Search

Background The value of MRI in pediatric congenital heart disease (CHD) is well recognized; however, the requirement for expert oversight impedes its widespread use. Four-dimensional (4D) multiphase steady-state imaging with contrast enhancement (MUSIC) is a cardiovascular MRI technique that uses ferumoxytol and captures all anatomic features dynamically. Purpose To evaluate multicenter feasibility of 4D MUSIC MRI in pediatric CHD. Materials and Methods In this prospective study, participants with CHD underwent 4D MUSIC MRI at 3.0 T or 1.5 T between 2014 and 2020. From a pool of 460 total studies, an equal number of MRI studies from three sites (n = 60) was chosen for detailed analysis. With use of a five-point scale, the feasibility of 4D MUSIC was scored on the basis of artifacts, image quality, and diagnostic confidence for intracardiac and vascular connections (n = 780). Respiratory motion suppression was assessed by using the signal intensity profile. Bias between 4D MUSIC and two-dimensional (2D) cine imaging was evaluated by using Bland-Altman analysis; 4D MUSIC examination duration was compared with that of the local standard for CHD. Results A total of 206 participants with CHD underwent MRI at 3.0 T, and 254 participants underwent MRI at 1.5 T. Of the 60 MRI examinations chosen for analysis (20 per site; median participant age, 14.4 months [interquartile range, 2.3-49 months]; 33 female participants), 56 (93%) had good or excellent image quality scores across a spectrum of disease complexity (mean score ± standard deviation: 4.3 ± 0.6 for site 1, 4.9 ± 0.3 for site 2, and 4.6 ± 0.7 for site 3; P < .001). Artifact scores were inversely related to image quality (r = -0.88, P < .001) and respiratory motion suppression (P < .001, r = -0.45). Diagnostic confidence was high or definite in 730 of 780 (94%) intracardiac and vascular connections. The correlation between 4D MUSIC and 2D cine ventricular volumes and ejection fraction was high (range of r = 0.72-0.85; P < .001 for all). Compared with local standard MRI, 4D MUSIC reduced the image acquisition time (44 minutes ± 20 vs 12 minutes ± 3, respectively; P < .001). Conclusion Four-dimensional multiphase steady-state imaging with contrast enhancement MRI in pediatric congenital heart disease was feasible in a multicenter setting, shortened the examination time, and simplified the acquisition protocol, independently of disease complexity. Clinical trial registration no. NCT02752191 © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Roest and Lamb in this issue.

Background Ferumoxytol is approved for use in the treatment of iron deficiency anemia, but it can serve as an alternative to gadolinium-based contrast agents. On the basis of postmarketing surveillance data, the Food and Drug Administration issued a black box warning regarding the risks of rare but serious acute hypersensitivity reactions during fast high-dose injection (510 mg iron in 17 seconds) for therapeutic use. Whereas single-center safety data for diagnostic use have been positive, multicenter data are lacking. Purpose To report multicenter safety data for off-label diagnostic ferumoxytol use. Materials and Methods The multicenter ferumoxytol MRI registry was established as an open-label nonrandomized surveillance databank without industry involvement. Each center monitored all ferumoxytol administrations, classified adverse events (AEs) using the National Cancer Institute Common Terminology Criteria for Adverse Events (grade 1-5), and assessed the relationship of AEs to ferumoxytol administration. AEs related to or possibly related to ferumoxytol injection were considered adverse reactions. The core laboratory adjudicated the AEs and classified them with the American College of Radiology (ACR) classification. Analysis of variance was used to compare vital signs. Results Between January 2003 and October 2018, 3215 patients (median age, 58 years; range, 1 day to 96 years; 1897 male patients) received 4240 ferumoxytol injections for MRI. Ferumoxytol dose ranged from 1 to 11 mg per kilogram of body weight (≤510 mg iron; rate ≤45 mg iron/sec). There were no systematic changes in vital signs after ferumoxytol administration (P > .05). No severe, life-threatening, or fatal AEs occurred. Eighty-three (1.9%) of 4240 AEs were related or possibly related to ferumoxytol infusions (75 mild [1.8%], eight moderate [0.2%]). Thirty-one AEs were classified as allergiclike reactions using ACR criteria but were consistent with minor infusion reactions observed with parenteral iron. Conclusion Diagnostic ferumoxytol use was well tolerated, associated with no serious adverse events, and implicated in few adverse reactions. Registry results indicate a positive safety profile for ferumoxytol use in MRI. © RSNA, 2019 Online supplemental material is available for this article.

Background Vitamin D deficiency may contribute to risk of cardiovascular disease, diabetes, and infections, in addition to known effects on mineral metabolism. Controversy remains regarding the use of nutritional vitamin D supplementation in chronic kidney disease (CKD), and the supplementation practices of pediatric nephrologists are unknown. Methods An electronic survey containing eight vignettes was sent to physician members of the International Pediatric Nephrology Association in 2011 to identify physician and patient characteristics that influence nephrologists to supplement CKD patients with nutritional vitamin D. Vignettes contained patient characteristics including light vs dark skin, CKD stage, cause of renal disease, parathyroid hormone (PTH), and 25(OH) vitamin D levels. Multivariate logistic generalized estimating equation regression was used to identify predictors of supplementation. Results Of 1,084 eligible physicians, 504 (46%) completed the survey. Supplementation was recommended in 73% of cases overall (ranging from 91% of those with vitamin D levels 30). Greater CKD severity was associated with greater recommendation of supplementation, especially for patients with higher vitamin D levels (test for interaction p Keywords Vitamin D * Nutrition * Case vignettes * Survey * Chronic kidney disease * Pediatrics, Introduction Multiple clinical practice guidelines for vitamin D supplementation in children and adults with chronic kidney disease (CKD) have been published in recent years. However, these guidelines contain conflicting recommendations [...]

Purpose: Mental practice using motor imagery (MP) improves motor strength and coordination in the upper and lower extremities in clinical patient populations. Its effectiveness as a rehabilitation tool for patients with lingual weakness is not yet well understood, nor are the underlying mechanisms within the context of swallow or lingual MP. Using previously published data on a lingual and MP exercise program, the objective of this study was to explore how MP of lingual exercise affects cortical activation in healthy older adults over time and how neural changes correlate with functional oral pressure outcomes. Method: A prospective randomized controlled study was previously completed; older healthy participants were randomized to one of four treatment groups receiving lingual MP, lingual physical practice, a combination of both, and a sham control. This paper reports descriptive data on cortical activation during both the physical and mental forms of lingual resistance in a subgroup of 13 participants using functional near-infrared spectroscopy at baseline and after 6 weeks of the assigned exercise regimen. Results: Aggregated data indicates that participants who completed 6 weeks of lingual exercise, either in physical or in MP form, had decreased oxygenated hemoglobin when completing a maximal lingual pressure task. Conclusions: Some participants in a lingual resistance MP program demonstrated trends similar to those seen after strength training. Combining MP with physical training may lead to greater changes in oxygenation compared to a physical or mental training program alone, although given the small number of participants, it is important not to overinterpret the results. MP is a promising, innovative approach that may enhance traditional exercise-based swallowing rehabilitation. [ABSTRACT FROM AUTHOR]

Pulmonary edema has many causes; differentiating between these conditions is important. The purpose of this review article is to describe the pathophysiology of pulmonary edema, thereby explaining the imaging findings that differentiate between etiologies. Chest computed tomography provides details on the physiological response and the changes in the anatomical structures of pulmonary edema. An understanding of the pathophysiology underlying the imaging findings facilitates the correct identification of the cause of pulmonary edema. [ABSTRACT FROM AUTHOR]

Pulmonary edema is a common condition with numerous causes, some of which are infrequently encountered. This review article describes various uncommon conditions/disease that are associated with pulmonary edema and which show characteristic imaging findings on chest computed tomography or other imaging modality. Thus, this review reflects the variety of factors involved in this frequently encountered condition. We demonstrate the wide range of situations that lead to the development of pulmonary edema by showing the imaging findings of unique cases. These rare varieties of pulmonary edema have distinctive imaging and clinical features that aid in providing an accurate diagnosis. [ABSTRACT FROM AUTHOR]