Max Hassan

Magnetic resonance imaging of the fetus

Abstract Fetal magnetic resonance imaging (FMRI) has gained considerable interest during the last decade, especially in its intracranial applications. Due to its high soft-tissue contrast and presumed safety, FMRI should be accepted as a complementary technique in prenatal diagnosis, useful either to elucidate equivocal findings on routine US studies or to further delineate some pathological entities. Normal patterns of fetal brain maturation, as shown by FMRI, are described because they are of paramount importance to accurately evaluate intracranial diseases. To date, however, FMRI requires specialised facilities and should be considered as an evolving clinical research modality and performed within precise guidelines in a multidisciplinary approach to prenatal pathology.

Femoral head vascularisation in Legg-Calvé-Perthes disease: comparison of dynamic gadolinium-enhanced subtraction MRI with bone scintigraphy

AbstractBackground. It has been reported that MRI using a dynamic gadolinium-enhanced subtraction technique can allow the early identification of ischaemia and the pattern of revascularisation in Legg-Calvé-Perthes (LCP) disease with increased spatial and contrast resolution. Therefore, dynamic gadolinium-enhanced subtraction (DGS) MRI may be a possible non-ionising substitute for bone scintigraphy. Objective. The purpose of this prospective study was to compare DGS MRI and bone scintigraphy in the assessment of femoral head perfusion in LCP disease. Materials and methods. Twenty-six DGS MR images and bone scintigraphies of 25 hips in 23 children were obtained at different stages of LCP disease; three stage I, 12 stage II, six stage III and five stage IV (Waldenström classification). The extent of necrosis, epiphyseal revascularisation pathways (lateral pillar, medial pillar, and/or transphyseal perfusion) and metaphyseal changes were analysed. Results. Total agreement between both techniques was noted in the depiction of epiphyseal necrosis (kappa=1), and metaphyseal abnormalities (kappa=0.9). DGS MRI demonstrated better revascularisation in the lateral (kappa=0.62) and medial pillars (kappa=0.52). The presence of basal transphyseal reperfusion was more conspicuous with MRI. Conclusions. DGS MRI allows early detection of epiphyseal ischaemia and accurate analysis of the different revascularisation patterns. These changes are directly related to the prognosis of LCP disease and can aid therapeutic decision making.

Dynamic gadolinium-enhanced subtraction MR imaging – a simple technique for the early diagnosis of Legg-Calvé-Perthes disease: preliminary results

Purpose. To determine whether the simple technique of dynamic gadolinium-enhanced subtraction MR imaging, which is available on standard MR units, can detect ischemia of the femoral head in children with early Legg-Calvé-Perthes disease (LCP). Materials and methods. Bone perfusion of eight hips in four patients (mean age 7.5 years) was studied using dynamic gadolinium-enhanced subtraction MR imaging at the onset of proven LCP (with initial negative plain films). Enhancement of subtracted images was compared with that on standard MR images and with bone scintigraphy find- ings. Results. Subtraction MR imaging depicted ischemia as a widespread absence of enhancement and was in good agreement with bone scintigraphy. The subtraction technique improved the sensitivity and the specificity of MR imaging in two children. Furthermore, subtraction MR imaging allowed recognition of the pattern of early reperfusion. Conclusion. Our preliminary results indicate that dynamic gadolinium-enhanced subtraction MRI is a simple and promising means of early recognition of ischemia in LCP.

Laryngeal ultrasonography in infants and children: a new way of investigating. Normal and pathological findings

Ultrasound of the larynx appears as a new way of imaging the larynx in infants and children. The normal sonographic anatomy is briefly described. The pathological findings of this method, its advantages and its drawbacks are discussed. It appears to be a very interesting method for functional disorders and space-occupying lesions.

Nasal pyriform aperture stenosis and absence of the anterior pituitary gland: Report of two cases

We describe two female infants with congenital nasal pyriform aperture stenosis and severe pituitary insufficiency. The anterior pituitary gland was undetectable with magnetic resonance imaging. Consanguinity of parents in both cases suggests autosomal recessive inheritance of this disorder. An early fetal developmental defect may explain this syndrome, which affects midline craniofacial structures. In patients with congenital pyriform aperture stenosis, magnetic resonance imaging of the brain and endocrine investigations should be performed for rapid diagnosis and treatment of the latter to avoid major neurologic complications.

Ilio-psoas abscess in neonates: treatment by ultrasound-guided percutaneous drainage.

Abstract Ilio-psoas abscess is rare in neonates and is usually treated by surgical drainage. We report two cases of ilio-psoas abscess in 15- and 21-day-old infants successfully treated by US-guided percutaneous drainage as a supplement to antibiotic therapy. Clinical improvement was observed within 24–48 h of drainage and subsequent imaging demonstrated resolution of the abscess cavity. The analysis of these cases and of those previously reported indicates that imaging is essential for diagnosis. In neonates, US-guided percutaneous drainage may represent the first-choice treatment of this disease in association with antibiotic therapy.

Ultrasonographic evaluation of the tongue and the floor of the mouth: normal and pathological findings

An ultrasonographic study of the tongue and the floor of the mouth was performed in 30 healthy children (aged from 1 day to 15 years) in order to assess the normal US anatomy of this region. The scans were performed in sagittal and coronal planes with a 7.5-mHz transducer. Moreover, 22 children (aged from 1 day to 15 years) presenting with various clinical symptoms underwent US examination. This series included infectious and congenital diseases. The US findings were correlated with surgery and pathology in 19 cases, with the clinical follow-up in 2 cases and with the nuclear study in 1 case. In each case, US could anatomically locate the lesion with very good accuracy. We conclude that US of the tongue and the floor of the mouth in children yields overall very good accuracy in the investigation of diseases of this region.In this study, our purpose was (1) to evaluate the normal sonographic anatomy of the tongue and the floor of the mouth in children and (2) to determine whether it was possible to correctly localize various lesions and to evaluate their nature in order to guide the therapeutic approach.

Abdominal pain in Henoch-Schönlein purpura.

Dear Sir, I read with interest the paper by Couture et al. in the Issue No 1, volume 22 of Pediatric Radiology. I was surprised not to find any reference to our work in this field which was first presented to the meeting of the French speaking Society of Pediatric Radiology in Marseille in September 1988 and later as a poster (175) at the 27th Annual meeting of the ESPR in Munich 1990. To the best of my knowledge abdominal wall muscles involvment had not been previously recognised. Our observations were based on three patients and we have subsequently seen three more patients with similar findings. In addition we have received several other reports from colleagues who have seen such cases. Sincerely yours, Dr. M. Hassan Dept. of Pediatric Imaging University of Paris VII R. Debre HSpital 48 B d Serurier F-75019 Paris France

Floyd H. Gilles and Marvin D. Nelson: The developing human brain: growth and adversities (1st edn)

Type of book Based on data from the National Collaborative Perinatal Project (NCPP), this book comprehensively describes many developmental events in the human brain such as brain weight accretion, myelination, germinal sub-ventricular tissue evolution and involution, angiogenesis and gyrus formation, as well as some common adverse influences that may distort the course of these events. It concentrates on human brain development in the last half of gestation and in neonates and infants, periods that are regarded as largely responsible for the acquisition of childhood functional neurological deficits. In order to avoid the widespread confusion about fetal and neonatal pathological conditions, the authors have emphasized the specific history of each entity and effectively delineate the evolution of current terms and concepts.

Heike E. Daldrup-Link, Charles A. Gooding: Essentials of pediatric radiology: a multimodality approach

Type of book This book is offered as a multimodality approach textbook providing a concise overview of both basic and complex topics encountered by pediatric radiologists in their daily practice. The intention of the authors is to provide readers with core material in their subspecialty. The book focuses particularly on multimodality imaging, attempting to cover the full gamut of radiological diagnostic techniques, including conventional radiography, US, Doppler US, up-to-date CT and MRI techniques, as well as positron emission tomography (PET)-CT.