Pediatric Radiology (Pediatr Radiol)

Publications in this journal

• Article: Role of diffusion-weighted imaging in differentiating benign and malignant pediatric abdominal tumors.

  Rakhee S Gawande, Gabriel Gonzalez, Solomon Messing, Aman Khurana, Heike E Daldrup-Link
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  ABSTRACT: BACKGROUND: Solid malignant tumors are more highly cellular than benign lesions and hence have a restricted diffusion of water molecules. OBJECTIVE: To evaluate whether diffusion-weighted MR imaging (DWI) can differentiate between benign and malignant pediatric abdominal tumors. MATERIALS AND METHODS: We retrospectively analyzed DWI scans of 68 consecutive children with 39 benign and 34 malignant abdominal masses. To calculate the apparent diffusion coefficient (ADC) maps and ADC values, we used 1.5-T sequences at TR/TE/b-value of 5,250-7,500/54-64/b = 0, 500 and 3-T sequences at 3,500-4,000/66-73/b = 0, 500, 800. ADC values were compared between benign and malignant and between data derived at 1.5 tesla (T) and at 3 tesla magnetic field strength, using the Mann-Whitney-Wilcoxon test, ANOVA and a receiver operating curve (ROC) analysis. RESULTS: There was no significant difference in ADC values obtained at 1.5 T and 3 T (P = 0.962). Mean ADC values (× 10(-3) mm(2)/s) were 1.07 for solid malignant tumors, 1.6 for solid benign tumors, 2.9 for necrotic portions of malignant tumors and 3.1 for cystic benign lesions. The differences between malignant and benign solid tumors were statistically significant (P = 0.000025). ROC analysis revealed an optimal cut-off ADC value for differentiating malignant and benign solid tumors as 1.29 with excellent inter-observer reliability (alpha score 0.88). CONCLUSION: DWI scans and ADC values can contribute to distinguishing between benign and malignant pediatric abdominal tumors.
  Pediatric Radiology 05/2013;
• Article: Analysis of fatty infiltration and inflammation of the pelvic and thigh muscles in boys with Duchenne muscular dystrophy (DMD): grading of disease involvement on MR imaging and correlation with clinical assessments.

  Hee Kyung Kim, Arnold C Merrow, Sahar Shiraj, Brenda L Wong, Paul S Horn, Tal Laor
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  ABSTRACT: BACKGROUND: Prior reports focus primarily on muscle fatty infiltration in Duchenne muscular dystrophy (DMD). However, the significance of muscle edema is uncertain. OBJECTIVE: To evaluate the frequency and degree of muscle fat and edema, and correlate these with clinical function. MATERIALS AND METHODS: Forty-two boys (ages 5-19 years) with DMD underwent pelvic MRI. Axial T1- and fat-suppressed T2-weighted images were evaluated to grade muscle fatty infiltration (0-4) and edema (0-3), respectively. Degree and frequency of disease involvement were compared to clinical evaluations. RESULTS: Gluteus maximus had the greatest mean fatty infiltration score, followed by adductor magnus and gluteus medius muscles, and had the most frequent and greatest degree of fatty infiltration. Gluteus maximus also had the greatest mean edema score, followed by vastus lateralis and gluteus medius muscles. These muscles had the most frequent edema, although the greatest degree of edema was seen in other muscles. There was correlation between cumulative scores of fatty infiltration and all clinical evaluations (P < 0.05). CONCLUSION: In DMD, the muscles with the most frequent fatty infiltration had the greatest degree of fatty infiltration and correlated with patient function. However, the muscles with the most frequent edema were different from those with the greatest degree of edema. Thus, edema may not predict patient functional status.
  Pediatric Radiology 05/2013;
• Article: Phenobarbital-enhanced hepatobiliary scintigraphy in the diagnosis of biliary atresia: two decades of experience at a tertiary center.

  Neha Kwatra, Eglal Shalaby-Rana, Srikala Narayanan, Parvathi Mohan, Sunil Ghelani, Massoud Majd
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  ABSTRACT: BACKGROUND: Hepatobiliary scintigraphy is highly sensitive for diagnosing biliary atresia; however, its specificity has varied in the literature from 35% to 97%. OBJECTIVE: The purpose of this study was to re-evaluate the accuracy of phenobarbital-enhanced hepatobiliary scintigraphy in differentiating biliary atresia from other causes of neonatal cholestasis. MATERIALS AND METHODS: We retrospectively reviewed all hepatobiliary scans of infants with cholestasis at our institution from December 1990 to May 2011. Per our routine protocol the scans were obtained after pretreatment with phenobarbital (5 mg/kg/day for 5 days) to achieve a serum level of ≥15 mcg/ml. Normal hepatic uptake with no biliary excretion by 24 h was considered consistent with biliary atresia. RESULTS: One hundred eighty-six infants with 210 hepatobiliary scans composed the study group. Forty-three (23%) infants had the final diagnosis of biliary atresia. Hepatobiliary scintigraphy was 100% sensitive, 93% specific and 94.6% accurate in diagnosing biliary atresia. Of the 186, 39/111 (35.1%) term and 2/68 (2.9%) preterm infants had biliary atresia; two of seven children with unknown gestational age also had biliary atresia. Other diagnoses included neonatal hepatitis, total parenteral nutrition cholestasis, Alagille syndrome, cystic fibrosis, choledochal cyst, hypothyroidism, alpha-1 antitrypsin deficiency and persistent cholestasis of unknown etiology. CONCLUSION: Phenobarbital-enhanced hepatobiliary scintigraphy is highly accurate in differentiating biliary atresia from other causes of neonatal cholestasis. Biliary atresia is rare in premature infants.
  Pediatric Radiology 05/2013;
• Article: Percutaneous thrombin injection in an infant to treat hepatic artery pseudoaneurysm after failed embolization.

  Jonathan M Lorenz, Darren van Beek, Thuong G Van Ha, Jessica Lai, Brian Funaki
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  ABSTRACT: Percutaneous thrombin injection has been described in case reports as an alternative to surgical intervention for the treatment of hepatic artery pseudoaneurysms associated with high-grade liver lacerations in adults. However, there is limited description in the literature of this technique being applied in children, particularly in preadolescents, and no published literature describes its use in infants. The procedure can be performed by pediatric radiologists and pediatric interventional radiologists skilled in ultrasound-guided aspiration techniques. We report successful application of percutaneous thrombin injection in an infant to treat a pseudoaneurysm of a left hepatic arterial branch in an 11-month-old girl with a grade IV liver laceration after superselective transcatheter arterial embolization failed to achieve thrombosis.
  Pediatric Radiology 05/2013;
• Article: Temporal and occipital lobe features in children with hypochondroplasia/FGFR3 gene mutation.

  Cristina M Philpott, Elysa Widjaja, Charles Raybaud, Helen M Branson, Peter Kannu, Susan Blaser
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  ABSTRACT: BACKGROUND: Thanatophoric dysplasia (TD) and hypochondroplasia are both caused by FGFR3 (fibroblast growth factor receptor 3) gene mutations. Temporal lobe dysplasia has been well described in thanatophoric dysplasia; however, only a couple of anecdotal cases of temporal lobe dysplasia in hypochondroplasia have been described. OBJECTIVE: To define temporal lobe abnormalities in patients with hypochondroplasia, given that they share the same genetic mutation. MATERIALS AND METHODS: We identified brain imaging studies of nine children with hypochondroplasia. The temporal lobes were assessed on CT and MRI for size and configuration of the temporal horn and aberrant sulcation of the inferior surface of the temporal lobe. RESULTS: All children had a triangular-shape temporal horn and deep transverse fissures of the inferior temporal lobe surface. Neuroimaging in our cohort revealed enlarged temporal lobes and oversulcation of the mesial temporal and occipital lobes, with abnormal inferomedial orientation of these redundant gyri. Hippocampal dysplasia was also universal. CONCLUSION: We confirmed frequent inferomesial temporal and occipital lobe abnormalities in our cohort of children with hypochondroplasia. Murine models with mutant fgfr3 display increased neuroprogenitor proliferation, cortical thickness and surface area in the temporo-occipital cortex. This is thought to result in excessive convolution and likely explains the imaging findings in this patient cohort. (Note that fgfr3 is the same genetic mutation in mice as FGFR3 is in humans.).
  Pediatric Radiology 05/2013;
• Article: Inappropriate and cloned clinical histories on radiology request forms for sick children.

  Chetan Chandulal Shah, Leann Linam, S Bruce Greenberg
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  ABSTRACT: BACKGROUND: An appropriate clinical history improves the perception and interpretation of radiographic examinations in children and adults. However, clinical history provided on radiology request has not been studied for its appropriateness and frequency of cloned clinical history. OBJECTIVE: The purpose of this study was to determine the frequency of inappropriate histories and cloned histories at a tertiary-care children's hospital. MATERIALS AND METHODS: We analyzed radiology request forms of 388 outpatient and inpatient radiographic examinations obtained on 3 days during the same month at a tertiary-care children's hospital. Appropriateness of the clinical history was judged by its relevance to the examination ordered and appropriate associated billable ICD-9 code. Cloning was defined as identical clinical histories appearing on the radiology request on three consecutive days. Cloned histories were further subdivided as being appropriate or inappropriate. RESULTS: A total of 18% (70/388) of the requests for clinical history were either inappropriate, cloned or both. Neonatal intensive care unit (NICU) referrals constituted the majority (82%, 9/11) of combined inappropriate history and cloning. NICU referrals accounted for 52% (28/54) of all inappropriate clinical histories, a significantly higher percentage than other inpatient locations (P = 0.006). The cardiovascular intensive care unit (CVICU) was the second most common patient location for inappropriate clinical histories (11%, 6/54). About one-third of the radiographic requests from the NICU had inappropriate histories (35%, 28/79). Among the outpatient referrals, 50% (4/8) of the inappropriate histories were from the emergency department. The most common cloned histories included "hypoplastic left heart syndrome" (15%, 4/27), "endotracheal tube placement" (11%, 3/27) and "evaluate lung fields and bowel" (11%, 3/27). The most commonly cloned clinical history was seen on referrals from the NICU at 63% (17/27), a significantly higher percentage than other inpatient locations (P = 0.006). The CVICU unit accounted for the second most common patient location for cloned clinical histories (26%, 7/27). The cloned clinical history on the referral request for radiography was unjustified in 48% (13/27) of the cases. NICU referrals had 85% (11/13) of the unjustified cloned histories. CONCLUSION: Inpatient units, particularly the NICU, were most likely to have inappropriate histories and cloning. Cloning was clinically justified in about half of the cases of cloning. The patterns of inappropriate histories and cloning suggest possible corrective measures.
  Pediatric Radiology 05/2013;
• Article: Is procedural sedation with propofol acceptable for complex imaging? A comparison of short vs. prolonged sedations in children.

  Mark A Griffiths, Pradip P Kamat, Courtney E McCracken, Harold K Simon
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  ABSTRACT: BACKGROUND: Concerns exist in the community of non-anesthesiologist sedation providers regarding the appropriateness of prolonged sedations using propofol for outpatient procedures. OBJECTIVE: To investigate interventions required, completion rate and resource use in prolonged vs. short sedations using propofol in outpatients. MATERIALS AND METHODS: We reviewed retrospectively 213 children sedated with propofol by a non-anesthesiologist sedation service. Cohorts were composed a priori of children sedated for ≥1 h and <1 h. Comparisons were made regarding need for interventions, sedation duration, sedation completion to discharge time, and procedural completion rate. RESULTS: Most sedations were for MRI (87.5% short vs. 94.5% prolonged) with no statistically significant difference in overall need for interventions (75.2% prolonged vs. 65.4% short) nor completion to discharge times (30.7 ± 11.5 min [prolonged] vs. 30.3 ± 11.7 min [short]) between both groups. One child failed to complete the intended scan. No one required endotracheal intubation or unplanned admission. CONCLUSION: Prolonged outpatient sedations with propofol conducted by appropriately trained non-anesthesiology sedation providers appears effective for imaging procedures with no increase in interventions or increased resource burden compared to short sedations. This information can assist all stakeholders in determining scope of practice and guidelines for moderately longer pediatric sedations with propofol.
  Pediatric Radiology 05/2013;
• Article: Fetal MRI on a multi-element digital coil platform.

  Suraj D Serai, Arnold C Merrow, Beth M Kline-Fath
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  ABSTRACT: Fetal MRI has an increasing list of indications and is most commonly employed when anomalies detected by prenatal ultrasonography require further characterization. This may occur when sonography is technically challenging or where specific MRI findings will determine pre- and postnatal management, including critical in utero and/or peripartum interventions. In these circumstances, there are high expectations for MRI to sort out complex diagnostic dilemmas through exquisite anatomical imaging that fetal surgeons and obstetricians can comprehend and relay to their patients. These expectations, in light of evolving clinical innovations, continue to drive advances in fetal imaging. Increasing signal-to-noise ratio (SNR) is fundamental to improving MR image quality, and proper coil selection is a key component of this pursuit. Since the introduction of parallel imaging techniques, the numbers of elements in phased-array coils have been continuously increased to achieve high SNR and shorter scan times. With the invention of a digital coil platform, it is now possible to connect combinations of multiple coil elements to enhance SNR beyond the capabilities of the adult eight-channel torso-coil routinely used in fetal imaging. This paper describes the application of multi-element radiofrequency coils on a digital broadband imaging platform with unique coil combinations to perform dedicated fetal MRI.
  Pediatric Radiology 05/2013;
• Article: Radiologic protection in pediatric radiology: ICRP recommendations.

  Ramon Sanchez, Pek-Lan Khong, Hans Ringertz
  Pediatric Radiology 05/2013;
• Article: Craniosynostosis: imaging review and primer on computed tomography.

  Chaitra A Badve, Mallikarjunappa M K, Ramesh S Iyer, Gisele E Ishak, Paritosh C Khanna
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  ABSTRACT: Craniosynostosis is encountered in the pediatric population in isolated or syndromic forms. The resulting deformity depends on the number and type of sutures involved and, in multi-sutural synostosis, the order of suture fusion. Primary craniosynostosis needs to be differentiated from the secondary variety and positional or deformational mimics. Syndromic craniosynostoses are associated with other craniofacial deformities. Evaluation with 3-D CT plays an important role in accurate diagnosis and management; however, implementation of appropriate CT techniques is essential to limit the radiation burden in these children. In this article, the authors briefly review the classification, embryopathogenesis and epidemiology and describe in detail the radiologic appearance and differential diagnoses of craniosynostosis.
  Pediatric Radiology 05/2013;
• Article: Subclavian vein aneurysm secondary to a benign vessel wall hamartoma.

  Patrick Warren, Maya Spaeth, Vinay Prasad, Patrick McConnell
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  ABSTRACT: Venous aneurysms are rare clinical entities, particularly in children, and their presentation and natural history often depend on the anatomical location and underlying etiology. We present a single case of a 12-year-old girl who presented with a palpable right supraclavicular mass. Imaging evaluation with CT, conventional venography, MRI and sonography revealed a large fusiform subclavian vein aneurysm with an unusual, mass-like fibrofatty component incorporated into the vessel wall. The girl ultimately required complete resection of the right subclavian vein with placement of a synthetic interposition graft. This case provides a radiology/pathology correlation of an entity that has not previously been described as well as an example of the utility of multiple imaging modalities to aid diagnosis and preoperative planning.
  Pediatric Radiology 05/2013;
• Article: Optic nerve tortuosity in children with neurofibromatosis type 1.

  Joyce Ji, Joshua Shimony, Feng Gao, Robert C McKinstry, David H Gutmann
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  ABSTRACT: BACKGROUND: Optic nerve tortuosity is often reported in children with neurofibromatosis type 1 (NF1). OBJECTIVE: To employ quantitative and subjective criteria to assess optic nerve tortuosity in individuals with NF1. MATERIALS AND METHODS: A retrospective study over a period of 8 years was performed on children with NF1, with and without optic pathway glioma, compared with children without NF1. A tortuosity index was computed for the optic nerve in each child using a high-resolution 3-D T1-weighted magnetization-prepared rapid gradient-echo sequence, which was averaged and compared across groups. RESULTS: The tortuosity index for subjects with NF1, regardless of an optic pathway glioma, was greater than those without NF1. There was no difference in the tortuosity index between NF1 subjects with optic pathway glioma and NF1 subjects without optic pathway glioma. There was also no correlation between subjective measures of tortuosity and the quantitative scoring (tortuosity index) or between the degree of tortuosity and subject age or gender. CONCLUSION: Individuals with NF1 have increased optic nerve tortuosity relative to unaffected individuals. Quantitative tortuosity index is a superior measure to subjective assessment in the evaluation of optic nerve tortuosity in children with NF1.
  Pediatric Radiology 05/2013;
• Article: Relative distribution of pertinent findings on portable neonatal abdominal radiographs: can we shield the gonads?

  Matthew Winfeld, Naomi Strubel, Lynne Pinkney, Shailee Lala, Sarah Milla, James Babb, Nancy Fefferman
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  ABSTRACT: BACKGROUND: Shielding of the gonads is a dose-saving strategy in pediatric radiography and its use is the law in New York and the majority of other states. However, routine use of gonadal shields is controversial because of concerns that important diagnostic information can be obscured. OBJECTIVE: The purpose of this study was to assess the frequency and spatial distribution of key findings on portable neonatal abdominal radiographs. MATERIALS AND METHODS: We reviewed the 2,544 portable neonatal intensive care unit anteroposterior abdominal radiographs performed in 2010 at a university medical center, of which 962 were inadequately shielded. These 962 radiographs were reviewed by pairs of pediatric radiologists for the presence of findings in different regions, including bowel abnormalities, pneumatosis, free air, inguinal hernias, osseous abnormalities, and catheter/tube tips. RESULTS: The fewest pertinent findings were present below the level of the sacrosciatic notches (n = 181, 18.8%). Of the 853 abnormalities below the level of the iliac crests in our cohort, six were isolated to these regions, whereas others had concomitant abnormalities more superiorly. Of 35 radiographs with pneumatosis or suspected pneumatosis in the pelvis, 33 had pneumatosis in more superior regions. Suspected free air was never isolated to the pelvis. Osseous abnormalities were only present in the pelvis below the sacrosciatic notch, and 37.5% of lower extremity catheters terminated below the level of the sacrosciatic notches. CONCLUSION: Pertinent findings on neonatal intensive care unit abdominal radiographs are rarely isolated to the pelvic regions.
  Pediatric Radiology 05/2013;
• Article: Comparison of radiation dose estimates, image noise, and scan duration in pediatric body imaging for volumetric and helical modes on 320-detector CT and helical mode on 64-detector CT.

  Jennifer H Johnston, Daniel J Podberesky, Terry T Yoshizumi, Erin Angel, Greta Toncheva, David B Larson, John C Egelhoff, Colin Anderson-Evans, Giao B Nguyen, Alessandra Barelli, Christopher Alsip, Shelia R Salisbury, Donald P Frush
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  ABSTRACT: BACKGROUND: Advanced multidetector CT systems facilitate volumetric image acquisition, which offers theoretic dose savings over helical acquisition with shorter scan times. OBJECTIVE: Compare effective dose (ED), scan duration and image noise using 320- and 64-detector CT scanners in various acquisition modes for clinical chest, abdomen and pelvis protocols. MATERIALS AND METHODS: ED and scan durations were determined for 64-detector helical, 160-detector helical and volume modes under chest, abdomen and pelvis protocols on 320-detector CT with adaptive collimation and 64-detector helical mode on 64-detector CT without adaptive collimation in a phantom representing a 5-year-old child. Noise was measured as standard deviation of Hounsfield units. RESULTS: Compared to 64-detector helical CT, all acquisition modes on 320-detector CT resulted in lower ED and scan durations. Dose savings were greater for chest (27-46%) than abdomen/pelvis (18-28%) and chest/abdomen/pelvis imaging (8-14%). Noise was similar across scanning modes, although some protocols on 320-detector CT produced slightly higher noise. CONCLUSION: Dose savings can be achieved for chest, abdomen/pelvis and chest/abdomen/pelvis examinations on 320-detector CT compared to helical acquisition on 64-detector CT, with shorter scan durations. Although noise differences between some modes reached statistical significance, this is of doubtful diagnostic significance and will be studied further in a clinical setting.
  Pediatric Radiology 05/2013;
• Article: Radiation dose reduction in pediatric CT-guided musculoskeletal procedures.

  Anand S Patel, Bruno Soares, Jesse Courtier, John D Mackenzie
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  ABSTRACT: BACKGROUND: Computed-tomography-guided interventions are attractive for tissue sampling of pediatric bone lesions; however, it comes with exposure to ionizing radiation, inherent to CT and magnified by multiple passes during needle localization. OBJECTIVE: We evaluate a method of CT-guided bone biopsy that minimizes ionizing radiation exposure by lowering CT scanner tube current (mAs) and voltage (kVp) during each localization scan. MATERIALS AND METHODS: We retrospectively reviewed all CT-guided bone biopsies (n = 13) over a 1-year period in 12 children. Three blinded readers identified the needle tip on the reduced-dose CT images (mAs = 50, kVp = 80) during the final localization scan at biopsy and rated the image quality as high, moderate or low. RESULTS: The image quality of the reduced-dose scans during biopsy was rated as either high or moderate, with needle tip visualized in 12 out of 13 biopsies. Twelve of 13 biopsies also returned sufficient sample for a pathological diagnosis. The average savings in exposure using the dose-reduction technique was 87%. CONCLUSION: Our results suggest that a low mAs and kVp strategy for needle localization during CT-guided bone biopsy yields a large dose reduction and produces acceptable image quality without sacrificing yield for biopsy diagnosis.
  Pediatric Radiology 04/2013;
• Article: Tracheobronchial calcifications in children.

  Lauren P Golding, Michael J Walsh, Thomas E Sumner, Thomas A Nakagawa
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  ABSTRACT: BACKGROUND: Tracheobronchial calcifications are considered a rare radiologic finding in children. Our clinical experience indicates that this finding is not infrequently seen among children with prosthetic heart valves who have been treated with warfarin sodium. OBJECTIVE: We hypothesized that calcifications of the tracheobronchial tree are more common than previously reported in this patient population. MATERIALS AND METHODS: We reviewed the medical records and imaging studies of children who underwent cardiac valve replacement at our institution to estimate the prevalence. RESULTS: Tracheobronchial calcifications were identified on chest radiographs in 6 out of 17 children (35%), indicating that this imaging finding might be frequently overlooked. CONCLUSION: All children positive for tracheobronchial calcifications had been anticoagulated with warfarin sodium between the time of surgery and development of positive imaging findings. Our findings suggest that tracheobronchial calcifications are not uncommon in children treated with warfarin. Further investigation is necessary to determine wether there is a cause-effect relationship in these children.
  Pediatric Radiology 04/2013;
• Article: MRI evaluation of the knee in children with infantile Blount disease: tibial and extra-tibial findings.

  Victor Ho-Fung, Camilo Jaimes, Joege Delgado, Richard S Davidson, Diego Jaramillo
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  ABSTRACT: BACKGROUND: Infantile Blount disease is a developmental condition characterized by disorganized endochondral ossification in the medial aspect of the proximal tibial physis. OBJECTIVE: To describe the MR imaging abnormalities in the proximal tibia, distal femur, menisci and ligaments of children with infantile Blount disease. MATERIALS AND METHODS: We retrospectively evaluated 11 children (18 total knee MR examinations) with infantile Blount disease and compared them with an age-matched control group with normal MR examinations. Morphological and morphometric measurements were performed. RESULTS: The medial menisci were enlarged with increased T2 signal intensity in all MR examinations. The medial femoral epiphyseal cartilage showed abnormal foci of increased signal intensity in nine (50%). The mid-coronal thickness of the medial tibial epiphyseal cartilage was decreased with concomitant increase in the mid-coronal joint space distance. Angular measurements of the proximal tibia demonstrated posteromedial down-sloping configuration. CONCLUSIONS: Most severe abnormalities of infantile Blount disease occur in the medial compartment of the knee, especially at the medial tibial physis and epiphysis. However, other important structures of the knee and the lateral compartment are often affected. MR imaging helps to delineate the extent of multiple tibial and extra-tibial abnormalities, including meniscal abnormalities, perichondrial membrane changes and premature physeal closure.
  Pediatric Radiology 04/2013;
• Article: Diagnostic performance of magnetic resonance arthrography of the shoulder in children.

  Nancy A Chauvin, Camilo Jaimes, Victor Ho-Fung, Lawrence Wells, Theodore Ganley, Diego Jaramillo
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  ABSTRACT: BACKGROUND: No reported data demonstrate the usefulness of magnetic resonance arthrography of the shoulder in children. OBJECTIVE: To evaluate the sensitivity, specificity and accuracy of MR arthrography in the assessment of superior labral anteroposterior (SLAP) tears of the shoulder, Bankart-type injuries and Hill-Sachs lesions in children as compared to arthroscopy. MATERIALS AND METHODS: We retrospectively interpreted 66 MR arthrograms of the shoulder and compared them with surgical findings. Assessment included evaluation of the osseous structures, labral-ligamentous complex and determination of skeletal maturity. We calculated sensitivity, specificity and accuracy and compared sensitivity and specificity between skeletally mature and immature children. RESULTS: MR arthrography demonstrated a sensitivity, specificity and accuracy of 88%, 98% and 94%, respectively, for depiction of SLAP tears; 94%, 92% and 94% for detection of Bankart-type injuries; and 100%, 94% and 97% for diagnosing Hill-Sachs lesions. There was no statistical difference between the skeletally immature and skeletally mature groups. CONCLUSION: There is no significant difference in the diagnostic accuracy of MR arthrography in skeletally immature versus skeletally mature children. MR shoulder arthrography is an effective method for the detection of labral and bone pathology.
  Pediatric Radiology 04/2013;
• Article: Scurvy in an autistic child: MRI findings.

  Preetam Gongidi, Craig Johnson, David Dinan
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  ABSTRACT: Scurvy results from a deficiency of vitamin C and is rarely seen in the United States. We describe the MRI findings of a case of scurvy in an autistic child with food-avoidant behavior. Advanced imaging is rarely performed in clinically well-understood disease entities such as scurvy. Typical radiographic findings are well described leading to definitive diagnosis, although the findings can be missed or misinterpreted given the rarity of scurvy in daily practice. To our knowledge, MRI features of scurvy in children in the US have been described in only one case report. This case of scurvy in an autistic child with food-avoidant behavior emphasizes that classic nutritional deficiencies, despite their rarity, must be included in the differential diagnosis of at-risk populations.
  Pediatric Radiology 04/2013;
• Article: Disorders of midgut rotation: making the correct diagnosis on UGI series in difficult cases.

  Vivian Tang, Alan Daneman, Oscar M Navarro, J Ted Gerstle
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  ABSTRACT: BACKGROUND: In some series of malrotation small numbers of children are described in whom the position of the duodenojejunal flexure was considered to be normal on straight anteroposterior (AP) view of an upper gastrointestinal (UGI) series. OBJECTIVE: The purpose of this study was to illustrate children with disorders of midgut rotation in whom the diagnosis was difficult because on the straight AP view of the UGI series the duodenojejunal flexure was either not clearly depicted or was projected to the left of the midline close to its expected normal position at or close to the level of the duodenal cap. MATERIALS AND METHODS: We reviewed 111 children with malrotation to determine the frequency that duodenojejunal flexure was not clearly depicted or was close to normal position. RESULTS: Seven patients had close to normal position of duodenojejunal flexure on AP view. The correct diagnosis was made on initial UGI series in four patients based on other features on AP and lateral views. In two of the other three patients, a repeat UGI series facilitated the correct diagnosis. In the final patient, an abnormal position of a nasojejunal tube suggested the correct diagnosis. CONCLUSION: Accurate diagnosis of anomalies of midgut rotation requires careful assessment of the entire duodenal sweep on both AP and lateral views to avoid false-negative interpretations.
  Pediatric Radiology 04/2013;