ABSTRACT
OBJECTIVES: This study was aimed at correlating a magnetic resonance index of activity (MaRIA) and a magnetic resonance enterography global score (MEGS) with activity indexes in a paediatric population with Crohn's disease (CD). METHODS: This retrospective study included 32 paediatric patients (median age 14.5 years, 18 male) with proven CD who underwent magnetic resonance enterography (MRE). A correlation analysis was performed on the MRE-based scores, the simplified endoscopic score for CD (SES-CD), the paediatric Crohn's disease activity index (PCDAI), and C-reactive protein (CRP) levels. Based on PCDAI, comparison of both global MaRIA and MEGS was made between patients with mild and moderate/severe disease activity. RESULTS: Global MaRIA correlated with SES-CD (r = 0.70, p = 0.001) and PCDAI (r = 0.42, p = 0.016). MEGS correlated with PCDAI (r = 0.46, p = 0.007) and CRP levels (r = 0.35, p = 0.046). MEGS differed significantly (p = 0.027) between patients grouped by clinical disease severity. CONCLUSIONS: MRE-based global scores correlated with clinical indexes of CD activity. Therefore, they represent a potential useful tool to predict CD activity and severity, as well as a possible promising alternative to endoscopy, to monitor paediatric patients with CD during their follow-up. KEY POINTS: ⢠MRE is widely used to for accurate assessment of CD. ⢠Global MaRIA and MEGS have been suggested as indicators of CD activity. ⢠Paediatric studies comparing MRE-based global scores with clinical CD activity are lacking. ⢠Such scores can serve as predictors of CD activity/severity in paediatric patients. ⢠MRE offers an alternative to clinical score/endoscopy for paediatric CD monitoring.
Subject(s)
Crohn Disease/diagnostic imaging , Magnetic Resonance Imaging/methods , Adolescent , Adult , Child , Colon/diagnostic imaging , Colon/pathology , Crohn Disease/pathology , Female , Humans , Ileum/diagnostic imaging , Ileum/pathology , Male , Reproducibility of Results , Retrospective Studies , Severity of Illness Index , Young AdultABSTRACT
A phaeochromocytoma is a rare catecholamine-secreting tumour arising from the chromaffin cells. We describe a case of a child with Von Hippel-Lindau disease, with an adrenal phaeochromocytoma who presented with severe dilated cardiomyopathy driven by secondary hypertension. Contrast-enhanced ultrasound findings are described and compared with both magnetic resonance imaging and computed tomography imaging.
ABSTRACT
PURPOSE: (18)F-fluorodeoxyglucose-positron emission tomography/computed tomography (PET/CT) has proved effective in detecting recurrent or metastatic differentiated thyroid carcinoma (DTC) in the follow-up of operated DTC patients with high thyroglobulin (Tg) levels and negative findings on radioiodine whole-body scan. The aim of this retrospective study was to assess the impact of PET/CT on the planning of appropriate treatment for known recurrent disease in operated DTC patients. MATERIALS AND METHODS: The study concerned 44 consecutive DTC patients (36 papillary, 8 follicular), who underwent total thyroidectomy and thyroid remnant ablation with (131)I and PET/CT. All patients had proven or strongly suspected recurrent disease judging from neck ultrasound (US) and fine-needle aspiration cytology, and detectable basal Tg levels. RESULTS: PET/CT findings were positive in 25/44 patients (56.81 %) and negative in 19. A positive PET/CT result predicted resectable tumour recurrences in 19/25 patients, but also detected additional tumour sites that prompted changes to the treatment plan in 6/25 patients (24 %). A negative PET/CT result led to clinical monitoring for 11/19 patients (57.89 %). CONCLUSIONS: PET/CT can help select patients, who might benefit from a tailored therapy by improving the detection of local recurrences not apparent on neck US or metastases.
Subject(s)
Multimodal Imaging , Neoplasm Recurrence, Local/diagnostic imaging , Thyroid Neoplasms/diagnostic imaging , Adult , Aged , Aged, 80 and over , Biopsy, Fine-Needle , Female , Fluorodeoxyglucose F18 , Humans , Image Interpretation, Computer-Assisted , Iodine Radioisotopes , Male , Middle Aged , Neoplasm Recurrence, Local/pathology , Neoplasm Staging , Patient Care Planning , Positron-Emission Tomography , Predictive Value of Tests , Radiopharmaceuticals , Retrospective Studies , Thyroid Neoplasms/pathology , Thyroid Neoplasms/surgery , Thyroidectomy , Tomography, X-Ray ComputedABSTRACT
Background. The challenging treatment of penetrating paediatric Crohn's disease (CD) involves pharmacological and surgical approaches. Despite a proved efficacy of anti-TNF agents for treatment of complex fistula, a large number of patients cannot achieve a complete healing and relapse during the followup. Aim. We report a paediatric case with CD and colonic perforation who was successfully treated with medical therapy only, including anti-TNFα. Case Presentation. During a colonoscopy performed on a 9-year-old girl with CD, a perforation occurred in correspondence of a fistula at the colonic splenic flexure. The formation of a collection was then detected (US, enteric-CT), as well as a fistula connecting the colon to the collection. The girl was kept fasting and treated with total parenteral nutrition and antibiotic therapy. Treatment with Infliximab was also started, and after the third dose a US control showed disappearance of the collection and healing of the enteric fistula. Parenteral nutrition was progressively substituted with enteral feeding, and no surgical treatments were needed. Discussion. In pubertal children with penetrating CD, the option of an efficacious medical treatment to avoid a major surgical approach on the bowel is to be aimed for growth improvement. This approach requires a strictly monitored long-term followup.
