Bart Vanzieleghem

Perinatal cortical infarction within middle cerebral artery trunks

AIM To define neonatal pial middle cerebral artery infarction. METHODS A retrospective study was made of neonates in whom focal arterial infarction had been detected ultrasonographically. A detailed study was made of cortical middle cerebral artery infarction subtypes. RESULTS Forty infarctions, with the exception of those in a posterior cerebral artery, were detected ultrasonographically over a period of 10 years. Most were confirmed by computed tomography or magnetic resonance imaging. Factor V Leiden heterozygosity was documented in three. The onset was probably antepartum in three, and associated with fetal distress before labour in one. There were 19 cases of cortical middle cerebral artery stroke. The truncal type (n=13) was more common than complete (n = 5) middle cerebral artery infarction. Of six infarcts in the anterior trunk, four were in term infants and five affected the right hemisphere. Clinical seizures were part of the anterior truncal presentation in three. One of these infants, with involvement of the primary motor area, developed a severe motor hemisyndrome. The Bayley Mental Developmental Index was above 80 in all of three infants tested with anterior truncal infarction. Of seven patients with posterior truncal infarction, six were at or near term. Six of these lesions were left sided. Clinical seizures were observed in three. A mild motor hemisyndrome developed in at least three of these infants due to involvement of parieto-temporal non-primary cortex. CONCLUSIONS Inability to differentiate between truncal and complete middle cerebral artery stroke is one of the explanations for the reported different outcomes. Severe motor hemisyndrome can be predicted from neonatal ultrasonography on the basis of primary motor cortex involvement. Clinical seizures were recognised in less than half of the patients with truncal infarction; left sided presentation was present in the posterior, but not the anterior truncal type of infarction. Asphyxia is a rare cause of focal arterial infarction.

Solitary hepatic infantile hemangioendothelioma: dynamic gadolinium-enhanced MR imaging findings

Abstract. We report the MRI findings of a solitary hepatic infantile hemangioendothelioma (IHE) diagnosed in a 14-day-old girl. To the best of our knowledge, only one report has illustrated the dynamic gadolinium-enhanced MR imaging features of IHE previously. Compounding the rarity of presentation as a solitary mass, the gadolinium-enhanced MRI appearance in our case is unique, because the IHE showed an early rim-like pseudocapsular enhancement followed by progressive fill-in of the lesion on delayed imaging.

Static, Dynamic and First-Pass MR Imaging of Musculoskeletal Lesions Using Gadodiamide Injection

Forty-five patients with known or suspected musculoskeletal tumors were examined with static and dynamic MR imaging to evaluate the safety, tolerability and diagnostic utility of gadodiamide injection and to assess the diagnostic value of dynamic MR imaging and parametric “first-pass” (FP) images. The proportion of patients presenting more diagnostic information on the contrast-enhanced compared to the precontrast spin-echo examinations was determined. The dynamic enhancement characteristics were evaluated with time-intensity curves and parametric images of the FP enhancement rate. The tolerance of gadodiamide injection was good. Contrast enhancement was useful for delineating tumor from muscle, and differentiating viable from necrotic tissue and cystic from solid lesions. Malignant tumors showed a significantly higher slope value, earlier onset of enhancement, and higher maximum enhancement than benign lesions. However, slope values could not be used to predict the malignant potential of a lesion, due to overlap between highly vascular benign and low vascular malignant lesions. By displaying highly vascular areas, parametric FP images provided useful information on the most active part in a tumor before biopsy and for assessing the incorporation of bone-chip allografts. Static, dynamic and FP MR imaging using gadodiamide injection appears safe and provides useful information for diagnosis, biopsy and follow-up of musculoskeletal lesions.

Lyme disease in a child presenting with bilateral facial nerve palsy : MRI findings and review of the literature

Abstract We report a 7-year-old boy with neuroborreliosis presenting with headache and bilateral facial nerve palsy. MRI demonstrated tentorial and bilateral facial and trigeminal nerve enhancement.

Imaging of the normal pontine cisternal segment of the abducens nerve, using three-dimensional constructive interference in the steady state MRI.

Abstract Our objective was to determine the visibility of the cisternal segment of the normal abducens nerve using a three-dimensional Fourier-Transform constructive interference in the steady state (3DFT-CISS) sequence. Its visibility was rated in 150 patients without clinical evidence of abducens nerve disturbance. Axial 1-mm 3DFT-CISS images were obtained (TR/TE 17/7 ms, flip angle 50 °, field of view 160 mm, matrix 256 × 256). The cisternal segment was seen in 79 % of cases, bilaterally in 73 % and unilaterally in 11 % of cases; neither cisternal segment was seen in 16 % of cases. Identification of Dorellos canal was often of help in detecting the point lateral to the dorsum sellae at which the nerve pierces the dura mater. Flow artifacts and vascular loops in the pontine cistern sometimes caused problems in interpretation. 3DFT-CISS MRI with 1-mm-thick sections can however be considered a reasonably reliable technique for showing the cisternal segment of the abducens nerve.

CT and MRI of the semicircular canals in the normal and diseased temporal bone.

Abstract. Imaging of the semicircular canals specifically is part of the imaging process of the temporal bone in general. The semicircular canals are easily seen on CT images and 3DFT-CISS-weighted MR images, both performed with 1.0-mm-thick slices, or even thinner slices. In selected cases, the T1-weighted images give unique information on the semicircular canals. This article briefly reviews the variety of semicircular canal anomalies that are most frequently present and can be routinely seen on CT and MR examinations of the temporal bone. It also provides a list that can be used by the radiologist in clinical practice to decide which technique, CT or MR, should be used to detect specific anomalies at the level of the semicircular canals.

Imaging studies in the diagnostic workup of neonatal nasal obstruction

Twelve neonates presenting with nasal obstruction after birth were evaluated by imaging studies for diagnostic reasons. Four groups were recognized: Group I: choanal atresia (n = 5) and choanal stenosis (n = 1); Group II: congenital nasal pyriform aperture stenosis (CNPAS) (n = 3) and holoprosencephaly (n = 1); Group III: nasolacrimal duct mucocele (n = 1); Group IV: nasal hypoplasia (n = 1). Associated anomalies were found in eight patients. Four patients with choanal atresia showed manifestations of the CHARGE (c oloboma, congenital h eart defect, a tretic choanae, r etarded physical and neuromotor development associated with central nervous system anomalies, g enital hypoplasia, and e ar anomaly and/or deafness) association. In the fifth patient with choanal atresia, the diagnosis of amnion disruption sequence was made. One patient with CNPAS had a solitary maxillary central incisor (SMCI), a mild form of holoprosencephaly. Besides proboscis and synophthalmos, SMCI was also present in the holoprosencephaly case. The patient with severe nasal hypoplasia had warfarin embryopathy. This review emphasizes the need for performing imaging studies in the diagnostic workup of neonates born with nasal obstruction.

The lacrimo-auriculo-dento-digital (LADD) syndrome: Temporal bone CT findings.

The temporal bone CT examination of a 16-year-old female patient with the LADD syndrome or Levy-Hollister syndrome showed multiple bilateral middle as well as inner ear malformations. Ossicular chain anomalies were seen, especially of the incus and stapes. The oval window was very narrow to absent. Both cochleas were hypoplastic and showed modiolar deficiency. A common cavity between the vestibule and lateral semicircular canal was bilaterally present.

Hearing loss as a presenting symptom of cleidocranial dysplasia.

Objectives To report two cases of cleidocranial dysplasia in which hearing loss was the first presenting symptom. Study design Retrospective case review. Patients Two cases of cleidocranial dysplasia, a rare autosomal dominant skeletal dysplasia affecting both membranous and enchondral bone formation. Setting Tertiary referral center. Interventions Clinical, audiometric, and imaging diagnostic procedures. Conclusion With this report, we want to illustrate the possibility of a rare genetic disorder as the underlying cause of hearing loss. We also want to emphasize the need for a multidisciplinary approach and evaluation of unexplained hearing loss to obtain a correct diagnosis, which is important for genetic counseling and management of the patient and his or her family.

Chondrodysplasia punctata with multiple congenital anomalies: a new syndrome?

Abstract We report a male neonate with craniofacial dysmorphic features, multiple congenital anomalies and an unusual form of chondrodysplasia punctata. Radiographic examination revealed punctate epiphyses and coronal clefting of the thoracic spine. The hand radiographs showed some similarities to the brachytelephalangic type of chondrodysplasia punctata. However, the disorder did not fit well with any known entity of chondrodysplasia punctata or other condition characterized by punctate epiphyses.