Clinical characteristics of central diabetes insipidus in Taiwanese children

Background/PurposeData on the clinical features of children with central diabetes insipidus (CDI) are lacking in Taiwan. This study investigated the clinical manifestations and etiology of CDI in Taiwanese children.MethodsFrom 1983 to 2012, 62 children with permanent diabetes insipidus were enrolled in the study. They were diagnosed at the Department of Pediatrics of National Taiwan University Hospital. Their medical records were thoroughly reviewed and their clinical symptoms and signs, laboratory data, and etiologies were analyzed.ResultsThe patients’ median age at diagnosis was 10 years and the median interval between initial manifestations and diagnosis was 0.5 years. The most common symptoms and signs were polyuria, polydipsia, nocturia, and growth retardation. Most patients had low urine osmolality and elevated plasma osmolality on diagnosis. Absence of a posterior pituitary hyperintense signal and thickening of the pituitary stalk were common findings on magnetic resonance imaging. Approximately 80% of the patients had anterior pituitary hormone deficiency and all patients had growth hormone deficiency. Approximately 60% of patients had intracranial lesions, the most common causes of which were germ cell tumor and Langerhans cell histiocytosis. Two patients were initially believed to have idiopathic CDI but intracranial lesions were detected during the follow-up period.ConclusionBecause a delayed diagnosis of CDI is common in Taiwanese children, a high index of suspicion is important. The underlying etiology of CDI in children may not initially be obvious. Long-term surveillance is therefore necessary, especially for the early detection of evolving treatable intracranial lesions

Diffusion-weighted images in children with meningoencephalitis

The objective of the study was to evaluate the maps of apparent diffusion coefficients (ADCs) and diffusion-weighted (DW) images in demonstrating meningoencephalitic lesions in children. Materials and methods: Between May 1998 and May 2000, 18 infants and children (4.5–190 months old) suffering from meningoencephalitis were included in the study. The diagnoses were bacterial meningoencephalitis in 8 and aseptic or viral in 10 patients. All 18 patients had brain MRI examinations. In the axial plane, three pulse sequences were performed on all patients: (1) FSE T2W images; (2) fast FLAIR images; (3) single-shot echoplanar DW images were acquired. Another 18 patients from the control group also received DW image examination. ADCs were computed for all regions on each DW image. Results: The absolute values of CNRs of lesions on T2W (7.27 ± 5.51), FLAIR (5.56 ± 5.03) and DW (13.36 ± 16.64) images were significantly greater than those on ADC maps (0.42 ± 0.30) in the study group of patients ( P < .01). In addition, absolute CNRs on DW images were significantly greater than on T2W and FLAIR images ( P < .01). However, lesions on ADC maps in the study group have significantly greater CNRs than in the control group (0.13 ± 0.12) ( P < .01). CNRs on initial DW images from patients with atrophy or swelling of meningoencephalitic lesions were significantly different from the CNRs of those patients without significant changes in meningoencephalitic lesions ( P=.02 < .05). Conclusion: The DW image is a sensitive tool for detecting meningoencephalitic lesions and is better than FSE T2W and fast FLAIR images in CNRs. Diffusion MR techniques provides new ways to possibly predict the outcome of intracranial infectious diseases in children

Cerebral Diffusion Tensor Images in Children with Tuberous Sclerosis: A Preliminary Report

Background. In tuberous sclerosis (TS), tubers usually involve the white matter. Diffusion tensor (DT) images are used to demonstrate white-matter tracts. Objective. To determine the changes in DT indices in supratentorial tubers and associated changes in the white-matter tracts adjacent to tubers in patients with TS. Materials and methods. The DT imaging indices, including first, second and third eigenvalues (EVs), apparent diffusion coefficients (ADCs), and fractional anisotropy (FA) in the white-matter lesions of tubers, were assessed in seven patients with TS exhibiting developmental delay and compared with controls. Results. EV1 , EV2, EV3, ADC and FA of the white-matter lesions of tubers were significantly different from contralateral unremarkable regions of the brain and from controls (P<0.05). The number of frontal and parietal tubers was significantly negatively correlated with EV1 of the superior longitudinal fasciculi of TS patients (r=-0.60, P = 0.04). In addition, TS patients had significantly larger ADCs in the corona radiata and sagittal stratum than the control subjects. EV3s of the inferior longitudinal fasciculus and sagittal stratum were significantly more increased in the TS patients than in the control subjects. Conclusions. EV1, EV2, EV3, ADC and FA maps are potential tools for demonstrating cerebral white-matter changes owing to TS

兒童腦膜腦炎之擴散影像

Purpose: The objective of the study was to evaluate the maps of apparent diffusion coefficients (ADCs) and diffusion- weighted (DW) images in demonstrating meningoencephalitic lesions in children. Materials and methods: Between May 1998 and May 2000, 18 infants and children (4.5-190 months old) suffering from meningoencephalitis were included in the study. The diagnoses were bacterial meningoencephalitis in 8 and aseptic or viral in 10 patients. All 18 patients had brain MRI examinations. In the axial plane, three pulse sequences were performed on all patients: (1) FSE T2W images ; (2) fast FLAIR images; (3) single-shot echoplanar DW images were acquired. Another 18 patients from the control group also received DW image examination. ADCs were computed for all regions on each DW image. Results: The absolute values of CNRs of lesions on T2W (7.27 +/- 5.51), FLAIR (5. 56 +/- 5.03) and DW (13.36 +/- 16.64) images were significantly greater than those on ADC maps (0.42 +/- 0.30) in the study group of patients (P<.01). In addition, absolute CNRs on DW images were significantly greater than on T2W and FLAIR images (P<.01). However, lesions on ADC maps in the study group have significantly greater CNRs than in the control group (0.13 +/- 0.12) (P<.01). CNRs on initial DW images from patients with atrophy or swelling of meningoencephalitic lesions were significantly different from the CNRs of those patients without significant changes in meningoencephalitic lesions (P=.02 less than or equal to. 05). Conclusion: The DW image is a sensitive tool for detecting meningoencephalitic lesions and is better than FSE T2W and fast FLAIR images in CNRs. Diffusion MR techniques provides new ways to possibly predict the outcome of intracranial infectious diseases in children. (C) 2002 Elsevier Science Inc. All rights reserved

Prenatal Three-Dimensional Ultrasound and Magnetic Resonance Imaging Evaluation of a Fetal Oral Tumor in Preparation for the Ex-Utero Intrapartum Treatment (Exit) Procedure

Recent attempts at predelivery management of obstructed fetal airways have focused on the EXIT (ex-utero intrapartum treatment) procedure, which allows sufficient time to secure the fetal airway through preservation of uteroplacental gas exchange. We report a fetus with an exophytic oral tumor noted at 34 weeks of gestation. In this case, three-dimensional (3D) ultrasound allowed a complete and interactive evaluation of the tumor and related facial anatomy, and confirmed that access to the fetal airway was unlikely during delivery. Fetal magnetic resonance imaging ( MRI) further demonstrated that the tumor originated in the nasopharynx and obstructed the upper airway. Both imaging results led to a final decision to offer an EXIT procedure for the neonate. At 36 weeks' gestation, a successful EXIT procedure was performed to reduce the risk of respiratory distress immediately after birth. This report highlights the value of 3D ultrasound and MRI as essential prerequisites for optimization of the triage process in selecting EXIT candidates. Copyright © 2004 ISUOG. Published by John Wiley & Sons, Ltd