RESUMEN
OBJECTIVE: Focal fatty infiltration of the liver, a benign entity that can be confused with a malignant lesion, is well characterized in adults but not in children. The goal of this study was to determine by CT the prevalence and characteristics of focal fatty infiltration in children and young adults. MATERIALS AND METHODS: We retrospectively analyzed 305 consecutive contrast-enhanced abdominal CT examinations of 218 children and young adults with no known liver disease, performed during 2 years at our institution, to identify focal fatty infiltration of the liver. The imaging criterion for focal fatty infiltration of the liver on helical CT was a geometric or ovoid low-attenuation area adjacent to the falciform ligament, gallbladder fossa, or porta hepatis. If a patient's findings met the CT criterion for focal fatty infiltration of the liver, all previous abdominal CT and MR imaging examinations performed for that patient were reviewed to assess the evolution of focal fatty infiltration of the liver. RESULTS: Of 218 children and young adults, 20 (9.2%) met the CT criterion for focal fatty infiltration of the liver. In our population, focal fatty infiltration of the liver was identified only adjacent to the falciform ligament. The prevalence of focal fatty infiltration of the liver increased significantly with advancing age: 0% for ages 1 month-4 years; 7.3% for 5-9 years; 10.2% for 10-14 years, and 25.6% for 15-19 years (p < 0.0001). CONCLUSION: Focal fatty infiltration of the liver was identified in 9.2% of patients in our population, and occurrence of this lesion in children increases significantly with advancing age. However, focal fatty infiltration of the liver is uncommon in infants and young children and should be a diagnosis of exclusion.
Asunto(s)
Hígado Graso/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adolescente , Factores de Edad , Niño , Preescolar , Estudios Transversales , Diagnóstico Diferencial , Hígado Graso/epidemiología , Hígado Graso/etiología , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Estudios Retrospectivos , Factores de RiesgoRESUMEN
OBJECTIVE: We undertook this study to determine the frequency, CT appearance, and clinical implications of the rare occurrence of pulmonary metastases among children presenting with neuroblastoma. MATERIALS AND METHODS: A search of the Children's Cancer Group database revealed 21 of 567 children with reported lung metastases at original diagnosis of neuroblastoma. CT examinations available for 17 of these patients were analyzed retrospectively to determine if lung metastases were present, and if so, to characterize their radiographic features. RESULTS: Seventeen (3%) of 567 patients presenting with Evans stage IV neuroblastoma had confirmed pulmonary metastases at diagnosis. All had metastases to at least one site other than the lungs. The most common CT appearance of pulmonary lesions was of up to five, small, bilateral, noncalcified nodules. In nine patients (53%), the pulmonary nodules initially resolved with treatment. In this cohort, six children developed progressive disease and died, and three are still alive. All eight children whose lung lesion did not completely respond to treatment died. Overall, children with pulmonary metastases had unfavorable Shimada histology, a higher association with amplification of the MYCN oncogene (p = 0.0002), and a decreased event-free survival (p < 0.001) when compared with all children with stage IV neuroblastoma without pulmonary metastases. CONCLUSION: The search for neuroblastoma lung metastases, which occur more frequently than previously reported, is clinically important because their presence portends a poor prognosis.
Asunto(s)
Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/secundario , Neuroblastoma/diagnóstico por imagen , Neuroblastoma/secundario , Tomografía Computarizada por Rayos X , Preescolar , Supervivencia sin Enfermedad , Femenino , Humanos , Incidencia , Neoplasias Pulmonares/mortalidad , Masculino , Neuroblastoma/mortalidad , Pronóstico , Estudios RetrospectivosRESUMEN
A subtype of supracardiac total anomalous pulmonary venous return (TAPVR) consists of the vertical vein passing between the left pulmonary artery and the left mainstem bronchus resulting in relative obstruction to pulmonary venous return. This has been termed the vascular vise. In this situation, the supracardiac type of TAPVR (Type I) may mimic radiographically the infradiaphragmatic type (Type 3).
Asunto(s)
Cardiopatías Congénitas/diagnóstico por imagen , Venas Pulmonares/anomalías , Enfermedad Veno-Oclusiva Pulmonar/diagnóstico por imagen , Velocidad del Flujo Sanguíneo , Procedimientos Quirúrgicos Cardíacos , Diagnóstico Diferencial , Ecocardiografía Doppler en Color , Femenino , Estudios de Seguimiento , Cardiopatías Congénitas/cirugía , Humanos , Recién Nacido , Masculino , Venas Pulmonares/diagnóstico por imagen , Enfermedad Veno-Oclusiva Pulmonar/cirugía , Radiografía Torácica , Procedimientos Quirúrgicos VascularesRESUMEN
BACKGROUND: The purpose of this study was to attempt to improve upon conventional coronal computed tomographic (CT) images of neonatal chest which to date have been made by reformatting thinly spaced axial images. MATERIALS AND METHODS: Nine neonates were studied by direct coronal CT scans with the patients' long axis 90 degrees to the scanning table. They were studied to further define their thoracic abnormalities detected on plain film. Spiral CT and cine scan (Imatron) were utilized. RESULTS: Congenital lung lesions such as congenital cystic adenomatoid malformation could not be diagnosed but their anatomical location could be accurately depicted, enabling easier surgical planning. The arterial supply to bronchopulmonary sequestrations was also identifiable. Tracheobronchial abnormalities such as tracheobronchus and bronchial atresia were also identifiable. Causing of air trapping, both intrinsic such as an atretic bronchus and extrinsic such as vascular compression were readily demonstrated. CONCLUSION: With neither special devices nor paraphernalia, the described method of direct coronal CT scans were both feasible and provided significant information. This technique allows for improved assessment of the tracheobronchial tree and more accurate detection, localization, and characteristics of lesions adjacent to the diaphragm.
Asunto(s)
Radiografía Torácica/métodos , Tórax/anomalías , Tomografía Computarizada por Rayos X , Bronquios/anomalías , Malformación Adenomatoide Quística Congénita del Pulmón/diagnóstico por imagen , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Reproducibilidad de los Resultados , Tráquea/anomalías , Tráquea/diagnóstico por imagenRESUMEN
Perforation, a severe complication of necrotizing enterocolitis (NEC), has a high mortality rate. Recently, we presented a new technique for evaluation of NEC: measuring the CT attenuation coefficient of urine after oral administration of iohexol. We present three cases of neonates with NEC who demonstrated serial increases in urine CT attenuation coefficients, all of whom subsequently deteriorated clinically and radiographically. Surgery in all three cases confirmed severe necrosis and/or perforation. These three cases suggest that the CT attenuation coefficient of urine after oral administration of iohexol may be a more sensitive indicator of NEC severity, progression, and perforation than clinical evaluation and radiography. More investigation is necessary, but eventually, this noninvasive technique may be able to decrease morbidity and mortality by predicting the need for surgical intervention or more aggressive medical management of NEC before perforation occurs.
Asunto(s)
Medios de Contraste/administración & dosificación , Enterocolitis Necrotizante/diagnóstico por imagen , Enterocolitis Necrotizante/orina , Yohexol , Tomografía Computarizada por Rayos X , Adulto , Progresión de la Enfermedad , Enterocolitis Necrotizante/cirugía , Femenino , Estudios de Seguimiento , Humanos , Recién Nacido , Yohexol/administración & dosificación , Masculino , Embarazo , Radiografía Abdominal , Rotura Espontánea , Índice de Severidad de la EnfermedadRESUMEN
Meconium peritonitis is a chemical peritonitis which occurs following bowel perforation during fetal life. It is generally looked upon as benign, resulting in no long-term sequelae. We present a case of a newborn infant with meconium peritonitis who developed infarcts in several organs. At autopsy the infarcts proved to be caused by emboli as a result of intravascular dissemination of meconium. To our knowledge, this is the first reported case of systemic spread of meconium peritonitis in the literature and suggests that meconium peritonitis may have more serious implications than generally thought.
Asunto(s)
Infarto/etiología , Meconio , Peritonitis/complicaciones , Ascitis/diagnóstico , Ascitis/etiología , Resultado Fatal , Femenino , Humanos , Recién Nacido , Infarto/diagnósticoRESUMEN
MR imaging has evolved as the most important diagnostic test for local staging of primary bone and soft tissue tumors, for monitoring response to chemotherapy, and for detecting postoperative tumor recurrence. MR imaging provides accurate preoperative staging of local tumor extent and helps to obtain adequate safety margins, prerequisites for successful limb-salvage surgery. Postcontrast MR imaging studies are helpful for evaluating the presence or absence of tumor necrosis during chemotherapy. Dynamic MR imaging after intravenous bolus administration of Gd-DTPA or other paramagnetic contrast media is particularly useful for assessing response to chemotherapy. Diffusion-weighted MR imaging is a new technique that is potentially capable of detecting and quantitating the amount of tumor necrosis after chemotherapy or radiation therapy.
Asunto(s)
Neoplasias Óseas/diagnóstico , Imagen por Resonancia Magnética/métodos , Neoplasias de los Músculos/diagnóstico , Adolescente , Animales , Antineoplásicos/uso terapéutico , Neoplasias Óseas/tratamiento farmacológico , Neoplasias Óseas/radioterapia , Niño , Medios de Contraste , Modelos Animales de Enfermedad , Gadolinio DTPA , Humanos , Inyecciones Intravenosas , Neoplasias de los Músculos/tratamiento farmacológico , Neoplasias de los Músculos/radioterapia , Necrosis , Invasividad Neoplásica , Recurrencia Local de Neoplasia/diagnóstico , Estadificación de Neoplasias , Ratas , Seguridad , Neoplasias de los Tejidos Blandos/diagnóstico , Neoplasias de los Tejidos Blandos/tratamiento farmacológico , Neoplasias de los Tejidos Blandos/radioterapia , Resultado del TratamientoRESUMEN
PURPOSE: To evaluate diffusion-weighted magnetic resonance (MR) imaging for detecting tumor necrosis in an animal model of osteogenic sarcoma. MATERIALS AND METHODS: Twelve rats with osteogenic sarcoma underwent T1-weighted unenhanced and gadolinium-enhanced spin-echo and diffusion-weighted spin-echo MR imaging. Histologic correlation was performed. Signal intensities, T2 relaxation times, normalized apparent diffusion coefficients, and relative signal intensity increases were calculated. RESULTS: On diffusion-weighted images, necrotic tumor showed low signal intensity (mean normalized apparent diffusion coefficient, 0.46 +/- 0.20 [1 standard deviation]), indicating rapid diffusion of water molecules as a result of loss of membrane integrity, while viable tumor showed high signal intensity (mean normalized apparent diffusion coefficient, 0.16 +/- 0.05; P < .0001). Differences in the T2 relaxation times and relative signal intensity increases between viable and necrotic tumor were not statistically significant. CONCLUSION: Normalized apparent diffusion coefficients are more accurate in differentiating between viable and necrotic tumor than are T2 relaxation times or relative signal intensity increases on contrast-enhanced images. Signal intensity overlap between viable and necrotic tumor on gadolinium-enhanced images may be caused by the small molecular size of the agent, which permeates the interstitial space freely, thereby also enhancing necrosis. Diffusion-weighted MR imaging depicts differences in diffusion and, ultimately, in membrane integrity between viable and necrotic tumor and may be used to monitor tumor viability during treatment.
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Neoplasias Óseas/patología , Imagen por Resonancia Magnética/métodos , Osteosarcoma/patología , Animales , Medios de Contraste , Gadolinio DTPA , Miembro Posterior , Necrosis , Trasplante de Neoplasias , Ratas , Ratas DesnudasRESUMEN
PURPOSE: To develop a new method for diagnosing necrotizing enterocolitis with use of computed tomography (CT). MATERIALS AND METHODS: Urine specimens from 22 neonates were obtained 8-12 hours after iohexol was administered enterally. Twelve neonates had suspected (n = 5) or definite (n = 7) necrotizing enterocolitis, and 10 neonates without necrotizing enterocolitis underwent routine upper gastrointestinal study. Urine from another 13 neonates without necrotizing enterocolitis who did not receive iohexol was collected. The attenuation coefficient of each urine specimen was determined with CT. RESULTS: The mean CT attenuation coefficient of urine from neonates who did not receive iohexol was 5.6 HU +/- 3.9, and that from neonates without necrotizing enterocolitis who underwent upper gastrointestinal study was 6.7 HU +/- 3.2. The mean CT attenuation coefficient of urine from patients with suspected necrotizing enterocolitis was 26.0 HU +/- 3.4, and that in patients with definite necrotizing enterocolitis was 71.0 HU +/- 18.8. The mean CT attenuation coefficients in neonates with necrotizing enterocolitis were significantly different from that in patients without necrotizing enterocolitis who underwent upper gastrointestinal study. CONCLUSION: Urine from neonates with necrotizing enterocolitis show significantly higher CT attenuation coefficients than those from patients without necrotizing enterocolitis. CT examination of urine may allow early detection of necrotizing enterocolitis.
Asunto(s)
Medios de Contraste/administración & dosificación , Enterocolitis Seudomembranosa/diagnóstico por imagen , Yohexol/administración & dosificación , Tomografía Computarizada por Rayos X , Orina , Administración Oral , Enterocolitis Seudomembranosa/orina , Humanos , Recién Nacido , Intubación Gastrointestinal , Masculino , Radiografía AbdominalRESUMEN
Feline esophagus is a term describing a specific radiological and endoscopic appearance of the esophagus that is attributed to chronic esophagitis. To date only one report has described this appearance in childhood. We present a histologically documented case of this entity including follow-up studies after therapy for esophagitis.
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Esofagitis/diagnóstico por imagen , Esófago/diagnóstico por imagen , Adolescente , Antiulcerosos/uso terapéutico , Endoscopía , Esofagitis/tratamiento farmacológico , Esofagitis/patología , Esófago/patología , Humanos , Masculino , Omeprazol/uso terapéutico , RadiografíaRESUMEN
The purpose of this study was to investigate the time course of development of collateral blood flow in an animal model of aortic coarctation. A juxtaductal aortic stenosis (model coarctation) was surgically created in five juvenile pigs. MRI was performed preoperatively, 1 to 2 days postoperatively, and 2 to 10 weeks postoperatively. Aortic blood flow was measured by velocity-encoded cine MR (VENC-MR). The percent change in aortic blood flow (delta BF) from proximal to distal descending thoracic aorta was calculated, and a multiple-comparison paired t test used to assess changes in delta BF over time. Invasive flow measurements were obtained in one animal before sacrifice using an ultrasonic probe. delta BF preoperatively was -2 +/- 8% (mean +/- SE). delta BF increased to 32 +/- 7% (mean +/- SE, P = .022) 2 days postoperatively and 55 +/- 19% (P = .032) 2 to 8 weeks postoperatively. Invasive measurements were in qualitative agreement with the VENC-MR data. VENC-MR is an accurate noninvasive method of measuring collateral blood flow in aortic coarctation. Recruitment and development of collateral flow pathways occur rapidly in an animal model.
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Coartación Aórtica/diagnóstico , Coartación Aórtica/fisiopatología , Circulación Colateral/fisiología , Imagen por Resonancia Cinemagnética , Animales , Animales Recién Nacidos , Velocidad del Flujo Sanguíneo , Modelos Animales de Enfermedad , Interpretación de Imagen Asistida por Computador , Sensibilidad y Especificidad , PorcinosRESUMEN
OBJECTIVE: An unfortunate consequence of increased success in childhood cancer survival rates is the increase in the number of secondary malignant neoplasms after therapy for the initial lesion. Renal cell carcinoma can occur as a secondary malignant neoplasm after therapy for neuroblastoma and may become more common as more patients with treated neuroblastomas survive into adulthood. We studied one case and reviewed four cases of secondary renal cell carcinoma to determine if the relationship between these two neoplasms is significant. CONCLUSION: An awareness of the association between these two neoplasms is important in the diagnostic follow-up of neuroblastoma so that secondary renal cell carcinoma is not confused with recurrence of primary disease.
Asunto(s)
Carcinoma de Células Renales , Neoplasias Renales , Neoplasias Primarias Secundarias , Neuroblastoma/terapia , Carcinoma de Células Renales/diagnóstico por imagen , Carcinoma de Células Renales/etiología , Niño , Humanos , Neoplasias Renales/diagnóstico por imagen , Neoplasias Renales/etiología , Masculino , Neoplasias Primarias Secundarias/diagnóstico por imagen , RadiografíaRESUMEN
Histologic studies on resected specimen have shown that tumor neovascularity is related to prognosis and response to therapy in a variety of human neoplasms. In nine patients with osteogenic or Ewing sarcoma, we evaluated the use of magnetic resonance angiography (MRA) to assess neovascularity non-invasively in vivo and to monitor response to chemotherapy. Seven patients with osteosarcoma and two patients with Ewing sarcoma were studied before and after chemotherapy by MRA (2-D time-of-flight gradient-echo sequence, TR = 50 msec, TE = 9.5 msec, theta = 50 degrees, acquisition time 13 min). MR angiograms were assessed for chemotherapy-induced changes in neovascularity. MRA showed both feeder vessels and neovascularity. Six patients responded to chemotherapy ( > or = 90% histologic tumor necrosis). MRA demonstrated marked reduction in neovascularity in all responders. Three patients did not respond to chemotherapy ( < 90% histologic tumor necrosis). MRA demonstrated persistent or increased neovascularity in the non-responders. MRA provides a unique opportunity to study tumoral neovascularity noninvasively in vivo and helps to assess response to chemotherapy in patients with osteogenic or Ewing sarcoma. These general principles may be applicable to other human tumors.
Asunto(s)
Neoplasias Óseas/tratamiento farmacológico , Angiografía por Resonancia Magnética , Neovascularización Fisiológica/efectos de los fármacos , Compuestos Organometálicos/uso terapéutico , Osteosarcoma/tratamiento farmacológico , Ácido Pentético/análogos & derivados , Sarcoma de Ewing/tratamiento farmacológico , Adolescente , Antineoplásicos/uso terapéutico , Neoplasias Óseas/diagnóstico , Neoplasias Óseas/fisiopatología , Método Doble Ciego , Femenino , Gadolinio DTPA , Humanos , Imagen por Resonancia Magnética , Masculino , Osteosarcoma/diagnóstico , Osteosarcoma/fisiopatología , Ácido Pentético/uso terapéutico , Sarcoma de Ewing/diagnóstico , Sarcoma de Ewing/fisiopatologíaRESUMEN
Left paraduodenal hernias are a rare cause of abdominal pain or obstruction. However, because there is high associated mortality (20 %), prompt and accurate diagnosis is essential. Because internal hernias are not detectable on physical examination, imaging is relied upon for pre-operative diagnosis. Although both computed tomography and barium studies demonstrate left paraduodenal hernias as a cluster of bowel located posterior to the stomach and to the left of the distal duodenum with absence of the normal interdigitation between loops, the findings may be subtle. Knowledge of these findings can avoid an unnecessary delay in diagnosis. We present the case of a 15-year-old girl with a left paraduodenal hernia, where initial CT and barium studies demonstrated nonobstructed jejunum within the hernia sac. Two weeks later a repeat study showed obstructed distal ileum, rather than proximal jejunum, within the sac.
Asunto(s)
Enfermedades Duodenales/diagnóstico por imagen , Hernia Ventral/diagnóstico por imagen , Enfermedades del Íleon/diagnóstico por imagen , Obstrucción Intestinal/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Abdomen Agudo/diagnóstico por imagen , Abdomen Agudo/etiología , Abdomen Agudo/cirugía , Adolescente , Sulfato de Bario , Diagnóstico Diferencial , Enfermedades Duodenales/cirugía , Femenino , Hernia Ventral/cirugía , Humanos , Enfermedades del Íleon/cirugía , Obstrucción Intestinal/cirugíaRESUMEN
PURPOSE: To evaluate the utility of fast, contrast-enhanced, sequential magnetic resonance (MR) imaging in differentiating between extraosseous tumor and perineoplastic edema. MATERIALS AND METHODS: Fourteen patients underwent sequential MR imaging (3.5 seconds per image) after bolus administration of gadopentetate dimeglumine. Initial rates of enhancement (initial slope) were calculated on a pixel-by-pixel basis and displayed as a "slope image"' in which pixel intensity reflected the slope value. Close correlation with wedge biopsy specimens was performed. RESULTS: Mean initial slope values were viable extraosseous tumor, 9.33 (standard deviation, 2.23); infiltrated muscle, 9.07 (2.31); edematous muscle without tumor infiltration, 5.48 (1.27); normal muscle, 1.11 (0.65). Differences in initial slope between all neoplastic and nonneoplastic tissues were statistically significant. Within individual patients, initial slope of edematous muscle was always 20% or more lower than that of neoplastic tissue. Slope images highlighted areas of viable extraosseous tumor and infiltrated muscle against edematous and normal tissues. CONCLUSION: Computer-generated slope images derived from sequential postcontrast MR images allow differentiation between tumor and nonneoplastic edema and may thereby guide the surgeon in planning limb-sparing procedures.
Asunto(s)
Neoplasias Óseas/diagnóstico , Medios de Contraste , Edema/diagnóstico , Aumento de la Imagen , Imagen por Resonancia Magnética , Neoplasias de los Músculos/diagnóstico , Enfermedades Musculares/diagnóstico , Adolescente , Adulto , Biopsia , Neoplasias Óseas/patología , Niño , Combinación de Medicamentos , Edema/patología , Femenino , Predicción , Gadolinio , Gadolinio DTPA , Humanos , Aumento de la Imagen/métodos , Procesamiento de Imagen Asistido por Computador , Modelos Logísticos , Imagen por Resonancia Magnética/métodos , Masculino , Meglumina , Persona de Mediana Edad , Neoplasias de los Músculos/patología , Músculo Esquelético/patología , Enfermedades Musculares/patología , Invasividad Neoplásica , Compuestos Organometálicos , Planificación de Atención al Paciente , Ácido Pentético/análogos & derivadosRESUMEN
OBJECTIVE: Magnetic resonance imaging has proven to be a useful diagnostic tool for the evaluation of various types of vascular rings and congenital heart disease. We report two cases showing the accuracy of MRI in detecting post-surgical complications in patients with these conditions. MATERIALS AND METHODS: The two cases reported here demonstrate the use of MRI to show the altered vascular anatomy and the mechanism of tracheal and/or esophageal compression. RESULTS: In the first case, MRI demonstrated narrowing of the right pulmonary artery due to a dilated and posteriorly displaced ascending aorta with residual coarctation, and esophageal compression by an aberrant left subclavian artery. In the second case, MRI demonstrated esophageal compression by a posteriorly displaced ascending aorta. CONCLUSION: We conclude that MRI is an effective noninvasive method for assessing the results and complications of surgical correction of aortic abnormalities.