Effective Blue Light-Absorbing AuAg Nanoparticles in InP Quantum Dots-Based Color Conversion.

In typical color-by-blue mode-based quantum dot (QD) display devices, only part of the blue excitation light is absorbed by QD emitters, thus it is accompanied by the leakage of blue light through the devices. To address this issue, we offer, for the first time, the applicability of AuAg alloy nanoparticles (NPs) as effective blue light absorbers in InP QD-based color-by-blue platforms. For this, high-quality fluorescent green and red InP QDs with a double shell scheme of ZnSe/ZnS were synthesized and embedded in a transparent polymer film. Separately, a series of Au/Ag ratio-varied AuAg NPs with tunable plasmonic absorption peaks were synthesized. Among them, AuAg NPs possessing the most appropriate absorption peak with respect to spectral overlap with blue emission are chosen for the subsequent preparation of AuAg NP polymeric films with varied NP concentrations. A stack of AuAg NP polymeric film on top of InP QD film is then placed remotely on a blue light-emitting diode, successfully resulting in systematically progressive suppression of blue light leakage with increasing AuAg NP concentration. Furthermore, the beneficial function of the AuAg NP polymeric overlayer in mitigating undesirable QD excitation upon exposure to ambient lights was further examined.

Localized cystic disease of the kidney in pediatric patients: Clinical and imaging findings with long term follow up.

INTRODUCTION: This study aimed to describe the clinical and imaging findings, including ultrasonography (US) findings, and long-term follow-up results in pediatric patients with localized cystic disease of the kidney (LCDK). MATERIAL AND METHODS: Retrospective review of pediatric patients diagnosed with LCDK based on imaging findings showing multiple localized renal cysts with intervening normal renal parenchyma from January 2002 to August 2020. Clinical presentations and US features of the affected and contralateral kidneys were reviewed and compared with computed tomography or magnetic resonance imaging findings, if available. RESULTS: A total of 18 patients (male:female = 11:7; median age, 8 years) were included. Initial clinical presentations were incidental findings (n = 5), abdominal pain (n = 5), or hematuria (n = 5). Of the seven patients (7/18, 39%) who showed multiple hyperechoic foci with ring-down artifacts within the cystic lesions on US, six patients showed focal calcification of the cysts on CT. Two patients (2/18, 11%) had milimetric cysts in the contralateral kidney. During follow-up (range, 2-122 months), there was an increase in lesion size, with ipsilateral renal growth in four patients (4/18, 22%). There was no renal function impairment at the initial presentation or during follow-up in all patients. CONCLUSIONS: LCDK can present with milimetric calcifications (39%), contralateral milimetric renal cysts (11%), and mild size increase during renal growth (22%) in children without renal function impairment. Follow-up US is recommended without surgical intervention in these typical cases.

The complete mitochondrial genome of Japanese sea lion, Zalophus japonicus (Carnivora: Otariidae) analyzed using the excavated skeletal remains from Ulleungdo, South Korea.

The Japanese sea lion, Zalophus japonicus, is an extinct pinniped species, which had inhabited along the coast of the Japanese archipelago and Korean peninsula. Its mitochondrial genome was determined by the assembly of PCR amplicons from the skeletal remains excavated from the Ulleungdo, South Korea. The whole mitogenome was 16,698 bp in length, which encoded 13 protein-coding genes (PCGs), 22 transfer RNAs (tRNA), 2 ribosomal RNAs (rRNA), an origin of light-strand replication (OL), and a control region (D-loop). Unusual start codons were identified in ND2 (ATA), ND3 (ATA), and ND5 (ATC), while COIII, ND3, and ND4 were terminated with an incomplete stop codon (T-/TA-). Phylogenetic analysis showed that Z. japonicus was a sister species to Z. californianus with 98.61% nucleotide sequence identity among 11 pinniped species in the infraorder Pinnipedia, which supported the previous results. The complete mitochondrial genome sequence of Z. japonicus would be valuable information for its restoration and the evolutional understandings of pinniped species in the Pacific Ocean.

Different Biochemical Compositions of Particulate Organic Matter Driven by Major Phytoplankton Communities in the Northwestern Ross Sea.

Marine particulate organic matter (POM) largely derived from phytoplankton is a primary food source for upper trophic consumers. Their biochemical compositions are important for heterotrophs. Especially, essential amino acids (EAAs) in phytoplankton are well known to have impacts on the survival and egg productions of herbivorous zooplankton. To estimate the nutritional quality of POM, the biochemical compositions [biomolecular and amino acid (AA) compositions] of POM were investigated in the northwestern Ross Sea during the late austral summer in 2018. Carbohydrates (CHO) accounted for the highest portion among different biomolecules [CHO, proteins (PRT), and lipids (LIP)] of POM. However, the higher contribution of PRT and lower contribution of CHO were observed in the southern section of our study area compared to those in the northern section. The spatial distribution of total hydrolyzable AAs in POM was considerably influenced by phytoplankton biomass, which indicates that the main source of particulate AA was generated by phytoplankton. Our results showed that the relative contribution of EAA to the total AAs was strongly associated with EAA index (EAAI) for determining protein quality. This result indicates that higher EAA contribution in POM suggests a better protein quality in consistency with high EAAI values. In this study, variations in the biochemical compositions in POM were principally determined by two different bloom-forming taxa (diatoms and Phaeocystis antarctica). The southern region dominated majorly by diatoms was positively correlated with PRT, EAA, and EAAI indicating a good protein quality, while P. antarctica-abundant northern region with higher CHO contribution was negatively correlated with good protein quality factors. Climate-driven environmental changes could alter not only the phytoplankton community but also the physiological conditions of phytoplankton. Our findings could provide a better understanding for future climate-induced changes in the biochemical compositions of phytoplankton and consequently their potential impacts on higher trophic levels.

Diffusion-Weighted Imaging for Differentiation of Biliary Atresia and Grading of Hepatic Fibrosis in Infants with Cholestasis.

OBJECTIVE: To determine whether the values of hepatic apparent diffusion coefficient (ADC) can differentiate biliary atresia (BA) from non-BA or be correlated with the grade of hepatic fibrosis in infants with cholestasis. MATERIALS AND METHODS: This retrospective cohort study included infants who received liver MRI examinations to evaluate cholestasis from July 2009 to October 2017. Liver ADC, ADC ratio of liver/spleen, aspartate aminotransferase to platelet ratio index (APRI), and spleen size were compared between the BA and non-BA groups. The diagnostic performances of all parameters for significant fibrosis (F3-4) were obtained by receiver-operating characteristics (ROCs) curve analysis. RESULTS: Altogether, 227 infants (98 males and 129 females, mean age = 57.2 ± 36.3 days) including 125 BA patients were analyzed. The absolute ADC difference between two reviewers was 0.10 mm²/s for both liver and spleen. Liver ADC value was specific (80.4%) and ADC ratio was sensitive (88.0%) for the diagnosis of BA with comparable performance. There were 33 patients with F0, 15 with F1, 71 with F2, 35 with F3, and 11 with F4. All four parameters of APRI (τ= 0.296), spleen size (τ= 0.312), liver ADC (τ= -0.206), and ADC ratio (τ= -0.288) showed significant correlation with fibrosis grade (all, p < 0.001). The cutoff values for significant fibrosis (F3-4) were 0.783 for APRI (area under the ROC curve [AUC], 0.721), 5.9 cm for spleen size (AUC, 0.719), 1.044 × 10-3 mm²/s for liver ADC (AUC, 0.673), and 1.22 for ADC ratio (AUC, 0.651). CONCLUSION: Liver ADC values and ADC ratio of liver/spleen showed limited additional diagnostic performance for differentiating BA from non-BA and predicting significant hepatic fibrosis in infants with cholestasis.

Determining the optimal timing of screening spinal cord ultrasonography to detect filum terminale lipoma in infants.

PURPOSE: The purpose of this study was to identify the optimal timing for screening spinal cord ultrasonography (US) to detect filum terminale lipoma in infants. METHODS: We retrospectively reviewed infants (<12 months old) who underwent repeated spinal cord US between April 2011 and January 2019. We excluded infants if they only had one US examination, or if they had lesions other than filum terminale lipoma. Infants with filum terminale lipoma on magnetic resonance imaging were included in the lipoma group and the others in the control group. A linear mixed model was used to assess differences in the growth pattern of filum terminale thickness by age and group. The cutoff thickness on US and its diagnostic performance were assessed according to age. RESULTS: Among 442 infants with 901 US examinations, 46 were included in the lipoma group and 58 in the control group. Sixty-seven infants had unmeasurable filum terminale thickness on initial US, including 55 neonates (82.1%) before 1 month of age. The lipoma group had significantly greater filum terminale thickness than the control group (P<0.001). Thickness increased with age in the lipoma group (P=0.027). The sensitivity of US was 87.5% and the area under the receiver operating characteristic curve was 0.949 (95% confidence interval, 0.849 to 0.991) with a cutoff value of 1.1 mm in 4- to 6-month-old infants. CONCLUSION: Screening spinal cord US could effectively diagnose filum terminale lipoma in 4- to 6-month-old infants with a cutoff thickness of 1.1 mm. Spinal cord US can be used to screen young infants with intraspinal abnormalities.

Liver stiffness and perfusion changes for hepatic sinusoidal obstruction syndrome in rabbit model.

BACKGROUND: Hepatic sinusoidal obstruction syndrome (SOS) is caused by damage to hepatic sinusoidal endothelial cells that results in fibrous obliteration of intrahepatic venules and necrosis of hepatocytes. Currently the diagnosis is primarily based on nonspecific clinical features and invasive liver biopsy. Therefore, noninvasive imaging methods are required for the early diagnosis and severity assessment of hepatic SOS. AIM: To determine the effectiveness of supersonic shear wave imaging (SSI) and dual energy computed tomography (DECT) for diagnosing hepatic SOS using a rabbit model. METHODS: Among nine New Zealand white rabbits (3-4 kg, male), three in control group ingested normal saline for 20 d and six in the SOS group ingested 6-thioguanine (5 mg/kg/d) for 20 d. Liver stiffness was measured using SSI on days 0, 3, 10, and 20. On the same days, liver perfusion was evaluated from virtual monochromatic images of 55 keV and iodine map using DECT. Morphologic changes in the liver were assessed using CT. Final pathology scores were compared between the two groups. Liver stiffness and perfusion parameters were compared according to the groups, days, and pathology scores. RESULTS: Final pathology scores were significantly higher in the SOS than the control group (median 22 vs 2, P = 0.024). No gross morphologic changes were seen in livers. Liver stiffness, Hounsfield Unit values, and iodine concentrations were higher in the SOS compared to the control group on days 10 and 20 (all, P ≤ 0.007). Compared to day 0, liver stiffness and perfusion parameters were higher on day 20 in the SOS group (all, P ≤ 0.001). Correlation coefficients for liver stiffness (r = 0.635), Hounsfield Unit values (r = 0.587), and iodine concentration (r = 0.611) with final pathology scores were positive without significance (all, P > 0.05). CONCLUSION: Liver stiffness and perfusion parameters were significantly increased in the livers of a rabbit SOS model. SSI and DECT might aid in early diagnosis of hepatic SOS.

Hepatic subcapsular or capsular flow in biliary atresia: is it useful imaging feature after the Kasai operation?

OBJECTIVES: To evaluate the implications of hepatic subcapsular and capsular flows using ultrasonography (US) in children after Kasai operation. METHODS: Children who underwent liver US including color Doppler US and microvascular imaging (MVI) from May 2017 to October 2017 were retrospectively included. Children who underwent the Kasai operation for biliary atresia were included in the Kasai group and children with normal liver were included in the control group. Using US results, the number of intrahepatic biliary cysts and the maximum diameter of the spleen were evaluated in the Kasai group. Liver stiffness values were included when patients in the Kasai group had transient elastography (TE) or shear wave elastography (SWE) results. Hepatic subcapsular and capsular flows on color Doppler US and MVI were compared between the two groups using the following scores: 0, no flow reaching the hepatic capsule; 1, any flow reaching the hepatic capsule; and 2, contiguous hepatic capsular flow. The logistic regression test was used to identify associations between age, intrahepatic biliary cysts, spleen size, SWV, TE results, and flow scores measured on Doppler US and MVI in the Kasai group using the odds ratio (OR) and 95% confidence interval (CI). RESULT: A total of 65 children (mean 7.6 ± 5.3 years), 44 in the Kasai group and 21 in the control group, were included. In the control group, one child had score 1 on MVI and others had score 0 on both Doppler US and MVI. Among the Kasai group, 28 children (63.6%) had score 1, while others had score 0 using Doppler US. Using MVI, 24 children (54.5%) had score 2, 18 children had score 1, and one child had score 0. In the Kasai group, increased liver stiffness on TE was the only factor significantly associated with the presence of subcapsular flow on color Doppler US (OR 1.225, 95% CI 1.020-1.470) and increased spleen size was the only factor significantly associated with increased flow scores on MVI (OR 1.397, 95% CI 1.002-2.724). CONCLUSION: Detection of hepatic subcapsular, capsular flows on US would be meaningful for children after receiving the Kasai operation. KEY POINTS: • Hepatic subcapsular or capsular flows can be useful not only for the diagnosis but also for the postoperative follow-up in patients with biliary atresia. • Increased liver stiffness and splenomegaly after the Kasai operation were associated with presence of subcapsular or capsular flow on ultrasonography. • Evaluation of hepatic subcapsular and capsular flows could be needed to assess disease progression after receiving the Kasai operation.

Renal elasticity and perfusion changes associated with fibrosis on ultrasonography in a rabbit model of obstructive uropathy.

PURPOSE: To evaluate elasticity and perfusion change associated with fibrosis in a rabbit model of unilateral ureter obstruction using shear wave elastography (SWE) and contrast-enhanced ultrasonography (CEUS). METHODS: Complete unilateral ureter obstruction by ligation was performed in the left kidney of 15 rabbits. Renal elasticity on SWE and perfusion change on CEUS at the renal cortex were measured before and after the operation. Histopathological renal fibrosis was quantified by the stained area ratio with Masson trichrome and Picrosirius red using ImageJ analysis. Renal elasticity and perfusion values were compared by the Mann-Whitney U test and Proc Mixed as a function of time. Spearman's correlation was used to analyze differences between imaging values and fibrosis. RESULTS: The duration of imaging follow-up was up to 49 days, with interval imaging performed 1-3 times. Renal elasticity values were higher in obstructed kidneys compared to contralateral kidneys (31.0 kPa vs 16.4 kPa, p < 0.001) and increased according to postoperative time (0.46 kPa/day). With respect to renal fibrosis, SWE values were positively correlated with Masson trichrome (ρ = 0.651, p < 0.001) and Picrosirius red (ρ = 0.514, p = 0.007). Among CEUS parameters, mean transit time was negatively correlated with renal fibrosis by Masson trichrome (ρ = - 0.639, p = 0.001) and Picrosirius red (ρ = - 0.625, p = 0.001). Rise time and time to peak were positively correlated with renal fibrosis. CONCLUSION: Obstructive uropathy resulted in changes to both renal elasticity and perfusion. Renal fibrosis was moderately associated with increased renal cortical stiffness and both delayed and decreased cortical perfusion. KEY POINTS: • Obstructive uropathy causes changes in elasticity and perfusion in a rabbit model. • Renal fibrosis from obstructive uropathy increases renal cortical stiffness, and both delay and decrease cortical perfusion.

Clinical utility of mono-exponential model diffusion weighted imaging using two b-values compared to the bi- or stretched exponential model for the diagnosis of biliary atresia in infant liver MRI.

PURPOSE: To investigate the clinical utility of mono-exponential model diffusion weighted imaging (DWI) using two b-values compared to the bi- or stretched exponential model to differentiate biliary atresia (BA) from non-BA in pediatric liver magnetic resonance imaging (MRI). METHODS: Patients who underwent liver MRI with DWI for suspected BA from November 2017 to September 2018 were retrospectively included and divided into BA and non-BA groups. Laboratory results including γ-glutamyl transferase (γGT) were compared between the two groups using the Mann-Whitney U test and Fisher's exact test. The hepatic apparent diffusion coefficient (ADC) 10 using ten b-values and ADC 2 using two b-values were obtained from the mono-exponential model. The slow diffusion coefficient (D), fast diffusion coefficient (D*), and perfusion fraction (f) were obtained from the bi-exponential model. The distributed diffusion coefficient (DDC) and heterogeneity index (α) were measured from the stretched exponential model. Parameters were compared between the two groups using a linear mixed model and diagnostic performance was assessed using the area under the curve (AUC) analysis. RESULTS: For 12 patients in the BA and five patients in the non-BA group, the ADC 10 (median 0.985 ×10-3 mm2/s vs. 1.332 ×10-3 mm2/s, p = 0.008), ADC 2 (median 0.987 ×10-3 mm2/s vs. 1.335 ×10-3 mm2/s, p = 0.017), D* (median 33.2 ×10-3 mm2/s vs. 55.3 ×10-3 mm2/s, p = 0.021), f (median 13.4%, vs. 22.1%, p = 0.009), and DDC (median 0.889 ×10-3 mm2/s vs. 1.323 ×10-3 mm2/s, p = 0.009) values were lower and the γGT (median 368.0 IU/L vs. 93.5 IU/L, p = 0.02) and α (median 0.699 vs. 0.556, p = 0.023) values were higher in the BA group. The AUC values for γGT (AUC 0.867 95% confidence interval [CI] 0.616-0.984), ADC 10 (AUC 0.963, 95% CI 0.834-0.998), ADC 2 (AUC 0.925, 95% CI 0.781-0.987), f (AUC 0.850, 95% CI 0.686-0.949), and DDC (AUC 0.925, 95% CI 0.781-0.987) were not significantly different, except for the D* and α values. CONCLUSION: Patients with BA had lower ADC 10, ADC 2, D*, f, and DDC values and higher γGT and α values than those in the non-BA group. The diagnostic performance of ADC 2 using only two b-values showed excellent diagnostic performance and was not significantly different from that of γGT, ADC 10, f, and DDC for diagnosing BA.

Performance of deep learning-based algorithm for detection of ileocolic intussusception on abdominal radiographs of young children.

The purpose of this study was to develop and test the performance of a deep learning-based algorithm to detect ileocolic intussusception using abdominal radiographs of young children. For the training set, children (≤5 years old) who underwent abdominal radiograph and ultrasonography (US) for suspicion of intussusception from March 2005 to December 2017 were retrospectively included and divided into control and intussusception groups according to the US results. A YOLOv3-based algorithm was developed to recognize the rectangular area of the right abdomen and to diagnose intussusception. For the validation set, children (≤5 years old) who underwent both radiograph and US from January to August 2018 with the suspicion of intussusception were included. Diagnostic performances of an algorithm and radiologists were compared. Total 681 children including 242 children in intussusception group were included in the training set and 75 children including 25 children in intussusception group were included in the validation set. The sensitivity of the algorithm was higher compared with that of the radiologists (0.76 vs. 0.46, p = 0.013), while specificity was not different between the algorithm and the radiologists (0.96 vs. 0.92, p = 0.32). Deep learning-based algorithm can aid screening of intussusception using abdominal radiography in young children.

Quantitative Imaging in Pediatric Hepatobiliary Disease.

Pediatric hepatobiliary imaging is important for evaluation of not only congenital or structural disease but also metabolic or diffuse parenchymal disease and tumors. A variety of ultrasonography and magnetic resonance imaging (MRI) techniques can be used for these assessments. In ultrasonography, conventional ultrasound imaging as well as vascular imaging, elastography, and contrast-enhanced ultrasonography can be used, while in MRI, fat quantification, T2/T2* mapping, diffusion-weighted imaging, magnetic resonance elastography, and dynamic contrast-enhanced MRI can be performed. These techniques may be helpful for evaluation of biliary atresia, hepatic fibrosis, nonalcoholic fatty liver disease, sinusoidal obstruction syndrome, and hepatic masses in children. In this review, we discuss each tool in the context of management of hepatobiliary disease in children, and cover various imaging techniques in the context of the relevant physics and their clinical applications for patient care.

Texture Analysis to Differentiate Malignant Renal Tumors in Children Using Gray-Scale Ultrasonography Images.

We assessed the feasibility of texture analysis to differentiate Wilms tumor, clear cell sarcoma and rhabdoid tumor of the kidney in children using gray-scale ultrasonography images. Children who had pre-operative renal ultrasonography images of the three tumors from January 2002 to February 2017 were retrospectively included as the test set, and children with the same criteria from March 2017 to December 2018 were included as the validation set. From histogram and second-order statistics, features were compared between the tumors, and diagnostic performances were assessed. Among a total of 32 children (24 children with Wilms tumors, five children with clear cell sarcomas and three children with rhabdoid tumors) from the test set, features from the second-order statistics showed an area under the curve greater than 0.89 for differentiating Wilms tumor from the others. These features aided in the differentiation of tumor type in the two children with Wilms tumors in the validation set. Therefore, texture analysis from gray-scale ultrasonography images can be used to differentiate Wilms tumors from clear cell sarcomas and rhabdoid tumors in children.

Quick assessment with controlled attenuation parameter for hepatic steatosis in children based on MRI-PDFF as the gold standard.

BACKGROUND: Controlled attenuation parameter (CAP) is a recently introduced, non-invasive and quantitative method to evaluate hepatic steatosis demonstrated in adults, but limited in obesity and not well evaluated in children. The aim of this study was to investigate the diagnostic performance for assessing hepatic steatosis grades using CAP in children based on MR proton density fat fraction (PDFF). METHODS: Children evaluated for non-alcoholic fatty liver disease (NAFLD) who were assessed for PDFF and CAP were enrolled retrospectively. Hepatic steatosis grades 0-3 were classified according to PDFF using cutoff values of 6, 17.5, and 23.3%. Subgroup analyses were performed in non-obese and obese groups using the 95th percentile body mass index (BMI) as a cutoff and BMI30 group when BMI > 30 kg/m2. Pearson's correlations between variables were also analyzed. RESULTS: In a total of 86 children, there were 53 in the obese group including 17 of the BMI30 group. CAP demonstrated 98.7% sensitivity and 80% specificity for diagnosing grades 1-3 vs. grade 0 using a cutoff value of 241 dB/m (area under the curve = 0.941, p < 0.001). The diagnostic performance for higher steatosis grades was suboptimal. CAP correlated with abdominal wall thickness in both obese (r = 0.549, p = 0.001) and non-obese (r = 0.386, p = 0.004) groups and did not correlate with PDFF in BMI30 group. CONCLUSION: In children with NAFLD, CAP showed excellent diagnostic performance for differentiating presence and absence of hepatic steatosis using a cutoff value of 241 dB/m. However, CAP was limited in evaluating grades of steatosis, especially in children with BMI > 30 kg/m2.

Quantitative CT and pulmonary function in children with post-infectious bronchiolitis obliterans.

OBJECTIVE: To investigate the feasibility of CT-based quantitative airway and air-trapping measurements and to assess their correlation with pulmonary function in children with post-infectious bronchiolitis obliterans (PIBO). MATERIALS AND METHODS: This retrospective study approved by the institutional review board included chest CT scans and pulmonary function tests (PFT) completed between January 2005 and December 2016 in children diagnosed with PIBO. The quantitative analysis of segmental and subsegmental bronchi was performed on each chest CT scan, measuring the areas or diameters of lumens, walls, or the entire airway. The air-trapping volume (ATV), the volume of lung area exhibiting lower attenuation than the mean attenuation of normal and air-trapping areas, was also measured in each lobe. Comparison analyses between CT parameters and PFT results were performed with Pearson or Spearman correlation. RESULTS: In total, 23 patients were enrolled (mean age 7.0 ± 3.3 years; range, 4-15 years). We successfully measured 89.6% of all segmental bronchi. In the airway analysis, wall area showed a negative correlation with forced expiratory volume in one second (FEV1) in the majority of the pulmonary lobes. Air-trapping analyses demonstrated that ATV was negatively correlated with FEV1 and positively correlated with reactance at 5 Hz. CONCLUSION: Quantitative airway and air-trapping measurements from chest CT are feasible and correlate with pulmonary function in pediatric PIBO patients.

Normal Changes and Ranges of Pediatric Testicular Volume and Shear Wave Elasticity.

To determine normal ranges for pediatric testicular volume and stiffness values (SV) on ultrasonography (US) and shear wave elastography (SWE) with respect to age and weight, testicular US scans (including SWE) of children (<10 y old) performed from February 2015 to January 2017 were retrospectively reviewed; grossly normal testes or testes with small hydroceles were included. Correlations between age weight, and testicular volume or SV were evaluated. Among a total of 52 boys (1-92 mo, median = 23.5 mo), there were positive correlations between testicular volume and age (R2 = 0.451, p < 0.001) and weight (R2 = 0.515, p < 0.001). Testicular SV was negatively correlated with age (R2 = 0.166, p = 0.051) and weight (R2 = 0.372, p = 0.049). Therefore, SV decreases while volume increases with increasing weight in testes of healthy children. Normal ranges for testicular volume and SV in children younger than 10 y are reported.

Predicting gastroesophageal varices through spleen magnetic resonance elastography in pediatric liver fibrosis.

BACKGROUND: A recent retrospective study confirmed that hepatic stiffness and splenic stiffness measured with magnetic resonance elastography (MRE) are strongly associated with the presence of esophageal varices. In addition, strong correlations have been reported between splenic stiffness values measured with MRE and hepatic venous pressure gradients in animal models. However, most studies have been conducted on adult populations, and previous pediatric MRE studies have only demonstrated the feasibility of MRE in pediatric populations, while the actual clinical application of spleen MRE has been limited. AIM: To assess the utility of splenic stiffness measurements by MRE to predict gastroesophageal varices in children. METHODS: We retrospectively reviewed abdominal MRE images taken on a 3T system in pediatric patients. Patients who had undergone Kasai operations for biliary atresia were selected for the Kasai group, and patients with normal livers and spleens were selected for the control group. Two-dimensional spin-echo echo-planar MRE acquisition centered on the liver, with a pneumatic driver at 60 Hz and a low amplitude, was performed to obtain hepatic and splenic stiffness values. Laboratory results for aspartate aminotransferase to platelet ratio index (APRI) were evaluated within six months of MRE, and the normalized spleen size ratio was determined with the upper normal size limit. All Kasai group patients underwent gastroesophageal endoscopy during routine follow-up. The Mann-Whitney U test, Kendall's tau b correlation and diagnostic performance analysis using the area under the curve (AUC) were performed for statistical analysis. RESULTS: The median spleen MRE value was 5.5 kPa in the control group (n = 9, age 9-18 years, range 4.7-6.4 kPa) and 8.6 kPa in the Kasai group (n = 22, age 4-18 years, range 5.0-17.8 kPa). In the Kasai group, the APRI, spleen size ratio and spleen MRE values were higher in patients with portal hypertension (n = 11) than in patients without (n = 11) (all P < 0.001) and in patients with gastroesophageal varices (n = 6) than in patients without (n = 16) (all P < 0.05), even though their liver MRE values were not different. The APRI (τ = 0.477, P = 0.007), spleen size ratio (τ = 0.401, P = 0.024) and spleen MRE values (τ = 0.426, P = 0.016) also correlated with varices grades. The AUC in predicting gastroesophageal varices was 0.844 at a cut-off of 0.65 (100% sensitivity and 75% specificity) for the APRI, and 0.844 at a cut-off of 9.9 kPa (83.3% sensitivity and 81.3% specificity) for spleen MRE values. CONCLUSION: At a cut-off of 9.9 kPa, spleen MRE values predicted gastroesophageal varices as well as the APRI and spleen size ratio in biliary atresia patients after the Kasai operation. However, liver MRE values were not useful for this purpose.

Liver intravoxel incoherent motion diffusion-weighted imaging for the assessment of hepatic steatosis and fibrosis in children.

AIM: To evaluate the correlation between intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) parameters and the degree of hepatic steatosis and fibrosis in children. METHODS: This retrospective study was approved by the institutional review board. The children (≤ 18 years) who underwent liver IVIM DWI with 8 b-values under the suspicion of hepatic steatosis or fibrosis from February 2013 to November 2016 were included. Subjects were divided into normal, fatty liver (FAT), and fibrotic liver (FIB) groups. The slow diffusion coefficient (D), fast diffusion coefficient (D*), perfusion fraction (f), and apparent diffusion coefficient (ADC) were measured. MR proton density fat fraction (PDFF), MR elastography (MRE), and IVIM values were compared. RESULTS: A total of 123 children (median age of 12 years old, range: 6-18 years) were included, with 8 in the normal group, 93 in the FAT group, and 22 in the FIB group. The D* values were lower in the FIB group compared with those of the normal (P = 0.015) and FAT (P = 0.003) groups. The f values were lower in the FIB group compared with the FAT group (P = 0.001). In multivariate analyses, PDFF value was positively correlated with f value (ß = 3.194, P < 0.001), and MRE value was negatively correlated with D* value (ß = -7.031, P = 0.032). The D and ADC values were not influenced by PDFF or MRE value. CONCLUSION: In liver IVIM DWI with multiple b-values in children, there was a positive correlation between hepatic fat and blood volume, and a negative correlation between hepatic stiffness and endovascular blood flow velocity, while diffusion-related parameters were not affected.

Interconversion of elasticity measurements between two-dimensional shear wave elastography and transient elastography.

AIMS: To enable comparison and interconversion of elasticity measurements between two-dimensional (2D) shear wave elastography (SWE) and transient elastography (TE). MATERIALS AND METHODS: Elasticities of three phantoms were measured by 2D SWE (supersonic shear imaging) using four probes and TE using two probes. We performed regression analyses to evaluate correlation between the measurements and phantom elasticities, and make converting equations. In pediatric biliary atresia patients who had stiffness measurements by both 2D SWE and TE within 1-year interval, TE measurements were retrospectively converted into correlating 2D SWE values. We compared the calculated values with 2D SWE measurements by intraclass correlation coefficient. RESULTS: Measurements in phantoms varied according to elastography method and probe selection. However, the measurement by both 2D SWE (R2, 0.974-0.985; p<0.001) and TE (R2, 0.996-0.999; p<0.001) showedsignificant linear correlation with phantom elasticity in all probe settings. From 67 biliary atresia patients (age, 2 months-20 years), agreements between the measured and calculated values were excellent in all 88 examinations within 1-year interval(ρ=0.828; p<0.001) and in 63 examinations within 2-month interval (ρ=0.863, p<0.001). CONCLUSIONS: The equations enabledinterconversion of elasticity values among different probes of 2D SWE and TE and provided reliable estimation of elasticityvalues for different probe settings in biliary atresia patients.

MRI-based decision tree model for diagnosis of biliary atresia.

OBJECTIVES: To evaluate MRI findings and to generate a decision tree model for diagnosis of biliary atresia (BA) in infants with jaundice. METHODS: We retrospectively reviewed features of MRI and ultrasonography (US) performed in infants with jaundice between January 2009 and June 2016 under approval of the institutional review board, including the maximum diameter of periportal signal change on MRI (MR triangular cord thickness, MR-TCT) or US (US-TCT), visibility of common bile duct (CBD) and abnormality of gallbladder (GB). Hepatic subcapsular flow was reviewed on Doppler US. We performed conditional inference tree analysis using MRI findings to generate a decision tree model. RESULTS: A total of 208 infants were included, 112 in the BA group and 96 in the non-BA group. Mean age at the time of MRI was 58.7 ± 36.6 days. Visibility of CBD, abnormality of GB and MR-TCT were good discriminators for the diagnosis of BA and the MRI-based decision tree using these findings with MR-TCT cut-off 5.1 mm showed 97.3 % sensitivity, 94.8 % specificity and 96.2 % accuracy. CONCLUSIONS: MRI-based decision tree model reliably differentiates BA in infants with jaundice. MRI can be an objective imaging modality for the diagnosis of BA. KEY POINTS: • MRI-based decision tree model reliably differentiates biliary atresia in neonatal cholestasis. • Common bile duct, gallbladder and periportal signal changes are the discriminators. • MRI has comparable performance to ultrasonography for diagnosis of biliary atresia.