RESUMO
ABSTRACT: We evaluated the use of quantitative contrast-enhanced ultrasound (CEUS) to study wash-out behavior of ultrasound contrast agents in the pediatric brain in cases of hypoxic ischemic injury (HII). Six neonates and young infants were imaged using CEUS for suspected HII in the Neonatal Intensive Care Unit/Pediatric Intensive Care Unit. After receiving a bolus of ultrasound contrast agent Lumason (Bracco Diagnostics Inc.), analysis was performed in the whole brain, cortex, cortical/subcortical gray and white matter and central gray nuclei to quantify wash-out metrics and ratios. On magnetic resonance imaging clinical imaging findings, 3 children were classified as unaffected and 3 with classical imaging findings consistent with HII. A lower wash-out rate was found in the case of HII compared with the unaffected cases. Here, we present initial work exploring the wash-out behavior for differentiation between unaffected and HII in the brain. These preliminary findings are indicative of altered hemodynamics in HII and are promising for the potential use of CEUS to quantitatively differentiate between the unaffected and HII brain. Little is known about the CEUS wash-out dynamics, especially in the setting of the pediatric brain injury. Our preliminary findings are encouraging and warrant further investigation into the mechanisms behind delayed clearance of the ultrasound contrast agent in the setting of HII.
Assuntos
Hipóxia-Isquemia Encefálica , Encéfalo/diagnóstico por imagem , Meios de Contraste , Humanos , Hipóxia-Isquemia Encefálica/diagnóstico por imagem , Hipóxia-Isquemia Encefálica/patologia , Lactente , Recém-Nascido , Imageamento por Ressonância Magnética , UltrassonografiaRESUMO
PURPOSE: To describe the morphology and function of duplicated collecting systems in pediatric patients undergoing functional MR urography (fMRU). METHODS: This is a HIPAA compliant IRB approved retrospective study of all patients with duplicated renal collecting systems undergoing fMRU at our institution between 2010 and 2017. Two pediatric radiologists evaluated the studies to determine the presence, morphology and function of duplicated collecting systems using both T2-weighted and dynamic post-contrast fat saturated T1-weighted images. Assessed morphologic features included pelvic and calyceal dilation, partial or complete ureteral duplication, ureteral dilation, ectopic ureteral insertion and ureteroceles. Functional analysis was carried out per moiety. RESULTS: A total of 86 examinations (63 girls; 23 boys), median age 2.6â¯years (Standard Deviation 6.4â¯years, interquartile range: 0.4-10.3â¯years) and 107 kidneys (39 right; 30 left and 19 bilateral), which yielded 214 evaluable moieties, were included in the final sample. One hundred and sixty-three (76.1%) of the moieties had normal morphological features and normal functional results (average calyceal transit time and renal transit time of 2â¯min 28â¯s and 3â¯min 16â¯s, respectively). The remaining 51 moieties (23.8%) were hypoplastic or dysplastic. Seventy-seven (35.9%) had pelvic and calyceal dilation. Slightly more than half of the kidneys had complete ureteral duplication (60/107; 56%); 50 (50/107, 46.7%) had ectopic ureters (23 intra- and 27 extravesical) and 9 (9/107, 8.4%) had ureteroceles. CONCLUSION: fMRU provides comprehensive information regarding the morphology and function of duplicated renal collecting systems in children. In particular, fMRU is useful for assessing barely or non-functioning renal poles and ectopic ureters.
Assuntos
Nefropatias/diagnóstico por imagem , Rim/anormalidades , Imageamento por Ressonância Magnética/métodos , Urografia/métodos , Insuficiência Adrenal , Criança , Pré-Escolar , Feminino , Retardo do Crescimento Fetal , Humanos , Lactente , Nefropatias/fisiopatologia , Masculino , Osteocondrodisplasias , Estudos Retrospectivos , Ureter/diagnóstico por imagem , Obstrução Ureteral/diagnóstico por imagem , Obstrução Ureteral/fisiopatologia , Anormalidades UrogenitaisRESUMO
OBJECTIVES: To evaluate the diagnostic accuracy of ultrasound elastography with acoustic radiation force impulse (ARFI) to detect congenital hepatic fibrosis and portal hypertension in children with autosomal recessive polycystic kidney disease (ARPKD). STUDY DESIGN: Cross-sectional study of 25 children with ARPKD and 24 healthy controls. Ultrasound ARFI elastography (Acuson S3000, Siemens Medical Solutions USA, Inc, Malvern, Pennsylvania) was performed to measure shear wave speed (SWS) in the right and left liver lobes and the spleen. Liver and spleen SWS were compared in controls vs ARPKD, and ARPKD without vs with portal hypertension. Linear correlations between liver and spleen SWS, spleen length, and platelet counts were analyzed. Receiver operating characteristic analysis was used to evaluate diagnostic accuracy of ultrasound ARFI elastography. RESULTS: Participants with ARPKD had significantly higher median liver and spleen SWS than controls. At a proposed SWS cut-off value of 1.56 m/s, the left liver lobe had the highest sensitivity (92%) and specificity (96%) for distinguishing participants with ARPKD from controls (receiver operating characteristic area 0.92; 95% CI 0.82-1.00). Participants with ARPKD with portal hypertension (splenomegaly and low platelet counts) had significantly higher median liver and spleen stiffness than those without portal hypertension. The left liver lobe also had the highest sensitivity and specificity for distinguishing subjects with ARPKD with portal hypertension. CONCLUSIONS: Ultrasound ARFI elastography of the liver and spleen, particularly of the left liver lobe, is a useful noninvasive biomarker to detect and quantify liver fibrosis and portal hypertension in children with ARPKD.
Assuntos
Técnicas de Imagem por Elasticidade/métodos , Doenças Genéticas Inatas/diagnóstico por imagem , Hipertensão Portal/epidemiologia , Cirrose Hepática/diagnóstico por imagem , Rim Policístico Autossômico Recessivo/diagnóstico por imagem , Rim Policístico Autossômico Recessivo/patologia , Ultrassonografia Doppler/métodos , Adolescente , Criança , Pré-Escolar , Comorbidade , Estudos Transversais , Feminino , Doenças Genéticas Inatas/epidemiologia , Doenças Genéticas Inatas/patologia , Hospitais Pediátricos , Humanos , Hipertensão Portal/diagnóstico por imagem , Hipertensão Portal/patologia , Cirrose Hepática/epidemiologia , Cirrose Hepática/patologia , Masculino , Philadelphia , Rim Policístico Autossômico Recessivo/epidemiologia , Curva ROC , Valores de Referência , Sensibilidade e Especificidade , Índice de Gravidade de DoençaRESUMO
OBJECTIVE: The aim of this study was to determine which plane is best for identification of the appendix and to assess if opacification of the appendix impacts visualization. METHODS: Retrospective review of 218 computed tomography examinations performed for suspected appendicitis was conducted by 2 pediatric radiologists evaluating conspicuity of the appendix depending on orthogonal plane and enteric contrast. RESULTS: Of the 180 cases in which the appendix was visualized, 154 were performed with multiplanar reformations. The best plane for identification of the appendix was coronal in 96, axial in 41, and sagittal in 17. Of the 218 computed tomography examinations, 169 had enteric contrast. The appendix was identified in 180 cases and completely opacified in 62, partially opacified in 26, without opacification in 59, and air filled in 33. Of the 38 cases in which the appendix was not identified, 29 had enteric contrast administration.In 131 of the 218 cases, the appendix was normal, and 58% demonstrated partial or complete opacification of the appendix. In 35 of the 218 cases, appendicitis was found, and there was predominantly no opacification or at most partial opacification of the appendix. CONCLUSIONS: The coronal plane is best to identify the appendix. No enteric contrast is required to visualize appendicitis.