Pediatric radiology Research Papers - Academia.edu (original) (raw)

Background Rickets affects young infants and toddlers. However, there is a paucity of literature regarding the types of fractures that occur in rachitic patients. Objective To evaluate the age of patients at which radiographically evident... more

Background Rickets affects young infants and toddlers. However, there is a paucity of literature regarding the types of fractures that occur in rachitic patients. Objective To evaluate the age of patients at which radiographically evident rickets occurs, and to characterize the age incidence and fractures that are observed in infants and toddlers with radiographically evident rickets. Materials and methods A retrospective study of children younger than 24 months was performed. Clinical data and radiographs were reviewed. Radiographs obtained within 1 month of the diagnosis were evaluated for the presence or absence of osteopenia, presence or absence of fraying–cupping, and presence and characterization of fractures. Results After exclusion criteria were applied, 45 children were included in the study. Children with rickets evident by radiograph were in the age range of 2–24 months. Fractures were present in 17.5% of the study group, exclusively in mobile infants and toddlers. Fracture types included transverse long bone fractures, anterior and anterior-lateral rib fractures, and metaphyseal fractures. All fractures occurred exclusively in patients with severe, overtly evident rickets. Conclusion Fractures occur in older infants and toddlers with overt rickets and can be seen by radiograph. Fractures do not resemble high-risk non-accidental trauma fractures.

Clinical, radiographic and morphologic analysis of nineteen cases of perinatal (lethal) hypophosphatasia was performed. Three families each had two affected offspring. All of the patients had lethal short limb dwarfism with very soft... more

Clinical, radiographic and morphologic analysis of nineteen cases of perinatal (lethal) hypophosphatasia was performed. Three families each had two affected offspring. All of the patients had lethal short limb dwarfism with very soft calvaria. Other clinical findings included polyhydramnios, blue sclerae and spurs in the mid-portion of the forearms and lower legs. Considerable variability was found in the skeletal radiographs. In addition to the well known radiographic features such as generalized decrease in the size of ossified bones with some bones not ossified at all, other changes observed included: 1) marked variability in the amount of bone ossification; 2) variability between patients as to which bones were most severely affected; 3)unusually dense, round, flattened, butterfly shaped; and saggitally clefted vertebral bodies; 4) variability in femoral shape including "chromosome" like, "campomelic" like, and shortening with or without metaphyseal cupping or irregularities; 5) osteochondral projections (Bowdler spurs) of the midshaft of the fibula and ulna. Recognition of the marked clinical and radiographic variability in this autosomal recessive lethal skeletal dysplasia is important for accurate genetic counseling and prenatal diagnosis.

The use of simulation and team training has become an excellent tool to reduce errors in high-risk industry such as the commercial airlines and in the nuclear energy field. The health care industry has begun to use similar tools to... more

The use of simulation and team training has become an excellent tool to reduce errors in high-risk industry such as the commercial airlines and in the nuclear energy field. The health care industry has begun to use similar tools to improve the outcome of high-risk areas where events are relatively rare but where practice with a tactical team can significantly reduce the chance of bad outcome. There are two parts to this review: first, we review the rationale of why simulation is a key element in improving our error rate, and second, we describe specific tools that have great use at the clinical bedside for improving the care of patients. These cross different (i.e. medical and surgical) specialties and practices within specialties in the health care setting. Tools described will include the pinch, brief/debriefing, read-backs, call-outs, dynamic skepticism, assertive statements, two-challenge rules, checklists and step back (hold points). Examples will assist the clinician in practical daily use to improve their bedside care of children.

Steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT) presents with focal or diffuse nonenhancing MR imaging abnormalities in 50% of patients with SREAT during subacute exacerbation. Vasculitic changes in biopsy... more

Steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT) presents with focal or diffuse nonenhancing MR imaging abnormalities in 50% of patients with SREAT during subacute exacerbation. Vasculitic changes in biopsy studies as well as the elevation of antithyroid antibodies and CSF protein suggests an inflammatory cause. We report the case of a patient with SREAT with changes on diffusion-weighted MR imaging, which improved with corticosteroid therapy and plasmapheresis, supporting the theory of inflammatory changes in exacerbation of presumptive SREAT.

Hemangiomas of the mediastinum are rare lesions comprising less than 0.5 % of all mediastinal masses [1±4]. Posterior mediastinal hemangiomas are slightly less common than anterior mediastinal . Extradural hemangiomas are also uncommon... more

Hemangiomas of the mediastinum are rare lesions comprising less than 0.5 % of all mediastinal masses [1±4]. Posterior mediastinal hemangiomas are slightly less common than anterior mediastinal . Extradural hemangiomas are also uncommon although almost all such lesions are thoracic, but they are infrequently associated with a dumb-bell mediastinal mass. We report the CT and pathological findings of two large posterior mediastinal hemangiomas with extradural extension occurring in small infants.

The sonographic findings of Mobius syndrome with brain stem calcification are presented. Prenatal and neonatal sonography disclosed characteristic hyperechoic dots or linear bands in the brain stem representing calcification, which... more

The sonographic findings of Mobius syndrome with brain stem calcification are presented. Prenatal and neonatal sonography disclosed characteristic hyperechoic dots or linear bands in the brain stem representing calcification, which suggests prenatal ischemic insult to the brain stem.

Radiologists play a key role in the recognition of child abuse. In the last century, radiologists pioneered the identification of nonaccidental injuries, including fractures and brain injury, and together with colleagues in paediatrics... more

Radiologists play a key role in the recognition of child abuse. In the last century, radiologists pioneered the identification of nonaccidental injuries, including fractures and brain injury, and together with colleagues in paediatrics advocated the protection of children from abuse. Prevalence studies in many countries have revealed the widespread and hidden nature of child maltreatment. New and complex forms of abuse, e.g. fabricated or induced illness, have been recognized. Physical abuse affects 7-9% of children in the UK, although fewer suffer the severe or life-threatening injuries seen by radiologists. A high index of suspicion of nonaccidental trauma is required where known patterns of injury or inconsistencies of presentation and history are detected. In many cases the diagnosis is readily made, although some cases remain contentious or controversial and consume much clinical time and energy. Differences of view between doctors are tested in the courts. Adverse publicity has made this work unpopular in the UK. Knowledge of the differential diagnosis of unexplained or apparent injury is essential for accurate diagnosis, vital where errors in either direction can be disastrous. New UK radiological guidelines will assist radiologists in achieving best evidence-based practice.

Prenatal diagnosis of congenital lung anomalies has increased in recent years as imaging methods have benefitted from technical improvements. The purpose of this pictorial essay is to illustrate typical imaging findings of a wide spectrum... more

Prenatal diagnosis of congenital lung anomalies has increased in recent years as imaging methods have benefitted from technical improvements. The purpose of this pictorial essay is to illustrate typical imaging findings of a wide spectrum of congenital lung anomalies on prenatal US and MRI. Moreover, we propose an algorithm based on imaging findings to facilitate the differential diagnosis, and suggest a follow-up algorithm during pregnancy and in the immediate postnatal period.

A 4-year-old girl suffering from congenital bilateral deafness underwent high-resolution helical CT (voxel size 0.3·0.3·0.7 mm) ( ) and T2-weighted 3D fast-spin-echo MRI (voxel size 0.5·0.5·0.7 mm) ) of the auditory organs as... more

A 4-year-old girl suffering from congenital bilateral deafness underwent high-resolution helical CT (voxel size 0.3·0.3·0.7 mm) ( ) and T2-weighted 3D fast-spin-echo MRI (voxel size 0.5·0.5·0.7 mm) ) of the auditory organs as pre-operative imaging work-up for cochlear implantation. To date, it has been axiomatic that CT depicts mineralized structures better than MRI, and that MRI performs better for soft tissue characterization with the penalty of lower spatial resolution. Fig. 1a-c Helical CT reformatted images. a Axial oblique view (0.3 mm slice thickness) depicts well all segments of the stapes: head, branches (arrowheads) and footplate, which appears thickened. b Frontal oblique view (0.5 mm slice thickness) showing the entire incus, incostapedial joint (large arrow) and stapes (thin arrows). c Sagittal oblique MIP view (14 mm thickness) showing all three ossicles: malleus (large arrow), incus (thin arrows) and stapes (arrowheads). The MIP algorithm has 'erased' the fluid content of the middle ear

Background The arterial vascularity of the hip has been investigated in normal infants using duplex Doppler sonography. This study addressed the differences in hip vascularity in infants with respect to gender and acetabular morphology.... more

Background The arterial vascularity of the hip has been investigated in normal infants using duplex Doppler sonography. This study addressed the differences in hip vascularity in infants with respect to gender and acetabular morphology. Objective To determine whether there is a relationship between the resistive index of the vessels of the femoral chondroepiphysis and the alpha angle in normal infant hips and in those with developmental dysplasia of the hip. Materials and methods We studied 76 hips (38 patients) with gray-scale and power Doppler US. The patients were referred because of a possible abnormal clinical hip examination or had risk factors for developmental dysplasia of the hip. The infants ranged in age from 1 day to 6 weeks. There were 13 boys and 25 girls. Gray-scale images were initially performed in the coronal and transverse planes to evaluate acetabular morphology, alpha angle and position of the femoral chondroepiphysis relative to the acetabulum. The hips were then examined with power Doppler US, in both sagittal and transverse planes, to identify arterial vessels within the femoral epiphysis. Resistive indices were then recorded from the spectral analysis in each vessel identified. Each examination was performed by one of five pediatric radiologists. Mixed model regression was used to assess the relationship between resistive index and alpha angle, age and gender. Results Of the 76 hips, 34 had an alpha angle of 60° or greater and were classified as normal, 26 had an alpha angle between 50° and 59° and were classified as immature, and 13 had an alpha angle of less than 50° and were either subluxed or dislocated at the time of examination. At least two vessels were documented in each femoral epiphysis except in three hips, in which no vessels could be documented because of technical factors. There was a statistically significant linear relationship between the alpha angle and resistive index, such that the resistive index tended to rise with increasing alpha angle (P=0.0022). In addition, female infants had a significantly higher average resistive index than the average resistive index in male infants with the same alpha angle (P=0.0005). Conclusion There is a direct linear relationship between alpha angle and resistive index in the infant hip. Female infants have a higher average resistive index than male infants. We believe that these results might serve as a model for predicting an infant hip at risk of ischemia. In addition, the fact that lower resistive indices of the femoral epiphysis are associated with acetabular dysplasia might help explain the documented low incidence of avascular necrosis in untreated hip dysplasia.

The diagnosis of subtle slipped capital femoral epiphysis (SCFE), for example in the contralateral asymptomatic hip, may require use of an exactly defined and reproducible lateral view where the slipping angle can be measured. To test a... more

The diagnosis of subtle slipped capital femoral epiphysis (SCFE), for example in the contralateral asymptomatic hip, may require use of an exactly defined and reproducible lateral view where the slipping angle can be measured. To test a simplified geometrical method and compare it to the conventional method (AP and frogleg views). The two methods were compared in 95 normal children 9-14 years old and 100 children 9-20 years old with SCFE. The slipping angle (SA) measurements had very high reproducibility, and the new method was diagnostically superior to the conventional method ( P<0.05). An exactly defined and reproducible lateral view is recommended for the X-ray diagnosis of SCFE. Nontraumatic SCFE appears to be bilateral in all cases.

Background Doppler US to measure abdominal blood flow velocities (ABFV) is increasingly used to investigate intestinal haemodynamics in several clinical conditions in neonates. Studies that provide reference values of ABFV during the... more

Background Doppler US to measure abdominal blood flow velocities (ABFV) is increasingly used to investigate intestinal haemodynamics in several clinical conditions in neonates. Studies that provide reference values of ABFV during the entire neonatal period are currently lacking. Objective To make available normal reference values of ABFV and Doppler indices in the coeliac trunk and superior mesenteric artery during the first month of life in term and healthy preterm infants. Materials and methods ABFV were obtained with colour Doppler US in 69 neonates (12 term, 57 preterm) divided into four gestational age groups (25-28 weeks, 29-32 weeks, 33-36 weeks, and 37-41 weeks). Results ABFV increased with increasing gestational and postnatal age. We also provide normal reference values of ABFV and Doppler indices to compare with measurements of abdominal blood flow changes during the neonatal period for diagnostic, therapeutic and prognostic purposes.

Background Radiological imaging is paramount for defining the genitourinary fistulae commonly associated with anorectal malformations prior to definitive surgery. The imaging options are resource-limited in many parts of the world.... more

Background Radiological imaging is paramount for defining the genitourinary fistulae commonly associated with anorectal malformations prior to definitive surgery. The imaging options are resource-limited in many parts of the world. Nonfluoroscopic pressure colostography after colostomy is a cheap method for the evaluation of anorectal malformations. Objective To describe our experience with nonfluoroscopic pressure colostography in the evaluation of anorectal malformations in boys. Materials and methods The study included 12 boys with anorectal malformation who had colostomy and nonfluoroscopic pressure-augmented colostography with water-soluble contrast medium between January 2006 and December 2007. Results Patient ages ranged from 2 days to 1 year. The types of genitourinary fistula were rectovesical (7.7%) and rectourethral (92.3%). Oblique radiographs were of diagnostic value in all patients. The types of anorectal malformations were high, intermediate and low in 75%, 8.3% and 16.7%, respectively. Short-segment urethral constriction was a common feature of rectourethral fistula (75%, n=9). Conclusion Our experience has shown that genitourinary fistulae associated with anorectal malformations can be demon-strated reliably by nonfluoroscopic pressure colostography with two oblique radiographs, providing an option in resource-poor settings where fluoroscopic equipment is scarce.

We read with great interest the Pictorial Interlude by P. R. Gutierrez, in the September 1998 issue of Pediatric Radiology [1], describing an unusual physeal injury through the sacro-coccygeal joint imaged with plain radiography and... more

We read with great interest the Pictorial Interlude by P. R. Gutierrez, in the September 1998 issue of Pediatric Radiology [1], describing an unusual physeal injury through the sacro-coccygeal joint imaged with plain radiography and follow-up CT.

Ultrasound is a remarkably powerful and versatile modality for pediatric imaging, without requiring exposure to radiation or sedatives. By providing information on blood flow, Doppler sonography can reveal details about normal physiology... more

Ultrasound is a remarkably powerful and versatile modality for pediatric imaging, without requiring exposure to radiation or sedatives. By providing information on blood flow, Doppler sonography can reveal details about normal physiology and disease processes not discernable from gray-scale anatomic images alone. However, in routine practice in many institutions Doppler remains underutilized, in part due to uncertainty of the meaning of changes in Doppler waveforms. In part I of this review, the basics of hemodynamics and how changes in blood flow affect the Doppler waveform are reviewed. Clinical applications in the investigation of hepatic disease are then discussed.

Salivary gland lesions are uncommon in children and may be related to the parotid, submandibular or sublingual glands. Inflammatory lesions are the most common cause of salivary gland abnormalities in children and can be due to acute... more

Salivary gland lesions are uncommon in children and may be related to the parotid, submandibular or sublingual glands. Inflammatory lesions are the most common cause of salivary gland abnormalities in children and can be due to acute viral, acute suppurative, or recurrent acute or chronic inflammation. Intraparotid lymphadenitis may also occur, as in cat-scratch disease or in other causes of cervical lymphadenitis. Salivary gland neoplasms are rare in children, and most of them are benign including mainly hemangioma, pleomorphic adenoma, or lymphangioma. Other lesions, such as sialolithiasis, mucocele, or ranula, may also be seen. Ultrasonography should be the initial imaging study used for the examination of salivary gland lesions in children, given the fact that most of such lesions are benign and are shown up clearly by sonography. In most cases, this technique permits the differentiation of intraglandular and extraglandular lesions, and may suggest the correct diagnosis. The entire lesion could not be totally depicted by US however, and other imaging techniques such as CT or MRI may be necessary. Vascular lesions can be demonstrated more clearly through the use of color Doppler imaging. Some of the lesions may appear similar, and clinical correlation is important for the differential diagnosis. This article discusses the sonographic appearance and clinical manifestations of the spectrum of salivary gland abnormalities that may occur in children.

Hydrocephalus is a common neurological disorder in children and the result of a variety of causes. However, with the advancement of imaging modalities, particularly MRI, previously reported rarer causes of hydrocephalus in children are... more

Hydrocephalus is a common neurological disorder in children and the result of a variety of causes. However, with the advancement of imaging modalities, particularly MRI, previously reported rarer causes of hydrocephalus in children are now being more readily appreciated. We report an 11-year-old boy with diffuse villous hyperplasia of the choroid plexus. He had a ventriculo-peritoneal (VP) shunt in-situ and a prior diagnosis from infancy of congenital aqueduct stenosis as the cause of his hydrocephalus. His current presentation was with further shunt dysfunction. CT and MRI demonstrated enlarged choroid plexuses but did not confirm aqueduct stenosis. CSF overproduction was demonstrated from the externalized ventricular drain. The enlarged choroid plexuses were surgically resected and histology confirmed choroid plexus hyperplasia. Identification of choroid plexus hyperplasia is important since the neurosurgical management of hydrocephalus is not VP shunt insertion, but resection of the hyperplastic choroid plexus.

Central venous catheters (CVC) are now commonly inserted by radiologists. Although complications are infrequent, they must be avoided where possible and recognized when they occur. We present a 10-year-old boy who developed right... more

Central venous catheters (CVC) are now commonly inserted by radiologists. Although complications are infrequent, they must be avoided where possible and recognized when they occur. We present a 10-year-old boy who developed right hemidiaphragmatic paralysis, requiring surgical plication, following US-guided insertion of a tunnelled right internal jugular CVC. The needle trajectory for internal jugular puncture must be planned to avoid the phrenic nerve.

A large number of hydronephrotic kidneys

Horizontal gaze palsy with progressive scoliosis (HGPPS) is a rare congenital disorder characterized by absence of conjugate horizontal eye movements and progressive scoliosis developing in childhood and adolescence. We present a child... more

Horizontal gaze palsy with progressive scoliosis (HGPPS) is a rare congenital disorder characterized by absence of conjugate horizontal eye movements and progressive scoliosis developing in childhood and adolescence. We present a child with clinical and neuroimaging findings typical of HGPPS. CT and MRI of the brain demonstrated pons hypoplasia, absence of the facial colliculi, butterfly configuration of the medulla and a deep midline pontine cleft. We briefly discuss the imaging aspects of this rare entity in light of the current literature.

MR urography (MRU) is an emerging technique particularly useful in paediatric uroradiology. The most common indication is the investigation of hydronephrosis. Combined static and dynamic contrast-enhanced MRU (DCE-MRU) provides both... more

MR urography (MRU) is an emerging technique particularly useful in paediatric uroradiology. The most common indication is the investigation of hydronephrosis. Combined static and dynamic contrast-enhanced MRU (DCE-MRU) provides both morphological and functional information in a single examination. However, specific post-processing must be performed and to our knowledge, dedicated software is not available in conventional workstations. Investigators involved in MRU classically use homemade software that is not freely accessible. For these reasons, we have developed a software program that is freely downloadable on the National Institute of Health (NIH) website. We report and describe in this study the features of this software program.

Duodenal obstruction caused by ileocolic intussusception in the absence of intestinal malrotation is extremely rare. We present and discuss the imaging findings in an infant with an intussusception secondary to a duplication cyst in whom... more

Duodenal obstruction caused by ileocolic intussusception in the absence of intestinal malrotation is extremely rare. We present and discuss the imaging findings in an infant with an intussusception secondary to a duplication cyst in whom sonography also showed inversion of the orientation of the mesenteric vessels and a distended stomach. A contrast medium study revealed a proximal duodenal obstruction with a beak appearance suggestive of midgut volvulus. At surgery, an ileocolic intussusception causing duodenal obstruction without concomitant malrotation or volvulus was found. The combination of duodenal obstruction and abnormal relationship of the mesenteric vessels as a result of ileocolic intussusception has not previously been reported in the literature.

Idiopathic periosteal hyperostosis with dysproteinemia has been recognized as a separate entity since its description by Goldbloom and colleagues in 1966. Very few cases have been reported to date, and the radiologic literature is very... more

Idiopathic periosteal hyperostosis with dysproteinemia has been recognized as a separate entity since its description by Goldbloom and colleagues in 1966. Very few cases have been reported to date, and the radiologic literature is very scanty regarding this syndrome. This article reviews the entity and illustrates it with our own example.

Digital radiography systems based on flat-panel detectors have been introduced into clinical practice in the past few years. The high detective quantum efficiency of these detectors allows the radiation dose to be reduced while... more

Digital radiography systems based on flat-panel detectors have been introduced into clinical practice in the past few years. The high detective quantum efficiency of these detectors allows the radiation dose to be reduced while maintaining image quality, an issue particularly significant for pediatric radiography. Another important aspect for dose optimization and monitoring is the integration of the detector into a computer-controlled x-ray examination system. This enables full control and complete reporting of all dose-relevant exposure parameters, including the determination of the exposure indicator and the patient dose (kerma-area product). In this paper the implementation of these principles in the Philips Digital Diagnost DR system is described and their relevance for pediatric applications is discussed.

The metacarpal index (MCI) of 500 normal Nigerian children whose ages range from birth to 16 years was determined. The MCI of Nigerian children is higher than that of their Caucasian counterpart, but similar to that of Jamaican children.... more

The metacarpal index (MCI) of 500 normal Nigerian children whose ages range from birth to 16 years was determined. The MCI of Nigerian children is higher than that of their Caucasian counterpart, but similar to that of Jamaican children. The adult range of MCI is reached at the relatively low age of 9 years. The index is higher in females than males and the value for the left hand is higher than that for the right hand.

Cervical spine trauma in children is rare and the diagnosis can be challenging due to anatomical and biomechanical differences as compared to adults. A variety of algorithms have been used in adults to accurately diagnose injuries, but... more

Cervical spine trauma in children is rare and the diagnosis can be challenging due to anatomical and biomechanical differences as compared to adults. A variety of algorithms have been used in adults to accurately diagnose injuries, but have not been fully studied in pediatric patients. In this article we review suggested imaging protocols and the general characteristics, types of injuries, and measurements used to diagnose cervical spine injuries in children.

PURPOSE: The aim of this study was to investigate the image quality preferences among radiographers and radiologists. The radiographers&#x27; preferences are mainly related to technical parameters, whereas radiologists assess image... more

PURPOSE: The aim of this study was to investigate the image quality preferences among radiographers and radiologists. The radiographers&#x27; preferences are mainly related to technical parameters, whereas radiologists assess image quality based on diagnostic ...

Intraosseous haemangioma, an uncommon benign vascular tumour, is most commonly seen in adults and tends to involve the vertebrae and the skull. Lesions of flat bones are rare and the imaging findings in these patients are non-specific. We... more

Intraosseous haemangioma, an uncommon benign vascular tumour, is most commonly seen in adults and tends to involve the vertebrae and the skull. Lesions of flat bones are rare and the imaging findings in these patients are non-specific. We report a unique case of intraosseous haemangioma in the ilium of a 7-year-old girl studied by US, radiography, scintigraphy, CT and MRI.

Imaging plays a major role in the diagnostic work-up of children with hepatobiliary or pancreatic diseases. It consists mainly of US, CT and MRI, with US and MRI being the preferred imaging modalities because of the lack of ionizing... more

Imaging plays a major role in the diagnostic work-up of children with hepatobiliary or pancreatic diseases. It consists mainly of US, CT and MRI, with US and MRI being the preferred imaging modalities because of the lack of ionizing radiation. In this review the technique of US, CT and MRI in children will be addressed, followed by a comprehensive overview of the imaging characteristics of several hepatobiliary and pancreatic disease entities most common in the paediatric age group.

Most haemangiomas and vascular malformations are identified according to clinical criteria. A good knowledge of the classification and clinical characteristics of the vascular anomalies is necessary when managing these patients. However,... more

Most haemangiomas and vascular malformations are identified according to clinical criteria. A good knowledge of the classification and clinical characteristics of the vascular anomalies is necessary when managing these patients. However, some cases are challenging either because of an atypical presentation (e.g., soft-tissue mass with normal overlying skin) or because of classification difficulties. Doppler US and MRI are the two main imaging modalities that allow classification of the vascular anomalies and are useful in those clinically uncertain cases to establish the correct diagnosis. This aids the choice of the most appropriate treatment and to inform the parents of the prognosis. Highresolution grey-scale and Doppler US allow excellent visualization of most superficial masses. Doppler US is the easiest way to assess the haemodynamics of a vascular lesion and to clarify a doubtful diagnosis between a haemangioma and vascular malformation. MRI is the best technique for evaluating the extent of the lesions and their relationship to adjacent structures. While newly developed drugs from angiogenesis research labs are awaited, radiologists have an important role in the treatment of haemangiomas and vascular malformations. Intervention remains crucial in cases of alarming haemangiomas and venous malformations (VM), lymphatic malformations (LM) and arteriovenous malformations (AVM). A multidisciplinary team, including paediatricians, haematologists, surgeons and radiologists, must manage the problem cases both in terms of diagnostic workup and therapeutic options. This paper will briefly discuss the imaging findings and treatment of vascular anomalies.

Background There are minimal data on radiation doses to infants and children undergoing a modified barium swallow (MBS) study. Objective To document screening times, dose area product (DAP) and effective doses to children undergoing MBS... more

Background There are minimal data on radiation doses to infants and children undergoing a modified barium swallow (MBS) study. Objective To document screening times, dose area product (DAP) and effective doses to children undergoing MBS and to determine factors associated with increased screening times and effective dose. Materials and methods Fluoroscopic data (screening time, DAP, kVp) for 90 consecutive MBS studies using pulse fluoroscopy were prospectively recorded; effective dose was calculated and data were analyzed for effects of behavior, number of swallow presentations, swallowing dysfunction and medical problems. Results Mean effective dose for the entire group was 0.0826±0.0544 mSv, screening time 2.48±0.81 min, and DAP 28.79±41.72 cGy cm 2 . Significant differences were found across three age groups (≤1.0, >1.0-3.0 and >3.0 years) for effective dose (mean 0.1188, 0.0651 and 0.0529 mSv, respectively; P < 0.001), but not for screening time or DAP. Effective dose was correlated with screening time (P=0.007), DAP (P<0.001), number of swallow presentations (P=0.007), lower age (P=0.017), female gender (P=0.004), and height (P<0.001). Screening time was correlated with total number of swallow presentations (P<0.001) and DAP (P<0.001). Conclusion Screening times, DAP, effective dose, and child and procedural factors associated with higher effective doses are presented for children undergoing MBS studies.

Raccoon roundworm encephalitis is a rare but devastating infection characterized by progressive neurological decline despite attempted therapy. Patients present with deteriorating neurological function, eosinophilia, and history of pica... more

Raccoon roundworm encephalitis is a rare but devastating infection characterized by progressive neurological decline despite attempted therapy. Patients present with deteriorating neurological function, eosinophilia, and history of pica or geophagia resulting in ingestion of the parasite. Neuroimaging studies demonstrate nonspecific findings of progressive white matter inflammation and cortical atrophy.

T2-weighted (T2-W) turbo spin-echo (TSE) MRI and short tau inversion recovery (STIR) imaging have been shown to be highly effective for the evaluation of bone marrow pathology [1±5]. However, conventional STIR sequences have long scan... more

T2-weighted (T2-W) turbo spin-echo (TSE) MRI and short tau inversion recovery (STIR) imaging have been shown to be highly effective for the evaluation of bone marrow pathology [1±5]. However, conventional STIR sequences have long scan times of up to 12 minutes and more because of long repetition times (TR), incorporation of inversion time (TI) and the spin echo (SE) component. The quality and fat-suppression capability of turbo inversion recovery magnitude (TIRM) images are approximately similar to STIR images. In compari-son to STIR sequences, TIRM allows for shorter acquisition time . In contrast to spectral fat suppression sequences (TSE with fat suppression), TIRM images can be acquired with low magnetic field systems and seem more stable. To determine the efficiency of TIRM sequences for detecting the very early stage of acute osteomyelitis in bone marrow, we prospectively compared the contrast-to-noise (C/N) ratios of TIRM, T1-weighted (T1-W) SE and T2-W TSE in a region of interest (ROI).