Doppler ultrasound in the diagnosis of Budd-Chiari syndrome in children after split liver transplantation.

PURPOSE: To assess the capabilities of a velocity ratio>3 for the diagnosis of Budd-Chiari syndrome (BCS) in children after split liver transplantation using Doppler ultrasonography (DUS). MATERIALS AND METHODS: A total of 28 children who underwent liver transplantation using a split procedure were included. There were 11boys and 17girls with a mean age of 3.8years (range: 0.7-12years). Velocity ratio between blood velocity upstream of the anastomosis and that at the level of the inferior vena cava anastomosis was calculated. Sensitivity, specificity and accuracy of DUS for the diagnosis of BCS were estimated using a velocity ratio>3. RESULTS: Eight children (8/28; 29%) had BCS and 20 (20/28; 71%) did not have BCS using the standard of reference. A velocity ratio>3 on DUS yielded 88% sensitivity (95% CI: 53-98%), 80% specificity (95% CI: 58-92%) and 82% accuracy (95% CI: 64-92%) for the diagnosis of BCS. CONCLUSION: A velocity ratio>3 on DUS is a reliable finding for the diagnosis of BCS in children after split liver transplantation.

Cardiac CT or MRI in pediatric practice: Which one to choose?

The different factors involved in the choice of the best cardiovascular imaging examination for pediatric patients are justification, radiation protection, sedation, resolutions (spatial and contrast), morphology or function, intervention and contrast enhancement. Computed tomography is preferable for all coronary artery conditions, any arterial or venous abnormalities in newborns and infants and in the preoperative assessment for tetralogy of Fallot. Magnetic resonance imaging is used for any tumoral or functional assessment, cardiomyopathy or arrhythmia or if the child's participation and/or size of the structures being examined allows using this technique.

[Systemic pulmonary anastomosis: a rare cause of massive hemoptysis]. / Anastomoses systémo-pulmonaires : une cause rare d'hémoptysie massive.

We report on the case of a 15-year-old boy with massive hemoptysis caused by anastomosis between bronchial and pulmonary arteries, successfully treated with embolization. No similar case was found in the literature, likely because of the high mortality rate of this type of malformation.

Value of diffusion-weighted images in differentiating mid-course responders to chemotherapy for osteosarcoma compared to the histological response: preliminary results.

BACKGROUND: Preoperative diffusion-weighted MRI (DW-MRI) has been described as an efficient method to differentiate good and poor responders to chemotherapy in osteosarcoma patients. A DW-MRI performed earlier during treatment could be helpful in monitoring chemotherapy. OBJECTIVE: To assess the accuracy of DW-MRI in evaluating response to chemotherapy in the treatment of osteosarcoma, more specifically at mid-course of treatment. MATERIALS AND METHODS: This study was carried out on a prospective series of adolescents treated for long-bone osteosarcoma. MR examinations were performed at diagnosis (MRI-1), at mid-course of chemotherapy (MRI-2), and immediately before surgery (MRI-3). A DW sequence was performed using diffusion gradients of b0 and b900. The apparent diffusion coefficients (ADC1, ADC2, ADC3, respectively), their differentials (ADC2 - ADC1 and ADC3 - ADC1), and their variation (ADC2 - ADC1/ADC1 and ADC3 - ADC1/ADC1) were calculated for each of these three time points. RESULTS: Fifteen patients were included. Patients with no increase in ADC showed a poor response to chemotherapy on their histology results. At mid-course, the three calculated values were significantly different between good and poor responders. ADC2 - ADC1 enabled us to detect, with 100% specificity, four out of seven of the poor responders. There was no significant difference in the values at MRI-3 between the two groups. CONCLUSION: DW-MRI performed both at baseline and mid-course of neoadjuvant chemotherapy is an efficient method to predict further histological response of osteosarcoma. This method could be used as an early prognostic factor to monitor preoperative chemotherapy.

[Value of the sesamoid bone of the thumb in the determination of bone age]. / Quelle valeur accorder à l'os sésamoïde du pouce dans la détermination de l'âge osseux?

PURPOSE: To assess the presence of ossification of the sesamoid bone of the thumb as a function of age and compare the results to data from the atlas by Greulich and Pyle describing the ossification of this bone in girls of 11 years and boys of 13 years. Materials and methods. Prospective study of 1372 children (780 boys and 592 girls between the ages of 0.4 and 19.7 years, mean age of 9.7 years) with known chronological age requiring radiographic evaluation of the wrist-hand after minor trauma. The presence of a sesamoid was analyzed by logistic regression using the method of probits. RESULTS: The minimum and maximum ages in our sample population were 10-15.1 years for boys and 8.8-15.2 years for girls. The P50 value (method of probits) corresponded to the chronological age at which 50% of the population had a visible sesamoid. It was 12.1 years for boys and 10.2 years for girls. CONCLUSION: The timing of ossification of the sesamoid of the thumb is widely variable. Ossification of this sesamoid should not be used as a precise indicator when determining bone age using the atlas by Greulich and Pyle.

Diffusion-weighted magnetic resonance imaging with apparent diffusion coefficient (ADC) determination in normal and pathological fetal kidneys.

OBJECTIVES: To assess the use of diffusion-weighted magnetic resonance imaging (DW-MRI) in the evaluation of the fetal kidney and to estimate age-dependent changes in the apparent diffusion coefficient (ADC) of normal and pathological fetal kidneys. METHODS: DW-MRI was performed on a 1.5-T machine at 23-38 gestational weeks in 51 pregnant women in whom the fetal kidneys were normal and in 10 whose fetuses had renal pathology (three with suspected nephropathy, three with renal tract dilatation, one with unilateral renal venous thrombosis, and three with twin-twin transfusion syndrome (TTTS)). The ADC was measured in an approximately 1-cm2 region of interest within the renal parenchyma. RESULTS: ADC values in normal renal parenchyma ranged from 1.1 to 1.8 10(-3) mm2 s-1. There was no significant age-dependent change in the ADC of normal kidneys. In cases of nephropathy, the ADC value was not always pathological but an ADC map could show abnormal findings. In cases of dilatation, the ADC value was difficult to determine when the dilatation was huge. In cases of TTTS, the ADC of the donor twin was higher than that of the recipient twin and the difference seemed to be related to the severity of the syndrome. CONCLUSION: Evaluation of the ADC for fetal kidneys is feasible. Fetal measurement of the ADC value and ADC maps may be useful tools with which to explore the fetal kidney when used in conjunction with current methods. DW-MR images, ADC value and ADC map seem to be useful in cases of suspected nephropathy (hyperechoic kidneys), dilated kidney and vascular pathology (renal venous thrombosis, TTTS).

[Reliability of the Sauvegrain and Nahum method to assess bone age in a contemporary population]. / Fiabilité de la détermination de l'âge osseux par la méthode de Sauvegrain et Nahum.

PURPOSE: The Sauvegrain and Nahum method can be used to assess bone age in addition to methods based on hand and wrist radiographs in children between 9 and 15 years of age. The aim of this study was to evaluate the reliability of this method in a contemporary population. MATERIAL AND METHODS: Elbow radiographs taken for acute trauma in 106 patients (42 girls, 64 boys) aged from 9 to 15 years old were analyzed by four radiologists. Inclusion in the study required the absence of chronic disease and previous trauma as well as parental consent. RESULTS: There was no significant difference between the four observers. The differences between bone age (BA) and chronological age (CA) were 5+/-1 months for the study group, 3.5+/-9 months for the female group, and 6+/-12 months for the male group. Bone age was overestimated compared with chronological age. There was a good correlation between CA and BA (r = 0.84). CONCLUSION: The Sauvegrain and Nahum method seems to overestimate CA in a contemporary population.