Tenosynovial giant cell tumor (TGCT) is a benign but locally aggressive synovial neoplasm that affects both adults and children. In pediatric patients, it commonly involves the knee and ankle, presenting with pain, swelling, and mechanical symptoms, which can mimic other joint disorders. Early and accurate identification is crucial to prevent joint damage and functional impairment. Ultrasound is the first-line imaging modality due to its accessibility and ability to assess synovial proliferation and vascularity, but MRI is the reference standard for diagnosis, showing characteristic low signal intensity on T1- and T2-weighted images and blooming artifact on gradient-echo images due to hemosiderin deposition. Advanced imaging techniques, such as diffusion-weighted imaging and dynamic contrast-enhanced MRI, further enhance lesion characterization. Treatment is primarily surgical, with arthroscopic resection preferred for localized TGCT and open synovectomy required for diffuse disease. This review explores the epidemiology, clinical presentation, imaging features, and treatment of pediatric TGCT, with an emphasis on the differential diagnosis, which includes juvenile idiopathic arthritis, hemophiliac arthropathy, venous malformation, primary synovial chondromatosis, synovial sarcoma, fibroma of the tendon sheath, desmoid-type fibromatosis, and epithelioid sarcoma. The role of multimodal imaging in diagnosis and management is also discussed.

BACKGROUND. The reported diagnostic performance of ultrasound (US) for midgut malrotation and volvulus varies. OBJECTIVE. The purpose of this study was to evaluate the diagnostic performance of US for midgut malrotation and volvulus separately and to assess individual sonographic signs for each diagnosis. METHODS. This multicenter, retrospective, cross-sectional study included children (who were defined as individuals 0-18 years old) who had US performed as the first imaging test for evaluation of suspected midgut malrotation or volvulus from January 1, 2018, to June 30, 2021. Clinical data were extracted from medical records. Blinded reviewers measured the proximal duodenum and assessed for malrotation and volvulus as well as for specific sonographic signs. Nondiagnostic and equivocal studies were excluded. The reference standards used for malrotation included surgery, upper gastrointestinal (UGI) series, and CT and/or MRI. Volvulus reference standards included the same plus clinical follow-up (minimum, 28 days). Sensitivity, specificity, and accuracy were calculated to evaluate diagnostic performance; the Wilcoxon rank sum test was used to compare median values. RESULTS. Malrotation analysis included 384 examinations; median patient age was 32 days (IQR, 5-182 days). Volvulus analysis included 900 examinations; median patient age was 60 days (IQR, 9-573 days). The sensitivity and specificity of US for malrotation were 93% (95% CI, 81-98%) and 96% (95% CI, 92-98%) by original report and 97% (95% CI, 87-100%) and 99% (95% CI, 97-100%) by blinded research review. The sensitivity and specificity of US for volvulus were 97% (95% CI, 85-100%) and 98% (95% CI, 96-99%) by original report and 97% (95% CI, 86-100%) and 99% (95% CI, 98-100%) by blinded research review. The most accurate sonographic signs were the intraperitoneal position of the third portion of the duodenum for malrotation (accuracy = 98%) and the whirlpool sign for volvulus (accuracy = 99%). The median proximal duodenal diameter was greater in children with volvulus (13 mm [IQR, 7-18 mm] versus 6 mm [IQR, 4-8 mm], p < .001). CONCLUSION. The performance of US for diagnosing both midgut malrotation and volvulus is excellent in the setting of a diagnostic imaging study. CLINICAL IMPACT. US can be used as the first-line imaging modality for diagnosing midgut malrotation and volvulus, with UGI series reserved for nondiagnostic or equivocal examinations.

Ultrasound (US) is increasingly used as the first-line imaging modality for the diagnosis of midgut volvulus, but may be non-diagnostic in some cases. To determine the frequency and factors associated with non-diagnostic US for each midgut volvulus and malrotation in a multi-institutional sample. We conducted a retrospective multi-institutional study of children (age 0-18 years) who underwent US to evaluate for midgut volvulus and malrotation between January 1, 2018, and June 30, 2021, and had an available reference standard of one of the following: upper GI series, CT/MRI, surgery, or, for volvulus, clinical follow-up at 30 days or greater. Blinded review of US images was performed by a single radiologist at each institution. When available, radiographs acquired ≤3 h from the US were reviewed for bowel gas pattern. After blinded review, original ultrasound reports were classified as diagnostic or non-diagnostic for midgut volvulus and malrotation. Stepwise logistic regression identified the most important predictors of non-diagnostic US. In total, 637 patients were imaged for midgut volvulus and 311 for malrotation. Based on original report review, non-diagnostic proportions of examinations for volvulus and malrotation were 13.5

Head US is the mainstay of initial neuroimaging in preterm and term neonates and young infants. Echogenic lesions are a commonly encountered finding on US images, with a wide spectrum of underlying causes. These include normal structures and normal variants such as the choroid plexus and cerebellar vermis, normal transmantle white matter tracts, and benign entities that should not be mistaken for disease, such as hyperechoic caudate nuclei and thalamostriate mineralizing vasculopathy. Many pathologic conditions associated with major morbidity and mortality also may appear echogenic on US images. These most commonly include germinal matrix hemorrhage; white matter injury; hypoxic-ischemic encephalopathy; and hemorrhagic, infectious, and ischemic lesions. These lesions may be differentiated by their location at the caudothalamic groove, in the periventricular or deep white matter, diffusely involving the white matter, involving the deep gray matter, in the peripheral parenchyma, or in the cerebellum. Use of a tailored gestational age- and location-based approach combined with salient clinical details and knowledge of the unique vulnerabilities and responses to perinatal stressors in the preterm and term period improve diagnostic confidence and enable radiologists to differentiate those echogenic lesions that require no further follow-up from those that require further imaging or laboratory workup and specialist referral. ©RSNA, 2025 Supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article.

Background: Cystic echinococcosis (CE) or hydatid disease caused by the cestode Echinococcus granulosus sensu lato is an uncommon infection in Canada especially among children. There are limited reports describing the clinical presentation and management in Canadian children. Methods: The medical records of all children diagnosed with CE at a quaternary paediatric centre in Ontario between January 1988 and August 2021 were retrospectively reviewed. The clinical course, management, and outcomes of each case were summarized. Results: We report two paediatric cases of cystic echinococcosis (CE) in detail and review four additional cases seen at our institution over 33.5 years. The first case was a previously healthy 12-year-old boy with pulmonary CE resulting in unilateral lung collapse and mediastinal shift, who was presumedly infected while living in the Middle East. The second case was a previously healthy 3-year-old girl with pulmonary CE acquired locally in southern Ontario. Four other cases of CE with hepatic involvement (median age 12.5 years) were identified during the study period. Five out of six patients received both surgical and medical therapy. Conclusion: CE is a rare but serious disease seen in southern Canada that has historically been associated with travel or migration. Due to changes in urban wildlife landscapes and increased global migration, CE may become more prevalent in Canadian children. We describe the first locally acquired case in rural southern Ontario diagnosed at our centre. Prompt recognition of this infection in children by health care providers is important to prevent morbidity and mortality.

Orbital pathologies can be broadly classified as ocular lesions, extraocular soft-tissue pathologies (non-neoplastic and neoplastic), and bony and traumatic lesions. In this paper, we discuss the key imaging features and differential diagnoses of bony and traumatic lesions of the pediatric orbit and globe, emphasizing the role of CT and MRI as the primary imaging modalities. In addition, we highlight the adjunctive role of ocular sonography in the diagnosis of intraocular foreign bodies and discuss the primary role of sonography in the diagnosis of traumatic retinal detachment.

Orbital pathologies can be broadly classified as ocular, extra-ocular soft-tissue (non-neoplastic and neoplastic), osseous, and traumatic. In part 1 of this orbital series, the authors will discuss the differential diagnosis and key imaging features of pediatric ocular pathologies. These include congenital and developmental lesions (microphthalmos, anophthalmos, persistent fetal vasculature, coloboma, morning glory disc anomaly, retinopathy of prematurity, Coats disease), optic disc drusen, infective and inflammatory lesions (uveitis, toxocariasis, toxoplasmosis), and ocular neoplasms (retinoblastoma, retinal hamartoma, choroidal melanoma, choroidal nevus). This pictorial review provides a practical approach to the imaging work-up of these anomalies with a focus on ocular US as the first imaging modality and additional use of CT and/or MRI for the evaluation of intracranial abnormalities. The characteristic imaging features of the non-neoplastic mimics of retinoblastoma, such as persistent fetal vasculature and Coats disease, are also highlighted.

Background: Normalization of antithrombin activity may prevent catheter -associated thrombosis in critically ill children at high risk of bleeding. Objectives: To characterize the temporal pattern of antithrombin activity, assess its association with catheter -associated thrombosis and clinically relevant bleeding, and evaluate its relationship with thrombin generation in these children. Methods: In this prospective cohort study, critically ill children <18 years old at high risk of bleeding with central venous catheter were eligible. Antithrombin activity and thrombin generation were measured from platelet -poor plasma and after in vitro antithrombin supplementation. Systematic surveillance ultrasound was performed to diagnose thrombosis. Children were followed for bleeding. Results: We enrolled 8 infants (median age: 0.2 years, IQR: 0.2, 0.3 years) and 72 older children (median age: 14.3 years, IQR: 9.1, 16.1 years). Mean antithrombin on the day of catheter insertion was 64 IU/dL (SD: 32 IU/dL) in infants and 83 IU/dL (SD: 35 IU/dL) in older children. Antithrombin normalized by the day of catheter removal. Thrombosis developed in 27 children, while 31 children bled. Thrombosis (regression coefficient: 0.008, 95% CI: -0.01, 0.03) and bleeding (regression coefficient: -0.0007, 95% CI: -0.02, 0.02) were not associated with antithrombin. Antithrombin was not correlated with in vivo change in endogenous thrombin potential (correlation coefficient: -0.07, 95% CI: -0.21, 0.08). In vitro supplementation reduced endogenous thrombin potential (correlation coefficient: -0.78; 95% CI: -0.95, -0.23). Conclusion: These findings may not support normalization of antithrombin activity to prevent catheter -associated thrombosis in critically ill children at high risk of bleeding.

Pediatric neoplastic extraocular soft-tissue lesions in the orbit are uncommon. Early multimodality imaging work-up and recognition of the key imaging features of these lesions allow narrowing of the differential diagnoses in order to direct timely management. In this paper, the authors present a multimodality approach to the imaging work-up of these lesions and highlight the use of ocular ultrasound as a first imaging modality where appropriate. We will discuss vascular neoplasms (congenital hemangioma, infantile hemangioma), optic nerve lesions (meningioma, optic nerve glioma), and other neoplastic lesions (plexiform neurofibroma, teratoma, chloroma, rhabdomyosarcoma, infantile fibrosarcoma, schwannoma).

As point-of-care ultrasound (POCUS) has emerged as a valuable tool for intussusception screening, this quality improvement study aimed to implement a “POCUS-first” pathway in a Pediatric Emergency Department (ED) to streamline workflow and expedite care for children with suspected intussusception. This was a prospective analysis of children diagnosed with ileocolic intussusception in a Pediatric ED between June 2022 and June 2023. The study compared the “POCUS-first” cohort with the group receiving only radiology-performed ultrasound. Key outcomes included physician initial assessment to radiology-performed US time and physician initial assessment to reduction time. Continuous improvement efforts incorporated pediatric emergency medicine physician training, education, and pathway dissemination through plan-do-study-act cycles. The study included 29 patients in the “POCUS-first” pathway group and 70 patients in the non-POCUS group. The “POCUS-first” pathway demonstrated a significantly shorter physician initial assessment to reduction time compared to the non-POCUS group (170.7 min vs. 240.6 min, p = 0.02). Among non-transferred patients, the “POCUS-first” group also had a significantly shorter emergency department length of stay (386 min vs. 544 min, p = 0.047). Implementation of a “POCUS-first” pathway for managing ileocolic intussusception led to notable improvements in process efficiency. The shorter physician initial assessment to reduction time highlights the potential for expedited decision-making and intervention. These study findings support the potential of this pathway to optimize the management and outcomes of children with ileocolic intussusception.

Radiologic evaluation of neonatal bowel obstruction is challenging owing to the overlapping clinical features and imaging appearances of the most common differential diagnoses. The key to providing an appropriate differential diagnosis comes from a combination of the patient's gestational age, clinical features, and imaging findings. While assessment of radiographs can confirm bowel obstruction and indicate whether it is likely proximal or distal, additional findings at upper or lower gastrointestinal contrast study together with use of US are important in providing an appropriate differential diagnosis. The authors provide an in-depth assessment of the appearances of the most common differential diagnoses of proximal and distal neonatal bowel obstruction at abdominal radiography and upper and lower gastrointestinal contrast studies. These are divided into imaging patterns and their associated differential diagnoses on the basis of abdominal radiographic findings. These findings include esophageal atresia variants including the "single bubble," "double bubble," and "triple bubble" and distal bowel obstruction involving the small and large bowel. Entities discussed include esophageal atresia, hypertrophic pyloric stenosis, pyloric atresia, duodenal atresia, duodenal web, malrotation with midgut volvulus, jejunal atresia, ileal atresia, meconium ileus, segmental volvulus, internal hernia, colonic atresia, Hirschsprung disease, and functional immaturity of the large bowel. The authors include the advantages of abdominal US in this algorithm, particularly for hypertrophic pyloric stenosis, duodenal web, malrotation with midgut volvulus, and segmental volvulus. ©RSNA, 2023 Online supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.

US is the imaging modality of choice for evaluation of a variety of abdominal conditions, and in recent years it has also become useful and promising as a bedside technique for assessment of acute abdominal conditions in neonates. Bedside US can help, complement, and sometimes replace radiographic or contrast-enhanced studies in critically ill and labile neonates who are difficult to transport to the fluoroscopy suite. Some of the features of bedside US can be applied as point-of-care US (POCUS) of the sick neonate. Some of the abdominal conditions in neonates that can be assessed and monitored with bedside US are necrotizing enterocolitis and its complications, malrotation with a midgut volvulus, segmental volvulus, meconium peritonitis, and complicated inguinal hernia. High-resolution US with the use of 15-MHz and higher-frequency probes allows characterization of the bowel anatomy and features of intestinal abnormalities in neonates in fine detail. Color Doppler US and microvascular imaging improve accuracy in the detection and characterization of bowel vascularity, which is important in the treatment and follow-up of patients with intestinal conditions. © RSNA, 2023 Quiz questions for this article are available through the Online Learning Center. The slide presentation from the RSNA Annual Meeting is available for this article.

Background: Nodular liver (NOD) in cystic fibrosis (CF) suggests advanced CF liver disease (aCFLD); little is known about progression of liver disease (LD) after detection of sonographic NOD. Methods: Clinical, laboratory, and ultrasound (US) data from Prediction by Ultrasound of the Risk of Hepatic Cirrhosis in CFLD Study participants with NOD at screening or follow-up were compared with normal (NL). Linear mixed effects models were used for risk factors for LD progression and Kaplan-Meier estimator for time-to-event. Results: 54 children with NOD (22 screening, 32 follow-up) and 112 NL were evaluated. Baseline (BL) and trajectory of forced expiratory volume, forced vital capacity, height/BMI z-scores were similar in NOD vs NL. Platelets were lower in NOD at BL (250 vs 331 x10 3 /microL; p < 0.001) and decreased by 8600/year vs 2500 in NL. Mean AST to Platelet Ratio Index (1.1 vs 0.4; p < 0.001), Fibrosis-4 Index (0.4 vs 0.2, p < 0.001), and spleen size z-score (SSZ) [1.5 vs 0.02; p < 0.001] were higher in NOD at BL; SSZ increased by 0.5 unit/year in NOD vs 0.1 unit/year in NL. Median liver stiffness (LSM) by transient elastography was higher in NOD (8.2 kPa, IQR 6-11.8) vs NL (5.3, 4.2-7, p < 0.0 0 01). Over 6.3 years follow-up (1.3- 10.3), 6 NOD had esophageal varices (cumulative incidence in 10 years: 20%; 95% CI: 0.0%, 40.0%), 2 had variceal bleeding, and 2 underwent liver transplantation; none had ascites or hepatic encephalopathy. No NL experienced liver-related events. Conclusions: NOD developed clinically evident portal hypertension faster than NL without worse growth or lung disease.

HomeRadioGraphicsVol. 43, No. 6 PreviousNext Pediatric ImagingRadioGraphics FundamentalsUS of the Spine in Neonates and Infants: A Practical GuideEmilio J. Inarejos Clemente , María Navallas Irujo, Oscar M. Navarro, Bárbara Salas Flores, Paulino Sousa Cacheiro, Enrique Ladera, Mónica Rebollo Polo, Marta Tijerín Bueno, Ignasi Barber Martínez de la TorreEmilio J. Inarejos Clemente , María Navallas Irujo, Oscar M. Navarro, Bárbara Salas Flores, Paulino Sousa Cacheiro, Enrique Ladera, Mónica Rebollo Polo, Marta Tijerín Bueno, Ignasi Barber Martínez de la TorreAuthor AffiliationsFrom the Department of Diagnostic Imaging, Hospital Sant Joan de Déu, Esplugues de Llobregat, Av Sant Joan de Déu 2, 08950 Barcelona, Spain (E.J.I.C., M.N.I., B.S.F., P.S.C., E.L., M.R.P., I.B.M.d.l.T.); Department of Medical Imaging, University of Toronto and Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada (O.M.N.); and Department of Diagnostic Imaging, Hospital Universitario San Agustín, Avilés, Spain (M.T.B.).Address correspondence to E.J.I.C. (email: [email protected]).Emilio J. Inarejos Clemente María Navallas IrujoOscar M. NavarroBárbara Salas FloresPaulino Sousa CacheiroEnrique LaderaMónica Rebollo PoloMarta Tijerín BuenoIgnasi Barber Martínez de la TorrePublished Online:May 4 2023https://doi.org/10.1148/rg.220136MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In AbstractThis online presentation reviews the use of spine US in newborns and infants, with emphasis on normal anatomy, imaging pitfalls, and normal variants of the spinal canal that may simulate disease.Suggested ReadingsLadino Torres MF, DiPietro MA. Spine ultrasound imaging in the newborn. Semin Ultrasound CT MR 2014;35(6):652–661. Crossref, Medline, Google ScholarLowe LH, Johanek AJ, Moore CW. Sonography of the neonatal spine: part 1—Normal anatomy, imaging pitfalls, and variations that may simulate disorders. AJR Am J Roentgenol 2007;188(3):733–738. Crossref, Medline, Google ScholarLowe LH, Johanek AJ, Moore CW. Sonography of the neonatal spine: part 2—Spinal disorders. AJR Am J Roentgenol 2007;188(3):739–744. Crossref, Medline, Google ScholarMeyers AB, Chandra T, Epelman M. Sonographic spinal imaging of normal anatomy, pathology and magnetic growing rods in children. Pediatr Radiol 2017;47(9):1046–1057. Crossref, Medline, Google ScholarSchenk JP, Herweh C, Günther P, Rohrschneider W, Zieger B, Tröger J. Imaging of congenital anomalies and variations of the caudal spine and back in neonates and small infants. Eur J Radiol 2006;58(1):3–14. Crossref, Medline, Google ScholarArticle HistoryReceived: May 28 2022Revision requested: June 24 2022Revision received: June 30 2022Accepted: July 6 2022Published online: May 04 2023 FiguresReferencesRelatedDetailsAccompanying This ArticleUltrasound of the Spine in Neonates and Infants: A Practical GuideMay 4 2023Default Digital Object SeriesRecommended Articles A Practical Approach to Diagnosis of Spinal DysraphismRadioGraphics2021Volume: 41Issue: 2pp. 559-575Multimodality Imaging Evaluation of Fetal Spine Anomalies with Postnatal CorrelationRadioGraphics2021Volume: 41Issue: 7pp. 2176-2192Nontraumatic Spinal Cord Compression: MRI Primer for Emergency Department RadiologistsRadioGraphics2019Volume: 39Issue: 6pp. 1862-1880Fluoroscopically Guided Epidural Injections of the Cervical and Lumbar SpineRadioGraphics2016Volume: 37Issue: 2pp. 537-561Spinal Hematomas: What a Radiologist Needs to KnowRadioGraphics2018Volume: 38Issue: 5pp. 1516-1535See More RSNA Education Exhibits US Of The Spine In Neonates And Infants: A Practical Guide Of Normal Findings, Normal Variants And Pathologic ConditionsDigital Posters2021Spinal Dysraphisms: Step-by-StepDigital Posters2022Breaking the Tie: Is That Cord Tethered?Digital Posters2019 RSNA Case Collection Tethered cordRSNA Case Collection2021Intradural Spinal Lipoma RSNA Case Collection2021Low Lying Conus with LipomaRSNA Case Collection2022 Vol. 43, No. 6 Slide PresentationMetrics Altmetric Score PDF download

Background: This study examines whether heterogeneous (HTG) pattern on liver ultrasound (US) identifies children at risk for advanced cystic fibrosis liver disease (aCFLD).Methods: Prospective 6-year multicenter case-controlled cohort study. Children with pancreatic insufficient cystic fibrosis (CF) aged 3-12 years without known cirrhosis underwent screening US. Participants with HTG were matched (by age, Pseudomonas infection status and center) 1:2 with participants with normal (NL) US pattern. Clinical status and laboratory data were obtained annually and US bi-annually for 6 years. Primary endpoint was development of nodular (NOD) US pattern consistent with aCFLD.Results: 722 participants underwent screening US, with 65 HTG and 592 NL. Final cohort included 55 HTG and 116 NL with = 1 follow-up US. ALT, AST, GGTP, FIB-4, GPR and APRI were higher, and platelets were lower in HTG compared to NL. HTG had a 9.5-fold increased incidence (95% confidence interval [CI]:3.4, 26.7, p < 0.0 0 01, 32.7% vs 3.4%) of NOD versus NL. HTG had a sensitivity of 82% and specificity of 75% for subsequent NOD. Negative predictive value of a NL US for subsequent NOD was 96%. Multivariate logistic prediction model that included baseline US, age, and log(GPR) improved the C-index to 0.90 compared to only baseline US (C-index 0.78). Based on survival analysis, 50% of HTG develop NOD after 8 years.Conclusions: Research US finding of HTG identifies children with CF with a 30-50% risk for aCFLD. A score based on US pattern, age and GPR may refine the identification of individuals at high risk for aCFLD.

Objectives: Cystic fibrosis liver disease (CFLD) begins early in life. Symptoms may be vague, mild, or nonexistent. Progressive liver injury may be associated with decrements in patient health before liver disease is clinically apparent. We examined Health-Related Quality of Life (HRQOL) in children enrolled in a multi-center study of CFLD to determine the impact of early CFLD on general and disease-specific QOL. Methods: Ultrasound (US) patterns of normal (NL), heterogeneous (HTG), homogeneous (HMG), or nodular (NOD) were assigned in a prospective manner to predict those at risk for advanced CFLD. Parents were informed of results. We assessed parent/child-reported (age ≥5 years) HRQOL by PedsQL 4.0 Generic Core and CF Questionnaire-revised (CFQ-R) prior to US and annually. HRQOL scores were compared by US pattern at baseline (prior to US), between baseline and 1 year and at 5 years. Multivariate analysis of variance (MANOVA) with Hotelling-Lawley trace tested for differences among US groups. Results: Prior to US, among 515 participants and their parents there was no evidence that HTG or NOD US was associated with reduced PedsQL/CFQ-R at baseline. Parents of NOD reported no change in PedsQL/CFQ-R over the next year. Child-report PedsQL/CFQ-R (95 NL, 20 NOD) showed improvement between baseline and year 5 for many scales, including Physical Function. Parents of HMG children reported improved CFQ-R scores related to weight. Conclusions: Early undiagnosed or pre-symptomatic liver disease had no impact on generic or disease-specific HRQoL, and HRQoL was remarkably stable in children with CF regardless of liver involvement.

Osteosarcoma and Ewing sarcoma are the most common bone sarcomas in children. Their clinical presentation is very variable depending on the age of the patient and tumor location. MRI is the modality of choice to assess these bone sarcomas and has an important function at diagnosis and also for monitoring recurrence or tumor response. Anatomic sequences include T1- and T2-weighted images and provide morphological assessment that is crucial to localize the tumor and describe anatomical boundaries. Multiparametric MRI provides functional information that helps in the assessment of tumor response to therapy by using different imaging sequences and biomarkers. This review manuscript illustrates the role of MRI in osteosarcoma and Ewing sarcoma in the pediatric population, with emphasis on a functional perspective, highlighting the use of diffusion-weighted imaging and dynamic contrast-enhanced MRI at diagnosis, and during and after treatment.

Midgut volvulus in association with malrotation is a pediatric surgical emergency. Prompt and accurate diagnosis is necessary to avoid bowel ischemia and necrosis, thereby reducing morbidity and mortality. Historically, the fluoroscopic upper gastrointestinal series has been the preferred imaging modality for the evaluation of both midgut malrotation and volvulus, although the use of ultrasound (US) is increasing. In this Narrative Review, we describe the findings of midgut malrotation and volvulus on US, including practical tips for acquisition and interpretation; discuss the advantages and challenges of both imaging modalities; and propose a path and safeguards for possible transition to the use of US as the first-line modality for diagnosis based on our experience in imaging children with midgut malrotation and volvulus.