Computed tomography of the musculoskeletal system.

To demonstrate the potential impact of computed tomography on orthopaedics, a brief review was done of four generations of scanners and of one new development (assay of bone mineral in the spine) that is presently being researched. To assess the utility of the method in treating orthopaedic problems, the cases of 140 patients, including patients with congenital anomalies, tumors, infections, and traumatic lesions, were analyzed. In the majority of the patients the technique provided useful information, often unobtainable with any other technique.

Facial vascular malformations in children. Conventional and digital, diagnostic and therapeutic angiography.

The authors present their experience with conventional and digital angiography of vascular malformations of the head and neck in children. 22 hemangioendotheliomas, 8 venous angiomas, and 3 arteriovenous fistula were studied. 22 patients were embolised. DSA offers many advantages during the diagnostic as well during the therapeutic phase of angiography. Embolization appears to have a major role in treatment of such vascular malformations.

Intracranial vascular malformations in children: computed tomographic and angiographic evaluation.

Thirty-nine cases of intracranial vascular malformations in children were reviewed. All patients underwent preoperative computed tomography (CT) and 35 had complete preoperative angiographic work-ups. The CT features of intracranial vascular malformations in children are described. Among the 39 patients, there were 30 parenchymal arteriovenous malformations, four dural arteriovenous malformations, three cavernous angiomas, and two venous angiomas. Combined CT and angiography allowed a highly specific diagnosis in 77% of the cases.

MR imaging of fetal cerebral anomalies.

BACKGROUND: Prenatal diagnosis of fetal brain anomalies relies mainly upon ultrasonography. However, even in the most experienced hands, the technique has limitations for some difficult diagnoses. MRI is an excellent imaging modality for the paediatric and adult brain. OBJECTIVE: To assess the value of prenatal MRI when a cerebral anomaly was detected by US and where the prognosis depended on the identification of other anomalies undetectable by US, or where fetuses were at risk for a CNS lesion even when the US was normal. MATERIALS AND METHODS: Four hundred prenatal MRI examinations were performed since 1988, and confirmed by postnatal follow-up or pathological examination. Two-thirds of the examinations were performed after 25 weeks of gestation, one-third between 21 and 26 weeks. Fetal immobilisation was obtained by maternal premedication with flunitrazepam, administered orally 1 h before the examination. The examinations were performed on 1.5 T scanners using one or two surface coils. RESULTS: Prenatal MRI allowed the diagnosis of serious unsuspected lesions such as neuronal migration disorders, ischaemic and haemorrhagic lesions and the abnormalities observed in tuberous sclerosis. It helped to characterise ventricular dilatation and anomalies of the corpus callosum and of the posterior fossa. CONCLUSIONS: MRI is a valuable complementary tool when prenatal US is incomplete, doubtful or limited. Prenatal MRI is particularly useful for the detection of ischaemic and haemorrhagic lesions, neuronal migration disorders and tuberous sclerosis lesions. Detection of these associated anomalies worsens the fetal prognosis, has medico-legal implications and modifies obstetric management. Normal prenatal MRI does not exclude an anomaly.

Angioplasty of renal transplant artery stenosis in children.

Systemic hypertension after renal transplantation in children is frequent, occurring in 85% of the cases and may be the cause of severe neurologic complications. This can be due to multiple factors such as: rejection, recurrence of initial disease, steroid, etc. ... Among those factors, renal transplant artery stenosis (RTAS) must be identified as it may be cured by angioplasty. We report our experience in 18 children who had undergone angioplasty for RTAS. Angioplasty was performed under general anesthesia with 3F, 4F or 5F balloon catheters. Angioplasty was successful in 14 cases (77%) immediately (10 cases), progressively (2 cases) or after a successfully redilated recurrence (2 cases). Two of the 4 failures were due to technical problems, a successful surgical treatment was then performed. The 2 others failures were explained by a severe transplant rejection. The complications were rare: 1 femoral artery thrombosis and spasms of the intra renal arteries but without repercussion on the renal function. In our experience, angioplasty seems to be the treatment of choice in RTAS in children. However the indications must be carefully established taking in account other possible causes of hypertension in such patients.

Detection of bone-marrow metastases using quantitative computed tomography.

A method is described for using quantitative computed tomography (CT) to detect subtle skeletal metastases not readily identified or precisely located by conventional methods. Four patients with intramedullary metastases are presented along with data from 13 control subjects. The results indicate that CT may demonstrate intramedullary changes that occur in skeletal metastases and that cannot be detected by other techniques. A difference in medullary CT number greater than 20 HU between limbs is abnormal. This asymmetry, however, is not specific for metastatic disease, and clinical judgment must be exercised in interpreting this finding.

Soft-tissue venous malformations in children: percutaneous sclerotherapy with Ethibloc.

Thirty-eight children with soft-tissue venous malformations (VMs) were treated with percutaneous injection of a new fibrosing agent (Ethibloc). The technique, results, side effects, and complications are detailed. Direct puncture of the VM allows evaluation of the draining venous system and direct injection of Ethibloc. This procedure alone or associated with surgery led to achievement of good or excellent results in 74% of the cases (complete cure in 50%), with minimal side effects and no major complications.