Rapid lung MRI in children with pulmonary infections: Time to change our diagnostic algorithms

Sodhi, Kushaljit Singh; Khandelwal, Niranjan; Saxena, Akshay Kumar; Singh, Meenu; Agarwal, Ritesh; Bhatia, Anmol; Lee, Edward Y.

doi:10.1002/jmri.25082

Cited by 87 publications

(63 citation statements)

References 35 publications

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“…Only three studies have compared MRI for the detection of lung consolidation against computed tomography as the gold standard (table 2). [64][65][66][67][68][69][70][71] Other studies have compared MRI findings with chest radiography; however, these studies provide weak evidence because chest radiography is considered an inadequate gold standard (table 2).…”

Section: Advances In Radiological Diagnosismentioning

confidence: 99%

Advances in the diagnosis of pneumonia in children

Zar

Andronikou

Nicol

2017

BMJ

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Pneumonia remains a major cause of childhood mortality and morbidity globally. Accurate diagnosis and attribution of the causes of pneumonia are important for measuring the burden of disease, implementing appropriate preventive or treatment strategies, and developing more effective interventions. This review summarizes recent diagnostic advances in radiological techniques, specimen collection, and laboratory methods. Although chest ultrasound and chest magnetic resonance imaging are promising modalities for radiological diagnosis, their role in clinical management and their impact on outcomes need further study. Rapid, highly sensitive, multiplex laboratory tests performed on upper respiratory tract samples or induced sputum can detect nucleic acid from potential pathogens in most children with pneumonia. However, it may be difficult to attribute causality because it is often impossible to distinguish between organisms colonizing or infecting the upper respiratory tract and those causing pneumonia. Currently available host biomarkers lack accuracy for distinguishing bacterial or mixed bacterial-viral infections from viral infections. New biomarkers derived from host transcriptional profile analysis may be more accurate but require validation. Prospective studies with appropriate control populations, including studies of clinical impact, are needed to improve our understanding of the role of tests. Although progress has been made in radiological techniques and laboratory testing, current methods for diagnosing and attributing the causes of pneumonia are suboptimal.

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Section: Advances In Radiological Diagnosismentioning

confidence: 99%

Advances in the diagnosis of pneumonia in children

Zar

Andronikou

Nicol

2017

BMJ

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“…Ultrasound and magnetic resonance imaging (MRI) are the imaging modalities that do not involve any ionizing radiation and, hence, are safe to use in children [5][6][7][8][9][10]. NASH is conventionally diagnosed with the help of classical USG liver findings along with elevated serum levels of alanine aminotransferase (ALT) [1].…”

Section: Introductionmentioning

confidence: 99%

Liver acoustic radiation force impulse (ARFI) in childhood obesity: comparison and correlation with biochemical markers

et al. 2016

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Purpose To compare and correlate the diagnostic efficiency of acoustic radiation force impulse (ARFI) elastography with biochemical markers for assessing hepatic changes in overweight and obese children. Methods This prospective study was approved by the institutional ethics committee. It included 54 overweight and obese children and 50 normal children (as a control group) in the age range 5-18 years. For all children, we performed grayscale ultrasonography to diagnose fatty liver, ARFI elastography to measure liver stiffness, and biochemical evaluation for aspartate aminotransferase (AST), alanine aminotransferase (ALT), and serum triglyceride (TG) levels. Results Of the 54 obese children, AST was elevated in 13 (24.1%) and ALT was elevated in 16 (29.6%); however, only 4 (25%) of these 16 obese children with abnormal aminotransferase levels had an AST/ALT ratio [0.8. Furthermore, all children with abnormal aminotransferase levels with AST/ALT ratio [0.8 also had abnormal readings of ARFI elastography. The TG was elevated ([150 mg/dL) in 2 out of 54 (3.7%) obese children. None of the normal children showed abnormal levels of aminotransferase and TG. Three out of 54 (5.6%) obese children did not show fatty liver changes, while 29 (53.7%) showed grade-I fatty liver changes, and 22 (40.7%) showed grade-II fatty liver changes. The mean (SD) ARFI value was 1.13 m/s (SD 0.199) for obese children and 1.02 m/s (SD 0.11) for children in the control group. Of the 54 obese children, 49 (90.7%) showed ARFI values of \1.19 m/s (normal), 4 (7.4%) had ARFI values from [1.19 to \1.75 m/s, and 1 (1.9%) had an ARFI value [1.75 m/s. Four children with an increased ARFI value also had an AST/ALT ratio [0.8. However, one obese child with a raised ARFI value did not have an elevated AST/ALT ratio, and none of his aminotransferase levels were abnormal. All normal children had ARFI values\1.19 m/s. Conclusion ARFI elastography shows excellent correlation with AST/ALT ratios in obese children and may be used as a noninvasive tool to detect nonalcoholic fatty liver disease (NAFLD) and associated hepatic changes, especially in pediatric patients, for whom liver biopsy is not always feasible.Keywords Children Á Obesity Á Liver Á Elastography Sommario Scopo Confrontare e correlare l'efficienza diagnostica di Acoustic Radiation forza d'impulso (ARFI) elastografia con marcatori biochimici nella valutazione delle alterazioni epatiche nei bambini in sovrappeso e obesi. Metodi Questo studio prospettico è stato approvato dal comitato etico istituzionale. 54 bambini in sovrappeso e obesi e 50 bambini normali (controlli) della fascia di età 5-18 years sono stati inclusi. In tutti i bambini, abbiamo eseguito l'ecografia in scala di grigi per la diagnosi di fegato grasso, ARFI elastografia per misurare la rigidità del fegato, e la valutazione biochimica per aspartato aminotransferasi (AST), alanina aminotransferasi (ALT) e livelli di trigliceridi nel siero (TG). Conclusione ARFI elastography mostra un'eccellente correlazione con il rapporto A...

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“…In our study, thoracic MRI was found accurate in detecting hilar and mediastinal LAPs, cardiac findings, moderate to severe chronic interstisitial parenchymal changes except mild ground glass opacity, bronchiectasis, subpleural‐intraparenchymal cysts, and nodules smaller than 3 mm in one case with stage 4 sarcoidosis. Due to low signal intensity those subtle parenchymal findings may not be demonstrated well which is considered as a failure of MRI in the literature . However, this condition should not rule out the clinical importance of MRI for routine follow‐up or monitoring of disease progression.…”

Section: Discussionmentioning

confidence: 99%

“…Due to low signal intensity those subtle parenchymal findings may not be demonstrated well which is considered as a failure of MRI in the literature. 10,12,18 However, this condition should not rule out the clinical importance of MRI for routine follow-up or monitoring of disease progression. Based on our results, thoracic MRI might be more likely to be used in late stages.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7] The diagnostic utility of lung MRI in various thoracic disorders of pediatric patients is reported recently in the literature, however, to our knowledge there has been no study to investigate pediatric sarcoidosis with contrast-enhanced lung MRI with fast imaging sequences. [8][9][10][11][12][13][14] Our purpose is to evaluate thoracic findings of pediatric pulmonary sarcoidosis on MRI and to compare them with CT findings.…”

Section: Introductionmentioning

confidence: 99%

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