Post-mortem radiology in fetal and neonatal death: the diagnostic value of post-mortem MRI versus autopsy regarding non-cardiac thoracic and abdominal abnormalities.

AIM: To compare the diagnostic value and accuracy of post-mortem magnetic resonance imaging (PMMRI) and autopsy for non-cardiac thoracic and abdominal abnormalities in fetal death. MATERIALS AND METHODS: This single-institution retrospective study included all consecutive cases of fetal and perinatal death between January 2015 and December 2021 for which PMMRI followed by autopsy was conducted. These cases comprised fetuses at >18 weeks of gestation and preterm and term neonates who lived for <24 h. All PMMRI and autopsy reports were re-assessed and scored for seven non-cardiac thoracic and 52 abdominal abnormalities, and concordance between autopsy and PMMRI findings was determined as the primary outcome. RESULTS: Eighty cases were included in this study. Fetal loss was caused by termination of pregnancy in 80% of cases. Further, the mean gestational age was 166 days (23 weeks and 5 days, range 126-283 days). The concordance between PMMRI and autopsy for non-cardiac thoracic and abdominal abnormalities was 83.1% (95% confidence interval [CI] 71.3-83.3) and 76.3% (95% CI 65.8-84.2%), respectively, with a substantial and moderate strength of agreement (Cohen's kappa = 0.63 and 0.51 respectively). CONCLUSION: PMMRI exhibited good overall diagnostic value for non-cardiac thoracic and abdominal abnormalities, specifically large structural abnormalities. PMMRI may offer parents and physicians a valuable addition to autopsy for the detection of non-cardiac thoracic and abdominal abnormalities, or even an alternative option when parents do not consent to autopsy.

Can high school students help to improve breast radiologists in detecting missed breast cancer lesions on full-field digital mammography?

Aim: To investigate whether full-field digital mammography (FFDM) and contrast-enhanced mammography (CEM), evaluated by non-experienced high school students, improves detection of missed breast cancer lesions on FFDM, in the same cohort of patients. Methods: Non-experienced first- and second year high school students examined fourteen cases of patients diagnosed with breast cancer. These cases consisted of missed breast cancer lesions on FFDM by a breast radiologist. Sensitivity of assessment of the students on FFDM and CEM was analysed and compared with the initial results of the breast radiologists. Results: A total of 134 high school students participated in this study. Mean age was 12.8 years (range 10-14). Based on FFDM, mean overall sensitivity of the students was 29.2% (18.9 - 39.6%). When recombined CEM images were used, mean overall sensitivity of students improved to 82.6% (74.0 - 91.2%) (p=0.001). Mean overall sensitivity of FFDM exams evaluated by radiologists was 75.7% (64.2 - 87.3%), which was lower when compared to student's evaluations on recombined CEM exams, yet not statistically significant (p=0.098). Conclusions: Contrast-enhanced mammography evaluated by non-experienced high school students might improve detection rate of breast cancer when compared to evaluations of only full-field digital mammography by radiologists.

Diagnostic accuracy of preoperative ultrasonography in predicting contralateral inguinal hernia in children: a systematic review and meta-analysis.

OBJECTIVES: The incidence of children developing metachronous contralateral inguinal hernia (MCIH) is 7-15%. Contralateral groin exploration during unilateral hernia repair can prevent MCIH development and subsequent second surgery and anaesthesia. Preoperative ultrasonography is a less invasive strategy and potentially able to detect contralateral patent processus vaginalis (CPPV) prior to MCIH development. METHODS: We queried MEDLINE, Embase and Cochrane library to identify studies regarding children aged < 18 years diagnosed with unilateral inguinal hernia without clinical signs of contralateral hernia, who underwent preoperative ultrasonography of the contralateral groin. We assessed heterogeneity and used a random-effects model to obtain pooled estimates of sensitivity, specificity and area under the receiver operating characteristic curve (AUC). RESULTS: Fourteen studies (2120 patients) were included, seven (1013 patients) in the meta-analysis. In studies using surgical exploration as reference test (n = 4, 494 patients), pooled sensitivity and specificity were 93% and 88% respectively. In studies using contralateral exploration as reference test following positive and clinical follow-up after negative ultrasonographic test results (n = 3, 519 patients), pooled sensitivity was 86% and specificity 98%. The AUC (0.984) shows high diagnostic accuracy of preoperative ultrasonography for detecting CPPV, although diagnostic ultrasonographic criteria largely differ and large heterogeneity exists. Reported inguinal canal diameters in children with CPPV were 2.70 ± 1.17 mm, 6.8 ± 1.3 mm and 9.0 ± 1.9 mm. CONCLUSION: Diagnostic accuracy of preoperative ultrasonography to detect CPPV seems promising, though may result in an overestimation of MCIH prevalence, since CPPV does not invariably lead to MCIH. Unequivocal ultrasonographic criteria are mandatory for proper diagnosis of CPPV and subsequent prediction of MCIH. KEY POINTS: • Diagnostic accuracy of preoperative ultrasonography for detection of CPPV in children with unilateral inguinal hernia is high. • Preoperative ultrasonographic evaluation of the contralateral groin assumedly results in an overestimation of MCIH prevalence. • Unequivocal ultrasonographic criteria are mandatory for proper diagnosis of CPPV and risk factor identification is needed to predict whether CPPV develops into clinically apparent MCIH.

Abusive head trauma: differentiation between impact and non-impact cases based on neuroimaging findings and skeletal surveys.

OBJECTIVES: To determine whether imaging findings can be used to differentiate between impact and non-impact head trauma in a group of fatal and non-fatal abusive head trauma (AHT) victims. METHODS: We included all AHT cases in the Netherlands in the period 2005-2012 for which a forensic report was written for a court of law, and for which imaging was available for reassessment. Neuroradiological and musculoskeletal findings were scored by an experienced paediatric radiologist. RESULTS: We identified 124 AHT cases; data for 104 cases (84%) were available for radiological reassessment. The AHT victims with a skull fracture had fewer hypoxic ischaemic injuries than AHT victims without a skull fracture (p=0.03), but the relative difference was small (33% vs. 57%). There were no significant differences in neuroradiological and musculoskeletal findings between impact and non-impact head trauma cases if the distinction between impact and non-impact head trauma was based on visible head injuries, as determined by clinical examination, as well as on the presence of skull fractures. CONCLUSIONS: Neuroradiological and skeletal findings cannot discriminate between impact and non-impact head trauma in abusive head trauma victims.

Splenic size after division of the short gastric vessels in Nissen fundoplication in children.

PURPOSE: Nissen fundoplication is an effective treatment for gastro-esophageal reflux disease (GERD). Mobilization of the gastric fundus during fundoplication requires division of short gastric vessels of the spleen, which may cause splenic ischemia. The aim of this study was to determine if Nissen fundoplication results in hypotrophy of the spleen. METHODS: We performed pre-operative and post-operative ultrasound measurements of the spleen in children undergoing Nissen fundoplication. During operation, the surgeon estimated the compromised blood flow by assessment of the percentage of discoloration of the spleen. RESULTS: Twenty-four consecutive children were analyzed. Discoloration of the upper pole of the spleen was observed in 11 patients (48%) of a median estimated splenic surface of 20% (range 5-50%). The median ratio for pre-operative and post-operative length, width, and area of the spleen was 0.97, 1.03, and 0.96, respectively. The percentage of the estimated perfusion defect during surgery was not correlated with the ratios. In three patients, the area ratio was smaller than 0.8 (0.67-0.75), meaning that the area decreased with at least 20% after surgery. In none of these patients a discoloration was observed. CONCLUSION: Discoloration of the spleen after Nissen fundoplication is not associated with post-operative splenic atrophy.

Major brain lesions by intrauterine herpes simplex virus infection: MRI contribution.

The majority of neonatal Herpes Simplex Virus (HSV) infections are acquired at birth as a consequence of direct fetal contact with the infected birth canal or through an ascending infection after premature rupture of the amniotic membranes. Intrauterine transmission of HSV infection from mother to the fetus is rare; in only 5% of the cases it occurs from haematogenous transplacental dissemination. We present a case of transplacental intrauterine HSV infection after a primary maternal HSV infection in the first trimester of pregnancy. The diagnosis was assessed by viral culture and serologic tests. Ultrasound imaging revealed fetal brain damage in the third trimester. Finally, the MRI showed the devastating extensiveness of the HSV infection, which was beyond the expectation based on the ultrasound images.

Sonographic genital ambiguity in a fetus due to a mosaic 45,X/46,X,idic(Y)(qter-p11.32::p11.32-qter) karyotype.

Nowadays, improved ultrasound techniques enable the detection of more subtle congenital abnormalities at an earlier stage of fetal development. Current cytogenetic techniques can characterize a chromosomal abnormality in greater detail. These advancements in both diagnostic possibilities have helped to answer many questions but have also created new issues and dilemmas in counselling. This is illustrated by this case report of a 35-year-old woman, who presented at the end of the second trimester of her first pregnancy. Sonographic examination indicated an abnormal external genital in a male fetus. A differential diagnosis of hypospadia was made. During follow-up, an amniocentesis was performed, and this showed a 45,X/46,X,idic(Y)(qter-p11.32::p11.32-qter) karyotype as the cause of the sonographic findings. Cytogenetic characterization of the isodicentric Y chromosome and pre- and post-natal findings in the child are reported. Cases with a similar karyotype reported in the literature are reviewed.

[Radiography of the medial ends of the clavicles by the method of the Dutch Immigration and Naturalisation Service is unsuitable for determining adulthood]. / Röntgenfoto's van mediale clavicula-uiteinden volgens de methode van de Immigratie- en Naturalisatiedienst: ongeschikt voor de bepaling van meerderjarigheid.

OBJECTIVE: A critical examination of the radiological technique used by the Dutch Immigration and Naturalisation Service (IND) for determining the adulthood of persons around the age of 18. DESIGN: Descriptive. METHOD: Radiographs of the hands and clavicles were reassessed in 29 asylum seekers (15 boys, 9 girls and 5 persons of unknown gender) in whom the IND suspected a discrepancy between the true age and the age stated. In each case, 1 hand radiograph and 3 clavicular views were taken: 1 posteroanterior standard view as well as 2 oblique views, in order to assess the epiphyses at the medial ends of the clavicles. Additionally, the radiographs of one of these subjects were shown to 241 radiologists and radiologists-in-training. RESULTS: On all the hand X-rays, the epiphyses were closed. Based on this, the skeletal age of the girls was at least 15 years and 11 months and that of the boys at least 17 years and 3 months. The medial ends of the clavicles could not be assessed on the standard views due to overprojection of the spinal column. In 55 of the 58 films in which the thorax was turned, the direction of the X-rays was not appropriate for assessing the growth plates. The other 3 could not be assessed as there were no existing objective radiological criteria. The assessments of the stage of development as an indication of skeletal age in the cases presented differed greatly from one another. CONCLUSION: The radiographs that were taken to establish whether or not the asylum seekers were underage were unsuitable for the purpose for which they were taken.

Ultrasonography of musculoskeletal infections in children.

Ultrasonography is an important modality for evaluation of musculoskeletal infections in children because it is rapid, nonionising and very sensitive for (infectious) fluid collections and joint effusions. Moreover, the images are not degraded by metallic or motion artefacts (as with CT and MRI) and finally, ultrasonography offers the possibility of fine-needle aspiration to confirm the infectious nature of a fluid collection without unnecessary contamination of adjacent anatomical compartments. Ultrasonography should be combined with radiography because both imaging techniques are complimentary. The purpose of this article is to emphasise the role of ultrasonography in the diagnosis of various diseases in childhood, including cellulitis, subcutaneous abscess, necrotizing fasciitis, pyomyositis, infectious bursitis and arthritis, osteomyelitis, foreign bodies and infectious lymphadenitis. Along with conventional radiography, ultrasonography is a very valuable modality for early diagnosis and follow-up of musculoskeletal infections in children.

MRI findings of the pituitary gland in short children born small for gestational age (SGA) in comparison with growth hormone-deficient (GHD) children and children with normal stature.

BACKGROUND: Disturbances in the GH/IGF-I axis are reported in 25-60% of short children born small for gestational age (SGA). We hypothesized that these abnormalities might be related to abnormalities in the pituitary region. Therefore, the results of magnetic resonance imaging (MRI) of short SGA children were compared to MRI results of other groups of short children and to normal controls. PATIENTS AND METHODS: MRI was performed in four groups of short children: SGA children without GH deficiency (SGA group; n = 17), SGA children with isolated GH deficiency (SGA + IGHD group; n = 10), non-SGA children with isolated GH deficiency (IGHD group; n = 24) and non-SGA children with multiple pituitary hormone deficiencies (MPHD group; n = 15). MRI was also performed in children with normal stature (control group; n = 13). Pituitary height (PH) and thickness of the pituitary stalk (PS) were measured and their relationship with the maximum GH peak during a GH stimulation test, serum IGF-I and IGFBP-3 levels was evaluated. RESULTS: Short SGA children either with or without IGHD did not show major anatomical abnormalities in the hypothalamic-pituitary region in contrast to 58% of the non-SGA IGHD children and 87% of the MPHD children who had anatomical abnormalities. PH in SGA children without GHD was normal whereas it was significantly lower in SGA children with IGHD. The lowest PHs were measured in non-SGA children with MPHD. A moderate decrease in PH was associated with significantly lower maximum serum GH peaks and lower serum IGF-I and IGFBP-3 levels. CONCLUSION: Measuring PHs in children with less severe GHD, who underwent MRI as part of the diagnostic process, might support the diagnosis of GHD even in the absence of anatomical abnormalities. Our study demonstrates that there is no indication to perform MRI of the pituitary region in short children born SGA without GHD.

[Diagnostic image (119). A neonate with abnormal distention and vomiting. Meconium ileus and cystic fibrosis]. / Diagnose in beeld (119). Een neonatus met een dikke buik en braken. Meconiumileus bij cystische fibrose.

A female neonate developed abdominal distension with vomiting. She was suffering from meconium ileus and cystic fibrosis.