Role of ultrasound in pediatric endocrine disorders

Dr. Elham zarei

Assistant Professor of Radiology

Aliasghar children hospital

THYROID DISEASE

PARATHYROID DISEASE

PANCREASE DISEASE

DISORDER OF PUBERTY

ADRENAL DISEASE

PRECOCIOUS PUBERTY

Out of all available imaging methods ,ultrasound due to its safety ,

availability and low cost ,seems to the best modality to assess the

breasts, internal organs of patients manifesting symptoms of precocious

puberty both in early diagnosis and follow up examination.

Technique

The pediatric uterus, vagina, and ovaries are optimally imaged when

the patient has a full bladder. All patients are therefore asked not to

void in the hour prior to undergoing imaging and are encouraged to

drink fluids

UTERUS

length

fundal and cervical thickness

transverse diameter

volume

shape

endometrial thickness

Uterine length Cutoff value

Ovary length Cutoff value

Uterine volume cutoff value

36 mm1/2 ml1/8 mlHaber et al. ( 1994 )

34 mm2 ml De Vries et al.( 2006)

30 mm 1/3 ml Binay et al. ( 2014)

Ovary

OVARIAN VOLUME

Less than 6 years of age : < 1 cc

In prepubertal girls ( 6-10 years old ) : 1.2 to 2.3 ml

Premenarchal girls ( 11-12 years old ) : 2 to 4 cc

Depending on the stage of development, the internal structure of the ovary may be classified to one of four groups :

type 1 – homogeneous – no follicles are detected;

type 2 – paucicystic – less than 6 follicles are visible with diameters not exceeding 10 mm;

type 3 – multicystic – more than 6 follicles are detected with diameters of up to 10 mm;

type 4 – macrocystic – at least one follicle is visible that is greater than or equal to 10 mm.

UTERINE ARTERY DOPPLER

A PI >4.6 at spectral Doppler US combined with a longitudinal uterine diameter <35 mm allows noninvasive exclusion of female precocious puberty with comparable accuracy and lower costs compared to examination of LH peak after GnRH stimulation.

Validation of an accurate and noninvasive tool to exclude female precocious puberty : pelvic ultrasound with uterine artery pulsatility index .Pier Luigi paesano , AJR 2019 August, Vol. 213, No. 2 : pp. 451-457

VAGINAL FOREIGN BODY

VAGINAL MASS

Breast Ultrasound

TESTICULAR VOLUME

ADRENAL GLAND ULTRASOUND

SONOGRAPHIC EVALUATION OF PEDIATRIC THYROID NODULES

Differentiation between children and adult nodules :

Relatively uncommon in children : 1-1/5 % vs 13%

Malignant rate is higher : 22-26 % vs 5-10 %

Malignant nodules with similar size have more LN involvement ,extrathyroid extension and pulmonary metastasis .

Lower mortality rate : 2% vs 6-15%

Ultrasound screening

A history of irradiation of the neck

Preexisting Thyroid Disease (Hashimoto thyroiditis )

MEN-2 syndromes

Composition

Echogenicity

Margin

Shape

Calcification

Macrocalcifications :

generating a posterior shadow

at the center of the nodule or in the margins.

If all the margins were totally calcified showing an egg-shell aspect, it was predictive of benignity(FNA was impossible )

If there were discontinuous calcifications, it was considered suspicious of malignity.

Vascularity

Without vascularization

predominantly peripheral

central and peripheral

predominantly central

Us features of malignant nodules

Specific features Microcalcification

Markedly hypoecoic

Taller than wide in transverse plane

Extension beyond thyroid margin

Cervical LN metastasis

Less specific features No halo around nodule

Ill-defined margin

Solid

Increased central vascularity

ATA

ACR -TIRADs

Recommendations

TR1 AND TR2 : no FNA required

TR3: ≥1.5 cm follow up, ≥2.5 cm FNA

follow up: 1, 3 and 5 years

TR4: ≥1.0 cm follow up, ≥1.5 cm FNA

follow up: 1, 2, 3 and 5 years

TR5: ≥0.5 cm follow up, ≥1.0 cm FNA

annual follow up for up to 5 years

Interval enlargement on follow up is felt to be significant if there is a increase of 20% and 2 mm in two dimensions, or a 50% increase in volume.

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