Bone age assessment with conventional ultrasonography in healthy infants from 1 to 24 months of age.

BACKGROUND: Radiographic bone age determination is part of the routine evaluation of suspected growth disorders. Simplicity and low cost are its major advantages, but although the effective dose of ionizing radiation is low, it should be taken into consideration given its cumulative effect. OBJECTIVES: To assess the chronological ultrasonographic emergence of the ossification centers of the hand and wrist. MATERIALS AND METHODS: Cross-sectional study of healthy patients ages 1 to 24 months (n=498) from Buenos Aires, Argentina. All patients underwent ultrasonographic evaluation of the left hand and wrist to identify the different bone nuclei; a subgroup of infants had their nuclei measured (n=228). RESULTS: Girls showed an earlier emergence of the evaluated nuclei and a trend to a greater size than age-matched boys. Size-for-age relation showed linear increase. Carpal bones (capitate and hamate) were the first to appear, as early as from the first 3 months of life, an age gap not thoroughly present on the radiographic atlas developed by Greulich and Pyle. The distal epiphysis of the radius and the second metacarpophalangeal joint (index finger) followed in order of emergence. The proximal epiphysis of the first metacarpal bone (thumb) was the last to emerge and was infrequently found on boys at age 24 months. Overall, these findings are in accordance with the radiographic atlas. An ultrasonography atlas of the left hand and wrist was outlined for girls and boys. CONCLUSION: Conventional ultrasonography allows proper identification of the ossification centers of the hand and wrist and may become an innocuous follow-up tool for patients with growth disorders.

Lesiones tendinosas del tobillo en resonancia magnética: análisis retrospectivo en 548 estudios / Tendinous lesions of the ankle in MRI: retrospective review in 548 exams

Objetivo: Determinar la prevalencia de las diversas lesiones tendinosas del tobillo y sus características iconográficas típicas en los pacientes sometidos a Resonancia Magnética (RM). Material y métodos: Se efectuó un análisis descriptivo, retrospectivo y de corte transversal, de 548 estudios de RM de tobillo durante un período de 18 meses (entre enero de 2006 y junio de 2007), que contabiliza el total de los exámenes obtenidos en resonadores de campo cerrado en Diagnóstico por Imágenes Adrogué y en las sedes Hospital Fiorito de Avellaneda y Fundación Científica del Sur. Resultados: Del total de exámenes (n=548), el 40.3% fueron realizados a pacientes de sexo femenino (n=221) y el 59.7% a pacientes de sexo masculino (n=327), con una edad promedio de 47.6 ± 17 años. El 60.5% de los estudios (n=331) no reveló alteraciones en ningún grupo tendinoso del tobillo, mientras que el 39.5% (n=217) demostró la presencia de algún tipo de patología tendinosa. Asimismo, 64 estudios (11.7%) revelaron alteraciones en el tendón tibial posterior; 47 (8.6%) en el tendón de Aquiles; 34 (6.2%) en el tendón peroneo lateral corto; 27 (4.9%) a nivel del tendón del flexor propio del hallux; 26 (4.7%) en el tendón peroneo lateral largo; 10 (1.8%) en el tendón flexor común de los dedos; 6 (1.1%) en el tendón tibial anterior; y 3 (0.5%) en el tendón extensor común de los dedos. Conclusiones: La RM constituye una excelente herramienta en la valoración de las diversas patologías tendinosas debido a su capacidad multiplanar y a su alto contraste tisular.

Purpose: To determine the prevalence of several tendinous lesions of the ankle, and the MR imaging features that characterize these lesions. Materials and methods: MR images in 548 exams of ankle were retrospectively reviewed. These studies were performed during a 18-months period of time in 3 MR scanners at Hospital Fiorito (Avellaneda), Diagnóstico por Imágenes Adrogué, and Fundación Científica del Sur Avellaneda. Results: The ankle MR images (n=548) were taken from 221 women, and 327 men; median age, 47.6 years. In 60.5% studies (n=331), no pathologic images were identified. Sixty four exams (11.7%) showed some kind of tendon injury in the tibialis posterior tendon, 47 (8.6%) in the Achilles tendon, 34 (6.2%) in the peroneus brevis tendon, 27 (4.9%) in the flexor hallucis longus tendon, and 26 (4.7%) in the peroneus longus tendon. Additional findings included lesions in the flexor digitorum longus tendons (n=10), in the tibialis anterior tendon (n=6), and in the extensor digitorum longus tendons (n=3). Conclusions: The high-quality soft-tissue contrast resolution, noninvasive nature, and multiplanar capabilities of the MR images make it an excellent tool for the detection and evaluation of a variety of tendon disorders in the ankle.

Magnetic resonance imaging in 300 cases of placenta accreta: surgical correlation of new findings.

BACKGROUND: To establish the usefulness of placental magnetic resonance in patients with a diagnosis of placenta accreta through the correlation of diagnostic images and surgical findings. METHODS: Three hundred patients with ultrasound signs of placenta accreta were studied. In 252 patients, magnetic resonance imaging (MRI) was performed in a closed 1.5 T-resonator, and in 48 patients, open 0.23 T-set was used. T1 and T2 slices in the three planes were performed, and placental invasion was classified in depth levels and topographic areas in relation to the posterior vesical wall. The final degree of invasion was established during surgery according to clinical and anatomical criteria. The information obtained with MRI was analyzed, thus establishing its relevance to the change in surgical technique. RESULTS: In 286 cases, MRI provided topographic information of placental invasion, and in 90 patients, it modified invasion levels. Undiagnosed parametrium extent was determined in 11 cases, and 11 other cases were reclassified as placenta previa. Changes in conduct following MRI study included: recommendation to modify surgery date at week 35, recommendation for prophylactic ureteral catheterization, recommendation for the use of intraoperative blood salvage, possibility of approach through Pfannenstiel incision, probability of segmental myometrial approach, probability of aortic clamping, need to investigate subclinical disseminated intravascular coagulation, need of posterior pelvic dissection, and the possibility of uterine conservation. CONCLUSIONS: Magnetic resonance imaging turned out to be essential to define the topography and area of placental invasion. New findings modified surgical tactic and technique, allowing a reduction in historical morbidity and a significant increase in conservative surgeries.

Estudio de las anomalías uterovaginales: hallazgos mediante RM en pediatría / Utero-vaginal abnormalities: MR imaging in pediatric patients

Propósito: Correlacionar los hallazgos prequirúrgicas obtenidos por medio de RM con la cirugía, de las malformaciones müllerianas en pacientes pediátricos. Material y métodos: Se estudiaron 14 pacientes comprendidas entre 12 y 17 años mediante RM. Las mismas fueron agrupadas en base a la clasificación de la American Fertility Society modificada por Rock. Resultados: Del total de las pacientes estudiadas 4 pertenecieron al grupo I, 4 al grupo II, 4 al grupo III y por último 2 la grupo IV. Conclusión: Se obtuvo una adecuada correlación entre la RM y la cirugía con respecto a la clasificación utilizada, siendo este método diagnóstico el indicado para el estudio prequirúrgico de las pacientes con malformaciones müllerianas

Patología vascular periférica aortoilíaca y de miembros inferiores y sus ramas principales: evaluación por medio de angiorresonancia con gadolinio / MR angiography of aortoiliac vessles and lower extremity arterial disease

Se estudiaron 25 pacientes por medio de angiorresonancia con gadolinio, con sospecha o diagnóstico de patología vascular periférica. Se utilizó una secuencia tinme of fight ultrarrápida menor de 40 seg. Se hallaron nueve aneurismas aórticos; un aneurisma renal, tres estenosis y dos M.A.V. (malformaciones arterio venosas) renales; dos estenosis de tronco celíaco, dos estenosis de la arteria mesentérica superior; cuatro casos de patología aortoilíaca; una estenosis femoral superficial, una estenosis tibial anterior y posterior y una disminución generalizada del calibre de la aorta con estenosis ilíaca y riñón "en galleta". Nuestra experiencia sugiere que la angiorresonancia es un método rápido y útil para la evaluación de la patología vascular periférica, sobre todo en pacientes imposibilitados en someterse a una angiografía convencional