MR Imaging Scoring System for White Matter Injury after Deep Medullary Vein Thrombosis and Infarction in Neonates.

BACKGROUND AND PURPOSE: Advanced imaging techniques have allowed earlier and more accurate detection of cerebral deep medullary vein thrombosis and infarction. Our objective was to develop an MR imaging scoring system to evaluate the severity of white matter injury in neonates with deep medullary vein thrombosis and infarction. MATERIALS AND METHODS: This was a retrospective study of infants born ≥32 weeks' gestation (2000-2016) diagnosed with deep medullary vein thrombosis and infarction on neuroimaging in the first 30 days of life. A 102-point deep medullary vein white matter injury global severity score was developed. MR images were scored by 2 pediatric radiologists. Subject clinical data and regional and global severity scores were recorded. RESULTS: Fifty-one patients (mean gestational age, 37.3 ± 2.2 weeks; mean birth weight, 3182 ± 720 g) were included with a mean age at diagnosis via MR imaging of postnatal day 10.1 ± 6.1. Global severity scores ranged from 1 to 53, with a median score of 11 (interquartile range, 5-25). Lesions were more common in the frontal and parietal regions and less common in the occipital and temporal regions. Fifty-five percent of the group had neonatal seizures. No difference in perinatal risk factors (gestational age, birthweight, 5-minute Apgar score, chorioamnionitis, delivery room resuscitation, ventilator, or inotrope requirement) was observed among severity score quartiles. CONCLUSIONS: An MR imaging scoring system provides a comprehensive and objective classification of WM injury after deep medullary vein thrombosis and infarction in late preterm and term neonates. The global severity score is independent of gestational age and other antenatal risk factors, consistent with presentation in previously healthy-appearing neonates.

Prevalence and evolution of intracranial hemorrhage in asymptomatic term infants.

BACKGROUND AND PURPOSE: Subdural hemorrhage (SDH) is often associated with infants experiencing nonaccidental injury (NAI). A study of the appearance and natural evolution of these birth-related hemorrhages, particularly SDH, is important in the forensic evaluation of NAI. The purpose of this study was to determine the normal incidence, size, distribution, and natural history of SDH in asymptomatic term neonates as detected by sonography (US) and MR imaging within 72 hours of birth. MATERIALS AND METHODS: Birth history, delivery method, duration of each stage of labor, pharmaceutic augmentation, and complications during delivery as well as postnatal physical examination were recorded. Brain MR imaging and US were performed on 101 asymptomatic term infants at 3-7 days, 2 weeks, 1 month, and 3 months. Clinical follow-up at 24 months was recorded. RESULTS: Forty-six neonates had SDH by MR imaging within 72 hours of delivery. SDH was seen in both vaginal and cesarean deliveries. All neonates were asymptomatic, with normal findings on physical examination. All 46 had supratentorial SDH seen in the posterior cranium. Twenty (43%) also had infratentorial SDH. US detected 11 of the 20 (55%) infratentorial SDHs and no supratentorial SDH. Most SDHs present at birth were

Effects of fungal food quality and starvation on the fatty acid composition of Protaphorura fimata (Collembola).

The lipid pattern of animals is influenced by species, life stage, environmental conditions and diet. We investigated the effects of food quality and starvation on the phospholipid (PLFA) and neutral lipid (NLFA) fatty acid pattern of the collembolan Protaphorura fimata. Collembolans were fed with two common soil fungi, Agrocybe gibberosa and Chaetomium globosum, of which the cellular lipid composition was analysed. A. gibberosa was grown on agar with different nitrogen contents, resulting in altered fatty acid patterns and C:N ratios, i.e. fungi of different food quality. Collembolans did not mirror the lipid composition of the fungal diet as the pattern of major NLFAs in P. fimata was vice versa. Presumably, altered food quality of fungi caused compensatory responses by the collembolans, thereby diminishing the fungal signal. In a further experiment P. fimata (previously maintained with C. globosum) was kept without food for up to 4 weeks. Starvation resulted in a decline in the total amount of NLFAs; however, it did not affect the fatty acid pattern, indicating that NLFAs were degraded indiscriminately. Generally, the PLFA profile of the collembolans changed only slightly due to variations in diet quality or starvation.

Digitizing pediatric chest radiographs: comparison of low-cost, commercial off-the-shelf technologies.

OBJECTIVE: To compare low-cost, off-the-shelf technology for digitizing pediatric chest radiographs. MATERIALS AND METHODS: Forty pediatric chest radiographs (hard copy), each with a single abnormality, were digitized using a commercial film digitizer and two low-cost METHODS: a digital camera and a flatbed scanner. A stratified, randomized, block design was used where 20 readers evaluated 40 different images to determine the ability to accurately detect the abnormality. Readers then rated all 160 images (40 images x 4 methods) for conspicuity of the abnormality and overall image quality. RESULTS: Abnormalities were correctly identified on 82.3 % of hard copy images, 82.9 % of flatbed scanner images, 74.3 % of film digitizer images, and 69.7 % of digital camera images (p < 0.05) when compared to hard copy or flatbed scanner images. Lesion conspicuity was rated higher on hard copy (p < 0.05) than all digitized images. Conspicuity ratings were similar for flatbed scanner and film digitizer images, but lower in digital camera images (p < 0.05). For overall image quality, all were rated significantly different from each other (p < 0.05), with hard copy > flatbed scanner > film digitizer > digital camera images. CONCLUSION: A low-cost flatbed scanner yielded digital pediatric chest images which were significantly superior to digital camera images While flatbed scanner images were interpreted with the equivalent diagnostic accuracy of hard copy images, they were rated lower for image quality and lesion conspicuity.

Inflammatory bowel disease in children and young adults: correlation of sonographic and clinical parameters during treatment.

OBJECTIVE: The objective of this study was to evaluate the sonographic findings of inflammatory bowel disease activity in children undergoing treatment. SUBJECTS AND METHODS: Eighty-eight sonograms were obtained of 23 bowel segments in 17 children and young adults (age range, 10-21 years; mean, 16 years) with new or recurrent inflammatory bowel disease. Sixteen segments were involved with Crohn's disease and seven with ulcerative colitis. Serial sonography (range, two to eight examinations; mean, four per segment) was performed while patients underwent treatment. Bowel wall thickness measurements and color and power Doppler sonography grading were recorded and compared with clinical data. RESULTS: All 17 patients had at least one abnormal bowel segment on initial sonography. The correlation was significant (p < 0.01). Agreement was 91% on direction of change over time between bowel wall thickness and Doppler grades, with 100% correlation between color and power Doppler sonography grades. In patients with Crohn's disease, the correlation was significant (p < 0.05) between bowel wall thickness and Doppler grades with two of seven and four of seven clinical parameters, respectively. In patients with ulcerative colitis, the correlation was significant (p < 0.05) between bowel wall thickness and Doppler sonography grades with four of seven and three of seven clinical parameters, respectively. The erythrocyte sedimentation rate correlated with all sonographic measurements in both patient groups. Combining bowel wall thickness and Doppler sonography, the percentage of agreement was significant in the direction of change, with five of seven clinical parameters in both patient groups. CONCLUSION: Gray-scale and color or power Doppler sonography can show changes in disease activity in children and young adults undergoing treatment for inflammatory bowel disease.

Unilateral leptospiral pneumonia and cold agglutinin disease.

Pneumonia that is unresponsive to appropriate antibiotic therapy suggests an infection due to more unusual or resistant organisms. In this report, a child with unilateral pneumonia, pleural effusion, and anti-I cold hemagglutinin antibodies is presented. The usual causes of this clinical picture were suspected and treated, but the child did not improve. Features of her history suggested a more unusual etiology, and a diagnosis of leptospirosis was made. A brief discussion of leptospiral disease in children is provided.

Peak enhancement of the liver in children using power injection and helical CT.

OBJECTIVE: Our objective was to determine the level and timing of peak hepatic enhancement in children using power injection of contrast media, helical CT, and computer-automated scan technology. SUBJECTS AND METHODS: Forty-nine abdominal CT studies were performed using computer-automated scan technology. Patients were divided into four groups on the basis of body weight and contrast dose (group 1A, < or = 20 kg and 2 ml/kg; group 1B, < or = 20 kg and 3 ml/kg; group 2, 21-40 kg and 2 ml/kg; group 3, > 40 kg and < or = 2 ml/kg). Contrast injection rates were based on body weight (groups 1A and 1B, 1 ml/sec; group 2, 1.5 ml/sec; and group 3, 2 ml/sec). The peak hepatic enhancement level in Hounsfield units and the time to reach peak enhancement were determined for each patient. RESULTS: The mean peak hepatic enhancement and time to peak enhancement after completion of contrast injection were group 1A, 45 H and 11 sec; group 1B, 62 H and 3 sec; group 2, 52 H and 12 sec; and group 3, 45 H and 10 sec. CONCLUSION: The level and timing of peak hepatic enhancement in pediatric patients can be obtained using computer-automated scan technology. These data may then be used to optimize hepatic enhancement when obtaining helical abdominal CT scans of pediatric patients.

Blunt abdominal trauma in children: impact of CT on operative and nonoperative management.

OBJECTIVE: The purpose of this study was to evaluate the impact of CT on operative management of children examined after blunt abdominal trauma. SUBJECTS AND METHODS: Fifteen-hundred consecutive children who sustained blunt abdominal trauma were prospectively examined with CT. CT findings and the decision for operative or nonoperative management were recorded prospectively. In the children who underwent laparotomy, indications for operative intervention as determined by the attending trauma surgeon and surgical findings were also recorded. RESULTS: Three hundred eighty-eight (26%) of the CT scans had abnormal findings: solid viscus injury, 286; other CT abnormality, 102. Twenty (7%) of 286 children with a solid viscus injury and 25 (83%) of 30 children with a hollow viscus injury underwent therapeutic laparotomy. Abnormalities seen on CT were noted in all 20 children with solid viscus injury and 24 of 25 children with hollow viscus injury who underwent therapeutic laparotomy. The decision for laparotomy was based on CT findings in five (25%) of 20 children with solid viscus injury and 17 (68%) of 25 children with hollow viscus injury. Eleven hundred twelve children (74%) had normal findings on CT. Only one of these children later required laparotomy. CONCLUSION: CT rarely influenced the decision for operative intervention in children who sustained blunt abdominal trauma. CT findings affected the decision for operative intervention in most children with hollow viscus injury; however, CT findings affected such a decision in only a small subset of children with solid viscus injury. Normal abdominal CT findings strongly predicted a lack of subsequent deterioration requiring operative intervention.

In-line pressures generated in small-bore central venous catheters during power injection of CT contrast media.

PURPOSE: To determine in-line pressures generated in small-bore central venous catheters during power injection of computed tomographic (CT) contrast media. MATERIALS AND METHODS: Five 3.0-7.0-F central venous catheters for pediatric patients were tested at full and half lengths in vitro. In-line pressures were measured during power injection of three contrast media. Rates of injection were increased in steps from 0.1 to 5.0 mL/sec or until a peak pressure of 100 psi (700 kPa) was achieved. The maximum tolerated flow rate was determined with reference to the manufacturer's suggested operating pressure limit for each catheter. RESULTS: At full length, the maximum tolerated flow rates were as follows: 2-3 mL/sec for the large lumen and 1-1.4 mL/sec for the small lumen of the 7.0-F double-lumen catheter; 0.2-0.4 and 0.8-1.2 mL/sec for the 3.0- and 4.0-F peripherally inserted central catheters, respectively; 0.7-1.2 mL/sec for the 6.6-F catheter; and only 0.2 mL/sec for the 4.2-F catheter, which ruptured during testing at higher flow rates. CONCLUSION: Flow rates were documented at which certain small-bore central venous catheters should tolerate power injection of CT contrast media with peak pressures remaining below the manufacturer's recommended operating pressure limits. These data may serve as a guide for clinical use.

Blunt hepatic and splenic trauma in children: correlation of a CT injury severity scale with clinical outcome.

The purpose of this report is to compare a computed tomography (CT) injury severity scale for hepatic and splenic injury with the following outcome measures: requirement for surgical hemostasis, requirement for blood transfusion and late complications. Sixty-nine children with isolated hepatic injury and 53 with isolated splenic injury were prospectively classified at CT according to extent of parenchymal involvement. Clinical records were reviewed to determine clinical outcome. Ninety-seven children (80%) were managed non-operatively without transfusion. One child with hepatic injury required surgical hemostasis, and 17 (25%) required transfusion of blood. Increasing severity of hepatic injury at CT was associated with progressively greater frequency of transfusion (P = 0.002 by chi 2-test). One child with splenic injury underwent surgery and eight (15%) required transfusion of blood. Splenic injury grade at CT did not correlate with frequency (P = 0.41 by chi 2-test) or amount (P = 0.35 by factorial analysis of variance) of transfusion. There was one late complication in the nonsurgical group. A majority of children with hepatic and splenic injury were managed non-operatively without requiring blood transfusion. The severity of injury by CT scan did not correlate with need for surgery. Increasing grade of hepatic injury at CT was associated with increasing frequency of blood transfusion. CT staging was not discriminatory in predicting transfusion requirement in splenic injury.

CT of the mesentery, omentum, and peritoneum in children.

Primary abnormalities of the peritoneum are rare in children. However, there is frequent secondary involvement of the peritoneal cavity and its specialized folds, the mesentery and omentum, in the presence of infectious, neoplastic, and traumatic conditions that originate at other sites in the abdomen or pelvis. Computed tomography (CT) is usually the modality of choice for evaluation of complex abdominal or pelvic pathologic conditions. Peritoneal cavity abnormalities include peritoneal fluid, pneumoperitoneum, and hemoperitoneum; peritoneal abscesses and peritonitis; metastases; and bladder or bowel rupture and solid organ injury. Mesenteric and omental abnormalities include an increase in or infiltration of mesenteric and omental fat; mesenteric lymphadenitis; mid-gut malrotation and bowel herniation; a variety of infections; metastases, lymphoma, and lymphangioma; and mesenteric injury. Knowledge of the spectrum of abnormalities that involve the mesentery, omentum, and peritoneal cavity and the characteristic CT appearances of these abnormalities is essential for improved diagnosis of these conditions.