PURPOSE:By retrospectively studying the chest computed tomography (CT) data of children with bronchial artery (BA)-pulmonary artery fistula, this study summarizes the characteristic imaging features of the disease and provides imaging support for the diagnosis and clinical treatment of these children. METHODS:Digital subtraction angiography and CT angiography data were collected from 74 children with pulmonary hemorrhage following BA embolization. Bronchial-pulmonary shunt was present in 30 cases. RESULTS:Of the 74 children with pulmonary hemorrhage in this study, seven exhibited signs of consolidation in the middle lobe of the right lung, and bronchial-pulmonary shunt existed in all of them. A total of 30 children with BA-pulmonary artery shunt (PAS) had BA tortuosity and thickening. Regarding primary BA-PAS, the middle lobe and lower lobe of the right lung were involved in 94.1% (16) of the children. Those with a fistula located in the middle lobe of the right lung accounted for 58.8% (10 cases), of which 40.0% (four cases) presented consolidation. In this study, 41.2% (seven) of the children with primary BA-PAS exhibited no abnormal changes on chest CT, and 58.8% (10 cases) exhibited abnormal changes in the unilateral lung. CONCLUSION:For children with pulmonary hemorrhage who have consolidation in the right middle lobe, the formation of BA-PAS should be anticipated. The possibility of primary BA-PAS should not be disregarded in children with pulmonary hemorrhage with tortuosity and dilation of BAs, despite no apparent abnormalities on lung CT, or ground-glass density or consolidation on only one side. CLINICAL SIGNIFICANCE:The chest CT of patients with pulmonary hemorrhage showed consolidation of the right middle lobe of the lung, which was highly likely to indicate BA-PAS.

Objective:The glymphatic system, a glial cell-dependent waste clearance pathway in the brain, is essential for the maintenance of brain homeostasis. This study aimed to explore the relationship between attention-deficit/hyperactivity disorder (ADHD) and its co-occurring clinical phenomena, including gross motor and language development, and the glymphatic system. Methods:A total of 56 children with ADHD and 33 age-and gender-matched typically developing (TD) children were included in this prospective study. Diffusion tensor image analysis along the perivascular space (DTI-ALPS) was used to calculate the ALPS index, which evaluates glymphatic system function. The ALPS index of ADHD patients was compared with that of TD, and the correlation between the gross motor retardation and speech and language delay in ADHD patients and ALPS index was further analyzed. Results:The ALPS index in ADHD patients was significantly lower than that in TD children (1.503 ± 0.153 vs. 1.591 ± 0.152, p < 0.05). After adjusting for age and sex, the ALPS index was negatively correlated with speech and language delay in ADHD patients (r = -0.329, p = 0.015). However, no significant correlation was found between the ALPS index and gross motor retardation in ADHD patients. Conclusion:Glymphatic system function may be impaired in ADHD patients. This study is the first to demonstrate that speech and language delay in ADHD patients may be associated with impaired glymphatic system function. Early intervention may be linked to better language trajectories in ADHD, providing a rationale for longitudinal trials to test causality.

Aim: To assesses the severity and prognosis of pediatric acute respiratory distress syndrome (PARDS) based on a chest radiograph (CXR) scoring method. Methods: 116 PARDS and 463 CXRs were selected. General demographics, pulmonary complications, and 28‐day mortality of the patients were recorded. Subgroup divided by prognosis (survive, death) and etiology (infection, non-infection). CXR scores were calculated for each of the four quadrants by infiltration extent (0-4) and density (1-3). The ROC curve and survival curve were established, the cut-off score for predicting prognosis was set. Results: The agreement between two independent observers was excellent (ICC=0.98, 95%CI:0.97-0.99). The hospital length of stay of death group was shorter than survive group, whereas the percentage of pulmonary complication of death group were significantly higher than survival group (all p<0.05). Day 3 score was independently associated with better survival (p<0.001). The aera under the curve of ROC was 0.773 (95%CI:0.709-0.838). The cut-off score was 21 (sensitivity 71.7%, specificity 76.5%), OR was 9.268 (95%CI: 1.257-68.320). The pulmonary complication showed an OR of 3.678 (95%CI: 1.174-11.521) for the prediction. Conclusions: CXR score can be used in PARDS for predicting prognosis and has a great agreement among radiologist and pediatrician. Pulmonary complication, Day 3 score whether greater than 21 points have a strong predictive effectiveness.

目的 基于临床和CT血管造影(CTA)特征分析儿童多发性大动脉炎(TA)并发心功能不全(CD)的危险因素.方法 回顾性分析39例T A患儿,男9例、女30例,年龄1个月～15岁、中位年龄8岁.39例中,7例伴CD(CD组),均为女性,年龄2～15岁、中位年龄13岁;32例无CD(无CD组),男9例、女23例,年龄1个月～14岁、中位年龄7岁;对比分析2组患儿性别、年龄及主动脉受累部位等.结果 2组患儿年龄分布范围差异有统计学意义(P<0.05).高血压、升主动脉受累是TA患儿伴发CD的独立危险因素(P均<0.05),高血压及升主动脉受累TA患儿发生CD的概率分别为非高血压及无升主动脉受累者的14.493和13.889倍.结论 高血压及升主动脉受累均为T A患儿伴发CD的独立危险因素,应积极予以干预.

Objective:To investigate the differences between Tanner-Whitehouse (TW)3-Carpal and TW3-RUS(radius, ulna and short bone)-based artificial intelligence (AI)-assisted bone age assessment system using real world data.Methods:The image data of 262 children who received X-ray examination of left wrist in the Affiliated Children′s Hospital, Capital Institute of Pediatrics from July to September 2021 were retrospectively collected. The AI bone age assistant methods based on TW3-RUS and TW3-Carpal criteria were used to obtain the bone age results, respectively. Two senior pediatric radiologists evaluated the bone age on the basis of TW3-RUS and TW3-Carpal criteria, and the averaged values of two reviewers was calculated and taken as the gold standard reference. The cases were stratified into six age groups at 3-year intervals according to the gold standard reference, including 1-3 ( n=10), 4-6 ( n=35), 7-9 ( n=70), 10-12 ( n=118), 13-15 ( n=27) and 16-18 ( n=2) years old groups. Intraclass correlation coefficient (ICC) was used to evaluate the consistency between AI results and the gold standard bone age results. Pearson correlation method was used to measure the reliability between AI results and the gold standard results. The difference of bone age results between using TW3-RUS and TW3-Carpal criteria in different age groups was compared using paired t-test. Results:As for the whole sample, the results based on TW3-RUS criteria were 8.9±3.1 years old for AI assessment and 8.7±2.9 years old for the golden standard reference, with the ICC of 0.983; and the results based on TW3-Carpal criteria were 8.7±3.0 years old for AI and 8.8±2.8 years old for the golden standard reference, with the ICC of 0.976. Positive correlation were found in both TW3-RUS ( r=0.985, P<0.001) and TW3-Carpal criteria groups ( r=0.978, P<0.001). There were significant differences between TW3-RUS and TW3-Carpal at age groups of 7-9( t=-3.36, P=0.001), 10-12( t=-1.77, P=0.046), and 13-15 years old ( t=1.84, P=0.040). The bone age assessment using TW3-RUS and TW3-Carpal criteria were both in good agreement with the gold standard reference in age group of 4-6 years old (ICC=0.929 and 0.940), as well as in age group of 7-9 years old (ICC=0.882 and 0.927, respectively), with the results using TW3-Carpal criteria were slightly higher. As for the age groups of 10-12 and 13-15 years old, the method using TW3-RUS criteria showed excellent agreement with the gold standard reference (ICC=0.962 and 0.963, respectively), which were better than the performance of method using TW3-Carpal criteria (ICC=0.744 and 0.605, respectively). Conclusions:AI-assisted bone age system based TW3-Carpal and TW3-RUS criteria both show good reliability and accuracy in the bone age measurements. The AI method based TW3-Carpal criteria shows better performance in age group of 4-9 years old, while the method based on TW3-RUS criteria may be better for children of age 10-15 years old.

Background: Quantification of vertebral arteries can provide insights into basilar curvature and plaque. Therefore, this retrospective study aimed at identifying the dominant vertebral artery (VA) causing basilar artery (BA) curvature and to further quantify the effect of dominant VA angle on BA curvature and BA plaque using high-resolution magnetic resonance imaging (HRMRI) and 3-dimensional time-of-flight magnetic resonance angiography (3D-TOF-MRA). Methods: This retrospective analysis included 521 participants who underwent HRMRI in the China-Japan Friendship Hospital from November 2015 to October 2021 for neurological symptoms or signs. The VA angle more related to BA curvature was defined as the dominant VA angle. Multivariable linear regression analysis was used to evaluate the relationship between the dominant VA angle and mid-BA angle, while multivariable logistics regression was used to evaluate the influence of the dominant VA angle and clinical risk factors on BA plaque. Results: In total, 259 participants were included in this study (mean age 53.71±13.12 years; 146 males). The balanced-type participants had a significantly lower probability of BA plaques (P<0.001). The Chi-squared test showed that the BA curvature direction was significantly associated with the side with larger VA diameter (P<0.001) and larger VA angle (P<0.001). As a result, the VA angle on the side with the larger diameter or the larger VA angle when the diameters were similar was considered to be the dominant VA angle. The dominant VA angle was independently correlated with the mid-BA angle (P<0.001). In addition, the dominant VA angle was also an independent risk factor for BA plaque. Additionally, 80° was the cutoff value of the dominant VA angle, and when the dominant VA angle was greater than 80°, the risk of BA plaque increased about 18-fold [odds ratio, 18.951; 95% confidence interval (CI): 4.545–79.026; P<0.001]. Conclusions: The dominant VA angle was independently associated with BA plaque, and a dominant VA angle greater than 80° may be a marker for a high risk of posterior circulation atherosclerosis.

Background. There is no radiological measurement to estimate the severity of pediatrics juvenile dermatomyositis (JDM) with interstitial lung disease (ILD). We validated the effectiveness of CT scoring assessment in JDM patients with ILD. Aim. To establish a CT scoring system and calculate CT scores in JDM patients with ILD and to determine its reliability and the correlation with Krebs von den Lungen-6 (KL-6). Methods. The study totally enrolled 46 JDM-ILD patients and 16 JDM without ILD (non-ILD, NILD) patients. The chest CT images (7.0 ± 3.6 years; 32 male and 30 female) were all analyzed. CT scores of six lung zones were retrospectively calculated, included image pattern score and distribution range score. Image pattern score was defined as follows: increased broncho-vascular bundle (1 point); ground glass opacity (GGO) (2 points); consolidation (3 points); GGO with bronchiectasis (4 points); consolidation with bronchiectasis (5 points); and honeycomb lung (6 points). Distribution range score was defined as no infiltrate (0 point); <30% (1 point); 30%–60% (2 points); and ≥60% (3 points). Two pediatric radiologists reviewed all CT images independently. The ROC curve was established, and the optimal cutoff score for severity discrimination was set. Results. The agreement between two observers was excellent, and the ICC was 0.930 (95% CI 0.882–0.959, p<0.01). CT score and KL-6 level had a positive linear correlation (r = 0.784, p<0.01). However, the correlation between CT scores of different lung zone and KL-6 level was different. The KL-6 cut off level suggested for JDM with ILD was 209.0 U/ml, with 73.9% sensitivity and 87.5% specificity, and the area under curve was (AUC) 0.864 (p<0.01). Conclusion. The CT scoring system we established, as a semiquantitative method, can effectively evaluate ILD in JDM-PM patients and provide reliable evidence for treatment.

Objective:To investigate imaging features and clinical diagnostic value of pyogenic sacroiliitis (PS) in children.Methods:A total of 7 children with PS admitted to Children′s Hospital, Captial Institute of Pediatrics from January 2016 to June 2021 were selected into this study. The clinical data, X-ray images result of sacroiliac joint, CT and MRI findings of these 7 PS children were analyzed retrospectively. The study was conducted in accordance with World Medical Association Declaration of Helsinki revised in 2013. Informed consent was obtained from each participate′ guardian.Results:① These 7 PS children aged from 6 to 14 years old, including 4 boys and 3 girls, were involved in unilateral PS. ②Only one case (children No.1) had an abnormality suggested by X-ray orthopantomogram of the coarse articular surface of iliac crest. ② CT images showed sacroiliac joint space narrowing in 2 cases (children No.1, 7) and articular surface destruction in 6 cases (children No.1-3, 5-7), 5 (children No. 1-3, 5, 6) of which were located in ilium surface. Euphotic zone under articular surface of iliac was seen in 3 cases (children No.1, 2, 5). In 3 cases (children No. 1, 2, 7), there was soft tissue swelling around sacroiliac joint. One (child No.2) of the 2 cases (children No.1, 2 ) performed enhanced CT showed abscess formation. ④The results of MRI showed that no definite sacroiliac joint stenosis was found in 7 children, and high signal shadow of fat-suppression protein density weighted imaging(FS PDWI) in sacroiliac joint space were seen in 6 children (children No.2-7), and 5 cases (children No.1, 2, 5-7) showed articular surface of sacroiliac joint destruction. Among 6 children (children No.1, 2, 4-7) with bone marrow involvement in bilateral articular surfaces of sacroiliac joint, only one child (child No.7) was located on sacrum side, and the rest were located on ilium side. Soft tissue of sacroiliac joint abscess occurred in 4 cases (children No.2, 5-7). FS PDWI of MRI showed that there was a round-like high signal focus in the diffuse high signal area, with clear edge and partial wall structure. After enhancement, annular enhancement of MRI could be seen in T1WI images, and 4 cases (children No.1, 2, 5, 6) showed signs of lymph node enlargement around sacroiliac joint.Conclusions:The clinical signs of PS in children lack of specificity and can be easily misdiagnosed. MRI has high sensitivity and specificity to auxiliary diagnosis of PS, it can fully evaluate sacroiliac joint inflammation, bone marrow edema under the sacroiliac joint and soft tissue swelling of sacroiliac. It has high detection rate of abscess and it′s the first choice for early diagnosis of this disease, which is better than X-ray and CT. CT can show the bone changes in progressive stage of lesions clearly (including articular surface bone destruction and joint space stenosis), which is helpful to judge prognosis of children, and is an important complementary imaging method for MRI examination.

目的 探讨调整胸片后处理参数在婴幼儿经外周置入中心静脉导管(peripherally inserted central venous catheter,PICC)术后导管末端定位中的应用效果.方法 选取2021年5月1日 至9月30日首都儿科研究所附属儿童医院住院接受PICC置管术的婴幼儿50例,床旁常规拍摄胸部正位片(A组)进行管位判定,同时参照胸椎图像后处理模式,再次生成近似胸椎正位片图像(B组).由低年资放射科和儿科医师分别对两组图像PICC术后导管末端位置显示情况进行客观评分.对两位观察者进行组内相关系数(intra-class correlation coefficient,ICC)评价.结果 两位观察者的一致性好(ICC=0.77,95％CI:0.60～0.89).两位观察者对A组的评分为(1.74±0.90)分和(1.72±0.84)分;对B组的评分为(2.70±0.51)分和(2.76±0.48)分,B组评分均高于A组,差异有统计学意义(P＜0.001),B组图像可以更清晰地显示PICC术后导管末端位置.结论 调整胸部正位片后处理参数模式,利用胸椎图像判断婴幼儿PICC术后导管末端位置效果佳,尤其对于低年资医师具有较大的帮助.

Bone marrow edema (BME) is one of the main imaging characteristics of juvenile idiopathic arthritis (JIA) in children and rheumatoid arthritis (RA) in adult. Previous studies have shown that BME occurred in approximately 64% of adults with RA and was a key predictor of poor prognosis. But BME with JIA has not been of great concern. Therefore, we evaluated the prevalence, characteristics, and prognosis of knee joint BME in children with JIA. In this retrospective study, we included children with JIA and knee joint involvement from January 2017 to December 2019. BME was evaluated according to the Juvenile Arthritis MRI Scoring system. Clinical characteristics were compared between the BME group and the non-BME group. The characteristics and prognosis of the BME were observed. A total of 128 children with 136 knee joint MRI data were identified, with 37 knee joints (27.2%) having BME. BME has positive correlation with synovial hypertrophy (Rs = 0.562, p = 0.019). There were significant differences in age (p = 0.010) and disease duration (p = 0.013) between the BME and non-BME groups. BME was found to be more common in older children and the patients with long duration of disease. Locations with BME were the lateral tibial plateau (17/37, 45.9%), the lateral weight-bearing femur (16/37, 43.2%), the medial tibial plateau and the medial femoral condyle (both with 15/37, 40.5%), and the medial weight-bearing femur (12/37, 32.4%). The lateral femoral condyle and both the lateral and medial sides of the patella were rarely involved. Of the 15 BME joints with the MRI follow-up data (interval 6.5 ± 3.0 months), the lesions disappeared or improved within 12 months after the treatments in 13 (86.7%) joints. The prevalence of knee BME in JIA was 27.2%. There was positive correlation between BME and synovial hypertrophy. Older children and children with long disease duration had a higher risk for BME, which was commonly a late presentation and more likely involved the weight-bearing surfaces of the joint. The overall prognosis was satisfactory after the standard treatments.

OBJECTIVE:The thyroid gland normally presents as a hyperdense organ on noncontrast computed tomography (CT) in adults. The correlation between thyroid gland CT density and its functional status has been studied; however, little is known regarding its density in children with normal thyroid functions. We aimed to assess the correlation between thyroid gland CT density and age in children with normal thyroid functions.METHODS:From April 2017 to March 2021, we enrolled 74 patients who had normal thyroid functions within 1 month before or after undergoing neck or cervical spine CT for trauma, neck masses, congenital diseases, and airway stenosis. Their CT images were retrospectively analyzed by 2 independent radiologists. Based on age, patients were divided into 4 groups: infant, preschool-aged, school-aged, and adolescence groups.RESULTS:Patients with thyroid gland hypodensity in the infant group (70%, 14 of 20) were significantly more numerous than those in preschool-aged (25%, 4 of 16), school-aged (20%, 5 of 25), and adolescence (15.4%, 2 of 13) groups (P = 0.007, 0.001, and 0.002, respectively, Fisher exact test). The mean CT density of the thyroid gland was also lower in the infant group compared with the densities in other age groups. There was a weak positive correlation between thyroid CT density and age (r = 0.264, P = 0.023, linear regression analysis).CONCLUSIONS:Thyroid CT density is related to age in children. The thyroid gland normally has a low density on noncontrast CT in most infants with normal thyroid function.

Objective:To investigate the prevalence, distribution, and prognosis of knee joint bone marrow edema (BME) in children with juvenile idiopathic arthritis (JIA).Methods:From January 2017 to December 2019, 128 JIA children in the Children′s Hospital, Capital Institute of Pediatrics were analyzed retrospectively, and 136 knees were included totally. BME was evaluated and counted from eight regions according to the juvenile arthritis MRI scoring system (JAMRIS). Chi-square test, independent sample t test or Mann-Whitney U test were used to compare the clinical characteristics between BME group (36 cases) and non-BME group (92 cases). The prognosis of BME were observed. Results:BME was found in 37 of 136 knee joints (27.2%). The ages of the children in BME group and non-BME were (8±4) and (6±4) years old, and the disease duration were 9 (3, 22) and 4 (2, 18) months, respectively, both with statistically significant differences (age: t=-2.63, P=0.010; duration: Z=-5.78, P=0.013). In 23 joints (62.2%,23/37), BME occurred at multiple locations simultaneously in the knee. Locations with BME, according to the frequency of involvement from most to least, were the lateral tibial plateau with 17, the lateral weight-bearing femur with 16, the medial tibial plateau and the medial femoral condyle both with 15, the medial weight-bearing femur with 12, the lateral femoral condyle with 8, the lateral patella with 7, and the medial patella with 5. The MRI score of most of medial femoral conclyle was 1(7/15). Of the 15 BME joints with the MRI follow-up data with interval (7±3) months, BME disappeared in 10 joints, improved in 3 joints and progressed in 2 joints within 12 months after the treatments. Conclusions:There is a low incidence of BME in JIA affected knee joint. Older children and the children with long disease duration have a higher risk for BME, and more likely involved the weight-bearing surfaces of the joint. The overall prognosis is satisfactory after the standard treatments.

目的 观察幼年特发性关节炎(JIA)累及踝部的MRI表现.方法 回顾性观察42例JIA患儿受累踝部的MRI资料,分析其特点.结果 JIA共累及46侧踝部,38例单侧、4例双侧踝部受累.①37侧(37/46,80.43％)踝见关节滑膜炎,累及28个(28/43,65.12％)胫距关节、10个(10/43,23.26％)距舟关节及5个(5/43,11.63％)跟距关节;②26侧(26/46,56.52％)踝见关节积液,多累及胫距关节(19/26,73.08％),且均合并同部位滑膜炎;③26侧踝可见腱鞘炎(26/46,56.52％),多累及内踝组(15/30,50.00％)或外踝组(11/30,36.67％),前踝组较少见(4/30,13.33％),其中22侧(22/26,84.62％)合并滑膜炎、4侧(4/26,15.38％)表现为单一腱鞘炎;④15侧(15/46,32.61％)踝见骨髓水肿样改变,均累及多骨骼,常见受累部位依次为距骨(13/31,41.94％)、跟骨(10/31,32.26％)、胫骨远端(8/31,25.81％);其中11侧(11/15,73.33％)病变位于关节面下,以宽基底与关节面相连,且均合并邻近关节滑膜炎,4侧(4/15,26.67％)未伴发滑膜炎或腱鞘炎病变均远离关节面;⑤13侧踝见软组织肿胀(13/46,28.26％),分别见于内踝(7/13,53.85％)、外踝(5/13,38.46％)或内外踝同时受累(3/13,23.08％).结论 JIA累及踝部的最主要MRI表现包括滑膜炎、关节积液和腱鞘炎,且腱鞘炎可作为唯一受累征象出现;骨髓水肿样改变常见,需与生理性表现相鉴别.

目的 观察胸部定量CT评价急性呼吸窘迫综合征(ARDS)患儿肺复张效果及选择呼气末正压(PEEP)的价值.方法 回顾性分析21例接受机械通气治疗ARDS患儿的胸部CT资料,记录肺复张前、后各通气区面积变化及肺内支气管数量变化,根据病变累及面积和程度进行CT评分,建立CT评分与PEEP关系的回归模型,观察CT对评价肺复张效果及选择最佳PEEP的价值.结果 肺复张前、后各通气区面积占比差异均有统计学意义(P均＜0.001),不通气区、低通气区、正常通气区及过度通气区对PEEP的敏感程度依次降低.肺复张后,显示病变最广泛的CT层面中,双肺亚段以上支气管数量高于肺复张前(9.4 ± 3.1vs.6.2±2.3;t=7.713,P＜0.001).肺复张后各通气区的CT评分与复张时所用PEEP呈线性正相关,其回归模型如下:PEEP(5～30 cmH2 O)=0.851×CT评分-5.383(P＜0.001,R2=0.684).结论 胸部定量CT可评价机械通气治疗对于ARDS患儿的肺复张效果,有助于临床选择PEEP.

Objective:To explore the value of size-specific dose estimate (SSDE) based on effective diameter and water equivalent diameter ( Dw) in pediatric head CT. Methods:A retrospective analysis of 187 children underwent unenhanced head CT scanning were reviewed and divided into 3 groups according to the age: Group 1 (<1 m), Group 2(≥1 m~6 y), Group 3 (≥6~14 y). All CTDI vol values were recorded. The central axial image in the scanning range was selected. The region of interest (ROI) containing all anatomical structures (including skin) was outlined and the area of ROI ( AROI), head circumference, average CT value (CT ROI) were measured. The Dw, conversion factor fH16 and SSDE were calculated. The CTDI vol, SSDE and the rate of change( Δvalue)were compared among groups. The regression model between CTDI vol and SSDE was established. Results:The Dw values of groups 1-3 were (11.24±0.51), (14.48±1.47), (16.69±0.90)mm, respectively. The CTDI vol values were(15.36±2.78), (18.83±4.60), (23.24±4.13)mGy, respectively. SSDE values were(27.92±4.91), (29.16±6.64), (32.38±5.35)mGy, respectively. The differences among Dw, CTDI vol and SSDE groups were all statistically significant ( F=207.69、38.48、8.15, P<0.001). The values of Dw, CTDI vol and SSDE were gradually increasing while the age was increasing. However, the Δ value gradually was decreasing with increasing age. The linear regression equation of CTDI vol and SSDE was established as SSDE=7.252 + 1.137×CTDI vol. Conclusions:The radiation dose of children′s head CT can be accurately assessed based on Dw combined with head conversion factor fH16 to estimate the body-specific dose SSDE. The radiation dose of children′s head CT was underestimated with the greater degree for smaller age.

BackgroundThe accuracy and consistency of bone age assessments (BAA) using standard methods can vary with physicians' level of experience.MethodsTo assess the impact of information from an artificial intelligence (AI) deep learning convolutional neural network (CNN) model on BAA, specialists with different levels of experience (junior, mid-level, and senior) assessed radiographs from 316 children aged 4–18 years that had been randomly divided into two equal sets-group A and group B. Bone age (BA) was assessed independently by each specialist without additional information (group A) and with information from the model (group B). With the mean assessment of four experts as the reference standard, mean absolute error (MAE), and intraclass correlation coefficient (ICC) were calculated to evaluate accuracy and consistency. Individual assessments of 13 bones (radius, ulna, and short bones) were also compared between group A and group B with the rank-sum test.ResultsThe accuracies of senior, mid-level, and junior physicians were significantly better (all P < 0.001) with AI assistance (MAEs 0.325, 0.344, and 0.370, respectively) than without AI assistance (MAEs 0.403, 0.469, and 0.755, respectively). Moreover, for senior, mid-level, and junior physicians, consistency was significantly higher (all P < 0.001) with AI assistance (ICCs 0.996, 0.996, and 0.992, respectively) than without AI assistance (ICCs 0.987, 0.989, and 0.941, respectively). For all levels of experience, accuracy with AI assistance was significantly better than accuracy without AI assistance for assessments of the first and fifth proximal phalanges.ConclusionsInformation from an AI model improves both the accuracy and the consistency of bone age assessments for physicians of all levels of experience. The first and fifth proximal phalanges are difficult to assess, and they should be paid more attention.

目的 采用高分辨率CT(HRCT)观察不同来源干细胞移植治疗B型尼曼-皮克病(NPD)患儿肺间质病变的效果.方法 回顾性分析6例B型NPD患儿接受造血干细胞移植前后肺部HRCT资料,其中3例接受非亲缘脐带血干细胞移植治疗,3例接受亲缘单倍体骨髓+外周血干细胞移植治疗;于3个层面(主动脉弓层面、气管隆嵴层面及右膈顶层面)观察移植前后肺间质病变(表现为小叶间隔增厚、小叶中心阴影和小叶内线3种CT征象)累及范围并进行评分,计算各征象评分变化速率及征象评分均值变化速率.结果 接受干细胞移植后,6例患儿肺间质病变评分均较移植前呈明显下降趋势;其中3例接受非亲缘脐带血干细胞移植者肺部小叶间隔增厚、小叶中心阴影和小叶内线的征象评分变化速率及征象评分均值变化速率平均值(1.16分/月、1.33分/月、1.11分/月、1.24分/月)均高于3例接受亲缘单倍体骨髓+外周血干细胞移植者(1.14分/月、0.86分/月、0.88分/月、1.03分/月).结论 干细胞移植可改善B型NPD患儿肺间质病变;非亲缘供体脐带血干细胞移植可能较亲缘单倍体移植治疗效果更佳.

目的 探讨儿童甲状腺CT值与甲状腺功能状态的关系及其临床应用价值.方法 回顾性分析行颈部或胸部平扫CT检查并在3个月内行甲状腺功能检查患儿资料.按照血清促甲状腺激素(TSH)水平分为正常组、降低组和升高组.采用单因素方差分析比较3组甲状腺CT值差异,并进行ROC曲线分析.结果 共纳入115例患儿,其中血清TSH水平正常组67例,降低组33例和升高组15例.血清TSH水平降低组和升高组甲状腺CT值分别为(93.98±21.09)HU 和(96.53±14.45)HU,低于正常组的(107.37±16.13)HU(F=7.346,P=0.001).ROC曲线分析显示,甲状腺CT密度cut-off值为86.75 HU时,敏感性为92.5％,特异性为45.8％.结论 甲状腺功能异常时甲状腺CT值下降,甲状腺CT值(cut-off值为86.75 HU)可作为儿童甲状腺功能异常的早期预警指标.

目的 以CT定量评估不同肺复张呼气末正压(PEEP)通气治疗急性呼吸窘迫综合征(ARDS)模型兔,并确定最佳PEEP.方法 纳入10只成年大耳兔,建立ARDS兔模型.采用压力控制通气进行肺复张,分别于4、8、12、16、20、24及28 cmH2O PEEP下行肺部CT扫描,并按CT值将肺分为不通气区(-100～100 HU)、低通气区(-500～-101 HU)、正常通气区(-800～-501 HU)及过度通气区(-1000～-801 HU),并将其占肺组织面积比值记为Rnon、Rlow、Rnormal及Rover;观察肺复张前、后的Rnon、Rlow、Rnormal及Rover变化,分析肺复张最佳PEEP.结果 肺复张过程中,随PEEP升高,Rnon、Rlow、Rnormal及Rover均发生明显变化(P均<0.05);PEEP为4、8、12 cmH2O时,Rnon两两比较差异均有统计学意义(P均<0.05);PEEP为4、8、12、16 cmH2O时,Rlow两两比较差异均有统计学意义(P均<0.05);PEEP为12 cmH2O时的Rnormal明显高于PEEP为4、20、24、28 cmH2O时(P均<0.05);PEEP为12、16、20、24、28 cmH2O时,Rover两两比较差异均有统计学意义.肺复张最佳PEEP为(12.48±5.72)cmH2O.结论 CT可有效评估肺复张效果;针对ARDS模型兔,推荐PEEP为(12.48±5.72)cmH2O.

Background. There is no accurate radiological measurement to estimate the severity of pediatrics acute respiratory distress syndrome (PARDS). We validated the effectiveness of an adult radiographic assessment of lung edema (RALE) score in PARDS. Aim. To assess the severity and prognosis of PARDS based on a chest radiograph (CXR) RALE scoring method. Methods. Pediatric Acute Lung Injury Consensus Conference (PALICC) criteria were used to diagnose PARDS. General demographics, pulmonary complications, and 28‐day mortality of the patients were recorded. Subgroups were compared by prognosis (survive and death) and etiology (infection and noninfection). Two observers calculated RALE independently. Each quadrant of CXR was scored by consolidation scores 0 (none alveolar opacity), 1 (extent <25%), 2 (extent 25%–50%), 3 (50%–75%), and 4 (>75%) and density scores 1 (hazy), 2 (moderate), and 3 (dense). Quadrant score equals consolidation score times density score. Total score equals to the sum of four quadrants scores. The ROC curve and survival curve were established, and the optimal cutoff score for discrimination prognosis was set. Results. 116 PARDS (72 boys and 44 girls) and 463 CXRs were enrolled. The median age was 25 months (5 months, 60.8 months) and with a mortality of 37.9% (44/116). The agreement between two independent observers was excellent (ICC = 0.98, 95% CI: 0.97–0.99). Day 3 score was independently associated with better survival ( p < 0.001 ). The area under the curve of ROC was 0.773 (95% CI: 0.709–0.838). The cutoff score was 21 (sensitivity 71.7%, specificity 76.5%), and the hazard ratio (HR) was 9.268 (95% CI: 1.257–68.320). The pulmonary complication showed an HR of 3.678 (95% CI: 1.174–11.521) for the discrimination. Conclusion. CXR RALE score can be used in PARDS for discriminating the prognosis and has a better agreement among radiologist and pediatrician. PARDS with pulmonary complications, day 3 score whether greater than 21 points, have a better predictive effectiveness.