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BACKGROUND: Osteosarcoma is the most common primary malignant bone tumour in children and adolescents. Lungs are the most frequent and often the only site of metastatic disease. The presence of pulmonary metastases is a significant unfavourable prognostic factor. Thoracotomy is strongly recommended in these patients, while computed tomography (CT) remains the gold imaging standard. The purpose of our study was to create tools for the CT-based qualification for thoracotomy in osteosarcoma patients in order to reduce the rate of useless thoracotomies. METHODS: Sixty-four osteosarcoma paediatric patients suspected of lung metastases on CT and their first-time thoracotomies (n = 100) were included in this retrospective analysis. All CT scans were analysed using a compartmental evaluation method based on the number and size of nodules. Calcification and location of lung lesions were also analysed. Inter-observer reliability between two experienced radiologists was assessed. The CT findings were then correlated with the histopathological results of thoracotomies. Various multivariate predictive models (logistic regression, classification tree and random forest) were built and predictors of lung metastases were identified. RESULTS: All applied models proved that calcified nodules on the preoperative CT scan best predict the presence of pulmonary metastases. The rating of the operated lung on the preoperative CT scan, dependent on the number and size of nodules, and the total number of nodules on this scan were also found to be important predictors. All three models achieved a relatively high sensitivity (72-92%), positive predictive value (81-90%) and accuracy (74-79%). The positive predictive value of each model was higher than of the qualification for thoracotomy performed at the time of treatment. Inter-observer reliability was at least substantial for qualitative variables and excellent for quantitative variables. CONCLUSIONS: The multivariate models built and tested in our study may be useful in the qualification of osteosarcoma patients for metastasectomy through thoracotomy and may contribute to reducing the rate of unnecessary invasive procedures in the future.
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Neoplasias Óseas , Neoplasias Pulmonares , Osteosarcoma , Toracotomía , Tomografía Computarizada por Rayos X , Humanos , Osteosarcoma/diagnóstico por imagen , Osteosarcoma/cirugía , Osteosarcoma/secundario , Osteosarcoma/patología , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/cirugía , Neoplasias Pulmonares/secundario , Neoplasias Pulmonares/patología , Adolescente , Niño , Estudios Retrospectivos , Masculino , Femenino , Neoplasias Óseas/secundario , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/cirugíaRESUMEN
Spinal involvement by chronic non-bacterial osteomyelitis (CNO) has been increasingly reported in recent years, often being presented as a diagnostic dilemma requiring differential diagnosis with bacterial spondylodiscitis and/or neoplasia. This study was aimed at identifying the imaging features of CNO facilitating its differentiation from other spinal diseases. Two radiologists assessed the imaging studies of 45 patients (16 male and 29 female, aged from 6 to 75 years, 15 children) with CNO collected from 5 referential centers. Spinal lesions were found in 17 patients (2 children and 15 adults), most often in the thoracic spine. In children, the lesions involved short segments with a destruction of vertebral bodies. In adults, the main findings were prominent bone marrow edema and osteosclerosis, endplate irregularities, and ankylosing lesions extending over long segments; paraspinal inflammation was mild and abscesses were not observed. In both children and adults, the involvement of posterior elements (costovertebral and facet joints) emerged as an important discriminator between CNO and neoplasia/other inflammatory conditions. In conclusion, a careful inspection of imaging studies may help to reduce the number of biopsies performed in the diagnostic process of CNO.
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Purpose: Pseudotumor is a rare complication after arthroplasty, most often of the hip joint, in response to metal particles present in the implant. There are merely sporadic reports of pseudotumor in patients with bone sarcoma after sparing surgery with endoprosthesis implant. The aim of this study is to present the characteristic imaging features of pseudotumor. Case report: We present a case of a 21-year-old male patient in whom a scheduled follow-up ultrasound revealed a painless lesion suspected of local recurrence at the border of the endoprosthesis and the bone stump 3.5 years after the end of treatment for osteosarcoma of the femur. Histopathology of the biopsy specimen revealed that the lesion was a pseudotumor. Conclusions: Although pseudotumor is sporadic in patients treated with endoprosthesis for bone sarcoma, their prolonged survival could bear the risk of such a complication. Imaging studies, in particular ultrasound, may be helpful in differentiating from local recurrence of sarcoma, however, the histopathology of the specimen obtained by open biopsy at a reference center is crucial for the final diagnosis.
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Gorham-Stout disease (GSD) is a very rare entity of unknown etiology, characterized by excessive intra-osseous proliferation of blood or lymphatic vessels, resulting in progressive resorption of bone matrix and destruction of bone. To date we have found only seven published cases concerning fully confirmed GSD of the shoulder girdle bones in children. Our case concerns an 8-year-old boy with involvement of the left clavicle and scapula. The knowledge of imaging and histopathological features is crucial for establishing the diagnosis of GSD, therefore the exchange of experiences in this field is essential for improving the care of affected patients.
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Osteólisis Esencial , Niño , Clavícula/diagnóstico por imagen , Humanos , Masculino , Osteólisis Esencial/diagnóstico por imagen , Escápula/diagnóstico por imagen , HombroRESUMEN
BACKGROUND: Most white matter diseases present on magnetic resonance imaging as focal or diffuse T2-hyperintensities. However, in a few of them, radially oriented stripes of low (relatively normal) signal intensity are observed within diffusely affected T2-hyperintense cerebral white matter and are called "tigroid pattern" in the literature. The fornix is a tiny white matter fibers bundle playing crucial role in cognitive functioning, easily overlooked on magnetic resonance imaging and not described in inborn errors of metabolism. CASE PRESENTATION: We present a case of glutaric aciduria type 1 with a follow-up of over nine years. The course of the disease is presented in three magnetic resonance scans at the age of 8 and 21 months, and 10 years, with diffusion restriction in the fornix in scan 1 and 2 and with tigroid pattern in scan 3. Despite appropriate diet and supplementation, injury of white matter progressed achieving diffuse stage with tigroid pattern. Psychological tests revealed deficits in patient's specific cognitive skills, most likely related to damage to the fornix. CONCLUSIONS: To our knowledge, this is the first report of tigroid pattern of white matter involvement in glutaric aciduria type 1 and the first report of forniceal injury in this disease which seems to be correlated with patient's low functioning in all kinds of memory skills, previously not reported in glutaric aciduria type 1.
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Glutaratos , Leucoencefalopatías , Errores Innatos del Metabolismo de los Aminoácidos , Encéfalo/diagnóstico por imagen , Encefalopatías Metabólicas , Glutaril-CoA Deshidrogenasa/deficiencia , Humanos , Leucoencefalopatías/diagnóstico por imagen , Imagen por Resonancia MagnéticaRESUMEN
INTRODUCTION: In countries where Haemophilus influenzae type B vaccine is used, Streptococcus pneumoniae is the most common cause of bacterial meningitis in young children and notable cause of morbidity/mortality. The authors present material of magnetic resonance imaging (MRI) of patients with pneumococcal meningitis from archive of Department of Diagnostic Imaging of Institute of Mother and Child in Warsaw. MATERIALS AND METHODS: We performed 27 brain MRI scans and 1 follow-up computed tomography (CT) in 10 children (2 girls and 8 boys) aged from neonate to 5 years at disease onset with proven pneumococcal infection. RESULTS: Follow-up period range was 0-12 years. Two children underwent only one MRI, one of them died before follow-up and the other was lost from further observation. There was one case of relatively benign disease course with mild changes on MRI. In another seemingly benign case, acute transient hydrocephalus was observed. Six children developed hydrocephalus, and two required ventriculoperitoneal shunting complicated by neuroinfection, shunt malfunction and revisions. Two patients developed epilepsy. In six children, spastic paresis of various severity was diagnosed, up to quadriplegia in one who is under the longest observation (>12 years) and survived in vegetative state. Three other children suffer from delayed psychomotor development to severe intellectual disability. CONCLUSIONS: MRI shows perfectly the degree of central nervous system (CNS) damage during and after pneumococcal invasion. Despite appropriate treatment, disease course may be unpredictably serious. Attempts to eliminate the obligation to vaccinate are extremely irresponsible taking into account potential danger of death, vegetative state or another form of severe damage to CNS. Social and financial costs of care of survivors are very high with shunts placements and changes, (neuro)infections, rehabilitation, families breakdown, etc.
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Discapacidad Intelectual/etiología , Meningitis Neumocócica/complicaciones , Niño , Estudios de Seguimiento , Trastornos de la Audición/etiología , Humanos , Hidrocefalia/etiología , Imagen por Resonancia Magnética , Masculino , Trastornos del Movimiento/etiología , Polonia , Pronóstico , Factores de Riesgo , Streptococcus pneumoniae/aislamiento & purificaciónRESUMEN
The detection of multiple cardiac tumors during fetal echocardiography allowed us to make the diagnosis of tuberous sclerosis complex in the mother and establish the reason of her first epileptic seizures.
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Ecocardiografía/métodos , Neoplasias Cardíacas/complicaciones , Neoplasias Cardíacas/diagnóstico por imagen , Esclerosis Tuberosa/complicaciones , Esclerosis Tuberosa/diagnóstico por imagen , Ultrasonografía Prenatal/métodos , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Embarazo , Convulsiones/etiología , Adulto JovenRESUMEN
BACKGROUND: The use of a specialized MR-compatible incubator (INC) is very poorly described in the literature and only with regard to brain imaging. OBJECTIVES: To present our own experience with brain and body magnetic resonance imaging (MRI) in the INC in a large cohort of neonates. MATERIAL AND METHODS: A total of 555 examinations were performed in 530 newborns with the use of a 1.5T system and Nomag IC 1.5 incubator, equipped with head and body coils. RESULTS: More than half of neonates (54%) were prematurely born at 22 + 6-36 + 6 gestational weeks. They were examined from the first to 153 days of life (median: 18.5, mean: 37.7) with body weights 600-5000 g (mean: 3051 g), 23% of less than 2500 g. The proportion of brain MRIs to other body regions was 533:85 = 86%:14%. In 36.6% of cases, MRI showed more abnormalities than ultrasound (USG), in a further 21.8%, MRI diagnosis was completely different, in 4.7%, a pathology described on a USG was ruled out on MRI. The superiority of MRI over USG was 63.1%. CONCLUSIONS: MR-compatible incubator significantly increased the availability of MRI to newborns, especially to premature and unstable newborns. The integration of body coils into the INC increased the spectrum of examinations and made possible the scanning not only of the brain but also the body. Dedicated neonatal coils improved image quality and allowed more accurate diagnosis than the previously used adult coils. Immobilization of the babies in the INC by means of Velcro belts and head fixation inserts is better than in adult coils. The closed space of the INC isolates newborns to a greater extent from the negative influence of noise in the MR environment.
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Incubadoras para Lactantes , Imagen por Resonancia Magnética/instrumentación , Imagen por Resonancia Magnética/métodos , Neuroimagen , Imagen de Cuerpo Entero , Encéfalo , Humanos , Recién Nacido , Neuroimagen/métodosRESUMEN
PURPOSE: Hypertrophic olivary degeneration (HOD) is a unique neurological condition caused by interruption of the dentato-rubro-olivary pathway, also known as the triangle of Guillain and Mollaret. Magnetic resonance (MR) imaging is the best modality to diagnose both the degeneration of the inferior olivary nucleus and the underlying cause. CASE REPORT: We describe a case of a unilateral HOD in a 16-year-old girl several months after a subtotal excision of a brainstem pilocytic astrocytoma. Taking into account the patient's history, tumour recurrence must have been considered, but the typical location and MR morphology, as well as the time of occurrence after brainstem surgery, contributed to the diagnosis of HOD. The causative factor was the interruption of the central tegmental tract, which forms one arm of the Guillain and Mollaret triangle. Additionally, this is an interesting case of a child, who stayed in a coma for several months following brainstem surgery, but finally was discharged home with only minor neurological defects and returned to normal life. CONCLUSIONS: Hypertrophic olivary degeneration is an infrequent neurological condition, especially in the paediatric population. Nevertheless, it should be considered when interpreting late postoperative scans of children with a history of a brain tumour.
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OBJECTIVES: The role of magnetic resonance imaging, similarly to ultrasound, in the evaluation of foetal anomalies is in-disputable. This gives rise to a question, whether prenatal diagnostics can replace postnatal one. To assess the diagnostic accuracy of foetal MRI in children with congenital anomalies by using postnatal MRI, X-ray/US and surgery (histopathol-ogy/autopsy) results as a reference standard. MATERIAL AND METHODS: 110 children were included in the analysis. All of them underwent foetal MRI, and the diagnoses were verified after birth. All the results were analysed both by: 1. evaluation of correctness of the prenatal diagnosis with the reference standard diagnosis of each patient, and 2. statistical evaluation of prenatal diagnosis using standard measures of binary diagnostic tests' abilities. RESULTS: The accordance of prenatal and final diagnoses was 70%. Only 3.64% of patients were misdiagnosed. Most of the prenatal diagnoses that were incomplete (23.64%), concerned children who underwent surgery, and among them patients with abdominal cystic laesions of undetermined origin on foetal MRI constituted the majority. In 2.73% of cases prenatal diagnoses remained inconclusive. CONCLUSIONS: High correlation of prenatal and postnatal tests' results in the study material confirms the high value of foetal MRI in perinatal diagnostics. Comprehensive assessment of the foetus in prenatal MRI is very effective and facilitates impor-tant therapeutic decisions in the prenatal period (in utero treatment) and in perinatal care (application or withdrawal from the EXIT procedure, surgery or backtracking from neonatal resuscitation if it should bear the hallmarks of persistent therapy).
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Anomalías Congénitas/diagnóstico , Enfermedades Fetales/diagnóstico , Diagnóstico Prenatal/métodos , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Embarazo , Atención Prenatal/métodos , Ultrasonografía Prenatal/métodosRESUMEN
PURPOSE: The purpose of this paper is to summarise and to present the experience of the main Polish centre for prenatal magnetic resonance imaging (MRI) and to discuss the place and role of MRI in antenatal diagnosis, management, and counselling. MATERIAL AND METHODS: Retrospective analysis of the examinations performed in the years 2001-2017. RESULTS: In total, 1221 medical records and/or image files were collected. The full documentation of ultrasonography and MRI referrals, reports, and images was not available in every case. During the first three years 98 pregnant women were examined (approximately 33 per year, one study per fortnight). After purchase of own MR scanner, the number of examinations grew constantly, reaching 208 in 2017, which means almost one per day, and the highest number was eight in one day. We examined 45 pairs of twins, including three pairs of conjoined twins. CONCLUSIONS: MRI at our Institute is a practically used second-line foetal imaging tool, necessary to confirm, complete, or correct sonographic diagnoses, with important impact on clinical decisions concerning management of pregnancy and of the neonate, termination of pregnancy, choice of the time, place, and mode of delivery, and neonatal care, as well as on counselling. In experienced hands, MRI is to date the last and the best non-invasive method of diagnosis in utero. It is frequently requested by the interdisciplinary team for foetal diagnosis and therapy and routinely performed in everyday practice.
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Purpose. To check whether primary involvement of brain/spinal cord by bone/soft tissue sarcomas' metastases in children is as rare as described and to present various morphological forms of bone/soft tissue sarcomas' CNS metastases. Methods. Patients with first diagnosis in 1999-2014 treated at single center were included with whole course of disease evaluation. Brain/spinal canal magnetic resonance imaging (MRI)/computed tomography were performed in cases suspicious for CNS metastases. Extension from skull/vertebral column metastases was excluded. Results. 550 patients were included. MRI revealed CNS metastases in 19 patients (incidence 3.45%), 14 boys, aged 5-22 years. There were 12/250 osteosarcoma cases, 2/200 Ewing's sarcoma, 1/50 chondrosarcoma, 3/49 rhabdomyosarcoma (RMS), and 1/1 malignant mesenchymoma. There were 10 single metastases and 7 cases of multiple ones; in 2 RMS cases only leptomeningeal spread in brain and spinal cord was found. Calcified metastases were found in 3 patients and hemorrhagic in 4. In one RMS patient there were numerous solid, cystic, hemorrhagic lesions and leptomeningeal spread. Conclusions. CNS metastases are rare and late in children with bone/soft tissue sarcomas, although in our material more frequent (3.45%) than in other reports (0.7%). Hematogenous spread to brain and hemorrhagic and calcified lesions dominated in osteosarcoma. Ewing sarcoma tended to metastasize to skull bones. Soft tissue sarcomas presented various morphological forms.
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Neoplasias Óseas/patología , Neoplasias del Sistema Nervioso Central/secundario , Neoplasias de los Tejidos Blandos/patología , Adolescente , Adulto , Niño , Preescolar , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Adulto JovenRESUMEN
BACKGROUND: In neonatal brains diffusion restriction, which is not limited to the region of insult, but is also found in distant locations from it seems to be a frequent finding, called pre-Wallerian degeneration. OBJECTIVES: The purpose of this study was to describe these findings and to estimate the frequency of their occurrence with an attempt to determine their clinical significance. METHODS: 125 brain MRI examinations of neonates with confirmed brain damage performed or consulted in our Institute were retrospectively reviewed, focusing on the presence of restricted diffusion in corticospinal tracts (CST) and corpus callosum (CC). Apparent diffusion coefficients (ADC) were measured in callosal splenium and compared to normal neonatal brains. RESULTS: Restricted diffusion was found in 21 newborns (16.8%): in 4 in CST (3.2%), in 5 in CC (4.0%), in 12 in both (9.6%). Mean ADC value in CC was 0.638, standard deviation (SD): 0.211µm2/s and in the control group 0.995, SD: 0.162µm2/s (p=0,001). CONCLUSIONS: Neonatal brain MRI should be searched for DWI abnormalities which are not rare and require careful studying of ADC maps. Diffusion restriction in the corpus callosum and/or corticospinal tracts below the region of insult should not be mistaken for acute ischemia as it most likely reflects early phase of secondary neuronal degeneration called pre-Wallerian degeneration. This finding helps in prognostication and guides the management of the affected neonates.
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Cuerpo Calloso/fisiopatología , Imagen de Difusión por Resonancia Magnética , Procesamiento de Imagen Asistido por Computador , Tractos Piramidales/fisiopatología , Cuerpo Calloso/crecimiento & desarrollo , Imagen de Difusión por Resonancia Magnética/métodos , Femenino , Humanos , Recién Nacido , Masculino , Tractos Piramidales/crecimiento & desarrollo , Estudios Retrospectivos , Accidente Cerebrovascular/fisiopatología , Degeneración Walleriana/fisiopatologíaRESUMEN
The amount of people living with cancer is increasing; they live longer and have thus a higher risk of developing neurological complications. Magnetic resonance as a diagnostic procedure of choice in detecting the reasons of neurological/psychiatric symptoms in oncological patients is nowadays relatively easily accessible. Early diagnosis established by radiologists familiar with neurological entities that may follow cancer treatment allow clinicians to provide proper treatment, even if the diagnosis seems unbelievable. The review of MR images of acute and chronic neurological complications of cancer treatment from the authors' own archive is the focus of this report. Neurological complications of cancer can be metastatic and non-metastatic; the first cannot be considered as a treatment complication, the latter can be chemoor radiotherapy-induced, acute, chronic and delayed. In our material we dealt with complications with dramatic course (stroke, PRES, acute leukoencephalopathy, Wernicke's encephalopathy) and with cases with milder and/or longer course (neuro-infections, chronic leukoencephalopathy, telangiectasias and/or cavernous hemangiomas, second tumors: glioma and meningioma after irradiation). The central nervous system is very susceptible to complications of systemic cancer and its treatment. Even though the first thought of clinicians and radiologists after a patient's first neurological/psychiatric symptoms appears concerns the metastatic spread of the disease, they need to have an understanding that there are a number of other causes of such symptoms. The knowledge of entities which can be expected and diagnostic experience prevent clinicians from making wrong diagnosis.
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Antineoplásicos/administración & dosificación , Encefalopatías/diagnóstico por imagen , Diagnóstico Precoz , Neoplasias/terapia , Radioterapia/efectos adversos , Antineoplásicos/efectos adversos , Humanos , Imagen por Resonancia Magnética , SobrevivientesRESUMEN
INTRODUCTION: One of the aims of fetal magnetic resonance imaging (MRI) is to avoid postnatal scanning. However, clinicians sometimes wish to have postnatal confirmation of prenatal findings. This study's purpose was to check whether there was indeed the added value of neonatal MRI performed in the MR-compatible incubator (INC) after fetal examination. MATERIALS AND METHODS: Material consists of 25 neonates (14 girls) who underwent prenatal and postnatal MRI in a 1.5 T scanner, the latter in INC. Mean time of prenatal MRI was 30th gestational week, of postnatal MRI-16th day of life. RESULTS: In 14 cases (56 %) postnatal findings were the same as prenatal ones. In 11 (44 %) postnatal MRI showed some different/new/more precise results, in two the differences were attributed to other factors than the advantage of postnatal MRI over prenatal one. Altogether then postnatal results were partly discordant with prenatal ones in 9/25 cases (36 %). CONCLUSIONS: In most cases there was no added value of postnatal MRI as compared to prenatal one. This value lied in small details that could not have been noticed on prenatal MRI or required contrast medium administration to be noticed. On the other hand, MR examination performed with use of the dedicated neonatal coils in the MR-compatible incubator is a safe and reliable method of visualization of these small details with better spatial resolution thus helping to establish final diagnosis, treatment plan and prognosis.
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Enfermedades Fetales/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Diagnóstico Prenatal/métodos , Femenino , Humanos , Incubadoras , Recién Nacido , Masculino , EmbarazoRESUMEN
BACKGROUND: Ewing sarcoma (ES) is the second most common pediatric malignant bone tumor with a wide spectrum of clinical presentations. Although metastatic disease to the lungs is often the cause of death, isolated lung metastases at diagnosis are not frequent. The specific role of chemotherapy, surgery, and lung radiation has not been clearly defined. We investigated prognostic factors and the impact of the different treatment modalities in a cohort of patients with ES with isolated lung metastases. MATERIALS AND METHODS: Thirty-eight patients with ES and isolated lung metastases were treated using modern multimodal therapy during the period 2000-2014. According to the imaging characteristics of lung nodules patients were allocated into one of four treatment groups: "0" without nodules, "1" one solitary nodule of <0.5cm or several nodules of <0.3cm, "2" solitary nodule of 0.5-1cm or multiple nodules of 0.3-0.5cm, "3" one pulmonary/pleural nodule of >1cm, or more than one nodule of >0.5cm. Factors predictive of outcome were analyzed. Overall survival was estimated by Kaplan-Meier methods and compared using long-rank test and Cox models. RESULTS: Treatment of the lung metastases was performed in 23 cases (60.5%): twenty patients underwent lung surgery, 6 of them received additional postoperative whole lung radiation; three patients received lung radiation only. Malignant cells were found in all lung nodules of patients from group "3", in 5 (62.5%) patients from group "2", and none of the group "1". There was a correlation between histological response of the primary tumor and outcome. Three-year estimates of EFS and OS were 45.19% and 60.7%, respectively. Patients with good response measured by chest CT had significantly better EFS than patients with poor response (81% vs. 27.66%, respectively, p=0.006). CONCLUSIONS: Metastatectomy may have a role in the treatment of highly selected patients with ES and isolated lung metastases depending on the histologic response to therapy. Further studies are needed to better define the use of surgery and the response-adapted criteria in the upfront management of this population.
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Neoplasias Óseas/patología , Neoplasias Pulmonares/secundario , Sarcoma de Ewing/secundario , Adolescente , Niño , Terapia Combinada/métodos , Manejo de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Sarcoma de Ewing/terapiaRESUMEN
Stenogyria, meaning multiple small compacted gyri separated by shallow sulci, is reported in the literature in association with Chiari II malformation (CM II) which in turn is reported in association with myelomeningocele (MMC). The authors present five cases of stenogyria (and other abnormalities found in CM II, like callosal hypoplasia/dysplasia, agenesis of the anterior commissure, hypoplasia of the falx cerebri) in children without the history of MMC or any other form of open spinal dysraphism. In these cases stenogyria was associated with Chiari I malformation, rhombencephalosynapsis and spina bifida. Stenogyria, which is not a true neuronal migration disorder, should not be mistaken for polymicrogyria which is also present in CM II. It is histologically different from polymicrogyria because the cortex is normally organized. Also on MRI, the general sulcal pattern is preserved in stenogyria, while it is completely distorted in polymicrogyria. The authors conclude that features traditionally attributed to CM II, like stenogyria, occur not only in the population of patients with MMC as opposed to the widely accepted theory.
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Malformación de Arnold-Chiari/patología , Corteza Cerebral/patología , Imagen por Resonancia Magnética , Polimicrogiria/patología , Malformación de Arnold-Chiari/complicaciones , Malformación de Arnold-Chiari/diagnóstico , Niño , Preescolar , Femenino , Humanos , Masculino , Polimicrogiria/etiologíaRESUMEN
BACKGROUND: Since 2003, very few publications have described brain examinations using neonatal MR-compatible incubator (INC). The authors present their first experience in these examinations, not limited to brain scans, with the use of an incubator equipped not only with head coil, but also with a coil designed for examinations of the spinal canal and spinal cord as well as the whole body, at the Institute of Mother and Child in Warsaw. MATERIAL/METHODS: Examinations were performed in 27 newborns (12 girls, 15 boys). Most of the neonates were prematurely born: 19 (70.4%) were born at gestational age of 23-37 weeks, mean of 30 weeks. They were examined at the corrected age of 26 weeks-1 month, mean of 36 weeks. Body weight of the newborns on the day of the study was 600-4,300 g, mean of 2,654 g. The study was performed with a GE Signa HDxT 1.5 T system with the use of a Nomag IC 1.5 incubator by Lammers Medical Technology Co., equipped with three coils: an eight-channel, phased-array head coil and a twelve-channel phased-array coil for the whole body, consisting of an eight-channel coil integrated in the incubator and a separate four-channel surface coil. RESULTS: Of the 27 children, 25 (92.6%) required a brain scan. Two children (7.4%) were referred to MRI for assessment of the spinal canal and the abdomen. We compared the results of transfontanelle ultrasound and MRI scans in 21 children. MRI provided significantly more diagnostic information in 18 cases (85.7%); in 3 cases (14.3%), no additional knowledge about the pathology was provided by the exam. CONCLUSIONS: The MR-compatible incubator increases the availability of MRI to newborns, especially premature newborns and those with low and extremely low body weight, for whom MR examinations are necessary to determine the extent of changes, not limited to the central nervous system, as well as to establish prognosis. Dedicated neonatal coils integrated with the incubator permit more accurate diagnosis than the previously used adult coils.
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BACKGROUND AND PURPOSE: The aim of the study was to assess anatomical variants and abnormalities in cerebral arteries on magnetic resonance angiography in 67 children with neurofibromatosis type 1 (NF1). MATERIALS AND METHODS: The study included 67 children aged 9 months to 18 years (mean 6.6 years). Control group comprised 90 children aged 2-18 years (mean: 11.8 years). All patients were examined at 1.5T scanner. RESULTS: We found cerebral arteriopathy (moyamoya disease) in one child (1.5%) in the study group. No aneurysms were found. Twenty-nine NF1 children (43.3%) had arterial anatomical variants. In 13 of them, more than one variant was diagnosed (44.8% of group with variants, 19.4% of study group). In control group, 19 children (21.1%) had variants, including four children with more than one variant (21% of group with variants, 4.4% of control group). Arterial variants were more common in NF1 patients compared with control group (p=0.026, binomial test for two proportions). Percentage of multiple variants was higher in study group than in control group, but this difference was not significant. Variants were more frequent on left side than on the right one (significant difference in control group; p=0.022, McNemara test). In study group, the number of left-sided anomalies (25) was similar to that of right-sided ones (22). There was no correlation between gender and variants, unidentified bright objects and variants or between optic gliomas and variants. CONCLUSIONS: Occurrence of arterial variants in NF1 patients was twofold higher than in control group. Multiple variants were more frequent in the study group although the difference did not reach statistical significance. Features of cerebral arteriopathy were found in one child with NF1.
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Círculo Arterial Cerebral/anomalías , Círculo Arterial Cerebral/patología , Neurofibromatosis 1/patología , Adolescente , Enfermedades Arteriales Cerebrales/etiología , Enfermedades Arteriales Cerebrales/patología , Arterias Cerebrales/anomalías , Arterias Cerebrales/patología , Niño , Preescolar , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Lactante , Angiografía por Resonancia Magnética , Imagen por Resonancia Magnética , Masculino , Glioma del Nervio Óptico/complicaciones , Glioma del Nervio Óptico/patologíaRESUMEN
Ultrasonography (US) remains the first method in the evaluation of fetal central nervous system (CNS) abnormalities but in case of the spinal canal and cord it is often insufficient since the bony structures may obscure these structures. Prenatal magnetic resonance imaging (MRI) is therefore the final noninvasive tool for the assessment of these malformations allowing for correction of sonographic findings, revealing the full extent of complex lesions and choosing the candidates for in utero treatment. The authors present the most frequent anomalies of spinal canal and spinal cord in the consecutive phases of pregnancy, illustrated with their own MR images, with reference to the literature and own experience. In 58 out of 252 fetuses examined due to suspicion of CNS anomalies (23.0%) the spinal canal and spinal cord abnormalities were found on MRI. The cases of diastematomyelia, myelomeningocele, tethered cord, caudal regression syndrome, anterior meningocele, cystic sacrococcygeal teratoma and syringohydromyelia are demonstrated.