Secondary ovarian neoplasms in children: imaging features with histopathologic correlation

Background. Although the pathologic features and imaging appearance of childhood primary ovarian neoplasms have been well described, little information is available about the malignancies that may secondarily involve the ovary. Objective. To determine the relationship between the imaging features and the histopathology of secondary ovarian neoplasms in children treated at our institution. Materials and methods. We searched our institutional database for codes indicating metastatic ovarian disease. Of the 35 patients with such codes,18 had pathologically proven secondary ovarian disease. From their medical records we recorded demographic data, presenting symptoms, and evidence of endocrine dysfunction. We reviewed the pre-oophorectomy imaging and the subsequent pathologic specimens. Results. One-third of the patients had bilateral pelvic masses; another third had large masses indistinguishable from the ovaries. Twelve (67 %) had either ascites, peritoneal implants, matted bowel, adenopathy, pleural effusions, or some combination of these. Five (28 %) had other metastatic disease. Primary tumors included colon adenocarcinoma (9), Burkitt's lymphoma (3), alveolar rhabdomyosarcoma (3), Wilms' tumor (1), neuroblastoma (1), and retinoblastoma (1). Conclusion. Although rare, secondary ovarian tumors should be considered in the differential diagnosis of children with ovarian masses. Bilateral ovarian masses or large masses indistinguishable from the ovaries, particularly in the presence of other metastatic foci, may help distinguish primary from secondary ovarian malignancies. Received: 14 September 2000 Accepted: 7 December 2000     

Chest computed tomography in children

This article describes the use of computed tomography for the evaluation of pediatric patients with a variety of chest diseases. Indications for chest CT, constraints of technical factors on the study, and analysis of the benefits of CT examination versus risks will also be discussed.     

Chest computed tomography findings in bronchopulmonary dysplasia and correlation with lung function

Objective

With changes in the predominant pathogenic factors in the new form of bronchopulmonary dysplasia (BPD), a different pattern of CT findings may be expected. This study aimed to (1) describe CT findings in infants with BPD and (2) correlate the CT findings with lung function abnormalities.

Study design and method

Retrospective review of 41 very low birthweight infants with BPD, who were referred for pulmonary investigations at between 10 and 20 months after birth because of persistent respiratory symptoms, and underwent CT and lung function tests.

Results

None of the infants had normal CT findings. The most frequent abnormalities were hyperlucent areas (n = 36; 88%), linear opacities (n = 39; 95%), and triangular subpleural opacities (n = 26; 63%). Bronchiectasis was not seen. None of the CT abnormalities correlated with the maximum expiratory flow at functional residual capacity (VmaxFRC). In contrast, increased number of subpleural opacities and limited linear opacities were associated with low FRC and longer duration of neonatal oxygen exposure. The numbers of triangular subpleural opacities also correlated with duration of mechanical ventilation.

Conclusions

Despite advances in neonatal care, many CT findings in infants with BPD are similar to those observed in the pre‐surfactant era, and are still associated with duration of supplemental oxygen and mechanical ventilation. The absence of bronchial involvement in the present study was the most striking difference from previous studies.Despite considerable obstetric and neonatal advances in the care of very low birthweight infants, bronchopulmonary dysplasia (BPD) continues to occur in 25–30% of surviving infants.1 BPD was initially described in premature infants who were supported with only supplemental oxygen and mechanical ventilation. As new treatment options became available, the characteristics of BPD changed. Before the surfactant treatment era, airway injury, inflammation and parenchymal fibrosis were the prominent findings in BPD.2,3 The “new” BPD seems to be a result of arrested lung development, characterised by abnormal alveolar septation and microvascular maturation. Husain and colleagues characterised this “new” BPD on the basis of autopsy lung specimens from surfactant‐treated infants with BPD.4 The consistent findings were negligible epithelial changes in the airways and a simplified distal lung due to impaired alveolarisation.4,5 The reduced risk of severe airway injury and the primary importance of arrested lung growth are associated with modifications in long‐term alterations in lung function tests. Small lung volumes are now a characteristic feature of infants with BPD whereas severe chronic airway obstruction is no longer seen.6,7 Similar to the changes seen in lung function tests, a different pattern of CT findings may be expected with changes in the main pathogenic factors of BPD. Previous CT findings included reticular opacities, multifocal areas of reduced density and marked bronchial wall thickening.8,9,10No recent study has reported both the results of lung function tests and CT evaluation in infants with BPD. Here we report on CT lesions in 1–2‐year‐old infants with BPD who were born before 32 weeks'' gestation and underwent investigations for persistent respiratory symptoms. We also correlated the CT findings with lung function abnormalities and examined the relative contributions of birth weight, gestational age and neonatal respiratory illness to the CT and lung function test findings.     

Dual-source computed tomography coronary artery imaging in children

Pediatric Radiology - Computed tomography (CT) has a well-established diagnostic role in the assessment of coronary arteries in adults. However, its application in a pediatric setting is still...     

Liver volume in children measured by computed tomography

Liver volume was measured by computed tomography in 54 children and young adults with no history of liver disease. Their ages ranged from 10 days to 22 years. The volume was calculated as follows: (1) the edges of the liver were traced on each scan image and the area was calculated by computer; (2) the areas were summed and multiplied by the scan interval in centimeters. The mean liver volume (± SD) was 178.2 ± 81.9 cm³ in infants (less than 12 months old) and 1114.3 ± 192.9 cm³ in adolescents (more than 16 years old). The mean liver volume in relation to body weight (± SD) was 34.1 ± 5.5 cm³/kg in infants and 20.2 ± 3.1 cm³/kg in adolescents. In general, liver volume increases rapidly in infants, gradually in schoolchildren, and not at all in adolescents. Volumetry might be clinically useful for evaluating the liver function in children and determining the graft size in liver transplantation. Received: 6 November 1995 Accepted: 22 January 1996     

Radiation risk to children from computed tomography

Imaging studies that use ionizing radiation are an essential tool for the evaluation of many disorders of childhood. Ionizing radiation is used in radiography, fluoroscopy, angiography, and computed tomography scanning. Computed tomography is of particular interest because of its relatively high radiation dose and wide use. Consensus statements on radiation risk suggest that it is reasonable to act on the assumption that low-level radiation may have a small risk of causing cancer. The medical community should seek ways to decrease radiation exposure by using radiation doses as low as reasonably achievable and by performing these studies only when necessary. There is wide agreement that the benefits of an indicated computed tomography scan far outweigh the risks. Pediatric health care professionals' roles in the use of computed tomography on children include deciding when a computed tomography scan is necessary and discussing the risk with patients and families. Radiologists should be a source of consultation when forming imaging strategies and should create specific protocols with scanning techniques optimized for pediatric patients. Families and patients should be encouraged to ask questions about the risks and benefits of computed tomography scanning. The information in this report is provided to aid in decision-making and discussions with the health care team, patients, and families.     

Cranial computed tomography findings in children with acute lymphoblastic leukemia at diagnosis

Forty children newly diagnosed with acute lymphoblastic leukemia (ALL) were examined by computed tomography (CT) of the central nervous system (CNS) on hospital admission before any medication was started. The results of the CT scans were defined as normal, borderline (slight or moderate dilatation of the ventricular system and/or basal cisterns and/or convolutional sulci), or pathologic (severe cerebral atrophy). The mean age of the patients was 5.8 years (range 1.7-15 years). Sixteen of the 40 patients (40%) had CT scan abnormalities with 14 patients having borderline scans and two patients pathologic scans. No child presented with neurologic symptoms or CNS leukemia. These data suggest that CT abnormalities of the brain are common in children with ALL at diagnosis and may represent clinically unsuspected lesions secondary to leukemia.     

Positron emission tomography/computed tomography (PET/CT) in children

Although PET imaging has been available for more than two decades, its use has greatly increased lately due to the advent of PET/CT, readily available sources of commercially supplied FDG, and mobile scanners. These features have enabled PET scanning to expand beyond select major university medical centers, with on-site cyclotron facilities to smaller institutions including free- standing children's hospitals. In these settings, imaging is generally limited to FDG, which suffices for most applications, with the majority of studies performed for tumor imaging. FDGI is being used for evaluation of many tumors in children, with its use in lymphoma being the most established. In lymphoma, it has proven quite useful in determining whether active tumor is present in residual masses following treatment, which may otherwise contain only residual fibrous tissue. For brain tumors, FDGI has some relation to tumor grade, although its more important role is distinguishing recurrent or residual tumor from the effects of treatment, particularly radiation necrosis. For neurological evaluation, interictal FDGI is helpful in localizing potential seizure foci for subsequent subdural EEG monitoring. Because of the relatively long uptake time of FDG, true ictal studies cannot be performed with FDG, and these remain within the domain of SPECT imaging of tracers such as Tc-99m HMPAO. Examinations utilizing radiopharmaceuticals other than FDG are significantly more limited in their availability and are limited to PET centers with on-site cyclotrons. However, these additional agents open the door to many additional studies, including more specific tumor-imaging agents of certain tumors such as neuroblastoma. Another neurotransmitter, F-18-fluoro-L-dopa, is of benefit outside of the central nervous system for evaluating infantile hyperinsulism. The use of PET/CT in children is increasing quickly, particularly FDGI imaging of tumors. It is expected that over the next few years, its role will become increasingly better defined.     

High-resolution computed tomography in young patients with cystic fibrosis: distribution of abnormalities and correlation with pulmonary function tests

Objective

To assess pulmonary abnormalities detected by high-resolution computed tomography (HRCT) in young children with cystic fibrosis (CF) and mild to moderate lung disease.

Study design

High-resolution computed tomography was performed in 60 children, 6 to 10 years old, with mild to moderate lung disease (forced expiratory volume in 1 minute [FEV₁], 52-137; mean, 102; SD, 15% predicted). HRCTs were scored by using a system that evaluates each lobe for severity and extent of CF lung disease. Findings of CF lung disease were tabulated in all subjects and in a subgroup with normal pulmonary function tests. HRCT scores were correlated with FEV₁, forced vital capacity (FVC), and forced expiratory flow between 25% and 75% of expired vital capacity (FEF_25-75) in 57 patients.

Results

Bronchiectasis was present in 35% of subjects, mucous plugging in 15%, and air trapping in 63%. No abnormality was detected in 25%. In 37 subjects with FEV₁, FVC, and FEF_25-75 >85% predicted, bronchiectasis was present in 30%. In 17% of these subjects, bronchiectasis was seen in ≥4 lobes. Correlations between HRCT scores and FEV₁ were significant and showed fair to moderate correlation (r = 0.36-0.46).

Conclusions

High-resolution computed tomography demonstrated a broad range of pulmonary abnormalities in young patients with CF with mild to moderate lung disease. In this study, abnormalities, including bronchiectasis, were common in young children with CF and normal pulmonary function tests.     

Clinical utility of high-resolution pulmonary computed tomography in children with antibody deficiency disorders

Objective. To assess the value of high-resolution computed tomography (HRCT) in determining the extent and significance of lung disease in children with antibody deficiency states. Materials and methods. Seventy HRCT scans performed on 37 children with various antibody deficiency disorders over a 5-year period were retrospectively scored using a previously described demerit scoring system (0–25 with 0 = worst, 25 = best). Points are subtracted from 25 with increasing severity of disease. The potential correlations between CT scores and clinical factors, including age at diagnosis, age at CT, type of immunoglobulin deficiency, length of respiratory symptoms before diagnosis, number of pneumonias before diagnosis, type, length and success of therapy, patient compliance and pulmonary function tests (PFTs), were assessed. Results. Of the 37 children, a demonstrated 22 abnormal scans (CT score ≤ 22). All nine demonstrated bronchiectasis with a lower lobe and right middle lobe predominance. Statistically significant correlations were seen between severity of lung disease (CT score) and length of respiratory symptoms before diagnosis (p = 0.01), success of therapy (P = 0.001) and PFTs (P = 0.0008). Of seven children who were followed with repeated scans, 4 of the 7 demonstrated CT scores which improved on high-dose intravenous immunoglobulin replacement therapy. Conclusion. HRCT is a useful adjunct to demonstrate the extent and severity of lung disease at diagnosis and during therapy. Correlation with clinical factors suggests a higher risk group needing more aggressive management. Received: 13 January 1997 Accepted: 5 May 1997     

Measurements of cervical lymph nodes in children on computed tomography

Background

No normal measurements or specific size criteria have been described for cervical lymph nodes in children.

Objective

To determine the normal measurements of cervical lymph nodes in children on CT.

Materials and methods

We included 142 children (ages 1–17 years) who underwent cervical CT examination after high-energy trauma. We evaluated axial and coronal 2-mm reconstructions for lymph nodes at six cervical levels. For the largest lymph node at each level, we measured diameters in both the long and short axial axes and the long coronal axis.

Results

A total of 733 lymph nodes were measured in 142 children (62% boys, 38% girls). The greatest measured diameters were 14 mm for the short axis in the axial plane, 24 mm for the long axis in the axial plane and 28 mm for the long axis in the coronal plane. The Pearson correlation coefficient for age and lymph node size at Levels IV–VI was in the range of 0.19–0.47.

Conclusion

Lymph nodes with an axial short-axis diameter exceeding 15 mm for Level II and 10 mm for all other cervical levels are uncommon in otherwise healthy children.

     

多排螺旋CT在小儿法乐四联症诊治中的应用价值

目的 探讨多排螺旋CT血管造影(MUCTA)三维重建应用于小儿法乐四联症(TOF)诊断及治疗中的价值.方法 2004年12月至2008年12月38例经胸二维超声心动图(TEE)诊断TOF患儿,为进一步明确肺动脉发育状况行MUCTA检查,均经外科手术证实.MUCTA扫描后应用三维重建处理,测算全肺动脉指数(Nakata),确定肺动脉发育状况,冠状动脉走向,主、肺动脉侧枝循环位置,设计手术方案.结果 38例患儿检查过程顺利均为TOF,其中合并房间隔缺损(ASD)3例、动脉导管未闭(PDA)2例、室间隔缺损(VSD)嵴下型38例,单纯右室流出道狭窄7例、合并肺动脉狭窄31例,冠状动脉走向异常2例、主、肺动脉侧枝循环19例、其中粗大侧枝循环3例.35例康复出院,3例术后死亡.结论 MUCTA对于诊断TOF心外畸形的显示清晰度超过其它影像学检查,特别是对观察肺动脉发育形态、肺动脉狭窄的部位、冠状动脉起源与走向异常、PDA、主肺动脉侧枝循环,精确测算Nakata指数、McGoon指数均有明显帮助.与TEE相结合能达到优势互补、能够更加完整、准确的诊断TOF,为手术决策,方案的制定提供了有效的依据,对提高TOF患儿的治疗效果有重要价值.     

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目的探讨多层螺旋CT(MSCT)及联合经胸二维超声心动图(TTE)检查在先天性心脏病诊断中的意义。方法收集广东省心血管病研究所自2002年9月至2003年12月间86例儿童先天性心脏病病例,全部患儿接受了MSCT和TTE检查,12例接受心导管检查,其中69例进行了外科手术,将术前MSCT、TTE和心导管检查结果分别与手术诊断进行比较。结果69例患儿共计有129处畸形,TTE正确诊断116处(89.9%),MSCT正确诊断112处畸形(86.8%),两者联合正确诊断127处畸形(98.4%),12例心导管检查未能提供更有价值的资料。结论MSCT对先天性心脏病诊断具有较高的价值,尤其是联合TTE可取代部分心导管检查为外科手术提供正确和充分的术前诊断。对于年龄小或重症不耐受心导管检查的患儿具有更大的意义。     

Emerging role of computed tomography coronary angiography in evaluation of children with Kawasaki disease

Coronary artery abnormalities are the most important complications in children with Kawasaki disease (KD). Two-dimensional transthoracic echocardiography currently is the standard of care for initial evaluation and follow-up of children with KD. However, it has inherent limitations with regard to evaluation of mid and distal coronary arteries and, left circumflex artery and the poor acoustic window in older children often makes evaluation difficult in this age group. Catheter angiography (CA) is invasive, has high radiation exposure and fails to demonstrate abnormalities beyond lumen. The limitations of echocardiography and CA necessitate the use of an imaging modality that overcomes these problems. In recent years advances in computed tomography technology have enabled explicit evaluation of coronary arteries along their entire course including major branches with optimal and acceptable radiation exposure in children. Computed tomography coronary angiography (CTCA) can be performed during acute as well as convalescent phases of KD. It is likely that CTCA may soon be considered the reference standard imaging modality for evaluation of coronary arteries in children with KD.