79 results on '"Barth RA"'
Search Results
2. Response to Restructuring radiology clerkship to promote active learning.
- Author
-
Farmakis SG, Chertoff JD, Straus CM, and Barth RA
- Subjects
- Humans, Radiography, Problem-Based Learning, Radiology education
- Abstract
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
- Published
- 2024
- Full Text
- View/download PDF
3. A Novel Fetal Magnetic Resonance Imaging Lung Volume Nomogram Stratified by Estimated Fetal Weight.
- Author
-
Farladansky-Gershnabel S, Jayapal P, Zalcman M, Barth RA, Rubesova E, Hintz SR, Zhang J, Leonard SA, El-Sayed YY, and Blumenfeld YJ
- Subjects
- Humans, Female, Pregnancy, Prenatal Diagnosis methods, Gestational Age, Retrospective Studies, Lung Volume Measurements methods, Nomograms, Magnetic Resonance Imaging methods, Lung diagnostic imaging, Lung embryology, Lung abnormalities, Fetal Weight
- Abstract
Introduction: Fetal magnetic resonance imaging (MRI) lung volume nomograms are increasingly used to prognosticate neonatal outcomes in fetuses with suspected pulmonary hypoplasia. However, pregnancies complicated by fetal anomalies associated with pulmonary hypoplasia may also be complicated by fetal growth restriction (FGR). If a small lung volume is suspected in such cases, it is often unclear whether the lungs are "small" because of underlying lung pathology, or small fetal size. Existing MRI lung volume nomograms have mostly been stratified by gestational age (GA), rather than estimated fetal weight (EFW). Therefore, we aimed to develop a novel fetal lung volume nomogram stratified by EFW., Methods: Consecutive fetal MRIs performed at a quaternary medical center from 2019 to 2021 were analyzed. MRIs performed due to fetal lung anomalies and cases with FGR were excluded. All MRIs were performed without IV contrast on GE 3 or 1.5 Tesla scanners (GE Healthcare). Images were reviewed by three experienced fetal radiologists. Freehand ROI in square centimeter was drawn around the contours of the lungs on consecutive slices from the apex to the base. The volume of the right, left and total lungs were calculated in mL. Lung volumes were plotted by both EFW and GA., Results: Among 301 MRI studies performed during the study period, 170 cases met inclusion criteria and were analyzed. MRIs were performed between 19- and 38-week gestation, and a sonographic EFW was obtained within a mean of 2.9 days (SD ± 5.5 days, range 0-14 days) of each MRI. Nomograms stratified by both EFW and GA were created using 200 g. and weekly intervals respectively. A formula using EFW to predict total lung volume was calculated: LV = 0.07497804 EFW0.88276 (R2 = 0.87)., Conclusions: We developed a novel fetal lung volume nomogram stratified by EFW. If validated, this nomogram may assist clinicians predict outcomes in cases of fetal pulmonary hypoplasia with concomitant FGR., (© 2024 S. Karger AG, Basel.)
- Published
- 2024
- Full Text
- View/download PDF
4. Real-time ultrasound-derived fat fraction in pediatric population: feasibility validation with MR-PDFF.
- Author
-
Zalcman M, Barth RA, and Rubesova E
- Subjects
- Humans, Male, Child, Female, Adolescent, Cross-Sectional Studies, Prospective Studies, Feasibility Studies, Magnetic Resonance Imaging, Liver diagnostic imaging, Liver pathology, Protons, Non-alcoholic Fatty Liver Disease
- Abstract
Background: Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in children. To avoid limitations of liver biopsy and MRI, quantitative ultrasound has become a research focus. Ultrasound-derived fat fraction (UDFF) is based on a combination of backscatter coefficient and attenuation parameter., Objective: The objectives of the study were to determine (1) agreement between UDFF/MRI proton density fat fraction (MR-PDFF) and (2) whether BMI and age are predictive for UDFF., Materials and Methods: This cross-sectional prospective study included a convenience sample of 46 children referred for clinically indicated abdominal MRI. MR-PDFF and five acquisitions of UDFF were collected. Intraclass correlation coefficient (ICC) and Bland-Altman analysis were used to assess agreement between MR-PDFF and UDFF. Receiver operating characteristic curves were calculated for UDFF prediction of liver steatosis (MR-PDFF ≥ 6%). Multivariable regression was performed to assess BMI and age as predictors for UDFF., Results: Twenty-two participants were male, 24 were female, and the mean age was 14 ± 3 (range: 7-18) years. Thirty-six out of 46 participants had normal liver fat fraction <6%, and 10/46 had liver steatosis. UDFF was positively associated with MR-PDFF (ICC 0.92 (95% CI, 0.89-0.96). The mean bias between UDFF and MR-PDFF was 0.64% (95% LOA, -5.3-6.6%). AUROC of UDFF for steatosis was of 0.95 (95% CI, 0.89-0.99). UDFF cutoff of 6% had a sensitivity of 90% (95% CI, 55-99%) and a specificity of 94% (95% CI, 81-0.99%). BMI was an independent predictor of UDFF (correlation: 0.55 (95% CI, 0.35-0.95))., Conclusions: UDFF shows strong agreement with MR-PDFF in children. A UDFF cutoff of 6% provides good sensitivity and specificity for detection of MR-PDFF of ≥ 6%., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
- Published
- 2023
- Full Text
- View/download PDF
5. Use of Artificial Intelligence in Radiology: Impact on Pediatric Patients, a White Paper From the ACR Pediatric AI Workgroup.
- Author
-
Sammer MBK, Akbari YS, Barth RA, Blumer SL, Dillman JR, Farmakis SG, Frush DP, Gokli A, Halabi SS, Iyer R, Joshi A, Kwon JK, Otero HJ, Sher AC, Sotardi ST, Taragin BH, Towbin AJ, and Wald C
- Subjects
- Adult, Humans, Child, Societies, Medical, Radiography, Diagnostic Imaging methods, Artificial Intelligence, Radiology methods
- Abstract
In this white paper, the ACR Pediatric AI Workgroup of the Commission on Informatics educates the radiology community about the health equity issue of the lack of pediatric artificial intelligence (AI), improves the understanding of relevant pediatric AI issues, and offers solutions to address the inadequacies in pediatric AI development. In short, the design, training, validation, and safe implementation of AI in children require careful and specific approaches that can be distinct from those used for adults. On the eve of widespread use of AI in imaging practice, the group invites the radiology community to align and join Image IntelliGently (www.imageintelligently.org) to ensure that the use of AI is safe, reliable, and effective for children., (Copyright © 2023 American College of Radiology. Published by Elsevier Inc. All rights reserved.)
- Published
- 2023
- Full Text
- View/download PDF
6. Perspective: Mandatory Radiology Education for Medical Students.
- Author
-
Farmakis SG, Chertoff JD, Straus CM, and Barth RA
- Subjects
- Humans, Curriculum, Radiography, Educational Status, Schools, Medical, Students, Medical, Radiology education, Education, Medical, Undergraduate methods, Education, Medical
- Abstract
Radiology education of medical students is increasingly important given the intersection of radiology with virtually all medical specialties and integral role of imaging in modern patient care. Yet radiology education requirements in US medical schools are variable with only a minority of schools requiring a clerkship in radiology. When required, the radiology curriculum is often limited to anatomy courses in the preclinical years or partially incorporated into required core clerkships and often taught by nonradiologists. Given the growing mandate for value-based care and emphasis on patient outcomes, medical students require better imaging education, both interpretive and non-interpretative skills. They should be taught how to apply appropriateness criteria for exam ordering and the relative costs of different imaging modalities given the economic implications of imaging overutilization. Medical students should also be educated regarding imaging safety considerations. In addition, they must learn the radiologist's role as consultant to assure appropriate ordering of imaging studies, oversight for performance of diagnostic exams and image-guided procedures, interpretation of studies, and communication of results. Increasing radiologist teaching and engagement with medical students also has the potential to improve diversity and inclusivity in radiology by increasing interest in the specialty as physicians who identify as underrepresented minorities (URMs) are more likely to practice in underserved areas and with underserved populations thus addressing healthcare disparities and improving access to healthcare for those patient populations. Medical schools should support preclinical and clinical curricula that is designed and taught by radiologists., (Copyright © 2022 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)
- Published
- 2023
- Full Text
- View/download PDF
7. Treatment of Fetal Cystic Fibrosis With Cystic Fibrosis Transmembrane Conductance Regulator Modulation Therapy.
- Author
-
Blumenfeld YJ, Hintz SR, Aziz N, Barth RA, Spano JM, El-Sayed YY, and Milla C
- Subjects
- Humans, Mutation, Cystic Fibrosis Transmembrane Conductance Regulator genetics, Cystic Fibrosis complications, Cystic Fibrosis genetics, Cystic Fibrosis therapy
- Abstract
Competing Interests: Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L23-0112.
- Published
- 2023
- Full Text
- View/download PDF
8. Pediatric Radiologist Workforce Shortage: Action Steps to Resolve.
- Author
-
Farmakis SG, Chertoff JD, and Barth RA
- Subjects
- Child, Humans, Radiologists, Workforce, Physicians
- Published
- 2021
- Full Text
- View/download PDF
9. Obstetric and neonatal outcomes in pregnancies complicated by fetal lung masses: does final histology matter?
- Author
-
Anderson JN, Girsen AI, Hintz SR, El-Sayed YY, Davis AS, Barth RA, Halabi S, Hazard FK, Sylvester KG, Bruzoni M, and Blumenfeld YJ
- Subjects
- Female, Humans, Infant, Newborn, Lung diagnostic imaging, Pregnancy, Retrospective Studies, Ultrasonography, Prenatal, Cystic Adenomatoid Malformation of Lung, Congenital, Prenatal Care
- Abstract
Purpose: Fetal lung masses complicate approximately 1 in 2000 live births. Our aim was to determine whether obstetric and neonatal outcomes differ by final fetal lung mass histology., Materials and Methods: A review of all pregnancies complicated by a prenatally diagnosed fetal lung mass between 2009 and 2017 at a single academic center was conducted. All cases included in the final analysis underwent surgical resection and histology diagnosis was determined by a trained pathologist. Clinical data were obtained from review of stored electronic medical records which contained linked maternal and neonatal records. Imaging records included both prenatal ultrasound and magnetic resonance imaging. Fisher's exact test was used for categorical variables and the Kruskal-Wallis test was used for continuous variables. The level of significance was p <.05., Results: Of 61 pregnancies complicated by fetal lung mass during the study period, 45 cases underwent both prenatal care and postnatal resection. Final histology revealed 10 cases of congenital pulmonary airway malformation (CPAM) type 1, nine cases of CPAM type 2, and 16 cases of bronchopulmonary sequestration. There was no difference in initial, maximal, or final CPAM volume ratio between groups, with median final CPAM volume ratio of 0.6 for CPAM type 1, 0.7 for CPAM type 2, and 0.3 for bronchopulmonary sequestration ( p = .12). There were no differences in any of the maternal or obstetric outcomes including gestational age at delivery and mode of delivery between the groups. The primary outcome of neonatal respiratory distress was not statistically different between groups ( p = .66). Median neonatal length of stay following delivery ranged from 3 to 4 days, and time to postnatal resection was similar as well, with a median of 126 days for CPAM type 1, 122 days for CPAM type 2, and 132 days for bronchopulmonary sequestration ( p = .76)., Conclusions: In our cohort, there was no significant association between histologic lung mass subtypes and any obstetric or neonatal morbidity including respiratory distress.
- Published
- 2021
- Full Text
- View/download PDF
10. Contrast-enhanced ultrasound of blunt abdominal trauma in children.
- Author
-
Paltiel HJ, Barth RA, Bruno C, Chen AE, Deganello A, Harkanyi Z, Henry MK, Ključevšek D, and Back SJ
- Subjects
- Adult, Child, Contrast Media, Humans, Spleen diagnostic imaging, Ultrasonography, Abdominal Injuries diagnostic imaging, Wounds, Nonpenetrating diagnostic imaging
- Abstract
Trauma is the leading cause of morbidity and mortality in children, and rapid identification of organ injury is essential for successful treatment. Contrast-enhanced ultrasound (CEUS) is an appealing alternative to contrast-enhanced CT in the evaluation of children with blunt abdominal trauma, mainly with respect to the potential reduction of population-level exposure to ionizing radiation. This is particularly important in children, who are more vulnerable to the hazards of ionizing radiation than adults. CEUS is useful in hemodynamically stable children with isolated blunt low- to moderate-energy abdominal trauma to rule out solid organ injuries. It can also be used to further evaluate uncertain contrast-enhanced CT findings, as well as in the follow-up of conservatively managed traumatic injuries. CEUS can be used to detect abnormalities that are not apparent by conventional US, including infarcts, pseudoaneurysms and active bleeding. In this article we present the current experience from the use of CEUS for the evaluation of pediatric blunt abdominal trauma, emphasizing the examination technique and interpretation of major abnormalities associated with injuries in the liver, spleen, kidneys, adrenal glands, pancreas and testes. We also discuss the limitations of the technique and offer a review of the major literature on this topic in children, including an extrapolation of experience from adults., (© 2020. Springer-Verlag GmbH Germany, part of Springer Nature.)
- Published
- 2021
- Full Text
- View/download PDF
11. Starting a pediatric contrast ultrasound service: made simple!
- Author
-
Darge K, Back SJ, Barth RA, Johnson AM, Kwon JK, McCarville MB, Morgan TA, Ntoulia A, Poznick L, Shellikeri S, Srinivasan AS, and Cahill AM
- Subjects
- Child, Fluoroscopy, Humans, Microbubbles, Ultrasonography, Contrast Media, Vesico-Ureteral Reflux
- Abstract
The addition of contrast US to an existing pediatric US service requires several preparatory steps. This overview provides a guide to simplify the process. Initially, it is important to communicate to all stakeholders the justifications for pediatric contrast US, including (1) its comparable or better diagnostic results relative to other modalities; (2) its reduction in procedural sedation or anesthesia by avoiding MRI or CT; (3) its reduction or elimination of radiation exposure by not having to perform fluoroscopy or CT; (4) the higher safety profile of US contrast agents (UCA) compared to other contrast agents; (5) the improved exam comfort and ease inherent to US, leading to better patient and family experience, including bedside US exams for children who cannot be transported; (6) the need for another diagnostic option in light of increasing demand by parents and providers; and (7) its status as an approved and reimbursable exam. It is necessary to have an UCA incorporated into the pharmacy formulary noting that only SonoVue/Lumason is currently approved for pediatric use. In the United States this UCA is approved for intravenous administration for cardiac and liver imaging and for vesicoureteric reflux detection with intravesical application. In Europe and China it is only approved for the intravesical use in children. All other applications are off-label. The US scanner needs to be equipped with contrast-specific software. The UCA has to be prepared just before the exam and it is important to strictly follow the steps as outlined in the packaging inserts in order to prevent premature destruction of the microbubbles. The initial training in contrast US is best focused on the frontline staff actually performing the US studies; these might be sonographers, pediatric or interventional radiologists, or trainees. It is important from the outset to educate the referring physicians about contrast US. It is helpful to participate in existing contrast US courses, particularly those with hands-on components., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of Springer Nature.)
- Published
- 2021
- Full Text
- View/download PDF
12. Liver Fat Quantification by Ultrasound in Children: A Prospective Study.
- Author
-
D'Hondt A, Rubesova E, Xie H, Shamdasani V, and Barth RA
- Subjects
- Adolescent, Child, Elasticity Imaging Techniques, Female, Humans, Magnetic Resonance Imaging methods, Male, Prospective Studies, Protons, ROC Curve, Reference Standards, Ultrasonography, Non-alcoholic Fatty Liver Disease diagnostic imaging
- Abstract
BACKGROUND. Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in children in certain regions and is rising in prevalence with increasing obesity. Accurate noninvasive imaging methods for diagnosing and quantifying liver fat are needed to guide NAFLD management. OBJECTIVE. The purpose of this article is to evaluate four ultrasound technologies for quantitative assessment of liver fat content in children using MRI proton density fat fraction (PDFF) as a reference standard. METHODS. This prospective study enrolled children who underwent clinical abdominal MRI without general anesthesia between November 2018 and July 2019. Patients underwent investigational liver ultrasound within a day of 1.5-T or 3-T MRI. Acquired ultrasound radiofrequency data were processed offline to compute the acoustic attenuation coefficient, hepatorenal index (HRI), Nakagami parameter, and shear-wave elastography (SWE) parameters (elasticity, viscosity, and dispersion). Ultrasound parameters were compared with MRI PDFF obtained using a multiecho sequence. A second observer independently performed offline attenuation coefficient and HRI measurements in all patients. RESULTS. A total of 48 patients were enrolled: 22 girls, 26 boys; mean age of 13 years (range, 7-17 years); mean body mass index (weight in kilograms divided by the square of height in meters) of 22.25 (range, 14.5-48.1). A total of 21% (10/48) had steatosis (PDFF ≥ 5%). PDFF was correlated with attenuation coefficient ( r = 0.76; 95% CI, 0.60-0.86; p < .001), HRI ( r = 0.84; 95% CI, 0.74-0.91; p < .001), and Nakagami parameter ( r = 0.55, 95% CI, 0.32-0.72, p < .001), but not SWE parameters ( r = 0.05-0.25; p > .05). In patients with no, mild, moderate, and severe steatosis according to PDFF, the mean (± SD) attenuation coefficient was 0.48 ± 0.08, 0.54 ± 0.03, 0.57 ± 0.04, and 0.86 ± 0.07 dB/cm/MHz, respectively, and the mean HRI was 1.28 ± 0.30, 1.59 ± 0.23, 2.25 ± 0.04, and 3.06 ± 0.49, respectively. For the attenuation coefficient, the threshold of 0.54 dB/cm/MHz achieved a sensitivity of 80% and a specificity of 82% for steatosis, and 0.60 dB/cm/MHz achieved a sensitivity of 80% and a specificity of 98% for moderate steatosis. For HRI, the threshold of 1.48 achieved sensitivity of 90% and specificity of 76% for steatosis, and 2.11 achieved sensitivity of 100% and specificity of 100% for moderate steatosis. The interobserver concordance coefficient was 0.92 for attenuation coefficient and 0.91 for HRI. CONCLUSION. Attenuation coefficient and HRI accurately detected and quantified liver fat in this small sample of children. CLINICAL IMPACT. Quantitative ultrasound parameters may guide NAFLD diagnosis and management in children.
- Published
- 2021
- Full Text
- View/download PDF
13. Ultrasound shear wave elastography: does it add value to gray-scale ultrasound imaging in differentiating biliary atresia from other causes of neonatal jaundice?
- Author
-
Sandberg JK, Sun Y, Ju Z, Liu S, Jiang J, Koci M, Rosenberg J, Rubesova E, and Barth RA
- Subjects
- Female, Humans, Infant, Infant, Newborn, Male, Ultrasonography, Biliary Atresia diagnostic imaging, Cholestasis, Elasticity Imaging Techniques, Jaundice, Neonatal diagnostic imaging
- Abstract
Background: Neonatal/infantile jaundice is relatively common, and most cases resolve spontaneously. However, in the setting of unresolved neonatal cholestasis, a prompt and accurate assessment for biliary atresia is vital to prevent poor outcomes., Objective: To determine whether shear wave elastography (SWE) alone or combined with gray-scale imaging improves the diagnostic performance of US in discriminating biliary atresia from other causes of neonatal jaundice over that of gray-scale imaging alone., Materials and Methods: Infants referred for cholestatic jaundice were assessed with SWE and gray-scale US. On gray-scale US, two radiology readers assessed liver heterogeneity, presence of the triangular cord sign, hepatic artery size, presence/absence of common bile duct and gallbladder, and gallbladder shape; associated interobserver correlation coefficients (ICC) were calculated. SWE speeds were performed on a Siemens S3000 using 6C2 and 9 L4 transducers with both point and two-dimensional (2-D) SWE US. Both univariable and multivariable analyses were performed, as were receiver operating characteristic curves (ROC) and statistical significance tests (chi-squared, analysis of variance, t-test and Wilcoxon rank sum) when appropriate., Results: There were 212 infants with biliary atresia and 106 without biliary atresia. The median shear wave speed (SWS) for biliary atresia cases was significantly higher (P<0.001) than for non-biliary-atresia cases for all acquisition modes. For reference, the median L9 point SWS was 2.1 m/s (interquartile range [IQR] 1.7-2.4 m/s) in infants with biliary atresia and 1.5 m/s (IQR 1.3-1.9 m/s) in infants without biliary atresia (P<0.001). All gray-scale US findings were significantly different between biliary-atresia and non-biliary-atresia cohorts (P<0.001), intraclass correlation coefficient (ICC) range 0.7-1.0. Triangular cord sign was most predictive of biliary atresia independent of other gray-scale findings or SWS - 96% specific and 88% sensitive. Multistep univariable/multivariable analysis of both gray-scale findings and SWE resulted in three groups being predictive of biliary atresia likelihood. Abnormal common bile duct/gallbladder and enlarged hepatic artery were highly predictive of biliary atresia independent of SWS (100% for girls and 95-100% for boys). Presence of both the common bile duct and the gallbladder along with a normal hepatic artery usually excluded biliary atresia independent of SWS. Other gray-scale combinations were equivocal, and including SWE improved discrimination between biliary-atresia and non-biliary-atresia cases., Conclusion: Shear wave elastography independent of gray-scale US significantly differentiated biliary-atresia from non-biliary-atresia cases. However, gray-scale findings were more predictive of biliary atresia than elastography. SWE was useful for differentiating biliary-atresia from non-biliary-atresia cases in the setting of equivocal gray-scale findings., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of Springer Nature.)
- Published
- 2021
- Full Text
- View/download PDF
14. Clinical use of shear-wave elastography for detecting liver fibrosis in children and adolescents with cystic fibrosis.
- Author
-
Levitte S, Lee LW, Isaacson J, Zucker EJ, Milla C, Barth RA, and Sellers ZM
- Subjects
- Adolescent, Child, Humans, Liver diagnostic imaging, Liver pathology, Liver Cirrhosis diagnostic imaging, Liver Cirrhosis pathology, Cystic Fibrosis complications, Cystic Fibrosis diagnostic imaging, Cystic Fibrosis pathology, Elasticity Imaging Techniques, Liver Diseases pathology
- Abstract
Background: Complications from liver cirrhosis are a leading cause of death in children with cystic fibrosis. Identifying children at risk for developing liver cirrhosis and halting its progression are critical to reducing liver-associated mortality., Objective: Quantitative US imaging, such as shear-wave elastography (SWE), might improve the detection of liver fibrosis in children with cystic fibrosis (CF) over gray-scale US alone. We incorporated SWE in our pediatric CF liver disease screening program and evaluated its performance using magnetic resonance (MR) elastography., Materials and Methods: Ninety-four children and adolescents with CF underwent 178 SWE exams, aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT) and platelet measurements. Of these, 27 children underwent 34 MR elastography exams. We evaluated SWE performance using 6-MHz and 9-MHZ point SWE, and 9-MHz two-dimensional (2-D) SWE., Results: The 6-MHz point SWE was the only method that correlated with MR elastography (r=0.52; 95% confidence interval [CI] 0.20-0.74; P=0.003). SWE of 1.45 m/s distinguished normal from abnormal MR elastography (79% sensitivity, 100% specificity, 100% positive predictive value [PPV], 55% negative predictive value [NPV], area under the receiver operating characteristic [AUROC] curve 0.94). SWE of 1.84 m/s separated mild-moderate (3.00-4.77 kPa) from severe (>4.77 kPa) MR elastography (88% sensitivity, 86% specificity, 78% PPV, 93% NPV, AUROC 0.79). Elevations of AST, ALT, GGT and thrombocytopenia were associated with higher SWE. AST-to-platelet ratio index of 0.42, fibrosis-4 of 0.29, and GGT-to-platelet ratio of 1.43 all had >95% NPV for SWE >1.84 m/s., Conclusion: Given its correlation with MR elastography, SWE might be a clinically useful predictor of liver fibrosis. We identified imaging criteria delineating the use of SWE to identify increased liver stiffness in children with CF. With multicenter validation, these data might be used to improve the detection and monitoring of liver fibrosis in children with CF.
- Published
- 2021
- Full Text
- View/download PDF
15. Economically Motivated Patient Steerage: The Pediatric Perspective.
- Author
-
Heller RE, Milla SS, and Barth RA
- Subjects
- Child, Humans, Pediatrics
- Published
- 2020
- Full Text
- View/download PDF
16. New Algorithm for the Integration of Ultrasound Into Cystic Fibrosis Liver Disease Screening.
- Author
-
Sellers ZM, Lee LW, Barth RA, and Milla C
- Subjects
- Adolescent, Child, Cohort Studies, Cystic Fibrosis complications, Cystic Fibrosis diagnostic imaging, Elasticity Imaging Techniques, Female, Humans, Male, Platelet Count, ROC Curve, Sensitivity and Specificity, Severity of Illness Index, Ultrasonography, Algorithms, Cystic Fibrosis diagnosis, Liver Cirrhosis complications
- Abstract
Objectives: Liver nodularity occurs across the spectrum of cystic fibrosis liver disease (CFLD), from regenerative nodules to cirrhosis, and can occur without liver enzyme abnormalities. Our aims were to determine if incorporating abdominal ultrasound (US) with annual laboratory testing improves the detection of CFLD and establish CF-specific thresholds for liver screening labs., Methods: CF patients at least 6 years old who were exocrine pancreatic-insufficient had an US with Doppler and shear wave elastography. Patients were divided into Normal, Echogenic, or Nodular groups, based on US findings. Results were compared with aspartate aminotransferase (AST), alanine aminotransferase (ALT), platelets, AST to platelet ratio index (APRI), Fibrosis 4 (FIB-4), and gamma-glutamyl transferase (GGT) to platelet ratio (GPR). Receiver operator curve, sensitivity, specificity, positive predictive value, negative predictive value, and optimal cut-off with Youden Index were calculated., Results: From 82 patients, incorporation of US identified more nodular livers than using labs alone. The Nodular group had significantly greater median AST (44), ALT (48), GGT (46), APRI (0.619), FIB-4 (0.286), GPR (1.431). Optimal cut-offs to detect liver nodularity in CF were AST >33, ALT >45, GGT >21, Platelets <230, APRI >0.367, FIB-4 >0.222, GPR >0.682. Using GGT, APRI, and GPR, we generated an algorithm to direct the use of US in CFLD screening., Conclusions: Using modified serum lab thresholds, addition of liver fibrosis indices, and/or abdominal US can increase detection of liver nodularity in CF. A combination of GGT, GPR, and APRI can help direct which CF children should undergo US evaluation. These tools may improve earlier identification of fibrosis and/or cirrhosis in CF patients.
- Published
- 2019
- Full Text
- View/download PDF
17. Prospective Assessment of Ultrasound Shear Wave Elastography for Discriminating Biliary Atresia from other Causes of Neonatal Cholestasis.
- Author
-
Dillman JR, DiPaola FW, Smith SJ, Barth RA, Asai A, Lam S, Campbell KM, Bezerra JA, Tiao GM, and Trout AT
- Subjects
- Alanine Transaminase blood, Biliary Atresia pathology, Biomarkers blood, Cholestasis etiology, Cholestasis pathology, Elasticity Imaging Techniques, Female, Humans, Infant, Infant, Newborn, Liver diagnostic imaging, Liver pathology, Male, Predictive Value of Tests, Prospective Studies, Ultrasonography, gamma-Glutamyltransferase blood, Biliary Atresia diagnostic imaging, Cholestasis diagnostic imaging
- Abstract
Objective: To prospectively assess the diagnostic performance of ultrasound shear wave elastography (SWE) and hepatobiliary laboratory biomarkers for discriminating biliary atresia from other causes of neonatal cholestasis., Study Design: Forty-one patients <3 months of age with neonatal cholestasis (direct bilirubin >2 mg/dL) and possible biliary atresia were prospectively enrolled. Both 2-dimensional (2D) and point ultrasound SWE were performed prior to knowing the final diagnosis. Median 2D (8) and point (10) shear wave speed measurements were calculated for each subject and used for analyses. The Mann-Whitney U test was used to compare shear wave speed and laboratory measurements between patients with and without biliary atresia. Receiver operating characteristic curve analyses and multivariable logistic regression were used to evaluate diagnostic performance., Results: Thirteen subjects (31.7%) were diagnosed with biliary atresia, and 28 subjects (68.3%) were diagnosed with other causes of neonatal cholestasis. Median age at the time of ultrasound SWE was 37 days. Median 2D (2.08 vs 1.49 m/s, P = .0001) and point (1.95 vs 1.21 m/s, P = .0014) ultrasound SWE measurements were significantly different between subjects with and without biliary atresia. Using a cut-off value of >1.84 m/s, 2D ultrasound SWE had a sensitivity = 92.3%, specificity = 78.6%, and area under the receiver operating characteristic curve (AuROC) of 0.89 (P < .0001). Using a cut-off value of >320 (U/L), gamma-glutamyl transferase (GGT) had a sensitivity = 100.0%, specificity = 77.8%, and AuROC of 0.85 (P < .0001). Multivariable logistic regression demonstrated an AuROC of 0.93 (P < .0001), with 2 significant covariates (2D ultrasound SWE [OR = 23.06, P = .01]; GGT [OR = 1.003, P = .036])., Conclusions: Ultrasound SWE and GGT can help discriminate biliary atresia from other causes of neonatal cholestasis., (Copyright © 2019 Elsevier Inc. All rights reserved.)
- Published
- 2019
- Full Text
- View/download PDF
18. The learning curve of contrast-enhanced 'microbubble' voiding urosonography-validation study.
- Author
-
Velasquez M, Emerson MG, Diaz E, Kennedy W, Rubesova E, and Barth RA
- Subjects
- Academic Medical Centers, Adolescent, Age Distribution, Child, Child, Preschool, Female, Fluoroscopy adverse effects, Follow-Up Studies, Humans, Incidence, Infant, Learning Curve, Male, Pyelonephritis etiology, Pyelonephritis prevention & control, Radiation Exposure prevention & control, Radiography, Risk Assessment, Sex Distribution, United States, Urination physiology, Urodynamics physiology, Vesico-Ureteral Reflux therapy, Contrast Media, Cystography methods, Fluoroscopy methods, Ultrasonography methods, Vesico-Ureteral Reflux diagnostic imaging, Vesico-Ureteral Reflux epidemiology
- Abstract
Introduction: Vesicoureteral reflux (VUR) is a common pediatric urologic condition associated with urinary tract infection and pyelonephritis. It can be diagnosed via fluoroscopic voiding cystourethrogram (VCUG) and, more recently, contrast-enhanced voiding ultrasonography (ceVUS), which does not expose the patient to ionizing radiation. Voiding urosonography contrast agents used for the diagnosis of VUR have been widely available in Europe but were approved by the Food and Drug Administration for use in the United States only in 2016., Objective: The objective was to optimize a protocol and compare the diagnostic performance of ceVUS to fluoroscopic VCUG in an academic medical center naïve to previous use of contrast-enhanced voiding urosonography., Study Design: Thirty-nine patients referred for clinically indicated evaluation of VUR were enrolled between September 2016 and March 2017. Patients underwent contrast-enhanced ultrasonography with prediluted Lumason and under the same catheterization underwent fluoroscopic VCUG. Comparative grading was performed by pediatric radiologists on-site at the time of examination., Results: Reflux was observed in 16 of 39 patients (20 of 64 renal units) ranging from grades 1 through 5. VCUG and ceVUS were concordant for detecting reflux in 10 of 39 patients (14 of 84 renal units) and excluding reflux in 23 of 39 patients (64 of 84 renal units) (Fig. 1). Using contrast enhanced voiding urosonography, 1 of 20 renal units had high-grade and 2 of 20 renal units had low-grade reflux that was not found on fluoroscopy. Using fluoroscopy, 1 of 20 renal units had high-grade and 2 of 20 renal units had low-grade reflux that had not been found on ceVUS. Two of 20 renal units were upgraded from low-grade on ceVUS to high-grade on fluoroscopy. This corresponds to a Cohen's kappa of 0.72 (confidence interval [CI] 0.54-0.91) or 'moderate.', Discussion: During our investigation, we noted that there was a technical learning curve related to poor contrast mixing and the need to titrate the concentration of Lumason. However, over the course of the study, we were able to correct the technical aspects. Ultimately, our results showed good correlation between VCUG and Lumason ceVUS and only slightly less correlation than published studies by experienced centers. Future studies with voiding should allow for improved urethral visualization., Conclusion: While there is a considerable learning curve to the implementation of ceVUS for the diagnosis of pediatric VUR, these technical aspects can be corrected. Even a center previously naïve to contrast-enhanced ultrasound technology can, over a short period of time, demonstrate good correlation between VCUG and ceVUS in the diagnosis of VUR. Translation of ceVUS into clinical practice is an alternative to VCUG for diagnosis of reflux, is feasible, and can eliminate the radiation exposure associated with a VCUG., (Copyright © 2019 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2019
- Full Text
- View/download PDF
19. Normal values of the resistivity index of the pericallosal artery with and without compression of the anterior fontanelle.
- Author
-
Elmfors AF, Sandgren T, Ford K, Rosenberg J, Ringertz H, Barth RA, and Rubesova E
- Subjects
- Female, Gestational Age, Humans, Infant, Newborn, Male, Reference Values, Reproducibility of Results, Retrospective Studies, Cerebral Arteries diagnostic imaging, Cerebral Arteries physiology, Cranial Fontanelles diagnostic imaging, Cranial Fontanelles physiology, Ultrasonography, Doppler, Transcranial methods, Vascular Resistance physiology
- Abstract
Background: Resistivity index (RI) of the pericallosal artery as is commonly measured during head ultrasound (US) examination in neonates. Some studies have shown that RI measured with gentle compression of the fontanelle provides additional information in cases of neonatal brain anomalies., Objective: The purpose of this study was to establish normal RI values with and without compression in a large population of neonates with normal cranial ultrasound as a function of gestational age., Materials and Methods: The authors of this retrospective study reviewed the RI of 323 infants with normal gray-scale cranial US and with a gestational age ranging 26-42 weeks. We conducted the exams both with and without compression of the anterior fontanelle and we studied changes in RI depending on gestational age, gender and type of delivery., Results: Infants with a gestational age of more than 35 weeks tended to have a lower RI (P=0.011). The compression of the anterior fontanelle emphasized the change in RI with increasing gestational age, with higher gestational ages having a lower RI (P<0.001). The results concerning the percentage change between baseline RI and RI with compression showed that infants with higher gestational ages have a smaller percentage change in RI (P=0.002)., Conclusion: We established the normal values for RI from 26 weeks to 42 weeks of gestation. The results of the study show the importance of taking the gestational age into consideration when evaluating the RI.
- Published
- 2019
- Full Text
- View/download PDF
20. Predicting Pathology From Imaging in Children Undergoing Resection of Congenital Lung Lesions.
- Author
-
Narayan RR, Abadilla N, Greenberg DR, Sylvester KG, Hintz SR, Barth RA, and Bruzoni M
- Subjects
- Female, Humans, Infant, Lung diagnostic imaging, Lung surgery, Lung Diseases congenital, Lung Diseases surgery, Male, Patient Care Planning, Pneumonectomy, Pregnancy, Prenatal Diagnosis methods, Preoperative Period, Respiratory System Abnormalities surgery, Retrospective Studies, Sensitivity and Specificity, Clinical Decision-Making methods, Lung pathology, Lung Diseases diagnostic imaging, Magnetic Resonance Imaging, Respiratory System Abnormalities diagnostic imaging, Tomography, X-Ray Computed
- Abstract
Background: Prenatal magnetic resonance imaging (MRI) is increasingly obtained to define congenital lung lesions (CLL) for surgical management. Postnatal, preoperative computed tomography (CT) provides further clarity at the cost of radiation. Depending on the lesion identified, the indication for resection remains controversial. We investigated the differences in detail found on prenatal MRI and postnatal CT compared with final pathology to determine their utility in preoperative decision-making., Materials and Methods: All children undergoing resection of CLLs at a single institution between July 2009 and February 2018 were retrospectively identified. Their imaging, operative, and pathology reports were compared. All imaging studies were examined by pediatric radiologists with experience in prenatal CLL diagnosis., Results: Fifty-five patients underwent CLL resection during the study period with 31 undergoing prenatal MRI, 45 postnatal CT, and 22 both. Resection was performed before 6 mo of age in 62% of patients. In the cohort undergoing both imaging studies, pathologic CLL diagnosis correlated with prenatal MRI and CT in 82% and 100% of patients, respectively (P = 0.13). Eight patients had systemic feeding vessels, of which 38% were identified on MRI, and 88% on CT (P = 0.13). Both studies had a specificity of 100% for detecting systemic feeding vessels., Conclusions: For children where prenatal MRI detected a systemic feeding vessel, CT was redundant for preoperative planning but had greater sensitivity. Ultimately, the CLL type predicted from postnatal CT was not significantly different from that predicted by prenatal MRI; however, both imaging modalities had some level of discrepancy with pathology., (Copyright © 2018 Elsevier Inc. All rights reserved.)
- Published
- 2019
- Full Text
- View/download PDF
21. Utility of prenatal MRI in the evaluation and management of fetal ventriculomegaly.
- Author
-
Katz JA, Chock VY, Davis AS, Blumenfeld YJ, Hahn JS, Barnes P, Barth RA, Rubesova E, and Hintz SR
- Subjects
- Adult, California epidemiology, Female, Humans, Hydrocephalus epidemiology, Logistic Models, Pregnancy, Prenatal Diagnosis methods, Retrospective Studies, Ultrasonography, Prenatal, Hydrocephalus diagnostic imaging, Magnetic Resonance Imaging
- Abstract
Objective: Fetal ventriculomegaly may occur in isolation or as part of a broader syndrome. We aimed to determine the added value of magnetic resonance imaging (MRI) for informing the pre-natal and postnatal care of pregnancies complicated by ventriculomegaly (VM)., Study Design: Retrospective analysis of all cases of prenatally diagnosed VM referred to the fetal center at Lucile Packard Children's Hospital Stanford 1/1/2009-6/1/2014 were reviewed. Ultrasound (US) and MRI findings were reviewed, and the added yield of MRI evaluated., Results: A total of 91 cases of fetal VM were identified and 74 (81%) underwent MRI. In 62/74 (84%) cases, additional CNS or non-CNS findings, not seen on US, were discovered on MRI, of which 58 were CNS-related. Forty-six (62%) of the additional findings were considered clinically relevant, of which 45 were CNS-related., Conclusion: Fetal MRI identifies additional, clinically relevant CNS and non-CNS findings in a majority of cases of VM following initial US.
- Published
- 2018
- Full Text
- View/download PDF
22. Current controversies in prenatal diagnosis 3: Fetal MRI should be performed in all prenatally detected fetuses with a major structural abnormality.
- Author
-
Platt LD, Barth RA, and Pugash D
- Subjects
- Female, Humans, Pregnancy, Congenital Abnormalities diagnostic imaging, Fetus diagnostic imaging, Magnetic Resonance Imaging, Prenatal Diagnosis
- Published
- 2018
- Full Text
- View/download PDF
23. Pediatric scrotal ultrasound: review and update.
- Author
-
Alkhori NA and Barth RA
- Subjects
- Child, Humans, Male, Scrotum abnormalities, Scrotum anatomy & histology, Testicular Diseases congenital, Scrotum diagnostic imaging, Testicular Diseases diagnostic imaging, Ultrasonography methods
- Abstract
In this pictorial essay the authors review the normal sonographic gray-scale and Doppler appearance of the pediatric scrotum with an emphasis on technique. The authors present an update on ultrasound diagnosis and outcomes in testicular torsion and differentiation from other acute scrotal processes, as well as sonographic imaging of testicular microlithiasis and uncommon or atypical scrotal masses including splenogonadal fusion, polyorchidism, meconium peritonitis and epidermoid cyst. Further, the authors discuss testicular neoplasms in the context of testicular microlithiasis.
- Published
- 2017
- Full Text
- View/download PDF
24. Impact of California Computed Tomography Dose Legislation: Survey of Radiologists.
- Author
-
Zucker EJ and Barth RA
- Abstract
Introduction: Highly publicized accounts of radiation overdose from computed tomography (CT) in both children and adults prompted legislation in California regulating CT dose. The purpose of this study was to determine the impact of the law (codified in Senate Bill [SB] 1237) on California radiologist practice patterns and understanding of CT dose., Materials and Methods: All radiologist members of the California Radiological Society were surveyed in August-September 2013. Questions gauged radiologists' familiarity with and attitudes toward the law, awareness of CT dose, and changes in practice following the law's enactment., Results: Of 1,300 surveyed, 138 (11%) responded; 132 of 137 (96%) were familiar with SB 1237. Of 135 responding, 126 and 115 (93% and 85%, respectively) knew to report CT dose index volume and dose-length product. Sixty of 134 (45%) attributed dose reporting to an increased awareness of appropriate dose ranges. Twenty-nine of 133 (22%) had modified protocols in concert with SB 1237s enactment. Of 31 responding, 5 (16%), 23 (74%), and 3 (74%) had modified protocols in only children, both adults and children, and only adults, respectively. Twenty-four of 129 (19%) utilized automated dose reporting; 48 (37%) and 57 (44%) used dictation/transcription and template-assisted voice recognition, respectively. Forty of 134 (30%) noted delays finalizing CT reports., Conclusions: Most radiologists who responded in our sample were familiar with SB 1237. Nearly half attributed dose reporting to an increased awareness of appropriate dose ranges. Almost one quarter indicated protocol modifications, the majority including children, occurring in conjunction with the law. Reporting inefficiency was a common concern., (Copyright © 2017. Published by Elsevier Inc.)
- Published
- 2017
- Full Text
- View/download PDF
25. Prediction of neonatal respiratory distress in pregnancies complicated by fetal lung masses.
- Author
-
Girsen AI, Hintz SR, Sammour R, Naqvi A, El-Sayed YY, Sherwin K, Davis AS, Chock VY, Barth RA, Rubesova E, Sylvester KG, Chitkara R, and Blumenfeld YJ
- Subjects
- Female, Fetal Diseases pathology, Fetus pathology, Gestational Age, Humans, Infant, Newborn, Lung Diseases congenital, Organ Size, Predictive Value of Tests, Pregnancy, Prognosis, Retrospective Studies, Sensitivity and Specificity, Fetal Diseases diagnosis, Lung diagnostic imaging, Lung pathology, Lung Diseases diagnosis, Magnetic Resonance Imaging methods, Respiratory Distress Syndrome, Newborn diagnosis, Ultrasonography, Prenatal
- Abstract
Objective: The objective of this article is to evaluate the utility of fetal lung mass imaging for predicting neonatal respiratory distress., Method: Pregnancies with fetal lung masses between 2009 and 2014 at a single center were analyzed. Neonatal respiratory distress was defined as intubation and mechanical ventilation at birth, surgery before discharge, or extracorporeal membrane oxygenation (ECMO). The predictive utility of the initial as well as maximal lung mass volume and congenital pulmonary airway malformation volume ratio by ultrasound (US) and magnetic resonance imaging (MRI) was analyzed., Results: Forty-seven fetal lung mass cases were included; of those, eight (17%) had respiratory distress. The initial US was performed at similar gestational ages in pregnancies with and without respiratory distress (26.4 ± 5.6 vs 22.3 ± 3 weeks, p = 0.09); however, those with respiratory distress had higher congenital volume ratio at that time (1.0 vs 0.3, p = 0.01). The strongest predictors of respiratory distress were maximal volume >24.0 cm
3 by MRI (100% sensitivity, 91% specificity, 60% positive predictive value, and 100% negative predictive value) and maximal volume >34.0 cm3 by US (100% sensitivity, 85% specificity, 54% positive predictive value, and 100% negative predictive value)., Conclusion: Ultrasound and MRI parameters can predict neonatal respiratory distress, even when obtained before 24 weeks. Third trimester parameters demonstrated the best positive predictive value. © 2017 John Wiley & Sons, Ltd., (© 2017 John Wiley & Sons, Ltd.)- Published
- 2017
- Full Text
- View/download PDF
26. Prenatally Diagnosed Cases of Binder Phenotype Complicated by Respiratory Distress in the Immediate Postnatal Period.
- Author
-
Blumenfeld YJ, Davis AS, Hintz SR, Milan K, Messner AH, Barth RA, Hudgins L, Chueh J, Homeyer M, Bernstein JA, Enns G, Atwal P, and Manning M
- Subjects
- Adult, Diagnosis, Differential, Female, Humans, Infant, Newborn, Magnetic Resonance Imaging, Male, Pregnancy, Ultrasonography, Prenatal, Maxillofacial Abnormalities complications, Maxillofacial Abnormalities diagnostic imaging, Prenatal Diagnosis methods, Respiratory Insufficiency complications
- Abstract
Binder phenotype, or maxillonasal dysostosis, is a distinctive pattern of facial development characterized by a short nose with a flat nasal bridge, an acute nasolabial angle, a short columella, a convex upper lip, and class III malocclusion. We report 3 cases of prenatally diagnosed Binder phenotype associated with perinatal respiratory impairment., (© 2016 by the American Institute of Ultrasound in Medicine.)
- Published
- 2016
- Full Text
- View/download PDF
27. Fetal suprarenal masses--assessing the complementary role of magnetic resonance and ultrasound for diagnosis.
- Author
-
Flanagan SM, Rubesova E, Jaramillo D, and Barth RA
- Subjects
- Adrenal Gland Diseases embryology, Adrenal Glands diagnostic imaging, Adrenal Glands pathology, California, Female, Humans, Male, Pennsylvania, Reproducibility of Results, Retrospective Studies, Sensitivity and Specificity, Adrenal Gland Diseases diagnosis, Adrenal Glands abnormalities, Image Enhancement methods, Magnetic Resonance Imaging methods, Multimodal Imaging methods, Ultrasonography, Prenatal methods
- Abstract
Objective: To assess the value and complementary roles of fetal MRI and US for characterization and diagnosis of suprarenal masses., Materials and Methods: We conducted a multi-institutional retrospective database search for prenatally diagnosed suprarenal masses between 1999 and 2012 and evaluated the roles of prenatal US and fetal MRI for characterization and diagnosis, using postnatal diagnosis or surgical pathology as the reference standard. Prenatal US and fetal MRI were assessed for unique findings of each modality., Results: The database yielded 25 fetuses (gestational age 20-37 weeks) with suprarenal masses. Twenty-one fetuses had prenatal US, 22 had MRI, 17 had both. Postnatal diagnoses included nine subdiaphragmatic extralobar sequestrations, seven adrenal hemorrhages, five neuroblastomas (four metastatic), two lymphatic malformations, one duplex kidney with upper pole cystic dysplasia, and one adrenal hyperplasia. Ultrasound was concordant with MRI for diagnoses in 12/17 (70.6%) cases. Discordant diagnoses between US and MRI included three neuroblastomas and two adrenal hemorrhages. In the three neuroblastomas US was equivocal and MRI was definitive for neuroblastoma, demonstrating heterogeneous, intermediate-signal solid masses and liver metastases. In the two cases of adrenal hemorrhage US was equivocal and MRI was definitive with signal characteristics of hemorrhage. In 2/4 neuroblastomas, Doppler US demonstrated a systemic artery suggesting extralobar sequestration; however MRI signal characteristics correctly diagnosed neuroblastoma. All cases of extralobar sequestration were correctly diagnosed by US and MRI., Conclusion: US and MRI both accurately detect suprarenal masses. MRI complements US in equivocal diagnoses and detects additional findings such as liver metastases in neuroblastoma.
- Published
- 2016
- Full Text
- View/download PDF
28. Added Value of Radiologist Consultation for Pediatric Ultrasound: Implementation and Survey Assessment.
- Author
-
Zucker EJ, Newman B, Larson DB, Rubesova E, and Barth RA
- Subjects
- Adolescent, Adult, Anxiety psychology, Female, Humans, Male, Middle Aged, Parents psychology, Pediatrics, Professional-Family Relations, Radiology, Referral and Consultation, Ultrasonography
- Abstract
Objective: The purpose of this study was to determine whether radiologist-parent (guardian) consultation sessions for pediatric ultrasound with immediate disclosure of examination results if desired increases visit satisfaction, decreases anxiety, and increases understanding of the radiologist's role., Subjects and Methods: Parents chaperoning any outpatient pediatric ultrasound were eligible and completed surveys before and after ultrasound examinations. Before the second survey, parents met with a pediatric radiologist on a randomized basis but could opt out and request or decline the consultation. Differences in anxiety and understanding of the radiologist's role before and after the examination were compared, and overall visit satisfaction measures were tabulated., Results: Seventy-seven subjects participated, 71 (92%) of whom spoke to a radiologist, mostly on request. In the consultation group, the mean score (1, lowest; 4, highest) for overall experience was 3.8 ± 0.4 (SD), consultation benefit was 3.7 ± 0.6, and radiologist interaction was 3.7 ± 0.6. Demographics were not predictive of satisfaction with statistical significance in a multivariate model. Forty-six of 68 (68%) respondents correctly described the radiologist's role before consultation. The number increased to 60 (88%) after consultation, and the difference was statistically significant (p < 0.001). There was also a statistically significant decrease in mean anxiety score from 2.0 ± 1.0 to 1.5 ± 0.8 after consultation (p < 0.001). Sixty-four of 70 (91%) respondents indicated that they would prefer to speak with a radiologist during every visit., Conclusion: Radiologist consultation is well received among parents and associated with decreased anxiety and increased understanding of the radiologist's role. The results of this study support the value of routine radiologist-parent interaction for pediatric ultrasound.
- Published
- 2015
- Full Text
- View/download PDF
29. Radiologist compliance with California CT dose reporting requirements: a single-center review of pediatric chest CT.
- Author
-
Zucker EJ, Larson DB, Newman B, and Barth RA
- Subjects
- California, Humans, Phantoms, Imaging, Reproducibility of Results, Retrospective Studies, Guideline Adherence, Mandatory Reporting, Pediatrics legislation & jurisprudence, Radiation Dosage, Radiography, Thoracic, Tomography, X-Ray Computed
- Abstract
Objective: Effective July 1, 2012, CT dose reporting became mandatory in California. We sought to assess radiologist compliance with this legislation and to determine areas for improvement., Materials and Methods: We retrospectively reviewed reports from all chest CT examinations performed at our institution from July 1, 2012, through June 30, 2013, for errors in documentation of volume CT dose index (CTDIvol), dose-length product (DLP), and phantom size. Reports were considered as legally compliant if both CTDIvol and DLP were documented accurately and as institutionally compliant if phantom size was also documented accurately. Additionally, we tracked reports that did not document dose in our standard format (phantom size, CTDIvol for each series, and total DLP)., Results: Radiologists omitted CTDIvol, DLP, or both in nine of 664 examinations (1.4%) and inaccurately reported one or both of them in 56 of the remaining 655 examinations (8.5%). Radiologists omitted phantom size in 11 of 664 examinations (1.7%) and inaccurately documented it in 20 of the remaining 653 examinations (3.1%). Of 664 examinations, 599 (90.2%) met legal reporting requirements, and 583 (87.8%) met institutional requirements. In reporting dose, radiologists variably used less decimal precision than available, summed CTDIvol, included only series-level DLP, and specified dose information from the scout topogram or a nonchest series for combination examinations., Conclusion: Our institutional processes, which primarily rely on correct human performance, do not ensure accurate dose reporting and are prone to variation in dose reporting format. In view of this finding, we are exploring higher-reliability processes, including better-defined standards and automated dose reporting systems, to improve compliance.
- Published
- 2015
- Full Text
- View/download PDF
30. Fast pediatric 3D free-breathing abdominal dynamic contrast enhanced MRI with high spatiotemporal resolution.
- Author
-
Zhang T, Cheng JY, Potnick AG, Barth RA, Alley MT, Uecker M, Lustig M, Pauly JM, and Vasanawala SS
- Subjects
- Child, Child, Preschool, Contrast Media, Data Compression methods, Feasibility Studies, Female, Humans, Image Enhancement methods, Image Interpretation, Computer-Assisted methods, Infant, Male, Respiration, Abdomen, Imaging, Three-Dimensional methods, Magnetic Resonance Imaging methods
- Abstract
Purpose: To develop a method for fast pediatric 3D free-breathing abdominal dynamic contrast enhanced (DCE) magnetic resonance imaging (MRI) and investigate its clinical feasibility., Materials and Methods: A combined locally low rank parallel imaging method with soft gating is proposed for free-breathing DCE MRI acquisition. With Institutional Review Board (IRB) approval and informed consent/assent, 23 consecutive pediatric patients were recruited for this study. Free-breathing DCE MRI with ∼1 mm(3) spatial resolution and a 6.5-sec frame rate was acquired on a 3T scanner. Undersampled data were reconstructed with a compressed sensing method without motion correction (FB-CS) and the proposed method (FB-LR). A follow-up respiratory-triggered acquisition (RT-CS) was performed as a reference standard. The reconstructed images were evaluated independently by two radiologists. Wilcoxon tests were performed to test the hypothesis that there was no significant difference between different reconstructions. Quantitative evaluation of contrast dynamics was also performed., Results: The mean score of overall image quality of FB-LR was 4.0 on a 5-point scale, significantly better (P < 0.05) than FB-CS reconstruction (mean score 2.9), and similar to RT-CS (mean score 4.1). FB-LR also matched the temporal fidelity of contrast dynamics with a root mean square error less than 5%., Conclusion: Fast 3D free-breathing DCE MRI with high scan efficiency and image quality similar to respiratory-triggered acquisition is feasible in a pediatric clinical setting., (© 2013 Wiley Periodicals, Inc.)
- Published
- 2015
- Full Text
- View/download PDF
31. Clinical correlation needed: what do emergency physicians do after an equivocal ultrasound for pediatric acute appendicitis?
- Author
-
Ramarajan N, Krishnamoorthi R, Gharahbaghian L, Pirrotta E, Barth RA, and Wang NE
- Subjects
- Acute Disease, Adolescent, Appendicitis surgery, Child, Child, Preschool, Diagnosis, Differential, Female, Follow-Up Studies, Humans, Infant, Male, Physical Examination, Retrospective Studies, Ultrasonography, Appendectomy methods, Appendicitis diagnostic imaging, Emergency Service, Hospital, Practice Patterns, Physicians'
- Abstract
Background: Although follow-up CT is recommended for pediatric appendicitis if initial ultrasound (US) is equivocal, many physicians observe the patient at home. There are limited data to understand currently how common or safe this practice is. Our objectives are to assess prevalence of acute appendicitis and outcomes in patients with equivocal US with and without follow-up CT and to identify variables associated with ordering a follow-up CT., Methods: Retrospective analysis of the prevalence of appendicitis and outcomes of patients 1-18 years old with an equivocal US at a pediatric emergency department from 2003 to 2008. Recursive partitioning analysis and multivariate logistic regression were used to identify variables associated with ordering follow-up CT., Results: Fifty-five percent (340/620) of children with equivocal US did not receive CT, none of whom returned with a missed appendicitis. The prevalence of appendicitis in children with equivocal US was 12.5% (78/620). In children with follow-up CT, the prevalence was 22.1% (62/280); in those without follow-up CT, the prevalence was 4.7% (16/340). Recursive partitioning identified age >11 years, leukocytosis >15,000 cells/ml, and secondary signs predisposing toward acute appendicitis on US as significant predictors of CT., Conclusions: We view our study as a fundamental part of the incremental progress to understand how best to use US and CT imaging to diagnose pediatric appendicitis while minimizing ionizing radiation. Children at low risk for appendicitis with equivocal US are amenable to observation and reassessment prior to reimaging with US or CT., (© 2014 Wiley Periodicals, Inc.)
- Published
- 2014
- Full Text
- View/download PDF
32. Advances in fetal imaging.
- Author
-
Rubesova E and Barth RA
- Subjects
- Humans, Imaging, Three-Dimensional, Fetal Diseases diagnosis, Magnetic Resonance Imaging, Prenatal Diagnosis, Ultrasonography, Prenatal
- Abstract
While ultrasound (US) has been a part of prenatal care for almost 40 years, technical progress over the last two decades has resulted in improved image quality and detection rate of congenital anomalies. The past 15 years have also seen the expansion of three-dimensional (3D) US, providing enhancements over with 2D US, and more realistic images of babies to parents and providers. Fetal magnetic resonance imaging (MRI) was first performed over 30 years ago, and has undergone major technical improvement over the past 15 to 20 years. Fetal MRI complements US by providing better visualization in the fetus when US is limited such as in oligohydramnios or severe maternal obesity. It offers a larger field of view and better tissue contrast than US and is not limited by shadowing from osseous structures. However, MRI has a limited resolution compared with US, is less readily available, and more expensive. While indications for fetal MRI have been clearly established for some abnormalities, such as neurological anomalies, other indications especially for fetal body imaging are not as clearly defined. In this article, we discuss recent developments in fetal MRI and 3D US and their common and newest indications., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)
- Published
- 2014
- Full Text
- View/download PDF
33. Clinical performance of contrast enhanced abdominal pediatric MRI with fast combined parallel imaging compressed sensing reconstruction.
- Author
-
Zhang T, Chowdhury S, Lustig M, Barth RA, Alley MT, Grafendorfer T, Calderon PD, Robb FJ, Pauly JM, and Vasanawala SS
- Subjects
- Child, Child, Preschool, Contrast Media, Feasibility Studies, Female, Humans, Infant, Male, Observer Variation, Reproducibility of Results, Sensitivity and Specificity, Single-Blind Method, Abdomen pathology, Algorithms, Data Compression methods, Gadolinium DTPA, Image Enhancement methods, Image Interpretation, Computer-Assisted methods, Magnetic Resonance Imaging methods
- Abstract
Purpose: To deploy clinically, a combined parallel imaging compressed sensing method with coil compression that achieves a rapid image reconstruction, and assess its clinical performance in contrast-enhanced abdominal pediatric MRI., Materials and Methods: With Institutional Review Board approval and informed patient consent/assent, 29 consecutive pediatric patients were recruited. Dynamic contrast-enhanced MRI was acquired on a 3 Tesla scanner using a dedicated 32-channel pediatric coil and a three-dimensional SPGR sequence, with pseudo-random undersampling at a high acceleration (R = 7.2). Undersampled data were reconstructed with three methods: a traditional parallel imaging method and a combined parallel imaging compressed sensing method with and without coil compression. The three sets of images were evaluated independently and blindly by two radiologists at one siting, for overall image quality and delineation of anatomical structures. Wilcoxon tests were performed to test the hypothesis that there was no significant difference in the evaluations, and interobserver agreement was analyzed., Results: Fast reconstruction with coil compression did not deteriorate image quality. The mean score of structural delineation of the fast reconstruction was 4.1 on a 5-point scale, significantly better (P < 0.05) than traditional parallel imaging (mean score 3.1). Fair to substantial interobserver agreement was reached in structural delineation assessment., Conclusion: A fast combined parallel imaging compressed sensing method is feasible in a pediatric clinical setting. Preliminary results suggest it may improve structural delineation over parallel imaging., (© 2013 Wiley Periodicals, Inc.)
- Published
- 2014
- Full Text
- View/download PDF
34. Fetal MRI correlates with postnatal CT angiogram assessment of pulmonary anatomy in tetralogy of Fallot with absent pulmonary valve.
- Author
-
Sun HY, Boe J, Rubesova E, Barth RA, and Tacy TA
- Subjects
- Airway Obstruction diagnosis, Airway Obstruction etiology, Dilatation, Pathologic, Female, Gestational Age, Humans, Lung diagnostic imaging, Lung pathology, Male, Predictive Value of Tests, Pulmonary Atelectasis diagnosis, Pulmonary Atelectasis etiology, Retrospective Studies, Tetralogy of Fallot complications, Tetralogy of Fallot diagnostic imaging, Tetralogy of Fallot pathology, Ultrasonography, Prenatal, Magnetic Resonance Imaging, Prenatal Diagnosis methods, Pulmonary Artery diagnostic imaging, Pulmonary Artery pathology, Pulmonary Valve abnormalities, Tetralogy of Fallot diagnosis, Tomography, X-Ray Computed
- Abstract
In tetralogy of Fallot with absent pulmonary valve, pulmonary stenosis and regurgitation results in significant pulmonary artery dilatation. Branch pulmonary artery dilatation often compresses the tracheobronchial tree, causing fluid trapping in fetal life and air trapping and/or atelectasis after birth. Prenatal diagnosis predicts poor prognosis, which depends on the degree of respiratory insufficiency from airway compromise and lung parenchymal disease after birth. Fetal magnetic resonance imaging (MRI) has been useful in evaluating the effects of congenital lung lesions on lung development and indicating severity of pulmonary hypoplasia. This report is the first demonstrating the utility of fetal MRI in tetralogy of Fallot/absent pulmonary valve patients, which predicted postnatal pulmonary artery size and visualized airway compression and lung parenchymal lesions. The distribution of lobar fluid trapping on fetal MRI correlated with air trapping on postnatal computed tomography angiogram., (© 2013 Wiley Periodicals, Inc.)
- Published
- 2014
- Full Text
- View/download PDF
35. Isolated umbilical vein varix with a poor outcome despite close fetal surveillance.
- Author
-
Brookfield KF, Osmundson SS, Chetty S, Chueh J, Blumenfeld YJ, Barth RA, and El-Sayed YY
- Subjects
- Fatal Outcome, Female, Fetal Death, Humans, Pregnancy, Fetal Monitoring methods, Ultrasonography, Prenatal methods, Umbilical Veins diagnostic imaging, Varicose Veins diagnostic imaging
- Published
- 2013
- Full Text
- View/download PDF
36. Conservatively managed fetal goiter: an alternative to in utero therapy.
- Author
-
Blumenfeld YJ, Davis A, Milan K, Chueh J, Hudgins L, Barth RA, and Hintz SR
- Subjects
- Adult, Female, Fetal Diseases diagnostic imaging, Goiter diagnostic imaging, Goiter embryology, Humans, Infant, Newborn, Male, Pregnancy, Thyroid Gland diagnostic imaging, Ultrasonography, Fetal Diseases therapy, Goiter therapy
- Abstract
Fetal goiter may arise from a variety of etiologies including iodine deficiency, overtreatment of maternal Graves' disease, inappropriate maternal thyroid replacement and, rarely, congenital hypothyroidism. Fetal goiter is often associated with a retroflexed neck and polyhydramnios, raising concerns regarding airway obstruction in such cases. Prior reports have advocated for cordocentesis and intra-amniotic thyroid hormone therapy in order to confirm the diagnosis of fetal thyroid dysfunction, reduce the size of the fetal goiter, reduce polyhydramnios, aid with the assistance of maternal thyroid hormone therapy and reduce fetal malpresentation. We report two cases of conservatively managed fetal goiter, one resulting in a vaginal delivery, and no evidence of postnatal respiratory distress despite the presence of polyhydramnios and a retroflexed neck on prenatal ultrasound.
- Published
- 2013
- Full Text
- View/download PDF
37. Imaging of fetal chest masses.
- Author
-
Barth RA
- Subjects
- Humans, Lung Diseases diagnosis, Lung Diseases embryology, Magnetic Resonance Imaging methods, Prenatal Diagnosis methods, Respiratory System Abnormalities diagnosis, Ultrasonography methods
- Abstract
Prenatal imaging with high-resolution US and rapid acquisition MRI plays a key role in the accurate diagnosis of congenital chest masses. Imaging has enhanced our understanding of the natural history of fetal lung masses, allowing for accurate prediction of outcome, parental counseling, and planning of pregnancy and newborn management. This paper will focus on congenital bronchopulmonary malformations, which account for the vast majority of primary lung masses in the fetus. In addition, anomalies that mimic masses and less common causes of lung masses will be discussed.
- Published
- 2012
- Full Text
- View/download PDF
38. Effectiveness of a staged US and CT protocol for the diagnosis of pediatric appendicitis: reducing radiation exposure in the age of ALARA.
- Author
-
Krishnamoorthi R, Ramarajan N, Wang NE, Newman B, Rubesova E, Mueller CM, and Barth RA
- Subjects
- Adolescent, Child, Child, Preschool, Female, Humans, Infant, Male, Reproducibility of Results, Sensitivity and Specificity, Appendicitis diagnosis, Image Enhancement methods, Radiation Dosage, Radiation Protection methods, Tomography, X-Ray Computed methods, Ultrasonography methods
- Abstract
Purpose: To evaluate the effectiveness of a staged ultrasonography (US) and computed tomography (CT) imaging protocol for the accurate diagnosis of suspected appendicitis in children and the opportunity for reducing the number of CT examinations and associated radiation exposure., Materials and Methods: This retrospective study was compliant with HIPAA, and a waiver of informed consent was approved by the institutional review board. This study is a review of all imaging studies obtained in children suspected of having appendicitis between 2003 and 2008 at a suburban pediatric emergency department. A multidisciplinary staged US and CT imaging protocol for the diagnosis of appendicitis was implemented in 2003. In the staged protocol, US was performed first in patients suspected of having appendicitis; follow-up CT was recommended when US findings were equivocal. Of 1228 pediatric patients who presented to the emergency department for suspected appendicitis, 631 (287 boys, 344 girls; age range, 2 months to 18 years; median age, 10 years) were compliant with the imaging pathway. The sensitivity, specificity, negative appendectomy rate (number of appendectomies with normal pathologic findings divided by the number of surgeries performed for suspected appendicitis), missed appendicitis rate, and number of CT examinations avoided by using the staged protocol were analyzed., Results: The sensitivity and specificity of the staged protocol were 98.6% and 90.6%, respectively. The negative appendectomy rate was 8.1% (19 of 235 patients), and the missed appendicitis rate was less than 0.5% (one of 631 patients). CT was avoided in 333 of the 631 patients (53%) in whom the protocol was followed and in whom the US findings were definitive., Conclusion: A staged US and CT imaging protocol in which US is performed first in children suspected of having acute appendicitis is highly accurate and offers the opportunity to substantially reduce radiation., (© RSNA, 2011.)
- Published
- 2011
- Full Text
- View/download PDF
39. MR imaging in cases of antenatal suspected appendicitis--a meta-analysis.
- Author
-
Blumenfeld YJ, Wong AE, Jafari A, Barth RA, and El-Sayed YY
- Subjects
- Adolescent, Adult, Case-Control Studies, Diagnosis, Differential, Female, Humans, Magnetic Resonance Imaging methods, Predictive Value of Tests, Pregnancy, Pregnancy Complications epidemiology, Prenatal Diagnosis methods, Radiography, Retrospective Studies, Young Adult, Appendicitis diagnostic imaging, Magnetic Resonance Imaging statistics & numerical data, Pregnancy Complications diagnostic imaging
- Abstract
Objective: Appendicitis is the most common surgical emergency in pregnancy. Acute appendicitis is often difficult to diagnose clinically, and concerns regarding antenatal CT imaging limit its use resulting in high false negative rates at laparotomy. MRI has recently been reported as a reasonable alternative to CT imaging in cases of suspected appendicitis. Our objective was to perform a meta-analysis of recently published data regarding the utility of MR imaging in cases of antenatal suspected acute appendicitis., Methods: We searched the PubMed database using keywords 'MRI', 'appendicitis', and 'pregnancy'. Five case series describing the role of MRI in cases of antenatal appendicitis were included. The sensitivity, specificity, positive, and negative predictive values were calculated., Results: Two hundred twenty-nine patients were included in the study. In the first analysis in which non-diagnostic scans were excluded, the sensitivity, specificity, positive and negative predictive values of MRI for diagnosing appendicitis were 95.0%, 99.9%, 90.4%, and 99.5%, respectively. In the second analysis, which included non-diagnostic scans, the sensitivity, specificity, positive and negative predictive values were 90.5%, 98.6%, 86.3%, and 99.0%, respectively, Conclusions: MR imaging may be useful in cases of suspected antenatal appendicitis. Data are still limited and larger prospective studies are necessary to confirm this finding.
- Published
- 2011
- Full Text
- View/download PDF
40. [Management of fetal mediastinal shift: a practical approach].
- Author
-
Colombani M, Rubesova E, Potier A, Quarello E, Barth RA, Devred P, Petit P, and Gorincour G
- Subjects
- Algorithms, Decision Trees, Female, Humans, Pregnancy, Thorax abnormalities, Thorax diagnostic imaging, Mediastinum abnormalities, Mediastinum diagnostic imaging, Ultrasonography, Prenatal
- Abstract
The purpose of this article is to review the technique of fetal chest ultrasound screening evaluation, the diagnostic work-up in the presence of fetal mediastinal shift and which ultrasound imaging features to look for. The first step in evaluating the fetal thorax is to confirm situs. Then, a median sagittal line is drawn from a four-chamber view to assist in spatial orientation followed by echotexture analysis of the structures of the thorax in the presence of mediastinal shift. We propose a systematic approach based on the direction of the mediastinal shift and echogenicity of the compressing hemithorax. When the hemithorax contralateral to the mediastinal shift is enlarged, which is the most frequent situation, diaphragmatic hernia and macrocystic congenital cystic adenomatoid malformation are the most likely etiologies when the mass is heterogeneous. Microcystic congenital cystic adenomatoid malformation, sometimes associated with sequestration, is the most frequent etiology when the mass is homogeneous. When the hemithorax ipsilateral to the mediastinal shift is small, which is less frequent, and the contralateral hemithorax is homogeneously isoechoic, then a diagnosis of lung hypoplasia-agenesis-aplasia should be considered., (Copyright © 2011 Elsevier Masson SAS and Éditions françaises de radiologie. All rights reserved.)
- Published
- 2011
- Full Text
- View/download PDF
41. Improved pediatric MR imaging with compressed sensing.
- Author
-
Vasanawala SS, Alley MT, Hargreaves BA, Barth RA, Pauly JM, and Lustig M
- Subjects
- Adolescent, Child, Child, Preschool, Female, Humans, Infant, Infant, Newborn, Male, Reproducibility of Results, Sensitivity and Specificity, Algorithms, Data Compression methods, Image Enhancement methods, Image Interpretation, Computer-Assisted methods, Magnetic Resonance Imaging methods
- Abstract
Purpose: To develop a method that combines parallel imaging and compressed sensing to enable faster and/or higher spatial resolution magnetic resonance (MR) imaging and show its feasibility in a pediatric clinical setting., Materials and Methods: Institutional review board approval was obtained for this HIPAA-compliant study, and informed consent or assent was given by subjects. A pseudorandom k-space undersampling pattern was incorporated into a three-dimensional (3D) gradient-echo sequence; aliasing then has an incoherent noiselike pattern rather than the usual coherent fold-over wrapping pattern. This k-space-sampling pattern was combined with a compressed sensing nonlinear reconstruction method that exploits the assumption of sparsity of medical images to permit reconstruction from undersampled k-space data and remove the noiselike aliasing. Thirty-four patients (15 female and 19 male patients; mean age, 8.1 years; range, 0-17 years) referred for cardiovascular, abdominal, and knee MR imaging were scanned with this 3D gradient-echo sequence at high acceleration factors. Obtained k-space data were reconstructed with both a traditional parallel imaging algorithm and the nonlinear method. Both sets of images were rated for image quality, radiologist preference, and delineation of specific structures by two radiologists. Wilcoxon and symmetry tests were performed to test the hypothesis that there was no significant difference in ratings for image quality, preference, and delineation of specific structures., Results: Compressed sensing images were preferred more often, had significantly higher image quality ratings, and greater delineation of anatomic structures (P < .001) than did images obtained with the traditional parallel reconstruction method., Conclusion: A combination of parallel imaging and compressed sensing is feasible in a clinical setting and may provide higher resolution and/or faster imaging, addressing the challenge of delineating anatomic structures in pediatric MR imaging.
- Published
- 2010
- Full Text
- View/download PDF
42. Magnetic resonance imaging in the prenatal diagnosis of congenital diarrhea.
- Author
-
Colombani M, Ferry M, Toga C, Lacroze V, Rubesova E, Barth RA, Cassart M, and Gorincour G
- Subjects
- Diarrhea congenital, Diarrhea embryology, Dilatation, Pathologic congenital, Dilatation, Pathologic diagnosis, Female, Gestational Age, Humans, Infant, Newborn, Intestine, Small embryology, Magnetic Resonance Imaging, Male, Meconium metabolism, Pregnancy, Amniotic Fluid microbiology, Diarrhea diagnosis, Fetal Diseases diagnosis, Intestine, Small abnormalities, Polyhydramnios diagnosis, Prenatal Diagnosis methods
- Abstract
Objective: Congenital diarrhea is very rare, and postnatal diagnosis is often made once the condition has caused potentially lethal fluid loss and electrolyte disorders. Prenatal detection is important to improve the immediate neonatal prognosis. We aimed to describe the prenatal ultrasound and magnetic resonance (MRI) imaging findings in fetuses with congenital diarrhea., Methods: The study reports the pre- and postnatal findings in four fetuses that presented with generalized bowel dilatation and polyhydramnios. We analyzed the fetal ultrasound and MRI examinations jointly, then compared our provisional diagnosis with the amniotic fluid biochemistry and subsequently with the neonatal stool characteristics., Results: In each of the four cases an ultrasound examination between 22 and 30 weeks' gestation showed moderate generalized bowel dilatation and polyhydramnios suggesting intestinal obstruction. MRI examinations performed between 24 and 32 weeks' gestation confirmed that the dilatation was of gastrointestinal (GI) origin, with a signal indicating intraluminal water visible throughout the small bowel and colon. The expected hypersignal on T1-weighted sequences characteristic of physiological meconium was absent in the colon and rectum. This suggested that the meconium had been completely diluted and flushed out by the water content of the bowel. The constellation of MRI findings enabled a prenatal diagnosis of congenital diarrhea. The perinatal lab test findings revealed two cases of chloride diarrhea and two of sodium diarrhea., Conclusion: Congenital diarrhea may be misdiagnosed as intestinal obstruction on prenatal ultrasound but has characteristic findings on prenatal MRI enabling accurate diagnosis; this is important for optimal neonatal management., (Copyright 2010 ISUOG. Published by John Wiley & Sons, Ltd.)
- Published
- 2010
- Full Text
- View/download PDF
43. Standardizing resistive indices in healthy pediatric transplant recipients of adult-sized kidneys.
- Author
-
Gholami S, Sarwal MM, Naesens M, Ringertz HG, Barth RA, Balise RR, and Salvatierra O
- Subjects
- Adolescent, Biopsy, Child, Child, Preschool, Follow-Up Studies, Humans, Infant, Kidney cytology, Kidney physiology, Kidney Failure, Chronic surgery, Kidney Transplantation physiology, Organ Size, Postoperative Period, Prospective Studies, Transplantation, Autologous, Treatment Outcome, Ultrasonography, Doppler, Young Adult, Kidney diagnostic imaging, Kidney Transplantation methods, Regional Blood Flow physiology, Renal Artery physiology, Renal Circulation physiology, Vascular Resistance physiology
- Abstract
Small pediatric recipients of an adult-sized kidney have insufficient renal blood flow early after transplantation, with secondary chronic hypoperfusion and irreversible histological damage of the tubulo-interstitial compartment. It is unknown whether this is reflected by renal resistive indices. We measured renal graft resistive indices and volumes of 47 healthy pediatric kidney transplant recipients of an adult-sized kidney in a prospective study for six months post-transplant. A total of 205 measurements were performed. The smallest recipients (BSA
or= 1.5 m(2) (p < 0.0001). Resistive indices increased during the first six months in the smallest recipients (p = 0.02), but not in the two larger recipient groups (BSA 0.75-1.5 m(2) and >or=1.5 m(2)). All three BSA groups showed a reduction in renal volume after transplantation, with the greatest reduction occurring in the smallest recipients. In conclusion, renal transplant resistive indices reflect pediatric recipient BSA dependency. The higher resistance to intra-renal vascular flow and significant decrease in renal volume in the smallest group likely reflect accommodation of the size discrepant transplanted adult-sized kidney to the smaller pediatric recipient vasculature with associated lower renal artery flow. - Published
- 2010
- Full Text
- View/download PDF
44. MR voiding cystography for evaluation of vesicoureteral reflux.
- Author
-
Vasanawala SS, Kennedy WA, Ganguly A, Fahrig R, Rieke V, Daniel B, and Barth RA
- Subjects
- Child, Child, Preschool, Contrast Media, Equipment Design, Female, Fluoroscopy, Gadolinium DTPA, Humans, Infant, Infant, Newborn, Magnetic Resonance Imaging instrumentation, Male, Magnetic Resonance Imaging methods, Vesico-Ureteral Reflux diagnosis
- Abstract
Objective: The purpose of our study is to present a real-time interactive continuous fluoroscopy MRI technique for vesicoureteral reflux (VUR) diagnosis., Conclusion: MR voiding cystography with a real-time interactive MR fluoroscopic technique on an open MRI magnet is feasible for the evaluation of VUR in children.
- Published
- 2009
- Full Text
- View/download PDF
45. Neonatal malrotation with midgut volvulus mimicking duodenal atresia.
- Author
-
Gilbertson-Dahdal DL, Dutta S, Varich LJ, and Barth RA
- Subjects
- Diagnosis, Differential, Duodenal Diseases surgery, Female, Humans, Infant, Newborn, Intestinal Volvulus surgery, Male, Radiography, Duodenal Diseases diagnostic imaging, Intestinal Volvulus diagnostic imaging
- Abstract
Objective: The purpose of this study was to describe the clinical, imaging, and surgical findings in the cases of four neonates with radiographic findings suggesting duodenal atresia (double-bubble sign) who were subsequently found to have malrotation with midgut volvulus., Conclusion: When the surgical treatment of a patient with the double-bubble sign is to be delayed, an upper gastrointestinal radiographic or ultrasound study is needed to evaluate for malrotation with midgut volvulus.
- Published
- 2009
- Full Text
- View/download PDF
46. Three-dimensional MRI volumetric measurements of the normal fetal colon.
- Author
-
Rubesova E, Vance CJ, Ringertz HG, and Barth RA
- Subjects
- Female, Fetal Organ Maturity, Gestational Age, Humans, Image Processing, Computer-Assisted, Pregnancy, Retrospective Studies, Colon embryology, Imaging, Three-Dimensional methods, Magnetic Resonance Imaging methods
- Abstract
Objective: The use of fetal MRI markedly improves characterization of abdominal congenital anomalies. Accurate prenatal diagnosis of the level and cause of congenital intestinal obstruction is desired for optimal parental counseling and perinatal care. Because accurate diagnosis would be aided by nomograms of colonic volume, this study was conducted to determine normal colonic volumes at different gestational ages., Materials and Methods: This retrospective study consisted of a review of 83 fetal MRI examinations performed on fetuses with no gastrointestinal abnormalities. MRI was performed with a 1.5-T system. Axial, sagittal, and coronal T1-weighted fast gradient-refocused echo images were acquired at TR/TE, 165/2.6; flip angle, 90 degrees; matrix size, 384 x 192; slice thickness, 5 mm; field of view, 38 cm(2). Two investigators determined the region of interest in the colon by outlining areas of high signal intensity of meconium slice by slice. They then calculated colonic luminal volume in the regions of interest. Colonic luminal volumes were reported relative to gestational age and abdominal circumference. Normative curves were generated, and interobserver and intraobserver analyses were performed., Results: Seventeen of the 83 fetuses (20%) were excluded because of movement artifacts on the images. Normal colonic luminal volume increased exponentially with gestational age and abdominal circumference. The range of colonic luminal volumes at 20-37 weeks' gestational age was 1.1-65 mL. Variation of volume was greater at advanced gestational age. Interobserver and intraobserver correlation was good., Conclusion: This study yielded preliminary volumetric measurements of the normal fetal colon at 20-37 weeks of gestational age that suggest the fetal colon grows exponentially.
- Published
- 2009
- Full Text
- View/download PDF
47. Fetus in fetu: 11 fetoid forms in a single fetus: review of the literature and imaging.
- Author
-
Gerber RE, Kamaya A, Miller SS, Madan A, Cronin DM, Dwyer B, Chueh J, Conner KE, and Barth RA
- Subjects
- Adult, Female, Humans, Pregnancy, Abnormalities, Multiple diagnostic imaging, Fetus abnormalities, Twins, Monozygotic, Ultrasonography, Prenatal methods
- Published
- 2008
- Full Text
- View/download PDF
48. Prenatal diagnosis of horseshoe lung and esophageal atresia.
- Author
-
Goldberg S, Ringertz H, and Barth RA
- Subjects
- Adult, Esophageal Atresia diagnostic imaging, Esophageal Atresia surgery, Female, Fetal Diseases diagnostic imaging, Humans, Magnetic Resonance Imaging, Pregnancy, Ultrasonography, Prenatal, Esophageal Atresia diagnosis, Fetal Diseases diagnosis, Lung abnormalities, Prenatal Diagnosis methods
- Abstract
We present a case of horseshoe lung (HL) and esophageal atresia suspected prenatally on US imaging and confirmed with fetal MRI. Prenatal diagnosis of HL and esophageal atresia allowed for prenatal counseling and informed parental decisions.
- Published
- 2006
- Full Text
- View/download PDF
49. Perinatal radiology.
- Author
-
Teele RL, Barth RA, and Estroff J
- Subjects
- Humans, Infant, Newborn, Medicine, Specialization, Perinatology, Radiology
- Published
- 2000
- Full Text
- View/download PDF
50. Normal pediatric testis: comparison of power Doppler and color Doppler US in the detection of blood flow.
- Author
-
Barth RA and Shortliffe LD
- Subjects
- Child, Preschool, Humans, Male, Prospective Studies, Regional Blood Flow, Sensitivity and Specificity, Signal Processing, Computer-Assisted, Testis blood supply, Testis diagnostic imaging, Ultrasonography, Doppler, Color methods
- Abstract
Purpose: To compare power Doppler and conventional color Doppler ultrasound (US) in the detection of blood flow in the normal pediatric testis and to assess the symmetry of blood flow and the spectral Doppler tracing waveforms in the normal pediatric testis., Materials and Methods: Testicular blood flow was assessed prospectively in 68 testes in 34 boys (age range, 6 weeks to 13 years; mean age, 4.6 years) with both conventional color and power Doppler US. Intratesticular blood flow was graded as follows: 0, no intratesticular flow; 1, single intratesticular Doppler signal identified; and 2, multiple intratesticular Doppler signals identified. The symmetry of intratesticular flow was assessed both subjectively and objectively by using the same grading system. Spectral Doppler tracings were obtained in 62 testes in 31 patients., Results: Power Doppler US demonstrated intratesticular blood flow in 66 (97%) testes. Color Doppler US demonstrated intratesticular blood flow in 60 (88%) testes. Combined techniques depicted blood flow in all 68 (100%) testes. Testicular blood flow was judged symmetric in all 34 (100%) patients with power Doppler US and in 31 (91%) patients with color Doppler US. Spectral Doppler tracings demonstrated absence of diastolic flow in 20 (32%) of 62 testes., Conclusion: In children, power Doppler US is more sensitive than color Doppler US in the detection of intratesticular blood flow. With power Doppler US, testicular blood flow in healthy children is symmetric, underscoring that the asymptomatic testis can be used as a baseline for assessing flow in the symptomatic testis.
- Published
- 1997
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.