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Human awareness of left space may be disrupted by cerebral lesions to the right hemisphere (hemispatial neglect). Current knowledge on the anatomical bases of this complex syndrome is based on the results of group studies that investigated primarily the best known aspect of the syndrome, which is visual neglect for near extrapersonal (or peripersonal) space. However, another component-neglect for personal space-is more often associated with, than double-dissociated from, extrapersonal neglect, especially, in chronic patients. The present investigation aimed at exploring the anatomical substrate of both extrapersonal and personal neglect by using different advanced methodological approaches to lesion-function correlation. Fifty-two right ischaemic patients were submitted to neuropsychological assessment and in-depth MRI evaluation. The borders of each patient's lesion were delimited onto its own high-resolution anatomical image and then submitted to an automated spatial normalization algorithm. Besides conventional lesion density plots and subtraction analysis, region-based statistical analyses were performed on percentage values of the lesioned tissue also using a new parcellation of the white matter (WM). Data were finally submitted to voxelwise statistical analysis using a recently proposed method (voxel-based lesion-symptom mapping). Results converged in showing that awareness of extrapersonal space is based on the integrity of a circuit of right frontal (ventral premotor cortex and middle frontal gyrus) and superior temporal regions, whereas awareness of personal space is rooted in right inferior parietal regions (supramarginal gyrus, post-central gyrus and especially the WM medial to them). Common but less crucial regions for both neglect sub-types were located in the temporo-peri-Sylvian cortex. We suggest that extrapersonal space awareness critically involves a ventral circuit recently described for the exogenous allocation and reorienting of attention in space. Disruption of personal space awareness, instead, seems to be due to a functional disconnection between regions important for coding proprioceptive and somatosensory inputs, and regions coding more abstract egocentric representations of the body in space. In conclusion, present data strongly support a segregation of personal and extrapersonal spatial awareness in humans, both from a functional and an anatomical point of view.

We studied five patients with multiple sclerosis with one plaque of demyelination more than 2 cm in diameter, using conventional and diffusion-weighted MRI, soon after the onset of symptoms and over 1-36 months. The orientationally averaged diffusion coefficient was increased in all the acute lesions, and increased further during follow-up in three. There was a strong correlation between and the degree of low signal on T1-weighted images. The quantitative information provided by allowed delineation of different diffusion patterns in large MS lesions, that may reflect heterogeneity of the anatomical substrate.

We report on a 5½ year-old Italian girl with a distinctive form of metaphyseal chondrodysplasia simulating cartilage hair hypoplasia. The pattern of metaphyseal changes and the associated bony abnormalities differentiate this patient from all the recognized forms of metaphyseal chondrodysplasia. © 2001 Wiley-Liss. Inc.

Objective. To compare the performance of a new sonographic (US) method of bone age estimation with other methods currently in use. Design and patients. One hundred and fifteen subjects underwent left hand/wrist radiography and US examination of the hip for bone age assessment. For each patient, measurements of skeletal age were available based on Greulich-Pyle and Tanner and Whitehouse, the latter being presented in three subtypes (RUS, carpals, and B20) in addition to the US values. To assess agreement between methods, each method was compared with every other method. Differences between calculated skeletal age and chronological age were assessed, and the sensitivity, specificity, and predictive values of each method computed. Results. Coupled B20/RUS values showed the best agreement, with 95% of observations within 2.45 years of each other, followed by carpals/B20, B20/GP, and GP/RUS. The US method agreed the least (difference of 4.19–5.13 years) with the other methods. The US method provided 85.8% (US vs RUS) to 91.3% (US vs GP) concordant results in recognizing differences between skeletal and chronological age, and showed a 72.5% sensitivity and a 56.8% specificity. Conclusion. Although the US method promises to permit a safe and cost-effective assessment of skeletal age, its low accuracy makes it currently unsuitable for clinical use.

In an attempt to clarify whether T1 relaxation time mapping may assist in characterizing the pathological brain tissue substrate of multiple sclerosis (MS), we compared the T1 relaxation times of lesions, areas of normal-appearing white matter (NAWM) located proximal to lesions, and areas of NAWM located distant from lesions in 12 patients with the relapsing-remitting and 12 with the secondary progressive (SP) subtype of disease. Nine healthy volunteers served as controls. Calculated mean T1 values were averaged across all patients within each clinical group, and comparisons were made by means of the Mann-Whitney U-test. Significant differences were found between all investigated brain regions within each clinical subgroup. Significant differences were also detected for each investigated brain region among clinical subgroups. While T1 values of NAWM were significantly higher in patients with SP disease than in normal white matter (NWM) of controls, no differences were detected when corresponding brain areas of patients with RR MS were compared with NWM of controls. T1 maps identify areas of the brain that are damaged to a different extent in patients with MS, and may be of help in monitoring disease progression.

It is widely documented that the left hemisphere is dominant in all complex linguistic tasks, including the processing of inflectional morphology. Both in Italian and in other languages, patients with brain damage with a selective deficit in derivational morphology have never been reported. Here we present the unusual case of two patients with very similar right-hemisphere lesions, who in the absence of aphasic disorders showed a selective inability in producing derivational morphology. Although both patients were unimpaired in producing verb infinitives, they both showed a selective deficit in producing nouns derived from verbs. This difficulty was not present in deriving nouns from other grammatical categories, such as adjectives. Interestingly, both patients mostly substituted the derived noun with the past participle of the verb. This pattern of results documents for the first time a right-hemisphere contribution in the domain of derivational morphology.

Background. A simple, accurate, reproducible and noninvasive method of body iron overload assessment would be of great clinical use.Objective. The purpose of the study was the implementation of a 0.5-T MRI method for liver iron overload measurement.Materials and methods. Thirty patients with thalassemia major took part in the study. Liver and paraspinal muscle signal intensity (SI) measurements were performed on T1-weighted images and normalized on a standard phantom, and a subjective hemochromatosis grading scale was made on both T1- and T2-weighted images. Serum ferritin levels and tissue iron from liver biopsy specimens were determined for comparison.Results. A close correlation was found between bioptic liver iron and both the liver-to-phantom SI ratio (r = −0.88) and the subjective grading scale (rho = 0.89). Serum ferritin correlated poorly with liver iron deposition, whether assessed by biopsy (r = 0.62) or MRI (r = -0.69).Conclusions. Both the subjective and the quantitative MRI methods proposed here are clinically valuable, with the former being adequate for a gross, the latter for an accurate estimation of tissue iron overload.

Exostoses are a common skeletal disorder. Despite their incidence, little is yet known about their origin and biological behaviour. In particular, spontaneous regression of exostoses — an extremely rare event — is still a subject for debate. In this study, we describe two additional cases of spontaneous regression of exostosis; one was a solitary lesion while the other occurred in a patient with multiple heritable exostoses. Radiographic findings are presented along with some of the theories which aim at explaining this phenomenon.

This paper analyses the relationship between the thickness of the anterior femoral head cartilage (FHC), as measured by ultrasound, and some anthropometric parameters, such as height, weight, skeletal and chronological age. In addition, it provides standard norms for FHC thickness in a paediatric population. Both hips were examined in 213 consecutive subjects (99 boys and 114 girls), aged 1.9–14 years. Seventy-four subjects underwent hand and wrist X-rays for skeletal maturation: 32 of these were dropped from the study because a discrepancy as high as two standard deviations was found between their skeletal and their chronological age. The thickness of FHC correlated strongly with skeletal and chronological age, standing height and body weight. A side difference of 0.2 mm in FHC was considered to be abnormal. The study population was divided into 13 groups according to chronological age and values of FHC for boys and girls are provided for each group. It is suggested that the magnitude of hyaline FHC is a valuable feature in the evaluation of skeletal maturation in children.

The skeletal dysplasias are a group of genetic disorders affecting skeletal development and maintenance, usually manifesting in childhood with disproportionate short stature. Although individually rare, they are not infrequent as a group. An accurate diagnosis is crucial for prevention and/or treatment of complications, estimate of child's growth, and proper genetic counseling. Radiology is the mainstay of diagnosis. Recognition of single radiographic signs or patterns of anomalies is required to reach the correct diagnosis. The radiographic features of Leri-Weill syndrome and Langer mesomelic dwarfism, two skeletal dysplasias caused by a defect in the short stature homeobox-containing gene, are briefly discussed.

A child with acute myelogenous leukemia who relapsed three months after an allogeneic bone marrow transplant received intermediate-dose cytarabine followed by interleukin 2 (IL-2). Complete remission was achieved after the first cycle of IL-2. Five more combined cycles of cytarabine and IL-2 were given over the next year, during which remission has persisted. IL-2 therapy affected serum tumor necrosis factor (TNF), interferon gamma (IFNγ) and soluble IL-2 receptor (sIL-2r) levels. In vitro cytotoxicity against leukemia cell lines and recipient leukemia cells was also increased.

BACKGROUND AND PURPOSE: Diffuse axonal injury (DAI) is a common type of primary neuronal injury in patients with severe traumatic brain injury (TBI), and is frequently accompanied by tissue tear hemorrhage. T2‐weighted gradient-recalled echo (GRE) sequences are more sensitive than T2-weighted spin-echo images for detection of hemorrhage. The purpose of this study is to compare turbo Proton Echo Planar Spectroscopic Imaging (t-PEPSI), an extremely fast sequence, with GRE sequence in the detection of DAI. METHODS: Twenty-one patients (mean age 26.8 years) with severe TBI occurred at least 3 months earlier, underwent a brain MR Imaging study on a 1.5-T scanner. A qualitative evaluation of the t-PEPSI sequences was performed by identifying the optimal echo time and in-plane resolution. The number and size of DAI lesions, as well as the signal intensity contrast ratio (SI CR), were computed for each set of GRE and t-PEPSI images, and divided according to their anatomic location as lobar and/or deep brain. RESULTS: There was no significant difference between GRE and t-PEPSI sequences in the detection of the total number of DAI lesions (291 vs. 230, respectively). GRE sequence delineated a higher number of DAI in the temporal lobe compared to the t-PEPSI sequence (74 vs. 37, P < .004), while no differences were found for the other regions. The SI CR was significantly lower with the t-PEPSI than the GRE sequence (P < .00001). CONCLUSION: Owing to its very short scan time and high sensitivity to the hemorrhage foci, the t-PEPSI sequence may be used as an alternative to the GRE to assess brain DAI in severe TBI patients, especially if uncooperative and medically unstable.

Two adult sisters are described who had a unique association of facial, ocular, and skeletal defects, and abdominal muscle hypoplasia, indicating autosomal recessive inheritance. Many of these features overlap those previously found in other malformation syndromes. However, the constellation of defects observed in these patients appears to represent a previously unreported syndrome and autosomal recessive inheritance is likely.

We describe a woman and her daughter affected by brachydactyly type C. The unusual feature in the child included the striking ‘angel-shaped’ appearance of the proximal phalanges of the index and middle fingers of one hand, whereas more typical triangular epiphyses with elongation of their radial side were present at the same location in the opposite hand. It is suggested that this peculiar phalangeal configuration occurs as a transitory event in early or mid childhood in phalanges that are marked by severe ossification delay, which is most prominent at the level of the primary ossification centre.

In vivo multiple spin echoes (MSE) images of bone marrow in trabecular bone were obtained for the first time on a clinical 1.5 T scanner. Despite of a reduced sensitivity of the MSE trabecular bone images with respect to the cerebral matter ones, it is possible to observe some features in the MSE trabecular bone images that may be useful in the diagnosis of osteopenic states. Two different CRAZED-type MSE imaging sequences based on spin-echo and EPI imaging modalities were applied in phantom and in vivo. Preliminary experimental results indicate that EPI imaging readout seems to conceal the MSE contrast correlated with pore dimension in porous media. However it is still possible to detect anisotropy effects related to the bone structure in MSE-EPI images. Some strategies are suggested to optimize the quality of MSE trabecular bone images.

We present a girl with short stature, growth hormone neurosecretory dysfunction, severe hypoplastic/aplastic changes of the bones of the hands and feet with dysharmonic ossification, severely delayed bone age, microcrania, and fibular hypoplasia. Parental consanguinity suggests autosomal recessive inheritance. An additional three cases [Eiken et al., 1984: Eur J Pediatr 141: 231-235] sharing some of the radiographic manifestations of this patient have been reported. However, distinctive findings in the present case seem to outline a separate entity.

A 36 year-old woman with a history of asthenia and palpitations was admitted to the Cardiac Surgery Department of Tor Vergata University, in Rome. Physical examination revealed short stature, depressed nasal bridge, hypertelorism, hypoacusia, pectus excavatum, diffuse brachydactyly, clinodactyly of the second digit of both the right hand and left foot. A 3/6 holosystolic increasing-decreasing murmur on the pulmonary focus was present at cardiac auscultation. Echocardiogram and cardiac catheterization revealed an ostium secundum atrial septal defect. X-ray examination of the hands exhibited shortening of the third, fourth and fifth metacarpals, shortening of the distal phalanges, shortening of the proximal and middle phalanges of the fifth digits and cone epiphysis of the middle phalanx of the second digits. Radiograph of the feet revealed shortening of the third and fourth and metatarsals on the left side, bilateral shortening of the first metatarsals and of the distal phalanges, cone epiphyses at the proximal base of the first toes. Additional radiographic findings included pectus excavatum and narrowing of the spinal canal. Laboratory investigations disclosed increased plasma levels of parathormone and hypocalcemia. The patient underwent primary closure of the atrial septal defect on cardiopulmonary bypass. Radiographic findings supported the diagnosis of Albright's hereditary osteodystrophy. This is a skeletal malformation involving type I-A pseudohypoparathyroidism and so-called pseudo-pseudohypoparathyroidism. Coexistence of hypocalcemia and high levels of parathormone indicated that our patient was affected with type I-A. About one-fourth of congenital heart diseases are associated with extracardiac anomalies. Although skeletal malformations appear to be the most frequent, the association of a congenital heart defect with Albright's hereditary osteodystrophy has never been described before.

We support the normal standards for two sonographic (US) signs of the posterior cranial fossa, namely the magnitude of the cisterna magna and the height of the fourth ventricle fastigium, in preterm and fullterm infants.The cisterna magna was measured as the distance between the inferior aspect of the cerebella vermis and the inner aspect of the occiput. The height of the fourth ventricle fastigium was calculated as the line drawn from the fastigium to the inner aspect of the occiput, close to the opisthion.The cisterna magna was .46 +/- .13 cm in preterm infants and .45 +/- .1 cm in fullterm infants (the difference was not significant), whereas the height of the fourth ventricle fastigium was 1.7 +/- .26 cm in preterm and 1.9 +/- .16 cm in fullterm infants (the difference was significant, p.005).The finding of a cisterna magna of equal size in preterm and fullterm infants is in agreement with the concept that subarachnoid and cisternal spaces of the posterior fossa are still large at birth and start to decrease in size later in life. Our results suggest that a cisterna magna smaller than .2 cm in height and/or a fastigium closer than 1.2 cm to the basiocciput in preterm and closer than 1.6 cm in fullterm infants indicate, in a proper clinical context, an abnormally low cerebellum position (Arnold-Chiari malformation). On the other hand, cisterna magna values exceeding .72 in preterm and .65 cm in fullterm infants, as well as fastigium values exceeding 2.22 cm in both groups may suggest the presence of the Dandy-Walker complex or of an arachnoid cyst.

We report on a further case of Goldenhar complex with uncommon and clinically remarkable associated anomalies. This additional case increases the number of observations and descriptions of patients with "expanded Goldenhar complex." Pathogenetic aspects are discussed.

The aim of our study was to evaluate the contrast-enhanced MR imaging (MRI) findings, in the early postoperative period, in unselected patients undergoing lumbar microdiscectomy (15/16 had total resolution of their symptoms). Contrast-enhanced imaging studies were performed, in all 16 patients of our series, before surgery, and at the third postoperative day and, two months after surgery. Postoperative paraspinal muscles enhancement was present in all patients. In the postoperative period, nerve root enhancement was present in 5/16 patients at the early survey and persisted in one after two months. A pseudohernia depicted as epidural intermediate signal intensity tissue, was seen in 13 patients at the third day MRI, and only in eight after two months. This pseudohernia enhanced peripherally in 8/13 patients and enhanced homogeneously in the remaining five at the first postsurgical examination; in the late MRI the peripheral enhancement was appreciable in only two patients while a homogeneous enhancement was observed in six. Clinical symptoms resolved completely in 14/16 patients on clinical evaluation at the third postoperative day, while the remaining two patients showed residual symptoms and signs of radicular compression. At the early MRI these two patients showed intradural nerve root enhancement. Two months later, one patient did not show the previously described nerve root enhancement and improved clinically, while the other had a positive Straight Leg Raising Sign with persistent intradural nerve root enhancement. In conclusion, no correlation between clinical course and contrast-enhancement of pseudohernia and extradural nerve root was appreciable, although intradural nerve root enhancement seems to represent a clinically relevant finding.

Objective. To establish the precision of sonographic measurement of the thickness of the articular cartilage of the hip and knee in children. Design. The precision was assessed by evaluating the intra- and interobserver variations in sonographic measurements. Patients. A total of 65 healthy children were in the study. The articular cartilage of the right hip and knee of 40 subjects (mean age 10.3 years, range 4–16.9 years) was evaluated in masked fashion by two observers to assess the interobserver variability. The articular cartilage of the right hip and knee of 25 children (mean age 10.4 years, range 6.2–15.5 years) was examined twice by the same observer to assess the intraobserver variability. Results and conclusions. Discrepancies between repeated measurements were expressed as data differences. The ”limits of agreement” of data differences, i.e. the mean +2 SD and the mean –2 SD, ranged from –0.26 to +0.22 mm and from –0.56 to +0.48 mm for the interobserver analysis of the femoral head cartilage (FHC) and femoral condylar cartilage (FCC), respectively. The ”limits of agreement” for the intraobserver analysis ranged from –0.16 to +0.15 mm and from –0.51 to +0.41 mm for the FHC and the FCC, respectively. The overall precision of the sonographic measurements was satisfactory. When used for determination of skeletal age, sonographic assessment of FHC thickness resulted in under/overestimation of skeletal age by about 7.5 months. In conclusion, sonographic measurement of articular cartilage is precise enough to be used in clinical practice.

High level of the CA 125 serum antigen is typically associated with ovarian malignancies. However the CA 125 antigen can also be found in association with inflammation or neoplasms of tissues other than ovaries, i.e. mesothelial cells, mullerian duct derivatives and gastroenteric tract. Therefore the marker is not specific for ovarian neoplasms. In childhood there is not a large experience about clinical meaning of high CA 125 serum levels. We report a case in a 14-year-old patient, female, affected by hydronephrosis. Our case confirms that high CA 125, especially in childhood, is not necessarily associated with ovarian or pelvic diseases. Moreover the review of literature suggests the opportunity to investigate CA 125 serum levels in children affected by hydronephrosis.

Despite its frequency, pneumonia is often surprisingly difficult to diagnose in children and young adults. In particular, the etiologic agent of pneumonia is difficult to recognize in an early stage, which obviously implies an empirical or delayed treatment. Chest radiography is one of the most common procedures required when pneumonia is suspected. This retrospective study was carried out to investigate the capabilities of chest radiography to identify the specific patterns of mycoplasma pneumonia in children. The chest radiographs of 76 children and adolescents (aged 4.2 to 16.4 years) with a radiographic diagnosis of pneumonia were reviewed. All patients were tested twice for serum antimycoplasma antibodies. Thirty-eight subjects (50%) with markedly increased antimycoplasma antibody levels were diagnosed as having mycoplasma infection. In the remaining 38 patients, viral (22 patients, 29%), bacterial (13 patients, 17%) and mixed (3 patients, 4%) infections were diagnosed on the grounds of clinical and laboratory data. Parahilar peribronchial infiltrates were found to be associated with both viral and mycoplasma infections, whereas segmental or lobar consolidation was associated with bacterial, viral and mycoplasma infections. Reticulonodular infiltrates were a specific pattern of mycoplasma pneumonia. The authors conclude that, in the presence of a reticulonodular infiltrate in a lobe, mycoplasma pneumonia can be confidently diagnosed.

Fifty-seven subjects aged 1.5-14 years (mean: 6.5; standard deviation: 3.3) complaining of hip pain and/or limp underwent clinical, US and radiologic examinations on admission and after variable time intervals. Twenty-eight of them were found to be affected with transient synovitis, 2 with rheumatic fever, 2 with slipped capital femoral epiphysis and 5 with Legg-Calvè-Perthes disease. The extant 20 subjects with normal US and X-ray findings were diagnosed as having irritable hip without effusion. No false-negative results were obtained from US (100% sensitivity), whereas X-ray provided false-negative results in 28 of 37 patients with hip disorders other than irritable hip without effusion (24.3% sensitivity). No significant difference in the extent of hip joint effusion was found at US between the various groups. In the transient synovitis group, joint effusion was apparent on X-ray image in 3 of 28 patients, in whom the effusion was significantly more severe than in the extant 25 patients. Capsular joint effusion resolved more rapidly in transient synovitis than in Legg-Calvè-Perthes disease. The patients with both rheumatic fever and transient synovitis exhibited the most rapid onset of symptoms. On the basis of our results, we suggest that each patient complaining of hip pain and/or limp should undergo US first and that X-rays be performed second, in selected cases only.

Slipped capital femoral epiphysis (SCFE) is an uncommon skeletal disorder of adolescence often overlooked because of its nonspecific clinical presentation. Anteroposterior radiography may fail to demonstrate a minimal slip even when clinical examination raises suspicion of the disease. On the other hand, prompt diagnosis is essential to obtain better therapeutic results. In our patient population joint effusion, which often accompanies SCFE, was readily recognized and quantified by ultrasonography (US). US also permitted recognition of the initial SCFE and assessment of the degree of slip by measuring the height of the physeal step. As to metaphyseal remodeling, plain radiography seems to be more informative than US; however, US has a role in the follow-up of SCFE because of the risk of slippage in the contralateral hip. This work suggests that US is useful as a primary imaging tool in the evaluation of subjects with limp or hip or knee pain to rule out SCFE.

Hemosiderosis, which results from transfusional therapy and from increased absorption of dietary iron, is a severe complication of thalassemia major. The complication is also very difficult to manage. An accurate determination of the total amount and of the distribution of body iron stores is essential for prognostic purposes and to evaluate the efficacy of chelation therapy. Therefore, a suitable tool for the noninvasive depiction of iron overload is to be hoped for. MR imaging has been usefully employed, of late, to this purpose. Sixteen thalassemic patients have been studied to evaluate iron depositions using a 1.5 T magnet. Signal intensities from liver, pancreas, spleen, bone marrow, and heart were considered. The signals were dramatically lower than the normal values obtained in a sex- and age-matched group; the differences were due to the iron. Iron distribution appeared inhomogeneous, with the highest overload in liver and bone marrow. Since cardiomyopathy represents the first cause of death in thalassemic patients, the relationship between cardiac function and iron overload in the heart has been thoroughly investigated. Finally, the authors conclude that MR will become a widely employed method for assessing iron overload and will contribute to improve the management of thalassemia major.

A thalassaemic girl presented with agranulocytosis, arthritis of both ankles and clinical and laboratory features consistent with the diagnosis of systemic vasculitis, during oral iron chelator L1 (deferiprone) treatment. Changes in the humoral and cell-mediated immune function, including antinuclear antibodies (ANA), anti-DNA and extractable-nuclear antigens (ENA) antibodies positivity, increased immunoglobulin values, decreased T suppressor and the presence of circulating immune complexes, suggest a cause-and-effect relationship with the observed clinical manifestations. A careful monitoring of the immune function is recommended in patients who are receiving the oral iron chelator L1.

The authors report a case of calcified ovarian metastases from a mucinous carcinoma of the colon observed in an 85-year-old woman. The radiological aspects observed at computed tomography (CT) are described and the possible mechanisms of tumoral calcifications are discussed.

BACKGROUND AND PURPOSE: Persistently hypointense lesions on T1-weighted MR images have been shown to correlate with the amount of axonal damage and clinical disability in multiple sclerosis (MS) patients. The purpose of this study was to investigate whether diffusion coefficient D(av) and fractional anisotropy (FA) are able to detect quantifiable differences among three groups of focal nonactive multiple sclerosis (MS) lesions that appear qualitatively different on T1-weighted images. METHODS: Conventional and diffusion tensor MR images of the brain were obtained in 18 patients with relapsing remitting (n = 10) or secondary progressive (n=8) MS and in 18 healthy volunteers. Focal nonactive MS lesions were classified as T1 isointense, T1 mildly hypointense, and T1 severely hypointense on unenhanced T1-weighted images. Differences among groups were assessed with one-way analysis of variance using the T1 lesion appearance as the grouping factor and either FA or coefficient D(av) as the dependent measure. RESULTS: FA was lowest and coefficient D(av) was highest in T1 severely hypointense lesions, and then, in ascending and descending order, respectively, T1 mildly hypointense lesions and T1 isointense lesions. A significant difference in the values of FA was detected only between T1 isointense lesions and T1 severely hypointense lesions (P < .01), whereas no difference was found between T1 mildly hypointense lesions and either one of these two groups. A significant difference was found in the values of coefficient D(av) among all investigated lesion groups. Coefficient D(av) was found to correlate inversely with the T1-weighted contrast ratio (r=−0.58, P < .0001), whereas FA and ΔFA (percentage of FA variation in the lesion, a relative FA measure that minimizes the effect of FA spatial dependence) were not. CONCLUSION: Coefficient D(av) is more sensitive than FA to variations in the degree of T1 hypointensity and, thus, in the amount of the permanent brain tissue damage in patients with MS.

A newborn girl is described with an association of spondylo-acrodysplasia, mild short limbed dwarfism without significant metaphyseal changes, joint dislocations, and severe immune system dysfunction. This association is distinct from other known immuno-osseous dysplasias, including Schimke dysplasia, ADA deficiency with osseous changes, and Omenn phenotype with short limbed dwarfism.

Computed tomography (CT) and, more recently, ultrasound (US), have proved excellent tools for quantifying adipose tissue distribution. Body fat distribution is an important factor in the treatment of obesity and its complications. We investigated the correlation between CT and US measurements in pediatric obesity.Forty obese children and adolescents aged 4.1-14.8 years were submitted to CT and US. Intra-abdominal, subcutaneous and total body fat were calculated (in cm2), with the CT image analysis software. The rectus muscle-spine and rectus muscle-aorta distances, as indicative of visceral fat thickness, were measured on US images with(out) compression. The distance between skin-fat and fat-rectus muscle interfaces was measured as subcutaneous fat thickness. We also compared US-CT findings with other morphometric variables--i.e., patient's (ideal) body weight and skin fold measures.At US, the rectus muscle-aorta and rectus muscle-spine distances ranged 2.4-7.5 cm (mean: 4.47 cm) and 3.6-8.9 cm (mean: 5.79 cm), respectively. The skin-rectus muscle distance ranged 1.2-7.5 cm (mean: 3.14 cm). A statistically significant correlation was found between the CT measurement of visceral fat and the aorta-rectus muscle and rectus muscle-spine distances (r = 0.80 and 0.74, respectively). The US measurements of subcutaneous fat were correlated with CT subcutaneous fat area (r = 0.82). No correlation was found between overweight, as calculated by body mass index, and CT or US fat.Our findings indicate that US is as useful as CT in evaluating body fat distribution in pediatric obesity.