European recommendations on practices in pediatric neuroradiology: consensus document from the European Society of Neuroradiology (ESNR), European Society of Paediatric Radiology (ESPR) and European Union of Medical Specialists Division of Neuroradiology (UEMS)

Pediatric neuroradiology is a subspecialty within radiology, with possible pathways to train within the discipline from neuroradiology or pediatric radiology. Formalized pediatric neuroradiology training programs are not available in most European countries. We aimed to construct a European consensus document providing recommendations for the safe practice of pediatric neuroradiology. We particularly emphasize imaging techniques that should be available, optimal site conditions and facilities, recommended team requirements and specific indications and protocol modifications for each imaging modality employed for pediatric neuroradiology studies. The present document serves as guidance to the optimal setup and organization for carrying out pediatric neuroradiology diagnostic and interventional procedures. Clinical activities should always be carried out in full agreement with national provisions and regulations. Continued education of all parties involved is a requisite for preserving pediatric neuroradiology practice at a high level

Myofibromatosis: imaging characteristics

Background : Infantile myofibromatosis is the most common fibrous tumor of infancy. It can involve the skin, muscle, bone, and viscera. This uncommon entity is subdivided into solitary and multicentric forms, with or without visceral involvement. Objective : To describe the imaging characteristics of extracranial myofibromatosis. Materials and methods : Six infants, aged 1 day–1 week, were evaluated by imaging. All six patients had evaluation of one of the masses by US; four patients had CT evaluation of at least one of the masses; and five patients had evaluation by MRI. Results : The US appearance of the myofibromas included a mass with a purely anechoic center with a thick wall, a mass with a partially anechoic center, and a mass without anechoic components. On enhanced CT, the masses had lower or similar attenuation compared to adjacent muscle, with some masses exhibiting peripheral enhancement. The MR appearance consisted of low signal on T1-weighted imaging. On T2-weighted imaging, two had low signal of the center and the other three had high signal. All masses showed peripheral enhancement after gadolinium administration. Conclusions : Myofibromas have variable appearance on US, with a mass with an anechoic center being the most common feature. On CT, the mass can exhibit peripheral enhancement, calcifications, and erosion of adjacent bone. The MR appearance consisted of low signal on T1-weighted imaging and high or low signal of the center on T2-weighted imaging. All masses showed peripheral enhancement after gadolinium administration.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/46718/1/247_2004_Article_1357.pd

Analysis of the French national evaluation of radiology residents

International audienc

Ordre de grandeur des doses délivrées en radiodiagnostic

cited By 5Typical patient radiation doses in diagnostic imaging Radiologists should be able to appreciate the radiation dose delivered to patients for routine diagnostic procedures. The radiology report should include data necessary to calculate the patient dose in Gray. Using the effective dose, it is possible to compare with other source of radiation exposure. Simple formulas, taking into account different anatomical regions, derived from dose-area product (conventional radiography) or dose-length product (CT) are provided to calculate the effective dose in Sievert. For conventional (non-interventional) radiography, the effective dose for a given exam is inferior or equal to the yearly background radiation. For CT, the effective dose corresponds to 1 to 10 years of yearly background radiation. © 2010. Éditions Françaises de Radiologie.Il est essentiel que tout radiologue soit capable d’apprécier le niveau de la dose délivrée par les explorations usuelles. La transcription sur le compte-rendu d’examen des éléments permettant de connaître la dose délivrée est obligatoire. À partir de ces données, il est possible par des calculs d’évaluer le niveau de dose et ainsi de connaître l’ordre de grandeur de l’irradiation exprimée en Gray ou sous multiples. La comparaison avec les autres sources d’exposition est possible par l’appréciation de la dose efficace qui tient compte de l’effet biologique attendu. Des formules simples tenant compte de la région anatomique sont proposées à partir des produits dose-surface (radiologie conventionnelle) et dose-longueur (TDM) pour évaluer cette dose efficace, qui s’exprime en sievert et sous-multiples (mSv). En radiographie conventionnelle (non interventionnelle), la dose efficace délivrée par une exploration est inférieure ou égale au niveau de l’irradiation naturelle annuelle. En tomodensitométrie, la dose efficace délivrée par une exploration représente, selon les régions anatomiques, de 1 à 10 ans d’irradiation naturelle

Radiography of scoliosis Comparative dose levels and image quality between a dynamic flat-panel detector and a slot-scanning device (EOS system)

International audienceTo compare radiation dose and image quality between a slot-scanning system (SSS) and a dynamic flat-panel detector (DFD) in assessing scoliosis in children. An experimental study was first performed with a phantom to assess the quality of each device. The clinical part included a prospective observational dosimetric and qualitative comparative study with acquisition of whole-spine X-ray SSS (31 children), DFD (26 children). Institutional review board approval and informed consent were obtained. Dosimetric statistical analysis was performed from dose area product (DAP) and entrance skin dose measured by thermo-luminescent dosimeters localized in the cervical, thoracic and sacral areas. Assessment of the diagnostic quality (phantom and clinical) was realized by independent evaluation by 3 observers, using statistical analysis of quality score and inter-observer reproducibility. DAP was equivalent with the 2 systems. Entrance skin dose was significantly higher with DFD in thoracic and pelvic regions (P<0.05). Image quality scores of the SSS were significantly better than DFD for a majority of criteria, in both phantom and clinical evaluations. For scoliosis evaluation, the SSS, compared to the DFD system, offers enhanced image quality while reducing the entrance skin dose in the most radiosensitive areas. © 2015 Éditions françaises de radiologie

Eur J Med Genet

Neurofibromatosis type 1 (NF1) is an autosomal dominant, multi-system, neurocutaneous disorder that predisposes to the development of benign and malignant tumors. Classical skeletal abnormalities encompass sphenoid wing dysplasia, congenital bowing of the long bones and vertebral osteopathy associated with non-dystrophic or dystrophic scoliosis found in about 10% of NF1 patients. We report a 17-year-old boy affected by NF1 with extreme severe spinal and thoracic malformations affecting bone and lung tissues, including hypoplasia of the right lung, unilateral costal agenesis and severe dystrophic scoliosis characterized by association of hemivertebra, fusion of adjacent vertebral bodies and defective pedicles. At birth, he presented an acute respiratory distress requiring invasive ventilator support. The diagnosis of NF1 was confirmed at age 5 by the identification of a de novo heterozygous mutation c.4537C > T, p.Arg1513* in NF1. Trio-based Whole Exome Sequencing (WES) was performed to exclude coexistence of a second hit but no clearly other pathogenic variant has been identified. Until now, only one similar NF1 patient suffering from the same association of severe scoliosis and chest deformity leading to respiratory insufficiency was described. The severe prenatal NF1-related scoliosis could explain the lung abnormal development by absence of mechanical constraints. Severe Thoracic and Spinal Bone Abnormalities may be part of the NF1 bone phenotype and should be taken into account to allow adequate genetic counseling

Arch Pediatr

AIM: To investigate the clinical, laboratory, electrophysiological, and imaging features associated with death or neurological impairment at 1 year of age in term neonates with hypoxic-ischemic encephalopathy (HIE) treated by therapeutic hypothermia (TH). METHODS: This was a single-center retrospective and descriptive study conducted over a period of 2 years. We included consecutive term newborns with moderate or severe HIE who were treated by TH initiated within the sixth hour after birth and continued for 72 h,. For all patients, brain magnetic resonance imaging (MRI) was performed before the eighth day and a score was established; furthermore, at least two electroencephalograms were recorded. RESULTS: Among the 33 patients included, 20 neonates had a favorable outcome and 13 had an unfavorable outcome. Early clinical seizures (15% vs. 53.8%, p = 0.047), the persistence of a poor prognosis according to the electroencephalogram pattern after TH (0% vs. 69.2%, p = 0.0001), and an elevated score on the early brain MRI (2 vs. 11, p < 0.001) combined with a high lactate/N-acetyl-aspartate ratio (0.52 vs. 1.33, p = 0.008) on spectroscopy were associated with death and a poor outcome. CONCLUSION: A combination of tools can help the medical team to establish the most reliable prognosis for these full-term neonates, to guide care, and to inform parents most appropriately and sincerely