Ultrasound and magnetic resonance imaging of healthy paediatric ankles and knees: a baseline for comparison with haemophilic joints.

The study was undertaken to document cartilage and soft tissue changes/findings in ankles and knees of normal children of different age groups to be used for comparison in the assessment of children with haemophilia. Cartilage thickness and soft tissue changes were recorded at predetermined sites of ankles/knees on both US and MRI in healthy boys in three age groups: 7-9; 10-14; and 15-18 years. To assess the validity of the ultrasound and MRI measurements, an ex vivo study was done using agar phantoms with techniques and scanners similar to those applied in vivo. Twenty (48%) knees and 22 (52%) ankles of 42 boys, were evaluated. There was a reduction in the thickness of joint cartilage with age. A difference in cartilage measurements was noted in most sites between the age groups on both US and MRI (P < 0.05 each), but such difference was not noted for joint fluid in ankles or knees (P = 0.20, P = 0.68 or P = 0.75, P = 0.63 for US, MRI, respectively). Although cartilage measurements were smaller on US than on MRI for both ankles and knees (P < 0.05 each), this observation was not recorded for fluid in knees (P = 0.02). For diminutive measurements (2 mm) mean US measurements were smaller than corresponding phantom's measurements, P = 0.02. Age-related measurements were noted for cartilage thickness on US and MRI in ankles and knees. US measurements were smaller than corresponding MRI measurements at most joint sites, which were supported by results on small-diameter phantoms.

An MRI scale for assessment of haemophilic arthropathy from the International Prophylaxis Study Group.

Evaluation of prophylactic treatment of haemophilia requires sensitive methods. To design and test a new magnetic resonance imaging (MRI) scale for haemophilic arthropathy, two scales of a combined MRI scoring scheme were merged into a single scale which includes soft tissue and osteochondral subscores. Sixty-one joint MRI's of 46 patients with haemophilia were evaluated by four radiologists using the new and older scales. Forty-six of the joints were evaluated using two X-ray scales. For all MRI scores, interreader agreement and correlations with X-ray scores and lifetime number of haemarthroses were analysed. The interreader agreement intraclass correlation coefficient was 0.82, 0.89 and 0.88 for the soft tissue and osteochondral subscores and the total score, as evaluated according to the new MRI scale, compared to 0.80 and 0.89 as for the older scales. The total score and osteochondral subscore according to the new scale, as well as scores according to the older scales were correlated (P < 0.01) with number of haemarthroses (Spearman correlation 0.35-0.68) and with the X-ray scores (Spearman correlation 0.40-0.76), but no correlation (P > 0.05) was found between the soft tissue subscore of the new MRI scale and the X-ray scores. The new MRI scale is simpler to apply than the older and has similar reader reliability and correlation with lifetime number of haemarthroses, and by separating soft tissue and osteochondral changes it gives additional information. The new scale is useful for analyses of early and moderate stages of arthropathy, and may help to evaluate prophylactic haemophilia treatment.

Isolated fourth ventricular cysticercus cyst: MR imaging in 4 cases with short literature review.

We describe the magnetic resonance imaging (MRI) signal characteristics of isolated (solitary lesion) intra fourth ventricular cysticercus cyst in 4 patients who clinically presented with obstructive hydrocephalus. All patients had routine MRI sequences (T1, T2, & proton density-weighted imaging), Fluid Attenuation Inversion Recovery (FLAIR), and post-gadolinium imaging followed by cerebrospinal fluid (CSF) flow study. It revealed a CSF signal intensity (on all pulse sequences), intra fourth ventricular cyst with a nidus (scolex), and wall enhancement. On T1-weighted and FLAIR images, the cyst wall and nidus (scolex) were seen in 3 cases, which were not seen in other routine sequences. The CSF flow study showed the intraluminal nature of the cyst. The MRI features suspected a cysticercus cyst, and per-operative findings and histopathological examination confirmed the diagnosis. The review of literature of the intra fourth ventricular cyst is briefly discussed.

Abdominal tuberculosis affecting lesser omentum.

We present a case of a young man who presented with fever and nonspecific epigastric symptoms and fluid collection in the lesser omental sac, which was proved to be of tubercular etiology.

Florid reactive periostitis of the forearm bones in a child.

Florid reactive periostitis is a pronounced periosteal reaction, usually affecting the hands and feet, for which there is no obvious cause. It is rare in children and in long bones. We report an unusual case of florid reactive periostitis in a ten-year-old girl that involved both bones of the forearm. The lesion resolved over a period of one year, leaving a residual exostosis. She developed a physeal bar in the distal ulna in the region of the lesion at one-year follow-up. This was thought to be a complication of the biopsy procedure and was treated by resection and proximal ulnar lengthening.

Magnetic resonance imaging signal characteristics in hydatid cysts.

The MRI features of hydatid cysts were retrospectively studied in 12 patients to look for specific signal characteristics. Twelve patients in the series included eight with abdominal, two with abdominal-pelvic, one with a sacral and one with a lung hydatid cyst. The T1-, T2- and proton density (PD)-weighted images of spin-echo sequence were used for imaging. The signal characteristics of the hydatid parent cyst capsule and fluid, daughter cyst fluid, detached germinal membrane and surrounding soft tissue reaction were noted. Observations revealed that the capsule is best seen on T2- and PD-weighted images. The daughter cysts are best demonstrated on T1-weighted images, whereas the difference in the signal intensities of parent cyst and daughter cyst fluid is better demonstrated on T2-weighted and T1-weighted images, and the detached germinal membrane is best seen on T2- and PD-weighted images. The signal characteristics of hydatid cyst morphology can help distinguish it from other entities.

Pulmonary hydatid disease mimicking sequestration: differentiation on magnetic resonance imaging.

A case of hydatid disease of the lung proven by thoracotomy and histopathological evaluation is described. It was clinically and radiologically suggestive of a complicated pulmonary sequestration or non-resolving consolidation.

Cysticercosis of the cerebellopontine angle cistern mimicking epidermoid inclusion cyst.

We report a case of a cystic lesion in the left cerebellopontine (CP) angle cistern. The magnetic resonance (MR) imaging features closely resembled an epidermoid inclusion cyst, and was interpreted as such. However, at surgery and on histopathological examination the lesion was found to be a cysticercus cyst. It may be impossible to distinguish between the two by imaging. The MR imaging findings of cysticercosis, epidermoid and other common differentials are discussed.

Sacral hydatidosis: value of MRI in the diagnosis.

We present a case of primary hydatid disease of the sacrum. The diagnosis was made on MR imaging obtained to evaluate the spine for recurrent disc disease. The patient had previously undergone laminectomy elsewhere for L4-5 radiculopathy. Ultrasound-guided aspiration and visualisation of scolices confirmed the diagnosis. No other site of involvement was found.

Natural history of cognitive deficits and their relationship to MRI T2-hyperintensities in NF1.

BACKGROUND: Cognitive impairment is the most common complication of neurofibromatosis type 1 (NF1) in childhood. Current research suggests a strong relationship between cognitive deficits and brain T2-hyperintensities. The majority of these lesions disappear as the child ages. Cross-sectional data suggest that there also are improvements in intellect. OBJECTIVE: To determine the natural history of cognitive functioning and MRI T2-hyperintensities from childhood into adulthood, and whether changes in MRI T2-hyperintensities over time are predictive of changes in cognitive functioning. METHODS: The authors conducted a prospective longitudinal study of a cohort of 32 patients with NF1 and 11 unaffected sibling controls. All patients underwent neuropsychological assessments and 27 children underwent MRI examinations. The patients were then reassessed after an 8-year period. RESULTS: and CONCLUSIONS: There was no improvement in cognitive ability as the children with NF1 developed into adulthood compared with controls. Despite significant decreases in the number, size, and intensity of the T2-hyperintensities over the 8-year period, these changes were not associated with changes in cognitive ability. T2-hyperintensities in the cortex or subcortical or deep white matter are more frequent with age and these lesions are likely to have a different pathology than basal ganglia lesions. The best predictor of cognitive dysfunction in adulthood was the presence of T2-hyperintensities in childhood, rather than current lesion status. There is a limited time window (<18 years) in which the presence of T2-hyperintensities can be used as biologic markers of cognitive dysfunction.