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Introduction Deep learning–based MRI reconstruction has recently been introduced to improve image quality. This study aimed to evaluate the performance of deep learning reconstruction in pediatric brain MRI. Methods A total of 107 consecutive children who underwent 3.0 T brain MRI were included in this study. T2-weighted brain MRI was reconstructed using the three different reconstruction modes: deep learning reconstruction, conventional reconstruction with an intensity filter, and original T2 image without a filter. Two pediatric radiologists independently evaluated the following image quality parameters of three reconstructed images on a 5-point scale: overall image quality, image noisiness, sharpness of gray–white matter differentiation, truncation artifact, motion artifact, cerebrospinal fluid and vascular pulsation artifacts, and lesion conspicuity. The subjective image quality parameters were compared among the three reconstruction modes. Quantitative analysis of the signal uniformity using the coefficient of variation was performed for each reconstruction. Results The overall image quality, noisiness, and gray–white matter sharpness were significantly better with deep learning reconstruction than with conventional or original reconstruction (all P  < 0.001). Deep learning reconstruction had significantly fewer truncation artifacts than the other two reconstructions (all P  < 0.001). Motion and pulsation artifacts showed no significant differences among the three reconstruction modes. For 36 lesions in 107 patients, lesion conspicuity was better with deep learning reconstruction than original reconstruction. Deep learning reconstruction showed lower signal variation compared to conventional and original reconstructions. Conclusion Deep learning reconstruction can reduce noise and truncation artifacts and improve lesion conspicuity and overall image quality in pediatric T2-weighted brain MRI.

Purpose Polymorphous low-grade neuroepithelial tumors of the young (PLNTY) is a newly recognized brain tumor with genetic abnormalities frequently involving either BRAF or FGFR2/FGFR3. There are few publications available about the neuroradiological features of PLNTY. In this systematic review, we assessed the demographic, clinical, and neuroradiological features of PLNTY. Methods Literature data were extracted from database searches in MEDLINE and SCOPUS databases up to June 10, 2021. Studies reporting on pathologically proven PLNTY with neuroradiological findings were included. After reviewing 103 abstracts, 9 articles encompassing 19 cases met the inclusion criteria. We also added five patients from our hospital. The correlations between the presence of “transmantle-like sign” and the following three factors: duration of seizures; tumor size; and pathologically proven cortical dysplasia, were examined. Results The median patient age was 15.5 years (range, 5–57 years), and 15/24 (62.5%) were female. All tumors were localized supratentorialy. The main radiological features included cortical or subcortical masses (95.8%) in the temporal lobe (66.7%), calcification (83.3%), well-defined margins (72.7%), solid and cystic components (66.6%), and T2-weighted imaging (T2WI) hyperintensity (50.0%). The duration of seizure was significantly longer (positive vs. negative (median [range]), 24 months [6 − 96 months] vs. 5 months [1 − 12 months], p  = 0.042), and the presence of the cortical dysplasia was significantly more frequent (3/8 vs 0/16, p  = 0.042) in the patients with transmantle-like sign. Conclusion PLNTY typically represents a calcified, well-defined mass in the supratentorial cortical or subcortical regions. The radiological findings defined here could facilitate the diagnosis of PLNTY.

Purpose This study aimed to investigate the efficacy of occipital emissary vein (OEV) detection in the diagnosis of idiopathic intracranial hypertension (IHH) in the pediatric age group, and to compare the prevalence and luminal diameter of OEV in patients with IHH and in healthy control subjects. Methods Conventional magnetic resonance imaging findings were assessed in the patients with IHH and in healthy control subjects who were under the age of 18, by two observers. The presence and luminal dimension of OEV and transverse sinus stenosis were also evaluated and compared between these two groups with magnetic resonance venography techniques. Results The rate of OEV existence was 7 times higher in the IIH group compared to the control group based on the second observer outcome ( p  = 0.010, OR = 7.0), with a very good interobserver agreement (Ƙ = 0.85). The dimension of OEV ranged between 0.6 and 2.5 mm. There was no correlation found between the opening pressure and the dimension of OEV ( p  = 0.834). Conclusion In conclusion, OEV existence could be an additional radiological finding for diagnosing IHH among pediatric patients, alongside other conventional findings.

Purpose In this paper, I will report the range of appearances of schizencephaly in children and fetuses by reviewing a 10-year experience from a single centre and detail classification systems for the different forms of schizencephaly. This will lead to re-assessment of possible aetiological and mechanistic causes of schizencephaly. Methods All cases of pediatric and fetal schizencephaly were located on the local database between 2007 and 2016 inclusive. The studies were reviewed for the presence, location and type of schizencephaly, as well as the state of the (cavum) septum pellucidum, the location of the fornices and the presence of other brain abnormalities. Results The review included 21 children and 11 fetuses with schizencephaly. Schizencephaly (type 1) was found in 9% of children but no fetuses, schizencephaly (type 2) was present in 67% of the pediatric cases and in 45% of fetuses, whilst schizencephaly (type 3) was present in approximately 24% of children and 55% of fetuses. Other brain abnormalities were found in 67% of children and 55% of fetuses. Conclusion I have proposed a new system for classifying schizencephaly that takes into account all definitions of the abnormality in the literature. Using that approach, I have described the appearances and associations of pediatric and fetal cases of schizencephaly from a single centre. Review of the current literature appears to favour an acquired destructive aetiology for most cases of schizencephaly, and I have proposed a mechanism to explain the cortical formation abnormalities found consistently in and around areas of schizencephaly.

Purpose Sturge-Weber syndrome (SWS) is a developmental disorder with venous hypertension and associated tissue responses including pial angiomatosis, cortical calcifications, and cerebral atrophy. Arterial spin-labeled (ASL) perfusion is an advanced MR sequence which can assess perfusion, without the need for contrast. We systematically evaluated the potential benefits of using ASL in Sturge-Weber syndrome, to determine the extent of intracranial perfusion abnormality and stage of disease, relevant for prognostication and surgical planning. Methods Two pediatric neuroradiologists retrospectively evaluated ASL perfusion imaging of 31 children with confirmed SWS and recorded the presence of hyper-perfusion, hypo-perfusion, or normal perfusion. The presence and distribution of ASL abnormality were compared against the presence and side of atrophy/calcification and pial angiomatosis on standard MR sequences. Results Thirty-one children (52% female, median age 16.7 months) with SWS had ASL imaging. Seven (23%) had hyper-perfusion, 15 (48%) had hypo-perfusion, and 9 (29%) had no perfusion abnormalities. ASL perfusion abnormality matched the location of SWS findings on conventional imaging in 86% (19/22). ASL demonstrated statistically significant increased perfusion in the early stage of the disease and decreased perfusion when there was atrophy. The parietal lobe was involved in 86% of cases. Conclusion ASL perfusion imaging is an advanced technique which may contribute to earlier diagnosis and more accurate prognostication of Sturge-Weber syndrome, helping guide management and potential surgical planning.

Purpose The purpose of this study was to determine the accuracy of “black bone” (BB) MRI for the detection of skull fractures in children with potential abusive head trauma. Methods A total of 34 pediatric patients were evaluated for potential abusive head trauma. All patients had both a non-contrast head CT (HCT) with multiplanar reformatted images and 3D volumetric reformatted images where available (gold standard) for fracture diagnosis and BB of the head with multiplanar reformatted images and 3D volumetric images. BB was performed using an ultrashort TE pointwise encoding time reduction with radial acquisition (PETRA) sequence at 1.5 T or 3 T. BB datasets were post-processed and 3D images created using Fovia’s High Definition Volume Rendering® software. Two board-certified pediatric neuroradiologists independently reviewed the HCT and BB imaging, blinded to the findings from the other modality. Results Median patient age was 4 months (range 1.2–30 months). A total of 20 skull fractures in six patients (18% incidence of skull fractures) were detected on HCT. BB demonstrated 83% sensitivity (95%[CI] 36–99%), 100% specificity (95%[CI] 88–100%), 100% PPV (95%[CI] 46–100%), 97% NPV (95%[CI] 82–99%), and 97% accuracy (95%[CI] 85–99%) for diagnosis of a skull fracture. BB detected 95% (19/20) of the skull fractures detected by CT. Conclusion A black bone MRI sequence may provide high sensitivity and specificity for detection of skull fractures in pediatric patients with abusive head trauma.

Purpose Nasal chondromesenchymal hamartomas (NCMH) are rare, predominantly benign tumors of the sinonasal tract. The distinction from higher grade malignancy may be challenging based on imaging features alone. To increase the awareness of this entity among radiologists, we present a multi-institutional case series of pediatric NCMH patients showing the varied imaging presentation. Methods Descriptive assessment of imaging appearances of the lesions on computed tomography (CT) and magnetic resonance imaging (MRI) was performed. In addition, we reviewed demographic information, clinical data, results of genetic testing, management, and follow-up data. Results Our case series consisted of 10 patients, with a median age of 0.5 months. Intraorbital and intracranial extensions were both observed in two cases. Common CT findings included bony remodeling, calcifications, and bony erosions. MRI showed heterogeneous expansile lesion with predominantly hyperintense T2 signal and heterogenous post-contrast enhancement in the majority of cases. Most lesions exhibited increased diffusivity on diffusion weighted imaging and showed signal drop-out on susceptibility weighted images in the areas of calcifications. Genetic testing was conducted in 4 patients, revealing the presence of DICER1 pathogenic variant in three cases. Surgery was performed in all cases, with one recurrence in two cases and two recurrences in one case on follow-up. Conclusion NCMHs are predominantly benign tumors of the sinonasal tract, typically associated with DICER1 pathogenic variants and most commonly affecting pediatric population. They may mimic aggressive behavior on imaging; therefore, awareness of this pathology is important. MRI and CT have complementary roles in the diagnosis of this entity.

Distinguishing tumours from other conditions is a primary challenge in paediatric neuro-radiology. This paper aims to describe mimics, which are non-neoplastic conditions that have features similar to a neoplastic process caused by a non-neoplastic entity, and chameleons, which are uncommon presentations of brain tumours that are mistaken for other diagnoses. By doing so, we aim to raise awareness of these conditions and prevent inappropriate investigations or treatment in children. When suspecting a brain tumour, a detailed history, physical examination, and appropriate laboratory investigations can provide important clues about the nature of the lesion and narrow the list of possible differential diagnoses. Presented here is a collection of cases that have puzzled us for various reasons, including the absence of symptoms, coincidental timing, or misleading radiological features. Included in this pictorial essay are cases in which only a biopsy has helped us to make the correct diagnosis, as well as cases in which an unsuccessful biopsy has allowed us to evaluate hypotheses that were previously unaddressed. The paper also highlights the limited knowledge we have about the intercausality between malformations and later onset tumours, and the spectrum of manifestations that metabolic and genetic disorders can have. Key points When making an oncological radiological diagnosis in children, there are several additional factors to consider compared to adults. This is particularly true due to the extreme histopathological heterogeneity. Children can present with mass-forming lesions caused by various conditions, including inflammatory, infectious, demyelinating, or malformative aetiologies. In some cases, MRI features can significantly overlap, making it challenging to initiate appropriate therapy based on imaging data. The lack of contrast enhancement or restricted diffusion does not always indicate a non-neoplastic cause or a less clinically aggressive tumour. A timely and minimally invasive biopsy may be necessary to confirm the presence of pathology that is not certain on MRI and to provide appropriate treatment for the child’s illness. MR spectroscopy, perfusion-weighted imaging and Amid Proton Transfer weighted imaging can aid in distinguishing between treatment-related features and relapses, and between inflammatory processes and tumours, if used and interpreted correctly.

Purpose Exposure to prenatal opioids may adversely impact the developing brain networks. The aim of this pilot study was to evaluate alterations in amygdalar functional connectivity in human infants with prenatal opioid exposure. Methods In this prospective IRB approved study, we performed resting state functional MRI (rs-fMRI) in 10 infants with prenatal opioid exposure and 12 infants without prenatal drug exposure at < 48 weeks corrected gestational age. Following standard preprocessing, we performed seed-based functional connectivity analysis with the right and left amygdala as the regions of interest after correcting for maternal depression and infant sex. We compared functional connectivity of the amygdala network between infants with and without prenatal opioid exposure. Results There were significant differences in connectivity of the amygdala seed regions to the several cortical regions including the medial prefrontal cortex in infants who had prenatal opioid exposure when compared with opioid naïve infants. Conclusion This finding of increased amygdala functional connectivity in infants with in utero opioid exposure suggests a potential role of maternal opioid exposure on infants’ altered amygdala function. This association with prenatal exposure needs to be replicated in future larger studies.

Purpose An accurate assessment of the World Health Organization grade is vital for patients with pediatric gliomas to direct treatment planning. We aim to evaluate the diagnostic performance of whole-tumor histogram analysis of diffusion-weighted imaging (DWI) and dynamic susceptibility contrast-enhanced perfusion-weighted imaging (DSC-PWI) for differentiating pediatric high-grade gliomas from pediatric low-grade gliomas. Methods Sixty-eight pediatric patients (mean age, 10.47 ± 4.37 years; 42 boys) with histologically confirmed gliomas underwent preoperative MR examination. The conventional MRI features and whole-tumor histogram features extracted from apparent diffusion coefficient (ADC) and cerebral blood volume (CBV) maps were analyzed, respectively. Receiver operating characteristic curves and the binary logistic regression analysis were performed to determine the diagnostic performance of parameters. Results For conventional MRI features, location, hemorrhage and tumor margin showed significant difference between pediatric high- and low-grade gliomas (all, P  < .05). For advanced MRI parameters, ten histogram features of ADC and CBV showed significant differences between pediatric high- and low-grade gliomas (all, P  < .05). The diagnostic performance of the combination of DSC-PWI and DWI (AUC = 0.976, sensitivity = 100%, NPV = 100%) is superior to conventional MRI or DWI model, respectively (AUC cMRI  = 0.700, AUC DWI  = 0.830; both, P  < .05). Conclusion The whole-tumor histogram analysis of DWI and DSC-PWI is a promising method for grading pediatric gliomas.