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ABSTRACT |
Tuesday, May 2, 11:20 AM–12:30 PM
Abstracts 090–095
Moderators: Harriet J. Paltiel, MD and Stefan Puig, MD
11:20 AM
090. MR Imaging of Normal Developmental Changes in Pediatric Female Pelvis
Gundogan M.*; Babyn P.; Chaudry G.; Diagnostic Imaging Department, University of Toronto. Hospital for Sick Children, Toronto, ON, Canada.
Address correspondence to M. Gundogan (mgundogan04{at}hotmail.com)
Objective: The purpose of this study is to establish normal developmental changes of the female pelvic organs on MRI in a pediatric population.
Materials and Methods: Retrospective review of all pelvic MR examinations performed in females over a 6-year period (from January 1999 to September 2005) were analyzed. Children with a history of previous abdominal/pelvic surgery, or radio/chemotherapy were excluded. In patients with multiple exams, only one was included in the study. A total of 141 patients were found and classified into four main groups by age. Group 1 (0–1years) n = 8; Group 2 (1–8y) n = 27; Group 3 (8–12y) n = 31; Group 4 (12–18) n = 75. Uterine, cervical, vagina and ovarian dimensions were calculated. The MRI appearance and thickness of the inner myometrium and endometrium was also assessed. The volume of the uterus, cervix, and ovaries was approximated according to its geometrical shape. The signal intensities, enhancement patterns and the configuration of the female pelvic organs were evaluated by Pearson correlation method. The MRI technique used was also evaluated.
Results: Between Groups 1 to 4, the uterine volume varied from 0.6 to 136 cm3, whilst the cervical and ovarian volumes measured between 08–22 cm3 and 0.6–27 cm3, respectively. The uterus:cervix ratio extended from 0.8 to 24, and the area of the vagina from 0.04 to 15 cm2. The infantile and postmenarchal uterus showed three distinct layers; hyperintense endometrium, dark inner myometrium and intermediate outer myometrium on T2 weighted and post contrast images, whilst the majority of the premenarchal uteri were homogeneously hyperintense on T2, with uniform hyper-intensity on the postcontrast images. The vagina significantly increases in size in the postmenarchal period, with associated mucosal hypertrophy.
Conclusion: MR imaging has become an important modality for the assessment of the pelvic organs in children. Extensive changes are evident on MRI during development. The radiologist should be aware of the expected appearance as a function of age.
091. Filar Cyst on Spinal Ultrasound: A Case-Control Study of Motor Milestone Attainment
Irani N.1*; Goud A.R.2; Lowe L.H.3; 1. Diagnostic Radiology, Allegheny General Hospital, Pittsburgh, PA; 2. School of Medicine, University of Missouri-Kansas City, Kansas City, MO; 3. Diagnostic Radiology, Children's Mercy Hospital and Clinics, Kansas City, MO.
Address correspondence to N. Irani (nirani{at}wpahs.org)
Objective: The aim of this study is to investigate the significance of simple cysts found within the filum terminale (or filar cysts) of neonates on lumbar spine sonography. These "cysts" are relatively common, but to date no study has established whether they are of any clinical significance. Attainment of developmental milestones in infants with solitary filar cysts is compared to those of age and sex matched controls.
Materials and Methods: A retrospective review of 664 consecutive lumbar spine sonograms over a 32 month period was performed to identify neonates with a filar cyst. A cohort of gestational age and sex matched controls were taken from the same period. Clinical follow up for achievement of developmental motor milestones was performed for each group, and an analysis for statistically significant difference between the cases and control population was performed.
Results: Overall, 78 of the 664 (11.7%) lumbar sonographic examinations demonstrated a filar cyst (37 male: 41 females). The incidence of filar cysts was highest in examinations done in infants less than 1 week of age (19.5%), and detection declined with increasing age. No filar cysts were seen on spinal ultrasound in infants greater than 6 months of age. Developmental follow up obtained for infants with filar cysts and the control population showed no statistically significant difference (all p values > 0.5) in the ages at which infants were able to turn over (4.9 mo ± 1.7 mo vs. 5.1 mo ± 1.4 mo), crawl (9.4 mo ± 1.4 mo vs 9.2 mo ± 2.3 mo), or walk (13.2 mo ± 3.6 mo vs 13.1 mo ± 3.4 mo).
Conclusion: This case control analysis demonstrates no difference in attainment of developmental milestones in infants with solitary filar cysts found at sonography compared to a control population. The higher prevalence of filar cysts on ultrasounds done at a younger age and lack of significant clinical motor deficits is consistent with the theory that filar cysts may be a normal embryologic remnant, requiring no clinical or imaging follow up when found in isolation on lumbar sonography.
092. Computed Tomography-Guided Lung Biopsies in Children
Katz L.; Amaral J.G.*; Connolly B.; Temple M.; John P.; Chait P.G.; Department of Diagnostic Imaging - Image Guided Therapy Centre, The Hospital for Sick Children, Toronto, ON, Canada.
Address correspondence to J.G. Amaral (joao.amaral{at}sickkids.ca)
Objective: To evaluate the accuracy and effectiveness of computed tomography (CT) guided lung biopsies in children.
Materials and Methods: A retrospective chart analysis of 53 children submitted to 59 CT guided lung biopsies from January 1991 to October 2003, was conducted. All patients with peripheral lung lesions biopsied under ultrasound guidance were excluded. Lesion sizes ranged from 0.2 cm to 4.5 cm in diameter. Demographic data, biopsy technique, histopathological results and complications were reviewed. Complication rates were based on immediate complications following the procedure. Research Ethics Board approval was obtained.
Results: Patients mean age was 11.8 years (range = 2 to 18 years). A co-axial technique was used in 38 out of 53 of the patients (71.7%). Samples were adequate for histopathological diagnosis in 47 out of 59 of the biopsies (80%). Minor complications, such as hemorrhage, occurred in 24 out of 59 of the biopsies (37.3%). The rate of pneumothorax was 27.1% (16 out of 59 of the biopsies), all of which occurred if more than one pleural puncture was made during the procedure. One patient (1.9%) presented with a hemothorax. Two patients (3.8%) required the placement of a chest tube. One death (1.9%) occurred related to the procedure due to severe bleeding resulting in respiratory distress. This patient was immunosuppressed and had invasive aspergillosis.
Conclusion: CT-guided lung biopsy is an appropriate diagnostic tool for characterization of intrapulmonary lesions. However, clear discussion with referring team of adequacy and potential risks of the procedure are fundamental, as major complications or even death may happen.
093. Radiation Dose Reduction for Abdominal CT Imaging with Automatic Tube Current Modulation (ATCM) in Pediatric Patients
Zhu X.1; Mahboubi S.1*; Nance M.L.2; 1. Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA; 2. Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA.
Address correspondence to S. Mahboubi (mahboubi{at}email.chop.edu)
Objective: Evaluate dose reduction effectiveness of Automatic Tube Current Modulation (ATCM) combining with weight-adjusted mAs in pediatric patients undergoing abdominal CT.
Materials and Methods: Since September 2004, we implemented ATCM combined with weight-adjusted mAs schedule for pediatric abdominal imaging. We retrospectively reviewed contrast enhanced CT abdominal studies for maximum and minimum mAs from actual mAs with ATCM. The percentages of dose reduction of combined mAs scheme (ATCM and weight-adjusted mAs) from that of only weight-adjusted reduction method were estimated for 6 weight groups.
Results: For the period of study, we reviewed 74 patients (mean age: 9.2 years, range: 10 days to 19 years). On average, the combination of ATCM with weight-adjusted mAs reduces radiation dose by 15.0%+2.5% from the weight-adjusted only mAs dose. The percentage dose reduction increases with the increase of weight of the groups, from a 12% reduction in weight groups 2–9 kg to a reduction of more than 17% in weight groups 50 kgand above. On average, the overall dose reduction from the dose of single mAs setting is 60%, range from 14% to 82%. The lowest weight group demonstrated the highest percentage dose saving for weight-adjusted mAs plus ATCM over a single mAs setting dosage.
Conclusion: Institutions should consider adopting ATCM plus weight-adjusted mAs protocols for abdominal CT. The combination of ATCM with weight-adjusted mAs can reduce abdominal CT dose by 60% from single mAs protocols - an average of 15% from further reduction from only weight-adjusted pediatric protocols.
094. Increased Risk of Associated Anomalies in Children with Multicystic Dysplastic Kidney: A 10-year Experience
Daly J.C.2*; Estroff J.A.1; 1. Radiology, Children's Hospital Boston, Boston, MA; 2. Medicine, Newton-Wellesley Hospital, Newton, MA.
Address correspondence to J.C. Daly (daly2b{at}hotmail.com)
Objective: Patients born with multicystic dysplastic kidney (MCDK) are known to be at increased risk for other urologic abnormalities. The purpose of this study is to delineate whether these patients also have a higher incidence of associated anomalies in other organ systems. This information is important for prenatal counseling, prognosis and follow-up care.
Materials and Methods: We retrospectively reviewed the charts of 296 children who had MCDK from 1993–2003 at a major metropolitan children's hospital. We looked for described anomalies of any organ system, prematurity and disabilities.
Results: Of the 296 patients with MCDK, 7 (2%) patients had chromosomal abnormalities including 11q deletion, XYY, XO, monosomy 7, 22 microdeletion, partial trisomy 8p, partial monosomy 6q, and trisomy 20. 150 (51%) had an additional urologic anomaly, including 68 (23%) with reflux on VCUG. 33 patients (11%) had cardiac anomalies including ASD, VSD, PFO, PDA, coarctation, velocardiofacial syn, dextrocardia, endocardial cushion defect, hypoplastic pulmonary arteries, pulmonic stenosis, Tetrology of Fallot or Tricuspid Atresia. 24 (8%) had a reproductive organ abnormality, half of which involved malpositioned/undescended testes. 3 (1%) patients had VACTERL syndrome. 15 patients (5%) had a CNS anomaly including agenesis of the corpus callosum, arachnoid cyst, periventricular leukomalacia, hydrocephalus, infarct, immature sulcal gyral pattern, microopthalmia, myelomeningocele, cortical blindness, seizures or cerebral palsy. 10 (3%) patients had either a cleft palate or dysmorphic facies. 23 patients (8%) had an orthopedic anomaly, of these, 10 patients (3%) had either a hand or foot deformity. 34 (12%) patients were born prematurely (< 38 weeks).
Conclusion: In this cohort, patients with MCDK had an increased incidence of associated anomalies, including urologic, cardiac, reproductive, orthopedic and CNS abnormalities. Patients diagnosed with MCDK should have a detailed anatomic survey with particular attention to the genitourinary, cardiac, CNS and bony structures. Since almost a quarter of our cohort was found to have some form of urinary reflux, patients with MCDK should have a routine VCUG. Because of the incidence of premature birth in this cohort, fetuses with MCDK may be at risk for early delivery. If an associated anomaly is found, chromosomal analysis should also be considered.
095. MR Imaging Findings in Immunocompromised Children with Human Herpes Virus 6 Encephalitis
Provenzale J.M.*; Mukundan S.; White L.E.; Lewis D.V.; Radiology, Pediatrics and Physical Therapy, Duke University Medical Center, Durham, NC.
Address correspondence to J.M. Provenzale (prove001{at}mc.duke.edu)
Objective: To test the hypothesis that children with human herpesvirus 6 (HHV6) encephalitis have MR imaging features distinguishing them from those with suspected encephalitis who test negative for HHV6.
Materials and Methods: The study population consisted of 11 children (average age 9 years) with suspected HHV6 encephalitis who were immunocompromised for stem cell transplantation and underwent MR imaging and cerebrospinal fluid polymerase chain reaction testing for HHV6 DNA. Seven patients tested + and 4 patients tested -. Two neuroradiologists and a neuroanatomist blinded to HHV6 status reviewed 14 MR scans for abnormal signal in the frontal, temporal and insular cortex, hippocampal formation, amygdaloid complex, basal ganglia, basal forebrain, hypothalamus, thalamus, and frontal, parietal and temporal white matter. Post-mortem histology and immunohistochemistry for HHV6 was performed on one HHV6+ child with bilateral hippocampal abnormalities.
Results: Hippocampal signal abnormality was common in both groups (6 HHV6+ and 2 HHV6- patients) but only HHV6+ patients had signal abnormality outside the hippocampus. Among these HHV+ patients, 3 showed widespread abnormalities involving the entire hippocampal formation (hippocampus, subiculum, entorhinal cortex), most of the amygdaloid complex, portions of the insula, and, variably, orbital and medial prefrontal cortex, olfactory cortical areas, septal and basal forebrain nuclei, and medial hypothalamic nuclei. One of these 3 patients showed marked insular and temporal abnormality that extended into the subocortical white matter of central frontoparietal region and temporal lobe. Three other HHV6+ patients showed a less widespread distribution of abnormality restricted mainly to the hippocampal formation and posterior amygdaloid complex. Postmortem examination of one child showed subacute hippocampal sclerosis, severe neuronal loss, reactive astrocytosis and strong immunoreactivity for HHV6 proteins.
Conclusion: Widespread abnormalities in cortical and subcortical limbic structures, including hippocampal formation and amygdaloid complex, were only seen in HHV6+ children, allowing them to be distinguished from HHV- children.
* Will present paper
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