equipment" (84/1038; 8.09%) and "stair-step" (a subset of "other") (41/1038; 3.95%) artifacts than the STIR sequences (39/1038 [3.76%] and 21/1038 [2.02%], respectively) (P < 0.001 and P = 0.01, respectively). T1-weighted sequences showed fewer artifacts on the wrists when the hands were under the bottom (P = 0.001). T1-weighted sequences showed less "equipment" artifacts when the hands were alongside the body (22/296; 7%) than on the abdomen (48/432; 11%) or under the bottom (14/128; 11%) (P < 0.001). STIR sequences showed more "motion" artifacts when the hands were on the abdomen (54/432; 13%) than alongside the body (30/296; 10%) or under the bottom (15/128; 12%) (P < 0.001). WB-MRI examinations had more "susceptibility" artifacts (38/960; 4%) and more "equipment" artifacts (81/960; 8.4%) in patients older than 10 years than in those under 10 years (23/752 [3.1%] and 42/752 [5.6%]) (P = 0.01 and P < 0.001, respectively). CONCLUSION Artifacts on WB-MRI do not affect coronal STIR and T1-weighted sequences equally, so the use of both sequence types appears useful. Hands position should be considered with respect to both diagnostic benefit and safety.
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Affiliation(s)
- Solène Le Cam
- Faculty of Medicine, Paris Saclay Université, 94270 Le Kremlin, Bicêtre, France; AP-HP, Bicêtre Hospital, Pediatric Imaging Department, 94270 Le Kremlin, Bicêtre, France
| | - Paul de Boissieu
- AP-HP, Bicêtre Hospital, Epidemiology and Public Health Department, 94270 Le Kremlin, Bicêtre, France
| | | | - Valérie Merzoug
- AP-HP, Bicêtre Hospital, Pediatric Imaging Department, 94270 Le Kremlin, Bicêtre, France
| | - Inès Mannes
- AP-HP, Bicêtre Hospital, Pediatric Imaging Department, 94270 Le Kremlin, Bicêtre, France
| | - Catherine Adamsbaum
- Faculty of Medicine, Paris Saclay Université, 94270 Le Kremlin, Bicêtre, France; AP-HP, Bicêtre Hospital, Pediatric Imaging Department, 94270 Le Kremlin, Bicêtre, France
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Improving protocols for whole-body magnetic resonance imaging: oncological and inflammatory applications. Pediatr Radiol 2022:10.1007/s00247-022-05478-5. [PMID: 35982340 DOI: 10.1007/s00247-022-05478-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/16/2022] [Accepted: 07/29/2022] [Indexed: 10/15/2022]
Abstract
Whole-body MRI is increasingly used in the evaluation of a range of oncological and non-oncological diseases in infants, children and adolescents. Technical innovation in MRI scanners, coils and sequences have enabled whole-body MRI to be performed more rapidly, offering large field-of-view imaging suitable for multifocal and multisystem disease processes in a clinically useful timeframe. Together with a lack of ionizing radiation, this makes whole-body MRI especially attractive in the pediatric population. Indications include lesion detection in cancer predisposition syndrome surveillance and in the workup of children with known malignancies, and diagnosis and monitoring of a host of infectious and non-infectious inflammatory conditions. Choosing which patients are most likely to benefit from this technology is crucial, but so is adjusting protocols to the patient and disease to optimize lesion detection. The focus of this review is on protocols and the elements impacting image acquisition in pediatric whole-body MRI. We consider the practical aspects, from scanner and coil selection to patient positioning, single-center generic and indication-specific protocols with technical parameters, motion reduction strategies and post-processing. When optimized, collectively these lead to better standardization of whole-body MRI, and when married to systematic analysis and interpretation, they can improve diagnostic accuracy.
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Al-Sarhani H, Gottumukkala RV, Grasparil ADS, Tung EL, Gee MS, Greer MLC. Screening of cancer predisposition syndromes. Pediatr Radiol 2022; 52:401-417. [PMID: 33791839 DOI: 10.1007/s00247-021-05023-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/14/2021] [Accepted: 02/17/2021] [Indexed: 12/19/2022]
Abstract
Pediatric patients with cancer predisposition syndromes are at increased risk of developing malignancies compared with their age-matched peers, necessitating regular surveillance. Screening protocols differ among syndromes and are composed of a number of elements, imaging being one. Surveillance can be initiated in infants, children and adolescents with a tumor known or suspected of being related to a cancer predisposition syndrome or where genetic testing identifies a germline pathogenic gene variant in an asymptomatic child. Pre-symptomatic detection of malignant neoplasms offers potential to improve treatment options and survival outcomes, but the benefits and risks of screening need to be weighed, particularly with variable penetrance in many cancer predisposition syndromes. In this review we discuss the benefits and risks of surveillance imaging and the importance of integrating imaging and non-imaging screening elements. We explore the principles of surveillance imaging with particular reference to whole-body MRI, considering the strategies to minimize false-negative and manage false-positive whole-body MRI results, the value of standardized nomenclature when reporting risk stratification to better guide patient management, and the need for timely communication of results to allay anxiety. Cancer predisposition syndrome screening is a multimodality, multidisciplinary and longitudinal process, so developing formalized frameworks for surveillance imaging programs should enhance diagnostic performance while improving the patient experience.
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Affiliation(s)
- Haifa Al-Sarhani
- Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.,Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Ravi V Gottumukkala
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Angelo Don S Grasparil
- Department of Radiological Sciences, Cardinal Santos Medical Center, San Juan City, Philippines
| | - Eric L Tung
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael S Gee
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mary-Louise C Greer
- Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada. .,Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
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Daldrup-Link HE, Theruvath AJ, Baratto L, Hawk KE. One-stop local and whole-body staging of children with cancer. Pediatr Radiol 2022; 52:391-400. [PMID: 33929564 PMCID: PMC10874282 DOI: 10.1007/s00247-021-05076-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/04/2021] [Accepted: 03/30/2021] [Indexed: 12/19/2022]
Abstract
Accurate staging and re-staging of cancer in children is crucial for patient management. Currently, children with a newly diagnosed cancer must undergo a series of imaging tests, which are stressful, time-consuming, partially redundant, expensive, and can require repetitive anesthesia. New approaches for pediatric cancer staging can evaluate the primary tumor and metastases in a single session. However, traditional one-stop imaging tests, such as CT and positron emission tomography (PET)/CT, are associated with considerable radiation exposure. This is particularly concerning for children because they are more sensitive to ionizing radiation than adults and they live long enough to experience secondary cancers later in life. In this review article we discuss child-tailored imaging tests for tumor detection and therapy response assessment - tests that can be obtained with substantially reduced radiation exposure compared to traditional CT and PET/CT scans. This includes diffusion-weighted imaging (DWI)/MRI and integrated [F-18]2-fluoro-2-deoxyglucose (18F-FDG) PET/MRI scans. While several investigators have compared the value of DWI/MRI and 18F-FDG PET/MRI for staging pediatric cancer, the value of these novel imaging technologies for cancer therapy monitoring has received surprisingly little attention. In this article, we share our experiences and review existing literature on this subject.
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Affiliation(s)
- Heike E Daldrup-Link
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Lucile Packard Children's Hospital, Stanford University, 725 Welch Road, Room 1665, Stanford, CA, 94305-5614, USA.
- Department of Pediatrics, Stanford University, Stanford, CA, USA.
- Cancer Imaging and Early Detection Program, Stanford Cancer Institute, Stanford, CA, USA.
| | - Ashok J Theruvath
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Lucile Packard Children's Hospital, Stanford University, 725 Welch Road, Room 1665, Stanford, CA, 94305-5614, USA
- Cancer Imaging and Early Detection Program, Stanford Cancer Institute, Stanford, CA, USA
| | - Lucia Baratto
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Lucile Packard Children's Hospital, Stanford University, 725 Welch Road, Room 1665, Stanford, CA, 94305-5614, USA
- Cancer Imaging and Early Detection Program, Stanford Cancer Institute, Stanford, CA, USA
| | - Kristina Elizabeth Hawk
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Lucile Packard Children's Hospital, Stanford University, 725 Welch Road, Room 1665, Stanford, CA, 94305-5614, USA
- Cancer Imaging and Early Detection Program, Stanford Cancer Institute, Stanford, CA, USA
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8
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Radbruch A, Paech D, Gassenmaier S, Luetkens J, Isaak A, Herrmann J, Othman A, Schäfer J, Nikolaou K. 1.5 vs 3 Tesla Magnetic Resonance Imaging: A Review of Favorite Clinical Applications for Both Field Strengths-Part 2. Invest Radiol 2021; 56:692-704. [PMID: 34417406 DOI: 10.1097/rli.0000000000000818] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
ABSTRACT The second part of this review deals with experiences in neuroradiological and pediatric examinations using modern magnetic resonance imaging systems with 1.5 T and 3 T, with special attention paid to experiences in pediatric cardiac imaging. In addition, whole-body examinations, which are widely used for diagnostic purposes in systemic diseases, are compared with respect to the image quality obtained in different body parts at both field strengths. A systematic overview of the technical differences at 1.5 T and 3 T has been presented in part 1 of this review, as well as several organ-based magnetic resonance imaging applications including musculoskeletal imaging, abdominal imaging, and prostate diagnostics.
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Affiliation(s)
- Alexander Radbruch
- From the Clinic for Diagnostic and Interventional Neuroradiology, University Hospital Bonn, Bonn
| | - Daniel Paech
- From the Clinic for Diagnostic and Interventional Neuroradiology, University Hospital Bonn, Bonn
| | - Sebastian Gassenmaier
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Tübingen
| | - Julian Luetkens
- Clinic for Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn
| | - Alexander Isaak
- Clinic for Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn
| | - Judith Herrmann
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Tübingen
| | | | - Jürgen Schäfer
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Tübingen
| | - Konstantin Nikolaou
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Tübingen
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9
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Schaal MC, Gendler L, Ammann B, Eberhardt N, Janda A, Morbach H, Darge K, Girschick H, Beer M. Imaging in non-bacterial osteomyelitis in children and adolescents: diagnosis, differential diagnosis and follow-up-an educational review based on a literature survey and own clinical experiences. Insights Imaging 2021; 12:113. [PMID: 34370119 PMCID: PMC8353023 DOI: 10.1186/s13244-021-01059-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 07/13/2021] [Indexed: 11/21/2022] Open
Abstract
Background Chronic non-bacterial osteomyelitis (CNO) is an autoinflammatory bone disorder affecting children and adolescents. Previously classified as a rare disease, recent studies suggest a higher incidence of the disease. CNO may develop into the clinical presentation of chronic recurrent osteomyelitis (CRMO) with high relapse rate and multifocality. Main body Diagnosis of CNO/CRMO is often delayed, with implications for disease severity and relapse rate. This can be significantly improved by knowledge of the disease entity and its characteristics. Imaging plays a key role in diagnosis, differential diagnosis and therapy monitoring. Magnetic resonance imaging (MRI) has several advantages compared to other imaging methods and is increasingly applied in clinical studies. Recent studies show that a whole-body (WB) coverage (WB-MRI) without contrast agent administration is a rational approach. This educational review is based on a systematic analysis of international peer-reviewed articles and presents our own clinical experiences. It provides an overview of disease entity, incidence and clinical diagnosis. The role of imaging, especially of whole-body MRI, is discussed in detail. Finally, practical advice for imaging, including flowcharts explaining when and how to apply imaging, is provided. Conclusion Knowing the specifics of CNO/CRMO and the importance of MRI/whole-body MRI allows rapid and efficient diagnosis as well as therapy support and helps to avoid irreversible secondary damage.
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Affiliation(s)
- Matthias C Schaal
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Liya Gendler
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Bettina Ammann
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany.,Center for Radiology, Neu-Ulm I Günzburg, Neu-Ulm, Germany
| | - Nina Eberhardt
- Department of Nuclear Medicine, University Hospital Ulm, Ulm, Germany
| | - Aleš Janda
- Department of Pediatrics and Adolescent Medicine, University Hospital Ulm, Ulm, Germany
| | - Henner Morbach
- Department of Pediatrics, University Hospital Würzburg, Würzburg, Germany
| | - Kassa Darge
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Hermann Girschick
- Department of Pediatrics and Adolescent Medicine, Vivantes Klinikum Im Friedrichshain - Landsberger Allee, Berlin, Germany
| | - Meinrad Beer
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
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Glutig K, Mentzel HJ, Prüfer FH, Teichgräber U, Obmann MM, Krämer M. RAVE-T2/T1 - Feasibility of a new hybrid MR-sequence for free-breathing abdominal MRI in children and adolescents. Eur J Radiol 2021; 143:109903. [PMID: 34392003 DOI: 10.1016/j.ejrad.2021.109903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/22/2021] [Accepted: 08/04/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The new radial volumetric encoding RAVE-T2/T1 hybrid sequence is a modern three-dimensional sequence with multiparametric approach, which includes T2- and T1-weighted contrasts obtained in identical slice position during one measurement. However, the RAVE-T2/T1 hybrid sequence is not yet being used in clinical routine. PURPOSE The aim of this study was to evaluate the RAVE-T2/T1 hybrid sequence in a pediatric population with a clinical indication for an abdominal MRI examination to demonstrate that the hybrid imaging may be less challenging to perform on children. MATERIALS AND METHODS Our retrospective observational study included pediatric patients of all age groups and required for an abdominal MRI examination. Non-contrast standard axial T1 DIXON and non-contrast RAVE-T2/T1 hybrid sequence were obtained at 3 T. MRI studies were analyzed independently by two pediatric radiologists using a 5-point Likert-type scale in five different categories. T1- and T2-weighted sequences were each compared with the RAVE-T2/T1-sequence using a Wilcoxon signed-rank test. RESULTS The analysis included 15 children (mean age, 11 years and 4 months, 7 girls and 8 boys). The Cohens Kappa of interrater agreement measured 0.62. The T2 weighted part of the RAVE-T2/T1 sequence was significantly better than the standard T2 HASTE sequence in four of five image quality categories: overall image quality (2.2 ± 0.7 vs 1.8 ± 0,7, p = 0.03), respiratory motion artefacts (3.8 ± 0.4 vs 2.0 ± 0.7, p <= 0.01), portal vein clarity (3.3 ± 0.8 vs 2.2 ± 0.7, p <= 0.01), hepatic margin sharpness (2.4 ± 1,0 vs 1.8 ± 0.7, p <= 0.01). The T1 weighted part of the RAVE-T2/T1 sequence was significantly better than the standard T1 DIXON weighted sequence in three of five image quality categories: respiratory motion artefacts (4.0 ± 0.2 vs 3.6 ± 0.8, p = 0.01), portal vein clarity (2.7 ± 0.9 vs 2.1 ± 0.7, p <= 0.01), hepatic margin sharpness (3.2 ± 0.7 vs 2.6 ± 0.9, p <= 0.01). CONCLUSIONS The RAVE-T2/T1 hybrid sequence is feasible and equal compared to standard T1- and T2-weighted sequences in the assessment of abdominal organs in a pediatric population. Due to non-inferiority to the current standard sequences for abdominal imaging, the RAVE-T2/T1 hybrid sequence is a good alternative for children who cannot be examined in breath-hold technique.
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Affiliation(s)
- K Glutig
- Jena University Hospital - Friedrich Schiller University Jena, Institute of Diagnostic and Interventional Radiology, Section of Pediatric Radiology, Am Klinikum 1, 07747 Jena, Germany.
| | - H-J Mentzel
- Jena University Hospital - Friedrich Schiller University Jena, Institute of Diagnostic and Interventional Radiology, Section of Pediatric Radiology, Am Klinikum 1, 07747 Jena, Germany
| | - F H Prüfer
- University Children's Hospital UKBB, University of Basel, Paediatric Radiology, Spitalstrasse 33, 4031 Basel, Switzerland
| | - U Teichgräber
- Jena University Hospital - Friedrich Schiller University Jena, Institute of Diagnostic and Interventional Radiology, Section of Pediatric Radiology, Am Klinikum 1, 07747 Jena, Germany
| | - M M Obmann
- University Hospital Basel USB, University of Basel, Clinic of Radiology and Nuclear Medicine, Petersgraben 4, 4031 Basel, Switzerland
| | - M Krämer
- Jena University Hospital - Friedrich Schiller University Jena, Institute of Diagnostic and Interventional Radiology, Section of Pediatric Radiology, Am Klinikum 1, 07747 Jena, Germany
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Li N, Zheng H, Xu G, Gui T, Yin Q, Chen Q, Lee J, Xin Y, Zhang S, He Q, Zhang X, Liu X, Zheng H, Wang D, Li Y. Simultaneous Head and Spine MR Imaging in Children Using a Dedicated Multichannel Receiver System at 3T. IEEE Trans Biomed Eng 2021; 68:3659-3670. [PMID: 34014817 DOI: 10.1109/tbme.2021.3082149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The purpose of this work was to enable simultaneous head and spine Magnetic Resonance imaging (MRI) in children at 3T by using a dedicated multichannel radiofrequency coil array system. METHODS A 24-channel head and spine pediatric coil system was developed and constructed. The coils performance was compared with a commercially available 24-channel adult head-neck coil and a spine coil (1-4 spine of 16-channel were selected). Signal-to-noise ratio (SNR) and parallel imaging capability were quantitatively evaluated by phantom studies and in vivo imaging experiments. With Institutional Review Board and Ethics Committee approval, the designed coil was used to acquire head and spine images on 27 children in clinical settings. RESULTS The pediatric coil provided substantial SNR improvements with an increase of 32 % to 40 % in the brain region and up to a two-fold increase in the surface. SNR increased by at least 18 % in the spine region. The coil enabled higher resolution and a faster imaging speed, owing to significantly improved SNR. Extensive coverage of the coil enabled high-quality fast imaging from head-neck to the whole spine. Good image quality with an average score 4.63 out of 5 was achieved using the developed pediatric coil in clinical studies. CONCLUSION Simultaneous head and spine MRI with superior performance have been successfully acquired in children subjects at 3T using the dedicated 24-channel head and spine pediatric coil system. SIGNIFICANCE The 24-channel pediatric coil system potentially can enhance pediatric head and spine MRI in clinical research and diagnosis.
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12
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Ballard DH, Burton KR, Lakomkin N, Kim S, Rajiah P, Patel MJ, Mazaheri P, Whitman GJ. The Role of Imaging in Health Screening: Screening for Specific Conditions. Acad Radiol 2021; 28:548-563. [PMID: 32404272 PMCID: PMC7655640 DOI: 10.1016/j.acra.2020.03.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 12/11/2022]
Abstract
There are well-established and emerging screening examinations aimed at identifying malignant and nonmalignant conditions at early, treatable stages. The Radiology Research Alliance's "Role of Imaging in Health Screening" Task Force provides a comprehensive review of specific imaging-based screening examinations. This work reviews and serves as a reference for screening examinations for breast and colon cancer in a healthy population along with screening for lung cancer, hepatocellular carcinoma, and the use of whole body magnetic resonance imaging in at-risk individuals. American College of Radiology scoring systems, along with case-based examples, are included to illustrate the different disease entities. The future of screening is discussed, particularly in the context of artificial intelligence.
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Affiliation(s)
- David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd; Campus Box 8131, St. Louis, MO 63110.
| | - Kirsteen R Burton
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario
| | | | - Shannon Kim
- Department of Radiology, Eastern Virginia Medical School Norfolk, Virginia
| | | | | | - Parisa Mazaheri
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd; Campus Box 8131, St. Louis, MO 63110
| | - Gary J Whitman
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center; Houston, Texas
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13
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Giraudo C, Lecouvet FE, Cotten A, Eshed I, Jans L, Jurik AG, Maas M, Weber M, Sudoł-Szopińska I. Whole-body magnetic resonance imaging in inflammatory diseases: Where are we now? Results of an International Survey by the European Society of Musculoskeletal Radiology. Eur J Radiol 2021; 136:109533. [PMID: 33454461 DOI: 10.1016/j.ejrad.2021.109533] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 12/07/2020] [Accepted: 01/05/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE To investigate the current role of WB-MRI for rheumatic inflammatory diseases in clinical practice using a survey addressed to musculoskeletal radiologists. METHODS A survey composed of 61 questions, subdivided in three sections, demographics (five questions), application of WB-MRI for inflammatory musculoskeletal diseases in adults and children (28 questions: 7 open and 21 multiple choice for each subgroup) was distributed via the European Society of Musculoskeletal Radiology (ESSR) from July 2 to December 31, 2018 to radiologists working in academic, private, and public workplaces. Comparisons among the different workplaces were performed using the Chi-squared and the Kruskal-Wallis test for nominal and ordinal data, respectively (p < 0.05). RESULTS Seventy-two participants out of the 1779 (4%) members of the ESSR with 10.4 ± 7.9 years of experience in musculoskeletal imaging, replied to at least one question. 30.6% and 12.3% of the respondents performed at least 50 WB-MRI examinations per year in adults and children, respectively. The most frequent indications were myositis in adults and chronic recurrent multifocal osteomyelitis (CRMO) in children, the latter mostly in academic centers (p = 0.013). The ESSR Arthrits Subcommitte's protocol was applied by half of the participants and especially radiologists working in private practice used it for adults (p = 0.025). Contrast medium was rarely used for adults particularly by academics (p = 0.04). Diffusion Weighted Imaging was applied for children mostly in private practice (p = 0.01) although, overall, it plays a marginal role. Scoring systems were rarely used. Ongoing research is limited. CONCLUSION WB-MRI is not routinely applied for musculoskeletal inflammatory diseases. The most frequent indications are myositis and CRMO.
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Affiliation(s)
- Chiara Giraudo
- Radiology Institute, Department of Medicine - DIMED, University of Padova, Italy.
| | - Frederic E Lecouvet
- Department of Radiology and Medical Imaging, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCL), Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Anne Cotten
- Department of Musculoskeletal Radiology, Lille University Hospital, Lille, France
| | - Iris Eshed
- Department of Radiology, Sheba Medical Center, affiliated with the Tel Aviv University, Tel Aviv, Israel
| | - Lennart Jans
- Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium
| | - Anne Grethe Jurik
- Department of Radiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Mario Maas
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Michael Weber
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
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14
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Pediatric Molecular Imaging. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00075-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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15
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Zadig P, von Brandis E, Lein RK, Rosendahl K, Avenarius D, Ording Müller LS. Whole-body magnetic resonance imaging in children - how and why? A systematic review. Pediatr Radiol 2021; 51:14-24. [PMID: 32588094 PMCID: PMC7796873 DOI: 10.1007/s00247-020-04735-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 04/03/2020] [Accepted: 05/20/2020] [Indexed: 12/16/2022]
Abstract
Whole-body magnetic resonance imaging (MRI) is increasingly being used for a number of indications. Our aim was to review and describe indications and scan protocols for diagnostic value of whole-body MRI for multifocal disease in children and adolescents, we conducted a systematic search in Medline, Embase and Cochrane for all published papers until November 2018. Relevant subject headings and free text words were used for the following concepts: 1) whole-body, 2) magnetic resonance imaging and 3) child and/or adolescent. Included were papers in English with a relevant study design that reported on the use and/or findings from whole-body MRI examinations in children and adolescents. This review includes 54 of 1,609 papers identified from literature searches. Chronic nonbacterial osteomyelitis, lymphoma and metastasis were the most frequent indications for performing a whole-body MRI. The typical protocol included a coronal STIR (short tau inversion recovery) sequence with or without a coronal T1-weighted sequence. Numerous studies lacked sufficient data for calculating images resolution and only a few studies reported the acquired voxel volume, making it impossible for others to reproduce the protocol/images. Only a minority of the included papers assessed reliability tests and none of the studies documented whether the use of whole-body MRI affected mortality and/or morbidity. Our systematic review confirms significant variability of technique and the lack of proven validity of MRI findings. The information could potentially be used to boost attempts towards standardization of technique, reporting and guidelines development.
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Affiliation(s)
- Pia Zadig
- Department of Radiology, University Hospital of North Norway, Sykehusvegen 38, 9019, Tromsø, Norway.
- University of Tromsø - The Arctic University of Norway, Tromso, Norway.
| | | | | | - Karen Rosendahl
- Department of Radiology, University Hospital of North Norway, Sykehusvegen 38, 9019, Tromsø, Norway
- University of Tromsø - The Arctic University of Norway, Tromso, Norway
| | - Derk Avenarius
- Department of Radiology, University Hospital of North Norway, Sykehusvegen 38, 9019, Tromsø, Norway
- University of Tromsø - The Arctic University of Norway, Tromso, Norway
| | - Lil-Sofie Ording Müller
- Department of Radiology and Intervention, Unit for Paediatric Radiology, Oslo University Hospital, Oslo, Norway
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16
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Tunariu N, Blackledge M, Messiou C, Petralia G, Padhani A, Curcean S, Curcean A, Koh DM. What's New for Clinical Whole-body MRI (WB-MRI) in the 21st Century. Br J Radiol 2020; 93:20200562. [PMID: 32822545 PMCID: PMC8519652 DOI: 10.1259/bjr.20200562] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 12/12/2022] Open
Abstract
Whole-body MRI (WB-MRI) has evolved since its first introduction in the 1970s as an imaging technique to detect and survey disease across multiple sites and organ systems in the body. The development of diffusion-weighted MRI (DWI) has added a new dimension to the implementation of WB-MRI on modern scanners, offering excellent lesion-to-background contrast, while achieving acceptable spatial resolution to detect focal lesions 5 to 10 mm in size. MRI hardware and software advances have reduced acquisition times, with studies taking 40-50 min to complete.The rising awareness of medical radiation exposure coupled with the advantages of MRI has resulted in increased utilization of WB-MRI in oncology, paediatrics, rheumatological and musculoskeletal conditions and more recently in population screening. There is recognition that WB-MRI can be used to track disease evolution and monitor response heterogeneity in patients with cancer. There are also opportunities to combine WB-MRI with molecular imaging on PET-MRI systems to harness the strengths of hybrid imaging. The advent of artificial intelligence and machine learning will shorten image acquisition times and image analyses, making the technique more competitive against other imaging technologies.
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Affiliation(s)
| | - Matthew Blackledge
- Department of Radiotherapy, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, UK
| | - Christina Messiou
- Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton, London, UK
| | - Giuseppe Petralia
- Department of Radiology, European Institute of Oncology, Via Ripamonti, 435 - 20141 Milan, Italy
| | - Anwar Padhani
- Mount Vernon Hospital, The Paul Strickland Scanner Centre, Rickmansworth Road, Northwood, Middlesex, UK
| | - Sebastian Curcean
- Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton, London, UK
| | | | - Dow-Mu Koh
- Drug Development Unit, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, UK
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17
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Feldhaus JM, Garner HW, Wessell DE. Society of skeletal radiology member utilization and performance of whole-body MRI in adults. Skeletal Radiol 2020; 49:1731-1736. [PMID: 32444914 DOI: 10.1007/s00256-020-03471-3] [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] [Received: 03/26/2020] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate musculoskeletal (MSK) radiologist whole-body magnetic resonance imaging (WBMRI) practice patterns in an effort to better understand current MSK clinical utilization and the need for standardized coding. METHODS A 12-question survey was created in Survey Monkey®. The survey was e-mailed to Society of Skeletal Radiology (SSR) members on September 19, 2018. The survey included questions on SSR member demographics and on their experience with WBMRI. RESULTS One hundred sixty-four of 1454 (11%) SSR members responded to the survey. A minority (32%; n = 52/164) of respondents reported that their institutions routinely perform WBMRI. The most common indication was multiple myeloma (78%, n = 51/65). The most commonly utilized sequences were coronal short tau inversion recovery (STIR) (79%, n = 52/66) and coronal T1 without fat saturation (73%, n = 48/66). A large proportion of respondents (48%, n = 31/64) did not know the code used for billing WBMRI at their institutions. Of the remaining respondents, 23% (n = 15/64) reported use of the bone marrow MRI code, 16% (n = 10/64) the chest/abdomen/pelvis combination code, and 9% (n = 6/64) the unlisted MRI procedure code. CONCLUSION There is variation in who is responsible for the protocol and interpretation of WBMRI, as well as how the exam is performed and how the exam is coded, which raise barriers to broad implementation. Recent WBMRI guidelines for multiple myeloma and prostate cancer can mitigate many of these barriers, but they do not address the coding and reimbursement challenges. Collaborative multi-society development of a new CPT® code for WBMRI may be a worthwhile endeavor.
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Affiliation(s)
- Jacob M Feldhaus
- GLOBIS: Global Imaging Solutions, 503 Eisenhower Drive, Savannah, GA, 31406, USA
| | - Hillary W Garner
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
| | - Daniel E Wessell
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
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18
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Whole-Body MRI Surveillance of Cancer Predisposition Syndromes: Current Best Practice Guidelines for Use, Performance, and Interpretation. AJR Am J Roentgenol 2020; 215:1002-1011. [PMID: 32809862 DOI: 10.2214/ajr.19.22399] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE. Whole-body MRI is a valuable tool in the surveillance of cancer predisposition syndromes (CPSs). Because it allows wide-FOV imaging without ionizing radiation, whole-body MRI is ideal in pediatric patients, enabling efficient assessment of different organ systems for multifocal disease. This article summarizes the use of whole-body MRI in pediatric patients with CPSs for earlier detection of malignancy, provides evidence where available, and offers guidance where lacking because of the rarity of CPSs. Protocol modifications and technique performance in specific CPSs are also considered. CONCLUSION. Whole-body MRI is the preferred imaging modality for surveillance of pediatric patients with CPSs, and the growing literature supports its importance in presymptomatic cancer detection.
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19
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Jurik AG. Quantification of Disease Activity in Chronic Nonbacterial Osteomyelitis by Whole-body Magnetic Resonance Imaging. J Rheumatol 2020; 47:646-649. [PMID: 32358167 DOI: 10.3899/jrheum.191136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Anne Grethe Jurik
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark.
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20
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Imaging mimics of chronic recurrent multifocal osteomyelitis: avoiding pitfalls in a diagnosis of exclusion. Pediatr Radiol 2020; 50:124-136. [PMID: 31901992 DOI: 10.1007/s00247-019-04510-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/19/2019] [Accepted: 08/12/2019] [Indexed: 12/19/2022]
Abstract
Chronic recurrent multifocal osteomyelitis (CRMO) is a pediatric autoinflammatory disorder that is characterized by multiple sterile inflammatory bone lesions with a relapsing and remitting course. CRMO belongs to the autoinflammatory family of rheumatologic disorders based on absence of significant titers of autoantibodies and autoreactive T-lymphocytes. In absence of pathognomonic clinical, radiographic or pathological features, diagnosis can be challenging. CRMO shares imaging features with other diseases. It is important for radiologists to be able to differentiate other diseases from CRMO because prognosis varies from completely benign to frankly malignant. In this article we first present the clinical and imaging features of CRMO to help readers gain an understanding of the disease process, then discuss our imaging approach to CRMO and review other disease processes that sometimes share similar imaging findings to CRMO and review differentiating features to help avoid misdiagnoses.
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21
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Park C, Aljabban I, Fanburg-Smith JC, Grant C, Moore M. Pediatric whole body MRI detects causative ovarian teratoma in opsoclonus myoclonus syndrome. Radiol Case Rep 2019; 15:204-209. [PMID: 31890069 PMCID: PMC6928268 DOI: 10.1016/j.radcr.2019.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/07/2019] [Accepted: 11/17/2019] [Indexed: 01/28/2023] Open
Abstract
Opsoclonus Myoclonus Syndrome (OMS, or Opsoclonus Myoclonus Ataxia) is a rare condition that presents with saccadic movements of the eyes, cerebellar ataxia, and choreiform movements of the limbs. While previous reports have described the use of ultrasound, CT, FDG-PET and traditional focused MRI for localization of OMS-associated masses, whole body MRI has not previously been reported for this purpose. Here we describe a 16-year-old patient who exhibited OMS and underwent whole body MRI to rule out the more commonly associated neuroblastoma. An ovarian mass was discovered, resected, and pathology confirmed benign teratoma - there was subsequent resolution of symptoms after complete surgical resection. Whole body MRI should be considered in pediatric cases of OMS due to the paraneoplastic nature of the disease with associated tumor, high sensitivity of disease detection, lack of ionizing radiation, excellent tissue resolution and demonstrated effectiveness in pediatric imaging.
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Affiliation(s)
- Christian Park
- Department of Radiology, Penn State Health, Hershey PA 17033, USA
- Corresponding author.
| | - Imad Aljabban
- Penn State College of Medicine, Hershey PA 17033, USA
| | - Julie C. Fanburg-Smith
- Pathology, Pediatrics, and Orthopedics, Penn State Health, Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Christa Grant
- Surgery and Pediatrics, Penn State Children's Hospital, Penn State Health, Hershey PA 17033, USA
| | - Michael Moore
- Radiology and Pediatrics, Penn State Health, Hershey PA 17033, USA
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22
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Saade-Lemus S, Degnan AJ, Acord MR, Srinivasan AS, Reid JR, Servaes SE, States LJ, Anupindi SA. Whole-body magnetic resonance imaging of pediatric cancer predisposition syndromes: special considerations, challenges and perspective. Pediatr Radiol 2019; 49:1506-1515. [PMID: 31620850 DOI: 10.1007/s00247-019-04431-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/16/2019] [Accepted: 05/15/2019] [Indexed: 02/06/2023]
Abstract
Cancer predisposition syndromes increase the incidence of tumors during childhood and are associated with significant morbidity and mortality. Imaging is paramount for ensuring early detection of neoplasms, impacting therapeutic interventions and potentially improving outcome. While conventional imaging techniques involve considerable exposure to ionizing radiation, whole-body MRI is a radiation-free modality that allows continuous imaging of the entire body and has increasingly gained relevance in the surveillance, diagnosis, staging and monitoring of pediatric patients with cancer predisposition syndromes. Nevertheless, widespread implementation of whole-body MRI faces several challenges as a screening tool. Some of these challenges include developing clinical indications, variability in protocol specifications, image interpretation as well as coding and billing practices. These factors impact disease management, patient and family experience and research collaborations. In this discussion we review the aforementioned special considerations and the potential direction that might help overcome these challenges and promote more widespread use of whole-body MRI in children with cancer predisposition syndromes.
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Affiliation(s)
- Sandra Saade-Lemus
- Department of Radiology, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
| | - Andrew J Degnan
- Department of Radiology, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Michael R Acord
- Department of Radiology, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Abhay S Srinivasan
- Department of Radiology, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Janet R Reid
- Department of Radiology, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Sabah E Servaes
- Department of Radiology, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Lisa J States
- Department of Radiology, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Sudha A Anupindi
- Department of Radiology, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
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23
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Daldrup-Link H. Artificial intelligence applications for pediatric oncology imaging. Pediatr Radiol 2019; 49:1384-1390. [PMID: 31620840 PMCID: PMC6820135 DOI: 10.1007/s00247-019-04360-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 12/21/2018] [Accepted: 02/14/2019] [Indexed: 12/27/2022]
Abstract
Machine learning algorithms can help to improve the accuracy and efficiency of cancer diagnosis, selection of personalized therapies and prediction of long-term outcomes. Artificial intelligence (AI) describes a subset of machine learning that can identify patterns in data and take actions to reach pre-set goals without specific programming. Machine learning tools can help to identify high-risk populations, prescribe personalized screening tests and enrich patient populations that are most likely to benefit from advanced imaging tests. AI algorithms can also help to plan personalized therapies and predict the impact of genomic variations on the sensitivity of normal and tumor tissue to chemotherapy or radiation therapy. The two main bottlenecks for successful AI applications in pediatric oncology imaging to date are the needs for large data sets and appropriate computer and memory power. With appropriate data entry and processing power, deep convolutional neural networks (CNNs) can process large amounts of imaging data, clinical data and medical literature in very short periods of time and thereby accelerate literature reviews, correct diagnoses and personalized treatments. This article provides a focused review of emerging AI applications that are relevant for the pediatric oncology imaging community.
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Affiliation(s)
- Heike Daldrup-Link
- Department of Radiology, Lucile Packard Children's Hospital, Pediatric Molecular Imaging Program, Stanford University School of Medicine, 725 Welch Road, Room 1665, Stanford, CA, 94305-5614, USA. .,Department of Pediatrics, Hematology/Oncology Section, Stanford University School of Medicine, Stanford, CA, USA.
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24
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Ording Müller LS, Humphries P. Commentary on: radiological diagnosis of chronic recurrent multifocal osteomyelitis using whole-body MRI-based lesion distribution patterns. Clin Radiol 2019; 74:737.e1-737.e2. [PMID: 31272598 DOI: 10.1016/j.crad.2019.05.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 05/08/2019] [Indexed: 01/07/2023]
Affiliation(s)
- L-S Ording Müller
- Division of Radiology and Nuclear Medicine, Department of Paediatric Radiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
| | - P Humphries
- Department of Radiology, Great Ormond Street Hospital, London, UK
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25
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Gottumukkala RV, Gee MS, Hampilos PJ, Greer MLC. Current and Emerging Roles of Whole-Body MRI in Evaluation of Pediatric Cancer Patients. Radiographics 2019; 39:516-534. [DOI: 10.1148/rg.2019180130] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Ravi V. Gottumukkala
- From the Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.V.G., M.S.G., P.J.H.); Department of Diagnostic Imaging, the Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8 (M.L.C.G.); and Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (M.L.C.G.)
| | - Michael S. Gee
- From the Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.V.G., M.S.G., P.J.H.); Department of Diagnostic Imaging, the Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8 (M.L.C.G.); and Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (M.L.C.G.)
| | - Perry J. Hampilos
- From the Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.V.G., M.S.G., P.J.H.); Department of Diagnostic Imaging, the Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8 (M.L.C.G.); and Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (M.L.C.G.)
| | - Mary-Louise C. Greer
- From the Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.V.G., M.S.G., P.J.H.); Department of Diagnostic Imaging, the Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8 (M.L.C.G.); and Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (M.L.C.G.)
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26
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Degnan AJ, Alson MD, Duszak R. Variability in billing practices for whole-body magnetic resonance imaging. Pediatr Radiol 2019; 49:153. [PMID: 30194459 DOI: 10.1007/s00247-018-4255-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 08/30/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Andrew J Degnan
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd.,, Philadelphia, PA, 19104, USA. .,Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | | | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
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27
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Schooler GR, Davis JT, Daldrup-Link H, Frush DP. Variability in billing practices for whole-body magnetic resonance imaging: reply to Degnan et al. Pediatr Radiol 2019; 49:154. [PMID: 30191257 DOI: 10.1007/s00247-018-4253-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 08/30/2018] [Indexed: 11/24/2022]
Affiliation(s)
- Gary R Schooler
- Department of Radiology, Division of Pediatric Radiology, Duke University Medical Center, 1905 McGovern-Davison Children's Health Center, Durham, NC, 27710, USA.
| | - Joseph T Davis
- Department of Radiology, Division of Pediatric Radiology, Duke University Medical Center, 1905 McGovern-Davison Children's Health Center, Durham, NC, 27710, USA
| | - Heike Daldrup-Link
- Department of Radiology, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, USA
| | - Donald P Frush
- Department of Radiology, Division of Pediatric Radiology, Duke University Medical Center, 1905 McGovern-Davison Children's Health Center, Durham, NC, 27710, USA
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