MRI for clinically suspected pediatric appendicitis: case interpretation.

As utilization of MRI for clinically suspected pediatric appendicitis becomes more common, there will be increased focus on case interpretation. The purpose of this pictorial essay is to share our institution's case interpretation experience. MRI findings of appendicitis include appendicoliths, tip appendicitis, intraluminal fluid-debris level, pitfalls of size measurements, and complications including abscesses.

MRI for clinically suspected pediatric appendicitis: an implemented program.

Background: Emergent MRI is now a viable alternative to CT for evaluating appendicitis while avoiding the detrimental effects of ionizing radiation. However, primary employment of MRI in the setting of clinically suspected pediatric appendicitis has remained significantly underutilized.

Objective: To describe our institution's development and the results of a fully implemented clinical program using MRI as the primary imaging evaluation for children with suspected appendicitis.

Intradiaphragmatic extralobar sequestration-a rare pulmonary anomaly.

Extralobar pulmonary sequestrations are most commonly found within the thoracic cavity, but have been described within the abdomen. We present the case of a 16-month-old boy with an intradiaphragmatic pulmonary sequestration and demonstrate a computed tomographic scan finding that might help identify this extremely rare abnormality preoperatively.

Radiation dose from DXA scanning to reproductive tissues of females.

The objective of this study was to use an anatomically arrayed whole-body phantom to measure radiation exposure to the ovaries and uterus during standard dual-energy Xray absorptiometry (DXA) scanning. DXA instrument manufacturers' published entrance skin exposure is about 3 mR (0.77 microC/kg), which is equivalent to the radiation exposure received during a transcontinental plane trip.

Vascular ring due to right aortic arch with mirror-image branching and left ligamentum arteriosus: complete preoperative diagnosis by magnetic resonance imaging.

Magnetic resonance imaging (MRI) has been increasingly employed in the evaluation of aortic arch abnormalities. We present a rare form of vascular ring, that of a right aortic arch with mirror-image branching and left ligamentum arteriosus, which was clearly defined preoperatively by MRI. The patient subsequently underwent successful surgical division of the vascular ring followed by improvement in respiratory symptoms.

Colovesical fistula resulting from a perforated colonic duplication.

Colovesical fistulas in children are most often associated with high anorectal imperforations. Acquired enterovesical fistulas in children only rarely have been reported as a consequence of an inflammatory process. We present a case of an acquired colovesical fistula formed by the erosion of an abscess at the distal end of a colonic duplication in a child who presented with fever of unknown origin.

Multiplanar image reconstruction and 3D imaging using a musculoskeletal phantom: conventional versus helical CT.

Purpose: Our goal was to perform a detailed comparison of the relative performances of helical CT (pitches 1.0, 1.5, and 2.

The impact of 2D versus 3D quantitation of tumor bulk determination on current methods of assessing response to treatment.

Purpose: Measurements from sequential axial "2D" data in cancer patients are commonly used to assess treatment response or disease progression. This study compares the volume of tumor bulk calculated with 3D reconstructions with that calculated by conventional methods to determine if it might change patient classification.

Method: All medical, gynecologic, and pediatric oncology patients under treatment who were evaluated with serial CT scans between January 1, 1992, and July 31, 1994, for whom the digital data were available were included in this study.

Routine use of a higher order interpolator and bone algorithm in thoracic CT.

Objective: This study was designed to evaluate the utility of the routine use of high spatial frequency algorithms and higher order helical interpolators for imaging lung parenchyma during routine thoracic CT.

Subjects And Methods: We evaluated 50 consecutive patients undergoing clinically indicated thoracic CT using the same imaging parameters and scanner. The helical volume was reconstructed three separate times using standard and higher order (180 degrees linear with double-sided lobes) interpolators and standard and high spatial frequency (bone) algorithms.

Postoperative neurologic complications after open heart surgery on young infants.

Objective: To ascertain the relation between postoperative neurologic complications and variables occurring before, during, and after hypothermic cardiopulmonary bypass surgery to correct congenital heart disease in young infants.

Design: Prospective analysis of mortality and neurologic morbidity before hospital discharge; systematic comparison with patient characteristics, metabolic status, surgery variables; and preoperative neurologic findings of the patients.

Setting: Intensive care unit in tertiary care center.

Three-dimensional quantitation of pediatric tumor bulk.

In pediatric oncology, therapeutic decisions are made based on tumor response to chemotherapeutic agents. Sequential measurement of tumor bulk and its percent change on therapy must be accurately assessed. Will 3-dimensional (3-D) volumetric determination improve our ability to assess tumor response to therapy? Forty-five CT scans of pediatric patients with unresectable thoracic or abdominal neoplasia were assessed for tumor bulk by the standard "2-dimensional (2-D)" volume formula (cross-sectional area x length) and by 3-D volumetric analysis.

Benign cystitis in children mimicking rhabdomyosarcoma.

Seventeen (13 male, 4 female) patients, aged 13 months to 13 years, with benign cystitis had imaging findings that mimicked those of rhabdomyosarcoma. Our experience indicates that in the child with hematuria, dysuria, and frequency plus cystographic or sonographic demonstration of a bladder with reduced capacity and circumferential wall thickening or sonographic findings of isoechoic bladder wall thickening (focal, multifocal or circumferential distribution), intact mucosa, and bullous lesions should strongly suggest inflammation and not malignancy. When an inflammatory lesion is suspected, follow-up imaging should be performed in 2 weeks, which if normal will preclude biopsy.

Imaging variants of the liver, pancreas, and spleen.

The liver, spleen, and pancreas are three of the most frequently imaged intra-abdominal organs. Each organ is a complex structure affected by multiple pathologic processes. However, in order to recognize the pathologic changes that affect each organ, one must have a detailed knowledge of the broad spectrum of normal variants that can be seen when imaging the upper abdomen.

Recognition of malposition of the liver and spleen: CT, MRI, nuclear scan and fluoroscopic imaging.

Thirteen children initially suspected to have an intrathoracic or intraabdominal mass had malposition of the liver and/or spleen discovered by ultrasound. This group consisted of five children with diaphragmatic eventration or hernia and eight with wandering spleen or liver. Careful ultrasonographic examinations were diagnostic in all patients; seven had surgical confirmation.

Nodules, masses, and pseudomasses in the pediatric lung.

The vast majority of pulmonary masses in children are nonmalignant. Most pediatric nodular disease is granulomatous in origin. Infections and congenital lesions outnumber neoplastic lesions.

Identical twins with Weissenbacher-Zweymüller syndrome and neural tube defect.

Neurologic abnormalities have been described only once previously in a child with Weissenbacher-Zweymüller syndrome (WZS), a rare skeletal dysplasia, evident neonatally. We report on identical twin male infants with skeletal findings typical of WZS, including small size at birth, proximal limb shortness, mid face hypoplasia, and myopia. In addition, twin B had a parieto occipital encephalocele while twin A had a meningocele at the same location.

Ewing's sarcoma.

Ewing's sarcoma is a highly malignant tumor of uncertain origin. A strong relationship is suggested between Ewing's sarcoma and tumors of neural origin. The radiologic manifestation of Ewing's sarcoma are protean and lesions may be lytic, mixed lytic-sclerotic, or rarely, predominantly sclerotic.

The newer radiographic contrast media.

The 1980s witnessed the development of many new contrast agents useful in radiographic and MRI to enhance the contrast discrimination between tissues and improve lesion conspicuity. In addition to improved efficacy, these agents are generally safer and cause less patient discomfort than older radiographic contrast media. The injection of any foreign material into the body always holds some risk, however, and it is the responsibility of clinicians and radiologists jointly to use these agents judiciously in the best interest of the patient.

CT and MR imaging of the pediatric orbit.

Orbital abnormalities encountered in the pediatric population differ substantially from those found in adult patients. Retinoblastoma, the most serious intraocular tumor, is often difficult to diagnose, but use of computed tomography (CT) (which reveals the characteristic focal calcification) and magnetic resonance (MR) imaging allows this tumor to be differentiated from pseudogliomas, such as Coats disease, and retrolental fibroplasia. CT and MR imaging help in the differentiation of orbital cellulitis from preseptal, lacrimal, and eyelid infectious processes and of orbital pseudotumor from Graves disease.

Case report 730. Malignant large cell lymphoma of tibial epiphysis.

We present a case of primary lymphoma of bone arising in the proximal tibial epiphysis of a 16-year-old boy. To the best of our knowledge, primary lymphoma of bone has not been described previously as a mimicker of chondroblastoma. This case report is intended to increase awareness among clinicians and radiologists that primary lymphoma of bone can present with a long clinical prodrome and initially benign radiographic appearance.

Focal fatty infiltration of the liver in a healthy child.

Fatty infiltration of the liver may occur in healthy children. The ultrasonographic, CT, and MRI findings are identical to those already described in the adult population.