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To determine frequency of duodenal anatomical variants on clinically indicated pediatric UGI examinations and determine the influence of these variants and exam quality on the reliability of diagnosis.Two-pediatric radiologists retrospectively reviewed 100-UGI exams performed on children ≤18-years. Exams were considered diagnostic if the duodenojejunal (DJ) flexure was identified. For diagnostic exams, readers categorized the duodenal location and shape as: normal, normal variant, or abnormal. Exam quality was assessed according to duodenal visualization, number of boluses required, and patient positioning.Reader 1: 90/100 exams diagnostic -77% normal duodenum, 20% normal variant, and 3% abnormal. Reader 2: 97/100 exams diagnostic - 88% normal, 8% normal variant, and 4% abnormal. Original reports: 99/100 exams diagnostic - 92% normal, 3% normal variant, and 5% abnormal. 42% of exams were "high-quality" and 58% were "low-quality". The number of abnormal was the same between readers in "high-quality" studies. In "low-quality" studies reader 1 and the original read diagnosed 1 further case as non-rotation which was diagnosed as a normal variant by reader 2. Two further cases were reported as non-rotation by the original reader. Inter-rater reliability was significantly higher among each pair of raters in "high quality" exams (κ 0.3; p ≤ 0.05) compared to "low quality" exams (k 0.1 - p 0.05).Duodenal variants were diagnosed in 8-20% of UGI. Compromised exam quality contributes to poor interrater reliability and may result in diagnostic errors of normal variant duodenums, posing a risk for unnecessary intervention and/or delayed treatment.

BACKGROUND. Extensive lymphatic malformations (LMs) may cause substantial morbidity. The mammalian target of rapamycin (mTOR) inhibitor sirolimus shows promise for treating vascular anomalies, alth...

Patients with tuberous sclerosis complex (TSC) can develop solid kidney masses from childhood. Imaging surveillance is done to detect renal cell carcinoma (RCC) and angiomyolipomas (AML), including AMLs at risk for hemorrhage. Intravenous contrast-enhanced ultrasound (CEUS) may be useful for screening as ultrasound is well tolerated by children and ultrasound contrast agents (UCA) are not nephrotoxic. Retrospective review of kidney CEUS exams of pediatric TSC patients. Qualitative CEUS analysis by consensus of 3 radiologists assessed rate, intensity, and pattern of lesion enhancement. Quantitative CEUS analysis was performed using Vuebox®. Where available, abdominal MRI was analyzed qualitatively for the same features and quantitatively by in-house-developed software. Time-intensity curves were generated from both CEUS and MRI where possible. Appearance of lesions were compared between CEUS and MRI and histology where available. Nine masses in 5 patients included one histologically proven RCC and 8 AMLs diagnosed by imaging. Quantitative CEUS of RCC showed malignant features including increased peak enhancement 162%, rapid wash-in rate 162%, and elevated washout rate 156% compared to normal kidney tissue; versus AML which was 68%, 105%, and 125%, respectively. All masses were hypoenhancing on MRI compared to normal kidney tissue; MR dynamic contrast study offered no distinction between RCC and AML. The only MRI feature differentiating RCC from AML was absence of fat. Temporal resolution afforded by CEUS was useful to distinguish malignant from benign kidney masses. CEUS may prove useful for screening, characterizing, and follow-up of kidney lesions in pediatric TSC patients.

Introducción: El lipoma intracraneal es una malformación congénita muy rara, que representa menos del 0,1% de los tu­mores intracraneales; son causadas por la persistencia anormal de un foco de meninges primitivas, que de una forma poco clara hasta el momento, se induce a diferenciarse en adipocitos. Presentación del caso: Este artículo reporta el caso de una mujer de 27 años que consultó al servicio de urgencias de un Hospital Universitario de Colombia por clínica de cefalea de larga evolución asociada a un episodio tónico clónico generalizado. En la exploración neurológica no presento signos de focalización o alteraciones, la tomografía computarizada (TC) evidenció una lesión hipodensa en la región interhemisférica, sospechando lipoma del cuerpo calloso (CC), que fue confirmado por espectroscopia de resonancia magnética nuclear (RMN). Teniendo en cuenta la ubicación de la lesión y posible patología, se inició tratamiento médico, se observó que la paciente permaneció estable durante los 6 meses de control. A continuación se realiza, la revisión de la literatura sobre Lipoma del cuerpo calloso. Conclusiones: El lipoma del cuerpo calloso es una enfermedad benigna rara, cuyo manejo quirúrgico es infrecuente y el control farmacológico es favorable, como se describe en este caso de una mujer de 27 años diagnosticada con esta patología.

Background Stiffness thresholds for liver MR elastography in children vary between studies and may differ from thresholds in adults. Normative liver stiffness data are needed to optimize diagnostic thresholds for children. Purpose To determine normal liver stiffness, and associated normal ranges for children, as measured with MR elastography across vendors and field strengths. Materials and Methods This was a prospective multicenter cohort study (ClinicalTrials.gov identifier: NCT03235414). Volunteers aged 7-17.9 years without a known history of liver disease were recruited at four sites for a research MRI and blood draw between February 2018 and October 2019. MRI was performed on three vendor platforms and at two field strengths (1.5 T and 3.0 T). All MRI scans were centrally analyzed; stiffness, proton density fat fraction (PDFF), and R2* values were expressed as means of means. Mean and 95% confidence intervals (CIs) for liver stiffness were calculated. Pearson correlation coefficient (r), two-sample t test, or analysis of variance was used to assess univariable associations. Results Seventy-one volunteers had complete data and no documented exclusion criterion (median age, 12 years; interquartile range [IQR], 10-15 years; 39 female participants). Median body mass index percentile was 54% (IQR, 32.5%-69.5%). Mean liver stiffness was 2.1 kPa (95% CI: 2.0, 2.2 kPa) with mean ± 1.96 kPa standard deviation of 1.5-2.8 kPa. Median liver PDFF was 2.0% (IQR, 1.7%-2.6%). There was no association between liver stiffness and any patient variable or MRI scanner factor. Conclusion Mean liver stiffness measured with MR elastography in children without liver disease was 2.1 kPa (similar to that in adults). The 95th percentile of normal liver stiffness was 2.8 kPa. Liver stiffness was independent of sex, age, or body mass index and did not vary with MRI scanner vendor or field strength. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Yin in this issue.

OBJECTIVES: To evaluate whether liver and spleen magnetic resonance elastography (MRE) can measure the severity of congenital hepatic fibrosis (CHF) and portal hypertension (pHTN) in individuals with autosomal recessive polycystic kidney disease (ARPKD), and to examine correlations between liver MRE and ultrasound (US) elastography. METHODS: Cross-sectional study of 9 individuals with ARPKD and 14 healthy controls. MRE was performed to measure mean liver and spleen stiffness (kPa); US elastography was performed to measure point shear wave speed (SWS) in both liver lobes. We compared: (1) MRE liver and spleen stiffness between controls vs. ARPKD; and (2) MRE liver stiffness between participants with ARPKD without vs. with pHTN, and examined correlations between MRE liver stiffness, spleen length, platelet counts, and US elastography SWS. Receiver operating characteristic (ROC) analysis was performed to examine diagnostic accuracy of liver MRE. RESULTS: Participants with ARPKD (median age 16.8 [IQR 13.3, 18.9] years) had higher median MRE liver stiffness than controls (median age 14.7 [IQR 9.7, 16.7 years) (2.55 vs. 1.92 kPa, p=0.008), but MRE spleen stiffness did not differ. ARPKD participants with pHTN had higher median MRE liver stiffness than those without (3.60 kPa vs 2.49 kPa, p=0.05). Liver MRE and US elastography measurements were strongly correlated. To distinguish ARPKD vs. control groups, liver MRE had 78% sensitivity and 93% specificity at a proposed cut-off of 2.48 kPa [ROC area 0.83 (95% CI: 0.63–1.00)]. CONCLUSION: Liver MRE may be a useful quantitative method to measure the severity of CHF and pHTN in individuals with ARPKD.

To determine the MRU imaging findings of calyceal diverticula in a large cohort of children and to compare the frequency of calyceal diverticula in our cohort with what has been previously reported. This was a HIPAA-compliant, IRB-approved retrospective study of all patients with suspected CD based on their medical records. All patients in this study underwent MRU at our institution between 2010 and 2017. Two pediatric radiologists reviewed each MRU blinded to clinical information and other urologic imaging regarding the presence, size, location, and morphology of the cyst and presence/absence of contrast within it. The time when contrast first appeared within the cystic mass was recorded, and a χ2 test was used to determine significance on differences between the different characteristics of renal cysts and diverticula. Fifty children (29 girls and 21 boys; median age of 11.5 years, IQR 7–16) with a total of 66 individual cystic masses were included. 21 (21/66, 31.8%) Cystic masses demonstrated contrast filling and were characterized as diverticula, resulting in a frequency of 26.6 cases per 1000 patients (21/787). The remaining 45 cystic masses (45/66, 68.1%) were cysts. The median diameter of CD was 2.5 cm (IQR 1.5–3.7). Contrast was observed within the cystic mass on average at 4.6 min (SD ± 2.4; range 1.5–13 min). The agreement between both radiologists was 91% (k = 0.78). 6 Cysts and 18 CD were confirmed surgically, MRU demonstrated accurate diagnosis in 100% of those cases. Magnetic resonance urography is reliable in differentiating calyceal diverticula from renal cysts. On MRU, all diverticula were identified within 15 min of contrast administration; hence longer delays in imaging are unnecessary.

Highlights • The clinical presentation of stump appendicitis is similar as a first episode of appendicitis. • The risk factors for SA are not clear, but the data available suggest that a primary laparoscopic appendectomy is not related. • The length of the stump left in the first surgery might be associated with stump appendicitis. • Incidence of stump appendicitis seems to be higher than previously reported., Introduction Acute appendicitis (AA) is the most common cause of acute surgical abdomen. Complications from surgical appendectomy include intraabdominal abscess, bleeding, surgical site infections, ileus, and stump appendicitis (SA). This last one is one of the least common ones with a reported incidence of 1:50.000. Methods We present a case and review 132 cases of SA reported in the literature. Demographic and clinical characteristics were evaluated, as well as details of the surgical treatment. Categorical variables are presented as quantities and proportions, and continuous variables with median and interquartile range. Additionally, we calculate an incidence from 3 papers reported in the literature and our own. Results We analyzed 132 cases, 60.3 % were male with a median age at SA of 33 years. There was a wide range time interval between the episode of AA and SA from 1 day to 60 years. Initial open appendectomy was reported in 62 cases. From all the patients with SA 51 % reported complications. The median length of the appendiceal stump was 3 cm. The incidence of SA fluctuated between 0.22–1.37 in 1.000 cases of appendectomies. Discussion SA is usually underrated, and which are the risk factors for this condition are not clear. The data available suggest that a primary laparoscopic appendectomy is not related to SA, but the length of the stump left in the first surgery might be associated. The incidence of SA seems to be higher than the one reported of 1 in 50.000.

To retrospectively review imaging planes, number of visible pyloric layers and location of measurements, in infants with suspected (HPS). 103 pyloric ultrasound studies for suspected HPS were included. For each study, we recorded whether longitudinal or transverse views were performed, the layers visualized (a schematic was developed for two pediatric radiologists to categorize the interfaces of the anatomic layers a–e) and position of the internal measurement cursor. Categories for the anterior (superficial wall) layers were from external to internal: (a) internal aspect of the muscularis propria; (b) external aspect of the muscularis mucosa; (c) internal aspect of the muscularis mucosa; (d) internal aspect of the mucosa interfacing with a mucosal fold (e) deep aspect of the mucosal fold. Median differences between HPS groups were calculated and inter-reader agreement (kappa score) was performed between both readers. In 100 studies (97 patients), longitudinal (99%) and transverse (69%) views of the pylorus were recorded. For longitudinal views, measurements included muscle thickness (95%), length (97%) and no pyloric diameter. For the transverse view, measurements included muscle thickness (16%) and the diameter (3%). Pyloric layer interfaces were visible: (a) in 64% (b) in 64% (c) in 66% (d) in 30% and (e) in 26%. The internal reference point of cursor placement for measuring the muscle wall thickness in the longitudinal view for one reader was as follows: (a) 46% (b) 27% (c) 30% (d) 1% and (e) 2% of studies. Surgically proven HPS group had a median thickness measurement 0.17 mm greater than the non-HPS studies (CI 95% 0.12–0.21, p

Patients with neurogenic bladders are monitored with renal bladder ultrasounds and video urodynamics studies (VUDS) to assess upper urinary tract injury. Ultrasound shear wave elastography (US-SWE) can assess tissue stiffness. If bladder compliance is affected by bladder wall fibrosis and stiffening, then high-pressure bladders may be detectable by US-SWE therefore reducing the need for VUDS in some patients.To determine if US-SWE can differentiate between low- and high-pressure bladders and hence be used for noninvasive assessment of neurogenic bladder in children.Prospective study of patients with neurogenic bladder undergoing clinically indicated VUDS between February and July of 2017. During VUDS, bladder wall US-SWE was measured at different filling percentages of estimated bladder capacity (EBC). The bladders were divided into cohorts according to the detrusor muscle pressure (P30/31 enrolled children completed the protocol. With an empty bladder, as well as at all other bladder volumes, no relationship was observed between PWe found no difference between SWE values of either the anterior or posterior bladder wall in neurogenic bladders with normal and abnormal filling pressures measured during VUDS. Our study differs from previously reported studies with more positive results in that our cut-off for abnormal bladder pressure was (PUS-SWE, while feasible, was not able to discriminate between low- and high-pressure bladders. Moreover, US-SWE did not show significant correlation with the current gold standard, VUDS.

Purpose To describe the morphology and function of duplicated collecting systems in pediatric patients undergoing functional MR urography (fMRU). Methods This is a HIPAA compliant IRB approved retrospective study of all patients with duplicated renal collecting systems undergoing fMRU at our institution between 2010 and 2017. Two pediatric radiologists evaluated the studies to determine the presence, morphology and function of duplicated collecting systems using both T2-weighted and dynamic post-contrast fat saturated T1-weighted images. Assessed morphologic features included pelvic and calyceal dilation, partial or complete ureteral duplication, ureteral dilation, ectopic ureteral insertion and ureteroceles. Functional analysis was carried out per moiety. Results A total of 86 examinations (63 girls; 23 boys), median age 2.6 years (Standard Deviation 6.4 years, interquartile range: 0.4–10.3 years) and 107 kidneys (39 right; 30 left and 19 bilateral), which yielded 214 evaluable moieties, were included in the final sample. One hundred and sixty-three (76.1%) of the moieties had normal morphological features and normal functional results (average calyceal transit time and renal transit time of 2 min 28 s and 3 min 16 s, respectively). The remaining 51 moieties (23.8%) were hypoplastic or dysplastic. Seventy-seven (35.9%) had pelvic and calyceal dilation. Slightly more than half of the kidneys had complete ureteral duplication (60/107; 56%); 50 (50/107, 46.7%) had ectopic ureters (23 intra- and 27 extravesical) and 9 (9/107, 8.4%) had ureteroceles. Conclusion fMRU provides comprehensive information regarding the morphology and function of duplicated renal collecting systems in children. In particular, fMRU is useful for assessing barely or non-functioning renal poles and ectopic ureters.

Objectives Developmental dysplasia of the hip (DDH) is one of the most common developmental deformities of the lower extremity. Although many children are successfully treated with a brace or harness, some require intraoperative closed or open reduction and spica casting. Surgical reduction is largely successful to relocate the hip; however, iatrogenic avascular necrosis is a major source of morbidity. Recent research showed that postoperative gadolinium-enhanced magnetic resonance imaging (MRI) can depict hip perfusion, which may predict a future incidence of avascular necrosis. As contrast-enhanced ultrasound (CEUS) assesses blood flow in real time, it may be an effective intraoperative alternative to evaluate femoral head perfusion. Here we describe our initial experience regarding the feasibility of intraoperative CEUS of the hip for the assessment of femoral head perfusion before and after DDH reduction. Methods This single-institution retrospective Institutional Review Board-approved study with a waiver of informed consent evaluated intraoperative hip CEUS in children with DDH compared to postoperative contrast-enhanced MRI. Pediatric radiologists, blinded to prior imaging findings and outcomes, reviewed both CEUS and MRI examinations separately and some time from the initial examination both independently and in consensus. Results Seventeen patients had 20 intraoperative CEUS examinations. Twelve of 17 (70.6%) had prereduction hip CEUS, postreduction hip CEUS, and postreduction gadolinium-enhanced MRI. Seven of 12 (58.3%) were evaluable retrospectively. All CEUS studies showed blood flow in the femoral epiphysis before and after reduction, and all MRI studies showed femoral head enhancement after reduction. The CEUS and MRI for all 7 patients also showed physeal blood flow. Conclusions Contrast-enhanced ultrasound is a feasible intraoperative tool for assessing adequate blood flow after hip reduction surgery in DDH.

To compare the reproducibility and accuracy of R2-relaxometry MRI for estimation of liver iron concentration (LIC) between in-house analysis and FDA-approved commercially available third party results. All MR studies were performed on a 1.5T scanner. Multi-echo spin-echo scans with a fixed TR and increasing TE values of 6 ms, 9 ms, 12 ms, 15 ms, and 18 ms (spaced at 3 ms intervals) were used. Post-processing of the images to calculate mean relaxivity, R2, included drawing of regions of interest to include the whole liver on mid-slice. The relationship between liver R2 values and estimated LIC calculated with in-house analysis and values reported by an external company (FerriScan®, Resonance Health, Australia) were assessed with correlation coefficients and Bland–Altman difference plots. Continuous variables are presented as mean ± standard deviation. Significance was set at p value

Incidental sonographic findings in thyroid and estrogen-responsive organs have been described in children and adults, but no publications describe incidental findings of these organs in infancy. We describe ultrasound features in thyroid, breast buds, testes, uterus, and ovaries in infants up to 32 weeks old that vary from the expected tissue architecture. Infants described in this paper were enrolled as healthy term neonates in a longitudinal study of normal feeding practices. Radiology reports for ultrasound exams in these infants described a range of findings that are similar to those reported in older populations. Knowledge of these asymptomatic variants occurring in infancy may guide radiologists in interpretation of these findings during clinical exams.

Summary Introduction Functional renal imaging, most commonly with MAG3 nuclear medicine renal scan, is recommended in the evaluation of children with urinary tract dilation (UTD) suspected of obstructive uropathy. Alternatively, renal function can be evaluated with functional Magnetic Resonance Urography (fMRU), which has superior anatomic detail. However, there are not enough data comparing both methods’ equivalency. In this study, we compare the functional and obstruction parameters of fMRU and MAG3 in a pediatric cohort presenting with obstructive uropathy. Study design This is an IRB-approved retrospective review of all children undergoing fMRU at a single, free-standing children's hospital between May 2008 and September 2017. Patients who also underwent a MAG3 renal scan within 6 months and who had no interval surgical intervention were included in the study. Bladder catheterization was performed prior to both imaging studies. Results 735 children had 988 fMRU studies performed during the study period. 37 unique patients (13 girls and 24 boys) with median age of 6 months (range: 2 mo–19 y) were included in the final sample. Median time interval between studies was 70 days (range 6–179 days). The majority of participants (26/37, 70.3%) presented with UTD P3 and had diagnosis of uretero-pelvic junction obstruction (UPJO) in 21/37. Differential renal function (DRF) was used to group 10 fMRU and 9 MAG3 patients as normal; 9 fMRU and 11 MAG3 as mild; 11 fMRU and 6 MAG3 as moderate; and 7 fMRU and 6 MAG3 as severe; Wilcoxon signed-rank test (p = 0.5106). Results were similar for DRF among patients with and without duplex kidneys. In the analysis of obstruction, using reference standard T½ MAG3 ≥ 20 min, a greater or equal than 6 min renal transit time (RTT) from fMRU showed a specificity of 94%, a sensitivity of 62%, and an AUC of 0.827. Discussion and conclusions The differential renal function determined by MAG3 and fMRU in children was not statistically different, therefore we concluded that it was similar and potentially equivalent. Better correlation was shown in patients who had normal split kidney function. While the tests are clinically equivalent, the variability of DRF within each clinical category (i.e., normal, mild, moderate, severe) is not surprising, because MAG3 does not clearly differentiate the dilated collecting system from the functional parenchymal tissue, while fMRU does. Using MAG3 as the gold standard, fMRU was 94.74% specific and 5% more sensitive in detecting UPJO with a RTT of 6min vs. 8min.

Ultrasound is commonly the first-line imaging modality for assessing the pediatric abdomen. An abnormal size of the liver, spleen, or kidneys may indicate disease, but the evaluation is challenging because the normal size changes with age. In addition, published normal value charts for children may vary by population and methods. In this systematic review, we summarized published data on the normal size of the pediatric liver, spleen, and kidneys as measured by ultrasound in which we found similar values across different populations, ages, and sexes.

Imaging modalities for diagnosing kidney and urinary tract disorders in children have developed rapidly over the last decade largely because of advancement of modern technology. General pediatricians and neonatologists are often the front line in detecting renal anomalies. There is a lack of knowledge of the applicability, indications, and nephrotoxic risks of novel renal imaging modalities. Here we describe the clinical impact of congenital anomalies of the kidneys and urinary tract and describe pediatric-specific renal imaging techniques by providing a practical guideline for the diagnosis of kidney and urinary tract disorders.

Transabdominal ultrasound remains the first-line imaging modality of the pediatric female pelvis. However, magnetic resonance imaging (MR imaging) is increasingly important in the investigation and characterization of suspected abnormalities. The superior soft tissue contrast resolution of MR imaging provides excellent evaluation of ovarian and uterine anatomy. MR imaging may be particularly useful in nonsexually active girls in whom transvaginal ultrasound is generally contraindicated. This chapter discusses MR imaging applications to evaluate normal anatomy and development as well as congenital and acquired disorders of the pediatric female genital tract.

Ultrasound (US) is used in the initial evaluation and surveillance of urinary tract dilation in children. Urinary tract dilation is diagnosed in 1–2% of all pregnancies during routine prenatal sonography with technological advances in US imaging. Urinary tract dilation classification systems, including the 2014 multidisciplinary consensus, assess anterior–posterior renal pelvic diameter and calyceal dilation. There is no consensus regarding optimal patient positioning — supine versus prone — during US assessment of urinary tract dilation. We performed this study to determine whether there is a significant difference in the measurement of the anterior–posterior renal pelvic diameter, presence of calyceal dilation, or resulting urinary tract dilation consensus score obtained between supine and prone positions. Two raters retrospectively reviewed renal bladder US exams of children with urinary tract dilation of one or both kidneys. We included technically adequate US examinations of orthotopic kidneys that were imaged in both supine and prone positions; we excluded children with renal anomalies or prior surgery. Anterior–posterior renal pelvic diameter measurements as well as central and peripheral calyceal dilation were documented in both supine and prone positions. A postnatal urinary tract dilation consensus score was assigned to each kidney based only on these features. Urinary tract dilation in either the supine or prone position was performed in 146 kidneys (69 right, 77 left) in 89 children. Median age was 0.26 years (interquartile ratio [IQR] 0.08–0.61 years). Female-to-male ratio was 1:3 (21/89). The interclass correlations of the anterior–posterior renal pelvic diameter were 0.88 and 0.87 in the supine and prone positions, respectively, without significant differences (P=0.1). When comparing all kidneys together, the mean anterior–posterior renal pelvic diameter was 7.1 mm (95% confidence interval [CI] 6.4–7.8) in supine and 7.9 (95% CI 7.1–8.7) in prone, with a mean difference between the measurements of 0.83 mm (95% CI 0.3–1.4; P=0.16). Central calyceal and peripheral calyceal dilation were more commonly found in the prone position versus the supine position in both kidneys. Central calyceal dilation was observed in 15 cases in the prone but not in the supine position. In one kidney, it was seen only in the supine but not in the prone position. Overall the urinary tract dilation score differed between positions in 10.3% (15/146) of cases, most of them (14/15) with a higher score in prone compared to the supine position. Scanning in prone position tends to more frequently show calyceal dilation and a greater size of the anterior–posterior renal pelvic diameter, resulting in higher urinary tract dilation classification scores, with almost perfect interobserver agreement.

Ultrasound is commonly the first-line imaging modality for assessing the pediatric abdomen. An abnormal size of the liver, spleen, or kidneys may indicate disease, but the evaluation is challenging because the normal size changes with age. In addition, published normal value charts for children may vary by population and methods. In this systematic review, we summarized published data on the normal size of the pediatric liver, spleen, and kidneys as measured by ultrasound in which we found similar values across different populations, ages, and sexes.

OBJECTIVE: To compare diffusion tensor imaging (DTI) of the kidneys and its derived parameters in children with autosomal recessive polycystic kidney disease (ARPKD) versus healthy controls. METHODS: In a prospective IRB-approved study, we evaluated the use of DTI to compare kidney parenchyma FA values in healthy controls (age-matched children with no history of renal disease) versus patients with ARPKD. A 20-direction DTI with b-values of b = 0 s/mm(2) and b = 400 s/mm(2) was used to acquire data in coronal direction using a fat-suppressed spinecho echo-planar sequence. Diffusion Toolkit and TrackVis were used for analysis and segmentation. TrackVis was used to draw regions of interest (ROIs) covering the entire volume of the renal parenchyma, excluding the collecting system. Fibers were reconstructed using a deterministic fiber tracking algorithm. The FA values based on the ROI data, mean length, and volume of the tracks based on the fiber tracking data were recorded. RESULTS: Eight healthy controls (mean age = 12.9 years ± 4.0; 1/8 males) and six ARPKD participants (mean age = 13.8 years ± 8.5; 5/6 males) were included in the study. Compared to healthy controls, patients with ARPKD had significantly lower FA values (0.33 ± 0.03 vs. 0.25 ± 0.02, p = 0.002) and mean track length (16.73 ± 3.43 vs. 11.61 ± 1.29 mm, p = 0.005). CONCLUSION: DTI of the kidneys shows significantly lower FA values and mean track length in children and young adults with ARPKD compared to normal subjects. DTI of the kidney offers a novel approach for characterizing renal disease based on changes in diffusion anisotropy and kidney structure.

PURPOSE: The goal of our study is to compare hepatic stiffness measures using gradient recalled echo (GRE) vs spin-echo echo planar imaging (SE-EPI) based MR Elastography (MRE) at 3T used to measure hepatic stiffness in a patients with suspected liver diseases. MATERIALS AND METHODS: This retrospective study included 52 patients with liver disease who underwent a 3T MRE exam including both an investigational SE-EPI based technique and a product GRE based technique. Regions of interest (ROI) were placed on the elastograms to measure elastography derived liver stiffness as well as the area included within the ROIs. The mean liver stiffness values and area of ROIs were compared. RESULTS: The mean liver stiffness was 3.72 kilopascal (kPa) ± 1.29 using GRE MRE and 3.78 kPa ± 1.13 using SE-EPI MRE. Measurement of liver stiffness showed excellent agreement between the two pulse sequences with a mean bias of −0.1 kPa (range −1.8 to 1.7 kPa) between sequences. The mean measurable ROI area was higher with SE-EPI (313.8 cm(2) ± 213.8) than with the GRE technique (208.6 cm(2) ± 114.8), and the difference was statistically significant (P < 0.05). CONCLUSIONS: Our data shows excellent agreement of measured liver stiffness between GRE and SE-EPI based sequences at 3T. Our results show the advantage of a SE-EPI MRE sequence in terms of image quality, ROI size and acquisition time with equivalent liver stiffness measurements as compared to GRE-MRE sequence.

RESUMEN Introducción El trauma es una causa común de consulta a servicio de emergencia en Cali, Colombia. De todas las consultas a urgencias el 30% representan trauma, siendo la 5 causa de mortalidad. Las características demográficas y el patrón del trauma que reciben los ancianos no han sido profundamente estudiados en países de ingresos medios. El objetivo de nuestro trabajo es caracterizar las lesiones relacionadas con trauma en pacientes ancianos e identificar posibles medidas preventivas. Métodos Un análisis secundario de la base de datos del registro de la Sociedad Panamericana de Trauma implementado en dos centros de referencia para trauma en Cali, Colombia, durante el periodo 2012-2013. Se incluyeron pacientes de 65 años o mayores. Las variables que se analizaron fueron demográficas, características de las lesiones, score de severidad del trauma (ISS), información clínica al ingreso, e información relacionada con la disposición final del paciente. Resultados De 14315 pacientes registrados en la base de datos de trauma, 1372 (10%) eran mayores de 65 años. La edad media de este grupo fue 74 años (DE ± 9.7). Los hombres fueron 723 (53%) de pacientes estudiados. El mecanismo primario de lesión traumática fueron las caídas en 984 (72%) seguido de las relacionadas a eventos de transito en 195 (14%). El 95% de los pacientes tuvieron un ISS Discusión Los pacientes ancianos representan una proporción importante de los traumatizados atendidos en urgencias. La causa más común de estas lesiones son las caídas y los relacionados con eventos de transito. La mayor proporción de los pacientes tuvieron un ISS bajo. Sin embargo, la mortalidad de este grupo etáreo superó a la mortalidad global. Muchos de los pacientes ancianos requirieron cirugía, llevando esto a mayor morbi/mortalidad y gastos económicos elevados. La prevención primaria es necesaria para disminuir el impacto en salud y económico que genera para el sistema de salud. How to cite this article Calle Toro JS, Sanchez AI, Morales M, Garcia AF. Trauma en ancianos – Experiencia de dos hospitales de referencia en Cali, Colombia. Panam J Trauma Crit Care Emerg Surg 2016;5(1):38-42.

Three-dimensional (3-D) printing is gaining terrain in medical education, presurgical evaluation and recently as forensic evidence in court. Physicians, including radiologists, often provide expert testimony in court cases involving children with rib fractures and other injuries concerning for child physical abuse. Effectively communicating the complexities of fractures and other skeletal findings to nonmedical personnel using standard radiology studies can be challenging, especially during medical courtroom testimony. For this reason, we printed two 3-D models of the rib cage from the chest computed tomography (CT) scans of two patients with suspected non-accidental injury. The patients also had available chest radiographs. The DICOM (Digital Imaging and Communications in Medicine) data were 3-D reconstructed and segmented using two attenuation thresholds. We removed unwanted structures and printed them on a commercially available scanner. A pediatric radiologist, blinded to clinical data, reviewed both 3-D models, identified all rib lesions and classified them according to their healing stage. We compared the 3-D models and the chest radiograph against the chest CT as the standard of care. We convened a meeting with the Child Protection Team at out institution to get their feedback and opinions about the models. From our observations of our experts, three spontaneous interactions were observed. Instinctively, the experts picked up and grasped the models, rotating them, feeling them and angling them to better visualize the fractures from multiple angles. The experts expressed a willingness to consider using the models in court.

Approximately 80% of patients with hepatitis C virus infection develop chronic liver disease as cirrhosis, and 40% develop autoimmune complications as mixed cryoglobulinemia (MC). Gastrointestinal involvement in MC is rare, and even more so is hepatic involvement. We report a case of an 87-year-old woman with a 10-year history of blood transfusion-acquired hepatitis C virus infection, without treatment. She consulted the emergency department for diffuse abdominal pain, associated with vomiting. After 2 weeks of hospitalization in the intensive care unit, a diagnosis of MC was made; cirrhosis and secondary mesenteric and hepatic vasculitis were confirmed by a diagnostic laparoscopy. Unfortunately the condition of the patient worsened with sepsis and resulted in death in the fourth week from admission. This case highlights the importance of having in mind gastrointestinal tract vasculitis as a medical cause of abdominal pain in patients with chronic hepatitis C virus infection and using data laboratory tests, images, and histopathologic studies to aid with the diagnosis.

Purpose With the advances in the new image techniques and 3D modeling, angiography computed tomography (A-CT) has became a very useful image for studying vessels. Renal artery (RA) variations are common, and have a clinical relevance in pre-operative planning. There are several descriptive studies made in high income countries, but there are not many in middle and low income countries. Our objective was to describe prevalence of RA variations in a study population in Cali, Colombia. Methods A database was made from a selection of A-CT 3D images from January 1, 2012 to September 30, 2014, from which the RA could be; visualized. Patients under 18 were excluded, also with no 3D A-CT, or not of; Colombian nationality. Frequencies, percentages were calculated using; Excel. Results A total of 560 patients were selected, from which 296 fulfilled all criteria. The most common causes of performing the A-CT were pathologies of the Aorta. Variations of the RA were present in 52% of the patients, 54% were man, 77% had unilateral variation and 33% had bilateral variations, 58% in the right side. The two most common variations were extra Renal arteries (hiliar and polar) seen in 70% of the patients. Conclusions Prevalence of RA can be as normal as the usual anatomy, more commonly found in men, unilateral and in the right side. The most common variations are accessories arteries to the polar zone and the renal hilium, but early division (double and triple) arteries are also common.

Introducción. El trauma es considerado un problema de salud pública. Es una de las causas de mayor discapacidad y mortalidad en Latinoamérica y Colombia no es la excepción. El objetivo de este estudio fue evaluar si el índice de shock, resultado de la frecuencia cardiaca sobre la tensión arterial sistólica, es útil para predecir la mortalidad a 24 horas, en pacientes con trauma penetrante de tórax atendidos en el servicio de urgencias de un hospital universitario de Colombia. Materiales y métodos. Se construyó una base de datos de pacientes con trauma de tórax que fueron hospitalizados entre enero de 2013 y diciembre de 2013. Se evaluaron las variables y se determinó el resultado según el índice de shock, generando una variable dicotómica con dos grupos: grupo A, con un índice menor de 0,9, y grupo B, con uno mayor de 0,9; se hizo un análisis univariado. Se calcularon medidas de tendencia central y dispersión para las variables continuas. Resultados. Se analizaron 170 pacientes, 75,9 % (129) presentaron índice de shock menor de 0,9 y, 24,1 % (41), uno mayor de 0,9. La media de la edad para el grupo A fue de 32,4 años y, para el grupo B, de 35,4 años. La media del índice de gravedad de la lesión (Injury Severity Score, ISS) para el grupo A fue de 11,3 y, en el grupo B, de 20,6. La mortalidad a las 24 horas después de la lesión en el grupo A fue de 13,2 % y, en el grupo B, de 60,9 %. Conclusión. Un índice de shock inicial superior a 0,9 supone un peor pronóstico a las 24 horas después de la lesión. Predice la mortalidad en el paciente con trauma penetrante de tórax en el servicio de urgencias de un hospital universitario de Colombia. El índice de shock es una escala fisiológica que se puede utilizar rápidamente en todos los pacientes.

Objective: To evaluate whether the shock index (SI), given by the formula SI = heart rate/systolic blood pressure (HR/SBP), is useful for predicting mortality at 24 h in trauma patients admitted to the emergency department of a university hospital in Colombia. Methods: A database of trauma patients admitted between January 2013 and December 2013 was constructed; the result according to the shock index was determined, generating a dichotomous variable with two groups: Group A (SI 0.9). Univariate analysis was performed. Results: A total of 666 patients were analyzed, 83.3% (555) had SI 0.9. The mean age for Groups A and B was 32.4 and 35.4 respectively. The average injury severity score for both groups was 9.6 and 17.6 respectively. Mortality at 24 h after injury for both groups was 3.1% (P = 0.032) and 59.5% (P = 0.027) respectively. Conclusions: An initial shock index greater than 0.9 implies a worse prognosis 24 h after injury. The shock index predicts mortality in multiple trauma patients in the emergency department, and is also a quick and applicable in all hospital.