Pediatric Radiology最新文献

{"title":"Imaging and characterization of pulmonary nodules in children with solid tumors: what makes a pulmonary nodule a metastasis?","authors":"Annemieke Simone Littooij, Simon P McGuirk, Johannes H M Merks, Luis Riera","doi":"10.1007/s00247-026-06630-1","DOIUrl":"https://doi.org/10.1007/s00247-026-06630-1","url":null,"abstract":"<p><p>Evaluating pulmonary nodules in children requires balancing reliable detection with minimizing risks, particularly radiation exposure. Chest radiography serves as a useful first-line modality, but computed tomography (CT) remains essential despite concerns about radiation dose and motion artifacts. Pulmonary nodules are frequently identified even in otherwise healthy children, and distinguishing benign lesions from metastatic disease in those with solid tumors continues to be clinically challenging, with no universally accepted diagnostic criteria. This article aims, firstly, to provide clues for defining pulmonary nodules with typically or definitively benign characteristics and, secondly, to underscore an overview of current imaging criteria per tumor group and the clinical implication of the presence of pulmonary nodules on event-free survival and overall survival. Accurate differentiation is crucial because it directly influences staging, management, and prognosis. Several issues like interobserver variability in detection/characterization and the inherent difficulty to finally characterize the nodule's etiology are still to be resolved, but the development of new techniques (magnetic resonance imaging (MRI), etc.) challenges these uncertainties.</p>","PeriodicalId":19755,"journal":{"name":"Pediatric Radiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The embryologic footprint of the thymus: study by imaging.","authors":"Jose Domingo Arce Valenzuela, Lizbet Perez-Marrero, Carolina Whittle, Isabel Schild Wenzel, Meiling Chiang Vera, Isabel Fuentealba Tapia","doi":"10.1007/s00247-026-06631-0","DOIUrl":"https://doi.org/10.1007/s00247-026-06631-0","url":null,"abstract":"<p><p>The thymus is one of the primary immune organs in childhood. During embryonic development, the migration of the thymus from the cervical region to the mediastinum coincides with the formation of other structures in the anterior cervical region, which can result in anomalous thymic locations. Among these, the most frequent are cervical remnants of accessory thymic tissue along the normal migration path and thymic extensions that project beyond their usual location. Ectopic locations, which deviate from the normal embryological course, are less common. Radiologists must recognize these variants and their imaging manifestations to avoid misdiagnosis and incorrect interventions. This article aims to review and illustrate, using imaging, the embryology, normal development, anatomy, and the most common locations of thymic tissue outside its normal position in the anterior mediastinum in children.</p>","PeriodicalId":19755,"journal":{"name":"Pediatric Radiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on Westra et al. \"Cumulative dose in pediatric CT \"frequent flyers\": cohort results and risk review\".","authors":"Marta Hernanz-Schulman","doi":"10.1007/s00247-026-06632-z","DOIUrl":"https://doi.org/10.1007/s00247-026-06632-z","url":null,"abstract":"","PeriodicalId":19755,"journal":{"name":"Pediatric Radiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric endocrine disorders: a review of intra-abdominal findings and appropriate imaging.","authors":"Alankrit Shatadal, Kimberly K Vidmar, David B Allen, Teresa Chapman","doi":"10.1007/s00247-026-06616-z","DOIUrl":"https://doi.org/10.1007/s00247-026-06616-z","url":null,"abstract":"<p><p>Endocrine disorders in pediatric patients often involve a variety of imaging modalities as part of a diagnostic workup or disease surveillance. This pictorial essay and review of the literature highlights adrenal and reproductive system imaging findings related to endocrine-related diseases. This review includes descriptions of normal adrenal gland anatomy and imaging characteristics, as well as the clinical presentations and diagnostic imaging of congenital adrenal hyperplasia and of benign and malignant adrenal masses. Additionally, normal reproductive tract development and puberty will be covered, followed by an overview of Müllerian anomalies, 46,XY gonadal dysgenesis, and polycystic ovarian syndrome. Differential diagnostic considerations, appropriate imaging protocols, and clinical management strategies will be discussed.</p>","PeriodicalId":19755,"journal":{"name":"Pediatric Radiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147819389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to comment of clarifying radiation-dose trade-offs in photon-counting detector pediatric cardiac computed tomographic angiography: protocol standardization as the missing variable.","authors":"Gladys M Arguello Fletes, Wei Zhou, LaDonna J Malone, Jason P Weinman, Lorna P Browne","doi":"10.1007/s00247-026-06579-1","DOIUrl":"10.1007/s00247-026-06579-1","url":null,"abstract":"","PeriodicalId":19755,"journal":{"name":"Pediatric Radiology","volume":" ","pages":"1202-1203"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147458996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric hydrocephalus and imaging evaluation of ventriculomegaly in the emergency setting.","authors":"Ali A Elzieny, Elodie Pace-Soler, Anna Kalathil Thomas, Bindu N Setty","doi":"10.1007/s00247-025-06397-x","DOIUrl":"10.1007/s00247-025-06397-x","url":null,"abstract":"<p><p>Hydrocephalus is a frequently encountered neurological disorder of cerebrospinal fluid (CSF) physiology or dynamics, resulting in the abnormal enlargement of CSF spaces and often presenting with signs and symptoms of raised intracranial pressure. The etiology of hydrocephalus is numerous, regardless of the model used to understand its pathophysiology. Differentiating ventricular enlargement due to hydrocephalus or parenchymal atrophy can be difficult in pediatric patients, but certain imaging signs could help differentiate the two entities. The management of hydrocephalus aims to restore normal CSF dynamics, alleviate symptoms, and prevent long-term neurological complications with the help of ventricular drains and shunts. In this review, we will cover the updated pathophysiology, key etiologies, characteristic imaging findings of acute hydrocephalus and its complications, thus providing practical guidance for pediatric radiology fellows and radiologists in emergency settings.</p>","PeriodicalId":19755,"journal":{"name":"Pediatric Radiology","volume":" ","pages":"1033-1049"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145506085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fluoroscopically guided jejunal tube placement via percutaneous gastrostomy in children: technical success, safety, and procedural parameters.","authors":"Michael Esser, Jakob Spogis, Johannes Hilberath, Jürgen F Schäfer, Ilias Tsiflikas","doi":"10.1007/s00247-026-06572-8","DOIUrl":"10.1007/s00247-026-06572-8","url":null,"abstract":"<p><strong>Background: </strong>Fluoroscopically guided jejunal tube placement via percutaneous endoscopic gastrostomy (PEG-J) provides minimally invasive post-pyloric access in children. Limited data exist regarding routine application and procedural risks.</p><p><strong>Objective: </strong>To evaluate the safety and technical success of PEG-J in pediatric patients, performed without general anesthesia or sedation.</p><p><strong>Materials and methods: </strong>All pediatric cases of fluoroscopically guided PEG-J procedures performed between 2011 and 2025 were included. Fluoroscopic images were reviewed to determine the final position of the tube tip. Technical success, complications, anatomical variants, and tube patency were assessed. Fluoroscopy time and dose area product (DAP) were documented.</p><p><strong>Results: </strong>A total of 126 PEG-J procedures in 60 children (36 males) were analyzed. The technical success rate was 85% (107/126) with final tube tip placement in the jejunum in 88 cases (82%) and in the duodenum in 19 cases (18%). Nineteen procedures (15%) were unsuccessful, including six with documented anatomical causes (steep vertical duodenal entry, n=2; malrotation, hiatus hernia, hooked stomach in superior mesenteric artery syndrome, steep take-off of the jejunum with kinking of the tube at the ligament of Treitz, n=1 each) and 13 without documented reasons. The median fluoroscopy time was 5 min 24 s (range, 2 s-37 min), at a frame rate of 0.5 frames per second. The median DAP was 6.1 cGy·cm² (range, 0.08-343 cGy·cm²).</p><p><strong>Conclusion: </strong>Fluoroscopically guided PEG-J placement is a safe and effective procedure in pediatric patients, with high technical success and low radiation exposure.</p>","PeriodicalId":19755,"journal":{"name":"Pediatric Radiology","volume":" ","pages":"1086-1095"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13134994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147444464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dynamic contrast-enhanced magnetic resonance imaging in paediatric brain tumours systematically reviewed.","authors":"Nathalie Ringrose, Şeyma Atmaca, Vera C Keil, Yeva Prysiazhniuk","doi":"10.1007/s00247-026-06600-7","DOIUrl":"10.1007/s00247-026-06600-7","url":null,"abstract":"<p><strong>Background: </strong>Dynamic contrast-enhanced magnetic resonance imaging (DCE MRI) is an advanced imaging technique that quantifies blood-brain permeability using dynamic contrast uptake.</p><p><strong>Objective: </strong>The clinical utility of DCE in paediatric brain tumours is unclear. This systematic review evaluates the efficacy of DCE for tumour differentiation and progression assessment in paediatric brain tumours, and summarises current technical implementation to inform clinical practice.</p><p><strong>Materials and methods: </strong>A string-based literature search was performed in PubMed and Web of Science. Original articles evaluating the utility of DCE were included. A modified quality assessment of diagnostic accuracy studies-2 (QUADAS-2) instrument evaluated the risk of bias.</p><p><strong>Results: </strong>Nine studies (2008-2025) were eligible (sample size 6-72 cases). Six studies investigated low-grade versus high-grade differentiation in mixed paediatric tumours (cumulative sample n=196) with successful discrimination through K^trans and/or k_ep in three studies (60 patients). Discrimination of two distinct histologies was usually more successful. Two studies evaluated the response to different treatments. Results for survival prediction based on DCE parameters were not promising. One study attempted to predict tumour aggressiveness in optic pathway glioma with good prognostic capacity for K^trans. DCE technical execution varied substantially among studies and was usually not compliant with current guidelines. Meta-analyses were impossible.</p><p><strong>Conclusion: </strong>DCE may be of added value to discriminate between two different paediatric brain tumour entities, but a general discrimination potential between low- and high-grade lesions is doubtful. More studies and greater technical homogeneity are needed to investigate the technique's prognostic potential for paediatric cohorts.</p>","PeriodicalId":19755,"journal":{"name":"Pediatric Radiology","volume":" ","pages":"1139-1154"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13134978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147593735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CT evaluation of pediatric craniocervical distraction injuries: a comprehensive review of morphometric parameters and practical applications.","authors":"Rithika Sriram, Yashasvi Shukla, Laura L Hayes, Vinay V R Kandula","doi":"10.1007/s00247-026-06583-5","DOIUrl":"10.1007/s00247-026-06583-5","url":null,"abstract":"<p><p>Craniocervical distraction injuries in children are uncommon but can be fatal, often resulting from high-impact trauma. Because these injuries predominantly affect ligaments, CT findings may be subtle or may occur without obvious fracture or malalignment. This review consolidates the relevant anatomy and key CT-based morphometric parameters essential for recognizing such injuries, including the basion-dens interval, Occipital condyle-C1 interval, atlanto-dental interval, and interspinous ratio. The article integrates normative data and updated measurement thresholds from recent literature, emphasizing their age-related variability and diagnostic implications. The purpose of this review is to provide pediatric radiologists with a consolidated resource that integrates the latest CT measurements and interpretive guidelines for quick and reliable consultation. By improving awareness of subtle quantitative deviations and anatomical nuances, this review aims to enhance diagnostic accuracy and promote early recognition of potentially unstable craniocervical injuries in pediatric trauma assessment.</p>","PeriodicalId":19755,"journal":{"name":"Pediatric Radiology","volume":" ","pages":"1050-1067"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13134998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147628163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dynamic digital radiography as a minimally invasive alternative to perfusion scintigraphy for assessing pulmonary blood flow in children: a prospective study.","authors":"Kiyotaka Go, Kentaro Suzuki, Kazuto Ueda, Yoshihito Morimoto, Hidenori Yamamoto, Toshihiko Suzuki, Yoshie Fukasawa, Yukako Muramatsu, Naoki Ohashi, Yoshiaki Sato, Yoshiyuki Takahashi, Taichi Kato","doi":"10.1007/s00247-026-06589-z","DOIUrl":"10.1007/s00247-026-06589-z","url":null,"abstract":"<p><strong>Background: </strong>In congenital diaphragmatic hernia, postoperative right-left asymmetry of pulmonary perfusion affects outcome. Although pulmonary perfusion scintigraphy (PPS) is widely used to assess pulmonary perfusion, it requires the use of radionuclides and peripheral venous access. In contrast, dynamic digital radiography (DDR) visualizes and analyzes pulmonary perfusion by extracting subtle changes in X-ray attenuation from sequential images acquired using a pulsed X-ray generator and a flat-panel detector.</p><p><strong>Objective: </strong>This study aimed to evaluate the accuracy of DDR for assessing pulmonary perfusion in children and verify the associated radiation dose.</p><p><strong>Materials and methods: </strong>Consecutive congenital diaphragmatic hernia survivors aged 5-7 years scheduled for routine PPS between January 2024 and June 2025 underwent DDR on the same day. The images were analyzed using a dedicated workstation. For each modality, we calculated the blood-flow ratio in the affected lung and assessed the agreement using Pearson correlation and Bland-Altman analysis. Effective doses were also compared.</p><p><strong>Results: </strong>Thirteen children (median age, 6.07 years; 10 left-sided diaphragmatic hernia) were included in the study. DDR-derived blood-flow ratio strongly correlated with PPS (r=0.977, P<0.01), with absolute inter-method blood-flow ratio differences <5%. Neither fixed nor proportional bias was observed. The median effective dose for DDR was 0.16 mSv-significantly lower than that for PPS (2.09 mSv). The blood-flow ratio calculated using DDR correlated well with the scintigraphy results.</p><p><strong>Conclusion: </strong>DDR could serve as a minimally invasive, low-dose alternative to PPS for the evaluation of pulmonary perfusion. Future validation in a broader pediatric population is warranted.</p>","PeriodicalId":19755,"journal":{"name":"Pediatric Radiology","volume":" ","pages":"1078-1085"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147574455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}