3D pediatric cranial bone imaging using high-resolution MRI for visualizing cranial sutures: a pilot study

OBJECTIVEThere is an unmet need to perform imaging in young children and obtain CT-equivalent cranial bone images without subjecting the patients to radiation. In this study, the authors propose using a high-resolution fast low-angle shot golden-angle 3D stack-of-stars radial volumetric interpolated breath-hold examination (GA-VIBE) MRI sequence that is intrinsically robust to motion and has enhanced bone versus soft-tissue contrast.METHODSPatients younger than 11 years of age, who underwent clinical head CT scanning for craniosynostosis or other cranial malformations, were eligible for the study. 3D reconstructed images created from the GA-VIBE MRI sequence and the gold-standard CT scan were randomized and presented to 3 blinded reviewers. For all image sets, each reviewer noted the presence or absence of the 6 primary cranial sutures and recorded on 5-point Likert scales whether they recommended a second scan be performed.RESULTSEleven patients (median age 1.8 years) underwent MRI after clinical head CT scanning was performed. Five of the 11 patients were sedated. Three clinicians reviewed the images, and there were no cases, either with CT scans or MR images, in which a reviewer agreed a repeat scan was required for diagnosis or surgical planning. The reviewers reported clear imaging of the regions of interest on 99% of the CT reviews and 96% of the MRI reviews. With CT as the standard, the sensitivity and specificity of the GA-VIBE MRI sequence to detect suture closure were 97% and 96%, respectively (n = 198 sutures read).CONCLUSIONSThe 3D reconstructed images using the GA-VIBE sequence in comparison to the CT scans created clinically acceptable cranial images capable of detecting cranial sutures. Future directions include reducing the scan time, improving motion correction, and automating postprocessing for clinical utility.

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Relevance of early head CT scans following neurosurgical procedures: an analysis of 892 intracranial procedures at Rush University Medical Center

Journal of Neurosurgery ◽

10.3171/2014.4.jns132429 ◽

2014 ◽

Vol 121 (2) ◽

pp. 307-312 ◽

Cited By ~ 12

Author(s):

Ricardo B. V. Fontes ◽

Adam P. Smith ◽

Lorenzo F. Muñoz ◽

Richard W. Byrne ◽

Vincent C. Traynelis

Keyword(s):

Operating Room ◽

Neurological Examination ◽

Medical Center ◽

Ct Scanning ◽

Ct Scans ◽

Type I ◽

Type Ii ◽

Head Ct ◽

Ct Findings ◽

Neurological Change

Object Early postoperative head CT scanning is routinely performed following intracranial procedures for detection of complications, but its real value remains uncertain: so-called abnormal results are frequently found, but active, emergency intervention based on these findings may be rare. The authors' objective was to analyze whether early postoperative CT scans led to emergency surgical interventions and if the results of neurological examination predicted this occurrence. Methods The authors retrospectively analyzed 892 intracranial procedures followed by an early postoperative CT scan performed over a 1-year period at Rush University Medical Center and classified these cases according to postoperative neurological status: baseline, predicted neurological change, unexpected neurological change, and sedated or comatose. The interpretation of CT results was reviewed and unexpected CT findings were classified based on immediate action taken: Type I, additional observation and CT; Type II, active nonsurgical intervention; and Type III, surgical intervention. Results were compared between neurological examination groups with the Fisher exact test. Results Patients with unexpected neurological changes or in the sedated or comatose group had significantly more unexpected findings on the postoperative CT (p < 0.001; OR 19.2 and 2.3, respectively) and Type II/III interventions (p < 0.001) than patients at baseline. Patients at baseline or with expected neurological changes still had a rate of Type II/III changes in the 2.2%–2.4% range; however, no patient required an immediate return to the operating room. Conclusions Over a 1-year period in an academic neurosurgery service, no patient who was neurologically intact or who had a predicted neurological change required an immediate return to the operating room based on early postoperative CT findings. Obtaining early CT scans should not be a priority in these patients and may even be cancelled in favor of MRI studies, if the latter have already been planned and can be performed safely and in a timely manner. Early postoperative CT scanning does not assure an uneventful course, nor should it replace accurate and frequent neurological checks, because operative interventions were always decided in conjunction with the neurological examination.

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The quantitative assessment of interstitial lung disease with positron emission tomography scanning in systemic sclerosis patients

Rheumatology ◽

10.1093/rheumatology/kez483 ◽

2019 ◽

Vol 59 (6) ◽

pp. 1407-1415 ◽

Cited By ~ 3

Author(s):

Daphne M Peelen ◽

Ben G J C Zwezerijnen ◽

Esther J Nossent ◽

Lilian J Meijboom ◽

Otto S Hoekstra ◽

...

Keyword(s):

High Resolution ◽

Interstitial Lung Disease ◽

Lung Disease ◽

Fdg Pet ◽

Quantitative Assessment ◽

Ct Scanning ◽

Ct Scans ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

Abstract Objectives The reversibility of interstitial lung disease (ILD) in SSc is difficult to assess by current diagnostic modalities and there is clinical need for imaging techniques that allow for treatment stratification and monitoring. 18F-Fluorodeoxyglucose (FDG) PET/CT scanning may be of interest for this purpose by detection of metabolic activity in lung tissue. This study aimed to investigate the potential role of 18F-FDG PET/CT scanning for the quantitative assessment of SSc-related active ILD. Methods 18F-FDG PET/CT scans and high resolution CT scans of eight SSc patients, including five with ILD, were analysed. For comparison, reference groups were included: eight SLE patients and four primary Sjögren’s syndrome (pSS) patients, all without ILD. A total of 22 regions of interest were drawn in each patient at apical, medial and dorsobasal lung levels. 18F-FDG uptake was measured as mean standardized uptake value (SUVmean) in each region of interest. Subsequently, basal/apical (B/A) and medial/apical (M/A) ratios were calculated at patient level (B/A-p and M/A-p) and at tissue level (B/A-t and M/A-t). Results SUVmean values in dorsobasal ROIs and B/A-p ratios were increased in SSc with ILD compared with SSc without ILD (P = 0.04 and P = 0.07, respectively), SLE (P = 0.003 and P = 0.002, respectively) and pSS (P = 0.03 and P = 0.02, respectively). Increased uptake in the dorsobasal lungs and increased B/A-t ratios corresponded to both ground glass and reticulation on high resolution CT. Conclusion Semi-quantitative assessment of 18F-FDG PET/CT is able to distinguish ILD from non-affected lung tissue in SSc, suggesting that it may be used as a new biomarker for SSc-ILD disease activity.

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Otosclerosis: Incidence of Positive Findings on High-Resolution Computed Tomography and Their Correlation to Audiological Test Data

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348940511400910 ◽

2005 ◽

Vol 114 (9) ◽

pp. 709-716 ◽

Cited By ~ 53

Author(s):

Ilka C. Naumann ◽

Beat Porcellini ◽

Ugo Fisch

Keyword(s):

Computed Tomography ◽

High Resolution ◽

Sodium Fluoride ◽

Bone Conduction ◽

Ct Scanning ◽

Ct Scans ◽

High Resolution Computed Tomography ◽

Computed Tomographic ◽

Mixed Hearing Loss ◽

Temporal Bone Ct

Objectives: Computed tomographic (CT) scanning with slices of 1 mm or more has not been sufficient to demonstrate otosclerotic foci in most cases to date. Methods: We investigated the validity of CT scans with a 0.5-mm cubical scan technique, with and without planar reconstruction, and correlated these findings with audiological data. Forty-four temporal bone CT scans from 30 patients with conductive or mixed hearing loss were evaluated. Results: Otosclerotic foci were visualized in 74% of the cases. With reconstruction at the workstation, the sensitivity increased to 85%. Whereas in fenestral otosclerosis a correlation was found between the size of the focus and the air-bone gap, no correlation was seen between the size of the focus and bone conduction thresholds with cochlear involvement. Otosclerotic foci in patients treated with sodium fluoride were smaller than those in patients without treatment. This finding may indicate a beneficial effect of sodium fluoride on otosclerotic growth. Conclusions: High-resolution CT scans are a valid tool that can be used to confirm, localize, and determine the size of clinically suspected otosclerotic foci.

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Routine CT scanning of patients retrieved to a tertiary centre on veno-venous extracorporeal membrane oxygenation: a retrospective risk benefit analysis

Perfusion ◽

10.1177/0267659118763266 ◽

2018 ◽

Vol 33 (6) ◽

pp. 438-444 ◽

Cited By ~ 1

Author(s):

Kate M. Richmond ◽

Katharine G. Warburton ◽

Simon J. Finney ◽

Sachin Shah ◽

Benjamin A.J. Reddi

Keyword(s):

Adverse Events ◽

Extracorporeal Membrane Oxygenation ◽

Clinical Information ◽

Ct Scanning ◽

Splenic Infarction ◽

Head Ct ◽

Membrane Oxygenation ◽

Scan Time ◽

Clinical Records ◽

Vv Ecmo

Introduction: Comprehensive clinical examination can be compromised in patients on veno-venous extracorporeal membrane oxygenation (VV-ECMO). Adjunctive diagnostic imaging strategies range from bedside imaging only to routine computed tomography (CT). The risk-benefit of either approach remains to be evaluated. Patients retrieved to the Royal Brompton Hospital (RBH) on VV-ECMO routinely undergo admission CT imaging of head, chest, abdomen and pelvis. This study aimed to identify how frequently changes in therapy or adverse events could be attributed to routine CT scanning. Methods: Demographic and clinical data were gathered retrospectively from patients retrieved to RBH on VV-ECMO (January 2014-2016). Scans were categorized as ‘routine’ or requested to clarify a specific clinical uncertainty. Clinical records were reviewed to identify attributable management changes and CT- related adverse events. Seventy-two patients were retrieved on VV-ECMO (median age 44 years) and 65 scanned on admission (mean radiation dose 2344mGy-cm). Routine head CT head yielded novel clinical information in 11 patients, 10 of whom had unexpected intracranial haemorrhage and, subsequently, had their anticoagulation withheld. Routine thoracic CT identified unexpected positive findings in three patients (early fibrosis, pulmonary vasculitis, pneumomediastinum), eliciting management variation in one (steroid administration). Routine abdomen/pelvis CT identified new information in three patients (adrenal haemorrhage, hepatosteatosis, splenic infarction), changing the management in one (withholding anticoagulation). Results: CT scanning was not associated with consequential adverse events (e.g. accidental decannulation, gas entrainment into the circuit, hypoxia, hypotension). Median transfer/scan time was 78 minutes, requiring five ITU staff-members. In our cohort, a policy of routine head CT changed the management in 17% of patients; the yield from routine chest, abdomen and pelvis CT was modest. CT transfer was safe, but resource intensive. Conclusion: Prospective studies should evaluate whether routine CT impacts outcome.

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Diagnostic reference levels for paediatric computed tomography

South African Journal of Radiology ◽

10.4102/sajr.v19i2.846 ◽

2015 ◽

Vol 19 (2) ◽

Cited By ~ 2

Author(s):

Zakariya Vawda ◽

Richard Pitcher ◽

John Akudugu ◽

Willem Groenewald

Keyword(s):

Computed Tomography ◽

Age Groups ◽

Ct Scanning ◽

Ct Scans ◽

Tertiary Level ◽

Diagnostic Reference Levels ◽

Reference Levels ◽

Dose Length Product ◽

Head Ct ◽

Institutional Review

Objectives: To establish local diagnostic reference levels (LDRLs) for emergency paediatric head computed tomography (CT) scans performed at a South African (SA) tertiary-level hospital and to compare these with published data.Materials and methods: A retrospective analysis was conducted of volume-based CT dose index (CTDIvol) and dose length product (DLP) data from uncontrasted paediatric head CT scans performed in the Trauma and Emergency Unit of a tertiary-level SA hospital from January to June 2013. A random sample of 30 patients in each of 3 age groups (0–2, >2–5 and >5–10 years) was used. LDRL values were compared with several national DRLs from Europe and Australia. Results: Mean CTDIvol and DLP values were: 30 mGy and 488 mGy.cm for the 0–2 years age group; 31 mGy and 508 mGy.cm for the >2–5 years group, and 32 mGy and 563 mGy.cm for the >5–10 years group, respectively. The mean DLP for 0–2 year-olds was the only parameter outside the range of corresponding published reference data. Stratification into narrower age groupings showed an increase in DLP values with age. Conclusion: An institutional review of the head CT scanning technique for emergency studies performed on children less than 2 years of age is recommended. The current study highlights the role of LDRLs in establishing institutional dosimetry baselines, in refining local imaging practice, and in enhancing patient safety. Standard age stratification for DRL and LDRL reporting is recommended.

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Analysis of limited-sequence head computed tomography for children with shunted hydrocephalus: potential to reduce diagnostic radiation exposure

Journal of Neurosurgery Pediatrics ◽

10.3171/2013.8.peds1322 ◽

2013 ◽

Vol 12 (5) ◽

pp. 491-500 ◽

Cited By ~ 19

Author(s):

Jonathan Pindrik ◽

Thierry A. G. M. Huisman ◽

Mahadevappa Mahesh ◽

Aylin Tekes ◽

Edward S. Ahn

Keyword(s):

Radiation Exposure ◽

Gold Standard ◽

Ct Scanning ◽

Descriptive Statistics ◽

Ct Scans ◽

Diagnostic Utility ◽

Ventricular Size ◽

Ct Scanner ◽

Head Ct ◽

Limited Sequence

Object Despite its diagnostic utility, head CT scanning imparts risks of radiation exposure. Children with shunt-treated hydrocephalus exhibit increased risks of radiation toxicity due to the higher vulnerability of developing, immature tissues and frequent scanning. Several methods have been used to achieve dose reduction, including modifications of CT scanner tube current and potential. This retrospective study explores the use of a newly defined limited sequence of axial head CT slices to evaluate children with shunted hydrocephalus and decrease radiation exposure from diagnostic CT scans. Methods Consistent sequences of 7 axial slices were extracted from previously performed standard head CT scans in children with shunted hydrocephalus. Chronologically distinct limited sequences of each patient were blindly, retrospectively reviewed by 2 pediatric neuroradiologists and 1 pediatric neurosurgeon. Limited-sequence CT evaluation focused on the adequacy of portraying the ventricular system, changes in ventricular size, and visualization of the proximal catheter. Reviewers assessed all original full series head CT scans at least 4 months later for comparison. Adequacy and accuracy of the limited-sequence CT compared with the gold standard head CT was investigated using descriptive statistics. Effective dose (ED) estimates of the limited-sequence and standard head CT scans were compared using descriptive statistics and the Mann-Whitney test. Results Two serial head CT scans from each of 50 patients (age range 0–17 years; mean age 5.5 years) were reviewed both in standard and limited-sequence forms. The limited-sequence CT adequately portrayed the ventricular system in all cases. The inaccuracy rate for assessing changes in ventricular size by majority assessment (2 of 3 reviewers evaluating inaccurately) was 3 (6%) of 50. In 1 case, the inaccurate assessment would not have altered clinical management, corresponding to a 2 (4%) of 50 clinically relevant inaccuracy rate. As compared with the gold standard complete head CT series, the limited-sequence CT exhibited high sensitivity (100%) and specificity (91%) for portraying changes in ventricular caliber. Additionally, the limited-sequence CT displayed the ventricular catheter in 91.7% of scans averaged across 3 observers. Among all scans reviewed, 97 pairs of standard head CT and complementary limited-sequence CT scans contained adequate dosing information to calculate the effective dose (ED). The ED50 of the limited-sequence CT (0.284 mSv) differed significantly from the ED50 of the standard head CT (4.27 mSv) (p < 0.0001). The limited-sequence CT reflected a median absolute reduction of 4.10 mSv and a mean percent reduction of 91.8% in ED compared with standard head CT. Conclusions Limited-sequence head CT scanning provided adequate and accurate diagnostic information in children with shunted hydrocephalus. Techniques including minimization of axial slice quantity and modification of CT scanner parameters can achieve significant dose reduction, maintaining a balance between diagnostic utility and patient safety.

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Enlarged subarachnoid spaces and intracranial hemorrhage in children with accidental head trauma

Journal of Neurosurgery Pediatrics ◽

10.3171/2016.8.peds16146 ◽

2017 ◽

Vol 19 (2) ◽

pp. 254-258 ◽

Cited By ~ 7

Author(s):

Amanda K. Fingarson ◽

Maura E. Ryan ◽

Suzanne G. McLone ◽

Corey Bregman ◽

Emalee G. Flaherty

Keyword(s):

Intracranial Hemorrhage ◽

Head Circumference ◽

Child Protection ◽

Ct Scanning ◽

Ct Scans ◽

Bivariate Analysis ◽

Subdural Hemorrhage ◽

Head Ct ◽

Subarachnoid Spaces ◽

Clinical Measurements

OBJECTIVE Benign external hydrocephalus (BEH) is an enlargement of the subarachnoid spaces (SASs) that can be seen in young children. It is controversial whether children with BEH are predisposed to developing subdural hemorrhage (SDH) with or without trauma. This issue is clinically relevant as a finding of unexplained SDH raises concerns about child abuse and often prompts child protection and law enforcement investigations. METHODS This retrospective study included children (1–24 months of age) who underwent head CT scanning after an accidental fall of less than 6 feet. Head CT scans were reviewed, cranial findings were documented, and the SAS was measured and qualitatively evaluated. Enlarged SAS was defined as an extraaxial space (EAS) greater than 4 mm on CT scans. Clinical measurements of head circumference (HC) were noted, and the head circumference percentile was calculated. The relationship between enlarged SAS and HC percentile, and enlarged SAS and intracranial hemorrhage (ICH), were investigated using bivariate analysis. RESULTS Of the 110 children included in this sample, 23 had EASs greater than 4 mm. The mean patient age was 6.8 months (median 6.0 months). Thirty-four patients (30.9%) had ICHs, including subarachnoid/subpial (6.2%), subdural (6.2%), epidural (5.0%), and unspecified extraaxial hemorrhage (16.5%). Enlarged SAS was positively associated with subarachnoid/subpial hemorrhage; there was no association between enlarged SASs and either SDH or epidural hemorrhage. A larger SAS was positively associated with larger HC percentile; however, HC percentile was not independently associated with ICH. CONCLUSIONS Enlarged SAS was not associated with SDH, but was associated with other ICHs. The authors' findings do not support the theory that BEH predisposes children to SDH with minor accidental trauma.

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