Third-window anomalies represent a heterogeneous group of inner ear disorders characterized by abnormal openings in the bony otic capsule, resulting in altered cochlear and vestibular fluid mechanics. By creating an alternative pathway for inner ear fluid motion due to a new opening in addition to the oval and round windows, these lesions disrupt normal sound transmission and vestibular function. In pediatric patients, recognition of third-window anomalies is particularly important, as early and accurate diagnosis supports appropriate clinical assessment and management. High-resolution computed tomography of the temporal bone is the primary imaging modality for evaluating third-window anomalies, enabling detailed assessment of the bony labyrinth. However, many of these abnormalities are subtle and may be underestimated or misinterpreted on standard axial images. The use of anatomy-oriented multiplanar reconstructions tailored to the suspected defect significantly improves lesion conspicuity and diagnostic confidence. This educational review summarizes the anatomic and pathophysiologic principles underlying third-window phenomena in children and illustrates the imaging features of major entities, including semicircular canal dehiscence, enlarged vestibular aqueduct, and less common cochlear dehiscence. The aim is to provide a clear and practical imaging-based framework to support radiologists involved in the evaluation of pediatric inner ear abnormalities.

Purpose:Laryngeal squamous cell carcinoma (LSCC) is a malignancy with significant morbidity and mortality. Accurate preoperative assessment of key histopathological features, including lymph node metastasis (LNM), extranodal extension (ENE), lymphovascular invasion (LVI), perineural invasion (PNI), and thyroid cartilage invasion (TCI), is crucial for optimising treatment strategies. Computed tomography (CT)-based texture analysis, a radiomics approach, has shown potential in identifying tumour heterogeneity and aggressive histopathological behaviour. The aim of the study was to evaluate the predictive value of CT-based texture analysis for detecting key histopathological features in LSCC and assess its potential as a non-invasive tool for preoperative risk stratification. Material and methods:This retrospective study included 32 LSCC patients who underwent contrast-enhanced neck CT within 4 weeks before surgery. Texture features were extracted using LIFEx software. Mann-Whitney U tests and receiver operating characteristic (ROC) curve analyses were performed to assess diagnostic performance. Results:Significant texture features were identified for LNM, ENE, and TCI (p < 0.05). GLZLM_HGZE ≤ 4635 predicted LNM with an AUC of 0.847 (95% CI: 0.708-0.986), sensitivity of 71%, and specificity of 84%. For ENE, GLZLM_HGZE ≤ 4625 achieved an AUC of 0.891, sensitivity of 85%, and specificity of 84%. TCI prediction was highest with GLZLM_SZLGE ≥ 0.00118 (AUC: 0.964, 95% CI: 0.909-1.000), with sensitivity of 88% and specificity of 93%. No significant predictors were found for LVI or PNI. Conclusions:CT-based texture analysis is a promising non-invasive tool for preoperative risk assessment in LSCC, particularly for LNM, ENE, and TCI. Further validation in larger studies is warranted.

OBJECTIVE:This study examined cortical thickness and appetite-regulating hormones-neuropeptide Y (NPY) and ghrelin-to better understand the neurobiological mechanisms underlying binge eating disorder (BED) and obesity in adolescence. We compared adolescents with BED and obesity, adolescents with obesity without BED, and healthy controls (HCs), and explored the relationships among these measures, BMI, and psychological symptoms. METHOD:Seventy adolescents (aged 12-18 years) were included: 24 adolescents with BED and obesity, 24 adolescents with obesity without BED, and 22 HC. Cortical thickness was measured using 3.0 T structural MRI with FreeSurfer-based analysis, and fasting serum levels of NPY and ghrelin were quantified by ELISA. Participants also completed the Eating Attitudes Test-40 (EAT-40), the Eating Disorder Examination Questionnaire (EDE-Q), the Children's Depression Inventory (CDI), and the State-Trait Anxiety Inventory for Children (STAI-C). RESULTS:Both groups with obesity showed significantly elevated NPY levels compared to HCs (p < 0.001), with no difference between adolescents with and without BED; fasting total ghrelin levels did not differ across groups. Adolescents with BED exhibited reduced cortical thickness in the right posterior cingulate cortex relative to both comparison groups (p = 0.002), while left posterior cingulate thinning was observed in both groups with obesity versus HCs (p = 0.004). No significant group differences were found in insular or anterior cingulate thickness. Both groups with obesity showed greater depressive symptoms, disordered eating attitudes, and eating-related psychopathology than HCs. In multiple regression analyses adjusted for diagnostic group membership, higher BMI (β = 0.47, p < 0.001) and lower left insular cortical thickness (β = -0.45, p = 0.031) were independently associated with elevated NPY levels. CONCLUSION:Findings suggest that elevated NPY levels may represent a shared neurobiological feature of adolescent obesity, whereas reduced right posterior cingulate cortical thickness may be more specifically associated with the diagnosis of BED. These findings contribute to understanding the neurobiological correlates of disordered eating behaviors during adolescence.

Introduction: Chest X-ray (CXR) is the primary imaging method for the diagnosis of foreign body (FB) aspiration (FBA) and the most common finding is ipsilateral hyperinflation due to air-trapping. FB related hyperinflation can be subtle and difficult to detect in the evaluation of the CXR. Radiodensity measurement of the lungs on CXR could be useful for the diagnosis of FBA. The aim of this study is to evaluate the diagnostic effectiveness of quantitative measurement of lung radiodensity in detecting hyperinflation on CXR of the patients with suspected FBA. Methods: Records of patients who underwent rigid bronchoscopy for evaluation of FBA between January 2008 and June 2020 were reviewed retrospectively. Initial CXR of the patients were re-evaluated quantitatively by measuring lung radiodensity in FBA present and FBA absent groups. Results: FB was detected in 154 patients, while FB was not detected in 87 patients during bronchoscopy. FB was in right lung in 89 patients, in left lung in 51 patients thus unilateral FB was present in 140 patients. Records of initial CXR evaluation of these 140 patients with unilateral FB showed unilateral lung hyperinflation in 60 patients (42.9%) and no unilateral hyperinflation in 80 patients (57.1%). Lung radiodensities of the FB-present lungs were statistically significantly less dense compared with radiodensities of the contralateral lungs. A 5.5% or more lung radiodensity difference compatible with hyperinflation were found in 113 out of 140 patients (80.7%) with unilateral FB during lung radiodensity measurements. During the initial CXR evaluation, the hyperinflation detection rate was 42.9%, with the lung radiodensity measurement, the hyperinflation detection rate increased to 80.7% Conclusion: Quantative lung radiodensity measurement of CXR in patients with suspected FB aspiration could increase the efficiency of FB related hyperinflation detection.

ObjectiveSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been associated with neurological complications beyond respiratory involvement. Although children usually experience mild systemic disease, immune-mediated central nervous system (CNS) disorders have emerged as an important cause of morbidity. Neuroimaging plays a central role in detecting these complications and supporting diagnostic decisions. This study aims to describe neuroimaging patterns in children who developed immune-mediated CNS disorders following SARS-CoV-2 infection.Materials and methodsWe retrospectively reviewed pediatric patients aged 0-18 years with laboratory-confirmed SARS-CoV-2 infection followed at a tertiary pediatric neurology center. Among post-COVID admissions, four patients with severe neurological involvement and characteristic neuroimaging abnormalities were identified. Clinical features, laboratory findings, cerebrospinal fluid analyses, electroencephalography results, and multimodal neuroimaging studies were evaluated.ResultsFour previously healthy male children developed immune-mediated neurological disorders associated with SARS-CoV-2 infection, including febrile infection-related epilepsy syndrome, acute disseminated encephalomyelitis, central nervous system vasculitis, and anti-N-methyl-D-aspartate receptor encephalitis. Brain MRI demonstrated disorder-specific patterns such as cortical diffusion restriction, multifocal demyelinating lesions, inflammatory vasculitic changes, and progressive parenchymal injury. In one patient, serial imaging showed progression from acute inflammation to chronic structural damage. All patients received immunomodulatory therapy, with variable neurological outcomes.ConclusionSARS-CoV-2 infection may trigger immune-mediated CNS disorders in children with distinct neuroimaging features. Recognition of these patterns is essential for early diagnosis, treatment guidance, and prognostic assessment. Neuroimaging also provides insight into the evolution of post-COVID-19 neuroinflammatory injury.

OBJECTIVE:This study aimed to evaluate the neurological and systemic outcomes of amantadine treatment in the acute phase of severe traumatic brain injury (TBI) in children. In addition, the potential factors associated with functional outcomes were analyzed. METHODS:This retrospective cohort study analyzed data of pediatric patients with severe TBI. Amantadine treatment was administered to all patients who presented after 2022. The treatment protocol was initiated on the third day of hospitalization, at a daily dose of 6 mg/kg, and at 100 mg twice daily for older children. The Functional Status Scale (FSS) was used to assess mental status, vision, hearing, communication, motor abilities, respiration, and feeding both at discharge from intensive care unit (ICU) and again 6 months after the incident of TBI. RESULTS:In this study, 60 patients had a median age of 14.5 years (IQR 8; range 2-17 years), while 32 patients received amantadine treatment. The length of median ICU stay and hospital stay were 11 and 20 days, respectively. At the 6-month follow-up, there was a significant improvement in FSS scores compared to those estimated at ICU discharge (P < .001), but no significant difference was observed between the amantadine and non-amantadine groups in terms of functional recovery, and inotrope requirement was identified as an independent risk factor for poor neurological outcome. CONCLUSION:Administration of amantadine did not provide a significant functional benefit. However, craniectomy was performed less frequently for patients who received amantadine. Amantadine treatment was well tolerated with a favorable safety profile.

Minor head trauma is a common reason for pediatric admissions to emergency departments and typically does not necessitate further diagnostic evaluation. However, there is a rare but significant risk of ischemic stroke following such trauma, making neuroimaging crucial in selected cases. In this case series, we assessed six pediatric patients diagnosed with ischemic stroke after experiencing minor head trauma in our clinic. The patients ranged in age from 9 to 56 months, including four boys and two girls. Each patient presented with focal neurological deficits within the first 72 h post-injury. No signs of intracranial hemorrhage or fractures were identified, and laboratory tests revealed no additional abnormalities. Two of the patients required decompression surgery due to neurological deterioration during follow-up, both of whom had a poor prognosis. In contrast, the remaining four patients exhibited diffusion restriction in the basal ganglia and made full recoveries with conservative treatment. Acute ischemic stroke following minor head trauma can lead in significant morbidity and mortality, although the underlying mechanisms remain unclear. It is essential for clinicians to consider acute ischemic stroke in the differential diagnosis for patients displaying neurological symptoms that are inconsistent with the severity of their trauma. In suspected cases, early neuroimaging with cranial MRI and BT/MR angiography plays a critical diagnostic role and may be life-saving.

To investigate the changes in interreader agreement and diagnostic performance among radiology residents when recognizing dural sinus variations before and after using multiplanar reconstruction (MPR). This retrospective study included 150 pediatric patients who underwent phase-contrast MR venography between November 2014 and July 2024. Dural sinus variations were evaluated based on their presence or absence, including right transverse sinus (RTS) hypoplasia, RTS aplasia, right sigmoid sinus (RSigS) hypoplasia, left transverse sinus (LTS) hypoplasia, LTS aplasia, left sigmoid sinus (LSigS) hypoplasia, hypoplasia of the rostral end of the superior sagittal sinus (SSS), duplication of the posterior part of the SSS, right occipital sinus, left occipital sinus, and falcine sinus. Additionally, the drainage sides of the straight sinus and SSS were examined. The RTS, LTS, and SSS diameters were recorded from maximum intensity projection (MIP) and MPR images. Two radiology specialists and five residents (2nd to 5th year) individually evaluated all images on 2D axial, MIP, and MPR images. A p-value of less than 0.05 was considered statistically significant. After MPR, the interreader agreement and diagnostic accuracies for recognizing dural sinus variations increased for all residents. The most significant improvement was observed in R5, the least experienced resident (p = 0.003). R5 also showed the most notable intrareader improvement in each variation. No differences were noted between MIP and MPR images when measuring the dural sinuses. The assessment of dural sinus variations is significantly improved for inexperienced readers when utilizing MPR.

Objectives: This study aimed to assess the diagnostic contribution of fetal MRI across different anatomical systems and evaluate its added value beyond prenatal ultrasonography. Methods: This retrospective cohort included 556 fetuses who underwent both prenatal ultrasound and fetal MRI in a single tertiary center. Cases were classified by anatomical system. The concordance between ultrasound and MRI findings, as well as additional or ruled-out findings identified by MRI, was analyzed. Statistical significance and clinical relevance were also evaluated. Results: Among the 556 cases, complete concordance between ultrasound and MRI findings was observed in 48.9%. MRI ruled out the initial diagnosis in 20.1% and revealed additional findings in 32% of cases. A total of 192 additional findings were identified, while 115 previously suspected anomalies were ruled out. The highest diagnostic contribution was observed in central nervous system (CNS) and gastrointestinal system (GIS) anomalies. Posterior fossa abnormalities and cystic or mass lesions were frequently detected as additional findings on MRI. In contrast, ultrasound alone was generally sufficient for evaluating genitourinary (GUS), thoracic, and vertebral anomalies. The overall diagnostic yield of MRI was higher in anatomically complex or sonographically ambiguous cases. Conclusions: Fetal MRI provides significant additional diagnostic value, particularly in CNS and GIS anomalies, by detecting additional findings, clarifying uncertain diagnoses, or excluding suspected anomalies. Its selective use may enhance both prenatal counseling and postnatal management.

In this case report, the symptoms, diagnosis, and treatment process of a ten-year-old male patient with cerebral palsy diagnosed with scurvy due to vitamin C deficiency are presented. A 10-year-old male patient with a diagnosis of cerebral palsy and epilepsy was admitted with complaints of pain, swelling, and inability to step on the right ankle and left knee for 3 weeks. Swelling and edema were present in the left knee and right ankle. There were petechial lesions and ecchymosis on the legs. In addition, gingival bleeding and hypertrophy were observed. Laboratory examinations revealed anemia and acute phase reactant elevation. Non-steroidal anti-inflammatory therapy was initiated, but no regression was observed. Radiographs of the left knee and magnetic resonance imaging were performed, and dense lines were detected in the metaphyseal line. When the patient's dense lines finding, myalgia, petechiae, anemia that is unresponsive to iron treatment, gingival hypertrophy, and bleeding were evaluated, it was found to be compatible with scurvy disease. Despite the prevalence of easy access to food and healthy nutrition information, scurvy disease should be considered in patients with selectively fed autism spectrum disorder or neurodevelopmental retardation, as in our case.

This report describes a case in which diplopia was developed as a finding of postinfectious anti- N -methyl- d -aspartate receptor encephalitis. Infectious encephalitis, especially herpes simplex virus, is essential as it is one of the triggers of autoimmune encephalitis. Even if the cases present unexpected clinical findings, we should be vigilant in terms of autoimmune processes, such as diplopia seen in our case.

Objective: Coronavirus disease-2019 (COVID-19) has milder clinical fea-tures in children, but information on the association between thoracic imaging and clinical severity of COVID-19 is limited. Material and Methods: Between March 26th and June 30th, 2020, 982 patients with suspected or confirmed COVID-19, 428 of whom had chest X-rays, were included in the study. Demographic and clinical features, chest X-ray and thoracic computed tomography (CT) imaging results, and clinical severity of the disease were analyzed retrospectively. Results: Laboratory-proven COVID-19 was detected in 116 (27.1%) pa-tients; 42 (36.3%) had asymptomatic, 60 (51.7%) had mild, 12 (10.3%) had moderate, and two (1.7%) had severe disease. Chest X-rays were abnormal in 12.1% (14/116) of the patients with confirmed COVID-19. Main pathologic findings on chest X-ray were peribranchial thickening (10/14, 71.4%) and ground-glass opacity (GGO) (4/14, 28.6%) in patients with confirmed COVID-19. Thorax CT imaging was performed in 182 (42.5%) patients, 38 (32.7%) had confirmed COVID-19, 39.5% (15/38) of whom had abnormal imaging. Posterior (n= 7), peripheral (n= 7), and both lobe (n= 5) involvement were more prominent. Consolidated GGO (7/38, 18.4%) and bronchial wall thickening (7/38, 18.4%) were the main pathologic CT imaging patterns. Thorax CT images were abnor-mal in 20% (5/25) of the patients with asymptomatic/mild disease, and in 76.9% (10/13) of the patients with moderate/severe disease (& chi;2= 11.5, Phi= 0.552; p= 0.001). Conclusion: Chest X-ray and thorax CT imaging were mainly normal in patients with asymptomatic/mild COVID-19 disease. In contrast, thorax CT imaging was abnormal in patients with moderate/severe COVID-19, and CT imaging scores correlated with COVID-19 clinical severity. How-ever, since COVID-19 disease is milder in children, applications involving high amounts of radiation such as thoracic CT imaging should only be applied to selected patients.

Objective: To evaluate the efficacy of the MRI-based texture analysis (TA) of the basal ganglia and thalami to distinguish moderate-to-severe hypoxic-ischemic encephalopathy (HIE) from mild HIE in neonates. Methods: This study included 68 neonates (15 with mild, 20 with moderate-to-severe HIE, and 33 control) were born at 37 gestational weeks or later and underwent MRI in first 10 days after birth. The basal ganglia and thalami were delineated for TA on the apparent diffusion coefficient (ADC) maps, T 1-, and T 2 weighted images. The basal ganglia, thalami, and the posterior limb of the internal capsule (PLIC) were also evaluated visually on diffusion-weighted imaging and T 1 weighted sequence. Receiver operating characteristic curve and logistic regression analyses were used. Results: Totally, 56 texture features for the basal ganglia and 46 features for the thalami were significantly different between the HIE groups on the ADC maps, T 2-, and T 2 weighted sequences. Using a Histogram_entropy log-10 value as >1.8 from the basal ganglia on the ADC maps (p < 0.001; OR, 266) and the absence of hyperintensity of the PLIC on T 1 weighted images (p = 0.012; OR, 17.11) were found as independent predictors for moderate-to-severe HIE. Using only a Histogram_entropy log-10 value had an equal diagnostic yield when compared to its combination with other texture features and imaging findings. Conclusion: The Histogram_entropy log-10 value can be used as an indicator to differentiate from moderate-to-severe to mild HIE. Advances in knowledge: MRI-based TA may provide quantitative findings to indicate different stages in neonates with perinatal asphyxia.

Magnetic resonance imagining (MRI) is gradually becoming the more preferred imaging modality in the evaluation of central nervous system (CNS) abnormalities rather than foetal ultrasonography (USG). The aim of this study was to compare the findings of prenatal neurosonography and foetal MRI. The study was a retrospective study analysing the records of 160 pregnant women who underwent both foetal MRI and USG due to suspicion of CNS abnormalities between 2008 and 2019. Indications for applying foetal MRI were neurosonography and foetal MRI findings. When the compatibility between MRI and USG results was examined in CNS abnormalities, it was found fully compatible in 61.3% of cases, partially compatible in 24.53% of cases, and not compatible in 14.5% of cases. When comparing prenatal neurosonography and foetal MRI findings, additional findings were reported in 16.9% of cases, and no additional finding was reported in 66.8% of cases. While normal anatomical findings were reported in 8.8% of the cases in MRI, the diagnosis made by neurosonography changed in 7.5%. Foetal MRI has more advantages than USG both in imaging the CNS abnormalities in more detail and in determining the accompanying additional anomalies.IMPACT STATEMENTWhat is already known on this subject: USG is a safe, practical and cost-effective primary imaging method that is widely used for foetal anomaly screening. However, there may sometimes be difficulties in evaluating the foetal brain structures due to foetal position which is unsuitable for imaging, extremely obese with a high body mass index, oligohydramnios and ossified foetal skull. For this reason, magnetic resonance imaging (MRI) is used as the most commonly used imaging method after USG in the evaluation of foetal anatomy, especially CNS.What do the results of this study add?: In our study, we saw that foetal MRI has more advantages than neurosonography in both seeing CNS abnormalities in more detail and recognising additional anomalies that may accompany.What are the implications of these findings for clinical practice and/or further research?: We have seen that besides neurosonography, foetal MRI can provide important information that can affect the clinical approach in pregnancy management by increasing the correct diagnosis in pregnancies with congenital CNS abnormalities. MRI: it is the best secondary imaging modality that can aid diagnosis in addition to neurosonography in the diagnosis of CNS abnormalities and in suspected cases. Therefore, foetal MRI should be used more widely in prenatal diagnosis.

PURPOSE:Our aim was to evaluate the performance of clot-based radiomics features (RFs) for predicting first pass effect (FPE) in patients with acute ischemic stroke (AIS). The secondary purpose was to search for any other variables associated with FPE.MATERIALS AND METHODS:Patients who underwent mechanical thrombectomy (MT) for anterior circulation large vessel stroke in a single center were retrospectively reviewed. Patients were divided into two groups: FPE and non-FPE. Two observers extracted RFs from the clot on pretreatment noncontrast computed tomography (NCCT) images. Demographic, clinical, periprocedural, and RFs were compared between the groups and receiver operating characteristic (ROC) curves were constructed. Logistic regression analysis was used to determine the independent predictors of FPE.RESULTS:Fifty-two patients (27 female, 25 male; mean age 64.50 ± 15.15) who were treated by stent retrievers as the first option were included in the study. FPE was achieved in 25 patients (25/52, 48.1%). Twelve RFs were significantly different between patients with FPE and non-FPE. The long-run low gray-level emphasis (odds ratio = 44.24, p = 0.003) and the zone percentage (odds ratio = 16.88, p = 0.017) were found as independent predictors of FPE. Female sex and a baseline ASPECT score of >8.5 were the other independent variables to predict FPE. The diagnostic accuracy to predict FPE was observed as 83% when using all independent predictors in our predictive model.CONCLUSIONS:Clot-based RFs on NCCT may help to estimate the success of the intended outcome of MT in patients with AIS.

Background Biallelic variants in PNPT1 cause a mitochondrial disease of variable severity. PNPT1 (polynucleotide phosphorylase) is a mitochondrial protein involved in RNA processing where it has a dual role in the import of small RNAs into mitochondria and in preventing the formation and release of mitochondrial double-stranded RNA into the cytoplasm. This, in turn, prevents the activation of type I interferon response. Detailed neuroimaging findings in PNPT1-related disease are lacking with only a few patients reported with basal ganglia lesions (Leigh syndrome) or non-specific signs. Objective and methods To document neuroimaging data in six patients with PNPT1 highlighting novel findings. Results Two patients exhibited striatal lesions compatible with Leigh syndrome; one patient exhibited leukoencephalopathy and one patient had a normal brain MRI. Interestingly, two unrelated patients exhibited cystic leukoencephalopathy resembling RNASET2-deficient patients, patients with Aicardi-Goutières syndrome (AGS) or congenital CMV infection. Conclusion We suggest that similar to RNASET2, PNPT1 be searched for in the setting of cystic leukoencephalopathy. These findings are in line with activation of type I interferon response observed in AGS, PNPT1 and RNASET2 deficiencies, suggesting a common pathophysiological pathway and linking mitochondrial diseases, interferonopathies and immune dysregulations.

Purpose: To evaluate the mean lung density in children with pectus excavatum (PE) and to assess the correlation between the cardiac rotation angle, Haller index, pulmonary function test, and lung density. Material and methods: This retrospective study included 33 children with PE and 31 healthy controls. The densities of lung parenchyma were evaluated by quantitative computed tomography (CT). Three lung levels were determined: T4 vertebra level, T10 vertebra level, and the level of the measurement of the cardiac rotation angle. The cardiac rotation angle and the Haller index were calculated. All measurements were done by 2 radiologists, independently. Student's t-test or the Mann-Whitney U test, intraclass correlation coefficients, Pearson or Spearman's rank correlation coefficient, and Kruskal-Wallis test were used for statistical analysis. A p-value less than 0.05 was considered as statistically significant. Results: All the lung levels in the PE group had lower mean densities than healthy children, with statistical significance in the right lung at the T10 vertebra level (-818.60 +/- 33.49 HU, -798.45 +/- 40.24 HU; p = 0.028). There was a correlation between the cardiac rotation angle and the Haller index (rho = 0.593; p < 0.001). There were no correlations between mean lung density and cardiac rotation angle, Haller index, and pulmonary function tests. Conclusions: The lower mean lung densities were found in PE, especially in the right lower lobe. The parenchymal aeration should be considered independently from the severity of PE.