Abnormal kidney ultrasound and function in a five-year-old boy born prematurely with a birth weight of 370 grams

It is known that prematurity and low birth weight are associated with chronic kidney disease and hypertension. A positive correlation between kidney volume and birth weight was also described. In our ongoing observational study in 5-year-old children, we perceived highly abnormal kidney ultrasound and functions of a male patient born weighing 370 grams. It was his first nephrology examination since discharge from the hospital. We believe that thorough follow up and timely diagnosis of developing renal insufficiency may help us to initiate proper treatment in high-risk children (Tab. 1, Fig. 1, Ref. 7). Text in PDF www.elis.sk Keywords: prematurity; extremely low birth weight; chronic kidney disease; renal ultrasound; renal function.

Ultrasound shear wave elastography: does it add value to gray-scale ultrasound imaging in differentiating biliary atresia from other causes of neonatal jaundice?

BACKGROUND

Neonatal/infantile jaundice is relatively common, and most cases resolve spontaneously. However, in the setting of unresolved neonatal cholestasis, a prompt and accurate assessment for biliary atresia is vital to prevent poor outcomes.

OBJECTIVE

To determine whether shear wave elastography (SWE) alone or combined with gray-scale imaging improves the diagnostic performance of US in discriminating biliary atresia from other causes of neonatal jaundice over that of gray-scale imaging alone.

MATERIALS AND METHODS

Infants referred for cholestatic jaundice were assessed with SWE and gray-scale US. On gray-scale US, two radiology readers assessed liver heterogeneity, presence of the triangular cord sign, hepatic artery size, presence/absence of common bile duct and gallbladder, and gallbladder shape; associated interobserver correlation coefficients (ICC) were calculated. SWE speeds were performed on a Siemens S3000 using 6C2 and 9 L4 transducers with both point and two-dimensional (2-D) SWE US. Both univariable and multivariable analyses were performed, as were receiver operating characteristic curves (ROC) and statistical significance tests (chi-squared, analysis of variance, t-test and Wilcoxon rank sum) when appropriate.

RESULTS

There were 212 infants with biliary atresia and 106 without biliary atresia. The median shear wave speed (SWS) for biliary atresia cases was significantly higher (P<0.001) than for non-biliary-atresia cases for all acquisition modes. For reference, the median L9 point SWS was 2.1 m/s (interquartile range [IQR] 1.7-2.4 m/s) in infants with biliary atresia and 1.5 m/s (IQR 1.3-1.9 m/s) in infants without biliary atresia (P<0.001). All gray-scale US findings were significantly different between biliary-atresia and non-biliary-atresia cohorts (P<0.001), intraclass correlation coefficient (ICC) range 0.7-1.0. Triangular cord sign was most predictive of biliary atresia independent of other gray-scale findings or SWS - 96% specific and 88% sensitive. Multistep univariable/multivariable analysis of both gray-scale findings and SWE resulted in three groups being predictive of biliary atresia likelihood. Abnormal common bile duct/gallbladder and enlarged hepatic artery were highly predictive of biliary atresia independent of SWS (100% for girls and 95-100% for boys). Presence of both the common bile duct and the gallbladder along with a normal hepatic artery usually excluded biliary atresia independent of SWS. Other gray-scale combinations were equivocal, and including SWE improved discrimination between biliary-atresia and non-biliary-atresia cases.

CONCLUSION

Shear wave elastography independent of gray-scale US significantly differentiated biliary-atresia from non-biliary-atresia cases. However, gray-scale findings were more predictive of biliary atresia than elastography. SWE was useful for differentiating biliary-atresia from non-biliary-atresia cases in the setting of equivocal gray-scale findings.

How clinical question influences radiation dose in paediatric cardiac CT scan?

Funding Acknowledgements

Type of funding sources: None.

Introduction

Number of Cardiac CT examinations in paediatric population is rising. Clinical questions might vary from cardiac anatomy, coronary arteries, cardiac function assessment to chest examination including evaluation of large vessels, eventually combinations of these tasks. Dose reduction in children is especially important. CT scanning mode selection, reduction of kVp and limited extent of scanning in z-axis are the most important parameters for dose reduction. However, dose reduction optimization should not limit the readability of the CCT, and consequently the ability to reply the clinical question.

Purpose

This study analyses the influence of different clinical questions to radiation dose of paediatric cardiac CT.

Methods

In total 123 patients (42 females, 81 males) were examined using third generation dual-source CT scanner (SOMATOM Force, Siemens Healthineers, Forchheim, Germany), age mean 10.5 ± SD 5.9 years (min 50 days – max 18.9 years), height 138 ± 39 cm (54 – 200), weight 49 ± 25 kg (3.7 – 103). Three main categories of clinical questions (Q) were set: Q1) Extent of scanning in z-axis: heart only (from carina to diaphragm) or whole chest, Q2) Coronary arteries evaluation: yes/no, Q3) Cardiac function assessment (yes/no). Radiation dose is represented as a dose length product (DLP) in mGy*cm. Effective dose (ED) in mSv and calculated from DLP using converting factor 0.026 mSv/mGy*cm. Multiple regression was used to evaluate influence of clinical question to radiation dose.

Results

Total DLP was 202 ± 282 mGy*cm (6 – 1751), ED was 5.25 ± 7.33 mSv (0.16 – 45.53). Multiple regression of Total DLP versus Q1-Q3, height, weight and average heart rate showed statistically significant influence of cardiac function assessment (413 ± 263 vs 132 ± 253 mGy*cm, p 0.0001) and weight (p 0.0443). Multiple regression after adjusting to weight showed statistically significant influence of cardiac function assessment only (p &lt;0.0001).

Conclusions

Only clinical question about cardiac function assessment caused statistically significant higher radiation dose acquired from cardiac CT in paediatric patients. There was no statistically significant influence of coronary artery evaluation and extent of scanning.

Abstract Figure.

CT-based True- and False-Lumen Segmentation in Type B Aortic Dissection Using Machine Learning

Purpose

To develop a segmentation pipeline for segmentation of aortic dissection CT angiograms into true and false lumina on multiplanar reformations (MPRs) perpendicular to the aortic centerline and derive quantitative morphologic features, specifically aortic diameter and true- or false-lumen cross-sectional area.

Materials and Methods

An automated segmentation pipeline including two convolutional neural network (CNN) segmentation algorithms was developed. The algorithm derives the aortic centerline, generates MPRs orthogonal to the centerline, and segments the true and false lumina. A total of 153 CT angiograms obtained from 45 retrospectively identified patients (mean age, 50 years; range, 22-79 years) were used to train (n = 103), validate (n = 22), and test (n = 28) the CNN pipeline. Accuracy was evaluated by using the Dice similarity coefficient (DSC). Segmentations were then used to derive the maximal diameter of test-set patients and cross-sectional area profiles of the true and false lumina.

Results

The segmentation pipeline yielded a mean DSC of 0.873 ± 0.056 for the true lumina and 0.894 ± 0.040 for the false lumina of test-set cases. Automated maximal diameter measurements correlated well with manual measurements (R ² = 0.95). Profiles of cross-sectional diameter, true-lumen area, and false-lumen area over several follow-up examinations were derived.

Conclusion

A segmentation pipeline was used to accurately identify true and false lumina on CT angiograms of aortic dissection. These segmentations can be used to obtain diameter and other morphologic parameters for surveillance and risk stratification.Supplemental material is available for this article.© RSNA, 2020.

Examining the Cellular Pathways Involved in Influenza Virus Induced Apoptosis

Apoptosis is essential in many physiological processes including wound healing and development of the immune response. Apoptosis also plays an important role in the pathogenesis of many infectious diseases including those caused by viruses. Influenza viruses induce apoptosis in cells that are permissive for viral replication and cells that do not support viral replication. The cellular pathways involved in influenza virus induced apoptosis are currently ill defined. Previous studies suggest that influenza virus infection increased the expression of the Fas antigen in HeLa cells, and that Fas antigen is partially involved in apoptosis. In these studies we examined the cellular pathways involved in avian influenza virus induced apoptosis in two cell lines that support productive viral replication: Madin-Darby canine kidney cells (MDCK) and mink lung epithelial (Mv1Lu) cells.

Localization of astrovirus in experimentally infected turkeys as determined by in situ hybridization

Twenty-one 3-day-old turkey poults from British United Turkeys of America were orally inoculated with a recently characterized astrovirus, TAstV-2, isolated from turkeys with poult enteritis and mortality syndrome. At 1, 2, 3, 4, 5, 7, and 9 days postinfection (dpi), three inoculated birds were euthanatized, and tissues (intestines, spleen, bursa, and thymus) were collected immediately into 10% neutral buffered formalin. Inoculated birds were diarrheic by 3 dpi, and frothy feces persisted throughout the experimental period. Histologically, there was only slight evidence of enteric damage, which was characterized by mild epithelial necrosis, lamina propria infiltrates, minimal villus atrophy, and mild crypt hyperplasia. In situ hybridization, using a negative sense digoxigenin-labeled riboprobe to the capsid gene of TAstV-2, revealed viral RNA in intestinal epithelial cells at the basal margins of the villi, in distal small intestine, and in cecum at 2 dpi, with subsequent extension to epithelium of the large intestine and proximal small intestine (3-5 dpi). Minimal virus remained by 9 dpi.

Phenylmercury and its mobilization in the organism by a metal complex-forming substance: 2,3-dimercapto-1-propane sodium sulfonate

Workers handling dressing machines for seed treatment with the product Agronal, containing a phenylmercury chloride fungicide, were exposed to high concentrations of phenylmercury dust in the working environment. Urine analyses for mercury result in concentration of up to 0.1 mg Hg/l of urine. After administration of a complex-forming substance-Unitol (2,3-dimercapto-1-propane sodium sulfonate)-a higher urinary excretion of mercury occurred. The amount of mercury excreted confirmed its deposit in the organism. It was speculated that subjective complaints by workers handling dressing machines could be caused by high exposure to phenylmercury. This suggestion cannot, however, be fully accepted because the complaints were not necessarily specific for mercury only, but could also have been caused by factors of nontoxic origin, such as stress at the workplace, discontent with work and environmental hygiene conditions, conflicts and alcoholism. Most probably, it was a case of interpotentiation of the effects of toxic and non-toxic nature.