小児における B-mode 上顎洞超音波検査の有用性について

To investigate the use of transfer learning when applying a deep learning source model from one institution (institution A) to another institution (institution B) for creating effective models (target models) for the detection of maxillary sinuses and diagnosis of maxillary sinusitis on panoramic radiographs. In addition, to determine appropriate numbers of training data for the transfer learning. Source model was created using 350 panoramic radiographs from institution A as training data. Transfer learning was performed by adding 25, 50, 100, 150, or 225 panoramic radiographs as training data from institution B to the source model; this yielded the target models T25, T50, T100, T150 and T225. Each model was then evaluated using test data that comprised 40 images from institution A, 30 images from institution B. The performance indices (recall, precision and F1 score) for detecting the maxillary sinuses by the source model exceeded 0.98 when using test data A from institution A, but they deteriorated when using test data B from institution B. In the evaluation of target models using test data B, model T25 showed improved detection performance (recall of 0.967). The diagnostic performance of model T50 for maxillary sinusitis exceeded 0.9 in sensitivity. Transfer learning, which involves applying a small amount of data to the source model, yielded high performances in detecting the maxillary sinuses and diagnosing the maxillary sinusitis on panoramic radiographs. This study serves as a reference when adapting source models to other institutions.

Ultrasound is one of the methods proposed by researchers to investigate paranasal sinus disease conditions like rhinosinusitis. This method, unlike Computed Tomographic (CT) scan, does not involve exposure to radiation, and it is cost effective. Moreover, an ultrasound scan is safe, readily available, and non-invasive compared to the sinus puncture method, and it is easily accepted by patients. However, there is no enough information on the utilization and accuracy of this method in the diagnosis of maxillary sinusitis. The aim of this review is to investigate and elaborate on the role of ultrasound scan in the diagnosis of maxillary sinusitis. We conducted a comprehensive literature search across multiple research databases, including PubMed, Scopus, Web of Science, Google Scholar, Embase, EBSCO and Cochrane database. The result indicated that both A-mode and B-mode ultrasound scans were accurate in the diagnosis of maxillary sinusitis, with excellent sensibility, specificity, positive and negative predictive values compared with Magnetic Resonant Imaging (MRI), CT scan and sinus endoscopy. Therefore, we recommend the use of ultrasound scan for the diagnosis of maxillary sinusitis, especially in our environment where there are factors that limit the utilization of CT scan and MRI (such as repeated breakdown of the machines, high cost, and lack of good electricity).

Maxillary sinusitis is a common inflammatory condition often diagnosed through imaging modalities such as "cone-beam computedtomography (CBCT)". A prospective clinical research was conducted involving 200 patients with suspected maxillary sinusitis. The AImodel achieved a sensitivity of 89.1%, specificity of 91.7%, positive predictive value of 92.5% and negative predictive value of 87.8%and overall accuracy of 90.4%. The area under the ROC curve was 0.948, indicating excellent diagnostic discrimination. AI demonstrateshigh reliability in diagnosing maxillary sinusitis on CBCT scans and may serve as an effective adjunct in clinical imaging interpretation,enhancing diagnostic efficiency and consistency.

BK Virus in Solid Organ Transplant Recipients

A prospective evaluation of the paranasal sinuses was performed on a consecutive series of 137 pediatric patients referred for cranial CT. Approximately one-half of the patients less than 13 years of age had some degree of maxillary or ethmoid sinus opacification. The prevalence and severity of opacification was approximately the same for the maxillary and ethmoid sinuses. Sphenoid sinus abnormality was less common (16% of patients) and was usually minimal or mild. No incidental frontal sinus abnormalities were observed. This study confirms previous reports, based on plain film radiography, of the prevalence of incidental maxillary sinus opacification in children. However, contrary to some prior studies, we did not find a relatively higher rate of opacification in children less than 1 year of age. This may be due to overdiagnosis of maxillary sinus opacification on plain films, in small children. The diagnosis of sinusitis in childhood must take into account not only the radiographic findings but clinical signs and symptoms. Correlation is needed to avoid overdiagnosis in patients referred for sinus radiography for nonspecific indications or who have incidental opacification noted on radiographic or CT studies of the skull and brain.

Ventilator-associated pneumonia (VAP) is common in Pediatric Intensive Care Units. Although early detection is crucial, current diagnostic methods are not definitive. This study aimed to identify lung ultrasound (LUS) findings and procalcitonin (PCT) values in pediatric patients with VAP to create a new early diagnosis score combined with the Clinical Pulmonary Infection Score (CPIS), the CPIS-PLUS score. Prospective longitudinal and interventional study. Pediatric patients with suspected VAP were included and classified into VAP or non-VAP groups, based on Centers of Disease Control (CDC) criteria for the final diagnosis. A chest-X-ray (CXR), LUS, and blood test were performed within the first 12 h of admission. CPIS score was calculated. A total of 108 patients with VAP suspicion were included, and VAP was finally diagnosed in 51 (47%) patients. CPIS-PLUS showed high accuracy in VAP diagnosis with a sensitivity (Sn) of 80% (95% CI 65-89%) and specificity (Sp) of 73% (95% CI 54-86%). The area under the curve (AUC) resulted in 0.86 for CPIS-PLUS vs. 0.61 for CPIS. In conclusion, this pilot study showed that CPIS-PLUS could be a potential and reliable tool for VAP early diagnosis in pediatric patients. Internal and external validations are needed to confirm the potential value of this score to facilitate VAP diagnosis in pediatric patients.

IntroductionVesicoureteral reflux appears in 20–50% of pediatric patients with recurrent urinary tract infections. The most common method of diagnosing this disease is voiding cystourethrography. However, contemporary pediatric radiology does not favor this method due to exposure to X-radiation.AimThe aim of this study was to assess the usefulness of 2D/3D/4D contrast-enhanced voiding urosonography in the diagnosis and treatment monitoring of vesicoureteral reflux in children and the possibility of using contrast-enhanced voiding urosonography to replace voiding cystourethrography.Material and methodsVoiding cystourethrography and contrast-enhanced voiding urosonography were conducted in 80 pediatric patients in order to assess sensitivity, specificity, positive and negative predictive values as well as the number of vesicoureteral refluxes detected by each of the two methods. The second stage of the study involved performing voiding urosonography in an extended protocol in 58 children in order to determine the usefulness of three-dimensional (3D/4D) examinations in the assessment of vesicoureteral reflux and the ability to assess the urethra.ResultsThe concordance between the two methods was 86.95%. The sensitivity of voiding urosonography was 84.51%, specificity – 90.99%, positive predictive value – 85.71% and negative predictive value – 90.17%. A 3D/4D assessment of the urinary bladder and transperineal 2D morphological assessment of the urethra were possible in all patients (100%). Assessment of the urethra during micturition with the use of 2D/3D/4D techniques was possible in all patients in whom voiding was elicited (95.83%), and 3D/4D assessment of vesicoureteral reflux was possible in all patients with reflux (100%). Although the application of 3D/4D techniques allowed accurate specification of the grade of reflux in all cases (100%), it appeared particularly useful in differentiating between grades II and III (70.97%).ConclusionsContrast-enhanced voiding urosonography allows the diagnosis and monitoring of treatment of vesicoureteral reflux in pediatric patients as well as assessment of the urethra in both girls and boys. The method is characterized by high sensitivity and specificity. Moreover, it is safe, relatively inexpensive and can replace voiding cystourethrography.

Infections are a major complication in pediatric oncology, with patients at increased risk due to chemotherapy-induced neutropenia and compromised immune status. This retrospective study, conducted between 2018 and 2022 at the "Maria Sklodowska Curie" Children's Emergency Clinical Hospital in Bucharest, evaluated 150 episodes of fever and sepsis in 94 pediatric oncology patients. The results revealed significant differences between the groups analyzed: children with central nervous system tumors had a higher frequency of sepsis (p = 0.03), while patients with leukemia and lymphoma had the longest intervals between treatment initiation and fever onset. Also, profound neutropenia was more pronounced in patients with lymphomas (median neutrophil count = 0.18, p = 0.003). These results emphasize the need for personalized monitoring of infectious risk and adaptation of prophylaxis strategies according to the type of malignancy. In conclusion, the obtained data contribute to substantiating an individualized approach in the management of fever and sepsis in pediatric oncology patients.

Diagnosing sinusitis remains a challenge for primary care physicians. There is a need for a simple, office-based technique to aid in the diagnosis of sinusitis without the cost and radiation risk of conventional radiologic imaging. We designed a low-cost near-infrared (NIR) device to transilluminate the maxillary sinuses. The use of NIR light allows for greater interrogation of deep-tissue structures as compared to visible light. NIR imaging of 21 patients was performed and compared with computed tomography (CT) scans. Individual maxillary sinuses were scored on a scale from 0 to 2 based on their degree of aeration present on CT and similarly based on the NIR signal penetration into the maxilla on NIR images. Our results showed that air-filled and fluid/tissue-filled spaces can be reasonably distinguished by their differing NIR signal penetration patterns, with average NIR imaging scores for fluid-filled maxillary sinuses (0.93+/-0.78, n=29) significantly lower than those for normal maxillary sinuses (1.62+/-0.57, n=13) (p=0.003). NIR imaging of the sinuses is a simple, safe, and cost-effective modality that can potentially aid in the diagnosis of sinusitis. Long-term, significant device refinement and large clinical trials will be needed to determine the diagnostic accuracy of this technique.

ObjectivesEvaluate the influence of an MRI contrast agent application on primary and follow-up staging in pediatric patients with newly diagnosed lymphoma using [18F]FDG PET/MRI to avoid adverse effects and save time and costs during examination.MethodsA total of 105 [18F]FDG PET/MRI datasets were included for data evaluation. Two different reading protocols were analyzed by two experienced readers in consensus, including for PET/MRI-1 reading protocol unenhanced T2w and/or T1w imaging, diffusion-weighted imaging (DWI), and [18F]FDG PET imaging and for PET/MRI-2 reading protocol an additional T1w post contrast imaging. Patient-based and region-based evaluation according to the revised International Pediatric Non-Hodgkin’s Lymphoma (NHL) Staging System (IPNHLSS) was performed, and a modified standard of reference was applied comprising histopathology and previous and follow-up cross-sectional imaging. Differences in staging accuracy were assessed using the Wilcoxon and McNemar tests.ResultsIn patient-based analysis, PET/MRI-1 and PET/MRI-2 both determined a correct IPNHLSS tumor stage in 90/105 (86%) exams. Region-based analysis correctly identified 119/127 (94%) lymphoma-affected regions. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for PET/MRI-1 and PET/MRI-2 were 94%, 97%, 90%, 99%, 97%, respectively. There were no significant differences between PET/MRI-1 and PET/MRI-2.ConclusionsThe use of MRI contrast agents in [18F]FDG PET/MRI examinations has no beneficial effect in primary and follow-up staging of pediatric lymphoma patients. Therefore, switching to a contrast agent–free [18F]FDG PET/MRI protocol should be considered in all pediatric lymphoma patients.Clinical relevance statementThis study gives a scientific baseline switching to a contrast agent–free [18F]FDG PET/MRI staging in pediatric lymphoma patients. This could avoid side effects of contrast agents and saves time and costs by a faster staging protocol for pediatric patients.Key Points• No additional diagnostic benefit of MRI contrast agents at [18F]FDG PET/MRI examinations of pediatric lymphoma primary and follow-up staging• Highly accurate primary and follow-up staging of pediatric lymphoma patients at MRI contrast–free [18F]FDG PET/MRI

Intracranial abscess has serious mortality. Therefore, early diagnosis and treatment is important. Intracranial abscess is rarely seen as a complication of sinusitis. Specially in children it has been reported rarely. Fever and headache can indicate complications in children.

Acute and chronic sinusitis in pediatric patients can lead to a variety of intracranial complications, such as intracranial abscesses (brain abscess, subdural empyema, and epidural abscess), meningitis, and venous sinus thrombosis, which are associated with significant morbidity and mortality. This study aims to improve clinical awareness of pediatric sinogenic intracranial abscesses through case presentations and a literature review. We retrospectively analyzed three pediatric cases (10-13years old) with sinogenic intracranial abscesses treated at our institution between 2024 and 2025. Demographic, clinical, radiological, and operative data were extracted from medical records and imaging studies. A review of relevant literature was also performed to summarize key insights into the pathophysiology, clinical manifestations, diagnosis, and management of this condition. Two girls and one boy were included in the study. All three patients presented with key symptoms of headache and fever. Cranial imaging confirmed intracranial purulent collections (epidural abscess or subdural empyema) secondary to sinusitis. All received intravenous antibiotic therapy, and two underwent combined neurosurgical and otolaryngological interventions. All achieved an uneventful recovery and were discharged without severe sequelae. The literature review identified Streptococcus species as the primary pathogens, with frontal and ethmoid sinus involvement being most common. Concurrent neurosurgical and otolaryngological intervention is recommended to optimize treatment outcomes. Pediatric sinogenic intracranial abscesses demand early recognition through integrated clinical and radiological assessment. Multimodal treatment including targeted antibiotics and timely surgical intervention is critical to improving outcomes and minimizing neurological sequelae.

Background: Disparities in pediatric cancer outcomes by race and ethnicity may be influenced by neighborhood characteristics, particularly residential economic and racial segregation. Prior to a new cancer diagnosis, pediatric patients are vulnerable to structural barriers embedded in their neighborhoods. In particular, residential economic and racial segregation may impede access to initial care for early cancer detection, increasing the likelihood of presenting with distant metastatic disease at diagnosis that can translate to excess morbidity and mortality. This study assesses the association of residential economic and racial segregation as measured by the Index of Concentration at the Extremes (ICE) with the likelihood of presenting with distant metastatic disease (as compared to local or locoregional disease) among children newly diagnosed with cancer. Methods: We studied a cohort of pediatric patients diagnosed with solid tumors at Children’s Healthcare of Atlanta between 2010 and 2016. Patients’ ZIP codes were linked to the ICE, which was constructed at the ZIP code level using American Community Survey 2012-2016 five-year estimates. The ICE was categorized into tertile 1 (most deprived) through tertile 3 (most privileged). Multivariable logistic regression models were used to assess the association between residential economic and racial segregation, defined by tertiles of the ICE, and the likelihood of presenting with distant metastatic disease, as determined by initial cancer staging. All models adjusted for patient- and disease-level covariates, including age, sex at birth, health insurance type, and cancer type. Results: Among 829 patients identified in our analytic sample, 27.6% had distant metastatic disease at diagnosis. Living in the most deprived (ICE tertile 1) versus the most privileged (ICE tertiles 2/3) neighborhoods was significantly associated with a higher likelihood of presenting with distant metastatic disease at diagnosis (adjusted odds ratio [OR] = 1.46; 95% confidence interval [CI] = 1.03 to 2.07; p=0.03). Additionally, non-Hispanic Black patients living in the most deprived neighborhoods were more likely to have distant metastatic disease at diagnosis compared to non-Hispanic White patients living in the most privileged neighborhoods (adjusted OR = 1.83; 95% CI = 1.15 to 2.92; p=0.002). Conclusion: This study provides new insights into how residential economic and racial segregation is associated with metastatic disease at diagnosis among children presenting with a new solid tumor. Our findings highlight the need for geographically targeted interventions to improve community care, resource allocation and investment, and public policies aimed at supporting this vulnerable patient population. Citation Format: Alexandra Cathcart, Sharon M. Castellino, Lu Zhang, Karen Wasilewski-Masker, Andrew L. Hong, Heeju Sohn, Xu Ji. Association of residential economic and racial segregation with metastatic disease at diagnosis in pediatric patients with solid tumors [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B135.

Acute bacterial sinusitis is among the most frequent outpatient infections in children and adolescents and is well suited to study in large healthcare utilization databases, but the validity of International Classification of Diseases, 10th Revision (ICD-10) codes together with antibiotic prescriptions to identify cases of acute bacterial sinusitis has not been established. We aimed to evaluate the validity of ICD-10 codes combined with antibiotic prescriptions to identify new diagnoses of acute bacterial sinusitis among pediatric patients evaluated in the outpatient setting. Children and adolescents aged 17 years and younger with an outpatient diagnosis of acute sinusitis along with an antibiotic prescription from an ambulatory facility affiliated with the Mass General Brigham health system were identified via a clinical data warehouse. Patients were stratified by age (0-5 years, 6-11 years, and 12-17 years), and 50 cases per age group were randomly sampled. Medical records were independently reviewed by two pediatric infectious diseases physicians to assess for the documentation of a clinician-defined diagnosis of acute bacterial sinusitis. Positive predictive values (PPVs) and 95% confidence intervals (CIs) were calculated. A total of 150 patients were included in the final cohort. Frontal, maxillary, and "unspecified" sinuses accounted for 88% of the diagnoses. The positive predictive value of the algorithm to identify clinician-defined diagnoses of acute bacterial sinusitis was 92% (95% CI 87%, 95%). The PPVs were consistent across age strata. ICD-10 codes for acute sinusitis, when paired with a same-day antibiotic prescription, have a high positive predictive value among a cohort of pediatric patients, suggesting that they can be used to study new acute bacterial sinusitis diagnoses with claims.

High-resolution manometry (HRM) is the gold standard for diagnosis of esophageal motility disorders. However, clinical signs associated with these disorders are nonspecific, and it is difficult to correlate clinical signs with HRM data. The main objective of our study was to assess the positive predictive value (PPV) and negative predictive value (NPV) of each clinical sign, as well as their sensitivity and specificity in the diagnosis of esophageal motility disorders. This is a bicentric retrospective cohort study based on HRM data collected between May 2012 and May 2016. The studied symptoms were weight loss, feeding difficulties, swallowing disorders, dysphagia, food blockages, vomiting, gastroesophageal reflux disease (GERD), belching, and respiratory symptoms. HRM data were analyzed according to the Chicago Classification (3.0). In total, 271 HRM data were analyzed, of which 90.4% showed abnormal results. HRM was well tolerated in 91% of the cases. The most common esophageal motility disorder was ineffective esophageal motility (38%). Weight loss was significantly associated (P = 0.003) with an abnormal HRM with a 96% PPV. With nonspecific clinical signs suggesting an esophageal motility disorder, weight loss was a predictive sign of abnormal HRM results. HRM was well tolerated in pediatric patients, and ineffective esophageal motility appears to be the most frequent motility disorder in our cohort, as already observed in adult patient studies.