1,720,983 research outputs found
OPTIMIZING THE RADIOLOGICAL APPROACH TO CHILDREN WITH SOFT TISSUE SARCOMA AND OTHER SOLID TUMORS.
Full text linkPediatric solid tumors are among the leading causes of malignancies in children, and optimizing radiological approaches is critical for diagnosis and treatment. Current international guidelines attempt to standardize imaging protocols based on factors such as age, tumor size, and cancer type, but gaps remain in defining the roles of various imaging techniques.
This thesis investigated the potential role of different radiological techniques, aiming to define new approaches. One of the goals was to assess the diagnostic accuracy of three magnetic resonance (MR) imaging sequences—Turbo Inversion Recovery Magnitude (TIRM), inverted TIRM (iTIRM), and T1-weighted Controlled Aliasing in Parallel Imaging Results in Higher Acceleration (CAIPIRINHA) DIXON with water contrast—for detecting lung metastases in children with sarcoma undergoing 18F-FDG-PET/MR for staging. TIRM demonstrated the highest sensitivity for identifying lung metastases, while iTIRM and T1w sequences exhibited higher specificity. MR imaging appears to offer strong diagnostic performance in assessing pulmonary metastases, providing a radiation-free alternative to computed tomography (CT).
In cases of Wilms tumor, the most common pediatric renal cancer, pulmonary relapse occurs in approximately 15% of cases, often months or years after treatment. Due to the limited number of recurrences, understanding the patterns of lung relapse remains challenging. The study aimed to evaluate whether pulmonary relapses detected by CT occurred at the site of the initial metastasis or in a different location. Our findings revealed a high probability of lung relapse occurring at the same site as the initial metastasis.
The PhD project also focused on clarifying the role of bone erosion (BE) as a risk factor in children with orbital rhabdomyosarcoma (RMS) included in the European Pediatric Soft Tissue Sarcoma Study Group (EpSSG) protocol. Patients with extensive BE showed worse outcomes, requiring more aggressive treatment, similar to those with parameningeal RMS.
For metastatic RMS, this study investigated the outcomes of patients with distant lymph node involvement as the only metastatic site. These patients showed better outcomes than those with other metastatic patterns, with particularly favorable results in fusion-negative cases.
In cases of olfactory neuroblastoma (ON) and NUT carcinoma (NC), both rare in pediatric populations, this research highlighted the need for harmonized international guidelines to improve diagnostic and treatment protocols.
Finally, radiomic analysis of pediatric soft tissue sarcomas using axial T2w PET/MR images revealed specific features that could serve as biomarkers for tumor grade and histotype, potentially aiding in more precise diagnostic and prognostic assessments. These findings underscore the importance of refining imaging techniques and protocols to improve outcomes in pediatric oncology
The Omental Cake Sign in Pediatric Tuberculosis
Full text linkUltrasound and computed tomography (CT) images showing ascites and omental infiltration (omental cake sign) in a 12-year-old girl with abdominal pain and fever for two weeks. The presence of abdominal and mediastinal lymphadenopathy as well as of a pulmonary consolidation at CT suggested a diagnosis of tuberculosis which was then clinically confirmed. After treatment with ethambutol, rifampicin and isoniazid, pyrazinamide, and vitamin B6 (i.e., intensive treatment for two months followed by a continuation phase with two drugs regimen for four months) the patient fully recovered. Abdominal involvement is rare in children with tuberculosis but the presence of omental involvement together with ascites and enlarged lymph nodes at imaging may suggest this diagnosis and guide the clinicians to proper testing
Neonatal cerebral ultrasound: anatomical variants and age-related diseases
Full text link: Cerebral ultrasound is a non-invasive imaging technique widely used for the assessment of brain anatomy and diseases in neonates and infants. Indeed, it allows a precise characterization of common variants such as cavum septum pellucidum or diseases like intraventricular hemorrhage. The aim of this pictorial review is to provide a comprehensive overview of the main ultrasound features of the most common cerebral anatomical variants and disorders detectable by cerebral ultrasound using an age-related approach which could support non-subspecialized radiologists
Pediatric congenital pulmonary malformations: key findings at imaging
Full text linkPediatric congenital pulmonary malformations are rare abnormalities which may affect airways, pulmonary parenchyma, and vasculature and diagnostic imaging plays a significant role in their identification and characterization. Although, nowadays, often the diagnosis of this heterogeneous group of malformations is performed prenatally by ultrasound and/or fetal magnetic resonance, after birth, computed tomography represents the main technique. Radiographs are often used as first line diagnostic tool while magnetic resonance demonstrated to be especially beneficial to investigate some malformations such as bronchogenic cysts. Therefore, radiologists should be aware of the main features associated with such alterations to guarantee a prompt diagnosis and, if necessary, guide towards the optimal treatment. Aim of this pictorial review is to provide a comprehensive overview of the typical features of congenital pulmonary malformations at imaging supporting general and pediatric radiologists in the diagnostic process
Lung relapse pattern in children with metastatic Wilms tumor
No full textWilms tumor is the most common pediatric renal cancer, and lungs represent the major site of metastasis and recurrence. Relapse occurs in 15%, months or years after treatment; so due to the small sample, acquiring more data about the pattern of lung relapse remains a challenge. The aim of our study was to evaluate if pulmonary relapse, detected by computed tomography (CT), occurred at the initial site of lung metastases or in a different location. According to our data, the CT pattern of lung relapse showed high probability of recurrence at the same site of initial metastasis
Automatic assessment of body composition in children with lymphoma: results of a [18F]FDG-PET/MR study
Full text linkObjectivesTo use Dixon-MR images extracted from [18F]FDG-PET/MR scans to perform an automatic, volumetric segmentation and quantification of body composition in pediatric patients with lymphoma. Materials and methodsPediatric patients with lymphoma examined by [F-18]FDG-PET/MR at diagnosis and restaging were included. At each time point, axial fat and water Dixon T1w images of the thighs were automatically segmented and muscle volume, subcutaneous, intramuscular, and intermuscular fat volume were quantified. The metabolic activity of the largest nodal lesion and of muscles and subcutaneous fat was recorded. The paired samples t-test and Spearman's correlation coefficient were applied to evaluate potential differences between the two time points and the relationship between metabolic and body composition metrics, respectively. By logistic regression analysis, the prognostic role of the investigated variables was assessed. The applied significance level was p < 0.05 for all analyses. ResultsThirty-seven patients (mean age +/- SD 14 +/- 3-years-old; 20 females) matched the inclusion criteria. After chemotherapy (interval between the two PET/MR scans, 56-80 days; median 65 days), muscle volume significantly decreased (629 +/- 259 cm3 vs 567 +/- 243 cm(3), p < 0.001) while subcutaneous, intramuscular and intermuscular fat increased (476 +/- 255 cm(3) vs 607 +/- 254 cm(3), p < 0.001; 63 +/- 20 cm(3) vs 76 +/- 26 cm(3), p < 0.001; 58 +/- 19 cm(3) vs 71 +/- 23 cm(3), p < 0.001); the metabolic activity of the main nodal lesion, muscles, and subcutaneous fat significantly decreased (p < 0.05, each). None of the examined variables acted as predictors of the response to treatment (p = 0.283). A strong correlation between BMI and subcutaneous fat volume at diagnosis (r = 0.675, p < 0.001) and restaging (r = 0.600, p < 0.001) emerged. ConclusionsThe proposed method demonstrated that pediatric patients with lymphoma undergo muscle loss and an increase of subcutaneous fat during treatment. Clinical relevance statementThe proposed automatic and volumetric MR-based assessment of body composition in children with lymphoma can be used to monitor the effect of chemotherapy and may guide tailored exercise programs during chemotherapy. Key Points..
Mediastinal Germ-cell Tumors Relapse in a Male With Klinefelter Syndrome. Is Longer Surveillance Needed?
Full text linkGerm cell tumors (GCTs) are a heterogeneous group of pediatric cancers. In up to one-third of male patients, a primary mediastinal location is associated with the presence of Klinefelter syndrome (KS). We describe a case of mediastinal GCT in a patient, with unacknowledged KS, that presented a relapse 7 years from diagnosis, that is, 2 years after the end of the follow-up program usually recommended for patients with GCT. There are no recommendations for screening for KS in patients with mediastinal GCT and there are no specific guidelines for surveillance of GCT in KS patients. Our experience suggests that KS should be suspected in patients with mediastinal GCT, and a longer follow-up plan should be implemented when GCT occurs in patients with KS
Assessment of Lung Nodules in Children With Pediatric Sarcoma Undergoing [18F]-FDG-PET/MR for Staging
Full text linkBone and soft tissue pediatric sarcomas metastasize to the lungs, and computed tomography (CT) represents the diagnostic gold standard. We aimed to investigate the diagnostic accuracy of turbo inversion recovery magnitude (TIRM), inverted TIRM (inverted turbo inversion recovery magnitude [iTIRM]), and T1-weighted (T1w) controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA) DIXON with water contrast for the diagnosis of lung metastases in children who underwent 18F-fluorydexoxyglucose-positron emission tomography/magnetic resonance ([18F]-FDG-PET/MR) for staging. TIRM showed the highest sensitivity (84.62%), whereas iTIRM and T1w had higher specificity (89.13% and 100%, respectively). Magnetic resonance imaging provides a good diagnostic performance for pulmonary metastases in children with sarcomas using both fluid sensitive and T1w sequences
Entrapment within an ottoman storage bed: an unusual accidental asphyxial death
Full text linkHerein, we present an uncommon forensic case of death by asphyxia. The victim was a woman whose body at death scene investigation (DSI) was discovered beside an ottoman storage bed. According to the rescue team, who had moved the body before our arrival, the body was originally found in the prone position and stuck with the neck, thorax and arms within the bed. Examination of the body showed hypostasis that was mainly distributed to the face and the lower chest while sparing the neck and the upper chest. The face was markedly swollen, and the eyes were congested with blood. Dissection and histology revealed pulmonary oedema and emphysema of both lungs. Integrating circumstantial, radiology and autopsy data, it was established that the victim, while trapped between the mattress and the edge of the ottoman storage bed, died by mechanical asphyxia due to cervical-thoracic compression and postural asphyxia acting simultaneously
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