Predictors of Neurodevelopmental Outcomes in Newborns Undergoing Hypothermia Therapy

PURPOSE: This study aimed to identify the early predictors of neurodevelopmental outcomes in infants undergoing therapeutic hypothermia for neonatal hypoxic ischemic encephalopathy. METHODS: The medical records of 24 neonates who underwent hypothermia therapy for hypoxic ischemic encephalopathy at the neonatal intensive care unit of Yeouido St. Mary's Hospital of the Catholic University of Korea between August 2013 and May 2016 were reviewed. Patients were divided into two groups according to their neurological outcome at the age of 18 to 24 months: a normal group (n=14), which included patients with normal neurological function, and an abnormal group (n=10), which included patients with neurological deficits. The clinical characteristics, clinical outcomes, and laboratory findings before and after hypothermia treatment were compared between the groups. RESULTS: There were no significant differences in the demographic characteristics between the two groups. With regard to clinical outcomes, only brain magnetic resonance imaging (MRI) findings showed significant differences between the normal and abnormal groups (21.4% vs. 100.0%, P 0.05). CONCLUSION: The presence of abnormal lesions on MRI was the most useful predictor of poor neurodevelopmental outcome in infants treated with therapeutic hypothermia after perinatal asphyxia.

Presentation Time of Necrotizing Enterocolitis Diagnosed by Sonography according to Gestational Age

PURPOSE: In this single center study, we assessed the timing of presentation of necrotizing enterocolitis (NEC) diagnosed by sonography according to the gestational age. METHODS: We retrospectively reviewed the medical records of 49 newborn patients who were diagnosed with NEC (modified Bell's stage II and higher according to abdominal sonography and simple abdominal radiography) and were admitted to the neonatal intensive care unit of St. Mary's Hospital between January 2008 and December 2012. Infants were grouped according to their gestational age (GA): Group I (GA or =37 weeks); early-onset NEC was considered when NEC developed at or =14 days of age. RESULTS: The number of infants in each group were: Group I (n = 16), Group II (n = 20), Group III (n = 11), and Group IV (n = 2). The mean age at diagnosis of NEC was: Group I (31.6 days), Group II (15.9 days), Group III (11.0 days), and Group IV (2.0 days). Early-onset NEC developed at a mean of 5.5 days of age, whereas late-onset NEC developed at a mean of 36.1 days of age. CONCLUSION: Based on early sonographic diagnosis, infants with lower gestational ages developed NEC at a more advanced postnatal age as compared to more mature infants. However, further studies are needed to understand the etiology of this disease process.

Usefulness of Abdominal Sonography in Accurate Diagnosis for Necrotizing Enterocolitis

PURPOSE: The purpose of this study was to examine the usefulness of abdominal sonography in the diagnosis of necrotizing enterocolitis (NEC). METHODS: We reviewed the medical records of 51 neonates who were diagnosed with NEC in the neonatal intensive care unit at Yeouido St. Mary's Hospital of the Catholic University in Korea between January 2008 and December 2012. The neonates underwent abdominal ultrasonography on the day of their diagnosis and on the third day after diagnosis. Simple abdominal radiography was performed on the same day as the sonography. The neonates were diagnosed with NEC in accordance with the abdominal sonographic findings. Abdominal radiography and sonography were used to assess the NEC stages in the neonates. RESULTS: On the day of NEC diagnosis by abdominal sonography, 50 neonates were diagnosed with stage II NEC and 1 was diagnosed with stage III NEC. However, simple radiography diagnosed 49 neonates with stage I NEC, 1 with stage II NEC, and 1 with stage III NEC. On the third day after NEC diagnosis by abdominal sonography, 48 neonates were diagnosed with stage II NEC and 3 were diagnosed with stage III NEC. On the other hand, simple radiography diagnosed 26 neonates with stage I NEC, 24 with stage II NEC, and 1 with stage III NEC. CONCLUSION: Abdominal sonography can be used as a tool for accurately diagnosing NEC and treating neonates showing ambiguous symptoms during the early stages of NEC.

Comparison of Clinico-Radiological Features between Congenital Cystic Neuroblastoma and Neonatal Adrenal Hemorrhagic Pseudocyst

OBJECTIVE: To evaluate the radiological and clinical findings of congenital cystic neuroblastomas as compared with those of the cystic presentation of neonatal adrenal hemorrhage. MATERIALS AND METHODS: We analyzed the US (n = 52), CT (n = 24), and MR (n = 4) images as well as the medical records of 28 patients harboring congenital cystic neuroblastomas (n = 16) and neonatal adrenal hemorrhagic pseudocysts (n = 14). The history of prenatal detection, location, size, presence of outer wall enhancement, internal septations, solid portion, calcification, turbidity, vascular flow on a Doppler examination, and evolution patterns were compared in two groups of cystic lesions, by Fischer's exact test. RESULTS: All (100%) neuroblastomas and three (21%) of the 14 hemorrhagic pseudocysts were detected prenatally. Both groups of cystic lesions occurred more frequently on the right side; 11 of 16 (69%) for neuroblastomas and 11 of 14 (79%) for hemorrhagic pseudocysts. The size, presence of solid portion, septum, enhancement, and turbidity did not differ significantly (p > 0.05) between the two groups of cystic lesions. However, tiny calcifications (n = 3) and vascular flow on color Doppler US (n = 3) were noted in only neuroblastomas. The cystic neuroblastomas became complex solid and cystic masses, and did not disappear for up to 90 days in the three following cases, whereas 11 of the 14 (79%) hemorrhagic pseudocysts disappeared completely and the three remaining (27%) evolved to calcifications only. CONCLUSION: Although the imaging findings of two groups of cystic lesions were similar, prenatal detection, the presence of calcification on initial images, vascularity on color Doppler US, and evolution to a more complex mass may all favor neuroblastomas.

Neostigmine for the treatment of acute colonic pseudo-obstruction (ACPO) in pediatric hematologic malignancies

BACKGROUND: Acute colonic pseudo-obstruction (ACPO) refers to dilatation of the colon and decreased bowel motility without evidence of mechanical obstruction. Neostigmine, an acetylcholinesterase inhibitor, has been used in patients in whom supportive therapy failed to resolve ACPO. Here, we report the results of administering neostigmine to treat ACPO in children with hematologic malignancies. METHODS: Between September 2005 and December 2009, 10 patients (8 male and 2 female) were diagnosed with ACPO at the Department of Pediatrics, Catholic University of Korea. Diagnosis of ACPO was based on typical clinical features as well as colonic dilatation found on abdominal CT imaging. Neostigmine was administered subcutaneously at a dosage of 0.01 mg/kg/dose (maximum 0.5 mg) twice daily for a maximum of 5 total doses. ACPO was determined to be responsive to neostigmine if the patient showed both stool passage and improvement of clinical symptoms. RESULTS: The study group included 8 acute lymphoblastic leukemia patients, 1 patient with malignant lymphoma, and 1 patient with juvenile myelomonocytic leukemia. The median age at ACPO diagnosis was 8.5 years (range, 3-14). Overall, 8 patients (80%) showed therapeutic response to neostigmine at a median of 29 hours after the initial administration (range, 1-70). Two patients (20%) showed side effects of grade 2 or above, but none complained of cardiovascular symptoms that required treatment. CONCLUSION: In this study, ACPO was diagnosed most often in late-childhood ALL patients. Subcutaneous neostigmine can be used to effectively treat ACPO diagnosed in children with hematologic malignancies without major cardiovascular complications.

Pelvic Ultrasonography Findings in Girls with Precocious Puberty / 대한소아내분비학회지

PURPOSE: We analyzed pelvic ultrasonography (USG) findings in girls with central precocious puberty (CPP) and assessed the role of uterine and ovarian measurements in discriminating between CPP and other pubertal conditions. METHODS: Seventy-four girls (chronological age 7.8 +/- 0.5 years, bone age 9.9 +/- 0.8 years) with precocious pubertal signs were enrolled. Measurements of uterine and ovarian parameters by pelvic USG included antero-posterior diameters of the uterine fundus and cervix, diameter of each ovary, number of follicles, and maximal diameter of the largest follicle. The pelvic USG parameters were compared between girls with CPP (n = 49) and girls with atypical premature thelarche (PT) (n = 25). RESULTS: Antero-posterior diameter of uterine fundus (1.05 +/- 0.34 vs. 0.74 +/- 0.78 cm, P = 0.001), maximal ovarian diameter (2.13 +/- 0.48 vs. 1.84 +/- 0.74 cm, P = 0.048) and mean ovarian area (2.31 +/- 0.79 vs. 1.69 +/- 0.71 cm, P = 0.002) were significantly greater in girls with CPP than in girls with atypical PT. For the diagnosis of CPP, the sensitivity and specificity of A-P diameter of uterine fundus (> 0.9 cm) was 65.3% and 84.0%, the sensitivity and specificity of maximal ovarian diameter (> 2.0 cm) was 55.1% and 76%, and the sensitivity and specificity of mean ovarian area (> 2.0 cm2) was 62.9% and 80.0%. CONCLUSION: Girls with CPP had significantly higher dimensions of the uterus and ovary measurements compared to girls with atypical PT, but sensitivity and specificity were not high enough to differentiate CPP from atypical PT. Pelvic USG may help the diagnosis of CPP in girls.

Ultrasound and MR Findings of Aleukemic Leukemia Cutis in a Patient with Complete Remission of Acute Lymphoblastic Leukemia: A Case Report

Aleukemic leukemia cutis is an extremely rare condition characterized by the infiltration of leukemic cells in skin without blasts in the peripheral blood. Leukemia cutis is considered a grave prognostic sign, thus early diagnosis is important. Leukemia cutis usually occurs in patients with myeloid leukemia. To the best of our knowledge, there has been no report regarding the radiological findings of aleukemic leukemia cutis, which is probably due to the presence of the skin changes in most patients. We report the ultrasound and MR findings of aleukemic leukemia cutis, even without the skin manifestation in patients with a history of complete remission of the acute lymphoblastic leukemia following an allogeneic peripheral blood stem cell transplantation.

Kikuchi's Disease in Children: Clinical Manifestations and Imaging Features

Previously published studies on Kikuchi disease (KD) have frequently addressed the computed tomography (CT) findings in the adult population, however, only a few studies have been reported for the pediatric age group. The purpose of this study is to analyze the clinical characteristics and imaging features of KD in children. Fifteen children (2-14 yr) who had a neck CT and pathology diagnosis of KD were included in this study. Clinical features, including the duration of lymphadenopathy and fever, prognosis, and laboratory values, were evaluated. We analyzed the sites, size, and lymph node pattern as seen on their CT scans. The median duration of fever was 10 days. Fourteen patients experienced improvement in their condition, although four of these patients experienced recurrent episodes of KD. All patients had affected cervical nodes at level V. Perinodal infiltrates were observed in the affected cervical nodes in 14 cases (93%), and non-enhancing necrosis was also noted within the affected cervical nodes in 10 cases (63%). In conclusion, the combination of imaging findings in conjunction with clinical findings of KD may help to determine whether or not to perform pathology analysis and follow-up studies.

Gastrointestinal Complications Following Hematopoietic Stem Cell Transplantation in Children

Gastrointestinal system involvement is one of the principal complications seen in the recipients of hematopoietic stem cell transplantation (HSCT), and it is also a major cause of morbidity and death in these patients. The major gastrointestinal complications include typhlitis (neutropenic enterocolitis), pseudomembranous enterocolitis, viral enteritis, graft-versus-host disease, benign pneumatosis intestinalis, intestinal thrombotic microangiopathy, and post-transplantation lymphoproliferative disease. As these patients present with nonspecific abdominal symptoms, evaluation with using such imaging modalities as ultrasonography and CT is essential in order to assess the extent of gastrointestinal involvement and to diagnose these complications. We present here a pictorial review of the imaging features and other factors involved in the diagnosis of these gastrointestinal complications in pediatric HSCT recipients.

Infantile Type Choledochal Cyst with Biliary Atresia: Report of two cases

Choledochal cysts in neonates and young infants take two forms: the choledochal cyst associated with biliary atresia (CCBA) and the choledochal cyst in the absence of biliary atresia (CC). Infants in both groups usually have similar clinical symptoms at presentation, but management and prognosis are different. While early portoenterostomy is required for CCBA, cyst excision with hepaticojejunostomy or choledochojejunostomy is usually performed for CC. The former shows a relatively poor prognosis, and the latter shows a better prognosis. Two infants who presented with clinical features of neonatal cholestasis, and clinically suspected to have choledochal cysts, were found on imaging studies and surgery to have extrahepatic bile duct atresia in association with choledochal cysts.

Myxoid Chondrosarcoma of the Sinonasal Cavity in a Child: a Case Report

Chondrosarcomas are malignant tumors of cartilage that rarely involve the sinonasal region, and myxoid chondrosarcoma is a rare histologic variant of chondrosarcoma that usually occurs in the soft tissue of extremities. Although several case reports and results of small series of chondrosarcomas in the sinonasal region in children are available, myxoid type chondrosarcoma is extremely rare. We recently experienced a case of low grade myxoid chondrosarcoma involving the sinonasal cavity in a 10-year-old boy, and here we report its radiologic-pathologic findings. In this case, chondroid calcification on CT and septal and marginal enhancement on MRI suggested a chondrosarcoma. Whole body PET-CT demonstrated no definite metastatic lesion and a low peak standardized uptake value primary tumor. However, no definite distinguishing imaging features were observed that distinguished low grade myxoid chondrosarcoma from conventional chondrosarcoma.

Subcapsular Hematoma of the Liver in a Neonate: Case Report

Subcapsular hematoma of the liver in the neonate is an uncommon clinical presentation, although these tumors are frequently found upon perinatal autopsy. We describe the sonographic and MR findings of a subcapsular hematoma of the liver in a neonate having a clinical history of an inserted umbilical venous catheter, necrotizing enterocolitis and sepsis, and we also include a review of the relevant literature.

High Grade Hemangioendothelioma of the Temporal Bone in a Child: A Case Report

Hemangioendothelioma is a rare vascular tumor characterized by endothelial tumor cells and variable malignant behavior, and it's not common for this lesion to involve the bone. Although there are a few reports of cranial involvement by hemangioendothelioma, only rare cases arising in temporal bone have been published. We present the radiologic findings of a 7-year-old boy who had a high grade hemangioendothelioma involving the temporal bone with intracranial extension. Evidence of flow voids on MR images suggested a tumor of vascular origin, and the ill-defined margins, cortical destruction and intracranial extension on the CT and MR images were correlated with the tumor's high histologic grade.

The Estimation of the Probable Cause and the Time of Cerebral Insult in Cerebral Palsy

OBJECTIVE: To estimate the probable cause and the time of cerebral insult in cerebral palsy (CP) based on MRI findings and risk factors. METHOD: The subjects comprised all sixty-seven patients with CP showing abnormal MRI findings between March 1999 and September 2001 at the Catholic University of Korea, St. Mary's Hospital. A detailed medical history was available for all patients including those not born in our hospital. They ranged in age from two months to five years. We analyzed the brain magnetic resonance (MR) findings of patients with CP to correlate the probable cause and the time of cerebral insult through the consideration of medical histories including prenatal, perinatal and postnatal histories. RESULTS: Of the 67 MRIs, abnormalities were the followings; periventricular leukomalacias (PVLs) in 49 cases, cortical or subcortical infarction in 4 cases, brain atrophy in 7 cases, neuronal migration disorder in 4 cases, and delayed myelination in 3 cases. Among the patients with PVL, perinatal risk factors were responsible for cerebral insult in preterm, but pre- and perinatal contribution were similar in patients born at full term. Among the patients with cerebral infarction, only one case with meningitis at 11 months was suspected for cerebral insult. These patients had no risk factor as a peri- or post-natal etiology. Four patients with neuronal migration disorder had no risk factor for peri- or postnatal etiology except for the one who was a twin. CONCLUSION: Review of brain MRI findings such as PVL, infarct, neuronal migration disorder and a detailed medical history including prenatal and perinatal etiology would be a useful method to estimate the probable cause and the time of cerebral insult in CP.

Which are Risk Factors developing Renal Cortical Defects on 99 mTc - DMSA Scintigraphy in Children with Acute Urinary Tract Infections?

PURPOSE: To determine (1) the relationship between the cortical defects seen on 99 mTc-DMSA renal scans and age, and (2) the presence and degree of vesicoureteral reflux, and then to depict the risk factors for cortical defects in children with acute urinary tract infection (UTI). Furthermore, to assess the diagnostic value of VCUG in predicting a defect on 99 mTc-DMSA renal scans. MATERIALS AND METHODS: We studied 134 kidneys in 67 children aged 15 days-10 years (M:F=39:28) in whom symptomatic UTI was present. In all these children, both DMSA renal scans and voiding cystourethrography (VCUG) were performed. Scanning took place within 7 days of diagnosis and VCUG was performed after one month of diagnosis. Scintigraphic findings were graded according to the extent and number of cortical defects. We evaluated the relationships between the cortical defects seen on DMSA scans and age, and the grade of vesicoureteral reflux. The diagnostic value of VCUG in predicting cortical defects was analysed. Results: The prevalence of cortical defects was greater in patients older than two years (38/54, 70%) than in those aged less than two (38/80, 48%). The frequency of cortical defects was related to vesicoureteral reflux (p or =2yrs) at the time of acute UTI, and high grade of vesicoureteral reflux. The specificity of VCUG in predicting cortical defects is relatively high but the sensitivitiy is low, and a significant proportion of cortical defects therefore occurred in the absence of vesicoureteral reflux.

Clinical Significance of the Corpus Callosum in Cerebral Palsy

PURPOSE: To evaluate, using magnetic resonance (MR) imaging, the clinal significance of the corpus callosum by measuring the size of various portions of the corpus callosum in children with cerebral palsy, and in paired controls. MATERIALS AND METHODS: Fifty-two children [30 boys and 22 girls aged between six and 96 (median, 19) months in whom cerebal palsy was clinically diagnosed underwent MR imaging. There were 23 term patients and 29 preterm, and the control group was selected by age and sex matching. Clinal subtypes of cerebal palsy were classified as hemiplegia(n =14), spastic diplegia(n=22), or spastic quadriplegia(n=16), and according to the severity of motor palsy, the condition was also classified as mild(n=26), moderate(n=13), or severe(n=13). In addition to the length and height of the corpus callosum, the thickness of its genu, body, transitional zone and splenium, as seen on midsagittal T1-weighted MR images, were also measured. Differences in the measured values of the two groups were statistically analysed and differences in the size of the corpus callosum according to the clinical severity and subtypes of cerebral palsy, and gestational age, were also assessed. RESULTS: Except for height, the measured values of the corpus callosum in patients with cerebral palsy were significantly less than those of the control group (p < 0.05). Its size decreased according to the severity of motor palsy. Compared with term patients, the corpus callosum in preterm patients was considerably smaller (p< 0.05). CONCLUSION: There was statistically significant correlation between the severity of motor palsy and the size of the corpus callosum. Quantitative evaluation of the corpus callosum might be a good indicator of neurologic prognosis, and a sensitive marker for assessing the extent of brain injury.

Evaluation of Severity in Aplastic Anemia by MR Imaging

PURPOSE: To evaluate the role of bone marrow (BM) magnetic resonance(MR) imaging for assessment of theseverity of aplastic anemia (AA). MATERIALS AND METHODS: Eighty patients with AA, ranging in age from 16 to 44years underwent MR imaging. Fifty four patients had clinically severe AA (SAA),while in 26 the condition wasmoderate(MAA). Sagittal T1-weighted images (T1WI) and short tau inversion recovery(STIR) images of lumbarvertebral BM were analysed. Bulk T1, T2 and rho values (msec) were also measured, with mixed sequences. Signalintensity (SI) on both T1WI and STIR was classified into four patterns according to the amount of fatty marrow :pattern I, homogeneous fatty marrow ; II, fatty marrow with focal cellular nodules ; III, mixed fatty and cellularmarrow ; IV, cellular marrow with focal fatty nodules. These SI patterns and bulk T1, T2 and rho values of thelumbar BM were compared with the clinical severity of AA. RESULTS: On both T1WI & STIR sequences, MR imaging oflumbar vertebral BM in patients with AA showed various SI patterns. Pattern I, II and III were much frequently seenin the SAA group (48 of 54 patients on T1WI and 43 of 54 on STIR) and pattern IV was common in the MAA group (16of 26 patients on T1WI and 18 of 26 on STIR). The SI patterns of AA seen on both T1WI and STIR sequences closelycorrelated with clinical severity (x2 test, p = 0.0001). Bulk T1 value was significantly different between SAA andMAA ( SAA : 382.82 msec +/- 113.91; MAA: 517.99 msec +/- 151.92 ; t test , p = 0.0001). CONCLUSION: The SI patternseen on MR imaging, and T1 relaxation time of lumbar spinal BM can be useful for assessing the severity of AA.

The Value of Tc-99m DTPA Diuretic Renography for Assessment of Dilated Upper Urinary Tract in Children / 대한핵의학회잡지

PURPOSE: The purpose of this study was to evaluate the accuracy of Tc-99m DTPA diuretic renal scans in children upper urinary tract. MATERIALS AND METHODS: We reviewed diuretic renal scans of 14 pediatric patients (age range: 3 days to 4 years) with unilateral hydronephrosis diagnosed by ultrasonography. Diuretic renal scan was done using Tc-99m DTPA and standardized protocol. In 3 neonates, diuretic renal scans were performed within 1 week and 3-7 months after birth. RESULTS: Six patients required pyeloplasty and eight were managed conservatively. All 6 patients requiring pyeloplasty were diagnosed as having ureteropelvic junction obstruction in the diuretic renal scan. In these 6 patients, post-operative renal scans at 3-12 months after surgery were converted to nonobstructive pattern in 5 and a nonobstructive patterns in 1. In 3 patients who underwent diuretic renal scan within 1 week after birth., nonobstructive patterns of initial scan were coverted to obstructive patterns in the follow-up scan. However, all patients with nonobstructive diuretic renal scans performed after the neonatal period did well on serial ultrasonography and showed favorable clinical outcome without progression to obstruction. CONCLUSION: Tc-99m DTPA diuretic renal scan with standarized protocol is useful in assessing suspected ureteropelvic junction obstruction in children as an initial diagnostic or post-operative follow-up modality. Nonobstructive or indeterminate scan RESULTS in the neonatal period requires follow-up scan to monitor development of the obstructive pattern.

Cranial Fasciitis in a Child: A Case Report

Cranial fasciitis is a rare fibroblastic tumor which shows a predilection for the scalp and skull of youngchil-dren. Histologically, cranial fasciitis is identical to nodular fasciitis which is typically found in theextremities of adults, though is unique in that it may present as an osteolytic lesion of the skull. We report acase of cranial fasciitis in a 20-month-old girl, describing the ultrasonography, CT and MRI findings.

Percutaneous Transcatheter Embolization of Extensive Congenital Arteriovenous Malformation Combined withAneurysms in the Chest Wall: A case report

Congenital arteriovenous malformation (AVM) usually involves the head, extremities and internal organs, but isuncommon in the chest wall. It is, moreover, rarely combined with aneurysms. It can be cured by surgery, but isoften difficult to treat. The purpose of this study is to report a case of extensive AVM involving the rightlateral chest wall combined with multiple aneurysms, which was successfully treated by transcatheter embolizationusing several embolic materials.