The purpose of the study was to determine the frequency of associated MR imaging findings in patients with symptomatic lumbar intraspinal synovial cysts, and to correlate MR with surgical findings. ...MR imaging studies of 18 patients with surgically and histopathologically proven lumbar intraspinal synovial cysts were retrospectively analyzed and correlated with surgical findings. The diameters of the synovial cysts ranged from 10 mm to 28 mm, with a mean of 16 mm. A nonhemorrhagic cyst was found in 15 patients (83%), and a hemorrhagic cyst in three patients (17%). Degenerative spondylolisthesis was found in six patients (33%) at the level of the synovial cyst, with displacement ranging from 3 to 5 mm, mean 4 mm. Surgery revealed instability and hypermobility of the facet joint at the level of the synovial cyst in all patients with degenerative spondylolisthesis, and in five additional patients. Symptomatic synovial cysts of the lumbar spine were associated with degenerative spondylolisthesis in six of 18 patients (33%) and with instability of the facet joint in 11 (61%). These findings may support the theory that increased segmental motion plays a role in the pathogenesis of synovial cysts.
Demonstration of a technique for three-dimensional (3-D) assessment of tracheal-stenoses, regarding site, length and degree, based on spiral computed tomography (S-CT). S-CT scanning and automated ...segmentation of the laryngo-tracheal tract (LTT) was followed by the extraction of the LTT medial axis using a skeletonization algorithm. Orthogonal to the medial axis the LTT 3-D cross-sectional profile was computed and presented as line charts, where degree and length was obtained. Values for both parameters were compared between 36 patients and 18 normal controls separately. Accuracy and precision was derived from 17 phantom studies. Average degree and length of tracheal stenoses was found to be 60.5% and 4.32 cm in patients compared with minor caliber changes of 8.8% and 2.31 cm in normal controls (p /spl Lt/ 0.0001). For the phantoms an excellent correlation between the true and computed 3-D cross-sectional profile was found (p /spl Lt/ 0.005) and an accuracy for length and degree measurements of 2.14 mm and 2.53% respectively could be determined. The corresponding figures for the precision were found to be 0.92 mm and 2.56%. LTT 3-D cross-sectional profiles permit objective, accurate and precise assessment of LTT caliber changes. Minor LTT caliber changes can be observed even in normals and, in case of an otherwise normal S-CT study, can be regarded as artifacts.
This study assessed the reliability of bone age determination in normal central European children using the Greulich and Pyle method and determined the effects of readers' experience on the measured ...bone ages. Plain hand radiographs of 47 children (aged 2 months to 18.8 years) with normal growth were analysed by four radiologists (two experienced paediatric radiologists and two radiology residents). The readers were blinded to the age of the children. The images were re-read by the same readers 2 months later. The mean intraobserver and interobserver variations were lower for experienced readers than for radiology residents. However, these differences were not statistically significant at the 5% level. The difference between the chronological age and the measured bone age was -1.5 +/- 7.6 months (p = 0.20) for the experienced readers and 2.7 +/- 10.3 months (p = 0.09) for the radiology residents. The differences between the measured bone age and chronological age were statistically significant (p = 0.04) for only one of the two radiology residents. Although the measurements by all four readers underestimated the chronological age, the differences between chronological age and bone age were within the normal variations of skeletal maturation as reported by Greulich and Pyle. Our data suggest that the reliability of bone age measurements increases with experience and that the Greulich and Pyle method may be used for central European children.
Objective: To briefly describe basic conventional imaging in paediatric uroradiology.
Method: The state of the art performance of standard imaging techniques (intravenous urography (IVU), voiding ...cystourethrography (VCU), and ultrasound (US)) is described, with emphasis on technical aspects, indications, and patient preparation such as adequate hydration. Only basic applications as used in routine clinical work are included.
Result and conclusion: Conventional imaging methods are irreplaceable. They cover the majority of daily clinical routine queries, with consecutive indication of more sophisticated modalities in those patients who need additional imaging for establishing the final diagnosis or outlining therapeutic options.
Management of intussusception Sorantin, Erich; Lindbichler, Franz
European radiology,
03/2004, Letnik:
14 Suppl 4
Journal Article
Recenzirano
Intussusception represents the most common abdominal emergency in infancy. The classical clinical triad, consisting of abdominal colics, red jelly stools and a palpable mass, is only present in ...approximately 50% of cases, 20% of patients are symptom free at clinical presentation. Primary imaging modality of choice is ultrasound scanning, which enables the diagnosis or exclusion of an intussusception at a sensitivity of 98-100%, specificity of 88% and a negative predictive value of 100%. In emergency cases, additional plain films are necessary to detect potential intestinal perforation, to identify intestinal obstruction or other diseases mimicking the clinical presentation. Once the diagnosis of an intussusception is established, non-surgical reduction (NSR) is used. A surgical approach is chosen in patients with signs of perforation, shock or peritonitis. Depending on the choice of guiding imaging technique, different contrast media are used for NSR. Barium suspension or air with fluoroscopic guidance, or saline only or mixed with water-soluble contrast under sonographic guidance, has to be used. Regardless of the used contrast medium, NSR is an effective technique, being successfully employed in more than 90% of cases.
At the Department of Pediatric Surgery in Graz, 31 boys and 23 girls were operated on for congenital diaphragmatic hernia (CDH) from 1978 to 1994. In 49 patients the defect was on the left, in five ...on the right side. In 46 cases, the hernia was diagnosed within the first week of life; in eight children at a later date. 19 children (35%) died. 25 of the 35 survivors (71%) came to a follow-up examination on average 9.4 (1-17) years after the operation. 24 h pH-monitoring or manometry and Upper G.I. series revealed pathological gastroesophageal reflux (GER) in 16 patients. Nine children were treated conservatively; in seven patients an antireflux procedure was performed. A thoracic position of the stomach or left liver lobe, presence of a hernial sac, gestational age, prenatal diagnosis, use of a patch or severity of lung hypoplasia did not significantly influence the incidence of GER. In three patients, a hiatal hernia was found. The motility of the diaphragm was documented with M-mode sonography (n = 18); a restricted motility could be demonstrated in five patients. GER is very common in patients after repair of CDH. We recommend long-term follow-up with special interest in respect of GER.
To evaluate the role of sonography in infants with hypertrophic pyloric stenosis undergoing conservative medical treatment.
Twenty‐two infants (17 male and 5 female; age range, 1‐12 weeks) were ...clinically and sonographically considered suitable for conservative treatment and underwent follow‐up during the course of the disease. Sonography was performed under a standardized protocol and included color Doppler sonography.
Fifteen infants (mean age, 9 weeks) needed surgery. They initially had a mean pyloric length of 18 mm, a diameter of 10.5 mm, and a wall thickness of 4 mm, with visible passage of food into the duodenum. These values deteriorated during follow‐up (mean preoperative values: length, 20 mm; diameter, 12 mm; and wall thickness, 4.5 mm); furthermore, passage of food through the pyloric canal ceased. Seven infants (mean age, 3 weeks) were successfully treated conservatively Their initial mean pyloric measurements were slightly smaller (length, 15 mm; diameter, 10 mm; and wall thickness, 3.8 mm) and did not deteriorate during follow‐up. In all of them, sonography showed improvement of passage through the pyloric canal within several days, as shown and documented by color Doppler sonography; morphologic changes persisted longer despite clinical improvement.
Sonography, including color Doppler sonography, is a valuable tool for monitoring infants with hypertrophic pyloric stenosis undergoing conservative treatment; however, initial sonograms cannot predict the further course of the disease.
To prospectively evaluate the potential of echo-enhanced color Doppler sonography (ee-CDS) using the acoustic stimulated emission technique in the diagnosis of vesicoureteral reflux (VUR) in ...children.
30 children (age: 0-9 years) with suspicion of VUR were submitted for echo-enhanced cystosonography (ee-CS) and conventional voiding cysto-urethrography (VCU). Conventional US and then color Doppler sonography (CDS) were performed after instillation of Levovist into the catheterized urinary bladder that had been prefilled with saline. Finally, output gain was increased in order to 'burst' the bubbles (= stimulated acoustic emission, burst-CS). Thereafter VCU was performed in the same session. The results of conventional ee-CS and burst-CS were compared to VCU findings.
Twenty-four refluxing systems were found in a total of 66 collecting systems by both techniques. Ee-CS and burst-CS detected VUR in four systems not seen by VCU (grades 1-4), but missed low-degree VUR in 2 cases. In low-degree VUR, burst-CS was particularly helpful in 9 patients with equivocal results on conventional ee-CS. In 6 of them, VUR was proven by burst-CS, the other 3 showed VURs neither on VCU nor on burst-CS.
Levovist ee-CS is feasible in the pediatric bladder. It enables reliable visualization of VUR in the renal collecting system. Burst-CS improves visualization of contrast reflux, particularly in non-dilative or minimally dilative VUR, which is sometimes difficult to depict with conventional ee-CS.
We report a boy who developed a vertebral stroke immediately after an appendectomy. Basilar impression was diagnosed eight years after this event when skull roentgenograms revealed basilar impression ...with high standing tip of the odontoid. We speculate that muscle relaxation and cervical hyperextension during intubation in the presence of basilar impression resulted in vertebral artery dissection and stroke. We suggest that patients with vertebral stroke and no obvious risk factors should be evaluated for the presence of malformations of the craniovertebral junction to be able to take precautions against excessive neck movement during intubation.
Metastasising chordomas are extremely rare and only four cases with drop metastases have been reported. We report a patient with an intracranial chondroid chordoma, typically involving the clivus, ...treated by repeated resection, percutaneous transluminal embolisation and radiosurgery. During follow-up with MRI asymptomatic intradural drop metastases were observed throughout the spine, with transgression of the intervertebral foramen, forming a "dumbbell".
