Pediatric Radiology最新文献

{"title":"The environmental impact of diagnostic imaging: opportunities for pediatric radiologists.","authors":"Jonathan Gross, Sumit Pruthi, Reed A Omary, Elizabeth J Snyder","doi":"10.1007/s00247-026-06656-5","DOIUrl":"10.1007/s00247-026-06656-5","url":null,"abstract":"<p><p>Healthcare operations are a major contributor to human-produced greenhouse gas emissions worldwide and in the USA in particular. Medical imaging, largely due to its high energy use requirements, disproportionately contributes to healthcare's negative environmental impacts. Although there has been growing concern about radiology's role in climate change, most existing knowledge of radiology's impact derives from adult radiology departments. Pediatric radiologists, however, have compelling reasons to consider and work to reduce our specialty's contributions to climate change: our pediatric patients are uniquely vulnerable to the negative effects of climate change and face wide-ranging impacts to their overall health and well-being. The aim of this manuscript is to review the major environmental impacts from radiology and to highlight potential areas for improvement.</p>","PeriodicalId":19755,"journal":{"name":"Pediatric Radiology","volume":" ","pages":"2206-2213"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13578057/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147988635","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":"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":"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":"2094-2119"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13271840/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuroimaging in cerebral folate deficiencies.","authors":"Asthik Biswas, Karanjot Chhatwal, Rahul Singh, Cheryl Hemingway, Yael Hacohen, Nihaal Reddy, Preeya Rehsi, Ata Siddiqui, Lara Menzies, Kshitij Mankad, Shamima Rahman, Sniya Sudhakar","doi":"10.1007/s00247-026-06609-y","DOIUrl":"10.1007/s00247-026-06609-y","url":null,"abstract":"<p><p>Cerebral folate deficiency refers to neurological disorders associated with a reduced cerebrospinal fluid (CSF) concentration of 5-methyltetrahydrofolate (5-MTHF), arising from primary defects in folate transport or metabolism, or secondarily from acquired or other inherited conditions. Clinical presentation ranges from infancy to adulthood, with manifestations including developmental delay, seizures, cognitive impairment, and neuropsychiatric symptoms. Folate plays a central role in one-carbon metabolism, requiring interaction with other B-vitamins, most notably vitamin B12, to support nucleotide synthesis, methylation reactions, and myelin production. Disruption of folate-dependent pathways contributes to the imaging findings of cerebral folate deficiencies, which include abnormal white matter, calcifications, cerebral or cerebellar atrophy, and in some cases, stroke, or stroke-like lesions. This review outlines folate biochemistry, transport mechanisms into the central nervous system, and associated genetic defects, followed by a discussion of imaging features in primary and secondary cerebral folate deficiencies. Relevant differential diagnoses, particularly cobalamin-related disorders, are also examined. Importantly, many cerebral folate deficiencies are potentially reversible with timely recognition and therapy, underscoring the important role of neuroimaging in diagnosis and follow-up of these disorders.</p>","PeriodicalId":19755,"journal":{"name":"Pediatric Radiology","volume":" ","pages":"2145-2161"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147932388","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":"Reduction of iodinated contrast waste, cost, and greenhouse gas emissions using imaging bulk packaging in a pediatric hospital.","authors":"Sakura M Noda, Matthew J Eckelman, Pauline Porter, Jaime Dyba, Ramesh S Iyer, Grace S Phillips, Helen H R Kim","doi":"10.1007/s00247-026-06654-7","DOIUrl":"10.1007/s00247-026-06654-7","url":null,"abstract":"<p><strong>Background: </strong>There are environmental and financial benefits to reducing iodinated contrast media (ICM) waste. While Imaging Bulk Package (IBP) bottles have been demonstrated to reduce contrast waste in adult hospitals, lower computed tomography (CT) volumes and smaller contrast doses pose challenges for utilizing IBP in children's hospitals.</p><p><strong>Objective: </strong>Primary outcome: quantification of CT contrast waste during a 6-month period at a single children's hospital.</p><p><strong>Secondary outcomes: </strong>quantification of single-use product waste and greenhouse gas emissions, identification of the 12-h periods of highest contrast use, and estimation of reductions in contrast waste, single-use product use, costs, and greenhouse gas emissions by using IBP ICM during peak hours.</p><p><strong>Materials and methods: </strong>All contrast-enhanced CT performed from January through June 2025 were reviewed. Volume of contrast wasted was calculated. The 12-h time period with the highest contrast-enhanced CT volume was determined. Reductions in contrast waste, single-use products, cost, and greenhouse gas emissions by using IBP ICM during these peak hours were estimated.</p><p><strong>Results: </strong>Approximately 291 contrast-enhanced CT exams were performed per month. Mean contrast waste was 37 mL per study, totaling 66 L of wasted contrast over 6 months. Peak hours were 9 AM to 9 PM on weekdays. The mean ICM waste per exam was 37 mL using single-dose bottles versus 17 mL using IBP bottles during peak hours (P<0.001). Using IBP ICM during peak hours and single-use ICM at other times could reduce contrast waste by 56%, glass bottle waste by 33%, and save $40,740 per year. Using IBP during peak hours with a syringeless contrast injector would decrease greenhouse gas emissions by 72% due to added benefits of decreased waste of single-use plastics.</p><p><strong>Conclusion: </strong>Implementing IBP ICM during peak hours would substantially reduce contrast waste, single-use product waste, and costs at our hospital. Other children's hospitals may evaluate their contrast utilization practices, including quantification of contrast waste and single-use products, to identify opportunities to reduce waste through use of IBP and syringeless contrast injectors.</p>","PeriodicalId":19755,"journal":{"name":"Pediatric Radiology","volume":" ","pages":"2214-2221"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147964357","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":"Establishing a dynamic magnetic resonance genitography protocol for presurgical evaluation of genitourinary malformations: a single-center experience.","authors":"Tatiana Morales-Tisnés, Suraj D Serai, Elizabeth Silvestro, Edward R Oliver, Myron Allukian, Thomas F Kolon, Susan J Back","doi":"10.1007/s00247-026-06645-8","DOIUrl":"10.1007/s00247-026-06645-8","url":null,"abstract":"<p><p>We present a novel, dynamic magnetic resonance (MR) genitography protocol developed for pre-surgical assessment of pediatric genitourinary malformations. This protocol has been applied in patients with cloacal malformations, covered cloacal exstrophy, imperforate anus, urogenital sinus, and conjoined twins with a pelvic connection. Traditionally, a combination of imaging modalities has been used as each has its limitations. Our approach combines catheter placement during an endoscopic exam under anesthesia with real-time, intracavitary gadolinium-enhanced magnetic resonance imaging, allowing dynamic cavity distension and simultaneous soft tissue visualization without ionizing radiation. Our protocol enables delineation of anatomical relationships and obstructed versus non-obstructed cavities, facilitating individualized surgical planning and enabling direct correlation of endoscopic to imaging observation. Additionally, 3D reconstructions and prints derived from multiphase imaging support multidisciplinary discussions, patient education, and intraoperative guidance. Here, we describe the examination under anesthesia procedures and imaging protocol development for dynamic MR genitography.</p>","PeriodicalId":19755,"journal":{"name":"Pediatric Radiology","volume":" ","pages":"2311-2322"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147959791","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":"Inter-reader agreement and diagnostic accuracy of early postoperative magnetic resonance imaging for detecting macroscopic residual disease in neuroblastic tumors.","authors":"Marianna Chaika, Cristian Urla, Steven W Warmann, Michael Esser, Jakob Spogis, Patrick Krumm, Andreas Schmidt, Henrike Borkers, Thorsten Simon, Jörg Fuchs, Jürgen F Schäfer","doi":"10.1007/s00247-026-06672-5","DOIUrl":"10.1007/s00247-026-06672-5","url":null,"abstract":"<p><strong>Background: </strong>Accurate detection of macroscopic residual disease after neuroblastoma resection is essential for postoperative treatment decisions, including radiotherapy. Standard imaging follow-up is often performed at a time point when postoperative and therapy-related changes may hamper reliable differentiation between residual disease and reactive findings.</p><p><strong>Objective: </strong>To assess inter-reader agreement and the diagnostic accuracy of early postoperative magnetic resonance imaging (MRI) for detecting residual disease after neuroblastoma surgery.</p><p><strong>Methods: </strong>This retrospective single-center study included patients with histologically confirmed neuroblastic tumors who underwent surgical resection at a reference center and received standardized early postoperative MRI with adequate preoperative imaging. Two independent pediatric radiologists, blinded to all clinical data, assessed all examinations. A hierarchical multimodal reference standard was established based on surgical reports including expert consensus between a senior pediatric radiologist and a pediatric surgeon, and follow-up imaging (median follow-up 33 months).</p><p><strong>Results: </strong>Thirty-nine patients (median age 46 months), predominantly with International Neuroblastoma Staging System (INSS) stage 4 neuroblastoma, were included; all patients had at least one image-defined risk factor. MRI was performed at a mean of 8±5 days after surgery. Residual disease was identified in 14 patients and confirmed by the reference standard. Five residual diseases were expected by the surgeons (median volume 8 ml), whereas nine were unexpected and small (median volume 1 ml). Diagnostic accuracy were 95% and 90% for the two readers, respectively, with substantial inter-reader agreement (Cohen's κ=0.76). Early postoperative MRI findings led to clinically relevant management adaptations in selected cases.</p><p><strong>Conclusion: </strong>Early postoperative MRI demonstrates high diagnostic accuracy and substantial inter-reader agreement in detecting macroscopic residual disease, providing a robust baseline for further assessment.</p>","PeriodicalId":19755,"journal":{"name":"Pediatric Radiology","volume":" ","pages":"2283-2291"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13578033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148043241","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":"Hepatic starry sky sign in a teenager.","authors":"Binglin Lai","doi":"10.1007/s00247-026-06655-6","DOIUrl":"10.1007/s00247-026-06655-6","url":null,"abstract":"","PeriodicalId":19755,"journal":{"name":"Pediatric Radiology","volume":" ","pages":"2342"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147942278","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":"Dual-coil localization with intentional pneumothorax for pulmonary nodule resection in pediatric patients: a novel technical approach.","authors":"Kumar Shashi, Melvin Dassinger, Charles James, Jeremiah Sabado","doi":"10.1007/s00247-026-06688-x","DOIUrl":"10.1007/s00247-026-06688-x","url":null,"abstract":"<p><p>Intraoperative identification of small, non-palpable pulmonary nodules during video-assisted thoracoscopic surgery (VATS) remains challenging in pediatric oncology patients. We describe a novel dual-coil CT-guided localization technique in which a controlled pneumothorax is created via a parallel needle, a small coil is anchored deep to the target nodule as a fluoroscopic margin reference, and a longer coil is deployed with its terminal segment suspended freely within the pleural space to provide immediate thoracoscopic surface identification. In three consecutive pediatric oncology patients, technical success was achieved in all cases with direct thoracoscopic coil visualization, fluoroscopically confirmed negative resection margins, and no conversion to open thoracotomy. No major complications occurred. Prospective validation is warranted.</p>","PeriodicalId":19755,"journal":{"name":"Pediatric Radiology","volume":" ","pages":"2323-2327"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148164011","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":"Quantifying human variability in pediatric bone age assessment: a multi-institutional multi-reader study and benchmark for AI evaluation.","authors":"Jin Long, David B Larson, Hans H Thodberg, Peter Bavngaard Thrane, Michelle Phung, Cicero T Silva, Neil U Lall, Alex Towbin, Sanjay P Prabhu, Curtis P Langlotz, Sergios Gatidis","doi":"10.1007/s00247-026-06758-0","DOIUrl":"https://doi.org/10.1007/s00247-026-06758-0","url":null,"abstract":"<p><strong>Background: </strong>Bone age assessment using the Greulich and Pyle atlas is widely used in pediatrics but is subject to substantial reader variability. As artificial intelligence (AI) systems increasingly support clinical workflows, understanding the magnitude and structure of human variability is essential for contextualizing AI performance.</p><p><strong>Objective: </strong>To quantify human variability in pediatric bone age assessment across multiple institutions and to compare human variability with two automated bone age estimation methods.</p><p><strong>Materials and methods: </strong>In this multi-reader, multi-case study, 1,285 left-hand and wrist radiographs from five US academic centers were independently interpreted by four radiologists per case from a centrally administered pool of 22 radiologists recruited across nine institutions. Bone age estimates were obtained using the Greulich and Pyle atlas. Variability was assessed at the image, rater, and institution levels using mixed-effects modeling. Inter-reader variability was estimated while accounting for patient age and sex. Performance of two automated methods (BoneXpert and a deep-learning algorithm) was evaluated in an interchangeability analysis using a three-rater consensus reference. Accuracy metrics included mean absolute error (MAE), root mean square error (RMSE), and rates of substantial deviation (>1.8 years).</p><p><strong>Results: </strong>Within-image variability among radiologists was higher in younger patients (<12 years) than in older patients (standard deviation (SD) 8.7 months vs. 4.2 months, P<0.001). Between-institution variability decreased substantially after adjustment for patient age (8.9 months to 0.3 months). Inter-rater variability remained stable after adjustment (1.2 months). Variability was greater in male patients and younger age groups. Several radiologists demonstrated systematic biases related to age or sex. In comparison with individual human readers, BoneXpert showed lower error (MAE 4.8 months vs. 6.5 months) and variability, while the deep-learning algorithm performed similarly to human readers (MAE 6.3 months). Substantial deviations occurred in 0.7% of BoneXpert estimates, 2.4% of deep-learning estimates, and 3.4% of single human readings.</p><p><strong>Conclusion: </strong>Pediatric bone age assessment using the Greulich and Pyle method demonstrates measurable human reader variability, particularly in younger children and male patients. Automated methods performed within or beyond the observed range of human variability. These findings provide a quantitative benchmark for interpreting AI performance in skeletal maturity assessment.</p>","PeriodicalId":19755,"journal":{"name":"Pediatric Radiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875405","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":"Imaging findings in pediatric interferonopathies.","authors":"Yuko Tsujioka, Gen Nishimura, Shinya Hattori, Ok Hwa Kim, AnnaCarin Horne, Tatsuo Kono, Masahiro Jinzaki","doi":"10.1007/s00247-026-06642-x","DOIUrl":"10.1007/s00247-026-06642-x","url":null,"abstract":"<p><p>Type I interferon (IFN-I) is a proinflammatory cytokine that activates signalling pathways crucial for antiviral defence in innate immunity. The IFN-I system is a self-preserving mechanism that normally responds to exogenous nucleic acids derived from pathogens, but not to endogenous nucleic acids from host cells. However, genetic defects that constitutively activate this pathway can lead to aberrant IFN-I production (the \"IFN signature\") and sterile inflammation (autoinflammation), giving rise to a group of monogenic disorders collectively termed \"autoinflammatory interferonopathies.\" This emerging perspective was initially prompted by the phenotypic similarities between Aicardi-Goutières syndrome and congenital toxoplasmosis, other infections, rubella, cytomegalovirus, and herpes simplex (TORCH) infection. Autoinflammatory interferonopathies can manifest with variable combinations of cutaneous changes, encephalopathy, vasculopathy, interstitial lung disease, and other features (e.g., skeletal changes), and are commonly accompanied by autoimmunity. More recently, the IFN signature has also attracted attention in autoimmune diseases such as systemic lupus erythematosus and dermatomyositis, which have been increasingly referred to as \"autoimmune interferonopathies.\" Collectively, interferonopathies provide a novel framework for immune-mediated diseases spanning an autoinflammatory-autoimmune continuum. Here, we outline the clinical, imaging, and pathogenic features of paediatric interferonopathies. While each disorder has distinctive imaging findings, many share common patterns reflecting common underlying pathophysiology.</p>","PeriodicalId":19755,"journal":{"name":"Pediatric Radiology","volume":" ","pages":"2162-2175"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148006287","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}