Publications by authors named "Diego Jaramillo"

133 Publications

Quantitative imaging of the spine in adolescent idiopathic scoliosis: shifting the paradigm from diagnostic to comprehensive prognostic evaluation.

Eur J Orthop Surg Traumatol 2021 Jan 31. Epub 2021 Jan 31.

Department of Radiology, Columbia University, New York, USA.

Purpose: We aimed to provide a perspective review of the available quantitative imaging modalities of the spine for prognostic evaluation of the adolescent idiopathic scoliosis (AIS).

Methods: A technical description of the current imaging technologies for quantitative assessment of the pediatric spine with scoliosis was provided, and the pros and cons of each method were discussed. Imaging modalities that quantify the overall 3D alignment of the spine as well as the structural specification of the spinal bone, intervertebral disc, endplates, and ligaments as it pertains to development and progression of the idiopathic spinal deformities in adolescents were discussed.

Results: Low-dose and microdose stereoradiography, ultrasound, and rasterstereography provide quantitative imaging of the 3D spinal alignment with low or no radiation in standing posture which allows repetitive imaging for early detection of the curve development. Quantitative magnetic resonance imaging, including ultrashort dual-echo time and T1-rho can provide quantitative assessment of the spinal tissues relevant to development of idiopathic spinal deformity in pediatric population. New computed tomography scans that uses dual-energy can provides high-resolution measure of the current-state of the bone quality and morphology as well as the osteogenic properties of the bone by quantitative evaluation of the bone marrow.

Conclusion: The presented imaging modalities can provide a wide spectrum of quantifiable information relevant to development and progression of the spinal deformity. Clinical application of these technologies can change the paradigm in clinical assessment of the pediatric scoliosis by improving our understanding of the pathogenesis of the idiopathic scoliosis.
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http://dx.doi.org/10.1007/s00590-021-02883-8DOI Listing
January 2021

Extracardiac imaging findings in COVID-19-associated multisystem inflammatory syndrome in children.

Pediatr Radiol 2021 Jan 12. Epub 2021 Jan 12.

Morgan Stanley Children's Hospital-New York Presbyterian Hospital, Columbia University Irving Medical Center, 3959 Broadway, W. 165th St., New York, NY, 10032, USA.

Background: Coronavirus disease 2019 (COVID-19)-associated multisystem inflammatory syndrome in children (MIS-C) is an emerging syndrome that presents with a Kawasaki-like disease and multiorgan damage in children previously exposed to COVID-19.

Objective: To review the extracardiac radiologic findings of MIS-C in a group of children and young adults with a confirmed diagnosis of MIS-C.

Materials And Methods: In a retrospective study from April 1, 2020, to July 31, 2020, we reviewed the imaging studies of 47 children and adolescents diagnosed with MIS-C, 25 females (53%) and 22 males (47%), with an average age of 8.4 years (range 1.3-20 years). Forty-five had chest radiographs, 8 had abdominal radiographs, 13 had abdominal US or MRI, 2 had neck US, and 4 had brain MRI.

Results: Thirty-seven of 45 (82%) patients with chest radiographs had findings, with pulmonary opacities being the most common finding (n=27, 60%), most often bilateral and diffuse, followed by peribronchial thickening (n=26, 58%). Eight patients had normal chest radiographs. On abdominal imaging, small-volume ascites was the most common finding (n=7, 54%). Other findings included right lower quadrant bowel wall thickening (n=3, 23%), gallbladder wall thickening (n=3, 23%), and cervical (n=2) or abdominal (n=2) lymphadenopathy. Of the four patients with brain MRI, one had bilateral parieto-occipital abnormalities and another papilledema.

Conclusion: The diagnosis of MIS-C and its distinction from other pathologies should be primarily based on clinical presentation and laboratory evidence of inflammation because imaging findings are nonspecific. However, it should be considered in the setting of bilateral diffuse pulmonary opacities, peribronchial thickening, right lower quadrant bowel inflammation or unexplained ascites in a child presenting with Kawasaki-like symptoms and a history of COVID-19 infection or recent COVID-19 exposure.
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http://dx.doi.org/10.1007/s00247-020-04929-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7801777PMC
January 2021

Magnetic resonance imaging of the fetal musculoskeletal system.

Pediatr Radiol 2020 12 30;50(13):2009-2027. Epub 2020 Nov 30.

Department of Radiology, Columbia University Medical Center, New York, NY, USA.

Diagnosing musculoskeletal pathology requires understanding of the normal embryological development. Intrinsic errors of skeletal development are individually rare but are of paramount clinical importance because anomalies can greatly impact patients' lives. An accurate assessment of the fetal musculoskeletal system must be performed to provide optimal genetic counseling as well as to drive therapeutic management. This manuscript reviews the embryology of skeletal development and the appearance of the maturing musculoskeletal system on fetal MRI. In addition, it presents a comprehensive review of musculoskeletal fetal pathology along with postnatal imaging.
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http://dx.doi.org/10.1007/s00247-020-04769-zDOI Listing
December 2020

Identifying Factors Important to Patients for Resuming Elective Imaging During the COVID-19 Pandemic.

J Am Coll Radiol 2020 Nov 2. Epub 2020 Nov 2.

Section Chief, Division of Musculoskeletal Radiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York. Electronic address:

Purpose: To identify factors important to patients for their return to elective imaging during the coronavirus disease 2019 (COVID-19) pandemic.

Methods: In all, 249 patients had elective MRIs postponed from March 23, 2020, to April 24, 2020, because of the COVID-19 pandemic. Of these patients, 99 completed a 22-question survey about living arrangement and health care follow-up, effect of imaging postponement, safety of imaging, and factors important for elective imaging. Mann-Whitney U, Fisher's exact, χ tests, and logistic regression analyses were performed. Statistical significance was set to P ≤ .05 with Bonferroni correction applied.

Results: Overall, 68% of patients felt imaging postponement had no impact or a small impact on health, 68% felt it was fairly or extremely safe to obtain imaging, and 53% thought there was no difference in safety between hospital-based and outpatient locations. Patients who already had imaging performed or rescheduled were more likely to feel it was safe to get an MRI (odds ratio [OR] 3.267, P = .028) and that the hospital setting was safe (OR 3.976, P = .004). Staff friendliness was the most important factor related to an imaging center visit (95% fairly or extremely important). Use of masks by staff was the top infection prevention measure (94% fairly or extremely important). Likelihood of rescheduling imaging decreased if a short waiting time was important (OR = 0.107, P = .030).

Conclusion: As patients begin to feel that it is safe to obtain imaging examinations during the COVID-19 pandemic, many factors important to their imaging experience can be considered by radiology practices when developing new strategies to conduct elective imaging.
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http://dx.doi.org/10.1016/j.jacr.2020.09.068DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7836756PMC
November 2020

Revisiting the radiographic assessment of osteoporosis-Osteopenia in children 0-2 years of age. A systematic review.

PLoS One 2020 2;15(11):e0241635. Epub 2020 Nov 2.

Columbia University Medical Center, New York, New York, United States of America.

Background: Imaging for osteoporosis has two major aims, first, to identify the presence of low bone mass (osteopenia), and second, to quantify bone mass using semiquantitative (conventional radiography) or quantitative (densitometry) methods. In young children, densitometry is hampered by the lack of reference values, and high-quality radiographs still play a role although the evaluation of osteopenia as a marker for osteoporosis is subjective and based on personal experience. Medical experts questioned in court over child abuse, often refer to the literature and state that 20-40% loss of bone mass is warranted before osteopenia becomes evident on radiographs. In our systematic review, we aimed at identifying evidence underpinning this statement. A secondary outcome was identifying normal references for cortical thickness of the skeleton in infants born term, < 2 years of age.

Methods: We undertook systematic searches in Medline, Embase and Svemed+, covering 1946-2020. Unpublished material was searched in Clinical trials and International Clinical Trials Registry Platform (ICTRP). Both relevant subject headings and free text words were used for the following concepts: osteoporosis or osteopenia, radiography, children up to 6 years.

Results: A total 5592 publications were identified, of which none met the inclusion criteria for the primary outcome; the degree of bone loss warranted before osteopenia becomes visible radiographically. As for the secondary outcome, 21 studies were identified. None of the studies was true population based and none covered the pre-defined age range from 0-2 years. However, four studies of which three having a crossectional and one a longitudinal design, included newborns while one study included children 0-2 years.

Conclusions: Despite an extensive literature search, we did not find any studies supporting the assumption that a 20-40% bone loss is required before osteopenia becomes visible on radiographs. Reference values for cortical thickness were sparse. Further studies addressing this important topic are warranted.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241635PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7605664PMC
December 2020

Magnetic resonance imaging evaluation of osteoid osteoma: utility of the dark rim sign.

Pediatr Radiol 2020 11 26;50(12):1742-1750. Epub 2020 Aug 26.

Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave., Cincinnati, OH, 45229, USA.

Background: While typical patterns of osteoid osteoma have been described on CT, MRI findings can overlap among different diseases, and atypical patterns exist. In this study, we assessed the presence of a novel dark rim sign and its utility in the MRI diagnosis of osteoid osteoma.

Objective: The purpose of this retrospective study was to assess the utility of the dark rim sign seen on MRI in children with osteoid osteoma.

Materials And Methods: MRI studies from 36 pediatric patients with osteoid osteoma and a control group of patients with either osteomyelitis or stress fracture were analyzed and then compared for the presence of the dark rim sign. Patients from the osteoid osteoma group were further divided based on nidus location and evaluated for the presence of the dark rim sign.

Results: The relationship between the dark rim sign and osteoid osteoma was statistically significant (P<0.001). A dark rim sign was identified in 25 of the 36 patients with osteoid osteoma. None of the control patients had a dark rim sign. The dark rim sign had 69.4% sensitivity, 100% specificity, 100% positive predictive value and 72.5% negative predictive value for detecting osteoid osteoma. The relationship between dark rim sign and nidus location was statistically significant (P<0.001) such that endosteal and medullary osteoid osteomas were more likely to have a dark rim sign than intracortical osteoid osteomas.

Conclusion: When the nidus of an osteoid osteoma is in an endosteal or medullary location, the dark rim sign may aid in the diagnosis.
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http://dx.doi.org/10.1007/s00247-020-04780-4DOI Listing
November 2020

The prevalence of athletic pubalgia imaging findings on MRI in patients with femoroacetabular impingement.

Skeletal Radiol 2020 Aug 6;49(8):1249-1258. Epub 2020 Mar 6.

Department of Radiology, Division of Musculoskeletal Radiology, NewYork-Presbyterian Hospital Columbia University Medical Center, 622 West 168th Street, MC-28, New York, NY, 10032, USA.

Objective: To determine the prevalence of athletic pubalgia imaging findings on MRI in patients with femoroacetabular impingement and assess for correlative risk factors.

Materials And Methods: A retrospective search identified 156 hips with femoroacetabular impingement and a control group of 113 without femoroacetabular impingement that had an MRI performed between January 1, 2015, and January 1, 2018. Two fellowship-trained musculoskeletal radiologists reviewed studies for the presence of acute osteitis pubis, chronic osteitis pubis, adductor tendinosis, and tendon tear; rectus abdominis tendinosis and tendon tear; and aponeurotic plate tear. Findings were correlated with various clinical and imaging risk factors. Univariate and multivariate statistical analyses were performed.

Results: Imaging findings of adductor tendinosis (p = 0.02) and chronic osteitis pubis (p = 0.01) were more prevalent in FAI patients than controls. Univariate analyses in FAI patients showed that an alpha angle ≥ 60° had a higher prevalence of aponeurotic plate tears (p = 0.02) and adductor tendinosis (p = 0.049). Multivariate analyses showed that an alpha angle ≥ 60° had a higher prevalence of chronic osteitis pubis (OR = 2.27, p = 0.031), sports participation had a higher prevalence of adductor tendon tears (OR = 4.69, p = 0.013) and chronic osteitis pubis (OR = 2.61, p = 0.0058), and males had a higher prevalence of acute osteitis pubis (OR = 5.17, p = 0.032).

Conclusion: Sports participation, alpha angle ≥ 60°, and male sex predict a higher prevalence of athletic pubalgia imaging findings in patients with femoroacetabular impingement.
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http://dx.doi.org/10.1007/s00256-020-03405-zDOI Listing
August 2020

Gaucher disease status and treatment assessment: pilot study using magnetic resonance spectroscopy bone marrow fat fractions in pediatric patients.

Clin Imaging 2020 Jul 22;63:1-6. Epub 2020 Feb 22.

Department of Radiology, Columbia University Medical Center, 622 West 168th Street, PH1-301, New York, NY 10032, USA. Electronic address:

Objective: To assess magnetic resonance spectroscopy (MRS) bone marrow fat fractions' ability to discern between untreated Gaucher disease patients and healthy controls based on assessment of bone marrow infiltration and evaluate response to enzyme replacement therapy (ERT) on serial imaging.

Methods: This retrospective case-controlled study compared conventional MRI and bone marrow MRS findings in six pediatric and young adult Gaucher disease patients with age- and sex-matched controls, examining femoral neck and lumbar spine bone marrow fat fractions and bone marrow burden (BMB) scores. Separate analysis of six patients with serial imaging on ERT was performed with analysis of fat fractions, BMB scores, organ volumes, and serum chitotriosidase.

Results: Untreated patients had significantly lower femoral and lumbar spine fat fractions than controls (0.32 versus 0.67, p = 0.041 and 0.17 versus 0.34, p = 0.041, respectively). Total BMB scores were significantly higher in patients (8.0 versus 3.5, p = 0.015). In patients on ERT with average follow-up of 3.5 years, femoral neck fat fraction was the sole significant predictor of treatment duration (R square: 0.804, p < 0.001) when adjusted for age. Femoral neck fat fraction also correlated with lumbar spine fat fraction, liver volume and chitotriosidase (p < 0.05). MRS test-retest reliability was excellent (Pearson correlations: 0.96, 0.99; p-values <0.001). BMB inter-rater reliability was good overall with an intra-class correlation coefficient of 0.79 for total score, although lumbar spine score reliability was poor at 0.45.

Conclusion: MRS-derived bone marrow fat fractions appear capable of detecting Gaucher disease severity and monitoring treatment-related changes as a predictor of ERT duration in pediatric and young adult patients.
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http://dx.doi.org/10.1016/j.clinimag.2020.02.009DOI Listing
July 2020

Imaging Biomarkers of the Physis: Cartilage Volume on MRI vs. Tract Volume and Length on Diffusion Tensor Imaging.

J Magn Reson Imaging 2020 08 10;52(2):544-551. Epub 2020 Feb 10.

Department of Radiology, Columbia University Medical Center, New York, New York, USA.

Background: Current methods to predict height and growth failure are imprecise. MRI measures of physeal cartilage are promising biomarkers for growth.

Purpose: In the physis, to assess how 3D MRI volume measurements, and diffusion tensor imaging (DTI) measurements (tract volume and length) correlate with growth parameters and detect differences in growth. We compared patients exposed to cis-retinoic acid, which causes physeal damage and growth failure, with normal subjects.

Study Type: Case-control.

Population: Twenty pediatric neuroblastoma survivors treated with cis-retinoic acid and 20 age- and sex-matched controls.

Field Strength/sequence: 3T; DTI and 3D double-echo steady-state (DESS) sequences.

Assessment: On distal femoral MR studies, physeal 3D volume and DTI tract measurements were calculated and compared to height.

Statistical Tests: We used partial Spearman correlation, analysis of covariance, logistic regression, Wald test, and the intraclass correlation coefficient (ICC).

Results: The height percentile correlated most strongly with DTI tract volumes (r = 0.74), followed by mean tract length (r = 0.53) and 3D volume (r = 0.40) (all P < 0.02). Only tract volumes and lengths correlated with annualized growth velocity. Relative to controls, patients showed smaller tract volumes (8.00 cc vs. 13.71 cc, P < 0.01), shorter tract lengths (5.92 mm vs 6.99 mm, P = 0.03), and smaller ratios of 3D cartilage volume to tract length; but no difference (4.51 cc vs 4.85 cc) in 3D MRI volumes. The 10 patients with the lowest height percentiles had smaller tract volumes (5.07 cc vs. 10.93 cc, P < 0.01), but not significantly different 3D MRI volumes. Tract volume is associated with abnormal growth, with an accuracy of 75%.

Data Conclusion: DTI tract volume of the physis/metaphysis predicts abnormal growth better than physeal cartilage volumetric measurement and correlates best with height percentile and growth velocity.

Evidence Level: 2 TECHNICAL EFFICACY: Stage 2 J. Magn. Reson. Imaging 2020;52:544-551.
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http://dx.doi.org/10.1002/jmri.27076DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7410391PMC
August 2020

Correction to: It's time to recognize the perichondrium.

Pediatr Radiol 2020 Feb;50(2):291-292

Department of Radiology, Columbia University Medical Center, New York, NY, USA.

The originally published version of this article contained typesetting errors in Table 1 and the legend for Fig. 10. The correct versions of the table and figure legend are included below. The original article has been corrected.
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http://dx.doi.org/10.1007/s00247-019-04586-zDOI Listing
February 2020

Imaging of osteochondrosis.

Pediatr Radiol 2019 11 4;49(12):1610-1616. Epub 2019 Nov 4.

New York Presbyterian Hospital, Columbia University Irving Medical Center, 622 W. 168th St., New York, NY, 10032, USA.

Osteochondrosis is an abnormality of the epiphyses or epiphyseal equivalents (round bones and apophyses) during later stages of endochondral ossification. This process of abnormal endochondral ossification can occur at various locations throughout the body. The pathogenesis of osteochondrosis is under active investigation. In humans, the process of abnormal endochondral ossification has been attributed to a combination of vascular insult and trauma. Although the proposed etiology of osteochondrosis varies based on body part affected, the overall process is defined by necrosis, revascularization and repair. As such, common radiologic findings include those of osseous destruction and associated inflammation. The purpose of this review is to discuss the current understanding of osteochondroses as a disease entity and explore imaging features of osteochondroses throughout the body.
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http://dx.doi.org/10.1007/s00247-019-04556-5DOI Listing
November 2019

When Local Bone Pain Is Just the Tip of the Iceberg-A Case Report of Three Patients With Chronic Multifocal Recurrent Osteomyelitis and Some Red Flags to Help Make the Diagnosis.

Front Pediatr 2019 14;7:407. Epub 2019 Oct 14.

Adolescent Rheumatology, Columbia University Medical Center, New York, NY, United States.

Chronic recurrent multifocal osteomyelitis (CRMO) is an uncommon cause of chronic inflammatory bone pain in children that can be disabling. Often, this diagnosis is considered only after a prolonged workup, leading to frustration for families and unnecessary interventions for patients. Here we describe three cases of CRMO to increase awareness of how it may present. The first patient had a typical presentation of focal bone pain (knee), for which she underwent bone scan (hint of >1 lesion), had a bone biopsy to rule out malignancy, received empiric antibiotics for presumed infection, and finally had whole-body imaging confirming CRMO when symptoms persisted. The second patient had a similar workup, but initially presented with clavicular pain. This location should raise suspicion for CRMO, as it is an uncommon location for infectious osteomyelitis. The third patient presented with delayed growth and right hip pain, and simultaneously developed palmoplantar pustulosis. These secondary findings can also serve as red flags for CRMO, as it has been linked to this skin condition and inflammatory bowel disease. All patients improved on non-steroidal anti-inflammatory (NSAID) medications, methotrexate, and/or tumor necrosis factor (TNF)-α antagonists. By raising awareness of clinical findings suggestive of CRMO, this report may help expedite diagnosis, so patients can be started on anti-inflammatory therapy.
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http://dx.doi.org/10.3389/fped.2019.00407DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6802603PMC
October 2019

It's time to recognize the perichondrium.

Pediatr Radiol 2020 02 14;50(2):153-160. Epub 2019 Oct 14.

Department of Radiology, Columbia University Medical Center, New York, NY, USA.

The perichondrium is a complex structure centered at the chondro-osseous junction of growing bones. It plays an important role in both normal skeletal development and in pathological conditions. This review illustrates the normal anatomy, function and imaging appearance of the perichondrium from fetal development to older childhood. The radiologic appearance of the perichondrium in skeletal trauma, infection and tumors in which it plays a role also are reviewed.
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http://dx.doi.org/10.1007/s00247-019-04534-xDOI Listing
February 2020

Correlation between diffusion tensor imaging parameters of the distal femoral physis and adjacent metaphysis, and subsequent adolescent growth.

Pediatr Radiol 2019 08 8;49(9):1192-1200. Epub 2019 Jun 8.

Department of Radiology, Columbia University Medical Center, 630 W. 168th St., MC 28, New York, NY, 10032, USA.

Background: Diffusion-tensor imaging (DTI) depicts the movement of water through columns of cartilage and newly formed bone and provides information about velocity of growth and growth potential.

Objective: To determine the correlation between DTI tractography parameters of the distal femoral physis and metaphysis and the height change after DTI in pubertal and post-pubertal children.

Materials And Methods: We retrospectively analyzed DTI images of the knee in 47 children with a mean age of 14.1 years in a 2-year period. In sagittal echoplanar DTI studies, regions of interest were placed in the femoral physis. Tractography was performed using a fractional anisotropy threshold of 0.15 and a maximum turning angle of 40°. The sample was divided to assess short-term and long-term growth after DTI. Short-term growth (n=25) was the height change between height at MRI and 1 year later. Long-term growth (n=36) was the height gain between height at MRI and at the growth plateau.

Results: For the short-term group, subjects with larger tract volume (R=0.40) and longer track lengths (R=0.38) had larger height gains (P<0.01). For the long-term group, subjects with larger tract volume (R=0.43) and longer track lengths (R=0.32) had a larger height gain at the growth plateau (P<0.01). Intra- and inter-observer variability were good-excellent.

Conclusion: Follow-up data of growth 1 year after DTI evaluation and at skeletal maturity confirms that DTI parameters are associated with the amount of post-imaging growth.
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http://dx.doi.org/10.1007/s00247-019-04443-zDOI Listing
August 2019

Evaluating growth failure with diffusion tensor imaging in pediatric survivors of high-risk neuroblastoma treated with high-dose cis-retinoic acid.

Pediatr Radiol 2019 07 4;49(8):1056-1065. Epub 2019 May 4.

Division of Oncology, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, PA, USA.

Background: The survival of patients with high-risk neuroblastoma has increased with multimodal therapy, but most survivors demonstrate growth failure.

Objective: To assess physeal abnormalities in children with high-risk neuroblastoma in comparison to normal controls by using diffusion tensor imaging (DTI) of the distal femoral physis and adjacent metaphysis.

Materials And Methods: We prospectively obtained physeal DTI at 3.0 T in 20 subjects (mean age: 12.4 years, 7 females) with high-risk neuroblastoma treated with high-dose cis-retinoic acid, and 20 age- and gender-matched controls. We compared fractional anisotropy (FA), normalized tract volume (cm/cm) and tract concentration (tracts/cm) between the groups, in relation to height Z-score and response to growth hormone therapy. Tractography images were evaluated qualitatively.

Results: DTI parameters were significantly lower in high-risk neuroblastoma survivors compared to controls (P<0.01), particularly if the patients were exposed to both cis-retinoic acid and total body irradiation (P<0.05). For survivors and controls, DTI values were respectively [mean ± standard deviation]: tract concentration (tracts/cm), 23.2±14.7 and 36.7±10.5; normalized tract volume (cm/cm), 0.44±0.27 and 0.70±0.21, and FA, 0.22±0.05 and 0.26±0.02. High-risk neuroblastoma survivors responding to growth hormone compared to non-responders had higher FA (0.25±0.04 and 0.18±0.03, respectively, P=0.02), and tract concentration (tracts/cm) (31.4±13.7 and 14.8±7.9, respectively, P<0.05). FA, normalized tract volume and tract concentration were linearly related to height Z-score (R>0.31; P<0.001). Qualitatively, tracts were nearly absent in all non-responders to growth hormone and abundant in all responders (P=0.02).

Conclusion: DTI shows physeal abnormalities that correlate with short stature in high-risk neuroblastoma survivors and demonstrates response to growth hormone treatment.
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http://dx.doi.org/10.1007/s00247-019-04409-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6599475PMC
July 2019

Extended field of view magnetic resonance imaging for suspected osteomyelitis in very young children: is it useful?

Pediatr Radiol 2019 03 8;49(3):379-386. Epub 2019 Jan 8.

Department of Radiology, Penn State Children's Hospital, 600 University Drive, Hershey, PA, 17033, USA.

Background: Osteomyelitis is a challenging diagnosis for clinicians, particularly in very young children. At our institution, the magnetic resonance imaging (MRI) protocol in suspected osteomyelitis for children 5 years of age or younger includes a large field of imaging regardless of the clinical site of concern.

Objective: To determine if extended field of view (FOV) MRI contributes important information in young children with suspected osteomyelitis.

Materials And Methods: A retrospective study was performed including children 5 years of age or younger with suspected osteomyelitis from January 2011 to September 2015. All children underwent coronal fluid-sensitive MRI from neck to feet. Focused imaging was performed as necessary on abnormal sites depicted on survey imaging. Two radiologists reviewed the imaging findings, which were compared to the clinical outcome.

Results: We studied 51 children with a mean age of 2.2 years (range: 21 days-5.5 years); 53% were boys. Osteomyelitis was depicted by MRI in 20 subjects (39.2%). Survey coronal fluid-sensitive imaging was accomplished by adding a single fluid-sensitive series in 1 child, 2 series in 31 children, 3 series in 16 children and 4 series in 3 children. Survey imaging added a median total time of 6:51 min to the examination (range: 2.29-20.54 min). Extended FOV imaging added important information in 11/51 subjects (21.6%), in 6 cases (11.8%) of infection and in 5 cases (9.8%) by suggesting alternative diagnoses.

Conclusion: The addition of extended FOV MRI in young children with suspected osteomyelitis added important clinical information in 21.6% of patients while only adding a median of 6:51 min to the examination. It is our experience that in children ≤5 years of age with suspected osteomyelitis, extended FOV imaging adds important information and may result in changes in management.
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http://dx.doi.org/10.1007/s00247-018-4317-3DOI Listing
March 2019

Normal meniscal dimensions at different patient ages-MRI evaluation.

Skeletal Radiol 2019 Apr 22;48(4):595-603. Epub 2018 Sep 22.

Department of Radiology, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.

Objective: The purpose of this work is to evaluate the normal meniscal and tibial dimensions in relation to age and gender in different children using conventional MRI sequences.

Materials And Methods: Morphometric measurements of the menisci were retrospectively performed on knee MRIs of children (< 18 years). All knee MRIs over a 7-year period were collected. Exclusion criteria included: prior knee surgery or diseases involving the knee joint. A total of 186 children were included, 110 boys and 76 girls, with a mean age of 8.2 years (range, 0.3-17.8 years). Menisci and tibial measurement changes with age and gender as well as differences between the medial and lateral menisci were evaluated.

Results: The medial menisci measurements increased with age (p value < 0.001). The lateral menisci measurements increased with age (p value < 0.001), except for the coronal meniscal width (p = 0.084). Coronal and sagittal percentage of meniscal coverage of the tibia decreased with age (p < 0.001). Medial menisci have greater sagittal width and anterior horn height than lateral menisci (p value < 0.001). Lateral menisci are larger in their coronal width and height, and sagittal posterior horn height in comparison to medial menisci (p < 0.001).

Conclusions: Menisci increase in all dimensions in correlation with age; except in the coronal meniscal width, which is a useful dimension to diagnose discoid meniscus on MRI, based on this, it would seem that the currently published size criteria, based on adults, could be applicable to children. The tibia has a faster rate dimension increase in correlation with age in comparison to the menisci.
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http://dx.doi.org/10.1007/s00256-018-3072-8DOI Listing
April 2019

Three-dimensional US in Infants with Developmental Dysplasia of the Hip: Ready for Prime Time.

Authors:
Diego Jaramillo

Radiology 2018 06 24;287(3):1016-1017. Epub 2018 Apr 24.

From the Department of Radiology, Nicklaus Children's Hospital and Stanford Medical School, 3100 SW 62nd Ave, Miami, FL 33155.

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http://dx.doi.org/10.1148/radiol.2018180141DOI Listing
June 2018

MR imaging features of cuboid fractures in children.

Pediatr Radiol 2018 05 9;48(5):680-685. Epub 2018 Feb 9.

Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.

Background: Cuboid fractures are rare, usually occult on initial radiographs and are often underdiagnosed. MRI is more sensitive than radiographs for detecting acute, non-displaced cuboid fractures in adults, but only case reports have described these findings in children.

Objective: To summarize the MR and clinical features of cuboid fractures and compare MR findings with initial and follow-up radiographs in a cohort of children.

Materials And Methods: A retrospective search for patients <18 years of age with cuboid fractures was performed during a 10-year period at a large tertiary children's hospital. Subjects with cuboid fractures reported on MRI and available clinical history were included. MR images were evaluated for fracture location, fracture morphology, percentage of marrow edema in the cuboid, subchondral disruption, and associated tendon or ligamentous injury. Initial and short-term follow-up radiographs were also reviewed when available.

Results: Nineteen children ages 18 months to 17 years (mean: 9.0 years, standard deviation: 4.1 years, 63% boys) were diagnosed with cuboid fractures by MRI. Most cases of cuboid fractures are related to acute trauma (63%) but can be seen as stress fractures (16%). Most fractures (17/19, 89%) were linear in configuration. Fractures were most commonly adjacent to the tarsometatarsal joint (10/19, 52%). The degree of marrow edema was variable. Ligamentous injury was seen in two patients and tendon pathology was seen in one, all adolescents. Initial radiographs (n=10) were negative in 9 cases (90%). All available follow-up radiographs (n=12, obtained 19-42 days after MRI) demonstrated sclerosis in the region of the fracture.

Conclusion: MR-depicted cuboid fractures in children typically occur in isolation. The fractures were most commonly adjacent to the tarsometatarsal joint and linear in morphology. Initial radiographs were usually normal and follow-up radiographs depicted sclerosis at the site of fracture in all available cases.
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http://dx.doi.org/10.1007/s00247-018-4076-1DOI Listing
May 2018

Minimally Manipulated Bone Marrow Concentrate Compared with Microfracture Treatment of Full-Thickness Chondral Defects: A One-Year Study in an Equine Model.

J Bone Joint Surg Am 2018 Jan;100(2):138-146

VA Palo Alto Health Care System, Palo Alto, California.

Background: Microfracture is commonly performed for cartilage repair but usually results in fibrocartilage. Microfracture augmented by autologous bone marrow concentrate (BMC) was previously shown to yield structurally superior cartilage repairs in an equine model compared with microfracture alone. The current study was performed to test the hypothesis that autologous BMC without concomitant microfracture improves cartilage repair compared with microfracture alone.

Methods: Autologous sternal bone marrow aspirate (BMA) was concentrated using a commercial system. Cells from BMC were evaluated for chondrogenic potential in vitro and in vivo. Bilateral full-thickness chondral defects (15-mm diameter) were created on the midlateral trochlear ridge in 8 horses. Paired defects were randomly assigned to treatment with BMC without concomitant microfracture, or to microfracture alone. The repairs were evaluated at 1 year by in vitro assessment, arthroscopy, morphological magnetic resonance imaging (MRI), quantitative T2-weighted and ultrashort echo time enhanced T2* (UTE-T2*) MRI mapping, and histological assessment.

Results: Culture-expanded but not freshly isolated cells from BMA and BMC underwent cartilage differentiation in vitro. In vivo, cartilage repairs in both groups were fibrous to fibrocartilaginous at 1 year of follow-up, with no differences observed between BMC and microfracture by arthroscopy, T2 and UTE-T2* MRI values, and histological assessment (p > 0.05). Morphological MRI showed subchondral bone changes not observed by arthroscopy and improved overall outcomes for the BMC repairs (p = 0.03). Differences in repair tissue UTE-T2* texture features were observed between the treatment groups (p < 0.05).

Conclusions: When BMC was applied directly to critical-sized, full-thickness chondral defects in an equine model, the cartilage repair results were similar to those of microfracture. Our data suggest that, given the few mesenchymal stem cells in minimally manipulated BMC, other mechanisms such as paracrine, anti-inflammatory, or immunomodulatory effects may have been responsible for tissue regeneration in a previous study in which BMC was applied to microfractured repairs. While our conclusions are limited by small numbers, the better MRI outcomes for the BMC repairs may have been related to reduced surgical trauma to the subchondral bone.

Clinical Relevance: MRI provides important information on chondral defect subsurface repair organization and subchondral bone structure that is not well assessed by arthroscopy.
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http://dx.doi.org/10.2106/JBJS.17.00132DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6819026PMC
January 2018

Ultrasound evaluation of stress injuries and physiological adaptations in the fingers of adolescent competitive rock climbers.

Pediatr Radiol 2018 03 7;48(3):366-373. Epub 2017 Dec 7.

Department of Pediatric Radiology, Lucile Packard Children's Hospital, 725 Welch Road, Palo Alto, CA, 94304, USA.

Background: The impact of high-intensity, repetitive training on the fingers of adolescent climbers is relatively unknown.

Objective: To evaluate this effect by ultrasound (US) and to confirm some findings by magnetic resonance imaging (MRI).

Materials And Methods: The US study was performed in 20 adolescent rock climbers (ages 10-17 years) and 6 non-climbing controls (ages 11-15 years). US was used to examine the third digit of the right hand for differences in thickness of soft tissue, flexor and extensor tendon, volar plate and bony and growth plate adaptations. In four climbers with finger deformity or pain, 3-T MR images were compared with US findings. Number of hours/week and years of climbing were used to group climbers in three levels (3=most intense training). Mann-Whitney test was used for statistical analysis.

Results: Compared with non-climbing controls, climbers demonstrated significantly thicker flexor tendons, volar plates and soft tissues. Joint effusions were found in 13/19 (68%) climbers. Significant phalangeal malalignment was seen in 10/19 (53%) climbers. Growth plate deformities were identified in three level 3 climbers. US findings correlated with MRI for effusions, phalangeal growth plate injury, malalignment and adaptive changes. MRI additional showed capsule rupture (n=1), stress fracture (n=1) and phalangeal physeal stress injury (n=1).

Conclusion: Competitive rock climbing results in physiological adaptations in the fingers, an example being significant soft-tissue hypertrophy of the flexor. US demonstrated several non-physiological changes in response to repetitive stress in half of the climbers. MRI showed additional stress injuries to the growth plate, joints and bone.
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http://dx.doi.org/10.1007/s00247-017-4033-4DOI Listing
March 2018

Contrast-enhanced voiding urosonography (ceVUS) with the intravesical administration of the ultrasound contrast agent Optison™ for vesicoureteral reflux detection in children: a prospective clinical trial.

Pediatr Radiol 2018 02 27;48(2):216-226. Epub 2017 Nov 27.

Department of Radiology, The Children's Hospital of Philadelphia, 34th Street & Civic Center Boulevard, Philadelphia, PA, 19104, USA.

Background: Contrast-enhanced voiding urosonography (ceVUS) is widely used outside the United States to diagnose vesicoureteral reflux (VUR) in children and is highly sensitive while avoiding exposure to ionizing radiation. At the onset of this study, two ultrasound (US) contrast agents were available in the United States. Pediatric safety data for intravenous administration was published for one, Optison™.

Objective: This study aimed to evaluate the diagnostic performance and safety of ceVUS using Optison™ and compare its diagnostic efficacy with voiding cystourethrogram (VCUG) for VUR detection and grading in children.

Materials And Methods: The United States Food and Drug Administration and institutional Investigational New Drug authorizations were obtained to conduct a prospective comparative study of ceVUS with Optison™ and VCUG. CeVUS was performed with intravesical administration of 0.2% Optison™/normal saline solution. A standard VCUG followed. Safety assessment included physical examination, and heart rate, pulse oximetry and adverse reactions monitoring before, during and immediately after the examinations. A follow-up questionnaire was completed by telephone 48-h after the studies.

Results: Sixty-two pelviureteric units were studied in 30 patients with a mean age of 3.5 years (range: 0.1-17 years) including 21 girls and 9 boys. No severe adverse events occurred. All patients had normal heart rate and blood oxygenation saturation prior to, during and after the studies. At the 48-h follow-up, one patient (3.3%) reported transient dysuria. Taking the VCUG as the reference standard, ceVUS had a sensitivity of 91.7% (95%; confidence interval [CI]: 61.5%-99.8%) and specificity of 98% (95%; CI: 89.4%-99.9%). The concordance between ceVUS and VCUG for VUR detection and grading was 84.3% and 81.8%, respectively. VUR grades were discrepant in 4/11 refluxing pelviureteric units, with VCUG upgrading VUR in 2.

Conclusion: Detection of VUR with Optison™ ceVUS was comparable to VCUG without exposure to ionizing radiation. CeVUS with Optison™ is a well-tolerated diagnostic procedure with a favorable safety profile.
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http://dx.doi.org/10.1007/s00247-017-4026-3DOI Listing
February 2018

Epithelioid hemangioma of bone: radiologic and magnetic resonance imaging characteristics with histopathological correlation.

Pediatr Radiol 2017 Nov 18;47(12):1631-1637. Epub 2017 Jul 18.

Department of Radiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, Suite 1422, Nashville, TN, 37232, USA.

Background: Epithelioid hemangioma is a rare vascular tumor that can occur in soft tissues or bone. The tumor is part of a spectrum of vascular tumors that also includes epithelioid hemangioendothelioma and angiosarcoma. When involving the bone, the tumor usually involves the metaphysis or diaphysis of the long tubular bones and most commonly occurs in adults. It has been rarely reported in pediatric patients, and in these reported patients, the tumor primarily involves the epiphysis.

Objective: To review three cases of epithelioid hemangioma of bone occurring in pediatric patients involving the epiphysis and to explore the imaging features of this tumor.

Materials And Methods: Retrospectively review three cases of epithelioid hemangioma occurring in skeletally immature patients.

Results: These tumors primarily involved the epiphyses or epiphyseal equivalent bones. One lesion was centered in the metaphysis but extended to the epiphysis. These are three cases presenting in an unusual location and at an unusual age.

Conclusion: Epithelioid hemangioma, though rare, can occur in pediatric patients and appears to involve the epiphyses in these patients. This is in contrast to the usual age and location reported. Epithelioid hemangioma may be considered for an epiphyseal lesion in a skeletally immature patient.
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http://dx.doi.org/10.1007/s00247-017-3922-xDOI Listing
November 2017

Hematogenous Osteomyelitis in Infants and Children: Imaging of a Changing Disease.

Radiology 2017 06;283(3):629-643

From the Departments of Radiology (D.J., J.D.) and Pediatrics (J.W.S.G.), Children's Hospital of Philadelphia, Philadelphia, Pa; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa (D.J., J.W.S.G.); Department of Pediatric Orthopaedic Surgery, Texas Children's Hospital, Houston, Tex (J.P.D.); Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Tex (J.P.D.); Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (T.L.); and Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (T.L.).

In children, hematogenous osteomyelitis is an infection that primarily affects the most vascularized regions of the growing skeleton. The disease has increased in frequency, virulence, and degree of soft-tissue involvement. The change in clinical manifestations and management over the past 2 decades should be reflected in the current imaging approach to the disease. Imaging of infection must depict the location of a single focus or of multiple foci of involvement and the presence of drainable collections. This review provides an overview of the imaging implications directed by the changing epidemiology, the newer insights of anatomy and pathophysiology, the imaging characteristics with emphasis on specific locations and disease complications, and the differential diagnosis considerations. In addition, basic imaging guidelines for appropriate extent of area to image based on patient age are provided. RSNA, 2017.
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http://dx.doi.org/10.1148/radiol.2017151929DOI Listing
June 2017

Diffusion-Tensor Imaging of the Physes: A Possible Biomarker for Skeletal Growth-Experience with 151 Children.

Radiology 2017 07 2;284(1):210-218. Epub 2017 Feb 2.

From the Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (M.A.B., J.D., J.I.B., N.A.C., R.R.G., A.N.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (J.I.B., N.A.C., M.A.B.); Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Mass (D.Z.); and Department of Radiology, Stanford University School of Medicine, Lucile Packard Children's Hospital, 725 Welch Rd, Palo Alto, CA 94304 (D.J.).

Purpose To determine the changes of diffusion-tensor imaging (DTI) and tractography in the distal femur and proximal tibia related to age, sex, and height. Materials and Methods Following institutional review board approval, with waiver of consent and with HIPAA compliance, the authors retrospectively analyzed DTI images of the knee in 151 children, 73 girls (median age, 14.1 years; range, 6.5-17.8 years) and 78 boys (median age, 16.6 years; range, 6.9-17.9 years), studied from January 2013 to October 2014. At sagittal echo-planar DTI (20 directions, b values of 0 and 600 sec/mm), regions of interest were placed in the tibial and femoral physes. Using a fractional anisotropy threshold of 0.15 and an angle threshold of 40°, the authors performed tractography and measured apparent diffusion coefficient (ADC) and tract length and volume. Changes related to age, sex, and height were evaluated by using fitted nonlinear polynomial functions on bootstrapped samples. Results Femoral tract volume and length increased and then decreased with age (P < .001); the peaks of femoral tract volume are consistent with the growth spurt, occurring earlier in girls (10.8 years) than in boys (13.0 years) (P < .001). Girls had smaller tract volumes in comparison to boys (P = .013). ADC peaks 2 years earlier than tract volume (girls at 9.3 years, boys at 11.0 years). Girls with greater than 50th percentile of height had longer tracts and greater tract volumes compared with girls with less than 50th percentile (P < .020). DTI parameters of boys do not correlate with percentile of height (P > .300). Conclusion DTI of the physis and metaphysis shows greater tract length and volumes in subjects who are at ages when the growth is fastest. ADC and tract length and volume have an earlier and smaller peak in girls than in boys. Femoral tract length and volume are larger in taller girls. RSNA, 2017.
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http://dx.doi.org/10.1148/radiol.2017160681DOI Listing
July 2017

Imaging of Sports-related Injuries of the Lower Extremity in Pediatric Patients.

Radiographics 2016 Oct;36(6):1807-1827

From the Department of Radiology, Florida Hospital, University of Central Florida College of Medicine, 601 E Rollins St, Orlando, FL 32803 (M.C.O., L.B., L.V., G.L.); Department of Radiology, VA Palo Alto Health Care System, Stanford University Medical Center, Palo Alto, Calif (D.J.); and Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pa (S.S.).

With increasing participation and intensity of training in youth sports in the United States, the incidence of sports-related injuries is increasing, and the types of injuries are shifting. In this article, the authors review sports injuries of the lower extremity, including both acute and overuse injuries, that are common in or specific to the pediatric population. Common traumatic injuries that occur in individuals of all ages (eg, tears of the acetabular labrum and anterior cruciate ligament) are not addressed, although these occur routinely in pediatric sports. However, some injuries that occur almost exclusively in high-level athletes (eg, athletic pubalgia) are reviewed to increase awareness and understanding of these entities among pediatric radiologists who may not be familiar with them and thus may not look for them. Injuries are described according to their location (ie, hip, knee, or foot and ankle) and pathologic process (eg, apophysitis, osteochondritis dissecans). Examples of abnormalities and normal variants of the anatomy that are often misdiagnosed are provided. The injuries reviewed represent a common and growing subset of pathologic processes about which all pediatric and musculoskeletal radiologists should be knowledgeable. Understanding physeal injury is especially important because missed diagnoses can lead to premature physeal closure and osteoarthritis. RSNA, 2016.
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http://dx.doi.org/10.1148/rg.2016160009DOI Listing
October 2016

Imaging the Injured Pediatric Athlete: Upper Extremity.

Radiographics 2016 Oct;36(6):1672-1687

From the Department of Radiology, Children's Hospital of Philadelphia, 34th St and Civic Center Blvd, Philadelphia, PA 19104 (J.D., N.A.C.); Department of Radiology, Stanford University Medical Center, Palo Alto, Calif (D.J.); and Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa (N.A.C.).

Increased physical activity in childhood has resulted in a large number of sports-related injuries. Although there is overlap between the sports-related injuries seen in pediatric and adult patients, important differences exist in the injury patterns of pediatric patients. These differences are related to the continuous changes in the developing skeleton and its relationship with adjacent soft tissues. The imbalance in strength between the growing bones and the nearby tendons and ligaments makes the bones prone to acute and chronic injuries. Acute injuries are more common in contact sports such as football and wrestling, whereas chronic injuries are often seen in baseball pitchers and gymnasts. Acute injuries unique to pediatric athletes include physeal fractures of the proximal and distal portions of the clavicle (periosteal sleeve fracture), the proximal humeral physis, and the coracoid process, as well as supracondylar, lateral condylar, and medial condylar fractures around the elbow. Chronic injuries, most commonly caused by repetitive microtrauma, include acromial apophyseolysis, Little Leaguer's shoulder, the constellation of findings seen in Little Leaguer's elbow, and injuries to the medial, lateral, and posterior elbow compartments. In addition, trochlear osteochondral lesions, gymnast's wrist, and rock climber's finger are less-common injuries that may be seen in children. In this article, the normal osseous development of the upper extremity is reviewed, with emphasis on the structures that are most commonly injured. The pathophysiology, imaging appearance, and imaging findings of pediatric athletic injuries are described, along with the prognostic implications. RSNA, 2016.
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http://dx.doi.org/10.1148/rg.2016160036DOI Listing
October 2016

Comparative analysis of anterior and posterior contrast injection approaches for shoulder MR arthrograms in adolescents.

Pediatr Radiol 2016 Dec 1;46(13):1848-1855. Epub 2016 Sep 1.

Musculoskeletal Imaging, Department of Radiology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.

Background: There is no consensus in the literature concerning the optimal approach for performing a fluoroscopically guided shoulder arthrogram injection in a pediatric population.

Objective: To compare adequacy of capsular injection and radiation doses between fluoroscopically guided anterior and posterior glenohumeral joint contrast injections in adolescents.

Materials And Methods: We evaluated imaging in 67 adolescents (39 boys, 28 girls; mean age 16.0 years; range 11.7-19.1 years) who underwent an anterior approach glenohumeral contrast injection with subsequent MR imaging, and 67 age- and gender-matched subjects (39 boys, 28 girls; mean age 16.0 years; range 11.1-19.2 years) who underwent a posterior approach injection during the period June 2010 to September 2015. Two pediatric radiologists independently evaluated all MR shoulder arthrograms to assess adequacy of capsular distention and degree of contrast extravasation. We recorded total fluoroscopic time, dose-area product (DAP) and cumulative air kerma (CAK).

Results: There were no significant differences in age, gender, height, weight or body mass index between the populations (P-values > 0.6). The amount of contrast extravasation between the groups was not significantly different (P = 0.27). Three anterior injections (4.5%) and one posterior (1.5%) were suboptimal (P = 0.62). Fluoroscopy time was not different: 1.1 min anterior and 1.3 min posterior (P = 0.14). There was a significant difference in CAK (0.7 mGy anterior and 1.1 mGy posterior; P = 0.007) and DAP (5.3 μGym anterior and 9.4 μGym posterior; P = 0.008). Inter-rater agreement was excellent (Cohen kappa >0.81).

Conclusion: Both techniques were technically successful. There was no difference in the fluoroscopy time for either approach. The radiation dose was higher with the posterior approach but this is of questionable clinical significance.
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http://dx.doi.org/10.1007/s00247-016-3691-yDOI Listing
December 2016

Normal Fetal Long Bone Length from Computed Tomography: Potential Value in the Prenatal Evaluation of Skeletal Dysplasias.

Fetal Diagn Ther 2016 13;40(4):291-297. Epub 2016 Apr 13.

Radiology Department, The Children's Hospital of Philadelphia, Philadelphia, Pa., USA.

Background: The prenatal evaluation of skeletal dysplasias is challenging. Ultrasound (US) has limited sensitivity in evaluating these abnormalities. Low-dose fetal computed tomography (CT) is a helpful adjunct in evaluating the fetus with severe abnormalities, but its use is limited by lack of data on normal fetal bone length.

Objective: To obtain CT measurements of fetal long bones and to compare published US normative bone length measures to examine their similarity.

Methods: A retrospective search of a radiographic database for gravid patients with CT of the abdomen/pelvis for acute maternal abdomen was performed. Fetal long bone measurements were plotted against gestational age (GA)/standard US measurements. Regression coefficients were calculated (p values <0.05 were considered significant). Bland-Altman plots were constructed to identify any systematic difference between CT and US bone length measures.

Results: Twenty-five cases met the inclusion criterion of fetal GA 16-39 weeks. The length of long bones increased with GA, with strong R2 values for each measurement. Plots of CT measurements against published 50th percentile sonographic values for age also showed strong and significant correlations, suggesting that values may be used interchangeably, a conclusion further substantiated by the Bland-Altman analyses.

Conclusion: A CT database for fetal long bone length is presented which can be used to evaluate the fetus with abnormal bones. Additionally we have established a strong correlation between measured fetal CT long bone values and the published 50th percentile normal values for US, which allows the interpreting radiologist to extrapolate CT measurements to US values in the evaluation of fetal bone length.
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http://dx.doi.org/10.1159/000444184DOI Listing
February 2017