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Infection during pregnancy is common and the developing fetal brain is vulnerable to vertical transmission due to immaturity of the fetal immune system. Infection is a major cause of multiple organ abnormalities, including the neuraxis, due to the neurotropism of the infectious agents. This review sets out to give an overview of fetal infection, review the general principles of the nature and timing of the infectious insult with respect to outcomes, review the neuroimaging of infection by ultrasound and magnetic resonance imaging (MRI), and review the various pathogens involved, including the two most common, cytomegalovirus (CMV) and Toxoplasma, and also other common viral and nonviral infections.

In questo lavoro, sulla base della nuova classificazione di Van der Knapp e Valk, sono state trattate le malformazioni congenite del Sistema Nervoso Centrale diagnosticabili nel feto e nel neonato con l'ecotomografia. Particolare attenzione è stata rivolta alla precisa caratterizzazione semeiologica di ciascuna malformazione nel tentativo di puntualizzare gli elementi necessari per una corretta diagnosi differenziale ecotomografica.

Early slipped capital femoral epiphysis (ESCFE) can be treated surgically, with excellent results, if it is diagnosed in its initial stage; however, the rate of late or missed diagnoses remains surprisingly high.We compared radiography, US and MR sensitivity in ESCFE diagnosis.We examined 21 symptomatic overweight patients (15 boys and 6 girls) aged 9 to 15 years with anteroposterior radiographs; frog leg images were not acquired in 3 cases only. US was performed in 19 cases and the images acquired with 5-7.5 MHz probes on the sagittal plane parallel to the femoral neck. MRI was performed in 9 cases, with coronal and sagittal T1 SE and T2* GE images.Our sensitivity rates were 66% for anteroposterior radiography (6 false negatives), 80% for combined anteroposterior and frog leg images (3 false negatives), 95% for US (1 false negative) and 88% for MRI (1 false negative).We believe that US is the method of choice in ESCFE diagnosis; if it is negative, but pain persists, MRI should be performed.

Chronic inflammatory bowel disease (CIBD) in children is represented mainly by ulcerative colitis (UC) and Crohn's disease (CD). Infectious forms, Behçet's disease and eosinophilic gastroenteritis are not included in this study. UC and CD are difficult to diagnose and to treat, and require a multispecialistic approach including pediatric gastroenterologists, surgeons, radiologists, endoscopists and pathologists. Progress in diagnostic techniques--i.e., nuclear medicine procedures, conventional, duplex and color-Doppler US, and endoscopy--has increased our knowledge of these diseases and it has made their diagnosis easier, opening new therapeutic perspectives. In our paper, after mentioning the major clinical and radiologic features of CIBD, we report on the patients hospitalized in the Gaslini Institute from 1984 to 1994. Thirty-six patients (age range: 3,9 to 14 years) were examined with several imaging techniques--i.e., plain radiography, US, contrast studies and CT--according to the clinical presentation and behavior of the disease. X-ray studies played the leading role in imaging mucosal disease spread (double contrast studies) and monitoring "surgical" complications (plain radiography). These techniques, which were always combined with US and, in some cases, CT, are also a major tool to study extraluminal CIBD spread--i.e., fistulas, pseudotumors, lymph nodes, abscesses and mesenteric changes. Color-Doppler US may play a critical role in the differential diagnosis of these and other small and large bowel pathologic conditions. The most typical CD patterns in bowel disease are listed in the paper, to give a contribution to the differential diagnosis of the chronic abdominal pain syndrome which is a very common condition in children.

Renal artery stenosis (RAS) in renal transplanted pediatric patients is a long-term complication. The clinical suspicion must be considered when patients exhibit signs of impaired renal function or refractory hypertension, not associated with other complications of renal transplantation -i.e., acute or chronic rejection, glomerulonephritis, cyclosporine toxicity. The intermediate step between clinical suspicion and angiography is represented by Doppler US. The authors report their experience with Doppler US in the screening of RAS in a pediatric series of transplanted patients. The incidence of RAS in our series (54 transplanted kidneys, 46 of them included in the study) was 4.3%. A severe stenosis was demonstrated by both Doppler US and angiography in 2 patients, with 100% Doppler sensitivity. In both stenoses, Doppler US showed high systolic peaks (blood flow velocityor = 2.5 m/s) and post-stenotic turbulence. Thanks to its high sensitivity, Doppler US is considered to be very useful in the screening of vascular complications in renal transplanted children.

Surgical closure of patent ductus arteriosus (PDA) and perioperative time have been proposed as conditions of increased risk of peri-intraventricular hemorrhage (PVH-IVH) in preterm infants. We examined by pre- and postoperative ultrasound (US) scan 15 low birth-weight neonates who underwent PDA ligation within the first two weeks of life. They were assessed with regard to clinical state, perioperative management and development of PVH-IVH. Fourteen did not show onset or extension of intracranial hemorrhage in the immediate postoperative period. One patient developed a wide III grade IVH in the 24 perioperative hours. His conditions were particularly severe, suggesting that many factors such as acidosis, hypoxia, hypercapnia and hypotension might have combined to lead to hemorrhage. We conclude that PDA ligation is not likely to increase the risk of PVH-IVH per se.

The sonographic diagnosis of cerebral hemorrhage, in preterm infants is quite easy. On the contrary the prematurity degree of the patient and the anatomic location of the intracerebellar hemorrhage makes of this important lesion a difficult diagnosis to achieve. We present our results of 248 preterm infants scanned by ultrasound, in our Institute, to detect intraventricular or subependymal hemorrhage. Out of the 248 patients the incidence of SEH or IVH was 21%, only 1 case of intracerebellar hemorrhage, as complication of IVH-SHE, was found. Another intracerebellar hemorrhage was diagnosed in a full term newborn without other signs of hemorrhage.

The authors report their experience in 8 cases of cranial post-traumatic superficial collections, studied by US. Traumatic cranial injuries with superficial collections are not rare in newborns; their early and complete diagnosis is necessary for a correct therapeutic approach. Sonography could be used as a first choice procedure but presents some limitations in the study of the posterior fossa. Therefore CT remains the technique of choice.

The congenital hip dysplasia is based on an abnormal acetabular rim, with pathologic capsula and ligaments. These pathologic structures can lead to the subtotal or total dislocation of the hips. In newborns the joint cartilaginous structures, can be visualized by sonography and it is possible to diagnose the different grade of dysplasia. Our series, in part previously selected, consist in 1120 joints. The results in newborns up to 3 months of age are: normal joints 79.5%, immature 10.7%, pathologic 9.8%. After 3 months of age: normal joints 93%, dysplastic 5.2%, subdislocated 0.6%, dislocated 1.2%. In all the cases we used the morphologic Graf technique and in newborns also the dynamic examination according to Novick to precise the minimal degree of the instability of the hips. Sonography permits an early diagnosis of hip dysplasia without false positive or negative results.