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Pediatric Radiology
Journal Prestige (SJR): 0.787  Citation Impact (citeScore): 2 Number of Followers: 7  Hybrid journal (It can contain Open Access articles)ISSN (Print) 1432-1998 - ISSN (Online) 0301-0449 Published by Springer-Verlag  [2468 journals]
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- Diagnostic imaging of child physical abuse: an Indian perspective
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PubDate: 2024-08-27
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- Comparison of best landmarks for calculating fetal jaw measurements by
ultrasound and MRI in micrognathia-
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Abstract: Background Micrognathia can be diagnosed in utero with ultrasound by measuring the jaw index and/or inferior facial angle, though it can be challenging due to fetal positioning. The jaw index can be measured with magnetic resonance imaging (MRI) using the masseter muscle, but indistinct margins can lead to inaccuracy; the easily visualized posterior teeth buds may be a better landmark. Objective We aimed to evaluate inter-reader variability, agreement with ultrasound, and association with postnatal outcomes using MRI to measure the inferior facial angle, jaw index by masseter muscle, and jaw index by posterior teeth buds. Materials and methods A single-institution retrospective review was performed of singleton pregnancies with prenatally diagnosed micrognathia by ultrasound or MRI from September 2013-June 2022. Ultrasound measurements were obtained by a maternal–fetal medicine specialist and MRI measurements by two radiologists to evaluate inter-reader variability. Intraclass correlation coefficients (ICC) and Bland–Altman analysis were used to assess agreement between imaging methods and logistic regressions and ROC curves to assess associations with postnatal outcomes. Results Forty-three fetuses (median gestational age 26 weeks (IQR 22–31); 47% male (20/43)) were included. Ultrasound measurements could not be obtained for jaw index in 15/43 (35%) fetuses and inferior facial angle in 11/43 (26%); MRI measurements were obtained by at least one reader in all cases. Jaw index by teeth buds demonstrated lowest inter-reader variability (ICC = 0.82, P < 0.001) and highest agreement with ultrasound (bias -0.23, 95% CI -2.8–2.2). All MRI measurements, but not ultrasound, predicted need for mandibular distraction (inferior facial angle P = 0.02, jaw index by masseter muscle P = 0.04, jaw index by teeth buds P = 0.01). Conclusion Fetal MRI measurements, particularly jaw index measured by posterior teeth buds, demonstrate low inter-reader variability and high agreement with ultrasound, and may predict need for mandibular distraction postnatally.
PubDate: 2024-08-24
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- A modified double-incision technique to place tunneled central lines in
children-
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Abstract: Abstract In children, there are two main techniques for placing a tunneled central venous catheter: single-incision (single puncture) and conventional (two punctures). Both have unique advantages and disadvantages. The modified single-stick technique combines the two aforementioned techniques to access the central venous system in an optimized way. This technique is feasible to perform particularly in young children and has a short learning curve for adult interventional radiologists.
PubDate: 2024-08-22
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- Collaborating with non-radiological clinical colleagues
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Abstract: Paediatric radiology is a challenging and intriguing subspecialty, dealing with children, guardians and non-radiological clinical colleagues. Paediatric radiologists are routinely in contact with numerous paediatric and surgical subspecialties, all having different needs, perceptions, prioritisations and expectations. Moreover, the radiologist is part of the team of radiographers, sonographers, nurses and secretaries, assisted by appropriate equipment and electronic tools. The framework of good collaboration to ensure safety and effectiveness for the imaged child is a shared responsibility among all medical practitioners involved. Communication in routine practice has many forms and includes appropriately filled radiology requests in accordance to the patient’s medical records, routine and timely production of structured, problem-solving radiology reports, face-to-face or electronic-assisted communications and discussions on a pre-defined framework, mutually-agreed and evidence-based protocols adjusted to local availability, skills and national and international guidelines. Mutual understanding of advantages and limitations of imaging is paramount. Well-meant discussions, professionalism and empathy should promote soft skills, bidirectional communication and good collaboration for the benefit of added-value paediatric radiology. International societies, health authorities, medical directors and senior consultants have the responsibility to suggest and safeguard frameworks and recommendations. Regular multidisciplinary meetings and multidisciplinary research projects under openness, honesty and transparency are pathways favouring good collaboration. Graphical
PubDate: 2024-08-22
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- Quantitative MRI in children with Crohn’s disease – where do
we stand'-
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Abstract: Crohn’s disease (CD) is a chronic inflammatory condition that affects the gastrointestinal tract, particularly the ileum and colon. This disease is characterized by recurrent bouts of intestinal inflammation with subsequent bowel wall damage, including scarring (i.e., fibrosis) and abnormal smooth muscle proliferation. MR enterography, an MRI examination tailored to assess the small bowel, is a first-line diagnostic tool for diagnosing CD in children, characterization and monitoring of disease severity and extent, and assessment of disease-related complications. To date, such MRI evaluations have been mostly qualitative, which can adversely impact diagnostic performance and inter-radiologist agreement. Quantitative MRI methods have been shown to aid in the evaluation of a variety of medical conditions and have been increasingly investigated in children and adults with CD. In CD, such objective techniques have been used to assist with diagnosis, assess treatment response, and characterize bowel wall histologic abnormalities. In the current work, we will review quantitative MRI methods for detecting and measuring intestinal active inflammation (MRI-based scoring systems, T1 relaxation mapping, diffusion-weighted imaging, intra-voxel incoherent motion, mesenteric phase contrast), bowel wall damage (magnetization transfer), and motility (quantitative cine imaging) in small bowel CD, with an emphasis on the pediatric population. Graphical
PubDate: 2024-08-21
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- Noncontrast free-breathing ECG-gated 3D balanced steady-state free
precession in congenital heart disease and aortopathy evaluation-
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Abstract: Background High-fidelity cardiac magnetic resonance (MR) imaging plays a pivotal role in the surveillance of congenital heart disease (CHD) and aortopathy. Objective We aimed to evaluate the quality and accuracy of free breathing, ECG-gated noncontrast three-dimensional (3D) balanced steady-state free precession (bSSFP) in cases of CHDs and aortopathies using contrast-enhanced 3D bSSFP as a reference. We also used one of our routinely used non-ECG-gated 2D-single-shot (SSh) bSSFP sequence as an adjunct to noncontrast 3D bSSFP. Materials and methods Institutional review board approval was obtained to perform a systematic retrospective analysis of image quality and vascular measurements. Patients with CHD and aortopathy, who were undergoing clinically indicated contrast-enhanced 3D bSSFP, were prospectively identified to also undergo additional noncontrast 3D bSSFP and 2D SSh bSSFP imaging as part of a clinical quality improvement initiative aimed at reducing the use of contrast when feasible. Two readers, blinded to each other’s evaluations, graded image quality on a 5-point Likert scale and performed vascular measurements in separate sessions for both 3D bSSFP images. They also reported the visibility of various mediastinal great vessels on 2D SSh bSSFP images. Raw agreement, the weighted kappa statistic, and intra-class correlation coefficients (ICCs) were computed to assess the consistency and agreement between the two readers. Comparative analysis of noncontrast and contrast-enhanced 3D bSSFP imaging was performed in adult and pediatric patients using a two-sided paired t-test and Bland–Altman analysis. A P-value < 0.05 was considered significant for all inference testing. Results A total of 29 patients (17 males, median age 20.3 years, interquartile range (IQR) 12.5, age range 7–39 years), including 11 pediatric patients under the age of 18 years (6 males, median age 14.5 years, IQR 4.0, age range 7–17 years), underwent retrospective analysis. The overall image quality score for contrast-enhanced 3D bSSFP was significantly higher (P < 0.0001) than that of noncontrast 3D bSSFP for both all subjects (4.4 ± 0.2, range 4.0–4.9 vs 3.7 ± 0.4, range 3.1–4.7) and only pediatric subjects (4.3 ± 0.3, range 4.0–4.9 vs 3.6 ± 0.5, range 3.1–4.4). By combining noncontrast 3D bSSFP and 2D bSSFP, reader 1 and reader 2 rated 423 and 420 vessels diagnostic, respectively, in a total of 435 vessel segments. All landmarks showed similar mean vessel diameters without significant differences between noncontrast and contrast-enhanced 3D bSSFP MR angiography (r = 0.99, bias -0.31 mm, 95% limits of agreement -2.04 mm to 1.43 mm). Conclusions Although contrast-enhanced images had better overall image quality, an imaging protocol consisting of noncontrast 2D SSh bSSFP and 3D bSSFP whole-chest images provides diagnostically adequate image quality, and accurate vascular measurements, comparable to free-breathing contrast-enhanced 3D bSSFP in both children and adults with CHD and aortopathies. Graphical
PubDate: 2024-08-21
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- Imaging panorama of pediatric central nervous system tuberculosis
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Abstract: Central nervous system tuberculosis (CNS TB) is the most dreaded manifestation of systemic tuberculosis in the pediatric age group. It is associated with high morbidity and mortality due to severe neurological complications and sequelae. Knowledge about the imaging spectrum of CNS TB will help in early presumptive diagnosis and prompt treatment, reducing the development of complications. Imaging also plays a vital role in monitoring the progression of disease after the initiation of antituberculosis therapy. Advanced magnetic resonance imaging (MRI) techniques have recently improved the diagnostic efficacy manifold. In this review, we describe the imaging characteristics, the role of advanced imaging techniques, and follow-up imaging in various types of CNS TB in the pediatric population. Graphical
PubDate: 2024-08-21
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- Weight-specific normal liver stiffness values in children
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Abstract: Background Two-dimensional (2-D) shear wave elastography is a commonly used sonographic elastography method for the noninvasive measurement of liver stiffness. There is little liver stiffness data available in the pediatric population and its association with the child’s weight is scarce. Objective The principal aim of our study was to determine weight-specific reference liver stiffness values in a pediatric population free of liver disease. Materials and methods In this retrospective single-center study, 2-D shear wave elastography values were recorded in children with no history of liver disease and with a clinically indicated ultrasound examination, between April 2021 and July 2022. Examinations were performed using an Aplio i800 and two Aplio a450 (Canon Medical Systems), with a convex probe (i8CX1 or 8C1 transducers). This population was divided into ten weight groups. We evaluated the relation between weight and liver elasticity values and compared right and left lobe measurements. Results During the period of the study, 235 children were included. We then excluded 64 patients (weight not available = 13, interquartile range to median ratio (IQR/M) greater than 30% = 51). On the final sample (171 patients, median age 6.5 years [0–18], median weight 22.6 kg [2.5–80]), stiffness values showed a global significant trend to increase with weight. In each group, there was no significant difference between right and left liver stiffness values. The mean normal liver stiffness value including all children was 5.3 ± 1.1 kPa. Conclusion Liver stiffness in our pediatric sample with no history of liver disease increases with weight. These data may help to distinguish normal from pathological elastography values.
PubDate: 2024-08-16
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- Ultrasound-estimated hepatorenal index: diagnostic performance and
interobserver agreement for pediatric liver fat quantification-
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Abstract: Background Semiquantitative and quantitative sonographic techniques have the potential for screening and surveillance of children at risk of nonalcoholic fatty liver disease. Objective To determine diagnostic performance and interobserver agreement of hepatorenal index (HRI) for pediatric ultrasound-based liver fat quantification. Materials and methods In an institutional review board (IRB)-approved retrospective study (April 2014 to April 2023), children (< 18 years) with clinically performed magnetic resonance imaging (MRI) scans for liver fat quantification were assessed. Inclusion criteria required availability of abdominal ultrasound within 3 months of quantitative MRI. Three blinded readers subjectively assessed for sonographic hepatic steatosis and calculated HRI. MRI proton density fat fraction (PDFF) was the reference standard. Interobserver agreement, correlation with PDFF, and optimal HRI (using ROC analysis) values were analyzed. The significance level was set at p < 0.05. Results A total of 41 patients (25 male) with median (interquartile range (IQR)) age of 13 (10–15) years were included. Median (IQR) MRI PDFF was 11.30% (2.70–17.95%). Hepatic steatosis distribution by MRI PDFF included grade 0 (34%), grade 1 (15%), grade 2 (22%), and grade 3 (29%) patients. Intraclass correlation coefficient for HRI among the three readers was 0.61 (95% CI 0.43–0.75) (p < 0.001). Moderate correlation was observed between manually estimated HRI and PDFF for each reader (r = 0.62, 0.67, and 0.67; p < 0.001). Optimal HRI cutoff was found to be 1.99 to diagnose hepatic steatosis (sensitivity 89%, specificity 93%). Median (IQR) HRI for each MRI grade of hepatic steatosis (0–4) was as follows: 1.2 (1.1–1.5), 2.6 (1.1–3.3), 3.6 (2.6–5.4), 5.6 (2.6–10.9), respectively (p < 0.001). Conclusion Ultrasound-estimated HRI has moderate interobserver agreement and moderate correlation with MRI-derived PDFF. HRI of 1.99 maximizes accuracy for identifying pediatric liver fat.
PubDate: 2024-08-13
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- Proposed changes to pediatric radiology training and certification: report
of the alternate training working group-
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PubDate: 2024-08-13
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- Dynamic functional network connectivity in children with profound
bilateral congenital sensorineural hearing loss-
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Abstract: Background Functional magnetic resonance imaging (fMRI) studies have revealed extensive functional reorganization in patients with sensorineural hearing loss (SNHL). However, almost no study focuses on the dynamic functional connectivity after hearing loss. Objective This study aimed to investigate dynamic functional connectivity changes in children with profound bilateral congenital SNHL under the age of 3 years. Materials and methods Thirty-two children with profound bilateral congenital SNHL and 24 children with normal hearing were recruited for the present study. Independent component analysis identified 18 independent components composing five resting-state networks. A sliding window approach was used to acquire dynamic functional matrices. Three states were identified using the k-means algorithm. Then, the differences in temporal properties and the variance of network efficiency between groups were compared. Results The children with SNHL showed longer mean dwell time and decreased functional connectivity between the auditory network and sensorimotor network in state 3 (P < 0.05), which was characterized by relatively stronger functional connectivity between high-order resting-state networks and motion and perception networks. There was no difference in the variance of network efficiency. Conclusions These results indicated the functional reorganization due to hearing loss. This study also provided new perspectives for understanding the state-dependent connectivity patterns in children with SNHL. Graphical
PubDate: 2024-08-13
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- Capability of multimodal large language models to interpret pediatric
radiological images-
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Abstract: Background There is a dearth of artificial intelligence (AI) development and research dedicated to pediatric radiology. The newest iterations of large language models (LLMs) like ChatGPT can process image and video input in addition to text. They are thus theoretically capable of providing impressions of input radiological images. Objective To assess the ability of multimodal LLMs to interpret pediatric radiological images. Materials and methods Thirty medically significant cases were collected and submitted to GPT-4 (OpenAI, San Francisco, CA), Gemini 1.5 Pro (Google, Mountain View, CA), and Claude 3 Opus (Anthropic, San Francisco, CA) with a short history for a total of 90 images. AI responses were recorded and independently assessed for accuracy by a resident and attending physician. 95% confidence intervals were determined using the adjusted Wald method. Results Overall, the models correctly diagnosed 27.8% (25/90) of images (95% CI=19.5–37.8%), were partially correct for 13.3% (12/90) of images (95% CI=2.7–26.4%), and were incorrect for 58.9% (53/90) of images (95% CI=48.6–68.5%). Conclusion Multimodal LLMs are not yet capable of interpreting pediatric radiological images. Graphical
PubDate: 2024-08-12
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- Spectrum of imaging findings of primary bone lymphoma in pediatric
patients-
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Abstract: Abstract Primary bone lymphoma, a rare oncologic entity, may initially present with minimal symptoms. Presenting symptoms range from local pain and mild systemic symptoms to large palpable masses and pathologic fractures. The term “primary bone lymphoma” indicates the finding of bone involvement without other organ sites for at least 6 months. Although some radiological features may raise suspicion about this tumor form, there are no pathognomonic imaging findings, and the diagnosis will likely be delayed for a long time. The most critical radiological feature is soft tissue involvement associated with a preserved cortical layer, much more than expected for an infiltrating lesion. Anyway, very different radiological findings may be displayed in patients with primary bone lymphoma. Although these radiological features of primary bone lymphoma have been discussed in the literature by various authors, there is little data concerning imaging in pediatric patients. This paper aims to depict the possible spectrum of imaging features of primary bone lymphoma in the pediatric age, providing an exemplification pictorial essay extracted from a single institution experience in the year range period 2006–2022.
PubDate: 2024-08-12
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- Hermes
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PubDate: 2024-08-12
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- Pediatric hemoptysis: diagnostic and interventional challenges
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Abstract: Hemoptysis in the pediatric population, while infrequent, poses significant challenges for both the family and healthcare practitioners. The severity of hemoptysis dictates management decisions. Most cases being mild and self-limiting are treated conservatively. However, “life-threatening hemoptysis” may occur, and is defined as any degree of blood loss that endangers the airway and is arbitrarily considered to be > 8 ml/kg in 24 h in children. It requires prompt airway management and resuscitation followed by a tailored approach consisting of bronchoscopy, computed tomography (CT), interventional radiology, and/or surgery depending on the patient ‘s clinical status and cardiopulmonary comorbidities. Bronchial arteries are hypertrophied in myriad conditions and account for 90–95% cases of hemoptysis due to their systemic pressure levels; the rest being contributed by pulmonary artery pathologies. Despite similar pathogenic mechanisms, the etiologies of pediatric hemoptysis differ from those in adults, with acute lower respiratory tract infections being the predominant cause. Imaging plays a crucial role in identifying the source and cause of hemorrhage. Multidetector computed tomography (MDCT) has emerged as a prime modality in the diagnostic evaluation of hemoptysis and provides a roadmap for potential interventional procedures. This article discusses the etiopathogenesis of hemoptysis along with a brief mention of the diagnostic modalities. It provides a structured reporting format and uses it to illustrate the imaging features in hemoptysis, with emphasis on CT angiography. The key findings in the lung parenchyma, airways, bronchial and non-bronchial systemic collaterals, and pulmonary arteries are elaborated upon. It further addresses the nuances of interventional management, particularly emphasizing the applications of bronchial artery embolization and pulmonary artery embolization in the pediatric population. The article also underscores the potential complications and factors influencing recurrence rates. Graphical
PubDate: 2024-08-12
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- FDG-PET/MRI in the presurgical evaluation of pediatric epilepsy
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Abstract: Abstract In patients with drug-resistant epilepsy, difficulties in identifying the epileptogenic zone are well known to correlate with poorer clinical outcomes post-surgery. The integration of PET and MRI in the presurgical assessment of pediatric patients likely improves diagnostic precision by confirming or widening treatment targets. PET and MRI together offer superior insights compared to either modality alone. For instance, PET highlights abnormal glucose metabolism, while MRI precisely localizes structural anomalies, providing a comprehensive understanding of the epileptogenic zone. Furthermore, both methodologies, whether utilized through simultaneous PET/MRI scanning or the co-registration of separately acquired PET and MRI data, present unique advantages, having complementary roles in lesional and non-lesional cases. Simultaneous FDG-PET/MRI provides precise co-registration of functional (PET) and structural (MR) imaging in a convenient one-stop-shop approach, which minimizes sedation time and reduces radiation exposure in children. Commercially available fusion software that allows retrospective co-registration of separately acquired PET and MRI images is a commonly used alternative. This review provides an overview and illustrative cases that highlight the role of combining 18F-FDG-PET and MRI imaging and shares the authors’ decade-long experience utilizing simultaneous PET/MRI in the presurgical evaluation of pediatric epilepsy.
PubDate: 2024-08-10
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- Pediatric forensic postmortem computed tomography: basics to advanced
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Abstract: Abstract The approach to postmortem computed tomography (CT) differs significantly from that of diagnostic CT in living patients. Elimination of artifacts such as noise and beam hardening as well as optimization of tissue contrast requires alteration of exposure parameters from protocols designed to limit radiation dose in children. Multiple scans may be performed, and detailed post-processing can be used to enhance subtle findings such as small intracranial extra axial collections and non-displaced fractures. Basics of postmortem CT technique are discussed here as well as advanced techniques in scanning and post-processing.
PubDate: 2024-08-10
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- Thrombosed massive portal vein aneurysm in an adolescent boy
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Abstract: Portal vein aneurysm is a rare vascular disorder, particularly in the pediatric population, with relatively few cases reported in the literature. The most frequent complication of portal vein aneurysm is thrombosis, which may lead to diagnostic uncertainty as it can resemble a tumor. Therefore, it is important to recognize this entity and its imaging features for accurate diagnosis. We present a case of a portal vein aneurysm in an adolescent boy, complicated with thrombosis, and report radiological findings, treatment, and short-term follow-up. Graphical
PubDate: 2024-08-08
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- Imaging of sudden unexpected death in infancy: a comprehensive nationwide
French survey-
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Abstract: Rationale and objectives Introduction of post-mortem imaging has helped improve sudden unexpected death in infancy (SUDI) management in Europe. French guidelines were issued in 2007 to homogenise SUDI investigations including imaging. The aim of this study was to evaluate current imaging management of SUDI in France. Material and methods Between January 2022 and July 2022, all 35 SUDI French referral centres were invited to answer an e-mailed online survey including 29 questions divided into four different sections covering imaging practices for SUDI including radiology department organisation, imaging modalities performed, methods of reading, and current training resources. Partial responses were secondarily completed by a personal call to the SUDI imaging consultant. The current implementation of the 2007 recommendations was compared with a previous evaluation from 2015 and with current North American practices. Results The participation rate of centres performing SUDI imaging was 100% (35/35). Imaging was systematically performed in 94.3% (33/35) of the centres: 74.3% (26/35) using radiography; 5.7% (2/35) using ultrasound; 94.3% (33/35) using computed tomography (CT), including 89% (31/35) whole-body CT and 5.7% (2/35) brain CT; and 20% (7/35) using magnetic resonance imaging (MRI). Two centres (5.7%, 2/35) did not systematically perform brain imaging. One (2.9%, 1/35) used ultrasound-guided biopsy. In comparison with 2015, rates of brain imaging increased by 25.4% (P=0.008). There was no significant difference in the number of forensic MRIs performed between France and North America (P=0.663). Conclusion Despite improvements since 2015, full compliance with French guidelines for SUDI investigations remains incomplete. The use of imaging, particularly CT and brain imaging, has increased. Further efforts are needed to standardise imaging practices for optimal SUDI investigations. Graphical abstract
PubDate: 2024-08-08
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- Fetal and neonatal post-mortem imaging referral template: recommendations
from the European Society of Paediatric Radiology Post-mortem Task Force-
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Abstract: Background In post-mortem (PM) fetal and neonatal imaging, relevant clinical information is crucial for accurate interpretation and diagnosis; however, it is usually incomplete. Objective To propose a standardized template for PM fetal and neonatal imaging referrals to enhance communication between referring clinicians and reporting radiologists. Materials and methods A modified Delphi approach was conducted amongst members of the European Society of Paediatric Radiology (ESPR) PM Task Force and other recommended PM imaging specialists worldwide to determine consensus on necessary information. These were based on three pre-existing referral templates already in use across a variety of centers. The study ran for 4 months (December 2023–April 2024). Results Nineteen specialists from 17 centers worldwide formed our expert panel. The final agreed referral template information includes the patient’s identification details (mother and fetus when available), fetal/neonatal information (gestational age, sex, type of demise (including type of termination of pregnancy (i.e., surgical or medical)), date and time of fetal demise (+ delivery) or neonatal death, singleton/multiple pregnancy, clinical information (obstetrical history, prenatal imaging findings, amniocentesis findings, physical external examination findings), provisional clinical diagnosis, and ordering physician’s information. Conclusion A comprehensive referral template has been created, representing expert consensus on the minimum data required for the conduct of quality PM fetal and neonatal imaging, with the goal of facilitating accuracy of image interpretation. Graphical
PubDate: 2024-08-08
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