Pediatric Odontogenic and Paranasal Sinus Infections.

Odontogenic and sinogenic infections are frequently encountered in the pediatric population. Although the diagnosis is often suspected clinically, imaging can play a significant role in localizing the site of infection, assessing for involvement of deep neck spaces, detection of abscess and other potentially life-threatening complications, and providing valuable information to help with treatment planning. This article reviews the general imaging considerations and anatomy relevant to odontogenic and paranasal sinus infections and describes the salient clinical and imaging features of infectious diseases of the dentition and sinuss.

Establishing language laterality: does resting-state functional MRI help?

OBJECTIVE: Task-based functional MRI (tb-fMRI) is now considered the standard, noninvasive technique in establishing language laterality in children for surgical planning. The evaluation can be limited due to several factors such as age, language barriers, and developmental and cognitive delays. Resting-state functional MRI (rs-fMRI) offers a potential path to establish language dominance without active task participation. The authors sought to compare the ability of rs-fMRI for language lateralization in the pediatric population with conventional tb-fMRI used as the gold standard. METHODS: The authors performed a retrospective evaluation of all pediatric patients at a dedicated quaternary pediatric hospital who underwent tb-fMRI and rs-fMRI from 2019 to 2021 as part of the surgical workup for patients with seizures and brain tumors. Task-based fMRI language laterality was based on a patient's adequate performance on one or more of the following: sentence completion, verb generation, antonym generation, or passive listening tasks. Resting-state fMRI data were postprocessed using statistical parametric mapping, FMRIB Software Library, and FreeSurfer as described in the literature. The laterality index (LI) was calculated from the independent component (IC) with the highest Jaccard Index (JI) for the language mask. Additionally, the authors visually inspected the activation maps for two ICs with the highest JIs. The rs-fMRI LI of IC1 and the authors' image-based subjective interpretation of language lateralization were compared with tb-fMRI, which was considered the gold standard for this study. RESULTS: A retrospective search yielded 33 patients with language fMRI data. Eight patients were excluded (5 with suboptimal tb-fMRI and 3 with suboptimal rs-fMRI data). Twenty-five patients (age range 7-19 years, male/female ratio 15:10) were included in the study. The language laterality concordance between tb-fMRI and rs-fMRI ranged from 68% to 80% for assessment based on LI of independent component analysis with highest JI and for subjective evaluation by visual inspection of activation maps, respectively. CONCLUSIONS: The concordance rates between tb-fMRI and rs-fMRI of 68% to 80% show the limitation of rs-fMRI in determining language dominance. Resting-state fMRI should not be used as the sole method for language lateralization in clinical practice.

Relationship between Ventricular Size on Latest Ultrasonogram and the Bayley Scores ≥ 18 Months in Extremely Low Gestational Age Neonates: A Retrospective Cohort Study.

OBJECTIVE: A ventricle-to-brain index (VBI) >0.35 is associated with low scores on the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) in preterm infants with birth weight <1,250 g. However, VBI obtained at the third ventricle has only moderate interobserver reliability. The objective of this study was to test (1) reliability of VBI measured at the foramen of Monro on the latest ultrasonogram (US) before discharge using the intraclass correlation coefficient (ICC) and (2) the relationship between VBI and BSID-III scores at ≥18 months corrected age. STUDY DESIGN: The present study is a single-center retrospective cohort study. RESULTS: The study included 270 preterm infants born at 230/7 to 286/7 weeks of gestational age. The ICC of VBI between independent measurements by two study radiologists on the first 50 patients was 0.934. Factors associated with the value of VBI included severe intraventricular hemorrhage, bronchopulmonary dysplasia, and systemic steroid administration for BPD but not postmenstrual age. In multivariate analysis, VBI was negatively and independently associated with cognitive (p = 0.002), language (p = 0.004), and motor (p < 0.001) BSID-III scores. The association between VBI and BSID-III scores was observed even in infants in whom the latest US was obtained before term equivalent age. The association between VBI and BSID-III scores was also observed after excluding those with severe intraventricular hemorrhage. CONCLUSION: In this very preterm cohort the measurement of VBI had excellent reliability. Moreover, VBI measurements were negatively associated with motor, language, and cognitive BSID-III scores. KEY POINTS: · Mean values of VBI are stable with postmenstrual age.. · Values at the foramen of Monro are reliable and reproducible.. · VBI is negatively associated with Bayley scores.. · The association is observed even before term age..

Recurrent painful ophthalmoplegic neuropathy: MRI findings in 2 patients.

Recurrent painful ophthalmoplegic neuropathy is a form of cranial neuralgia and rare source of pediatric headache. We present 2 children who presented with headaches accompanied by visual symptoms including eye pain, blurry vision, and diplopia. MRI in both patients demonstrated enhancement of the cisternal segment of the oculomotor nerve in the affected side, correlating with the observed symptoms.

Imaging findings of Menkes disease, a radiographic mimic of abusive trauma.

Menkes disease is a rare X-linked recessive disorder caused by impaired copper absorption and transport. Presented here is a case of a 12-week-old male who presented with hypotonia and multiple metaphyseal fractures. Further imaging and workup revealed a diagnosis of Menkes disease. While nonaccidental trauma is a much more common cause of metaphyseal bone fractures, encephalopathy, and subdural hematomas in infants, Menkes syndrome should be considered in the setting of corroborating signs and symptoms, as early diagnosis and treatment can delay progression of the disease.

MRI findings of metronidazole neurotoxicity in a pediatric patient with chronic diarrhea.

Neurotoxicity is a rare side effect of metronidazole therapy. Shown here are findings of metronidazole toxicity in a patient, who received chronic metronidazole as prophylaxis for pseudomembranous colitis following bowel resection as an infant. Findings depicted include increased T2 signal in the dentate nuclei and brainstem. Discontinuing the medication resulted in reversal of the findings.