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Somasundaram E, Taylor Z, Alves VV, Qiu L, Fortson B, Mahalingam N, Dudley J, Li H, Brady SL, Trout AT, Dillman JR. Deep-Learning Models for Abdominal CT Organ Segmentation in Children: Development and Validation in Internal and Heterogeneous Public Datasets. AJR Am J Roentgenol 2024. [PMID: 38691411 DOI: 10.2214/ajr.24.30931] [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] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
Background: Deep-learning abdominal organ segmentation algorithms have shown excellent results in adults; validation in children is sparse. Objective: To develop and validate deep-learning models for liver, spleen, and pancreas segmentation on pediatric CT examinations. Methods: This retrospective study developed and validated deep-learning models for liver, spleen, and pancreas segmentation using 1731 CT examinations (1504 training, 221 testing), derived from three internal institutional pediatric (age ≤18) datasets (n=483) and three public datasets comprising pediatric and adult examinations with various pathologies (n=1248). Three deep-learning model architectures (SegResNet, DynUNet, and SwinUNETR) from the Medical Open Network for AI (MONAI) framework underwent training using native training (NT), relying solely on institutional datasets, and transfer learning (TL), incorporating pre-training on public datasets. For comparison, TotalSegmentator (TS), a publicly available segmentation model, was applied to test data without further training. Segmentation performance was evaluated using mean Dice similarity coefficient (DSC), with manual segmentations as reference. Results: For internal pediatric data, DSC for normal liver was 0.953 (TS), 0.964-0.965 (NT models), and 0.965-0.966 (TL models); normal spleen, 0.914 (TS), 0.942-0.945 (NT models), and 0.937-0.945 (TL models); normal pancreas, 0.733 (TS), 0.774-0.785 (NT models), and 0.775-0.786 (TL models); pancreas with pancreatitis, 0.703 (TS), 0.590-0.640 (NT models), and 0.667-0.711 (TL models). For public pediatric data, DSC for liver was 0.952 (TS), 0.876-0.908 (NT models), and 0.941-0.946 (TL models); spleen, 0.905 (TS), 0.771-0.827 (NT models), and 0.897-0.926 (TL models); pancreas, 0.700 (TS), 0.577-0.648 (NT models), and 0.693-0.736 (TL models). For public primarily adult data, DSC for liver was 0.991 (TS), 0.633-0.750 (NT models), and 0.926-0.952 (TL models); spleen, 0.983 (TS), 0.569-0.604 (NT models), and 0.923-0.947 (TL models); pancreas, 0.909 (TS), 0.148-0.241 (NT models), and 0.699-0.775 (TL models). DynUNet-TL was selected as the best-performing NT or TL model and was made available as an opensource MONAI bundle (https://github.com/cchmc-dll/pediatric_abdominal_segmentation_bundle.git). Conclusion: TL models trained on heterogeneous public datasets and fine-tuned using institutional pediatric data outperformed internal NT models and TotalSegmentator across internal and external pediatric test data. Segmentation performance was better in liver and spleen than in pancreas. Clinical Impact: The selected model may be used for various volumetry applications in pediatric imaging.
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Affiliation(s)
- Elanchezhian Somasundaram
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Zachary Taylor
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Vinicius V Alves
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Lisa Qiu
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Benjamin Fortson
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Neeraja Mahalingam
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jonathan Dudley
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Hailong Li
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Samuel L Brady
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Dillman JR, Trout AT, Taylor AE, Khendek L, Kasten JL, Sheridan R, Sharma D, Karns R, Rojas CC, Zhang B, Miethke AG. Association Between MR Elastography Liver Stiffness and Histologic Liver Fibrosis in Children and Young Adults With Autoimmune Liver Disease. AJR Am J Roentgenol 2024. [PMID: 38630086 DOI: 10.2214/ajr.24.31108] [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] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Background: Liver fibrosis is an important clinical endpoint of progression of autoimmune liver disease (AILD); its monitoring would benefit from noninvasive imaging tools. Objective: To assess the relationship between MR elastography (MRE) liver stiffness measurements and histologic liver fibrosis, as well as to evaluate the performance of MRE and biochemical-based clinical markers for stratifying histologic liver fibrosis severity, in children and young adults with AILD. Methods: This retrospective study used an existing institutional registry of children and young adults diagnosed with AILD [primary sclerosing cholangitis (PSC), ASC (autoimmune sclerosing cholangitis), or AIH (autoimmune hepatitis)]. The registry was searched to identify patients who underwent both a research abdominal 1.5-T MRI that included liver MRE (performed for registry enrollment) and a clinically indicated liver biopsy within a 6-month interval. MRE used a 2D gradient-recalled echo sequence. One analyst measured mean liver shear stiffness (kPa) for each examination. Laboratory markers of liver fibrosis [aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis-4 score (FIB-4)] were recorded. For investigational purposes, one pathologist determined histologic METAVIR liver fibrosis stage, blinded to clinical and MRI data. Spearman rank-order correlation was calculated between MRE liver stiffness and METAVIR liver fibrosis stage. ROC analysis was used to evaluate diagnostic performance for identifying advanced fibrosis (i.e., differentiating METAVIR F0-F1 from F2-F4 fibrosis), calculating sensitivity and specificity at the Youden's index. Results: The study included 46 patients (median [IQR] age, 16.6 [13.7-17.8] years; 20 female, 26 male); 12 had PSC, 10 had ASC, and 24 had AIH. Median MRE liver stiffness was 2.9 kPa (IQR: 2.2-4.0 kPa). MRE liver stiffness and METAVIR fibrosis stage showed strong positive correlation (rho=0.68). For identifying advanced liver fibrosis, MRE liver stiffness had AUC of 0.81, with sensitivity of 65.4% and specificity of 90.0%; APRI had AUC of 0.72, with sensitivity of 60.0% and specificity of 85.0%; and FIB-4 had AUC of 0.71, with sensitivity of 64.0% and 85.0%. Conclusion: MRE liver stiffness measurements were associated with histologic liver fibrosis severity. Clinical Impact: The findings support a role for MRE in noninvasive monitoring of liver stiffness, a surrogate for fibrosis, in children and young adults with AILD.
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Affiliation(s)
- Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Center, Cincinnati, OH
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
- Center for Autoimmune Liver Disease (CALD), Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Center, Cincinnati, OH
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
- Center for Autoimmune Liver Disease (CALD), Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Amy E Taylor
- Center for Autoimmune Liver Disease (CALD), Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Leticia Khendek
- Center for Autoimmune Liver Disease (CALD), Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Jennifer L Kasten
- Division of Pathology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Rachel Sheridan
- Division of Pathology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Divya Sharma
- Division of Pathology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Rebekah Karns
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Cyd Castro Rojas
- Center for Autoimmune Liver Disease (CALD), Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Bin Zhang
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Alexander G Miethke
- Center for Autoimmune Liver Disease (CALD), Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Ayyala RS, Dillman JR, Tkach JA, Young R, Kotagal M, Depinet H, Trout AT. Implementation of a Program for Appendicitis MRI in a Pediatric Hospital. AJR Am J Roentgenol 2024; 222:e2330695. [PMID: 38230903 DOI: 10.2214/ajr.23.30695] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
MRI is increasingly used as an alternate to CT for the evaluation of suspected appendicitis in pediatric patients presenting to the emergency department (ED) with abdominal pain, when further imaging is needed after an initial ultrasound examination. The available literature shows a similar diagnostic performance of MRI and CT in this setting. At the authors' institution, to evaluate for appendicitis in children in the ED, MRI is performed using a rapid three-sequence free-breathing protocol without IV contrast media. Implementation of an MRI program for appendicitis in children involves multiple steps, including determination of imaging resource availability, collaboration with other services to develop imaging pathways, widespread educational efforts, and regular quality review. Such programs can face numerous practice-specific challenges, such as those involving scanner capacity, costs, and buy-in of impacted groups. Nonetheless, through careful consideration of these factors, MRI can be used to positively impact the care of children presenting to the ED with suspected appendicitis. This Clinical Perspective aims to provide guidance on the development of a program for appendicitis MRI in children, drawing on one institution's experience while highlighting the advantages of MRI and practical strategies for overcoming potential barriers.
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Affiliation(s)
- Rama S Ayyala
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH 45229
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH 45229
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Jean A Tkach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH 45229
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Rachel Young
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH 45229
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Meera Kotagal
- Department of Pediatric Surgery and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Holly Depinet
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH 45229
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
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Murray A, Rodas Marquez SP, Krishnamurthy M, Lopez-Nunez O, Gurria JP, Trout AT, Almazan S, Mutyala K, Shah A, Howell J. Multifocal Insulinoma as the Unique Presenting Feature of MEN1 in an Adolescent. Horm Res Paediatr 2024:000538211. [PMID: 38442699 DOI: 10.1159/000538211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/27/2024] [Indexed: 03/07/2024] Open
Abstract
Introduction Multiple Endocrine Neoplasia Type 1 (MEN1) is an autosomal dominant inherited disorder defined by the presence of two of the following endocrinopathies: primary hyperparathyroidism, anterior pituitary tumors, and duodenopancreatic neuroendocrine tumors (NETs). NETs, which can secrete hormones including insulin, gastrin, and glucagon, among others, are common in patients with MEN1 and are a major cause of morbidity and premature death. NETs are more common later in life, with very few cases described in children. Here, we describe a unique case of an adolescent with multifocal pancreatic NETs as the single presenting feature of MEN1. Case Presentation A 13-year-old healthy male presented with severe weakness, altered mental status, and syncope in the setting of a venous blood glucose (BG) of 36 mg/dL. Workup showed an elevated insulin level (14 mcIU/mL) when BG was 39 mg/dL with positive response to glucagon, concerning for hyperinsulinism. Diazoxide and chlorothiazide were started but not well tolerated secondary to emesis. Three suspected NETs were identified by MRI and 68-Ga DOTATATE PET-CT imaging, including the largest, a 2.1 cm mass in the pancreatic head. A fourth mass in the pancreatic tail was identified via intraoperative ultrasound. All lesions were successfully enucleated and excised, and glucose levels normalized off diazoxide by post-op day 2. While the primary lesion stained for insulin and somatostatin by immunofluorescence (IF), consistent with his clinical presentation, the additional tumors expressed glucagon, somatostatin, pancreatic polypeptide, and chromogranin A but were negative for insulin. Genetic testing confirmed a pathogenic heterozygous mutation in MEN1 (c.969C>A, p.Tyr323). He had no other signs of MEN-associated comorbidities on screening. Discussion/Conclusion This case demonstrates that young patients with MEN1 can present with multifocal NETs. These NETs may have polyhormonal expression patterns despite a clinical presentation consistent with one primary hormone. Our patient had clinical symptoms and laboratory evaluation consistent with an insulinoma but was found to have four NETs, each with different IF staining patterns. Advanced pre-operative and intraoperative imaging is important to identify and treat all present NETs. Moreover, serum hormone levels pre- and post-treatment could help evaluate whether NETs are actively secreting hormones into the bloodstream or simply expressing them within the pancreas. Finally, this case highlights the importance of genetic testing for MEN1 in all young patients with insulinomas.
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Debnath P, Trout AT. Patient factors affecting 18F FDG uptake in children. Clin Imaging 2024; 107:110093. [PMID: 38295511 DOI: 10.1016/j.clinimag.2024.110093] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/12/2024] [Accepted: 01/20/2024] [Indexed: 02/02/2024]
Abstract
PURPOSE To characterize physiologic uptake of 18F FDG in children undergoing PET/CT as a step to informing efforts to optimize FDG PET image quality in children. METHODS This retrospective study included 193 clinically indicated 18F FDG PET/CT examinations from 139 patients. 3D spherical regions of interest (ROIs) in the liver and in the thigh muscle (an area of uniform low-level uptake) were used to measure counts and mean standardized uptake value by body weight (SUVmean-bw). Counts, SUVs, and liver signal to noise ratio (SNR) were assessed for associations with patient-specific predictor variables using Pearson correlation and multivariable linear regression. RESULTS Mean patient age was 11.0 ± 5.4 (SD) years, mean liver SUVmean-bw was 1.77 ± 0.60 and mean liver counts was 5387 ± 1875 Bq/mL. On univariable analysis liver SUVmean-bw and liver counts were strongly correlated with weight (r = 0.87, p < 0.0001), age (r = 0.75, p < 0.0001) and total injected activity (r = 0.85, p < 0.0001). Mean thigh counts were significantly associated only with injected activity/kilogram (r = 0.37, p < 0.0001). On multivariable analysis, body weight and age (which is collinear with body weight) were the only significant independent predictors (p < 0.0001). Liver SNR was moderately associated with all predictors apart from injected activity per kilogram (r = 0.09, p = 0.23). CONCLUSION Liver counts on 18F FDG PET/CT have a significant positive association with age and body weight. However, liver SNR has no significant association with injected activity per kilogram suggesting that increasing dose per kilogram may not improve image quality in young children.
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Affiliation(s)
- Pradipta Debnath
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Kasota Building MLC 5031, Cincinnati, OH 45229, United States of America
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Kasota Building MLC 5031, Cincinnati, OH 45229, United States of America; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America.
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Hayatghaibi SE, Trout AT, Wright DR. Meeting the Needs of Patient Preferences in Imaging. Acad Radiol 2024:S1076-6332(24)00084-9. [PMID: 38431486 DOI: 10.1016/j.acra.2024.02.015] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/02/2024] [Accepted: 02/08/2024] [Indexed: 03/05/2024]
Abstract
Healthcare continues to transition toward a patient-centered paradigm, where patients are active in medical decisions. Fully embracing this new paradigm means updating how clinical guidelines are formulated, accounting for patient preferences for medical care. Recently, several societies have incorporated patient preference evidence in their updated clinical practice guidelines, and patients in their expert panels. To fully transition to a patient-centered-paradigm, imaging organizations should rethink the formulation of clinical guidelines, accounting for patient preference evidence.
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Affiliation(s)
- Shireen E Hayatghaibi
- University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA; Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave., Cincinnati, Ohio 45229, USA.
| | - Andrew T Trout
- University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA; Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave., Cincinnati, Ohio 45229, USA; Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Davene R Wright
- Division of Child Health Research and Policy, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
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Ata NA, Trout AT, Dillman JR, Tkach JA, Ayyala RS. Technical and Diagnostic Performance of Rapid MRI for Evaluation of Appendicitis in a Pediatric Emergency Department. Acad Radiol 2024; 31:1102-1110. [PMID: 37863782 DOI: 10.1016/j.acra.2023.09.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/22/2023] [Accepted: 09/24/2023] [Indexed: 10/22/2023]
Abstract
RATIONALE AND OBJECTIVES Rationale MRI is increasingly used for diagnosis of pediatric appendicitis in the emergency care setting. Scan and room time are important to optimize workflow, especially in situations with limited MRI availability and accessibility. To describe our process to optimize and implement a rapid, non-contrast, free-breathing MRI protocol for appendicitis and to characterize the accuracy for diagnosis. MATERIALS AND METHODS Initial MRI protocol implemented for suspected appendicitis included five respiratory-triggered axial and coronal single shot fast spin echo (SSFSE) and radial T2W sequences with and without fat suppression (FS). This protocol was reassessed based on image quality. Subsequently, the coronal and axial T2W SSFSE FS sequence were removed. A three-sequence exam comprised the rapid MRI appendicitis protocol used for the remainder of the study. All examinations were performed on a 1.5 T scanner. For all examinations, the following information was obtained: scan time, diagnosis of appendicitis (by radiology report), surgery and pathology reports, and alternative diagnoses documented in radiology reports. MRI examination scan durations were compared between the five-sequence and three-sequence protocols, with Mann-Whitney U test, and proportions of false diagnoses were compared to Fisher's exact test. RESULTS 216 examinations were performed; 21 and 195 performed with five- and three-sequence protocol, respectively. The median duration of the five-sequence protocol was 20 (16.9-23.5) minutes vs.11 (9.5-13) minutes for the three sequence protocol (p < 0.0001). The majority (n = 157, 80.5% of 195) of examinations were performed in a goal time of< 15 min. 23 examinations took longer than 20 min (n = 12, n = 11 for the three- and five-sequence protocols, respectively) were due to repeat sequences or addition of non-standard sequences (requested by interpreting radiologist). 27 (90%) of the 30 reported positive cases were confirmed by pathology. There were three false-positive diagnoses (all three-sequence protocol exams) and one false-negative diagnosis (five-sequence protocol exam). Alternative diagnoses, including pancreatitis, omental infarct, masses, and ovarian pathology, were made in 42 (19%) cases. CONCLUSION A three-sequence, non-contrast, free- breathing MRI examination can be performed in less than 15 min in the emergency department and has high diagnostic accuracy for acute appendicitis in children and young adults.
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Affiliation(s)
- Nadeen Abu Ata
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, Ohio, 45229, USA (N.A.A., A.T.T., J.R.D., J.A.T., R.S.A.); Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA (N.A.A., A.T.T., J.R.D., J.A.T., R.S.A.)
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, Ohio, 45229, USA (N.A.A., A.T.T., J.R.D., J.A.T., R.S.A.); Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA (N.A.A., A.T.T., J.R.D., J.A.T., R.S.A.); Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA (A.T.T.)
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, Ohio, 45229, USA (N.A.A., A.T.T., J.R.D., J.A.T., R.S.A.); Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA (N.A.A., A.T.T., J.R.D., J.A.T., R.S.A.)
| | - Jean A Tkach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, Ohio, 45229, USA (N.A.A., A.T.T., J.R.D., J.A.T., R.S.A.); Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA (N.A.A., A.T.T., J.R.D., J.A.T., R.S.A.)
| | - Rama S Ayyala
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, Ohio, 45229, USA (N.A.A., A.T.T., J.R.D., J.A.T., R.S.A.); Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA (N.A.A., A.T.T., J.R.D., J.A.T., R.S.A.).
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Lindsay Mart F, Gutmark-Little I, Streich-Tilles T, Trout AT, Khoury J, Bowers K, Casnellie L, Backeljauw P. Current Recommended Estrogen Dosing for Pubertal Induction in Turner Syndrome Results in Normal Uterine Growth. J Clin Endocrinol Metab 2024; 109:e1040-e1047. [PMID: 37933636 DOI: 10.1210/clinem/dgad649] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/08/2023]
Abstract
CONTEXT Most individuals with Turner syndrome (TS) require estrogen for pubertal induction. Current estrogen dosing guidelines are based on expert consensus opinion. OBJECTIVE Evaluate whether current international guidelines for estrogen dosing during pubertal induction of individuals with TS result in normal uterine growth. We hypothesized that uterine size in individuals with TS who reached adult estrogen dosing is smaller than in mature females without TS. METHODS Cross-sectional study of patients with TS at the Cincinnati Center for Pediatric and Adult Turner Syndrome Care. Twenty-nine individuals (age 15-26 years) with primary ovarian insufficiency who reached adult estrogen dosing (100 µg of transdermal or 2 mg of oral 17β-estradiol) were included. Comparison of uterine measurements with a published sample of 292 age-appropriate (age 15-20 years) controls without TS. Uterine length, volume, and fundal-cervical ratio (FCR) were measured. Clinical information (karyotype, Tanner staging for breast development, laboratory data) was extracted from an existing institutional patient registry. RESULTS There was no evidence of compromise of the uterine size/configuration in the TS cohort compared with the controls; in fact, uterine length, mean 7.7 cm (±1.3) vs 7.2 cm (±1.0) (P = .03), and volume, mean 60.6 cm3 (±26.6) vs 50.5 cm3 (±20.5) (P = .02), were both larger in individuals with TS. CONCLUSION Current international guidelines for hormone replacement using 17β-estradiol in individuals with TS appear adequate to allow for normal uterine growth by the end of pubertal induction.
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Affiliation(s)
- Faith Lindsay Mart
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3026, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Iris Gutmark-Little
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3026, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Tara Streich-Tilles
- Division of Pediatric and Adolescent Gynecology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3026, USA
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Andrew T Trout
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3026, USA
| | - Jane Khoury
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3026, USA
| | - Katherine Bowers
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3026, USA
| | - Lori Casnellie
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3026, USA
| | - Philippe Backeljauw
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3026, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
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Fortson BL, Abu-El-Haija M, Mahalingam N, Thompson TL, Vitale DS, Trout AT. Pancreas volumes in pediatric patients following index acute pancreatitis and acute recurrent pancreatitis. Pancreatology 2024; 24:1-5. [PMID: 37945498 PMCID: PMC10872738 DOI: 10.1016/j.pan.2023.10.025] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/27/2023] [Accepted: 10/31/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND/OBJECTIVES Pancreas volume derived from imaging may objectively reveal volume loss relevant to identifying sequelae of acute pancreatitis (AP) and ultimately diagnosing chronic pancreatitis (CP). The purposes of this study were to: (1) quantify pancreas volume by imaging in children with either (a) a single episode of AP or (b) acute recurrent pancreatitis (ARP), and (2) compare these volumes to normative volumes. METHODS This retrospective study was institutional review board approved. A single observer segmented the pancreas (3D Slicer; slicer.org) on n = 30 CT and MRI exams for 23 children selected from a prospective registry of patients with either an index attack of AP or with ARP after a known index attack date. Patients with CP were excluded. Segmented pancreas volumes were compared to published normal values. RESULTS Mean pancreas volumes normalized to body surface area (BSA) in the index AP and ARP groups were 38.2 mL/m2 (range: 11.8-73.5 mL/m2) and 27.9 mL/m2 (range: 8.0-69.2 mL/m2) respectively. 43 % (6/14) of patients post-AP had volumes below the 25th percentile, 1 (17 %) of which was below the 5th percentile (p = 0.3027 vs. a normal distribution). Post-ARP, 44 % (7/16) of patients had volumes below the 5th percentile (p < 0.001). CONCLUSIONS A significant fraction (40 %) of children with ARP have pancreas volumes <5th percentile for BSA even in the absence of CP. A similar, but not statistically significant, fraction have pancreas volumes <25th percentile after an index attack of AP. Pancreatic parenchymal volume deserves additional investigation as an objective marker of parenchymal damage from acute pancreatitis and of progressive pancreatitis in children.
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Epstein KN, Trout AT, Debnath P, Pitt S, O'Hara SM, Kanj RV, Murtagh-Kurowski E, Ayyala RS. Rapid, free-breathing non-contrast MRI for first-line imaging evaluation of ovarian torsion in the emergency department. Pediatr Radiol 2024; 54:228-235. [PMID: 38097821 DOI: 10.1007/s00247-023-05827-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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Transabdominal ultrasound (US) is first-line imaging to evaluate ovaries in girls presenting to the emergency department (ED) with suspected ovarian torsion. Ovaries may be difficult to visualize sonographically; therefore, prompt diagnosis using US alone can be challenging. Rapid MRI as first-line imaging may help streamline patient throughput, especially with increasing MRI availability in the ED. OBJECTIVE To assess feasibility of rapid MRI for diagnosis of ovarian torsion. MATERIALS AND METHODS A retrospective, single-center IRB approved study of MRI performed in female pediatric patients presenting with abdominopelvic pain from August 2022 to January 2023. Imaging occurred according to one of three clinical pathways (US-first approach vs MRI-first approach vs US + MRI-second-line approach). A rapid three-sequence free-breathing MRI protocol was utilized. Frequency of ovarian torsion and secondary diagnoses was recorded. Length of MR scan time, time from ED arrival to time of diagnosis, and whether patient had US prior to MR exam were obtained. A historical cohort of patients with US only performed for assessment of ovarian torsion were evaluated for length of the US examination and time from ED arrival to time of diagnosis. Intervals were compared using the uncorrected Fisher's least significant difference and Turkey's multiple comparison tests. RESULTS A total of 140 MRI exams (mean age 14.6 years) and 248 historical US exams (mean age 13.5 years) were included. Of the patients with MRI, 41 (29%) patients were imaged with US + MRI and 99 (71%) imaged with MRI only; 4% (6/140) MR exams were suspicious for ovarian torsion, with one true positive case (1/6 TP) and 5 false positive cases (5/6 FP); 26.4% (37/140) of exams had secondary diagnoses. Median MRI scan time was 11.4 min (4.4) vs median historical US scan time was 24.1 min (19.7) (P<0.001). Median time from arrival in ED to MRI read was 242 (140). Median time from arrival in ED to US only read was 268 min (148). This was not a statistically significant difference when compared to the MRI only cohort. CONCLUSION First-line MRI imaging for evaluation of ovarian torsion is a rapid and feasible imaging modality for female patients in the emergent setting.
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Affiliation(s)
- Katherine N Epstein
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Avenue, Cincinnati, OH, 45229, USA.
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Avenue, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Pradipta Debnath
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Avenue, Cincinnati, OH, 45229, USA
| | - Sunny Pitt
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Avenue, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Sara M O'Hara
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Avenue, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Rula V Kanj
- Department of Obstetrics and Gynecology, Northwell Health, Long Island, NY, USA
| | - Eileen Murtagh-Kurowski
- Department of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, Anderson Center for Health System Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Rama S Ayyala
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Avenue, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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11
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Hardie RC, Trout AT, Dillman JR, Narayanan BN, Tanimoto AA. Performance Analysis in Children of Traditional and Deep Learning CT Lung Nodule Computer-Aided Detection Systems Trained on Adults. AJR Am J Roentgenol 2024; 222:e2330345. [PMID: 37991333 DOI: 10.2214/ajr.23.30345] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
BACKGROUND. Although primary lung cancer is rare in children, chest CT is commonly performed to assess for lung metastases in children with cancer. Lung nodule computer-aided detection (CAD) systems have been designed and studied primarily using adult training data, and the efficacy of such systems when applied to pediatric patients is poorly understood. OBJECTIVE. The purpose of this study was to evaluate in children the diagnostic performance of traditional and deep learning CAD systems trained with adult data for the detection of lung nodules on chest CT scans and to compare the ability of such systems to generalize to children versus to other adults. METHODS. This retrospective study included pediatric and adult chest CT test sets. The pediatric test set comprised 59 CT scans in 59 patients (30 boys, 29 girls; mean age, 13.1 years; age range, 4-17 years), which were obtained from November 30, 2018, to August 31, 2020; lung nodules were annotated by fellowship-trained pediatric radiologists as the reference standard. The adult test set was the publicly available adult Lung Nodule Analysis (LUNA) 2016 subset 0, which contained 89 deidentified scans with previously annotated nodules. The test sets were processed through the traditional FlyerScan (github.com/rhardie1/FlyerScanCT) and deep learning Medical Open Network for Artificial Intelligence (MONAI; github.com/Project-MONAI/model-zoo/releases) lung nodule CAD systems, which had been trained on separate sets of CT scans in adults. Sensitivity and false-positive (FP) frequency were calculated for nodules measuring 3-30 mm; nonoverlapping 95% CIs indicated significant differences. RESULTS. Operating at two FPs per scan, on pediatric testing data FlyerScan and MONAI showed significantly lower detection sensitivities of 68.4% (197/288; 95% CI, 65.1-73.0%) and 53.1% (153/288; 95% CI, 46.7-58.4%), respectively, than on adult LUNA 2016 subset 0 testing data (83.9% [94/112; 95% CI, 79.1-88.0%] and 95.5% [107/112; 95% CI, 90.0-98.4%], respectively). Mean nodule size was smaller (p < .001) in the pediatric testing data (5.4 ± 3.1 [SD] mm) than in the adult LUNA 2016 subset 0 testing data (11.0 ± 6.2 mm). CONCLUSION. Adult-trained traditional and deep learning-based lung nodule CAD systems had significantly lower sensitivity for detection on pediatric data than on adult data at a matching FP frequency. The performance difference may relate to the smaller size of pediatric lung nodules. CLINICAL IMPACT. The results indicate a need for pediatric-specific lung nodule CAD systems trained on data specific to pediatric patients.
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Affiliation(s)
- Russell C Hardie
- Department of Electrical and Computer Engineering, University of Dayton, 300 College Park, Dayton, OH 45469
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Barath N Narayanan
- Sensor and Software Systems, University of Dayton Research Institute, Dayton, OH
| | - Aki A Tanimoto
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
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12
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Ghosh A, Li H, Towbin AJ, Turpin BK, Trout AT. Histogram Analysis of Apparent Diffusion Coefficient Maps Provides Genotypic and Pretreatment Phenotypic Information in Pediatric and Young Adult Rhabdomyosarcoma. Acad Radiol 2024:S1076-6332(24)00011-4. [PMID: 38296742 DOI: 10.1016/j.acra.2024.01.011] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/02/2024] [Accepted: 01/05/2024] [Indexed: 02/02/2024]
Abstract
INTRODUCTION We evaluate the role of apparent diffusion coefficient (ADC) histogram metrics in stratifying pediatric and young adult rhabdomyosarcomas. METHODS We retrospectively evaluated baseline diffusion-weighted imaging (DWI) from 38 patients with rhabdomyosarcomas (Not otherwise specified: 2; Embryonal: 21; Spindle Cell: 2; Alveolar: 13, mean ± std dev age: 8.1 ± 7.76 years). The diffusion images were obtained on a wide range of 1.5 T and 3 T scanners at multiple sites. FOXO1 fusion status was available for 35 patients, nine of whom harbored the fusion. 13 patients were TNM stage 1, eight had stage 2 disease, nine were stage 3, and eight had stage 4 disease. 23 patients belonged to Clinical Group III and seven to Group IV, while two and five were CG I and II, respectively. Nine patients were classified as low risk, while 21 and five were classified as intermediate and high risk respectively. Histogram parameters of the apparent diffusion coefficient (ADC) map from the entire tumor were obtained based on manual tumor contouring. A two-tailed Mann-Whitney U test was used for all two-group, and the Kruskal-Wallis's test was used for multiple-group comparisons. Bootstrapped receiver operating characteristic (ROC) curves and areas under the curve (AUC) were generated for the statistically significant histogram parameters to differentiate genotypic and phenotypic parameters. RESULTS Alveolar rhabdomyosarcomas had a statistically significant lower 10th Percentile (586.54 ± 164.52, mean ± std dev, values are in ×10-6mm2/s) than embryonal rhabdomyosarcomas (966.51 ± 481.33) with an AUC of 0.85 (95%CI. 0.73-0.95) for differentiating the two. The 10th percentile was also significantly different between FOXO1 fusion-positive (553.87 ± 187.64) and negative (898.07 ± 449.38) rhabdomyosarcomas with an AUC of 0.83 (95% CI 0.71-0.94). Alveolar rhabdomyosarcomas also had statistically significant lower Mean, Median, and Root Mean Squared ADC histogram values than embryonal rhabdomyosarcomas. Four, five, and seven of the 18 histogram parameters evaluated demonstrated a statistically significant increase with higher TNM stage, clinical group, assignment, and pretreatment risk stratification, respectively. For example, Entropy had an AUC of 0.8 (95% CI. 0.67-0.92) for differentiating TNM stage 1 from ≥ stage 2 and 0.9 (95% CI. 0.8-0.98) for differentiating low from intermediate or high-risk stratification. CONCLUSION Our findings demonstrate the potential of ADC histogram metrics to predict clinically relevant variables for rhabdomyosarcoma, including FOXO1 fusion status, histopathology, Clinical Group, TNM staging, and risk stratification.
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Affiliation(s)
- Adarsh Ghosh
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
| | - Hailong Li
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Alexander J Towbin
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Brian K Turpin
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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13
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Alves VDPV, Ata NA, MacLean J, Sharp SE, Li Y, Brady S, Trout AT. Reduced count pediatric whole-body 18F-FDG PET imaging reconstruction with a Bayesian penalized likelihood algorithm. Pediatr Radiol 2024; 54:170-180. [PMID: 37962603 DOI: 10.1007/s00247-023-05801-8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Advanced positron emission tomography (PET) image reconstruction methods promise to allow optimized PET/CT protocols with improved image quality, decreased administered activity and/or acquisition times. OBJECTIVE To evaluate the impact of reducing counts (simulating reduced acquisition time) in block sequential regularized expectation maximization (BSREM) reconstructed pediatric whole-body 18F-fluorodeoxyglucose (FDG) PET images, and to compare BSERM with ordered-subset expectation maximization (OSEM) reconstructed reduced-count images. MATERIALS AND METHODS Twenty children (16 male) underwent clinical whole-body 18F-FDG PET/CT examinations using a 25-cm axial field-of-view (FOV) digital PET/CT system at 90 s per bed (s/bed) with BSREM reconstruction (β=700). Reduced count simulations with varied BSREM β levels were generated from list-mode data: 60 s/bed, β=800; 50 s/bed, β=900; 40 s/bed, β=1000; and 30 s/bed, β=1300. In addition, a single OSEM reconstruction was created at 60 s/bed based on prior literature. Qualitative (Likert scores) and quantitative (standardized uptake value [SUV]) analyses were performed to evaluate image quality and quantitation across simulated reconstructions. RESULTS The mean patient age was 9.0 ± 5.5 (SD) years, mean weight was 38.5 ± 24.5 kg, and mean administered 18F-FDG activity was 4.5 ± 0.7 (SD) MBq/kg. Between BSREM reconstructions, no qualitative measure showed a significant difference versus the 90 s/bed β=700 standard (all P>0.05). SUVmax values for lesions were significantly lower from 90 s/bed, β=700 only at a simulated acquisition time of 30 s/bed, β=1300 (P=0.001). In a side-by-side comparison of BSREM versus OSEM reconstructions, 40 s/bed, β=1000 images were generally preferred over 60 s/bed TOF OSEM images. CONCLUSION In children who undergo whole-body 18F-FDG PET/CT on a 25-cm FOV digital PET/CT scanner, reductions in acquisition time or, by corollary, administered radiopharmaceutical activity of >50% from a clinical standard of 90 s/bed may be possible while maintaining diagnostic quality when a BSREM reconstruction algorithm is used.
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Affiliation(s)
- Vinicius de Padua V Alves
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Kasota Building MLC 5031, Cincinnati, OH, 45226, USA
| | - Nadeen Abu Ata
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Kasota Building MLC 5031, Cincinnati, OH, 45226, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Joseph MacLean
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Kasota Building MLC 5031, Cincinnati, OH, 45226, USA
| | - Susan E Sharp
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Kasota Building MLC 5031, Cincinnati, OH, 45226, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Yinan Li
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Kasota Building MLC 5031, Cincinnati, OH, 45226, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Samuel Brady
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Kasota Building MLC 5031, Cincinnati, OH, 45226, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Kasota Building MLC 5031, Cincinnati, OH, 45226, USA.
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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14
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Morin CE, Hasweh R, Anton C, Dillman JR, Orscheln E, Smith EA, Kotagal M, Weiss BD, Ouyang J, Zhang B, Trout AT, Towbin AJ. Gadolinium-based contrast media does not improve the staging of neuroblastoma image-defined risk factors at diagnosis. Pediatr Blood Cancer 2024; 71:e30724. [PMID: 37845799 DOI: 10.1002/pbc.30724] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/23/2023] [Accepted: 10/06/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Neuroblastoma risk stratification relies on prognostic risk factors and image-defined risk factors (IDRFs). Evaluating neuroblastoma typically involves magnetic resonance imaging (MRI) with gadolinium-based contrast media (GBCM, "contrast"). However, there are concerns regarding adverse effects and cost of GBCM. We aimed to assess the impact of intravenous GBCM on interobserver agreement for neuroblastoma staging on baseline MRI. PROCEDURE We reviewed baseline MRI scans of 50 children with abdominopelvic neuroblastomas confirmed by histopathology. Duplicate sets of images were created, with post-contrast T1-weighted sequences removed from one set. Four pediatric radiologists independently analyzed the scans in a randomized manner. They recorded primary tumor size, presence of IDRFs, and metastatic lesions. Agreement among the reviewers was measured using kappa and Fleiss kappa statistics. RESULTS Mean age of included children was 3.3 years (range: 0.01-14.9 years), and 20 [40%] were females. Mean tumor size was 5.7 cm in greatest axial diameter. Pre-contrast versus post-contrast MRI showed excellent agreement for tumor measurement. Overlapping confidence intervals (CIs) were seen in nearly all categories of interobserver agreement on the presence or absence of individual IDRFs, with agreement ranging from poor to substantial, regardless of the presence of contrast. The overall interobserver agreement on the presence of at least one IDRF was substantial with contrast (kappa = .63; 95% CI: .52-.75) and moderate without contrast (kappa = .5; 95% CI: .39-.61); although the overlapping CIs suggest a lack of meaningful difference. Similarly, interobserver agreement on the presence or absence of individual sites of metastatic disease ranged from poor to substantial. The interobserver agreement on the overall determination of presence of metastatic disease was fair with contrast (kappa = .49; 95% CI: .38-.61) and moderate without contrast (kappa = .71; 95% CI: .59-.826). CONCLUSIONS Contrast does not improve tumor size measurement or radiologist agreement on the presence or absence of IDRFs or metastatic disease in children with newly diagnosed neuroblastoma.
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Affiliation(s)
- Cara E Morin
- Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Reem Hasweh
- Division of Radiology, Al-Balqa Applied University, Al-Salt, Jordan
| | - Chris Anton
- Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Emily Orscheln
- Department of Radiology, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Ethan A Smith
- Department of Surgery, University of Cincinnati College of Medicine, Division of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Meera Kotagal
- Cancer and Blood Disease Institute, Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Brian D Weiss
- Department of Mathematical Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Jiarong Ouyang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Bin Zhang
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Alexander J Towbin
- Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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15
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Trout AT, Squires JH, Rees MA, Plunk MR, Murati MA, Marine MB, Browne LP, Anupindi SA, Abu-El-Haija M. Consensus Minimum MRI Protocol for the Child With Acute Recurrent or Chronic Pancreatitis. AJR Am J Roentgenol 2024; 222:e2329940. [PMID: 37646385 PMCID: PMC10921424 DOI: 10.2214/ajr.23.29940] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Imaging plays an important role in the diagnosis and follow-up of children with acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP). Consensus is lacking for a minimum MRI protocol for the child with known or suspected ARP or CP. Lack of standardization contributes to variable diagnostic performance and hampers application of uniform interpretive criteria for clinical diagnosis and multicenter research studies. We convened a working group to achieve consensus for a minimum MRI protocol for children with suspected ARP or CP. The group included eight pediatric radiologists experienced in interpreting MRI for pediatric pancreatitis and one medical pancreatologist and functioned from November 2022 to March 2023. Existing clinical protocols were summarized across sites represented by group members, and commonly used sequences guided the group's discussion. The final consensus minimum MRI protocol includes five noncontrast sequences and two postcontrast sequences (which are required only in select clinical scenarios). The working group also provides recommended acquisition parameters, sequence-specific technical suggestions, and general recommendations for optimal imaging technique. We recommend that all sites imaging children with ARP and CP for clinical care, and particularly those engaged in cooperative group trials for pancreatitis, ensure that their local protocol includes these minimum sequences.
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Affiliation(s)
- Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Judy H Squires
- Department of Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Mitchell A Rees
- Department of Radiology, Nationwide Children's Hospital, Columbus, OH
| | - Matthew R Plunk
- Department of Radiology, Children's Wisconsin, Milwaukee, WI
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI
| | - Michael A Murati
- Department of Radiology, University of Minnesota Masonic Children's Hospital, Minneapolis, MN
| | - Meghan B Marine
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN
- Department of Pediatric Radiology, Riley Hospital for Children, Indianapolis, IN
| | - Lorna P Browne
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO
- Department of Pediatric Radiology, Children's Hospital of Colorado, Aurora, CO
| | - Sudha A Anupindi
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Maisam Abu-El-Haija
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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16
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Derinkuyu BE, Dillman JR, Lubert AM, Palermo JJ, Opotowsky AR, Trout AT. Associations of Liver Stiffness Measured by Ultrasound Shear-Wave Elastography With Portal Hypertension and Circulatory Failure in Individuals With Fontan Circulation. AJR Am J Roentgenol 2024; 222:e2329640. [PMID: 37530396 DOI: 10.2214/ajr.23.29640] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
BACKGROUND. The Fontan operation palliates single-ventricle congenital heart disease but causes hepatic congestion with associated progressive hepatic fibrosis. OBJECTIVE. The purpose of this study was to evaluate associations between liver stiffness measured using ultrasound (US) shear-wave elastography (SWE) in patients with Fontan palliation and the occurrence of portal hypertension and Fontan circulatory failure during follow-up. METHODS. This retrospective study included 119 individuals 10 years old or older (median age, 19.1 years; 61 female patients, 58 male patients) with Fontan circulation who underwent liver US with 2D SWE from January 1, 2015, to January 1, 2022, and had 1 year or more of clinical follow-up (unless experiencing earlier outcome-related events). Median liver stiffness from the initial US examination was documented. Varices, ascites, splenomegaly, and thrombocytopenia (VAST) scores (range, 0-4) were determined as a marker of portal hypertension on initial US examination and 1 year or more of follow-up imaging (US, CT, or MRI). Composite clinical outcome for Fontan circulatory failure (death, mechanical circulatory support, cardiac transplant, or unexpected Fontan circulation-related hospitalization) was assessed. Analysis included the Wilcoxon rank sum test, logistic regression analysis with stepwise variable selection, and ROC analysis. RESULTS. Median initial liver stiffness was 2.22 m/s. Median initial VAST score was 0 (IQR, 0-1); median follow-up VAST score was 1 (IQR, 0-2) (p = .004). Fontan circulatory failure occurred in 37 of 119 (31%) patients (median follow-up, 3.4 years). Initial liver stiffness was higher in patients with a follow-up VAST score of 1 or greater (2.37 m/s) than in those with a follow-up VAST score of 0 (2.08 m/s) (p = .005), and initial liver stiffness was higher in patients with (2.43 m/s) than without (2.10 m/s) Fontan circulatory failure during follow-up (p < .001). Initial liver stiffness was the only significant independent predictor of Fontan circulatory failure (OR = 3.76; p < .001); age, sex, Fontan operation type, dominant ventricular morphology, and initial VAST score were not independent predictors. Initial liver stiffness had an AUC of 0.70 (sensitivity, 79%; specificity, 57%; threshold, > 2.11 m/s) for predicting a follow-up VAST score of 1 or greater and an AUC of 0.74 (sensitivity, 84%; specificity, 52%; threshold, > 2.12 m/s) for predicting Fontan circulatory failure. CONCLUSION. In patients with Fontan circulation, increased initial liver stiffness was associated with portal hypertension and circulatory failure during follow-up, although it had moderate performance in predicting these outcomes. CLINICAL IMPACT. US SWE may play a role in post-Fontan surveillance, supporting tailored medical and surgical care.
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Affiliation(s)
- Betul E Derinkuyu
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Adam M Lubert
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Joseph J Palermo
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Alexander R Opotowsky
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
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17
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Khanna G, Trout AT, Offiah AC. Celebrating 50 years of Pediatric Radiology. Pediatr Radiol 2023; 53:2571. [PMID: 38038735 DOI: 10.1007/s00247-023-05821-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Affiliation(s)
- Geetika Khanna
- Department of Radiology & Imaging Sciences, Emory University and Children's Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, GA, 30322, USA.
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Amaka C Offiah
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- Department of Radiology, Sheffield Children's NHS Foundation Trust, Sheffield, UK
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18
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Dillman JR, Trout AT. Multisample Ultrasound Point Shear Wave Elastography of the Liver: Repeatability and Agreement With Conventional Point Shear Wave Elastography. J Ultrasound Med 2023; 42:2749-2756. [PMID: 37615225 DOI: 10.1002/jum.16309] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE To characterize the technical performance of a multisample ultrasound point shear wave elastography (pSWE) technique that allows 15 individual measurements of liver stiffness in a single acquisition. METHODS In 56 overweight and obese adults, research ultrasound examinations were performed using conventional pSWE and multisample pSWE (Sequoia; Siemens Healthineers). Five independent measurements were acquired with the conventional technique over five consecutive breath holds (5C1 and DAX transducers). A single multisample acquisition (DAX transducer) of up to 15 unique measurements was acquired during a single breath hold. All imaging was performed before (baseline) and after a "coffee break" (repeat). Median liver stiffness measurements between techniques and between baseline and repeat imaging were compared using Pearson correlation (r) and intra-class correlation (ICC) coefficients. RESULTS Mean participant age was 33.7 ± 11.4 years; 40 participants were female. There was high correlation between conventional pSWE measurements obtained using the 5C1 and DAX transducers at baseline (r = .75 [95% CI: 0.61-0.85], P < .0001) and repeat (r = .88 [95% CI: 0.78-0.92], P < .0001). There was moderate agreement between conventional pSWE measurements obtained using the 5C1 and DAX transducers at baseline (ICC = 0.69 [95% CI: 0.52-0.81]), and good agreement at repeat (ICC = 0.81 [95% CI: 0.65-0.90]). There was moderate correlation (r = .59 [95% CI: 0.39-0.74], P < .0001) and moderate agreement (ICC = 0.58 [95% CI: 0.38-0.73]) between baseline conventional and multisample pSWE measurements acquired using the DAX transducer; there was high correlation (r = .73 [95% CI: 0.57-0.83], P < .0001) and moderate agreement (ICC = 0.72 [95% CI: 0.56-0.82] between techniques at repeat. There was moderate correlation (r = .65 [95% CI: 0.46-0.78], P < .0001) and moderate agreement (ICC = 0.64 [95% CI: 0.45-0.77]) between baseline and repeat multisample pSWE measurements. CONCLUSIONS Multisample pSWE, allowing up to 15 measurements in a single breath hold, showed moderate to high correlation and moderate agreement with conventional pSWE.
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Affiliation(s)
- Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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19
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Wayland JL, Doll JR, Lawson MJ, Stankiewicz TE, Oates JR, Sawada K, Damen MSMA, Alarcon PC, Haslam DB, Trout AT, DeFranco EA, Klepper CM, Woo JG, Moreno-Fernandez ME, Mouzaki M, Divanovic S. Thermoneutral Housing Enables Studies of Vertical Transmission of Obesogenic Diet-Driven Metabolic Diseases. Nutrients 2023; 15:4958. [PMID: 38068816 PMCID: PMC10708424 DOI: 10.3390/nu15234958] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 11/19/2023] [Accepted: 11/22/2023] [Indexed: 12/18/2023] Open
Abstract
Vertical transmission of obesity is a critical contributor to the unabated obesity pandemic and the associated surge in metabolic diseases. Existing experimental models insufficiently recapitulate "human-like" obesity phenotypes, limiting the discovery of how severe obesity in pregnancy instructs vertical transmission of obesity. Here, via utility of thermoneutral housing and obesogenic diet feeding coupled to syngeneic mating of WT obese female and lean male mice on a C57BL/6 background, we present a tractable, more "human-like" approach to specifically investigate how maternal obesity contributes to offspring health. Using this model, we found that maternal obesity decreased neonatal survival, increased offspring adiposity, and accelerated offspring predisposition to obesity and metabolic disease. We also show that severe maternal obesity was sufficient to skew offspring microbiome and create a proinflammatory gestational environment that correlated with inflammatory changes in the offspring in utero and adulthood. Analysis of a human birth cohort study of mothers with and without obesity and their infants was consistent with mouse study findings of maternal inflammation and offspring weight gain propensity. Together, our results show that dietary induction of obesity in female mice coupled to thermoneutral housing can be used for future mechanistic interrogations of obesity and metabolic disease in pregnancy and vertical transmission of pathogenic traits.
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Affiliation(s)
- Jennifer L. Wayland
- Immunology Graduate Program, University of Cincinnati College of Medicine, Cincinnati, OH 45220, USA
- Medical Scientist Training Program, University of Cincinnati College of Medicine, Cincinnati, OH 45220, USA
- Division of Immunobiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Jessica R. Doll
- Division of Immunobiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Matthew J. Lawson
- Division of Immunobiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Traci E. Stankiewicz
- Division of Immunobiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Jarren R. Oates
- Immunology Graduate Program, University of Cincinnati College of Medicine, Cincinnati, OH 45220, USA
- Division of Immunobiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Keisuke Sawada
- Immunology Graduate Program, University of Cincinnati College of Medicine, Cincinnati, OH 45220, USA
- Medical Scientist Training Program, University of Cincinnati College of Medicine, Cincinnati, OH 45220, USA
- Division of Immunobiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Michelle S. M. A. Damen
- Division of Immunobiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Pablo C. Alarcon
- Immunology Graduate Program, University of Cincinnati College of Medicine, Cincinnati, OH 45220, USA
- Medical Scientist Training Program, University of Cincinnati College of Medicine, Cincinnati, OH 45220, USA
- Division of Immunobiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - David B. Haslam
- Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45220, USA
| | - Andrew T. Trout
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45220, USA
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH 45220, USA
| | - Emily A. DeFranco
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH 45220, USA
| | - Corie M. Klepper
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Jessica G. Woo
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45220, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Maria E. Moreno-Fernandez
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45220, USA
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Marialena Mouzaki
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45220, USA
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Senad Divanovic
- Immunology Graduate Program, University of Cincinnati College of Medicine, Cincinnati, OH 45220, USA
- Medical Scientist Training Program, University of Cincinnati College of Medicine, Cincinnati, OH 45220, USA
- Division of Immunobiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45220, USA
- Center for Inflammation and Tolerance, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
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20
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Browne WF, Sung J, Majdalany BS, Khaja MS, Calligaro K, Contrella BN, Ferencik M, Gunn AJ, Kapoor BS, Keefe NA, Kokabi N, Kramer CM, Kwun R, Shamoun F, Sharma AM, Steenburg SD, Trout AT, Vijay K, Wang DS, Steigner ML. ACR Appropriateness Criteria® Sudden Onset of Cold, Painful Leg: 2023 Update. J Am Coll Radiol 2023; 20:S565-S573. [PMID: 38040470 DOI: 10.1016/j.jacr.2023.08.012] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
Acute onset of a cold, painful leg, also known as acute limb ischemia, describes the sudden loss of perfusion to the lower extremity and carries significant risk of morbidity and mortality. Acute limb ischemia requires rapid identification and the management of suspected vascular compromise and is inherently driven by clinical considerations. The objectives of initial imaging include confirmation of diagnosis, identifying the location and extent of vascular occlusion, and preprocedural/presurgical planning. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | - Jeffrey Sung
- Research Author, Weill Cornell Medical College, New York, New York
| | - Bill S Majdalany
- Panel Chair, University of Vermont Medical Center, Burlington, Vermont
| | - Minhaj S Khaja
- Panel Vice-Chair, University of Michigan, Ann Arbor, Michigan
| | - Keith Calligaro
- Pennsylvania Hospital, Philadelphia, Pennsylvania; Society for Vascular Surgery
| | | | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon; Society of Cardiovascular Computed Tomography
| | - Andrew J Gunn
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Nicole A Keefe
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | | | - Christopher M Kramer
- University of Virginia Health, Charlottesville, Virginia; Society for Cardiovascular Magnetic Resonance
| | - Richard Kwun
- Swedish Medical Center, Issaquah, Washington; American College of Emergency Physicians
| | - Fadi Shamoun
- Mayo Clinic Arizona, Phoenix, Arizona; American Society of Echocardiography
| | - Aditya M Sharma
- University of Virginia Health System, Charlottesville, Virginia, Primary care physician
| | - Scott D Steenburg
- Indiana University School of Medicine and Indiana University Health, Indianapolis, Indiana; Committee on Emergency Radiology-GSER
| | - Andrew T Trout
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Commission on Nuclear Medicine and Molecular Imaging
| | - Kanupriya Vijay
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - David S Wang
- Stanford University Medical Center, Stanford, California
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21
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Baird TA, Wright DR, Britto MT, Lipstein EA, Trout AT, Hayatghaibi SE. Patient Preferences in Diagnostic Imaging: A Scoping Review. Patient 2023; 16:579-591. [PMID: 37667148 DOI: 10.1007/s40271-023-00646-7] [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] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND As new diagnostic imaging technologies are adopted, decisions surrounding diagnostic imaging become increasingly complex. As such, understanding patient preferences in imaging decision making is imperative. OBJECTIVES We aimed to review quantitative patient preference studies in imaging-related decision making, including characteristics of the literature and the quality of the evidence. METHODS The Pubmed, Embase, EconLit, and CINAHL databases were searched to identify studies involving diagnostic imaging and quantitative patient preference measures from January 2000 to June 2022. Study characteristics that were extracted included the preference elicitation method, disease focus, and sample size. We employed the PREFS (Purpose, Respondents, Explanation, Findings, Significance) checklist as our quality assessment tool. RESULTS A total of 54 articles were included. The following methods were used to elicit preferences: conjoint analysis/discrete choice experiment methods (n = 27), contingent valuation (n = 16), time trade-off (n = 4), best-worst scaling (n = 3), multicriteria decision analysis (n = 3), and a standard gamble approach (n = 1). Half of the studies were published after 2016 (52%, 28/54). The most common scenario (n = 39) for eliciting patient preferences was cancer screening. Computed tomography, the most frequently studied imaging modality, was included in 20 studies, and sample sizes ranged from 30 to 3469 participants (mean 552). The mean PREFS score was 3.5 (standard deviation 0.8) for the included studies. CONCLUSIONS This review highlights that a variety of quantitative preference methods are being used, as diagnostic imaging technologies continue to evolve. While the number of preference studies in diagnostic imaging has increased with time, most examine preventative care/screening, leaving a gap in knowledge regarding imaging for disease characterization and management.
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Affiliation(s)
- Trey A Baird
- University of Cincinnati, College of Medicine, Cincinnati, OH, USA
| | - Davene R Wright
- Division of Child Health Research and Policy, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Maria T Britto
- University of Cincinnati, College of Medicine, Cincinnati, OH, USA
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Ellen A Lipstein
- University of Cincinnati, College of Medicine, Cincinnati, OH, USA
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Andrew T Trout
- University of Cincinnati, College of Medicine, Cincinnati, OH, USA
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Shireen E Hayatghaibi
- University of Cincinnati, College of Medicine, Cincinnati, OH, USA.
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
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22
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Trout AT. Expanding the reach of nuclear medicine by bringing imaging to the patient. Pediatr Radiol 2023; 53:2434-2435. [PMID: 37775541 DOI: 10.1007/s00247-023-05781-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 10/01/2023]
Affiliation(s)
- Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 5031, Cincinnati, OH, 45229, USA.
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23
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Hayatghaibi SE, Kandil AI, Zhang B, Alves VV, Ayyala RS, Dillman JR, Trout AT. Trends in Anesthesia/Sedation for Computed Tomography and Magnetic Resonance Imaging Encounters in Pediatric Emergency Departments, 2012-2022. JAMA Pediatr 2023; 177:1105-1107. [PMID: 37578776 PMCID: PMC10425861 DOI: 10.1001/jamapediatrics.2023.2832] [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: 04/17/2023] [Accepted: 05/27/2023] [Indexed: 08/15/2023]
Abstract
This cross-sectional study assesses trends over time in sedation/anesthesia use for computed tomography (CT) and magnetic resonance imaging (MRI) across pediatric emergency departments (EDs).
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Affiliation(s)
- Shireen E. Hayatghaibi
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Ali I. Kandil
- Department of Anesthesiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Bin Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Vinicius V. Alves
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Rama S. Ayyala
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Jonathan R. Dillman
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Andrew T. Trout
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
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24
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Najashi KA, Najashi NA, Ahmed T, Abdelnaeem R, Alolit S, Zuaybir AA, Atiyah M, Trout AT, Alsaied T, Veldtman GR. The prognostic role of liver volumetry in Fontan patients. Cardiol Young 2023; 33:1834-1839. [PMID: 36258282 DOI: 10.1017/s1047951122002992] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND HYPOTHESES High venous pressures and associated hepatic congestion are important drivers for Fontan-associated liver disease. The prognostic significance of hepatomegaly as a marker of congestion however is not well defined and is further explored in this research study. METHODS Fontan patients who have had liver ultrasound scans were identified from the Prince Sultan Cardiac Centre Fontan Database and had their anatomic, surgical, clinical histories abstracted from the electronic medical records following institutional ethics approval. Liver volumes were determined retrospectively from reviewing individual US images, and these, divided into tertiles, were analysed in the context of the predefined endpoints of (i) Primary - death or heart or liver transplantation, or (ii) Secondary - combined endpoint of death, transplantation, arrhythmia, or protein-losing enteropathy. RESULTS Mean indexed liver volumes for the entire cohort (n = 199) were 1065.1 ± 312.1 ml/m2, range 387 to 2071 ml/m2. Patients with the largest liver volumes (highest tertile) were less likely to have a functioning fenestration compared to those in the lowest tertile 44% versus 56% p = 0.016 and experienced the highest burden of mortality and heart or heart-liver transplantation, p = 0.016, and were more likely to reach the composite endpoint of death, protein-losing enteropathy, arrhythmia, or transplantation, p = 0.010. Liver volumes had an overall predictive accuracy for the combined outcome of 61% (CI 53%, 67%, p = 0.009). CONCLUSIONS Liver volumetry may serve as a potentially important congestion biomarker for adverse outcomes after the Fontan operation.
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Affiliation(s)
- Khalid Al Najashi
- Pediatric Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Nejoud Al Najashi
- Radiology Department, Prince Sultan Medical Military City, Riyadh, Saudi Arabia
| | - Taghreed Ahmed
- Pediatric Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Rayan Abdelnaeem
- Pediatric Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Sultan Alolit
- Radiology Department, Prince Sultan Medical Military City, Riyadh, Saudi Arabia
| | - Amani Al Zuaybir
- Radiology Department, Prince Sultan Medical Military City, Riyadh, Saudi Arabia
| | - Merna Atiyah
- Pediatric Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Tarek Alsaied
- Paediatric Cardiology, UPMC Children's Hospital of Pittsburgh, PA, USA
| | - Gruschen R Veldtman
- Scottish Adult Congenital Cardiac Service, Golden Jubilee National Hospital, Glasgow, Scotland, UK
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25
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P V Alves V, T Trout A, Dewit M, Mouzaki M, Arce-Clachar AC, S Bramlage K, R Dillman J, A Xanthakos S. Clinical Performance of Transient Elastography With Comparison to Quantitative Magnetic Resonance Imaging, Ultrasound, and Biopsy in Children and Adolescents With Known or Suspected Fatty Liver Disease. Child Obes 2023; 19:461-469. [PMID: 36269577 DOI: 10.1089/chi.2022.0136] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Indexed: 01/07/2023]
Abstract
Background: Performance of vibration-controlled transient elastography (VCTE) is inadequately validated in pediatric nonalcoholic fatty liver disease (NAFLD). We aimed to assess the technical performance of VCTE in pediatric NAFLD and define the agreement between VCTE and reference standards of imaging and/or biopsy. Methods: This prospective study recruited participants with known or suspected NAFLD who underwent a research VCTE examination (FibroScan Mini 430). Ten valid VCTE liver stiffness measurements (kPa) and controlled attenuation parameter (CAP) (dB/m) measurements were obtained for each participant. Available clinically acquired MR elastography and magnetic resonance imaging proton density fat fraction (PDFF), liver ultrasound shear wave elastography, and biopsy served as references standards. Results: Eighty-four consecutive participants were included (55 males, mean age 15.0 ± 3.5 years, mean BMI 36.6 ± 9.4 kg/m2). VCTE examinations were complete in 80/83 participants. 37/83 participants were examined with an XL probe. There was no significant correlation between CAP and PDFF [n = 16; r = 0.17 (95% confidence interval [CI]: -0.34 to 0.61), p = 0.5] or between VCTE liver stiffness and MR elastography stiffness [n = 27; r = 0.31 (95% CI: -0.07 to 0.62), p = 0.10]. For prediction of any fibrosis stage ≥1 on biopsy (n = 9/15 participants), VCTE median liver stiffness >5.1 kPA had an area under receiver operating characteristic curve of 0.52 (95% CI: 0.26-0.78) with a sensitivity of 88.9% and specificity of 16.6% (p > 0.99). Conclusions: Complete VCTE examinations could be obtained in most pediatric patients with NAFLD. Neither VCTE liver stiffness nor CAP correlated well with measures of liver fat or stiffness by established imaging modalities and biopsy.
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Affiliation(s)
- Vinicius P V Alves
- Department of Radiology and Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Andrew T Trout
- Department of Radiology and Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Radiology and University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Morgan Dewit
- Department of Radiology and Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Marialena Mouzaki
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ana Catalina Arce-Clachar
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kristin S Bramlage
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jonathan R Dillman
- Department of Radiology and Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Radiology and University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Stavra A Xanthakos
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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26
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Trout AT, Norris RE, de Blank PMK, Backus LR, Towbin AJ, Nash JM. Clinical trials: A plea to cooperative groups, consortia, pharmaceutical companies, and lead investigators for reasonable imaging protocols. Pediatr Blood Cancer 2023; 70:e30362. [PMID: 37057805 DOI: 10.1002/pbc.30362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 04/15/2023]
Affiliation(s)
- Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Robin E Norris
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Peter M K de Blank
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lori R Backus
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Alexander J Towbin
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jaylynn M Nash
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Green S, Mouzaki M, Abu Ata N, Trout AT. Prevalence of incidental sonographic findings of hepatic steatosis in children under 4 years of age. Pediatr Radiol 2023; 53:2221-2228. [PMID: 37563321 DOI: 10.1007/s00247-023-05729-z] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND The age of onset of nonalcoholic fatty liver disease (NAFLD) and its prevalence in young children is incompletely understood. OBJECTIVE We sought to evaluate the prevalence of ultrasound findings of hepatic steatosis in a cohort of children less than 4 years of age. MATERIALS AND METHODS This is an institutional review board-approved retrospective review of ultrasounds performed on children less than 4 years of age from January 2022 to August 2022 at a single quaternary care center. Two independent blinded reviewers evaluated for qualitative and semi-quantitative findings of hepatic steatosis. Per prior literature, hepatorenal index (HRI)>1.75 was used as a threshold suggestive of hepatic steatosis. Chi-square, Mann-Whitney U test, and logistic regression analyses were performed for univariable and multivariable statistical analyses. Kappa statistics were used to assess agreement between reviewers. RESULTS Eighty-five males and 102 females, median age of 1.1 years (interquartile range 2.1 years), were included. Qualitative findings of hepatic steatosis were seen in 26/187 (14%; 95% CI 10-20%). An HRI>1.75 was present in 15/187 (8%; 95% CI: 5-13%) of examinations, including 11 females and 4 males, and 7/123 (6%) participants <2 years old. Among participants with overweight or obesity, 8/43 (19%) had HRI>1.75 vs. 7/144 (5%) participants without overweight or obesity (P=0.004). Each percentile increase in anthropometrics percentile (weight-to-length or BMI, depending on age) was associated with 22 increased odds of HRI>1.75 (P=0.02). CONCLUSION Prevalence of sonographic findings of hepatic steatosis in an unselected sample of preschool-age children is 8-14%, and are more common in participants with overweight/obesity.
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Affiliation(s)
- Shannon Green
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Marialena Mouzaki
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Nadeen Abu Ata
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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28
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Swauger SE, Fashho K, Hornung LN, Elder DA, Thapaliya S, Anton CG, Trout AT, Abu-El-Haija M. Association of pancreatic fat on imaging with pediatric metabolic co-morbidities. Pediatr Radiol 2023; 53:2030-2039. [PMID: 37106090 PMCID: PMC10915690 DOI: 10.1007/s00247-023-05669-8] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND The relationship between pancreatic fat on imaging and metabolic co-morbidities has not been established in pediatrics. We sought to investigate the relationship between pancreatic fat measured by MRI and endocrine/exocrine dysfunctions along with the metabolic co-morbidities in a cohort of children. OBJECTIVE To investigate relationships between pancreatic fat quantified by MRI and endocrine and exocrine conditions and metabolic co-morbidities in a cohort of children. MATERIALS AND METHODS: This was a retrospective review of pediatric patients (n = 187) who had a clinically indicated MRI examination between May 2018 and February 2020. After 51 patients without useable imaging data were excluded, the remaining 136 subjects comprised the study sample. Laboratory studies were assessed if collected within 6 months of MRI and patient charts were reviewed for demographic and clinical information. MRI proton density fat fraction (PDFF) sequence had been acquired according to manufacturer's specified parameters at a slice thickness of 3 mm. Two blinded radiologists independently collected PDFF data. RESULTS The median age at MRI was 12.1 (IQR: 9.0-14.8) years and the majority of patients were Caucasian (79%), followed by African American and Hispanic at 12% and 11% respectively. There was a higher median pancreas fat fraction in patients with exocrine conditions (chronic pancreatitis or exocrine insufficiency) compared to those without (3.5% vs 2.2%, p = 0.03). There was also a higher median fat fraction in the head of pancreas in patients with endocrine insufficient conditions (insulin resistance, pre-diabetes, type 1 and type 2 diabetes) compared to those without endocrine insufficiency when excluding patients with active acute pancreatitis (3.5% vs 2.0%, p = 0.04). Patients with BMI > 85% had higher mean fat fraction compared to patients with BMI ≤ 85% (head: 3.8 vs 2.4%, p = 0.01; body: 3.8 vs 2.5%, p = 0.005; tail: 3.7 vs 2.7%, p = 0.049; overall pancreas fat fraction: 3.8 vs 2.6%, p = 0.002). CONCLUSION Pancreas fat is elevated in patients with BMI > 85% and in those with exocrine and endocrine insufficiencies.
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Affiliation(s)
- Sarah E Swauger
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- Division of Pediatric Endocrinology, University of Kentucky College of Medicine, 2195 Harrodsburg Rd, Suite 125, Lexington, KY, 40504, USA.
| | - Kaity Fashho
- Division of Pediatrics, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Lindsey N Hornung
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Deborah A Elder
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Samjhana Thapaliya
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Christopher G Anton
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Andrew T Trout
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Maisam Abu-El-Haija
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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29
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Hafiz R, Kocaoglu M, Trout AT. Comparison of phase contrast magnetic resonance imaging and scintigraphy for determination of split pulmonary blood flow in children and young adults with congenital heart disease. Pediatr Radiol 2023; 53:2040-2047. [PMID: 37271756 DOI: 10.1007/s00247-023-05693-8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Measurement of differential blood flow to the lungs is important to understanding flow dynamics in the setting of congenital heart disease. Split blood flow via the pulmonary arteries guides and demonstrates the effect of interventions. Minimally invasive imaging of pulmonary blood flow can be achieved with scintigraphy or magnetic resonance imaging (MRI). OBJECTIVE To assess agreement of pulmonary blood flow measurements obtained by scintigraphy and MRI in children and young adults. MATERIALS AND METHODS We performed a retrospective review of patients < 21 years of age who had undergone both nuclear medicine pulmonary perfusion scans (Tc-99 m MAA) and cardiac MRI examinations from January 2012 to August 2021 at our tertiary pediatric hospital. Patient demographics, medical/surgical information, and estimates of split blood flow by both modalities were recorded. Pearson's correlation coefficient was used to determine the relationship between split blood flow measured by the two examinations. Agreement was calculated using interclass correlation coefficient (ICC) for absolute agreement and Bland-Altman difference analysis. RESULTS Correlation between split blood flow measured by scintigraphy and MRI using net flow was 0.90 (95% CI: 0.83-0.94, P < 0.001) and the ICC for agreement on split blood flow was 0.90 (95% CI: 0.84-0.94). Mean difference in split blood flow by Bland-Altman analysis was 0.79% with 95% limits of agreement (-11.2 to 12.8%). CONCLUSION There is excellent agreement between Tc-99 m scintigraphy and phase contrast MRI for quantification of split pulmonary blood flow in children and young adults with congenital heart disease.
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Affiliation(s)
- Rawan Hafiz
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3835 Edwards Road Apt. 520, Cincinnati, OH, 45209, USA.
| | - Murat Kocaoglu
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3835 Edwards Road Apt. 520, Cincinnati, OH, 45209, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3835 Edwards Road Apt. 520, Cincinnati, OH, 45209, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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30
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Eklund MJ, States LJ, Acord MR, Alazraki AL, Behr GG, El-Ali AM, Morin CE, Saigal G, Shet NS, Thacker PG, Trout AT. Imaging of pediatric pancreas tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper. Pediatr Blood Cancer 2023; 70 Suppl 4:e29975. [PMID: 36215203 PMCID: PMC10642208 DOI: 10.1002/pbc.29975] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 11/10/2022]
Abstract
Primary pancreatic tumors in children are rare with an overall age-adjusted incidence of 0.018 new cases per 100,000 pediatric patients. The most prevalent histologic type is the solid pseudopapillary neoplasm, followed by pancreatoblastoma. This paper describes relevant imaging modalities and presents consensus-based recommendations for imaging at diagnosis and follow-up.
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Affiliation(s)
- Meryle J Eklund
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lisa J States
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Michael R Acord
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Adina L Alazraki
- Departments of Pediatrics and Radiology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Gerald G Behr
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Alexander M El-Ali
- Department of Radiology, NYU Grossman School of Medicine, New York, New York, USA
| | - Cara E Morin
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Gaurav Saigal
- Department of Radiology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Narendra S Shet
- Department of Diagnostic Imaging and Radiology, Children's National Hospital, Washington, District of Columbia, USA
| | - Paul G Thacker
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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31
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Squires JH, Martinez-Rios C, Davis JC, Dietz KR, Epelman MS, Lai HA, Lim-Dunham JE, McDaniel JD, Mhlanga JC, Pandit-Taskar N, Parisi MT, Trout AT, Weidman EK, Alazraki AL. Imaging of pediatric thyroid tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper. Pediatr Blood Cancer 2023; 70 Suppl 4:e29957. [PMID: 36165682 PMCID: PMC10658740 DOI: 10.1002/pbc.29957] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 11/09/2022]
Abstract
Pediatric thyroid cancer is rare in children; however, incidence is increasing. Papillary thyroid cancer and follicular thyroid cancer are the most common subtypes, comprising about 90% and 10% of cases, respectively. This paper provides consensus imaging recommendations for evaluation of pediatric patients with thyroid cancer at diagnosis and during follow-up.
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Affiliation(s)
- Judy H Squires
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Claudia Martinez-Rios
- Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medical Imaging, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - James C Davis
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kelly R Dietz
- Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Monica S Epelman
- Department of Radiology, Nicklaus Children's Hospital, Miami, Florida, USA
| | - Hollie A Lai
- CHOC-Children's Health Orange County, Orange, California, USA
| | - Jennifer E Lim-Dunham
- Department of Radiology, Loyola University Stritch School of Medicine, Maywood, Illinois, USA
| | - Janice D McDaniel
- Department of Radiology, Akron Children's Hospital, Akron, Ohio, USA
- Department of Radiology, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Joyce C Mhlanga
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Neeta Pandit-Taskar
- Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
- Department of Radiology, Weill Cornell Medical College, New York City, New York, USA
| | - Marguerite T Parisi
- Departments of Radiology and Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Elizabeth K Weidman
- Department of Radiology, Weill Cornell Medicine - New York Presbyterian Hospital, New York City, New York, USA
| | - Adina L Alazraki
- Department of Radiology, Division of Pediatric Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Radiology, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
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32
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Lai HA, Sharp SE, Bhatia A, Dietz KR, McCarville B, Rajderkar D, Servaes S, Shulkin BL, Singh S, Trout AT, Watal P, Parisi MT. Imaging of pediatric neuroblastoma: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper. Pediatr Blood Cancer 2023; 70 Suppl 4:e29974. [PMID: 36184716 PMCID: PMC10680359 DOI: 10.1002/pbc.29974] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/07/2022]
Abstract
Neuroblastoma is the most common extracranial solid neoplasm in children. This manuscript provides consensus-based imaging recommendations for pediatric neuroblastoma patients at diagnosis and during follow-up.
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Affiliation(s)
- Hollie A. Lai
- Department of Radiology, Children’s Health Orange County, Orange, CA
| | - Susan E. Sharp
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Aashim Bhatia
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Kelly R. Dietz
- Department of Radiology, University of Minnesota, Minneapolis, MN
| | - Beth McCarville
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN
| | | | - Sabah Servaes
- Department of Radiology, West Virginia University Children’s Hospital, Morgantown, WV
| | - Barry L. Shulkin
- Department of Diagnostic Imaging, University of TN Health Science Center, St. Jude Children’s Research Hospital, Memphis, TN
| | - Sudha Singh
- Department of Radiology, Monroe Carrell Jr Children’s Hospital, Vanderbilt University, Nashville, TN
| | - Andrew T. Trout
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Pankaj Watal
- Department of Radiology, Nemours Children’s Hospital, Florida and University of Central Florida College of Medicine, Orlando, FL
| | - Marguerite T. Parisi
- Departments of Radiology and Pediatrics, University of Washington School of Medicine and Seattle Children’s Hospital, Seattle, WA
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33
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Campbell AP, Qiu L, Dillman JR, Trout AT, Szabo S, Lopez-Nunez OF, Pugmire BS, Schapiro AH. Endemic mycoses in children in North America: a review of radiologic findings. Pediatr Radiol 2023; 53:984-1004. [PMID: 36922418 PMCID: PMC10017348 DOI: 10.1007/s00247-023-05636-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 08/13/2022] [Revised: 02/17/2023] [Accepted: 02/17/2023] [Indexed: 03/18/2023]
Abstract
Clinically significant endemic mycoses (fungal infections) in the United States (U.S.) include Blastomyces dermatitidis, Histoplasma capsulatum, and Coccidioides immitis/posadasii. While the majority of infections go clinically unnoticed, symptomatic disease can occur in immunocompromised or hospitalized patients, and occasionally in immune-competent individuals. Clinical manifestations vary widely and their diagnosis may require fungal culture, making the rapid diagnosis a challenge. Imaging can be helpful in making a clinical diagnosis prior to laboratory confirmation, as well as assist in characterizing disease extent and severity. In this review, we discuss the three major endemic fungal infections that occur in the U.S., including mycology, epidemiology, clinical presentations, and typical imaging features with an emphasis on the pediatric population.
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Affiliation(s)
- Abraham P Campbell
- Department of Radiology, MLC 5031, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Lisa Qiu
- Department of Radiology, MLC 5031, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Jonathan R Dillman
- Department of Radiology, MLC 5031, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Andrew T Trout
- Department of Radiology, MLC 5031, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Sara Szabo
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Oscar F Lopez-Nunez
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Brian S Pugmire
- Department of Radiology, Rady Children's Hospital San Diego, San Diego, CA, USA
| | - Andrew H Schapiro
- Department of Radiology, MLC 5031, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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34
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Bigelow AM, Riggs KW, Morales DLS, Opotowsky AR, Lubert AM, Dillman JR, Veldtman GR, Heydarian HC, Trout AT, Cooper DS, Goldstein SL, Chin C, Palermo JJ, Ollberding NJ, Mays WA, Alsaied T. Isosorbide DiNitrate Effect on Hemodynamic Profile, Liver Stiffness, and Exercise Tolerance in Fontan Circulation (The NEET Clinical Trial). Pediatr Cardiol 2023:10.1007/s00246-023-03156-3. [PMID: 37084132 PMCID: PMC10119822 DOI: 10.1007/s00246-023-03156-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/27/2023] [Indexed: 04/22/2023]
Abstract
After Fontan operation, decreased venous capacitance and venoconstriction are adaptive mechanisms to maintain venous return and cardiac output. The consequent higher venous pressure may adversely impact end-organ function, exercise capacity and result in worse clinical outcomes. This pilot study evaluated the safety and effect of isosorbide dinitrate (ISDN), a venodilator, on exercise capacity, peripheral venous pressure (PVP), and liver stiffness in patients with Fontan circulation. In this prospective single-arm trial, 15 individuals with Fontan circulation were evaluated at baseline and after 4 weeks of therapeutic treatment with ISDN. Primary aims were to assess the safety of ISDN and the effect on maximal exercise. We also aimed to evaluate the effect of ISDN on ultrasound-assessed liver stiffness, markers of submaximal exercise, and PVP at rest and peak exercise. Repeated measures t-tests were used to assess change in variables of interest in response to ISDN. Mean age was 23.5 ± 9.2 years (range 11.2-39.0 years), and 10/15 (67%) were male. There was no statistically significant change in peak VO2 (1401 ± 428 to 1428 ± 436 mL/min, p = 0.128), but VO2 at the anaerobic threshold increased (1087 ± 313 to 1115 ± 302 mL/min, p = 0.03). ISDN was also associated with a lower peak exercise PVP (22.5 ± 4.5 to 20.6 ± 3.0 mmHg, p = 0.015). Liver stiffness was lower with ISDN, though the difference was not statistically significant (2.3 ± 0.4 to 2.1 ± 0.5 m/s, p = 0.079). Of the patients completing the trial, mild headache was common (67%), but there were no major adverse events. Treatment with ISDN for 4 weeks is well-tolerated in patients with a Fontan circulation. ISDN is associated with an increase in VO2 at anaerobic threshold, lower peak PVP, and a trend toward lower liver stiffness. Larger, longer duration studies will be necessary to define the impact of ISDN on clinical outcomes in the Fontan circulation.Clinical Trial Registration: URL: https://clinicaltrials.gov . Unique identifier: NCT04297241.
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Affiliation(s)
- Amee M Bigelow
- Department of Pediatrics, The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Drive, Cincinnati, OH, 45229, USA.
- Department of Pediatrics, The Heart Center, Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive, Columbus, OH, 43205, USA.
| | - Kyle W Riggs
- Department of Pediatrics, The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Drive, Cincinnati, OH, 45229, USA
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, Manhasset, NY, USA
| | - David L S Morales
- Department of Pediatrics, The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Drive, Cincinnati, OH, 45229, USA
| | - Alexander R Opotowsky
- Department of Pediatrics, The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Drive, Cincinnati, OH, 45229, USA.
| | - Adam M Lubert
- Department of Pediatrics, The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Drive, Cincinnati, OH, 45229, USA
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Gruschen R Veldtman
- Scottish Adult Congenital Cardiac Service and University of Glasgow, Institute of Cardiovascular Medicine and Sciences, Golden Jubilee Hospital, Glasgow, UK
| | - Haleh C Heydarian
- Department of Pediatrics, The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Drive, Cincinnati, OH, 45229, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - David S Cooper
- Department of Pediatrics, The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Drive, Cincinnati, OH, 45229, USA
| | - Stuart L Goldstein
- Faculty of Medicine, Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Clifford Chin
- Department of Pediatrics, The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Drive, Cincinnati, OH, 45229, USA
| | - Joseph J Palermo
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - Nicholas J Ollberding
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Wayne A Mays
- Department of Pediatrics, The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Drive, Cincinnati, OH, 45229, USA
| | - Tarek Alsaied
- Department of Pediatrics, The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Drive, Cincinnati, OH, 45229, USA
- Pittsburgh Children's Hospital Medical Center, The Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA, USA
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35
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Saad M, Vitale DS, Lin TK, Thapaliya S, Zhou Y, Zhang B, Trout AT, Abu-El-Haija M. Image or scope: Magnetic resonance imaging and endoscopic testing for exocrine and endocrine pancreatic insufficiency in children. Pancreatology 2023:S1424-3903(23)00099-6. [PMID: 37087303 DOI: 10.1016/j.pan.2023.04.005] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/22/2023] [Accepted: 04/15/2023] [Indexed: 04/24/2023]
Abstract
OBJECTIVES We sought to evaluate associations between Magnetic Resonance Imaging (MRI) findings, exocrine pancreatic insufficiency (EPI) and endocrine insufficiency (prediabetes or diabetes) in children. METHODS This was a retrospective study that included patients<21 years of age who underwent MRI and endoscopic pancreatic function testing (ePFT; reference standard for pancreatic exocrine function) within 3 months. MRI variables included pancreas parenchymal volume, secreted fluid volume in response to secretin, and T1 relaxation time. Data were analyzed for the full sample as well as the subset without acute pancreatitis (AP) at the time of imaging. RESULTS Of 72 patients, 56% (40/72) were female with median age 11.4 years. A 5 mL decrease in pancreas parenchymal volume was associated with increased odds of exocrine pancreatic dysfunction by both ePFT (OR = 1.16, p = 0.02 full sample; OR = 1.29, p = 0.01 no-AP subset), and fecal elastase (OR = 1.16, p = 0.04 full sample; OR = 1.23, p = 0.02 no-AP subset). Pancreas parenchymal volume had an AUC 0.71 (95% CI: 0.59, 0.83) for predicting exocrine pancreatic dysfunction by ePFT and when combined with sex and presence of AP had an AUC of 0.82 (95% CI: 0.72, 0.92). Regarding endocrine function, decreased pancreas parenchymal volume was associated with increased odds of diabetes (OR = 1.16, p = 0.03), and T1 relaxation time predicted glycemic outcomes with an AUC 0.78 (95% CI: 0.55-1), 91% specificity and 73% sensitivity. CONCLUSIONS Pancreas parenchymal volume is an MRI marker of exocrine and endocrine pancreatic dysfunction in children. A model including sex, AP, and pancreas volume best predicted exocrine status. T1 relaxation time is also an MRI marker of endocrine insufficiency.
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Affiliation(s)
- Michelle Saad
- Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - David S Vitale
- Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Tom K Lin
- Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Samjhana Thapaliya
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Yuan Zhou
- Department of Mathematical Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Bin Zhang
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Andrew T Trout
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Maisam Abu-El-Haija
- Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Strouse PJ, Khanna G, Trout AT, Offiah AC. Editors' notebook: figures, tables, appendices, and supplementary material. Pediatr Radiol 2023; 53:1045-1048. [PMID: 37046098 DOI: 10.1007/s00247-023-05662-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Affiliation(s)
- Peter J Strouse
- Section of Pediatric Radiology, C.S. Mott Children's Hospital, Room 3-231, Department of Radiology, Michigan Medicine, 1540 E. Hospital Drive, Ann Arbor, MI, 48109-4252, USA.
| | - Geetika Khanna
- Department of Radiology & Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Amaka C Offiah
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- Department of Radiology, Sheffield Children's NHS Foundation Trust, Sheffield, UK
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de Padua V Alves V, Dillman JR, Somasundaram E, Taylor ZP, Brady SL, Zhang B, Trout AT. Computed tomography-based measurements of normative liver and spleen volumes in children. Pediatr Radiol 2023; 53:378-386. [PMID: 36471169 DOI: 10.1007/s00247-022-05551-z] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/29/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Quantification of organ size has utility in clinical care and research for diagnostics, prognostics and surgical planning. Volumetry is regarded as the best measure of organ size and change in size over time. Scarce reference values exist for liver and spleen volumes in healthy children. OBJECTIVE To report liver and spleen volumes for a sample of children defined by manual segmentation of contrast-enhanced CT images with the goal of defining normal values and thresholds that might indicate disease. MATERIALS AND METHODS This retrospective study included clinically acquired contrast-enhanced CTs of the abdomen/pelvis for children and adolescents imaged between January 2018 and July 2021. Liver and spleen volumes were derived through manual segmentation of CTs reconstructed at 2.5-, 3- or 5-mm slice thickness. A subset of images (5%, n=16) was also segmented using 0.5-mm slice thickness reconstructions to define agreement based on image slice thickness. We used Pearson correlation and multivariable regression to assess associations between organ volumes and patient characteristics. We generated reference intervals for the 5th, 25th, 50th (median), 75th and 95th percentiles for organ volumes as a function of age and weight using quantile regression models. Finally, we calculated Bland-Altman plots and intraclass correlation coefficients (ICC) to quantify agreement. RESULTS We included a total of 320 children (mean age ± standard deviation [SD] = 9±4.6 years; mean weight 38.1±18.8 kg; 160 female). Liver volume ranged from 340-2,002 mL, and spleen volume ranged from 28-480 mL. Patient weight (kg) (β=12.5), age (months) (β=1.7) and sex (female) (β = -35.3) were independent predictors of liver volume, whereas patient weight (kg) (β=2.4) and age (months) (β=0.3) were independent predictors of spleen volume. There was excellent absolute agreement (ICC=0.99) and minimal absolute difference (4 mL) in organ volumes based on reconstructed slice thickness. CONCLUSION We report reference liver and spleen volumes for children without liver or spleen disease. These results provide reference ranges and potential thresholds to identify liver and spleen size abnormalities that might reflect disease in children.
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Affiliation(s)
- Vinicius de Padua V Alves
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Kasota Building MLC 5031, Cincinnati, OH, 45229, USA
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Kasota Building MLC 5031, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Elanchezhian Somasundaram
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Kasota Building MLC 5031, Cincinnati, OH, 45229, USA
| | - Zachary P Taylor
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Kasota Building MLC 5031, Cincinnati, OH, 45229, USA
| | - Samuel L Brady
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Kasota Building MLC 5031, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Bin Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Kasota Building MLC 5031, Cincinnati, OH, 45229, USA.
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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Strouse PJ, Trout AT, Khanna G, Offiah AC. Editors' notebook: abbreviations. Pediatr Radiol 2023; 53:823-824. [PMID: 36826479 DOI: 10.1007/s00247-023-05627-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Affiliation(s)
- Peter J Strouse
- Section of Pediatric Radiology, C. S. Mott Children's Hospital, Room 3-231, Department of Radiology, Michigan Medicine, 1540 E. Hospital Drive, Ann Arbor, MI, 48109, USA.
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Geetika Khanna
- Department of Radiology & Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Amaka C Offiah
- Department of Oncology and Metabolism, Sheffield Children's Hospital, University of Sheffield, Sheffield, UK.,Department of Radiology, Sheffield Children's NHS Foundation Trust, Sheffield, UK
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Mahalingam N, Trout AT, Zhang B, Castro-Rojas C, Miethke AG, Dillman JR. Longitudinal changes in quantitative magnetic resonance imaging metrics in children and young adults with autoimmune liver disease. Abdom Radiol (NY) 2023; 48:1933-1944. [PMID: 36799997 DOI: 10.1007/s00261-022-03733-9] [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] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 02/18/2023]
Abstract
PURPOSE To assess longitudinal changes in quantitative MRI metrics in pediatric and young adult patients with autoimmune liver disease (AILD). METHODS This prospective, IRB-approved study included 20 children and young adults (median age = 15 years) with primary sclerosing cholangitis (PSC)/autoimmune sclerosing cholangitis (ASC) and 19 (median age = 17 years) with autoimmune hepatitis (AIH). At a field strength of 1.5-T, T2*-corrected T1 mapping (cT1), 3D fast spin-echo MRCP, and 2D gradient recalled echo MR elastography (MRE) were performed at baseline, one year, and two years. cT1 and quantitative MRCP were processed using LiverMultiScan and MRCP + , respectively (Perspectum Ltd, Oxford, UK). Linear mixed models were used to assess longitudinal changes in quantitative MRI metrics. Spearman rank-order correlation was used to assess relationships between changes in quantitative MRI metrics. RESULTS Changes in quantitative MRI metrics greater than established repeatability coefficients were measured in six (cT1) and five (MRE) patients with PSC/ASC as well as in six patients (cT1 and MRE) with AIH, although linear mixed models identified no significant changes for the subgroups as a whole. For PSC/ASC, there were positive correlations between change in liver stiffness and changes in bile duct strictures (ρ = 0.68; p = 0.005) and bile duct dilations (ρ = 0.70; p = 0.004) between baseline and Year 2. CONCLUSION On average, there were no significant changes in quantitative MRI metrics over a two-year period in children and young adults with AILD. However, worsening cholangiopathy was associated with increasing liver stiffness by MRE in patients with PSC/ASC.
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Affiliation(s)
- Neeraja Mahalingam
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 250 Albert Sabin Way, Cincinnati, OH, 45229, USA.
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 250 Albert Sabin Way, Cincinnati, OH, 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Bin Zhang
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Cyd Castro-Rojas
- Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Alexander G Miethke
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 250 Albert Sabin Way, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Shen W, Middleton MS, Cunha GM, Delgado TI, Wolfson T, Gamst A, Fowler KJ, Alazraki A, Trout AT, Ohliger MA, Shah SN, Bashir MR, Kleiner DE, Loomba R, Neuschwander-Tetri BA, Sanyal AJ, Zhou J, Sirlin CB, Lavine JE. Changes in abdominal adipose tissue depots assessed by MRI correlate with hepatic histologic improvement in non-alcoholic steatohepatitis. J Hepatol 2023; 78:238-246. [PMID: 36368598 PMCID: PMC9852022 DOI: 10.1016/j.jhep.2022.10.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 10/10/2022] [Accepted: 10/12/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND & AIMS Non-alcoholic steatohepatitis (NASH) is prevalent in adults with obesity and can progress to cirrhosis. In a secondary analysis of prospectively acquired data from the multicenter, randomized, placebo-controlled FLINT trial, we investigated the relationship between reduction in adipose tissue compartment volumes and hepatic histologic improvement. METHODS Adult participants in the FLINT trial with paired liver biopsies and abdominal MRI exams at baseline and end-of-treatment (72 weeks) were included (n = 76). Adipose tissue compartment volumes were obtained using MRI. RESULTS Treatment and placebo groups did not differ in baseline adipose tissue volumes, or in change in adipose tissue volumes longitudinally (p = 0.107 to 0.745). Deep subcutaneous adipose tissue (dSAT) and visceral adipose tissue volume reductions were associated with histologic improvement in NASH (i.e., NAS [non-alcoholic fatty liver disease activity score] reductions of ≥2 points, at least 1 point from lobular inflammation and hepatocellular ballooning, and no worsening of fibrosis) (p = 0.031, and 0.030, respectively). In a stepwise logistic regression procedure, which included demographics, treatment group, baseline histology, baseline and changes in adipose tissue volumes, MRI hepatic proton density fat fraction (PDFF), and serum aminotransferases as potential predictors, reductions in dSAT and PDFF were associated with histologic improvement in NASH (regression coefficient = -2.001 and -0.083, p = 0.044 and 0.033, respectively). CONCLUSIONS In adults with NASH in the FLINT trial, those with greater longitudinal reductions in dSAT and potentially visceral adipose tissue volumes showed greater hepatic histologic improvements, independent of reductions in hepatic PDFF. CLINICAL TRIAL NUMBER NCT01265498. IMPACT AND IMPLICATIONS Although central obesity has been identified as a risk factor for obesity-related disorders including insulin resistance and cardiovascular disease, the role of central obesity in non-alcoholic steatohepatitis (NASH) warrants further clarification. Our results highlight that a reduction in central obesity, specifically deep subcutaneous adipose tissue and visceral adipose tissue, may be related to histologic improvement in NASH. The findings from this analysis should increase awareness of the importance of lifestyle intervention in NASH for clinical researchers and clinicians. Future studies and clinical practice may design interventions that assess the reduction of deep subcutaneous adipose tissue and visceral adipose tissue as outcome measures, rather than simply weight reduction.
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Affiliation(s)
- Wei Shen
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA;; Institute of Human Nutrition, College of Physicians & Surgeons, Columbia University Irving Medical Center; NY, USA;; Columbia Magnetic Resonance Research Center (CMRRC), Columbia University, USA.
| | - Michael S Middleton
- Liver Imaging Group, Department of Radiology, UCSD School of Medicine, San Diego, CA, USA
| | | | - Timoteo I Delgado
- Liver Imaging Group, Department of Radiology, UCSD School of Medicine, San Diego, CA, USA
| | - Tanya Wolfson
- Computational and Applied Statistics Laboratory (CASL), San Diego Supercomputer Center at UCSD, San Diego, CA, USA
| | - Anthony Gamst
- Computational and Applied Statistics Laboratory (CASL), San Diego Supercomputer Center at UCSD, San Diego, CA, USA;; Department of Mathematics, UCSD, San Diego, CA, USA
| | - Kathryn J Fowler
- Liver Imaging Group, Department of Radiology, UCSD School of Medicine, San Diego, CA, USA
| | - Adina Alazraki
- Emory University School of Medicine, Department of Radiology and Imaging Sciences and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center and Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Michael A Ohliger
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Shetal N Shah
- Section of Abdominal Imaging and Nuclear Medicine Department, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mustafa R Bashir
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA;; Center for Advanced Magnetic Resonance Development, (CAMRD), Department of Radiology, Duke University Medical Center, Durham, NC, USA;; Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - David E Kleiner
- Laboratory of Pathology, National Cancer Institute, Bethesda, MD, USA
| | - Rohit Loomba
- NAFLD Research Center, Division of Gastroenterology, Department of Medicine, University of California-San Diego, La Jolla, CA, USA
| | | | | | - Jane Zhou
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, UCSD School of Medicine, San Diego, CA, USA
| | - Joel E Lavine
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA;; Institute of Human Nutrition, College of Physicians & Surgeons, Columbia University Irving Medical Center; NY, USA
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Schilling SM, Trout AT, Ayyala RS. Gender disparity in academic advancement: exploring differences among adult and pediatric radiologists. Pediatr Radiol 2023; 53:487-492. [PMID: 36447051 PMCID: PMC9708121 DOI: 10.1007/s00247-022-05547-9] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 10/13/2022] [Accepted: 11/08/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Gender imbalance in research output and academic rank in academic radiology is well-documented and long-standing. Less is known regarding this imbalance among pediatric radiologists. OBJECTIVE To characterize gender differences for academic rank and scholarly productivity of pediatric radiologists relative to adult radiologists. MATERIALS AND METHODS During summer 2021, faculty data for the top 10 U.S. News & World Report ranked adult radiology programs and the top 12 largest pediatric hospital radiology departments were collected. Information regarding self-reported gender, age, years of practice and academic rank was accessed from institutional websites and public provider databases. The h-index and the number of publications were acquired via Scopus. Group comparisons were performed using Mann-Whitney and chi-square tests. RESULTS Three hundred and sixty-four (160 women) pediatric and 1,170 (468 women) adult radiologists were included. Compared to adult radiologists, there were significantly fewer pediatric radiologists in advanced ranks (associate or full professor) (P = 0.024), driven by differences between male (P = 0.033) but not female radiologists (P = 0.67). Among pediatric radiologists, there was no significant difference in years in practice (P = 0.29) between males and females. There also was no significant difference in academic rank by gender (P = 0.37), different from adult radiology where men outnumber women in advanced ranks (P < 0.001). Male pediatric radiologists displayed higher academic productivity (h-index: 9.0 vs. 7.0; P = 0.01 and number of publications: 31 vs. 18; P = 0.003) than their female colleagues. CONCLUSION Academic pediatric radiology seems to have more equitable academic advancement than academic adult radiology. Despite similar time in the workforce, academic output among female pediatric radiologists lags that of their male colleagues.
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Affiliation(s)
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Rama S Ayyala
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH, 45229, USA.
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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Lazow MA, Fuller C, Trout AT, Stanek JR, Reuss J, Turpin BK, Szabo S, Salloum R. Immunohistochemical assessment and clinical, histopathologic, and molecular correlates of membranous somatostatin type-2A receptor expression in high-risk pediatric central nervous system tumors. Front Oncol 2022; 12:996489. [PMID: 36465400 PMCID: PMC9713413 DOI: 10.3389/fonc.2022.996489] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 07/17/2022] [Accepted: 10/31/2022] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION 177Lu-DOTATATE, a radionuclide therapy that binds somatostatin type-2A receptors (SST2A), has demonstrated efficacy in neuroendocrine tumors and evidence of central nervous system (CNS) penetration, supporting potential expansion within pediatric neuro-oncology. Understanding the prevalence of SST2A expression across pediatric CNS tumors is essential to identify patients who may benefit from somatostatin receptor-targeted therapy and to further elucidate the oncogenic role of SST2A. METHODS SST2A immunohistochemistry (IHC) was performed on tumor specimens and interpreted by an experienced pathologist (blinded), utilizing semi-quantitative scoring of membranous expression within viable tumor. Immunoreactive cell percentage was visually scored as 0 (none), 1 (<10%), 2 (10-50%), 3 (51-80%), or 4 (>80%). Staining intensity was scored as 0 (none), 1 (weak), 2 (moderate), or 3 (strong). Combined scores for each specimen were calculated by multiplying percent immunoreactivity and staining intensity values (Range: 0-12). RESULTS A total of 120 tumor samples from 114 patients were analyzed. Significant differences in SST2A IHC scores were observed across histopathologic diagnoses, with consistently high scores in medulloblastoma (mean ± SD: 7.5 ± 3.6 [n=38]) and meningioma (5.7 ± 3.4 [n=15]), compared to minimal or absent expression in ATRT (0.3 ± 0.6 [n=3]), ETMR (1.0 ± 0 [n=3]), ependymoma (grades I-III; 0.2 ± 0.7 [n=27]), and high-grade glioma (grades III-IV; 0.4 ± 0.7 [n=23]). Pineoblastoma (3.8 ± 1.5 [n=4]) and other embryonal tumors (2.0 ± 4.0 [n=7]) exhibited intermediate, variable expression. Among medulloblastomas, SST2A IHC scores were higher in non-SHH (8.5 ± 3.1) than SHH (5.0 ± 3.3) molecular subgroups (p=0.033). In a subset of paired primary and recurrent specimens from four patients, SST2A IHC scores remained largely unchanged. DISCUSSION High membranous SST2A expression was demonstrated in medulloblastoma, meningioma, and some rarer embryonal tumors with potential diagnostic, biologic, and therapeutic implications. Somatostatin receptor-targeted therapy such as 177Lu-DOTATATE deserves further investigation in these highly SST2A-expressing pediatric CNS tumors.
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Affiliation(s)
- Margot A. Lazow
- Pediatric Neuro-Oncology Program, Nationwide Children’s Hospital, Columbus, OH, United States
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States
- Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Christine Fuller
- Department of Pathology, Upstate Medical University, Syracuse, NY, United States
| | - Andrew T. Trout
- Department of Radiology and Medical Imaging, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Joseph R. Stanek
- Pediatric Neuro-Oncology Program, Nationwide Children’s Hospital, Columbus, OH, United States
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Jaime Reuss
- Department of Pathology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Brian K. Turpin
- Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Sara Szabo
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Department of Pathology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Ralph Salloum
- Pediatric Neuro-Oncology Program, Nationwide Children’s Hospital, Columbus, OH, United States
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States
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Dillman JR, Tkach JA, Pedneker A, Trout AT. Quantitative abdominal magnetic resonance imaging in children-special considerations. Abdom Radiol (NY) 2022; 47:3069-3077. [PMID: 34196762 DOI: 10.1007/s00261-021-03191-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/20/2021] [Accepted: 06/21/2021] [Indexed: 01/18/2023]
Abstract
The use of quantitative MRI methods for assessment of the abdomen in children has become commonplace over the past decade. Increasingly employed methods include MR elastography, chemical shift encoded (CSE) MR imaging for determination of proton density fat fraction, diffusion-weighted imaging, and a variety of relaxometry techniques, such as T1 and T2* mapping. These techniques can be used in a variety of settings to distinguish normal from abnormal tissue as well as determine the severity of disease. The performance of quantitative MRI methods in the pediatric population presents unique challenges as compared to adult populations. These challenges relate to multiple factors, including patient size, pediatric physiology, inability to breath hold, and greater physical motion during the examination. The purpose of this review article is to review quantitative MRI methods that may be used in clinical practice to assess the pediatric abdomen and to discuss special considerations when performing these techniques in children.
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Affiliation(s)
- Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Jean A Tkach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Amol Pedneker
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Alves VPV, Dillman JR, Tkach JA, Bennett PS, Xanthakos SA, Trout AT. Comparison of Quantitative Liver US and MRI in Patients with Liver Disease. Radiology 2022; 304:660-669. [PMID: 35608446 DOI: 10.1148/radiol.212995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Quantitative US techniques can be used to identify changes of liver disease, but data regarding their diagnostic performance and relationship to MRI measures are sparse. Purpose To define associations between quantitative US and MRI measures of the liver in children, adolescents, and young adults with liver disease and to define the predictive ability of quantitative US measures to detect abnormal liver stiffening and steatosis defined with MRI. Materials and Methods In this prospective study, consecutive patients aged 8-21 years and known to have or suspected of having liver disease and body mass index less than 35 kg/m2 underwent 1.5-T MRI and quantitative liver US during the same visit at a pediatric academic medical center between April 2018 and December 2020. Acquired US parameters included shear-wave speed (SWS) and attenuation coefficient, among others. US parameters were compared with liver MR elastography and liver MRI proton density fat fraction (PDFF). Pearson correlation, multiple logistic regression, and receiver operating characteristic curve analyses were performed to assess associations and determine the performance of US relative to that of MRI. Results A total of 44 study participants (mean age, 16 years ± 4 [SD]; age range, 8-21 years; 23 male participants) were evaluated. There was a positive correlation between US SWS and MR elastography stiffness (r = 0.73, P < .001). US attenuation was positively correlated with MRI PDFF (r = 0.45, P = .001). For the prediction of abnormal (>2.8 kPa) liver shear stiffness, SWS (1.56 m/sec [7.3 kPa] cutoff) had an area under the receiver operating characteristic curve (AUC) of 0.95 with 91% sensitivity (95% CI: 71, 99) (20 of 22 participants) and 95% specificity (95% CI: 76, 99) (20 of 21 participants). For the prediction of abnormal (>5%) liver PDFF, US attenuation (0.55 dB/cm/MHz cutoff) had an AUC of 0.75 with a sensitivity of 73% (95% CI: 39, 94) (eight of 11 participants) and a specificity of 73% (95% CI: 55, 86) (24 of 33 participants). Conclusion In children, adolescents, and young adults with known or suspected liver disease, there was moderate to high correlation between US shear-wave speed (SWS) and MR elastography-derived stiffness. US SWS predicted an abnormal liver shear stiffness with high performance. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Khanna and Alazraki in this issue.
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Affiliation(s)
- Vinicius P V Alves
- From the Department of Radiology (V.P.V.A, J.R.D., J.A.T., P.S.B., A.T.T.) and Division of Gastroenterology, Hepatology and Nutrition (S.A.X.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Kasota Building MLC 5031, Cincinnati, OH 45226; and Departments of Radiology (J.R.D., A.T.T.) and Pediatrics (S.A.X., A.T.T.), University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jonathan R Dillman
- From the Department of Radiology (V.P.V.A, J.R.D., J.A.T., P.S.B., A.T.T.) and Division of Gastroenterology, Hepatology and Nutrition (S.A.X.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Kasota Building MLC 5031, Cincinnati, OH 45226; and Departments of Radiology (J.R.D., A.T.T.) and Pediatrics (S.A.X., A.T.T.), University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jean A Tkach
- From the Department of Radiology (V.P.V.A, J.R.D., J.A.T., P.S.B., A.T.T.) and Division of Gastroenterology, Hepatology and Nutrition (S.A.X.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Kasota Building MLC 5031, Cincinnati, OH 45226; and Departments of Radiology (J.R.D., A.T.T.) and Pediatrics (S.A.X., A.T.T.), University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Paula S Bennett
- From the Department of Radiology (V.P.V.A, J.R.D., J.A.T., P.S.B., A.T.T.) and Division of Gastroenterology, Hepatology and Nutrition (S.A.X.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Kasota Building MLC 5031, Cincinnati, OH 45226; and Departments of Radiology (J.R.D., A.T.T.) and Pediatrics (S.A.X., A.T.T.), University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Stavra A Xanthakos
- From the Department of Radiology (V.P.V.A, J.R.D., J.A.T., P.S.B., A.T.T.) and Division of Gastroenterology, Hepatology and Nutrition (S.A.X.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Kasota Building MLC 5031, Cincinnati, OH 45226; and Departments of Radiology (J.R.D., A.T.T.) and Pediatrics (S.A.X., A.T.T.), University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Andrew T Trout
- From the Department of Radiology (V.P.V.A, J.R.D., J.A.T., P.S.B., A.T.T.) and Division of Gastroenterology, Hepatology and Nutrition (S.A.X.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Kasota Building MLC 5031, Cincinnati, OH 45226; and Departments of Radiology (J.R.D., A.T.T.) and Pediatrics (S.A.X., A.T.T.), University of Cincinnati College of Medicine, Cincinnati, Ohio
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Lin TK, Vitale DS, Abu-El-Haija M, Anton CG, Crotty E, Li Y, Zhang B, Trout AT. Magnetic Resonance Cholangiopancreatography vs Endoscopy Retrograde Cholangiopancreatography for Detection of Anatomic Variants of the Pancreatic Duct in Children. J Pediatr 2022; 244:120-124. [PMID: 35065151 DOI: 10.1016/j.jpeds.2022.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 08/22/2021] [Revised: 12/27/2021] [Accepted: 01/12/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To compare the efficacy of magnetic resonance cholangiopancreatography (MRCP) with endoscopy retrograde cholangiopancreatography (ERCP) in children for the identification of pancreatic duct variants. STUDY DESIGN We identified children with a pancreatic duct variant by ERCP and separately queried our MRCP database for similar variants. Patients with a paired ERCP-MRCP were reviewed. Three radiologists blinded to the ERCP and MRCP findings were asked to independently review the MRCP studies and define the pancreatic duct anatomy. These blinded reviewers also graded the magnetic resonance imaging examination quality. RESULTS Seventy-four pairs of ERCP-MRCP examinations were identified. Pancreas divisum was the most frequent ductal variant encountered (73%). There was fair agreement between the radiology reviewers as to the quality of the magnetic resonance imaging studies (Fleiss Kappa agreement). Concordance of the reviewers with that of the ERCP was moderate for the exact diagnosis, moderate for the presence of pancreas divisum, and fair for agreement on the presence of any duct variant. Concordance among reviewers was moderate for the exact diagnosis, moderate for normal vs abnormal, and substantial for the presence of pancreas divisum. CONCLUSIONS Diagnostic limitations exist when comparing MRCP with the gold reference standard of ERCP, specifically when assessing for pancreatic duct variants in children.
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Affiliation(s)
- Tom K Lin
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
| | - David S Vitale
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Maisam Abu-El-Haija
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Christopher G Anton
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Eric Crotty
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Yinan Li
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Bin Zhang
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Andrew T Trout
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
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46
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Dillman JR, Benoit SW, Gandhi DB, Trout AT, Tkach JA, VandenHeuvel K, Devarajan P. Multiparametric quantitative renal MRI in children and young adults: comparison between healthy individuals and patients with chronic kidney disease. Abdom Radiol (NY) 2022; 47:1840-1852. [PMID: 35237897 DOI: 10.1007/s00261-022-03456-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Multiparametric quantitative renal MRI may provide noninvasive radiologic biomarkers of chronic kidney disease (CKD) based on investigations in animal models and adults. We aimed to (1) obtain normative multiparametric quantitative MRI data from the kidneys of healthy children and young adults, (2) compare MRI measurements between healthy control participants and patients with CKD, and (3) determine if MRI measurements correlate with clinical and laboratory data as well as histology. METHODS This was a prospective, case-control study of 20 healthy controls and 12 CKD patients who underwent percutaneous renal biopsy ranging from 12 to 23 years of age between October 2018 and March 2020. Kidney function was documented and pathology assessed for fibrosis/inflammation. Utilizing a field strength of 1.5T, we examined renal T1, T2, and T2* relaxation mapping, MR elastography (MRE), and diffusion-weighted imaging (DWI). A single analyst made all manual measurements for quantitative MRI pulse sequences. Independent measurements from cortex, medulla, and whole kidney were obtained by drawing regions of interest on single slices from the upper, mid, and lower kidney. A weighted average was calculated for each kidney; if two kidneys, the right and left were averaged. Continuous variables were compared with Mann-Whitney U test; bivariate relationships were assessed using Spearman rank-order correlation. RESULTS Median estimated glomerular filtration rate (eGFR) was 112.3 ml/min/1.73 m2 in controls (n = 20, 10 females) and 55.0 ml/min/m2 in CKD patients (n = 12, 2 females) (p < 0.0001). Whole kidney (1333 vs. 1291 ms; p = 0.018) and cortical (1212 vs 1137 ms; p < 0.0001) T1 values were higher in CKD patients. Cortical T1 values correlated with eGFR (rho = - 0.62; p = 0.0003) and cystatin C (rho = 0.58; p = 0.0007). Whole kidney (1.87 vs. 2.02 10-3 mm2/s; p = 0.007), cortical (1.89 vs. 2.04 10-3 mm2/s; p = 0.008), and medullary (1.87 vs. 1.98 10-3 mm2/s; p = 0.0095) DWI apparent diffusion coefficients (ADC) were lower in CKD patients. Whole kidney ADC correlated with eGFR (rho = 0.45; p = 0.012) and cystatin C (rho = - 0.46; p = 0.009). Cortical histologic inflammation correlated with DWI ADC (rho = - 0.71; p = 0.011). CONCLUSION Renal T1 relaxation and DWI ADC measurements differ between pediatric healthy controls and CKD patients, correlate with laboratory markers of CKD, and may have histologic correlates.
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Affiliation(s)
- Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45244, USA.
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Stefanie W Benoit
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Deep B Gandhi
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45244, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45244, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jean A Tkach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45244, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Katherine VandenHeuvel
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Prasad Devarajan
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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47
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Moore MM, Gee MS, Iyer RS, Chan SS, Ayers TD, Bardo DME, Chandra T, Cooper ML, Dotson JL, Gadepalli SK, Gill AE, Levin TL, Nadel HR, Schooler GR, Shet NS, Squires JH, Trout AT, Wall JJ, Rigsby CK. ACR Appropriateness Criteria® Crohn Disease-Child. J Am Coll Radiol 2022; 19:S19-S36. [PMID: 35550801 DOI: 10.1016/j.jacr.2022.02.020] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 02/19/2022] [Indexed: 10/18/2022]
Abstract
Crohn disease is an inflammatory condition of the gastrointestinal tract with episodes of exacerbation and remission occurring in children, adolescents, and adults. Crohn disease diagnosis and treatment depend upon a combination of clinical, laboratory, endoscopic, histological, and imaging findings. Appropriate use of imaging provides critical information in the settings of diagnosis, assessment of acute symptoms, disease surveillance, and therapy monitoring. Four variants are discussed. The first variant discusses the initial imaging for suspected Crohn disease before established diagnosis. The second variant pertains to appropriateness of imaging modalities during suspected acute exacerbation. The third variant is a substantial discussion of recommendations related to disease surveillance and monitoring of Crohn disease. Finally, panel recommendations and discussion of perianal fistulizing disease imaging completes the document. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Michael M Moore
- Co-Director, Division of Radiology Innovation and Value Enhancement, Penn State Health Children's Hospital, Hershey, Pennsylvania.
| | - Michael S Gee
- Research Author, Deputy Chair of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ramesh S Iyer
- Panel Chair, Seattle Children's Hospital, Seattle, Washington; Chair, SPCC (CoPLL)
| | - Sherwin S Chan
- Panel Vice-Chair, Vice Chair of Radiology, Children's Mercy Hospital, Kansas City, Missouri
| | - Travis D Ayers
- Medical Director of Inflammatory Bowel Disease, Arkansas Children's Hospital, Little Rock, Arkansas; North American Society for Pediatric Gastroenterology, Hepatology & Nutrition
| | - Dianna M E Bardo
- Vice Chair of Radiology-Quality & Safety, Phoenix Children's Hospital, Phoenix, Arizona
| | - Tushar Chandra
- Magnetic Resonance Medical Director, Chief of Research, Chief of Medical Education, Co-Director of 3D and Advanced Imaging Lab, Nemours Children's Hospital, Orlando, Florida
| | - Matthew L Cooper
- Pediatric Radiology Division Chief and Radiology Medical Director, Riley Hospital for Children, Indianapolis, Indiana
| | - Jennifer L Dotson
- Co-Director of the Center for Pediatric and Adolescent IBD, Nationwide Children's Hospital, Columbus, Ohio; American Academy of Pediatrics
| | - Samir K Gadepalli
- Surgical Director for Pediatric IBD, Director of Clinical Research for Pediatric Surgery, and Associate Program Director for Pediatric Surgery Fellowship, University of Michigan, Ann Arbor, Michigan; American Pediatric Surgical Association
| | - Anne E Gill
- Children's Healthcare of Atlanta and Emory University, Atlanta, Georgia
| | - Terry L Levin
- The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York; Chair ACR Pediatric Practice Parameters
| | - Helen R Nadel
- Lucile Packard Children's Hospital at Stanford, Stanford, California; Member Committee on Practice Parameters-Pediatric ACR; and Alternate to Senate Stanford University School of Medicine
| | | | - Narendra S Shet
- Children's National Hospital, Washington, District of Columbia
| | - Judy H Squires
- Chief of Ultrasound and Associate Program Director for Diagnostic Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Andrew T Trout
- Director of Clinical Research for Radiology and Director of Nuclear Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Vice-Chair-JRCNMT
| | - Jessica J Wall
- Associate Medical Director of Pediatric Transport, UCLA Medical Center, Los Angeles, California; American College of Emergency Physicians
| | - Cynthia K Rigsby
- Specialty Chair, Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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Mahalingam N, Trout AT, Gandhi DB, Sahay RD, Singh R, Miethke AG, Dillman JR. Correction to: Associations between MRI T1 mapping, liver stiffness, quantitative MRCP, and laboratory biomarkers in children and young adults with autoimmune liver disease. Abdom Radiol (NY) 2022; 47:1511. [PMID: 35169894 PMCID: PMC8930856 DOI: 10.1007/s00261-022-03437-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Yodoshi T, Orkin S, Trout AT, Catalina Arce-Clachar A, Bramlage K, Liu C, Fei L, Dillman JR, Xanthakos SA, Mouzaki M. Non-Invasive Approaches to Estimate Liver Steatosis and Stiffness in Children With Non-Alcoholic Fatty Liver Disease. J Pediatr Gastroenterol Nutr 2022; 74:495-502. [PMID: 34908012 PMCID: PMC9673005 DOI: 10.1097/mpg.0000000000003371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To develop pediatric-specific models that predict liver stiffness and hepatic steatosis in non-alcoholic fatty liver disease (NAFLD), based on clinical and laboratory data. METHODS Children with NAFLD, who had undergone magnetic resonance imaging with proton density fat fraction (MRI-PDFF) for steatosis quantification and/or magnetic resonance elastography (MRE) for liver stiffness assessment were included. We used data from patients imaged between April 2009 to July 2018 to develop a predictive model for fat fraction and stiffness. We validated the performance of the models using data from a second cohort, imaged between 2018 and 2019. RESULTS The first cohort (n = 344) consisted of predominantly non-Hispanic (80%), male (67%) adolescents. MRE data were available for 343 children, while PDFF data were available for 130. In multivariable regression, ethnicity, insulin levels, platelet count, and aspartate aminotransferase independently predicted liver stiffness and these variables were used to develop the predictive model. Similarly, sex, ethnicity, alanine aminotransferase, and triglycerides levels independently predicted liver PDFF and were used in the PDFF model. The AUC of the optimal cutoff for the model that predicted a stiffness of >2.71 kPa was 0.70 and for the model that predicted PDFF >5% was 0.78. The validation group (n = 110) had similar characteristics. The correlation coefficient of the model with the measured liver stiffness was 0.30 and with the measured liver PDFF was 0.26. CONCLUSIONS Pediatric-specific models perform poorly at predicting exact liver stiffness and steatosis; however, in the absence of magnetic resonance imaging can be used to predict the presence of significant steatosis (>5%) and/or significant stiffness (>2.71). Thus, imaging remains an invaluable adjunct to laboratory investigations in determining disease severity.
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Affiliation(s)
- Toshifumi Yodoshi
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Clinical Research and Quality Management, University of the Ryukyus Graduate School of Medicine, Okinawa Chubu Hospital, Okinawa, Japan
- Department of Pediatrics, Okinawa Chubu Hospital, Okinawa, Japan
| | - Sarah Orkin
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Andrew T. Trout
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Ana Catalina Arce-Clachar
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Kristin Bramlage
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Chunyan Liu
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Lin Fei
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Jonathan R. Dillman
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Stavra A. Xanthakos
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Marialena Mouzaki
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
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50
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Ritter DM, Fessler BK, Ebrahimi-Fakhari D, Wei J, Franz DN, Krueger DA, Trout AT, Towbin AJ. Prevalence of thoracoabdominal imaging findings in tuberous sclerosis complex. Orphanet J Rare Dis 2022; 17:124. [PMID: 35292049 PMCID: PMC8922878 DOI: 10.1186/s13023-022-02277-x] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 03/07/2022] [Indexed: 12/02/2022] Open
Abstract
Background Tuberous sclerosis complex (TSC) results in neurodevelopmental phenotypes, benign tumors, and cysts throughout the body. Recent studies show numerous rare findings in TSC. Guidelines suggest routine abdominal and chest imaging to monitor these thoracoabdominal findings, but imaging is not uniformly done across centers. Thus, the prevalence of many findings is unknown. To answer this, we categorized the clinical reads of 1398 thoracoabdominal scans from 649 patients of all ages in the Cincinnati Children’s Hospital TSC Repository Database. Results Typical TSC findings were present in many patients: kidney cysts (72%), kidney fat-containing angiomyolipomas (51%), kidney lipid-poor angiomyolipomas (27%), liver angiomyolipomas (19%), and lung nodules thought to represent multifocal micronodular pneumocyte hyperplasia (MMPH) (18%). While many features were more common in TSC2 patients, TSC1 patients had a higher prevalence of MMPH than TSC2 patients (24% versus 13%, p = 0.05). Many rare findings (e.g., lymphatic malformations and liver masses) are more common in TSC than in the general population. Additionally, most thoracoabdominal imaging findings increased with age except kidney cysts which decreased, with the 0–10 years age group having the highest percentage (69% 0–10 years, 49% 10–21 years, 48% 21 + years, p < 0.001). Finally, in our population, no patients had renal cell carcinoma found on abdominal imaging. Conclusions These results show that regular thoracoabdominal scans in TSC may show several findings that should not be ignored or, conversely, over-reacted to when found in patients with TSC. Female sex, TSC2 mutation, and age are risk factors for many thoracoabdominal findings. The data suggest novel interactions of genetic mutation with pulmonary nodules and age with renal cysts. Finally, in agreement with other works, these findings indicate that several rare thoracoabdominal imaging findings occur at higher rates in the TSC population than in the general population. This work supports obtaining detailed thoracoabdominal imaging in patients with TSC. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02277-x.
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Affiliation(s)
- David M Ritter
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. .,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Bailey K Fessler
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Daniel Ebrahimi-Fakhari
- Department of General Pediatrics, University Children's Hospital Muenster, Muenster, Germany
| | - Jun Wei
- The First Hospital of Yichang, Yichang, China
| | - David N Franz
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Darcy A Krueger
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Andrew T Trout
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Alexander J Towbin
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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