Liver biopsy with guidance in scanning A preliminary report.

A method to improve the accuracy of obtaining biopsy material of a lesion detected at liver scanning is presented. The site of the lesion is determined in two orthographic projections during scintigraphy and indicated on the patient's skin. With guidance of indicator fluoroscopy in two perpendicular projections percutaneous biopsy from any part of the liver may be performed.

Acute haematogenous osteomyelitis in children - the reliability of skeletal scintigraphy.

Thirty-nine bone scans were performed in children (1 week - 14 years of age), with symptoms and signs of acute osteomyelitis. All but two scintigrams were obtained within the first week of the disease. Nine scans showed locally increased isotope accumulation. The diagnosis of osteomyelitis was later confirmed by radiological examination or by positive cultures. Twenty-nine scans were reported negative. Nevertheless, four patients developed characteristic radiological signs of osteomyelitis. In one of these four cases a decreased uptake ("cold" lesion) in the scintigram was over-looked. In spite of surgical drainage the patient developed chronic osteomyelitis. It is concluded that bone scanning is a valuable adjunct in the early diagnosis of osteomyelitis. A negative scintigram, however, does not exclude this diagnosis. A "cold" lesion may indicate a high pressure abscess and a risk for sequestrum formation. Prompt surgical drainage is advocated when such lesions are encountered in the scintigram.

A method for assessment of skeletal maturity in children below one year of age.

Although there is a continuing clinical interest in the radiological determination of skeletal development in children below one year of age, none of the existing methods is particularly appropriate. We have therefore developed a new and simple method of assessment. This takes into account the dose of radiation and the two aspect of size and maturity of the skeleton; and so we choose to study the lateral view of the tarsus. The calcaneus and talus are ossification centers appearing before birth. The sum of length and height of these centers constitutes the first part of the assessment. The second part of our evaluation includes an appraisal of the cuboid, the third cuneiform and distal epiphyses of tibia and fibula. For practical purposes we have chosen to relate the two different aspects of skeletal maturity which we have assessed to the weight of the baby.

Computer tomography of the head in children. Technical aspects.

A modified routine for computer tomography of children, avoiding general anesthesia is discussed. The patients were sedated and examined in a supporting plastic cradle. Radiation doses to various parts of the body were measured during the scanning and the results confirm that the dose levels are within generally accepted limits.

Pulmonary lesions mimicking pericardial effusion on ultrasonography.

Two children with right middle lobe lesions mimicking pericardial effusion on ultrasonography are presented. They were admitted with fever and chest radiographs showed atelectasis or consolidation of the middle lobe of the right lung along the right heart border. A low-echogenic layer suggesting pericardial fluid was seen on ultrasonography, but with a spatial distribution closely corresponding to the lesions seen on the chest radiographs. If the possibility that a lung lesion adjacent to the heart can simulate pericardial fluid on ultrasonography is kept in mind, the correct diagnosis should not be difficult to make.

Normal width of cranial sutures in the neonate and infant. An objective method of assessment.

A material of 107 normal skull films have been used to determine the normal range of the cranial sutures in the age group 0 to 45 days of age. Assessment is based on the lateral view and includes evaluation of both coronal and lambdoid sutures as well as the degree of V-shape of the coronal sutures. Values obtained are easily classified as normal, borderline or pathologic by use of a simple diagram.

Radiologic differentiation between cysts and malignant tumours of the maxilla.

Analysis of 41 cases with large maxillary lesions (23 malignant tumours, 13 cysts and 5 other lesions) with the aid of special criteria based on the radiologic appearances of various lesions to distinguish cysts from malignant tumours and inflammatory processes.

Accuracy of echoventriculography as compared with computer tomography in children.

The accuracy of echoventriculography (echo-VG) using CT findings as a reference has been examined in 144 children. Lateral ventricular index on echo-VG was compared with anterior horn and body indices on CT. The correlation coefficient was 0.617 and 0.725, respectively. Twelve cases with a deviation exceeding 2 SD in the regression between the indices were analysed. The conclusion is that echo-VG is fairly accurate and useful as a screening method and for follow-up examinations in children.

A computer-based system for measurements and analyses in radiology.

A computer-based system for direct measurements on images and for analyses of data is presented. Distances, angles, and areas are measured on a backlighted digitizer table. Calibration corrects for actual magnification. Data are analyzed and compared to normal values by a microcomputer. The system is precise and time saving.

Accuracy of ultrasonic assessment of residual urine in children.

Bladder volumes were determined by realtime ultrasonography and compared to catheterised volumes in a consecutive series of 101 children. Volumes were calculated as the product of the longitudinal, transversal and sagittal diameter and a correction factor of 0.52. There was a good correlation between the methods (r = 0.96) although large volumes tended to be underestimated by ultrasonography. Small volumes could be assessed accurately.

Antenatal renal pelvis dilatation emphasizing vesicoureteric reflux: two-year follow-up of minor postnatal dilatation.

AIM: To describe the occurrence of foetal renal pelvis dilatation in an unselected population of pregnancies and to describe the clinical course in a subgroup of infants with minor renal pelvis dilatation (RPD). METHODS: During 1996-1999 the foetuses of 17850 consecutive pregnant women were scanned with ultrasonography (USG) in the 16th-19th gestational week and later in the pregnancy when indicated. RPD was defined as anterior-posterior pelvic diameter > or = 5 mm. After birth all infants were examined with USG twice. If any postnatal USG showed RPD > or = 10 mm, extended radiological investigation was performed. Infants with pelvis dilatation < 10 mm and no calyceal or ureteric dilatation were not investigated further and antibiotic prophylaxis was discontinued. The children were followed up at 2 y of age. RESULTS: 109 foetuses (0.6%) with RPD were identified. Postnatally, 94/109 were available for follow-up: 43 had postnatal dilatation > or = 10 mm and were investigated and treated according to clinical routine, while 51 had dilatation < 10 mm and were followed up after they had reached at least 2 y of age. No case of pyelonephritis was recorded. USG in 48/51 children was normal. CONCLUSION: The data indicate that infants with minor RPD do not constitute a risk group for renal morbidity and thus do not need antibiotic prophylaxis and extensive radiological examination.

Incidence of basal ganglia calcifications on computed tomography.

In a group of 3,800 computed tomography examinations, 14 patients (0.4%) were found to have high attenuating lesions suggesting calcifications within the basal ganglia. The lesions were bilateral in all patients. A majority of the patients had psychic symptoms and convulsions. Electroencephalographic changes were frequent and extrapyramidal symptoms occurred. Until now only three patients have been endocrinologically examined. One of them had hypoparathyroidism. Since parathyroid dysfunction frequently is associated with calcifications of the basal ganglia, these patients should be referred for endocrinological evaluation.

Scintigraphic evaluation of traumatic splenic lesions in children.

Ninety-eight children with recent blunt abdominal trauma which initially evoked clinical suspicion of splenic injury were examined with colloid scintigraphy of the spleen and the liver using multiple imaging views and with abdominal survey. Nineteen children were, in addition, examined with tomographic scintigraphy. The clinical findings and the course of the disorder were reanalyzed. Scintigraphy indicated splenic injury in 56 children and hepatic injury in another 5 children. The left lateral and the left oblique were the optimum imaging views for detecting splenic ruptures. Tomographic scintigraphy did not improve the diagnostic yield. Abdominal survey failed to indicate almost every second case of splenic rupture and provided no additional information of significance. The clinical review agreed with the scintigraphic diagnosis of splenic lesions but, in addition, it suggested possible splenic lesions in another 10 children with normal scintigraphy. This discrepancy cannot be explained as surgery was not employed; the occurrence of splenic lesions too small to become detectable at scintigraphy or to provoke clinically evident symptoms may be supposed.

Residual urine in children with acute cystitis and in healthy children: assessment by sonography.

Residual urine was assessed by ultrasound in children with single attacks of symptomatic lower urinary tract infection and in healthy controls. Residual urine was found significantly more often in the 39 patients during acute illness as well as during a follow-up of 6 months, compared to 55 control children. Infections caused by P-fimbriated Escherichia coli were not more often associated with residual urine than infections with nonP-fimbriated Escherichia coli or other bacterial species. It is suggested that residual urine is a facilitating host factor among others in the pathogenesis of symptomatic urinary tract infection in childhood.

Intrauterine cranial gunshot wound in a 32-week fetus.

Intrauterine cranial gunshot wounds are rare and usually associated with a fatal outcome for the fetus. We present a case where preterm delivery, neonatal intensive care, and later removal of the bullet resulted in a normal child without any untoward sequelae.