llluminating the thymus mystery in pediatric CT studies

Purpose: This study aims to provide a comprehensive assessment of thymic morphology, attenuation, and anatomical variations in pediatric patients using modern multi-detector computed tomography (MDCT). Additionally, it seeks to establish reference values and analyze the factors influencing thymic density. Materials and methods: A retrospective analysis was conducted on 622 pediatric chest CT scans obtained between 2017 and 2024. Thymic shape, contour, density, and size parameters were evaluated. Thymic attenuation was graded using a standardized scoring system, and measurements of thymic dimensions were recorded. Statistical analyses were performed to assess correlations between thymic density, age, gender, and morphological characteristics. Results: Thymic morphology exhibited significant variation, with quadrilateral shape being the most common (42.1%), followed by round-oval (29.7%) and triangular (28.1%). Thymic attenuation showed no significant correlation with age (p=0.156) or gender (p=0.191). Regression analysis revealed a negative association between anteroposterior diameter and thymic density (β=-0.4019, p=0.015), while transverse diameter was positively correlated with thymic density (β=0.5465, p<0.001). No significant association was found between thymic shape, contour, localization, and thymic attenuation. Conclusion: This study provides a detailed evaluation of normal thymic imaging characteristics in pediatric patients, offering reference values for radiologists. Recognizing thymic variability across different age groups is essential to avoid misdiagnosis and unnecessary interventions. Future research should focus on longitudinal studies and advanced imaging techniques to refine diagnostic criteria.