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Resume L'evaluation des tumeurs osseuses en imagerie peut faire appel a toutes les methodes de radiodiagnostic. La radiographie simple reste incontournable. Elle evalue la dynamique evolutive de la lesion et permet d'envisager un ou plusieurs diagnostics grâce notamment a des criteres morphologiques et topographiques. La tomodensitometrie est utilisee pour sa resolution spatiale en explorant des regions difficilement accessibles en radiographie, et est egalement interessante pour l'etude de la corticale osseuse et de la matrice tumorale. Les principaux atouts de l'imagerie par resonance magnetique sont sa resolution en contraste et ses nombreux plans de coupe possibles, utiles pour l'extension locoregionale d'une tumeur. La scintigraphie est surtout employee pour savoir si une lesion est unique ou si elle s'integre dans une pathologie polyostotique. Echographie, angiographie, radiologie interventionnelle ont des indications tres precises. Selon les caracteristiques radiographiques d'une lesion, differentes attitudes sont preconisees allant de l'absence de toute investigation complementaire lorsque la benignite est evidente, au bilan d'extension locoregional et general, avant biopsie, en cas de suspicion de malignite.

Resumen Para el estudio por imagen de los tumores oseos se puede recurrir a todos los metodos de radiodiagnostico. La radiografia directa sigue siendo ineludible. A partir de criterios morfologicos y topograficos, permite evaluar la dinamica evolutiva de la lesion y pensar en uno o mas diagnosticos. La tomografia computarizada se emplea por su resolucion espacial al explorar regiones de dificil acceso para la radiografia, y resulta igualmente interesante para el estudio de la cortical osea y de la matriz tumoral. Las principales ventajas de la resonancia magnetica son la resolucion de contraste y los multiples planos de corte posibles, utiles para determinar la extension locorregional de un tumor. La gammagrafia se emplea sobre todo para saber si una lesion es unica o forma parte de un proceso poliostotico. La ecografia, la angiografia y la radiologia intervencionista tienen indicaciones precisas. Las caracteristicas radiograficas de una lesion determinan la conducta ulterior, desde la ausencia absoluta de otro examen complementario cuando la benignidad es evidente, hasta el estudio de extension locorregional y general, con biopsia previa, en caso de sospecha de malignidad.

Six patients with eosinophilic granuloma were studied retrospectively in order to correlate the MRI appearances with the pathology. Ages ranged from 2 years 6 months to 11 years. The bones involved were the humerus, ulna, radius, femur, clavicle and ilium. Plain films, MRI and pathology specimens were obtained. A lytic lesion with indistinct margins, endosteal erosions and periosteal reaction was seen in all cases on plain radiographs. Bone marrow signal was decreased on T1-weighted images and increased on T2-weighted images throughout the bony lesion in all cases. T2-weighted images showed extensive soft-tissue abnormalities suggesting inflammatory changes in four cases. In two cases abnormalities were limited. Extensive changes correlated histologically with an early phase lesion. Localized minor changes were associated with a mid-phase lesion. Inflammatory soft-tissue changes could be associated with eosinophilic granuloma. The size of the soft tissue mass correlated well with the activity of the bony lesion.

Twenty-one patients (26 hips) with typical signs of Legg-Perthes-Calvé (LPC) disease on plain radiographs were explored by MRI. Patients were imaged with a 0.5 T MR unit. Gadolinium-enhanced spin-echo MR images were obtained after nonenhanced T1-weighted (spin-echo) and T2*-weighted (gradient-echo) images. Four different areas were identified in the femoral epiphysis (necrosis, regenerative, cartilaginous and normal fatty bone tissue). The histological evolution of LPC is well described by Catterall and others. Comparing their descriptions with our MR findings, we suggest classification of LPC into five phases: necrosis: regeneration, reconstruction, reossification and sequelae.

We report a case of chondroblastoma involving the upper tibial epiphysis, which had an unusually aggressive course, with articular involvement at initial presentation. Intra-articular and soft tissue recurrence occurred after treatment consisting of curettage and bone grafting. Although the incidence of local intraosseous recurrence of chondroblastoma is relatively high, intra-articular and soft tissue implantation is rare and is usually due to intra-articular spillage during surgery. Spontaneous articular involvement is rarely seen.

Gorham's disease usually manifests as diffuse osteolysis but may be complicated with pleural effusion. We describe the case of a 12 year-old boy who had repeated pleural effusions. Radiographs show a mediastinal widening and an interstitial syndrome related to hemolymphangiomatous involvement.

A 7-year-old girl presented with an abdominal cystic mass close to the pancreas. US and CT could not identify its origin. The diagnosis of duplication of the transverse colon was made at surgery. This location is rare. The differential diagnosis in this case included a pancreatic cystadenoma, a pseudocyst or a mesenteric cyst.

This study evaluates the place of percutaneous nephrostomy (PCN) in neonates with posterior urethral valves (PUV).11 neonates with PUV, 10 of which were diagnosed antenatally, were treated. PCN drainage was performed in 9 cases, prior to endoscopic resection. Six PCN were bilateral and 3 were unilateral, for the following indications: renal failure in 5 cases, severe infection in 2 cases, evaluation of a dilated kidney in 2 cases.These PCN were left in place for an average of 18 days. Two cases of asymptomatic postoperative bacteriuria were observed. One nephrectomy and one cutaneous ureterostomy followed by reimplantation for megaureter were performed on the diverted kidneys.PCN has become the method of upper tract diversion in most cases of neonatal PUV. In addition to the classical indications (severe urinary tract infection, renal failure), it allows perfectly safe resection of valves in the case of upper tract dilatation and assessment of the kidneys.

This case of mesenchymatous hamartoma in a nine-year-old boy, was an incidental finding on a chest X ray. CT and MRI suggested the diagnosis showing a large (9 x 11 x 14 cm) mass developed in the right lower lung with sharp margins, without any sign of pulmonary or mediastinal compression. This lesion contained fatty areas on both CT and MRI. It showed no calcification. It enhanced slightly after IV contrast. On T2 WI, it appeared lobulated with low signal intensity septa. Presence of fatty tissues and lobulated margins were suggestive of the diagnosis of mesenchymatous hamartoma. A 1.2 kg mass was surgically removed. The tumor was attached to the right lower lobe by a small pedicle. Pathological examination disclosed fatty and connective tissues. This rare observation shows a good correlation between CT, MR, surgery and pathological examination.

A case of retroperitoneal pulmonary fistula caused by a neonatal adrenal abscess is reported. The adrenal abscess was diagnosed by means of needle aspiration which guided the choice of antibiotic therapy. The fistula was demonstrated by direct injection of contrast medium into the adrenal abscess. Treatment by needle aspiration of the adrenal abscess and intravenous antibiotics was successful.

Image quality and patient doses received during chest bedside examinations performed with conventional (film-screen combination) and photostimulable phosphorus plate systems were compared in a study carried out in 1993 in a French pediatric radiology department. Seventy one children (36 males and 35 females) aged between 9 days and 18 years (average: 43 months) were included in the study. Technical performances of all radiological equipment used were permanently checked through a quality control program. One conventional and 3 "photostimulable" films were performed for each patient included (mAs product selected for "photostimulable" system was progressively reduced down to 60% of that of conventional technique). TLD Lithium Fluoride chips were used to measure entrance surface dose during the examination. Image quality of 284 films (213 "photostimulable" + 71 conventional) was assessed by three independent radiologists. Advantages and drawbacks of both studied imaging techniques are discussed in terms of patient dose reduction and image quality.

Chez 17 nouveaux-nes et nourrissons porteurs d'un syndrome de la jonction pyelo-ureterale severe, c'est-a-dire avec un rein muet ou un retard de secretion superieur ou egal a 4 heures a l'UIV, une nephrostomie percutanee (NPC) a ete mise en place systematiquement, avec une etude separee de la clearance de la creatinine pour chaque rein, entre 1981 et 1993. Une pyeloplastie a ete effectuee dans 9 cas, avec un succes pour 6 d'entre eux (recul moyen = 7,7 ans) et une nephrectomie dans les 8 autres cas. Il apparait que la NPC a confirme qu'aucun rein muet, dans cette serie, ne meritait d'etre conserve. Parmi les reins avec un retard secretoire important a l'UIV, la NPC a montre que ceux qui devaient etre conserves avaient une clearance de la creatinine superieure a 1 ml/mn/1.73 m 2 , ou une clearance theorique pour l'âge et le poids superieure a 6%. La NPC permet donc de preciser la valeur fonctionnelle des reins avec syndrome de la jonction pyelo-ureterale severe chez le nouveau-ne et le nourrisson et d'en deduire ceux qui doivent beneficier d'une chirurgie conservatrice.

endoscopic retrograde cholangiography may be difficult or unfeasible in children. It also may be complicated by acute pancreatitis. The purpose of this study was to determine the diagnostic contribution of spiral CT cholangiography in pediatric patients.seven patients, age ranging from 10 months to 13 years were explored without general anesthesia. Eight spiral CT cholangiographies were performed. The patients were suspected to have biliary or pancreatic lesions. Spiral CT was performed 60 minutes after slow infusion of iodipamide (Transbilix-Guerbet). The dose was correlated to the body surface. 3D reconstructions were done using the surface rendering or the MIP technique.biliary tract opacification and 3D reconstructions were considered of good quality in 6 out of 8 studies. It was normal in 2 cases. A duplication of the duodenum communicating with the choledocus was found in 1 case. Biliary lithiasis with a stone in the cystic duct was found in 1 case. Two choledocal cysts with bile ducts dilatation were diagnosed. A post operative biliary leak with bile ducts dilatation was found in one case. The spiral CT was not diagnostic in 2 patients: a case of choledocal cyst, the study was of poor quality due to inadequate sedation and a case of Caroli's disease with a high serum bilirubin level. Four patients had an endoscopic or a percutaneous cholangiography: to explore the pancreatic ducts (2 cases), poor CT study due to the inadequate sedation in 1 child, and the case of Caroli's disease.spiral CT is feasible even in young children. It should reduce the indications for endoscopic or percutaneous cholangiography. It has to be performed as the first examination in cases of biliary or pancreatic diseases when surgery is contemplated.

Intestinal duplications are rare and are usually diagnosed in the first two years of infancy. They can occur at any level of the alimentary tract from the oral cavity to the anus. Duodenal duplication accounts for approximately 7% of all intestinal duplications. A previously healthy 4-year 6-month old boy was admitted with progressive increasing vomiting. Physical examination was normal, the serum amylase level was moderately increased. Upper gastrointestinal series showed an extrinsic compression defect of the proximal duodenum. Ultrasonography showed a 3 cm diameter cyst in the head of the pancreas. A duplication was suggested. Helical CT cholangiography showed a communication between duplication and the biliopancreatic common channel. The biliary tree was normal. Surgical resection of the intrapancreatic lesion was performed. Microscopic examination of the specimen revealed a duodenal duplication.

To assess the validity and the interest to health of systematic herniography in cases of unilateral inguinal hernia in children under two years of age.Decision theory was used to assess the effect of herniography on individual health by estimating gonadic benefit and establishing a benefit-risk ratio, and on collective health by the use of cost-effectiveness analysis.a decision tree and algorithms were developed.Decision analysis is used in complex medical decision making, clarifying choices and subdividing a problem into several more manageable sub-problems. The threshold approach pinpoints factors requiring more information.

We report one case of multilocular cyst of the kidney in one year and three months female infant who underwent echography, computed tomography and MRI before surgery. MR image accurately reflect the morphology of the tumor: the capsule is hypointense on T1-weighted images, the septa show moderate enhancement with intravenous contrast. Varied intensities from fluid in the visualised locules presumably represent different concentration of proteins. MR imaging features are highly suggestive but non pathognomonic of the disease. Positive diagnosis always require histology.

Teleradiology consists of the transmission of radiological images from one point to another. The use of a commercial telephone network allows easy and inexpensive transmission. Numerous applications are possible: management of patient transfers (for example the neurosurgery emergency service), distant interpretation of radiological images (telediagnosis), faster return of urgent examinations (direct transmission to examination monitors in medical or surgical emergency departments). Teleradiology raises technical problems: data entry (as not all radiological images are digitalised), quality and duration of transfer time, quality of display monitors; medicolegal problems: medical responsibility as well as storage (magnetic, magneto-optical or optical supports are not legally recognised at the present time). Although only in the early stages in France, teleradiology is being developed with relatively inexpensive equipment which can be described as an "image telephone".

The major benefit of antenatal ultrasonography is to allow early diagnosis of urinary tract malformations before postnatal infection worsens the prognosis. In the majority of cases, there is a unilateral and moderate dilatation requiring a check-up only during the second week of life; treatment subsequently depends on the etiology of the uropathy and the consequences on the kidney. Unilateral severe dilatations and bilateral, but moderate, dilatations must be managed immediately after birth in a pediatric surgical center. In the rare cases of severe bilateral obstructive uropathy, in utero decompression by catheterisation or surgery is now considered to be uselessly invasive, considering that renal dysplasia is already present when the malformation is detected.