The role of ultrasonography in predicting vesicoureteral reflux.

OBJECTIVE: To evaluate the accuracy of renal and bladder ultrasonography (RBU) in predicting vesicoureteral reflux (VUR) in infants and children. MATERIALS AND METHODS: A total of 134 children who had VUR demonstrated on voiding cystourethrography (VCU) and also had RBU within 1 month of the VCU were included in the study, which took place between January 2005 and December 2012. VUR and hydronephrosis were graded with standard methods on VCU and RBU, respectively. Using VCU findings of reflux as the gold standard, diagnostic accuracy measures were performed for hydronephrosis and ureteral visualization on RBU, including sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. RESULTS: Reflux grade was significantly associated with the degree of hydronephrosis (P = .0032). The sensitivity, negative predictive value, and accuracy of ultrasonography in predicting reflux was significantly higher for grade IV+ or grade V reflux compared with lower reflux grades. Also, the specificity of ultrasonography in predicting reflux was constant and at high level across all reflux grades, suggesting that ultrasonography is a good diagnostic screening tool. CONCLUSION: Normal RBU is rare with grade IV-V reflux, and moderate to severe hydronephrosis is rare with reflux grades

Importance of MRI in the diagnosis of vertebral involvement in generalized cystic lymphangiomatosis.

A 9-year-old boy presented with the sudden onset of pleuritic chest pain and on CT was found to have a large pleural effusion, mediastinal fluid, splenic lesions and multiple apparently sclerotic vertebral bodies. Subsequent MRI showed that those vertebral bodies that appeared sclerotic were in fact normal, and the vertebral bodies initially interpreted as normal had an abnormal T1 and T2 hyperintense signal on MRI and were relatively lucent on CT. MRI also demonstrated abnormal heterogeneous T2 hyperintense paraspinal tissue and several multicystic soft tissue masses. Biopsy of two adjacent vertebral bodies, one relatively sclerotic and one lucent, demonstrated findings of bony remodeling without a specific diagnosis. Biopsy of an infiltrative mediastinal mass confirmed the diagnosis of generalized cystic lymphangiomatosis. MRI should be included in the assessment of vertebral involvement in this condition because CT and biopsy findings may be nonspecific.

Intramuscular nodular fasciitis of the rectus abdominis muscle in an 11-year-old girl.

Nodular fasciitis is a benign rapidly proliferating fibrous tumor that is common in adults but relatively uncommon in children. When present in children, nodular fasciitis is typically subcutaneous in location and involves the head and neck. We present a case of intramuscular nodular fasciitis involving the rectus abdominis muscle in an 11-year-old girl and discuss the importance of distinguishing this rare but benign lesion from a more aggressive sarcomatous process.

Magnetic resonance enterography and wireless capsule endoscopy in the evaluation of patients with inflammatory bowel disease.

BACKGROUND: Magnetic resonance enterography (MRE) is increasingly used in children due to growing concerns of radiation. OBJECTIVE: To determine the performance of MRE, imaging findings were compared to wireless capsule endoscopy (WCE) and histology results in children with/or suspected inflammatory bowel disease (IBD). MATERIALS AND METHODS: Pathology and WCE reports were retrospectively reviewed in 23 patients who had MRE. RESULTS: The sensitivity of MRE was 75.0% while the sensitivity of WCE was 77.8%. CONCLUSION: MRE and WCE are complementary techniques in evaluation of the small bowel in IBD.

Visualization of the normal appendix with MR enterography in children.

BACKGROUND: Magnetic resonance (MR) imaging may provide a radiation-sparing alternative to CT in diagnosing appendicitis in children in whom US is equivocal. However, comparability with CT in the detection of the appendix remains to be established. OBJECTIVE: To determine the detection rate of the normal appendix in children on oral and IV contrast-enhanced MRI. METHODS: MR imaging of 58 patients who had previously undergone MR enterography was retrospectively reviewed. Detection rate, body mass index, age and gender were recorded. RESULTS: The normal appendix was detected in 28 cases (48%), with greatest detection rate on the axial fast imaging employing steady-state acquisition (FIESTA) sequence. Children in whom the appendix was detected had significantly higher BMI compared to children in whom the appendix was not seen. Neither age nor gender demonstrated a significant association with detection rate. CONCLUSION: The detection rate of the normal appendix in children on oral and IV contrast-enhanced MRI was 48%, which is comparable to detection rates on CT, as well as to previously reported detection rates on MR imaging with neither oral nor IV contrast agents. These findings may serve to guide the development of MRI protocols for pediatric appendicitis.

Radiologic-pathologic correlation in acute appendicitis: can we use it as a quality measure to assess interpretive accuracy of radiologists?

Radiologic-pathologic correlation was evaluated as a quality assurance tool by documenting error rates of 18 radiologists interpreting computed tomographic (CT) scans for acute appendicitis in 763 patients. The departmental error rate was 3.1%. Meaningful individual error rates could be determined in only the seven radiologists who interpreted ≥30 CT scans for acute appendicitis. Radiologic-pathologic correlation is an effective departmental monitor of interpretive accuracy, but individual accuracy can be assessed only for radiologists reading a large number of cases with pathologic proof.

Incidence of immediate gadolinium contrast media reactions.

OBJECTIVE: Our objective was to determine the incidence of immediate adverse events for gadolinium-based contrast agents. MATERIALS AND METHODS: All gadolinium-based contrast agent adverse events reported to radiology quality assurance committees were graded according to American College of Radiology criteria and divided by the total number of injections to determine incidence during the past 10 years. For each event, an age- and examination-matched control patient was identified to compare sex, weight, creatinine, eosinophil count, allergic history and gadolinium-based contrast agent dose differences. The U.S. Food and Drug Administration (FDA) Adverse Event Reporting System (AERS) database was analyzed to compare local experience to national trends. RESULTS: Abdominal MRI had the highest rates of adverse events, 0.013% compared with brain (0.0045%, p < 0.001) or spine (0.0034%, p < 0.001). Adverse events were more likely in women, with a female to male ratio of 3.3, and in patients with history of prior allergic reactions (p < 0.001). Immediate adverse events rates were 0.2, 0.5, 1.2, and 3.3 per 1,000 injections for gadodiamide, gadopentetate dimeglumine, gadobenate dimeglumine, and gadoteridol, respectively. Gadobenate dimeglumine had more severe patient reactions, including three patients who arrested (defined as the patient becoming unresponsive and the code team being called), one of whom died. From 2004 to 2009, the FDA received reports on 40 gadolinium-based contrast agent U.S. deaths unrelated to nephrogenic systemic fibrosis, with an incidence per million doses of 0.15, 0.19, 0.97, 2.7, and 0.7 for gadodiamide, gadoversetimide, gadopentetate dimeglumine, gadobenate dimeglumine, and gadoteridol, respectively. CONCLUSION: This limited retrospective analysis shows that gadolinium-based contrast agents are very safe, with only rare reports of death, and raises the possibility that nonionic linear gadolinium-based contrast agents and gadopentetate dimeglumine may have fewer severe immediate adverse events compared with gadobenate dimeglumine.

Multimodality imaging of a neonatal wandering spleen.

Wandering spleen, a rare entity, is caused by the absence or laxity of the normal anchoring splenic ligaments. Only three neonatal cases have been reported in the English-language literature. We present the clinical and multimodality imaging findings of a newborn with laceration and hemorrhage of a wandering spleen. The course was complicated by the concurrent diagnosis of glucose-6-phosphate dehydrogenase deficiency, which confused the clinical picture when a falling hematocrit raised the question of rebleeding several days after presentation.

Pelvic cake kidney with a solitary ureter and bilateral congenital absence of the vas deferens.

Cross-fused renal ectopia is an uncommon anomaly, typically drained by 2 ureters. We present a rare case of a patient with bilateral absence of the vas deferens found to have a "cake" or "lump" kidney with fused collecting systems drained by a single ureter.

Pulmonary blastoma in a neonate: a lesion distinct from pleuropulmonary blastoma with unique cytogenetic features.

Pulmonary blastoma is a rare malignant primary lung neoplasm typically seen in adults that accounts for 0.3-1.3% of lung malignancies. It has been categorized as a subtype of sarcomatoid carcinoma according to the current World Health Organization Classification of Lung Tumours and is distinct from the more common pediatric lung tumor pleuropulmonary blastoma. We report a case of neonatal pulmonary blastoma, illustrating the imaging characteristics of this rare tumor. The subject of pediatric lung masses is confusing because the terms pleuropulmonary blastoma and pulmonary blastoma have been used interchangeably in previously reported cases. We recommend use of the current WHO classification to differentiate these lesions as additional cases are described. Additionally, we discuss distinctive cytogenetic features of this case.

Segmental dilatation of the ileum in a healthy adolescent.

Segmental intestinal dilatation is a rare entity presenting overwhelmingly in infants and young children with congenital malformations, anemia, or history of gastrointestinal pathology, characterized by a focally distended segment of bowel with abrupt transition points without an obstructing barrier. We present a 16-year-old girl with no significant medical history who presented with bowel obstruction clinically. Segmental dilatation of the ileum was evident on a CT scan and small bowel series. Following surgical resection, pathologic examination of the segment revealed the presence of heterotopic gastric mucosa. The girl's symptoms resolved after surgery. Awareness of the imaging presentation of this entity can inform the evaluation of older children with nonspecific symptoms mimicking bowel obstruction.

A dominantly inherited spondylometaphyseal dysplasia with "corner fractures" and congenital scoliosis.

Spondylometaphyseal dysplasia (SMD) is a term applied to a varied group of skeletal dysplasias that principally involve the spine and the metaphyses of long bones. SMD Sutcliffe or "Corner Fracture" type is characterized by short stature, developmental coxa vara, fragmented appearance of the metaphyses ("corner fractures"), abnormally shaped vertebrae, odontoid hypoplasia, and dominant inheritance. We report a family with a dominantly inherited SMD with "corner fractures" and severe, congenital scoliosis but neither coxa vara nor odontoid abnormalities. This could either represent phenotypic variability in SMD-"Corner Fracture" type, or be a new, dominantly inherited SMD. The presence of severe, congenital scoliosis and short stature is present in all members of this family, and not typically seen in SMD-"Corner Fracture" type, supporting our hypothesis that this might represent a new, dominantly inherited SMD.

Spontaneous hemopneumothorax.

Spontaneous hemopneumothorax is a potentially fatal condition associated with 1-12% of all spontaneous pneumothoraces. Prompt diagnosis is essential in order to allow for rapid surgical intervention. A case of a 15-year-old male with spontaneous hemopneumothorax diagnosed by CT is presented. The patient recovered after surgery with no complications.