Background: Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease (NAFLD), is increasingly prevalent in children. However, reliable noninvasive diagnostic tools remain limited. The hepatorenal index (HRI) has been proposed as a quantitative ultrasound method to assess hepatic steatosis. This study aims to evaluate the diagnostic accuracy of HRI in detecting pediatric MASLD. Methods: A systematic review and meta-analysis were conducted on 13 September 2025, following PRISMA-DTA guidelines, with the protocol registered in PROSPERO (CRD420251146939). MEDLINE, PubMed, Cochrane Library, ScienceDirect, and Google Scholar were searched. Studies that assessed HRI against reference standards (MRI-PDFF or liver biopsy) in pediatric MASLD were included. Pooled diagnostic parameters were estimated using a bivariate random-effects model, with heterogeneity evaluated by I² statistics and publication bias by funnel plot asymmetry. Results: Four studies involving 194 pediatric patients (47.9% MASLD), mostly male (57.7%), met the inclusion criteria. The suggested HRI cut-off varies from ≥1.215 to 1.99. The pooled sensitivity and specificity were 90% (95% CI 70–97) and 84% (95% CI 73–92), respectively, with an AUC of 0.91 (95% CI 0.88–0.93). Positive and negative likelihood ratios were 6 and 0.12, corresponding to post-test probabilities of 32% and 1%, respectively. No significant publication bias or heterogeneity was detected. Conclusions: Although HRI demonstrates strong diagnostic performance, it currently lacks sufficient discriminatory power to definitively confirm or exclude MASLD in pediatric populations and should therefore be regarded as a supportive rather than definitive diagnostic tool pending further high-quality validation studies.

Posterior Reversible Encephalopathy Syndrome (PRES) is a rare but potentially reversible neurological manifestation associated with Multisystem Inflammatory Syndrome in Children (MIS-C). We report an eight-year-old boy who developed PRES secondary to MIS-C following asymptomatic SARS-CoV-2 exposure. The patient presented with fever, seizures, decreased consciousness, and visual disturbances. MRI revealed characteristic bilateral parieto-occipital and posterior temporal cortical–subcortical hyperintensities, while CT scans were normal. The patient achieved full neurological recovery with corticosteroid therapy, blood pressure control, and supportive management. This case underscores the importance of early MRI in detecting PRES when clinical or CT findings are inconclusive, emphasizing the need for heightened awareness among pediatric clinicians to prevent irreversible neurological sequelae.

Background: Tuberculosis infections are endemic diseases in Asian countries. Although the incidence is rare, tuberculous spondylitis manifests as a severe and life-threatening disease. This study aims to correlate the abnormal result of erythrocyte sedimentation rate (ESR) and magnetic resonance (MR) imaging findings. Subjects and Method: MR imaging of 60 patients with characteristics of spinal tuberculosis in 4-year 5 month period (January 2019 – May 2023) from Siloam Lippo Village is retrospectively analyzed and reviewed. Data were collected from Infinitt PACS and analyzed by SPSS. Dependent variables in this study are clinical suspicion for tuberculosis infection, erythrocyte sedimentation rate (ESR), and tuberculosis infection in different organs. Meanwhile, the independent variables in this study are multilevel vertebral involvement, multilevel disc involvement, abscess formation, and myelopathy. Results: Association with elevated ESR (erytrocyte sedymentation rate) are seen in 11 out of 31 patients aged >40 (OR=0.45; CI 95%= 0.16 to 1.26; p=0.120), 19 out of 37 patients with clinically suspected for tuberculosis infection (OR=1.98; CI 95% 0.68 to 5.78; p=0.210); 27 out of 55 patients with multilevel vertebral body involvement (OR=0.8; CI 95%= 0.12 to 5.17); p=1); 13 out of 30 patients with intervertebral disc involvement (OR=0.87; CI 95% 0.32 –to2.42); p=0.8); 20 out of 50 patients with abscess formation(OR=0.29; CI 95%=0.66 to 1.24; p=0.08); 5 out of 12 patients with tuberculosis infection on other organs(OR=0.84; CI 95%=0.24 – 3.04; p=0.8); and 5 out of 6 patients with myelopathy(OR=7.3; CI95%=0.79 TO 66.6; p=0.04). Conclusion: MR has an important role in detecting extrapulmonary tuberculosis lesions, especially in the spine. Elevated ESR results play important roles for physicians in identifying patients with the possibility of spondylitis TB.

BackgroundBrain metastases (BMs) most frequently originate from primary tumors of the lung and breast, and significantly impact cancer patient prognosis. Metastases can be detected synchronously along with the primary tumor or metachronously, following treatment of localized disease. The objective of this study was to identify key prognostic factors influencing survival in synchronous metastases (SM) and metachronous metastases (MM), focusing on metastatic duration, tumor volume response, and gamma knife radiosurgery. MethodsA retrospective cohort study was conducted involving 100 patients with brain metastases (48 synchronous, 52 metachronous). Age, gender, primary tumor, gamma knife status, metastasis location, peritumoral index group, volume reduction, metastatic duration, metastasis characteristics, and intensity pattern based on MRI. A Cox proportional hazards regression was used to analyze the data. Based on the Cox regression coefficients, a prognostic index was constructed. ResultsCalculated HR comprised MM (HR=0.49;95% CI :0.24–0.97], gamma knife treatment (HR = 0.15;95% CI: 0.07–0.29], and volume response (HR=0.40;95% CI: 0.16–0.99), all indicating a significantly reduced mortality risk. A prognostic index was calculated for all patients; those with scores ≤–1.513 were classified as low risk. Kaplan-Meier analysis showed that the low-risk group had a significantly longer mean survival period (75.52 months) compared to the high-risk group (31.43 months) (p<0.001). ConclusionMetachronous presentation, gamma knife therapy, and greater tumor volume reduction independently predict better survival. The developed prognostic index provides a clinically useful tool for personalized risk assessment and treatment planning in patients with brain metastases.