A. Luana Stanescu

Pediatric ovarian torsion: a pictorial review.

Imaging is crucial in expediting the diagnosis and guiding definitive therapy in children with ovarian torsion. This article reviews the multimodality spectrum of imaging findings in pediatric ovarian torsion, focusing primarily on US appearances. We describe predisposing conditions that can lead to torsion, the pathological basis of the radiologic findings in ovarian torsion, and the common diagnostic pitfalls.

Pediatric Abdominal Organ Transplantation: Current Indications, Techniques, and Imaging Findings.

The anatomy, normal postoperative radiological appearance, and imaging features of common postoperative complications of pediatric abdominal transplants are reviewed, including renal, liver, and intestinal transplants. Doppler ultrasound is the mainstay of imaging after transplantation. Computed tomography (CT) and CT angiography, MR imaging and magnetic resonance (MR) angiography, MR cholangiopancreatography, conventional angiography, and nuclear medicine imaging may be used for problem-solving in pediatric transplant patients. Accurate and timely radiological diagnosis of transplant complications facilitates appropriate treatment and minimizes morbidity and mortality.

Neonatal Gastrointestinal Emergencies: Step-by-Step Approach

Neonatal gastrointestinal emergencies are caused by a diverse set of primarily congenital entities that may affect the upper or lower gastrointestinal tracts, and occasionally both. Although a diagnosis can sometimes be made on prenatal imaging, more commonly patients present after birth and require prompt diagnosis to facilitate timely treatment. Imaging plays a central role in the accurate diagnosis of these entities and typically consists of an initial abdominal series followed by either an upper gastrointestinal series or contrast enema. The authors review the most common neonatal gastrointestinal emergencies and provide a step-by-step approach to the accurate imaging diagnosis.

Contrast-enhanced CT features of hepatoblastoma: Can we predict histopathology?

BACKGROUND Hepatoblastoma is the most common hepatic malignancy occurring in the pediatric population. Intratumoral cellular behavior varies, and the small-cell undifferentiated histopathology carries a poorer prognosis than other tissue subtypes. Neoadjuvant chemotherapy is recommended for this tumor subtype prior to surgical resection in most cases. Early identification of tumors with poor prognosis could have a significant clinical impact. Objective The aim of this work was to identify imaging features of small-cell undifferentiated subtype hepatoblastoma that can help distinguish this subtype from more favorable tumors and potentially guide the clinical management. We also sought to characterize contrast-enhanced CT (CECT) features of hepatoblastoma that correlate with metastatic disease and patient outcome. MATERIALS AND METHODS Our study included 34 patients (24 males, 10 females) with a mean age of 16months (range: 0-46months) with surgically confirmed hepatoblastoma and available baseline abdominal imaging by CECT. Clinical data and CT abdominal images were retrospectively analyzed. RESULTS Five tumors with small-cell undifferentiated components were identified. All of these tumors demonstrated irregular margins on CT imaging. Advanced PRETEXT stage, vascular invasion and irregular margins were associated with metastatic disease and decreased survival. Capsular retraction was also significantly associated with decreased survival. Irregular tumor margins demonstrated statistically significant association with the presence of small-cell undifferentiated components. No other imaging feature showed statistically significant association. CONCLUSION Tumor margin irregularity, vascular invasion, capsular retraction, and PRETEXT stage correlate with worse patient outcomes. Irregular tumor margin was the only imaging feature significantly associated with more aggressive tumor subtype.

Pediatric Thoracic Organ Transplantation

In the past decade, with improved surgical technique and knowledge of immunosuppression, pediatric lung and heart transplantation have been established as viable therapeutic interventions for pediatric patients with end-stage cardiopulmonary disease from various underlying congenital and acquired disorders. Although outcomes for pediatric patients are similar to those for adult patients, thoracic organ transplantation in this special age group carries unique challenges for preoperative and postoperative imaging evaluation. The article provides an up-to-date review of the postoperative transplant anatomy, imaging techniques, and complications of pediatric lung and heart transplantation.

Peer Review: Lessons Learned in A Pediatric Radiology Department

The purpose of this article is to illustrate types of diagnostic errors and feedback given to radiologists, using cases to support and clarify these categories. A comment-enhanced peer review system may be leveraged to generate a comprehensive feedback categorization scheme. These include errors of observation, errors of interpretation, inadequate patient data gathering, errors of communication, interobserver variability, informational feedback, and compliments. Much of this feedback is captured through comments associated with interpretative agreements.

Use of 18F-FDG PET-CT for Detection of Active Disease in Acute Myeloid Leukemia.

A 4-year-old girl with history of acute myeloid leukemia post chemotherapy and stem cell transplant presented with pancytopenia. F-FDG PET-CT (PET-CT) showed multiple metastatic bone and extra medullary soft tissue lesions. Bone marrow biopsy after additional chemotherapy was negative. Concurrent FDG PET-CT demonstrated hypermetabolic foci in the left thigh and hand consistent with residual soft tissue disease. These lesions resolved after further treatment, but a subsequent PET-CT identified a new site of biopsy-proven chloroma. This case illustrates the important role of FDG PET-CT in identifying clinically undetectable extramedullary sites of disease, which may impact subsequent clinical management.

Nuclear Medicine Applications in Pediatric Musculoskeletal Diseases: The Added Value of Hybrid Imaging

Abstract The introduction of diphosphonates in the 1970s revolutionized not only nuclear medicine but musculoskeletal imaging as well, providing functional assessment of entities such as osteomyelitis, trauma, and osseous metastatic disease. Although rarely the first‐line imaging modality used today, nuclear medicine procedures continue to play a pivotal role in the evaluation of musculoskeletal diseases in children, providing whole‐body assessment of disease involvement. More recently, the introduction of technologies such as single‐photon emission computed tomography/computed tomography (SPECT/CT), as well as newer positron‐emitting tracers such as 18 fluorine‐fluorodeoxyglucose and sodium 18F‐fluorine, particularly when combined with CT (positron emission tomography/CT), have injected new life into the older established techniques and expanded the application of nuclear medicine imaging into new arenas. This article discusses the utility of standard nuclear medicine procedures as they apply to children with musculoskeletal disorders, focusing on the added value of and indications for SPECT/CT. Subsequently, we discuss the expanding role of positron‐emitting agents in infection, trauma, and for the diagnosis, staging, and therapeutic response monitoring of children with malignant bone and soft tissue tumors. Differences between disease processes encountered in children as compared with adults are discussed; developmental variants that can, but should not, be confused with disease are illustrated. The need for pediatric‐specific protocols is addressed.

Respiratory Distress in Neonates. Underlying Causes and Current Imaging Assessment

The imaging evaluation of the neonate in respiratory distress has been described since the most early days of pediatric radiology but advances in diagnosis and treatment have changed the patient population presenting with these conditions and altered the imaging findings. In this article, the range of conditions that cause neonatal respiratory distress is depicted, including congenital lung malformations and lung disease in both preterm and full-term infants. An updated approach to the imaging of these conditions is reviewed, with a focus on changes that have resulted from advances in treatment and diagnosis.

Pediatric Chest Radiographs: Common and Less Common Errors

OBJECTIVE Radiographic imaging of the pediatric chest presents several unique challenges and nuances, stemming from congenital variants and pathologic processes specific to this population. Errors in interpretation may lead to inappropriate further imaging, incurring additional radiation exposure and cost, as well as psychologic effects on the patients and their families. CONCLUSION Here, we aim to highlight some common and less common pitfalls in pediatric chest radiography, as well as some tools for avoiding potential mistakes.