Gonca Koc

Susceptibility-Based Differentiation of Intracranial Calcification and Hemorrhage in Pediatric Patients.

Differential diagnosis of intracranial hemorrhage versus calcification on conventional magnetic resonance images (MRIs) is often challenging. Although computed tomography (CT) confirms calcification, phase information obtained during susceptibility-weighted imaging can be useful in distinguishing between 2 pathologies. Fourteen patients previously diagnosed to have hemorrhage or calcification with imaging were included in the study retrospectively. Phase shift values of hemorrhage and calcification were compared by using Student t test. The pathologies identified were tuberous sclerosis, Sturge-Weber syndrome, craniopharyngioma, congenital cytomegalovirus, subependymal hemorrhages, and hemorrhagic microembolic infarction. Calcifications appeared hypointense whereas hemorrhages were hyperintense on phase maps (left-handed magnetic resonance system). Statistical comparison of phase shift values yielded significant difference between hemorrhage versus calcification (P < .01). Phase maps were found to offer valuable data to differentiate 2 pathologies when used complementary to conventional magnetic resonance images. Considering the relatively higher risks of radiation exposure in children, susceptibility-weighted imaging with phase maps may help to waive radiation exposure from CT.

Brain diffusion tensor imaging in children with tuberous sclerosis

PURPOSE To evaluate diffusion characteristics of tubers and white matter lesions in children with tuberous sclerosis (TS) using diffusion tensor imaging (DTI). MATERIALS AND METHODS Eighteen children (11 male, 7 female; mean age 9.3years, age range 1-16years) with a definite diagnosis of TS were recruited in this study. Apparent diffusion coefficient (ADC), fractional anisotropy (FA), radial diffusivity (RD), and axial diffusivity (AD) values in 89 tubers and 37 white matter lesions were measured and compared with those of contralateral normal regions. RESULTS ADC, AD, and RD values were significantly higher and FA values were lower in lesions, than the ones measured in contralateral normal regions for tubers (P<0.001). Similarly RD values were significantly higher and FA values were lower in white matter lesions (P<0.05). ADC and AD measures were detected to increase in white matter lesions, however no statistically significant difference was observed. The increase in the mean values of RD was significantly greater than the increase in the AD values for tubers and white matter lesions (P<0.05). CONCLUSION DTI can provide valuable information about the cytoarchitectural changes in TS lesions beyond morphologic MRI findings alone.

Magnetic Susceptibility Changes in the Basal Ganglia and Brain Stem of Patients with Wilson’s Disease: Evaluation with Quantitative Susceptibility Mapping

Objectives: Wilson’s disease (WD) is characterized with the accumulation of copper in the liver and brain. The objective of this study is to quantitatively measure the susceptibility changes of basal ganglia and brain stem of pediatric patients with neurological WD using quantitative susceptibility mapping (QSM) in comparison to healthy controls. Methods: Eleven patients with neurological WD (mean age 15 ± 3.3 years, range 10–22 years) and 14 age-matched controls were prospectively recruited. Both groups were scanned on a 1.5 Tesla clinical scanner. In addition to T1- and T2-weighted MR images, a 3D multi-echo spoiled gradient echo (GRE) sequence was acquired and QSM images were derived offline. The quantitative measurement of susceptibility of corpus striatum, thalamus of each hemisphere, midbrain, and pons were assessed with the region of interest analysis on the QSM images. The susceptibility values for the patient and control groups were compared using two-sample t-test. Results: One patient with WD had T1 shortening in the bilateral globus pallidus. Another one had hyperintensity in the bilateral putamen, caudate nuclei, and substantia nigra on T2-weighted images. The rest of the patients with WD and all subjects of the control group had no signal abnormalities on conventional MR images. The susceptibility measures of right side of globus pallidus, putamen, thalamus, midbrain, and entire pons were significantly different in patients compared to controls (P < 0.05). Conclusion: QSM method exhibits increased susceptibility differences of basal ganglia and brain stem in patients with WD that have neurologic impairment even if no signal alteration is detected on T1- and T2-weighted MR images.

Inflammatory Myofibroblastic Tumor of the Kidney and Bilateral Lung Nodules in a Child Mimicking Wilms Tumor With Lung Metastases.

Renal inflammatory myofibroblastic tumor (IMT) is an extremely rare lesion especially in children. This report describes a case of renal IMT accompanied by multiple lung nodules mimicking Wilms tumor with lung metastasis in a 3-year-old boy. To our knowledge, this is a unique case of IMT which has not been reported in the literature previously.

Idiopathic Brain Herniation A Report of Two Paediatric Cases

‘Idiopathic’ herniation of the brain is a rare entity previously reported in 13 cases. It may be incidentally encountered in neuroimaging studies acquired for various clinical indications. We herein describe two cases of idiopathic brain herniation that were incidentally diagnosed. A 12-year-old boy presented with a six-month history of daytime sleepiness and sudden spells of sleep. Herniation of the left inferior temporal gyrus was revealed in MRI acquired with the suspicion of epilepsy. His overnight polysomnogram and multiple sleep latency tests were compatible with the diagnosis of narcolepsy. The other case, a two-year-old girl, was transferred from an outside hospital due to partial seizures with the fever. Herniation of the precuneal gyrus was encountered in MRI acquired after controlling her seizures with the initiation of phenytoin. The brain herniations of both patients were considered to be inconsistent with their medical conditions, so that they were symptom-free with only medical treatment for following three and six months, respectively. This is a rare presentation of idiopathic brain herniation as an incidental finding that accompanied narcolepsy and epilepsy. Awareness of this entity would avoid excessive surgical and medical treatments.

Neural Correlates of Default Mode Network Connectivity in Children with Attention Deficit and Hyperactivity Disorder

The Purpose: The objective of this study is to explore neural correlates of Default Mode Network (DMN) regions in children with attention deficit and hyperactivity disorder (ADHD) using resting-state functional magnetic resonance imaging (rs-fMRI). Methods: The study included ten children with ADHD (aged between 9 and 16) and ten age-matched controls. Four DMN regions (medial prefrontal cortex (MPFC), the posterior cingulate cortex (PCC), left and right inferior parietal lobes (IPL) and the corresponding Broadmann areas in each one were used as seeds and their functional connectivity with the whole brain was explored and compared between ADHD and control groups using t-test (p<0.05). Results: We observed that when DMN regions were selected as seeds, the connected regions were different between two groups and were mostly in the right hemisphere in ADHD patients contrary to the left hemisphere in the control group. Conclusion: In conclusion, neural correlates of DMN regions differ in ADHD patients compared to healthy controls. Our findings suggest that in ADHD patients, DMN regions show more connectivity with the right hemisphere of the brain whereas the left hemisphere is more functionally connected with DMN in health controls. Further research is required to explore this atypical DMN connectivity in ADHD using larger cohort.

Brain abscesses in children: results of 24 children from a reference center in Central Anatolia, Turkey.

Childhood brain abscesses are a rare and potentially life-threatening condition requiring urgent diagnosis and treatment. This retrospective study analyzed the clinical and radiologic findings of 24 (7 girl, 17 boys) cases with brain abscess. Mean age was 92.98 ± 68.04 months. The most common presenting symptoms were nausea-vomiting (45.8%) and headache (41.7%). Brain abscess was most commonly located in the frontal region. Diffusion restriction was determined in 78.4% of lesions. The mean apparent diffusion coefficient value in these lesions was 0.511 ± 0.23 × 10–3 mm2/s. Cultures were sterile in 40% of cases. Antimicrobial therapy was given to only 16.7% of cases. Predisposing factors were identified in 91.6% of cases (congenital heart disease in 20.8% and immunosuppression in 20.8%). Mortality level was 12.5%. In conclusion, immunocompromised states, and congenital heart disease have become an important predisposing factor for brain abscesses. Effective and prompt management should ensure better outcome in childhood.

Brain susceptibility changes in neurologically asymptomatic pediatric patients with Wilson’s disease: evaluation with quantitative susceptibility mapping:

Background Wilson’s disease (WD) is a copper metabolism disorder that causes hepatolenticular degeneration. It is important to diagnose WD before central nervous system involvement. Purpose To demonstrate the early susceptibility changes associated with the copper accumulation in the brain of neurologically asymptomatic pediatric patients with WD using quantitative susceptibility mapping (QSM). Material and Methods Twelve patients with neurologically asymptomatic WD (mean age = 13.7 ± 3.3 years) and 14 age-matched controls were prospectively examined using a 1.5-T clinical scanner. Routine magnetic resonance (MR) sequences and a three-dimensional multi-echo spoiled gradient echo (GRE) sequence were used and QSM maps were reproduced. The quantitative susceptibility of corpus striatum, thalamus, substantia nigra, and pons were analyzed with the region of interest analysis on QSM maps. The susceptibility values of two groups were statistically compared using a two-sample t-test. Results Conventional MR images of the patients and control group were similar. However increased magnetic susceptibility in the thalamus, pons and left posterior putamen were observed in the patients compared to the control group (p < 0.05). Conclusion We observed statistically increased susceptibility values in the brains of neurologically asymptomatic patients with WD although the conventional MR images were normal. This might be compatible with early brain impairment, before neurological symptoms occur.

Imaging Findings of Intraluminal Duodenal Duplication Cyst in a Pediatric Patient

A 10-year-old girl was admitted with complaints of abdominal discomfort episodes. Physical examination was unremarkable, and laboratory findings were within normal limits, which were as follows: hemoglobin, 13.5 g/dL; white cell count, 6 10/mL; platelet count, 280 10/mL; blood urea nitrogen, 11 mg/dL; creatinine, 0.6 mg/dL; aspartate aminotransferase, 15 U/L; alanine aminotransferase, 17 U/ L; alkaline phosphatase, 60 U/L; total bilirubin, 0.5 mg/dL; and amylase, 35 U/L. Abdominal ultrasonography and computed tomography exhibited an intraluminal cyst in the second part of the duodenum (Figures 1A and 1B). The cyst was located distal to the papilla, measuring 13 21 39 mm. The enhanced and multilayered wall of the cyst, which was identical to the duodenum wall, was well demonstrated on magnetic resonance imaging (Figures 1C and 1D). The imaging revealed a shared medial wall of both the cyst and the duodenum. There was no dilatation of the biliary tree, and the pancreas and gall bladder appeared normal. Based on the imaging findings, a diagnosis of intraluminal duodenal duplication cyst was established. Surgical resection was planned as the treatment of choice.

Sonography in the Diagnosis of Congenital Adrenal Hyperplasia in a Neonate

Congenital adrenal hyperplasia (CAH) is a relatively rare inherited disease that primarily affects the synthesis of steroid hormones by the adrenal glands. Patients usually present in the weeks following birth with salt wasting and virilization. In patients who are clinically suspected, a definitive diagnosis is established with the detection of increased levels of precursor hormones. An evaluation of the adrenal glands by ultrasonography may help make an accurate diagnosis of CAH prior to a biochemical confirmation. We report the case of a neonate with 21-hydroxylase deficiency who was diagnosed with the typical appearance of the adrenal glands for CAH revealed with ultrasonography.