Neonatal cranial ultrasound versus MRI and neurodevelopmental outcome at school age in children born preterm

AIM: To examine the correlation between neonatal cranial ultrasound and school age magnetic resonance imaging (MRI) and neurodevelopmental outcome. METHODS: In a prospective 2 year cohort study, 221 children (gestational age < or =32 weeks and/or birth weight < or =1500 g) participated at a median age of 8.1 years (inclusion percentage 78%). Conventional MRI, IQ (subtests of the WISC), and motor performance (Movement Assessment Battery for Children) at school age were primary outcome measurements. RESULTS: Overall, there was poor correspondence between ultrasound group classifications and MRI group classifications, except for the severe group (over 70% agreement). There was only a 1% chance of the children with a normal cranial ultrasound having a major lesion on MRI. Mean IQ (standard deviation) was significantly lower in children with major ultrasound or MRI lesions, but was also lower in children with minor lesions on MRI compared to children with a normal MRI (91+/-16, 100+/-13, 104+/-13 for major lesions, minor lesions, and normal MRI, respectively). Median total impairment score (TIS) was significantly higher in children with major lesions on ultrasound or MRI as well as in children with minor lesions on MRI (TIS 4.0 and 6.25 for normal and minor lesions on MRI, respectively; p<0.0001). CONCLUSIONS: A normal neonatal cranial ultrasound excluded a severe lesion on MRI in 99% of cases. MRI correlated more strongly with mean IQ and median TIS than ultrasound. Subtle white matter lesions are better detected with MRI which could explain the stronger correlation of MRI with IQ and motor performance.     

肝豆状核变性磁共振成像动态变化及相关因素分析

目的 了解肝豆状核变性(HLD)治疗过程中核磁共振成像(MRI)的动态变化及相关因素。方法对63例HLD患儿行脑及肝MRI常规序列扫描。42/63例显示异常MRI,其中22/42例MRI异常者复查1次/1.0-1.5年,共2-4次结果 10/22例惠儿MRI显示脑和肝异常信号,9/22例脑受累,3/22例肝受累。随访显示,青霉胺剂量不足且初治年龄>15岁者MRI病灶改善缓慢或无变化;停药2个月以上MRI病灶即可重现。恢复治疗后临床和MRI改善缓慢。治疗合理组临床痊愈率和MRI病灶消失率及好转率均明显高于治疗不合理组。结论HLD经合理治疗,肝及脑部MRI异常信号可随着临床改善而渐减甚至消失。治疗不合理者MRI病灶改善缓慢、无变化或重现。MRI有助于HLD疗效及预后的判断。     

Evaluation of dysfunction following reconstruction of an anorectal anomaly

To evaluate the utility of anorectal manometry (ARM) and magnetic resonance imaging (MRI) with an endocoil in the assessment of dysfunction in children with repaired anorectal anomalies (ARA), 15 patients aged 1 to 15 years with repaired ARAs and chronic faecal incontinence or constipation were prospectively recruited. They underwent clinical assessment using a modified Wingfield score (MWS). ARM and MRI with an endocoil and conventional external coil were carried out. The results of ARM alone, MRI alone, and a combination of ARM and MRI were correlated with the MWS. Manometric internal anal sphincter (IAS) scores determined from sphincter length and activity correlated with MWS (r = 0.56, P = 0.02); manometric scores of rectal peristaltic activity did not. Overall manometric score (IAS and rectal scores combined) showed a correlation with MWS (r = 0.55, P = 0.02). Endoanal MRI sphincter scores did not correlate with MWS, but the presence of a megarectum on MRI did (r = 0.44, P = 0.05). Overall MRI score did not correlate with MWS. Minor neurosacral anomalies were shown on MRI in 3 children who had poor functional scores. Combined manometric and MRI scores showed a correlation with MWS (r = 0.58, P = 0.01). ARM and MRI are potentially useful in the assessment of dysfunction of children with repaired ARAs. Both modalities require refinement and further assessment in the context of directing management.     

Evaluation of cerebral hemodynamics with perfusion MRI in childhood moyamoya disease

The purpose of our study was to evaluate the role of perfusion MRI and to compare the findings with those of conventional imaging in childhood moyamoya disease (MMD). Perfusion MRI was performed preoperatively on 13 cases of childhood MMD. Based on the perfusion MRI findings, patients were classified into four groups: those with normal regional cerebral blood volume (rCBV) and time to peak (TTP) (group 1, n = 2); those with normal rCBV and delayed TTP (group 2, n = 1); those with increased rCBV and delayed TTP (group 3, n = 5), and those with decreased rCBV and delayed TTP (group 4, n = 5). Lesion volume as determined using the rCBV map was compared with that on MRI and single photon emission computerized tomography (SPECT). The characteristics of groups 1, 2 and 3 were a high frequency of transient ischemic attacks, normal finding on MRI, early angiographic stages, decreased reserve on SPECT and favorable operative outcome. In group 3, angiography revealed abundant collateral channels. In group 4, all cases had infarction on MRI and abnormal perfusion on SPECT. Angiographic stages tended to have progressed, and operative outcome was less favorable. Perfusion MRI documented hemodynamic asymmetries in the five cases with normal MRI. Perfusion MRI is suggested to have a sensitivity intermediate between rest and acetazolamide SPECTs. We conclude that perfusion MRI may be a valuable tool for characterizing and monitoring ischemia in MMD. Perfusion MRI provides additional functional information not available from conventional MRI and has a potential role comparable to SPECT in the evaluation of MMD.     

Very-low-birth-weight, preterm infants with or without intracranial hemorrhage. Neurologic, cognitive and cranial MRI correlations at 4-8-year follow-up

Fourteen very-low-birth-weight (VLBW) preterm infants with and without intracranial hemorrhage (ICH) were prospectively followed from birth to 4 to 8 years for the purpose of determining neurologic and cognitive sequelae associated with ICH severity and to correlate outcomes with brain morphology as determined by Magnetic Resonance Imaging (MRI). Intracranial hemorrhage was documented by cranial ultrasonography performed in early life. Follow-up assessments included neurologic and psychometric examinations and cranial MRI scans. Of six children with no ICH, five had normal results on all three follow-up measures. Three children with Grade I-II ICH had mild to moderate neurologic and cognitive sequelae with focal white matter MRI abnormalities. Five children with Grade III-IV ICH had severe neurologic, cognitive, and MRI deficits, including MRI regional and diffuse white matter abnormalities and/or cortical atrophy. Focal and diffuse neurologic deficits correlated with the extent of MRI morphologic abnormalities. Results of this study indicate that ICH severity correlated with outcomes in children at follow-up; the more severe the ICH, the more adverse the neurologic, cognitive, and MRI results. MRI white matter abnormalities were present in all children with any degree ICH, while ventriculomegaly was seen only in severe ICH (Grade III-IV ICH). Neurologic deficits correlated with MRI structural abnormalities.     

Juvenile osteochondritis dissecans: a 5-year review of the natural history using clinical and MRI evaluation

BACKGROUND: Although MRI prognostic features for juvenile osteochondritis dissecans (JOCD) have been determined, the natural history of JOCD on serial MRI has not been fully documented. OBJECTIVES: To document the natural history of JOCD on serial MRI and to correlate this with arthroscopy and clinical outcome over a 5-year follow-up. MATERIALS AND METHODS: Twenty-one knees in 19 patients (15 boys, 4 girls; age range 5-15 years) with JOCD underwent MRI and clinical follow-up over 5 years. Lesions were classified as stable or unstable on MRI and compared with clinical and arthroscopic data. RESULTS: On 5-year follow-up, 17 of 19 patients were asymptomatic and 2 of 19 had minimal pain. Fourteen arthroscopies were performed on 11/21 knees. One of twenty-one had fragment fixation. On initial MRI, eight knees had marked fragmentation, high signal at the fragment/bone interface and incomplete defects in the hyaline cartilage (MRI stage III-stable), but no tear. Of these, five had arthroscopy, all confirming intact cartilage. One of twenty-one knees was unstable (MRI stage IVb) with a detached osteochondral fragment, requiring surgery. CONCLUSIONS: Despite extensive subchondral bone changes on MRI, all cases with intact cartilage (95%) improved with conservative treatment. Early MRI allows prompt diagnosis and institution of conservative treatment. This results in healing and avoidance of surgery in most patients.     

小儿化脓性脑膜炎头部磁共振成像研究

目的 了解小儿化脓性脑膜炎(化脑)不同分期的磁共振成像(MRI)表现及动态变化,探讨MRI在化脑诊治方面的应用价值.方法 诊断的化脑患儿中,按头部MRI至少检查2次的标准,共选出9例患儿,对其临床资料及不同分期头部MRI成像结果 进行回顾性分析.结果 4例头部MRI检查结果 正常,5例头部MRI检查结果 异常.依据不同分期头部MRI的动态变化诊断出脑梗死、脑软化、脑积水、硬膜下积液、硬膜下积脓及硬膜下与硬膜外出血等并发症及合并症.结论 MRI不同分期表现能反映化脑患儿头部并发症情况,同时反映出上述病变的发展变化.化脑患儿临床病情轻重与头部MRI结果 不平行,其病情严重度评价应结合临床表现及头部MRI等进行综合分析.     

The value of anal endosonography compared with magnetic resonance imaging following the repair of anorectal malformations

BACKGROUND: Surgery for anorectal malformations (ARMs) attempts to position the neo-anus anatomically within the anal sphincter complex. Currently, MRI is the imaging modality of choice in determining the position of the neo-anus after reconstructive surgery. OBJECTIVE: The aim of this study was to compare the accuracy of anal endosonography (AES) with conventional MRI in demonstrating the anatomy of the neo-anus following repair of ARMs. MATERIALS AND METHODS: Fourteen children (ten girls, four boys), born with ARMs (four low, ten high) underwent both AES and pelvic MRI following anorectoplasty. The results of both investigations were compared with muscle stimulation and were reported blindly by a clinician and a radiologist. RESULTS: AES findings were comparable with MRI in 9 of the 14 cases. In four cases, MRI and AES findings differed, with nerve stimulation supporting AES but not MRI. CONCLUSIONS: AES is an accurate alternative to MRI in the assessment of anorectoplasty. It provides more detailed information and can be performed under anaesthesia in combination with a surgical procedure.     

The anorectal sphincter after rectal pull-through surgery for anorectal anomalies: MRI evaluation

The puborectalis muscle sling was evaluated with MRI in 10 pediatric patients who had rectal pull-through surgery for anorectal anomalies. MRI (1.5T) demonstrated the puborectalis muscle equally or better than CT in 5 patients who had both CT and MRI. The amount of puborectalis muscle mass and the location of the pulled-through intestine in relation to the puborectalis sling was well shown with MRI. Our study suggests that MRI can be reliably substituted for CT in the majority of these patients, to assist in planning further surgery for relief of persistent postoperative fecal incontinence.     

磁敏感加权成像与常规磁共振序列诊断新生儿颅内出血的比较研究

目的 探讨磁敏感加权成像（SWI）在新生儿颅内出血的应用价值。方法 纳入2009年8月至2011年2月复旦大学附属儿科医院NICU临床疑诊脑损伤的新生儿,同时进行常规MRI和SWI扫描。分为足月儿组和早产儿组,统计常规MRI和SWI检测的出血部位、出血病灶数目和出血面积的差别。结果 596例临床疑诊脑损伤的新生儿进入分析。①常规MRI检出颅内出血117例（19.6%）,早产儿组72例（61.5%）;SWI检出颅内出血134例（22.5%）,早产儿组81例（60.4%）,包括生发基质出血40例（早产儿33例,足月儿7例）,侧脑室出血68例（早产儿54例,足月儿14例）,脉络丛出血30例（早产儿18例,足月儿12例）,第三脑室出血6例（早产儿）,中脑导水管出血3例（早产儿）,第四脑室出血27例（早产儿23例,足月儿4例）,大脑实质出血22例（早产儿14例,足月儿8例）,小脑出血20例（早产儿11例,足月儿9例）,脑干出血1例（足月儿）,蛛网膜下腔出血10例（早产儿4例,足月儿6例）,硬膜下出血36例（早产儿17例,足月儿19例）,硬膜外出血2例（足月儿）。②生发基质-脑室内出血（6个部位）中,除了中脑导水管出血外,其他5个部位的出血病灶检出数目SWI均大于常规MRI（P均＜0.05）。SWI对蛛网膜下腔出血的检出数目大于常规MRI（P＜0.05）;对硬膜下出血和硬膜外出血的检出数目上,SWI和MRI差异无统计学意义（P＞0.05）。③SWI序列81例早产儿生发基质-脑室出血主要为生发基质出血（44个）、侧脑室出血（90个）和脉络丛出血（26个）;53例足月儿生发基质-脑室出血以侧脑室出血（23个）和脉络丛出血（18个）多见。④98例在SWI和常规MR同时显示出血的病例,颅内出血（生发基质-脑室内出血、大脑和小脑实质出血）面积（cm2）SWI均大于常规MRI的T2WI序列,（0.69±0.63）vs（0.49±0.48） ,P<0.001。结论 SWI较常规MRI在检出新生儿各种类型的颅内出血和蛛网膜下腔出血的阳性率、病灶数目和出血面积方面有明显的优势, 可作为常规MRI的有力补充。     

Contribution of magnetic resonance imaging in the neonatal diagnosis of congenital cardiopathies. Apropos of 10 cases

The aim of this study was to evaluate potential indications of Magnetic Resonance Imaging (MRI) in the diagnostic workup of congenital heart disease in the newborn in comparison with two other means of investigation: Doppler-echocardiography and angiography. The imaging permitted to make the diagnosis in the 10 cases. MRI was superior than echocardiography in one newborn with a double aortic arch. MRI detected small muscular ventricular septum defects in two newborns with transposition of the great vessels. There was good agreement between MRI and angiographic images. Neither age nor prematurity proved to pose a limit on the diagnosis of MRI. MRI proved to be a good investigative tool which should be used after echocardiography, eventually making it possible to avoid angiography.     

新生儿不同病原菌化脓性脑膜炎在磁共振影像学上的特点

目的：探讨不同病原菌感染的新生儿化脓性脑膜炎（简称化脑）患儿的头颅磁共振（MRI）成像特点。方法：回顾性分析2005年1月到2012年2月住院治疗并行头颅MRI检查的58例新生儿化脑患儿的临床资料,对其病原体及影像学表现进行分析。结果：58例新生儿化脑患儿中首次头颅MRI检查出现神经系统并发症的有44例,发生率76%。革兰阴性菌感染以大肠杆菌感染最常见（6例）,其头颅MRI表现为脑室膜炎4例,硬膜下积液1例,脑梗死1例;革兰阳性菌感染以李斯特菌居多（3例）,头颅MRI均表现为不同程度的脑白质损伤。结论：不同病原体感染化脑的MRI成像表现不同,提示不同病原体感染化脑在MRI上的表现特点有助于临床诊断及治疗。     

Value of fetal cerebral MRI in sonographically proven cardiac rhabdomyoma

Background Tuberous sclerosis complex (TSC) is an autosomal dominant phakomatosis associated with intracardiac rhabdomyomas. Objective The aim of our study was to examine the value of cerebral MRI in diagnosing TSC in fetuses with intracardiac rhabdomyomas, applying the TSC Consensus Conference (TSCCC) criteria. Materials and methods In a prospective manner six consecutive fetuses with cardiac rhabdomyomas (21–34 weeks’ gestation) underwent cerebral MRI. The MRI results were correlated with clinical follow-up at 10–34 months after birth, histology, and genetic data. Results In five of the six fetuses the diagnosis of TSC was established. In two of five fetuses MRI demonstrated cerebral manifestations of TSC that correlated well with severe epilepsy manifesting during the follow-up period. In another two of five fetuses MRI as well as clinical follow-up were normal. One of five pregnancies was terminated and histology demonstrated microscopically small subependymal nodules not demonstrated by MRI. Conclusion The results of our study agree with the available literature that fetal MRI is sufficient for the detection of cerebral lesions in TSC and should be better promoted. The TSCCC criteria can also be applied to fetal MRI.     

Limitations of ultrasonography for diagnosing white matter damage in preterm infants

OBJECTIVES: To compare the accuracy of ultrasonography (US) and magnetic resonance imaging (MRI) in diagnosing white matter abnormalities in preterm infants and to determine the specific indications for MRI. DESIGN: Prospective cohort study. SETTING: A neonatal intensive care unit in France. PATIENTS: All preterm infants (相似文献   

Spine evaluation in children with anorectal malformations

The value of radiography, ultrasound and magnetic resonance imaging (MRI) in detecting skeletal and intraspinal pathology was assessed in infants with anorectal malformations, and the need for spinal MRI examination in this group of patients was evaluated. Twenty-one infants were examined with radiography, ultrasound and MRI of the lower spine. The detection of skeletal and intraspinal abnormalities was compared for the three imaging modalities. Fifteen patients were normal in all three examinations. Radiography showed bony skeletal abnormalities in six children, although sometimes very subtle. By ultrasound both bony and cartilaginous malformations were detected in all six patients and by MRI in five patients. Five of the six children with skeletal abnormalities had intraspinal pathology, detected in all cases by ultrasound and MRI. However, the abnormalities were more clearly demonstrated by MRI than by ultrasound. Spinal radiographs must be examined carefully for abnormalities, because they can indicate the presence or absence of intraspinal pathology. Normal radiographic and sonographic appearance of spinal anatomy in children with anorectal malformation makes MRI superfluous, but if radiographs or ultrasound are abnormal, MRI should be used to accurately depict possible intraspinal pathology.

     

Magnetic resonance imaging of lesions of the posterior fossa and upper cervical cord in childhood

Magnetic resonance imaging (MRI) promises to be an effective, noninvasive means of visualizing intracranial pathology. It should be especially useful in the evaluation of posterior fossa and cervical spinal cord disease of childhood; computed tomographic (CT) evaluation is frequently suboptimal in this region. MRI results are reported for 46 consecutively seen children with posterior fossa and/or cervical spinal cord disease (28 had brain malignancies; seven had congenital anomalies; three had cerebrovascular accidents). MRI was performed primarily by the partial saturation on a .12 Tesla resistive proton unit. All patients underwent concurrent CT evaluation. MRI demonstrated abnormalities in 96% of scans in patients with structural CNS disease (48 of 50). CNS malignancies were visualized in 100% (28 of 28) of children studied. MRI was especially useful in demonstrating the full extent of infiltrating gliomas and the anatomic location of other mass lesions. MRI frequently demonstrated disease to be more extensive than seen on CT. MRI was more sensitive than CT in documenting response to treatment and disease relapse in patients with infiltrating tumors. Cystic regions within tumors were poorly seen on MRI. Congenital anomalies were demonstrated in all patients evaluated and were better delineated using MRI than CT. MRI is sensitive in the evaluation of posterior fossa and cervical spinal cord disease of childhood and it has obvious advantages over CT; however, its specificity in such evaluations has yet to be proven.     

磁共振成像在儿童肝豆状核变性预后判断中的意义

目的探讨磁共振成像（MRI）在儿童肝豆状核变性（hepatolenticular degeneration,HLD）预后判断中的意义。方法对临床确诊为HLD的70例患儿应用MRI进行脑及肝常规序列扫描。其中25例予MRI动态观察,结合临床资料进行综合分析。结果70例患儿中48例显示脑或／和肝异常MRI。25例动态观察患者中12例MRI显示脑和肝异常信号,10例脑受累,3例肝受累。青霉胺剂量不足、初治年龄〉15岁或治疗前病程〉5年者,MRI病灶严重且改善缓慢或无变化。停药2个月以上MRI病灶即可重现,并伴有异常的神经系统症状和体征,但肝型患者可无临床症状和肝功能异常。动态MRI显示,治疗合理组临床及MRI病灶缓解率明显高于治疗不合理组;25例患儿经合理治疗1年以上临床及MRI逐渐好转直至消失,并都能正常学习与工作,13例缓解迁延及11例复发患者均存在治疗不合理因素,且MRI病灶严重,其中12／14例患者不能学习或工作。结论肝豆状核变性经合理治疗后,肝及脑部MRI异常信号可随临床改善而逐渐消失。治疗不合理者MRI病灶严重、改善缓慢、无变化或重现。MRI检查有助于肝豆状核变性预后的判断。     

Routine magnetic resonance imaging of the spine in children with Gaucher disease: does it help therapeutic management?

Background Routine magnetic resonance imaging (MRI) surveillance of bone marrow change in patients with Gaucher disease (GD) is recommended, but interpretation of imaging findings in the developing skeleton may be difficult.Objectives To assess the agreement between routine spinal MRI findings and clinical course in paediatric GD patients receiving enzyme replacement therapy (ERT).Materials and methods A retrospective institutional review of all GD patients on ERT who had had repeated routine spinal MRI in accordance with national recommendations (n=14) was carried out. Vertebral body bone marrow MRI T1 signal was assessed relative to intervertebral discs. MRI findings were then compared with recorded date(s) of ERT initiation and possible therapy changes.Results Nine patients had spinal MRI both before and after the start of ERT. MRI T1 marrow signal was normal in two and abnormal in three of the nine patients both before and after the start of ERT. Two of the nine patients had normalization and one had conversion from normal to abnormal T1 signal. Interpretation was uncertain in one. Seven episodes of treatment intensification occurred. MRI T1 marrow signal was normal before five and uncertain before two of the seven episodes.Conclusion Routine spinal MRI had low accuracy for predicting clinically indicated therapy intensification.     

Abnormal diffusion-weighted MRI in medulloblastoma: does it reflect small cell histology?

A 12-year-old boy presented with the classic CT and MRI findings of medulloblastoma and the unusual finding of increased signal on diffusion MRI. The small-cell histology of medulloblastoma may account for the increased signal seen on diffusion MRI. Diffusion MRI with echoplanar technique may be useful in evaluation of these tumors and metastatic disease. Received: 14 December 1998 Accepted: 29 January 1999     

Assessment of disease activity and extent by magnetic resonance imaging in ulcerative colitis

BACKGROUND: We determined whether magnetic resonance imaging (MRI) could determine the activity and site of involvement in ulcerative colitis. METHODS: Colonoscopy, double-contrast barium enema and gadodiamide-enhanced MRI were performed prospectively in six patients with ulcerative colitis, including three females aged 10-22 years, both in the active and the remission stages. RESULTS: Characteristic findings of MRI in the active stage of ulcerative colitis were loss of haustral markings and thickening and contrast enhancement of the colonic wall. In five of six patients, the site of disease distribution determined by MRI was in accordance with that determined by colonoscopy. CONCLUSIONS: Gadodiamide-enhanced MRI is a safe and useful method of determining disease activity and extent in patients with ulcerative colitis.