Pediatric optic nerve and globe measurements on magnetic resonance imaging: establishing norms for children.

BACKGROUND: Normal optic nerve diameter (OND) and optic nerve sheath diameter (ONSD) may be beneficial for describing optic nerve pathway abnormality reflecting increased intracranial pressure. Nonetheless, magnetic resonance imaging (MRI) measurement of the normal ONSD range and its associations with clinical factors and eyeball transverse diameter (ETD) are not well established in children. PURPOSE: To establish normal OND, ONSD, ETD, and OND/ONSD and ONSD/ETD measurements in children and their associations with age and sex. MATERIAL AND METHODS: We evaluated and analyzed 336 brain MRI studies of children aged 0.5 months to 18 years. We measured a total of 672 optic nerves. The OND and ONSD were measured 1 cm anterior to the optic foramina and 3 mm behind the optic disc on an axial T2 sequence. RESULTS: The mean OND 3 mm and 1 cm, ONSD 3 mm and 1 cm, and ETD were 0.23 ± 0.05 mm and 0.16 ± 0.04 mm, 0.53 ± 0.08 mm and 0.38 ± 0.06 mm, and 2.3 ± 0.13, respectively. Only ONSD 1 cm was independent of age (P = 0.247). ONSD 3 mm and ETD were significantly wider in boys compared to girls and significantly influenced by age (both P < 0.001). Age at scan and ETD were significantly correlated (P < 0.001). CONCLUSION: We established MRI-based OND, ONSD, ETD, and ONSD/ETD and OND/ONSD ratio normative values in children, which can be helpful in pediatric populations with disease.

Comparison of Ultrasound and Computed Tomography Scanning Accuracy in Diagnosing Acute Appendicitis at King Abdulaziz University Hospital.

BACKGROUND: Choosing the most effective and accurate preoperative modality is one of the most significant tools in the clinical diagnosis of acute appendicitis (AA) to prevent negative appendectomies, diagnosis confusion, and delayed treatment. This decision making remains challenging to emergency physicians and surgeons which lead this study to determine the sensitivity and specificity of ultrasound (US) and computed tomography (CT) in predicting AA using pathology reports as a reference at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia. METHODS: This study was conducted retrospectively at the Emergency Department, KAUH in Jeddah, Saudi, Arabia using 351 medical records with a clinical picture of acute appendicitis and no history of trauma. The sensitivity and specificity were calculated for ultrasound and computed tomography imaging. The positive predictive values (PPV) and negative predictive value (NPV) were also evaluated. RESULTS: Out of the total 351 patients included in this study, 83 patients underwent surgical appendectomies and the pathology results revealed that 64 patients were diagnosed with AA while 19 showed a normal appendix. Of the 64 patients, 18 underwent US imaging while 62 underwent CT imaging. Compared to pathology results, US imaging results revealed that 12 out of 14 positive patients (85.7%) and only two out of four negative patients (50.0%) were correctly predicted while two out of 14 positive patients (14.3%) and two out of four negative patients (50.0%) were falsely diagnosed. On the other hand, CT imaging results revealed that 46 out of 49 positive patients (93.9%) and 9 out of 13 negative patients (69.2%) were correctly predicted while only three out of 49 positive patients (6.1%) and only four out of 13 negative patients (30.8%) were incorrectly diagnosed. CONCLUSION: Having an accuracy of 88.71%, sensitivity of 92.00%, and specificity of 75.00%, CT imaging was found to be more effective and accurate than US imaging which was only 77.78% accurate, 85.71% sensitive, and 50.00% specific. Statistical analyses also revealed that US results have a significant difference with pathology results (P= 0.130) while CT result has no significant difference (P <0.001).

Atypical Presentation and Neuroradiological Features of Giant Ecchordosis Physalyphora in a Seven-Year-Old Patient: A Case Report.

This study presented the rare case of a seven-year-old patient with atypical presentation and neuroradiological features of giant ecchordosis physaliphora. The patient underwent cross-sectional imaging due to persistent headache without neurological or visual symptoms. CT scan imaging of the head revealed a hypodense tumor in the prepontine cistern. This lesion caused smooth scalloping of the dorsal clivus without aggressive erosion or calcification, and an osseous stalk was also identified between the lesion and the dorsal wall of the clivus. Sagittal T1 weighted image (T1WI) MRI showed a bilobed, solid and cystic, well-defined lesion, measuring 3.5 cm in terms of craniocaudal diameter, found alongside the midline within the prepontine cistern. After the evaluation of radiological images, the patient was then subjected to endoscopic transnasal complete tumor excision. Histological examination revealed sheets and lobules of clear cells with cytoplasmic globules "physaliphorous cells", and myxoid stroma. There was nuclear pleomorphism associated with focal areas of necrosis. After full recovery and discharge, the patient was followed up for the first year with four-month interval brain MRI scans showing no evidence of residual tumors. On the 12 months follow-up scan, the MRI scan revealed a 1.5 x 0.7 cm recurrent mass in the retroclival right paramidline prepontine cistern, which was most notably seen on the diffusion-weighted images. Series of proton beam therapy with annual MRI scans demonstrated regression of the tumor, eventually allowing the patient to live free of neurological symptoms up to this day. Results suggest that the utilization of radiological imaging such as CT and MRI scans was successful in identifying the ecchordosis physaliphora and differentiating it from chordomas. It can also be inferred that atypical radiological and histopathological findings of ecchordosis physaliphora lesions might suggest that they are prone to recurrence, which is an atypical feature for such entities. Further studies are recommended to explore and better understand these uncommon observations in patients with ecchordosis physaliphora.