First name
Savvas
Last name
Andronikou

Title

Neuroendocrine cell hyperplasia of infancy: Feasibility of objective evaluation with quantitative CT.

Year of Publication

2022

Number of Pages

43-48

Date Published

06/2022

ISSN Number

1873-4499

Abstract

OBJECTIVE: To describe quantitative CT parameters of children with a typical pattern for NEHI and compare them to controls.

MATERIALS AND METHODS: Eleven patients (7 boys) with NEHI and an available chest CT concordant NEHI were identified. Eleven age-, sex-, height-matched, with CT technique-matching were identified for comparison. An open-source software was used to segment the lung parenchyma into lobes using the fissures. Quantitative parameters such as low attenuation areas, mean lung density, kurtosis, skewness, ventilation heterogeneity, lung mass, and volume were calculated for both controls and cases.

RESULTS: Analysis of the lung parenchyma showed that patients with NEHI had a lower mean lung density (-615 HU vs -556 HU, p = 0.03) with higher ventilation heterogeneity (0.23 vs 0.19, p = 0.04), lung mass (232 g vs 146 g, p = 0.01) and volume (595 mL vs 339 mL, p = 0.008) compared to controls. Most lobes followed this trend, except the middle lobe that showed only a higher lung mass (32.9 g vs 19.6 g, p = 0.02) and volume (77.4 vs 46.9, p = 0.005) in patients with NEHI compared to controls.

CONCLUSION: Quantitative CT is a feasible technique in children with a typical pattern for NEHI and is associated with differences in attenuation, ventilation heterogeneity, and lung volume.

DOI

10.1016/j.clinimag.2022.06.004

Alternate Title

Clin Imaging

PMID

35700553

Title

Practice Variation in Use of Neuroimaging Among Infants With Concern for Abuse Treated in Children's Hospitals.

Year of Publication

2022

Number of Pages

e225005

Date Published

2022 Apr 01

ISSN Number

2574-3805

Abstract

<p><strong>Importance: </strong>Infants who appear neurologically well and have fractures concerning for abuse are at increased risk for clinically occult head injuries. Evidence of excess variation in neuroimaging practices when abuse is suspected may indicate opportunity for quality and safety improvement.</p>

<p><strong>Objective: </strong>To quantify neuroimaging practice variation across children's hospitals among infants with fractures evaluated for abuse, with the hypothesis that hospitals would vary substantially in neuroimaging practices. As a secondary objective, factors associated with neuroimaging use were identified, with the hypothesis that age and factors associated with potential biases (ie, payer type and race or ethnicity) would be associated with neuroimaging use.</p>

<p><strong>Design, Setting, and Participants: </strong>This cross-sectional study included infants with a femur or humerus fracture or both undergoing abuse evaluation at 44 select US children's hospitals in the Pediatric Health Information System (PHIS) from January 1, 2016, through March 30, 2020, including emergency department, observational, and inpatient encounters. Included infants were aged younger than 12 months with a femur or humerus fracture or both without overt signs or symptoms of head injury for whom a skeletal survey was performed. To focus on infants at increased risk for clinically occult head injuries, infants with billing codes suggestive of overt neurologic signs or symptoms were excluded. Multivariable logistic regression was used to investigate demographic, clinical, and temporal factors associated with use of neuroimaging. Marginal standardization was used to report adjusted percentages of infants undergoing neuroimaging by hospital and payer type. Data were analyzed from March 2021 through January 2022.</p>

<p><strong>Exposures: </strong>Covariates included age, sex, race and ethnicity, payer type, fracture type, presentation year, and hospital.</p>

<p><strong>Main Outcomes and Measures: </strong>Use of neuroimaging by CT or MRI.</p>

<p><strong>Results: </strong>Of 2585 infants with humerus or femur fracture or both undergoing evaluations for possible child abuse, there were 1408 (54.5%) male infants, 1726 infants (66.8%) who were publicly insured, and 1549 infants (59.9%) who underwent neuroimaging. The median (IQR) age was 6.1 (3.2-8.3) months. There were 748 (28.9%) Black non-Hispanic infants, 426 (16.5%) Hispanic infants, 1148 (44.4%) White non-Hispanic infants. In multivariable analyses, younger age (eg, odds ratio [OR] for ages &lt;3 months vs ages 9 to &lt;12 months, 13.2; 95% CI, 9.54-18.2; P &lt; .001), male sex (OR, 1.47; 95% CI, 1.22-1.78; P &lt; .001), payer type (OR for public vs private insurance, 1.48; 95% CI, 1.18-1.85; P = .003), fracture type (OR for femur and humerus fracture vs isolated femur fracture, 5.36; 95% CI, 2.11-13.6; P = .002), and hospital (adjusted range in use of neuroimaging, 37.4% [95% CI 21.4%-53.5%] to 83.6% [95% CI 69.6%-97.5%]; P &lt; .001) were associated with increased use of neuroimaging, but race and ethnicity were not. Publicly insured infants were more likely to undergo neuroimaging (62.0%; 95% CI, 60.0%-64.1%) than privately insured infants (55.1%; 95% CI, 51.8%-58.4%) (P = .001).</p>

<p><strong>Conclusions and Relevance: </strong>This study found that hospitals varied in neuroimaging practices among infants with concern for abuse. Apparent disparities in practice associated with insurance type suggest opportunities for quality, safety, and equity improvement.</p>

DOI

10.1001/jamanetworkopen.2022.5005

Alternate Title

JAMA Netw Open

PMID

35442455

Title

Normal age-related quantitative CT values in the pediatric lung: from the first breath to adulthood.

Year of Publication

2021

Number of Pages

111-118

Date Published

2021 Jan 04

ISSN Number

1873-4499

Abstract

<p><strong>OBJECTIVE: </strong>To characterize the normal progression of quantitative CT parameters in normal children from birth to adulthood.</p>

<p><strong>MATERIALS AND METHODS: </strong>Patients aged 0-18&nbsp;years with non-contrast-enhanced chest CT and evidence of normal lung parenchyma were included. Patients with respiratory symptoms, incomplete anthropometric measurements, or sub-optimal imaging technique were excluded. Segmentation was performed using an open-source software with an automated threshold segmentation. The following parameters were obtained: mean lung density, kurtosis, skewness, lung volume, and mass. Linear and exponential regression models were calculated with age and height as independent variables. A p-value of &lt;0.05 was considered significant.</p>

<p><strong>RESULTS: </strong>220 patients (111 females, 109 males) were included. Mean age was 9.6&nbsp;±&nbsp;5.9&nbsp;years and mean height was 133.9&nbsp;±&nbsp;35.1&nbsp;cm. Simple linear regression showed a significant relationship between mean lung density with age (R 2&nbsp;=&nbsp;0.70) and height (R 2&nbsp;=&nbsp;0.73). Kurtosis displayed a significant exponential correlation with age (R 2&nbsp;=&nbsp;0.70) and height (R 2&nbsp;=&nbsp;0.71). Skewness showed a significant exponential correlation with age (R 2&nbsp;=&nbsp;0.71) and height (R 2&nbsp;=&nbsp;0.73). Lung mass showed a correlation with age (R 2&nbsp;=&nbsp;0.93) and height (R 2&nbsp;=&nbsp;0.92). Exponential regression showed a significant relationship between lung volume with age (R 2&nbsp;=&nbsp;0.88) and height (R 2&nbsp;=&nbsp;0.93).</p>

<p><strong>CONCLUSION: </strong>Quantitative CT parameters of the lung parenchyma demonstrate changes from birth to adulthood. As children grow, the mean lung density decreases, and the lung parenchyma becomes more homogenous.</p>

DOI

10.1016/j.clinimag.2020.12.021

Alternate Title

Clin Imaging

PMID

33524938

Title

Interpretation of pediatric chest radiographs by non-radiologist clinicians in Botswana using World Health Organization criteria for endpoint pneumonia.

Year of Publication

2020

Number of Pages

913-922

Date Published

2020 Jun

ISSN Number

1432-1998

Abstract

<p><strong>BACKGROUND: </strong>In low- and middle-income countries, chest radiographs are most frequently interpreted by non-radiologist clinicians.</p>

<p><strong>OBJECTIVE: </strong>We examined the reliability of chest radiograph interpretations performed by non-radiologist clinicians in Botswana and conducted an educational intervention aimed at improving chest radiograph interpretation accuracy among non-radiologist clinicians.</p>

<p><strong>MATERIALS AND METHODS: </strong>We recruited non-radiologist clinicians at a referral hospital in Gaborone, Botswana, to interpret de-identified chest radiographs for children with clinical pneumonia. We compared their interpretations with those of two board-certified pediatric radiologists in the United States. We evaluated associations between level of medical training and the accuracy of chest radiograph findings between groups, using logistic regression and kappa statistics. We then developed an in-person training intervention led by a pediatric radiologist. We asked participants to interpret 20 radiographs before and immediately after the intervention, and we compared their responses to those of the facilitating radiologist. For both objectives, our primary outcome was the identification of primary endpoint pneumonia, defined by the World Health Organization as presence of endpoint consolidation or endpoint effusion.</p>

<p><strong>RESULTS: </strong>Twenty-two clinicians interpreted chest radiographs in the primary objective; there were no significant associations between level of training and correct identification of endpoint pneumonia; concordance between respondents and radiologists was moderate (κ=0.43). After the training intervention, participants improved agreement with the facilitating radiologist for endpoint pneumonia from fair to moderate (κ=0.34 to κ=0.49).</p>

<p><strong>CONCLUSION: </strong>Non-radiologist clinicians in Botswana do not consistently identify key chest radiographic findings of pneumonia. A targeted training intervention might improve non-radiologist clinicians' ability to interpret chest radiographs.</p>

DOI

10.1007/s00247-020-04625-0

Alternate Title

Pediatr Radiol

PMID

32524176

Title

Quantitative CT analysis for bronchiolitis obliterans in perinatally HIV-infected adolescents-comparison with controls and lung function data.

Year of Publication

2020

Date Published

2020 Mar 14

ISSN Number

1432-1084

Abstract

<p><strong>OBJECTIVE: </strong>To compare quantitative chest CT parameters in perinatally HIV-infected adolescents with and without bronchiolitis obliterans compared with HIV-uninfected controls and their association with lung function measurements.</p>

<p><strong>MATERIALS AND METHODS: </strong>Seventy-eight (41 girls) HIV-infected adolescents with a mean age of 13.8 ± 1.65&nbsp;years and abnormal pulmonary function tests in the prospective Cape Town Adolescent Antiretroviral Cohort underwent contrast-enhanced chest CT on inspiration and expiration. Sixteen age-, sex-, and height-matched non-infected controls were identified retrospectively. Fifty-one HIV-infected adolescents (28 girls) displayed mosaic attenuation on expiration suggesting bronchiolitis obliterans. Pulmonary function tests were collected. The following parameters were obtained: low- and high-attenuation areas, mean lung density, kurtosis, skewness, ventilation heterogeneity, lung mass, and volume.</p>

<p><strong>RESULTS: </strong>HIV-infected adolescents showed a significantly higher mean lung density, ventilation heterogeneity, mass, and high- and low-attenuation areas compared with non-infected individuals. Kurtosis and skewness were significantly lower as well. HIV-infected adolescents with bronchiolitis obliterans had a significantly lower kurtosis and skewness compared with those without bronchiolitis obliterans. Lung mass and volume showed the strongest correlations with forced expiratory volume in 1&nbsp;s (FEV), forced vital capacity (FVC), and alveolar volume. Low-attenuation areas below -&nbsp;950&nbsp;HU and ventilation heterogeneity showed the strongest correlation with FEV/FVC (range, - 0.51 to - 0.34) and forced expiratory flow between 25 and 75% of FVC (range, - 0.50 to - 0.35).</p>

<p><strong>CONCLUSION: </strong>Quantitative chest CT on inspiration is a feasible technique to differentiate perinatally HIV-infected adolescents with and without bronchiolitis obliterans. Quantitative CT parameters correlate with spirometric measurements of small-airway disease.</p>

<p><strong>KEY POINTS: </strong>• Perinatally HIV-infected adolescents showed a more heterogeneous attenuation of the lung parenchyma with a higher percentage of low- and high-attenuation areas compared with non-infected patients. • Kurtosis and skewness are able to differentiate between HIV-infected adolescents with and without bronchiolitis obliterans using an inspiratory chest CT. • Quantitative CT parameters of the chest correlate significantly with pulmonary function test. Low-attenuation areas and ventilation heterogeneity are particularly associated with spirometric parameters related to airway obstruction.</p>

DOI

10.1007/s00330-020-06789-7

Alternate Title

Eur Radiol

PMID

32172382

Title

Providing Expert Pediatric Teleradiology Services Around the Globe: The World Federation of Pediatric Imaging Experience.

Year of Publication

2019

Date Published

2019 Jul 03

ISSN Number

1558-349X

Abstract

<p>In 2011, the World Federation of Pediatric Imaging (WFPI), a nonpolitical, nondenominational organization operating for nonprofit, educational, scientific, research, and utreach purposes, was launched by the world’s regional pediatric imaging societies. As part of its mission statement, WFPI must help address challenges in the global delivery of pediatric imaging services, including a global shortage of pediatric radiologists. One mechanism to address such challenges is through the provision of teleradiology for low-resources institutions. Teleradiology, in this setting, offers a number of benefits including improved access to specialists and reduced traveling time and costs. Previous research has found that teleradiology services to access specialist advice in lower resource settings, where there is no alternative way of obtaining such expertise, may be useful in providing reassurance for the referrer or patient, in changing the management of the patient, and in clarifying the diagnosis. However, there are obstacles related to the use of teleradiology including difficulty of online access and navigation for users in low-resources setting, timeliness of the interpretations, legal implications of teleradiology readings, and concerns about staffing and overall sustainability because this type of outsourcing might limit the development of local expertise. Despite these challenges, WFPI believes in the value of teleradiology, and after a successful pilot project in South Africa between 2012 and 2013 and the trial of different software interfaces in 2013, a formal web-based platform for consultation and second opinion rendition of pediatric imaging studies was implemented in 2014. This case study describes the adoption and utilization of the teleradiology portal.</p>

DOI

10.1016/j.jacr.2019.06.006

Alternate Title

J Am Coll Radiol

PMID

31278921

Title

Three-dimensional printed models of the rib cage in children with non-accidental injury as an effective visual-aid tool.

Year of Publication

2019

Date Published

2019 Mar 15

ISSN Number

1432-1998

Abstract

<p>Three-dimensional (3-D) printing is gaining terrain in medical education, presurgical evaluation and recently as forensic evidence in court. Physicians, including radiologists, often provide expert testimony in court cases involving children with rib fractures and other injuries concerning for child physical abuse. Effectively communicating the complexities of fractures and other skeletal findings to nonmedical personnel using standard radiology studies can be challenging, especially during medical courtroom testimony. For this reason, we printed two 3-D models of the rib cage from the chest computed tomography (CT) scans of two patients with suspected non-accidental injury. The patients also had available chest radiographs. The DICOM (Digital Imaging and Communications in Medicine) data were 3-D reconstructed and segmented using two attenuation thresholds. We removed unwanted structures and printed them on a commercially available scanner. A pediatric radiologist, blinded to clinical data, reviewed both 3-D models, identified all rib lesions and classified them according to their healing stage. We compared the 3-D models and the chest radiograph against the chest CT as the standard of care. We convened a meeting with the Child Protection Team at out institution to get their feedback and opinions about the models. From our observations of our experts, three spontaneous interactions were observed. Instinctively, the experts picked up and grasped the models, rotating them, feeling them and angling them to better visualize the fractures from multiple angles. The experts expressed a willingness to consider using the models in court.</p>

DOI

10.1007/s00247-019-04368-7

Alternate Title

Pediatr Radiol

PMID

30877337

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