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Liu AR, Gano D, Li Y, Diwakar M, Courtier JL, Zapala MA. Rate of head ultrasound abnormalities at one month in very premature and extremely premature infants with normal initial screening ultrasound. Pediatr Radiol 2022; 52:1150-1157. [PMID: 35102433 PMCID: PMC9107425 DOI: 10.1007/s00247-022-05285-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/28/2021] [Accepted: 01/14/2022] [Indexed: 10/28/2022]
Abstract
BACKGROUND Premature infants are at risk for multiple types of intracranial injury with potentially significant long-term neurological impact. The number of screening head ultrasounds needed to detect such injuries remains controversial. OBJECTIVE To determine the rate of abnormal findings on routine follow-up head ultrasound (US) performed in infants born at ≤ 32 weeks' gestational age (GA) after initial normal screening US. MATERIALS AND METHODS A retrospective study was performed on infants born at ≤ 32 weeks' GA with a head US at 3-5 weeks following a normal US at 3-10 days at a tertiary care pediatric hospital from 2014 to 2020. Exclusion criteria included significant congenital anomalies, such as congenital cardiac defects necessitating surgery, congenital diaphragmatic hernia or spinal dysraphism, and clinical indications for US other than routine screening, such as sepsis, other risk factors for intracranial injury besides prematurity, or clinical neurological abnormalities. Ultrasounds were classified as normal or abnormal based on original radiology reports. Images from initial examinations with abnormal follow-up were reviewed. RESULTS Thirty-three (14.2%) of 233 infants had 34 total abnormal findings on follow-up head US after normal initial US. Twenty-seven infants had grade 1 germinal matrix hemorrhage, and four had grade 2 intraventricular hemorrhage. Two had periventricular echogenicity and one had a focus of cerebellar echogenicity that resolved and was determined to be artifactual. CONCLUSION When initial screening head ultrasounds in premature infants are normal, follow-up screening ultrasounds are typically also normal. Abnormal findings are usually limited to grade 1 germinal matrix hemorrhage.
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Affiliation(s)
- Amanda R Liu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, Benioff Children's Hospital, 1975 Fourth St., San Francisco, CA, 94158, USA.
| | - Dawn Gano
- Department of Neurology & Pediatrics, University of California, San Francisco, Benioff Children's Hospital, San Francisco, CA, USA
| | - Yi Li
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, Benioff Children's Hospital, 1975 Fourth St., San Francisco, CA, 94158, USA
| | - Mithun Diwakar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, Benioff Children's Hospital, 1975 Fourth St., San Francisco, CA, 94158, USA
| | - Jesse L Courtier
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, Benioff Children's Hospital, 1975 Fourth St., San Francisco, CA, 94158, USA
| | - Matthew A Zapala
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, Benioff Children's Hospital, 1975 Fourth St., San Francisco, CA, 94158, USA
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Hung NJ, Theologis AA, Courtier JL, Harmon D, Diab M. Ureteral injury following anterior thoracolumbar spinal instrumented fusion for adolescent idiopathic scoliosis: a case report with CT angiography analysis of surgically relevant anatomy. Spine Deform 2021; 9:1691-1698. [PMID: 34075563 DOI: 10.1007/s43390-021-00363-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 05/03/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To report a rare ureteral injury following anterior spinal fusion for adolescent idiopathic scoliosis (AIS) that resulted in complete nephrectomy and to delineate the anatomical relationship between the proximal ureter and the anterior lumbar spine based on CT angiography (CTA). METHODS Thoracolumbar spine CTAs of children with AIS were reviewed. We measured the following relationships to the ureters: lateral-most aspect of vertebral body, anterior psoas at intervertebral disc/vertebral body levels, and lateral psoas at vertebral body level. Spine level at which the renal arteries originated from the aorta was identified. Distance from origin to corresponding vertebral body/intervertebral disc also was measured. RESULTS Forty-one girls and seven boys (mean age 12 years, range 7-18) were analyzed. Scoliosis lumbar convexity was left 94% and right 6%. From L1 to L4, ureter was identified within 1-2 cm of vertebral body. Distance between ureter and vertebral body and ureter and anterior psoas at intervertebral disc/vertebral body levels was less on left vs. right from L1 to L4 (p < 0.0001). Distance between ureter and lateral psoas was less on left vs. right from L1 to L2 (p = 0.0205; p = 0.0132) and greater on left vs. right from L3 to L4 (p = 0.0022; p = 0.0076). Renal artery originated at L1/L2 in > 50%. There was no difference in distance from renal artery origin to vertebral body/intervertebral disc (p = 0.4764). CONCLUSION Ureteral injury is a potentially morbid complication of anterior spine surgery. Injury can occur secondary to disrupted blood supply and mechanical tissue damage. Surgeons must clearly understand the juxta-spinal anatomy to limit dissection and modify retraction to reduce risk. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Nicole J Hung
- Department of Orthopaedic Surgery, University of California, San Francisco (UCSF), 1825 4th St., San Francisco, CA, 94158, USA
| | - Alekos A Theologis
- Department of Orthopaedic Surgery, University of California, San Francisco (UCSF), 1825 4th St., San Francisco, CA, 94158, USA
| | - Jesse L Courtier
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, USA
| | - Derek Harmon
- Department of Anatomy, UCSF, San Francisco, CA, USA
| | - Mohammad Diab
- Department of Orthopaedic Surgery, University of California, San Francisco (UCSF), 1825 4th St., San Francisco, CA, 94158, USA.
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Chapman MC, Soares BP, Li Y, Shum DJ, Glenn OA, Glastonbury CM, Courtier JL. Congenital Oral Masses: An Anatomic Approach to Diagnosis. Radiographics 2020; 39:1143-1160. [PMID: 31283464 DOI: 10.1148/rg.2019180128] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Although congenital oral masses are rare, they are readily detectable during fetal US screening. Most congenital oral masses are benign, but some may cause mechanical airway obstruction, resulting in poor outcomes at delivery. The radiologist's ability to describe these abnormalities and their physiologic sequelae accurately can have a substantial effect on perinatal treatment. Furthermore, despite being rare, congenital oral lesions encountered at screening and at follow up fetal MRI provide the opportunity to make a specific diagnosis by following a simple anatomic approach. This article describes an anatomic algorithm as the framework for accurate diagnosis of congenital oral lesions. The imaging appearance of the most common congenital oral cavity neoplasms is outlined, including vascular anomalies, epulides, choristomas, congenital lingual thyroid anomalies, lingual hamartomas, and epignathi, and other conditions that mimic these at US. Also reviewed are perinatal management of masses that affect the fetal airway and the imaging features key to optimizing delivery outcomes. Online supplemental material is available for this article. ©RSNA, 2019.
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Affiliation(s)
- Molly C Chapman
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA (M.C.C., Y.L., D.J.S., O.A.G., C.M.G., J.L.C.) and the Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD (B.P.S.)
| | - Bruno P Soares
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA (M.C.C., Y.L., D.J.S., O.A.G., C.M.G., J.L.C.) and the Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD (B.P.S.)
| | - Yi Li
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA (M.C.C., Y.L., D.J.S., O.A.G., C.M.G., J.L.C.) and the Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD (B.P.S.)
| | - Dorothy J Shum
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA (M.C.C., Y.L., D.J.S., O.A.G., C.M.G., J.L.C.) and the Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD (B.P.S.)
| | - Orit A Glenn
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA (M.C.C., Y.L., D.J.S., O.A.G., C.M.G., J.L.C.) and the Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD (B.P.S.)
| | - Christine M Glastonbury
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA (M.C.C., Y.L., D.J.S., O.A.G., C.M.G., J.L.C.) and the Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD (B.P.S.)
| | - Jesse L Courtier
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA (M.C.C., Y.L., D.J.S., O.A.G., C.M.G., J.L.C.) and the Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD (B.P.S.)
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Zapala MA, Livingston K, Bokhari D, Phelps AS, Courtier JL, Ma C, Seo Y, MacKenzie JD. Improved diagnostic confidence and accuracy of pediatric elbow fractures with digital tomosynthesis. Pediatr Radiol 2020; 50:363-370. [PMID: 31745596 DOI: 10.1007/s00247-019-04548-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/27/2019] [Accepted: 09/24/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pediatric elbow fractures are common but remain challenging to accurately diagnose. Digital tomosynthesis is a technique that has shown promise in difficult adult fracture patterns but has not been formally studied in the pediatric population. OBJECTIVE To assess the added value of digital tomosynthesis on the detection and diagnostic confidence of pediatric elbow fractures. MATERIALS AND METHODS A retrospective study was performed between January 2016 and December 2017 in pediatric patients (≤18 years) to assess the ability of conventional elbow radiographs and digital tomosynthesis to detect elbow fractures. One hundred twenty-one pediatric patients with concern for pediatric elbow trauma (64 males, 57 females; mean age: 8.1 years, range: 1 year to 17 years) were imaged with both conventional elbow radiographs and digital tomosynthesis. Two blinded pediatric radiologists identified fractures and indicated their diagnostic confidence. Observer agreement was assessed with Cohen's Kappa coefficient and a nonparametric Wilcoxon rank sum test was used to compare the degree of diagnostic confidence between standard radiographs alone and standard radiographs with digital tomosynthesis. McNemar's test was used to assess the difference in the rate of fracture detection between the two methods and sensitivity, specificity, precision, accuracy and diagnostic odds ratios were calculated. RESULTS Compared with standard radiographs alone, standard radiographs with digital tomosynthesis improved inter-rater agreement, sensitivity, specificity, accuracy, precision and the diagnostic odds ratio for fracture detection and increased diagnostic confidence (Rater 1: P=0.01, Rater 2: P=0.003). CONCLUSION The addition of digital tomosynthesis with conventional elbow radiographs improves diagnostic confidence and performance for the detection of pediatric elbow fractures.
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Affiliation(s)
- Matthew A Zapala
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, Benioff Children's Hospital, 1975 Fourth St., San Francisco, CA, 94158, USA.
| | - Kristin Livingston
- Department of Orthopaedic Surgery, University of California, San Francisco, Benioff Children's Hospital, San Francisco, CA, USA
| | - Danial Bokhari
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, Benioff Children's Hospital, 1975 Fourth St., San Francisco, CA, 94158, USA.,Department of Radiology and Radiological Sciences, Johns Hopkins Children's Center, Baltimore, MD, USA
| | - Andrew S Phelps
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, Benioff Children's Hospital, 1975 Fourth St., San Francisco, CA, 94158, USA
| | - Jesse L Courtier
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, Benioff Children's Hospital, 1975 Fourth St., San Francisco, CA, 94158, USA
| | - Collin Ma
- Office of Environment, Health and Safety, University of California, San Francisco, San Francisco, CA, USA
| | - Youngho Seo
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, Benioff Children's Hospital, 1975 Fourth St., San Francisco, CA, 94158, USA
| | - John D MacKenzie
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, Benioff Children's Hospital, 1975 Fourth St., San Francisco, CA, 94158, USA
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Abstract
Medical errors are a leading cause of morbidity and mortality in the medical field and are substantial contributors to medical costs. Radiologists play an integral role in the diagnosis and care of patients and, given that those in this field interpret millions of examinations annually, may therefore contribute to diagnostic errors. Errors can be categorized as a "miss" when a primary or critical finding is not observed or as a "misinterpretation" when errors in interpretation lead to an incorrect diagnosis. In this article, the authors describe the cognitive causes of such errors in diagnostic medicine, specifically in radiology. Recognizing the cognitive processes that radiologists use while interpreting images should improve one's awareness of the inherent biases that can impact decision making. The authors review the common biases that impact clinical decisions, as well as strategies to counteract or minimize the potential for misdiagnosis. System-level processes that can be implemented to minimize cognitive errors are reviewed, as well as ways to implement personal changes to minimize cognitive errors in daily practice. ©RSNA, 2017.
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Affiliation(s)
- Lindsay P Busby
- From the Departments of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, M-391, San Francisco, CA 94143-0628
| | - Jesse L Courtier
- From the Departments of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, M-391, San Francisco, CA 94143-0628
| | - Christine M Glastonbury
- From the Departments of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, M-391, San Francisco, CA 94143-0628
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Oates A, Ahuja S, Lee MM, Phelps AS, Mackenzie JD, Courtier JL. Pediatric renal transplant biopsy with ultrasound guidance: the 'core' essentials. Pediatr Radiol 2017; 47:1572-1579. [PMID: 28573315 DOI: 10.1007/s00247-017-3905-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 04/03/2017] [Accepted: 05/11/2017] [Indexed: 12/16/2022]
Abstract
This review provides a comprehensive and practical approach to pediatric percutaneous renal transplant biopsies, highlighting techniques and strategies to optimize adequate sample yield and ensure patient safety. In children with end-stage renal disease, transplantation is the preferred choice of therapy, providing for overall lower long-term morbidity and mortality compared with dialysis. In the ongoing management of renal transplant patients, core tissue sampling via a percutaneous renal biopsy remains the gold standard when transplant dysfunction is suspected. Indications for renal transplant biopsy and techniques/tools for adequate sample yield are discussed. Strategies for common challenges such as poor visualization and renal transplant mobility are addressed. We discuss the clinical signs, techniques and imaging findings for common complications including hematomas, arteriovenous fistulas and pseudoaneurysms. Although the percutaneous renal transplant biopsy procedure is generally safe with rare complications, care must be taken to ensure major complications are promptly recognized and treated. Adequate tissue samples obtained via renal biopsy are imperative to promptly identify transplant rejection to provide valuable information for patient diagnosis, treatment and outcomes. Radiologist and nephrologist attention to proper ultrasound techniques and optimal biopsy tools are critical to ensure tissue adequacy and minimize complications.
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Affiliation(s)
- Aris Oates
- Division of Nephrology, Department of Pediatrics, University of California, 550 16th St., 5th floor, Mailstop 3214, San Francisco, CA, 94143- 3214, USA.
| | - Saveen Ahuja
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Marsha M Lee
- Division of Nephrology, Department of Pediatrics, University of California, 550 16th St., 5th floor, Mailstop 3214, San Francisco, CA, 94143- 3214, USA
| | - Andrew S Phelps
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - John D Mackenzie
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Jesse L Courtier
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
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Ehman EC, Phelps AS, Ohliger MA, Rhee SJ, MacKenzie JD, Courtier JL. Detection of bowel inflammation with fused DWI/T2 images versus contrast-enhanced images in pediatric MR enterography with histopathologic correlation. Clin Imaging 2016; 40:1135-1139. [PMID: 27497037 DOI: 10.1016/j.clinimag.2016.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 06/20/2016] [Accepted: 07/18/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the fused, colorized diffusion weighted imaging (DWI) and anatomic T2 images compared to routine contrast-enhanced T1 images at pediatric magnetic resonance enterography (MRE). METHODS Fused, colorized DWI/T2 images were created from patients with magnetic resonance enterography (MRE) and colonoscopy/biopsy. Radiologists noted inflammation in five bowel segments (terminal ileum-rectosigmoid colon) on postcontrast images and DWI/T2 images. Test characteristics and agreement were calculated. RESULTS For 20 patients, sensitivity/specificity/positive predictive value (PPV)/negative predictive value (NPV) were 0.53/0.90/0.77/0.76 for DWI/T2 and 0.45/0.90/0.72/0.73 for postcontrast images. Intraobserver agreement was ҡ=0.45-0.73. Interobserver agreement was ҡ=0.53 for DWI/T2 and ҡ=0.63 for postcontrast images. CONCLUSION DWI/T2 images are similar in sensitivity/specificity to contrast-enhanced images and with moderate intra/interobserver reliability.
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Affiliation(s)
- Eric C Ehman
- Department of Radiology and Biomedical Imaging, UCSF, 505 Parnassus Ave., San Francisco, CA 94143-0628.
| | - Andrew S Phelps
- Department of Radiology and Biomedical Imaging, UCSF Benioff Children's Hospital, 1975 4th Street, CL1578L, San Francisco, CA 94158.
| | - Michael A Ohliger
- Department of Radiology and Biomedical Imaging, UCSF, 505 Parnassus Ave., San Francisco, CA 94143-0628.
| | - Sue J Rhee
- Department of Pediatrics, Division of Ped. Gastroenterology, UCSF Benioff Children's Hospital, Box 0136, 550 16th Street, San Francisco, CA 94134.
| | - John D MacKenzie
- Department of Radiology and Biomedical Imaging, UCSF Benioff Children's Hospital, 1975 4th Street, CL1578L, San Francisco, CA 94158.
| | - Jesse L Courtier
- Department of Radiology and Biomedical Imaging, UCSF Benioff Children's Hospital, 1975 4th Street, CL1578L, San Francisco, CA 94158.
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Phelps AS, Gould RG, Courtier JL, Marcovici PA, Salani C, MacKenzie JD. How Much Does Lead Shielding during Fluoroscopy Reduce Radiation Dose to Out-of-Field Body Parts? J Med Imaging Radiat Sci 2016; 47:171-177. [DOI: 10.1016/j.jmir.2015.12.082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 12/03/2015] [Accepted: 12/16/2015] [Indexed: 11/30/2022]
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Lin C, MacKenzie JD, Courtier JL, Gu JT, Milojevic D. Magnetic resonance imaging findings in juvenile spondyloarthropathy and effects of treatment observed on subsequent imaging. Pediatr Rheumatol Online J 2014; 12:25. [PMID: 25067925 PMCID: PMC4110533 DOI: 10.1186/1546-0096-12-25] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 06/29/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is often used to diagnose and monitor treatment effects of juvenile spondyloarthropathy (SpA). Our objective was to describe MRI findings in juvenile SpA and determine predictors of active sacroiliitis and response to treatment. METHODS Children who had MRI of the sacroiliac (SI) joints and were referred to the pediatric rheumatology clinic from 2009 to 2012 were retrospectively studied. The clinical parameters, laboratory studies and findings on MRI were collected and a composite score ratio (CR) was calculated for both SI joints on each MRI study based on a semi-quantitative scale that included evaluation of bone marrow edema (BME), synovial enhancement (SE), and erosions (ER). The findings on MRI were correlated with clinical and laboratory values. RESULTS 50 subjects who underwent 76 MRI for suspected or known SpA were included in the study. Sacroiliitis was seen in 48 MRIs in 32 subjects. Of the subjects with sacroiliitis, mean age ± standard deviation was 13.7 ± 2.6 years, 71% were male and 41% were HLA B27 positive. SE without BME was seen in 31% cases of sacroiliitis. In subjects with sacroiliitis, 79% also had hip arthritis and 41% had enthesitis of the pelvic region on MRI. In 38% of subjects with sacroiliitis, physical exam was not indicative of sacroiliitis or hip arthritis. Longitudinal data were available for 13 subjects. Sacroiliitis on MRI improved in 9 subjects with the greatest improvement in MRI composite score ratio after initiation of etanercept therapy. CR improvement was due to improvement of BME and SE components, while the ER score remained the same or worsened in all but 1 subject. CONCLUSION History, physical exam or laboratory data may not predict sacroiliitis in children. Magnetic resonance imaging plays a valuable role in the initial evaluation and later treatment monitoring of children with spondyloarthropathy. Synovial enhancement is significantly reduced after treatment, and unlike adults, synovial enhancement may be detected without accompanying bone marrow edema, which suggests gadolinium contrast may be an important component in the assessment of children with spondyloarthropathy.
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Affiliation(s)
- Clara Lin
- Children’s Hospital Colorado Pediatric Rheumatology, 13123 East 16th Street, Box B311, 80045 Aurora, CO, USA
| | - John D MacKenzie
- UCSF Pediatric Radiology, 505 Parnassus Ave, Moffitt Room: M396, Box 0628, 94143 San Francisco, CA, USA
| | - Jesse L Courtier
- UCSF Pediatric Radiology, 505 Parnassus Ave, Moffitt Room: M396, Box 0628, 94143 San Francisco, CA, USA
| | - Jeffrey T Gu
- UCSF Pediatric Radiology, 505 Parnassus Ave, Moffitt Room: M396, Box 0628, 94143 San Francisco, CA, USA
| | - Diana Milojevic
- Floating Hospital for Children @ Tufts Medical Center, 800 Washington Street #190, 02111 Boston, MA, USA
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Koc G, Courtier JL, Phelps A, Marcovici PA, MacKenzie JD. Computed tomography depiction of small pediatric vessels with model-based iterative reconstruction. Pediatr Radiol 2014; 44:787-94. [PMID: 24531191 DOI: 10.1007/s00247-014-2899-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 12/31/2013] [Accepted: 01/23/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Computed tomography (CT) is extremely important in characterizing blood vessel anatomy and vascular lesions in children. Recent advances in CT reconstruction technology hold promise for improved image quality and also reductions in radiation dose. This report evaluates potential improvements in image quality for the depiction of small pediatric vessels with model-based iterative reconstruction (Veo™), a technique developed to improve image quality and reduce noise. OBJECTIVE To evaluate Veo™ as an improved method when compared to adaptive statistical iterative reconstruction (ASIR™) for the depiction of small vessels on pediatric CT. MATERIALS AND METHODS Seventeen patients (mean age: 3.4 years, range: 2 days to 10.0 years; 6 girls, 11 boys) underwent contrast-enhanced CT examinations of the chest and abdomen in this HIPAA compliant and institutional review board approved study. Raw data were reconstructed into separate image datasets using Veo™ and ASIR™ algorithms (GE Medical Systems, Milwaukee, WI). Four blinded radiologists subjectively evaluated image quality. The pulmonary, hepatic, splenic and renal arteries were evaluated for the length and number of branches depicted. Datasets were compared with parametric and non-parametric statistical tests. RESULTS Readers stated a preference for Veo™ over ASIR™ images when subjectively evaluating image quality criteria for vessel definition, image noise and resolution of small anatomical structures. The mean image noise in the aorta and fat was significantly less for Veo™ vs. ASIR™ reconstructed images. Quantitative measurements of mean vessel lengths and number of branches vessels delineated were significantly different for Veo™ and ASIR™ images. Veo™ consistently showed more of the vessel anatomy: longer vessel length and more branching vessels. CONCLUSION When compared to the more established adaptive statistical iterative reconstruction algorithm, model-based iterative reconstruction appears to produce superior images for depiction of small pediatric vessels on computed tomography.
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Affiliation(s)
- Gonca Koc
- Department of Radiology and Biomedical Imaging, UCSF Benioff Children's Hospital, 505 Parnassus Ave., San Francisco, CA, 94143-0628, USA
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Koc G, Courtier JL, Kim JS, Miniati DN, MacKenzie JD. Intra-abdominal inverted umblical cord in gastroschisis: a unique ultrasound finding. Pediatr Radiol 2014; 44:109-11. [PMID: 23907187 DOI: 10.1007/s00247-013-2765-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 06/10/2013] [Accepted: 07/10/2013] [Indexed: 10/26/2022]
Abstract
A relatively new surgical technique allows for sutureless closure of a gastroschisis defect. Immediately after birth, a long umbilical cord stump is temporarily inverted into the abdominal cavity and later retracted and used to close the abdominal wall defect. Knowledge of this entity is important since the inverted umbilical cord simulates an intra-abdominal mass on cross-sectional imaging. While this procedure is well described in the surgical literature, the imaging features of inverted umbilical cord have yet to be reported. The case presented here highlights the sonographic imaging findings of the umbilical cord during the intestinal decompression phase of sutureless repair of gastroschisis.
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Affiliation(s)
- Gonca Koc
- Department of Radiology and Biomedical Imaging, University of California San Francisco, Benioff Children's Hospital, 505 Parnassus Ave., San Francisco, CA, 94143-0628, USA
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Cabarrus M, Sun YL, Courtier JL, Stengel JW, Coakley FV, Webb EM. The prevalence and patterns of intraluminal air in acute appendicitis at CT. Emerg Radiol 2012; 20:51-6. [DOI: 10.1007/s10140-012-1076-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 09/07/2012] [Indexed: 12/20/2022]
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