Charles J. Chung

Magnetic resonance imaging of neuroblastoma using current techniques

We evaluated the ability of current magnetic resonance (MR) scanning techniques to detect and stage neuroblastoma in children, using surgical and histopathologic correlation. We prospectively and retrospectively reviewed 16 MR examinations from 14 patients with neuroblastoma (13 patients) or ganglioneuroblastoma (1 patient) and compared these to computed tomography (CT) (5 patients) and pathology (all patients). Sequences included: precontrast T1-weighted and T2-weighted images, and gadolinium-enhanced T1-weighted images. The study time for each MR exam was also calculated. Five primary tumors were intrathoracic paraspinous masses, eight were adrenal, and 1 was presacral. Neural foraminal invasion was demonstrated on MR in four of 14 patients. Three of the four patients had undergone CT and neural foraminal invasion was shown in one. Vascular encasement was demonstrated in five of 14 patients on MR images. Three of the five patients had undergone CT and vascular involvement was shown in two. All cases of neural foramina invasion and vascular encasement were proven at surgery. There were no false positive or false negative MR studies of neural foraminal invasion or vascular encasement. Bone marrow invasion was shown in two of 14 patients on MR images which were confirmed by bone marrow aspirate. No false negative cases of bone marrow invasion was shown. In one patient, CT considered one neuroblastoma to be adrenal in location which was correctly shown to be intrathoracic on MR. The mean study time for MR imaging was 49 min. Current MR techniques are accurate at detecting and staging neuroblastoma, and coverage of chest, abdomen, and pelvis can be performed in less than one hour.

Cervical neurofibromas in children with NF-1

Background. Children with neurofibromatosis type 1 (NF1) are at increased risk of developing plexiform neurofibroma throughout the body, including the cervical soft tissues. However, the incidence of cervical soft tissue tumors and the value of screening MR for children with NF1 are not known. Purpose. The purposes of this study were to determine the incidence and clinical significance of cervical tumors seen on MR imaging in children with NF1. Materials and methods. A retrospective review of the brain and orbit MR with cervical images obtained on 95 children who meet the NIH consensus criteria for NF1 and who are followed at our neurofibromatosis clinic was carried out. Results. Cervical tumors were found on MR imaging in 21 of 95 (22 %) children. Of 21 children with cervical tumors, 14 children were determined to be surgical candidates. In nine children, MR imaging altered the clinical management by demonstrating tumors for which surgery was indicated, but the tumors were not suspected prior to MR imaging. Conclusion. Cervical tumors are commonly seen in children with NF1. MR imaging may demonstrate a significant number of tumors that require surgery, but were not suspected prior to MR imaging.

Malignant intraperitoneal neoplasms of childhood

Objective. The purpose of this paper is to review and categorize the CT appearances of primary and secondary intraperitoneal neoplasms in children. Materials and methods. We retrospectively reviewed the CT images of 14 cases of intraperitoneal neoplasms. They were reviewed for bowel wall thickening, mesenteric nodules, ascites, calcification, peritoneal nodules, omental caking, and contrast enhancement. Results. Computed tomography images of 14 cases of intraperitoneal neoplasms were evaluated: rhabdomyosarcoma (5), lymphoma (3), neuroblastoma (2), germ cell tumor (1), mesothelioma (1), Wilms tumor (1), and hepatocellular carcinoma (1). Nodular enhancement was seen in all cases, ascites in most, significant bowel wall thickening only with lymphoma, and calcification only with germ cell tumors. Omental caking was present both with rhabdomyosarcoma and lymphoma. Conclusions. While rare in pediatrics, intraperitoneal neoplasms occur in children, and CT is useful in identifying these peritoneal neoplasms.

Kawasaki disease presenting as focal colitis

Kawasaki disease (mucocutaneous lymph node syndrome) typically presents with fever, rash lymphadenitis, and mucositis. The colon is rarely involved and, to date, colitis has not been described as the presenting symptom. We report the imaging findings of a child with Kawasaki disease who presented with fever and focal left colitis.

Geniculate ganglion meningioma

Abstract Primary ectopic meningiomas are rare, but may be seen in the head and neck region. The temporal bone and its neural foramen are rarely the site of a primary meningioma. This report describes the CT and MRI appearance of an ectopic meningioma arising at the anatomic location of the geniculate ganglion, and discusses the differential diagnosis as well as the possible origin of the tumor.

Coexisting hyperplastic antral polyp and hypertrophic pyloric stenosis

Abstract This report describes a child with hypertrophic pyloric stenosis with persistent vomiting after pyloromyotomy due to a coexistent hypertrophic antral polyp.

Visualization of protein losing enteropathy in infantile systemic hyalinosis with Tc-99m HSA after albumin challenge.

A 5-month-old girl with diarrhea, irritability, and dehydration was admitted and placed on a restricted protein intake. Tc-99m HSA imaging showed no evidence of a protein losing enteropathy. The patient was given albumen replacement and repeat Tc-99m HSA imaging demonstrated activity in the small bowel and colon. The patient was diagnosed to have infantile systemic hyalinosis, a disease characterized by painful joint contractures, persistent diarrhea, and presence of hyaline material in the dermis. This case suggests the need for albumin challenge in detecting protein losing enteropathy if protein intake had been severely restricted.

MR imaging of a severe cervical fracture-dislocation after traumatic delivery

Abstract We present the acute MR findings in an infant with a complicated traumatic delivery, asphyxia, spinal cord injury, and a radiographically apparent cervical spine fracture-dislocation. MRI including diffusion-weighted imaging allowed early characterization and localization of the extent of spinal cord injury.

Utility of bone imaging in differentiation of pulmonary metastatic calcification from cystine crystal deposition in cystinosis

A child with cystinosis was known to have cystine crystals in the thyroid and kidneys. While she was being evaluated for a pulmonary infiltrate, a bone scan was performed that showed uptake in the lungs, but not in the thyroid. These findings confirmed that the lung uptake was due to metastatic calcification and not due to cystine crystal deposition in the lungs.