Thoracic ganglioneuroma with intra-spinal prolongations in childhood

A case of thoracic ganglioneuroma is described because of the intraspinal extension of the lesionwithout any neurological features.     

A rare case of idiopathic staghorn urolithiasis in childhood. Imaging diagnosis]

The authors describe one case of kidney staghorn lithiasis in a little patient 1 1/2 years old, as complication of a megacalycosis with associated pyelo-ureteral junction dysplasia. They underline the value of ultrasound both as a first examination and, particularly, in the follow up because of the non invasivity of the technique and the correct information about the persistence of calculi and dilatation.     

Imaging intracranial tuberculosis in childhood

A morphologically based imaging review of intracranial tuberculosis in childhood is presented. The computed tomography and magnetic resonance features of parenchymal tuberculoma, tuberculous meningitis and meningeal/meniningocerebral tuberculoma are illustrated. Recent insight into the nature of tuberculoma necrosis and its magnetic resonance correlation is reviewed. Pathogenesis, relevant clinical background and the role of modern imaging is discussed.     

Imaging of liver tumours in childhood

Primary liver tumours account for 6% of all paediatric neoplasms. In a child with a clinical abdominal mass, imaging (in consultation with a paediatric surgeon) aims to confirm the intrahepatic site, determine its likely resectability, exclude metastatic abdominal disease, and characterise the mass. The imaging in 44 patients with primary liver tumour over a 33-year period was reviewed and correlated with surgical/pathological findings. Characterising hepatic masses with ultrasound, computed tomography, nuclear medicine, and angiography is less important than determining its resectability and alerting the surgeon to vascular anomalies and the presence of metastatic disease. We conclude that a chest X-ray and ultrasound study are the primary methods for evaluation of a child with suspected hepatic mass. With careful attention to technique, the mass can be evaluated and an assessment made of tumour resectability preoperatively. Based on this review, we propose a schema for the initial evaluation of suspected hepatic masses in children. Offprint requests to: J. F. de Ocampo     

Imaging findings in noncraniofacial childhood rhabdomyosarcoma

Rhabdomyosarcoma (RMS) is the most common soft-tissue sarcoma of childhood. This paper is focuses on imaging for diagnosis, staging, and follow-up of noncraniofacial RMS.     

Imaging findings in craniofacial childhood rhabdomyosarcoma

Rhabdomyosarcoma (RMS) is the commonest paediatric soft-tissue sarcoma constituting 3–5% of all malignancies in childhood. RMS has a predilection for the head and neck area and tumours in this location account for 40% of all childhood RMS cases. In this review we address the clinical and imaging presentations of craniofacial RMS, discuss the most appropriate imaging techniques, present characteristic imaging features and offer an overview of differential diagnostic considerations. Post-treatment changes will be briefly addressed.     

Imaging in early phase childhood cancer trials

Advances made in the treatment of childhood malignancies during the last four decades have resulted in overall cure rates of approximately 80%, but progress has slowed significantly during the last 10 years, underscoring the need for more effective and less toxic agents. Current research is focused on development of molecularly targeted agents, an era ushered in with the discovery of imatinib mesylate for the treatment of chronic myelogenous leukemia. Since imatinib’s introduction into the clinic, an increasing number of tyrosine kinase inhibitors have been developed and entered into clinical trials and practice. Parallel to the initial advances made in molecularly targeted agents has been the development of a spectrum of novel imaging modalities. Future goals for imaging in childhood cancer research thus include (1) patient identification based on target identification or other biologic characteristics of the tumor, (2) assessing pharmacokinetic-pharmacodynamic (PK-PD) effects, and (3) predictive value with an early indication of patient benefit. Development and application of novel imaging modalities for children with cancer can serve to streamline development of molecularly targeted agents.     

新生儿腹膜后占位性病变诊治分析

目的探讨新生儿腹膜后占位性病变的诊断与治疗方法。方法回顾性分析本院2003年至2008年间年龄小于2个月的腹膜后占位性病变患儿的临床特征、治疗及预后。结果收治病例12例，男8例，女4例，中位年龄4．5d，均因腹部包块入院。其中肾上腺血肿4例，B超及CT表现为肾上腺区囊性占位，24h尿3甲氧-4羟基苦杏仁酸（VMA）均无升高，门诊随访1个月左右肿块吸收；神经母细胞瘤3例，B超及CT表现为腹膜后囊性或囊实性肿块影，24h尿VMA无明显升高，其中1例为Ⅳs期，予化疗后手术切除，术后继续化疗，定期随访疗效满意；1例为Ⅳ期，皮肤结节活检明确诊断后家属放弃治疗；1例为Ⅰ期，门诊随访2个月左右肿块开始消退；畸胎瘤5例，B超及CT表现为混合性占位（囊性＋实质性＋钙化）；24h尿VMA无升高；4例予手术治疗，其中1例术后因“失血性休克”死亡，其余3例治愈出院，门诊随访疗效满意。结论新生儿腹膜后占位大多能通过影像学及实验室检查明确诊断。肾上腺血肿可自行消退，预后良好。神经母细胞瘤可采用包括手术及化疗等的综合治疗，效果满意，也有一部分可自然消退，不需治疗。新生儿畸胎瘤大多为良性病变，可手术切除，预后良好。     

Catecholamine metabolites in ganglioneuroma

With rare exception, ganglioneuroma (GN) is a benign lesion which presents as a localized mass without metastatic potential and which is chemotherapy resistant. Thus, its distinction from neuroblastoma (NB) may be important. The diagnosis of GN implies the absence of neuroblastic elements. Incomplete resection prevents complete microscopic examination and raises the possibility that focal NB was not sampled. In an attempt to determine what features other than histology distinguish these two entities, we reviewed the charts of 25 patients with GN with regard to patient age and sex, tumor location and size, and urine catecholamine metabolite levels. One patient with GN (5%) and gross total resection had elevated quantitative vanillylmandelic acid (VMA) and homovanillic acid (HVA) levels (2.4 × upper limit of normal for age), and two others had positive spot analyses for VMA. An additional patient with a large mass, multiple biopsies of which documented GN, also had greatly elevated (approximately 5 × normal) VMA and HVA levels. However, a subsequent attempt at resection disclosed several gross foci of NB. Even excluding this patient, there was a trend for elevated values in GN patients to correlate with tumor size (P = .07 and .14 for VMA and HVA, respectively). The incidence of elevated values appears to increase as a function of tumor size, and small tumors are not likely to result in positive urinary measurements. We conclude that while elevations of VMA and HVA are consistent with a well-documented diagnosis of GN, extreme elevations (>3 × nl) should prompt careful serial evaluation for occult NB.© 1994 Wiley-Liss, Inc.     

Imaging of traumatic dislocation of the hip in childhood

Background Traumatic hip dislocation in childhood is a rare consequence of violent trauma. After reduction, outcome is usually favourable although epiphyseal necrosis can occur. Reduction must be carried out as soon as possible and is achieved easily, although if the labrum is involved, surgery may be required to achieve complete reduction.Objective To analyze a retrospective series of traumatic hip dislocations in children, describing the therapeutic and imaging strategy.Materials and methods A total of 42 patients were studied. Their mean age was 10 years 3 months. All relevant radiographic, CT, MRI and radionuclide bone scan examinations were reviewed. Special attention was paid to associated lesions.Results In 22 patients the dislocation was caused by low-energy trauma. Road traffic accidents accounted for 17 dislocations. An acetabular fracture was present in six patients and the femoral head was fractured in three. Reduction was easily achieved in 31 patients. In 11 patients the postreduction radiograph and CT showed joint space asymmetry secondary to labral entrapment. Only two patients developed epiphyseal necrosis.Conclusions It has been difficult to define and evaluate accurate principles for a medical imaging strategy in this group of patients. Analysis of plain radiographs is essential before and after reduction of the joint, and it is important to perform postreduction CT in every patient whose joint space remains widened. A radionuclide bone scan should be performed between the second and third weeks after injury to assess epiphyseal vascularity. With the use of specific sequences, MRI may be an alternative modality to assess epiphyseal vitality.