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Background: The most common complication of preterm birth is bronchopulmonary dysplasia (BPD), widely referred to as the chronic lung disease of prematurity. All current definitions rely on characterizing the disease based on respiratory support level, and do not provide full understanding of the underlying cardiopulmonary pathophysiology.Objective: To evaluate a rapid functional lung imaging technique in premature infants in the Neonatal Intensive Care Unit (NICU) to quantitate pulmonary ventilation and perfusion using 1.5 Tesla Magnetic Resonance Imaging (MRI).Methods: We conducted a prospective MRI study of 12 premature infants in the NICU using the phase resolved lung (PREFUL) MRI technique to calculate pulmonary ventilation and perfusion parameters in preterm infants with and without bronchopulmonary dysplasia (BPD) Grade 0/1 (n=6) and Grade 2/3 (n=6).Results: The exclusive ventilation defect percentage (VDP%) showed a significant increase in premature infants with Grade 2/3 BPD vs. Grade 0/1 BPD [15.0% vs. 7.0%, p=0.008]. The total VDP% also showed a significant increase between groups [16.0% vs. 8.0%, p=0.013]. No significant perfusion defect percentages (QDP%) were found between groups. Conclusion: PREFUL lung MRI is feasible for assessment of ventilation and perfusion defect percentages in preterm infants in the NICU and shows regional variation in localized lung function in this vulnerable population.

Chondroid lipomas are rare, benign lipomatous tumors that occur most frequently in adults during the fourth decade of life. While a female predominance was observed in the initial series of 20 cases described in 1993, the subsequent 49 reported cases do not support a strong gender predilection. We report a case of a chondroid lipoma presenting in a 9-year-old female as a painless, enlarging, left gluteal mass. This is the second case to be reported in the first decade of life and the fourth pediatric case reported in the literature (age

A palpable finding along the chest wall is a frequent indication for pediatric US. Accurate identification of benign lesions can reassure families and appropriately triage children who need follow-up, cross-sectional imaging, or biopsy. In this pictorial essay, we review chest wall anatomy, illustrate US techniques and discuss key US imaging features of common benign lesions and normal variants.

Parsonage-Turner Syndrome (PTS), also known as idiopathic brachial plexopathy or neuralgic amyotrophy, is an uncommon condition characterized by acute onset of shoulder pain, most commonly unilateral, which may progress to neurologic deficits such as weakness and paresthesias (Feinberg and Radecki, 2010 [1]). Although the etiology and pathophysiology of PTS remains unclear, the syndrome has been reported in the postoperative, postinfectious, and post-vaccination settings, with recent viral illness reported as the most common associated risk factor (Beghi et al., 1985 [2]). Various viral, bacterial, and fungal infections have been reported to precede PTS, however, currently there are no reported cases of PTS in the setting of recent infection with SARS-CoV2 (COVID-19). We present a case of a 17 year old female patient with no significant past medical or surgical history who presented with several weeks of severe joint pain in the setting of a recent viral illness (SARS-CoV2, COVID-19). MRI of the left shoulder showed uniform increased T2 signal of the supraspinatus, infraspinatus, teres minor, teres major, and trapezius muscles, consistent with PTS. Bone marrow biopsy results excluded malignancy and hypereosinophilic syndrome as other possible etiologies. Additional rheumatologic work-up was also negative, suggesting the etiology of PTS in this patient to be related to recent infection with SARS-CoV2 (COVID-19). Radiologists should be aware of this possible etiology of shoulder pain as the number of cases of SARS-CoV2 (COVID-19) continues to rise worldwide., Highlights • Parsonage-Turner syndrome (PTS) is a rare cause of acute unilateral shoulder pain. • Recent viral illness is the most common associated risk factor for PTS. • We report a novel case of PTS in the setting of SARS-CoV2 (COVID-19) infection.

The role of magnetic resonance imaging (MRI) in pediatric appendicitis is increasing; MRI findings predictive of appendiceal perforation have not been specifically evaluated. To assess the performance of MRI in differentiating perforated from non-perforated appendicitis. A retrospective review of pediatric patients undergoing contrast-enhanced MRI and subsequent appendectomy was performed, with surgicopathological confirmation of perforation. Appendiceal diameter and the following 10 MRI findings were assessed: appendiceal restricted diffusion, wall defect, appendicolith, periappendiceal free fluid, remote free fluid, restricted diffusion within free fluid, abscess, peritoneal enhancement, ileocecal wall thickening and ileus. Two-sample t-test and chi-square tests were used to analyze continuous and discrete data, respectively. Sensitivity and specificity for individual MRI findings were calculated and optimal thresholds for measures of accuracy were selected. Seventy-seven patients (mean age: 12.2 years) with appendicitis were included, of whom 22 had perforation. The perforated group had a larger mean appendiceal diameter and mean number of MRI findings than the non-perforated group (12.3 mm vs. 8.6 mm; 5.0 vs. 2.0, respectively). Abscess, wall defect and restricted diffusion within free fluid had the greatest specificity for perforation (1.00, 1.00 and 0.96, respectively) but low sensitivity (0.36, 0.25 and 0.32, respectively). The receiver operator characteristic curve for total number of MRI findings had an area under the curve of 0.92, with an optimal threshold of 3.5. A threshold of any 4 findings had the best ability to accurately discriminate between perforated and non-perforated cases, with a sensitivity of 82% and specificity of 85%. Contrast-enhanced MRI can differentiate perforated from non-perforated appendicitis. The presence of multiple findings increases diagnostic accuracy, with a threshold of any four findings optimally discriminating between perforated and non-perforated cases. These results may help guide management decisions as MRI assumes a greater role in the work-up of pediatric appendicitis.

Scurvy is a rare disease in developed nations. In the field of pediatrics, it primarily is seen in children with developmental and behavioral issues, malabsorptive processes, or diseases involving dysphagia. We present the case of an otherwise developmentally appropriate 4-year-old boy who developed scurvy after gradual self-restriction of his diet. He initially presented with a limp and a rash and was subsequently found to have anemia and hematuria. A serum vitamin C level was undetectable, and after review of the MRI of his lower extremities, the clinical findings supported a diagnosis of scurvy. Although scurvy is rare in developed nations, this diagnosis should be considered in a patient with the clinical constellation of lower-extremity pain or arthralgias, a nonblanching rash, easy bleeding or bruising, fatigue, and anemia. This case highlights the importance of carefully assessing a child’s dietary and developmental status at well-child visits, which can help avoid a more invasive workup.

Epipericardial fat necrosis is a rare cause of acute pleuritic chest pain reported in approximately 40 cases. This diagnosis mimics a myocardial infarction, pulmonary embolism, or pericarditis; however, the cardiac enzymes and electrocardiogram are usually normal. We present the first reported case of epipericardial fat necrosis in an adolescent.

To evaluate the accuracy of renal and bladder ultrasonography (RBU) in predicting vesicoureteral reflux (VUR) in infants and children.A total of 134 children who had VUR demonstrated on voiding cystourethrography (VCU) and also had RBU within 1 month of the VCU were included in the study, which took place between January 2005 and December 2012. VUR and hydronephrosis were graded with standard methods on VCU and RBU, respectively. Using VCU findings of reflux as the gold standard, diagnostic accuracy measures were performed for hydronephrosis and ureteral visualization on RBU, including sensitivity, specificity, positive predictive value, negative predictive value, and accuracy.Reflux grade was significantly associated with the degree of hydronephrosis (P = .0032). The sensitivity, negative predictive value, and accuracy of ultrasonography in predicting reflux was significantly higher for grade IV+ or grade V reflux compared with lower reflux grades. Also, the specificity of ultrasonography in predicting reflux was constant and at high level across all reflux grades, suggesting that ultrasonography is a good diagnostic screening tool.Normal RBU is rare with grade IV-V reflux, and moderate to severe hydronephrosis is rare with reflux gradesIV. RBU is a valid screening test for the selection of patients with a first urinary tract infection who should undergo VCU. Diagnosis of grade IV and V reflux will be delayed in very few cases, using a definition of abnormal RBU to include all degrees of hydronephrosis (Society for Fetal Urology classification).

To compare histopathology with ADC values in strictured bowel segments in pediatric patients with known Crohn's disease and surgical bowel resection.Magnetic resonance enterography (MRE) images of 14 subjects with Crohn's disease who had surgical bowel resection for strictures were retrospectively reviewed. Five of 14 subjects had DWI (b=0, 500, 1000) sequences included in the MRE study. ADC measurements were made by placing ROI's in the strictured bowel wall and compared to full-thickness histologic analysis of resected specimens. ADC values were also compared to control ADC measurements (in normal and inflamed-nonstenotic bowel segments) as well as the mean ADC values of Crohn's patients published in the literature.All five subjects had transmural fibrosis. The mean ADC value with b = 500 was 0.92 ± 0.10 × 10(-3) mm(2)/s and with b = 1000 was 0.8 ± 0.05 × 10(-3) mm(2)/s. There was a significant difference in ADC values between strictures and inflamed-nonstenotic segments (p=0.0143) and between normal and diseased bowel segments (p=0.009-0.0143).Quantitative ADC measures of transmural fibrosis are lower compared to the reported values of inflammation in Crohn's disease. To our knowledge, this is the first pediatric pilot study to investigate the correlation of quantitative DWI with histology of surgical specimens in pediatric patients with Crohn's disease. Our results are comparable to a recently published study in adult Crohn's patients showing a significant correlation between a decrease in ADC values and fibrosis.

We present a 3-month-old boy with a type IIA sling left pulmonary artery associated with imperforate anus and rectourethral fistula. Tracheobronchial abnormalities are demonstrated using multidetector CT with 3-D volume rendering of the airways. This case represents a novel variant of an already rare entity with an unusually high right upper lobe bronchus and no evidence of associated tracheobronchial stenosis.

A 9-year-old boy presented with the sudden onset of pleuritic chest pain and on CT was found to have a large pleural effusion, mediastinal fluid, splenic lesions and multiple apparently sclerotic vertebral bodies. Subsequent MRI showed that those vertebral bodies that appeared sclerotic were in fact normal, and the vertebral bodies initially interpreted as normal had an abnormal T1 and T2 hyperintense signal on MRI and were relatively lucent on CT. MRI also demonstrated abnormal heterogeneous T2 hyperintense paraspinal tissue and several multicystic soft tissue masses. Biopsy of two adjacent vertebral bodies, one relatively sclerotic and one lucent, demonstrated findings of bony remodeling without a specific diagnosis. Biopsy of an infiltrative mediastinal mass confirmed the diagnosis of generalized cystic lymphangiomatosis. MRI should be included in the assessment of vertebral involvement in this condition because CT and biopsy findings may be nonspecific.

To compare gradient-echo (GRE) phase magnetic resonance (MR) imaging and quantitative susceptibility mapping (QSM) in the detection of intracranial calcifications and hemorrhages.This retrospective study was approved by the institutional review board. Thirty-eight patients (24 male, 14 female; mean age, 33 years ± 16 [standard deviation]) with intracranial calcifications and/or hemorrhages diagnosed on the basis of computed tomography (CT), MR imaging (interval between examinations, 1.78 days ± 1.31), and clinical information were selected. GRE and QSM images were reconstructed from the same GRE data. Two experienced neuroradiologists independently identified the calcifications and hemorrhages on the QSM and GRE phase images in two randomized sessions. Sensitivity, specificity, and interobserver agreement were computed and compared with the McNemar test and k coefficients. Calcification loads and volumes were measured to gauge intermodality correlations with CT.A total of 156 lesions were detected: 62 hemorrhages, 89 calcifications, and five mixed lesions containing both hemorrhage and calcification. Most of these lesions (146 of 151 lesions, 96.7%) had a dominant sign on QSM images suggestive of a specific diagnosis of hemorrhage or calcium, whereas half of these lesions (76 of 151, 50.3%) were heterogeneous on GRE phase images and thus were difficult to characterize. Averaged over the two independent observers for detecting hemorrhages, QSM achieved a sensitivity of 89.5% and a specificity of 94.5%, which were significantly higher than those at GRE phase imaging (71% and 80%, respectively; P.05 for both readers). In the identification of calcifications, QSM achieved a sensitivity of 80.5%, which was marginally higher than that with GRE phase imaging (71%; P = .08 and .10 for the two readers), and a specificity of 93.5%, which was significantly higher than that with GRE phase imaging (76.5%; P.05 for both readers). QSM achieved significantly better interobserver agreements than GRE phase imaging in the differentiation of hemorrhage from calcification (κ: 0.91 vs 0.55, respectively; P.05).QSM is superior to GRE phase imaging in the differentiation of intracranial calcifications from hemorrhages and with regard to the sensitivity and specificity of detecting hemorrhages and the specificity of detecting calcifications.

Skeletal infections secondary to Candida albicans are uncommon and described primarily in adults. Nearly all 22 pediatric cases of C. albicans osteomyelitis described to date have occurred in neonates with specific risk factors or in children with a severe immunodeficiency. We report an unusual presentation of C. albicans osteomyelitis and arthritis in a 1-year-old boy without an immunodeficiency, which led to a delayed diagnosis. He most likely developed C. albicans arthritis and osteomyelitis during the neonatal period with a subsequent indolent and subacute presentation. Our literature search found no prior or recent reviews of C. albicans osteomyelitis in pediatric patients. On the basis of this patient and the case reports previously published, we discuss an approach to the evaluation and management of pediatric patients with Candida osteomyelitis.

Magnetic resonance imaging (MRI) is increasingly employed as a diagnostic modality for suspected appendicitis in children. However, there is uncertainty as to which MRI sequences are sufficient for safe, timely and accurate diagnosis. Several recent studies have described different MRI protocols, including exams both with and without the use of intravenous contrast. We hypothesized that intravenous contrast may be useful in some patients but could be safely omitted in others. All MRI examinations (n=112) performed at our institution for evaluating appendicitis in children were retrospectively reevaluated. Exams were reread by pediatric radiologists under three conditions: With postcontrast images, Without postcontrast images, and Without/With – selective use of postcontrast sequences only when needed for diagnostic certainty. Samples were scored as positive, negative or equivocal for appendicitis. Findings were compared to pathological or clinical follow-up in the medical record. Without the use of intravenous contrast yielded more equivocal results (12.4%) compared to With contrast (3.4%). By selectively using postcontrast sequences, the Without/With group yielded fewer equivocal results (1.1%) compared to Without while also reducing contrast use 79.8% compared to the With contrast group. No significant differences in conditional sensitivity or conditional specificity were detected among the three groups. MRI diagnosis of acute appendicitis can be performed without contrast for most patients; injection of contrast can be reserved for only those patients with equivocal non-contrast imaging.

Magnetic resonance (MR) imaging may provide a radiation-sparing alternative to CT in diagnosing appendicitis in children in whom US is equivocal. However, comparability with CT in the detection of the appendix remains to be established. To determine the detection rate of the normal appendix in children on oral and IV contrast-enhanced MRI. MR imaging of 58 patients who had previously undergone MR enterography was retrospectively reviewed. Detection rate, body mass index, age and gender were recorded. The normal appendix was detected in 28 cases (48 %), with greatest detection rate on the axial fast imaging employing steady-state acquisition (FIESTA) sequence. Children in whom the appendix was detected had significantly higher BMI compared to children in whom the appendix was not seen. Neither age nor gender demonstrated a significant association with detection rate. The detection rate of the normal appendix in children on oral and IV contrast-enhanced MRI was 48 %, which is comparable to detection rates on CT, as well as to previously reported detection rates on MR imaging with neither oral nor IV contrast agents. These findings may serve to guide the development of MRI protocols for pediatric appendicitis.

Wandering spleen, a rare entity, is caused by the absence or laxity of the normal anchoring splenic ligaments. Only three neonatal cases have been reported in the English-language literature. We present the clinical and multimodality imaging findings of a newborn with laceration and hemorrhage of a wandering spleen. The course was complicated by the concurrent diagnosis of glucose-6-phosphate dehydrogenase deficiency, which confused the clinical picture when a falling hematocrit raised the question of rebleeding several days after presentation.

To retrospectively investigate whether quantitation of taurine (Tau) concentrations with proton magnetic resonance (MR) spectroscopy in vivo improves the differentiation of primitive neuroectodermal tumors (PNET) from other common brain tumors in pediatric patients.The institutional review board approved this review of clinical data; it was not necessary to obtain parental consent. This study was HIPAA compliant. Single-voxel proton spectroscopy was added to the preoperative MR imaging work-up of 29 patients (12 boys and 17 girls; mean age, 6.5 years +/- 3.5) with untreated brain tumors; 13 had PNETs, and 16 had other tumors. Absolute concentrations (measured in millimoles per kilogram of brain tissue) of metabolites of the proton spectrum were determined. Student t tests were used for statistical comparisons.Elevated absolute Tau concentration proved to be the most significant metabolite in the differentiation of PNETs from other tumors (6.09 mmol/kg +/- 2.24 vs 0.76 mmol/kg +/- 0.95, P.001). PNETs also exhibited a higher ratio of Tau relative to choline (1.21 +/- 0.48 vs 0.28 +/- 0.39, P.001), a higher ratio of Tau relative to creatine (1.28 +/- 0.44 vs 0.38 +/- 0.67, P.001), a reduced a ratio of N-acetyl-aspartate relative to choline (0.20 +/- 0.20 vs 0.79 +/- 0.56, P.001), and an increased choline concentration (5.30 mmol/kg +/- 1.64 vs 3.08 mmol/kg +/- 2.53, P.05). Tau concentrations ranged from 2.62 to 11.15 mmol/kg in individual patients with a PNET.Single-voxel quantitative (1)H MR spectroscopy performed in patients with untreated pediatric brain tumors showed that the Tau concentration was significantly elevated in PNETs and was useful in the differentiation of PNETs from other tumors.

Rationale and objectives To test the repeatability, reproducibility and accuracy of the three-point Dixon (3PD) sequence for estimating true fat volume ratios using a fat/water phantom. Materials and methods A phantom, constructed from test tubes of varying fat content, was imaged using the 3PD sequence on a 1.5T MRI scanner by two operators four times each. Fat volume ratios were calculated from these images and compared with true fat volumes. Results Measures of fat volume ratios calculated from the 3PD MR images correlated strongly with values for true fat volumes (r = 0.96). Conclusion The 3PD technique was found to be highly reproducible and accurate, and may be useful for in vivo quantification of fat in lean tissues, such as the liver, pancreas or skeletal muscle.

Crohn’s disease has been associated with restricted diffusion in diseased small bowel segments on diffusion-weighted imaging (DWI). However, data addressing longitudinal changes in DWI findings and their potential clinical ramifications in the pediatric population are lacking. The purpose of this study was to follow DWI changes in diseased small bowel segments between serial magnetic resonance enterography (MRE) examinations, and to correlate these changes with other imaging parameters and clinical status. This retrospective study evaluated patients less than 21 years of age undergoing serial MRE examinations including DWI for Crohn’s disease involving the small bowel. All patients carried a diagnosis of Crohn’s disease established by pathology or corroborative clinical and imaging findings. Longitudinal changes in mean apparent diffusion coefficient (ADC) values within the wall of affected small bowel lesions were recorded and normalized to both unaffected bowel and skeletal muscle. ADC changes were correlated with qualitative imaging phenotype, as reflected by a defined set of non-DWI imaging parameters, as well as with clinical disease activity. Seventeen lesions were evaluated longitudinally, distributed among 13 patients (9 boys and 4 girls, mean age at baseline 16.6 years), each of whom had two sequential MRE examinations. Lesions demonstrating a fibrostenotic imaging phenotype at follow-up MRE had a significantly lower change in mean ADC value between examinations than lesions that did not have a fibrostenotic imaging phenotype (p = 0.0005), an effect that persisted when ADC values were normalized to unaffected bowel and skeletal muscle. Across all studies, lesions with a fibrostenotic imaging phenotype had lower ADC values than those with an inflammatory imaging phenotype, which were in turn lower than those with a normal imaging phenotype (p = 0.0001). Patterns of longitudinal DWI changes in Crohn’s disease may differ among small bowel lesions depending upon their specific natural histories. These findings may assist in the evaluation of the ADC value as a potential imaging surrogate when evaluating lesion status, particularly as it pertains to relative contributions of inflammation and fibrosis.

Xanthogranulomatous pyelonephritis (XPN) is the result of chronic renal infection. It is very rare in childhood and the focal form, which is said to be more common in children, is often misdiagnosed as a renal tumor. We report a case of a focal XPN in a 14-year-old girl. The true preoperative diagnosis may be very hard in children especially in the focal form but it seems to be possible by the help of dynamic contrast-enhanced MRI.

Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is the most common cause of severe neonatal thrombocytopenia and intracranial bleeding in term newborns. Intracranial hemorrhage (ICH) commonly results in death or severe, lasting neurologic disability. The timing of ICH is also important for management of the next affected pregnancy in cases of FNAIT. This manuscript reviews the advantages and disadvantages of the different radiologic methodologies to identify and characterize ICH. It discusses the limits of ultrasound and the advantages of magnetic resonance imaging allowing avoidance of the radiation associated with computed tomography (CT) scans.

Radiologic–pathologic correlation was evaluated as a quality assurance tool by documenting error rates of 18 radiologists interpreting computed tomographic (CT) scans for acute appendicitis in 763 patients. The departmental error rate was 3.1%. Meaningful individual error rates could be determined in only the seven radiologists who interpreted ≥30 CT scans for acute appendicitis. Radiologic–pathologic correlation is an effective departmental monitor of interpretive accuracy, but individual accuracy can be assessed only for radiologists reading a large number of cases with pathologic proof.

We describe a boy, 10 years and 5 months old, who developed acute adrenal gland insufficiency which was confirmed by hormonal investigation. Abdominal magnetic resonance imaging showed unilateral enlargement of the right adrenal gland, whereas the other gland seemed normal - no cause was apparent. Three months later the patient presented with thrombosis in the right femoral vein and in the veins of the right leg. Autoantibodies against cardiolipin were strongly positive, while antinuclear antibodies and antibodies against double-stranded deoxyribonucleic acid were absent. There was no evidence of antiphospholipid syndrome associated with drugs, connective tissue disorders, or malignancies, strongly suggesting the diagnosis of primary antiphospholipid syndrome. The development of adrenal insufficiency has been reported in primary antiphospholipid syndrome due to adrenal hemorrhage following vascular occlusion of adrenal vessels or secondary to anticoagulant therapy. It was interesting to note that in our patient adrenal gland insufficiency preceded other clinical evidence of the syndrome by 3 months. The primary antiphospholipid syndrome should be considered a possible cause of Addison's disease when the etiology is not obvious. Copyright (C) 2002 S. Karger AG, Basel.

The prevalence of osteoporosis and the incidence of fractures are substantially lower in black than in white subjects, a finding generally attributed to racial differences in adult bone mass. Whether these racial differences are present in childhood is the subject of considerable interest, as the amount of bone gained during growth is a major determinant of future susceptibility to fractures. We measured the density and size of the vertebrae and femurs of 80 black and 80 white healthy children, 8-18 yr of age, matched for age, gender, height, weight, and stage of sexual development, using computed tomography. Race had a significant and differential effect on the bones in the axial and appendicular skeletons. In the axial skeleton, black children had greater cancellous bone density, but similar cross-sectional area of the vertebral bodies. In contrast, in the appendicular skeleton, black children had greater femoral cross-sectional area, but similar cortical bone area and cortical bone density. Compared to white children, vertebral bone density and femoral cross-sectional area at sexual maturity were, on the average, 10.75% and 5.7% higher, respectively, in black children. Such significant variations may contribute to the racial differences in the prevalence of osteoporosis between black and white adults.

Recent observations suggest that throughout life the size of the vertebral bodies in females is smaller than that in males even after accounting for differences in body size. To confirm these reports and to determine whether similar differences exist in the appendicular skeleton, detailed measurements of the sizes of the vertebrae and the femur were obtained using computed tomography in 30 pairs of prepubertal boys and girls matched for age, height, and weight. Anthropometric parameters as well as gender influenced the cross-sectional area of the vertebrae. Heavier children had greater vertebral cross-sectional area than slender children regardless of gender, and the vertebral bodies were found to be significantly smaller in girls than in matched boys (approximately 11%), both using Student's t test (P < 0.0001) and its multivariate analog, the Hotelling's T2 test (P < 0.0001). In contrast to these findings in the axial skeleton, gender status did not influence the size of the bones in the appendicular skeleton, and neither the cross-sectional area (3.28 +/- 0.84 vs. 3.10 +/- 0.56 cm2) nor the cortical bone area (1.80 +/- 0.37 vs. 1.85 +/- 0.36 cm2) at the midshaft of the femur differed between boys and girls. These values, however, correlated strongly with all anthropometric indexes, and multiple regression analyses indicated that both measurements were primarily related to weight. The results suggest that although increases in mechanical loading associated with growth are the main determinant of the cross-sectional properties of the appendicular skeleton in children, factors other than body mass and related to gender have a significant role in the regulation of the sizes of the bones in the axial skeleton.

The purpose of this study was to determine if the generalized osteosclerosis seen on skeletal radiographs of patients with osteopetrosis is associated with an increase in bone density.Five children (three girls, two boys, 6-12 years old) with autosomal dominant osteopetrosis who had sustained a fracture with minimal trauma had the density and area of cortical bone at the midshaft of the femur and the amount of cancellous vertebral bone per voxel measured by quantitative CT. Values for five children with osteopetrosis were compared with measurements for two control groups of healthy subjects matched for age, sex, Tanner stage of sexual development, race, weight, and height.Both the area of femoral cortical bone and the amount of cancellous vertebral bone per voxel were significantly greater in the children with osteopetrosis than in the healthy children. The density of bone in the children with osteopetrosis was the same as the density in the healthy subjects. Neither sex, age, height, or weight influenced bone density, and values were similar for all 15 children.The osteosclerosis depicted on skeletal radiographs of patients with osteopetrosis results from an increase in the amount of bone, not from an increase in the percentage of mineralized bone per unit volume of tissue.

To assess the value of computed tomographic (CT) measurements of cortical bone in children with osteopenia.The area and density of cortical bone in the midshaft of the femur were measured with CT in 37 children with osteopenia. Twenty had osteoporosis in one leg, nine had osteogenesis imperfecta (IO), and eight had vitamin D-resistant rickets. Comparisons were made between the CT measurements of the normal and abnormal extremities and between patients with OI or rickets and a group of 17 healthy, matched children.Sex, age, height, and weight did not influence cortical bone density; values were similar for the 17 control subjects. Children with osteoporosis and IO had reduced bone area but normal bone density. Compared with control subjects, patients with rickets had similar bone area but reduced bone density (869 mg/cm3 K2HPO4 +/- 79 [standard deviation] vs 1,132 mg/cm3 K2HPO4 +/- 41).CT measurements of area and density of cortical bone aided the differentiation of the various disorders that cause osteopenia in children.

Nodular fasciitis is a benign rapidly proliferating fibrous tumor that is common in adults but relatively uncommon in children. When present in children, nodular fasciitis is typically subcutaneous in location and involves the head and neck. We present a case of intramuscular nodular fasciitis involving the rectus abdominis muscle in an 11-year-old girl and discuss the importance of distinguishing this rare but benign lesion from a more aggressive sarcomatous process.

Adnexal torsion is rare before menarche. We report the case of a 10-year-old girl with persistent left lower quadrant pain proven by surgery to be caused by adnexal torsion due to a hemorrhagic cyst. Sonography showed a well-defined, complex, predominantly solid mass with some sound through-transmission and a small amount of fluid. The left ovary could not be distinguished from the mass; the right ovary appeared normal. Doppler sonography demonstrated no blood flow within the mass. MRI revealed a circumferential region of high signal intensity in the periphery of the mass and multiple hyperintense foci in the left ovary. (C) 2001 John Wiley & Sons, Inc.

A 21-year-old woman with tuberous sclerosis presented with abdominal distension and flank pain. Imaging studies, including CT and MR imaging, revealed bilateral renal mass lesions, containing fat and suggesting the diagnosis of tuberous sclerosis. However the imaging characteristics of one of these lesions differed from the others with no radiologically detectable fat tissue in this solid lesion suggesting renal cell carcinoma. Histopathological examination of this lesion in the left kidney revealed an angiomyolipoma within minimal fat tissue. The radiological diagnosis of angiomyolipomas with minimal fat tissue remains difficult and the differential diagnosis is discussed.

Pulmonary blastoma is a rare malignant primary lung neoplasm typically seen in adults that accounts for 0.3-1.3% of lung malignancies. It has been categorized as a subtype of sarcomatoid carcinoma according to the current World Health Organization Classification of Lung Tumours and is distinct from the more common pediatric lung tumor pleuropulmonary blastoma. We report a case of neonatal pulmonary blastoma, illustrating the imaging characteristics of this rare tumor. The subject of pediatric lung masses is confusing because the terms pleuropulmonary blastoma and pulmonary blastoma have been used interchangeably in previously reported cases. We recommend use of the current WHO classification to differentiate these lesions as additional cases are described. Additionally, we discuss distinctive cytogenetic features of this case.

Segmental intestinal dilatation is a rare entity presenting overwhelmingly in infants and young children with congenital malformations, anemia, or history of gastrointestinal pathology, characterized by a focally distended segment of bowel with abrupt transition points without an obstructing barrier. We present a 16-year-old girl with no significant medical history who presented with bowel obstruction clinically. Segmental dilatation of the ileum was evident on a CT scan and small bowel series. Following surgical resection, pathologic examination of the segment revealed the presence of heterotopic gastric mucosa. The girl’s symptoms resolved after surgery. Awareness of the imaging presentation of this entity can inform the evaluation of older children with nonspecific symptoms mimicking bowel obstruction.

Cross-fused renal ectopia is an uncommon anomaly, typically drained by 2 ureters. We present a rare case of a patient with bilateral absence of the vas deferens found to have a "cake" or "lump" kidney with fused collecting systems drained by a single ureter.

The median nerve is one of the most commonly affected peripheral nerves in various pathologies such as entrapment syndromes or transections. The diagnostic procedures applied in these situations are electromyography, physical examination methods, ultrasonography, and magnetic resonance imaging. Diffusion tensor imaging (DTI) has been used mostly in imaging the central nervous system (CNS) to visualize white matter tracts. Several studies have shown the clinical applications of DTI in neuronal disorders such as stroke, epilepsy, and CNS tumors. Recently, peripheral nerves have been visualized with DTI. Also, in several pathologies such as carpal tunnel syndrome and transection of the median nerve, on postoperative follow-up anisotropy indexes were shown to be affected. However, new studies with larger series are needed. Copyright © 2009 by Thieme Medical Publishers, Inc.

The authors describe common embryological pathways responsible for coexistent neurenteric and enterogenous cysts in a patient with spinal dysraphism.

The purpose of this study was to determine the normative apparent diffusion coefficient (ADC) values at 3T using high b-value (3000 s/mm(2)) diffusion-weighted images (DWI) and compare the signal characteristics of the high b value with standard b-value (1000 s/mm(2)) DWI.Institutional review board approval was obtained for this prospective study which included 20 volunteers (10 M, 10 F, mean age: 38.7+/-14.9) without any known clinical disease or radiological findings. All brain examinations were performed with 3T MR by using similar parameters of b1000 and b3000 DWI sequences. DWI and ADC maps were obtained. Signal intensity, noise, signal to noise ratio (SNR), contrast to noise (CNR), contrast ratio (CR), and ADC values of bilateral posterior limb of internal capsule, frontal white matter, parietal gray matter, pons, thalamus, splenium of corpus callosum were measured on b1000 and b3000 DW images.In all anatomic locations, MR signal intensity, SNR and ADC values of b3000 images were significantly lower than MR signal intensity, SNR and ADC values of b1000 images (p0.001). The CNR and CR values at the posterior limb of internal capsule and pons were significantly increased on b3000 images (p0.001) and decreased in the other regions measured.The ADC values calculated from standard b-value DWI were significantly higher than those calculated from high b-value DWI. These results agree with the previous studies. In the regions where CNR values increase with high b value, b3000 DWI images may provide additional clinical information.

The aim of this study was to assess the feasibility of diffusion tensor imaging (DTI) of the prostate and to determine normative fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of healthy prostate with a 3-Tesla magnetic resonance imaging (MRI) system. Thirty volunteers with a mean age of 28 (25-35) years were scanned with a 3-Tesla MRI (Intera Achieva; Philips, The Netherlands) system using a six-channel phased array coil. Initially, T2-weighted turbo spin-echo (TSE) axial images of the prostate were obtained. In two subjects, a millimetric hypointense signal change was detected in the peripheral zones on T2-weighted TSE images. These two subjects were excluded from the study. DTI with single-shot echo-planar imaging (ssEPI) was performed in the remaining 28 subjects. ADC and FA values were measured using the manufacturer supplied software by positioning 9-pixel ROIs on each zone. Differences between parameters of the central and peripheral zones were assessed. Mean ADC value of the central (1.220 +/- 0.271 x 10(-3) mm(2)/s) was found to be significantly lower when compared with the peripheral gland (1.610 +/- 0.347 x 10(-3) mm(2)/s) (P0.01). Mean FA of the central gland was significantly higher (0.26), compared with the peripheral gland (0.16) (P0.01). This study shows the feasibility of prostate DTI with a 3-Tesla MR system and the normative FA and ADC values of peripheral and central zones of the normal prostate. The results are compatible with the microstructural organization of the gland.

OBJECTIVE. The purposes of this study were to visualize the human median nerve on diffusion tensor imaging and to determine the normal fractional anisotropy (FA) value and apparent diffusion coefficient (ADC) of the normal median nerve. SUBJECTS AND METHODS. The wrists of 20 healthy volunteers and of two patients with carpel tunnel syndrome were examined with a 3-T MRI system with a standard eight-channel sensitivity-encoding head coil. Diffusion tensor imaging was performed with a spin-echo echo-planar sequence. A T1-weighted sequence was performed for anatomic reference. After tractography, the FA value and ADC of the whole nerve were calculated automatically. Manual focal measurements also were obtained at the levels of the flexor retinaculum, wrist, and forearm. RESULTS. We visualized the median nerve with MR diffusion tensor tractography and followed the nerve for approximately 77.5 mm. We found the normative diffusion values of the median nerve were an FA of 0.709 ± 0.046 (SD) and an ADC of 1.016 ± 0.129 × 10-3 mm 2/s. There was a statistically significant difference between the FA values obtained at the level of the flexor retinaculum and the values obtained from the other parts of the median nerve (p < 0.0001). We found a decrease in FA value (p < 0.01) and an increase in ADC (p < 0.05) with advancing age. CONCLUSION. The normative diffusion values of the human median nerve can be used as a reference in evaluation, diagnosis, and follow-up of entrapment, trauma, and regeneration of the median nerve. © American Roentgen Ray Society.

Gastroschisis and hypertrophic pyloric stenosis rarely occur in the same patient, with few reports of this unusual association published to date. We describe a neonate with prenatally diagnosed gastroschisis treated with interval silo reduction and closure. Following definitive repair, the patient had a 30-day interval of difficulty feeding and occasional emesis that progressed to projectile vomiting. Upper GI series was consistent with hypertrophic pyloric stenosis. Upon surgical exploration, multiple gastric adhesions were found to cause a 180° organoaxial gastric volvulus with aberrant relocation of the pylorus to the left upper quadrant. Following adhesiolysis and reduction of the volvulus, a Ramstedt pyloromyotomy was performed on the hypertrophied pylorus. Postoperatively, the patient's diet was advanced as tolerated, and he was discharged home on postoperative day 10.

To test the repeatability, reproducibility and accuracy of the three-point Dixon (3PD) sequence for estimating true fat volume ratios using a fat/water phantom.A phantom, constructed from test tubes of varying fat content, was imaged using the 3PD sequence on a 1.5T MRI scanner by two operators four times each. Fat volume ratios were calculated from these images and compared with true fat volumes.Measures of fat volume ratios calculated from the 3PD MR images correlated strongly with values for true fat volumes (r = 0.96).The 3PD technique was found to be highly reproducible and accurate, and may be useful for in vivo quantification of fat in lean tissues, such as the liver, pancreas or skeletal muscle.

Background: It has been suggested that increased hepatic and intramuscular fat is associated with insulin resistance, and that increased pancreatic fat is related to impaired insulin secretion. Objective: We postulated that in obese nondiabetic teenagers insulin levels would be directly related to increases in intramuscular and hepatic fat and inversely related to increases in pancreatic fat. Materials and methods: MRI was used to assess the percentage of fat in the liver, muscle and pancreas in 15 healthy Mexican-American girls, 14–17 years old, with body mass indexes (BMIs) ranging from 17.7 kg/m2 to 46 kg/m2. Results: Strong correlations were observed between BMI and fat content in the liver, muscle, and pancreas (r2s between 0.50 and 0.89; P

Objective: The purpose of this study was to determine the role and cost effectiveness of surveillance imaging at the management of pediatric brain tumors. Materials and methods: In this study, the imaging and clinical finding of 59 patients who had been diagnosed and followed by the Dokuz Eylul University Pediatric Oncology Group as primary central nervous system tumors between 1988 and 2000 were retrospectively evaluated. Results: We found that the 87.5% of tumor recurrence occurs within 21 months and 93.8% occur within 29 months. About 25% of these recurrences were asymptomatic and these (n=16) could be detected by surveillance imaging with a frequency rate of 1.59%. The cost of imaging for our patients was calculated to be 788 US$ (mean) for a follow-up period of 24 months which would have been 739 US$ if a standard surveillance protocol would have been followed. Conclusion: Surveillance imaging is an effective follow-up in detecting symptomatic recurrence in pediatric brain tumors.

Hemifacial microsomia is a craniofacial disorder involving structures derived from the first and second brachial arches. Bony structures, soft tissue, and the facial nerve can all be hypoplastic or absent. In this retrospective study of 70 patients at the Children's Hospital Los Angeles, craniofacial dysmorphology, temporal bone computed tomography, and audiological evaluations were examined. The purpose of this study was to identify further relationships between clinical findings, temporal bone anatomy, and audiological findings in these patients. Significant relationships were identified between total radiographic score and overall clinical findings (p < 0.001). Clinical measurements of mandibular hypoplasia were also predictive of temporal computed tomographic findings (p < 0.001), whereas clinical ear findings were related specifically to specific temporal bone abnormalities such as hypoplasia of the middle ear (p = 0.008) and fusion or absence of ossicles (p < 0.001). Interestingly, neither clinical findings nor temporal bone computed tomographic findings were related to either hearing loss type or degree. Audiology should not be deferred on the basis of relatively mild clinical findings.

This multicentric study aimed to bring neuroblastoma patients together under IPOG-NBL-92 protocol and evaluate the results within the period between 1992 and 2001 in Izmir. Sixty-seven neuroblastoma patients from 4 pediatric oncology centers in Izmir were included in the study. IPOG-NBL-92 protocol modified from German Pediatric Oncology (GPO)-NB-90 protocol was applied: Patients in stage 1 received only surgery, while surgery plus 4 chemotherapy courses (cisplatin, vincristine, ifosfamide) were given in stage 2 and surgery plus 6 chemotherapy courses (cisplatin, vincristine, ifosfamide, epirubicin, cyclophosphamide) were given in stages 3 and 4 patients. In patients who were kept in complete remission (CR), a maintenance therapy of one year was applied. Radiotherapy was given to the primary site following induction chemotherapy plus surgery in stages 3 and 4 patients with partial remission (PR). The stages of the patients were as follows: 5% in stage 1, 39% in stage 3, 49% in stage 4, and 7% in stage 4S. Primary tumor site was abdomen in 88% of cases. CR rates were as 100% in stage 1, 76% in stage 3, 35% in stage 4, and 75% in stage 4S. Relapse was observed in 32% of patients in a median of 19 months. The median follow-up time for survivors was 33 (17-102) months. Five-year OS rate was 31% and the EFS rate was 30% in all patients. Five-year overall and event-free survival rates were 63 and 30% in stage 3, but 6 and 5%, respectively, in stage 4 patients. Univariate analysis established that the age, stage, primary tumor site, and high LDH and NSE levels conferred a significant difference. The IPOG-NBL-92 protocol has proved to be satisfactory with tolerable toxicity and reasonable CR and survival rates. However, more effective treatments suitable to Turkey's social and economic conditions are urgently needed for children over 1 year of age with advanced neuroblastoma.