AJNR Blog » Pediatrics http://www.ajnrblog.org American Journal of Neuroradiology Wed, 01 Feb 2012 21:10:26 +0000 en hourly 1 Educational Presentation: Holoprosencephaly http://www.ajnrblog.org/2011/01/12/educational-presentation-holoprosencephaly/ http://www.ajnrblog.org/2011/01/12/educational-presentation-holoprosencephaly/#comments Wed, 12 Jan 2011 20:25:07 +0000 MCastillo http://www.ajnrblog.org/?p=3966 Holoprosencephaly (FILEminimizer)

Here is a nice and concise presentation on the different types of holoprosencephaly done  by one of our Neuroradiology Fellows,  Dr. Janica Walden.  We hope that you enjoy it and find it instructive and useful.… Continue reading >>

]]> Holoprosencephaly (FILEminimizer)

Here is a nice and concise presentation on the different types of holoprosencephaly done  by one of our Neuroradiology Fellows,  Dr. Janica Walden.  We hope that you enjoy it and find it instructive and useful.

]]> http://www.ajnrblog.org/2011/01/12/educational-presentation-holoprosencephaly/feed/ 0 Propanolol as Treatment for Infantile Hemangiomas http://www.ajnrblog.org/2009/10/19/propanolol-as-treatment-for-infantile-hemangiomas/ http://www.ajnrblog.org/2009/10/19/propanolol-as-treatment-for-infantile-hemangiomas/#comments Mon, 19 Oct 2009 16:25:12 +0000 MCastillo http://www.ajnrblog.org/?p=2098 Infantile Hemangioma Propanolol Treatment

You may have heard that Propanolol is currently being used as treatment for some infantile hemangiomas of both types (RICH and NICH).  In this presentation prepared for our weekly case conference by Mr. Danilo Bernardo the results of such therapy are illustrated and discussed.… Continue reading >>

]]> Infantile Hemangioma Propanolol Treatment

You may have heard that Propanolol is currently being used as treatment for some infantile hemangiomas of both types (RICH and NICH).  In this presentation prepared for our weekly case conference by Mr. Danilo Bernardo the results of such therapy are illustrated and discussed.

]]> http://www.ajnrblog.org/2009/10/19/propanolol-as-treatment-for-infantile-hemangiomas/feed/ 0 Anomalies After Exposure to Methotrexate in the 1st Trimester http://www.ajnrblog.org/2009/08/11/anomalies-after-exposure-to-methotrexate-in-the-1st-trimester/ http://www.ajnrblog.org/2009/08/11/anomalies-after-exposure-to-methotrexate-in-the-1st-trimester/#comments Tue, 11 Aug 2009 11:49:32 +0000 Marcela Posada http://www.ajnrblog.org/?p=1781 Continue reading →]]> 124727206 Picture1 Picture2

This is a 2 day-old term baby with history of methotrexate exposure during first trimester as an abortion attempt. No other relevant clinical history. The MRI study shows large bilateral choroid plexus cysts, partial sacral agenesis and a filar lipoma.  If anyone has had experience with this situation, please let us know.

Methotrexate is a folic acid antagonist, which is known to have teratogenic effects in the first trimester of gestation. It interrupts the synthesis of thymidylate, purine nucleotides, and some amino acids, thereby interfering with the formation of DNA, RNA, and proteins. Methotrexate has multiple therapeutic uses in women of reproductive age such as treatment of neoplastic disease, psoriasis, rheumatoid arthritis, lupus, ulcerative colitis, ectopic pregnancy and as well as an agent for induce abortion. Failure rate of abortion is 2-10% and there are reports of normal pregnancy outcomes.

There are well described congenital anomalies resulting from methotrexate exposure in first trimester of pregnancy; dose dependence is unclear. Cranial dysostosis, hypertelorism, external ear anomalies, micrognathia and posterior cleft palate have been described. Multiple skeletal and axial anomalies are also noted.

We have found two case reports in the literature of choroid plexus cysts after methotrexate exposure during the first trimester of pregnancy. The caudal vertebral anomalies have been reported mostly in rats.

]]> http://www.ajnrblog.org/2009/08/11/anomalies-after-exposure-to-methotrexate-in-the-1st-trimester/feed/ 0 Neonatal Pituitary Gland http://www.ajnrblog.org/2009/07/26/neonatal-pituitary-gland/ http://www.ajnrblog.org/2009/07/26/neonatal-pituitary-gland/#comments Sun, 26 Jul 2009 22:11:44 +0000 Alfonso CERASE http://www.ajnrblog.org/?p=1618 This is a one month-old female with congenital hypothyroidism, hypoplasia of the thyroid gland, elevated TSH (eight times normal value), elevated FSH and LH (four times normal values), normal GH, without diabetes insipid. She is now being treated for the hypothyroidism, and we are waiting for hormonal follow-up; MRI follow-up in three to six month follow-up.

Has anyone an explanation for the focal bright spot on T1-weighted images in the cranial portion of the pituitary stalk, just down the median eminence, in the presence of a normal neurohypophysis?

Is it an “ectopic” adenohypophysis?

Is this a thin pituitary stalk in … Continue reading >>

]]> This is a one month-old female with congenital hypothyroidism, hypoplasia of the thyroid gland, elevated TSH (eight times normal value), elevated FSH and LH (four times normal values), normal GH, without diabetes insipid. She is now being treated for the hypothyroidism, and we are waiting for hormonal follow-up; MRI follow-up in three to six month follow-up.

Has anyone an explanation for the focal bright spot on T1-weighted images in the cranial portion of the pituitary stalk, just down the median eminence, in the presence of a normal neurohypophysis?

Is it an “ectopic” adenohypophysis?

Is this a thin pituitary stalk in pituitary gland hypoplasia?

What will happen at follow-up?

It is  the start of  an infiltrative disease?

…It is simply that I do not know the normal and physiological behavior of the pituitary gland?…

A, Sagittal T1

B, Coronal T1C, Coronal T2D, Sagittal Gd-T1

Best regards to all of You!

]]> http://www.ajnrblog.org/2009/07/26/neonatal-pituitary-gland/feed/ 0 CT Still Useful for Retinoblastoma? http://www.ajnrblog.org/2009/07/19/ct-still-useful-for-retinoblastoma/ http://www.ajnrblog.org/2009/07/19/ct-still-useful-for-retinoblastoma/#comments Sun, 19 Jul 2009 14:26:57 +0000 esschwartz http://www.ajnrblog.org/?p=1610 The article “Is CT Still Useful in the Study Protocol of Retinoblastoma?“, published July 17 in the Publication Preview section of AJNR, confirms that even when high-field MRI is not available, CT can be avoided in the workup of the patient with suspected retinoblastoma, when MRI is combined with a good ophthalmoscopic exam and ocular sonography. Certainly with 3D imaging at 3T, the detection rate with MRI could reasonably be expected to be even higher, allowing us to “Image Gently” and more accurately.

The authors state that “CT is still the method of choice for detecting intraocular calcium … Continue reading >>

]]> The article “Is CT Still Useful in the Study Protocol of Retinoblastoma?“, published July 17 in the Publication Preview section of AJNR, confirms that even when high-field MRI is not available, CT can be avoided in the workup of the patient with suspected retinoblastoma, when MRI is combined with a good ophthalmoscopic exam and ocular sonography. Certainly with 3D imaging at 3T, the detection rate with MRI could reasonably be expected to be even higher, allowing us to “Image Gently” and more accurately.

The authors state that “CT is still the method of choice for detecting intraocular calcium and investigating orbital pathologies”, but support this with articles from 1997 and 1999. At CHOP, we have virtually eliminated the use of CT in our patients presenting with suspected retinoblastoma, and for follow up of treated patients. Have we all just changed our approach and not documented it very well in the literature?

As fewer enucleations are performed, in favor of eye-sparing procedures, it is increasingly important that all of the orbital structures be accurately assessed for residual and recurrent disease. In the same setting as the orbit MRI, brain MRI can assess for intracranial lesions. The ophthalmologic examination can often be coordinated to precede or follow the MRI, with the same sedation or anesthesia, as most affected are young children.

Anyone out there still routinely using CT for retinoblastoma?

]]> http://www.ajnrblog.org/2009/07/19/ct-still-useful-for-retinoblastoma/feed/ 1 ASL Perfusion in Cortical Dysplasia http://www.ajnrblog.org/2009/02/17/522/ http://www.ajnrblog.org/2009/02/17/522/#comments Tue, 17 Feb 2009 13:58:58 +0000 MCastillo http://www.ajnrblog.org/?p=522 Arterial spin labeling perfusion is becoming an important clinical tool. We find it particularly useful in children in whom it is difficult to obtain contrast enhanced MR perfusion due to the smaller size of needles used.  Here is a case of a balloon cell type cortical dysplasia in the right temporoparietal region 110775172110734214with low cerebral blood flow on the ASL study.  I think that our Blogsite is the ideal place to share these cases with the rest of the Neuroradiology community.  Similar findings to the ones shown here were reported in the following article found in the publication preview section … Continue reading >>

]]> Arterial spin labeling perfusion is becoming an important clinical tool. We find it particularly useful in children in whom it is difficult to obtain contrast enhanced MR perfusion due to the smaller size of needles used.  Here is a case of a balloon cell type cortical dysplasia in the right temporoparietal region 110775172110734214with low cerebral blood flow on the ASL study.  I think that our Blogsite is the ideal place to share these cases with the rest of the Neuroradiology community.  Similar findings to the ones shown here were reported in the following article found in the publication preview section of www.ajnr.org:

Pollock J, Whitlow C, Tan H, et al. Pulsed Arterial Spin-Labeled MR Imaging Evaluation of Tuberous Sclerosis. AJNR Am J Neuroradiol. 10.3174/ajnr.A1428

]]> http://www.ajnrblog.org/2009/02/17/522/feed/ 0 Fetal MRI http://www.ajnrblog.org/2009/02/05/fetal-mri/ http://www.ajnrblog.org/2009/02/05/fetal-mri/#comments Thu, 05 Feb 2009 12:59:34 +0000 oglenn http://www.ajnrblog.org/?p=384 fig3b_narrows_6-17-copyI was wondering how many sites are doing fetal MRI, and who is interpreting the images (neuroradiologists, pedi neuroradiologists, other radiologists, perinatologists, pedi neurosurgeons). If you do fetal MRI at your site (academics or private practice), it would be great to hear from you. Thanks.… Continue reading >>

]]> fig3b_narrows_6-17-copyI was wondering how many sites are doing fetal MRI, and who is interpreting the images (neuroradiologists, pedi neuroradiologists, other radiologists, perinatologists, pedi neurosurgeons). If you do fetal MRI at your site (academics or private practice), it would be great to hear from you. Thanks.

]]> http://www.ajnrblog.org/2009/02/05/fetal-mri/feed/ 3 Regarding Pontine Tegmental Cap Dysplasia http://www.ajnrblog.org/2009/01/22/regarding-pontine-tegmental-cap-dysplasia/ http://www.ajnrblog.org/2009/01/22/regarding-pontine-tegmental-cap-dysplasia/#comments Thu, 22 Jan 2009 18:07:41 +0000 MCastillo http://transfer2.slothjockey.com/?p=107 There is a very nice article on this very uncommon malformation in AJNR 2009; 30: 113.  We have only seen it in patients being screened for congenital sensorineural hearing loss.  In these patients, its severity varies.  In the above mentioned article, 4 of 6 patients had cranial nerve VIII abnormalities.  I would be interested in learning from other neuroradiologists who are familar with the malformation what their experience has been.… Continue reading >>

]]> There is a very nice article on this very uncommon malformation in AJNR 2009; 30: 113.  We have only seen it in patients being screened for congenital sensorineural hearing loss.  In these patients, its severity varies.  In the above mentioned article, 4 of 6 patients had cranial nerve VIII abnormalities.  I would be interested in learning from other neuroradiologists who are familar with the malformation what their experience has been.

]]> http://www.ajnrblog.org/2009/01/22/regarding-pontine-tegmental-cap-dysplasia/feed/ 0