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Background and purposeConsiderable overlap exists in the MR imaging features of hypoglycemic injury and hypoxic-ischemic brain injury, with similar predilections for the occipital and parietal lobes. In partial, prolonged hypoxia-ischemia, there is cortical destruction at the interarterial watershed zones, and in concomitant hypoglycemia and hypoxia-ischemia, an exaggerated final common pathway injury occurs. We interrogated secondary white matter tract-based thalamic injury as a tool to separate pure injuries in each group.Materials and methodsA retrospective observational study of the MRIs of 320 children with a history of hypoxia-ischemia and/or hypoglycemia was undertaken with 3 major subgroups: 1) watershed-type hypoxic-ischemic injury, 2) neonatal hypoglycemia, and 3) both perinatal hypoxia-ischemia and proved hypoglycemia. Cerebral and thalamic injuries were assessed, particularly hyperintensity of the posterolateral margin of the thalami. A modified Poisson regression model was used to assess factors associated with such thalamic injury.ResultsParieto-occipital injuries occurred commonly in patients with hypoglycemia and/or hypoxia-ischemia. Eighty-five of 99 (86%) patients with partial, prolonged hypoxia-ischemia exhibited the thalamus L-sign. This sign was also observed in patients who had both hypoglycemia and hypoxia-ischemia, predominantly attributable to the latter. Notably, the risk of a thalamus L-sign injury was 2.79 times higher when both the parietal and occipital lobes were injured compared with when they were not involved (95% CI, 1.25-6.23; P = .012). The thalamus L-sign was not depicted in patients with pure hypoglycemia.ConclusionsWe propose the thalamus L-sign as a biomarker of partial, prolonged hypoxia-ischemia, which is exaggerated in combined hypoglycemic/hypoxic-ischemic injury.

Competing Interests: None declared.

Background: Injury patterns in hypoxic-ischaemic brain injury (HIBI) are well recognised but there are few studies evaluating cerebral injury using neuroquantification models., Objectives: Quantification of brain volumes in a group of patients with clinically determined cerebral palsy., Method: In this retrospective study, 297 children with cerebral palsy were imaged for suspected HIBI with analysis of various cerebral substrates. Of these, 96 children over the age of 3 years with a clinical diagnosis of cerebral palsy and abnormal MRI findings underwent volumetric analyses using the NeuroQuant ® software solution. The spectrum of volumetric changes and the differences between the various subtypes (and individual subgroups) of HIBI were compared., Results: Compared with the available normative NeuroQuant ® database, the average intracranial volume was reduced to the 1st percentile in all patient groups ( p < 0.001). Statistically significant differences were observed among the types and subgroups of HIBI. Further substrate volume reductions were identified and described involving the thalami, brainstem, hippocampi, putamina and amygdala. The combined volumes of five regions of interest (frontal pole, putamen, hippocampus, brainstem and paracentral lobule) were consistently reduced in the Rolandic basal ganglia-thalamus (RBGT) subtype., Conclusion: This study determined a quantifiable reduction of intracranial volume in all subtypes of HIBI and predictable selective cerebral substrate volume reduction in subtypes and subgroups. In the RBGT subtype, a key combination of five substrate injuries was consistently noted, and thalamic, occipital lobe and brainstem volume reduction was also significant when compared to the watershed subtype., Contribution: This study demonstrates the value of integrating an artificial intelligence programme into the radiologists' armamentarium serving to quantify brain injuries more accurately in HIBI. Going forward this will be an inevitable evolution of daily radiology practice in many fields of medicine, and it would be beneficial for radiologists to embrace these technological innovations., Competing Interests: The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article., (© 2023. The Authors.)

Objective: Human cases of acute profound hypoxic-ischemic (HI) injury (HII), in which the insult duration timed with precision had been identified, remains rare, and there is often uncertainty of the prior state of fetal health., Study Design: A retrospective analysis of 10 medicolegal cases of neonatal encephalopathy-cerebral palsy survivors who sustained intrapartum HI basal ganglia-thalamic (BGT) pattern injury in the absence of an obstetric sentinel event., Results: Cardiotocography (CTG) admission status was reassuring in six and suspicious in four of the cases. The median time from assessment by admission CTG or auscultation to birth was 687.5 minutes (interquartile range [IQR]: 373.5-817.5 minutes), while the median time interval between first pathological CTG and delivery of the infant was 179 minutes (IQR: 137-199.25 minutes). The mode of delivery in the majority of infants (60%) was by unassisted vaginal birth; four were delivered by delayed caesarean section. The median (IQR) interval between the decision to perform a caesarean section and delivery was 169 minutes (range: 124-192.5 minutes)., Conclusion: The study shows that if a nonreassuring fetal status develops during labor and is prolonged, a BGT pattern HI injury may result, in the absence of a perinatal sentinel event. Intrapartum BGT pattern injury and radiologically termed "acute profound HI brain injury" are not necessarily synonymous. A visualized magnetic resonance imaging (MRI) pattern should preferably solely reflect the patterns description and severity, rather than a causative mechanism of injury., Key Points: · BGT HI injury pattern on MRI may develop in the absence of a perinatal sentinel event.. · BGT pattern injury may not be synonymous with "acute profound HI brain injury.". · MRI pattern and severity thereof should be described rather than a causative mechanism of injury.., Competing Interests: None declared., (Thieme. All rights reserved.)

Background and Purpose: Considerable overlap exists in the MR imaging features of hypoglycemic injury and hypoxic-ischemic brain injury, with similar predilections for the occipital and parietal lobes. In partial, prolonged hypoxia-ischemia, there is cortical destruction at the interarterial watershed zones, and in concomitant hypoglycemia and hypoxia-ischemia, an exaggerated final common pathway injury occurs. We interrogated secondary white matter tract-based thalamic injury as a tool to separate pure injuries in each group., Materials and Methods: A retrospective observational study of the MRIs of 320 children with a history of hypoxia-ischemia and/or hypoglycemia was undertaken with 3 major subgroups: 1) watershed-type hypoxic-ischemic injury, 2) neonatal hypoglycemia, and 3) both perinatal hypoxia-ischemia and proved hypoglycemia. Cerebral and thalamic injuries were assessed, particularly hyperintensity of the posterolateral margin of the thalami. A modified Poisson regression model was used to assess factors associated with such thalamic injury., Results: Parieto-occipital injuries occurred commonly in patients with hypoglycemia and/or hypoxia-ischemia. Eighty-five of 99 (86%) patients with partial, prolonged hypoxia-ischemia exhibited the thalamus L-sign. This sign was also observed in patients who had both hypoglycemia and hypoxia-ischemia, predominantly attributable to the latter. Notably, the risk of a thalamus L-sign injury was 2.79 times higher when both the parietal and occipital lobes were injured compared with when they were not involved (95% CI, 1.25-6.23; P = .012). The thalamus L-sign was not depicted in patients with pure hypoglycemia., Conclusions: We propose the thalamus L-sign as a biomarker of partial, prolonged hypoxia-ischemia, which is exaggerated in combined hypoglycemic/hypoxic-ischemic injury., (© 2022 by American Journal of Neuroradiology.)

Aim: To describe the spectrum of parasagittal injury on MRI studies performed on children following severe perinatal term hypoxia-ischaemia, using a novel MRI grading system, and propose a new central pattern correlated with neuropathologic features., Methods: MR scans of 297 patients with perinatal term hypoxia-ischaemia were evaluated for typical patterns of brain injury. A total of 83 patients that demonstrated the central/basal ganglia-thalamus and perirolandic pattern of injury were categorised according to the degree of severity. The perirolandic injury was graded by the degree of interhemispheric widening, paracentral lobule involvement and perirolandic cortex destruction leading to a tiered categorisation. Of these 83 patients, 19 had the most severe subtype of injury. A detailed analysis of the clinical data of a subset of 11 of these 19 patients was conducted., Results: We demonstrated the mild subtype in 21/83(25%), the moderate subtype in 22/83(27%) and the severe subtype in 21/83(25%). A fourth pattern was identified in 19/83(23%) patients with a diamond-shaped expansion of the interhemispheric fissure, concomitant thalamic, putaminal, hippocampal and other smaller substrate involvement indicative of the most destructive subtype., Conclusions: We propose a new MR grading system of injury at the parasagittal perirolandic region related to severe, sustained central perinatal term hypoxia-ischaemia. We also introduce a previously undescribed pattern of injury, the most severe form of this spectrum, seen especially after prolongation of the second stage of labour. This constellation of high metabolic substrate, targeted tissue destruction is consistently demonstrated by MRI, termed the massive paramedian injury pattern., (© 2022. The Author(s).)

This article provides a correlation of the pathophysiology and magnetic resonance imaging (MRI) patterns identified on imaging of children with hypoxic ischemic brain injury (HIBI). The purpose of this pictorial review is to empower the reading radiologist with a simplified classification of the patterns of cerebral injury matched to images of patients demonstrating each subtype. A background narrative literature review was undertaken of the regional, continental and international databases looking at specific patterns of cerebral injury related to perinatal HIBI. In addition, a database of MRI studies accumulated over a decade (including a total of 314 studies) was analysed and subclassified into the various patterns of cerebral injury. Selected cases were annotated to highlight the areas involved and for ease of identification of the affected substrate in daily practice., Keywords: Hypoxic ischemic encephalopathy; Magnetic resonance imaging; Acute profound; Partial prolonged; Hypoxic ischemic brain injury; Ulegyria; Multicystic; Encephalopathy., Competing Interests: The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this pictorial review., (© 2020. The Authors.)

Objective: To refine and evaluate a recently published radiological disease severity score for the prediction of month 2 and end of treatment outcomes in pulmonary tuberculosis (TB). Radiological extent of disease has been linked to early and late outcomes of anti-tuberculosis treatment, but no validated tools are available to quantify this parameter., Design: We enrolled 449 adult, human immunodeficiency virus negative participants with smear- or culture-proven TB from three TB biomarker studies in Cape Town, South Africa. Full-size posteroanterior baseline chest X-rays (CXRs) were evaluated by two clinicians after standardising the published scoring method and the predictive ability assessed for month 2 and final treatment outcomes., Results: Baseline CXR scores were significantly different in the favourable and unfavourable outcome groups; however, the predictive ability for outcomes at all time points was poor (ROC area under curve ⩿0.68). Inter-reader reliability was high (r = 0.86, P < 0.001), but agreement in cavity identification was modest., Conclusion: Standardised application of a CXR score derived from the presence of cavities and overall extent of parenchymal disease in active TB showed good inter- and intrareader reliability. Scores differed significantly in treatment outcome groups, but did not allow accurate outcome prediction.

Introduction: The association of a lumbosacral transitional vertebra with accelerated degeneration of the disc above has been described. Lumbosacral transitional vertebrae have also been reported as a cause of extraforaminal entrapment of the L5 nerve root between the transverse segment of the transitional vertebra and the sacral ala optimally demonstrated by coronal MRI. The association of the lumbosacral transitional vertebra pseudoarthroses and S1 nerve root entrapment due to degenerative stenosis of the nerve root canal has never been described., Methods: We present 12 patients with lumbosacral transitional vertebrae that were referred for symptoms and signs of S1 nerve root radiculopathy in which the sagittal and axial MRI sequences failed to identify a plausible cause for the patients' S1 nerve root symptoms. A coronal T1-weighted imaging (T1WI) MRI sequence was consequently added to the investigation., Results: The coronal T1WI MRI sequence demonstrated hypertrophic degenerative stenosis of the S1 nerve root canal at the level of the lumbosacral transitional vertebra pseudoarthrosis, with entrapment of the respective S1 nerve root in all patients., Conclusion: We emphasize the value of coronal T1WI MRI of the lumbosacral junction and sacrum if the cause for S1 radicular symptoms was not identified on conventional sagittal and axial MRI sequences in patients with lumbosacral transitional vertebrae.

Background: Anorectal malformations are often associated with rectal pouch fistulas. Surgical correction requires accurate evaluation of the presence and position of such fistulas. Fluoroscopy is currently the chosen modality for the detection of fistulas. The role of MRI is unexplored., Objective: To compare the diagnostic accuracy of MR versus fluoroscopic fistulography in the pre-operative evaluation of infants with anorectal malformation., Materials and Methods: We conducted a pilot study of infants requiring defunctioning colostomy for initial management of anorectal malformation. Dynamic sagittal steady-state free-precession MRI of the pelvis was acquired during introduction of saline into the mucous fistulas. Findings were compared among MR fistulography, fluoroscopic fistulography and intraoperative inspection., Results: Eight children were included. Median age at fistulography was 15 weeks, inter-quartile range 13-20 weeks; all were boys. There was full agreement among MR fistulography, fluoroscopic fistulography and surgical findings., Conclusion: The pilot data suggest that MR fistulography is promising in the pre-operative evaluation of children with anorectal malformation.

The possibility of periodontal disease, chipping of various teeth, or extrusion from use of a mouthstick is minimized with a mouthpiece that covers the complete dentition. Even the simplest of these devices permits increased function for the quadriplegic patient. A case is reported of a young man for whom the oral telescoping orthosis was fitted with a mouthpiece that covered the complete dentition. Damage to the hard or soft tissue structures has not been apparent in eight years of use. Furthermore, the functional capability of the patient has been enhanced. The oral telescoping orthosis is recommended for motivated quadriplegic patients who retain sufficient control of the head and oral and pharyngeal muscles.

Facilities for magnetic resonance imaging (MRI) have been available in South Africa since November 1985. This article summarizes our experience with this new imaging modality, illustrates normal anatomical features and pathological conditions in sagittal, coronal and axial planes, and compares MRI with computed tomography scans of the same regions.

Cysticercosis is an infection with a larval or a bladder-worm stage of the species of Taenia. Cysticerci have a predeliction for the nervous system where they may be found in the meninges, the ventricles and within the brain itself. Brain involvement or parenchymatous form has an acute and chronic phase. Before the advent of CT scanning radiology was of little value in the acute parenchymatous cysticercosis, but with CT the changes within the brain can be recognised. In reviewing 14 cases of acute parenchymatous cysticercosis three CT patterns were found. 1. A diffuse low density pattern with no or little change after contrast medium 2. Multiple low densities with small rounded central areas of enhancement. 3. Large cystic lesions which may become ring lesions after contrast medium. We conclude that in an endemic area for cysticercosis, when one of these CT patterns is present, cysticercosis should be considered in the differential diagnosis. In a child where the clinical features are suggestive, the CT pattern may be diagnostic of cysticercosis. In the chronic parenchymatous stage the cysts have calcified and this may occur within one year of the acute onset. In 11 cases of chronic parenchymatous cysticercosis where the calcification was visible on the plain skull radiographs the CT scan added very little additional information. It may however be of value in confirming intracranial calcifications where their presence on the plain skull radiograph is in doubt.