Retrospective and integrative analyses of molecular characteristics and their specific imaging parameters in pediatric grade 1 gliomas.

BACKGROUND: Pediatric low-grade gliomas (PLGG) are the most common brain tumors diagnosed during childhood and represent a heterogeneous group associating variable molecular abnormalities. To go further and develop specific statistical patterns between tumor molecular background, imaging features, and patient outcome, a retrospective study was performed in a group of non-neurofibromatosis type 1 (non-NF1) grade 1 PLGGs. PATIENTS AND METHODS: Seventy-eight children, followed from 2004 to 2017, were retrospectively reported. In this population, we analyzed radiological and molecular parameters. Their therapeutic management comprised surgery or surgery plus chemotherapies. RESULTS: Considering all 78 patients, 59 had only a surgical removal and 19 patients were treated with postoperative chemotherapy. Twelve progressions were reported in the partially resected and chemotherapeutic groups, whereas four deaths occurred only in the highly treated patients. As expected, in the global cohort, PLGG with BRAF p.V600E and/or CDKN2A loss exhibited poor outcomes and we evidenced significant associations between those molecular characteristics and their imaging presentation. In the chemo-treated patients, when associating initial and 6-month magnetic resonance imaging (MRI) parameters to the molecular features, the good risk situations were significantly linked to the presence of a large tumor cyst at diagnosis and the appearance during treatment of a higher cystic proportion that we called cystic conversion. CONCLUSION: So, additionally to the presence of BRAF p.V600E or CDKN2A deletion in grade 1 PLGGs, the absence on diagnostic MRI of cystic parts and/or cystic conversion at 6-month chemotherapy were significantly linked to a worst prognosis and response to treatment. These imaging features should be considered as prognostic markers in future PLGG studies.

Anterior approach for knee arthrography: tolerance evaluation and comparison of two routes.

PURPOSE: To prospectively evaluate patient tolerance and technical success of the anterior knee puncture approach for arthrography by using two different routes. MATERIALS AND METHODS: The study had Strasbourg University Hospital review board approval. Informed consent was obtained from all patients (and from their parents, if patients were minors). In 159 patients (89 male and 70 female; age range, 14-82 years; mean age, 44.3 years +/- 16 [standard deviation]) referred for computed tomographic (CT) arthrography, anterior puncture of the knee was performed by using an anterolateral (n = 73) or anterior paramedian (n = 86) route. For each patient, body mass index, absolute pain on a visual analog scale, relative pain (compared with anticipatory pain), and history of previous knee arthrography were recorded. A score reflecting the technical success of the procedure was established by using a five-point scale. Factors influencing tolerance and technical success were analyzed with Pearson correlation coefficients. Student t and chi2 tests were used to compare the two routes. RESULTS: The anterior approach for knee arthrography was well tolerated (mean visual analog scale score, 12.9 +/- 16.4) and technically successful (mean technical success score, 1.36 +/- 0.84) in most cases. Absolute pain was not influenced by age, sex, or body mass index and was only weakly correlated (r = 0.33) with the technical success score. The technical success score weakly correlated (r = 0.23) with the body mass index. A slight but significant reduction in absolute (P < .05) and relative (P < .01) pain was observed for the anterolateral route compared with the anterior paramedian route, while no significant differences (P > .05) were found for other parameters, including the technical success score. CONCLUSION: The anterior approach for knee arthrography is technically successful and well tolerated, particularly when an anterolateral route is used.

Twenty years' experience for reduction of ileocolic intussusceptions by saline enema under sonography control.

BACKGROUND: Ultrasonography is a well-established efficient diagnostic tool for ileocolic intussusceptions in children. It can also be used to control hydrostatic reduction by saline enemas. This reduction method presents the advantage of avoiding radiations. Parents can even stay with their children during the procedure, which is comforting for both. The purpose of this study was to present our 20 years' experience in intussusception reductions using saline enema under ultrasound control and to assess its efficiency and safety. MATERIAL AND METHODS: This retrospective single center study included patients with ileocolic intussusceptions diagnosed by ultrasound between June 1993 and July 2013. We excluded the data of patients with spontaneous reduction or who underwent primary surgery because of contraindications to hydrostatic reduction (peritonitis, medium or huge abdominal effusion, ischemia on Doppler, bowel perforation). A saline enema was infused into the colon until the reduction was sonographically confirmed. The procedure was repeated if not efficient. Light sedation was practiced in some children. RESULTS: Eighty-tree percent of the reductions were successful with a median of 1 attempt. Reduction success decreased with the number of attempts but was still by 16% after 4 attempts. The early recurrence rates were 14.5%, and 61.2% of those had a successful second complete reduction. Forty-six patients needed surgery (11 of them had a secondary intussusception). Sedation multiplies success by 10. In this period, only one complication is described. CONCLUSION: Ultrasound guided intussusception reduction by saline enema is an efficient and safe procedure. It prevents exposure of a young child to a significant amount of radiation, with similar success rate. We had very low complication rate (1/270 cases or 3‰). The success rate could be increased by standardized procedures including: systematic sedation, trained radiologists, accurate pressure measurement, and number and duration of attempts.