What to Do for Atypia of Uncertain Significance in Pediatric Thyroid Nodules? - Journal of Clinical Research in Pediatric Endocrinology

Background/Objectives: While ancillary tests for brain death diagnosis are not routinely recommended in guidelines, they may be necessary in specific clinical scenarios. Computed tomography angiography (CTA) is particularly advantageous in pediatric patients due to its noninvasive nature, accessibility, and rapid provision of anatomical information. This study aims to assess the diagnostic sensitivity of a revised venous system (ICV-SPV) utilizing a 4-point scoring system in children clinically diagnosed with brain death. Materials and Methods: A total of 43 pediatric patients clinically diagnosed with brain death who underwent CTA were retrospectively analyzed. Imaging was performed using a standardized brain death protocol. Three distinct 4-point scoring systems (A20-V60, A60-V60, ICV-SPV) were utilized to assess vessel opacification in different imaging phases. To evaluate age-dependent sensitivity, patients were categorized into three age groups: 26 days–1 year, 2–6 years, and 6–18 years. The sensitivity of each 4-point scoring system in diagnosing brain death was calculated for all age groups. Results: The revised venous scoring system (ICV-SPV) demonstrated the highest overall sensitivity in confirming brain death across all age groups, significantly outperforming the reference 4-point scoring systems. Furthermore, the ICV-SPV system exhibited the greatest sensitivity in patients with cranial defects. Conclusions: The revised 4-point venous CTA scoring system, which relies on the absence of ICV and SPV opacification, is a reliable tool for confirming cerebral circulatory arrest in pediatric patients with clinical brain death.

Introduction: The accurate differentiation of fat-poor and atypical adrenal adenomas from metastases remains a diagnostic challenge. This study aimed to evaluate the predictive value of MRI-based radiomic, radiologic, and combined radiomic-radiologic machine learning (ML) models. Methods: This single-center retrospective study included 37 patients with 44 adrenal masses (19 adenomas; 25 metastases). Data were split into training and testing sets (2:1). To expand the training set, data augmentation was performed by multiple sampling (56 labeled slices from 30 masses). Radiomic features were extracted from T2-weighted (T2W), in-phase, out-of-phase, and apparent diffusion coefficient (ADC) sequences, while mass size, T2W signal intensity, heterogeneity, and signal drop were assessed as radiologic features. Dimension reduction was performed by reliability analysis and wrapper-based feature selection with five algorithms. A support vector machine was used for classification, and performance was assessed using 10-fold cross-validation and unseen testing. Friedman test and post-hoc analyses compared bootstrapped unseen test AUCs. Results: Only 12% of radiomic features demonstrated excellent reproducibility. A significant difference was observed among the three models, χ2(2)=779.5, p<0.001. The combined radiomic-radiologic model achieved the best performance (AUC 0.939; accuracy 85.7%), outperforming radiomic-only (AUC 0.898; accuracy 85.7%) and radiologic-only (AUC 0.857; accuracy 78.5%) models (adjusted p<0.001). Discussion: Integrating radiomic and radiologic features improved classification performance compared to using either feature set alone. Although the reproducibility of radiomic features was limited, their complementary value enhanced model robustness. Conclusion: A combined radiomic-radiologic ML model based on multi-sequence MRI may serve as a promising non-invasive tool for differentiating atypical adrenal adenomas from metastases.

Introduction and Objective: The aim of this study was to evaluate the coronary arteries in patients undergoing thoracic CT angiography for congenital heart disease, to determine the frequency of detection of coronary artery anomalies in congenital heart diseases, and to determine which type of anomaly is more common in which disease. Materials and Methods: In our investigation, a 128-detector multidetector computed tomography machine was used to perform thorax CT angiography. The acquisition parameters were set to 80–100 kVp based on the patient’s age and mAs that the device automatically determined based on the patient’s weight. During the examination, an intravenous (IV) nonionic contrast material dose of 1–1.5 mL/kg was employed. An automated injector was used to inject contrast material at a rate of 1.5–2 mL/s. In the axial plane, 2.5 mm sections were extracted, and they were rebuilt with 0.625 mm section thickness. Results: Between October 2022 and May 2024, 132 patients who were diagnosed with congenital heart disease by echocardiography and underwent Thorax CT angiography in our department were retrospectively evaluated. Of the evaluated patients, 32 were excluded with exclusion criteria such as patients being younger than 3 months, older than 18 years, insufficient contrast enhancement in imaging and contrast-enhanced imaging, thin vascular structure, and motion and contrast artifacts; the remaining 100 patients were included in this study. The age range of these patients was 3 months to 18 years (mean age 4.4 years). Conclusion: In congenital heart diseases, attention to the coronary arteries on thoracic CT angiography examination in the presence of possible coronary anomalies may provide useful information.

Aims: Pediatric non-traumatic intracranial hemorrhage (pNTIH) is an important cause of acute neurological morbidity with an etiological spectrum distinct from that of adults. This study aimed to evaluate the imaging findings, etiological distribution, and age-related characteristics of pNTIH in children.Methods: This retrospective, single-center study included 56 pediatric patients aged 0-18 years who were diagnosed with pNTIH between September 2022 and January 2026. Radiological evaluation included computed tomography (CT), magnetic resonance imaging (MRI), and advanced vascular imaging modalities, including CT angiography (CTA), MR angiography (MRA), and digital subtraction angiography (DSA). Etiologies were determined using a combination of clinical, laboratory, and imaging findings.Results: Arteriovenous malformation (AVM) was the most common etiology (23.2%), followed by cerebral aneurysm (14.3%) and venous ischemia-related hemorrhage (12.5%). AVM, venous ischemia, and cavernoma-related hemorrhages were more common in older children, whereas treatment related hemorrhage was more frequent in infants. Increasing age was associated with a higher likelihood of AVM-related hemorrhage (OR=1.14; 95% CI, 1.01-1.29; p=0.032). CTA was performed in 71.4% of patients, MRA in 53.6%, and DSA in 26.8%. Early mortality occurred in 3 patients (5.4%).Conclusion: Non-traumatic intracranial hemorrhage in children demonstrates age-dependent etiological variation. Early multimodality imaging is essential for accurate etiological diagnosis and timely management.