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Objective:To investigate the imaging and clinical characteristics of posttransplantation lymphoproliferative disorders (PTLD) after liver transplantation in children.Methods:From February 2017 to November 2020, the imaging and clinical data of 17 children with PTLD after liver transplantation confirmed by pathology or clinical diagnosis were retrospectively analyzed in Shanghai Children′s Medical Center, School of Medicine, Shanghai Jiao Tong University. The site, range, density/signal/echo of the lesions were observed.Results:The mean age at transplantation was 8 (7, 11) months, and 14 patients were younger than 1 year old. The interval between liver transplantation and PTLD diagnosis was 22 (10, 34) months, ranging from 3 to 54 months. The interval was less than 1 year in 6 patients (early onset) and equal or greater than 1 year in 11 patients (late onset). Fifteen patients had Epstein-Barr virus infection. Among the 12 pathologically confirmed PTLD cases, 8 cases were diffuse large B-cell lymphoma, 3 cases were Burkitt lymphoma, and 1 case was reactive plasma cell hyperplasia. Among the 17 children with PTLD, 8 cases demonstrated involvement of lymph nodes and 16 cases had extranodal involvement. The latter included 15 cases of abdominal involvement. Abdominal sites involved included small intestine in 14 cases, colon in 7 cases, mesentery in 4 cases, kidney in 3 cases, liver in 2 cases, abdominal lymph nodes in 2 cases, peritoneum in 1 case, and stomach in 1 case. The sites of extra-abdominal involvement included lymph nodes in 7 cases, lung in 3 cases, skull in 1 case, brain in 1 case, pleura in 1 case, chest wall in 1 case, and nasopharynx in 1 case. The most common abdominal imaging abnormalities were thickening of the intestinal wall, eccentric mass and dilation of the lumen. Both small intestines and colons could be involved, and the former more commonly. Multiple masses were found in patients with liver and kidney involvement. The most common imaging manifestation of PTLD outside the abdomen was lymph node enlargement, which was found in 7 cases, and the most common was in the neck. The manifestation was shorter diameter of lymph nodes>10 mm, uniform density and signal, with mild enhancement.Conclusions:PTLD can occur months to years after liver transplantation in children, which can affect many parts of the whole body. Extranodal lesions are more than intranodal lesions. Abdominal involvement is most common in PTLD, and the infection rate of EB virus is high. Combined with medical history, EB virus infection status and imaging examination are helpful for early diagnosis.
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Objective@#To investigate the radiographic manifestations and clinical relevance to central nervous system complications of leukemia (CNSCL)in children.@*Methods@#The CT and magnetic resonance imaging(MRI) fin-dings and clinical features of 49 pediatric patients with CNCSL in Shanghai Children′s Medical Center Affiliated to Shanghai Jiaotong University School of Medicine from May 2010 to June 2018 were retrospectively analyzed.@*Results@#(1) Cerebrovascular abnormalities in 23 cases included hemorrhage(20 cases), infarction(2 cases) and sinus thrombosis(1 case). One case of epidural hematoma and 19 cases of intracerebral multiple bleeding were seen in the hemorrhage group, which demonstrated high-density on CT and different signal on MRI as time went by.Microhe-morrhage displayed as low signal on susceptibility weighted imaging.(2) Among 23 cases of leukemic infiltration, the dura and/or skull were involved in 18 cases, which presented as fusiform or mass, with high density on CT, low signal on T1WI, intermediate signal on T2WI and strong enhancement; 6 leptomeningeal infiltration demonstrated as meningeal thickening and enhancement; 2 parenchymal involvement manifested with high-density mass; 2 oculomotor nerve and 1 optic nerve infiltration demonstrated thickening and enhancement.(3)White matter disease was seen in 2 cases, with hyper-intensity on T2WI.(4) One case of secondary tumor was glial tumor in the brainstem.@*Conclusions@#The radiographic manifestations of CNCSL in children are various.CT and MRI are of important diagnostic values.Choosing the best imaging examination method and sequence according to clinical symptoms and test results can provide more valuable information for clinical diagnosis and treatment.
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Objective To investigate the radiographic manifestations and clinical relevance to central nervous system complications of leukemia(CNSCL)in children. Methods The CT and magnetic resonance imaging(MRI)fin﹣dings and clinical features of 49 pediatric patients with CNCSL in Shanghai Children′s Medical Center Affiliated to Shanghai Jiaotong University School of Medicine from May 2010 to June 2018 were retrospectively analyzed. Results (1)Cerebrovascular abnormalities in 23 cases included hemorrhage(20 cases),infarction(2 cases)and sinus thrombosis(1 case). One case of epidural hematoma and 19 cases of intracerebral multiple bleeding were seen in the hemorrhage group,which demonstrated high－density on CT and different signal on MRI as time went by. Microhe﹣morrhage displayed as low signal on susceptibility weighted imaging.(2)Among 23 cases of leukemic infiltration,the dura and/or skull were involved in 18 cases,which presented as fusiform or mass,with high density on CT,low signal on T1WI,intermediate signal on T2WI and strong enhancement;6 leptomeningeal infiltration demonstrated as meningeal thickening and enhancement;2 parenchymal involvement manifested with high－density mass;2 oculomotor nerve and 1 optic nerve infiltration demonstrated thickening and enhancement.(3)White matter disease was seen in 2 cases,with hyper－intensity on T2WI.(4)One case of secondary tumor was glial tumor in the brainstem. Conclusions The radiographic manifestations of CNCSL in children are various. CT and MRI are of important diagnostic values. Choosing the best imaging examination method and sequence according to clinical symptoms and test results can provide more valuable information for clinical diagnosis and treatment.
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Objective To summarize the image features of prenatal ultrasound and MRI of fetal right congenital diaphragmatic hernia (CDH). Methods Between June 2007 and December 2014, eight fetuses with suspicious right pleural abnormalities diagnosed by conventional prenatal ultrasound received MRI examination within 24 to 48 hours after ultrasonography at Shanghai Children′s Medical Center. The imaging sequences included steady-state free-precession (SSFP) sequence, single-shot turbo spin echo (SSTSE) sequence and T1-weighted imaging (T1WI) sequence. Prenatal ultrasound and MRI findings were compared with postnatal imaging diagnoses, surgery or autopsy. The image features of prenatal ultrasound and MRI of fetal right CDH were analyzed. Results Among the eight cases of fetal prenatal ultrasound, 7 cases presented right pleural abnormal heterogeneous echo, 1 case showed right pleural effusion. Fetal prenatal MRI showed seven cases of right-sided pleural abnormalities, included a portion of the liver in 2 cases, a portion of the bowel in 2 cases, a portion of the liver and the bowel in 3 cases. One case was with bilateral pleural abnormalities, the liver and the bowel in right thoracic cavity, a portion of the bowel in left thoracic cavity. Prenatal ultrasound and MRI findings were compared with postnatal upper gastrointestinal tract barium contrast, enhanced chest CT, surgery or autopsy. Prenatal ultrasound correctly diagnosed 4 cases of fetal right CHD, misdiagnosed right CHD as right pleural mass in 2 cases, missed 1 case of right CHD, and misdiagnosed 1 case of bilateral CHD as right CHD. MRI correctly diagnosed 7 cases of fetal right CHD and 1 case of bilateral CHD. Conclusions Prenatal ultrasound couldn′t identify the detailed contents herniated into the fetal thoracic cavity of right CDH, especially when the liver herniated into the fetal thoracic cavity. However, prenatal MRI could clearly show the hernia contents in the fetal thoracic cavity, and make the correct diagnosis of fetal right CHD as well as the hernia contents in the fetal thoracic cavity. Both SSFSE and T1WI sequences can distinguish detailed contents herniated into the thoracic cavity.
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Objective To improve the understanding,the incidence and imaging findings of tuberous sclerosis complex (TSC) combined with cardiac rhabdomyomas (CRs) in fetuses and infants.Methods The imaging findings of 9 infants with TSC combined with CRs and 4 fetuses with TSC combined with CRs from our hospital between June,2006 and November,2013 were retrospectively reviewed.Results The brain MRI of 9 with TSC combined with CRs showed bilateral subependy-mal nodules,subcortical white matter and cortical tubers.Subependymal nodules were isointense or hypointense on spin-echo T1WI and hypointense or hyperintense on spin-echo T2WI.Subcortical white matter and cortical tubers were hypointense or hyperintense on T1WI and hypointense or hyperintense on T2WI.There was varying contrast enhancement.Three of 9 infants presented single cardiac tumor and 6 of 9 infants presented multiply cardiac lesions.CRs on contrast cardiac MRI showed round solid masses in ventricular septums,ventricular outflow tract,ventricle or atrial free walls.The masses were isointense relative to the cardiac muscles on T1WI,T2WI and B-TFE sequence.There was varying contrast enhancement.Four fetuses with TSC on ultrafast MRI showed bilateral multiply subependymal nodules,the nodules were isointense or hyperintense on TFE T1WI and isointense or hypointense signals on SSTSE or B-FFE sequence,Four fetuses with CRs showed isointense to hyperintense solid masses in ventricular septums on ultrafast MRI,ventricle or atrial free walls on B-FFE sequence and SSTSE sequence images.Conclusions TSC in infant and fetus is a kind of neurocutaneous syndrome,usually combines with CRs.Fetal ultrafast and routine MRI is a useful method to make a definite diagnosis for cranial and cardiac lesions.The development of MRI might improve the timeliness and accuracy of the assessment for this disease.
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Objective To explore the value of MRI on fetal autosomal recessive polycystic kidney disease (ARPKD).Methods Sixteen pregnant women,aged from 28 to 38 years (average 30 years) and with gestation age from 22 to 36 weeks (average 25 weeks) underwent MR scanning with a 1.5 T MR unit within 24 to 48 hours after ultrasound examinations.The imaging sequences included steady-state free-precession (SSFP) sequence,single-shot turbo spin echo (SSTSE) sequence and T1-weighted fast imaging sequence.Prenatal US and MR imaging findings were compared with autopsy or pathological results.Results A total of 16 cases of ARPKD showed bilateral markedly enlarged kidneys and diffuse high signal small cysts in renal medulla on SSTSE sequence.Among the 16 cases,11 cases were with oligohydramnios,1 1 cases were with pulmonary hypoplasia,and 6 cases were with hepatic fibrosis.Eleven cases of pulmonary hypoplasia and 6 cases of hepatic fibrosis were all missed by US.For the diagnosis of the renal anomalies,US missed one case.MRI diagnosis was correct in all these cases.Conclusions MRI shows great advantages on the diagnosis of fetal ARPKD,and it is not affected by the amount of amniotic fluid.It can be used to evaluate kidney and lung abnormalities accurately.
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Objective To explore the diagnostic value of MRI on fetal neural tube defects.Methods Ten pregnant women,aged from 25 to 35 years(average 28 years)and with gestation from 20-39 weeks(average 33 weeks)were studied with a 1.5 T superconductive MR unit within 24 to 48 hours after ultrasound(US)studies.The imaging protocol included fast-imaging employing steady-state acquisition,single-shot FSE and T_1-weighted fast inversion recovery motion insensitive sequences in the axial,frontal,and sagittal planes relative to the fetal brain,thorax,abdomen,and spines.Prenatal US and MRI findings were compared with postnatal MRI diagnoses(3 fetuses)or autopsy(7 fetuses).Results Ten pregnant women(9 with a single fetus and 1 with twin fetuses)were examined.For all cases,the diagnoses established by MRI were correct when compared with postnatal diagnosis or autopsy.In 7 cases,US and MRI findings were in complete agreement with postnatal diagnoses.US missed the diagnosis in 1 case and misdiagnosed in 2 cases.Ten neural tube defects in this study included anencephaly(1 case),exencephaly (1 case),meningoencephalocele associated with amniotic band sequence(1 case),meningocele(1 case),thoracic myelomeningocele(1 case),lumbar spinal bifida(1 case),sacroiliac myelomeningocele(2 cases),sacroiliac large cystic spinal meningocele(1 case),sacroiliac spinal bifida(1 case).Conclusions Prenatal MRI is effective in the assessment of fetal neural tube defects.It can exactly discriminate herniated contents and locate the spinal lesion level.