Computed tomography-based virtual colonoscopy in the assessment of bowel endometriosis: The surgeon's point of view.

OBJECTIVE: To discuss the role of computed tomography-based virtual colonoscopy (CTC) in preoperative assessment of bowel endometriosis. METHODS: Retrospective study using data prospectively recorded, including 127 patients with colorectal endometriosis, having undergone CTC for bowel endometriosis. The study was conducted in a tertiary referral center during 38 consecutive months. Preoperative assessment included CTC, magnetic resonance imaging (MRI), endorectal ultrasound (ERUS) and clinical examination. Information concerning identification of deep infiltrating endometriosis (DIE) of the bowel, the length and height of colorectal involvement, stenosis of digestive lumen and associated digestive localizations were compared with intraoperative findings. RESULTS: Sensitivity and specificity of CTC for DIE of the rectum, the sigmoid colon, associated digestive localizations, and stenosis of the digestive lumen were respectively 97% and 84%, 93% and 88%, 84% and 97%, 96% and 96%. Intraoperative estimation of the length of digestive tract involved by DIE was closer to that provided by CTC than those provided by MRI and ERUS. When CTC revealed stenosis of digestive lumen, higher rates of colorectal resection (63% vs. 9.6%, < 0.001) and disc excision (25.9% vs. 11%, 0.03) were recorded. DISCUSSION: For those surgeons using various procedures for management of bowel endometriosis, accurate information on the length and height of bowel involvement, as well as the existence of bowel stenosis enables informed decision regarding the feasibility of conservative techniques versus bowel resection. Preoperative identification of associated localizations above the sigmoid colon is another major advantage related to CTC. CONCLUSIONS: CTC provides accurate data on the length and height of colorectal involvement by DIE, stenosis of digestive lumen and associated lesions of digestive tract, which impact on the choice of surgical procedure.

[MRI of the brain in the evaluation of children with developmental delay]. / Apport de l'IRM cérébrale à l'exploration des retards psychomoteurs de l'enfant.

PURPOSE: To analyze the diagnostic value of MRI in children with developmental delay. Materials and Methods. From 1991 to 1997, 224 examinations were performed. Retrospective analysis of clinical findings and diagnostic yield was carried out. RESULTS: MRI was abnormal in 109 cases. It never resulted in any patient care modification. 55 malformations, 12 cases of cerebral atrophy, 7 cases of white matter disease and 2 patients with phakomatose were identified. Myelination delay (26 cases), increased signal of posterior white matter on T2-weighted images (9 cases) or widened Virchow-Robin spaces (3 cases) were frequently encountered, but it remained unclear whether they represented normal variants or true abnormalities. Post ischemic lesions were identified in 10 cases. Frequency of abnormal studies was significantly lower in children with developmental delay and behavioral disorders than in patients with other clinical presentation. CONCLUSION: Diagnostic yield of cerebral MRI can justify its performance by comparison to other imaging modalities. It should be correlated with other investigations performed in a specialized unit. Its main interest is for classification and research. Risk of sedation or anesthesia should also be taken in account. Risk can be lowered using adequately equipped MR units and organizing procedures in collaboration with anesthesiologists.

Renal sinus hyperechogenicity in acute pyelonephritis: description and pathological correlation.

This paper reports on the association between renal sinus hyperechogenicity and acute pyelonephritis. The medical records and imaging studies of 18 children displaying this pattern were retrospectively studied. Thickening of the renal pelvis and renal enlargement were the most frequent associated sonographic abnormalities. Further subtle findings can be found on sonography and colour/power Doppler. Their identification can help in the diagnostic approach to acute pyelonephritis and may obviate the need for other imaging modalities such as enhanced CT or 99mTc-DMSA scintigraphy. Renal sinus hyperechogenicity was also identified in a parallel study performed in female rabbits with experimental pyelonephritis and was shown, histologically, to be related to exudates of fibrin and polymorphonuclear leukocytes, interstitial oedema and micro-abscesses.

[Retrograde cystography after a first episode of acute pyelonephritis in the child and adolescent]. / Cystographie rétrograde après un premier épisode de pyélonéphrite aiguë chez la fillette et l'adolescente.

In spite of its invasiveness, voiding cystourethrography remains the gold-standard examination for detecting vesico-ureteric reflux. The aim of this study was to determine if voiding cysto-urethrography is useful at any pediatric age in girls after a first acute pyelonephritis. 152 patients have been retrospectively studied. Both reflux frequency and grade progressively decreased according to age. Sonography was unable to predict reflux. In more than 3-year-old girls, 8/30 children with reflux had voiding dysfunction. We suggest clinical and/or a flow-metric evaluation for voiding dysfunction prior to voiding cystourethrography. After 9 years, reflux was so rare that voiding cystourethrography should be discussed on an individual basis.

[Evolution and radiologic surveillance on community-acquired pneumonia in children]. / Evolution et surveillance radiologiques des pneumopathies communautaires de l'enfant.

Although useful for the diagnosis of lower respiratory tract infections, chest X-rays have a weak specificity in the etiological diagnosis. It is of particular interest when complications are suspected. A radiological follow-up allows to exclude sequellae or a preexisting pulmonary abnormality; however follow-up X-rays are to be delayed 2 to 3 weeks after the clinical recovery due to the late radiological recovery. CT is indicated as a complementary investigation in cases of complications and sequellae.

[Postnatal echography and cystography after prenatal diagnosis of minor dilatation of the kidney pelvis. Prospective study of 89 cases]. / Echographie et cystographie postnatales après diagnostic prénatal d'une dilatation mineure du bassinet. Etude prospective sur 89 cas.

We evaluated postnatal management after the prenatal diagnosis of moderate dilatation of the renal pelvis (antero-posterior diameter superior to 1 mm per month of pregnancy and inferior to 15 mm at full term). Eighty-nine neonates who had a moderate dilatation in utero were evaluated by ultrasound and voiding cysto-urethrography. Ultrasound was performed between day 2 and day 7 in 83 cases, after day 7 in 6 cases. Voiding cysto-urethrography was performed during first month in 80 cases, after this period in 9 cases. Sixty-five neonates were shown to have a malformation of the urinary tract: reflux (n = 27), megaureter (n = 20), uretero-pelvic junction obstruction (n = 19), renal duplication (n = 7), posterior urethral valves (n = 2), horseshoe kidney (n = 1), ureteric cyst (n = 1). Reflux which is frequent in neonates with urinary tract infection, is the most frequent cause of moderate dilatation of the fetal renal pelvis. Combination of ultrasound and voiding cysto-urethrography in neonates allows a quick, full diagnosis. It helps rationalize the use of prophylactic antibiotic treatment.

[Sedation with oral hydroxyzine and rectal chloral hydrate in pediatric MRI and CT]. / Sédation par hydroxyzine orale et hydrate de chloral rectal en IRM et TDM pédiatriques.

AIM: To assess the efficacy and risks of oral hydroxyzine and rectal chloral hydrate to sedate children undergoing CT or MRI. PATIENTS AND METHODS: 110 children underwent 117 studies. Medical history, treatments, doses per kg of sedative drugs, study quality, sedation time and side effects were prospectively recorded. RESULTS: 25 minutes was the mean time necessary to put children to sleep, 59 minutes was the mean time of sedation 96% of studies were interpretable. 2 children showed transient side effects. CONCLUSION: This sedation regimen appeared efficient. However, its limitations and risks have to be known by radiologists. Sedation-related problems also have to be considered by hospital managers when a new CT or MR equipment is being acquired.

Power Doppler sonographic pattern of acute pyelonephritis in children: comparison with CT.

OBJECTIVE: Focal areas of decreased perfusion may be shown by power Doppler sonography in children with acute pyelonephritis. The purposes of this study were to assess the ability of power Doppler sonography to reveal acute pyelonephritis and to compare the sonographic images with enhanced CT images. SUBJECTS AND METHODS: We performed B-mode sonography, power Doppler sonography, and enhanced CT (reference method) of the kidneys of 30 children with symptoms suggesting upper urinary tract infection. All imaging studies were obtained within 24 hr of admission of each child to our hospital. Power Doppler sonography was performed with the same equipment and the same settings for all children. Imaging studies were performed before the results of urine cultures were obtained. Triangular areas of decreased perfusion visible on both longitudinal and axial scans were considered indicative of acute pyelonephritis on power Doppler sonographic images. On CT images, areas of decreased attenuation of the renal parenchyma visible immediately after IV injection of iodinated contrast agent or areas of increased attenuation on delayed scans were considered indicative of acute pyelonephritis. Power Doppler sonography and CT were compared for each renal pole (n = 120). RESULTS: For 17 (89%) of the 19 patients with CT-proven acute pyelonephritis, power Doppler sonography diagnosed this condition on the correct side. Seventeen (77%) of the 22 poles showing acute pyelonephritis on CT scans were also revealed by power Doppler sonography. The two patients in whom acute pyelonephritis was not revealed by power Doppler sonography were an obese 15-year-old girl and a 7-year-old boy with right upper pole pyelonephritis. This boy was one of the first patients to be included in the study. Also, in an obese 11-year-old girl, a false-positive indication of pyelonephritis was given by power Doppler sonography. CONCLUSION: Power Doppler sonography seems to be significantly more sensitive than conventional sonography for the detection of acute pyelonephritis in children. This noninvasive technique should be able to replace CT or dimercaptosuccinic acid scintigraphy in many children with urinary tract infections.

Rib displacement threatening the spinal cord in a scoliotic child with neurofibromatosis.

About 30% of children with neurofibromatosis are affected by scoliosis usually due to bony dysplasia and/or neurogenic tumors. We report the case of a scoliotic girl with type 1 neurofibromatosis presenting with a costovertebral dislocation at the apex of the spinal curvature.

Legg-Perthes-Calvé disease: staging by MRI using gadolinium.

Twenty-one patients (26 hips) with typical signs of Legg-Perthes-Calvé (LPC) disease on plain radiographs were explored by MRI. Patients were imaged with a 0.5 T MR unit. Gadolinium-enhanced spin-echo MR images were obtained after nonenhanced T1-weighted (spin-echo) and T2*-weighted (gradient-echo) images. Four different areas were identified in the femoral epiphysis (necrosis, regenerative, cartilaginous and normal fatty bone tissue). The histological evolution of LPC is well described by Catterall and others. Comparing their descriptions with our MR findings, we suggest classification of LPC into five phases: necrosis: regeneration, reconstruction, reossification and sequelae.

Soft tissue signal abnormality associated with eosinophilic granuloma. Correlation of MR imaging with pathologic findings.

Six patients with eosinophilic granuloma were studied retrospectively in order to correlate the MRI appearances with the pathology. Ages ranged from 2 years 6 months to 11 years. The bones involved were the humerus, ulna, radius, femur, clavicle and ilium. Plain films, MRI and pathology specimens were obtained. A lytic lesion with indistinct margins, endosteal erosions and periosteal reaction was seen in all cases on plain radiographs. Bone marrow signal was decreased on T1-weighted images and increased on T2-weighted images throughout the bony lesion in all cases. T2-weighted images showed extensive soft-tissue abnormalities suggesting inflammatory changes in four cases. In two cases abnormalities were limited. Extensive changes correlated histologically with an early phase lesion. Localized minor changes were associated with a mid-phase lesion. Inflammatory soft-tissue changes could be associated with eosinophilic granuloma. The size of the soft tissue mass correlated well with the activity of the bony lesion.

[Ultrasonography of the esophagus in children]. / Echographie de l'oesophage de l'enfant.

The main role of ultrasonography of the esophagus in children is to exclude gastro-esophageal reflux. This technique can be used in patients with chronic ENT and/or respiratory tract infections. If US is positive, medical treatment can be instituted. Other causes such as allergy or immune deficiency must be investigated whenever US remains negative. Since US allows a poor assessment of the severity of reflux, it is not recommended in clinically obvious GER. US is also not very sensitive for esophagitis. A detailed study of the anatomy and dynamics of the esophagus and stomach can be performed, but such studies have no value as a first-line examination. Whenever reflux persists despite medical treatment, US can be proposed to look for hiatus hernia.

Spontaneous intracerebral hematomas from vascular causes. Predictive value of CT compared with angiography.

The aim of the present study was to assess the diagnostic accuracy of CT in determining the underlying causes of brain hematomas with a state-of-the art CT. For this purpose, CT and angiographic data of 149 subjects with spontaneous intracerebral hematomas (ICH) were statistically compared in a blind, retrospective study, taking angiography, supported when possible by surgical findings, as providing the correct diagnoses. 5 groups were distinguished on the basis of CT data: 103 patients with isolated deep ICH had normal angiograms; 9 patients with isolated superficial ICH and 8 with deep ICH and intraventricular hemorrhage (IVH) had arteriovenous malformations (AVMs). 4 with this combination showed no angiographic abnormalities, one had an aneurysm. 14 subjects with ICH and subarachnoid hemorrhage (SAH) had a middle cerebral or carotid artery aneurysm; and 10 with ICH, SAH and IVH had also an aneurysm, in 7 on the anterior communicating artery. Sensitivity, specificity, positive and negative predictive values were respectively: for AVMs 100, 96, 77 and 100%; and for aneurysms 96, 100, 100 and 99%. Kendall coefficient was 0.95, indicating close correlation between the two modalities. This study confirms that CT can accurately predict the likelihood, nature and location of vascular ICHs. It indicates whether angiography is necessary or not, and if so, what vascular tree ought to be explored.