Harmonizing national growth references for multi-centre surveys, drug monitoring and international postmarketing surveillance.

AIM: National European growth references differ. We aimed to convert (harmonize) currently used charts into a single unified interchangeable LMS format for each European nation. METHODS: Nine currently used national European growth references from Belgium (2009), France (1979), Poland (2001), Sweden (2002), Switzerland (1989), the UK (1990), Italy (2006) and Germany (1979 and 1997) were harmonized and compared with the international WHO child growth standards and WHO growth reference data for 5-19 years. RESULTS: European growth charts can be harmonized. The approach appears useful as height, and body mass index (BMI) is inappropriately represented by WHO references. European height references exhibit warping when plotted against the WHO reference. The French appears too short, the other Europeans too tall. Also, the BMI is not appropriately represented by the WHO references. CONCLUSIONS: Harmonizing references is a novel, convenient and cost-effective approach for converting historic and/or incomplete local or national growth reference charts into a unified interchangeable LMS format. Harmonizing facilitates producing growth references 'on demand', for limited regional purposes, for ethnically, socio-economically or politically defined minorities, but also for matching geographically different groups of children and adolescents for international growth and registry studies.

Dynamic fast-gradient echo MR imaging of pancreatic tumours.

The purpose of this study was to determine the diagnostic utility of dynamic magnetic resonance imaging (MRI) of the pancreas. Twenty-eight adult patients with known or suspected pancreatic tumours were examined. Pre- and post-gadolinium (GdDTPA-BMA) scans were obtained in combination with an oral negative contrast medium (ferristene) to mark the gastrointestinal tract. In 6 cases a more precise diagnosis could be made by dynamic MRI compared to unenhanced MRI. Surgery could confirm the MR diagnosis based on contrast enhancement in 83% compared to 78% for CT. The results of signal intensity (SI) measurements show that a combination of differences in baseline values before enhancement and the slope of enhancement within the first 20 s is a reliable criterion to distinguish between normal pancreas and hypovascular tumours. These tumours already show lower SI values before as well as lower slopes after early enhancement. Mainly two effects facilitate the final MRI diagnosis: (1) the delineation of the pancreas from the duodenum by the negative contrast medium, and (2) the enhancement pattern of pancreatic tumours by gadolinium-enhanced dynamic MRI compared to normal tissue within the early enhancement after contrast injection.