ABSTRACT
CLINICAL/METHODICAL ISSUE: Acute, non-traumatic abdominal pain is one of the main reasons for medical consultation in pediatric patients. Knowledge of different diseases and their age dependence is essential for correct diagnosis and treatment. STANDARD RADIOLOGICAL METHODS: Ultrasonography is the imaging method of choice. Xray is only used in case of emergency, e.â¯g., suspected perforation. METHODICAL INNOVATIONS: Contrast-enhanced ultrasonography (CEUS) and elastography complement ultrasonography. PERFORMANCE: Magnetic resonance imaging is of increasing relevance for differential diagnosis of unclear sonographic results. PRACTICAL RECOMMENDATIONS: The primary imaging modality in pediatric patients is ultrasonography. Cross-sectional imaging should only be used in cases of unclear sonographic findings.
Subject(s)
Abdomen, Acute , Appendicitis , Radiography/methods , Abdominal Pain , Child , Diagnosis, Differential , Humans , Magnetic Resonance Imaging , UltrasonographySubject(s)
Lymphangioma, Cystic/diagnosis , Lymphangioma, Cystic/surgery , Mesenteric Cyst/diagnosis , Mesenteric Cyst/surgery , Peritoneal Neoplasms/diagnosis , Peritoneal Neoplasms/surgery , Diagnosis, Differential , Female , Follow-Up Studies , Humans , Image Interpretation, Computer-Assisted , Imaging, Three-Dimensional , Infant, Newborn , Lymphangioma, Cystic/congenital , Lymphangioma, Cystic/pathology , Magnetic Resonance Imaging , Mesenteric Cyst/congenital , Mesenteric Cyst/pathology , Peritoneal Neoplasms/congenital , Peritoneal Neoplasms/pathology , PrognosisABSTRACT
Autoimmune pancreatitis is a relatively rare form of chronic pancreatitis which is characterized by a lymphoplasmatic infiltrate with a storiform fibrosis and often goes along with painless jaundice and discrete discomfort of the upper abdomen. Clinically we distinguish between two subtypes, which differ in terms of their histology, clinical picture and prognosis. Type 1 autoimmune pancreatitis is the pancreatic manifestation of the IgG4-associated syndrome which also involves other organs. About one third of the patients can only be diagnosed after either histological prove or a successful steroid trail. Type 2 is IgG4-negative with the histological picture of an idiopathic duct centric pancreatitis and is to higher degree associated with inflammatory bowel disease. A definitive diagnosis can only be made using biopsy. Usually both forms show response to steroid treatment, but in type 1 up to 50â% of the patients might develop a relapse. The biggest challenge and most important differential diagnosis remains the discrimination of AIP from pancreatic cancer, because also AIP can cause mass of the pancreatic head, lymphadenopathy and ductal obstruction. This article summarizes recent advances on epidemiology, clinical presentation, diagnostic strategy, therapy and differential diagnosis in this relatively unknown disease.
Subject(s)
Autoimmune Diseases/diagnosis , Autoimmune Diseases/drug therapy , Immunosuppressive Agents/therapeutic use , Pancreatitis/diagnosis , Pancreatitis/drug therapy , Steroids/therapeutic use , HumansABSTRACT
Magnetic resonance imaging (MRI) with small surface coils is a well established method for the diagnostic evaluation of finger masses. Until now, histological examination has been required to reliably assess tumor extent and infiltration of surrounding structures. Ultra-high-field MR microscopy (MRM) allows evaluation of anatomical structures and pathologies with submillimeter resolution. This study describes the diagnostic prospects and potential of MRM based on the ex-vivo examination of different finger pathologies. Ten human digits were examined by ex-vivo MRM at 7.1 Tesla (ClinScan, Bruker BioScan) using a T2-weighted turbo spin echo (TSE) sequence. Imaging parameters were: TE 48 ms; TR 8370 ms; slice thickness 700 µm; matrix size 1024 × 1024 pixels; FOV 37 × 37 mm; in-plane resolution 36 × 36 µm/voxel. Afterwards specimens were examined histologically. Histology and MRM were correlated. MRM allowed evaluation of the anatomy of the nail, the tendon insertions, the distal interphalangeal joint, and the neurovascular bundles. Finger abnormalities evaluated by MRM included osteomyelitis and metastatic disease. Subsequent histological examination confirmed MRM findings regarding origin, internal makeup, and extent of the structures visualized. This study demonstrates the potential of MRM for imaging small anatomical structures and pathologies of the human finger. Our ex-vivo findings correlate strongly with histology, suggesting that MRM may gain a central role in assessing anatomical structures and pathology in terms of morphology, extent, and infiltration of surrounding structures. Therefore, with increasing availability, MRM is expected to become an essential tool not only in experimental studies but also for daily routine.
