Preoperative Nutrition Status Predicts Hospital Length of Stay and Unplanned Reoperation Risk in Pediatric Patients With Inflammatory Bowel Disease.

Introduction: Many pediatric inflammatory bowel disease (IBD) patients require surgical intervention during their lifetime. Poor nutrition status correlates with adverse surgical outcomes in the adult population. A paucity of data exists on the association of preoperative nutrition status and postoperative outcomes in the pediatric population.

Comparison of clinical and abdominal CT imaging findings in children evaluated for abusive and accidental abdominal trauma.

Background: Diagnosis of child abuse in children evaluated for a blunt abdominal trauma can be challenging due to overlapping types of injuries.

Objective: Identify clinical characteristics and CT findings that differentiate children evaluated for accidental abdominal trauma (AcAT) and abusive abdominal trauma (AbAT).

Materials And Methods: Retrospective (1/2010 to 6/2024) study on children < 3 years-old who had an abdominal CT scan for AcAT or AbAT.

Prenatal hydrocolpos: imaging findings and differential diagnosis.

Prenatal hydrocolpos is characterized by fluid distension of the vagina. Hydrocolpos can be caused by multiple underlying etiologies and often demonstrates overlapping imaging features compared to other cystic abdominal and pelvic lesions. The purpose of the current pictorial essay is to provide a systematic prenatal magnetic resonance imaging (MRI) approach to differentiating the primary etiologies leading to hydrocolpos.

Chest CT in the evaluation of child abuse - When is it useful?

Background: Indications for chest CT in evaluation of child abuse are unknown.

Objective: Determine which groups of children can best benefit from chest CT.

Participants And Setting: 10-year (1/2010 to 12/2019) retrospective study of children <3 years who had chest CT within 3 days of the initial skeletal survey.

Radiologists' Diagnostic Performance in Differentiation of Rickets and Classic Metaphyseal Lesions on Radiographs: A Multicenter Study.

Despite evidence supporting the specificity of classic metaphyseal lesions (CML) for the diagnosis of child abuse, some medicolegal practitioners claim that CML result from rickets rather than trauma. The purpose of this study was to evaluate radiologists' diagnostic performance in differentiating rickets and CML on radiographs. This retrospective seven-center study included children younger than 2 years who underwent knee radiography from January 2007 to December 2018 and who had either rickets (25-hydroxyvitamin D level < 20 ng/mL and abnormal knee radiographs) or knee CML and a diagnosis of child abuse from a child abuse pediatrician.

Fractures of child abuse.

The objective of this paper is to review common challenges when evaluating fractures in the setting of possible child abuse and approaches to navigate them. This paper reviews the variety of imaging modalities available for evaluating child abuse and the advantages/disadvantages of each. Additionally, the authors discuss management of equivocal fractures, including the impact of double-reading skeletal surveys.

Magnetic resonance imaging of the fetal gastrointestinal system.

In this paper the authors review the normal imaging appearance of the fetal gastrointestinal tract and patterns of fetal gastrointestinal tract obstruction. The authors include a detailed summary from esophagus to the rectum, including the expected pattern of meconium and small-bowel contents at different gestational ages. Common fetal gastrointestinal tract obstructions are reviewed with accompanying case examples, emphasizing the role of the meconium and bowel-caliber patterns in establishing differential diagnoses.

Accuracy of ultrasound in the diagnosis of classic metaphyseal lesions using radiographs as the gold standard.

Background: Diagnosis of classic metaphyseal lesions (CMLs) in children suspected for child abuse can be challenging. Ultrasound (US) can potentially help diagnose CMLs. However, its accuracy is unknown.

Ultrasound evaluation of right diaphragmatic eventration and hernia.

Background: A hernia is due to a defect in the diaphragm. An eventration is due to a thinned diaphragm with no central muscle. Distinguishing right diaphragmatic hernia from eventration on chest radiographs can be challenging if no bowel loops are herniated above the diaphragm.

Ultrasound findings in classic metaphyseal lesions: emphasis on the metaphyseal bone collar and zone of provisional calcification.

Background: The classic metaphyseal lesion (CML) is highly specific for non-accidental trauma in infants. While the radiographic findings are well documented, there is little literature on the ultrasound (US) appearance.

Objective: To evaluate US findings in CMLs identified on radiographs.

Compliance With Skeletal Surveys for Child Abuse in General Hospitals: A Statewide Quality Improvement Process.

The purpose of this study is to perform a statewide quality improvement process to improve compliance with the American College of Radiology (ACR) guidelines in performing skeletal surveys for suspected child abuse. We prospectively identified all outside hospital skeletal surveys for suspected child abuse in children younger than 3 years referred to our tertiary children's hospital in 2016-2017. We included a 3-month baseline and 21-month intervention period.

Classic metaphyseal lesion acquired during physical therapy.

A classic metaphyseal lesion (CML) is highly specific for nonaccidental trauma. Missing CMLs can be devastating to the child as the child can continue to be exposed to inflicted trauma. Yet, there are rare case reports on CMLs that occur due to birth trauma, IV line placement, and treatment for clubfoot.

Fetal MRI in the Identification of a Fetal Ventral Wall Defect Spectrum.

 To ascertain if useful criteria for prenatal diagnosis of fetal ventral body wall defects (VBWDs) exists by reviewing published literature on diagnosis of VBWD as compared with our own diagnostic experience.  A comprehensive literature review of diagnostic criteria of fetal VBWD including pentalogy of Cantrell (POC), omphalocele, exstrophy, imperforate anus, spina bifida (OEIS), cloacal exstrophy, limb-body wall complex (LBWC), and body stalk anomaly was performed followed by a retrospective review of all fetal magnetic resonance imaging (MRI) examinations from our medical center over a 2-year period.  Classically, OEIS is omphalocele, bladder exstrophy, imperforate anus, and spina bifida.

The added value of a second read by pediatric radiologists for outside skeletal surveys.

Background: Fractures are the second most common finding in non-accidental trauma after cutaneous signs. Interpreting skeletal surveys could be challenging as some fractures are subtle and due to anatomical variations that can mimic injuries.

Objective: To determine the effect of a second read by a pediatric radiologist of skeletal surveys for suspected non-accidental trauma initially read at referring hospitals by general radiologists.

A comprehensive severity score for the morbidly adherent placenta: combining ultrasound and magnetic resonance imaging.

Background: Ultrasound (US) is the first-line imaging modality to assess the morbidly adherent placenta, but sensitivity and specificity are lacking.

Objective: This investigation aims to improve diagnostic accuracy with a comprehensive score using clinical history, US, and magnetic resonance imaging (MRI).

Materials And Methods: We conducted a retrospective cohort study of pregnant women who received both transvaginal US and MRI with suspicion for morbidly adherent placenta between 2009 and 2016.

Ultrasound diagnosis of tracheal cartilaginous sleeve in a patient with Pfeiffer syndrome.

There is an association between tracheal cartilaginous sleeve and syndromic craniosynostosis. We present a case of tracheal cartilaginous sleeve diagnosed by ultrasound (US) in a patient with Pfeiffer syndrome. The patient developed respiratory failure and was suspected at bronchoscopy to have tracheal cartilaginous sleeve.

JOURNAL CLUB: Can Coronal STIR Be Used as Screening for Acute Nontraumatic Hip Pain in Children?

Objective: The objective of this study is to evaluate whether coronal STIR MRI can be used as a screening test for nontraumatic acute hip pain in children.

Materials And Methods: From 2008 to 2012, we identified all patients younger than 18 years at our tertiary care facility who underwent pelvic MRI including coronal STIR for the following indications: acute hip pain, limping, or refusal to bear weight. Patients with a history of trauma were excluded.

Can ultrasound be used as the primary imaging in children with suspected Crohn disease?

Background: There is growing literature on the use of ultrasound (US) for evaluation of Crohn disease in adults, but few studies have been conducted on children. Several studies demonstrated high accuracy of US in the diagnosis of Crohn disease. Using US as the primary screening imaging modality for Crohn disease can reduce health care costs, the need for sedation and ionizing radiation exposure.

Diagnosis of pediatric colonic volvulus with abdominal radiography: how good are we?

Background: Colonic volvulus is rare in children and associated with colonic dysmotility. Diagnosis of colonic volvulus on radiographs in these patients can be challenging. The purpose of the study was to identify the accuracy of abdominal radiographs and findings suggestive of colonic volvulus.

Double-read of skeletal surveys in suspected non-accidental trauma: what we learned.

Background: Missing a fracture in a child on skeletal surveys for suspected non-accidental trauma can have devastating results. Double-read has the potential to improve fracture detection. However the yield of double-read is unknown.

Is CT cystography an accurate study in the evaluation of spontaneous perforation of augmented bladder in children and adolescents?

Background: Spontaneous bladder perforation (SBP) is a potentially fatal complication of augmented bladder. Imaging is often used for diagnosis. In this study we present our experience with CT cystography (CTC) in the diagnosis of SBP.