Improved Diagnostic Sensitivity of Bowel Disease of Prematurity on Contrast-Enhanced Ultrasound

Bowel diseases of prematurity, including necrotizing enterocolitis, are dreaded ailments of neonates. Early diagnosis is difficult, with clinical and radiographic findings often inconclusive. We present a novel use of contrast-enhanced ultrasound in detection of pediatric bowel disease. Early identification of compromised blood flow or an at-risk bowel can be quantitatively detected and monitored. This ability has implications for guidance of emerging therapies, allowing targeting of inflammation. These findings represent an advancement in detection of bowel disease in neonates.     

Functional and morphologic evaluation of congenital urinary tract dilatation by using combined static-dynamic MR urography: findings in kidneys with a single collecting system

PURPOSE: To assess combined static-dynamic magnetic resonance (MR) urography in the evaluation of congenital urinary tract dilatation in infants and children. MATERIALS AND METHODS: Sixty-two patients with urinary tract dilatation underwent prospective examination with combined static-dynamic MR urography. A combination examination involved use of a static T2-weighted three-dimensional inversion-recovery fast spin-echo sequence and a dynamic T1-weighted two-dimensional fast field-echo sequence with gadopentetate dimeglumine-DTPA and furosemide application. Twelve additional patients underwent examination with only static MR urography. Thus, both image quality and morphologic features were assessed in 74 patients with the use of MR urography. The results were compared with those of ultrasonography and, when available, conventional urography or surgery. In 62 patients, the dynamic sequence was used to calculate split renal function from renograms generated from parenchymal regions of interest and to assess urinary excretion from whole-kidney renograms. Results were compared with those of diuretic renal scintigraphy (DRS) for split function (Spearman rank correlation coefficient) and urinary excretion (kappa coefficient). RESULTS: Stenoses at the ureteropelvic (n = 33) and ureterovesical (n = 31) junctions and within the ureter (n = 3) and nonstenotic dilatation (n = 23) were clearly depicted, while the normal urinary tract (n = 51) was depicted in its entirety in 47 of 51 examinations. Image quality was considered good or excellent in 95% of the kidney-ureter units. For split renal function, dynamic MR urography and DRS showed significant correlation (r = 0.92, P <.001). For urinary excretion, MR urography and DRS showed strong agreement (kappa = 0.67), with concordant classification of urinary excretion in 59 (81%) of 73 abnormal kidney-ureter units and in all 47 (100%) normal kidney-ureter units. CONCLUSION: Combined static-dynamic MR urography provides high-quality depiction of the urinary tract in infants and children, while allowing accurate determination of single-kidney function and reliable evaluation of urinary excretion.     

Combined static-dynamic MR urography for the simultaneous evaluation of morphology and function in urinary tract obstruction

Objective. A new approach, combined static-dynamic MR urography is evaluated to determine its potential utility for the functional-morphological diagnosis of paediatric urinary tract obstruction. In this initial investigation we sought to evaluate the procedure by imaging the urinary tract of piglets. Materials and methods. Twenty-nine healthy piglets were studied with MR urography (MRU), ^{99 m}Tc-MAG3 diuretic renal scintigraphy (DRS), ultrasound (US) and excretory urography (EU). The functional and morphological findings were compared. For MRU we combined a respiration-triggered 3D-IR-TSE sequence and a dynamic 2D-FFE sequence after Gd-DTPA injection. Results. MRU depicted the complete urinary tract with superior image quality compared to EU. Calculation of time-intensity curves from the dynamic sequence permitted determination of single kidney function from parenchymal ROIs and urinary excretion using the whole kidney ROI. MRU and DRS showed significant agreement in the assessment of both single kidney function and urinary excretion. Disturbances of urinary drainage were generally caused by an overfilled bladder. Conclusions. Combined static-dynamic MRU is well suited for the depiction of the complete urinary tract and for the determination of individual kidney function and urinary excretion in the piglet. Received: 21 February 2000 Accepted: 14 March 2000     

Combined static-dynamic MR urography for the simultaneous evaluation of morphology and function in urinary tract obstruction

PURPOSE: To assess the diagnostic value of combined static-dynamic MR urography (MRU) for the functional-morphological evaluation of experimentally induced urinary tract obstruction in the piglet. MATERIALS AND METHODS: In 20 piglets unilateral ureteric stenosis was created operatively. Post-surgery repeated comparative examinations were obtained with MRU, diuretic renal scintigraphy (DRS), excretory urography (EU) and ultrasound (US). MRU was performed as a combination study with a static 3D-IR-TSE sequence and a dynamic 2D-FFE sequence after Gd-DTPA with frusemide administration. RESULTS: MRU allowed complete depiction of the prestenotic urinary tract and of the stenosis in all cases. In 43 comparative studies MRU was superior to EU in 36, EU to MRU in 2. When single kidney function was calculated with both MRU and DRS, results were highly correlated (r = 0.92). When urinary excretion was compared, significant agreement was achieved with concordant findings in 86% and slightly discordant results in 12%. CONCLUSIONS: Static-dynamic MR urography permits excellent depiction of experimentally induced urinary tract obstruction in piglets and reliable assessment of individual renal function and urinary excretion. Two advantages of the method stand out--it does not require radiation and it permits functional-morphological correlation.     

Radiation exposure during chest X-ray examinations in a premature intensive care unit: phantom studies

Background. There are few reports on the radiation dose received by infants, their family and radiographers exposed to scatter radiation in a premature baby intensive care unit. Objective. To evaluate the degree of radiation exposure from diagnostic X-ray examinations with mobile X-ray machines in a premature intensive care unit. Materials and methods. The radiation exposure of an adjacent newborn, the radiographer and other persons in the room was simulated using phantoms during X-ray examination of the chest using vertical and horizontal beams. Results. Most of the measured doses were below the registration limit of the measuring apparatus and had to be extrapolated by multiple exposures. Without exception, the maximal doses were significantly lower than the permitted limit for persons not professionally exposed to X-rays. Conclusions. Recommendations to avoid unnecessary radiation exposure are given. Received: 29 September 1997 Accepted: 24 September 1998     

Statisch-dynamische MR-Urographie Vergleich mit Ausscheidungsurographie und Szintigraphie bei experimentell induzierter Harntransportstörung (HTS)

Purpose. To assess the diagnostic value of combined static-dynamic MR urography (MRU) for the functional-morphological evaluation of experimentally induced urinary tract obstruction. Methods: Static-dynamic MRU – combination study with a respiratory-triggered 3D-IR-TSE sequence and a dynamic 2D-FFE sequence after Gd-DTPA and furosemide – was obtained in comparison with ^99mTc-MAG3 diuretic renal scintigraphy (DRS), excretory urography (EU) and ultrasound (US) in 29 healthy piglets and in 20 piglets with surgically induced ureteric stenosis (total of 50 postoperative examination blocks). Results: MRU allowed complete depiction of the urinary tract in all controls, in operated piglets the stenosis was always correctly identified. Quality of MRU was superior to EU in 36 of 43 comparative studies. Calculation of single kidney function from parenchymal renograms, and assessment of urinary excretion from whole-kidney renograms resulted in a highly significant agreement of MRU with DRS. Conclusion: Static-dynamic MR urography allows excellent depiction of experimentally induced urinary tract obstruction, and reliable assessment of individual renal function and urinary excretion. Two advantages of the method stand out, it does not require radiation and it permits a functional-morphological correlation.     

Fremdk?rperaspiration

Die Fremdk?rperaspiration stellt eine h?ufige Ursache für Atemnot und respiratorische Insuffizienz bei S?uglingen und Kleinkindern zwischen 6 Monaten und 3 Jahren dar. R?ntgendichte Fremdk?rper bereiten bei Abbildung des gesamten Respirationstraktes keine diagnostischen Schwierigkeiten. Nicht r?ntgendichte Fremdk?rper erfordern ein differenzierteres Vorgehen, wobei der erste radiologische Schritt in einer konventionellen Thoraxaufnahme in In- und Exspiration bestehen sollte. Zus?tzliche Aufnahmen, Durchleuchtungsuntersuchung und gegebenenfalls die Durchführung einer computertomographischen oder szintigraphischen Untersuchung h?ngen vom Ergebnis der Thoraxaufnahme ab. H?ufigstes radiologisches Erscheinungsbild ist die einseitige exspiratorische Ventilstenose mit überbl?hung des betroffenen Lungenabschnittes. Seltener finden sich Atelektasen, rezidivierende Pneumonien an identischer Lokalisation und inspiratorische Ventilstenosen. Kombinationsbilder sind m?glich, selbst ein unauff?lliges Untersuchungsergebnis kann eine Aspiration nicht ausschlie?en.