Cardiac hydatid cyst in a child: Diagnostic value of echocardiography and magnetic resonance imaging

Cardiac hydatid cyst is extremely rare in children. We report a case of a cardiac echinococcal cyst in an 11 year old boy, diagnosed by two-dimensional echocardiography and magnetic resonance imaging (MRI). The cyst was located in the posterior wall of the left ventricle and was excised surgically. Echocardiographic and MRI findings are discussed.     

Diffuse myocardial fibrosis among healthy pediatric heart transplant recipients: Correlation of histology,cardiovascular magnetic resonance,and clinical phenotype

Fibrosis is commonly described in heart allografts lost late after transplantation. CMR‐derived ECV is a validated measure of DMF in native adult hearts that may predict heart failure and mortality. We explored associations of ECV with histologic myocardial fibrosis and clinical features after pediatric heart transplantation. Twenty‐five recipients (7.0±6.3 years at transplant and 10.7±6.5 years post‐transplant) were prospectively recruited for CMR and BNP measurement at the time of surveillance biopsy. All had normal ejection fractions and lacked heart failure symptoms. Fibrosis was quantified on biopsy after picrosirius red staining as CVF. ECV was quantified using contemporaneous hematocrit on basal and mid‐short‐axis slices. ECV was moderately correlated with CVF (r=.47; P=.019). We found no associations of ECV with hemodynamics, ischemic time, time since transplantation, or number of prior biopsies or acute rejections. Compared to healthy non‐transplant controls, there was no significant difference in ECV (25.1±3.0 vs 23.7±2.0%, P=.09). Log‐transformed BNP was correlated with ECV (recipients: r=.46, P=.02; recipients and controls: r=.45, P=.006). These findings suggest ECV quantifies DMF and relates to biological indicators of cardiac function after pediatric heart transplantation.     

Follow-up of acute pulmonary complications in cystic fibrosis by magnetic resonance imaging: a pilot study

The aim of this pilot study was to obtain information on the value of MRI in the follow-up of atelectasis and pneumonic infiltrates in cystic fibrosis (CF). Six patients aged 5-15 y were initially examined using chest X-ray and magnetic resonance imaging (MRI). Both methods provided identical information. During follow-up, MRI proved suitable to monitor pulmonary complications. CONCLUSION: MRI of the lung is feasible and valuable in the follow-up of atelectasis and pulmonary infiltrates in CF.     

Dose‐related cerebellar abnormality in rats with prenatal exposure to X‐irradiation by magnetic resonance imaging volumetric analysis

Cerebellar abnormalities in 4‐week‐old rats with a single whole body X‐irradiation at a dose of 0.5, 1.0, or 1.5 Gy on embryonic day (ED) 15 were examined by magnetic resonance imaging (MRI) volumetry. A 3D T₂W‐MRI anatomical sequence with high‐spatial resolution at 11.7‐tesla was acquired from the fixed rat heads. By MRI volumetry, whole cerebellar volumes decreased dose‐dependently. Multiple linear regression analysis revealed that the cortical volume (standardized β = 0.901; P < 0.001) was a major explanatory variable for the whole cerebellar volume, whereas both volumes of the white matter and deep cerebellar nuclei also decreased depending on the X‐irradiation dose. The present MRI volumetric analysis revealed a dose‐related cerebellar cortical hypoplasia by prenatal exposure to X‐irradiation on E15.     

Evaluation of working memory impairment in children with primary nocturnal enuresis: evidence from event-related functional magnetic resonance imaging

Aim: To assess the working memory and explore the differential activations of brain areas in children with primary nocturnal enuresis (PNE) by performing functional magnetic resonance imaging (fMRI) scans using the categorical N‐Back task. Methods: Thirteen right‐handed PNE children (M/F = 7:6, average age 11.4 ± 0.8 years) and 15 age‐matched, right‐handed, healthy controls (M/F = 9:6, 11.3 ± 1.0 years) were recruited for the study. First, intelligence tests were performed using Chinese Wechsler Young Children Scales of Intelligence in PNE children and controls. The full intelligence quotient (FIQ), verbal IQ (VIQ), performance IQ (PIQ) and memory/caution (M/C) factor were measured. After intelligence tests, event‐related fMRI scans were performed using the categorical N‐Back working memory task on a 3.0T MR scanner. The percent of correct responses (PCR) and the mean reaction time to correct response (mRT) were recorded and compared; fMRI data were analysed using SPM2, the differences in activation were compared with the single subject and between‐group levels. Results: The FIQ, VIQ and PIQ in the PNE group were within the normal range and did not significantly differ from the control group (P > 0.05). The M/C factor was statistically significantly lower in the PNE group (P < 0.05). In the N‐Back test, PNE children had lower PCR and longer mRT than controls (P < 0.05). A between‐group analysis of fMRI data revealed significant attenuation in the left posterior cerebellar lobes of PNE children. Conclusion: PNE children had deficits in working memory, and dysfunction in the left cerebella might be associated with their working memory deficits.     

Transition from brand to generic tacrolimus is associated with a decrease in trough blood concentration in pediatric heart transplant recipients

There are limited data available on the bioequivalence of generic and brand‐name tacrolimus in pediatric and heart transplant patients. We characterized changes in 12‐hour trough concentrations and clinical outcomes after transition from brand to generic tacrolimus in pediatric thoracic organ transplant recipients. Patients with a pharmacy‐confirmed date of switch between generic and brand tacrolimus were identified, as well as a matched control group that did not switch for comparison. We identified 18 patients with a confirmed date of switch, and in 12 patients that remained on the same dose, trough concentrations were 14% less than when they were on brand (p = 0.037). The average change was ?1.15 ± 1.76 ng/mL (p = 0.045). The control group did not experience a change in trough concentration and was different than the switched group (p = 0.005). There were no differences in dosage changes or kidney or liver function. In the year after switch, 24% of patients who were switched to generic experienced a rejection event vs. 18% in the patients on brand. We suggest a strategy of monitoring around the time of transition, and education of the patient/family to notify the care team when changes from brand to generic or between generics occur.     

Cardiac tumour in a neonate with tuberous sclerosis: echocardiographic demonstration and magnetic resonance imaging

In a neonate with tuberous sclerosis, cardiac tumours were diagnosed by two-dimensional echocardiography and evaluated by electrocardiogram-gated magnetic resonance imaging (MRI). The tumour size, shape and mobility in the ventricular cavities were more precisely determined by two-dimensional echocardiography than electrocardiogramgated MRI, while the extent of tumour mass at the apex was more clearly delineated by MRI. As two-dimensional echocardiography provides real-time imaging of cardiac anatomy without sedation, it is useful for initial evaluation of cardiac masses in neonates with genetic predisposition to tuberous sclerosis.Abbreviation MRI magnetic resonance imaging     

静息态功能磁共振对伴中央颞区棘波的儿童良性癫痫认知功能变化的研究

目的采用基于静息态脑功能成像的局部一致(ReHo)算法,分析伴中央颞区棘波的儿童良性癫痫(BECTS)患儿脑功能的变化,探讨其脑功能的连接及连接模式的变化,从而早期发现BECTS患儿认知功能的损害。方法简单随机选取2015年1月至2017年12月在深圳市儿童医院就诊的20例BECTS患儿及健康体检20例儿童分别进行基本信息采集和功能磁共振(fMRI)检测,其中fMRI从静息态进行数据采集。结果显著降低的ReHo值出现在默认模式网络(DMN)区域,而楔前叶(体素=422,t=-5.0856)、楔叶(体素=85,t=-4.2403)、角回(体素=191,t=-4.6812)、扣带回皮质(体素=313,t=-5.2382)以及中央前回(体素=12,t=-3.4827)、补充运动区(体素=1356,t=-6.5962)的ReHo值也显著下降。而显著增高的ReHo值出现在双侧小脑(体素=71,t=5.6582)、右侧颞上回(体素=24,t=5.1840)、岛盖(体素=337,t=6.8149)和左侧顶叶(体素=12,t=4.3787)、顶下小叶(体素=11,t=3.4337)等区域。结论BECTS患儿DMN区域、Wernicke区及角回脑功能出现显著受损,可能是BECTS患儿认知功能障碍的机制之一。岛盖、中央沟附近的感觉运动区和皮质脑功能增强,从而导致癫痫发作,出现典型临床症状。fMRI对评价BECTS患儿的脑功能具有较高特异性和敏感性,能早期发现该类型癫痫患儿认知功能的损害。     

Feasibility and applicability of diffusion‐weighted and dynamic contrast‐enhanced magnetic resonance imaging in routine assessments of children with high‐grade gliomas

Diffusion‐weighted (DW) and dynamic contrast‐enhanced (DCE) magnetic resonance imaging (MRI) have been used as imaging biomarkers in adults with high‐grade gliomas (HGGs). We incorporated free‐breathing DW‐MRI and DCE‐MRI, at a single time point, in the routine follow‐up of five children (median age 9 years, range 8–15) with histologically confirmed HGG within a prospective imaging study. It was feasible to incorporate DW‐MRI and DCE‐MRI in routine assessments of children with HGG. DW and DCE parameters were repeatable in paediatric HGG. Higher median ADC_100‐1000 significantly correlated with longer survival in our sample.     

真空固定器联合喂奶方式在新生儿头颅磁共振成像中的应用——前瞻性随机对照研究

目的 评价真空固定器联合喂奶方式在新生儿头颅磁共振成像（MRI）中的有效性和安全性。方法 前瞻性选择2019年9~11月浙江大学医学院附属儿童医院新生儿科需要进行头颅MRI检查的胎龄 > 34周且生命体征平稳、不需要吸氧的高胆红素血症新生儿为研究对象,随机分为真空固定器联合喂奶组和常规镇静组,所有患儿均在头颅MRI检查前后进行生命体征监测,记录MRI完成情况。结果 共纳入80例新生儿,真空固定器联合喂奶组40例,常规镇静组40例。真空固定器联合喂奶组头颅MRI检查成功率高于常规镇静组（92% vs 75%,P < 0.05）。扫描成功的患儿中,真空固定器联合喂奶组检查完成后的最快心率低于常规镇静组（P < 0.05）;两组患儿在头颅MRI前后经皮血氧饱和度、呼吸频率、体温等差异无统计学意义（P > 0.05）。所有患儿均未发生呼吸暂停、急性过敏反应、恶性高热等并发症。结论 真空固定器联合喂奶方式在不增加风险的前提下提高了头颅MRI检查的成功率,有效减少镇静剂的使用。     

振幅整合脑电图联合头颅磁共振定量指标对中晚期早产儿近期神经发育预测价值的前瞻性研究

目的 探讨振幅整合脑电图（amplitude-integrated electroencephalogram,aEEG）、头颅磁共振成像（cranial magnetic resonance imaging,cMRI）的定量指标双顶径（biparietal width,BPW）、两半球间距（interhemispheric distance,IHD）与中晚期早产儿近期神经发育的关系。 方法 前瞻性选择2018年9月至2020年4月入住新生儿重症监护病房的104例中晚期早产儿为研究对象,在生后72 h内采用Naqeeb法及睡眠-觉醒周期（sleep-wake cycling,SWC）进行aEEG评估;在矫正胎龄37周时完成cMRI检查,并在T2冠状位测量BPW和IHD;矫正月龄6月龄时采用0~6岁儿童发育筛查测验（Developmental Screening Test for Child Under Six,DST）随访神经发育,并根据发育商（development quotient,DQ）分为DST正常组（≥85分,78例）和DST异常组（DQ<85分,26例）,分析比较两组间各指标差异,以及aEEG和cMRI的关系。 结果 DST异常组aEEG正常率、SWC成熟率低于DST正常组（P<0.05）;与DST正常组相比,DST异常组的IHD偏大、BPW偏小（P<0.05）。不成熟的SWC、aEEG异常、较大的IHD是DST异常的危险因素（P<0.05）,较大的BPW是DST异常的保护因素（P<0.05）。 结论 中晚期早产儿生后72 h内的aEEG、矫正胎龄37周时cMRI定量指标BPW和IHD可能影响其矫正月龄6月龄时的神经发育结局。     

Clinical and magnetic resonance imaging features of children,adolescents, and adults with a clinically isolated syndrome

Background

The diagnosis of multiple sclerosis (MS) both in children and adults is based on clinical and magnetic resonance imaging (MRI) features according to the McDonald criteria. Little is known about differences in the presentation between pre-pubertal children, adolescents, and adult patients at disease onset.

Cortical recruitment patterns in children born prematurely compared with control subjects during a passive listening functional magnetic resonance imaging task

OBJECTIVES: To use functional magnetic resonance imaging (fMRI) to test the hypothesis that subjects who were born prematurely develop alternative systems for processing language. STUDY DESIGN: Subjects who were born prematurely (n = 14; 600-1250 g birthweight) without neonatal brain injury and 10 matched term control subjects were examined with a fMRI passive listening task of language, the Clinical Evaluation of Language Fundamentals (CELF) and portions of the Comprehensive Test of Phonological Processing (CTOPP). The fMRI task was evaluated for both phonologic and semantic processing. RESULTS: Although there were differences in CELF scores between the subjects born prematurely and control subjects, there were no significant differences in the CTOPP measures in the 2 groups. fMRI studies demonstrated that the groups differentially engaged neural systems known to process language. Children born at term were significantly more likely to activate systems for the semantic processing of language, whereas subjects born prematurely preferentially engaged regions that subserve phonology. CONCLUSIONS: At 12 years of age, children born prematurely and children born at term activate neural systems for the auditory processing of language differently. Subjects born prematurely engage different networks for phonologic processing; this strategy is associated with phonologic language scores that are similar to those of control subjects. These biologically based developmental strategies may provide the substrate for the improving language skills noted in children who are born prematurely.