Afsaneh Amirabadi

Although effects of deafness on the brain have been reported, little is known about the differential impact of genetic versus acquired etiologies. Our purpose was to assess cortical volumetric differences and hemispheric asymmetry in children with gap junction protein beta-2 (GJB2)- and congenital cytomegalovirus (cCMV)-related hearing loss compared with age- and sex-matched controls. In this retrospective study, 3D T1-weighted sequences of children with cCMV-related hearing loss, GJB2-related hearing loss, and normal hearing were analyzed using FreeSurfer volumetric segmentation. Cortical volumes of Heschl gyrus (HG), planum polare (PP), planum temporale (PT), lateral aspect of superior temporal gyrus (LSTG), primary visual cortex, and cuneus were assessed. We performed a linear mixed model analysis to investigate cortical volumetric differences between 1:3 case:control-matched groups, adjusting for age, sex, and field strength. The laterality index was calculated to assess hemispheric asymmetry, and a 2-tailed 1-sample t test was used to compare the distribution of values against zero. Statistical significance was determined at a threshold of P < .05. Twenty-two children with cCMV-related hearing loss, 7 children with GJB2-related hearing loss, and 87 age- and sex-matched children with normal hearing were included. Significant differences were observed between the cortical volumes in the right (P = .03), left (P = .03), and total cuneus (P = .02) between GJB2-related hearing loss and controls; HG (P = .02) and PT (P < .001) on the right; LSTG (P = .002) on the left; and the total HG (P = .02) and PT (P < .001) between cCMV-related hearing loss and controls. HG was significantly larger on the left in GJB2-related SNHL (P = .01), and the HG, PT, and LSTG were significantly larger on the left with a significantly larger right cuneus in both cCMV-related hearing loss and controls (P < .01). GJB2-related hearing loss is associated with volumetric alterations in the visual cortices, and alterations in the auditory cortical regions occur in cCMV-related hearing loss. Particular auditory areas showed significant leftward asymmetry in GJB2- and cCMV-related hearing loss and controls. In contrast, the visual areas showed significant rightward asymmetry in both CMV-related hearing loss and controls.

Background Synovial-joint abnormalities in children can be caused by different conditions, including autoimmune arthritis, infection, and neoplasm. An ultrasound-guided biopsy targeting the synovial membrane can aid in determining the etiology when the cause is unclear. Objective To determine the diagnostic performance, findings, and outcomes of ultrasound-guided joint biopsy in children. Materials and method This is a retrospective study on patients who underwent ultrasound-guided joint biopsy from May 2000 to December 2024. Patient demographics, clinical information, imaging, procedure details, pathology findings, adverse events, and clinical outcomes were collected and reviewed. Results Thirty-one patients (25 females) with a mean age of 10.2 years underwent 34 biopsies. Presenting symptoms were pain (33/34), mobility issues (33/34), and swelling (20/34). Effusion (19/28), joint capsule thickening (24/28), and contrast enhancement (20/28) were the most common MRI findings, while joint capsule thickening (29/29) and effusion (19/29) were the most frequent ultrasound findings. The most common joints biopsied were the hip (16/34), knee (9/34), and ankle (4/34). Core needle biopsy was performed in all cases. The mean number of passes was 4.5 (SD 1.8), obtaining a mean of 4.1 cores (SD 1.9). Biopsy was diagnostic in 20/34 (59% [CI 41–76%]) joints, and only one patient required surgical biopsy. Synovitis was the most common diagnosis (14/34), followed by pigmented villonodular synovitis (2/34). No major adverse events were observed. Conclusion Ultrasound-guided joint biopsy in children has moderate diagnostic performance; however, it can be clinically impactful, even when non-diagnostic, helping in joint disease management, potentially preventing surgery, with low adverse event incidence. Graphical abstract

Background: Hypometabolism of the thalamus has been reported in epilepsy patients. This study aimed to investigate the prognostic value of thalamic metabolic activity in children with epilepsy. Methods: A total of 200 children with epilepsy and 237 children without epilepsy (sex- and age-matched control group) underwent 18F-FDG PET/CT in this study. Localization of the interictal hypometabolic epileptic focus was performed visually. Bilateral thalamic metabolic activity was evaluated qualitatively (thalamic FDG uptake in relation to the cerebral cortex) and semi-quantitatively (SUV max, normalized SUV (ratio to ipsilateral cerebellum), and absolute asymmetric index (AAI). Results: A total of 133 patients (66.5%) with epilepsy showed cerebral cortical hypometabolism in the interictal 18F-FDG PET study; there were 76 patients on the right side, 55 patients on the left side, and two patients on both sides. Of these 133 patients, 45 also had visually observed asymmetric hypometabolism in the thalamus. Semi-quantitatively, asymmetry was more prominent in epileptic patients. AAI was a more sensitive variable than other variables. Average AAIs were 3.89% and 7.36% in the control and epilepsy patients, respectively. Metabolic activity in the thalami was significantly reduced in epileptic patients compared to the control group. Associated hypometabolism of the ipsilateral thalamus was observed in 66.5% of epileptic patients with a focal cortical defect semi-quantitatively. Overall, 61 out of 200 patients showed thalamus hypometabolism. Some 51 out of 61 patients (83.6%) with thalamus hypometabolism showed refractory disease; however, the refractory disease was noted in 90 out of 139 (64.7%) patients without thalamus hypometabolism. Brain surgery was performed in 86 epileptic patients (43%). Some 35 out of 86 patients had thalamus hypometabolism. Recurrence of epilepsy was observed more in patients with thalamus hypometabolism (48% vs. 25%), with p ≤ 0.01. Conclusion: This study suggests that patients with thalamus metabolic abnormalities may be more medically resistant to therapy and less responsive to surgical treatments. Therefore, the thalamus metabolic abnormality could be used as a prognostic sign in pediatric epilepsy. Recent studies have also suggested that incorporating thalamic metabolic data into clinical workflows may improve the stratification of treatment-resistant epilepsy in children.

Background Neuroangiography represents a critical diagnostic and therapeutic imaging modality whose associated radiation may be of concern in children. The availability of in vivo radiation damage markers would represent a key advancement for understanding radiation effects and aid in the development of radioprotective strategies. Objective Determine if biomarkers of cellular damage can be detected in the peripheral blood mononuclear cells (PBMC) of children undergoing neuroangiography. Materials and methods Prospective single-site study of 27 children. Blood collected pre and post neuroangiography, from which PBMC were isolated and assayed for biomarkers of mitochondrial stress (mitochondrial membrane potential (MMP), reactive oxygen species (ROS), and mitochondrial DNA (mtDNA)) and DNA damage (γH2AX). Dose response of biomarkers vs. radiation dose was analyzed using linear regressions. The cohort was divided into higher (HD) and lower dose (LD) groups and analyzed using linear mixed models and compared using Welch’s t-tests. Results No biomarker exhibited a dose-dependent response following radiation (γH2AX: R² = 0.0012, P = 0.86; MMP: R² = 0.016, P = 0.53; mtDNA: R² = 0.10, P = 0.11; ROS: R² = 0.0023, P = 0.81). Groupwise comparisons showed no significant differences in γH2AX or ROS after radiation (γH2AX: LD: 0.6 ± 6.0, P = 0.92; HD: -7.5 ± 6.3 AU, P = 0.24; ROS: LD: 1.3 ± 2.8, P = 0.64; HD: -3.6 ± 3.0 AU, P = 0.24). Significant changes were observed to mitochondrial markers MMP (-53.7 ± 14.7 AU, P = 0.0014) and mtDNA (-1.1 ± 0.4 AU, P = 0.0092) for HD, but not the LD group (MMP: 26.1 ± 14.7 AU, P = 0.090; mtDNA: 0.2 ± 0.4, P = 0.65). Conclusions Biomarkers of mitochondrial stress in PBMC were identified during pediatric neuroangiography and warrant further investigation for radiation biodosimetry. However, isolating radiation-specific effects from those of procedural stress and general anesthesia requires further investigation. Graphical Abstract

Objectives: To assess the effect of the COVID-19 pandemic on the proportion of abnormal paediatric neuroimaging findings as a surrogate marker for potential underutilisation. Methods: Consecutive paediatric brain MRIs performed between March 27th and June 19th 2019 (T_baseline) and March 23rd and June 1st 2020 (T_pandemic) were reviewed and classified according to presence or absence and type of imaging abnormality, and graded regarding severity on a 5-point Likert scale, where grade 4 was defined as abnormal finding requiring non-urgent intervention and grade 5 was defined as acute illness prompting urgent medical intervention. Non-parametric statistical testing was used to assess for significant differences between T_pandemic vs. T_baseline. Results: Fewer paediatric MRI brains were performed during T_pandemic compared to T_baseline (12.2 vs 14.7 examinations/day). No significant difference was found between the two time periods regarding sex and age (T_baseline: 557 females (44.63%), 7.95 ± 5.49 years, T_pandemic: 385 females (44.61%), 7.64 ± 6.11 years; p = 1 and p = .079, respectively). MRI brain examinations during T_pandemic had a higher likelihood of being abnormal, 41.25% vs. 25.32% ( p<.0001). Vascular abnormalities were more frequent during T_pandemic (11.01% vs 8.01%, p = .02), congenital malformations were less common (8.34% vs 12.34%, p = .004). Severity of MRI brain examinations was significantly different when comparing group 4 and group 5 individually and combined between T_baseline and T_pandemic ( p = .0018, p < .0001, and p <.0001, respectively). Conclusions: The rate of abnormality and severity found on paediatric brain MRI was significantly higher during the early phase of the pandemic, likely due to underutilisation.

Objectives: This scoping review was conducted to determine the barriers and enablers associated with the acceptance of artificial intelligence/machine learning (AI/ML)-enabled innovations into radiology practice from a physician’s perspective. Methods: A systematic search was performed using Ovid Medline and Embase. Keywords were used to generate refined queries with the inclusion of computer-aided diagnosis, artificial intelligence, and barriers and enablers. Three reviewers assessed the articles, with a fourth reviewer used for disagreements. The risk of bias was mitigated by including both quantitative and qualitative studies. Results: An electronic search from January 2000 to 2023 identified 513 studies. Twelve articles were found to fulfill the inclusion criteria: qualitative studies (n = 4), survey studies (n = 7), and randomized controlled trials (RCT) (n = 1). Among the most common barriers to AI implementation into radiology practice were radiologists’ lack of acceptance and trust in AI innovations; a lack of awareness, knowledge, and familiarity with the technology; and perceived threat to the professional autonomy of radiologists. The most important identified AI implementation enablers were high expectations of AI’s potential added value; the potential to decrease errors in diagnosis; the potential to increase efficiency when reaching a diagnosis; and the potential to improve the quality of patient care. Conclusions: This scoping review found that few studies have been designed specifically to identify barriers and enablers to the acceptance of AI in radiology practice. The majority of studies have assessed the perception of AI replacing radiologists, rather than other barriers or enablers in the adoption of AI. To comprehensively evaluate the potential advantages and disadvantages of integrating AI innovations into radiology practice, gathering more robust research evidence on stakeholder perspectives and attitudes is essential.