Angela T. Byrne

Natural history of untreated syringomyelia in pediatric patients

OBJECT The natural history of syringomyelia in pediatric patients remains uncertain. Although symptomatic and operative cases of syringomyelia are well studied, there are fewer articles in the literature on the nonoperative syrinx and its clinical and radiological course. The purpose of this research was to analyze the natural history of untreated syringomyelia in pediatric patients presenting with minimal neurological symptoms. METHODS A review of the neurosurgery database at British Columbias Childrens Hospital identified all pediatric patients (< 18 years of age) with syringes identified on MR imaging. Patients were included in this study if they had at least 2 MR images of the spine, at least 1 year apart, while receiving nonoperative treatment. Magnetic resonance imaging was used to determine changes in the size of the syrinx over time. Clinic notes were analyzed to establish demographic and clinical features and to determine any clinical changes over time. RESULTS A total of 17 patients were included in the study. Symptoms at presentation were often mild and included limb numbness (3 cases), headaches (2 cases), mild sensory deficits (2 cases), mild motor deficits (3 cases), and intermittent incontinence (7 cases). The consultant neurosurgeon believed that the syrinx was not contributing to the symptoms in these 17 patients. The syrinx either remained unchanged (7 cases) or diminished in size (8 cases) in a total of 15 patients (88%). In the remaining 2 patients the authors noted an increase in syrinx size, in 1 of whom the clinical course also worsened. Both of these patients had a Chiari malformation and subsequently underwent craniocervical decompression. Overall, the mean change was -0.7 mm of maximal axial diameter (range -2.6 to +2.7 mm). Sixteen patients (94%) exhibited no worsening of symptoms over time. CONCLUSIONS Syringomyelia often remains stable in patients receiving nonoperative treatment. However, given that 2 (12%) of 17 syringes in this series enlarged, it is likely appropriate to include periodic imaging in the follow-up of these cases.

Gynaecological Causes of Pelvic Pain

Pelvic pain in girls is a common clinical complaint in childhood and throughout adolescence and an important cause of morbidity particularly in the postmenarchal female. Clinical evaluation in these patients is challenging. Abdominopelvic pain in the absence of a history of cyclical pain related to the menstrual cycle is a very non-specific symptom, with a range of gynaecological and non-gynaecological causes. Non-gynaecological aetiologies of pain include gastrointestinal, urological, musculoskeletal and psychosomatic disorders. Gynaecological causes of pelvic pain include complications related to ovarian cysts (cyst rupture, haemorrhage or torsion), torsion of adnexal masses or normal ovaries, and fallopian tube pathology including torsion and pelvic inflammatory disease. Other causes of pain more specific to reproductively mature adolescents include ovulatory Mittelschmerz (mid-cycle) pain, endometriosis and complications of pregnancy. Exclusion of pregnancy in this age group is an important initial step in clinical management. This chapter concentrates on the imaging of the common and important causes of acute abdominal or pelvic pain with a gynaecologic aetiology. A brief discussion of the ultrasound imaging of pregnancy is included. The role of imaging in gynaecologic conditions resulting in chronic pelvic pain syndromes is also considered.

Gynaecological Disorders in the Neonate and Young Child

Improvements in antenatal imaging have resulted in greater detection of genitourinary pathology in the female fetus such as ovarian cyst, hydrocolpos and cloacal malformation. Postnatal US imaging follow-up is initially indicated in these children and will contribute significantly to the subsequent management plan, including the timing and nature of imaging follow-up. US is the first line investigation for a suspected abdominopelvic mass, inguinal hernia or labial mass. This chapter will review the role of diagnostic imaging in the neonate or young child with suspected ovarian or genital tract pathology.

Pediatric Applications for PET/CT and SPECT/CT

Positron emission tomography/computed tomography (PET/CT) and single photon emission computed tomography/computed tomography (SPECT/CT) are becoming increasingly important imaging tools in the noninvasive evaluation and monitoring of children with known or suspected malignant diseases. The recent advent of dual-modality imaging systems has added unprecedented diagnostic capabilities by revealing the precise anatomical localization of metabolic information and metabolic characterization of normal and abnormal structures. In addition, the use of CT transmission scanning for attenuation correction has shortened the total acquisition time, which is an especially desirable attribute in pediatric imaging.