Search

Background Accurate estimation of kidney size and volume in the solitary functioning kidney is crucial because of a higher risk of developing kidney injury. MRI is an accurate method and is suitable for kidney volume measurement. Usually, axial axis images and measurement methods are preferred for kidney volume measurements. However, the anteroposterior diameter of the kidney is smaller than the longitudinal diameter, meaning that imaging in the coronal axis could provide needed information in a shorter time, enabling imaging of younger patients without sedation. Therefore, the purpose of this study was to compare coronal and axial axis kidney volume measurement methods and evaluate intra-observer and inter-observer reliability. Methods Axial axis T2W and coronal axis FIESTA images of kidneys were obtained with 10 mm slice thickness and no slice gap in pediatric patients with congenital solitary kidneys. Free-hand manual tracing was used to calculate volumes in both methods. Images were analyzed by two operators with different levels of experience. The expert operator computed solitary kidney volume twice in both methods for the intra-observer reliability, while the beginner operator's measurements were used for the inter-observer reliability. Results High intra-observer (0.965 for axial and 0.972 for coronal) and inter-observer reliability were revealed (0.964 for axial and 0.963 for the coronal) for both measurement methods. Conclusion The coronal plane volume measurement method, which has a significantly shorter examination and post-processing time, is a highly reproducible and reliable method that can enable volume measurement with MRI in younger children, as the imaging time will be shortened. Graphical abstract, Author(s): Derya Bako [sup.1] , Adem Yasin Köksoy [sup.2] , Mehmet Turmak [sup.3] Author Affiliations: (1) Department of Pediatric Radiology, Van Regional Training and Research Hospital, , Van Bölge Egitim [...]

Introduction: The failure of the normal ascent of the kidney can result in ectopic kidneys (EK) and fusion anomalies. EKs are often accompanied by urological and extrarenal abnormalities. This study aims to provide a comprehensive overview of EKs, associated renal and extrarenal anomalies, and kidney functions among patients with simple and cross ectopic kidneys. Materials and Methods: Clinical records of patients diagnosed with EK admitted to the pediatric nephrology unit between June 2017 and June 2022 were retrospectively evaluated. Results: In this study, 41.20% (n: 61) of patients had crossed ectopic (CE) kidneys. The most common type of crossed ectopia was inferior CE (n:33 56.9%). The most frequent presenting features were an empty renal fossa (7.40%, n: 11). During the first evaluation, 18.91% (n:28) of patients had hydronephrosis, most of which were mild (SFU 1-2). Vesicoureteric reflux (VUR) was evident in 7.4% of patients. The mean DMSA (dimercaptosuccinic acid) uptake was lower in EK (40.37±7.31) compared to orthotopic kidneys. Comparison of simple and CE kidneys showed similar results regarding the presence of hydronephrosis, vesicoureteral reflux (VUR), and differential function of EKs. In both groups, serum creatinine levels and estimated glomerular filtration rate (eGFR) were preserved. Conclusion: Patients with ectopic kidneys often present with renal and extrarenal anomalies. Although hydronephrosis is a common occurrence, it is usually mild and transient, and incidence of vesicoureteral reflux is low. Considering the preservation of renal function in mid-term period, it may be more appropriate to evaluate each patient's need for a complete urological examination on a case-by-case basis. [ABSTRACT FROM AUTHOR]

PURPOSE This study aimed to detect supratentorial cortical and subcortical morphological changes in pediatric patients with infratentorial tumors. METHODS The study included 24 patients aged 4-18 years who were diagnosed with primary infratentorial tumors and 41 age- and gender-matched healthy controls. Synthetic magnetization-prepared rapid gradient echo images of brain magnetic resonance imaging were generated using deep learning algorithms applied to T2-axial images. The cortical thickness, surface area, volume, and local gyrification index (LGI), as well as subcortical gray matter volumes, were automatically calculated. Surface-based morphometry parameters for the patient and control groups were compared using the general linear model, and volumes between subcortical structures were compared using the t-test and Mann--Whitney U test. RESULTS In the patient group, cortical thinning was observed in the left supramarginal, and cortical thickening was observed in the left caudal middle frontal (CMF), left fusiform, left lateral orbitofrontal, left lingual gyrus, right CMF, right posterior cingulate, and right superior frontal (P < 0.050). The patient group showed a volume reduction in the pars triangularis, paracentral, precentral, and supramarginal gyri of the left hemisphere (P < 0.05). A decreased surface area was observed in the bilateral superior frontal and cingulate gyri (P < 0.05). The patient group exhibited a decreased LGI in the right precentral and superior temporal gyri, left supramarginal, and posterior cingulate gyri and showed an increased volume in the bilateral caudate nucleus and hippocampus, while a volume reduction was observed in the bilateral putamen, pallidum, and amygdala (P < 0.05). The ventricular volume and tumor volume showed a positive correlation with the cortical thickness in the bilateral CMF while demonstrating a negative correlation with areas exhibiting a decreased LGI (P < 0.05). CONCLUSION Posterior fossa tumors lead to widespread morphological changes in cortical structures, with the most prominent pattern being hypogyria. CLINICAL SIGNIFICANCE This study illuminates the neurological impacts of infratentorial tumors in children, providing a foundation for future therapeutic strategies aimed at mitigating these adverse cortical and subcortical changes and improving patient outcomes. [ABSTRACT FROM AUTHOR]

Objective: The purpose of our study was to devise a new brain Magnetic Resonance Imaging (MRI) scoring system based on the Loes and modified Loes scores in phenylketonuria (PKU) patients. Materials and Methods: The brain MRI scans of patients with late diagnosed PKU were evaluated retrospectively. Patients’ age at diagnosis, age at which diet started, age at MRI, and, blood phenylalanine (Phe) levels at the time point closest to the MRI were recorded. Results: Eleven patients aged from 3 to 28 years were included in the study. The median MRI involvement score was 17 (interquartile range = 3). The most involved white matter areas were the parietooccipital areas. There was a significant (P = .046) correlation between the blood Phe level at the timepoint closest to the imaging and the MRI involvement score. Conclusion: Our study provides insights into the MRI findings and scoring system in PKU patients. We have developed a scoring system based on the widely used Loes and modified Loes scoring systems that can be implemented in clinical practice. Also, our study contributes to the long-forgotten and largely abandoned area-imaging findings in late diagnosed and untreated PKU patients and set the stage for the future research in this field. [ABSTRACT FROM AUTHOR]

The liver is the second potential target organ of COVID-19 after lungs. However, the COVID-19 induced liver injury's definition, clinical importance and even the real existence of a clinically important liver injury during the disease course is still unclear. Therefore, in seeking information about the existence of the liver injury we decided to evaluate sonographic findings and consecutive tissue stiffness alterations with shear wave elastography in critically ill COVİD-19 patients. A total of 28 critically ill COVID-19 patients from ICU were randomly enrolled in this study between October 2020 and December 2020. US and SWE findings, age, gender, comorbidities, previous liver disease history, aspartate transaminase (AST), and alanine transaminase levels (ALT) were recorded. A total of 28 participants were included in this study, data for the 19 participants were evaluated. Hepatomegaly was detected in 12 (63%) cases. 2 patients had periportal cuffing whi le 1 patient had hepatosplenomegaly. The mean liver stiffness value was 4.73 kPa with a reference range between 2.55 and 8.49 kPa. Only one patient's liver stiffness value exceeded normal limits. The mild increase of liver function biomarkers, the lack of typical sonographic findings for virus-induced hepatitis and lack of any significant increase in tissue stiffness expected in acute hepatitis, are not supporting the previous hypotheses of direct virus-mediated liver damage due to COVID-19. On the contrary, a mild liver injury seen in these patients may be attributed to the collateral liver damage mainly from dysregulated and severe immune response. [ABSTRACT FROM AUTHOR]

The genitourinary system is the second most common site involved in brucellosis, and epididymo-orchitis is the most common presentation of genitourinary system involvement in males. Grayscale ultrasound of the right testis showing (a) a diffusely enlarged right testis with heterogeneous and patchy hypoechoic areas (arrows), (b) a well-defined hypoechoic lesion in the upper pole (arrows) and (c) a diffusely enlarged and hyperechoic spermatic cord and tail of the epididymis. The genitourinary system is the second most common site involved in brucellosis, and epididymo-orchitis is the most common presentation of genitourinary system involvement in males.1 The rate of epididymo-orchitis in patients with brucellosis is considered to be 2-20%.3 Imaging features and involvement patterns are usually non-specific and indistinguishable from other more common pathologies, which makes diagnoses more difficult, especially in patients with scrotal involvement as the initial presentation. [Extracted from the article]

Objective: Malformations of cortical development (MCD) are rare central nervous system abnormalities that are caused by disruption of normal cortical development stages, including neural cell proliferation, cell type differentiation, neuronal migration, and final neuronal positioning. It has different phenotypic presentations which largely depend on the underlying cause of the disorder and is associated with other neurologic and systemic disorders. MCD frequently present with seizures, various degrees of developmental delay, and intellectual disability. Material and Methods: The findings of clinical, laboratory, electrophysiological, and magnetic resonance imaging of thirty-six patients diagnosed with MCD in the last five years have been reported. Responses to drug therapies in epileptic patients and phenotypic expressions in patients with the genetically proved mutation were also reviewed. Results: Developmental delay, intellectual disability, and seizures (%72) were the main clinical findings. MCD has been recognized with magnetic resonance imaging in all patients. Diffuse cortical malformations have been detected in a third of our patients. Single and/or multiple brain lobe involvements have been determined in other patients. Congenital muscular dystrophy was the most diagnosed disease in the patients who had elucidated with genetic tests. Conclusion: Seizures, developmental delay, and intellectual disability could be caused by many disorders including MCD. The type and diffusiveness of the MCD, associated neurologic and systemic findings should be accurately evaluated. Recent developments in genetic methods have improved the accurate diagnosis, prognosis prediction, and treatment planning strategies in patients with MCD. [ABSTRACT FROM AUTHOR]

Mitochondrial encephalomyopathy, lactic acidosis, and recurrent stroke-like episodes (MELAS) syndrome is a rare but one of the most common maternally inherited multisystem disorder. Although patients with MELAS present a variable clinical profile, strokelike lesions have been detected in 90% of cases, with stroke being the first presenting symptom in 25% of cases. However, cases of local brain edema requiring decompressive craniectomy has not been reported. A 12-year-old male patient was admitted to our pediatric intensive care unit with altered mental status, seizures, and vision loss. The patient was stuporous and presented neck stiffness. Complete blood count, serum electrolytes, biochemistry (including lactate level), acute phase reactants, and repeated blood gas analysis were unremarkable. Brain magnetic resonance imaging (MRI) revealed an edematous stroke-like lesion in the right occipital lobe accompanied by brain swelling. Intravenous ceftriaxone, acyclovir, intravenous immunoglobulin (IVIG), and pulse steroid therapy were started for possible diagnosis of viral/bacterial/autoimmune encephalitis; levetiracetam, phenytoin, and an infusion of sodium thiopental were started for refractory status epilepticus; and a 3% NaCl infusion was started for local brain edema. The results of serum autoimmune encephalitis panel were negative. Further investigations for rheumatic, vascular, and metabolic disorders were unremarkable. Despite these supportive treatments, the patient was clinically decompensated due to brain swelling that progressed to the left midline shift, and he underwent decompressive craniectomy. Histologic examination of brain biopsy specimen revealed non-specific encephalitis findings. A pathogenic variant of the MT-TL1 gene (m.3243A > T), responsible for MELAS, was detected. The patient?s condition dramatically improved after specific treatment for MELAS. If the diagnosis and treatment are delayed, MELAS syndrome can cause serious brain edema, which may ultimately require decompressive craniectomy.