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MRI-MRCP in the follow-up in the medium and long term of children with biliary atresia treated with surgical therapy.

M. Giardiello, M. Panico, R. Cuocolo, M. Iorio, M. Maurea, M. Mollica, A. Brunetti; Napoli/IT

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Learning objectives: Biliary atresia (BA) is a fibro-obliterative cholangiopathy and is the most common cause of neonatal cholestasis of surgical relevance. The purpose of our study is the use of MRI in the diagnostic evaluation of children with BA successfully treated with the Kasai procedure (portoenterostomy).

Background: We retrospectively reviewed the MRI-MRCP studies of 28 patients (14 males) diagnosed with BA treated with portoenterostomy.

Findings and procedure details: We used 3 Tesla Magnetom Trio, Siemens (24 patients) and 1,5 Tesla Intera, Philips (4 patients),with TSE T2,TSE T2 fat-sat, Dual-FFE T1 in and out-phase,TSE T2 3D respiratory-triggered and SS FSE T2 single slab. MRI-MRCP showed malformation of the biliary tree and stenosis of the intrahepatic bile d[...]

Conclusion: MRI-MRCP has proved useful in the follow-up in the long term of children with BA showing cirrhosis, fibrosis and abnormalities of the intra-hepatic bile ducts in the patients treated with portoenterostomy. Longitudinal studies are needed to find over time the correlation between the clinical and lab[...]

Personal information: Corresponding author: M.D. Mariarosaria Giardiello e-mail mariarosariagiardiello@gmail.com Department of Radiology, University Federico II of Naples. Address: Azienda Ospedaliera Universitaria "Federico II" Reparto Radiologia edificio 10 via S. Pansini 5 80131 Napoli Italia .    

References: Pediatric cholangiopathies: diseases of the gallbladder and biliary tract. Sharafinski ME Jr, Meyers AB, Vorona G. Abdom Radiol (NY). 2016 Aug 12. The long-term outcome of the Kasai operation in patients with biliary atresia: a systematic review E.J. Bijl1, K.D. Bharwani1, R.H.J. Houwen2, R.A. de M[...]


Bleedings to be known in young patients with hemophilia.

M. Gavrel1, A. Rafowicz2, R. d'Oiron2, S. Franchi-Abella2, T. Lambert2, C. Adamsbaum2; 1 Le Kremlin-Bicetre/FR 2 Hôpital Bicetre, Le Kremlin-Bicetre/FR

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Learning objectives: 1. To highlight the rare locations of hematomas in young patients with hemophilia including unusual pseudotumors.     2. To describe the clinical and radiological findings and discuss the differential diagnoses.      

Background: Hemophilia is an X-linked congenital bleeding disorder, mostly due to deficiencies of either clotting protein factor VIII (hemophilia A) or factor IX (hemophilia B). It is estimated to affect between 1/10 000 and 1/ 5000 males (1-2).   In this context, the two major and well-known locations&nbs[...]

Findings and procedure details: 1. HEMATOMAS OF THE CENTRAL NERVOUS SYSTEM (CNS)   1.1. Intra-cranial hematomas (ICH)   The incidence of ICH in hemophilic patients ranges from 2,2% to 7,5% (3). The vast majority of events involve children (50-72%) (4) in whom ICH represent the second most common initial hemorrhagic compl[...]

Conclusion: Rare locations of bleeding occur in children and young adults with hemophilia, and may be challenging and misinterpreted : this review present a spectrum of them. Radiologists should be aware of such rare locations of bleeding including pseudotumors to avoid any invasive diagnostic procedure and unn[...]

Personal information:

References: 1. Srivastava A, Brewer AK, Mauser-Bunschoten EP, Key NS, Kitchen S, Llinas A, et al. Guidelines for the management of hemophilia. Haemoph Off J World Fed Hemoph. 2013 Jan;19(1):e1–47   2. Soucie JM, Evatt B, Jackson D. Occurrence of hemophilia in the United States. The Hemophilia Surveill[...]


Sickle Cell Disease: a pictorial review of well-known and less well-known imaging findings in children.

M. Giannotta, M. B. Leone, M. Baldazzi, E. Facchini, M. Zompatori; Bologna/IT

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Learning objectives: Sickle cell Disease (SCD) is characterized by a wide spectrum of clinical presentations, with various involvement of cerebral, thoracic and abdominal districts, as well as a large range of musculoskeletal manifestations; so, it could present some diagnostic pitfalls, not only for Clinicians but also[...]

Background: Sickle Cell Disease (SCD) is a hemolytic anemia due to reduced or abnormal production of hemoglobin, because of a single aminoacid substitution in the β-globine gene. This genetic mutation leads to the production of a defective form of hemoglobin, hemoglobin S (HbS), which aggregates with other abno[...]

Findings and procedure details: Imaging techniques   When suspecting SCD, as for instrumental diagnostics, abdominal ultrasound (US) represents a first-level exam, easy to repeat, safe and cheap, that allows evaluation of abdominal parenchymal organs and of retroperitoneum, also assessing the presence of fluid and/or intra-ab[...]

Conclusion: In conclusion, SCD frequently shows hazy symptoms and non-specific clinical signs, as well as a series of events similar to those of other illnesses. The imaging findings described in this article, both the better-known ones, and others more uncommon, but possible indicators as well, highlight the d[...]

Personal information: Marica Giannotta1, Maria Barbara Leone1, Michelangelo Baldazzi1, Elena Facchini2, Maurizio Zompatori1     Department of Specialized, Diagnostic and Experimental Medicine, University of Bologna, Sant'Orsola - Malpighi Hospital, Bologna, Italy Pediatric Unit, University of Bologna, Sant[...]

References: 1. Lonergan GJ, Cline DB, Abbondanzo SL (2001) Sickle Cell Anemia. RadioGraphics 21:971-994   2. Lanzkron S, Carrol CP, Haywood C Jr (2013) Mortality rates and age at death from Sickle Cell Disease. Public Health Rep 128:110-116   3. Ganguly A, Boswell W, Aniq H (2011) Musculoskeletal Mani[...]


Paediatric scoliosis - beyond the curve.

E. Gerety, J. Crawford, J. Hughes; Cambridge/UK

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Learning objectives: To understand what should be included when reporting a radiograph for paediatric scoliosis. To learn how to correctly measure the Cobb angle.   To recognise vertebral developmental anomalies.   To recognise common surgical interventions for scoliosis and their complications.

Background: INTRODUCTION: Scoliosis is a common problem with an incidence of 3% of the population (reviewed in 1, 2) and is important both functionally and cosmetically. Pulmonary function may be affected in severe scoliosis. A variety of surgical interventions are utilised and radiologists have an important ro[...]

Findings and procedure details: We undertook a departmental audit of the reporting of radiographs for paediatric scoliosis and found considerable variability in the content and accuracy of the reports. Following discussion with our paediatric spinal surgeons, we established standard criteria that should be incl[...]

Conclusion: At our tertiary referral centre, further education is planned for the reporting of paediatric scoliosis radiographs, with respect to accurate reporting of the side, region, apex and Cobb angle of the scoliosis. Risser stage is rarely reported in our centre, partially because the iliac crests are not[...]

Personal information: Emma Gerety is a final year trainee in Clinical Radiology specialising in musculoskeletal radiology, with a special interest in paediatric musculoskeletal imaging and trauma imaging. John Crawford is a consultant orthopaedic spinal surgeon, specialising in paediatric spinal surgery.   Jacquel[...]

References: 1. Radiographic evaluation of scoliosis. Malfair D, Flemming AK, Dvorak MF et al. AJR 2010; 194(3 suppl):S8-22.   2. Scoliosis imaging: what radiologists should know. Kim H, Kim HS, Moon ES, Yoon CS et al. Radiographics 2010; 30(7)1823-1842.   3. ACR-SPR-SSR practice parameter fo[...]


Radiographic diagnosis of incidental ligamentous instability of children's cervical spine

L. Urina, M. Urina; Kiev/UA

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Aims and objectives: Headache, dizziness, pain in a neck are frequent complaints for children. One of the reasons of these complaints (if no trauma in anamnesis) can be ligamentous instability. Instability is the disability to maintain normal connections in the segments motionless or in motion. The aim of the work is [...]

Methods and materials: Investigations were conducted by “Indiagraf”, the digital equipment. 146 children were included into this study. There were 65 girls, 81 boys (9 – 18 years old). Pathology is edduced for 36 (24,7%) patients, among them 17 girls and 19 boys. Diagnosis of the instability in the upper cervical spine w[...]

Results: 5 groups of pathology are distinguished: 1. Ligamentous instability in an upper cervical spine: 5 patients were diagnosed with atlanto-axial rotatory fixation (AARF). (Fig.3); 2. Compression fraction (2 patients). (Fig.4); 3. Anomaly of development (2 patients). (Fig.5); 4. Ligamentous instability i[...]

Conclusion: Ligamentous instability is one of the reasons of children's headache and pain. The lateral and the anteroposterior open mouth projection radiographs are used for primary diagnosis. The angle of kyphotic deformity on the lateral neutral x-ray represents the degree of the ligamentous instability. The[...]

Personal information: Larisa Urina, radiologyst, Ukraine, Kyiv, Children’s hospital № 3. Marina Urina, radiologyst, Ukraine, Kyiv, Ukrainian Scientific and Practical Center of Endocrine Surgery, Transplantation of Endocrine Organs and Tissues of the Ministry of Health of Ukraine.

References: 1. Dachling Pang “Disorders of the pediatric spine” Raven Press New York 596 – 604, 1995y. 2. Cattel HS, Filtzer DL“Pseudosubluxation and other normal variations in the cervical spine in children” 1295 – 1309, 1965 y. 3. Pang D. Wiberger J. E Spinal cord injury without radiographic abnormalities [...]


What the pediatric lateral ventricles tell us.

R. Dominguez Piedra1, M. Martinez-Leon1, V. Romero Laguna1, M. SANCHEZ PORRO DEL RIO2; 1 Málaga/ES 2 Cádiz/ES

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Learning objectives: The pediatric brain is increasingly being studied through a wide range of technics. The lateral ventricles, which could give us extra-information, are very important to make the correct diagnosis of the subjacent cause. To study the lateral ventricles, we have almost all the radiology techniques at [...]

Background: The pediatric brain is increasingly being studied through a wide range of technics. The lateral ventricles, which could give us extra-information, are very important to make the correct diagnosis of the subjacent cause. In this work, we are going to show the different morphologies that can be found [...]

Findings and procedure details: Lateral ventricles could be studied through the three main techniques. Ultrasounds is the optimal one for screening and some parenchymal pathology in new-born. Computed tomography scan allows better spatial resolution and a complete study of the head. Magnetic resonance gives better soft tissue cont[...]

Conclusion: As it has been shown, the lateral ventricles adopt a broad range of patterns. That is why it is necessary for the radiologist to know which they are and what they represent.

Personal information:

References: Donnelly, Lane F. Diagnostic imaging: pediatrics. Vol. 7. Amirsys Incorporated, 2005. De Bruyn, Rose, and Kassa Darge. Pediatric ultrasound: how, why and when. Elsevier Health Sciences, 2010. Osborn, Anne G., et al. Diagnostic imaging: brain. Elsevier Health Sciences, 2015. Del Cura Rodríguez JL, Pe[...]


The Radiologists Role in the Management of Paediatric Drooling - experience in a national tertiary referral paediatric radiology department. 

H. A. Fleming1, K. Davies2, S. Ryan1; 1 Dublin/IE 2 Galway/IE

Aims and objectives: In children with neurological disability, sialorrhoea presents as a common debilitating problem, leading to chronic skin irritation, soiling of clothes, social alienation and difficulty using keyboard technology. Treatment modalities for drooling can be divided into behavioural (or oral motor therap[...]

Methods and materials: We conducted a retrospective review on all patients treated by one or several botulinum toxin (Botox®) injection sessions performed under ultrasound guidance by a paediatric radiologist over an eight year period. No patients received concurrent medical therapy for the sialorrhea. We recorded the res[...]

Results: A single consultant radiologist performed 71 ultrasound-guided injections of the submandibular glands in 41 patients most of whom had severe neurological disabilities, over the eight year period. Patients ranged between 2- 21 years with a mean age of 10 years. There were a total of 15 female and 2[...]

Conclusion: The physical and psychological effects of drooling greatly impacts on the quality of life for children and parental carers. Patients may also suffer significant physical morbidity such as skin excoriation, aaspiration and dehydration. Drooling can also interfere with the use of keyboards and other e[...]

Personal information:

References: 1. Bushara KO. Sialorrhea in amyotrophic lateral sclerosis: a hypothesis of a newtreatment-botulinum toxin A injections of the parotid glands. Med Hypotheses.1997; 48(4): 337-339 2.  Dressler D, Saberi FA, Barbosa ER. Botulinum toxin: mechanisms of action.  Arq Neuropsiquiatr. 2005; 63(1[...]

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