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Background: Abusive head trauma (AHT) is the leading cause of death in infants with traumatic brain injury (TBI). Early recognition of AHT is important for improving outcomes, but it can be challenging due to its similar presentations with non-abusive head trauma (nAHT). This study aims to compare clinical presentations and outcomes between infants with AHT and nAHT, and to identify the risk factors for poor outcomes of AHT., Methods: We retrospectively analyzed infants of TBI in our pediatric intensive care unit from January 2014 to December 2020. Clinical manifestations and outcomes were compared between patients with AHT and nAHT. Risk factors for poor outcomes in AHT patients were also analyzed., Results: 60 patients were enrolled for this analysis, including 18 of AHT (30%) and 42 of nAHT (70%). Compared with those with nAHT, patients with AHT were more likely to have conscious change, seizures, limb weakness, and respiratory failure, but with a fewer incidence of skull fractures. Additionally, clinical outcomes of AHT patients were worse, with more cases undergoing neurosurgery, higher Pediatric Overall Performance Category score at discharge, and more anti-epileptic drug (AED) use after discharge. For AHT patients, conscious change is an independent risk factor for a composite poor outcome of mortality, ventilator dependence, or AED use (OR = 21.9, P = 0.04) CONCLUSION: AHT has a worse outcome than nAHT. Conscious change, seizures and limb weaknesses but not skull fractures are more common in AHT. Conscious change is both an early reminder of AHT and a risk factor for its poor outcomes., Competing Interests: Declaration of competing interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023. Published by Elsevier B.V.)

Background/purpose: Identifying child abuse is sometimes challenging due to its various presentations. To facilitate timely identification of critical or complex cases of physical abuse outside our child protection center, we established an outreach multidisciplinary team (OMDT) to support Kaohsiung City Government in 2014. The objective of this study was to describe our experience of OMDT services during a 6-year period and examine its role in assisting law enforcement., Methods: We retrospectively analyzed all OMDT cases from January 2014 to January 2020. Clinical characteristics and OMDT reports were reviewed. After inspection by our OMDT, cases were determined as indicating either a high risk or low risk of child abuse. Associations among clinical characteristics, radiographic findings, OMDT decisions and case outcomes including law enforcement and prosecution were examined., Results: Thirty-two cases (22 [68.8%] males and 10 [31.2%] females; mean age 24.2 months) received OMDT service, of whom 28 (87.5%) were admitted to the pediatric intensive care unit. The victims had an average of 2.2 types of wounds in 3.4 locations. The most common finding on radiography was subdural hemorrhage (18, 56.3%), followed by subarachnoid hemorrhage (31, 31.3%). Law enforcement was activated in 20 (64.5%) cases, and was only associated with the high-risk group as determined by the OMDT (p < 0.05) but not with any other variables., Conclusion: Our experience indicates that an OMDT can play an important role in child protection and activating law enforcement for children with complex or critical physical abuse. We suggest that in Taiwan, OMDT services should be incorporated into child protection centers, National Health Insurance system and governmental child protection policies., Competing Interests: Declaration of competing interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.)

Magnetic resonance cholangiopancreatography (MRCP) is an emerging imaging technique for direct visualization of biliary and pancreatic ducts without the need for an invasive procedure, ionizing radiation, or iodine contrast media administration. The purpose of this study was to evaluate the efficacy of non-breath-hold MRCP in depicting normal and diseased biliary and pancreatic ducts. A retrospective analysis of 162 patients who underwent MRCP was performed, and a comparison between MRCP and direct cholangiography was made. The overall accuracy of MRCP in diagnosing malignant and benign pancreaticobiliary diseases was also calculated. MRCP depicted more than three hepatic segments in 99% of patients with dilated intrahepatic ducts and in 63% of patients with nondilated intrahepatic ducts. MRCP demonstrated the main hepatic duct, gallbladder, and cystic duct in 100%, 89%, and 72% of patients, respectively. The dilated extrahepatic duct, nondilated extrahepatic duct, dilated pancreatic duct, and nondilated pancreatic duct were visualized in 100%, 98%, 95%, and 77% of patients, respectively. The accuracy of MRCP in diagnosing hepatolithiasis, cholecystolithiasis, and choledocholithiasis was 96%, 97%, and 96%, respectively. The obstruction levels and characteristics determined by MRCP were in agreement with those determined from direct cholangiography in 98% of malignant obstructions and 89% of benign obstructions. The overall accuracy of a combination of MRCP and conventional magnetic resonance imaging in diagnosing pancreaticobiliary diseases was 81% for malignant diseases, 86% for benign diseases, and 82% for stone diseases. We conclude that non-breath-hold MRCP can reliably depict normal and diseased pancreaticobiliary ducts except for cystic ducts and nondilated pancreatic ducts.

Gadolinium (III)-di(benzyl carbamoylmethyl) diethylenetrinitrilotriacetic acid [Gd(DTPA-BBA)] is a newly developed paramagnetic complex designed for use as a hepatobiliary-specific contrast agent. The purpose of this study was to examine the relaxivity, biodistribution, and magnetic resonance (MR) imaging characteristics of Gd(DTPA-BBA) in rats. Our results showed that the T1 relaxivity of Gd(DTPA-BBA) (3.89 dm3/mmol/s in aqueous solution) was similar to that of Gd(III) diethylenetriamine-pentaacetate [Gd(DTPA)]2- (4.08 dm3/mmol/s) and Gd(III) benzyloxypropionicte-traacetate [Gd(BOPTA)]2- (4.40 dm3/mmol/s). Biodistribution studies indicated that Gd(DTPA-BBA) exhibited hepatobiliary and urinary elimination. In MR imaging studies, Gd(DTPA-BBA) provided biphasic enhancement of normal liver parenchyma, which was characterized by an initial steep increase in enhancement followed by a plateau. The initial relative enhancement (RE%) of the liver, at 1 minute after administration of 0.2 mmol/kg Gd(DTPA-BBA) was 113 +/- 19. The plateau RE% of the liver (48 +/- 13) occurred within 10 minutes and persisted for at least 60 minutes after injection of the contrast agent. In addition, Gd(DTPA-BBA) provided better RE% of the liver than [Gd(DTPA)]2-. The contrast RE% of liver abscess capsules reached a plateau within 5 minutes after injection of 0.1 mmol/kg Gd(DTPA-BBA). Although the hepatic enhancement of Gd(DTPA-BBA) was inferior to that of [Gd(BOPTA)]2-, the results suggest that Gd(DTPA-BBA) has potential as an MR contrast agent for nonspecific and hepatobiliary uses.

To define the patterns of pathologic changes in cerebral palsy (CP) and to assess the etiology and time of brain damage, we reviewed the magnetic resonance images and clinical records of 86 pediatric CP patients seen over 8 years. Patients were divided into two groups, based on the gestational age at birth. The majority of CP patients (69) had spasticity. In the premature group (< 37 wk gestational age) n = 27), spastic diplegia (12 patients) and quadriplegia (8) were the major subtypes. In the term group (> or = 37 wk gestational age) ( n = 59), spastic hemiplegia (23) and quadriplegia (12) were most common. The other main clinical manifestations in the two groups were seizures (36) and mental retardation (15). Magnetic resonance (MR) imaging provided significant findings in 82 patients (95%). In the 27 patients born prematurely, MR imaging revealed periventricular leukomalacia (17), multicystic encephalomalacia (3), cortical and subcortical atrophy (4), migration disorders (2), and basal ganglia injury (1). Among the patients born at term, the MR imaging findings were more heterogeneous; they included cortical and subcortical atrophy (17), brain malformations (17), periventricular leukomalacia (6), multicystic encephalomalacia (5), porencephaly (4), hemiatrophy (3), delayed myelination (3), and none (4). MR imaging alone could define the time of brain insults in 73 of our 86 CP patients. Combined with clinical histories, MR imaging could help assess the time of insult in 93% of patients. The brain insults occurred prenatally in 34 of our patients, perinatally in 37, and postnatally in eight. The time of insult could not be determined in six patients. In the premature patients, the insult occurred most frequently perinatally (74%), whereas in the term group it occurred most frequently prenatally (54%). MR imaging was found to be very helpful in the evaluation of the various neuropathologic changes in CP, in the depiction of the etiology, and in the determination of the time of brain injury.

The development of specific agents for hepatobiliary magnetic resonance imaging (MRI), iron (III) ethylenebis-(2-hydroxyphenylglycinate) [Fe(EHPG)-] and its derivative iron (III)-N, N' ethylenebis[5-bromo-2-hydroxyphenyl)-glycinate] [Fe(5-Br-EHPG)-] was investigated. Test procedures included method of synthesis, identification, and a test for purity, lipophilicity, toxicity, relaxivity, biodistribution and animal MRIs. Free EHPG and free Fe3+ were undetectable in the purity test. The partition coefficient for the lipophilicity of Fe(EHPG)- was 0.007 and for Fe(5-Br-EHPG)- it was 1.785. The acute toxicity test of Fe(EHPG)- in mice revealed that the LD50 dose of Fe(EHPG)- was 8 mmol/kg. Their relaxivity values were 1.167 and 0.780 s-1mM-1 in an agarose gel system and 1.313 and 0.725 s-1mM-1 in an aqueous solution, respectively. Biodistribution was performed with 59Fe(EHPG)- in anesthetized dogs. There was 1.097% to 1.19% contrast excretion through the opened common bile duct and 54.29% to 61.45% through the urinary tract in a six-hour period. After six hours, the residual contrast agent was only evident in the kidney and liver. The MRIs of dogs with intravenous contrast administration showed significant opacification of the common bile duct within a 10-minute period. Complete opacification of the biliary system could be identified within 1.5 hours. There was no significant difference in the enhancement effect between the inversion recovery sequence and T1-weighted spin echo sequence. The change in signal intensity of the hepatobiliary system on MRIs was similar between Fe(EHPG)- and Fe(5-Br-EHPG)-. The recommended administration dose was 0.083 mmol/kg for both contrast agents.(ABSTRACT TRUNCATED AT 250 WORDS)