Jesse Courtier

All Publications

• Does Pediatric Radiology Need Faster Horses? Rethinking Strategies to Workforce and Workflow ACADEMIC RADIOLOGY Courtier, J., Hess, C. P. 2023; 30 (9): 2046-2049

  View details for DOI 10.1016/j.acra.2023.05.040

  View details for Web of Science ID 001069669900001

  View details for PubMedID 37394413

• Evaluating a Suspected Perianal Abscess in a Child. AJR. American journal of roentgenology Chawla, T., Courtier, J., Elias, J. J., Hosokawa, T. 2025

  View details for DOI 10.2214/AJR.25.34044

  View details for PubMedID 41090645

• The umbilicus and pelvic incidence to inform surgical incisions for anterior lumbar interbody fusions: A radiographic analysis EUROPEAN SPINE JOURNAL Arora, A., Cort, K., Gomez-Sanchez, C., Sharfman, Z. T., Kasir, R., Hiramoto, J., Courtier, J., Theologis, A. A. 2025; 34 (5): 1900-1906

  Abstract

  To radiographically assess the umbilicus' level (i.e. latitude) relative to the anterior lumbar spine based on varying pelvic incidence (PI) magnitudes.Pediatric patients (ages 10-18 years) with a previously obtained CT abdomen/pelvis were reviewed. Excluded were patients with prior spine surgery, spinal deformity, and/or underlying lumbar spinal degenerative pathology. On sagittal CT images, 2 radiologists recorded the vertebral level/disc space that corresponded to the umbilicus' latitude level. On the CTs' scout lateral images, two spine surgeons measured the PI. The spinal level corresponding to the umbilicus' latitude was compared between 3 groups based on PI magnitude: low (< 45°), middle (45°-65°), and high (65°).107 patients (average age = 14.82.0 years; 62.6% female; average BMI=25.9±10.1) met inclusion criteria. Of all patients, the umbilicus' level ranged from the L3-4 disc to the L5 vertebral body with the L4-5 disc (36.4%) and L4 vertebral body (29.0%) being the most common levels. Average PI was 47.2° 11.9° (Low PI-41.1%; Middle PI-46.7%; High PI-12.1%). The umbilicus' level relative to the spine significantly varied based on PI magnitude (p<0.001). In Low PI, the majority's umbilicus corresponded to the L4-5 disc (50%) or L5 vertebral body (18.2%). In Middle PI, the majority's umbilicus was at the L4 vertebral body (34.0%) and L4-5 disc (34.0%). In High PI, the majority's umbilicus corresponded to the L3-4 disc (38.5%) or L4 vertebral body (46.2%).The umbilicus' level relative to the lumbar spine significantly varies based on PI magnitude. Patients with lower PIs (low sacral slope) have their umbilicus more commonly located over the distal lumbar spine (L4-5 disc/L5 vertebral body), while high PI patients (high sacral slope) have more superiorly located vertebral levels when referencing the umbilicus. Additional clinical investigations will be beneficial to confirm utility of these findings in guiding location of ALIF incisions.

  View details for DOI 10.1007/s00586-025-08846-5

  View details for Web of Science ID 001462952200001

  View details for PubMedID 40199751

• Assessment of superior mesenteric vascular flow quantitation in children using four-dimensional flow magnetic resonance imaging: A feasibility study WORLD JOURNAL OF RADIOLOGY Leesmidt, K., Vakil, P., Verstraete, S., Liu, A. R., Durand, R., Courtier, J. 2025; 17 (2): 99333

  Abstract

  Four-dimensional (4D) flow magnetic resonance imaging (MRI) is used as a noninvasive modality for assessing hemodynamic information with neurovascular and body applications. The application of 4D flow MRI for assessment of bowel disease in children has not been previously described.To determine feasibility of superior mesenteric venous and arterial flow quantitation in pediatric patients using 4D flow MRI.Nine pediatric patients (7-14 years old, 5 male and 4 female) with history or suspicion of bowel pathology, who underwent magnetic resonance (MR) enterography with 4D flow MR protocol from November 2022 to October 2023. Field strength/sequence: 3T MRI using 4D flow MR protocol. Flow velocity and peak speed measurements were performed by two diagnostic radiologists placing the region of interest in perpendicular plane to blood flow on each cross section of superior mesenteric artery (SMA) and superior mesenteric vein (SMV) at three predetermined levels. Bland-Altman analysis, showed good agreement of flow velocity and peak speed measurements of SMV and SMA between two readers.Mean SMV flow velocity increased from proximal to mid to distal (0.14 L/minute, 0.17 L/minute, 0.22 L/minute respectively). Mean SMA flow velocity decreased from proximal to mid to distal (0.35 L/minute, 0.27 L/minute, 0.21 L/minute respectively). Observed agreement was good for flow velocity measurements of SMV (mean bias -0.01 L/minute and 95% limits of agreement, -0.09 to 0.08 L/minute) and SMA (mean bias -0.03 L/minute and 95% limits of agreement, -0.23 to 0.17 L/minute) between two readers. Good agreement for peak speed measurements of SMV (mean bias -1.2 cm/second and 95% limits of agreement, -9.4 to 7.0 cm/second) and SMA (mean bias -3.2 cm/second and 95% limits of agreement, -31.4 to 24.9 cm/second).Flow quantitation using 4D Flow is feasible to provide hemodynamic information for SMV and SMA in children.

  View details for DOI 10.4329/wjr.v17.i2.99333

  View details for Web of Science ID 001440468800004

  View details for PubMedID 40060952

  View details for PubMedCentralID PMC11885928

• Factors and Labor Cost Savings Associated with Successful Pediatric Imaging without Anesthesia: a Single-Institution Study. Academic radiology Chen, J. V., Zapala, M. A., Zhou, A., Vu, N., Meyer, L., Smith, M. D., Kelleher, C., Glenn, O. A., Courtier, J., Li, Y. 2023; 30 (9): 1979-1988

  Abstract

  In pediatric imaging, sedation is often necessary to obtain diagnostic quality imaging. We aim to quantify patient and imaging-specific factors associated with successful pediatric scans without anesthesia and to evaluate labor cost savings associated with our institutional Scan Without Anesthesia Program (SWAP).Patients who participated in SWAP between 2019-2022 were identified. Chart review was conducted to obtain sociodemographic and clinical information. Radiology database was used to obtain scan duration, modality/body part of examination, and administration of contrast. Mann-Whitney U and Chi-Square tests were used for univariate analysis of factors associated with success. Multivariate logistic regression was used to evaluate independent contributions to success. Associated hospital labor cost savings were estimated using salary information obtained through publicly available resources.Of 731 patients, 698 had successful and 33 had unsuccessful scans (95% success rate). In univariate analysis, older age, female sex, absence of developmental delay, and administration of contrast were significantly associated with successful scans. Multivariate analyses revealed that older age, female sex, and absence of developmental delay were significant independent factors lending toward success. Imaging-related factors were not associated with outcome in multivariate analysis. Estimated labor cost savings were $139,367.80 per year for the medical center.SWAP had an overall success rate of 95%. Older age, absence of developmental delay, and female sex were independently significantly associated with successful outcome. Cost analysis reveals substantial labor cost savings to the institution compared with imaging under anesthesia.

  View details for DOI 10.1016/j.acra.2022.12.041

  View details for PubMedID 36641347

• Rate of head ultrasound abnormalities at one month in very premature and extremely premature infants with normal initial screening ultrasound PEDIATRIC RADIOLOGY Liu, A. R., Gano, D., Li, Y., Diwakar, M., Courtier, J. L., Zapala, M. A. 2022; 52 (6): 1150-1157

  Abstract

  Premature infants are at risk for multiple types of intracranial injury with potentially significant long-term neurological impact. The number of screening head ultrasounds needed to detect such injuries remains controversial.To determine the rate of abnormal findings on routine follow-up head ultrasound (US) performed in infants born at ≤ 32 weeks' gestational age (GA) after initial normal screening US.A retrospective study was performed on infants born at ≤ 32 weeks' GA with a head US at 3-5 weeks following a normal US at 3-10 days at a tertiary care pediatric hospital from 2014 to 2020. Exclusion criteria included significant congenital anomalies, such as congenital cardiac defects necessitating surgery, congenital diaphragmatic hernia or spinal dysraphism, and clinical indications for US other than routine screening, such as sepsis, other risk factors for intracranial injury besides prematurity, or clinical neurological abnormalities. Ultrasounds were classified as normal or abnormal based on original radiology reports. Images from initial examinations with abnormal follow-up were reviewed.Thirty-three (14.2%) of 233 infants had 34 total abnormal findings on follow-up head US after normal initial US. Twenty-seven infants had grade 1 germinal matrix hemorrhage, and four had grade 2 intraventricular hemorrhage. Two had periventricular echogenicity and one had a focus of cerebellar echogenicity that resolved and was determined to be artifactual.When initial screening head ultrasounds in premature infants are normal, follow-up screening ultrasounds are typically also normal. Abnormal findings are usually limited to grade 1 germinal matrix hemorrhage.

  View details for DOI 10.1007/s00247-022-05285-y

  View details for Web of Science ID 000750329900001

  View details for PubMedID 35102433

  View details for PubMedCentralID PMC9107425

• Mullerian Duct Anomalies: Role in Fertility and Pregnancy RADIOGRAPHICS Sugi, M. D., Penna, R., Jha, P., Poder, L., Behr, S. C., Courtier, J., Mok-Lin, E., Rabban, J. T., Choi, H. H. 2021; 41 (6): 1857-1875

  Abstract

  Müllerian duct anomalies (MDAs) have important implications for the reproductive health of female patients. In patients with both infertility and recurrent pregnancy loss, the incidence of MDAs is as high as 25%. Congenital uterine anomalies are often only part of a complex set of congenital anomalies involving the cervix, vagina, and urinary tract. Multiple classification systems for MDAs exist, each with different criteria that vary most for the diagnosis of septate uterus. Recognizing the features that guide clinical management is essential for interpretation. Identification of an MDA should prompt evaluation for associated urinary tract anomalies. In patients with infertility who seek to use assisted reproductive technologies such as intrauterine insemination, recognition of MDAs may have an affect on reproductive success, particularly in patients who have an incomplete and clinically occult septum that divides the cervix. Two-dimensional US is the first-line modality for evaluating the uterus and adnexa. Three-dimensional (3D) US or MRI may help to visualize the external uterine fundal contour and internal indentation of the endometrial cavity, which are two morphologic characteristics that are keys to the diagnosis of congenital uterine anomalies. Hysterosalpingo contrast-enhanced US may be performed in conjunction with 3D US to evaluate uterine morphologic characteristics, the endometrial cavity, and tubal patency in a single examination. MRI helps to characterize rudimentary uteri in patients with müllerian hypoplasia and allows assessment for ectopic ureters, abnormally positioned ovaries, or associated deep infiltrative endometriosis. Online supplemental material is available for this article. ©RSNA, 2021.

  View details for DOI 10.1148/rg.2021210022

  View details for Web of Science ID 000704341800027

  View details for PubMedID 34597219

• Ureteral injury following anterior thoracolumbar spinal instrumented fusion for adolescent idiopathic scoliosis: a case report with CT angiography analysis of surgically relevant anatomy SPINE DEFORMITY Hung, N. J., Theologis, A. A., Courtier, J. L., Harmon, D., Diab, M. 2021; 9 (6): 1691-1698

  Abstract

  To report a rare ureteral injury following anterior spinal fusion for adolescent idiopathic scoliosis (AIS) that resulted in complete nephrectomy and to delineate the anatomical relationship between the proximal ureter and the anterior lumbar spine based on CT angiography (CTA).Thoracolumbar spine CTAs of children with AIS were reviewed. We measured the following relationships to the ureters: lateral-most aspect of vertebral body, anterior psoas at intervertebral disc/vertebral body levels, and lateral psoas at vertebral body level. Spine level at which the renal arteries originated from the aorta was identified. Distance from origin to corresponding vertebral body/intervertebral disc also was measured.Forty-one girls and seven boys (mean age 12 years, range 7-18) were analyzed. Scoliosis lumbar convexity was left 94% and right 6%. From L1 to L4, ureter was identified within 1-2 cm of vertebral body. Distance between ureter and vertebral body and ureter and anterior psoas at intervertebral disc/vertebral body levels was less on left vs. right from L1 to L4 (p < 0.0001). Distance between ureter and lateral psoas was less on left vs. right from L1 to L2 (p = 0.0205; p = 0.0132) and greater on left vs. right from L3 to L4 (p = 0.0022; p = 0.0076). Renal artery originated at L1/L2 in > 50%. There was no difference in distance from renal artery origin to vertebral body/intervertebral disc (p = 0.4764).Ureteral injury is a potentially morbid complication of anterior spine surgery. Injury can occur secondary to disrupted blood supply and mechanical tissue damage. Surgeons must clearly understand the juxta-spinal anatomy to limit dissection and modify retraction to reduce risk.Level IV.

  View details for DOI 10.1007/s43390-021-00363-x

  View details for Web of Science ID 000658358800001

  View details for PubMedID 34075563

  View details for PubMedCentralID 4104146

• Comparing Computed Tomography-Derived Augmented Reality Holograms to a Standard Picture Archiving and Communication Systems Viewer for Presurgical Planning: Feasibility Study. JMIR perioperative medicine Dallas-Orr, D., Penev, Y., Schultz, R., Courtier, J. 2020; 3 (2): e18367

  Abstract

  BACKGROUND: Picture archiving and communication systems (PACS) are ubiquitously used to store, share, and view radiological information for preoperative planning across surgical specialties. Although traditional PACS software has proven reliable in terms of display accuracy and ease of use, it remains limited by its inherent representation of medical imaging in 2 dimensions. Augmented reality (AR) systems present an exciting opportunity to complement traditional PACS capabilities.OBJECTIVE: This study aims to evaluate the technical feasibility of using a novel AR platform, with holograms derived from computed tomography (CT) imaging, as a supplement to traditional PACS for presurgical planning in complex surgical procedures.METHODS: Independent readers measured objects of predetermined, anthropomorphically correlated sizes using the circumference and angle tools of standard-of-care PACS software and a newly developed augmented reality presurgical planning system (ARPPS).RESULTS: Measurements taken with the standard PACS and the ARPPS showed no statistically significant differences. Bland-Altman analysis showed a mean difference of 0.08% (95% CI -4.20% to 4.36%) for measurements taken with PACS versus ARPPS' circumference tools and -1.84% (95% CI -6.17% to 2.14%) for measurements with the systems' angle tools. Lin's concordance correlation coefficients were 1.00 and 0.98 for the circumference and angle measurements, respectively, indicating almost perfect strength of agreement between ARPPS and PACS. Intraclass correlation showed no statistically significant difference between the readers for either measurement tool on each system.CONCLUSIONS: ARPPS can be an effective, accurate, and precise means of 3D visualization and measurement of CT-derived holograms in the presurgical care timeline.

  View details for DOI 10.2196/18367

  View details for PubMedID 33393933

• Abdominal Applications of Pediatric Body MR Angiography: Tailored Optimization for Successful Outcome AMERICAN JOURNAL OF ROENTGENOLOGY Edwards, E. A., Lee, M. M., Acord, M. R., Courtier, J. 2020; 215 (1): 206-214

  Abstract

  OBJECTIVE. The purpose of this article is to summarize current common techniques and indications for pediatric abdominopelvic MR angiography and strategies for optimizing them to achieve successful outcomes. We also discuss newer MR angiography techniques, including whole-body imaging and blood pool contrast agents, as well as various approaches to reducing the need for anesthesia in pediatric MRI. CONCLUSION. Pediatric body vascular imaging presents a unique set of challenges that require a tailored approach. Emerging pediatric abdominopelvic MR angiography techniques hold promise for continued improvement in pediatric body MR angiography.

  View details for DOI 10.2214/AJR.19.22289

  View details for Web of Science ID 000543311000046

  View details for PubMedID 32374667

• Congenital superior mesenteric artery aneurysm in a 6-week-old infant presenting with upper gastrointestinal bleeding JOURNAL OF VASCULAR SURGERY Subbaraj, L., Beleniski, F., Courtier, J., Vartanian, S., Nijagal, A. 2020; 71 (4): 1391-1394

  Abstract

  Visceral artery aneurysms are rare in infants and children. The majority of cases are caused by genetic syndromes, trauma, or infection. Although the majority of aneurysms are asymptomatic, visceral artery aneurysms can present with abdominal pain, nausea/vomiting, or rupture. Aneurysm rupture can manifest as hemodynamic instability and/or gastrointestinal bleeding. We present the case of a congenital idiopathic aneurysm of the superior mesenteric artery in a 6-week-old infant who presented with gastrointestinal bleeding. We report a stepwise surgical approach to achieving aneurysm exclusion and thrombosis, and highlight the robust mesenteric collateral circulation that can develop in pediatric patients.

  View details for DOI 10.1016/j.jvs.2019.06.106

  View details for Web of Science ID 000521493900043

  View details for PubMedID 31401110

• Evaluating the Performance of Augmented Reality in Displaying Magnetic Resonance Imaging-Derived Three-Dimensional Holographic Models JOURNAL OF MEDICAL IMAGING AND RADIATION SCIENCES Chang, F., Laguna, B., Uribe, J., Vu, L., Zapala, M. A., Devincent, C., Courtier, J. 2020; 51 (1): 95-102

  Abstract

  Establishing accuracy and precision of magnetic resonance (MR)-derived augmented reality (AR) models is critical before clinical utilization, particularly in preoperative planning. We investigate the performance of an AR application in representing and displaying MR-derived three-dimensional holographic models.Thirty gold standard (GS) measurements were obtained on a magnetic resonance imaging (MRI) phantom (six interfiducial distances and five configurations). Four MRI pulse sequences were obtained for each of the five configurations, and distances measured in Picture Archiving and Communication System (PACS). Digital imaging and communications in medicine files were translated into three-dimensional models and then loaded onto a novel AR platform. Measurements were also obtained with the software's AR caliper tool. Significant differences among the three groups (GS, PACS, and AR) were assessed with the Kruskal-Wallis test and nonsample median test. Accuracy analysis of GS vs. AR was performed. Precision (percent deviation) of the AR-based caliper tool was also assessed.No statistically significant difference existed between AR and GS measurements (P = .6208). PACS demonstrated mean squared error (MSE) of 0.29%. AR digital caliper demonstrated an MSE of 0.3%. Three-dimensional T2 CUBE AR measurements using the platform's AR caliper tool demonstrated an MSE of 8.6%. Percent deviation of AR software caliper tool ranged between 1.9% and 3.9%.AR demonstrated a high degree of accuracy in comparison to GS, comparable to PACS-based measurements. AR caliper tool demonstrated overall lower accuracy than with physical calipers, although with MSE <10% and greatest measured difference from GS measuring <5 mm. AR-based caliper demonstrated a high degree of precision.There was no statistically significant difference between GS measurements and three-dimensional AR measurements in MRI phantom models.

  View details for DOI 10.1016/j.jmir.2019.10.006

  View details for Web of Science ID 000529923800013

  View details for PubMedID 31862176

• Improved diagnostic confidence and accuracy of pediatric elbow fractures with digital tomosynthesis PEDIATRIC RADIOLOGY Zapala, M. A., Livingston, K., Bokhari, D., Phelps, A. S., Courtier, J. L., Ma, C., Seo, Y., MacKenzie, J. D. 2020; 50 (3): 363-370

  Abstract

  Pediatric elbow fractures are common but remain challenging to accurately diagnose. Digital tomosynthesis is a technique that has shown promise in difficult adult fracture patterns but has not been formally studied in the pediatric population.To assess the added value of digital tomosynthesis on the detection and diagnostic confidence of pediatric elbow fractures.A retrospective study was performed between January 2016 and December 2017 in pediatric patients (≤18 years) to assess the ability of conventional elbow radiographs and digital tomosynthesis to detect elbow fractures. One hundred twenty-one pediatric patients with concern for pediatric elbow trauma (64 males, 57 females; mean age: 8.1 years, range: 1 year to 17 years) were imaged with both conventional elbow radiographs and digital tomosynthesis. Two blinded pediatric radiologists identified fractures and indicated their diagnostic confidence. Observer agreement was assessed with Cohen's Kappa coefficient and a nonparametric Wilcoxon rank sum test was used to compare the degree of diagnostic confidence between standard radiographs alone and standard radiographs with digital tomosynthesis. McNemar's test was used to assess the difference in the rate of fracture detection between the two methods and sensitivity, specificity, precision, accuracy and diagnostic odds ratios were calculated.Compared with standard radiographs alone, standard radiographs with digital tomosynthesis improved inter-rater agreement, sensitivity, specificity, accuracy, precision and the diagnostic odds ratio for fracture detection and increased diagnostic confidence (Rater 1: P=0.01, Rater 2: P=0.003).The addition of digital tomosynthesis with conventional elbow radiographs improves diagnostic confidence and performance for the detection of pediatric elbow fractures.

  View details for DOI 10.1007/s00247-019-04548-5

  View details for Web of Science ID 000514542500012

  View details for PubMedID 31745596

• Congenital Oral Masses: An Anatomic Approach to Diagnosis RADIOGRAPHICS Chapman, M. C., Soares, B. P., Li, Y., Shum, D. J., Glenn, O. A., Glastonbury, C. M., Courtier, J. L. 2019; 39 (4): 1143-1160

  Abstract

  Although congenital oral masses are rare, they are readily detectable during fetal US screening. Most congenital oral masses are benign, but some may cause mechanical airway obstruction, resulting in poor outcomes at delivery. The radiologist's ability to describe these abnormalities and their physiologic sequelae accurately can have a substantial effect on perinatal treatment. Furthermore, despite being rare, congenital oral lesions encountered at screening and at follow up fetal MRI provide the opportunity to make a specific diagnosis by following a simple anatomic approach. This article describes an anatomic algorithm as the framework for accurate diagnosis of congenital oral lesions. The imaging appearance of the most common congenital oral cavity neoplasms is outlined, including vascular anomalies, epulides, choristomas, congenital lingual thyroid anomalies, lingual hamartomas, and epignathi, and other conditions that mimic these at US. Also reviewed are perinatal management of masses that affect the fetal airway and the imaging features key to optimizing delivery outcomes. Online supplemental material is available for this article. ©RSNA, 2019.

  View details for DOI 10.1148/rg.2019180128

  View details for Web of Science ID 000474437100017

  View details for PubMedID 31283464

• Value of dedicated small-field-of-view sacroiliac versus large-field-of-view pelvic magnetic resonance imaging for evaluating pediatric sacroiliitis PEDIATRIC RADIOLOGY Wagle, S., Gu, J. T., Courtier, J. L., Phelps, A. S., Lin, C., MacKenzie, J. D. 2019; 49 (7): 933-940

  Abstract

  Optimized MRI parameters can be leveraged to improve signal intensity, accelerate imaging acquisition and increase resolution. Higher-resolution imaging with a small field of view (FOV) has been proposed as standard practice for investigating sacroiliac (SI) joints, but the improvement in disease detection and characterization over pelvic imaging with large FOV has not been established.The purpose of this study was to compare dedicated MR images of the SI joints with survey imaging (large-FOV pelvic MRI) for detecting sacroiliitis.Fifty-eight pediatric patients suspected of having sacroiliitis underwent dedicated sacroiliac joint and survey pelvic imaging at the same imaging session. We independently evaluated the small- and large-FOV image data sets for presence or absence of sacroiliitis, e.g., bone marrow edema, erosions and synovitis. We used nonparametric statistical tests to compare lesion scores for severity of inflammation. We created test characteristics for the survey pelvic images (low-resolution images of the sacroiliac joints) using dedicated sacroiliac images (small-FOV, high-resolution images) as the gold standard.Dedicated sacroiliac small-FOV MRI detected more sacroiliitis compared to survey pelvic imaging with large FOV (χ2=6.125, P=0.013). Readers detected significantly more features of inflammation on small- compared to large-FOV images, e.g., erosions (P=0.039), synovitis (P=0.009), sclerosis (P=0.017) and osteitis (P=0.001). Test characteristics for pelvic large-FOV imaging were sensitivity=0.76, specificity=1.00, positive predictive value = 1.00 and negative predictive value = 0.75.This study provides test characteristics for survey pelvic MRI with lower-resolution large-field-of-view images as a screening tool for detecting sacroiliitis. Pelvic screening studies with large FOV have lower sensitivity, and dedicated sacroiliac MRI with small FOV is superior in detecting sacroiliitis when compared to pelvic screening MRI.

  View details for DOI 10.1007/s00247-018-4323-5

  View details for Web of Science ID 000469812600012

  View details for PubMedID 30623211

• Implementing Virtual and Augmented Reality Tools for Radiology Education and Training, Communication, and Clinical Care RADIOLOGY Uppot, R. N., Laguna, B., McCarthy, C. J., De Novi, G., Phelps, A., Siegel, E., Courtier, J. 2019; 291 (3): 570-580

  Abstract

  Advances in virtual immersive and augmented reality technology, commercially available for the entertainment and gaming industry, hold potential for education and clinical use in medicine and the field of medical imaging. Radiology departments have begun exploring the use of these technologies to help with radiology education and clinical care. The purpose of this review article is to summarize how three institutions have explored using virtual and augmented reality for radiology.

  View details for DOI 10.1148/radiol.2019182210

  View details for Web of Science ID 000468618200003

  View details for PubMedID 30990383

• Assessment of quiet T2 weighted PROPELLER sequence in pediatric abdominal imaging CLINICAL IMAGING Zaccagnino, E., Devincent, C., Leelakanok, N., Phelps, A. S., Zapala, M., Worters, P., Courtier, J. 2019; 53: 12-16

  Abstract

  Elevated acoustic noise during Magnetic Resonance Imaging (MRI) has been associated with patient anxiety and altered cochlear function. Acoustic Reduction Technique (ART) T2 weighted (T2w) periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) has been studied in brain MR but not abdominopelvic imaging. The purpose of our study was to evaluate the image quality and acoustic noise level of ART T2w PROPELLER sequence in comparison with the conventional T2w PROPELLER sequence in pediatric abdomino-pelvic imaging.Eleven consecutive pediatric patients undergoing abdomino-pelvic MRI were scanned on a 3 Tesla magnet using standard and ART T2w PROPELLER sequences. After scanning completion, objective sound level measurements were performed with a sound level meter and microphone. Mann-Whitney U test was used for a non-parametric two-tailed statistical analysis of acoustics, image rating and scan time with significance level set to 0.05. Overall inter-rater agreement was calculated using Cohen's kappa coefficient.Eleven pediatric patients (4 females and 7 males) between 26 days and 18 years of age (mean = 10.0, SD = 5.8) were included. ART T2w produced lower levels of acoustic noise than standard technique in a comparison of mean decibel readings from eleven trials of standard and ART T2w (p value = 0.00008). Streak artifacts were rated greater in ART T2w by both raters (p-value = 0.00278 and 0.00252). There was no significant difference in bile duct blurring, respiratory ghosting, pulsation, fat suppression or hepatic parenchymal depiction.Presence of additional streaking artifacts should be considered along with the benefit of reduced acoustic noise from ART T2w.

  View details for DOI 10.1016/j.clinimag.2018.09.014

  View details for Web of Science ID 000454470300004

  View details for PubMedID 30286312

• Phase II Trial of Alisertib in Combination with Irinotecan and Temozolomide for Patients with Relapsed or Refractory Neuroblastoma CLINICAL CANCER RESEARCH DuBois, S. G., Mosse, Y. P., Fox, E., Kudgus, R. A., Reid, J. M., McGovern, R., Groshen, S., Bagatell, R., Maris, J. M., Twist, C. J., Goldsmith, K., Granger, M., Weiss, B., Park, J. R., Macy, M. E., Cohn, S. L., Yanik, G., Wagner, L. M., Hawkins, R., Courtier, J., Lai, H., Goodarzian, F., Shimada, H., Boucher, N., Czarnecki, S., Luo, C., Tsao-Wei, D., Matthay, K. K., Marachelian, A. 2018; 24 (24): 6142-6149

  Abstract

  In phase I testing, alisertib tablets with irinotecan and temozolomide showed significant antitumor activity in patients with neuroblastoma. This study sought to confirm activity of this regimen; evaluate an alisertib oral solution; and evaluate biomarkers of clinical outcomes.We conducted a two-stage phase II trial of alisertib tablets (60 mg/m2/dose × 7 days), irinotecan (50 mg/m2/dose i.v. × 5 days), and temozolomide (100 mg/m2/dose orally × 5 days) in patients with relapsed or refractory neuroblastoma. The primary endpoint was best objective response. A separate cohort was treated with alisertib at 45 mg/m2 using oral solution instead of tablets. Exploratory analyses sought to identify predictors of toxicity, response, and progression-free survival (PFS) using pooled data from phase I, phase II, and oral solution cohorts.Twenty and 12 eligible patients were treated in the phase II and oral solution cohorts, respectively. Hematologic toxicities were the most common adverse events. In phase II, partial responses were observed in 19 evaluable patients (21%). The estimated PFS at 1 year was 34%. In the oral solution cohort, 3 patients (25%) had first cycle dose-limiting toxicity (DLT). Alisertib oral solution at 45 mg/m2 had significantly higher median Cmax and exposure compared with tablets at 60 mg/m2. Higher alisertib trough concentration was associated with first cycle DLT, whereas MYCN amplification was associated with inferior PFS.This combination shows antitumor activity, particularly in patients with MYCN nonamplified tumors. Data on an alisertib oral solution expand the population able to be treated with this agent.

  View details for DOI 10.1158/1078-0432.CCR-18-1381

  View details for Web of Science ID 000453267600007

  View details for PubMedID 30093449

  View details for PubMedCentralID PMC6295246

• Clinically Actionable Hypercholesterolemia and Hypertriglyceridemia in Children with Nonalcoholic Fatty Liver Disease JOURNAL OF PEDIATRICS Harlow, K. E., Africa, J. A., Wells, A., Belt, P. H., Behling, C. A., Jain, A. K., Molleston, J. P., Newton, K. P., Rosenthal, P., Vos, M. B., Xanthakos, S. A., Lavine, J. E., Schwimmer, J. B., Nonalcoholic Steatohepatitis Clini 2018; 198: 76-+

  Abstract

  To determine the percentage of children with nonalcoholic fatty liver disease (NAFLD) in whom intervention for low-density lipoprotein cholesterol or triglycerides was indicated based on National Heart, Lung, and Blood Institute guidelines.This multicenter, longitudinal cohort study included children with NAFLD enrolled in the National Institute of Diabetes and Digestive and Kidney Diseases Nonalcoholic Steatohepatitis Clinical Research Network. Fasting lipid profiles were obtained at diagnosis. Standardized dietary recommendations were provided. After 1 year, lipid profiles were repeated and interpreted according to National Heart, Lung, and Blood Institute Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction. Main outcomes were meeting criteria for clinically actionable dyslipidemia at baseline, and either achieving lipid goal at follow-up or meeting criteria for ongoing intervention.There were 585 participants, with a mean age of 12.8 years. The prevalence of children warranting intervention for low-density lipoprotein cholesterol at baseline was 14%. After 1 year of recommended dietary changes, 51% achieved goal low-density lipoprotein cholesterol, 27% qualified for enhanced dietary and lifestyle modifications, and 22% met criteria for pharmacologic intervention. Elevated triglycerides were more prevalent, with 51% meeting criteria for intervention. At 1 year, 25% achieved goal triglycerides with diet and lifestyle changes, 38% met criteria for advanced dietary modifications, and 37% qualified for antihyperlipidemic medications.More than one-half of children with NAFLD met intervention thresholds for dyslipidemia. Based on the burden of clinically relevant dyslipidemia, lipid screening in children with NAFLD is warranted. Clinicians caring for children with NAFLD should be familiar with lipid management.

  View details for DOI 10.1016/j.jpeds.2018.02.038

  View details for Web of Science ID 000436817000016

  View details for PubMedID 29661561

  View details for PubMedCentralID PMC6019181

• Bias in Radiology: The How and Why of Misses and Misinterpretations RADIOGRAPHICS Busby, L. P., Courtier, J. L., Glastonbury, C. M. 2018; 38 (1): 236-247

  Abstract

  Medical errors are a leading cause of morbidity and mortality in the medical field and are substantial contributors to medical costs. Radiologists play an integral role in the diagnosis and care of patients and, given that those in this field interpret millions of examinations annually, may therefore contribute to diagnostic errors. Errors can be categorized as a "miss" when a primary or critical finding is not observed or as a "misinterpretation" when errors in interpretation lead to an incorrect diagnosis. In this article, the authors describe the cognitive causes of such errors in diagnostic medicine, specifically in radiology. Recognizing the cognitive processes that radiologists use while interpreting images should improve one's awareness of the inherent biases that can impact decision making. The authors review the common biases that impact clinical decisions, as well as strategies to counteract or minimize the potential for misdiagnosis. System-level processes that can be implemented to minimize cognitive errors are reviewed, as well as ways to implement personal changes to minimize cognitive errors in daily practice. ©RSNA, 2017.

  View details for DOI 10.1148/rg.2018170107

  View details for Web of Science ID 000424923200019

  View details for PubMedID 29194009

  View details for PubMedCentralID PMC5790309

• Assessing 3D T2 FSE sequence for identification of the normal appendix: working toward a single-sequence MR appendicitis protocol EMERGENCY RADIOLOGY Leelakanok, N., Phelps, A. S., Zapala, M. A., Kato, K., Ohliger, M., Li, Y., Courtier, J. 2017; 24 (6): 653-660

  Abstract

  To assess the ability of a single isotropic 3D T2 FSE sequence to identify the normal appendix in children with potential implication as alternative second-line modality in pediatric appendicitis.Retrospective review of MR abdomino-pelvis or pelvis in children from Oct 2014-Dec 2016 was done. Only exams with 3D T2 FSE sequence performed on a single scanner type were selected. Patients with history of post appendectomy, studies in which field of view did not include ileocecal valve, with technical and protocol errors, or with fat-saturated acquisition were excluded. All images were blindly reviewed by three radiologists. The following questions were asked: (1) Is the appendix visualized?, (2) What is the most clearly demonstrable plane?, (3) Where is the appendix located?, (4) Are there any findings indicating appendicitis? Average pairwise percentage and Fleiss Kappa were used to assess the inter-rater agreement on the visualization and location of the appendix.A total of 22 MRI studies were reviewed (F = 13:M = 9, Mean age = 11.45 yrs. [SD = 4.3]). Total MRI scan time was estimated at 6 mins. Readers saw appendix in 72.7-81.8%, and saw with high confidence in 12 cases (54.5%), low confidence in 4-6 case (18.2-27.3%), and did not see in 4-6 cases(18.2-27.3%). The average pairwise percentage agreement was 71.2%. Fleiss Kappa of overall rating of visualization was 0.52 (p < 0.001). Fleiss Kappa of high confidence of visualization was 0.76 (p < 0.001). Reader 1 and reader 2 saw the appendix best on the axial plane. Reader 3 saw the appendix best on the coronal plane. For location, deep pelvis was the most common identified location. The average pairwise percentage agreement was 68.2% and Fleiss Kappa was 0.76 (p < 0.001). There is no findings indicating appendicitis.A single 3D T2 FSE sequence had good ability to detect normal appendices and also allowed multiplanar reconstructions, which may use as a single-sequence protocol in cases of suspected appendicitis in children when ultrasound is inconclusive.

  View details for DOI 10.1007/s10140-017-1538-y

  View details for Web of Science ID 000415193700006

  View details for PubMedID 28725923

• Pediatric renal transplant biopsy with ultrasound guidance: the 'core' essentials PEDIATRIC RADIOLOGY Oates, A., Ahuja, S., Lee, M. M., Phelps, A. S., Mackenzie, J. D., Courtier, J. L. 2017; 47 (12): 1572-1579

  Abstract

  This review provides a comprehensive and practical approach to pediatric percutaneous renal transplant biopsies, highlighting techniques and strategies to optimize adequate sample yield and ensure patient safety. In children with end-stage renal disease, transplantation is the preferred choice of therapy, providing for overall lower long-term morbidity and mortality compared with dialysis. In the ongoing management of renal transplant patients, core tissue sampling via a percutaneous renal biopsy remains the gold standard when transplant dysfunction is suspected. Indications for renal transplant biopsy and techniques/tools for adequate sample yield are discussed. Strategies for common challenges such as poor visualization and renal transplant mobility are addressed. We discuss the clinical signs, techniques and imaging findings for common complications including hematomas, arteriovenous fistulas and pseudoaneurysms. Although the percutaneous renal transplant biopsy procedure is generally safe with rare complications, care must be taken to ensure major complications are promptly recognized and treated. Adequate tissue samples obtained via renal biopsy are imperative to promptly identify transplant rejection to provide valuable information for patient diagnosis, treatment and outcomes. Radiologist and nephrologist attention to proper ultrasound techniques and optimal biopsy tools are critical to ensure tissue adequacy and minimize complications.

  View details for DOI 10.1007/s00247-017-3905-y

  View details for Web of Science ID 000413939900003

  View details for PubMedID 28573315

• Intravoxel incoherent motion analysis of renal allograft diffusion with clinical and histopathological correlation in pediatric kidney transplant patients: A preliminary cross-sectional observational study PEDIATRIC TRANSPLANTATION Poynton, C. B., Lee, M. M., Li, Y., Laszik, Z., Worters, P. W., Mackenzie, J. D., Courtier, J. 2017; 21 (6)

  Abstract

  The purpose of this study was to compare IVIM values in pediatric renal transplants with histopathology and clinical management change. Fifteen pediatric renal transplant recipients (mean 15.7±2.9 years) were prospectively scanned on a 3T MR scanner with multi-b DTI, prior to same-day transplant biopsy. IVIM maps from 14 subjects were analyzed (one excluded due to motion). Mean values were computed from cortical ROIs and medullary ROIs corresponding to the biopsy site. Subjects were also grouped according to whether or not the biopsy resulted in a change in clinical management. Cortico-medullary IVIM estimates and histopathologic Banff scores were correlated with KT. Cortico-medullary IVIM differences between the "change" and "no change" groups was compared with Mann-Whitney U test. Cortical Dp showed significant moderate negative correlation with Banff t and ci scores (KT=-0.497, P=.035 and KT=-0.46, P=.046) and moderate positive correlation with Banff i score (KT=0.527, P=.028). Cortical Pf showed significant moderate correlation with ci and ct scores (KT=0.489, P=.035 and KT=0.457, P=.043). Tissue diffusivity, Dt , estimated with IVIM was significantly different between the "change" and "no change" groups in medullary ROIs (U=6, P=.021). IVIM analysis has potential as a noninvasive biomarker in assessment of pediatric renal allograft pathology.

  View details for DOI 10.1111/petr.12996

  View details for Web of Science ID 000407930300012

  View details for PubMedID 28653457

• Incidental Findings On Pediatric Abdominal Magentic Resonance Angiography ACADEMIC RADIOLOGY Leelakanok, N., Zapala, M. A., Edwards, E. A., Phelps, A. S., Mackenzie, J. D., Courtier, J. 2017; 24 (9): 1107-1113

  Abstract

  Abdominal magnetic resonance angiography (MRA) has gained favor in pediatric patients owing to its lack of ionizing radiation and noninvasive nature. Reports exist regarding incidental findings on body MRA in adult patients. However, the incidental findings in pediatric abdominal MRA have not been previously reported. Our study aims to determine the frequencies, characteristics, and categories of incidental findings in pediatric patients undergoing abdominal MRA.Retrospective study was performed in 78 consecutive contrast-enhanced abdominal MRA of patients between ages 0 and 20 years over a 7-year time period. The presence of incidental vascular and extravascular findings was noted. Reports were categorized in consensus by two radiologists as no incidental finding (group A), normal or normal variants or nonsignificant incidental common findings (group B), or abnormal incidental findings (group C). Group C was reviewed to determine whether additional management was performed.A total of 40 boys and 38 girls (51%:49%) were reported, with a mean age of 12.3 years (standard deviation ±5.6 years, range 7 days to 20 years). Three most common indications for MRA were renal artery stenosis (24.4%), vasculitis (21.8%), and suspected intra-abdominal venous thrombosis (14.1%). We identified a total of 92 incidental findings in 50 of 78 patients; 60 findings in 29 patients in group B, and 32 findings in 21 patients in group C. Atelectasis at the lung bases was the most common incidental finding in group B (14 of 78 patients). The most common findings in group C were ascites, scoliosis, and splenomegaly. There were three abnormal incidental findings that led to causative workup and/or further management (moderate ascites, pericardial and pleural effusion, and venous malformation). The remaining cases with abnormal findings received treatment of their primary conditions only.Pediatric abdominal MRA revealed a large number of incidental findings. The large majority were findings without clinical significance. Basal lung atelectasis was the most common overall incidental and nonsignificant finding, whereas ascites was the most common abnormal incidental finding. Although not all abnormal incidental findings affected management, appropriate identification and communication of relevant findings would improve patient care.

  View details for DOI 10.1016/j.acra.2017.01.019

  View details for Web of Science ID 000408398900009

  View details for PubMedID 28285838

• Pediatric chest CT at chest radiograph doses: when is the ultralow-dose chest CT clinically appropriate? EMERGENCY RADIOLOGY Villanueva-Meyer, J. E., Naeger, D. M., Courtier, J. L., Hope, M. D., Lambert, J. W., MacKenzie, J. D., Phelps, A. S. 2017; 24 (4): 369-376

  Abstract

  Computed tomography (CT) use in emergency departments represents a significant contribution to pediatric patients' exposure to ionizing radiation. Here, we evaluate whether ultralow-dose chest CT can be diagnostically adequate for other diagnoses and whether model-based iterative reconstruction (MBIR) can improve diagnostic adequacy compared to adaptive statistical iterative reconstruction (ASIR) at ultralow doses.Twenty children underwent chest CTs: 10 standard-dose reconstructed with ASIR and 10 ultralow-dose reconstructed with ASIR and MBIR. Four radiologists assessed images for their adequacy to exclude five hypothetical diagnoses: foreign body, fracture, lung metastasis, pulmonary infection, and interstitial lung disease. Additionally, pairwise comparison for subjective image quality was used to compare ultralow-dose chest CT with ASIR and MBIR. Radiation dose and objective image noise measures were obtained.For exclusion of an airway foreign body, the adequacy of ultralow-dose CT was comparable to standard-dose (p = 0.6). For the remaining diagnoses, ultralow-dose CT was inferior to standard-dose (p = 0.03-<0.001). MBIR partially recovered the adequacy of ultralow-dose CT to exclude pulmonary infection (p = 0.017), but was suboptimal for the other diagnoses. Image noise was significantly lower with MBIR compared to ASIR in ultralow-dose CT (p < 0.001), although subjective preference showed only a slight advantage of MBIR (58 versus 42%).Ultralow-dose chest CT may be adequate for airway assessment, but suboptimal for the evaluation parenchymal lung disease. Although MBIR improves objective and subjective image quality, it does not completely restore the diagnostic adequacy of ultralow-dose CT when compared to standard-dose CT.

  View details for DOI 10.1007/s10140-017-1487-5

  View details for Web of Science ID 000406193300007

  View details for PubMedID 28289906

  View details for PubMedCentralID PMC5522642

• Intussusception: past, present and future Edwards, E. A., Pigg, N., Courtier, J., Zapala, M. A., MacKenzie, J. D., Phelps, A. S. SPRINGER. 2017: 1101-1108

  Abstract

  Intussusception is a common etiology of acute abdominal pain in children. Over the last 70 years, there have been significant changes in how we diagnose and treat intussusception, with a more recent focus on the role of ultrasound. In this article we discuss historical and current approaches to intussusception, with an emphasis on ultrasound as a diagnostic and therapeutic modality.

  View details for DOI 10.1007/s00247-017-3878-x

  View details for Web of Science ID 000407304600008

  View details for PubMedID 28779197

• Pilot Study of Renal Diffusion Tensor Imaging as a Correlate to Histopathology in Pediatric Renal Allografts AMERICAN JOURNAL OF ROENTGENOLOGY Li, Y., Lee, M. M., Worters, P. W., MacKenzie, J. D., Laszik, Z., Courtier, J. L. 2017; 208 (6): 1351-1357

  Abstract

  Fractional anisotropy (FA) is a measure of molecular motion obtained from diffusion tensor imaging (DTI). The objective of this study was to assess the use of FA as a noninvasive correlate of renal allograft histopathology.Sixteen pediatric renal allograft recipients were imaged using DTI in a prospective study, between October 2014 and January 2016, before a same-day renal allograft biopsy. The Kendall tau correlation coefficient was used to assess the relationship between cortical and medullary FA values and several clinically important Banff renal allograft histopathology scores. The Mann-Whitney U test was also used to compare cortical and medullary FA values in the region of biopsy in patients whose biopsy results did and in those whose biopsy results did not change clinical management.Medullary FA values had direct inverse correlation with several histopathology scores: tubulitis (designated "t" score in Banff pathologic classification, p < 0.04), interstitial inflammation (i score, p < 0.005), tubular atrophy (ct score, p < 0.002), and interstitial fibrosis (ci score, p < 0.007). Cortical FA values inversely correlated with peritubular capillaritis (ptc score, p < 0.02). Neither medullary nor cortical FA values correlated with glomerulitis (g score). At a b value of 800 s/mm2, medullary FA values of pediatric renal allograft recipients whose renal biopsies prompted a change in clinical management (mean ± SD at a b value of 800 s/mm2 = 0.262 ± 0.07; n = 9) were statistically different compared with the group whose biopsy results did not change clinical management (mean ± SD at a b value of 800 s/mm2 = 0.333 ± 0.06; n = 7) (p < 0.006).FA is a noninvasive correlate of several important renal allograft histopathology scores and a potential noninvasive method of assessing renal allograft health in pediatric allograft recipients.

  View details for DOI 10.2214/AJR.16.17418

  View details for Web of Science ID 000401892800030

  View details for PubMedID 28379715

• Advanced imaging techniques in pediatric body MRI PEDIATRIC RADIOLOGY Courtier, J., Rao, A. G., Anupindi, S. A. 2017; 47 (5): 522-533

  Abstract

  While there are many challenges specific to pediatric abdomino-pelvic MRI, many recent advances are addressing these challenges. It is therefore essential for radiologists to be familiar with the latest advances in MR imaging. Laudable efforts have also recently been implemented in many centers to improve the overall experience of pediatric patients, including the use of dedicated radiology child life specialists, MRI video goggles, and improved MR suite environments. These efforts have allowed a larger number of children to be scanned while awake, with fewer studies being done under sedation or anesthesia; this has resulted in additional challenges from patient motion and difficulties with breath-holding and tolerating longer scan times. In this review, we highlight common challenges faced in imaging the pediatric abdomen and pelvis and discuss the application of the newest techniques to address these challenges. Additionally, we highlight the newest advances in quantified imaging techniques, specifically in MR liver iron quantification. The techniques described in this review are all commercially available and can be readily implemented.

  View details for DOI 10.1007/s00247-017-3778-0

  View details for Web of Science ID 000399444300004

  View details for PubMedID 28409251

• Postnatal MRI for CDH: A pictorial review of late-presenting and recurrent diaphragmatic defects CLINICAL IMAGING Kim, W., Courtier, J., Morin, C., Shet, N., Strauch, E., Kim, J. S. 2017; 43: 158-164

  Abstract

  Late-presenting or recurrent diaphragmatic defects can pose a diagnostic challenge due to varying clinical presentations. Current diagnostic approaches include plain film radiograph for initial assessment, with other imaging modalities such as fluoroscopy, ultrasound, CT and MRI mainly utilized for troubleshooting. As a radiation-free modality, MRI can provide a more definitive diagnosis in particular cases due to its ability to visualize discontinuity of the diaphragm, distinguishing it from eventration. MRI can also accurately characterize hernia contents, defect location and size. We present our MRI technique and review cases of different hernia types with relevant discussion of the imaging findings and correlation with intraoperative findings. MRI can be a useful diagnostic tool in the assessment of late presenting or recurrent diaphragmatic hernias.

  View details for DOI 10.1016/j.clinimag.2017.03.007

  View details for Web of Science ID 000401298400032

  View details for PubMedID 28324716

• Ultrasound elastography: is there a shear wave speed cutoff for pediatric liver fibrosis and inflammation? CLINICAL IMAGING Phelps, A., Ramachandran, R., Courtier, J., Perito, E., Rosenthal, P., MacKenzie, J. D. 2017; 41: 95-100

  Abstract

  The objective was to identify a shear wave speed (SWS) cutoff in pediatric liver disease to detect fibrosis and inflammation.We performed an institutional-review-board-approved prospective study of liver SWS in 41 children undergoing liver biopsy.In patients without inflammation, SWS was higher when fibrosis was present compared to when fibrosis was not present (average SWS 1.8 vs. 1.4 m/s, respectively, P=.02). A SWS cutoff of 1.7 m/s had 100% positive predictive value and 24% negative predictive value for detecting fibrosis or inflammation.Point shear wave elastography is an insufficient stand-alone screening tool for liver fibrosis and inflammation in a heterogeneous patient population.

  View details for DOI 10.1016/j.clinimag.2016.10.012

  View details for Web of Science ID 000390730400019

  View details for PubMedID 27840268

• Assessing the learning potential of an interactive digital game versus an interactive-style didactic lecture: the continued importance of didactic teaching in medical student education PEDIATRIC RADIOLOGY Courtier, J., Webb, E. M., Phelps, A. S., Naeger, D. M. 2016; 46 (13): 1787-1796

  Abstract

  Games with educational intent offer a possible advantage of being more interactive and increasing learner satisfaction.We conducted a two-armed experiment to evaluate student satisfaction and content mastery for an introductory pediatric radiology topic, taught by either an interactive digital game or with a traditional didactic lecture.Medical students participating in a fourth-year radiology elective were invited to participate. Student cohorts were alternatively given a faculty-supervised 1h session playing a simple interactive digital Tic-tac-toe quiz module on pediatric gastrointestinal radiology or a 1h didactic introductory lecture on the same topic. Survey questions assessed the learners' perceived ability to recall the material as well as their satisfaction with the educational experience. Results of an end-of-rotation exam were reviewed to evaluate a quantitative measure of learning between groups. Survey responses were analyzed with a chi-squared test. Exam results for both groups were analyzed with a paired Student's t-test.Students in the lecture group had higher test scores compared to students in the game group (4.0/5 versus 3.6/5, P = 0.045). Students in the lecture group reported greater understanding and recall of the material than students in the game group (P < 0.001 and P = 0.004, respectively). Students in the lecture group perceived the lecture to be more enjoyable and a better use of their time compared to those in the game group (P = 0.04 and P < 0.001, respectively). There was no statistically significant difference between the lecture and game group in ability to maintain interest (P = 0.187). In comparison to pre-survey results, there was a statistically significant decrease in interest for further digital interactive materials reported by students in the game group (P = 0.146).Our experience supported the use of a traditional lecture over a digital game module. While these results might be affected by the specific lecture and digital content in any given comparison, a digital module is not always the superior option.

  View details for DOI 10.1007/s00247-016-3692-x

  View details for Web of Science ID 000388743000004

  View details for PubMedID 27580908

• In Children With Nonalcoholic Fatty Liver Disease, Cysteamine Bitartrate Delayed Release Improves Liver Enzymes but Does Not Reduce Disease Activity Scores GASTROENTEROLOGY Schwimmer, J. B., Lavine, J. E., Wilson, L. A., Neuschwander-Tetri, B. A., Xanthakos, S. A., Kohli, R., Barlow, S. E., Vos, M. B., Karpen, S. J., Molleston, J. P., Whitington, P. F., Rosenthal, P., Jain, A. K., Murray, K. F., Brunt, E. M., Kleiner, D. E., Van Natta, M. L., Clark, J. M., Tonascia, J., Doo, E., NASH CRN 2016; 151 (6): 1141-+

  Abstract

  No treatment for nonalcoholic fatty liver disease (NAFLD) has been approved by regulatory agencies. We performed a randomized controlled trial to determine whether 52 weeks of cysteamine bitartrate delayed release (CBDR) reduces the severity of liver disease in children with NAFLD.We performed a double-masked trial of 169 children with NAFLD activity scores of 4 or higher at 10 centers. From June 2012 to January 2014, the patients were assigned randomly to receive CBDR or placebo twice daily (300 mg for patients weighing ≤65 kg, 375 mg for patients weighing >65 to 80 kg, and 450 mg for patients weighing >80 kg) for 52 weeks. The primary outcome from the intention-to-treat analysis was improvement in liver histology over 52 weeks, defined as a decrease in the NAFLD activity score of 2 points or more without worsening fibrosis; patients without biopsy specimens from week 52 (17 in the CBDR group and 6 in the placebo group) were considered nonresponders. We calculated the relative risks (RR) of improvement using a stratified Cochran-Mantel-Haenszel analysis.There was no significant difference between groups in the primary outcome (28% of children in the CBDR group vs 22% in the placebo group; RR, 1.3; 95% confidence interval [CI], 0.8-2.1; P = .34). However, children receiving CBDR had significant changes in prespecified secondary outcomes: reduced mean levels of alanine aminotransferase (reduction, 53 ± 88 U/L vs 8 ± 77 U/L in the placebo group; P = .02) and aspartate aminotransferase (reduction, 31 ± 52 vs 4 ± 36 U/L in the placebo group; P = .008), and a larger proportion had reduced lobular inflammation (36% in the CBDR group vs 21% in the placebo group; RR, 1.8; 95% CI, 1.1-2.9; P = .03). In a post hoc analysis of children weighing 65 kg or less, those taking CBDR had a 4-fold better chance of histologic improvement (observed in 50% of children in the CBDR group vs 13% in the placebo group; RR, 4.0; 95% CI, 1.3-12.3; P = .005).In a randomized trial, we found that 1 year of CBDR did not reduce overall histologic markers of NAFLD compared with placebo in children. Children receiving CBDR, however, had significant reductions in serum aminotransferase levels and lobular inflammation. ClinicalTrials.gov no: NCT01529268.

  View details for DOI 10.1053/j.gastro.2016.08.027

  View details for Web of Science ID 000390955500029

  View details for PubMedID 27569726

  View details for PubMedCentralID PMC5124386

• Detection of bowel inflammation with fused DWI/T2 images versus contrast-enhanced images in pediatric MR enterography with histopathologic correlation CLINICAL IMAGING Ehman, E. C., Phelps, A. S., Ohliger, M. A., Rhee, S. J., MacKenzie, J. D., Courtier, J. L. 2016; 40 (6): 1135-1139

  Abstract

  To evaluate the fused, colorized diffusion weighted imaging (DWI) and anatomic T2 images compared to routine contrast-enhanced T1 images at pediatric magnetic resonance enterography (MRE).Fused, colorized DWI/T2 images were created from patients with magnetic resonance enterography (MRE) and colonoscopy/biopsy. Radiologists noted inflammation in five bowel segments (terminal ileum-rectosigmoid colon) on postcontrast images and DWI/T2 images. Test characteristics and agreement were calculated.For 20 patients, sensitivity/specificity/positive predictive value (PPV)/negative predictive value (NPV) were 0.53/0.90/0.77/0.76 for DWI/T2 and 0.45/0.90/0.72/0.73 for postcontrast images. Intraobserver agreement was ҡ=0.45-0.73. Interobserver agreement was ҡ=0.53 for DWI/T2 and ҡ=0.63 for postcontrast images.DWI/T2 images are similar in sensitivity/specificity to contrast-enhanced images and with moderate intra/interobserver reliability.

  View details for DOI 10.1016/j.clinimag.2016.07.006

  View details for Web of Science ID 000387529900013

  View details for PubMedID 27497037

• How Much Does Lead Shielding during Fluoroscopy Reduce Radiation Dose to Out-of-Field Body Parts? JOURNAL OF MEDICAL IMAGING AND RADIATION SCIENCES Phelps, A. S., Gould, R. G., Courtier, J. L., Marcovici, P. A., Salani, C., MacKenzie, J. D. 2016; 47 (2): 171-177

  Abstract

  Fluoroscopy technologists routinely place a lead shield between the x-ray table and the patient's gonads, even if the gonads are not directly in the x-ray field. Internal scatter radiation is the greatest source of radiation to out-of-field body parts, but a shield placed between the patient and the x-ray source will not block internal scatter. Prior nonfluoroscopy research has shown that there is a small reduction in radiation dose when shielding the leakage radiation that penetrates through the collimator shutters. The goal of this in vitro study was to determine if there was any radiation dose reduction when shielding leakage radiation during fluoroscopy.This was an in vitro comparison study of radiation doses using different collimation and shielding strategies during fluoroscopy. Ionization chamber measurements were obtained during fluoroscopy of an acrylic block with and without collimation and shielding. Ionization chamber readings were taken in-field at 0 cm and out-of-field at 7.5, 10, and 12.5 cm from beam center.Collimation reduced 87% of the out-of-field radiation dose, and the remaining measurable dose was because of internal scatter. The radiation dose contribution from leakage radiation was negligible, as there was not any measurable radiation dose difference when shielding leakage radiation, with P value of .48.These results call into question the clinical utility of routinely shielding out-of-field body parts during fluoroscopy.

  View details for DOI 10.1016/j.jmir.2015.12.082

  View details for Web of Science ID 000387042500009

  View details for PubMedID 31047181

• Image quality and dose optimisation for infant CT using a paediatric phantom EUROPEAN RADIOLOGY Lambert, J. W., Phelps, A. S., Courtier, J. L., Gould, R. G., MacKenzie, J. D. 2016; 26 (5): 1387-1395

  Abstract

  To optimise image quality and reduce radiation exposure for infant body CT imaging.An image quality CT phantom was created to model the infant body habitus. Image noise, spatial resolution, low contrast detectability and tube current modulation (TCM) were measured after adjusting CT protocol parameters. Reconstruction method (FBP, hybrid iterative and model-based iterative), image quality reference parameter, helical pitch and beam collimation were systematically investigated for their influence on image quality and radiation output.Both spatial and low contrast resolution were significantly improved with model-based iterative reconstruction (p < 0.05). A change in the helical pitch from 0.969 to 1.375 resulted in a 23% reduction in total TCM, while a change in collimation from 20 to 40 mm resulted in a 46% TCM reduction. Image noise and radiation output were both unaffected by changes in collimation, while an increase in pitch enabled a dose length product reduction of ~6% at equivalent noise. An optimised protocol with ~30% dose reduction was identified using model-based iterative reconstruction.CT technology continues to evolve and require protocol redesign. This work provides an example of how an infant-specific phantom is essential for leveraging this technology to maintain image quality while reducing radiation exposure.• A size-specific phantom is critical in protocol development for infant CT. • New reconstruction technology enables ~30% dose reduction at equivalent image quality. • A consistent performance is observed for this scanner system across protocol changes. • A tradeoff exists between reducing exposure time and enabling tube current modulation.

  View details for DOI 10.1007/s00330-015-3951-5

  View details for Web of Science ID 000373642300020

  View details for PubMedID 26304803

• Magnetic resonance imaging of Mullerian duct anomalies in children PEDIATRIC RADIOLOGY Li, Y., Phelps, A., Zapala, M. A., MacKenzie, J. D., MacKenzie, T. C., Courtier, J. 2016; 46 (6): 796-805

  Abstract

  Müllerian duct anomalies encompass a wide variety of disorders resulting from abnormalities in the embryological development of the Müllerian ducts. In the prepubertal pediatric population, Müllerian duct anomalies are often incidental findings on studies obtained for other reasons. The onset of menses can prompt more clinical symptoms. Proper characterization of Müllerian duct anomalies is important because these anomalies can affect the development of gynecological disorders as well as fertility. Müllerian duct anomalies also carry a high association with other congenital anomalies, particularly renal abnormalities. MRI is widely considered the best modality for assessing Müllerian duct anomalies; it provides multiplanar capability, clear anatomical detail and tissue characterization without ionizing radiation. MRI allows for careful description of Müllerian duct anomalies, often leading to classification into the most widely accepted classification system for Müllerian duct anomalies. This system, developed by the American Society of Reproductive Medicine, includes seven subtypes: uterine agenesis/hypoplasia, unicornuate, didelphys, bicornuate, septate, arcuate, and diethylstilbestrol (DES) drug-related uterus. In cases of complex anomalies that defy classification, MRI allows detailed depiction of all components of the anatomical abnormality, allowing for proper management and surgical planning.

  View details for DOI 10.1007/s00247-016-3583-1

  View details for Web of Science ID 000376994800007

  View details for PubMedID 27229498

• The ABCs (Airway, Blood Vessels, and Compartments) of Pediatric Neck Infections and Masses AMERICAN JOURNAL OF ROENTGENOLOGY Ho, M., Courtier, J., Glastonbury, C. M. 2016; 206 (5): 963-972

  Abstract

  The radiologist plays several important roles in the diagnosis and management of pediatric neck infections and masses. Although the clinical diagnosis of an infection is often clear, the radiologist should evaluate for an underlying cause and for drainable collections. With neck masses, the radiologist's role is to form a differential diagnosis and evaluate for biopsy of a potentially neoplastic lesion. With both clinical scenarios, the radiologist should also evaluate for complications.The mnemonic device ABCs (airway, blood vessels, and compartments) serves as a useful reminder for potentially critical complications of pediatric neck infections and masses.

  View details for DOI 10.2214/AJR.15.15812

  View details for Web of Science ID 000374860500016

  View details for PubMedID 26959095

• Phase I Study of the Aurora A Kinase Inhibitor Alisertib in Combination With Irinotecan and Temozolomide for Patients With Relapsed or Refractory Neuroblastoma: A NANT (New Approaches to Neuroblastoma Therapy) Trial JOURNAL OF CLINICAL ONCOLOGY DuBois, S. G., Marachelian, A., Fox, E., Kudgus, R. A., Reid, J. M., Groshen, S., Malvar, J., Bagatell, R., Wagner, L., Maris, J. M., Hawkins, R., Courtier, J., Lai, H., Goodarzian, F., Shimada, H., Czarnecki, S., Tsao-Wei, D., Matthay, K. K., Mosse, Y. P. 2016; 34 (12): 1368-+

  Abstract

  Alisertib is an oral Aurora A kinase inhibitor with preclinical activity in neuroblastoma. Irinotecan and temozolomide have activity in patients with advanced neuroblastoma. The goal of this phase I study was to determine the maximum tolerated dose (MTD) of alisertib with irinotecan and temozolomide in this population.Patients age 1 to 30 years with relapsed or refractory neuroblastoma were eligible. Patients received alisertib tablets at dose levels of 45, 60, and 80 mg/m(2) per day on days 1 to 7 along with irinotecan 50 mg/m(2) intravenously and temozolomide 100 mg/m(2) orally on days 1 to 5. Dose escalation of alisertib followed the rolling six design. Samples for pharmacokinetic and pharmacogenomic testing were obtained.Twenty-three patients enrolled, and 22 were eligible and evaluable for dose escalation. A total of 244 courses were administered. The MTD for alisertib was 60 mg/m(2), with mandatory myeloid growth factor support and cephalosporin prophylaxis for diarrhea. Thrombocytopenia and neutropenia of any grade were seen in the majority of courses (84% and 69%, respectively). Diarrhea in 55% of courses and nausea in 54% of courses were the most common nonhematologic toxicities. The overall response rate was 31.8%, with a 50% response rate observed at the MTD. The median number of courses per patient was eight (range, two to 32). Progression-free survival rate at 2 years was 52.4%. Pharmacokinetic testing did not show evidence of drug-drug interaction between irinotecan and alisertib.Alisertib 60 mg/m(2) per dose for 7 days is tolerable with a standard irinotecan and temozolomide backbone and has promising response and progression-free survival rates. A phase II trial of this regimen is ongoing.

  View details for DOI 10.1200/JCO.2015.65.4889

  View details for Web of Science ID 000374335100017

  View details for PubMedID 26884555

  View details for PubMedCentralID PMC4872349

• Clinical management of infantile cholelithiasis JOURNAL OF PEDIATRIC SURGERY Jeanty, C., Derderian, S., Courtier, J., Hirose, S. 2015; 50 (8): 1289-1292

  Abstract

  Infantile cholelithiasis is a rare disease process, and management strategies are poorly defined. We therefore examined the risk factors, complications, and management of this disease at our institution.We retrospectively reviewed infants with cholelithiasis diagnosed on ultrasound between 1997 and 2013. Details of the patient's medical history, presentation, imaging findings, laboratory values, and treatment were reviewed and analyzed.Over the 16-year period, 50 infants were evaluated for cholelithiasis. Thirty-seven (74%) had at least one risk factor for gallstone development which included total parenteral nutrition, diuretic therapy, cephalosporin antibiotic treatment, sepsis, congenital heart disease (CHD), prematurity, or a malabsorptive gastrointestinal condition. Thirteen (26%) infants were symptomatic, most commonly presenting with emesis and jaundice. Complications from gallstones included choledocholithiasis (9), cholecystitis (3), and pancreatitis (1). Nearly half (6/13) of patients with complicated cholelithiasis had CHD. Of infants presenting with complications, 9 had a cholecystectomy, most commonly via a laparoscopic approach, 2 had an ERCP for choledocholithiasis, and 2 were medically managed. In patients managed conservatively, resolution of gallstones occurred in 25%.Infantile cholelithiasis has variable outcomes ranging from spontaneous resolution to choledocholithiasis or cholecystitis. While patients with complicated cholelithiasis often undergo an operation, infants <1year of age have higher anesthetic and surgical risks. Conservative management with ERCP or medical treatment can also be successful, which offers an alternative to operative intervention in properly selected patients.

  View details for DOI 10.1016/j.jpedsurg.2014.10.051

  View details for Web of Science ID 000360121000009

  View details for PubMedID 25783306

• Metastatic Diffuse Intrinsic Pontine Glioma to the Peritoneal Cavity Via Ventriculoperitoneal Shunt: Case Report and Literature Review JOURNAL OF NEUROLOGICAL SURGERY REPORTS Barajas, R., Phelps, A., Foster, H. C., Courtier, J., Buelow, B. D., Gupta, N., Nicolaides, T., Glenn, O. A., Banerjee, A. 2015; 76 (1): 91-96

  Abstract

  Extraneural metastatic disease resulting from a primary central nervous system neoplasm is a rare clinical finding in the pediatric population. We report a case of peritoneal glioblastoma carcinomatosis following placement of a ventriculoperitoneal shunt and chemoradiotherapy in a 6-year-old female patient who initially presented with diffuse intrinsic pontine glioma. This case demonstrates the importance of evaluation of extraspinal structures when imaging for extension of disease. Additionally, this report highlights the cross-sectional imaging characteristics of glioblastoma peritoneal carcinomatosis and presents additional information that will facilitate the timely diagnosis of extraneural metastases of primary high-grade glial neoplasms in the pediatric population.

  View details for DOI 10.1055/s-0035-1547365

  View details for Web of Science ID 000215676800021

  View details for PubMedID 26251821

  View details for PubMedCentralID PMC4520967

• Phase I Study of Vorinostat as a Radiation Sensitizer with <SUP>131</SUP>I-Metaiodobenzylguanidine (<SUP>131</SUP>I-MIBG) for Patients with Relapsed or Refractory Neuroblastoma CLINICAL CANCER RESEARCH DuBois, S. G., Groshen, S., Park, J. R., Haas-Kogan, D. A., Yang, X., Geier, E., Chen, E., Giacomini, K., Weiss, B., Cohn, S. L., Granger, M., Yanik, G. A., Hawkins, R., Courtier, J., Jackson, H., Goodarzian, F., Shimada, H., Czarnecki, S., Tsao-Wei, D., Villablanca, J. G., Marachelian, A., Matthay, K. K. 2015; 21 (12): 2715-2721

  Abstract

  (131)I-metaiodobenzylguanidine (MIBG) is a radiopharmaceutical with activity in neuroblastoma. Vorinostat is a histone deacetylase inhibitor that has radiosensitizing properties. The goal of this phase I study was to determine the MTDs of vorinostat and MIBG in combination.Patients ≤ 30 years with relapsed/refractory MIBG-avid neuroblastoma were eligible. Patients received oral vorinostat (dose levels 180 and 230 mg/m(2)) daily days 1 to 14. MIBG (dose levels 8, 12, 15, and 18 mCi/kg) was given on day 3 and peripheral blood stem cells on day 17. Alternating dose escalation of vorinostat and MIBG was performed using a 3+3 design.Twenty-seven patients enrolled to six dose levels, with 23 evaluable for dose escalation. No dose-limiting toxicities (DLT) were seen in the first three dose levels. At dose level 4 (15 mCi/kg MIBG/230 mg/m(2) vorinostat), 1 of 6 patients had DLT with grade 4 hypokalemia. At dose level 5 (18 mCi/kg MIBG/230 mg/m(2) vorinostat), 2 patients had dose-limiting bleeding (one grade 3 and one grade 5). At dose level 5a (18 mCi/kg MIBG/180 mg/m(2) vorinostat), 0 of 6 patients had DLT. The most common toxicities were neutropenia and thrombocytopenia. The response rate was 12% across all dose levels and 17% at dose level 5a. Histone acetylation increased from baseline in peripheral blood mononuclear cells collected on days 3 and 12 to 14.Vorinostat at 180 mg/m(2)/dose is tolerable with 18 mCi/kg MIBG. A phase II trial comparing this regimen to single-agent MIBG is ongoing.

  View details for DOI 10.1158/1078-0432.CCR-14-3240

  View details for Web of Science ID 000357336600010

  View details for PubMedID 25695691

  View details for PubMedCentralID PMC4470833

• Pediatric inflammatory bowel disease: imaging issues with targeted solutions ABDOMINAL IMAGING Anupindi, S. A., Podberesky, D. J., Towbin, A. J., Courtier, J., Gee, M. S., Darge, K., Dillman, J. R. 2015; 40 (5): 975-992

  Abstract

  To date, there have been many advances in inflammatory bowel disease (IBD) imaging in every cross-sectional imaging modality, particularly in children. The main emphasis in pediatric IBD imaging is on robust and reproducible measures of small bowel Crohn's disease inflammation, accurate diagnosis of IBD-related complications, and minimizing radiation burden to the patient, as repeat imaging is necessary over the course of their disease. In this article, we discuss the current state-of-the-art imaging techniques, in addition to routine fluoroscopy, including MR and CT enterography and bowel ultrasound. We also present the emerging use of new methods to characterize disease severity and distinguish active inflammation from fibrosis such as diffusion-weighted imaging, bowel elastography, and contrast-enhanced ultrasound. The diagnostic performance of particular examinations, their strengths and weaknesses, and role in IBD management will be discussed. Although these advanced imaging techniques applied to children are similar to those performed in adults, special considerations related to their application in pediatric patients will also be reviewed.

  View details for DOI 10.1007/s00261-015-0423-y

  View details for Web of Science ID 000355337000005

  View details for PubMedID 25920487

• Nonanesthesia Magnetic Resonance Enterography in Young Children: Feasibility, Technique, and Performance JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION Courtier, J., Cardenas, A., Tan, C., Towne, M., Rhee, S. J., Heyman, M. B., MacKenzie, J. D. 2015; 60 (6): 754-761

  Abstract

  The aim of the present study was to demonstrate the effectiveness and cost savings of a nonanesthesia approach to magnetic resonance enterography (MRE) in 14 young pediatric patients (age 4-7 years) with clinically suspected early-onset inflammatory bowel disease using an MRE protocol.MRE was performed using a combination of an abbreviated imaging protocol, magnetic resonance imaging video goggles, and Child Life Services support. MRE results were correlated with both colonoscopy and pathology results using Pearson correlation coefficient. Sensitivity, specificity, and positive and negative predictive values were calculated.MRE was performed successfully in 13 of 14 patients (age range 4 years 0 months to 7 years 6 months). MRE findings matched with results in 12 of 13 patients in whom colonoscopy was successfully performed. Both MRE and colonoscopy demonstrated a high specificity (100%) and a positive predictive value (100%), but a low sensitivity (43%) and a negative predictive value (50%).MRE can be successfully performed in children ages 4 to 7 years using this approach. In addition to decreased risks to the child, the lack of anesthesia also offers a potential overall cost reduction.

  View details for DOI 10.1097/MPG.0000000000000712

  View details for Web of Science ID 000355242100011

  View details for PubMedID 25996792

• <SUP>131</SUP>I-Metaiodobenzylguanidine with Intensive Chemotherapy and Autologous Stem Cell Transplantation for High-Risk Neuroblastoma. A New Approaches to Neuroblastoma Therapy (NANT) Phase II Study BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION Yanik, G. A., Villablanca, J. G., Mans, J. M., Weiss, B., Groshen, S., Marachelian, A., Park, J. R., Tsao-Wei, D., Hawkins, R., Shulkin, B. L., Jackson, H., Goodarzian, F., Shimada, H., Courtier, J., Hutchinson, R., Haas-Koga, D., Hasenauer, C., Czarnecki, S., Katzenstein, H. M., Matthay, K. K. 2015; 21 (4): 673-681

  Abstract

  (131)I-Metaiodobenzylguanidine ((131)I-MIBG) has been used as a single agent or in combination with chemotherapy for the treatment of high-risk neuroblastoma. The activity and toxicity of (131)I-MIBG when combined with carboplatin, etoposide, and melphalan (CEM) and autologous stem cell transplantation (SCT) are now investigated in a phase II multicenter study. Fifty patients with MIBG-avid disease were enrolled into 2 cohorts, stratified by response to induction therapy. The primary study endpoint was response of patients with refractory (n = 27) or progressive disease (n = 15). A second cohort of patients (n = 8) with a partial response (PR) to induction therapy was included to obtain preliminary response data. (131)I-MIBG was administered on day -21 to all patients, with CEM given days -7 to -4, and SCT given on day 0. (131)I-MIBG dosing was determined by pre-therapy glomerular filtration rate (GFR), with 8 mCi/kg given if GFR was 60 to 99 mL/minute/1.73 m(2) (n = 13) and 12 mCi/kg if GFR ≥ 100 mL/minute/1.73 m(2) (n = 37). External beam radiotherapy was delivered to the primary and metastatic sites, beginning approximately 6 weeks after SCT. Responses (complete response + PR) were seen in 4 of 41 (10%) evaluable patients with primary refractory or progressive disease. At 3 years after SCT, the event-free survival (EFS) was 20% ± 7%, with overall survival (OS) 62% ± 8% for this cohort of patients. Responses were noted in 3 of 8 (38%) of patients with a PR to induction, with 3-year EFS 38% ± 17% and OS 75% ± 15%. No statistically significant difference was found comparing EFS or OS based upon pre-therapy GFR or disease cohort. Six of 50 patients had nonhematologic dose-limiting toxicity (DLT); 1 of 13 in the low GFR and 5 of 37 in the normal GFR cohorts. Hepatic sinusoidal obstructive syndrome (SOS) was seen in 6 patients (12%), with 5 events defined as dose-limiting SOS. The median times to neutrophil and platelet engraftment were 10 and 15 days, respectively. Patients received a median 163 cGy (61 to 846 cGy) with (131)I-MIBG administration, with 2 of 3 patients receiving >500 cGy experiencing DLT. The addition of (131)I-MIBG to a myeloablative CEM regimen is tolerable and active therapy for patients with high-risk neuroblastoma.

  View details for DOI 10.1016/j.bbmt.2014.12.008

  View details for Web of Science ID 000351790300015

  View details for PubMedID 25639769

• Scrotal Swelling in the Neonate JOURNAL OF ULTRASOUND IN MEDICINE Basta, A. M., Courtier, J., Phelps, A., Copp, H. L., MacKenzie, J. D. 2015; 34 (3): 495-505

  Abstract

  Discovery of scrotal swelling in a neonate can be a source of anxiety for parents, clinicians, and sonologists alike. This pictorial essay provides a focused review of commonly encountered scrotal masses and mimics specific to the neonatal setting. Although malignancy is a concern, it is very uncommon, as most neonatal scrotal masses are benign. Key discriminating features and management options are highlighted to improve the radiologist's ability to diagnose neonatal scrotal conditions and guide treatment decisions. Neonatal scrotal processes ranging from common to uncommon will be discussed.

  View details for DOI 10.7863/ultra.34.3.495

  View details for Web of Science ID 000361840100015

  View details for PubMedID 25715370

  View details for PubMedCentralID PMC4914382

• Pairwise Comparison Versus Likert Scale for Biomedical Image Assessment AMERICAN JOURNAL OF ROENTGENOLOGY Phelps, A. S., Naeger, D. M., Courtier, J. L., Lambert, J. W., Marcovici, P. A., Villanueva-Meyer, J. E., MacKenzie, J. D. 2015; 204 (1): 8-14

  Abstract

  Biomedical imaging research relies heavily on the subjective and semi-quantitative reader analysis of images. Current methods are limited by interreader variability and fixed upper and lower limits. The purpose of this study was to compare the performance of two assessment methods, pairwise comparison and Likert scale, for improved analysis of biomedical images.A set of 10 images with varying degrees of image sharpness was created by digitally blurring a normal clinical chest radiograph. Readers assessed the degree of image sharpness using two different methods: pairwise comparison and a 10-point Likert scale. Reader agreement with actual chest radiograph sharpness was calculated for each method by use of the Lin concordance correlation coefficient (CCC).Reader accuracy was highest for pairwise comparison (CCC, 1.0) and ranked Likert (CCC, 0.99) scores and lowest for nonranked Likert scores (CCC, 0.83). Accuracy improved slightly when readers repeated their assessments (CCC, 0.87) or had reference images available (CCC, 0.91).Pairwise comparison and ranked Likert scores yield more accurate reader assessments than nonranked Likert scores.

  View details for DOI 10.2214/AJR.14.13022

  View details for Web of Science ID 000348562300024

  View details for PubMedID 25539230

• Magnetic resonance imaging findings in juvenile spondyloarthropathy and effects of treatment observed on subsequent imaging PEDIATRIC RHEUMATOLOGY Lin, C., MacKenzie, J. D., Courtier, J. L., Gu, J. T., Milojevic, D. 2014; 12: 25

  Abstract

  Magnetic resonance imaging (MRI) is often used to diagnose and monitor treatment effects of juvenile spondyloarthropathy (SpA). Our objective was to describe MRI findings in juvenile SpA and determine predictors of active sacroiliitis and response to treatment.Children who had MRI of the sacroiliac (SI) joints and were referred to the pediatric rheumatology clinic from 2009 to 2012 were retrospectively studied. The clinical parameters, laboratory studies and findings on MRI were collected and a composite score ratio (CR) was calculated for both SI joints on each MRI study based on a semi-quantitative scale that included evaluation of bone marrow edema (BME), synovial enhancement (SE), and erosions (ER). The findings on MRI were correlated with clinical and laboratory values.50 subjects who underwent 76 MRI for suspected or known SpA were included in the study. Sacroiliitis was seen in 48 MRIs in 32 subjects. Of the subjects with sacroiliitis, mean age ± standard deviation was 13.7 ± 2.6 years, 71% were male and 41% were HLA B27 positive. SE without BME was seen in 31% cases of sacroiliitis. In subjects with sacroiliitis, 79% also had hip arthritis and 41% had enthesitis of the pelvic region on MRI. In 38% of subjects with sacroiliitis, physical exam was not indicative of sacroiliitis or hip arthritis. Longitudinal data were available for 13 subjects. Sacroiliitis on MRI improved in 9 subjects with the greatest improvement in MRI composite score ratio after initiation of etanercept therapy. CR improvement was due to improvement of BME and SE components, while the ER score remained the same or worsened in all but 1 subject.History, physical exam or laboratory data may not predict sacroiliitis in children. Magnetic resonance imaging plays a valuable role in the initial evaluation and later treatment monitoring of children with spondyloarthropathy. Synovial enhancement is significantly reduced after treatment, and unlike adults, synovial enhancement may be detected without accompanying bone marrow edema, which suggests gadolinium contrast may be an important component in the assessment of children with spondyloarthropathy.

  View details for DOI 10.1186/1546-0096-12-25

  View details for Web of Science ID 000339582200001

  View details for PubMedID 25067925

  View details for PubMedCentralID PMC4110533

• Computed tomography depiction of small pediatric vessels with model-based iterative reconstruction PEDIATRIC RADIOLOGY Koc, G., Courtier, J. L., Phelps, A., Marcovici, P. A., MacKenzie, J. D. 2014; 44 (7): 787-794

  Abstract

  Computed tomography (CT) is extremely important in characterizing blood vessel anatomy and vascular lesions in children. Recent advances in CT reconstruction technology hold promise for improved image quality and also reductions in radiation dose. This report evaluates potential improvements in image quality for the depiction of small pediatric vessels with model-based iterative reconstruction (Veo™), a technique developed to improve image quality and reduce noise.To evaluate Veo™ as an improved method when compared to adaptive statistical iterative reconstruction (ASIR™) for the depiction of small vessels on pediatric CT.Seventeen patients (mean age: 3.4 years, range: 2 days to 10.0 years; 6 girls, 11 boys) underwent contrast-enhanced CT examinations of the chest and abdomen in this HIPAA compliant and institutional review board approved study. Raw data were reconstructed into separate image datasets using Veo™ and ASIR™ algorithms (GE Medical Systems, Milwaukee, WI). Four blinded radiologists subjectively evaluated image quality. The pulmonary, hepatic, splenic and renal arteries were evaluated for the length and number of branches depicted. Datasets were compared with parametric and non-parametric statistical tests.Readers stated a preference for Veo™ over ASIR™ images when subjectively evaluating image quality criteria for vessel definition, image noise and resolution of small anatomical structures. The mean image noise in the aorta and fat was significantly less for Veo™ vs. ASIR™ reconstructed images. Quantitative measurements of mean vessel lengths and number of branches vessels delineated were significantly different for Veo™ and ASIR™ images. Veo™ consistently showed more of the vessel anatomy: longer vessel length and more branching vessels.When compared to the more established adaptive statistical iterative reconstruction algorithm, model-based iterative reconstruction appears to produce superior images for depiction of small pediatric vessels on computed tomography.

  View details for DOI 10.1007/s00247-014-2899-y

  View details for Web of Science ID 000338213600002

  View details for PubMedID 24531191

• Intra-abdominal inverted umblical cord in gastroschisis: a unique ultrasound finding PEDIATRIC RADIOLOGY Koc, G., Courtier, J. L., Kim, J. S., Miniati, D. N., MacKenzie, J. D. 2014; 44 (1): 109-111

  Abstract

  A relatively new surgical technique allows for sutureless closure of a gastroschisis defect. Immediately after birth, a long umbilical cord stump is temporarily inverted into the abdominal cavity and later retracted and used to close the abdominal wall defect. Knowledge of this entity is important since the inverted umbilical cord simulates an intra-abdominal mass on cross-sectional imaging. While this procedure is well described in the surgical literature, the imaging features of inverted umbilical cord have yet to be reported. The case presented here highlights the sonographic imaging findings of the umbilical cord during the intestinal decompression phase of sutureless repair of gastroschisis.

  View details for DOI 10.1007/s00247-013-2765-3

  View details for Web of Science ID 000329357300015

  View details for PubMedID 23907187

• Magnetic Resonance Enterography Inflammatory Bowel Disease and Beyond MAGNETIC RESONANCE IMAGING CLINICS OF NORTH AMERICA Anupindi, S. A., Terreblanche, O., Courtier, J. 2013; 21 (4): 731-+

  Abstract

  This article addresses the current technique and protocols for magnetic resonance (MR) enterography, with a primary focus on inflammatory bowel disease (IBD) and a secondary detailed discussion of other diseases of the small bowel beyond IBD. A brief discussion of MR imaging for appendicitis is included, but the evaluation of appendicitis does not require an enterographic protocol. The focused key points and approach presented in this article are intended to enhance the reader's understanding to help improve patient compliance with the MR enterographic studies, overcome challenges, and improve interpretation.

  View details for DOI 10.1016/j.mric.2013.05.002

  View details for Web of Science ID 000327573300008

  View details for PubMedID 24183523

• Radiation dose reduction in pediatric CT-guided musculoskeletal procedures PEDIATRIC RADIOLOGY Patel, A. S., Soares, B., Courtier, J., MacKenzie, J. D. 2013; 43 (10): 1303-1308

  Abstract

  Computed-tomography-guided interventions are attractive for tissue sampling of pediatric bone lesions; however, it comes with exposure to ionizing radiation, inherent to CT and magnified by multiple passes during needle localization.We evaluate a method of CT-guided bone biopsy that minimizes ionizing radiation exposure by lowering CT scanner tube current (mAs) and voltage (kVp) during each localization scan.We retrospectively reviewed all CT-guided bone biopsies (n = 13) over a 1-year period in 12 children. Three blinded readers identified the needle tip on the reduced-dose CT images (mAs = 50, kVp = 80) during the final localization scan at biopsy and rated the image quality as high, moderate or low.The image quality of the reduced-dose scans during biopsy was rated as either high or moderate, with needle tip visualized in 12 out of 13 biopsies. Twelve of 13 biopsies also returned sufficient sample for a pathological diagnosis. The average savings in exposure using the dose-reduction technique was 87%.Our results suggest that a low mAs and kVp strategy for needle localization during CT-guided bone biopsy yields a large dose reduction and produces acceptable image quality without sacrificing yield for biopsy diagnosis.

  View details for DOI 10.1007/s00247-013-2691-4

  View details for Web of Science ID 000324643600009

  View details for PubMedID 23624510

  View details for PubMedCentralID PMC3769501

• Anal duplication in a one-year-old girl JOURNAL OF PEDIATRIC SURGERY CASE REPORTS Cheng, L. S., Courtier, J., MacKenzie, T. C. 2013; 1 (10): 373-374

  Abstract

  We report a case of a patient with anal duplication discovered incidentally at 1 year of age. Pre-operative evaluation excluded any complications or associated anomalies. She underwent surgical excision with an excellent outcome.

  View details for DOI 10.1016/j.epsc.2013.10.002

  View details for Web of Science ID 000218747000013

  View details for PubMedID 25774340

  View details for PubMedCentralID PMC4358227

• Shooting a Moving Target: Use of Real-Time Cine Magnetic Resonance Imaging in Assessment of the Small Bowel JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION Courtier, J., Ohliger, M., Rhee, S. J., Terreblanche, O., Heyman, M. B., MacKenzie, J. D. 2013; 57 (4): 426-431

  Abstract

  The chronic nature of inflammatory bowel disease (IBD) creates a lifelong effect on the morbidity of children affected by the disease. The ability to confidently identify and characterize complications resulting from IBD in the pediatric patient is of critical importance. Magnetic resonance enterography (MRE) is especially valuable in the diagnostic assessment of IBD; however, precise elucidation of complications including strictures can be difficult with standard MRE sequences. The recent development of faster MRI pulse sequences provides rapid, real-time imaging of the intestinal tract. In this review, we describe how the addition of cine MRE confidently pinpoints areas of stricture, aids in lesion detection and diagnosis, and provides valuable information on intestinal motility.

  View details for DOI 10.1097/MPG.0b013e3182a33d3d

  View details for Web of Science ID 000326745500013

  View details for PubMedID 24080754

  View details for PubMedCentralID PMC9040679

• The prevalence and patterns of intraluminal air in acute appendicitis at CT EMERGENCY RADIOLOGY Cabarrus, M., Sun, Y., Courtier, J. L., Stengel, J. W., Coakley, F. V., Webb, E. M. 2013; 20 (1): 51-56

  Abstract

  The purpose of this study is to investigate if the presence and distribution of intraluminal air in the appendix contributes to the computed tomography (CT) diagnosis of appendicitis. We identified 100 consecutive patients (57 men and 43 women; mean age, 38) with CT prior to appendectomy for acute appendicitis over a 5-year period and a control group of 100 consecutive patients (29 men and 71 women; mean age, 39) who underwent CT for acute abdominal pain without appendicitis. Patients were scanned using multidetector row CT scanners at 1.25 or 5-mm slice thickness, peak tube voltage of 120 kVp, and milliamperse automatically adjusted to attain a noise index of 12. Ninety-two of 100 study patients and 95 of 100 controls received 150 mL intravenous contrast. Two independent readers noted the presence and distribution pattern of intraluminal air in the appendix, appendiceal diameter, wall hyperemia, wall thickening (>3 mm), and wall stratification and presence of any secondary signs of appendicitis including fat stranding and free fluid. Data were compared between groups using Fisher's exact test and Student's t test. Intraluminal air in the appendix was more common in control patients versus patients with appendicitis (66 of 100 versus 27 of 100, p < 0.001). No significant differences in the patterns of intraluminal air were found between cases and controls. Among appendicitis cases, there was no significant difference in mean appendiceal diameter (12.8 versus 12.0, p = 0.20) or number of CT signs of appendicitis (1.93 versus 1.86, p = 0.78) in cases with intraluminal air versus without. No case of appendicitis demonstrated intraluminal air without secondary signs of appendicitis. Although intraluminal air is sometimes assumed to exclude a diagnosis of appendicitis, it is actually a common finding seen in up to 27 % of cases at CT. The pattern of intraluminal air was not helpful in differentiating a normal appendix from appendicitis.

  View details for DOI 10.1007/s10140-012-1076-6

  View details for Web of Science ID 000217351500008

  View details for PubMedID 22996072

• Hepatic portocholecystostomy for biliary atresia: A 25-year follow-up and review JOURNAL OF PEDIATRIC SURGERY Schecter, S. C., Courtier, J., Cho, S., Saadai, P., Hirose, S., Mackenzie, T. C., Miniati, D. 2013; 48 (1): 262-266

  Abstract

  We report the successful salvage of a patient's native liver 25 years after hepatic portocholecystostomy for biliary atresia. Our case demonstrates the effectiveness of biliary specific, high-resolution CT imaging in the diagnosis of, and operative planning for complex cases of biliary obstruction. We also report the longest-term pathologic follow-up of biliary atresia after hepatic portocholecystostomy. Life-long follow-up of patients with biliary atresia is important to prevent life-threatening complications of biliary stasis/obstruction.

  View details for DOI 10.1016/j.jpedsurg.2012.10.058

  View details for Web of Science ID 000313879800056

  View details for PubMedID 23331828

• Primary mixed malignant tumor of bone in an 18-year-old male: Report of a case with radiologic-pathologic correlation JOURNAL OF BONE ONCOLOGY Courtier, J., Robbins, E., Soares, B., Horvai, A., Mackenzie, J. D. 2012; 1 (3): 101-105

  Abstract

  We report a case of primary malignant mixed tumor (MMT) of bone in an 18-year-old boy with X-ray, CT, MR, scintigraphic, FDG PET, and pathologic correlation. Primary MMT of bone is a highly aggressive tumor and presents both a diagnostic and clinical treatment challenge. This tumor is extremely rare and to the best of our knowledge, this is the first report of the diagnostic imaging findings for primary MMT arising from bone in a patient of this age group.

  View details for DOI 10.1016/j.jbo.2012.10.002

  View details for Web of Science ID 000209277200007

  View details for PubMedID 26909264

  View details for PubMedCentralID PMC4723350

• Imaging of Mullerian Duct Anomalies RADIOGRAPHICS Behr, S. C., Courtier, J. L., Qayyum, A. 2012; 32 (6): E233-E250

  Abstract

  The müllerian ducts are paired embryologic structures that undergo fusion and resorption in utero to give rise to the uterus, fallopian tubes, cervix, and upper two-thirds of the vagina. Interruption of normal development of the müllerian ducts can result in formation of müllerian duct anomalies (MDAs). MDAs are a broad and complex spectrum of abnormalities that are often associated with primary amenorrhea, infertility, obstetric complications, and endometriosis. MDAs are commonly associated with renal and other anomalies; thus, identification of both kidneys is important. However, MDAs are not associated with ovarian anomalies. Hysterosalpingography (HSG) is routinely used in evaluation of infertility. Because a key component of MDA characterization is the external uterine fundal contour, HSG is limited for this purpose. Patients suspected of having an MDA are often initially referred for pelvic ultrasonography (US). Magnetic resonance (MR) imaging is typically reserved for complex or indeterminate cases. MR imaging is the imaging standard of reference because it is noninvasive, does not involve ionizing radiation, has multiplanar capability, allows excellent soft-tissue characterization, and permits a greater field of interrogation than does US. Use of MR imaging for evaluation of MDAs reduces the number of invasive procedures and related costs by guiding management decisions.

  View details for DOI 10.1148/rg.326125515

  View details for Web of Science ID 000310202800001

  View details for PubMedID 23065173

• Type IV intestinal atresia, congenital bilateral perisylvian syndrome, and chronic pulmonary hypertension secondary to multiple vascular disruption syndrome in a monochorionic twin JOURNAL OF PEDIATRIC SURGERY Shue, E. H., Soares, B., Courtier, J., Hogue, J., Shimotake, T., MacKenzie, T. C. 2012; 47 (10): 1938-1942

  Abstract

  We describe a rare case of multiple intestinal atresias, congenital bilateral perisylvian polymicrogyria, and chronic pulmonary hypertension in a surviving monochorionic twin with co-twin demise. This constellation of congenital anomalies represents a multiple vascular disruption syndrome due to intrauterine vascular compromise in the setting of possible twin-to-twin transfusion syndrome.

  View details for DOI 10.1016/j.jpedsurg.2012.08.021

  View details for Web of Science ID 000310777300043

  View details for PubMedID 23084212

• The diagnosis and management of intradiaphragmatic extralobar pulmonary sequestrations: a report of 4 cases Nijagal, A., Jelin, E., Feldstein, V. A., Courtier, J., Urisman, A., Jones, K. D., Lee, H., Hirose, S., MacKenzie, T. C. W B SAUNDERS CO-ELSEVIER INC. 2012: 1501-1505

  Abstract

  Intradiaphragmatic extralobar pulmonary sequestrations (IDEPSs) are a rare subset of bronchopulmonary sequestrations (BPS). We report the largest series of patients with IDEPS and describe the diagnostic and operative challenges associated with this condition.We retrospectively reviewed our experience with fetal and pediatric BPS from 1995 to 2010 to identify patients with IDEPS.We identified 27 patients with BPS and 4 patients in whom the masses were within the diaphragm. In 1 patient, the prenatal ultrasound correctly identified the mass as being within the diaphragm itself, whereas the remaining cases were thought to be intraabdominal or had discordant preoperative imaging findings. The diagnosis of an IDEPS proved challenging to make prospectively using prenatal ultrasound, computed tomography, or magnetic resonance imaging. All patients underwent attempted resection. Two cases required a combined laparoscopic and thoracoscopic approach to accurately localize the mass. The postoperative recovery of these patients was uneventful.We present the largest reported experience of IDEPS. Because preoperative imaging studies cannot always determine whether a sequestration is intraabdominal, intrathoracic, or intradiaphragmatic, operative planning may pose a challenge. However, the use of minimally invasive approaches can allow exploration of both the thoracic and abdominal cavities with low morbidity.

  View details for DOI 10.1016/j.jpedsurg.2011.11.066

  View details for Web of Science ID 000308000100013

  View details for PubMedID 22901907

• Imaging of Nontraumatic Adrenal Hemorrhage AMERICAN JOURNAL OF ROENTGENOLOGY Jordan, E., Poder, L., Courtier, J., Sai, V., Jung, A., Coakley, F. V. 2012; 199 (1): W91-W98

  Abstract

  The purpose of this pictorial essay is to review the imaging findings of acute, chronic, and tumor-related nontraumatic adrenal hemorrhage.Rapid development or evolution of a nonenhancing adrenal mass or masses with an adreniform shape or high T1 signal intensity on MR images of a patient under stress or with a bleeding diathesis, including anticoagulant use, suggests acute adrenal hemorrhage. Chronic hemorrhage appears as a thin-walled pseudocyst or atrophy. Imaging findings that may indicate underlying tumor include intralesional calcification, enhancement, and hypermetabolic activity on PET images.

  View details for DOI 10.2214/AJR.11.7973

  View details for Web of Science ID 000305804000011

  View details for PubMedID 22733936

• Multimodality Imaging of Fat-Containing Adrenal Metastasis From Hepatocellular Carcinoma CLINICAL NUCLEAR MEDICINE Tariq, U., Poder, L., Carlson, D., Courtier, J., Joe, B. N., Coakley, F. V. 2012; 37 (6): E157-E159

  Abstract

  A biopsy-proven fat-containing metastasis to the adrenal gland in a patient with hepatocellular carcinoma demonstrated low density on nonenhanced CT, heterogeneity on contrast-enhanced CT, and marked signal loss on opposed-phase gradient-echo MRI, mimicking an adrenal adenoma. However, the mass was not present on older studies and showed increased FDG uptake on PET. The possibility of a fat-containing metastasis should be considered for an apparent adrenal adenoma in a patient with a primary hepatocellular carcinoma.

  View details for DOI 10.1097/RLU.0b013e31824439ab

  View details for Web of Science ID 000304316800007

  View details for PubMedID 22614216

• Targeted MRI Contrast Agents for Pediatric Hepatobiliary Disease JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION Courtier, J. L., Perito, E. R., Rhee, S., Tsai, P., Heyman, M. B., MacKenzie, J. D. 2012; 54 (4): 454-462

  Abstract

  New options are available for the magnetic resonance imaging (MRI) assessment of pediatric hepatobiliary disease. This article describes the potential utility for MRI with contrast agents tailored for hepatobiliary imaging. MRI contrast agents that preferentially target the liver may be helpful in characterizing liver masses and bile duct abnormalities in select children. The imaging approach is noninvasive and relatively rapid to perform. It also provides anatomic and functional information and is a radiation-free alternative to other imaging strategies. This relatively new imaging procedure is placed in the context of more established imaging modalities. The pharmacokinetics, technical considerations, and potential applications of these hepatobiliary-specific contrast agents also are discussed.

  View details for DOI 10.1097/MPG.0b013e3182467a4b

  View details for Web of Science ID 000302171800005

  View details for PubMedID 22193178

• CT and MRI of Early Intrauterine Pregnancy AMERICAN JOURNAL OF ROENTGENOLOGY Shin, D. S., Poder, L., Courtier, J., Naeger, D. M., Westphalen, A. C., Coakley, F. V. 2011; 196 (2): 325-330

  Abstract

  The objective of this article is to describe the CT and MRI findings of early intrauterine pregnancy.Early pregnancy should be considered when CT or MRI shows a fluid-filled cystlike structure in the uterus of a woman of reproductive age especially if there is a coexistent ovarian corpus luteum cyst.

  View details for DOI 10.2214/AJR.09.3723

  View details for Web of Science ID 000287135600015

  View details for PubMedID 21257883

• Fetal tracheolaryngeal airway obstruction: prenatal evaluation by sonography and MRI PEDIATRIC RADIOLOGY Courtier, J., Poder, L., Wang, Z. J., Westphalen, A. C., Yeh, B. M., Coakley, F. V. 2010; 40 (11): 1800-1805

  Abstract

  We reviewed the sonographic and MRI findings of tracheolaryngeal obstruction in the fetus. Conditions that can cause tracheolaryngeal obstruction include extrinsic causes such as lymphatic malformation, cervical teratoma and vascular rings and intrinsic causes such as congenital high airway obstruction syndrome (CHAOS). Accurate distinction of these conditions by sonography or MRI can help facilitate parental counseling and management, including the decision to utilize the ex utero intrapartum treatment (EXIT) procedure.

  View details for DOI 10.1007/s00247-010-1800-x

  View details for Web of Science ID 000282590000012

  View details for PubMedID 20737145

  View details for PubMedCentralID PMC2950274