A. Hammou

Percutaneous treatment of hydatid cysts (Echinococcus granulosus).

A new method called PAIR (Puncture-Aspiration of cyst contents—Injection of hypertonic saline solution—Reaspiration) was used as a percutaneous treatment of hydatid cysts. In 37 patients, 120 cysts were punctured. All patients had not been considered surgical candidates. The cysts were localized in the liver, peritoneum, spleen, kidneys, muscles, and bones. In 70% of patients, good results were obtained. Recurrence occurred in 5 of 120 cysts, all at the beginning of our experience when a low concentration of sodium chloride solution was injected. Moderate allergic reactions occurred during seven cyst aspirations. No anaphylactic shock, sudden deaths or dissemination of cyst contents were observed.

Douleurs osseuses fébriles chez l'enfant : Apport de l'IRM

PURPOSE To assess the value of MRI for early diagnosis of osteomyelitis in children presenting with sepsis and acute onset of musculoskeletal pain. MATERIALS AND METHODS MRI including fat suppressed T2W, and fat suppressed pre- and postcontrast T1W sequences was performed within 48 hours of admission in 26 children with clinical (fever and acute musculoskeletal pain) and biological (elevated WBC count and ESR in all cases, and elevated CRP in 12 patients) suspicion of acute osteomyelitis. None of the patients had sickle cell disease. RESULTS MRI was normal in 7 children (26%). Bone marrow signal abnormality was noted in 19 cases (74%) consistent with acute osteomyelitis in 18 cases and metastatic neuroblastoma in 1 case. CONCLUSION MRI is useful for evaluation of children presenting with sepsis and acute musculoskeletal pain, early diagnosis of osteomyelitis and to prevent unnecessary hospital admission and work-up.

Effective dose for scoliosis patients undergoing full spine radiography

Scoliotic patients underwent many radiological examinations during their control and treatment periods. Nowadays, few studies have calculated effective dose which is the primary indicator of radiation risk. In this study, the PCXMC program is used to calculate the effective doses associated with scoliosis radiography. Five age groups of patients, proposed by the National Radiological Protection Board, have been chosen: <1, 1-4, 5-9, 10-15 and ≥16 y (adult patients). Patient and radiographic data were collected from 99 patient examinations for both anteroposterior and lateral full spine X-ray projections. Results showed the effective dose ranged from 118 to 1596 μSv for the frontal projection and from 97 to 1370 μSv for the lateral projection, with patient age varying from 3 months to 22 y. This study presents the effective dose against patient age and demonstrates the necessity to optimise patient protection for this type of examination.

Dysplasia epiphysealis hemimelica: A report of four cases

UNLABELLED Dysplasia epiphysealis hemimelica (DEH), also known as Trevors disease, is a rare congenital skeletal developmental disorder in childhood. It is characterized by an asymmetric osteocartilaginous overgrowth arising from epiphyses or epiphyseal equivalents. Lesions have hemimelic topography, usually occur in the lower limbs, most commonly in the ankle and the knee and affect either the medial or lateral part of one epiphysis. OBJECTIVE The purpose of this study is to describe the imaging features of DEH by reporting four cases. MATERIALS AND METHODS We present four cases of DEH in one female and three males aged between 7 and 15 years. Lower limb is involved in all cases and patients suffer from pain, limited function and deformity. Radiographs and CT findings were reviewed. All patients were treated by surgical excision. RESULTS Plain X-ray revealed in all cases an irregular ossification arising from the affected epiphysis. The CT scan revealed an irregular fragmented osteocartilaginous mass involved from the epiphysis, with enlargement of epiphyses and intra-articular extension. CONCLUSION The early diagnosis and treatment of DEH is necessary in preventing articular function, CT assists in defining the anatomic relationship between the mass and its parent epiphysis and in evaluating the condition of the articular cartilage and soft tissue. The distinct clinical and radiographic features should enable to differentiate the osteochondroma and the DHE.

Douleurs osseuses fébriles chez l’enfant drépanocytaire : apport de l’IRM

Resume Objectif Le but de ce travail est de rapporter les elements semiologiques IRM permettant d’orienter vers le diagnostic de crise vaso-occlusive en cas de douleur osseuse aigue febrile chez un enfant drepanocytaire. Materiels et methodes Une exploration par IRM (sequences spin-echo en ponderation T1 et T2 et en ponderation T1 avec saturation de graisse sans et avec injection de Gadolinium) a ete pratiquee chez 10 enfants drepanocytaires, explores pour douleurs osseuses febriles. Le diagnostic de crise vaso-occlusive a ete retenu devant une reponse rapide au traitement symptomatique et une bacteriologie negative. Resultats L’IRM a ete pathologique dans tous les cas. L’atteinte multifocale a ete notee dans 2 cas. Les anomalies du signal medullaire ont ete constantes. Dans 10 cas, l’atteinte a ete metaphyso-diaphysaire a type d’hypersignal T1 et T2. La prise de contraste est constante et heterogene avec un aspect en tache d’encre. Les anomalies periostees ont ete notees dans 8 cas, elles sont precoces, d’aspect inflammatoire ou stratifie. Un amincissement de la corticale a ete note dans 1 cas. L’atteinte des parties molles a ete observee dans 5 cas, de type inflammatoire dans 4 cas. Conclusion L’atteinte synchrone de plusieurs os, les anomalies du signal medullaire en rapport avec des produits de degradation de l’hemoglobine, la prise de contraste heterogene, l’anomalie precoce du perioste et l’atteinte discrete des parties molles, orientent vers le diagnostic de crise vaso-occlusive.

Cystic hydatic disease in sheep: treatment with percutaneous aspiration and injection with dipeptide methyl ester.

An in vitro and in vivo study was conducted to show the effect of dipeptide methyl ester on the protoscolices of Echinococcus granulosus and in naturally infected sheep. Easily punctured cysts were located by ultrasonography. A PAIR and PAI method were performed bythe injection of dipeptide methyl ester into these cysts at a final concentration of 110 mmol/L. Follow-up was conducted monthly by ultrasonography. After injection of the compound, the sheep were sacrificed at different times from 6 to 17 weeks. The size and the morphological aspect of treated cysts were noted. Samples were collected for histologyand electron microscopy. In conclusion, these studies revealed significant and rapid detachment of the membrane of the treated cyst and alteration of the inner membrane in less than 5 min after injection of the drug, confirming the effect of the compound on the laminated layer of the parasite.

Hétérotopies de la substance grise. À propos de quatre observations pédiatriques

Resume L’epilepsie severe de l’enfant pose un probleme de diagnostic etiologique. Les heterotopies de la substance grise constituent une cause rare. Les auteurs rapportent quatre observations concernant des filles âgees de trois ans, six ans, sept ans et neuf ans sans antecedents particuliers. Il n’a pas ete retrouve de consanguinite. L’âge de debut de l’epilepsie est situe entre neuf mois et quatre ans. Le retard psychomoteur a ete retrouve chez trois patientes et la regression psychomotrice chez une patiente. Trois malades avaient presente un etat de mal convulsif. L’IRM a visualise une forme sous ependymaire dans un cas et une forme corticale diffuse dans trois cas associee a une agenesie partielle du corps calleux dans un cas et une pachygyrie dans deux cas.

RP3 Apport de l’IRM dans l’exploration des malformations cerebrales

Objectifs Les malformations du systeme nerveux central sont nombreuses, variees et de pronostic le plus souvent severe. Elles constituent un probleme de sante publique. Dans ce travail, nous nous proposons d’illustrer les aspects semiologiques IRM, des premiers cas de malformations cerebrales explorees par l’equipe des radiopediatres de l’hopital d’Enfants de Tunis. Notre but est de contribuer a une meilleure connaissance de ce groupe de malformations en milieu radiologique et pediatrique general. Materiels et methodes Notre travail a porte sur 123 observations de patients ayant beneficie d’une IRM cerebrale qui a revele une malformation. Ces observations sont colligees sur une periode de 6 ans, allant d’octobre 1996 a avril 2002, durant la meme periode 639 IRM cerebrales ont ete pratiquees. Resultats Nous avons denombre 77 garcons et 46 filles, l’âge des malades est compris entre 1 mois et 16 ans. Les signes d’appel sont varies : convulsions (35 %), retard psychomoteur (25 %), anomalie du PC (12 %), anomalies neurologiques (20 %), troubles du langage et du comportement (20 %), anomalies squelettiques (10 %). Devant la multiplicite des images a montrer, nous avons prefere presenter nos illustrations sous forme d’un CD-Rom interactif de 30 observations representatives. Conclusion Actuellement, l’IRM cerebrale antenatale et pediatrique est la methode de choix pour explorer les anomalies cerebrales complexes et/ou inaccessibles a l’echographie.

PEDIATRIC HEAD CT EXPOSURE DOSES IN TUNISIA: A PILOT STUDY TOWARDS THE ESTABLISHMENT OF NATIONAL DIAGNOSTIC REFERENCE LEVELS

&NA; The purpose of this study was to assess and analyze the radiation doses during head pediatric CT from different CT units within six Tunisian hospitals representing different geographic regions in order to optimize the dose given and minimize the radiology risk to this category of patients and towards the derivation of national diagnostic reference levels. Patient data and exposure parameters were collected for four age groups (<1, 1‐5, 5‐10 and 10‐15 y). Clinical protocols and exposure settings were analyzed. Doses were collected in terms of CTDIvol and DLP values. Effective and Organ doses to specific radiosensitive organs were estimated using the Monte Carlo simulation software ‘Impact CTDosimetry’. Results showed large variations in CT protocols and doses between different radiology departments. CTDIvol and DLP values demonstrated a broad range between the CT units and between the axial and helical scan techniques in the same unit. CTDI vol values were estimated to be 24.9, 31.7, 45.5 and 47.8 mGy for <1, 1‐5, 5‐10 and 10‐15 y age groups, respectively. In term of DLP, median values were ˜346, 528, 824, 897 mGy cm for the same age groups, respectively. Effective dose ranged from 1.4 to 5 mSv. Dose values were comparable with those reported in the literature. The study shows an evident need for continuous training of staff in radiation protection concepts, especially within the regional hospitals, emphasizes the importance of the production and the update of recommendations and good practice guidelines using interdisciplinary working groups and opens the way for the establishment of national DRLs.

Leadership and Innovations to Improve Quality Imaging and Radiation Safety in Africa

Most of the African communities are rural and have poor access to general healthcare and diagnostic imaging. There is a severe shortage of healthcare professionals, including radiologists, ultrasonographers, radiographers and medical physicists, especially in the rural areas. Other challenges for the region include work volume, population exposure, equipment, imaging budget and awareness in radiation safety and protection.