Quantitative apparent diffusion coefficient (ADC) values as an imaging biomarker for fibrosis in pediatric Crohn's disease: preliminary experience

PURPOSE

To compare histopathology with ADC values in strictured bowel segments in pediatric patients with known Crohn's disease and surgical bowel resection.

METHODS

Magnetic resonance enterography (MRE) images of 14 subjects with Crohn's disease who had surgical bowel resection for strictures were retrospectively reviewed. Five of 14 subjects had DWI (b=0, 500, 1000) sequences included in the MRE study. ADC measurements were made by placing ROI's in the strictured bowel wall and compared to full-thickness histologic analysis of resected specimens. ADC values were also compared to control ADC measurements (in normal and inflamed-nonstenotic bowel segments) as well as the mean ADC values of Crohn's patients published in the literature.

RESULTS

All five subjects had transmural fibrosis. The mean ADC value with b = 500 was 0.92 ± 0.10 × 10(-3) mm(2)/s and with b = 1000 was 0.8 ± 0.05 × 10(-3) mm(2)/s. There was a significant difference in ADC values between strictures and inflamed-nonstenotic segments (p=0.0143) and between normal and diseased bowel segments (p=0.009-0.0143).

CONCLUSIONS

Quantitative ADC measures of transmural fibrosis are lower compared to the reported values of inflammation in Crohn's disease. To our knowledge, this is the first pediatric pilot study to investigate the correlation of quantitative DWI with histology of surgical specimens in pediatric patients with Crohn's disease. Our results are comparable to a recently published study in adult Crohn's patients showing a significant correlation between a decrease in ADC values and fibrosis.

Effects of dietary rosemary, rosemary volatile oil and vitamin E on broiler performance, meat quality and serum SOD activity

1. The current study was conducted to evaluate the effects of dietary supplementation with vitamin E (as alpha-tocopherol acetate), dried rosemary leaves and rosemary volatile oil on the performance, meat quality (measured as sensory variables, pH, colour, malondialdehyde (MDA) level, and bacteria count) and serum superoxide dismutase (SOD) activity in broilers fed on maize-soybean meal based diets. 2. A total of 800 broiler chicks were randomly allocated to 8 dietary treatments, which were set up with 1 control group and 7 experimental groups. The control group (VitE1) was given a basal diet including 50 mg/kg alpha-tocopherol acetate, while the experimental groups were given 5 x 7 g/kg rosemary plant (R1), 8 x 6 g/kg plant (R2), 11 x 5 g/kg plant (R3), 100 mg/kg plant oil (RO1), 150 mg/kg plant oil (RO2), 200 mg/kg plant oil (RO3) or 200 mg/kg alpha-tocopherol acetate (VitE2). 3. Although there were no statistical differences observed for feed consumption, other performance variables including live weight gain, feed efficiency and carcase yield were significantly affected. The addition of rosemary volatile oil had more effect on the performance variables than did the rosemary plant itself. 4. As a measure of meat shelf life, TBA analyses were performed on the meat samples on d 1, 3 and 5 after culling. Meat MDA levels of groups fed diets with rosemary and rosemary volatile oil were significantly lower than that of groups fed diets containing alpha-tocopherol acetate alone. 5. Significant differences were also seen between the control and experimental groups for meat colour and meat pH values as well as for sensory analyses. 6. Microbiological analyses conducted at the end of the experiment showed that E. coli counts were significantly reduced in meat samples from the experimental groups. 7. In conclusion, dietary supplementation with rosemary and its volatile oil improved broiler meat quality. Moreover growth performance was positively affected by the rosemary volatile oil supplementations.

Cystic splenosis mimicking a renal mass: a case report and review of the literature

Splenosis is a well-known entity, caused by autotransplantation of splenic tissue as a result of trauma or splenectomy. Patients are generally asymptomatic, and this entity is diagnosed during routine diagnostic imaging. Cystic changes in splenic implants have been defined before but, as to our knowledge, radiological demonstration of cystic components has not been published in the literature. It is well-known that unusual locations of the splenic implants create diagnostic problems, sometimes leading to unnecessary surgical interventions. In this report splenosis, mimicking a renal tumour, with cystic changes in the biggest splenule, and diagnosis with ferrumoxide-enhanced MRI is presented.

Primary antiphospholipid syndrome: an unusual cause of adrenal insufficiency

We describe a boy, 10 years and 5 months old, who developed acute adrenal gland insufficiency which was confirmed by hormonal investigation. Abdominal magnetic resonance imaging showed unilateral enlargement of the right adrenal gland, whereas the other gland seemed normal - no cause was apparent. Three months later the patient presented with thrombosis in the right femoral vein and in the veins of the right leg. Autoantibodies against cardiolipin were strongly positive, while antinuclear antibodies and antibodies against double-stranded deoxyribonucleic acid were absent. There was no evidence of antiphospholipid syndrome associated with drugs, connective tissue disorders, or malignancies, strongly suggesting the diagnosis of primary antiphospholipid syndrome. The development of adrenal insufficiency has been reported in primary antiphospholipid syndrome due to adrenal hemorrhage following vascular occlusion of adrenal vessels or secondary to anticoagulant therapy. It was interesting to note that in our patient adrenal gland insufficiency preceded other clinical evidence of the syndrome by 3 months. The primary antiphospholipid syndrome should be considered a possible cause of Addison's disease when the etiology is not obvious.

Transient neonatal hypoglycemia: cranial US and MRI findings

A case of transient neonatal hypoglycemia with patchy hyperechogenic white matter abnormalities in the frontal and parietooccipital lobes on cranial US is presented. An MRI examination revealed T1 and T2 shortening of the lesions in the occipital and frontal white matter. Follow-up cranial US demonstrated recovery of white matter changes in the patient with normal neurological outcome.

The benign course of carotid-cavernous fistula in a child

Carotid-cavernous fistulas (CCF) are reported very rarely in childhood and their clinical course and prognosis are uncertain. We report a 9-year-old boy presented with left eye swelling, neck pain and headache. The MRI findings suggested a CCF with enlarged left superior ophthalmic vein. Ocular Doppler ultrasonography revealed enlarged left superior ophthalmic vein, and arterialization of Doppler wave form. The cerebral angiogram showed normal anatomy. Control Doppler examination findings supported the diagnosis of closure of fistula. The clinical and radiological findings of this unusual presentation are discussed.

MRI follow-up of basal ganglia involvement in subacute sclerosing panencephalitis

A 12-year-old male with subacute sclerosing panencephalitis is presented. Magnetic resonance imaging revealed basal ganglia involvement without white matter changes for several months. Basal ganglia changes are not infrequent in subacute sclerosing panencephalitis, but they tend to appear in advanced clinical stages. Prominent basal ganglia involvement may occur very rarely in subacute sclerosing panencephalitis. In our patient, serial magnetic resonance imaging demonstrated the involvement of white matter after 2 years of magnetic resonance imaging follow-up. In contrast with the neuroradiologic progression, our patient's clinical status remained stable.

Short-term follow-up of the juvenile rheumatoid knee with fat-saturated 3D MRI

OBJECTIVE

To determine the correlation between clinical status and 3D, fat-saturated contrast-enhanced MRI findings in assessing the response to treatment in patients with knee-joint involvement from juvenile rheumatoid arthritis (JRA).

MATERIALS AND METHODS

Synovial hypertrophy, effusion, cartilage and epiphyseal status were scored using spin-echo (SE) T1-weighted, SE T2-weighted and contrast-enhanced, fat-suppressed 3D MRI in 42 knees of 21 patients. MRI findings were evaluated by scoring results and compared with the clinical scoring results. Progression, improvement and equivalence were analysed between 0-3 and 3-6 months, both clinically and by MRI.

RESULTS

Fat-suppression imaging generated high contrast between cartilage, synovium, effusion and bone. Correlation coefficients according to progression, improvement and equivalent findings of months 1-3 and months 3-6 comparison of clinical and MRI scores were found to be 0.50 and 0.70, respectively.

CONCLUSION

Contrast-enhanced 3D MRI with fat suppression provides good discrimination between synovial hypertrophy and fluid. Fat-suppressed imaging offers better contrast between cartilage and synovium. Long-term MRI follow-up of JRA improves direct follow-up of pathological changes and helps in modifying treatment regimens.

Sonographic and MRI findings in prepubertal adnexal hemorrhagic cyst with torsion

Adnexal torsion is rare before menarche. We report the case of a 10-year-old girl with persistent left lower quadrant pain proven by surgery to be caused by adnexal torsion due to a hemorrhagic cyst. Sonography showed a well-defined, complex, predominantly solid mass with some sound through-transmission and a small amount of fluid. The left ovary could not be distinguished from the mass; the right ovary appeared normal. Doppler sonography demonstrated no blood flow within the mass. MRI revealed a circumferential region of high signal intensity in the periphery of the mass and multiple hyperintense foci in the left ovary.

Spinal epidural gas after cardiac surgery

The authors describe a patient with severe lower back and left leg pain in the early postoperative period after cardiac surgery. Radiologic examination revealed gas in the spinal epidural space at the level of L4-5. The pain could not be relieved with analgesics and the patient underwent lumber surgery after cardiac surgery. After decompression, the patient improved and was discharged with no symptoms.

Aneurysmal dilatation of the paraumbilical vein in an infant

The paraumbilical veins are one of the most common collateral pathways developing in portal hypertension. Aneurysmal dilatation of a patent paraumbilical vein is a very unusual finding. We report the first infant case of a paraumbilical vein aneurysm and its Doppler ultrasound findings.

Sturge-Weber syndrome without facial nevus

An 11-month-old patient with Sturge-Weber syndrome with the absence of facial angioma and normal mental development is presented. Noncontrast computed tomography revealed left parieto-occipital atrophy with heavy gyriform calcifications. Axial T(2)-weighed magnetic resonance imaging confirmed the presence of low-signal areas corresponding to the gyral calcifications evident on computed tomography. Contrast-enhanced T(1)-weighted axial and coronal images exhibited high signals in the left parieto-occipital cortical and subcortical areas, representing angiomatous malformations. The clinical appearance and pathologic features of the reported patient were compared with those of similar patients described in published reports.

Various radiological appearances of angiomyolipomas in the same kidney

A 21-year-old woman with tuberous sclerosis presented with abdominal distension and flank pain. Imaging studies, including CT and MR imaging, revealed bilateral renal mass lesions, containing fat and suggesting the diagnosis of tuberous sclerosis. However the imaging characteristics of one of these lesions differed from the others with no radiologically detectable fat tissue in this solid lesion suggesting renal cell carcinoma. Histopathological examination of this lesion in the left kidney revealed an angiomyolipoma within minimal fat tissue. The radiological diagnosis of angiomyolipomas with minimal fat tissue remains difficult and the differential diagnosis is discussed.

MRI of fibromatosis colli

Magnetic resonance imaging (MRI) appearance of fibromatosis colli has been reported in only two cases in the literature. We herein describe the MRI findings in a case of fibromatosis colli: the signal intensity of the fusiform mass on T2 weighted images was slightly less than on T1 weighted images, consistent with the presence of some fibrous tissue within the muscle mass.

Anterior lumbosacral radiculopathy after intrathecal methotrexate treatment

Intrathecal chemotherapy with methotrexate or cytosine arabinoside is the standard approach to prophylaxis and treatment of central nervous system leukemia in children. Progressive paraplegia, one of the devastating neurologic complications related to this mode of treatment, has been attributed to spinal cord toxicity. Reported are three children who developed progressive paraparesis after intrathecal methotrexate administration followed by complete or partial recovery. Gadolinium enhancement of anterior lumbosacral spinal nerve roots was demonstrated in all three patients, and an elevation of cerebrospinal fluid immunoglobulin G synthesis was evident in two patients with more severe symptoms. The clinical data suggest that anterior lumbosacral radiculopathy is also a type of neurologic complication associated with intrathecal methotrexate treatment.

Coexistent neurenteric cyst and enterogenous cyst. Further support for a common embryologic error

The authors describe common embryological pathways responsible for coexistent neurenteric and enterogenous cysts in a patient with spinal dysraphism.

Herpes encephalitis in children. MRI assessment

The magnetic resonance imaging (MRI) findings in 14 patients with biopsy or polymerase chain reaction proven herpes simplex encephalitis were retrospectively reviewed to evaluate the diagnostic value of MRI in the early diagnosis of herpes simplex encephalitis in children. In addition to the early findings, follow-up MRI scans were obtained in four patients. Typical limbic system involvement was seen in 78 percent of the cases. Contrast-enhanced MRI was found to be superior to routine MRI sequences and computerized tomography (CT) in the early detection of inflammation. Follow-up MR images in four patients demonstrated the volume loss and late petechial hemorrhage in the involved regions. Magnetic resonance imaging is the method of choice in the diagnosis and follow-up of herpes simplex encephalitis.

Differential effect of race on the axial and appendicular skeletons of children

The prevalence of osteoporosis and the incidence of fractures are substantially lower in black than in white subjects, a finding generally attributed to racial differences in adult bone mass. Whether these racial differences are present in childhood is the subject of considerable interest, as the amount of bone gained during growth is a major determinant of future susceptibility to fractures. We measured the density and size of the vertebrae and femurs of 80 black and 80 white healthy children, 8-18 yr of age, matched for age, gender, height, weight, and stage of sexual development, using computed tomography. Race had a significant and differential effect on the bones in the axial and appendicular skeletons. In the axial skeleton, black children had greater cancellous bone density, but similar cross-sectional area of the vertebral bodies. In contrast, in the appendicular skeleton, black children had greater femoral cross-sectional area, but similar cortical bone area and cortical bone density. Compared to white children, vertebral bone density and femoral cross-sectional area at sexual maturity were, on the average, 10.75% and 5.7% higher, respectively, in black children. Such significant variations may contribute to the racial differences in the prevalence of osteoporosis between black and white adults.

Diagnostic value of MR arthrography in detection of intrinsic carpal ligament lesions: use of cine-MR arthrography as a new approach

Twenty-five patients with chronic wrist pain and a preliminary diagnosis of carpal instability were examined with conventional MR imaging and MR arthrography with single compartment intra-articular injection. A new cine-MR arthrography technique, with image acquisition at every 5 s during intra-articular injection, was performed in 17 subjects. The purpose of this study was to determine the diagnostic value of MR arthrography in ligamentous lesions of the wrist and to assess the value of cine-MR arthrography in comparison with arthroscopy and/or surgery. Magnetic resonance arthrography, a semi-invasive technique, increased the diagnostic accuracy of intrinsic carpal ligament injuries. Cine-MR arthrography can be considered as a promising technique especially for the evaluation of lunatotriquetral and scapholunate ligament injuries of the wrist.

Differential effect of gender on the sizes of the bones in the axial and appendicular skeletons

Recent observations suggest that throughout life the size of the vertebral bodies in females is smaller than that in males even after accounting for differences in body size. To confirm these reports and to determine whether similar differences exist in the appendicular skeleton, detailed measurements of the sizes of the vertebrae and the femur were obtained using computed tomography in 30 pairs of prepubertal boys and girls matched for age, height, and weight. Anthropometric parameters as well as gender influenced the cross-sectional area of the vertebrae. Heavier children had greater vertebral cross-sectional area than slender children regardless of gender, and the vertebral bodies were found to be significantly smaller in girls than in matched boys (approximately 11%), both using Student's t test (P < 0.0001) and its multivariate analog, the Hotelling's T2 test (P < 0.0001). In contrast to these findings in the axial skeleton, gender status did not influence the size of the bones in the appendicular skeleton, and neither the cross-sectional area (3.28 +/- 0.84 vs. 3.10 +/- 0.56 cm2) nor the cortical bone area (1.80 +/- 0.37 vs. 1.85 +/- 0.36 cm2) at the midshaft of the femur differed between boys and girls. These values, however, correlated strongly with all anthropometric indexes, and multiple regression analyses indicated that both measurements were primarily related to weight. The results suggest that although increases in mechanical loading associated with growth are the main determinant of the cross-sectional properties of the appendicular skeleton in children, factors other than body mass and related to gender have a significant role in the regulation of the sizes of the bones in the axial skeleton.

Pathogenesis of osteosclerosis in autosomal dominant osteopetrosis

OBJECTIVE

The purpose of this study was to determine if the generalized osteosclerosis seen on skeletal radiographs of patients with osteopetrosis is associated with an increase in bone density.

SUBJECTS AND METHODS

Five children (three girls, two boys, 6-12 years old) with autosomal dominant osteopetrosis who had sustained a fracture with minimal trauma had the density and area of cortical bone at the midshaft of the femur and the amount of cancellous vertebral bone per voxel measured by quantitative CT. Values for five children with osteopetrosis were compared with measurements for two control groups of healthy subjects matched for age, sex, Tanner stage of sexual development, race, weight, and height.

RESULTS

Both the area of femoral cortical bone and the amount of cancellous vertebral bone per voxel were significantly greater in the children with osteopetrosis than in the healthy children. The density of bone in the children with osteopetrosis was the same as the density in the healthy subjects. Neither sex, age, height, or weight influenced bone density, and values were similar for all 15 children.

CONCLUSION

The osteosclerosis depicted on skeletal radiographs of patients with osteopetrosis results from an increase in the amount of bone, not from an increase in the percentage of mineralized bone per unit volume of tissue.

Prospective study investigating routine usage of ultrasonography as the initial diagnostic modality for the evaluation of children sustaining blunt abdominal trauma

In this prospective study, 217 children sustaining blunt abdominal trauma were initially evaluated with ultrasonography (US) and those with any abnormal ultrasonographic findings were further evaluated with computed tomography. Results of ultrasonographic examination were normal in 157 children and showed abnormalities such as free intraperitoneal fluid (FIF), intra-abdominal organ injury, and intrapleural fluid in 60 children. Computed tomographic examination of the 42 children with organ injury, the seven children with minimal FIF of no definite source, and the three children with intrapleural fluid revealed findings consistent with ultrasonographic findings. Computed tomographic examination of the eight children with more than minimal FIF of no definite source detected by US showed the source as liver injury in one and spleen injuries in two patients. The source of FIF could not be identified with computed tomography in five patients. After clinic follow-up examination, one of these five patients was operated on for abdominal tenderness, fever, and air-fluid levels detected on plain abdominal radiographs, and duodenal perforation was encountered. Clinical courses of the patients with normal ultrasonographic findings were uneventful. We conclude that US, aside from being a screening tool, is alone sufficient in the evaluation of the majority of the children sustaining blunt abdominal trauma. Although this is a preliminary study with further work needed to be done, we propose that further evaluation with computed tomography should be performed on those children in whom more than minimal FIF of no definite source is detected with US.

Osteopenia in children: CT assessment

PURPOSE

To assess the value of computed tomographic (CT) measurements of cortical bone in children with osteopenia.

MATERIALS AND METHODS

The area and density of cortical bone in the midshaft of the femur were measured with CT in 37 children with osteopenia. Twenty had osteoporosis in one leg, nine had osteogenesis imperfecta (IO), and eight had vitamin D-resistant rickets. Comparisons were made between the CT measurements of the normal and abnormal extremities and between patients with OI or rickets and a group of 17 healthy, matched children.

RESULTS

Sex, age, height, and weight did not influence cortical bone density; values were similar for the 17 control subjects. Children with osteoporosis and IO had reduced bone area but normal bone density. Compared with control subjects, patients with rickets had similar bone area but reduced bone density (869 mg/cm3 K2HPO4 +/- 79 [standard deviation] vs 1,132 mg/cm3 K2HPO4 +/- 41).

CONCLUSION

CT measurements of area and density of cortical bone aided the differentiation of the various disorders that cause osteopenia in children.

Malrotation discovered during routine radionuclide gastric emptying study

In infants with recurrent vomiting, and especially bilious vomiting, the algorithmic approach is to perform conventional barium upper gastrointestinal radiography to rule out malrotation and midgut volvulus, which are surgical emergencies. However, children with protracted vomiting and failure to thrive are candidates for medical treatment. These children are often evaluated by radionuclide gastric emptying studies to assess gastric emptying. Three patients are presented in whom the radionuclide gastric emptying study revealed the presence of a malrotation anomaly which had been undetected by antecedent barium gastrointestinal radiographic studies.

Pulmonary blastoma: a rare case of childhood malignancy

A case of pulmonary blastoma is presented with review of the radiographic, ultrasonographic and CT appearances of this rare malignant tumor of children. Pulmonary blastoma arises from primitive lung mesenchyma and histologically resembles fetal lung. The clinical presentation is usually respiratory distress. The prognosis of the disease is poor even if surgical resection, supplemental chemotherapy and radiation therapy are performed. We present a case of pulmonary blastoma who died two days after surgical resection.

Lingual thyroid: the diagnostic value of magnetic resonance imaging

Lingual thyroid is an uncommon developmental aberration of embryogenesis. It may present as a mid-line, non-tender, painless, reddish appearing swelling in the throat. Magnetic resonance imaging (MRI) is a relatively new diagnostic method for this condition. Two cases of lingual thyroid are reviewed with their MRI's and surgical results.