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Our purpose was to analyze detection, diagnostic characterization, and staging of renal solid lesions using different fast T1-weighted sequences with fat suppression in breath-hold mode compared with a gradient-echo sequence after contrast application. Twenty-five patients with focal renal lesions were examined with a T1-weighted ultrafast turbo spin-echo (UTSE) sequence with frequency selective fat suppression (SPIR), two different segmented echo-planar imaging (EPI) sequences - a spin-echo and a gradient-echo echo-planar sequence (SE-, FFE-EPI) combined with SPIR and a gradient-echo (fast field echo, FFE) sequence in a prospective study. The images of all sequences were visually evaluated and in addition to qualitative evaluation the contrast-to-noise ratio (CNR) for cyst and solid lesions was measured. Among the different T1-weighted sequences, the best detection and characterization of renal solid lesions were obtained with the UTSE SPIR and the SE-EPI sequence (sensitivity: 100 and 75%, respectively; specificity: 90 and 75%, respectively). The FFE and FFE-EPI sequences showed lower sensitivity (86%) and the same specificity (75%). The staging of renal tumors was best achieved with the UTSE SPIR and SE-EPI sequence (84 and 73%, respectively). The staging was correct in only 47% and 58 for the FFE and FFE-EPI sequences, respectively. The investigated sequences showed no significant differences in CNR. The combination of fat suppression and breath-hold mode improves detection, characterization, and staging of renal lesions. The UTSE SPIR and SE-EPI sequence in breath-hold mode showed specific image artifacts, but offered high sensitivity and specificity for detection and characterization of renal lesions compared with the FFE sequence. The results of this study suggest, for T1-weighted imaging of renal tumors, use of UTSE or SE-EPI sequences with fat suppression in breath-hold mode for renal imaging. [ABSTRACT FROM AUTHOR]

Little is known about the outcome of acute thrombotic occlusion of segments of the cavopulmonary connections (CPC) in infants and children with univentricular hearts. Early recognition and aggressive therapy may result in successful salvage of some of these patients. Five consecutive patients (age range 4-8 months) presenting with acute occlusion of a CPC segment underwent emergency cardiac catheterization. After angiographic confirmation, the occluded segment was crossed using an endhole catheter and guidewire combination. Serial balloon dilation and stent implantation (ten stents in total) were undertaken to recanalize the occlusion. The stents used were mounted on balloons ranging in diameter from 6 mm to 8 mm, depending on the size of the native vessel. The sites of occlusion were the left pulmonary artery (n=4), and the left-sided superior caval vein (n=3). All occlusions could be successfully recanalized. In three patients, early reocclusion necessitated either surgery or repeat catheterization and angioplasty. There were two early deaths, due to recurrent thrombotic obstruction confirmed either at autopsy or angiography. The remaining patients are alive and well; the majority of survivors have undergone completion of the Fontan operation. A high index of clinical suspicion combined with aggressive therapy can result in successful recanalization in some infants with acutely occluded CPC segments, with acceptable long-term outcome.

Background: Central venous access via the femoral vein (FV) is safe, relatively easy and very usual in infants and children undergoing cardiac surgery for congenital heart disease. It has a low insertion-related complication rate., Results: It is therefore a good choice for short-term central venous lines and a preferred insertion site for less experienced staff. The maintenance-related complications of thrombus formation and infections are higher compared to the internal jugular and the subclavian venous access., Conclusions: Some of these complications are reduced by the use of heparin bonded catheters, routine use of antibiotics, and timely removal of these lines in patients with persistent signs of infection but without another focus being defined.

Central venous access via the internal jugular vein (IJV) is safe, relatively easy and very commonly used in infants and children undergoing cardiac surgery for congenital heart disease. Because of the wide range of anatomical variations an ultrasound-guided technique is advantageous in many cases, in particular in patients who have had previous punctures or those in whom difficulties are anticipated for various reasons. The right internal jugular vein is the preferred vein for central venous access as it offers straight access to the superior vena cava. The rate of complications - insertion-related as well as long term - are lower compared to the femoral and the subclavian access.