Lumbosacral osseous tumors in children

A wide variety of benign and malignant neoplasms in children involve the lumbosacral region. When a solitary lesion of the lower spine occurs, tumors or tumor-like lesions represent an important group of entities for diagnostic consideration. Diagnostic investigation should begin with a patient history, physical examination, laboratory testing, and radiography. Roentgenograms, which demonstrate bone deviations, should be used as an initial examination. The results should direct further imaging studies, such as computed tomography (CT), magnetic resonance imaging (MRI), and bone scintigraphy. CT should be the chosen modality for delineating tumoral osteoid matrix formation. MRI shows soft-tissue masses and medullary infiltration better than any other radiological modality. A multimodal radiological approach is helpful in the overall evaluation and differential diagnosis of vertebral lesions in children. Although imaging features, especially of benign lesions, may yield a high percentage of accurate diagnoses, in cases with radiological findings highly suggestive of malignancy, a specific diagnosis cannot always be made, and histopathological findings are essential to achieve the diagnosis that will guide the therapy.     

Intra-articular osteoid osteoma.

Osteoid osteomas located within the capsule of a joint are uncommon and present challenging diagnostic difficulties. Twelve patients with an intra-articular osteoid osteoma were studied retrospectively to determine the spectrum of clinical and radiological findings. The features differ significantly from the well known classical hallmarks of the extra-articular lesion. The symptoms are non-specific with pain similar to other common joint disorders and the response to salicylate less precise. On plain radiography intra-articular lesions are difficult to identify, lacking the florid periosteal new bone and intense perifocal sclerotic reaction. A detectable focal lesion is commonly absent with considerable delay between the onset of symptoms and radiological detection of the tumour nidus. Bone scintigraphy and computed tomography (CT) are essential for an accurate and early diagnosis. These imaging techniques reveal abnormalities in bone and cartilage growth, new bone formation and sclerosis distant from the tumour on either side of the joint, and disruption of the articular surface. Radiological follow up after surgery shows that these changes can be reversible, especially when the diagnosis is made early.     

Ewing-Sarkom,fibrogene Tumoren,Riesenzelltumor, Hämangiom des Skeletts

Radiological imaging only reflects the anatomy and its pathological abnormalities. Therefore, the radiologist should be able to recognize the basic features of the pathological anatomy of bone tumors. This can only be learned working closely with a pathologist who is experienced in this field. On the other hand, the pathologist needs from the radiologist their diagnostic assessment with information on size, location, aggressiveness and the existence of a bone tumor’s matrix, of the whole lesion, because he usually only receives a small part for examination in the form of a biopsy. In this article, the features and fundamentals (standards) of radiological–pathological cooperation as the mainstay for a precise diagnosis in bone tumors are outlined. The radiological appearance and the histopathological features behind it are presented for Ewing’s sarcoma, fibrogenic tumors, giant cell tumor, and hemangioma of the bone.     

Intraluminal duodenal diverticulum: radiological and endoscopic ultrasonography findings of an unusual cause of acute pancreatitis

Intraluminal duodenal diverticulum is a rare congenital web of membrane which may be symptomatic when it becomes distended. This report describes a case revealed by presenting as an acute pancreatitis. The radiological findings are reported. The findings at CT, upper gastro-intestinal series, endoscopic ultrasound and endoscopic retrograde cholangiopancreatography are described and differential diagnostic features from choledochocele and duodenal duplication are discussed. By endoscopic ultrasonography, observation of a thin wall, without different layers such as choledochocele or duodenal duplication, may be useful for diagnosis. Received: 10 December 1998; Revised: 11 March 1999; Accepted: 14 April 1999     

Mucocele of the appendix. Sonographic, computed tomographic and radiologic characteristics

The knowledge of the diagnostic imaging methods features of the mucocele of the appendix is important for a correct preoperative diagnosis, especially to avoid the formation of pseudomyxoma peritonei. A case of a mucocele of the appendix with a special sonographic appearance by a patient with an additional carcinoma of the left kidney is reported. The computer-tomographic and radiological features of the mucocele (plain abdominal film, i.v. urography, barium enema) are presented and discussed with a review of the literature. A sonographically-guided fine-needle puncture of the mucocele was performed. Its importance for the diagnosis is discussed.     

A multilocular radiolucency with spindle cell proliferation in a case of ossifying fibroma: a potential pitfall

Ossifying fibroma (OF) is a benign tumour characterized by cementum or bone formation accompanied by a fibrocellular stroma. The diagnosis of OF may be apparent when the histological features are supported by clinical and radiological information. In this report, an OF with predominantly spindle cell proliferation and purely radiolucent, multilocular lesion in a middle-aged woman is presented.     

Imaging of periosteal reactions associated with focal lesions of bone

Periosteal reaction (PR) is the response of cortical bone to an underlying insult. It is manifest in a limited number of histological and radiological patterns. Although not specific for a particular diagnosis, the appearance of PR aids the radiological characterization of bone lesions. Once ossified, PR is demonstrated well on plain radiography but can also be visualized on ultrasound, CT, MRI and bone scintigraphy, particularly in the early stage. This article provides a pictorial review of the patterns of PR with particular reference to bone tumours.     

Pigmented villo-nodular synovitis: bone involvement of the fingers.

Pigmented villo-nodular synovitis may occur in either diffuse or nodular form. In the latter the fingers are the commonest site to be involved. The disease is rare, and in only 15% is there bone involvement. Two cases showing bone involvement of the fingers are presented. One of the cases (Case 2) adds radiological support to the theory of Scott (1968), based on pathological studies, that suggested that the bone changes are due to invasion by the villo-nodular tissue through and along the nutrient foramina. The site of these bone changes appears sufficiently typical to be a radiological diagnostic aid. The differential diagnosis of the radiological appearances of the disease in the digits is discussed.     

Systematic review and meta-analysis for the use of ultrasound versus radiology in diagnosing of pneumonia

Background

Physicians are increasingly using point of care lung ultrasound (LUS) for diagnosing pneumonia, especially in critical situations as it represents relatively easy and immediately available tool. They also used it in many associated pathological conditions such as consolidation, pleural effusion, and interstitial syndrome with some reports of more accuracy than chest X-ray. This systematic review and meta-analysis are aimed to estimate the pooled diagnostic accuracy of ultrasound for the diagnosis of pneumonia versus the standard chest radiological imaging.

Methods and main results

A systematic literature search was conducted for all published studies comparing the diagnostic accuracy of LUS against a reference Chest radiological exam (C X-ray or Chest computed Tomography CT scan), combined with clinical criteria for pneumonia in all age groups. Eligible studies were required to have a Chest X-ray and/or CT scan at the time of clinical evaluation. The authors extracted qualitative and quantitative information from eligible studies, and calculated pooled sensitivity and specificity and pooled positive/negative likelihood ratios (LR). Twenty studies containing 2513 subjects were included in this meta-analysis. The pooled estimates for lung ultrasound in the diagnosis of pneumonia were, respectively, as follows: Overall pooled sensitivity and specificity for diagnosis of pneumonia by lung ultrasound were 0.85 (0.84–0.87) and 0.93 (0.92–0.95), respectively. Overall pooled positive and negative LRs were 11.05 (3.76–32.50) and 0.08 (0.04–0.15), pooled diagnostic Odds ratio was 173.64 (38.79–777.35), and area under the pooled ROC (AUC for SROC) was 0.978.

Conclusion

Point of care lung ultrasound is an accurate tool for the diagnosis of pneumonia. Considering being easy, readily availability, low cost, and free from radiological hazards, it can be considered as important diagnostic strategy in this condition.

     

Superficial acral fibromyxoma: a report of two cases with radiological findings

Superficial acral fibromyxoma is a recently described soft tissue neoplasm with a predilection for the tips of the fingers and toes. As such it must be included in the radiological differential diagnosis of soft tissue lesions eroding bone in this location. The radiological features of this distinctive tumour have not so far been described. We report two cases with radiological and histopathological features.     

MR imaging of periosteal and cortical changes of bone

The changes seen in the periosteum and cortical bone are fundamental radiographic features of bone disease. The basic radiographic findings used for diagnosis of bone lesions (patterns of cortical destruction and of periosteal new bone formation) can be well identified with magnetic resonance (MR) imaging. The authors used comparative radiographic, computed tomographic, and MR images to illustrate patterns of periosteal reaction (simple, laminated, spiculated, Codman triangle), geographic and permeative cortical destruction, cortical erosion, cortical expansion and continuity, and intraosseous and extraosseous calcification. The only feature not well demonstrated by MR imaging is pattern or extent of soft-tissue calcification. Although MR images are not required for diagnosis of most peripheral bone lesions, when they are obtained, these fundamental diagnostic features should not be ignored.     

Primary hemangiopericytoma of bone located in the tibia

 Primary hemangiopericytoma of the bone is a rare tumor. We describe a patient with primary hemangiopericytoma of the tibia treated by surgery. The clinical and radiological features of this tumor are described. The radiological and histopathological differential diagnosis of hemangiopericytoma is discussed.     

Radiological imaging features of non-uterine leiomyosarcoma

Leiomyosarcomas are unusual soft-tissue tumours that occur in the retroperitoneum, peripheral soft tissues, gastrointestinal and genito-urinary tracts, vessels and (rarely) in bone. The aim of this pictonal review is to delineate the more specific radiological features that would suggest a radiological diagnosis of leiomyosarcoma prior to biopsy.     

炎性肠病相关骨质疏松的影像学研究进展

骨质疏松症（OP）是炎性肠病（IBD）病人最常见的肠道外表现之一。双能X线吸收测量仪、CT、MRI以及定量超声等影像方法可以评估IBD病人的骨量、骨结构、骨髓脂肪以及骨强度变化,对IBD的诊断治疗及预后评估具有重要意义。就IBD相关OP的发病机制、影像学研究进展及其临床应用予以综述。     

恶性婴儿石骨症的临床及X线分析

目的:探讨恶性婴儿石骨症的临床影像学特点.方法:回顾性分析8例恶性婴儿石骨症临床、实验室检查及影像学资料,从临床影像学角度分析、归纳其临床病理特征及影像学特点.结果:本组患儿均呈贫血貌,肝脾肿大和生长发育迟缓,视神经受损2例.实验室检查异常指标:血红蛋白、红细胞、血小板均减少,2例患儿血钙浓度下降明显.影像学特征:①婴儿期全身性的骨质硬化,骨密度增高髓腔闭塞;②长骨塑形障碍显示棒球杆征,骨膜新骨形成;③长骨干骺端横行透亮带、见骨中骨征;④石骨症佝偻病改变及病理性骨折.结论:通过X线表现结合临床以及实验室检查通常能够明确恶性婴儿石骨症的诊断.     

Moderne Ultraschalltechniken und ihre Anwendungen am kindlichen Harntrakt

In children ultrasound plays a central role in the diagnostic imaging of the urinary tract. It is used most frequently and as a primary diagnostic option. Consequently, innovations in ultrasound technology and ultrasound contrast media have major impact on pediatric urosonography. Harmonic imaging is a modality that produces artifact-free images with high resolution. It has been shown that harmonic imaging is superior to fundamental mode in many urosonographic indications. Color Doppler is an established imaging modality, but its application for diagnosis of stones in the urinary tract, especially in children, is relatively new. The so-called twinkling sign, a color Doppler artifact at the site where one normally expects the acoustic shadow to be, enhances the conspicuity of the stone. A further development is three-dimensional (3D) ultrasound. It offers better volume measurement of the bladder and kidneys than 2D ultrasound. Contrast-enhanced voiding urosonography has already proven to be a valuable alternative in the diagnosis of vesicoureteral reflux. Thus, a significant decrease of radiation exposure has become possible as it replaces the radiological methods. With the introduction of contrast-specific ultrasound imaging modalities, further improvements in voiding urosonography are emerging.     

Management von Speicheldr��senerkrankungen mittels Kontrastmittelapplikation

Obstructive diseases of the salivary glands are a common problem in otorhinolaryngology. They are mostly due to sialolithiasis followed by duct stenosis and other rarer causes. Several diagnostic modalities exist which allow classification of the disease; however, in 5-10% of all cases ultrasound and conventional radiological imaging do not provide a clear diagnosis. Ultrasound examination with contrast material injected into the duct (IA-CEUS, intraductal administered contrast-enhanced ultrasound) enables improved evaluation of obstructive diseases of the salivary glands and at the same time an evaluation of the parenchyma of the glands is possible. As a complementary method to conventional investigation techniques IA-CEUS is an economic and rapid method with low side-effects which improves the diagnostic assessment of ultrasound and results in a better treatment for patients.     

马杜拉足的临床X线病理对照研究(附100例分析)

目的:分析马杜拉足的临床X线特点及某些征象的病理基础,并对致病菌加以探讨。方法:收集经手术证实的马杜拉足100例进行临床X线分析,其中选有窦道形成的30例做病理及细菌学检查。结果:临床特点:1病程长;2软组织肿胀;3多发窦道形成,可经窦道排出黑褐色颗粒。X线表现:1软组织肿胀,可见软组织内结节样改变;2溶骨性骨破坏,死骨少见,足骨间关节及多骨受累,溶骨破坏较骨修复占优势。病理特点:1霉菌性肉芽肿形成;2霉菌颗粒;3溶骨性骨破坏。结论:马杜拉足在X线上具有持征性表现,X线平片是诊断本病的主要影像学方法。     

Diffuse und vaskul?re Lebererkrankungen

In addition to focal liver lesions, diffuse and vascular disorders of the liver represent a wide spectrum of liver diseases which are from the radiological point of view often difficult or nearly impossible to diagnose. Classical diagnostic methods are computed tomography and magnetic resonance imaging in addition to ultrasound. Diffuse parenchymal damage caused by diseases of various etiologies is therefore difficult to evaluate because it often lacks characteristic morphological features. For hepatic steatosis, hemochromatosis/siderosis as an example of a diffuse storage disease and sarcoidosis and candidiasis as infectious/inflammatory diseases, an image-based diagnosis is appropriate in some cases. For most diffuse liver diseases, however only nonspecific changes are visualized. Vascular pathologies of the liver, such as the Budd-Chiari syndrome and portal vein thrombosis, however, can usually be diagnosed very clearly using radiology and there is also a very effective interventional radiological treatment. Chronic diseases very often culminate in liver cirrhosis which is highly associated with an increased risk of liver cancer.