RESUMEN
OBJECTIVE: Feasibility study of contrast enhanced MR enterography without enteroclysis as a new diagnostic tool for children with known or suspected Crohn's disease. METHODS: We prospectively included 15 children, 8-18 years old, with clinical suspicion of Crohn's disease. MR enterography without enteroclysis was performed on a 1,5 T clinical MR system. A total of 1000 ml of mannitol 5% was orally administered 60 minutes prior to MRI. Coronal and axial breath-hold sequences were acquired. The following sequences were obtained: True-FISP, FLASH T1 2D/3D with Fat saturation before and after gadolinium injection. Two radiologists, blinded to patient information, independently reviewed all examinations to record image quality, the degree of distension of the distal ileum, the presence of abnormal bowel segments and the presence of extra-intestinal complications. MRI findings were correlated to sonographic, endoscopic and biological results (sensitivity, specificity, Kappa test). RESULTS: The examinations were considered of satisfactory diagnostic quality in 93.3% of patients. Respiratory artifacts were present in one case. The entire GI tract could be identified on all sequences. Distention of the distal ileum was recorded as good to excellent in 89% of healthy subjects. Five MR examinations were considered abnormal with isolated ileal involvement in 2 cases, ileocolic involvement in 2 cases, and isolated colonic involvement in 1 case. The sensitivity and specificity of MR for the positive diagnosis of Crohn's disease were 100% and 83% respectively. Three extra-intestinal complications were detected: one case of ileo-ileal fistula, not identified on ultrasonography, an asymptomatic anal fistula and a symptomatic inflammatory stricture. CONCLUSION: MR enterography without enteroclysis is a well tolerated, effective non invasive method in the evaluation of known or suspected Crohn's disease. Because of the absence of ionizing radiation, MR enterography should become the gold standard in pediatric patients.
Asunto(s)
Medios de Contraste , Enfermedad de Crohn/diagnóstico , Gadolinio DTPA , Imagen por Resonancia Magnética/métodos , Administración Oral , Adolescente , Artefactos , Niño , Enfermedades del Colon/diagnóstico , Constricción Patológica/diagnóstico , Enfermedad de Crohn/diagnóstico por imagen , Estudios de Factibilidad , Humanos , Enfermedades del Íleon/diagnóstico , Aumento de la Imagen/métodos , Fístula Intestinal/diagnóstico , Intestinos/patología , Manitol/administración & dosificación , Estudios Prospectivos , Fístula Rectal/diagnóstico , Sensibilidad y Especificidad , Método Simple Ciego , UltrasonografíaRESUMEN
OBJECTIVE: To review the imaging appearances, management and outcome of a large number of children with intussusception owing to pathologic lead points (PLP) in an attempt to define the role of various imaging modalities in this clinical setting. MATERIALS AND METHODS: Review of the records and imaging studies of 43 children with intussusception due to PLP diagnosed between 1986 and 1999. RESULTS: The commonest PLP found were Meckel diverticulum, polyps, Henoch-Schonlein purpura and cystic fibrosis. PLP were depicted on sonography in 23 (66%) of 35 patients, on computed tomography in 5 (71%) of 7, on air enema in 3 (11%) of 28, and on barium enema in 6 (40%) of 15. Air enema successfully reduced 60% of the intussusceptions. Nine children had recurrent intussusceptions. CONCLUSION: Sonography depicted two-thirds of PLP and provided a specific diagnosis in nearly one-third of our series. Our review does not provide sufficient data on how to continue the investigation of those patients in whom sonography does not depict a PLP but in whom there is a high index of suspicion for its presence. It remains a diagnostic challenge as to how to search for PLP in these patients, and other imaging modalities have to be requested according to each particular case.
Asunto(s)
Apéndice , Enfermedades del Ciego/diagnóstico , Enfermedades del Colon/diagnóstico , Enfermedades del Íleon/diagnóstico , Intususcepción/diagnóstico , Adolescente , Aire , Apéndice/diagnóstico por imagen , Sulfato de Bario , Enfermedades del Ciego/diagnóstico por imagen , Enfermedades del Ciego/etiología , Neoplasias del Ciego/complicaciones , Niño , Preescolar , Enfermedades del Colon/diagnóstico por imagen , Enfermedades del Colon/etiología , Fibrosis Quística/complicaciones , Enema , Femenino , Fluoroscopía , Estudios de Seguimiento , Hemangioma/complicaciones , Humanos , Vasculitis por IgA/complicaciones , Enfermedades del Íleon/diagnóstico por imagen , Enfermedades del Íleon/etiología , Neoplasias del Íleon/complicaciones , Lactante , Recién Nacido , Pólipos Intestinales/complicaciones , Intususcepción/diagnóstico por imagen , Intususcepción/etiología , Masculino , Divertículo Ileal/complicaciones , Divertículo Ileal/diagnóstico , Divertículo Ileal/diagnóstico por imagen , Síndrome de Peutz-Jeghers/complicaciones , Cintigrafía , Recurrencia , Factores de Tiempo , Tomografía Computarizada por Rayos X , UltrasonografíaAsunto(s)
Dolor Abdominal/etiología , Apéndice , Enfermedades del Ciego/diagnóstico por imagen , Enfermedades del Íleon/diagnóstico por imagen , Válvula Ileocecal , Intususcepción/diagnóstico por imagen , Apéndice/diagnóstico por imagen , Infecciones Bacterianas/diagnóstico , Enfermedades del Ciego/terapia , Niño , Clostridioides difficile/aislamiento & purificación , Heces/microbiología , Humanos , Enfermedades del Íleon/terapia , Válvula Ileocecal/diagnóstico por imagen , Enfermedades Intestinales/diagnóstico , Intususcepción/terapia , Complicaciones Posoperatorias/diagnóstico , Recurrencia , Factores de Tiempo , Ultrasonografía , Yersinia enterocolitica/aislamiento & purificaciónAsunto(s)
Neoplasias Abdominales/secundario , Linfoma de Burkitt/patología , Neoplasias del Colon/secundario , Neoplasias Gastrointestinales/patología , Leiomioma/patología , Leiomiosarcoma/patología , Neoplasias Pulmonares/secundario , Neoplasias Abdominales/diagnóstico por imagen , Adolescente , Sulfato de Bario , Linfoma de Burkitt/diagnóstico por imagen , Preescolar , Neoplasias del Colon/diagnóstico por imagen , Medios de Contraste , Femenino , Neoplasias Gastrointestinales/diagnóstico por imagen , Humanos , Leiomioma/diagnóstico por imagen , Leiomiosarcoma/diagnóstico por imagen , Neoplasias Pulmonares/diagnóstico por imagen , Masculino , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
PURPOSE: To evaluate the role of MR Cholangiography in a pediatric population with biliary complications after liver transplantation and particularly with anastomotic stenosis. PATIENTS AND METHODS: Ten MR cholangiography studies were performed in 10 children with liver transplant who were suspected of having biliary complications between December 1996 and April 1998. The findings on MR were correlated with the results from liver biopsy, liver ultrasound, liver function tests and with clinical information when available. RESULTS: MR cholangiography identified 9 children with biliary tree dilatation, 4 with anastomotic stenosis, 5 with multiple bile ducts stenosis, 2 with stones in the intra-hepatic biliary tree and 2 with abnormalities suspicious for acute cholangitis. Three of 4 anastomotic stenoses were confirmed and treated by percutaneous cholangiography. There was no correlation between the different exams in 6 children but MR cholangiography confirmed the final diagnosis. CONCLUSION: In children with liver transplantation, MR cholangiography may be useful to evaluate and to confirm a diagnosis of bile duct complications and it is helpful in the absence of correlation between liver biopsy, ultrasound and liver function test.
Asunto(s)
Enfermedades de los Conductos Biliares/diagnóstico , Enfermedades de los Conductos Biliares/etiología , Colangiografía/métodos , Trasplante de Hígado/efectos adversos , Imagen por Resonancia Magnética , Adolescente , Niño , Preescolar , Humanos , LactanteRESUMEN
We report two children who presented with multiple renal cysts involving only one kidney and in whom there was no family history of renal disease and who did not have syndromes known to be associated with renal cystic disease. This unilateral involvement may represent a distinct entity, which has only been previously described in three cases; however, long-term follow-up will be needed to confirm this hypothesis. We illustrate the sonographic and computed tomographic findings, and the differential diagnosis is discussed.