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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. World Health Organizaton. Pneumonia.  Available at: http://www.who.int/news-room/fact-sheets/detail/pneumonia. Review/Other-Dx N/A No abstract available. No results stated in abstract. 4
2. Wardlaw T, Salama P, Johansson EW, Mason E. Pneumonia: the leading killer of children. Lancet. 368(9541):1048-50, 2006 Sep 23. Review/Other-Dx N/A No abstract available. No results stated in abstract. 4
3. Bradley JS, Byington CL, Shah SS, et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 53(7):e25-76, 2011 Oct. Review/Other-Dx N/A To provide guidance in the care of otherwise healthy infants and children and addresses practical questions of diagnosis and management of community-acquiredpneumonia (CAP) evaluated in outpatient (offices, urgent care clinics, emergency departments) or inpatient settings in the United States. No results stated in abstract 4
4. Harris M, Clark J, Coote N, et al. British Thoracic Society guidelines for the management of community acquired pneumonia in children: update 2011. Thorax. 66 Suppl 2:ii1-23, 2011 Oct. Review/Other-Dx N/A To provide 2002 The British Thoracic Society (BTS) management guidelines for community acquired pneumonia (CAP) in children. No results stated in abstract 4
5. McIntosh K.. Community-acquired pneumonia in children. [Review] [83 refs]. N Engl J Med. 346(6):429-37, 2002 Feb 07. Review/Other-Dx N/A No abstract in article. No results stated in abstract. 4
6. le Roux DM, Zar HJ. Community-acquired pneumonia in children - a changing spectrum of disease. [Review][Erratum appears in Pediatr Radiol. 2017 Dec;47(13):1855; PMID: 29110044]. Pediatr Radiol. 47(11):1392-1398, 2017 Oct. Review/Other-Dx N/A To review the impact of recent preventative and management advances in pneumonia epidemiology, etiology, radiologic presentation and outcome in children. No results stated in abstract 4
7. Bruns AH, Oosterheert JJ, El Moussaoui R, Opmeer BC, Hoepelman AI, Prins JM. Pneumonia recovery: discrepancies in perspectives of the radiologist, physician and patient. Journal of General Internal Medicine. 25(3):203-6, 2010 Mar. Observational-Dx 119 Patients To compare the radiographic resolution of mild to moderately severe community-acquired pneumonia (CAP) to resolution of clinical symptoms as assessed by the physician or rated by the patient. Radiographic resolution, clinical cure and normalization of the CAP score were observed in 30.8%, 93% and 32% of patients at day 10, and in 68.4%, 88.9% and 41.7% at day 28, respectively. More severe CAP (PSI score >90) was independently associated with delayed radiographic resolution at day 28 (OR 4.7, 95% CI 1.3-16.9). All 12 patients with deterioration of radiographic findings during follow-up had clinical evidence of treatment failure. 2
8. American College of Radiology. ACR Appropriateness Criteria®: Fever Without Source or Unknown Origin—Child. Available at: https://acsearch.acr.org/docs/69438/Narrative/. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for fever without source or unknown origin-child. No abstract available. 4
9. Jain S, Williams DJ, Arnold SR, et al. Community-acquired pneumonia requiring hospitalization among U.S. children. N Engl J Med. 372(9):835-45, 2015 Feb 26. Review/Other-Dx 2638 children To conduct an active population-based surveillance for community-acquired pneumonia requiring hospitalization among children <18 years in three hospitals in Memphis, Nashville and Salt Lake City. From January 2010 through June 2012, we enrolled 2638 of 3803 eligible children (69%), 2358 of whom (89%) had radiographic evidence of pneumonia. The median age of the children was 2 years (interquartile range, 1 to 6); 497 of 2358 children (21%) required intensive care, and 3 (<1%) died. Among 2222 children with radiographic evidence of pneumonia and with specimens available for bacterial and viral testing, a viral or bacterial pathogen was detected in 1802 (81%), one or more viruses in 1472 (66%), bacteria in 175 (8%), and both bacterial and viral pathogens in 155 (7%). The annual incidence of pneumonia was 15.7 cases per 10,000 children (95% confidence interval [CI], 14.9 to 16.5), with the highest rate among children younger than 2 years of age (62.2 cases per 10,000 children; 95% CI, 57.6 to 67.1). Respiratory syncytial virus was more common among children younger than 5 years of age than among older children (37% vs. 8%), as were adenovirus (15% vs. 3%) and human metapneumovirus (15% vs. 8%). Mycoplasma pneumoniae was more common among children 5 years of age or older than among younger children (19% vs. 3%). 4
10. Cakir Edis E, Hatipoglu ON, Yilmam I, Eker A, Tansel O, Sut N. Hospital-acquired pneumonia developed in non-intensive care units. Respiration. 78(4):416-22, 2009. Review/Other-Dx 154 adult patients To determine the incidence rate of non-ICU HAP, the risk factors associated with mortality and the survival rates of hospital-acquired pneumonia (HAP) patients at 6 weeks and 1 year. During the study, and not counting those in the ICU, 45,679 adult patients were hospitalized. Of these, 154 patients developed HAP (incidence 3.3cases/1,000 patients). The mean age of those developing HAP was 64.53 8 14.92 years (range 15–98). Survival rates at the 3rd, 7th, 14th, 42nd and 365th day were 91, 89, 69, 49 and 29%, respectively. Independent risk factors associated with 6-week mortality were: age [relative risk (RR) 1.026; 95% confidence interval (CI) 1.008–1.045], chronic renal failure (RR 1.8; 95% CI 1.087–3.086), aspiration risk (RR 2.86; 95% CI 1.249–6.564), steroid use (RR 2.35; 95% CI 1.306–4.257), andmultilobar infiltration (RR 2.1; 95% CI 1.102–4.113). 4
11. Chang I, Schibler A. Ventilator Associated Pneumonia in Children. [Review]. Paediatr Respir Rev. 20:10-16, 2016 Sep. Review/Other-Dx N/A To explore the issues surrounding the definition of Ventilator Associated Pneumonia (VAP) including recommendations on how to address the problem and how to measure success in the reduction of VAP in your own institution using strategic guidelines. No results stated in abstract 4
12. Darby JB, Singh A, Quinonez R. Management of Complicated Pneumonia in Childhood: A Review of Recent Literature. Rev Recent Clin Trials. 12(4):253-259, 2017. Review/Other-Tx N/A To review recently published literature to inform clinician about the most up to date management of complicated pneumonia in children. Narrow spectrum antibiotics including ampicillin and azithromycin remain important first line agents, but directed therapy towards causative pathogens is the ideal standard practice. Novel DNA isolation technologies hold promise for raising the diagnostic yield of pleural fluid. Surgical interventions are often required and new literature further supports the use of fibrinolytics and minimally invasive chest tube thoracostomy. Not to be overlooked is the importance of supportive measuresincluding oxygen therapy and adequate fluid, electrolyte and nutrition support. The use of other adjunctive therapies such as steroids in pediatric complicated pneumonia remains controversial. 4
13. Andronikou S, Goussard P, Sorantin E. Computed tomography in children with community-acquired pneumonia. [Review]. Pediatric Radiology. 47(11):1431-1440, 2017 Oct.Pediatr Radiol. 47(11):1431-1440, 2017 Oct. Review/Other-Dx N/A To outline the situations where CT needs to be considered in community-acquired pneumonia, describe the imaging features of the parenchymal and pleural complications, discuss how CT may have a larger role to play in developing countries where HIV and tuberculosis are prevalent, note the role of CT scanning whenthere is a possibility of foreign body aspiration and address radiation concerns. No results stated in abstract 4
14. Byington CL, Spencer LY, Johnson TA, et al. An epidemiological investigation of a sustained high rate of pediatric parapneumonic empyema: risk factors and microbiological associations. Clin Infect Dis. 34(4):434-40, 2002 Feb 15. Observational-Dx 540 Children To examine the increasing incidence of paediatric empyema during the 1990s at Primary Children's Medical Center in Salt Lake City, Utah, USA Of 540 children hospitalized with community-acquired bacterial pneumonia (CAP) who were discharged from 1 July 1993 through 1 July 1999, 153 (28.3%) had empyema. The annual population incidence of empyema increased during the study period from 1 to 5 cases per 100 000 population aged <19 years. Streptococcus pneumoniae was identified as the most common cause of CAP with or without empyema; serotype 1 accounted for 50% of the cases of pneumococcal empyema. Patients with empyema were more likely to be >3 years old, to have =7 days of fever, to have varicella, and to have received antibiotics and ibuprofen before admission to the hospital, compared with patients without empyema (P<0.0001 for each factor). The increasing incidence of empyema was associated with infection due to S. pneumoniae serotype 1, outpatient treatment with certain antibiotics, ibuprofen use, and varicella. 2
15. Dorman RM, Vali K, Rothstein DH. Trends in treatment of infectious parapneumonic effusions in U.S. children's hospitals, 2004-2014. J Pediatr Surg. 51(6):885-90, 2016 Jun. Observational-Dx 5569 patients To examine trends in the treatment of patients with infectious parapneumonic effusions in U.S. children's hospitals over the past decade. 5569 patientswere included in the final analysis. The proportion of patients treatedwith antibiotics alone increased from 62% to 74% from 2004 to 2014 (p < 0.001). Among patients requiring pleural space drainage, the frequency of VATS peaked in 2009 (50.8%), dropping to 36.4% in 2014 (p < 0.001),while tube thoracostomy, usually with fibrinolytics, rose from 39.0% in 2009 to 53.2% in 2014 (p < 0.001). 3
16. James CA, Braswell LE, Pezeshkmehr AH, Roberson PK, Parks JA, Moore MB. Stratifying fibrinolytic dosing in pediatric parapneumonic effusion based on ultrasound grade correlation. Pediatr Radiol. 47(1):89-95, 2017 Jan. Observational-Dx 32 patients To evaluate experience with lower fibrinolytic dose for parapneumonic effusions and to assess potential dose stratification based on a simple ultrasound grading system. Of 32 patients with parapneumonic effusion, all except one received at least some 1-mg tPA doses. Dosing was solely 1-mg tPA in 81% of subjects; 19% of subjects also received 2-mg tPA doses. Mean fibrinolytic duration was 3.1 days for grade 1 effusions compared to 5.4 days for grade 2 effusions. A second pleural procedure was required in 15.6% of children. Pleural drainage with fibrinolytic therapy was successful in 97%; only one child required surgical drainage. Grade 2 US differed significantly from grade 1 US, with grade 2 occurring in younger patients (P< 0.0001), smaller patients (P < 0.0001), those needing a second procedure (P= 0.001), those with positive pleural culture or polymerase chain reaction test (P= 0.006), and those with longer treatment duration (P=0.03). 3
17. Lai JY, Yang W, Ming YC. Surgical Management of Complicated Necrotizing Pneumonia in Children. Pediatr neonatol. 58(4):321-327, 2017 Aug. Observational-Tx 56 patients To report the outcomes of surgery for necrotizing pneumonia (NP) in a single institution. Thirty-one cases were uncomplicated and 25 were complicated. Operative procedures included 38 decortications (31 uncomplicated and seven complicated), 14 wedge resections, and four lobectomies (complicated only). Preoperatively, patients with complicated necrotizing pneumonia had a higher incidence of pneumothorax (32% vs. 14.3%; p = 0.001), endotracheal intubation (44% vs. 9.7%; p = 0.008), and hemolytic uremic syndrome (20% vs. 3.2%; p = 0.01). These patients also had higher incidences of intraoperative transfusion (68% vs. 9.7%; p = 0.03), major postoperative complications (16% vs. 0%; p = 0.02), reoperations(16% vs. 0%; p = 0.02), and longer postoperative stay (19.8 +- 24.2 days vs. 11.2 +- 5.8 days; p = 0.03). Four complicated patients, who initially had decortications and limited resections, underwent reoperations. Compared with uncomplicated patients, those who underwent decortications and wedge resection required longer postoperative stays (23.6 +- 9.9 days, p < 0.01 and 21.1 += 30.7 days, p = 0.04, respectively), whereas patients who had lobectomy had a similar duration of recovery (9.0 +- 2.1 days, p = 0.23). All patients improved significantly at follow-up. 2
18. Redden MD, Chin TY, van Driel ML. Surgical versus non-surgical management for pleural empyema. [Review]. Cochrane Database Syst Rev. 3:CD010651, 2017 Mar 17. Review/Other-Tx 8 RCT, 391 participants To assess the effectiveness and safety of surgical versus non-surgical treatments for complicated parapneumonic effusion or pleuralempyema. There was no difference in the proportion of patients of all ages who survived empyema in relation to surgical or non-surgical treatment.However, this finding was based on limited data: one study reported one death with each treatment option, and seven studies reportedno deaths. There was no difference in rates of complications between patients treated with surgical or non-surgical options.There was limited evidence to suggest that VATS reduced length of stay in hospital compared to non-surgical treatments. 4
19. Hodina M, Hanquinet S, Cotting J, Schnyder P, Gudinchet F. Imaging of cavitary necrosis in complicated childhood pneumonia. Eur Radiol. 12(2):391-6, 2002 Feb. Review/Other-Dx 9 patients To illustrate the chest radiographs (CR) and CT imaging features and sequential findings of cavitary necrosis in complicated childhood pneumonia. Chest radiographs showed consolidations in 8 of the 9 patients. On CT examination, cavitary necrosis was localized to 1 lobe in 2 patients and 7 patients showed multilobar or bilateral areas of cavitary necrosis. In 3 patients of 9, the cavitary necrosis was initially shown on CT and visualization by CR was delayed by a time span varying from 5 to 9 days. In all patients with cavities, a mean number of five cavities were seen on antero-posterior CR, contrasting with the multiple cavities seen on CT. Parapneumonic effusions were shown by CR in 3 patients and in 5 patients by CT. Bronchopleural fistulae were demonstrated by CT alone ( n=3). No purulent pericarditis was demonstrated. The CT scan displayed persistent residual pneumatoceles of the left lower lobe in 2 patients. Computed tomography is able to define a more specific pattern of abnormalities than conventional CR in children with necrotizing pneumonia and allows an earlier diagnosis of this rapidly progressing condition. Lung necrosis and cavitation may also be associated with Aspergillus or Legionella pneumonia in the pediatric population. 4
20. Montella S, Corcione A, Santamaria F. Recurrent Pneumonia in Children: A Reasoned Diagnostic Approach and a Single Centre Experience. [Review]. Int. j. mol. sci.. 18(2), 2017 Jan 29. Review/Other-Dx N/A To discuss a reasoned diagnostic approach to recurrent pneumonia (RP) in childhood. No results stated in abstract 4
21. Brand PL, Hoving MF, de Groot EP. Evaluating the child with recurrent lower respiratory tract infections. [Review]. Paediatr Respir Rev. 13(3):135-8, 2012 Sep. Review/Other-Dx N/A To discuss the approach to diagnosis and management of children presenting with recurrent lower respiratory tract infections from a clinician’spoint of view. No results stated in abstract 4
22. American College of Radiology. ACR–NASCI–SIR–SPR Practice Parameter for the Performance and Interpretation of Body Computed Tomography Angiography (CTA). Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/body-cta.pdf. Review/Other-Dx N/A Guidance document to promote the safe and effective use of diagnostic and therapeutic radiology by describing specific training, skills and techniques. No abstract available. 4
23. Cao AM, Choy JP, Mohanakrishnan LN, Bain RF, van Driel ML. Chest radiographs for acute lower respiratory tract infections. [Review]. Cochrane Database Syst Rev. (12)CD009119, 2013 Dec 26. Review/Other-Tx 2024 patients, 2 RCTs To assess the effectiveness of chest radiographs in addition to clinical judgement, compared to clinical judgement alone, in themanagement of acute LRTIs in children and adults. Two RCTs involving 2024 patients (1502 adults and 522 children) were included in this review. Both RCTs excluded patients with suspected severe disease. It was not possible to pool the results due to incomplete data. Both included trials concluded that the use of chest radiographs did not result in a better clinical outcome (duration of illness and of symptoms) for patients with acute LRTIs. In the study involving children in South Africa, the median time to recovery was seven days (95% confidence interval (CI) six to eight days (radiograph group) and six to nine days (control group)), P value = 0.50, log-rank test) and the hazard ratio for recovery was 1.08 (95% CI 0.85 to 1.34). In the study with adult participants in the USA, the average duration of illness was 16.9 days versus 17.0 days (P value > 0.05) in the radiograph and no radiograph groups respectively. This result was not statistically significant and there were no significant differences in patient outcomes between the groups with or without chest radiograph. 4
24. Andronikou S, Lambert E, Halton J, et al. Guidelines for the use of chest radiographs in community-acquired pneumonia in children and adolescents. [Review]. Pediatr Radiol. 47(11):1405-1411, 2017 Oct. Review/Other-Dx N/A To discuss current perspectives on paediatric chest radiograph referral practice and radiographic findings in children with suspected community-acquiredpneumonia in different clinical settings. No results stated in abstract 4
25. Pereda MA, Chavez MA, Hooper-Miele CC, et al. Lung ultrasound for the diagnosis of pneumonia in children: a meta-analysis. [Review]. Pediatrics. 135(4):714-22, 2015 Apr. Meta-analysis 8 studies To summarize evidence on the diagnostic accuracy of lung ultrasound (LUS) for childhood pneumonia. Five studies (63%) reported using highly skilled sonographers. Overall methodologic quality was high, but heterogeneity was observed across studies. LUS had a sensitivity of 96% (95% confidence interval [CI]: 94%–97%) and specificity of 93% (95% CI: 90%–96%), and positive and negative likelihood ratios were 15.3 (95% CI: 6.6–35.3) and 0.06 (95% CI: 0.03–0.11), respectively. The area under the receiver operating characteristic curve was 0.98. Limitations included the following: most studies included in our analysis had a low number of patients, and the number of eligible studies was also small. Good
26. Stadler JAM, Andronikou S, Zar HJ. Lung ultrasound for the diagnosis of community-acquired pneumonia in children. [Review]. Pediatr Radiol. 47(11):1412-1419, 2017 Oct. Review/Other-Dx N/A To give an overview of the equipment and techniques used to perform lung Ultrasound (US) in children with suspected pneumonia and the interpretation of relevant sonographic findings No results stated in abstract 4
27. Xin H, Li J, Hu HY. Is Lung Ultrasound Useful for Diagnosing Pneumonia in Children?: A Meta-Analysis and Systematic Review. Ultrasound Quarterly. 34(1):3-10, 2018 Mar. Meta-analysis 51 articles To summarize the diagnostic usefulness of Lung ultrasonography (LUS) for childhood pneumonia Our search identified 1038 articles, and we selected 51 of these for detailed review. Eight studies containing 1013 patients met all the inclusion criteria and were included in the final meta-analysis. The pooled sensitivity and specificity for the diagnosis of pneumonia using LUS were 93.0% (95% confidence interval, 88.0%–96.0%) and 96.0% (95% confidence interval, 92.0%–98.0%), respectively. The pooled positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 25.8 (11.0, 60.4), 0.07 (0.05, 0.12), and 344 (104, 1140), respectively. In addition, the summary receiver operating characteristic area under the curve was calculated to be 0.98 (0.97, 0.99). A Fagan plot analysis demonstrated that when pretest probabilities were 25%, 50%, and 75%, the positive posttest probabilities were 90%, 96%, and 99%, respectively, and the negative posttest probabilities were 2%, 7%, and 18%, respectively. Four clinical signs were most frequentlyobserved using LUS in the screening of children with pneumonia: pulmonary consolidation, positive air bronchogram, abnormal pleural line, and pleural effusion. Good
28. Zhan C, Grundtvig N, Klug BH. Performance of Bedside Lung Ultrasound by a Pediatric Resident: A Useful Diagnostic Tool in Children With Suspected Pneumonia. Pediatric Emergency Care. 2016 Oct 04. Observational-Dx 82 children To investigate how beside lung ultrasound performed by a pediatric resident compared with chest radiography in children with suspected pneumonia. A total of 82 children underwent both chest radiography and lung ultrasound (57% boys; median [interquartile range] age, 1.5 [1.1-2.5] years). The lung ultrasound took 7 to 20 minutes to perform, and 10% were of suboptimal quality due to an uneasy child. The prevalence of consolidations by chest radiography was 50%. Lung ultrasound had a sensitivity of 40% (95% confidence interval [CI], 30%-51%), specificity of 91% (95% CI, 83%-96%), positive likelihood ratio of 4.71 (95% CI, 2.21-10.04), and negative likelihood ratio of 0.65 (95% CI, 0.54-0.79). 3
29. Jones BP, Tay ET, Elikashvili I, et al. Feasibility and Safety of Substituting Lung Ultrasonography for Chest Radiography When Diagnosing Pneumonia in Children: A Randomized Controlled Trial. Chest. 150(1):131-8, 2016 Jul. Observational-Tx 191 patients To determine the feasibility and safety of substituting Lung ultrasonography (LUS) for Chest radiography (CXR) when evaluating children suspected of having pneumonia. There was a 38.8% reduction (95% CI, 30.0%-48.9%) in CXR among investigational subjects compared with no reduction (95% CI, 0.0%-3.6%) in the control group. Novice and experienced physician-sonologists achieved 30.0% and 60.6% reduction in CXR use, respectively. There were no cases of missed pneumonia among all study participants (investigational arm, 0.0%: 95% CI, 0.0%-2.9%; control arm, 0.0%: 95% CI, 0.0%-3.0%), or differences in adverse events, or subsequent unscheduled health-care visits between arms. 1
30. Soudack M, Plotkin S, Ben-Shlush A, et al. The Added Value of the Lateral Chest Radiograph for Diagnosing Community Acquired Pneumonia in the Pediatric Emergency Department. Isr Med Assoc J 2018;20:5-8. Observational-Dx 451 children To determine the value of the frontal and lateral chest radiographs compared to frontal view stand-alone images for the management of children with suspected community acquired pneumonia seen in a pediatric emergency department. Findings consistent with bacterial pneumonia were diagnosed in 94 (20.8%) of the frontal stand-alone radiographs and in 109 (24.2%) of the combined frontal and lateral radiographs. The sensitivity, specificity, positive predictive value, and negative predictive value of the frontal radiograph alone were 86.2%, 93.9%, 81.7%, and 95.5%, respectively. False positive and false negative rates were 15% and 21%, respectively, for the frontal view alone. The number of lateral radiographs needed to diagnose one community acquired pneumonia was 29. 3
31. Islam S, Calkins CM, Goldin AB, et al. The diagnosis and management of empyema in children: a comprehensive review from the APSA Outcomes and Clinical Trials Committee. [Review]. J Pediatr Surg. 47(11):2101-10, 2012 Nov. Review/Other-Dx N/A To review the current evidence on the diagnosis and management of empyema. No results stated in abstract 4
32. King S, Thomson A. Radiological perspectives in empyema. [Review] [35 refs]. Br Med Bull. 61:203-14, 2002. Review/Other-Dx N/A To summarize the imaging investigations in children with empyema, provide an overview of the risks and benefits of these techniques, and discuss the appearances of empyema on imaging studies. No results stated in abstract. 4
33. Lichtenstein D, Goldstein I, Mourgeon E, Cluzel P, Grenier P, Rouby JJ. Comparative diagnostic performances of auscultation, chest radiography, and lung ultrasonography in acute respiratory distress syndrome. Anesthesiology. 100(1):9-15, 2004 Jan. Observational-Dx 32 patients To assess whether lung ultrasonography could be an alternative to bedside chest radiography for assessing the presence and extent of alveolar consolidation, alveolar–interstitial syndrome, and pleural effusion in ventilated patients with acute respiratory distress syndrome (ARDS). Auscultation had a diagnostic accuracy of 61% for pleural effusion, 36% for alveolar consolidation, and 55% for alveolar–interstitial syndrome. Bedside chest radiography had a diagnostic accuracy of 47% for pleural effusion, 75% for alveolar consolidation, and 72% for alveolar–interstitial syndrome. Lung ultrasonography had a diagnostic accuracy of 93% for pleural effusion, 97% for alveolar consolidation, and 95% for alveolar–interstitial syndrome. Lung ultrasonography, in contrast to auscultation and chest radiography, could quantify the extent of lung injury. Interobserver agreement for the ultrasound findings as assessed by the ? statistic was satisfactory: 0.74, 0.77, and 0.73 for detection of alveolar–interstitial syndrome, alveolar consolidation, and pleural effusion, respectively. 2
34. Calder A, Owens CM. Imaging of parapneumonic pleural effusions and empyema in children. [Review] [28 refs]. Pediatr Radiol. 39(6):527-37, 2009 Jun. Review/Other-Dx N/A To review the pathophysiology, treatment options and imaging findings of complicated parapneumonic effusion and empyema in children. No results stated in abstract. 4
35. Donnelly LF, Klosterman LA. The yield of CT of children who have complicated pneumonia and noncontributory chest radiography. AJR Am J Roentgenol. 170(6):1627-31, 1998 Jun. Observational-Dx 56 CT scans and radiographs To investigate the usefulness of CT in evaluating children who donot respond appropriately to treatment for pneumonia, when chest radiography is noncontributory. One hundred ten CT findings, not revealed by radiography, were seen on 56 CTscans (2.0 per CT scan): parenchymal complications (n = 40), pleural complications (n = 37), inaccurateestimation of cause of chest opacity on radiography (n = 20), pericardial effusion (n =13). All CT scans showed at least one significant finding (100% yield) not seen on radiography. 4
36. Pinotti KF, Ribeiro SM, Cataneo AJ. Thorax ultrasound in the management of pediatric pneumonias complicated with empyema. Pediatr Surg Int. 22(10):775-8, 2006 Oct. Observational-Dx 52 children To prospectively study the value of thoracic ultrasound (US) before pleural drainage in children with parapneumonic effusion (PPE). From August 2001 to July 2003, 52 children were examined. US was performed on 48 of these children, of whom 35 received chest tube drainageand 13 only received clinical treatment. US identified 38 patients with free flowing and 10 with loculated pleural fluid. About 25 of the free flowing(65.8%) and 10 (100%) of the loculated patients received chest tube drainage. Echogenicity was anechoic in 13, echoic without septations in 17 and echoicwith septations in 18. Chest tube drainage was required in 6 anechoic (46.15%), 14 echoic without septations (82.35%), and 15 echoic with septations (83.33%).Quantity of fluid estimated by US varied from 20 to 860 ml. Effusion volume was higher in patients that were echoic with septations and loculated effusions.Pleural glucose and pH were lower, and LDH was higher in loculated PPE patients. 2
37. Donnelly LF, Klosterman LA. CT appearance of parapneumonic effusions in children: findings are not specific for empyema. AJR Am J Roentgenol. 169(1):179-82, 1997 Jul. Observational-Dx 30 patients (14 boys, 16 girls) To compare the CT findings of paraneumonic effusions with the results of thoracentesis, thoracscopy, or both to determine whether these CT findings can reliably differentiate empyemas from transudative paraneumonic effusions in children. Thirty patients were identified as having a paraneumonic pleural effusion revealed on contrast-enhanced CT scans and by pleural fluid analysis. Twenty-one of these parapneumonic effusions met the clinical criteria for empyema, and nine were considered not to be empyemas. Neither any individual CT finding nor the CT score accurately differentiated empyema from transudative paraneumonic effusions (p> .1): pleural enhancement (empyema 100%, transudative effusion 89%), pleural thickening (empyema 57%, transudative effusion 56%), abnormal extrapleural space (empyema 66%, transudative effusion 67%), extracostal chest wall edema (empyema 33%, transudative effusion 56%), and average CT score (empyema 2.5, transudative effusion 2.3). 3
38. Chen IC, Lin MY, Liu YC, et al. The role of transthoracic ultrasonography in predicting the outcome of community-acquired pneumonia in hospitalized children. PLoS ONE. 12(3):e0173343, 2017. Observational-Dx 142 patients To assess the association between transthoracic ultrasound (TUS) findings and clinical outcome in children with community-acquired pneumonia (CAP). The study enrolled 142 patients (median age, 60 months): 28 (19.7%) required ICU admission, 14 (9.89%) underwent tube thoracotomy, and 26 (18.3%) had a hospital stay > 9 days. Multifocal involvement seen by TUS were independently associated with ICU admission, a prolonged hospital stay, and tube thoracotomy (p = 0.0027, p = 0.02, and p = 0.0262, respectively). A pleural effusion and fluid bronchogram were independent predictors of a longer hospital stay (p = 0.003 and p = 0.006, respectively). In addition, a fluid bronchogram was an independent predictor of tube thoracotomy (p = 0.0262). 3
39. Kurian J, Levin TL, Han BK, Taragin BH, Weinstein S. Comparison of ultrasound and CT in the evaluation of pneumonia complicated by parapneumonic effusion in children. AJR Am J Roentgenol. 193(6):1648-54, 2009 Dec. Observational-Dx 19 children To compare chest ultrasound and chest CT in children with complicated pneumonia and parapneumonic effusion. Eighteen of 19 patients had an effusion on both chest ultrasound and chest CT. The findings of effusion loculation as well as parenchymal consolidation and necrosis or abscess were similar between the two techniques. Chest ultrasound was better able to visualize fibrin strands within the effusions. Of the 14 patients who underwent video-assisted thoracoscopy, five had surgically proven parenchymal abscess or necrosis. Preoperatively, chest ultrasound was able to show parenchymal abscess or necrosis in four patients, whereas chest CT was able to show parenchymal abscess or necrosis in three. 3
40. Gorkem SB, Coskun A, Yikilmaz A, Zurakowski D, Mulkern RV, Lee EY. Evaluation of pediatric thoracic disorders: comparison of unenhanced fast-imaging-sequence 1.5-T MRI and contrast-enhanced MDCT. AJR Am J Roentgenol. 200(6):1352-7, 2013 Jun. Observational-Dx 71 pediatric patients To investigate the efficacy of thoracic MRI with fast imaging sequences without contrast administration at 1.5 T for evaluating thoracic abnormalities by comparing MRI findings with contrast-enhanced MDCT findings. With MDCT as the reference standard, 51 of 71 (72%) patients had abnormal findings on MDCT studies, including infections in 21 (42%) cases, neoplasms in 19 (37%) cases, interstitial lung disease in seven (14%) cases, pleural effusion in three (6%) cases, and congenital bronchogenic cyst in one (2%) case. The overall diagnostic accuracy, sensitivity, and specificity of MRI for detecting thoracic abnormalities were 69 of 71 (97%), 49 of 51 (96%), and 20 of 20 (100%). Two undiagnosed findings with MRI that were detected with MDCT were mild bronchiectasis and small pulmonary nodule (3 mm). Almost perfect interobserver agreement was found between two reviewers with 70 of 71 agreements (? = 0.97; 95% CI, 0.92–1.00; p < 0.001). 2
41. Liszewski MC, Gorkem S, Sodhi KS, Lee EY. Lung magnetic resonance imaging for pneumonia in children. [Review]. Pediatr Radiol. 47(11):1420-1430, 2017 Oct. Review/Other-Dx N/A To provide up-to-date MR imaging techniques that can be implemented in most radiology departments to evaluate pneumonia in children. No results stated in abstract 4
42. Sodhi KS, Khandelwal N, Saxena AK, et al. Rapid lung MRI in children with pulmonary infections: Time to change our diagnostic algorithms. Journal of Magnetic Resonance Imaging. 43(5):1196-206, 2016 May. Experimental-Dx 75 patients To determine the diagnostic utility of a new rapid MRI protocol, as compared with computed tomography (CT) for the detection of various pulmonary and mediastinal abnormalities in children with suspected pulmonary infections. MRI with a new rapid MRI protocol demonstrated sensitivity, specificity, PPV, and NPV of 100% for detecting pulmonary consolidation, nodules (>3 mm), cyst/cavity, hyperinflation, pleural effusion, and lymph nodes. The kappa-test showed almost perfect agreement between MRI and multidetector CT (MDCT) in detecting thoracic abnormalities (k = 0.9). No statistically significant difference was observed between MRI and MDCT for detecting thoracic abnormalities by the McNemar test (P = 0.125). 2
43. Yikilmaz A, Koc A, Coskun A, Ozturk MK, Mulkern RV, Lee EY. Evaluation of pneumonia in children: comparison of MRI with fast imaging sequences at 1.5T with chest radiographs. Acta Radiol. 2011;52(8):914-919. Observational-Dx 40 patients To investigate the efficacy of chest MRI with fast imaging sequences at 1.5T for evaluating pneumonia in children by comparing MRI findings with those of chest radiographs. All consolidation, lung necrosis/abscess, bronchiectasis, and pleural effusion detected with chest radiographs were also detected with MRI. There was statistically substantial agreement between chest radiographs and MRI in detecting consolidation (k = 0.78) and bronchiectasis (k = 0.72) in children with pneumonia. The agreement between chest radiographs and MRI was moderate for detecting necrosis/abscess (k = 0.49) and fair for detecting pleural effusion (k = 0.30). 3
44. Peltola V, Ruuskanen O, Svedstrom E. Magnetic resonance imaging of lung infections in children. Pediatr Radiol. 2008;38(11):1225-1231. Review/Other-Dx N/A To illustrate MRI findings in children with pneumonia caused by Mycoplasma pneumoniae, Streptococcus pneumoniae, and other pathogens. No results stated in abstract. 4
45. Seo H, Kim TJ, Jin KN, Lee KW. Multi-detector row computed tomographic evaluation of bronchopleural fistula: correlation with clinical, bronchoscopic, and surgical findings. J Comput Assist Tomogr. 34(1):13-8, 2010 Jan. Review/Other-Dx 24 patients To evaluate the usefulness of multi-detector row computed tomography (CT) in the diagnosis of bronchopleural fistula (BPF) and to correlate CT features with clinical, bronchoscopic, and surgical findings. Computed tomography demonstrated fistulous tract (central type, 3; peripheral type, 11) or indirect signs of BPF (central type, 3; peripheral type, 6), whereas bronchoscopy demonstrated 2 fistula openings (all central type) and indirect signs of BPF (central type, 2; peripheral type, 1). 4
46. Ramgopal S, Ivan Y, Medsinge A, Saladino RA. Pediatric Necrotizing Pneumonia: A Case Report and Review of the Literature. [Review]. Pediatr Emerg Care. 33(2):112-115, 2017 Feb. Review/Other-Dx 1 case report To review the literature and describe the clinical presentation, diagnosis, microbiological etiology, and management of necrotizing pneumonia in children. No results stated in abstract 4
47. Lai SH, Wong KS, Liao SL. Value of Lung Ultrasonography in the Diagnosis and Outcome Prediction of Pediatric Community-Acquired Pneumonia with Necrotizing Change. PLoS ONE. 10(6):e0130082, 2015. Observational-Dx 236 children To investigate the value of lung ultrasonography in diagnosing pediatric necrotizing pneumonia and its role in predicting clinical outcomes. Our results showed a high correlation between the degree of impaired perfusion in ultrasonography and the severity of necrosis in computed tomography (r = 0.704). The degree of impaired perfusion can favorably be used to predict massive necrosis in computed tomography (area under the receiver operating characteristic curve, 0.908). The characteristics of impaired perfusion and hypoechoic lesions in ultrasonography were associated with an increasedrisk of pneumatocele formation (odds ratio (OR), 10.11; 95% CI, 2.95–34.64) and the subsequent requirement for surgical lung resection (OR, 8.28; 95% CI, 1.86–36.93). Furthermore, a longer hospital stay would be expected if moderate-to-massive pleural effusion was observed in addition to impaired perfusion in ultrasonography (OR, 3.08; 95% CI, 1.15–8.29). 2
48. Nair A, Godoy MC, Holden EL, et al. Multidetector CT and postprocessing in planning and assisting in minimally invasive bronchoscopic airway interventions. [Review]. Radiographics. 32(5):E201-32, 2012 Sep-Oct. Review/Other-Dx N/A To review existing and novel bronchoscopic techniques and highlight pertinent multidetector CT and postprocessing techniques that enhance the evaluation, planning, and monitoring of such procedures for various tracheobronchial, peripheral airway, and parenchymal conditions. No results stated in the abstract. 4
49. Chen HJ, Yu YH, Tu CY, et al. Ultrasound in peripheral pulmonary air-fluid lesions. Color Doppler imaging as an aid in differentiating empyema and abscess. Chest. 135(6):1426-1432, 2009 Jun. Observational-Dx 34 patients To reevaluate the clinical significance of sonographic appearances, in particular the application of color Doppler ultrasound imaging, in discriminating peripheral air-fluid lung abscess from empyema. Among the sonographic characteristics, complex-septated effusions and passive atelectasis were specific for empyema, but the sensitivity was only 40% (n =12 of 30) and 47% (n =14 of 30), respectively. The identification of color Doppler ultrasound vessel signals in pericavitary consolidation was the most useful and specific for identifying lung abscesses. In our series, if we define the identification of color Doppler ultrasound vessel signals in a pericavitary consolidation as a predictorfor peripheral lung abscess, we can achieve sensitivity, specificity, positive predictive value, and negative predictive value of 94%, 100%, 100%, and 94%, respectively. 2
50. Wu HD, Yang PC, Lee LN. Differentiation of lung abscess and empyema by ultrasonography. J Formos Med Assoc. 90(8):749-54, 1991 Aug. Observational-Dx 50 patients with lung abscesses or empyema To assess the value of chest ultrasonography in the differentiation between a lung abscess and empyema, 50 patients, including 24 cases of lung abscess and 26 cases of empyema, were studied. The total scores for the four features were then assessed. Ninety-six percent of the empyema cases scored 2 or more, while 96% of the lung abscess cases scored 1 or zero. The efficacy of differential diagnosis was 96%. We conclude that chest ultrasonography is a useful tool in the differentiation between lung abscess and empyema and that ultrasonography alone is sufficient to make a correct diagnosis in most cases. 3
51. Yang PC, Luh KT, Lee YC, et al. Lung abscesses: US examination and US-guided transthoracic aspiration. Radiology. 180(1):171-5, 1991 Jul. Observational-Dx 35 patients with lung abscesses To eval­uate lung abscesses and to guide trans­thoracic aspiration. Twenty-five abscesses (71%) had local adhesion to parietal pleura (lesion-pleura symphysis). Ultrasound­ guided transthoracic needle aspira­tion of fluid from the abscess cavity was performed successfully in 31 of 33 patients (94%). A total of 65 patho­gens were isolated from 31 aspuates (41 anaerobes and 24 aerobes), not­withstanding the fact that 23 of the patients had been previously treated with antibiotics. Only two of 65 pathogens (3%) could be recovered from blood culture, seven (11 % ) from sputum culture, and two from bron­choalveolar lavage (3%). Two pa­tients developed minimal pneumo­thorax. 4
52. Tonson la Tour A, Spadola L, Sayegh Y, et al. Chest CT in bronchopulmonary dysplasia: clinical and radiological correlations. Pediatric Pulmonology. 48(7):693-8, 2013 Jul. Observational-Dx 19 infants To investigate whether there is a correlation between radiological pulmonary lesions and relevant BPD clinical data (gestational age, type and duration of mechanical ventilation, and severity of BPD) and assess the usefulness of a CT score in evaluating clinical severity. All CT scans showed abnormalities. The most frequent lesion was bronchial wall thickening observed in all patients, followed by linear (89.5%) and subpleural (89.5%) opacities. Areas of decreased attenuation were found in 68.4%. Bullae/emphysema and bronchiectasis were the less frequent item described (26.3% and 21.1%, respectively). The presence of areas of decreased attenuation significantly correlated with BPD severity (P = 0.03). However, there was no significantcorrelation between the CT score and clinical data. 2
53. Montella S, Maglione M, Bruzzese D, et al. Magnetic resonance imaging is an accurate and reliable method to evaluate non-cystic fibrosis paediatric lung disease. Respirology. 17(1):87-91, 2012 Jan. Observational-Dx 50 subjects To assess the accuracy and reliability of MRI compared with high-resolution computed tomography (HRCT) in children with non-cystic fibrosis (CF) chronic lung disease. Bronchiectasis, mucous plugging, peribronchial wall thickening, consolidation, bullae, abscesses and emphysema were detected by HRCT in 72, 68,66, 60, 10, 8 and 8% of subjects, respectively. Sensitivity, specificity, accuracy and positive and negative likelihood ratios for MRI were good or excellent formost of the changes that were assessed. Median total Helbich scores for HRCT and MRI were 10 (range 0–20) and 10 (range 0–18), respectively. There wasgood-to-excellent agreement between the two techniques for all scores (r >= 0.8). A Bland–Altman plot confirmed this agreement between total scores (biasvalue: 0.2 +- 1.18; 95% limits of agreement of mean difference: -2.12–2.52). 2
54. Lee EY, Tracy DA, Mahmood SA, Weldon CB, Zurakowski D, Boiselle PM. Preoperative MDCT evaluation of congenital lung anomalies in children: comparison of axial, multiplanar, and 3D images. AJR. American Journal of Roentgenology. 196(5):1040-6, 2011 May. Observational-Dx 46 pediatric patients To compare the preoperative diagnostic accuracy of axial, multiplanar, and 3D MDCT images for evaluating congenital lung anomaliesin pediatric patients and to assess the potential added diagnostic value of multiplanar and 3D MDCT images in this setting. The final study cohort consisted of 46 pediatric patients (28 males and 18 females; mean age, 5.6 ± 6 [SD] months; range, 1 day–50 months). Histopathologic diagnoses included congenital pulmonary airway malformation (n = 19, 41%), sequestration (n = 15, 33%), congenital lobar emphysema (n = 7, 15%), and bronchogenic cyst (n = 5, 11%). Both independent reviewers correctly diagnosed types, location, associated mass effect, and associated anomalous arteries of all congenital lung anomalies with high accuracy (100%) and confidence level (mean confidence level < 1.2) on each type of image display (axial, multiplanar, and 3D). However, for the detection of anomalous veins, multiplanar and 3D images were associated with greater diagnostic accuracy and higher confidence level than axial images alone. Specifically, diagnostic accuracy for the detection of anomalous veins (n = 15; 33%) was 60% (9/15 cases) for axial MDCT images, 80% (12/15) for multiplanar MDCT images, and 100% (15/15) for 3D MDCT images (Friedman test, p = 0.011). Confidence levels for the detection of anomalousveins were significantly higher with 3D MDCT images (mean level = 1.0) and multiplanar MDCT images (mean level = 1.5) compared with axial MDCT images alone (mean level = 2.6) (Friedman test, p < 0.01). Both multiplanar and 3D MDCT images were found to provide added diagnostic value for accurately detecting anomalous veins associated with congenial lung anomalies (paired Student t tests, p < 0.012). 2
55. Saeed A, Kazmierski M, Khan A, McShane D, Gomez A, Aslam A. Congenital lung lesions: preoperative three-dimensional reconstructed CT scan as the definitive investigation and surgical management. European Journal of Pediatric Surgery. 23(1):53-6, 2013 Feb. Observational-Dx 38 children To review postnatal investigations and management of congenital lung lesions. A total of 38 children were identified between January 2000 and December 2011; 22 were males and 16 were females. The mean gestational age at diagnosiswas 21 weeks (range18 to 26 weeks). Five children showed complete resolution antenatally. Four children were symptomatic at birth. Postnatal CXR showed anabnormality in only 17 infants. CT scan with three-dimensional (3D) reconstructions was performed at the mean age of 7.7 months (range 1 day to 42 months). CT scan correlated well with per-operative findings and provided adequate anatomical information r = 0.98. Open thoracotomy and lobectomy/excision was performed in 23, and 15 had thoracoscopic lobectomy/excision. The mean age of operation was 18 months (range 2 days to 96 months). Twenty patients had signs of recurrent preoperative infection with pleural adhesions and hilar thickening resulting in conversion of 10 thoracoscopic cases to open surgery. Histology confirmed 26 congenital cystic adenomatoid malformations, 2 hybrid lesions, 7 sequestrations, and 3 bronchopulmonary malformations. 3
56. Griffin N, Devaraj A, Goldstraw P, Bush A, Nicholson AG, Padley S. CT and histopathological correlation of congenital cystic pulmonary lesions: a common pathogenesis?. Clinical Radiology. 63(9):995-1005, 2008 Sep. Observational-Dx 24 patients To determine whether similarities exist in both the imaging and histopathological features of congenital cystic lung lesions and whether a more appropriate classification would be to adopt the theory of ‘‘malinosculation’’. There were five type 1 congenital cystic adenomatoid malformations (CCAMs), six type 2 CCAMs, one type 4CCAM, one bronchial atresia, four pleuropulmonary blastomas (PPBs), and seven sequestrations. CCAMs(types 1, 2 and 4),sequestrations and PPBs appeared as cystic lesions, with cyst size less than 2 cm in type 2 CCAMs. Sequestrations weredistinguished radiologically from CCAMs by systemic vessels. Reduced pulmonary attenuation was seen in bronchial atresia,type 2 CCAMs and in sequestrations. Histopathology showed an overlap in entities with sequestrations demonstratingCCAMtype 2 histology and segmental atresia noted in both type 2 CCAMsand sequestrations. PPBs showed histological andimaging overlap with type 4 CCAMs and were distinguished on histology by the presence of blastematous proliferation. 2
57. Shimohira M, Hara M, Kitase M, et al. Congenital pulmonary airway malformation: CT-pathologic correlation. Journal of Thoracic Imaging. 22(2):149-53, 2007 May. Observational-Dx 13 patients To correlate computed tomography (CT) findings with those of pathologic examination and evaluated the predictability of the Congenital pulmonary airway malformation (CPAM) subtype. Eight, 3, and 2 cases were diagnosed as groups A, B, and C, respectively. All of the 8 cases diagnosed as group A wereStocker’s type 1. One of the 3 cases diagnosed as group B was type 2, but the remaining 2 were type 1 and type 4, respectively.One of the 2 cases diagnosed as group C was type 3 but the other was type 2. 3
58. Thakkar HS, Durell J, Chakraborty S, et al. Antenatally Detected Congenital Pulmonary Airway Malformations: The Oxford Experience. European Journal of Pediatric Surgery. 27(4):324-329, 2017 Aug. Review/Other-Dx 91 patients To offer surgery to mitigate the risk of infection and possible malignancy in antenatally detected congenital pulmonary airway malformations. A total of 64 (73%) patients underwent surgery with the most common lesions being congenital pulmonary airway malformations (CPAMs) (24), hybrid lesions (19), and pulmonary sequestrations (12). The median age at surgery was 5 months (1 day to 17 months). Using a minimal access approach, 41 (64%) cases were completed with 17 performed open from the onset. Open surgery was indicated in neonates who became symptomatic within the first few weeks of life as well as patients in respiratory distress that would not tolerate either single-lung ventilation or gas insufflation. There were six further conversions to open from minimal access surgery due to poor visualization or technical difficulties. One patient needed a perioperative blood transfusion and one patient had a more prolonged stay due to persistent air leak managed conservatively. Among asymptomatic patients, evidence of microscopic disease was seen, which included infection as well as two cases of tumors, one pleuropulmonary blastoma seen as part of a CPAM, and one rhabdomyomatous dysplasia seen in the CPAM component of a hybrid lesion. 4
59. Buyukoglan H, Mavili E, Tutar N, et al. Evaluation of diagnostic accuracy of computed tomography to assess the angioarchitecture of pulmonary sequestration. Tuberkuloz ve Toraks. 59(3):242-7, 2011. Observational-Dx 8 patients (6 males, 2 females) To evaluate the accuracy of multidetector computed tomography (MDCT) in demonstrating the feeding artery and draining veins. No results stated in abstract. 4
60. Long Q, Zha Y, Yang Z. Evaluation of pulmonary sequestration with multidetector computed tomography angiography in a select cohort of patients: A retrospective study. Clinics (Sao Paulo, Brazil). 71(7):392-8, 2016 Jul. Observational-Dx 43 patients To evaluate the role of multidetector computed tomography angiography in diagnosing patients with pulmonary sequestration. Multidetector computed tomography successfully detected all pulmonary sequestrations in the 43 patients (100%). This included 40 patients (93.0%) with intralobar sequestration and 3 patients (7.0%) with extralobar sequestration. The locations of pulmonary sequestration were left lower lobe (28 cases, 70% ofintralobar sequestrations), right lower lobe (12 cases, 30% of intralobar sequestrations) and costodiaphragmatic sulcus (3 cases). Cases of sequestered lung presented as mass lesions (37.2%), cystic lesions (32.6%), pneumonic lesions (16.3%), cavitary lesions (9.3%) and bronchiectasis (4.6%). The angioarchitecture of pulmonary sequestration, including feeding arteries from the thoracic aorta (86.1%), celiac truck (9.3%), abdominal aorta (2.3%) and left gastric artery (2.3%) and venous drainage into inferior pulmonary veins (86.0%) and the azygos vein system (14.0%), was visualized on multidetector computed tomography. Finally, the multidetector computed tomography angiography results of the sequestered lungs and angioarchitectures were surgically confirmed in all the patients. 2
61. Ren JZ, Zhang K, Huang GH, et al. Assessment of 64-row computed tomographic angiography for diagnosis and pretreatment planning in pulmonary sequestration. Radiologia Medica. 119(1):27-32, 2014 Jan. Observational-Dx 45 patients To evaluate the clinical implications and results of a prospective protocol using 64-row computed tomographic angiography (CTA) for diagnosis and pre-treatment planning in pulmonary sequestration (PS). Digital subtraction angiography and/or surgery revealed PS in 38 patients, and 7 patients had no PS. The patient-based evaluation yielded an accuracy of 97.8 %, sensitivity of 97.4 %, specificity of 100 %, PPV of 100 % and NPV of 87.5 %, in the detection of PS. CTA clearly depicted the PS in all 38 patients, and the aberrant systemic artery was accurately demonstrated in 37 out of 38 patients where endovascular treatment was possible. Working views for endovascular treatment were found in all patients with PS, and the choice of coil was correct in 37 out of 38 patients using CTA. 3
62. Yoon HM, Kim EA, Chung SH, et al. Extralobar pulmonary sequestration in neonates: The natural course and predictive factors associated with spontaneous regression. European Radiology. 27(6):2489-2496, 2017 Jun. Observational-Dx 51 neonates To describe the natural course of extralobar pulmonary sequestration (EPS) and identify factors associated with spontaneous regression of EPS. Fifty-one neonates were included. The cumulative proportions of patients reaching PDV>50 % and PDD>50 % were 93.0 % and 73.3 % at 4 years, respectively. Tissue attenuation was significantly associated with PDV rate (B=-21.78, P<.001). The tissue attenuation (B=-22.62, P=.001) and diameter of the largest systemic feeding arteries (B=-48.31, P=.011) were significant factors associated with PDD rate. 3
63. Yue SW, Guo H, Zhang YG, Gao JB, Ma XX, Ding PX. The clinical value of computer tomographic angiography for the diagnosis and therapeutic planning of patients with pulmonary sequestration. European Journal of Cardio-Thoracic Surgery. 43(5):946-51, 2013 May. Observational-Dx 43 patients (26 male patients 17 female patients) To evaluate the clinical value of computed tomographic (CT) angiography for diagnosis and therapeutic planning in patients with pulmonary sequestration. Digital subtraction angiography and/or surgery confirmed pulmonary sequestration in 37 patients; six patients had no pulmonary sequestration. The diagnostic performance of CT angiography for pulmonary sequestration in the patient-based evaluation yielded an accuracy of 97.7%, sensitivity of 97.3%, specificity of 100%, positive predictive value (PPV) of 100% and negative predictive value (NPV) of 85.7%. The aberrant systemic artery-based evaluation yielded an accuracy of 98.0%, sensitivity of 97.8%, specificity of 100%, PPV of 100% and NPV of 85.7%. Treatments could be correctly planned using CT angiography with 100% accuracy, sensitivity, specificity, PPV and NPV according to the aneurysm-based evaluation. 2
64. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4
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