Journal of Pediatric Neuroradiology - Volume 2, issue 4

Authors: Winfeld, Matthew | Jensen, Jens | Adisetiyo, Vitria | Fieremans, Els | Helpern, Joseph | Karajannis, Matthias | Allen, Jeffrey | Gardner, Sharon | Milla, Sarah

Article Type: Research Article

Abstract: The purpose of this study is to determine the accuracy with which a non-Gaussian measure of diffusion, mean kurtosis (MK), predicts the histologic grade of pediatric brain tumors. After institutional review board approval, 21 World Health Organization (WHO) grade I, 7 WHO grade II, and 7 WHO grade IV pathologically-proven intracranial pediatric malignancies were retrospectively reviewed for preoperative diffusional kurtosis imaging. Multiple diffusion metrics of the tumors including MK, mean diffusivity (MD) and fractional anisotropy (FA) were determined. Comparisons between groups were performed using the Mann-Whitney test (p < .05). Receiver operating characteristics analysis was done to assess accuracy of …each metric in predicting histologic grade. MK was significantly higher for grade IV neoplasms (0.97, p < 0.0004) than grade I (0.62) or grade II (0.67) tumors. MD was significantly higher for grade I (1.43) compared with grade IV neoplasms (1.07, p < 0.018), however not for grade II (1.43) compared with grade IV (p < 0.08) tumors. FA did not differ significantly between grades. Area under the receiver operating characteristic curve was highest for MK (0.94) and lower for MD (0.89). FA performed only slightly better than chance (0.54). MK is an accurate diffusion metric for predicting histologic grade of pediatric brain tumors, consistent with conclusions from prior studies demonstrating similar results in adult populations. Show more

Keywords: Magnetic resonance imaging, diffusion, kurtosis, brain tumors

DOI: 10.3233/PNR-13072

Citation: Journal of Pediatric Neuroradiology, vol. 2, no. 4, pp. 301-305, 2013

Authors: Platzek, Ivan | Kitzler, Hagen H | Gudziol, Volker | Wiggermann, Philipp | Laniado, Michael | Hahn, Gabriele

Article Type: Research Article

Abstract: Imaging plays an important role for therapy planning in patients with suspected neck abscess, which can be life-treatening. The purpose of this retrospective study was to assess the sensitivity and specificity of magnetic resonance imaging (MRI) for neck abscess detection in pediatric patients. Thirty patients (14 m, 16 f; age range 2 mo – 16 yr; mean age 5 yr 6 mo) with suspected deep neck infection were examined on a 1.5 T MRI scanner. The MRI protocol included contrast-enhanced and nonenhanced images. The reference standard was based on surgical findings (26 patients) or on follow-up (four patients). The scans …were evaluated independently by two board certified radiologists. Cohen`s kappa was used to assess inter-rater agreement. Diagnostic confidence for the contrast-enhanced images and turbo inversion recovery magnitude images was compared using the Wilcoxon test. Twenty-seven out of thirty patients had abscesses. Sensitivity and specificity for abscesses was 100%. Both readers agreed in 29 of 30 cases (κ = 0,84). Diagnostic confidence was higher when using contrast-enhanced images alone in comparison to turbo inversion recovery magnitude images (p = 0.008). MRI has excellent sensitivity and specificity for head and neck abscesses in pediatric patients. The use of contrast media improves the diagnostic confidence for detecting abscesses. Show more

Keywords: Neck, abscess, infection, MRI, contrast agent

DOI: 10.3233/PNR-13073

Citation: Journal of Pediatric Neuroradiology, vol. 2, no. 4, pp. 307-312, 2013

Authors: Pulivarthi, Swaroopa | Rodriguez, Gustavo J. | Bershad, Eric M. | Mckinney, Alexander | Divani, Afshin A.

Article Type: Other

Abstract: Cerebrovascular disorders, particularly intracerebral hemorrhage (ICH), rarely occur in children. The most common underlying cause for ICH in the pediatric population is arteriovenous malformation (AVM). The best approach to diagnostic evaluation of pediatric ICH is unknown due to its low incidence (2–3/100,000 children). In recent years, early discovery of underlying cause of pediatric ICH has been possible due to a more widespread use of imaging modalities such as computed tomography (CT), magnetic resonance imaging (MRI) and digital subtraction angiography (DSA). We report a case of a 5-year-old boy with a ICH of unknown etiology. He presented with left hemiparesis and …left facial droop for one hour. Non-contrast CT scan demonstrated right periventricular hematoma extending to all ventricles. Follow-up MRI, CT angiography and DSA were unremarkable. Laboratory findings including liver function tests, hematologic studies were normal. Screening for hemoglobinopathies was negative. Transthoracic echocardiography was unremarkable. Surgery for ventricular drain placement and intense physical therapy were performed. During the follow ups at 1 and 6 mo of initial admission, repeat brain MRI and magnetic resonance angiography were unremarkable. The complete diagnostic evaluation in children presenting with ICH of undetermined origin is critically important, but still the etiology may not be identified in some cases. As AVMs are the most common cause of ICH in children and may rarely regress following hemorrhage, our patient’s normal follow-up imaging may be related to such a spontaneous thrombosis of an underlying AVM. Show more

Keywords: Intracerebral hemorrhage, pediatric, etiology, stroke

DOI: 10.3233/PNR-13074

Citation: Journal of Pediatric Neuroradiology, vol. 2, no. 4, pp. 313-318, 2013

Authors: Offiah, Curtis | Hall, Edward

Article Type: Other

Abstract: In the United Kingdom, 2010 saw the second anticipated rise in the number of cases of novel influenza A H1N1 pdm09 (“swine flu”). Fatal outcomes largely relate to pulmonary sequel with fatal frank intracranial complications occurring much less frequently. Acute necrotizing encephalopathy is one such complication with a variable, but sometimes fatal, outcome. The condition has been reported largely in the East Asian pediatric population and is a very infrequent and elusive diagnosis largely because of the lack of recognition of the radiological appearances. The present case was diagnosed as a result of correlation of peri-mortem magnetic resonance imaging appearances …of the brain with neuropathological findings at formal autopsy and brain necropsy: the virus was detected through reverse transcriptase polymerase chain reaction analysis and necropsy demonstrated classical features of necrosis in affected brain parenchyma with notable absence of inflammatory infiltrate. The report seeks to highlight the salient radiological feature of symmetrical hemorrhagic bilateral thalamic lesions - the presence of this particular feature in the appropriate clinical setting should prompt consideration of this radiologically elusive diagnosis. Show more

Keywords: Encephalopathy, influenza A (H1N1) pdm09, swine flu

DOI: 10.3233/PNR-13075

Citation: Journal of Pediatric Neuroradiology, vol. 2, no. 4, pp. 319-324, 2013

Authors: Das, Suman | Chattejee, Kaushani | Mazumdar, Jayitri | Sarkar, Nirmalya | Aich, Bholanath

Article Type: Other

Abstract: In this article, the authors intend to illustrate a striking brain malformation due to early onset severe fetal hydrocephalus that superficially suggests the presence of semilobar holoprosencephaly.

Keywords: Developmental brain anomaly, fetal hydrocephalus, semilobar holoprosencephaly

DOI: 10.3233/PNR-13076

Citation: Journal of Pediatric Neuroradiology, vol. 2, no. 4, pp. 325-327, 2013

Authors: Benbir, Gülçin | Muhammed, Reza P. | Hasiloglu, Zehra I. | Albayram, Sait | Yalçınkaya, Cengiz

Article Type: Other

Abstract: Although stroke may develop after varicella zoster virus infection, the relation between varicella vaccine and ischemic stroke is vague. A 13-month-old boy was admitted due to sudden onset right-sided hemiparesis. The past medical and family history were unremarkable, except for the administration of chickenpox vaccine 2 d before. Cranial magnetic resonance imaging showed acute cerebral ischemia. Detailed examinations for the etiological work-up were all normal. A definite causal relationship is difficult to establish between stroke and varicella vaccination, however.post vaccinaton complication may be considered in stroke patients without other demonstrable risk factors.

Keywords: Pediatric stroke, varicella, vaccination

DOI: 10.3233/PNR-13077

Citation: Journal of Pediatric Neuroradiology, vol. 2, no. 4, pp. 329-332, 2013

Authors: Galluzzi, Paolo | Occhini, Rossella | Cerase, Alfonso | Toti, Paolo | Hadjistilianou, Theodora | Venturi, Carlo | De Francesco, Sonia

Article Type: Other

Abstract: We report a 9-year-old-boy with no predisposing factors who presented with left eye leukocoria from a complete retinal detachment at ophthalmoscopy. Imaging showed an intraocular dome-shaped mass of low to moderate internal reflectivity at ultrasound, low T2-weighted signal intensity, lack of T1-weighted high signal intensity, and subtle gadolinium-enhancement at magnetic resonance imaging, and lack of calcifications at computed tomography. Due to the rapid extensive intraocular growth, the affected eye was enucleated. Pathologic examination showed a choroidal melanoma with only focal pigmentation. Despite its very rare incidence in the pediatric population, choroidal melanoma should be included in the differential diagnosis of …leukocoria. Show more

Keywords: Choroidal malignant melanoma, computed tomography, focal pigmentation, magnetic resonance imaging, pediatric ocular malignancy

DOI: 10.3233/PNR-13078

Citation: Journal of Pediatric Neuroradiology, vol. 2, no. 4, pp. 333-337, 2013

Authors: Fink, A. Michelle | Bekhit, Elhamy K.

Article Type: Other

Abstract: Giant congenital cervical teratomas and cerebral arteriovenous malformations (AVMs) are both rare and life threatening. The co-occurrence of these conditions has not previously been described, however new theories regarding the etiology of cerebral AVMs include a “response to injury”. We describe a patient with a vascular giant cystic cervical teratoma diagnosed in fetal life and a cerebral hemorrhage from an ipsilateral AVM later in childhood. We postulate that the development of the AVM may have been related to vascular steal from the tumor in utero. We raise awareness of the potential association of vascular neck masses with intracranial AVMs.

Keywords: Fetal MRI, EXIT procedure, fetal neck mass, cystic teratoma, intracranial AVM

DOI: 10.3233/PNR-13079

Citation: Journal of Pediatric Neuroradiology, vol. 2, no. 4, pp. 339-341, 2013

Article Type: Other

Citation: Journal of Pediatric Neuroradiology, vol. 2, no. 4, pp. 343-345, 2013

Article Type: Other

Citation: Journal of Pediatric Neuroradiology, vol. 2, no. 4, pp. 347-348, 2013