Fast magnetic resonance imaging for diagnosing pulmonary tuberculosis in children: the sub-10-min unenhanced scan.

PURPOSE: In this study, we aimed to report the feasibility and quality of fast (unenhanced < 10-min duration) magnetic resonance imaging (MRI) for the detection of lymphadenopathy in non-sedated children with suspected tuberculosis (TB). MATERIAL AND METHODS: This was a prospective study that involved children (< 13 years of age) hospitalised at Red Cross Children's Hospital with suspected pulmonary TB who were referred for a fast MRI of the chest. The limited short-duration MRI protocol included coronal short tau inversion recovery (STIR) and axial diffusion-weighted imaging (DWI) sequences with additional axial STIR and axial and coronal T2 sequences if the patient was compliant. The scan time was capped at 10 min and a study was considered successfully completed when DWI and STIR images were obtained in axial planes. MRI quality was recorded as 'acceptable quality'; 'poor quality, but readable'; and 'non-diagnostic'. RESULTS: Of the 192 fast MRI protocol scans, 166 (86%) were successfully completed within the 10-min allotted scan period. There was no age or sex difference between successful and unsuccessful studies. The mean duration of successful scans was 6.5 min (standard deviation = 1.5 min, range = 4-10 min). CONCLUSION: Fast (sub-10-min scan) MRI is feasible for diagnosis of lymphadenopathy in non-sedated children in the setting of suspected TB, including those below 6 years of age.

Disseminated Human Subarachnoid Coenurosis.

Background: Traditionally, human coenurosis has been ascribed to Taenia multiceps while neurocysticercosis has been attributed solely to Taenia solium infection. Historically, however, the identification and differentiation of cestodal infection was primarily based on inaccurate morphological criteria. With the increasing availability of molecular methods, the accuracy of identification of the larval cestode species has improved, and cestodal species not typically associated with central nervous system (CNS) infection are now being identified as aetiological agents. Case report: We present a case of a 5-year-old male patient who presented with acute hydrocephalus. Initial MRI revealed multiple cysts in the cerebrospinal fluid (CSF) spaces with a predominance of clumped grape-like cysts in the basal cisterns with resultant acute obstructive hydrocephalus. The child underwent an emergency ventriculo-peritoneal (VP) shunt. A presumptive diagnosis of neurocysticercosis racemosus was made and the child was started on empiric albendazole (15 mg/kg/day) and praziquantel (30 mg/kg/day) treatment, along with concomitant prednisone (1 mg/kg) treatment. Despite prolonged anti-helminthic therapy, the child continued to deteriorate, and endoscopic removal of the 4th ventricular cysts was required. Post-operative MRI revealed radiological improvements, with a reduction in the number and size of cysts, especially in the basal cisterns, with no cysts visualized in the fourth ventricle. DNA was extracted from CSF and cyst tissue using the QiAMP DNA mini kit (Qiagen). The PCR performed on the extracted DNA displayed a band of 275 bp on an agarose gel. The consensus sequence had 97.68% similarity to Taenia serialis 12S ribosomal RNA gene. The child, unfortunately, continued to do poorly, requiring multiple VP shunt revisions for repeated blockage of the VP shunt system, and ultimately demised, despite the 'successful' surgical intervention and continued maximal medical management. Discussion and conclusions: There have been approximately 40 reported cases of human CNS coenurosis, with the assumed etiological agent being confined to T. multiceps. In 2020, the first case of human CNS coenurosis caused by T. serialis was reported. This case involved a single parenchymal lesion in the occipital lobe, which, following complete surgical excision, was confirmed to be T. serialis by mitochondrial gene sequencing. The case we present is the first case of disseminated subarachnoid coenurosis caused by T. serialis. It appears that T. serialis infection can mimic either of the two basic pathological forms of neurocysticercosis, namely, cysticercosis cellulosae or cysticercosis racemosus. We postulate that the term coenurosis racemosus is applicable if CNS T. serialis infection presents with extensive, multiple grape-like bladders proliferating within the subarachnoid space.

Chest Imaging for Pulmonary TB-An Update.

The diagnosis of pulmonary tuberculosis (PTB) in children is challenging. Difficulties in acquiring suitable specimens, pauci-bacillary load, and limitations of current diagnostic methods often make microbiological confirmation difficult. Chest imaging provides an additional diagnostic modality that is frequently used in clinical practice. Chest imaging can also provide insight into treatment response and identify development of disease complications. Despite widespread use, chest radiographs are usually non-specific and have high inter- and intra-observer variability. Other diagnostic imaging modalities such as ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) can provide additional information to substantiate diagnosis. In this review, we discuss the radiological features of PTB in each modality, highlighting the advantages and limitations of each. We also address newer imaging technologies and potential use.

Suprasellar arachnoid cyst due to ectopic choroid plexus: case report.

Arachnoid cysts (ACs) are malformations that account for about 1% of all intracranial lesions. The aetiology and progression of these lesions have been debated, with one possible explanation being the production of cerebro-spinal fluid (CSF) by ectopic choroid plexus (CP). To our knowledge, only seven cases of ACs incorporating CP have been reported, and we believe this to be the first reported case of a suprasellar AC containing ectopic CP. A 1-year-old boy presented with developmental delay and macrocephaly. MRI scan revealed hydrocephalus due to a suprasellar AC. An endoscopic ventriculocisternostomy was undertaken. Intra-operatively, intra-cystic, pink frond-like tissue resembling choroid plexus was identified. Histologically, the cyst wall was composed of fibrous tissue, with layered arachnoid cells, while the frond-like tissue was composed of papillary structures in keeping with normal choroid plexus tissue. We postulate that the rest of the ectopic CP may have been trapped within the double layered arachnoid fold of the diencephalic leaf of Liliequist's membrane which may drive the formation and development of certain suprasellar ACs.

Chest imaging in paediatric pulmonary TB.

Tuberculosis (TB) remains a significant cause of death from an infectious disease worldwide. The diagnosis of pulmonary TB in children is often challenging as children present with non-specific clinical symptoms, have difficulties providing specimens and have a low bacillary load. Radiological imaging supports a clinical diagnosis of pulmonary TB in children, can assess response to treatment and evaluate complications of TB. However, radiological signs on plain radiographs are often non-specific and inter-observer variability in the interpretation contribute to the difficulties in radiological interpretation and diagnosis. The goal of this review is to discuss the advantages and features of cross-sectional imaging such as ultrasound, Computed tomography (CT) and Magnetic resonance imaging (MRI) in diagnosing pulmonary TB (PTB) and its complications in children.

Rectal Perforation following High-Pressure Distal Colostogram.

In patients with anorectal malformations and a colostomy, the high-pressure distal colostogram is the technique of choice to determine the type of malformation and thus to plan the surgical repair. Perforations associated with high-pressure distal colostograms are very rare. The aim of our study was to identify pitfalls to prevent perforation secondary to high-pressure distal colostogram. The study included two male patients and was complicated with rectal perforations secondary to high-pressure distal colostogram. Both patients had an imperforate anus without a fistula. One patient had extraperitoneal rectal perforation with progressive contrast spillage into the peritoneum and demised. The other patient developed an extraperitoneal perforation and an associated necrotizing fasciitis of his perineum and scrotum, but he recovered well after debridement. Two further cases of rectal perforation have been described in the literature. Rectal perforation, although rare, is a described life-threatening complication secondary to high-pressure distal colostogram. The cause is excessive contrast pressure. Injection of contrast should be stopped once the distal end of the colon has a convex shape. Intraperitoneal perforation may cause hypovolemic/septic shock, and patients need to be appropriately resuscitated and should undergo laparotomy. Extraperitoneal perforation requires close monitoring for possible local complications, which may necessitate early debridement.

Intrathoracic tuberculous lymphadenopathy in children: a guide to chest radiography.

Making the diagnosis of pulmonary tuberculosis in children can be difficult because microbiological confirmation is not often achieved. Diagnosis is therefore often based on clinical features in combination with chest radiograph findings. Chest radiographs can demonstrate lymphadenopathy of the hilar and para-tracheal regions on the anteroposterior view, and subcarinal lymphadenopathy on the lateral view. However poor interobserver agreement has been reported for radiologist and clinician assessment of lymphadenopathy. This might reflect the lack of standardised imaging criteria for diagnosis as well as radiologists' objectives for achieving sensitivity rather than specificity. In this paper the authors provide a pictorial aid of chest radiographs in children with culture-confirmed tuberculosis to help clinicians identify lymph node enlargement in primary pulmonary tuberculosis. This collection of images comprises chest radiographs accompanied by schematics and either CT or MRI scan confirmation of pathological lymph node enlargement at the positions commonly affected in tuberculosis.

Corpus callosum thickness in children: an MR pattern-recognition approach on the midsagittal image.

Thickening of the corpus callosum is an important feature of development, whereas thinning of the corpus callosum can be the result of a number of diseases that affect development or cause destruction of the corpus callosum. Corpus callosum thickness reflects the volume of the hemispheres and responds to changes through direct effects or through Wallerian degeneration. It is therefore not only important to evaluate the morphology of the corpus callosum for congenital anomalies but also to evaluate the thickness of specific components or the whole corpus callosum in association with other findings. The goal of this pictorial review is raise awareness that the thickness of the corpus callosum can be a useful feature of pathology in pediatric central nervous system disease and must be considered in the context of the stage of development of a child. Thinning of the corpus callosum can be primary or secondary, and generalized or focal. Primary thinning is caused by abnormal or failed myelination related to the hypomyelinating leukoencephalopathies, metabolic disorders affecting white matter, and microcephaly. Secondary thinning of the corpus callosum can be caused by diffuse injury such as hypoxic-ischemic encephalopathy, human immunodeficiency virus (HIV) encephalopathy, hydrocephalus, dysmyelinating conditions and demyelinating conditions. Focal disturbance of formation or focal injury also causes localized thinning, e.g., callosal dysgenesis, metabolic disorders with localized effects, hypoglycemia, white matter injury of prematurity, HIV-related atrophy, infarction and vasculitis, trauma and toxins. The corpus callosum might be too thick because of a primary disorder in which the corpus callosum finding is essential to diagnosis; abnormal thickening can also be secondary to inflammation, infection and trauma.

Technical developments in postprocessing of paediatric airway imaging.

CT postprocessing allows more scan information to be viewed at one time allowing an accurate diagnosis to be made more efficiently, and is particularly important in paediatric practice where invasive clinical diagnostic tools can be replaced or at least assisted by modern postprocessing techniques. Four visualization techniques in clinical use are described in this paper including the advantages and disadvantages of each: multiplanar reformation, maximum and minimum intensity projections, shaded surface display and volume rendering. Volume-rendered internal visualization in the form of virtual endoscopy is also discussed. In addition, the clinical usefulness in paediatric practice of demonstrating airway compression and its causes are discussed. Advanced postprocessing techniques that must still find their way from the biomedical research environment into clinical use are introduced with specific reference to computer-aided diagnosis.