Bone cysts: unicameral and aneurysmal bone cyst.

Simple and aneurysmal bone cysts are benign lytic bone lesions, usually encountered in children and adolescents. Simple bone cyst is a cystic, fluid-filled lesion, which may be unicameral (UBC) or partially separated. UBC can involve all bones, but usually the long bone metaphysis and otherwise primarily the proximal humerus and proximal femur. The classic aneurysmal bone cyst (ABC) is an expansive and hemorrhagic tumor, usually showing characteristic translocation. About 30% of ABCs are secondary, without translocation; they occur in reaction to another, usually benign, bone lesion. ABCs are metaphyseal, excentric, bulging, fluid-filled and multicameral, and may develop in all bones of the skeleton. On MRI, the fluid level is evocative. It is mandatory to distinguish ABC from UBC, as prognosis and treatment are different. UBCs resolve spontaneously between adolescence and adulthood; the main concern is the risk of pathologic fracture. Treatment in non-threatening forms consists in intracystic injection of methylprednisolone. When there is a risk of fracture, especially of the femoral neck, surgery with curettage, filling with bone substitute or graft and osteosynthesis may be required. ABCs are potentially more aggressive, with a risk of bone destruction. Diagnosis must systematically be confirmed by biopsy, identifying soft-tissue parts, as telangiectatic sarcoma can mimic ABC. Intra-lesional sclerotherapy with alcohol is an effective treatment. In spinal ABC and in aggressive lesions with a risk of fracture, surgical treatment should be preferred, possibly after preoperative embolization. The risk of malignant transformation is very low, except in case of radiation therapy.

[Congenital malformations of the lung, the radiologist's point of view]. / Malformations pulmonaires congénitales, le point de vue du radiologue.

Congenital lung malformations include a complex range of developmental abnormalities. Currently, most are diagnosed prenatally or during early childhood. They may, however, be discovered later, incidentally or in connection with non-specific symptoms, sometimes severe. Knowledge of their radiological appearances is necessary for their detection. Proper technique and analysis of cross-sectional imaging, computed tomography and magnetic resonance imaging, allow a definitive diagnosis in most patients and pre-treatment evaluation of surgical cases. This review will describe the radiological aspects of congenital pulmonary malformations, especially those which may occur in late childhood or adult life. When present, alternative diagnoses will be discussed. A distinction will be made between anomalies originating from bronchopulmonary structures, such as bronchial atresia, bronchogenic cyst, congenital lobar overinflation, cystic adenomatoid malformation, and forms related to vascular anomalies (vascular rings, anomalous left pulmonary artery, pulmonary underdevelopment, proximal interruption of the pulmonary artery, pulmonary sequestration, scimitar syndrome).

Depistage echographique de la maladie luxante de hanche : qu'en est-il de la gemellite comme facteur de risque ?

Objectif : Le depistage echographique de la maladie luxante de hanche repond a des indications particulieres; dont l'existence de facteurs de risque. La gemellite fait partie de ces facteurs derisque. Le but de cette etude etait d'apprecier l'incidence reelle de la grossesse gemellaire dans la survenue de la maladie luxante de hanche. Materiels et Methodes : Nous avons realise une etude retrospective; de fevrier 1991 a mars 2004; de 316 dossiers d'echographies de hanche; realisees de maniere systematique chez des jumeaux; par une equipe pratiquant la methode morphologique de GRAF. Resultats : L'age moyen des nourrissons au premier examen etait de 2 mois en moyenne (de 1 a 3;4 mois). Dans 81 des cas; l'examen echographique initial etait normal. Les enfants presentant une hanche de type IIa etaient ages de 1;7 mois en moyenne. Ces hanches de type IIa; controlees dans un delai moyen de 1;8 mois; se sont normalisees dans 98;4 des cas. Seulement deux nourris- sons ont ete traites; un pour une hanche de type IIb unilateral; l'autre pour des hanches de type IIc bilateral. Ces deux nourrissons etaient nes en presentation de siege des cas. Seulement deux nourrissons ont ete traites; un pour une hanche de type IIb unilateral; l'autre pour des hanches de type IIc bilateral. Ces deux nourrissons etaient nes en presentation de siege

[Kidney trauma in children: state of the art medical imaging]. / Traumatisme du rein de l'enfant: bonnes pratiques en imagerie médicale.

Traumatic renal lesions have some particularities in the pediatric age group, especially for anatomic reasons. Imaging is very important for diagnosis and staging. Ultrasonography with Doppler is the first line examination performed in children and frequently allows initial diagnosis. From the Doppler-ultrasonographic results and the type of trauma, renal Computed Tomography (CT) is complementary performed. The association of these imaging techniques allows comprehensive work-up of traumatic renal lesions, and also of associated or pre-existing lesions. Conservative management is the rule in most cases. Interventional imaging techniques are sometimes used for therapeutic care of renal pedicular vascular lesions or lesions of the collecting system. Far from the traumatic event, imaging allows to follow up the morphologic and functional evolution of major renal lesions, in particular lesions of excretory renal ducts.

[Imaging of the pediatric pancreas: state of the art]. / Imagerie du pancréas de l'enfant en 2005.

The use of high frequency (7-12 MHz) transducers on state of the art US units equipped with Doppler imaging provides excellent evaluation of the pediatric pancreas that compares to other cross-sectional imaging techniques. The availability of multidetector CT imaging reduces the need for sedation but requires additional review of the indications and protocols to avoid unnecessary radiation exposure. Evaluation of pancreatitis and tumors remains the main indication. Advances in MR imaging and MRCP has lead to very good results in children. Storage diseases of the pancreas can be diagnosed at MRI. The length of the examinations, the need for sedation and the limited spatial resolution remain the main pitfalls of MR imaging of the pancreas in pediatric patients.

[Immature hemangiomas in infants: MR and Doppler-US imaging features]. / Sémiologie IRM et écho-Doppler des hémangiomes immatures du nourrisson: à propos de 12 cas.

PURPOSE: To determine the MR imaging features of immature hemangiomas. To discuss the value of MR imaging compared to Doppler ultrasonography (US). MATERIALS AND METHODS: We performed a retrospective study of clinical, Doppler US and MRI data of 12 immature hemangiomas in 11 children. The mean age was 2 months and 21 days. The mean clinical follow up was 22 months and 7 days. RESULTS: MRI was performed for non-diagnosed lesions (4 cases) or to further define lesion extension (8 cases). The lesions either involved the head and neck (8 cases) or the extremities (4 cases). At MR imaging, all immature hemangiomas corresponded to well defined homogeneous T2W hyperintense masses. On T1-weighted images, 11 immature hemangiomas were isointense with intense homogeneous enhancement. Eleven tumors contained linear low signal intensity flow voids. Ten lesions had superficial cutaneous and/or subcutaneous extension whereas 2 lesions had intra-muscular extension. At Doppler US, immature hemangiomas were highly vascularized masses, with well defined margins, often compressibles, homogeneous isoechoic or heterogeneous with nodular hypoechoic foci, relative to subcutaneous fat. A diagnosis of immature hemangioma was confirmed either by pathology (2 cases) or clinical follow up (10 cases). CONCLUSION: In our study, the MR imaging features of immature hemangiomas were reproducible and similar to reports from the literature. MRI is a useful tool to better define the extent of immature hemangiomas, which can be difficult to assess at US. The sensitivity and specificity of MR imaging for this pathology remain to be defined.

[Non-traumatic abdominal emergencies in paediatric practice]. / Les urgences abdominales non traumatiques de l'enfant.

Do advances in MR imaging and Computed Tomography have encroached upon the private territory of Ultrasound-Doppler imaging on paediatric practice? Do the enthusiasm promoted by the use of CT on non traumatic acute abdomen in adult has contaminated the indomitable village of paediatric radiologist? Undoubtfully, Ultrasound-Doppler stayed the first imaging modality to perform. However, the habits are less crystallised than a few years ago. The goal of this article is to describe the ultrasound findings and the potential indications for MRI or CT in the major non traumatic abdominal paediatric emergencies.

Neurocutaneous melanosis: radiological-pathological correlation.

We report the case of a young patient with neurocutaneous melanosis (NCM) who presented with temporary aphasia and right hemiparesis followed by progressive coma and death. To our knowledge, this is the first case of this disease examined by CT, MRI, angiography and in which an autopsy was performed to assert the diagnosis with histology. Besides, we discuss differential diagnoses and interest of MRI for early diagnosis.