Publications by authors named "Emilio J Inarejos Clemente"

19 Publications

  • Page 1 of 1

Multiparametric MRI evaluation of bone sarcomas in children.

Insights Imaging 2022 Mar 1;13(1):33. Epub 2022 Mar 1.

Department of Diagnostic Imaging. Hospital Sant Joan de Déu, Av. Sant Joan de Déu, 2, CP:08950, Esplugues de Llobregat, Barcelona, Spain.

Osteosarcoma and Ewing sarcoma are the most common bone sarcomas in children. Their clinical presentation is very variable depending on the age of the patient and tumor location. MRI is the modality of choice to assess these bone sarcomas and has an important function at diagnosis and also for monitoring recurrence or tumor response. Anatomic sequences include T1- and T2-weighted images and provide morphological assessment that is crucial to localize the tumor and describe anatomical boundaries. Multiparametric MRI provides functional information that helps in the assessment of tumor response to therapy by using different imaging sequences and biomarkers. This review manuscript illustrates the role of MRI in osteosarcoma and Ewing sarcoma in the pediatric population, with emphasis on a functional perspective, highlighting the use of diffusion-weighted imaging and dynamic contrast-enhanced MRI at diagnosis, and during and after treatment.
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http://dx.doi.org/10.1186/s13244-022-01177-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8885969PMC
March 2022

An algorithm combining procalcitonin and lung ultrasound improves the diagnosis of bacterial pneumonia in critically ill children: The PROLUSP study, a randomized clinical trial.

Pediatr Pulmonol 2022 03 29;57(3):711-723. Epub 2021 Dec 29.

Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.

Background: Lung ultrasound (LUS) and procalcitonin (PCT) are independently used to improve accuracy when diagnosing lung infections. The aim of the study was to evaluate the accuracy of a new algorithm combining LUS and PCT for the diagnosis of bacterial pneumonia.

Methods: Randomized, blinded, comparative effectiveness clinical trial. Children <18 years old with suspected pneumonia admitted to pediatric intensive care unit were included, and randomized into experimental group (EG) or control group (CG) if LUS or chest X-Ray (CXR) were done as the first pulmonary image, respectively. PCT was determined. In patients with bacterial pneumonia, sensitivity, specificity, and predictive values of LUS, CXR, and of both combined with PCT were analyzed and compared. Concordance between the final diagnosis and the diagnosis concluded through the imaging test was assessed.

Results: A total of 194 children, with a median age of 134 (interquartile range [IQR]: 39-554) days, were enrolled, 96 randomized into the EG and 98 into the CG. Bacterial pneumonia was diagnosed in 97 patients. Sensitivity and specificity for bacterial pneumonia diagnosis were 78% (95% confidence interval [CI]: 70-85) and 98% (95% CI: 93-99) for LUS, 85% (95% CI: 78-90) and 53% (95% CI: 43-62) for CXR, 90% (95% CI: 83-94) and 85% (95% CI: 76-91) when combining LUS and PCT, and 95% (95% CI: 90-98) and 41% (95% CI: 31-52) when combining CXR and PCT. The positive predictive value for LUS and PCT was 88% (95% C:I 79%-93%) versus 68% (95% CI: 60-75) for CXR and PCT. The concordance between the final diagnosis and LUS had a kappa value of 0.69 (95% CI: 0.62-0.75) versus 0.34 (95% CI: 0.21-0.45) for CXR, (p < 0.001).

Conclusions: The combination of LUS and PCT presented a better accuracy for bacterial pneumonia diagnosis than combining CXR and PCT. Therefore, its implementation could be a reliable tool for pneumonia diagnosis in critically ill children.
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http://dx.doi.org/10.1002/ppul.25790DOI Listing
March 2022

Omphalomesenteric Duct Anomalies in Children: A Multimodality Overview.

Radiographics 2021 Nov-Dec;41(7):2090-2110

From the Departments of Diagnostic Imaging (E.J.I.C., M.N.I., E.L., C.C., P.S., I.B.M.d.l.T.) and Pathology (M.S.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; and Departments of Medical Imaging, University of Toronto, and Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada (O.M.N.).

The omphalomesenteric duct is an embryologic structure that connects the yolk sac with the primitive midgut of the developing fetus. Omphalomesenteric duct anomalies include a group of entities that result from failed resorption of the omphalomesenteric duct. These anomalies include Meckel diverticulum, omphalomesenteric fistula, fibrous bands, cysts, and umbilical polyps. Meckel diverticulum is the most common congenital anomaly of the gastrointestinal tract and is usually asymptomatic. Symptoms develop when Meckel diverticulum involves complications such as hemorrhage, inflammation, and perforation, or when it causes intussusception or bowel obstruction. Hemorrhage is the most common complication of Meckel diverticulum, and technetium 99m-pertechnetate scintigraphy is the imaging modality of choice for detecting acute bleeding. US and CT are commonly used for the evaluation of patients with other complications such as obstruction and inflammation. Nevertheless, the diagnosis of these complications can be challenging, as their clinical manifestations are usually nonspecific and can masquerade as other acute intraabdominal entities such as appendicitis, inflammatory bowel disease, or other causes of bowel obstruction. There are other umbilical disorders, such as urachal remnants and umbilical granuloma, that may present with symptoms and imaging findings similar to those of omphalomesenteric duct anomalies. An accurate preoperative diagnosis of omphalomesenteric duct anomaly is crucial for appropriate management and a better outcome, particularly when these anomalies manifest as a life-threatening condition. The authors review the anatomy, clinical features, and complications of omphalomesenteric duct anomalies in children, describing the relevant differential diagnoses and associated imaging findings seen with different imaging modalities. RSNA, 2021.
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http://dx.doi.org/10.1148/rg.2021210048DOI Listing
November 2021

Assessing the Reliability of the OMERACT Juvenile Idiopathic Arthritis Magnetic Resonance Scoring System for Temporomandibular Joints (JAMRIS-TMJ).

J Clin Med 2021 Sep 7;10(18). Epub 2021 Sep 7.

Department of Diagnostic Imaging, University Children's Hospital Zürich, 8032 Zürich, Switzerland.

Contrast-enhanced magnetic resonance imaging (MRI) remains the most comprehensive modality to assess juvenile idiopathic arthritis (JIA)-related inflammation and osteochondral damage in the temporomandibular joints (TMJ). This study tested the reliability of a new JIA MRI scoring system for TMJ (JAMRIS-TMJ) and the impact of variations in calibration and reader specialty. Thirty-one MRI exams of bilateral TMJs were scored independently using the JAMRIS-TMJ by 20 readers consisting of radiologists and non-radiologist clinicians in three reading groups, with or without a calibrating atlas and/or tutorial. The inter-reader reliability in the multidisciplinary cohort assessed by the generalizability coefficient was 0.61-0.67 for the inflammatory and 0.66-0.74 for the damage domain. The atlas and tutorial did not improve agreement within radiologists, but improved the agreement between radiologist and non-radiologist groups. Agreements between different calibration levels were 0.02 to 0.08 lower by the generalizability coefficient compared to agreement within calibration levels; agreement between specialty groups was 0.04 to 0.10 lower than within specialty groups. Averaging two radiologists raised the reliability above 0.8 for both domains. Therefore, the reliability of JAMRIS-TMJ was moderate-to-good depending on the presence of specialty and calibration differences. The atlas and tutorial are necessary to improve reliability when the reader cohort consists of multiple specialties.
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http://dx.doi.org/10.3390/jcm10184047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8467699PMC
September 2021

Percutaneous cryoablation of chondroblastoma and osteoblastoma in pediatric patients.

Insights Imaging 2021 Jul 27;12(1):106. Epub 2021 Jul 27.

Department of Interventional Radiology, Hospital Clínic Barcelona, Barcelona, Spain.

Background: To review the safety and efficacy of percutaneous cryoablation for the treatment of chondroblastoma and osteoblastoma in the pediatric and adolescent population.

Materials And Methods: A retrospective review from 2016 to 2020 was performed to evaluate clinical and imaging response to percutaneous cryoablation in 11 symptomatic patients with diagnosis of chondroblastoma and osteoblastoma treated from two pediatric hospitals with at least 12-month follow-up. Technical success (correct needle placement and potential full coverage of the tumor with the planned ablation zone) and clinical success (relief of the symptoms) were evaluated. The primary objective was to alleviate pain related to the lesion(s). Immediate and late complications were recorded. Patients were followed in clinic and with imaging studies such as MRI or CT for a minimum of 6 months.

Results: A total of 11 patients were included (mean 14 years, age range 9-17; male n = 8). Diagnoses were osteoblastoma (n = 4) and chondroblastoma (n = 7). Locations were proximal humerus (n = 1), femur condyle (n = 1), and proximal femur (n = 1) tibia (n = 3), acetabulum (n = 3), thoracic vertebra (n = 1) and lumbar vertebra (n = 1). Cryoablation was technically successful in all patients. Clinical success (cessation of pain) was achieved in all patients. No signs of recurrence were observed on imaging follow-up in any of the patients. One of the patients developed periprocedural right L2-L3 transient radiculopathy as major immediate complication.

Conclusions: Percutaneous image-guided cryoablation can be considered potentially safe and effective treatment for chondroblastoma and osteoblastoma in children and adolescents.
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http://dx.doi.org/10.1186/s13244-021-01036-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8314258PMC
July 2021

Discrete Choice Experiment on a Magnetic Resonance Imaging Scoring System for Temporomandibular Joints in Juvenile Idiopathic Arthritis.

Arthritis Care Res (Hoboken) 2022 02 29;74(2):308-316. Epub 2021 Dec 29.

The Hospital for Sick Children, Toronto, Ontario, Canada.

Objective: To determine the relative importance weights of items and grades of a newly developed additive outcome measure called the juvenile idiopathic arthritis (JIA) magnetic resonance imaging (MRI) scoring system for the temporomandibular joint (TMJ) (JAMRIS-TMJ).

Methods: An adaptive partial-profile, discrete choice experiment (DCE) survey using the 1000Minds platform was independently completed by members of an expert group consisting of radiologists and non-radiologist clinicians to determine the group-averaged relative weights for the JAMRIS-TMJ. Subsequently, an image-based vignette ranking exercise was done, during which experts individually rank ordered 14 patient vignettes for disease severity while blinded to the weights and unrestricted to JAMRIS-TMJ assessment criteria. Validity of the weighted JAMRIS-TMJ was tested by comparing the consensus-graded, DCE-weighted JAMRIS-TMJ score of the vignettes with their unrestricted image-based ranks provided by the experts.

Results: Nineteen experts completed the DCE survey, and 21 completed the vignette ranking exercise. Synovial thickening and joint enhancement showed higher weights per raw score compared to bone marrow items and effusion in the inflammatory domain, while erosions and condylar flattening showed nonlinear and higher weights compared to disk abnormalities in the damage domain. The weighted JAMRIS-TMJ score of the vignettes correlated highly with the ranks from the unrestricted comparison method, with median Spearman's ρ of 0.92 (interquartile range [IQR] 0.87-0.95) for the inflammation and 0.93 (IQR 0.90-0.94) for the damage domain.

Conclusion: A DCE survey was used to quantify the importance weights of the items and grades of the JAMRIS-TMJ. The weighted score showed high convergent validity with an unrestricted, holistic vignette ranking method.
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http://dx.doi.org/10.1002/acr.24577DOI Listing
February 2022

MRI of Rhabdomyosarcoma and Other Soft-Tissue Sarcomas in Children.

Radiographics 2020 May-Jun;40(3):791-814. Epub 2020 Apr 3.

From the Departments of Diagnostic Imaging (E.J.I.C., M.N., I.B.M.d.l.T., J.M.d.C.), Pathology (M.S.), Orthopaedics (F.T.), and Oncology and Haematology (M.G.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (O.M.N.); and Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ont, Canada (O.M.N.).

Soft-tissue sarcomas in children comprise a heterogeneous group of entities with variable manifestation depending on the age of the patient and the location of the tumor. MRI is the modality of choice for evaluating musculoskeletal soft-tissue tumors and plays a paramount role in both initial diagnosis and assessment of tumor response during and after treatment. Conventional MRI sequences, such as T1- and T2-weighted imaging, offer morphologic information, which is important for localizing the lesion and describing anatomic relationships but not accurate for determining its malignant or benign nature and may be limited in differentiating tumor response from therapy-related changes. Advanced multiparametric MRI offers further functional information that can help with these tasks by using different imaging sequences and biomarkers. The authors present the role of MRI in rhabdomyosarcoma and other soft-tissue sarcomas in children, emphasizing a multiparametric approach with focus on the utility and potential added value of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced MRI in characterization and staging, determination of pretreatment extent, and evaluation of tumor response and recurrence after treatment. RSNA, 2020.
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http://dx.doi.org/10.1148/rg.2020190119DOI Listing
April 2021

Toward Developing a Semiquantitative Whole Body-MRI Scoring for Juvenile Idiopathic Arthritis: Critical Appraisal of the State of the Art, Challenges, and Opportunities.

Acad Radiol 2021 02 3;28(2):271-286. Epub 2020 Mar 3.

Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada. Electronic address:

With powerful new therapies available for management of juvenile idiopathic arthritis (JIA), early diagnosis leading to appropriate treatment may prevent long-term structural joint damage. Although magnetic resonance imaging (MRI) is typically used to assess individual body parts, indications for whole body (WB) MRI are increasing. Its utility as a diagnostic and monitoring tool has already been widely investigated in adult rheumatology patients, but less so in pediatric rheumatologic patients. This paper is a comprehensive review of scoring systems and a proposal for the conceptual development of a WB-MRI scoring system for the evaluation of JIA. In this review we identify, summarize, and critically appraise the available literature on the use of WB-MRI in inflammatory arthritis, addressing relevant considerations on components of a classification system that can lead to the development of a future pediatric WB-MRI scoring system for use in children with JIA. We also discuss advantages and challenges of developing such a WB-MRI scoring system for assessment of JIA and outline next steps toward the conceptual development of this scoring system.
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http://dx.doi.org/10.1016/j.acra.2020.01.022DOI Listing
February 2021

Autoinflammatory diseases in childhood, part 2: polygenic syndromes.

Pediatr Radiol 2020 03 17;50(3):431-444. Epub 2020 Feb 17.

Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.

Autoinflammatory diseases are a family of disorders characterized by aberrant stimulation of inflammatory pathways without involvement of antigen-directed autoimmunity. They can be further divided in monogenic and polygenic types. Those without an identified genetic mutation are known as polygenic and include systemic-onset juvenile idiopathic arthritis, idiopathic recurrent acute pericarditis, Behçet syndrome, chronic recurrent multifocal osteomyelitis and inflammatory bowel disease among others. Autoinflammatory diseases are characterized by recurrent flares or persistent systemic inflammation and fever, as well as lymphadenopathy and cutaneous, abdominal, thoracic and articular symptoms. Although these syndromes can mimic infections clinically, the inflammatory lesions in autoinflammatory disorders are aseptic. However, because of their infrequency, varied and nonspecific presentation, and the new genetic identification, diagnosis is usually delayed. In this article, which is Part 2 of a two-part series, the authors review the main polygenic autoinflammatory diseases that can be seen in childhood, with special emphasis wherever applicable on imaging features that may help establish the correct diagnosis. However, the major role of imaging is to delineate organ involvement and disease extent.
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http://dx.doi.org/10.1007/s00247-019-04544-9DOI Listing
March 2020

Autoinflammatory diseases in childhood, part 1: monogenic syndromes.

Pediatr Radiol 2020 03 17;50(3):415-430. Epub 2020 Feb 17.

Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.

Autoinflammatory diseases constitute a family of disorders defined by aberrant stimulation of inflammatory pathways without involving antigen-directed autoimmunity. They may be divided into monogenic and polygenic types. Monogenic autoinflammatory syndromes are those with identified genetic mutations, such as familial Mediterranean fever, tumor necrosis factor receptor-associated periodic fever syndrome (TRAPS), mevalonate kinase deficiency or hyperimmunoglobulin D syndrome, cryopyrin-associated periodic fever syndromes (CAPS), pyogenic arthritis pyoderma gangrenosum and acne (PAPA) syndrome, interleukin-10 and interleukin-10 receptor deficiencies, adenosine deaminase 2 deficiency and pediatric sarcoidosis. Those without an identified genetic mutation are known as polygenic and include systemic-onset juvenile idiopathic arthritis, idiopathic recurrent acute pericarditis, Behçet syndrome, chronic recurrent multifocal osteomyelitis and inflammatory bowel disease among others. Autoinflammatory disorders are defined by repeating episodes or persistent fever, rash, serositis, lymphadenopathy, arthritis and increased acute phase reactants, and thus may mimic infections clinically. Most monogenic autoinflammatory syndromes present in childhood. However, because of their infrequency, diverse and nonspecific presentation, and the relatively new genetic recognition, diagnosis is usually delayed. In this article, which is Part 1 of a two-part series, the authors update monogenic autoinflammatory diseases in children with special emphasis on imaging features that may help establish the correct diagnosis.
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http://dx.doi.org/10.1007/s00247-019-04536-9DOI Listing
March 2020

Intrauterine Intestinal Volvulus.

J Pediatr 2020 04 20;219:278-279. Epub 2019 Dec 20.

Neonatology Department, Sant Joan de Déu Hospital, Universidad de Barcelona, BCNatal, Barcelona, Spain.

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http://dx.doi.org/10.1016/j.jpeds.2019.11.017DOI Listing
April 2020

Connective Tissue Disorders in Childhood: Are They All the Same?

Radiographics 2019 Jan-Feb;39(1):229-250

From the Departments of Radiology (M.N., E.J.I.C., M.R.P.) and Rheumatology (E.I., J.A.), Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08950 Esplugues de Llobregat, Barcelona, Spain; Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (M.N., O.M.N.); and Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada (M.N., O.M.N.).

Systemic connective tissue disorders are characterized by the presence of autoantibodies and multiorgan system involvement. Juvenile systemic lupus erythematosus with or without associated antiphospholipid syndrome; juvenile dermatomyositis; sclerodermiform syndromes, including systemic and localized sclerodermas and eosinophilic fasciitis; mixed connective tissue disease; and Sjögren syndrome are the disorders that affect children most frequently. Diagnosis is difficult, because the clinical presentation of patients is diverse, from mild to severe disease. In addition, all organs may be affected. However, a variety of imaging techniques are now available to investigate rheumatic disease in children. These imaging modalities offer the potential for earlier diagnosis and improved assessment of therapeutic response. This article reviews the main connective tissue disorders that affect children, highlighting their key imaging features on images acquired with different diagnostic imaging modalities and correlating these features with clinical and pathologic findings, when available. RSNA, 2019.
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http://dx.doi.org/10.1148/rg.2019180078DOI Listing
March 2020

Imaging Evaluation of Pediatric Parotid Gland Abnormalities.

Radiographics 2018 Sep-Oct;38(5):1552-1575. Epub 2018 Aug 10.

From the Departments of Diagnostic Imaging (E.J.I.C., M.N., M.R.P.), Pathology (M.S.C.), and Maxillary and Oral Surgery (J.R.P., A.A.C.), Hospital Sant Joan de Deu, Av. Sant Joan de Deu 2, CP 08950 Esplugues de Llobregat (Barcelona), Spain; and Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada (M.T.).

Parotid gland lesions in children can be divided into benign or malignant. The age of the patient helps narrow the differential diagnosis, with vascular and congenital lesions being more frequent in the 1st year of life, while solid tumors are more frequent in older children. Inflammatory disease usually has rapid onset in comparison with that of neoplastic or congenital processes, which have more gradual clinical evolution. Currently, multiple imaging techniques are available to study the parotid region, such as US, CT, and MRI. However, it is still a challenge to distinguish nonmalignant lesions from malignant ones. US is the first-line diagnostic approach in children to characterize the morphology and vascularity of these lesions. CT in children may be indicated for evaluation of abscesses or sialolithiasis. MRI is the imaging modality of choice for investigating the nature of the lesion and its extent. In addition to complete and detailed clinical information, knowledge of parotid gland anatomy and characteristic radiologic features of parotid disorders is essential for optimal radiologic evaluation and avoiding unnecessary interventional diagnostic procedures or treatment. This article illustrates a variety of entities (congenital, inflammatory, vascular, neoplastic) that can occur in the parotid gland, highlighting the most frequent radiologic patterns of manifestation and correlating them with clinical, surgical, and pathologic findings. RSNA, 2018.
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http://dx.doi.org/10.1148/rg.2018170011DOI Listing
December 2018

Imaging of temporomandibular joint abnormalities in juvenile idiopathic arthritis with a focus on developing a magnetic resonance imaging protocol.

Pediatr Radiol 2018 06 8;48(6):792-800. Epub 2018 May 8.

Department of Maxillofacial Radiology, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway.

Inflammation and damage in the temporomandibular joint (TMJ) often develop without clinical symptoms but can lead to severe facial growth abnormalities and impaired health-related quality of life, making early diagnosis of TMJ changes crucial to identify. Inflammatory and osteochondral changes detectable through magnetic resonance imaging (MRI) occur in TMJs of approximately 40% of children with juvenile idiopathic arthritis (JIA), and no other imaging modality or physical method of examination can reliably detect these changes. Therefore contrast-enhanced MRI is the diagnostic standard for diagnosis and interval monitoring of JIA. However the specific usage of MRI for TMJ arthritis is not standardized at present. There is a recognized need for a consensus effort toward standardization of an imaging protocol with required and optional sequences to improve detection of pathological changes and shorten study time. Such a consensus imaging protocol is important for providing maximum information with minimally necessary sequences in a way that allows inter-site comparison of results of clinical trials and improved clinical management. In this paper we describe the challenges of TMJ imaging and present expert-panel consensus suggestions for a standardized TMJ MRI protocol.
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http://dx.doi.org/10.1007/s00247-017-4005-8DOI Listing
June 2018

Qualitative and semi-quantitative assessment of temporomandibular joint MRI protocols for juvenile idiopathic arthritis at 1.5 and 3.0T.

Eur J Radiol 2018 Jan 31;98:90-99. Epub 2017 Oct 31.

Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, University of Toronto, 686 Bay Street, Toronto, ON M5G1A4, Canada; Department of Medical Imaging, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON M5G1X8, Canada. Electronic address:

Objective: Temporomandibular joints (TMJs) frequently develop silent inflammatory and osteochondral changes in children with juvenile idiopathic arthritis. Data-driven recommendations for TMJ imaging protocol are needed to reduce measurement error and scanning time. This study compares the impact of different protocols, imaging coils, and magnet strength on the reliability of image assessment and the subjective quality of images.

Materials And Methods: Three groups of bilateral TMJ MR studies were retrospectively collected from two institutions, including 24 1.5T and 19 3.0T studies using dedicated TMJ surface coils, and 23 1.5T studies with head coil. Post-contrast sequences were re-compiled from the full protocol to create minimum protocol studies for the three groups. Two radiologists and two non-radiologists first scored the three minimum protocol images according to pre-specified definitions, then scored the full protocol images. Minimum-to-full protocol agreement, inter-reader agreement, and subjective item visibility scores were assessed.

Results: With dedicated TMJ dual surface coils, minimum-vs-full protocol agreement was moderate to good (0.5-0.8 intraclass correlation coefficients or kappa) for most items, and was not influenced by the magnet strength. Inter-reader reliability was more significantly influenced by the imaging coil and reader's training background than by protocol length or magnet strength differences. Sagittal and coronal planes weighted on PD, T2 Fat Suppressed and T1 Fat Suppressed -postcontrast adequately visualized all the different features, whereas the axial plane was more limited to visualizing synovium.

Conclusion: Inter-reader reliability and qualitative measure of image quality improved more consistently with the coil offering the higher resolution, rather than increased magnet strength.
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http://dx.doi.org/10.1016/j.ejrad.2017.10.024DOI Listing
January 2018

Toward Establishing a Standardized Magnetic Resonance Imaging Scoring System for Temporomandibular Joints in Juvenile Idiopathic Arthritis.

Arthritis Care Res (Hoboken) 2018 05 12;70(5):758-767. Epub 2018 Apr 12.

University Children's Hospital, Zürich, Switzerland.

Objective: The temporomandibular joints (TMJs) are frequently affected in children with juvenile idiopathic arthritis (JIA). Early detection is challenging, as major variation is present in scoring TMJ pathology on magnetic resonance imaging (MRI). Consensus-driven development and validation of an MRI scoring system for TMJs has important clinical utility in timely improvement of diagnosis and serving as an outcome measure. We report on a multi-institutional collaboration toward developing a TMJ MRI scoring system for JIA.

Methods: Seven readers independently assessed MRI scans from 21 patients (42 TMJs, from patients ages 6-16 years) using 3 existing MRI scoring systems from American, German, and Swiss institutions. Reliability scores, scoring system definitions, and items were discussed among 10 JIA experts through 2 rounds of Delphi surveys, nominal group voting, and subsequent consensus meetings to create a novel TMJ MRI scoring system.

Results: Average-measure absolute agreement intraclass correlation coefficients (avICCs) for the total scores of all 3 scoring systems were highly reliable at 0.96 each. Osteochondral items showed higher reliability than inflammatory items. An additive system was deemed preferable for assessing minor joint changes over time. Eight items were considered sufficiently reliable and/or important for integration into the consensus scoring system: bone marrow edema and enhancement (avICC 0.57-0.61, smallest detectable difference [SDD] ± 45-63% prior to redefining), condylar flattening (avICC 0.95-0.96, SDD ± 23-28%), effusions (avICC 0.85-0.88, SDD ± 25-26%), erosions (avICC 0.94, SDD ± 20%), synovial enhancement and thickening (previously combined, avICC 0.90-0.91, SDD ± 33%), and disk abnormalities (avICC 0.90, SDD ± 19%).

Conclusion: A novel TMJ MRI scoring system was developed by consensus. Further iterative refinements and reliability testing are warranted in upcoming studies.
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http://dx.doi.org/10.1002/acr.23340DOI Listing
May 2018

Utility of MDCT MIP Postprocessing Reconstruction Images in Children With Hereditary Hemorrhagic Telangiectasia.

J Comput Assist Tomogr 2016 May-Jun;40(3):375-9

From *The Department of Diagnostic Imaging, Hospital Sant Joan de Deu, University of Barcelona, Barcelona, Spain; †Chest Division, The Department of Pediatrics, The Hospital for Sick Children; ‡The Department of Diagnostic Imaging, The Hospital for Sick Children; and §The Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.

Objective: The aim of the study was to evaluate whether maximum intensity projection (MIP) images improve the detection and the delineation of the anatomic makeup of pulmonary nodules and/or arteriovenous malformations (pAVMs) in children with hereditary hemorrhagic telangiectasia (HHT).

Materials And Methods: Two radiologists (D.M., E.I.C.) performed a blinded review of chest multidetector computed tomography scans in 39 children (age, 0-18 years) with proven HHT. Multiplanar 2.5 mm slices were blindly compared with multiplanar MIP for the presence of nodules and/or overt pAVMs and for the ability to identify vessels associated with the pAVMs. Parameters that were assessed included number of definitive nodules, number of definitive pAVMs, and the ability to detect the feeding artery or draining vein in both conventional and MIP images.

Results: Our study showed similar detection rates between axial scans and MIP images for the detection of nodules (axial R1: 75 vs 62, P = 0.05; MIPS: 78 vs 86, P = 0.05) and in the determination of definite pAVMS (axials: 21 vs 29, P = 0.0007; MIPS: 27 vs 35, P = 0.01). Statistically significant differences were obtained in the ability to identify the feeding artery and draining vein between standard 2.5 mm slices and MIP images (axials: 13 vs 13, P = 0.0008; MIPS: 27 vs 23, P = 0.01). No other data parameters achieved statistically significance.

Conclusions: Maximum intensity projection images in children with HHT can help identify the presence and the anatomy of pAVMs for future embolization.
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http://dx.doi.org/10.1097/RCT.0000000000000385DOI Listing
January 2017

[Retropharyngeal abscess with mediastinal invasion: Exclusive antibiotic treatment].

An Pediatr (Barc) 2016 Aug 1;85(2):112-113. Epub 2016 Feb 1.

Unitats d́Hospitalització, Servei de Pediatria, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues de Llobregat, Barcelona, España.

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http://dx.doi.org/10.1016/j.anpedi.2015.11.005DOI Listing
August 2016

A primary inflammatory myofibroblastic tumor of the scapula in a child: imaging findings.

Skeletal Radiol 2015 May 14;44(5):733-7. Epub 2014 Oct 14.

Hospital Sant Joan de Deu, University of Barcelona, Barcelona, Spain,

Inflammatory myofibroblastic tumor (IMT) is an uncommon tumor characterized by inflammatory cell infiltration and differentiated myofibroblastic spindle cells. IMT was first described in the lung and retroperitoneum. Occurrence in bone has been well described in the maxilla and occasionally in the long bones in the adult population. We present a unique case of IMT arising primarily from the scapula in an 8-year-old patient, not described previously in the pediatric or adult literature. Imaging demonstrated an ill-defined and aggressive osteolytic lesion with cortical bone destruction associated with an important soft tissue component that extended into the adjacent muscles. Histologically, the tumor was composed of spindle and polygonal cells distributed in an inflammatory background with different proportions of plasma cells, lymphocytes, eosinophils and neutrophils. The absence of cellular atypia helped to differentiate this entity from malignant spindle cell tumors, and imaging could differentiate the tumor from the nontumoral inflammatory reaction.
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http://dx.doi.org/10.1007/s00256-014-2023-2DOI Listing
May 2015
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