Defekografia i wlew doodbytniczy w ocenie przyczyn zaparć przewlekłych i nietrzymania stolca u dzieci

Background: The aim of the study was to assess the role of radiographic examinations, i.e. barium enema and defecography, in the diagnosis of chronic disturbances in defecation in children. Materials/Methods: The study group of 117 children was divided into 2 groups: children with constipation (subgroup A: children with constipation only, subgroup B: children with constipation and fecal incontinence) and children with fecal incontinence. Defecography was performed in 62 patients, barium enema in 70 patients, and defecography with barium enema in 32 patients. Retrospectively, a group of 20 children with barium enema, but without constipation or incontinence, was analyzed. Results: We assessed the length and width of the colon, features of non-specific inflammatory processes, and competence of the ileocecal valve. No statistically significant differences in the occurrence of the above-mentioned symptoms were observed between these study groups. Anorectal angle, pelvic floor excursion (descent), paste evacuation, width of the anal canal, and morphology of the rectum were assessed in the defecographic examination. Statistically significant differences concerning pelvic floor excursion, paste evacuation, and anal canal width as well as the coexistence of an abnormal anorectal angle and paste evacuation were observed between children with obstruction and children with fecal incontinence. Conclusions: 1. Barium enema has little diagnostic value in chronic constipation in children. 2. The advantages of defecography are a) precise definition of the kind and severity of disturbances in pelvic floor function; this is essential for effective treatment, b) the simplicity of the investigation, and c) its cost effectiveness. 3. The disadvantages of defecography are a) equivocal interpretation of single abnormal parameters, b) patient age should be above 6 years due to the necessity of close cooperation during examination, and c) the use of ionizing radiation, making the examination one of the last in the chain of diagnostic methods

Diagnostyka obrazowa choroby Coatsa

Background: Coats' disease is a rare congenital vascular abnormality of the retina consisting of multiple teleangiectases, breakdown of the retina-blood barrier, and formation of subretinal lipoproteinaceous exudate, leading to retinal detachment. Material/Methods: Globe imaging using US, CT, and MR was performed in five patients with decreased visual acuity (4 boys and 1 girl), aged 1-16 years, with a diagnosis or suspicion of Coats' disease. Results: Retinal thickening in the temporal quadrant was observed in one child. In the other four children, V-shaped retinal detachments with exudate accumulated beneath the detached retina were observed. All affected globes showed decreased anterior-posterior diameters compared with the contralateral eye. Calcifications of the retinal regions were not present. Conclusions: Globe imaging in Coats' disease precisely shows retinal abnormalities and typical subretinal exudates. These lesions are nonspecific and differentiation from other causes of exudative retinal detachment should be performed

Disseminated lesions of the central nervous system in course of pediatric brain tumors

Background: Neoplasms of the central nervous system (CNS) are, apart from leukemia, the most frequent malignant disorders in the childhood. Among the brain tumors, those of poorly differentiated cells - give metastatic lesions to the CNS. The aim of the paper was to evaluate the features of CT and MR images detecting dissemination of the primary brain tumors. Material/Methods: From 1993 to 2005 in the Department of Radiology of the Polish Mother’s Memorial Hospital - Research Institute, the disseminations to CNS were observed in 35 children who were previously operated for primary brain tumors. CT and MR examinations of the brain were performed in all patients (22 males and 13 females; age: 5 mo - 18 y) and MR imaging of the spinal cord was done in 18 children. Results: Multiple metastases to the cerebral structures were detected more often (in 23 patients - 66%) as compared to single lesions. The most frequent disseminations were observed in patients with diagnosis of medulloblastoma - 13 children, PNET - 4 and pineoblastoma - 3 patients. Twelve children had single metastatic tumors (out of the primary neoplasm location): in the course of medulloblastoma - 6, and PNET - 2 patients. Eighteen MR examinations of the spinal canal showed disseminations of the brain tumors in 9 children; concomitant metastatic nodules in the brain were detected in 4 patients. Conclusions: CT and MR imaging of the CNS enables evaluating the dissemination of primary brain tumors in children. Any asymptomatic progression of the primary neoplastic disease may be detected by means of control diagnostic imaging, which reveals the tumor spread. Especially in patients with medulloblastoma and pineoblastoma, the spine MR imaging with gadolinium is mandatory

Ultrasonografia w ocenie martwiczego zapalenia jelit u noworodków z urodzeniową masą ciała poniżej 2000 g – doniesienie wstępne

Objectives: Necrotizing enterocolitis (NEC) is a common cause of morbidity in the neonatal care units, especially in cases of preterm neonates with low and very low birth weight. Plain abdominal radiography remains to be the main diagnostic tool in the diagnosis and follow-up of NEC. However, it is sometimes impossible to depict all pathological findings in the radiographs. Furthermore, radiography exposes the youngest, most sensitive patients to consecutive episodes of radiation. Ultrasound examination seems to be an interesting alternative to current standard usage of radiography, and its role is still underestimated. The aim of the paper was to assess the applicability of ultrasound examination in the diagnosis and monitoring of neonates suffering from NEC. Material and methods: The study group consisted of 12 neonates (gestational age 25-36 weeks, weight 540-1900 g), suspected of NEC development. Abdominal radiographs obtained with the use of anterior-posterior and lateral projections, as well as ultrasound examination, were performed. During bowel sonography, attention was paid to the presence of intraabdominal fluid, free intraperitoneal gas, bowel wall thickness and bowel wall perfusion. Intramural gas, free intraperitoneal gas and signs of bowel distension were evaluated on the radiographs. Results: Bowel distension was found in all patients. The presence of intraluminal gas was detected in 3 neonates, whereas the signs of bowel perforation were present in only 2 patients. Ultrasound evaluation revealed bowel wall thickening together with increased bowel wall perfusion in 9 patients. Only one neonate presented thinning of the bowel wall, decreased bowel wall perfusion and presence of free intraperitoneal fluid. These findings were connected with a poor outcome of that patient. Conclusions: Ultrasound examination can be extremely helpful for the initial diagnosis as well as the follow-up of patients developing NEC. It allows to depict the majority of pathological findings for NEC, even those not visible on plain abdominal radiography. It is important to emphasize that abdominal sonography (with special reference to the bowel sonography), together with plain abdominal radiography, should be considered as standard imaging modalities for the assessment of necrotizing enterocolitis.Wstęp: Martwicze zapalenie jelit (NEC) stanowi istotny problem diagnostyczny i terapeutyczny, szczególnie w grupie wcześniaków z małą i bardzo małą masą urodzeniową. Podstawowym narzędziem służącym do oceny stopnia zaawansowania choroby jest częste wykonywanie zdjęć rentgenowskich jamy brzusznej. Jednak ze względu na występowanie niemych radiologicznie przypadków NEC oraz narażenie na promieniowanie jonizujące szczególnie wrażliwych, najmłodszych pacjentów, poszukuje się obecnie alternatywnych metod diagnostycznych, które służyłyby ocenie, jak i monitorowaniu chorych. Cel pracy: Celem pracy jest ocena roli ultrasonografii w diagnostyce i monitorowaniu noworodków z martwiczym zapaleniem jelit. Materiał i metody: Badaniem objęto grupę dwunastu noworodków z małą i bardzo małą masą urodzeniową, u których klinicznie zdiagnozowano występowanie NEC. Diagnostyka obrazowa polegała na wykonywaniu zdjęć rentgenowskich w projekcjach przednio – tylnej i bocznej oraz jednoczasowej ocenie ultrasonograficznej z opcją kolorowego Dopplera. Na zdjęciach rentgenowskich oceniano: rozdęcie pętli jelit, obecność gazu w ścianie jelita oraz cechy perforacji. W przypadku badania ultrasonograficznego rejestrowano: grubość ściany jelita, obecność gazu oraz przepływ krwi w jej obrębie, a także obecność wolnego płynu oraz gazu w jamie otrzewnej. Wyniki: Rozdęcie jelit w obrazie rentgenowskim stwierdzono u wszystkich dwunastu pacjentów. Obecność gazu w ścianie jelita wykazano w trzech, a perforację w dwóch przypadkach. W ocenie ultrasonograficznej u dziewięciu pacjentów wykryto pogrubienie ściany jelita i wzmożenie przepływu naczyniowego. U jednego noworodka wystąpiło ścieńczenie ściany jelita, brak przepływu naczyniowego w jej obrębie oraz obecność wolnego płynu w jamie otrzewnej, co stanowiło złe czynniki rokownicze u tego pacjenta. Wnioski: Badanie ultrasonograficzne jest bardzo użyteczną metodą diagnostyczną noworodków z objawami NEC. Umożliwiając wizualizację objawów niewidocznych na zdjęciach rentgenowskich, ułatwia ocenę kliniczną i monitorowanie pacjentów. Połączenie badania ultrasonograficznego jamy brzusznej noworodka, ze zwróceniem szczególnej uwagi na ocenę jelit, ze zdjęciem rentgenowskim tej okolicy, winno być rozważone jako standardowe podejście diagnostyczne w NEC

Radiological diagnostics in neonates with different types of congenital cystic adenomatoid malformation of the lungs (CCAM) treated in Polish Mother's Memorial Hospital Research Institute (PMMHRI) in 1991-2005

Background: Congenital cystic adenomatoid malformation of the lungs (CCAM) is a rare congenital malformation of the respiratory tract. Authors present possibilities of the diagnostics of neonates with presumed CCAM based on radiological and morphological assessment of the respiratory tract. Clinical course of the CCAM may vary from uneventful to serious with different stage of the respiratory distress. The aim of the study was to establish diagnostic and clinical criteria of CCAM for neonates based on postnatal diagnostics in the reference centre. Material/Methods: We studied 27 cases of neonates with different types of CCAM (type I, II, III) who had been diagnosed and/or treated in the Neonatal Department of PMMHRI in 01.01.1991-31.03.2005. The diagnosis was established based on clinical course of the malformation, chest x-ray and CT of the neonate's lungs, autopsy and/or histopathology. Results: In the Neonatal Department of PMMHRI in 01.01.1991-31.03.2005 we observed 8 cases of CCAM type I (29,7%), 10 cases of CCAM type II (37%) and 9 cases of CCAM type III (33,3%). Diagnostic criteria were established based on radiological diagnostics of 17 cases and were confirmed by pathology. In 10 remaining cases of CCAM diagnosis was established by authopsy. Differential diagnosis included diaphragmatic hernia, bronchogenic cyst, enterogenic cyst, lung sequestrqtion, congenital lobar emphysema, hypoplasia or agenesis of the lungs, pneumonia/RDS. The guideline was established. Conclusions: 1. In case of CCAM suspicion monitoring in reference center is required 2. Surgical treatment should be applied based on the postnatal radiological diagnosis. 3. In case of CCAM in neonate complete differential diagnosis is required. 4. Asymptomatic course of CCAM or with a very few signs from respiratory tract can be difficult for identification both clinical and radiological

Vascular rings and sling in children imaging with multislice CT

Background: The term "vascular ring" determines abnormal congenital arrangements of arteries that encircle trachea and esophagus. The rings may be partial or complete, composed only from the vessels or from the vessels combined with fibrous structure (usually ligamentum arteriosum). They are formed by derivatives of the embryonic aortic arches - most often from the IVth pairs (e.g. double aortic arches or right aortic arches) or from the VIth pairs (e.g. left pulmonary artery sling). Depending on the tightness of the ring, these abnormalities may be clinically asymptomatic, evoking repeated respiratory difficulties and/or dysphagia in children at the school age or pronounced respiratory distress in newborns. Nowadays MR or MSCT imaging is applied to visualize the vessels anomalies. Aim: To present the examples of MSCT appearances of the vascular rings and their effects on tracheobronchial tree and esophagus in children. Material/Methods: Five children, aged 1 month - 13 years, with suspicions of vascular rings underwent MSCT investigation of the chest by means of 16-row scanner (Aquillon, Toshiba), using voltage of 120 kVp, current values 40 mA - 170 mA and tube rotation time 500 ms. In all cases three dimensional reformatting was performed. Results: 1. One-month-old girl with respiratory difficulties, cyanosis and recognized tetralogy of Fallot presented the anatomy of double aortic arch with left arch atresia. 2. Two children: 13-year-old boy with recurrent respiratory infections and stridor and 7-year-old girl treated for asthma (false positive diagnosis) - showed rings caused by right aortic arch with aberrant left subclavian artery, completed by left ligamentum arteriosum. 3. The left aortic arch with aberrant right subclavian artery (arteria lusoria) with esophageal compression was recognized in sixteen-month-old boy without clinical symptoms of dysphagia or respiratory difficulties. 4. Left pulmonary artery sling was seen in 13-month-old girl with respiratory distress; there were also: a.) concomitant common trunk for innominate artery and left common carotid artery and b.) persistent left vena cava superior. The compressions and stenoses of the tracheobronchial tree and/or esophagus were visualized in all patients. The radiation dose reduction was obtained due to the diminishing of the current values in the study protocol e.g. to 40 mA (20 mAs) in neonates and infants. Conclusions: MSCT, with low dose protocol, allows for accurate and comprehensive display of the vessels, trachea with main bronchi and esophagus in vascular rings in children. This visualization is significant and adequate for preoperative surgical planning

Diaphragmatic hernia in Reference Hospital ICZMP – diagnostic problems and outcome

Objectives: The aim of the study was to analyze US/ECHO examinations in fetuses with diaphragmatic hernia (DH) diagnosed and treated in our institution from 1994-2006, and their follow-up. Material and methods: Retrospective analysis of the data base from Department for Diagnoses & Prevention of Fetal Malformations, Research Institute of the Polish Mother’s Memorial Hospital: 14 481 fetal echo/ultrasound examinations in 10 077 fetuses have been analyzed to retrieve 115 fetuses with DH. Results: The mean gestational age at the targeted US/ECHO examination was 30 wks. There were 8 terminations of pregnancies (at mean 21 wks), 6 intrauterine demises, 60 neonatal deaths after delivery (in 1-3rd day of postnatal life), 8 deaths after surgery, 19 neonates were discharged home and in 14 cases the follow-up could not be monitored. The most common anomalies accompanying DH have been central nervous system anomalies (20%), polyhydramnion (16%) and cong heart defects (10%). In this subgroup, there was 100% mortality. Isolated DH has been diagnosed in every third case. In this subgroup, 27 neonates had undergone surgery and the survival rate was 70%, however since 2004 there was not a single death on record. Conclusions: Late gestational age of US/ECHO examinations in our tertiary center suggests that DH has been relatively difficult to detect during ultrasound screening. DH and the other structural malformations have been a lethal disease in our series in 100%. Isolated DH was much less frequent and was present in every third case (29%), and in this group the survival rate was 70%, regardless of the way of the delivery (CS or Vaginal)

Phantom studies as useful method for optimization of CT procedures with single-slice scanners

Background: Optimization of X-ray diagnostic procedures requires a selection of exposure parameters adequately for the patient anatomical structure and clinical needs, meanwhile use of the ready software protocols is a daily routine. The paper presents the methods and the results based on phantom studies aimed to optimize the exposure parameters for the examined object in examinations performed using single-slice CT scanners. Material/Methods: The studies were concerned with the significance of particular exposure parameters for image quality and patient doses in routine head procedures. Image quality was evaluated using a Catphan 424 phantom. Dosimetric measures of exposure were evaluated by computed tomography dose index (CTDI), and dose-length-product (DLP) was measured using a Nomex dosimeter. Results/Conclusions: Two single-slice CT scanners were investigated in details: a fourth generation one (Picker PQ-2000) and a third generation one (Siemens Somatom Balance). The dependence of image quality factors on high voltage, anode current, scan time, slice thickness were described and CTDI was evaluated. For both the CT scanners tested, the combinations of exposure parameters were found for which low dose value was accompanied by good image quality. Moreover, the high-contrast resolution was not practically changed with dose reduction, in opposite to low-contrast resolution being related to exposure parameters and the type of CT scanner. Dose reduction possible for the fourth generation scanner is deeper

Patologiczny obraz naczyń prążkowiowo-wzgórzowych u noworodka z wrodzoną infekcją CMV

Background: Lenticulostriate vasculopathy (LSV) is rare pathological picture found during ultrasound imaging of CNS in neonates with cytomegalovirus congenital infection. Case report: Preterm infant born by caesarean section in 31st week of gestation, with minimal clinical and laboratory signs of CMV infection, presented with evident CT pathology and particular ultrasound picture of LSV. Conclusion: Ultrasound evaluation of LSV presence and its advance could be important diagnostic procedure especially in patients with clinically „silent” congenital CNS infections