The oscillatory flow of the cerebrospinal fluid in the Sylvian aqueduct and the prepontine cistern measured with phase contrast MRI in children with hydrocephalus-a preliminary report.

INTRODUCTION: Recognizing patients with ventriculomegaly who are at risk of developing acute hydrocephalus presents a challenge for the clinician. The association between disturbed cerebrospinal fluid flow (CSF) and impaired brain compliance may play a role in the pathogenesis of hydrocephalus. Phase contrast MRI is a noninvasive technique which can be used to assess CSF parameters. The aim of the work is to evaluate the effectiveness of phase contrast MRI in recognizing patients at risk of acute hydrocephalus, based on measuring the pulsatile CSF flow parameters in the Sylvian aqueduct and prepontine cistern in children with ventriculomegaly. AIM: The aim of the work is to characterize the parameters of cerebrospinal fluid (CSF) flow in the Sylvian aqueduct and prepontine cistern in children with ventriculomegaly with regard to patient age and symptoms. We hypothesize that the relationship between CSF flow parameters in these two regions will vary according to analyzed factors and it will allow to recognize children at risk of hydrocephalus. MATERIALS AND METHODS: A group of 26 children with ventriculomegaly (five girls and 21 boys) underwent phase contrast MRI examinations (Philips 3T Achieva with Q-flow integral application). Amplitudes of average and peak velocities of the CSF flow through the Sylvian aqueduct and prepontine cistern were used to calculate ratios of oscillation and peak velocities, respectively. The relationship between the oscillation coefficient, the peak velocity coefficient, and stroke volume was then assessed in accordance with age and clinical symptoms. RESULTS: The peak velocity coefficient was significantly higher in patients with hyper-oscillating flow through the Sylvian aqueduct (3.04 ± 3.37 vs. 0.54 ± 0.28; p = 0.0094). Moreover, these patients tended to develop symptoms more often (p = 0.0612). No significant age-related changes were observed in CSF flow parameters. CONCLUSION: Phase contrast MRI is a useful tool for noninvasive assessment of CSF flow parameters. The application of coefficients instead of direct values seems to better represent hemodynamic conditions in the ventricular system. However, further studies are required to evaluate their clinical significance and normal limits.

[Cranial ultrasound through posterolateral fontanelle in visualization of posterior fossa abnormalities in preterm and term neonates]. / Ultrasonografia glowy przez ciemiaczko tylno- boczne w ocenie nieprawidlowosci tylnego dolu czaszki u wczesniaków i noworodk>w donoszonych.

OBJECTIVES: The aim of the study was to evaluate the usefulness of US in the diagnosis of posterior fossa abnormalities in neonates by posterolateral fontanelle as compared with the anterior fontanelle approach and MRI. MATERIAL AND METHODS: US studies were performed on 1337 neonates, including 512 preterm infants, through the anterior and posterolateral fontanelles. Abnormalities were detected in 134 patients. Among them, abnormalities in posterior fossa were visualized with the posterolateral approach in 14 neonates. MR images were obtained in that subgrqup. RESULTS: The lesions consisted of cerebellar hemorrhage and congenital cerebellar malformations. Foci of hemorrhage were visualized by US in preterm neonates (n = 5), only through the posterolateral approach and on MRI. Dandy-Walker malformations (n = 2) were detected by US with both approaches and confirmed on MRI. In pontocerebellar hypoplasia (n =2), US with both approaches, showed hypoplastic cerebellar hemispheres and fluid in the posterior fossa. MRI, additionally visualized pontine hypoplasia. Fluid collection in the posterior fossa and translocation of cerebellar hemispheres were observed in the other 6 neonates by US with both approaches. MRI revealed arachnoid cysts (n = 2), mega cisterna magna (n = 3) and Blake's pouch (n = 1). CONCLUSIONS: US using posterolateral fontanelle is the method of choice for the diagnosis of cerebellar hemorrhage. These lesions are not visualized through anterior fontanelle. US visualization of the abnormal structures in some cerebellar malformations has similar effectiveness for both approaches. MRI plays the crucial role in identification and differential diagnosis of these malformations.

[Ultrasound examination in diagnosis and monitoring of necrotizing enterocolitis in a group of newborns with birth weight below 2000 g--a preliminary report]. / Ultrasonografia w ocenie martwiczego zapalenia jelit u noworodków z urodzeniowa masa ciala ponizej 2000 g--donlesienie wstepne.

OBJECTIVES: Necrotizing enterocolitis (NEC) is a common cause of morbidity in the neonatal care units, especially in cases of preterm neonates with low and very low birth weight. Plain abdominal radiography remains to be the main diagnostic tool in the diagnosis and follow-up of NEC. However; it is sometimes impossible to depict all pathological findings in the radiographs. Furthermore, radiography exposes the youngest, most sensitive patients to consecutive episodes of radiation. Ultrasound examination seems to be an interesting alternative to current standard usage of radiography and its role is still underestimated. The aim of the paper was to assess the applicability of ultrasound examination in the diagnosis and monitoring of neonates suffering from NEC. MATERIAL AND METHODS: The study group consisted of 12 neonates (gestational age 25-36 weeks, weight 540-1900 g), suspected of NEC development. Abdominal radiographs obtained with the use of anterior-posterior and lateral projections, as well as ultrasound examination, were performed. During bowel sonography attention was paid to the presence of intraabdominal fluid, free intraperitoneal gas, bowel wall thickness and bowel wall perfusion. Intramural gas, free intraperitoneal gas and signs of bowel distension were evaluated on the radiographs. RESULTS: Bowel distension was found in all patients. The presence of intraluminal gas was detected in 3 neonates, whereas the signs of bowel perforation were present in only 2 patients. Ultrasound evaluation revealed bowel wall thickening together with increased bowel wall perfusion in 9 patients. Only one neonate presented thinning of the bowel wall, decreased bowel wall perfusion and presence of free intraperitoneal fluid. These findings were connected with a poor outcome of that patient. CONCLUSIONS: Ultrasound examination can be extremely helpful for the initial diagnosis as well as the follow-up of patients developing NEC. It allows to depict the majority of pathological findings for NEC, even those not visible on plain abdominal radiography It is important to emphasize that abdominal sonography (with special reference to the bowel sonography), together with plain abdominal radiography should be considered as standard imaging modalities for the assessment of necrotizing enterocolitis.

Clinical Results and MRI Evaluation of Patellar Osteochondral Fracture Fixation following Patellar Dislocation.

AIM: The aim of the study was to analyze the clinical results and MRI scans after transpatellar osteochondral fracture fixation following patellar dislocation. METHODS: Our study group comprised 17 patients with patellar dislocation followed by osteochondral fracture of the articular surface of the patella. All patients underwent surgery where the fractured osteochondral fragments of the patella were attached using the transpatellar suture technique. The mean age at the time of surgery was 14.1 years, and the mean follow-up period was 7.5 years. RESULTS: The results of the patellar compression test and the apprehension test were negative in all patients. The mean Lysholm and Kujala scores were 89.2 and 89.6, respectively. The MRI scan revealed healing of the fixed fragment and restoration of the articular surface in all patients. In 16 cases, subchondral bone of the fixed fragment area was described as irregular: its articular cartilage was narrowed and not homogenous. Progressive degenerative changes were observed in the patellofemoral joint at follow-up in three patients. CONCLUSIONS: By fixing osteochondral fragments, the patellar articular surface can be restored. The MRI scans show that the cartilage in the reconstructed surface is narrowed after a mean 7.5-year follow-up.