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AIM: To compare the diagnostic value and accuracy of post-mortem magnetic resonance imaging (PMMRI) and autopsy for non-cardiac thoracic and abdominal abnormalities in fetal death. MATERIALS AND METHODS: This single-institution retrospective study included all consecutive cases of fetal and perinatal death between January 2015 and December 2021 for which PMMRI followed by autopsy was conducted. These cases comprised fetuses at >18 weeks of gestation and preterm and term neonates who lived for <24 h. All PMMRI and autopsy reports were re-assessed and scored for seven non-cardiac thoracic and 52 abdominal abnormalities, and concordance between autopsy and PMMRI findings was determined as the primary outcome. RESULTS: Eighty cases were included in this study. Fetal loss was caused by termination of pregnancy in 80% of cases. Further, the mean gestational age was 166 days (23 weeks and 5 days, range 126-283 days). The concordance between PMMRI and autopsy for non-cardiac thoracic and abdominal abnormalities was 83.1% (95% confidence interval [CI] 71.3-83.3) and 76.3% (95% CI 65.8-84.2%), respectively, with a substantial and moderate strength of agreement (Cohen's kappa = 0.63 and 0.51 respectively). CONCLUSION: PMMRI exhibited good overall diagnostic value for non-cardiac thoracic and abdominal abnormalities, specifically large structural abnormalities. PMMRI may offer parents and physicians a valuable addition to autopsy for the detection of non-cardiac thoracic and abdominal abnormalities, or even an alternative option when parents do not consent to autopsy.
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OBJECTIVES: The incidence of children developing metachronous contralateral inguinal hernia (MCIH) is 7-15%. Contralateral groin exploration during unilateral hernia repair can prevent MCIH development and subsequent second surgery and anaesthesia. Preoperative ultrasonography is a less invasive strategy and potentially able to detect contralateral patent processus vaginalis (CPPV) prior to MCIH development. METHODS: We queried MEDLINE, Embase and Cochrane library to identify studies regarding children aged < 18 years diagnosed with unilateral inguinal hernia without clinical signs of contralateral hernia, who underwent preoperative ultrasonography of the contralateral groin. We assessed heterogeneity and used a random-effects model to obtain pooled estimates of sensitivity, specificity and area under the receiver operating characteristic curve (AUC). RESULTS: Fourteen studies (2120 patients) were included, seven (1013 patients) in the meta-analysis. In studies using surgical exploration as reference test (n = 4, 494 patients), pooled sensitivity and specificity were 93% and 88% respectively. In studies using contralateral exploration as reference test following positive and clinical follow-up after negative ultrasonographic test results (n = 3, 519 patients), pooled sensitivity was 86% and specificity 98%. The AUC (0.984) shows high diagnostic accuracy of preoperative ultrasonography for detecting CPPV, although diagnostic ultrasonographic criteria largely differ and large heterogeneity exists. Reported inguinal canal diameters in children with CPPV were 2.70 ± 1.17 mm, 6.8 ± 1.3 mm and 9.0 ± 1.9 mm. CONCLUSION: Diagnostic accuracy of preoperative ultrasonography to detect CPPV seems promising, though may result in an overestimation of MCIH prevalence, since CPPV does not invariably lead to MCIH. Unequivocal ultrasonographic criteria are mandatory for proper diagnosis of CPPV and subsequent prediction of MCIH. KEY POINTS: ⢠Diagnostic accuracy of preoperative ultrasonography for detection of CPPV in children with unilateral inguinal hernia is high. ⢠Preoperative ultrasonographic evaluation of the contralateral groin assumedly results in an overestimation of MCIH prevalence. ⢠Unequivocal ultrasonographic criteria are mandatory for proper diagnosis of CPPV and risk factor identification is needed to predict whether CPPV develops into clinically apparent MCIH.
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Hérnia Inguinal/diagnóstico por imagem , Hérnia Inguinal/cirurgia , Herniorrafia , Cuidados Pré-Operatórios/métodos , Criança , Feminino , Hérnia Inguinal/patologia , Herniorrafia/métodos , Humanos , Laparoscopia , Masculino , Prevalência , Curva ROC , Fatores de Risco , Sensibilidade e Especificidade , Hidrocele Testicular/diagnóstico por imagem , UltrassonografiaRESUMO
PURPOSE: Nissen fundoplication is an effective treatment for gastro-esophageal reflux disease (GERD). Mobilization of the gastric fundus during fundoplication requires division of short gastric vessels of the spleen, which may cause splenic ischemia. The aim of this study was to determine if Nissen fundoplication results in hypotrophy of the spleen. METHODS: We performed pre-operative and post-operative ultrasound measurements of the spleen in children undergoing Nissen fundoplication. During operation, the surgeon estimated the compromised blood flow by assessment of the percentage of discoloration of the spleen. RESULTS: Twenty-four consecutive children were analyzed. Discoloration of the upper pole of the spleen was observed in 11 patients (48%) of a median estimated splenic surface of 20% (range 5-50%). The median ratio for pre-operative and post-operative length, width, and area of the spleen was 0.97, 1.03, and 0.96, respectively. The percentage of the estimated perfusion defect during surgery was not correlated with the ratios. In three patients, the area ratio was smaller than 0.8 (0.67-0.75), meaning that the area decreased with at least 20% after surgery. In none of these patients a discoloration was observed. CONCLUSION: Discoloration of the spleen after Nissen fundoplication is not associated with post-operative splenic atrophy.
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Fundoplicatura/métodos , Refluxo Gastroesofágico/cirurgia , Baço/diagnóstico por imagem , Estômago/irrigação sanguínea , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Refluxo Gastroesofágico/diagnóstico por imagem , Refluxo Gastroesofágico/fisiopatologia , Humanos , Lactente , Recém-Nascido , Isquemia/diagnóstico , Isquemia/prevenção & controle , Laparoscopia/métodos , Masculino , Tamanho do Órgão , Período Pós-Operatório , Período Pré-Operatório , Fluxo Sanguíneo Regional , Estudos Retrospectivos , Baço/irrigação sanguínea , Estômago/cirurgia , Resultado do Tratamento , UltrassonografiaRESUMO
Aim: To investigate whether full-field digital mammography (FFDM) and contrast-enhanced mammography (CEM), evaluated by non-experienced high school students, improves detection of missed breast cancer lesions on FFDM, in the same cohort of patients. Methods: Non-experienced first- and second year high school students examined fourteen cases of patients diagnosed with breast cancer. These cases consisted of missed breast cancer lesions on FFDM by a breast radiologist. Sensitivity of assessment of the students on FFDM and CEM was analysed and compared with the initial results of the breast radiologists. Results: A total of 134 high school students participated in this study. Mean age was 12.8 years (range 10-14). Based on FFDM, mean overall sensitivity of the students was 29.2% (18.9 - 39.6%). When recombined CEM images were used, mean overall sensitivity of students improved to 82.6% (74.0 - 91.2%) (p=0.001). Mean overall sensitivity of FFDM exams evaluated by radiologists was 75.7% (64.2 - 87.3%), which was lower when compared to student's evaluations on recombined CEM exams, yet not statistically significant (p=0.098). Conclusions: Contrast-enhanced mammography evaluated by non-experienced high school students might improve detection rate of breast cancer when compared to evaluations of only full-field digital mammography by radiologists.
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Tosse/diagnóstico , Dispneia/diagnóstico , Febre/diagnóstico , Artéria Pulmonar/anormalidades , Angiografia , Pré-Escolar , Meios de Contraste/farmacologia , Feminino , Humanos , Artéria Pulmonar/patologia , Radiografia Torácica/métodos , Risco , Tomografia Computadorizada por Raios X/métodosRESUMO
RATIONALE AND OBJECTIVES: To understand normal bone development, studies in healthy children and adolescents are important. To assess the applicability of tibial quantitative ultrasound measurements (QUS) in children, we performed a study that compared dual-energy x-ray absorptiometry (DXA) of the lumbar spine and whole body with tibial QUS. METHODS: For this study we recruited 146 Dutch children and adolescents, 58 boys (median age, 14.1 years; range, 7.6-23.4 years) and 88 girls (median age, 18.0 years; range, 7.6-23.5 years). Tanner stage, weight, and height were assessed for all participants. Bone mineral density (BMD; g x cm(-2)) of the whole body and lumbar spine (L2-L4) and bone mineral apparent density (BMAD) of the lumbar spine (g x cm(-3)) were assessed by using the Lunar DPXL. For tibial QUS, the Soundscan compact system was used. RESULTS: Both lumbar as well as whole-body BMD showed a strong, significant correlation with tibial QUS in boys and girls: rtotal body boys = 0.81, rtotal body girls = 0.77, rlumbar spine boys = 0.79, and rlumbar spine girls = 0.72. Lumbar spine BMAD also showed significant correlations with tibial QUS: rboys= 0.63 and rgirls = 0.63 (for all correlations, P < 0.001). CONCLUSIONS: Our study showing strong, significant correlations between DXA and tibial QUS measurements suggests that tibial QUS is a technique that may be applicable in children and adolescents.
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Absorciometria de Fóton , Densidade Óssea , Desenvolvimento Ósseo , Vértebras Lombares/diagnóstico por imagem , Tíbia/diagnóstico por imagem , Adolescente , Adulto , Fatores Etários , Criança , Interpretação Estatística de Dados , Feminino , Humanos , Masculino , Fatores Sexuais , UltrassonografiaRESUMO
In early childhood intussusception a characteristic gas pattern is often visible on plain radiographs which can be used for diagnosis. To test this hypothesis, radiographs of 163 children with intussusception, and as many controls, were reviewed. By using multivariable analysis, it appeared that five out of seven parameters (reduced amount of gas in the jejunum; lateralization of the ileum; indiscernible caecum; reduced amount of feces in the colon; and visibility of the intussusceptum) had discriminatory value. For each parameter a weighting (in points) was derived and the patients were classified: the higher the score the more likely that an intussusception was present. A sensitivity of 90% and a specificity of 90% were obtained.
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Intussuscepção/diagnóstico por imagem , Ceco/diagnóstico por imagem , Criança , Pré-Escolar , Dilatação Patológica/diagnóstico por imagem , Fezes , Feminino , Gases , Humanos , Íleo/diagnóstico por imagem , Lactente , Jejuno/diagnóstico por imagem , Masculino , Radiografia , Estômago/diagnóstico por imagemRESUMO
Pelvic phleboliths are familiar structures to radiologists although their pathogenesis is not fully understood. The literature suggests a relationship between the prevalence of phleboliths and diverticular disease, and with a low-fibre diet. Phleboliths are said to be seen more frequently in women and on the left side in the pelvis. Their number seems to increase with advancing age. We have attempted to establish relations of phleboliths with diverticulitis, diverticulosis, sex, age and pelvic location. In this study the only statistically significant relation was an increase of the number of phleboliths with advancing age.
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Doença Diverticular do Colo/complicações , Divertículo do Colo/complicações , Trombose/etiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Calcinose/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pelve/irrigação sanguíneaRESUMO
The purpose of this prospective study was to define the incidence of magnetic resonance imaging (MRI) abnormalities in the brain in patients with idiopathic central precocious puberty without any additional neurological signs and symptoms, and to evaluate the routine use of gadolinium contrast in these patients. 30 patients (29 girls, one boy; age range 1.9-11.9 years) with idiopathic central precocious puberty were studied. MRI of the brain in axial, coronal and sagittal planes was performed before and after administration of gadopentetate dimeglumine, with special attention to the region of the third ventricle. There are three major findings: (1) the height of the pituitary gland is increased up to adult size compared with normal individuals; (2) in four patients (13%) major structural abnormalities were found; three hamartomas of the tuber cinereum and one gliomatous process extending from the chiasm to the optic tract; and (3) the routine use of gadopentetate dimeglumine did not reveal new abnormalities although the lack of enhancement made a positive contribution to diagnostic certainty. We conclude that contrast enhanced MR examination is a safe and reliable method for the exclusion of abnormalities in children with precocious puberty and for the follow-up of those patients in whom abnormalities are present.
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Encéfalo/patologia , Imageamento por Ressonância Magnética , Puberdade Precoce/patologia , Adolescente , Criança , Pré-Escolar , Combinação de Medicamentos , Feminino , Gadolínio DTPA , Hamartoma/complicações , Hamartoma/diagnóstico , Humanos , Doenças Hipotalâmicas/complicações , Doenças Hipotalâmicas/diagnóstico , Lactente , Masculino , Meglumina , Compostos Organometálicos , Ácido Pentético/análogos & derivados , Hipófise/patologia , Estudos Prospectivos , Puberdade Precoce/etiologia , Túber Cinéreo/patologiaRESUMO
In the field of bone densitometry, attention has recently been focused on the pediatric population. Quantitative ultrasound (QUS) as bone assessment technique has many advantages for children in comparison with bone assessment techniques that use ionizing radiation. In this pilot study, we investigated the use of calcaneal and tibial QUS systems in a healthy Caucasian pediatric population. We studied 120 healthy Caucasian Dutch children between ages 7 and 19 yr: 53 boys (mean age of 12.5 yr, range 4.5-18) and 67 girls (mean age of 13.5 yr; range 7.1-19). We recruited children from a large population who previously had participated in a bone assessment study performed at our hospital. Two operators performed calcaneal QUS of the right calcaneus and tibial QUS of the right tibia. The correlation between calcaneal and tibial ultrasound was modest but significant (r = 0.29; p < 0.01). Using the calcaneal device, we found in girls a weak positive correlation between skeletal age and speed of sound (SOS) (r = 0.38), broadband ultrasound attenuation (r = 0.57), and quantitative ultrasound index (r = 0.46), all with a value of p < 0.01. For boys all parameters failed to reach significance. Using the tibial device, we found a good correlation between skeletal age and SOS in girls (r = 0.76) and modest correlation in boys (r = 0.50), both with a value of p < 0.01. This is one of the first studies to present a comparison between two ultrasound techniques in children. At present we feel that, in light of the poor correlation with skeletal age, calcaneal ultrasound has yet to prove its efficacy in children. Tibial ultrasound seems to be a good bone assessment technique in children.
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Densidade Óssea , Calcâneo/diagnóstico por imagem , Tíbia/diagnóstico por imagem , Adolescente , Criança , Feminino , Humanos , Masculino , Projetos Piloto , Ultrassonografia , População BrancaRESUMO
The authors report their experience with hepatic artery ligation in two newborns, as well as relevant findings from a literature review. A 2-day-old boy had progressive cardiac and respiratory difficulty. A firm liver was palpable, with an overlying thrill. Sonography and arteriography showed diffuse arteriovenous shunting in both liver lobes. Hepatic artery ligation provided remarkable hemodynamic and clinical improvement. Another boy was admitted 3 weeks after birth because of bilious vomiting with abdominal distension and bloody stools. Abdominal examination showed a large liver with a systolic bruit and thrill. X-rays showed cardiac enlargement and dilated bowel loops with air-fluid levels. Arteriography and sonography showed arteriovenous and arterioportal venous shunting. Laparotomy was performed, and a large vascular malformation was palpated in both liver lobes. The entire bowel was congested and cyanotic, but there were no signs of obstruction. This patient had acute portal hypertension imitating intestinal obstruction. Ligation of the hepatic artery improved the color of the bowel, and the thrill disappeared. Five and nearly 4 years after the operation, both boys are growing normally without medication or diet. Sonography showed almost complete resolution of the hemangiomas.
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Malformações Arteriovenosas/cirurgia , Hemangioma/cirurgia , Artéria Hepática/cirurgia , Neoplasias Hepáticas/cirurgia , Fígado/irrigação sanguínea , Veia Porta/anormalidades , Malformações Arteriovenosas/diagnóstico por imagem , Diagnóstico Diferencial , Insuficiência Cardíaca/etiologia , Hemangioma/diagnóstico por imagem , Artéria Hepática/anormalidades , Humanos , Hipertensão Portal/diagnóstico , Hipertensão Portal/etiologia , Recém-Nascido , Obstrução Intestinal/diagnóstico , Ligadura , Fígado/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Veia Porta/diagnóstico por imagem , Radiografia , UltrassonografiaRESUMO
For more than 10 years the authors have been using ultrasonography to confirm clinically suspected intussusception without performing a contrast enema. The aim of this study is to review this diagnostic policy. Between 1980 and 1989, 163 children who, on clinical examination and plain abdominal radiographs were suspected of having intussusception, underwent ultrasonography to confirm the diagnosis. In 33 children, ultrasonography did not show intussusception; of the remaining 130 children, intussusception was diagnosed in 128. In two children in whom intussusception was noted subsequently, the diagnosis was not established on ultrasound. Thus, ultrasonography had a sensitivity of 98.5% and a specificity of 100% in the diagnosis of intussusception. It is a quick, simple, noninvasive method to diagnose intussusception, with high accuracy. The role of contrast enema is limited to therapeutic application.
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Intestinos/diagnóstico por imagem , Intussuscepção/diagnóstico por imagem , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Sensibilidade e Especificidade , UltrassonografiaRESUMO
Relatively little is known about the variables that influence lung deposition of inhaled aerosols in children. A model of the upper airways of an infant could be a useful tool to study these variables in vitro. The objective of this study was to construct an anatomically correct model of the upper airways of a young child. A routine three-dimensional (3D) CT scan of the skull and neck of a child was selected that included the airway from the nasal cavity down to the subglottic region. The CT scan was edited to obtain an anatomically correct distinction between air and mucosa. Next, a model was constructed with a stereolithographic technique using a UV-sensitive resin. To validate the model, a 3D CT scan of the model was made and compared to the anatomy of the original image. To study aerosol deposition, the model was connected to a breathing simulator. Medical aerosols were delivered to the model by MDI/spacer during stimulated breathing. An upper airway model was made of a 9-month-old child that needed reconstructive surgery for a skull deformity and with normal anatomy of the upper airways. The nasal airway of the model was open for air passage and the oral airway was closed. The CT scan of the model matched the original in vivo CT scan closely. Aerosol deposition measurements showed that dose passing the model, or lung dose, was comparable with in vivo lung deposition data. We have constructed an anatomically correct model of the upper airways of a child, using a stereolithographic method for in vitro studies of aerosol deposition in young children. This model will be used to obtain insight in aerosol treatment that cannot be obtained in vivo.
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Aerossóis , Modelos Anatômicos , Nariz , Faringe , Broncodilatadores/administração & dosagem , Budesonida/administração & dosagem , Criança , Feminino , Humanos , Lactente , Nebulizadores e Vaporizadores , Tamanho da Partícula , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: A critical examination of the radiological technique used by the Dutch Immigration and Naturalisation Service (IND) for determining the adulthood of persons around the age of 18. DESIGN: Descriptive. METHOD: Radiographs of the hands and clavicles were reassessed in 29 asylum seekers (15 boys, 9 girls and 5 persons of unknown gender) in whom the IND suspected a discrepancy between the true age and the age stated. In each case, 1 hand radiograph and 3 clavicular views were taken: 1 posteroanterior standard view as well as 2 oblique views, in order to assess the epiphyses at the medial ends of the clavicles. Additionally, the radiographs of one of these subjects were shown to 241 radiologists and radiologists-in-training. RESULTS: On all the hand X-rays, the epiphyses were closed. Based on this, the skeletal age of the girls was at least 15 years and 11 months and that of the boys at least 17 years and 3 months. The medial ends of the clavicles could not be assessed on the standard views due to overprojection of the spinal column. In 55 of the 58 films in which the thorax was turned, the direction of the X-rays was not appropriate for assessing the growth plates. The other 3 could not be assessed as there were no existing objective radiological criteria. The assessments of the stage of development as an indication of skeletal age in the cases presented differed greatly from one another. CONCLUSION: The radiographs that were taken to establish whether or not the asylum seekers were underage were unsuitable for the purpose for which they were taken.
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Determinação da Idade pelo Esqueleto/métodos , Clavícula/diagnóstico por imagem , Emigração e Imigração , Refugiados , Adolescente , Adulto , Feminino , Mãos/diagnóstico por imagem , Humanos , Masculino , Países BaixosRESUMO
A female neonate developed abdominal distension with vomiting. She was suffering from meconium ileus and cystic fibrosis.
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Fibrose Cística/diagnóstico , Doenças do Íleo/diagnóstico , Obstrução Intestinal/diagnóstico , Abdome/anormalidades , Fibrose Cística/genética , Feminino , Humanos , Íleo/anormalidades , Íleo/patologia , Recém-Nascido , Mecônio , Vômito/etiologiaRESUMO
Between August 1989 and August 1992 four neonates with rupture of the liver were admitted to the Neonatal Intensive Care Unit of the Sophia Children's Hospital in Rotterdam, the Netherlands. Two neonates were born after breech delivery, two after caesarean section because of foetal distress. All four patients had Apgar scores < 5 after 1 minute and of < 8 after 5 minutes and required artificial ventilation for a prolonged period. All infants collapsed within 6 hours after birth. Surgical treatment was not considered because of the poor clinical condition. All patients were treated conservatively. Clinical signs were: rapid onset pallor, hypotension, tachycardia and abdominal distension. Ultrasonography of the abdomen confirmed the clinical diagnosis of rupture of the liver. Despite rapid diagnosis and maximal non-surgical treatment mortality was 75%. Surgical intervention is indicated in neonatal liver rupture with significant intra-abdominal bleeding.
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Hepatopatias/diagnóstico , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Hepatopatias/complicações , Hepatopatias/terapia , Masculino , Prognóstico , Ruptura Espontânea , Choque/etiologiaRESUMO
OBJECTIVE: To gain insight into the clinical en economic results of the treatment of femoral shaft fractures in children by means of traction for 3 weeks and spica immobilization for 3 weeks as an outpatient in comparison with traction for 6 weeks. DESIGN: Retrospective. SETTING: Sophia children's hospital in Rotterdam. METHOD: Between 1981 and 1989, 278 children were admitted because of a femoral shaft fracture. This follow-up study concerned 229 children of whom 139 were treated by means of 6 weeks' traction (group 1) and 90 received the combination treatment (group 2). The two groups were comparable with regard to age, sex, cause, type and site of the fracture. RESULTS: All fractures healed, complications were rare and equally divided between the two groups. There was no significant difference between the two groups with regard to shortening and angulation of bone fragments. The mean duration of hospital stay was almost 47 days in group 1 as against 22 days in group 2, leading to a reduction of Dfl. 19,500.--in hospitalization costs per child. CONCLUSION: The results of treatment of femoral shaft fractures by means of traction in combination with spica immobilization equal those of 6 weeks' traction. The shortened duration of hospital stay leads to a considerable reduction in costs.
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Moldes Cirúrgicos , Fraturas do Fêmur/terapia , Tração/métodos , Adolescente , Criança , Pré-Escolar , Controle de Custos , Feminino , Fraturas do Fêmur/economia , Humanos , Lactente , Masculino , Satisfação do Paciente , Estudos RetrospectivosRESUMO
OBJECTIVES: To determine whether imaging findings can be used to differentiate between impact and non-impact head trauma in a group of fatal and non-fatal abusive head trauma (AHT) victims. METHODS: We included all AHT cases in the Netherlands in the period 2005-2012 for which a forensic report was written for a court of law, and for which imaging was available for reassessment. Neuroradiological and musculoskeletal findings were scored by an experienced paediatric radiologist. RESULTS: We identified 124 AHT cases; data for 104 cases (84%) were available for radiological reassessment. The AHT victims with a skull fracture had fewer hypoxic ischaemic injuries than AHT victims without a skull fracture (p=0.03), but the relative difference was small (33% vs. 57%). There were no significant differences in neuroradiological and musculoskeletal findings between impact and non-impact head trauma cases if the distinction between impact and non-impact head trauma was based on visible head injuries, as determined by clinical examination, as well as on the presence of skull fractures. CONCLUSIONS: Neuroradiological and skeletal findings cannot discriminate between impact and non-impact head trauma in abusive head trauma victims.