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BACKGROUND: Deep learning has been employed using brain functional connectome data for evaluating the risk of cognitive deficits in very preterm infants. Although promising, training these deep learning models typically requires a large amount of labeled data, and labeled medical data are often very difficult and expensive to obtain. OBJECTIVE: This study aimed to develop a self-training deep neural network (DNN) model for early prediction of cognitive deficits at 2 years of corrected age in very preterm infants (gestational age ≤32 weeks) using both labeled and unlabeled brain functional connectome data. MATERIALS AND METHODS: We collected brain functional connectome data from 343 very preterm infants at a mean (standard deviation) postmenstrual age of 42.7 (2.5) weeks, among whom 103 children had a cognitive assessment at 2 years (i.e. labeled data), and the remaining 240 children had not received 2-year assessments at the time this study was conducted (i.e. unlabeled data). To develop a self-training DNN model, we built an initial student model using labeled brain functional connectome data. Then, we applied the trained model as a teacher model to generate pseudo-labels for unlabeled brain functional connectome data. Next, we combined labeled and pseudo-labeled data to train a new student model. We iterated this procedure to obtain the best student model for the early prediction task in very preterm infants. RESULTS: In our cross-validation experiments, the proposed self-training DNN model achieved an accuracy of 71.0%, a specificity of 71.5%, a sensitivity of 70.4% and an area under the curve of 0.75, significantly outperforming transfer learning models through pre-training approaches. CONCLUSION: We report the first self-training prognostic study in very preterm infants, efficiently utilizing a small amount of labeled data with a larger share of unlabeled data to aid the model training. The proposed technique is expected to facilitate deep learning with insufficient training data.

Contrast-enhanced ultrasound (CEUS) is increasingly performed for focal liver lesion evaluation because of its high safety profile and ability to yield a definitive diagnosis in many patients, obviating multiphase CT or MRI. CEUS uses specific ultrasound contrast agents (UCAs) that are exceedingly safe, without the risk of renal or liver toxicity. UCAs are cleared rapidly from the body, allowing for multiple injections during a single examination, with no potential for deposition in the patient. This review highlights the performance of CEUS for liver lesion evaluation and illustrates the imaging appearance of common liver lesions in children and adults.

BACKGROUND. CT is the imaging modality of choice to identify lung metastasis. OBJECTIVE. The purpose of this study was to evaluate the performance of reduced-dose CT for the detection of lung nodules in children and young adults with cancer. METHODS. This prospective study enrolled patients 4-21 years old with known or suspected malignancy who were undergoing clinically indicated chest CT. Study participants underwent an additional investigational reduced-dose chest CT examination in the same imaging encounter. Separated deidentified CT examinations were reviewed in blinded fashion by three independent radiologists. One reviewer performed a subsequent secondary review to match nodules between the standard- and reduced-dose examinations. Diagnostic performance was computed for the reduced-dose examinations using the clinical examinations as the reference standard. Intraobserver agreement and interobserver agreement were calculated using Cohen kappa. RESULTS. A total of 78 patients (44 male patients and 34 female patients; mean age, 15.2 ± 3.8 [SD] years) were enrolled. The mean estimated effective dose was 1.8 ± 1.1 mSv for clinical CT and 0.3 ± 0.1 mSv for reduced-dose CT, which is an 83% dose reduction. Forty-five of the 78 (58%) patients had 162 total lung nodules (mean size, 3.4 ± 3.3 mm) detected on the clinical CT examinations. A total of 92% of nodules were visible on reduced-dose CT. The sensitivity and specificity of reduced-dose CT for nodules ranged from 63% to 77% and from 80% to 90%, respectively, across the three reviewers. Intraob-server agreement between clinical CT and reduced-dose CT was moderate to substantial for the presence of nodules (κ = 0.45-0.67) and was good to excellent for the number of nodules (κ = 0.68-0.84) and nodule size (κ = 0.69-0.86). Interobserver agreement for the presence of nodules was moderate for both reduced-dose (κ = 0.53) and clinical (κ = 0.54) CT. A median of one nodule was present on clinical CT in patients with a falsely negative reduced-dose CT examination. CONCLUSION. Reduced-dose CT depicts more than 90% of lung nodules in children and young adults with cancer. Reviewers identified the presence of nodules with moderate sensitivity and high specificity. CLINICAL IMPACT. CT performed at a 0.3-mSv mean effective dose has acceptable diagnostic performance for lung nodule detection in children and young adults and has the potential to reduce patient dose or expand CT utilization (e.g., to replace radiography in screening or monitoring protocols). TRIAL REGISTRATION. ClinicalTrials.gov NCT03681873.

BACKGROUND: Patients with autoimmune hepatitis (AIH) and primary or autoimmune sclerosing cholangitis are at nutritional risk; their body composition and has not been extensively studied. We aimed to describe their body composition and identify clinical links. METHODS: Using magnetic resonance imaging (MRI), two reviewers segmented total psoas muscle area (tPMSA), visceral fat area (VFA) and subcutaneous fat area (mm(2)) and measured visceral and subcutaneous thickness (mm). Clinical, laboratory and quality of life (QoL; using PedsQL) data were collected. Sarcopenia was defined as tPMSA ≤5th percentile. Analysis of variance, Wilcoxon rank test and multivariable modelling were performed. A paediatric cohort with non-alcoholic fatty liver disease (NAFLD) was used as a comparator following propensity score matching. RESULTS: Fifty-eight patients with autoimmune liver disease (AILD) (33 [57%] with AIH) were included: median age 16 years (interquartile range [IQR]: 13-18), 33 (57%) male. Median time from diagnosis to MRI was 15 months (IQR: 2-39 months). Two patients (3%) had a BMIz indicative of mild malnutrition. tPMSA was measurable in 52 subjects (90%). Of those, 25 (48%) had sarcopenia. Sarcopenic patients had a lower blood urea nitrogen compared to non-sarcopenic (median [IQR]: 9.5 [8.0, 12.0] vs 11 [10, 14] mg/dL; P = .023). There was no difference in corticosteroid use between groups. The VFA of sarcopenic patients was higher (3156 [2064, 7492]) vs 2084 [688, 3092]) mm(2); P = .005). Patient-reported QoL negatively associated with VFA and general health negatively associated with VFA. Compared with NAFLD, the odds ratio for sarcopenia with AILD was 14.5 (95% confidence interval: 2.3-90.7). CONCLUSION: In autoimmune liver diseases, sarcopenia is highly prevalent, associated with increased visceral fat and QoL.

Magnetic resonance elastography (MRE) of the liver has emerged as the non-invasive standard for the evaluation of liver fibrosis in chronic liver diseases (CLDs). The utility of MRE in the evaluation of different CLD in both adults and children has been demonstrated in several studies, and MRE has been recommended by several clinical societies. Consequently, the clinical indications for evaluation of CLD with MRE have increased, and MRE is currently used as an add-on test during routine liver MRI studies or as a standalone test. To meet the increasing clinical demand, MRE is being installed in many academic and private practice imaging centers. There is a need for a comprehensive practical guide to help these practices to deliver high-quality liver MRE studies as well as troubleshoot the common issues with MRE to ensure smooth running of the service. This comprehensive clinical practice review summarizes the indications and provides an overview on why to use MRE, technical requirements, system set-up, patient preparation, acquiring the data, and interpretation.

Masses and masslike lesions of the pancreas are uncommon in the pediatric population. However, owing to overlapping clinical and imaging features, it can be challenging to differentiate the various causes of pediatric pancreatic masses at initial patient presentation. Clinical data such as patient age, signs and symptoms at presentation, laboratory test results, and potential underlying cancer predisposition syndrome can be helpful when formulating a differential diagnosis. US may be the first imaging study to depict a pancreatic mass in a child, as this examination is frequently performed in children with nonspecific abdominal signs and symptoms because of its wide availability and relatively low cost and the lack of a need for sedation or anesthesia. CT or MRI is typically required for more thorough characterization of the mass and surgical planning. Complete characterization of pancreatic masses includes assessment of vascular involvement, local invasion, and extrapancreatic spread of tumor. The authors provide an up-to-date comprehensive review of the clinical manifestations, histopathologic features, and imaging findings of primary and secondary tumors of the pancreas in children and young adults. Advances in imaging, current prognostic information, and treatment paradigms also are highlighted. Finally, nontumorous masslike lesions of the pediatric pancreas, including vascular malformations, cystic disorders (eg, von Hippel-Lindau syndrome, cystic fibrosis), intrapancreatic accessory spleen, and autoimmune pancreatitis, are discussed.

To determine if differences between individual sonographers and radiologists performing and interpreting appendix ultrasound affect clinically important outcomes in children with suspected acute appendicitis.Patients18 years of age who presented to our emergency department (ED) with suspected acute appendicitis and underwent an appendix ultrasound were identified. Sonographers who performed fewer than 100 examinations and radiologists who interpreted fewer than 100 examinations during the study period were excluded. Multivariable logistic regression was performed to assess the effect of sonographer, radiologist, clinical variables, and system factors on key clinical outcomes, including hospital admission and appendectomy.In all, 9,283 appendix ultrasounds (mean age, 9.9 ± 4.2 years; 5,400 [58.2%] boys) performed by 31 sonographers (mean number of examinations, 299 ± 140 [range, 115-610]) and interpreted by 31 radiologists (mean number of examinations, 299 ± 157 [range, 101-845]) were included. Mean admission frequency per sonographer was 34.0% ± 3.3% (range, 27.8%-42.6%) and per radiologist was 33.5% ± 3.9% (range, 23.7%-41.6%). Mean appendectomy frequency per sonographer was 20.3% ± 2.6% (range, 14.9%-27.0%) and per radiologist was 20.3% ± 3.1% (range, 15.2%-28.7%). Significant multivariable predictors of hospital admission included temperature (P.0001), white blood cell count (P.0001), male sex (P = .002), imaging performed at the main hospital (versus satellite hospital) (P = .001), abdominal tenderness with ultrasound transducer compression (P.0001), presence of rebound tenderness (P = .001), and presence of acute appendicitis by ultrasound (P.0001), but not sonographer or radiologist. Predictors of appendectomy included weight (P.0001), white blood cell count (P.0001), male sex (P = .0004), abdominal tenderness with ultrasound transducer compression (P.0001), and the presence of acute appendicitis by ultrasound (P.0001), but not sonographer or radiologist.Differences in individual sonographers and radiologists did not predict clinically important outcomes in children undergoing ultrasound in the ED for suspected acute appendicitis.

Repeated administrations of linear gadolinium-based contrast media (GBCM) are associated with T1-weighted (T1-W) signal intensity change in brain structures. The purpose of this study was to compare different brain structures in children after unconfounded, repeated administrations of either a macrocyclic or linear GBCM. We performed a retrospective cohort study, identifying subjects with ≥5 unconfounded administrations of gadoterate meglumine. We matched subjects with repeated administrations of gadopentetate dimeglumine to the gadoterate meglumine arm based on the number of unconfounded GBCM administrations. Two reviewers drew regions of interest on 27 structures in and around the brain. We recorded demographic, modality and study parameters and evaluated them to determine whether they were associated with T1-W signal intensity (SI) changes. Linear mixed effects models evaluated the relationships between the number of GBCM doses and T1-W SI ratio. Finally, we identified differences in the rate of T1-W SI ratio change among individuals using a linear mixed effects model with random slope. We included a total of 52 patients (age range at first MRI: 6.0 months to 17.1 years), 26 in each arm. We detected a significant change in the T1-W SI ratio with repeated administrations of GBCM in one location in the gadoterate meglumine arm and in four locations in the gadopentetate dimeglumine arm. Patient gender and age were not associated with T1-W SI change. Modality vendor, imaging sequence and field strength were variably associated with a systematic difference in the ability to detect a T1-W SI change. Finally, linear mixed effects model with random slope showed that there were individual differences in the slope of SI change at various structures among individuals for both arms. This effect was present in more brain structures in the gadopentetate dimeglumine arm (14 vs. 8). There is a significant change in the T1-W SI ratio over time in multiple brain structures after repeated gadopentetate dimeglumine administrations. This effect was only seen in one ratio after repeated administrations of gadoterate meglumine. There are individual differences in the rate of change of SI ratios over time after repeated administration of gadopentetate dimeglumine and gadoterate meglumine, suggesting that individual differences are present.

Hepatic steatosis has been described as a common finding in adults following total pancreatectomy with islet autotransplantation (TPIAT) but it is unknown if this occurs in children and adolescents.To define the frequency of post-TPIAT hepatic steatosis in a sample of children and adolescents and to identify clinical predictors of incident steatosis post-TPIAT.In this prospective study, consecutive participants at least 1-month post-TPIAT underwent a liver MRI with proton density fat fraction (PDFF) and blood draw at our pediatric academic medical center between April 2021 and January 2022. Comparison clinical pre-TPIAT liver MRI or ultrasound and insulin use and graft function data were extracted from the medical record. T-tests were used for the comparison of means across continuous variables between participants with and without post-TPIAT steatosis.A total of 20 participants (mean: 13 ± 4 years; 12 female) were evaluated. Mean liver PDFF at research MRI was 7.4 ± 6.2% (range: 2-25%). Seven participants (35%) had categorical hepatic steatosis (PDFF5%) post-TPIAT, five of whom had pre-TPIAT steatosis, reflecting a 13% (2/15; 95% CI: 2-40%) incidence of post-TPIAT steatosis. Participant characteristics were not significantly different between subgroups with and without post-TPIAT steatosis. Mean PDFF at research MRI was not different between graft function subgroups (7.5% optimal/good vs. 7.3% marginal/failure; p = .96).Our study shows a moderate prevalence but low incidence of hepatic steatosis in a small sample of children and adolescents post-TPIAT. This study raises questions about a causal relationship between TPIAT and hepatic steatosis.

Contrast-enhanced ultrasound (CEUS) has emerged as a valuable modality for bowel imaging in adults and children. CEUS enables visualization of the perfusion of the bowel wall and of the associated mesentery in healthy and disease states. In addition, CEUS images can be used to make quantitative measurements of contrast kinetics, allowing for objective assessment of bowel wall enhancement. Bowel CEUS is commonly applied to evaluate inflammatory bowel disease and to monitor treatment response. It has also been applied to evaluate necrotizing enterocolitis, intussusception, appendicitis and epiploic appendagitis, although experience with these applications is more limited. In this review article, we present the current experience using CEUS to evaluate the pediatric bowel with emphasis on inflammatory bowel disease, extrapolating the established experience from adult studies. We also discuss emerging applications of CEUS as an adjunct or problem-solving tool for evaluating bowel perfusion. Electronic supplementary material The online version of this article (10.1007/s00247-020-04868-x) contains supplementary material, which is available to authorized users.

Objective Children and adolescents with Crohn disease (CD) commonly gain weight during treatment induction, which is thought to be a marker of better health. Body composition is, however, rarely assessed at diagnosis, and changes during early treatment are not often quantified. Therefore, it is unknown if these gains are truly healthy. We sought to evaluate skeletal muscle changes during initial treatment for CD by using routine imaging. Methods Single-center prospective study. Pediatric patients diagnosed with small bowel CD underwent serial magnetic resonance enterography (MRE) imaging, laboratory testing, and disease-activity assessment, at diagnosis, 1 and 6 months of treatment. MRE-based cross-sectional morphometry was used to measure psoas muscle cross sectional area (CSA). Psoas CSA z-scores were calculated using normative data. Results We enrolled 30 children (ages 9--17 years). Twenty-eight of 30 (93%) received anti-tumor necrosis factor therapy and 4 required surgical resection. Children with below-average psoas CSA and body mass index (BMI) z-scores at diagnosis were much more likely to fail treatment or undergo surgery by 6 months compared with those with higher z-scores (55% vs 0%; P = 0.001). Children with no activity limitations at diagnosis had significantly larger muscle gains in the first month, compared with those whose activity was limited at diagnosis (P = 0.012). Most patients had higher psoas CSA z-scores by 6 months, and these increases were associated with weight and BMI z-score increases. Conclusions Skeletal muscle growth contributes to weight gain during treatment induction in most patients with CD. Psoas muscle CSA on diagnostic imaging may have prognostic value in children with CD.

To assess diagnostic imaging utilization and the proportion of negative appendectomies for pediatric appendicitis at US children's hospitals between 2004 and 2018.This was a retrospective study using data from the Pediatric Health Information System (PHIS) database. Pediatric patients (age: 0-17 years) who underwent an appendectomy at one of 32 children's hospitals from January 1, 2004, through September 30, 2018, were included. Patients were identified based on International Classification of Diseases, 9th revision and International Classification of Diseases, 10th revision procedure codes. Patient demographics, imaging performed, and the frequency of negative appendectomy were analyzed.The final study population consisted of 104,033 children. From 2004 to 2018, CT utilization decreased from 56.8% (2,951 of 5,198) to 18.6% (1,201 of 6,455; P.001). Ultrasound utilization increased from 26.4% (1,371 of 5,198) to 63.4% (4,093 of 6,455; P.001). Radiography utilization remained stable at 16.7% (870 of 5,198) and 15.8% (1,018 of 6,455; P = .160). MRI use increased from 0.1% (6 of 5,198) to 2.2% (143 of 6,455; P.001). During the study period, the negative appendectomy rate slightly decreased, from 3.74% (4,742 of 126,778 in 2004-2011) to 3.14% (4,258 of 135,561 in 2012-2018; P.001).There has been a shift in imaging of children with appendicitis over 15 years in the United States, because the use of CT has decreased and ultrasound use has increased. This shift has likely added value to the health care system without adversely affecting outcomes (negative appendectomy rate).

Objective To use time-driven activity-based costing to compare the costs of pathways for evaluating suspected pediatric midgut volvulus using either fluoroscopic upper gastrointestinal examination (UGI) or focused abdominal ultrasound (US). Methods Process maps were created through patient shadowing, medical record review, and frontline staff interviews. Using time-driven activity-based costing methodology, practical capacity cost rates were calculated for personnel, equipment, and facility costs. Supply costs were included at institutional purchase prices. The cost of each process substep was determined by multiplying step-specific capacity costs by the median time required for each step, and substep costs were summed to generate total pathway cost. Multivariate sensitivity analyses were performed applying minimum and maximum labor costs. Assuming UGI would be used to troubleshoot nondiagnostic US, a break-even analysis was performed to determine the cost impact of varying frequencies of UGI on the total cost of the US-based pathway. Results Process maps were created from 105 (48 girls, 57 boys) patient encounters. Base case pathway times were 90 min (UGI) and 55 min (US). Base case cost for UGI was $282.74 (range: $170.86-$800.82) when performed by a radiology practitioner assistant and $545.66 (range: $260.97-$1,974.06) when performed by a radiologist. Base case cost for US was $155.67 (range: $122.94-$432.29) when performed by a sonographer and $242.64 (range: $147.46-$1,330.05) when performed by a radiologist. For a US-based pathway, the total cost break-even pathway mix (percent UGI required for troubleshooting) was 57%. Conclusion US can be a faster and less costly alternative to UGI in pediatric patients with suspected midgut volvulus.

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/m

Multiple region-of-interest (ROI) sampling strategies have been described for liver fat quantification by MRI PDFF. While adult studies have shown that sampling strategies including as few as four ROIs provide a reasonable tradeoff between laboriousness and quantitative performance, there is a paucity of similar data for pediatric patients.To assess agreement between different ROI sampling strategies for liver MRI PDFF analysis in children and adolescents.This retrospective, internal review board-approved study included clinical MRI PDFF acquisitions for 50 children and adolescents. Four different ROI sampling paradigms reported in the literature were reproduced to measure mean liver PDFF. An 18-ROI (2 in each Couinaud segment) paradigm was considered the reference standard. Spearman correlation, intraclass correlation coefficients (ICCs), and Bland-Altman analyses were used to quantify agreement.Mean age for the 50 participants was 14 ± 2.5 years (range 8-17 years). Based on the 18-ROI paradigm, mean PDFF was significantly higher for the right lobe (24.0 ± 13.7% right, 22.0 ± 13.1% left; p = 0.001). PDFF values for each individual Couinaud segment were highly correlated with the reference standard (ρ = 0.977 to 0.993, p 0.0001). PDFF values derived from all sampling paradigms, including strategies using large free-hand ROIs, were strongly correlated with the reference standard (ρ = 0.995 to 0.998, p 0.0001) with excellent agreement (ICC range 0.995 to 0.998).Liver PDFF sampling paradigms using large ROIs showed strong correlation, excellent agreement, and nonsignificant mean differences from a reference standard paradigm sampling every Couinaud segment in children. Paradigms that exclusively sample the right lobe may overestimate liver PDFF.

To compare bowel wall T1 relaxation estimates in young patients with newly diagnosed ileal CD to healthy control participants, characterize their change over time in response to biologic medical therapy, and evaluate their associations with clinical markers of intestinal inflammation.Patients with newly diagnosed ileal CD and healthy control participants were prospectively recruited between December 2018 and October 2021. Patients underwent research MRI examinations of the bowel at baseline and at 6-weeks and 6-months into biologic medical treatment; control participants underwent single MRI examinations. MRI examinations included native T1 relaxometry of the terminal ileum using a modified Look-Locker inversion recovery (MOLLI) sequence. T1 estimates were measured on scanner-generated parametric maps. Clinical markers of intestinal inflammation were recorded at each visit. Group differences were assessed using the Mann-Whitney U test; the Friedman test was used to assess longitudinal changes in T1 estimates. Spearman correlation was used to evaluate associations between T1 estimates and inflammatory markers.Nineteen participants with CD (12 males; median age 14 years) and 15 control participants (7 males; median age 17 years) were included in the study. Bowel wall T1 estimates in CD patients (median 1302 ms) were significantly longer compared to control participants (median 1159 ms) (p 0.001). In CD patients, T1 estimates changed over time after treatment (p = 0.001), with largest reductions between baseline and 6-weeks (p 0.001). T1 estimates correlated with inflammatory markers, including erythrocyte sedimentation rate (ρ = 0.35; p = 0.01), c-reactive protein level (ρ = 0.34; p = 0.02), and weighted Pediatric Crohn's Disease Activity Index (ρ = 0.39; p = 0.005). T1 estimates did not correlate with serum albumin (ρ = - 0.28; p = 0.051) and fecal calprotectin (ρ = 0.07; p = 0.63).Bowel wall T1 estimates are abnormally increased in newly diagnosed ileal CD patients and decrease in response to medical therapy.

Background Portal hypertension in the Fontan circulation is a function of elevated systemic venous pressure and liver fibrosis. Purpose To quantify the prevalence of radiologic evidence of portal hypertension and elevated VAST score (one point each for varices, ascites, splenomegaly, and thrombocytopenia) of 2 or greater in children and adults with Fontan circulation and to determine the association with hemodynamics and adverse outcomes. Materials and Methods This was a retrospective study of individuals with Fontan circulation who underwent abdominal MRI or CT for focal liver lesion surveillance between January 2012 and December 2019. Portal hypertension was defined as the presence of at least two of the following: varices, ascites, or splenomegaly. Fontan deterioration was defined as a composite of heart failure signs or symptoms requiring diuretic escalation, placement of a ventricular assist device, heart transplant, or death. Relationships between variables and the composite end point were assessed using univariable and multivariable logistic regression. Results A total of 123 patients (age range, 9-55 years; 32 children) were evaluated (median age, 23 years; IQR, 17-30 years; 63 male patients). Median time since diagnosis of Fontan circulation was 16 years (IQR, 12-23 years). Twenty-five of the 123 patients (20%) had radiologic evidence of portal hypertension, and 34 (28%) had a VAST score of 2 or greater. Fontan deterioration occurred in 25 of the 123 patients (20%); median follow-up duration was 0.4 year (IQR, 0.1-3.1 years). Compared with patients who had Fontan circulation without deterioration, patients with Fontan deterioration were more likely to have moderate or severe ventricular systolic dysfunction (

Data suggest an increased risk of thyroid dysfunction following iodine-based contrast material (IBCM) in children. To estimate the prevalence of thyroid stimulating hormone (TSH) abnormalities following exposure to a single dose of intravenous IBCM during computed tomography (CT) in young children. Inpatients ≤24 months of age who underwent a single CT with intravenous IBCM (exposed cohort) or abdominal ultrasound (US) (unexposed cohort) examination and had a TSH value obtained within 90 days after imaging between January 2009 to November 2018 were identified. Propensity score matching with 20 variables was performed. Primary thyroid dysfunction was defined by abnormally high or low TSH value. Multivariable logistic regression identified risk factors, including intravenous IBCM, for thyroid dysfunction. From the eligible 4,215 imaging examinations, 114 unique patients were included in the propensity matched population (n=57 per group). Thyroid dysfunction was identified in 14% (8/57) and 7% (4/57) of the IBCM-exposed and IBCM-unexposed cohorts, respectively. No patient in either cohort was started on thyroid hormone supplementation within the 3 months after imaging. Intravenous IBCM exposure was not a significant predictor of thyroid dysfunction on univariable (odds ratio [OR]=2.16, 95% confidence interval [CI]=0.61–7.64, P=0.23) or multivariable (OR=2.61, 95% CI=0.65–10.55, P=0.18) analyses. Significant independent predictors of post-imaging thyroid dysfunction included height (OR=1.25, P=0.0095) and trisomy 21 (OR=4.04, P=0.019). Hospitalized children ≤24 months of age who received a single dose of intravenous IBCM for CT examination had a similar prevalence of TSH abnormalities compared to a propensity score matched group who underwent abdominal US. One dose of intravenous IBCM likely does not cause prolonged TSH abnormalities; however, larger studies are needed.

The Fontan operation has dramatically altered the natural history of functionally single ventricle congenital heart disease. Patients who have undergone the Fontan operation are living longer and, thus, noncardiac morbidity resulting from the Fontan operation is increasingly being recognized. Fontan-associated liver disease (FALD), one of the chief morbidities following the Fontan operation, is believed to be a multifactorial process that manifests as hepatic congestion and fibrosis, portal hypertension, and development of focal liver lesions, including malignant tumors. This article reviews the imaging findings of FALD in the pediatric and young adult population, reviews the literature related to the imaging of FALD and discusses possible screening algorithms for this population. The need for further research to better understand the causes of FALD, to establish if early liver stiffness measurements (or their change over time) predict long-term outcomes and complications, and to define optimal liver screening procedures is highlighted.

Ultrasound shear wave elastography (SWE) measures liver stiffness noninvasively, but few studies have defined cutoff values for detecting liver fibrosis in pediatric patients using 2-D ultrasound SWE. To evaluate the diagnostic performance of 2-D ultrasound SWE and define cutoff values for liver fibrosis in pediatric patients, using Canon (Toshiba) Aplio ultrasound systems. This was an institutional review board-approved retrospective study of patients (≤18 years old) who had undergone both liver 2-D ultrasound SWE and percutaneous liver biopsy within 6 months. Liver biopsies were staged using the METAVIR (fibrosis) scoring system. Continuous data were compared using the Mann-Whitney U test. Receiver operating characteristic (ROC) curve analysis was used to evaluate diagnostic performance. Forty-six patients, with a median age of 11.5 years (interquartile range: 8.0–14.3 years), were included. Twenty-three patients were male (50%). Twenty-seven patients had a METAVIR fibrosis score of F0–1, and 19 patients had a score of F2–4. For differentiating METAVIR F0–1 from F2-–4, the area under the ROC (AuROC) was 0.75 (95% confidence interval [CI]: 0.60–0.90). A cutoff of >1.89 m/s yielded sensitivity of 73.7% (95% CI: 51.2–88.2) and specificity of 77.8% (95% CI: 59.2–89.4). For the subset of patients without histological hepatic steatosis (n=35), the AuROC was 0.86 (95% CI: 0.71–1.0). The same cutoff of >1.89 m/s yielded a sensitivity of 80.0% (95% CI: 54.8–93.0) and specificity of 95.0% (95% CI 76.4–99.7). Two-dimensional ultrasound SWE distinguishes patients with no/mild fibrosis from those with moderate/severe fibrosis with good sensitivity and specificity. Diagnostic performance is comparable to that published for magnetic resonance elastography and is likely adversely impacted by steatosis.

BACKGROUND: Multiple quantitative magnetic resonance imaging (MRI) methods have been described to noninvasively detect and characterize liver fibrosis, including diffusion-weighted imaging (DWI). PURPOSE: To evaluate associations between liver MRI DWI apparent diffusion coefficient (ADC) values and clinical factors and other quantitative liver MRI metrics in pediatric patients with autoimmune liver disease (AILD). MATERIALS AND METHODS: Fifty-seven research liver MRI examinations performed from January 2017 to August 2018 for pediatric AILD registry participants were evaluated. Liver DWI ADC values, liver and spleen stiffness (kPa), and iron-corrected T1 (cT1; Perspectum Diagnostics) were measured at four anatomic levels. Participant age, sex, and laboratory data (alanine aminotransferase [ALT], total bilirubin, alkaline phosphatase, gamma-glutamyl transferase [GGT]) were recorded. Spearman’s rank-order correlation (rho) and multiple linear regression were used to evaluate the associations between liver ADC values and predictor variables. RESULTS: Mean (SD) participant age was 14.8 (4.0) years, 45.6% (26/57) were girls. Mean liver DWI ADC value was 1.34 (0.14 × 10(−3)) mm(2)/s. Liver ADC values showed weak to moderate correlations with liver stiffness (r = − 0.42, p = 0.001), spleen stiffness (r = − 0.34; p = 0.015), whole-liver mean cT1 (r = − 0.39; p = 0.007), ALT (r = − 0.50; p = 0.0001), and GGT (r = − 0.48; p = 0.0004). Multiple linear regression showed liver stiffness (p = 0.0009) and sex (p = 0.023) to be independent predictors of liver ADC values. CONCLUSION: Liver DWI ADC values are significantly associated with liver and spleen stiffnesses, liver cT1, ALT, GGT, and participant sex, with liver stiffness and sex remaining significant at multivariable regression. Liver ADC ultimately may play a role in multi-parametric prediction of chronic liver disease/fibrosis severity.

OBJECTIVE. The objective of our study was to assess whether secretin improves visualization of a nondilated pancreatic duct and whether it increases identification of variant duct anatomy on MRCP i...

Pancreas volume might be a quantitative metric of pancreas health and function in children.To establish normative pancreas volumes and determine factors associated with pancreas volume.We conducted a retrospective study of 140 healthy children (balanced from 0 to 18 years, stratified by age and gender) who underwent contrast-enhanced CT of the abdomen. Pancreas volume was manually segmented by a single reviewer using 3D Slicer and corrected by a pediatric radiologist. We used Bland-Altman difference analysis to quantify differences in initial and refined segmented pancreas volume, and the Mann-Whitney U test to compare continuous variables. We used Pearson correlation for univariate associations. To determine predictors, we used multivariable regression. Finally, we generated quantile regression equations to determine pancreas volume based on age or body surface area (BSA).Pancreas volume for the study sample ranged from 2 mL to 99 mL. Age (r=0.90, P0.0001), body mass index (BMI) (r=0.66, P0.0001), BSA (r=0.94, P0.0001), height (r=0.91, P0.0001) and weight (r=0.90, P0.0001) were all positively correlated with pancreas volume on univariate analysis. On multivariable analysis, BSA (+36 mL/mWe report pancreas volumes for healthy children. We found that age, BMI, BSA, height and weight were each significantly, positively correlated with pancreas volume in univariate analyses, while BSA and female gender were significant independent predictive factors on multivariable analysis.

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.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.Median estimated glomerular filtration rate (eGFR) was 112.3 ml/min/1.73 mRenal 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.

Rationale and Objectives To determine if, during the first wave of the COVID-19 pandemic, 1) the proportion of complicated appendicitis changed, and 2) if imaging strategies for appendicitis in children changed. Materials and Methods Retrospective cross-sectional study using administrative data from the Pediatric Health Information System, inclusive of pediatric patients diagnosed with appendicitis from March to May in 2017, 2018, 2019 and 2020. We compared trends during COVID-19 pandemic (March-May 2020) with corresponding pre-COVID-19 periods in 2017-2019. Study outcomes were the proportion of complicated appendicitis and trends in imaging for appendicitis explained by patient-level variables. Results The proportion of complicated appendicitis cases increased by 4.4 percentage points, from 46.5% pre-COVID-19 (2017-2019) to 50.9% during COVID-19 (2020), p

Non-alcoholic fatty liver disease (NAFLD) is increasing in prevalence and is the most common cause of pediatric chronic liver disease. Objective US-based measures of hepatic steatosis are an unmet clinical need.To evaluate the diagnostic performance of quantitative measurement of liver echogenicity (hepatorenal index, or HRI) for hepatic steatosis in a pediatric cohort.We identified pediatric patients (≤18 years old) who underwent both clinically indicated abdominal US and MRI with liver proton-density fat fraction (PDFF) within the 3-month period during the timeframe of July 2015-April 2020 (n=69). Using ImageJ, we drew small circular regions of interest (ROIs) and large freehand ROIs in the liver and right kidney on single longitudinal and transverse images to measure echogenicity (arbitrary units). We calculated four HRIs (liver-to-kidney ratio) as well as liver histogram features. Five pediatric radiologists independently reported the qualitative presence/absence of hepatic steatosis. We used Pearson correlation (r) to assess associations and receiver operating characteristic (ROC) curve analyses to evaluate diagnostic performance. Multivariable logistic regression was used to further assess relationships.Mean patient age was 11.6 (standard deviation [SD] 4.7, range 0.3-18) years; 27/69 (39.1%) were female. Mean PDFF was 12.5% (SD 13.1%, range 1-48%); 34/69 (49.3%) patients were classified as having hepatic steatosis by MRI (PDFF ≥6%). There were significant, positive correlations between all four US HRI methods and PDFF (r=0.51-0.61); longitudinal freehand ROIs exhibited the strongest correlation (r=0.61; P0.0001). Longitudinal freehand ROI HRI had moderate diagnostic performance for the binary presence of steatosis (area under the curve [AUC]=0.80, P0.0001), with an optimal cut-off value1.75 (sensitivity=70.6%, specificity=77.1%). Radiologists' sensitivity for detecting hepatic steatosis ranged from 79.4% to 97.1%, and specificity ranged from 91.2% to 100%. Significant multivariable predictors of PDFF ≥6% included HRI (P=0.002; odds ratio [OR]=34.2), body mass index (BMI) percentile (P=0.005; OR=1.06), and liver gray-scale echogenicity standard deviation (P=0.02; OR=0.79) (receiver operating characteristic AUC = 0.92).Quantitative US HRI has moderate diagnostic performance for detecting liver fat in children and positively correlates with MRI PDFF. Incorporation of BMI-percentile and gray-scale echogenicity standard deviation improved diagnostic performance.

Pneumatosis intestinalis (PI) is air collections within the wall of the intestine that can be associated with life threatening conditions. Recurrent episodes of PI have been reported; however, little is known about risks for recurrent disease. This study aims to identify predictors of recurrent PI and evaluate long-term outcomes in patients with recurrent PI.This retrospective case-control study evaluated patients, ages 6 months to 18 years, with imaging evidence of PI over a 30-month period. Images were analyzed by consensus to confirm PI. Recurrent PI was defined as new findings of PI after resolution by imaging and/or at least 1-month interval between episodes of PI. Univariate and multivariable analyses were performed using logistic regression, with significance set to P 0.05.Forty-six children were included. Recurrent PI occurred in 17 (37%) patients, with a total of 39 episodes. Predictors of recurrent PI all related to the segment of bowel involved with small bowel PI predictive of recurrent PI (odds ratio [OR] 1.6; 95% confidence interval [CI] 1.01, 2.4) and colonic PI protective (OR 0.6; 95% CI 0.4, 0.87) after adjusting for age. Predictors for surgical intervention included cerebral palsy (OR 17; 95% CI 1.7, 167) and PI involving small bowel (OR 19; 95% 3.1, 114).Location of PI is predictive of recurrence. Clinical outcomes were similar between groups with single episode and recurrent PI.

OBJECTIVE. The purpose of this study is to develop a machine learning model to categorically classify MR elastography (MRE)-derived liver stiffness using clinical and nonelastographic MRI radiomic features in pediatric and young adult patients with known or suspected liver disease. MATERIALS AND METHODS. Clinical data (27 demographic, anthropomorphic, medical history, and laboratory features), MRI presence of liver fat and chemical shift-encoded fat fraction, and MRE mean liver stiffness measurements were retrieved from electronic medical records. MRI radiomic data (105 features) were extracted from T2-weighted fast spin-echo images. Patients were categorized by mean liver stiffness (< 3 vs ≥ 3 kPa). Support vector machine (SVM) models were used to perform two-class classification using clinical features, radiomic features, and both clinical and radiomic features. Our proposed model was internally evaluated in 225 patients (mean age, 14.1 years) and externally evaluated in an independent cohort of 84 patients (mean age, 13.7 years). Diagnostic performance was assessed using ROC AUC values. RESULTS. In our internal cross-validation model, the combination of clinical and radiomic features produced the best performance (AUC = 0.84), compared with clinical (AUC = 0.77) or radiomic (AUC = 0.70) features alone. Using both clinical and radiomic features, the SVM model was able to correctly classify patients with accuracy of 81.8%, sensitivity of 72.2%, and specificity of 87.0%. In our external validation experiment, this SVM model achieved an accuracy of 75.0%, sensitivity of 63.6%, specificity of 82.4%, and AUC of 0.80. CONCLUSION. An SVM learning model incorporating clinical and T2-weighted radiomic features has fair-to-good diagnostic performance for categorically classifying liver stiffness.

To determine the diagnostic performance of ultrasound for diagnosing ureteral calculi in children using a clinical effectiveness approach. Billing records and imaging reports were used to identify children (≤ 18 years old) evaluated for suspected urolithiasis using ultrasound between March 2012 and March 2017. Patients without unenhanced CT within 24 h (reference standard) were excluded. Imaging (ultrasound and CT) reports were reviewed for presence, number, size, and location of calculi. Diagnostic performance of ultrasound (versus CT) was calculated on an individual ureter basis both by direct calculus visualization as well as direct visualization combined with suspected presence of ureteral stone based on indirect ultrasound findings. 41 ureteral calculi were present in 38 of 69 (55.1%) patients. Mean patient age was 14.7 ± 3.6 years, and 35 of 69 (51%) patients were boys. Based on direct calculus visualization, ultrasound had a sensitivity of 12.8% (95% CI 5.6–26.7%), specificity of 100% (95% CI 96.3–100%), positive predictive value (PPV) of 100% (95% CI 56.6–100%), and negative predictive value (NPV) of 74.4% (95% CI 66.4–81.1%). When ultrasound examinations reported as suspicious for ureteral calculi based on indirect findings also were considered positive, ultrasound had a sensitivity of 41.0% (95% CI 27.1–56.6%), specificity of 95.0% (95% CI 88.7–97.8%), PPV of 76.2% (95% CI 54.9–89.4%), and NPV of 80.3% (95% CI 72.2–86.5%). In clinical practice, ultrasound has low sensitivity for directly visualizing ureteral calculi subsequently identified by CT, although sensitivity improves when considering suspicious examinations as positive.

Background Hepatic steatosis, caused by nonalcoholic fatty liver disease, is a leading cause of chronic liver disease. The interplay between hepatic steatosis and the development of liver disease following the Fontan procedure is not well understood. This study examined the prevalence and associations of hepatic steatosis in patients with a Fontan circulation. Methods and Results This was a single‐center retrospective study of 95 patients with a Fontan circulation with liver magnetic resonance imaging performed between 2012 and 2019. The average age at magnetic resonance imaging was 21.5±8.5 years. The percent liver fat signal was determined using magnetic resonance chemical shift‐encoded proton density fat fraction imaging. Hepatic steatosis was defined as liver fat ≥5% and was present in 10.5% of the cohort. The presence of hepatic steatosis was associated with higher body mass index (29±4 versus 24±6 kg/m 2 , P =0.006), a higher frequency of obesity (50% versus 12%, P =0.015), lower high‐density lipoprotein cholesterol (35±9 versus 43±14 mg/dL, P =0.050), and greater subcutaneous fat thickness (2.6±0.7 versus 1.8±1.0 cm, P =0.043). There was no association between hepatic steatosis and cardiovascular imaging or hemodynamic variables from cardiac catheterization. Conclusions Risk factors for hepatic steatosis in patients with Fontan circulation include obesity and dyslipidemia, similar to what is seen in the general population. Fontan hemodynamics were not associated with hepatic steatosis.

Elevated magnetic resonance elastography (MRE)-derived liver stiffness may be associated with worse outcomes in people with Fontan circulation. We sought to evaluate the association between liver stiffness and Fontan failure or portal hypertension. Single center cross-sectional retrospective study of people with Fontan circulation who underwent MRE between 2011 and 2020. The cohort was divided into adult (age ≥ 21 years) and pediatric ( 21 years) groups. Fontan circulatory failure (FF) was defined as any of the following: death, transplantation, ventricular assist device, heart failure symptoms requiring escalation of diuretics. Radiologic portal hypertension was defined as the presence of one or more of the following: splenomegaly, ascites, or gastrointestinal varices. 128 patients were included (average age = 22.6 ± 8.7 years) and 58 (45%) were children. Median liver stiffness was 4.3 kPa (interquartile range (IQR) 3.8-5.8) for the entire cohort. Thirty patients (23%) developed FF (16 adults, 14 children). Liver stiffness was higher in adults with FF compared to those without FF (4.9 (IQR 4.0-6.0) vs. 4.2 (IQR 3.8-4.7) kPa, p = 0.04). There was no difference in liver stiffness between pediatric patients with and without FF (4.4 (IQR 4.1-5.4) vs. 4.4 (IQR 3.8-5.0), p = 0.5). Adults with radiologic portal hypertension and adults with moderate or severe atrioventricular valve regurgitation had higher liver stiffness than adults without. MRE-derived liver stiffness is associated with atrioventricular valve regurgitation, portal hypertension, and poor clinical outcomes in adults with Fontan circulation. There was no association between liver stiffness and FF in pediatric patients. This difference may be due to the progressive nature of Fontan-associated liver disease.

Deep learning Computed Tomography (CT) reconstruction (DLR) algorithms promise to improve image quality but the impact on clinical diagnostic performance remains to be demonstrated. We aimed to compare DLR to standard iterative reconstruction for detection of urolithiasis by unenhanced CT in children and young adults.This was an IRB approved retrospective study involving post-hoc reconstruction of clinically acquired unenhanced abdomen/pelvis CT scans. Images were reconstructed with six different manufacturer-standard DLR algorithms and reformatted in 3 planes (axial, sagittal, and coronal) at 3 mm intervals. De-identified reconstructions were loaded as independent examinations for review by 3 blinded radiologists (R1, R2, R3) tasked with identifying and measuring all stones. Results were compared to the clinical iterative reconstruction images as a reference standard. IntraClass correlation coefficients and kappa (k) statistics were used to quantify agreement.CT data for 14 patients (mean age: 17.3 ± 3.4 years, 5 males and 9 females, weight class: 31-70 kg (n = 6), 71-100 kg (n = 7), 100 kg (n = 1)) were reconstructed into 84 total exams. 7 patients had urinary tract calculi. Interobserver agreement on the presence of any urinary tract calculus was substantial to almost perfect (k = 0.71-1) for all DLR algorithms. Agreement with the reference standard on number of calculi was excellent (ICC = 0.78-0.96) and agreement on the size of the largest calculus was fair to excellent (ICC = 0.51-0.97) depending on reviewer and DLR algorithm.Deep learning reconstruction of unenhanced CT images allows similar renal stone detectability compared to iterative reconstruction.

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.

PURPOSE: To compare automated versus standard of care manual processing of 2D gradient recalled echo (GRE) liver MR Elastography (MRE) in children and young adults. MATERIALS AND METHODS: 2D GRE liver MRE data from research liver MRI examinations performed as part of an autoimmune liver disease registry between March 2017 and March 2020 were analyzed retrospectively. All liver MRE data were acquired at 1.5 T with 60 Hz mechanical vibration frequency. For manual processing, two independent readers (R1, R2) traced regions of interest on scanner generated shear stiffness maps. Automated processing was performed using MREplus+ (Resoundant Inc.) using 90% (A90) and 95% (A95) confidence masks. Agreement was evaluated using intra-class correlation coefficients (ICC) and Bland–Altman analyses. Classification performance was evaluated using receiver operating characteristic curve (ROC) analyses. RESULTS: In 65 patients with mean age of 15.5 ± 3.8 years (range 8–23 years; 35 males) median liver shear stiffness was 2.99 kPa (mean 3.55 ± 1.69 kPa). Inter-reader agreement for manual processing was very strong (ICC = 0.99, mean bias = 0.01 kPa [95% limits of agreement (LoA): − 0.41 to 0.44 kPa]). Correlation between manual and A95 automated processing was very strong (R1: ICC = 0.988, mean bias = 0.13 kPa [95% LoA: − 0.40 to 0.68 kPa]; R2: ICC = 0.987, mean bias = 0.13 kPa [95% LoA: − 0.44 to 0.69 kPa]). Automated measurements were perfectly replicable (ICC = 1.0; mean bias = 0 kPa). CONCLUSION: Liver shear stiffness values obtained using automated processing showed excellent agreement with manual processing. Automated processing of liver MRE was perfectly replicable.

Performing and optimizing MRI of the chest, abdomen and pelvis in neonates and young infants can be challenging. This is a result of several factors, including patient size, desire to avoid or minimize sedation/general anesthesia, and the relative rarity of these examinations. However, with proper preparation and protocol optimization, high-quality diagnostic images can be acquired that can aid in diagnosis and patient management. In addition, numerous special considerations arise when performing body MRI in neonates compared to older pediatric patients. This review article provides an update on the performance and optimization of MRI of the body in neonates and infants. Furthermore, the authors present common indications for neonatal body MRI and discuss the use of intravenous gadolinium-based contrast agents in this vulnerable patient population.

Background Transmural healing (TH) is associated with better long-term outcomes in Crohn disease (CD), whereas pretreatment ileal gene signatures encoding myeloid inflammatory responses and extracellular matrix production are associated with stricturing. We aimed to develop a predictive model for ileal TH and to identify ileal genes and microbes associated with baseline luminal narrowing (LN), a precursor to strictures. Materials and Methods Baseline small bowel imaging obtained in the RISK pediatric CD cohort study was graded for LN. Ileal gene expression was determined by RNASeq, and the ileal microbial community composition was characterized using 16S rRNA amplicon sequencing. Clinical, demographic, radiologic, and genomic variables were tested for association with baseline LN and future TH. Results After controlling for ileal location, baseline ileal LN (odds ratio [OR], 0.3; 95% confidence interval [CI], 0.1-0.8), increasing serum albumin (OR, 4; 95% CI, 1.3-12.3), and anti-Saccharomyces cerevisiae antibodies IgG serology (OR, 0.97; 95% CI, 0.95-1) were associated with subsequent TH. A multivariable regression model including these factors had excellent discriminant power for TH (area under the curve, 0.86; positive predictive value, 80%; negative predictive value, 87%). Patients with baseline LN exhibited increased Enterobacteriaceae and inflammatory and extracellular matrix gene signatures, coupled with reduced levels of butyrate-producing commensals and a respiratory electron transport gene signature. Taxa including Lachnospiraceae and the genus Roseburia were associated with increased respiratory and decreased inflammatory gene signatures, and Aggregatibacter and Blautia bacteria were associated with reduced extracellular matrix gene expression. Conclusions Pediatric patients with CD with LN at diagnosis are less likely to achieve TH. The association between specific microbiota, wound healing gene programs, and LN may suggest future therapeutic targets.

Artificial intelligence (AI) uses computers to mimic cognitive functions of the human brain, allowing inferences to be made from generally large datasets. Traditional machine learning (e.g., decision tree analysis, support vector machines) and deep learning (e.g., convolutional neural networks) are two commonly employed AI approaches both outside and within the field of medicine. Such techniques can be used to evaluate medical images for the purposes of automated detection and segmentation, classification tasks (including diagnosis, lesion or tissue characterization, and prediction), and image reconstruction. In this review article we highlight recent literature describing current and emerging AI methods applied to abdominal imaging (e.g., CT, MRI and US) and suggest potential future applications of AI in the pediatric population.

To determine if individual sonographers and radiologists impact appendix visualization by ultrasound and utilization of computed tomography (CT) in children with suspected acute appendicitis.Appendix ultrasound examinations performed at Cincinnati Children's Hospital Medical Center on Emergency Department patients ≤ 18 years old were retrospectively identified. Examinations performed/interpreted by sonographers/radiologists with fewer than 100 examinations were excluded. Multivariable logistic regression was used to assess the effect of sonographer, radiologist, clinical variables, and system factors on imaging outcomes, including appendix visualization and subsequent CT utilization.A total of 9271 ultrasound examinations (mean [SD] patient age, 9.9 [4.2] years; 5392 [58.2%] boys) performed by 31 sonographers (mean number examinations, 299 [139]; range, 115-610) and interpreted by 31 radiologists (mean number examinations, 299 [157]; range, 101-845) were included. The mean frequency of appendix visualization per sonographer was 57.8% [8.7%] (range, 40.9-76.0%) and per radiologist was 59.5% [4.1%] (range, 51.7-66.3%). The mean rate of CT utilization per sonographer was 9.2% [2.0%] (range, 5.9-14.0%) and per radiologist was 9.2% [1.8%] (range, 3.4-12.1%). Predictors of appendix visualization by ultrasound included patient weight (p0.0001), sex (p = 0.0003), white blood cell count (p0.0001), temperature (p = 0.002), abdominal tenderness (p = 0.004), presence of appendicitis (p0.0001), sonographer (p0.0001), and radiologist (p = 0.02). Predictors of CT utilization included patient weight (p0.0001), white blood cell count (p0.0001), abdominal tenderness (p0.0001), rebound tenderness (p = 0.0003), and presence of appendicitis (p0.0001), but not sonographer or radiologist.Individual sonographers and radiologists were associated with appendix visualization by ultrasound in children with suspected acute appendicitis; neither was associated with CT utilization.• Individual sonographers and radiologists are significantly and independently associated with appendix visualization by ultrasound in children with suspected acute appendicitis. • Frequency of appendix visualization per sonographer demonstrated significant and wide variability across 31 sonographers, ranging from 40.9 to 76.0%. • Fewer than 10% of patients with an ultrasound examination for suspected acute appendicitis underwent CT imaging within the following 24 h. Individual radiologists and sonographers were not predictive of CT utilization within 24 h.

Survivors following very premature birth (i.e., ≤ 32 weeks gestational age) remain at high risk for neurodevelopmental impairments. Recent advances in deep learning techniques have made it possible to aid the early diagnosis and prognosis of neurodevelopmental deficits. Deep learning models typically require training on large datasets, and unfortunately, large neuroimaging datasets with clinical outcome annotations are typically limited, especially in neonates. Transfer learning represents an important step to solve the fundamental problem of insufficient training data in deep learning. In this work, we developed a multi-task, multi-stage deep transfer learning framework using the fusion of brain connectome and clinical data for early joint prediction of multiple abnormal neurodevelopmental (cognitive, language and motor) outcomes at 2 years corrected age in very preterm infants. The proposed framework maximizes the value of both available annotated and non-annotated data in model training by performing both supervised and unsupervised learning. We first pre-trained a deep neural network prototype in a supervised fashion using 884 older children and adult subjects, and then re-trained this prototype using 291 neonatal subjects without supervision. Finally, we fine-tuned and validated the pre-trained model using 33 preterm infants. Our proposed model identified very preterm infants at high-risk for cognitive, language, and motor deficits at 2 years corrected age with an area under the receiver operating characteristic curve of 0.86, 0.66 and 0.84, respectively. Employing such a deep learning model, once externally validated, may facilitate risk stratification at term-equivalent age for early identification of long-term neurodevelopmental deficits and targeted early interventions to improve clinical outcomes in very preterm infants.

In adults with chronic liver diseases, ultrasound and magnetic resonance shear wave elastography (SWE) can replace liver biopsy in several clinical scenarios. Several guidelines on the use of ultrasound SWE for the adult population have been published. However, the number of publications in the pediatric population is limited, and available guidelines on SWE do not specifically address pediatric chronic liver diseases. In this article, we review the literature on the use of SWE for pediatric chronic liver diseases and provide expert opinion on how to use SWE, both ultrasound and magnetic resonance techniques, in the pediatric population.

Gadolinium-based contrast agents (GBCAs) have been used to improve image quality of MRI examinations for decades and have an excellent overall safety record. However, there are well-documented risks associated with GBCAs and our understanding and management of these risks continue to evolve. The purpose of this review is to discuss the safety of GBCAs used in MRI in adult and pediatric populations. We focus particular attention on acute adverse reactions, nephrogenic systemic fibrosis and gadolinium deposition. We also discuss the non-GBCA MRI contrast agent ferumoxytol, which is increasing in use and has its own risk profile. Finally, we identify special populations at higher risk of harm from GBCA administration.

There are few data describing practice patterns related to the use of sedation/anesthesia for diagnostic imaging in pediatric radiology departments.To understand current practice patterns related to imaging with sedation/anesthesia in pediatric radiology departments based on a survey of the Society of Chiefs of Radiology at Children's Hospitals (SCORCH) in conjunction with the American College of Radiology's Pediatric Imaging Sedation and Anesthesia Committee.A multi-question survey related to imaging with sedation/anesthesia in pediatric radiology departments was distributed to SCORCH member institutions in January 2019. A single reminder email was sent. Descriptive statistical analyses were performed.Of the 84 pediatric radiology departments, 23 (27%) completed the survey. Fifty-seven percent of the respondents self-identified as academic/university-affiliated and 13% as a division/section in an adult radiology department. Imaging sedation (excluding general anesthesia) is commonly performed by pediatric anesthesiologists (76%) and intensive care unit physicians (intensivists, 48%); only 14% of departments expect their pediatric radiologists to supervise imaging sedation. Ninety-six percent of departments use child life specialists for patient preparation. Seventy percent of departments have preparatory resources available on a website, including simulation videos (26%) and audio clips (17%). Nearly half (48%) of the departments have a mock scanner to aid in patient preparation. Imaging sedation/anesthesia is most often scheduled at the request of ordering clinicians (65%), while 57% of departments allow schedulers to place patients into imaging sedation/anesthesia slots based on specified criteria.Imaging sedation/anesthesia practice patterns vary among pediatric radiology departments, and understanding current approaches can help with standardization and practice improvement.

Compressed SENSE (C-SENSE) allows more rapid MRI acquisition through incoherent, pseudorandom k-space undersampling. The purpose of our study was to compare conventional sensitivity encoded imaging (SENSE) quantitative MR images to those obtained using C-SENSE for measurement of liver proton density fat fraction (PDFF), T2*, and stiffness.Clinical liver MRI examinations that included SENSE and C-SENSE quantitative MRI sequences were retrospectively identified. Patient age, gender, liver PDFF (%), T2* (ms), and stiffness (kPa) were recorded. Spearman's rank-order correlation (r) was used to evaluate association between methods, and Bland-Altman analysis was used to determine the mean bias and 95% limits of agreement.Clinical liver MRI examinations that included SENSE and C-SENSE quantitative MRI sequences were retrospectively identified. Patient age, gender, liver PDFF (%), T2* (ms), and stiffness (kPa) were recorded. Spearman's rank-order correlation (r) was used to evaluate association between methods, and Bland-Altman analysis was used to determine the mean bias and 95% limits of agreement. Thirty-six examinations met the inclusion criteria. Mean patient age was 15.7 ± 7.7 years; twelve exams (33%) were in female patients. Liver PDFF showed very strong positive correlation (r = 0.98) between sequences, with a mean bias of 0.28% (95% LOA: -0.85, 1.41%). T2* showed moderate positive correlation (r = 0.53), with a mean bias of - 3.0 ms (95% LOA: - 12.0, 6.0 ms). Stiffness showed very strong positive correlation (r = 0.97), with a mean bias of 0.13 kPa (95% LOA: - 0.37, 0.63 kPa) that increased with increasing liver stiffness.There were strong positive correlations between SENSE and C-SENSE MRI measurements of liver PDFF and stiffness, with no to minimal bias. However, there was moderate correlation and greater negative mean bias between T2* measurements. Our results demonstrate the potential of compressed sensing to reliably measure PDFF and stiffness in the clinic.