Pediatr Radiol (2007) 37 (Suppl 2):S153–S199 DOI 10.1007/s00247-007-0489-y

SUPPLEMENT

* Springer-Verlag 2007

Posters P1 Childhood pulmonary tuberculosis: value of the CT and HRCT findings Leticia González, Inmaculada Herráez, José Ignacio Quintana, Laura López, Marta Hidalgo, Juan Ignacio López Hospital De León Purpose: To describe findings and determine benefit of CT in childhood pulmonary tuberculosis. Material and Methods: Retrospective study of the CT findings in 12 patients, HIV negative, with the diagnosis of pulmonar tuberculosis (1 bacteriological and 11 clinicalradiological). In 5, HRCT were available. Medical records and chest radiographs were also reviewed. Results: CT findings: consolidation (6), in 5 patients with concomitant lymphadenopathy. Hiliar or mediastinal adenopathy in 9 of 12, 7 with periferical contrast enhancement and 1 was calcificied. 2 pleural effusions, 1 associated mediastinal effusion. HRCT findings: consolidation (3),atelectasis (2),endobronquial spread of infection (1). The additional information provided by CT altered the clinical management in 8 patients. Chest radiographs failed to reveal adenopathies in 7 of the 9 patients. Conclusion: Adenophaties are a radiologic hallmark of primary tuberculosis in childhood. CT permits to demostrate them better than chest radiographs and provides important information for the management of the disease.

P2 Pictorial essay of GI and GU manifestation of systemic disease in children Teresa Victoria, Mona A. Mahboubi, Soroosh Mahboubi Children’s Hospital of Philadelphia In this didactive exhibit we would like to present common pre- and postnatal GI and GU manifestations of systemic disease, including cystic renal disease of infancy and childhood, tuberous sclerosis, cystic fibrosis and neurofibromatosis. Typical radiographic pre- and postnatal MRI and US findings of cystic renal disease of infancy and childhood, in-

cluding autosomal dominant, and recessive polycystic renal disease, are demonstrated. The GU manifestations of tuberous sclerosis range from the more benign (renal cysts and angiomyolipoma) to the more ominous (renal cell carcinoma), as pictorially depicted. Cystic fibrosis has numerous radiographic findings in the GI system, including meconium ileus, DIOS, fibrosing colonopathy, intussusception, pancreatic cystosis, biliary abnormalities, and unusual appearances of the appendix. Children with neurofibromatosis I are prone to several tumors including neurofibromas, leiomyomas, ganglioneuromas and carcinoid. A rare GU manifestation of neurofibromatosis, renal artery stenosis, is also presented. The teaching point of the exhibit is to familiarize the viewer with common GI and GU manifestations of systemic disease.

P3 Neck lumps and bumps detected during the first year of life Inbal Cohen, Rosalind Dietrich, Mahmood Mafee, John Hesselink Ucsd Medical Center Purpose: Neck masses in children are not common in the first year of life. Mostly are benign and congenital in origin but acquired lesions are seen frequently. When detecting young infant with a neck mass, the initial consideration should be the patient’s age group. After age, the location of the neck mass is a very important consideration. This is especially true in the congenital neck masses where they usually occur in consistent locations. The aim of this presentation is to demonstrate imaging characteristics of various congenital and acquired masses organized by their cell of origin. Methods and Materials: Overall, 17 cases of congenital and acquired neck masses were found in children less than 1 year of age, between the period of January 2004 and September 2006 in UCSD medical center. Results: 17 cases were detected by US, CT and MRI, including fetal MRI. These masses were divided by cell of

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origin, including congenital, vascular, inflammatory, infectious, benign and malignant masses. Conclusions: Familiarity with mass origin, location and its characteristic features as well as the proper imaging tools and techniques can help us characterize a pediatric neck lesion more accurately and guide clinical management.

P4 Early complications of acute pyelonephritis in children. Ultrasound imaging findings Maria Chasiotou, Ioannis Deligiannis, Demetris Kaymenakis, Natalia Barbaliou, Eustathia Koskina, Aggeliki Lianou, George Polyzois Agia Sofia Children’s Hospital, Athens Purpose: To represent the ultrasound imaging features of early complications of the acute pyelonephritis in children, while their identification, usually modifies the therapeutic regimen, by drainage and nephrostomy. Method and Material: In a 2, 5 years of a retrograde study the ultrasound imaging features of 32 children (19 M, 13 F), age 2 days–13 years old with early complications of acute pyelonephritis were valued. The choice for the correct probe depends directly on the age and the body structure of the child. Results: 18 children with pyonephrosis (12 Left, 6 Right)3 cases of double calyceal system (involvement of the upper system). 4/18 ureteral hernia, 5/18 stenosis of the ureteral bladder junction10 cases of inflammation of the renal pelvis and ureter 4 cases of renal abscesses, 3 with renal location and 1 with peri-renal spread 3 children with focal nephritis Conclusion: Ultrasound is the initial investigation of choice for the examination of children with acute pyelonephritis. Ultrasound could diagnose either with combination of other imaging examinations or not, any underlying dysplasia which enchase the appearance of renal inflammation. Ultrasound controls the course of the disease and diagnoses any complications that could differentiate the treatment from conservative to surgical.

P5 Complications of Meckel’s diverticulum in children. Imaging findings Maria Chasiotou, Demetrios Kaymenakis, Kondylia Miliakou, Eustathia Koskina, Natalia Barbaliou, Ioannis Deligiannis Agia Sofia Children’s Hospital Meckel’s diverticulum is a remnant of the omphalomesenteric duct which protrudes from the mesenteric wall

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of ileum. It might be responsible for painless intestinal haemorrhage when it contains ectopic gastric mucosa. Purpose: To represent the imaging features (Abdominal US, Abdominal X-Ray, Barium enema) in children with picture of acute abdomen, due to complications of Meckel’s diverticulum. Method and Material: In a retrograde study were reported the imaging features (Abdominal US, Abdominal X-Ray, Barium enema) in 13 children (9 M, 4 F) of age 2,5–7 years old, which were admitted with symptoms of acute abdomen due to complication of Meckel’s diverticulum, as it was then surgically confirmed. Results: 6 cases of intussusception (non reduced by Barium Enema) 4 cases of acute obstruction 3 cases of diverticular abscess formation (2 cases of peritonitis and 1 case of perforation) Conclusion: In children with picture of acute abdomen, differential diagnosis should include complications of Meckel’s diverticulum when all common causes of acute abdomen in children are excluded.

P6 Ultrasound imaging findings in children with parotid enlargement Maria Chasiotou, Natalia Barbaliou, Ioannis Deligiannis, George Polyzois, Aggeliki Lianou, Eustathia Koskina, Kondylia Miliakou Agia Sofia Children’s Hospital, Athens Purpose: The importance of ultrasound examination in children, with unilateral or bilateral enlargement of the parotid glad. Method and Material: In a 3 years retrograde study, 68 ultrasounds were valued. In 43 children (23F and 20M) of age 1 month–14 years old, pathological findings in the parotid gland were diagnosed by ultrasound. The ultrasound control included bilateral examination of the parotids even when the lesion was unilateral. The examination was performed with linear probe of 5– 12 MHz Results: 16 cases of bilateral involvement Unilateral 27 16 cases of mass diagnosis (3 adenomas, 5 haemangiomas, 5 lymhangiomas, 1 recurrence of leukaemia and 2 rabdomyosarcomas) 12 children with inflammation (4 with abscess formation where drainage performed) 7 children with immunosuppression (2 HIV, 2 SLE, 1ALL, 1 Sjogren’s syndrome, 1 bone marrow transplantation) 8 children with granulomas (4 cases of cat scratch disease) Conclusion: Ultrasound is the initial investigation of choice for parotid gland enlargement.

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Ultrasound values the structure, the dimensions and the blood perfusion. Ultrasound supports the final diagnosis of a mass or inflammation of the parotid, illustrates collections that need drainage and controls the course of the inflammation and autoimmune diseases that involve parotid gland.

P7 Cystic neuroblastoma in a newborn: A case report and literature review Ahmet Sýðýrcý, Sema Uðuralp, Neþe Karadað Ýnönü Üniversitesi Turgut Özal Týp Merkezi Department of Pathology An abdominal cystic mass with a 2.5×1.8 cm diameter was diagnosed in a 28 week- gestation female fetus using antenatal ultrasonography (US). Postnatal US confirmed a cystic mass in the right adrenal region. The abdominal computed tomography revealed a hypo dense, thick walled cyst which pushed the right kidney to the lower side. Intraoperatively, the mass appeared to be within the right adrenal gland, and a right adrenalectomy was performed. Histology confirmed a poorly differentiated neuroblastoma. Cystic neuroblastoma (CNB) should be considered in the differential diagnosis of suprarenal cystic masses. It can be suggested that any cystic adrenal mass with characteristic US signs (thick wall) in a neonate must be removed even though the mass size is not increased.

P8 Morphologic MR-urography using HASTE secuences in pediatric urologic congenital malformations Xavier Salvador1, Sònia Aixut1, Juan Carlos Pernas1, Enric Montserrat1, Gloria Fraga2, JM Garat3, O. Angerri3 1- Servei de Radiodiagnóstic, Hospital De La Santa Creu I Sant Pau. 2- Servei de Pediatria, Hospital De La Santa Creu I Sant Pau. 3- Servei de Urologia Pediátrica, Fundació Puigvert Aim: The aim of this poster is to show our experience of the usefulness of MR-urography using HASTE T2 weighted secuences (2D & 3D) without sedation nor performing dynamic series, on the evaluation of congenital malformations of the urinary system. Material and Methods: We collected 10 cases with ages that ranges from 2 days to 2 years old, of different congenital urologic pathologies such as ureteral duplicities with ureterocele, primary megaureter, ureteropelvic union stenosis, ureteral valves among others. Conventional explorations such as ultrasonography (US), voiding cystourethrography (VCUG), and intravenous urography

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(IVU) were performed following stablished protocol, afterwards MR-urography was performed. Conclusion: MR-urography using HASTE sequences clarifies the definitive diagnostic and completes the findings of the other conventional explorations. MRurography has certain advantages because does not use ionizing radiation, is fast and cheap, allows a morphologic evaluation of dilated and non-fuctioning urinary structures, does not need endovenous contrast and in our experience there is no need of sedation. We believe that MRurography with HASTE secuences can play a role, at least as a complementing imaging modality, in the diagnostic algorithm of the urinary tract malformations, mostabout in the setting of non-functioning and dilated urinary structures.

P9 Magnetic resonance imaging (MRI) findings of the brain of paediatric patients presenting with epilepsy or recurrent seizures at our hospital: Hospital Tengku Ampuan Afzan (HTAA), Kuantan, Pahang, Malaysia Azian Abd. Aziz, Azlin Saat, Ahmad Razali Md. Ralib, Mohd. Amran Abdul Rashid International Islamic University Malaysia Objectives: To see if there is any distinctive brain abnormalities detected on MRI in paediatric patients presenting to our hospital with epilepsy or seizures due to known or unknown insults. Methodology: MRI findings of paediatric cases from newborn to 18 years of age presenting with seizures or diagnosed as epilepsy that underwent MRI brain at our hospital from 1st July 2005 to 31st July 2006 were retrospectively reviewed and tabulated. All the images were separately reviewed by 2 Consultant Radiologists. Results: A total of 58 patients had MRI brain done for the investigation of epilepsy or seizures. Abnormal MRI was detected in 28 patients comprising of 11 boys and 17 girls while in the remaining 30 patients no abnormality was evident. Among the abnormalities visualized include hypoxic-ischemic related injury, cerebral infarction, cerebral atrophy, tumours, Tuberous Sclerosis, benign enlargement of CSF spaces, arachnoid cyst, agenesis of corpus callosum and a vascular malformation. Conclusion: No distinctive brain abnormalities were observed in our paediatric patients presenting with seizures or epilepsy. Abnormal structure observed on MRI is not necessarily the cause of the seizures. Patients with recurrent seizures on the other hand will not necessarily have abnormality detected on their MRI brain.

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disease and to compare MR findings with those of ileocolonoscopy with biopsy. Materials and Methods: 30 consecutive patients (age: range 6–14 years) with symptoms of inflammatory bowel disease or small-bowel obstruction underwent ileocolonoscopy with biopsy and MRI at 1.5 T with contrast medium administration, after drink 1000 ml of mannitolo as oral contrast agent without enteroclysis. MRI was evaluated with an overall score calculated, taking into account both wall thickness and contrast enhancement. Results: In 21 patients MRI of the distal ileum was markedly abnormal revealing both an increase in wall thickness and parietal contrast enhancement, and showed in 18 cases a high concordance with endoscopy and histology. In 9 patients MRI did not reveal involvement of the small bowel proximal to the terminal ileum. Conclusion: In conclusion MR without enteroclysis provides adequate image quality and sufficient distention of the entire small bowel. It can detect extraluminal pathologic conditions and provide detailed information about the wall of the small bowel and the entire abdomen.

Upper airway disease in children: comparison of three-dimensional virtual endoscopy of multidetector computed tomography with bronchoscopy Cecilia Lanza1, Vittoria Galeazzi1, Miriam Pasqualini1, Stefano Avenali2, Giancarlo Fabrizzi1 1- Azienda Ospedaliero-Universitaria Ospedali RiunitiPresidio Salesi-Pediatric Radiology Department, 2- Azienda Ospedaliero-Universitaria Ospedali Riuniti-Presidio SalesiPediatric Intensive Care Unit Introduction: The radiographic diagnosis of upper airway lesions is often imprecise. Endoscopy, which allows detailed examination of the upper airway, is an invasive procedure requiring sedation or anesthesia. This prospective study was undertaken to show the value of 16-slides CT scanning with three-dimensional virtual endoscopy in diagnosing airway lesions in children using endoscopy as the reference method. Material and Methods: Twenty consecutive pediatric patients, aged 10 days to 3 months old, with clinical evidence of airway disease, received a 16 slides-CT scan of the lung and neck with three-dimensional virtual endoscopy and flexible fiberoptic endoscopy. Results: Endoscopy identified 13 abnormalities, 11 of which were identified by CT. Four patients had focal tracheal stenoses, three had tracheomalacia or laryngomalacia, two had a laryngoesophageal cleft and four had focal stenosis in the subglottic area due to endotracheal tube. Conclusions: For the greatest diagnostic accuracy in evaluation of the pediatric airway, CT with three-dimensional virtual endoscopy should be used. It is rapid, non invasive, and requires no sedation in most children. Although additional work is needed to clarify the role of CT in pediatric patiens with airway diseases.

P12 The ultrasound features of musculoskeletal infection in children: a pictorial review Harvey EL Teo KK Women’s And Children’s Hospital This pictorial essay will illustrate the imaging features of the wide spectrum of musculoskeletal (cellulitis, abscess, pyomyositis, septic arthritis, osteomyelitis) infection in children with an emphasis on ultrasound. It will also highlight the role that ultrasound can play in the management of these patients as well as recommend an imaging algorithm in the management of these patients incorporating all imaging modalities

P11 Gadolinium enhanced MRI performed using a mannitolo solution as oral contrast agent in revealing inflammation of the distal ileum in children with Crohn’s disease: our experience Cecilia Lanza, Giovanni Pieroni, Vittoria Galeazzi, Miriam Pasqualini, Leonardo Costarelli, Giancarlo Fabrizzi Azienda Ospedaliero-Universitaria Ospedali Riuniti-Presidio Salesi-Pediatric Radiology Department Aim: To evualated the diagnostic value of gadolinium enhanced MRI performed using a mannitolo solution as oral contrast agent to distend the small bowel in revealing inflammation of the distal ileum in children with Crohn’s

P13 Stress injuries in the adolescent athlete: a review of magnetic resonance imaging features Peter Young1,2, Zenooz Navid1,2, Weiss-Kelley Amanda1,2 1- Case Universtiy Hospitals Health System 2- University Hospitals of Cleveland Stress injuries are a common cause of musculoskeletal pain in the adolescent athlete. Appropriate and prompt diagnosis is critical in establishing appropriate treatment. Routine radiographic examination in the great majority of these cases is normal, with findings only evident on MRI.

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We will review the pathophysiology of stress injury in young athletes, correlating locations of stress fractures with association with various athletic activities. The poster will also review classification systems for the grading of stress injuries to bone which can be used as a predictor of time to return to athletic activity. While the majority of the stress related injury to bone in the athlete occurs in the foot and the tibia, the skeletal structures upper extremity also are prone to stress fracture with certain activities. The pelvis, thorax, and spinal structures may also be affected. Learning Objectives: By viewing this poster the radiologist will familiarize himself with the MRI appearance and anatomic locations of stress fractures in adolescent athletes. He/she will also understand the grading of these injuries so as to aid the clinician in formulating a prognosis and treatment plan.

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pulmonary venous return underwent MDCT and subsequent three-dimensional (3D) reconstruction. Six cases underwent conventional angiography and 4 received operations. Results: There were five children with supracardiac type, one cardiac type and one mixed type. MDCT with 3D reconstruction and conventional angiography correctly depicted the type and location of anomalous pulmonary venous return except one. The return of right inferior pulmonary vein to right atrium (RA) was misdiagnosed as connected to inferior vena cava (IVC)-RA junction. Conclusion: The post-processing images from 3D workstation having commercially available software in children showed excellent correlation with conventional angiography and operative finding. This technique is easily performed after adequate sedation. MDCT is useful in diagnosis and follow-up of known or suspected vascular abnormalities. The results are helpful in planning invasive treatment procedures.

P14 Pulmonary artery abnormalities in children - a pictorial essay Sanjay Maroo Royal Hospital For Sick Children Learning Objectives: 1. Familiarisation with various types of congenital pulmonary artery abnormalities in children with congenital heart disease. 2. Demonstration of key MR and CT features of such abnormalities. Abstract: Recognition of pulmonary artery abnormalities is important because these may be associated with specific clinical symptoms and may be previously undiagnosed. Knowledge of such may influence the approaches to future vascular or surgical intervention for congenital heart disease.

P15 Anomalous pulmonary venous return - role of multidetector CT in children Hung-Chieh Chen, Chui-Mei Tiu, Chen Fen Chiu, Ai Hua Chung, Jen Dar Chen, Chun Yu, Cheng-Yen Chang Taipei Veterans General Hospital, Radiology Department Purpose: Multi-detector computed tomography (MDCT) with volume rendering (VR) is a noninvasive method with well-known uses in adults for evaluation of pulmonary venous anatomy. We present a pictorial review on the use of MDCT in the evaluation of children who had anomalous pulmonary venous return and correlate with conventional angiography as well as operative finding. Material and Methods: From 2004 January to 2006 December, 7 children (2 d/o–17 y/o) who had anomalous

P16 Factors influencing effective dose during paediatric modified barium swallow studies Kelly Weir1,2, Sandra McMahon3, Gillian Long4, Judith Bunch4, Nirmala Pandeya5, Kerry Coakley6, Anne Chang7 1- Discipline of Paediatrics and Child Health, University of Queensland. 2- Speech Pathology Dept, Royal Childrens’ Hospital, Brisbane. 3- SpeechNet Speech Pathology Services, Brisbane. 4- Medical Imaging Dept., Royal Childrens’ Hospital, Brisbane. 5- Queensland Institute of Medical Research, Brisbane. 6- Biomedical Technology Service, Royal Brisbane and Women’s Hospital, Brisbane. 7- Respiratory Medicine Dept., Royal Childrens’ Hospital, Brisbane Purpose: To document screening times and radiation dose to children undergoing modified barium swallow (MBS) studies and to determine factors influencing effective dose. Materials and Methods: Prospective data including screening times, dose area product (DAP) and effective doses were recorded for 90 consecutive children undergoing MBS studies. This data was analysed for effects of behaviour, total number of food and fluid presentations, presence of swallowing dysfunction and underlying medical problems. Results: Overall mean values were: effective dose 0.0826 ¡À 0.0544 mSv, screening time 2.48 ¡À 0.81 mins and DAP 28.79 ¡À 41.72 cGy-cm2. Significant differences were found across 3 age groups (¡Ü1.0, >1.0–3.0, >3.0 years) for effective dose (mean 0.1188, 0.0651 and 0.0529 mSv respectively; p<0.001), but not for screening time or DAP. Effective dose was correlated with screening time (p=0.007), DAP (p<0.001), total number of swallow presentations (p=0.007), lower age (p=0.017), female gender (p=0.004) and height

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(p<0.001). Screening time wa correlated with total number of swallow presentations (p<0.001) and DAP (p<0.001). Conclusion: Screening times, DAP and effective dose for children undergoing MBS studies are presented. Child and procedural factors associated with higher effective dose are identified.

P17 Introducing a new classification system for congenital scoliosis and segmentation disorders of the spine Amaka Offiah1, Ben Alman2, Alberto Cornier3, Philip Giampietro4, Oliver Tassy5, Peter Turnpenny6 1- Great Ormond Street Hospital For Children, London, UK. 2- University of Toronto, Toronto, Canada. 3- San Juan Bautista University, Puerto Rico. 4- Marshfield Clinic, Wisconsin, USA. 5- Stowers Institute, Kansas City, USA. 6- Royal Devon & Exeter Hospital, Exeter, UK Background & Aim: Currently much confusion exists surrounding the nomenclature of congenital scoliosis and segmentation disorders of the spine, (e.g. the eponymous “Jarcho-Levin dysplasia” is often incorrectly ascribed; the term “spondylocostal dysplasia” is applied when “spondlylothoracic dysostosis” is meant etc). This confusion has been recognised by the International Consortium for Vertebral Anomalies and Scoliosis (ICVAS)leading to the development of a new classification system. Materials & Methods: In May 2006, the ICVAS classification system was developed by practitioners in radiology, orthopaedic surgery and clinical genetics during the course of a 3-day round table meeting. Result: A simple classification system was devised. The system is governed by a few basic “rules” which the poster will introduce. Vertebral segmentation defects (VSD) have been subdivided into single, multiple and generalised vertebral segmentation defects (SVSD, MVSD, GVSD). Examples are illustrated. Conclusion: Delegates will be introduced to a classification system that will be clinically useful to radiologists, spine surgeons and clinical geneticists. Ultimately there will be an internationally recognised nomenclature, optimising clinical and molecular (genetic) diagnosis of these disorders.

P18 CT brain scans in suspected non-accidental injury - a national survey Kshitij Mankad, LeeAnne Elliott Bradford Royal Infirmary, UK

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Purpose: National survey on whether paediatric radiologists feel that CT Brain scans should be routinely included in the survey of all suspected cases of non-accidental injury (NAI). Methods: First round Delphi questionnaires were sent to consultant paediatric radiologists in 12 children’s and 80 teaching/general hospitals. The stem questions were: (1) Years of experience in imaging for NAI (2)Should CT Brain be done routinely for every case? (3)In your current practice do you perform a CT in all suspected cases? Results: 66 responses received from 52 hospitals (hospital response rate 57.8%). 48.5% of responders had over 10 years of experience. 43.9% agreed with question2. 68.2% responded in the negative to question3. 45% of those disagreeing with question2 stated radiation risk as their reason, 25.8% stated that the decision should be based on clinical suspicion. The main reason stated by those agreeing with question2 was exclusion of occult injury. Of the responders from specialist hospitals, 62.1% agreed with question2. Conclusions: Early results suggest that opinion is divided. This data and reflected suggestions will be used to plan future studies aiming to achieve a national consensus on the use of CT Brain in suspected cases of NAI.

P19 Succinic semialdehyde dehdrogenase deficiency: MR spectroscopy and diffusion weighted imaging findings Murat Kocaoglu1, Nail Bulakbasi1, Hatice Tuba Sanal1, Sabahattin Vurucu2, Cem Tayfun1, Ibrahim Somuncu1 1- Gulhane Military Medical School, Department of Radiology. 2- Gulhane Military Medical School, Pediatric Neurology Background and Purpose: Succinic semialdehyde dehydrogenase (SSADH) deficiency or 4-hydroxybutyric aciduria (GHB) is a rare autosomal recessive disorder affecting the catabolism of the neurotransmitter ã-aminobutyric acid (GABA). The purpose of this presentation is to study the spectral profile and diffusion weighted imaging (DWI) features of the SSADH deficiency. Materials and Methods: A retrospective review of the magnetic resonance (MR) imaging studies of all patients with the diagnosis of SSADH deficiency imaged in our institution was performed. Patients were examined by 1,5 Tesla superconducting MR scanner. Multi-voxel spectroscopy using double SE point resolved spectroscopy sequence (TE:35 ms) was obtained at the level of the globus pallida. Peak integral values were normalized to the internal Cr peak. DWI was obtained by using axial echo-planar SE sequence. Results: There were two males and one female between 3 to 10 years of age. Both cases had symmetrically increased globus pallida signal intensity on T2 weighted images. The patients

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had higher glutamate-glutamine complex/Cr ratio and had higher ADC values in globus pallidus than those of controls. Conclusion: MR spectroscopy and DWI may be useful for noninvasive diagnosis and monitoring of SSADH deficiency and validating new therapeutic approaches.

P20 Pictorial review of interruption of the aortic arch with an emphasis on multislice CT angiography Dong Hyun Yang1, Hyun Woo Goo1, In-Sook Park2, Jae Kon Ko2, Young Hwee Kim2, Dong-Man Seo3, Tae-Jin Yun3, Jeong-Jun Park3 1- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine. 2- Department of Pediatric Cardiology, Asan Medical Center, University of Ulsan College of Medicine. 3- Department of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine Purpose: We illustrate imaging features of interruption of the aortic arch (IAA) in preoperative and postoperative periods with an emphasis on multislice CT angiography. Materials and Methods: We reviewed 28 cardiac CT examinations in 19 patients with IAA for five years. Echocardiography was performed in all patients, cardiac MRI in three patients, and cardiac catheterization in six patients. Results: We described preoperative CT features of IAA regarding the aortic arch, subaortic obstruction, ventricular septal defect, patent ductus arteriosus, other combined cardiovascular anomalies. Postoperative complications such as aortic restenosis, subaortic obstruction, and bronchial compression were demonstrated on cardiac CT. Recent trends of surgical techniques used for IAA repair were also described. We emphasized the current role of multislice cardiac CT in the evaluation of patients with IAA. Conclusion: Cardiac CT using multislice scanner appears quite suitable for an urgent complementary diagnostic imaging method in unstable patients with IAA and for the evaluation of postoperative complications.

P21 Mesoblastic nephroma (MN), review Lourdes Parra-Ruiz1, Maria I. Martinez-Leon1, Bernardo Weill-Lara2, Beatriz Asenjo-García3, Cristina Bravo-Bravo1, Pascual Garcia-Herrera Taillefer1, Luisa Ceres-Ruiz1, Ignacio Alonso-Garcia1 1- Pediatric Radiology. Hospital Materno-Infantil Carlos Haya. Malaga. Spain. 2- Pathology. Hospital MaternoInfantil Carlos Haya. Malaga. Spain. 3- Radiology. Hospital Materno-Infantil Carlos Haya. Malaga. Spain

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Background: Uncommon benign neoplasm but the most common solid renal tumor in neonate, 90% discovered first year of life. Material & Methods: Six pathologically proved MN diagnosed in newborns were retrospectively reviewed in a period of 29 years. Results: Technique used for diagnosis was US (83%), US + CT (67%) and XR (16%), half of the cases intrautero. All cases were large solid intrarenal heterogeneous mass, 83% multiloculated, 16% involving renal sinus, 33% with local infiltration of perinephric tissues, 33% across midline, 100% without nephroblastomatosis foci neither calcifications or renal vein invasion. Complications such as HTA, sepsis, peritonitis, hemoperitoneum, hematuria or mesenteric artery thrombosis, were found in 66% cases. 100% of cases underwent surgery and 33% chemotherapy (because of intraoperatory tumor rupture). Biopsy demonstrate 67% celular type and 33% combined leiomyomatous and cellular component, 67% stage IIa and 33% stage III. 100% follow up by US during first 5 years, survival rate 83′3%. Conclusion: MN is rare but must be the primary diagnosis in neonate with palpable solid renal mass. Imaging findings do not allow differentiate MN from Wilms tumor. However, MN exhibits benign behaviour, being nephrectomy the treatment.

P22 Intracranial venous anatomy on cerebral magnetic resonance venography in the pediatric population Ali Hekmatnia, Ehsan Yousefian, Kia Nouri-Mahdavi, Mojgan Hamedi, Reza Basiratnia, Maryam Ghadamgahi Isfahan University of Medical Sciences Purpose: Little information is available about age- and sex-related variations in intracranial veins and venous sinuses in children as seen on magnetic resonance venography (MRV). We studied the normal intracranial venous anatomy in different age and sex groups in children by MRV. Materials and Methods: Eighty-four children with normal brain magnetic resonance imaging (MRI) were studied with MRV. Children with a history of brain tumor, vasculitis, and anticoagulant therapy were excluded. Results: There were 39 (46%) female and 45 (54%) male children. The mean patient age was 7+5.5 years. The transverse sinus was visualized bilaterally, only on the left side, only on the right side, and on neither side in 48 (57.1%), 9 (10.7%), 26 (31%), and 1 (1.2%) children, respectively. The occipital sinuses were visualized in 44% (35.7% bilaterally and 8.3% unilaterally). The sigmoid sinuses were visualized in 41.7%.

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Galen’s vein was visualized in 85.7%. Rosenthal’s vein was visualized in 82.1%. The superior sagittal sinus was visualized in all patients. There was a statistically significant difference in intracranial venous anatomy between children younger than 5 years and those older than 5. Conclusion: MRV is a valuable imaging modality in the assessment of intracranial venous anatomy and its agerelated variations.

P23 The dentate nucleus in health and disease Aoife Mc Erlean, Khaled Abdalla, Veronica Donoghue, Stephanie Ryan Department of Radiology, Children’s University Hospital, Temple Street, Dublin, Ireland Purpose/Learning Objectives: The purpose of this exhibit is 1: to demonstrate the normal anatomy and imaging features of the dentate nuclei and to illustrate the changes that are seen with myelination 2: to describe the imaging characteristics of paediatric diseases which involve the dentate nucleus 3: to develop a systematic approach to the differential diagnosis of dentate nucleus abnormalities on Magnetic Resonance (MR) imaging Materials and Methods/Results: The dentate nuclei lie deep within the cerebellum in the roof of the fourth ventricle and they play a vital role in the pathways involved in fine motor control and coordination. They are susceptible to a variety of disease processes including encephalitis, histiocytosis X, metabolic and genetic disorders. Some of these pathological processes preferentially affect the dentate nuclei, while concomitant basal ganglia or white matter involvement can be a striking finding in others. Conclusion: A familiarity with the normal appearance of the dentate nuclei at different ages in combination with the radiological distribution of pathology in the brain allows a logical approach to MR abnormalities identified in these deep cerebellar nuclei.

P24 Multidetector CT evaluation of the hepatic changes in children and adolescents with insulin-dependent diabetes mellitus Shin-Lin Shih, Yu-Peng Liu, Yi-Shan Tsai, Yi-Fang Chen, Fei-Shih Yang Department of Radiology, Mackay Memorial Hospital

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Purpose: To assess the changes of hepatic volume and density in children and adolescents with insulin-dependent diabetes mellitus by multidetector CT (MDCT). Material and Methods: The institutional review board approved the study. Written informed consent was obtained from the patients or their parents. The MDCT examination was prospectively performed on 40 diabetic patients (19 males, 21 females) aged 8 to 26 years with a 16-detector CT scanner (Sensation 16, Siemens Medical System, Erlangen, Germany). The selection of tube voltage and current followed the ¡§as low as reasonably achievable¡¨ principle. The section thickness was 1 mm, with beam pitch 1, and reconstruction interval of 0.7 mm. The control group consisted of age-matched patients (13 males, 20 females) who underwent CT for abdominal conditions, excluding those with active hepatic infection, tumor or history of prior hepatic surgery. The hepatic volume and density were measured in these two groups. Results: There was no significant difference in the ratio of hepatic volume to either body surface area or body mass index between two groups. However, increased hepatic density in the diabetic group Conclusions: The hepatic density was higher in the patients with diabetes mellitus than that in the control group.

P25 Bronchopulmonary sequestration in fetuses evaluated by magnetic resonance imaging Yu-Peng Liu, Shin-Lin Shih, Yi-Fang Chen, Fei-Shih Yang Department of Radiology, Mackay Memorial Hospital Purpose: To assess the feeding artery, venous return, and volume change of fetal bronchopulmonary sequestration (BPS) by MRI. Material and Methods: MRI was performed twice at interval of ten weeks in six fetuses with suspected lung disease after prenatal examination. The institutional review board approved the study, for which the written consent was given by the mothers. We used a 1.5-Tesla MR scanner (Twinspeed, GE Medical Systems, Milwaukee, WI) with a torso phased-array coil. The images were obtained with SSFSE sequence. We tried to identify the feeding artery and venous return of BPS, and the volume change was evaluated by planimetric measurement. Results: Initial MR images demonstrated the abnormal feeding artery from aorta in all six fetuses and the venous drainage into pulmonary veins in three. Follow-up MR images ten weeks later showed partial regression of the sequestered lung in four fetuses, complete regression in one, and non-regression with a relatively decreased ratio to lung volume in one.

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Conclusion: Fetal MRI could clearly demonstrate the abnormal feeding artery from aorta into the sequested lung in order to differentiate BPS from congenital cystic adenomatoid malformation. Volume change of the sequestered lung in utero may be observed in serial examinations.

P26 The treatment of osteoid osteoma with radiofrequency thermal ablation in pediatric age Fabrizzi Giancarlo, Alborino Salvatore, Antico Ettore, Candelari Roberto, Paci Enrico, Ulisse Serena Azienda Ospedaliero-Universitaria Ancona, Dipartimento di Scienze Radiologiche, SOD Radiologia Generale e Pediatrica Introduction: Osteoid osteoma accounts for about 12% of benign bone tumors. It occurs during the second-third decade of life with prevalence among males and localization in the femur, tibia, limbs and rachis. Surgical excision is the preferred treatment, but it has several limits (localization, extensive bone demolition, hospital stay, elevated costs). Alternative minimally invasive treatments such as laser or radiofrequency (RF) ablation have recently been proposed. Aim: We report our experience in the treatment of extrarachial osteoid osteoma with RF ablation. Materials and Methods: Since July 2002 we have treated four teenagers (aged 12–15), 3 males and 1 female, with tibial and femoral localizations. Results. Procedures performed under peripheral anaesthesia, remission of painful symptoms in all patients, no complications. Discussion and Conclusions: Percutaneous treatment is a safe and efficient technique and is the preferred treatment for osteoid osteomas. In literature, complications are minor, clinical results and failure percentages are comparable to surgery, however, pain remission is faster and it is possible to return to a normal life immediately.

P27 Ischio-pubic-patellar syndrome Helga Schmidt, Rainer König, Stefan Zielen Johann-Wolfgang-Goethe-Universität, Frankfurt/Main The ischio-pubic-patellar syndrome is a relatively rare, autosomal dominant skeletal dysplasia. It is important to differentiate this condition from the potentially more serious nail-patella syndrome. We describe a 13-year-old schoolgirl of African descent with normal mental development, short stature, large head, facial dysmorphism, cleft palate and congenital deafness.

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Physical examination revealed terminal malformations of the halluces and thumbs. She suffered from a chronic hepatitis-B and frequent respiratory infections. Radiographic skeletal surveys performed since birth demonstrated macrocephaly, pituitary fossa calcification, vertebral dysplasia, as well as hand and feet malformations. Additional features were bilateral hypoplasia of the patella in association with bilateral ischio-pubic dysplasia and ileal hypoplasia with an ischio-pubic defect. The most common combination of patellar hypoplasia and nail deformities is characteristic of nail-patella syndrome; however, this condition is associated with iliac horns and renal disease. Other differential diagnoses are the autosomal recessive RAPADILINO syndrome, congenital anomaly of the patella, or a small or absent patella. A mutation in the human TBX4 gene (small patella syndrome; OMIM #147891) has not yet been excluded. The cardinal clinical and radiological findings in this child are short stature, facial dysmorphism, hand, pedal and vertebral malformations, hypoplasia of patella and ischio-pubic defect.

P28 Cardio-broncho-vascular anomalies in paediatrics - value of 64 slice CT-angiography (64CTA) Jeevesh Kapur1, David Stringer2, Gu Qing Long2 1- National University Hospital, Singapore. 2- KK Women’s and Children Hospital, Singapore Purpose: Evaluate role of 64CTA in the investigation of cardio-broncho-vascular anomalies (CBVA) in paediatrics. Materials and Methods: Following abnormal echocardiogram, 64CTA, (0.5 mm thick, Omnipaque 3 mls/kg with reconstruction) was performed. Results: 17 patients had 38 CBVA [1 Tetralogy of Fallot, 1 hypoplastic right heart, 4 VSD, 5 left PA sling, 1 absent right PA, 3 narrowed PA, 1 mesocardia, 1 ASD, 3 PDA, 1 PA hypertension, 1 aberrant right subclavian artery, 1 right aortic arch, 1 innominate artery compression, 1 double SVC, 1 Marfan dilated aorta, 1 coarctation, 1 left SVC, 1 double SVC) with associated tracheomalacia (2), bronchopulmonary sequestration (1), lung aplasia (1), tracheobronchial anomaly (5)]. All anomalies were detected with no complications. The clarity and accuracy of the vascular and tracheal structures delineated gave confidence to the clinicians to treat on 64CTA alone. 12 patients underwent surgery. In 10, 64CTA obviated the need for pre-operative angiography (CA). In 5 patients, only 64CTA was performed and no surgery was performed. Conclusion: Less invasive, lower cost 64CTA replaces the need for CA in the majority of CBVA.

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cyst, enlarged kidneys, dilated tubules, preserved cortical rim. 7 patients with autosomal dominant polycystic kidney disease, showed different sized and located cysts, normal or enlarged kidneys. 1 patient with nephronoptisis had cortical hyperechogenicity and small kidneys; 2 children with medullary sponge kidney showed cortico-medullary small cysts with nephrocalcinosis. One case with glomerulocystic disease showed small cysts, hyperechoic cortex. 2 children with tuberous sclerosis had variable sized cortical cysts, hyperechoic foci, angiomyolipoma. 17 patients affected of multicystic dysplasic kidney showed unilateral cyst clusters with lack of parenchyma. In 13 children we found isolated cysts. Conclusion: Growing use of HRUS allows early detection of underlying cystic disease. The US findings, combined with clinical history, lead to a finest classification and follow-up.

Imaging of fetal coronary arteries and pulmonary veins with gray and color flow Doppler sonography Eun-Kyung Ji, Tae Hee Kwon CHA Geneneral Hospital, Pochon CHA University Purpose: To demonstrate normal fetal coronary arteries and pulmonary veins on gray and color Doppler sonography. Material and Methods: Between 20 and 28 gestational weeks well-selected fetuses are included. Using curved 9-4 probe, axial, coronal, short axis view and oblique axial views are obtained to see all coronary arteries and pulmonary veins. Results: On axial scans, we could evaluate four chambers, great vessels, and all pulmonary veins. After visualized aortic valves, right and left coronary arteries ostia are seen on short axis view with slight tilting. Mid portion of right coronary artery could be traced along right atrioventricular groove on slightly tilted short axis view. Left anterior descending coronary artery is seen along upper surface of interventricular septum on oblique axial view. On coronal scan, pulmonary veins and their confluence could be demonstrated on color Doppler image. Conclusion: Detailed fetal cardiac anatomy including coronary arteries and all pulmonary veins could be obtained in second trimester with combination of gray and color Doppler sonography.

P30 HRUS findings in children with benign renal cystic disease Lara Berrocal Morales, M. Victòria Garriga Farriol, Anna Marín Aznar, Santiago Medrano Martorell, Deysi García Figueredo, Núria Rosón Gradaille, Sònia Carbó Cerdán, Xavier Pruna Comella, Miguel Cuadrado Blázquez, Rosa Pineda Herrero Fundació Hospital Asil de Granollers Purpose: Renal cystic disease encloses an heterogeneus group of pathologies. Ultrasound (US) is the primary imaging modality in the renal cystic disease study. Our aim is to describe the high-resolution ultrasonographic (HRUS) findings useful for their diagnosis. Materials and Methods: 42 US with benign renal cystic disease diagnosis were performed in children (19 girls and 23 boys), from 1997 to 2007. High multifrequency linear array transducer was used. Results: 2 patients with autosomal recessive polycystic kidney disease showed cortico-medullary macro or micro-

P31 Serial C-reactive protein and sonography contribution in the management of necrotizing enterocolitis (NEC) M. Victòria Garriga Farriol, Santiago Medrano Martorell, Amalia Zuasnábar, Anna Marín Aznar, Lara Berrocal Morales, Núria Rosón Gradaille, Deysi García Figueredo, Xavier Pruna Comella, Sònia Carbó Cerdán, Carme Blancas Hinarejos. Fundació Hospital Asil De Granollers Purpose: To assess serial C-Reactive protein (CRP), BMode and color Doppler sonography in diagnosis, staging and management of NEC. Material and Methods: 8 neonates (case 1–8) were diagnosed of NEC (October 2005–January 2006) using clinical signs, blood chemistry, cultures and abdominal plain film (8/8) Staging following modified Bell’s criteria was: IA (C6-7-8), IB (C5), IIA (C4), IIIA (C2-3), IIIB (C1). US and color-Doppler were conducted with linear-array transducer (7–10 MHz). Serial CRP (peak level 48 h until normalization) (8/8) were recorded. Results: Stage I: CRP <1 mg/dl. RX: Intestinal dilatation. US: normal findings. Stage II: CRP 7.7–22.2 mg/dl. RX: fixed and dilated bowel. US: free abdominal fluid. Stage III: CRP 0.9–16.6 mg/dl. RX: pneumatosis (C1), portal gas (C2). US: pneumatosis, portal gas, ascites (C1– C2–3). Thickening of bowel wall and increased color Doppler of bowel wall in two cases (C2–3).

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Outcome: stages II and I were promptly delivered. C1 dead in the first 24 hours. C2 was transferred for intestinal resection. C3 was transferred for peritoneal drainage. Conclusion: CRP becomes abnormal in stage II and III. Sonography and color-Doppler enables a better staging. Persistent elevated CRP after medical management with abnormal US findings may indicate surgical intervention.

P32 Pediatric foreign bodies Fatima Pires, Luisa Lobo, Jose Fonseca-Santos Hospital De Santa Maria Learning Objectives: To describe imaging features of pediatric foreign bodies (FB)- tracheobronchial and esophageal. To emphasise the role of imaging evaluation in diagnostic and follow up orientation. Background: Ingestion and aspiration of FB remains a common pediatric problem and may constitute a life hazard. Medical history is the key to diagnosis, although often delayed or overlooked. Precise diagnosis is essential to adequate treatment. We describe imaging features of pediatric FB aspiration and ingestion, among selected cases studied in our department. Imaging Findings: An overview of imaging findings of tracheobronchial and esophageal FB is presented. Chest X-ray plays a major role. Further evaluation can be accomplished with Chest Computed Tomography (CCT) that may be useful in showing the exact location of a foreign body and possible complications. Bronchoscopy, or esophageal endoscopy, are essential for diagnosis and treatment. Conclusion: Foreign body aspiration and ingestion are important pediatric issues. Medical history is the key for the diagnosis. The main problem remains the lack of history of aspiration/ingestion. Imaging evaluation can be extremely helpful for the diagnosis in suspected and non-suspected cases. High index of suspicion is essential to prevent delayed diagnosis and serious complications.

P33 Adrenoleukodystrophy Shruti Moholkar, Fiona Dickinson, Andrew Rickett, Mark Horsefield University Hospitals of Leicester, Leicester, UK

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Learning Objectives: Review of imaging features in children with Adrenoleukodystrophy Material and Methods: Retrospective review of imaging in 3 siblings with suspected adrenoleukodystrophy. A 7 year old boy was admitted with altered vision and unsteady gait. His CT showed symmetrical low attenuation areas in the parieto-occipital region indicative of Adrenoleukodystrophy. His 2 brothers, aged 5 and 9, were also found to have biochemical evidence of ALD and went on to have MR imaging. Results: The older sibling’s MRI shows bilaterally symmetrical white matter change involving parieto-occipital regions, splenium of the corpus callosum and the brain stem with peripheral enhancement following IV contrast. A Loes score was estimated at 10.5/34. MR spectroscopy was surprisingly normal. Follow up MR 2 months later was largely unchanged; the Choline peak had increased in area, with a new peak at resonance frequency of lipids. The MR imaging and spectroscopy on the youngest sibling was normal. They are both asymptomatic. Conclusion: A normal MR spectroscopy for the older sibling on first examination seems to be a better match to his normal clinical status than the imaging results. T2-weighted MR imaging may be more reliable than MRS to screen for early disease, contrary to previous belief.

P34 A spectrum of hemodynamic findings on cardiac CT Hyun Woo Goo1, Dong Hyun Yang1, In-Sook Park2, Jae Kon Ko2, Young Hwee Kim2, Dong-Man Seo3, Tae-Jin Yun3, Jeong-Jun Park3 1- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine. 2- Department of Pediatric Cadiology, Asan Medical Center, University of Ulsan College of Medicine. 3- Department of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine Purpose: Cardiac CT is usually used for morphologic evaluation of cardiovascular structures. We illustrate a spectrum of hemodynamic findings on cardiac CT. Materials and Methods: We reviewed 778 cardiac CT examinations performed in our institution for 6 years. We focused on hemodynamic findings depicted on cardiac CT and collected a spectrum of the CT findings. Results: Hemodynamic findings of cardiovascular structures demonstrated on cardiac CT categorized into intracardiac shunt, compromised pulmonary circulation, and

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bidirectional cavopulmonary shunt or Fontan pathway. Intracardiac shunt includes right-to-left or left-to-right shunt through ventricular septal defect and right-to-left shunt through patent foramen ovale. Compromised pulmonary circulation includes delayed transit time of pulmonary circulation in severe pulmonary artery stenosis and unopcified pulmonary venous flow in pulmonary artery obstruction with systemic arterial collateral. In bidirectional cavopulmonary shunt or Fontan pathway, preferential pulmonary blood flow, mixing pattern of caval flow, and obstruction of Fontan pathway with collaterals could be shown at CT. Conclusion: In addition to morphologic findings of cardiovascular structures, cardiac CT may reveal their hemodyamic findings, which gives us better insights into cardiovascular hemodynamics.

P35 Pelvic masses in childhood: correlation between open low-field MRI, sonographic and pathological findings Valeria Bolli1, Vittoria Galeazzi1, Cecilia Lanza1, Giovanni Pieroni1, Giancarlo Fabrizzi1, Alba Cruccetti2, Ascanio Martino2 1- Azienda Ospedaliero-Universitaria Ospedali Riuniti Presidio Salesi- Pediatric Radiology Department. 2- Azienda Ospedaliero-Universitaria Ospedali Riuniti Presidio SalesiPediatric Surgery Department Aim: The purpose of this study was to correlate ultrasonographic (US) and low field-MRI findings of pelvic masses in childhood, and evaluate the potential of MRI in determining benign and malignant pelvic masses using surgical-pathological findings as the reference method. Methods: 48 pediatric patients (age: 3 months–14 years) with pelvis masses surgically proven were reviewed. All patients underwent US and 28 of them had low-field MRI (0,2 T) in an open system. Only in 2 cases was necessary sedation. Results: 20 patients had only ultrasound for the acute onset: in all cases pathological findings confirmed the US diagnosis of adnexal pathology. 28 patients underwent US and MRI: in 5 cases pathological findings didn’t confirmed MRI diagnosis. These lesions were: 1 yolk sac tumour, 1 ovarian tumour, 1 hemangiopericytoma, 1 Sertoly-Leyding cell tumour, 1endodermal sinus tumour. In 4 cases US undervalue the measurement of the lesions size. Conclusion: Low field MRI features of pelvic masses correlate well with histopathological findings and achieve helps in the diagnosis and differentiation of malignant from benign lesions. MRI of children is easy in an open MRI system: few sedations, easy monitoring of sedated patients and cost reductions.

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P36 Pediatric pulmonary tuberculosis: pathogenesis and spectrum of radiological findings Preeyacha Pacharn Siriraj Hospital, Mahidol University Tuberculosis (TB) is a clinical syndrome caused by infection of Mycobacterium tuberculosis (M.tuberculosis). Inhalation is the most common route of transmission and the disease most often involves lungs and airways. The incidence of pulmonary TB in Thailand and many other countries has increased in recent years, including multi-drug resistant cases. Most children who have M.Tuberculosis infection do not have symptoms specifically for the disease. Pathological changes reveal non-cavitary and pauci-bacillary in nature. Therefore, the diagnosis of intrathoracic TB in childhood depends largely on tuberculin skin test and the interpretation of the chest radiograph. Wide varieties of radiographic abnormalities have previously been described in childhood TB include parenchymal opacities, lymphadenopathy, pleural effusions, parenchymal calcification and pulmonary cavitation. Primary and postprimary TB syndromes tend to present with characteristic constellations of such findings. The purpose of this review is to illustrate the radiographic appearances of various stages and different patterns of childhood pulmonary TB in correlation with pathological process.

P37 Benign intracranial fluid collections: a neuroimaging approach Maria Theofanopoulou1, Ioannis Nikas2, Vasiliki Dermentzoglou1 1- Private Practice, “Ionia Iatriki”, Diagnostic Centers, Athens, Greece. 2- Imaging Department Aghia Sofia Children’s Hospital, Athens, Greece Purpose: Benign intracranial fluid collections (CNS cysts), comprise a diverse group, which can be classified on the basis of pathological, clinical and neuroradiologic criteria. Aim of this study is to describe their neuroimaging features and offer helpful hints to narrow the differential diagnosis. Materials and Methods: In our presentation of intracranial CNS cysts, arachnoid cysts were excluded, as they have been exhaustively discussed in the literature. Results: The broad variety of benign cysts who exist in the CNS includs: A. cysts derived from neuroepithelial malformations (colloid cysts, neuroepithelial, neurenteric cysts, epidermoid-dermoid, Rathke’s cleft cyst, pineal cysts) and

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B. developmental variations of cerebral structures (cavum velum pellucidum, vergae, veli interpositi and enlargement of perivascular spaces). As in most of the cases there is no pathologic confirmation, diagnosis is achieved based solely on imaging findings, which may influence the therapeutic approach. Conclusion: MRI plays an important role in the identification of the above entities. Excellent knowledge of the radiologic appearance of these cysts is essential in their therapeutic management (conservative or surgical) and also in avoiding unnecessary imaging follow-ups.

P38 Correlation between color doppler sonography (CDS) and laboratory and clinical findings in children and teenagers with autoimmune thyroiditis (AT) Raffaella Peschechera1, Anna Paola Manzini1, Aurora Rossodivita2, A. Biscaglia1, Antonella Savelli1, Giulia Maresca1, Lorenzo Bonomo1 1- Dipartimento Di Bioimmagini E Scienze Radiologiche UCSC Roma. 2- Dipartimento di Scienza Pediatriche UCSC Roma Purpose: To evaluate correlation between CDS and laboratory and clinical findings in children and teenagers with AT. Methods and Materials: 32 consecutive patients with diagnosis of AT, on the basis of clinical and laboratory findings (values of thyroid hormones and antithyroidal antibodies against thyroglobulin -AbTg- and the microsomal antigen -AbTPO-), were subjected to CDS, evaluating thyroid volume, sonographic pattern, enlarged peri-thyroid limph nodes and vascularity distribution and entity. Results: Four patterns were found: pattern I in 3 cases, with mild structural unhomogeneity; pattern II in 15 cases, with prevalent normal thyroid echogenicity and some little areas of hypoechogenicity; pattern III in 13 cases, with thyroid structural subversion, diffusely hypoechoic and thin hyperechoic stria; pattern IV in 1 case, with small and unhomogeneous thyroid. Conclusion: Two patterns were found to be more frequent and corresponding to a precise clinical and laboratory finding. Pattern II was associated with normal/little enlarged gland, normal/little increased vascularity, no enlarged peri-thyroid limph nodes and normal thyroid function or subclinical hypothyroidism. Pattern III was associated with very enlarged gland, very increased vascularity, numerous peri-thyroid limph nodes and with severe hypothyroidism, or in two cases, with hyperthyroidism.

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P39 Hydrosalpinx in adolescent girls with Hirshsprung’s disease: the association of two rare conditions Laura Merlini1, Giorgio La Scala2, Barbara Peiry2, Mehrak Anooshiravani1, Luca Spadola1, Solène Ferey1, Tristan Zand1, Laura Rubbia3, Christophe Chardot1, Sylviane Hanquinet1 1- Paediatric Radiology Unit, University of Geneva Children’s Hospital. 2- Paediatric Surgery Clinic, University of Geneva Children’s Hospital. 3- Department of Pathology, University of Geneva Hospital Purpose: to illustrate 3 cases of bilateral hydrosalpinx in post-pubertal girls with Hirschsprung disease (HD) and to discuss possible etiologies. Patients and Methods: we identified bilateral hydrosalpinx on US examination performed for pelvic pain in three postpubertal girls with HD. The patients had two rectosigmoid and one total-colonic HD, treated respectively using Duhamel, Soave pull-through and Martin procedures. None of the patients had intra-pelvic complications likely to produce tubal obstruction. All the girls were not yet sexually active. Hydrosalpinx was confirmed by laparoscopy performed for acute appendicitis in one case and in two cases by MRI. Discussion: Hirschsprung disease is rare in girls (1:20′000), and hydrosalpinx is extremely rare in sexually non-active adolescent girls, with only one bilateral case reported in literature. We hypothesize three possible etiologies to the association of these two rare conditions: postoperative adhesions, an abnormality in the autonomous innervation of the fallopian tubes, or an anomaly involving Cajal’s pacemaker cells. Conclusions: The association of HD and hydrosalpinx is unlikely to be fortuitous. Its etiology is unclear and further studies are warranted to identify the prevalence of hydrosalpinx in girls with HD, to understand its pathogenesis and to evaluate possible repercussions on fertility.

P40 Variability of biometric fetal magnetic resonance imaging and ultrasound measurements Katrin Brauer, Alison D. Murray, Thomas W. Redpath, Tatiana V. Macfarlane. University of Aberdeen, UK Purpose: Assess and compare variability of fetal ultrasound (US) and magnetic resonance imaging (MRI) measurements of biparietal diameter (BPD), head circumference (HC) and abdominal circumference (AC).

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Material and Methods: 20 consecutive normal singleton pregnancies (24–39 weeks gestation), enrolled in a study of fetal growth. T2 weighted axial images of the fetal brain and abdomen obtained (1.5 T MR scanner), fetal US was performed the same day. Fetal BPD, HC and AC were measured 3 times with both modalities. Coefficient of variation (CV), the ratio of standard deviation relative to its mean, was used to measure variability. CV was calculated using root mean square method and expressed as %. Results: For MRI, CVs for BDP, HC and AC were 0.62% (95% Confidence Interval (CI) 0.40–0.77), 0.36% (95% CI 0.24–0.45) and 0.40% (95% CI 0.31–0.48), respectively. For US CVs were 1.43% (95% CI 1.05–1.72), 1.43% (95% CI 1.08–1.70) and 1.55% (1.16–1.86), respectively. The mean difference between MRI and US measurements was 2.09 mm, (standard deviation (SD) 1.48); 3.96 mm (SD 7.80); and 15.90 mm (SD 11.87) for BPD, HC and AC respectively. Conclusion: Variation in both methods was very small relative to their means. Variability in US measurements was greater than variability in MRI.

P41 Method to perform perfusion-weighted MRI in neonates Pia Wintermark1, Adrien C. Moessinger1, Amina Abdelmoumene1, François Gudinchet1, Leonor T. Alamo Maestre2, Reto Meuli1 1- Division of Neonatology, Department of Pediatrics, University Hospital (CHUV), 1011 Lausanne, Switzerland. 2- Department of Radiology, University Hospital (CHUV) and Lausanne Medical School, 1011 Lausanne, Switzerland Purpose: To determine whether perfusion-weighted imaging (PWI) is technically feasible in neonates with various gestational age, weight and pathologies. Material and Methods: PWI was acquired using a 1.5 T MRI scanner, with a dynamic post-contrast T2* perfusion gradient-echo EPI technique. A device, consisting of a 5 mL-syringe connected to a 3 mL-tubing extension with stopcocks at each end, was used to perform manually in an easy, quick, and reproducible way the intravenous injection of 0.1 mmol/kg of gadolinium contrast agent, followed by a 5 mL saline bolus injection given in less than 5 seconds. Results: Complete imaging and data is available for 28 studies on 25 non-sedated infants, with an average gestational age of 39 weeks (range 31–42 weeks), and an average weight of 2902 grams (range 815–4000 grams). Six of 28 were normal. Brain pathologies were: hypoxicischemic encephalopathy (8), stroke (2), intracerebral hemorrhage (6), congenital infection (2), and hemimegalencephaly (1). No motion artifact was present. Signal

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intensity against time curve was obtained for each of them, permitting to build perfusion maps and to analyze them with the Siemens Perfusion Analysis Package. Conclusion: The feasibility of PWI are demonstrated in neonates with various gestational age, weight and pathologies.

P42 Various image modalities of the pediatric thyroid disease: focus on thyroiditis and masses Yun-Woo Chang1, HyunSook Hong2, Deuk Lin Choi1, Dong Whan Lee3, Young Ah Cho4 1- Department of Radiology, Soonchunhyang University Hospital. 2- Department of Radiology, Soonchunhyang Buchon Hospital. 3- Department of Pediatrics, Soonchunhyang Univesity Hospital. 4- Department of Radiology, Pochon Jungmoon University, Bundang CHA hospital Purpose: We illustrate the pediatric thyroid disease focus on thyroiditis and masses. Materials & Methods: Pediatric thyroid diseases are included thyroiditis (suppurative thyroiditis, Hashimoto thyroiditis), Graves¡¯ disease and solitary thyroid nodules (adenoma, cystic degenerative nodules, papillary carcinoma, follicular carcinoma). Results: We review the pediatric thyroid diseases according to thyroiditis and masses using ultrasonography and various image modalities. Conclusions: Although thyroid disease is not as common as in children, but it dose occur in the pediatric patients similar to those in adults. Ultrasonography should be adapted as the first-line imaging examination for pediatric patients with suspected thyroid disease.

P43 Cystic Fibrosis A review of Chest HRCT findings in Glasgow Michael Digby 1- Yorkhill Hospital, Glasgow, Scotland. 2- West of Scotland Radiology Training Scheme Pictorial Review of chest HRCT findings in Cystic Fibrosis subgroup since advent of multislice CT in 2002. Includes 21 examinations at Yorkhill Hospital, Glasgow, Scotland. Prevalance of each finding e.g bronchiectasis, mosaic attenuation, nodules etc tabulated. Pictorial examples of findings given. Comparison made to previous reviews. Results discussed.

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P44 Rasmussen encephalitis: neuroimaging findings in 8 cases Daniela Longo, Gianclaudio Ciofetta, Luciana Delfino, Vittorio Cannatà, Elisabetta Genovese, Lucia Fusco, Francesco Velarde, Federico Vigevano, Francesca Diomedi Camassei, Giuseppe Fariello. Ospedale Pediatrico Bambino Gesù Rasmussen encephalitis is a chronic disease characterised by seizures, progressive hemiparesis and cognitive deterioration, consisting in a cause of drug resistant seizures. Objectives: to compare anatomic and functional neuroimaging studies in a series of patients with Rasmussen encephalitis and evaluate their hole in diagnosis. Materials and Methods: From January 2005 to November 2006 we evaluated neuroimaging data of 8 patients with clinical, electrophysiological (EEG) and morphological studies consistent with Rasmussen encephalitis. MR imaging, single-photon emission computed tomography (SPECT) and proton magnetic resonance spectroscopy were reviewed. Results: MR imaging findings revealed unihemispheric cortical and subcortical atrophy, ipsilateral caudate and putaminal atrophy with discrete increased T2 and FLAIR signal and atrophy of the ipsilateral cerebral peduncle and pons. Ipsilateral cerebellar hemisphere atrophy was found in one patient. White-matter increased signal intensity was observed in 3 patients. Proton magnetic resonance spectroscopy showed decreased N-acetyl- aspartate (NAA) levels and increased choline (cho) peaks in 3 patients. In two cases histopathological studies were obtained. Conclusions: based on the reported staging proposed by Bien et all, we classified our patients neuroimaging findings, also correlating with histopathological results. SPECT provided further information.

P45 Congenital lung lesions (CLL): embryology, nosology, prenatal imaging, postnatal issues Laurent Garel, Françoise Rypens, Josée Dubois, Andrée Grignon, Gilles Perreault, Chantal Lapierre, Jacques Boisvert, Jean-Claude Décarie, Marie-Claude Miron, Denis Filiatrault Department of Medical Imaging, CHU Sainte-Justine Purpose: CLL result from an insult to the developing lung bud, that is mainly airway obstruction at pathology. CLL represent a continuum of abnormalities that are classified nowadays as 1- bronchopulmonary malformations, 2- pulmonary hyperplasia and related conditions, 3-

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congenital lobar overinflation and related conditions, 4systemic arterial connections to normal lung, 5- other cystic lesions. Prenatal imaging has resulted in an increased number of cases. It has outlined the natural history of CLL, the significant prenatal prognostic predictors, and showed the limits of pattern recognition. Because most newborns with CLL are asymptomatic, postnatal investigations are based upon prenatal findings in the majority of cases. Learning Objectives: 1 - To summarize the current knowledge regarding the embryology, nosology, pathophysiology of CLL. 2 - To emphasize the fact that CLL represent a continuum of interrelated anomalies that can present isolated or in association. 3 - To illustrate prenatal cases of CLL, throughout pregnancy with postnatal correlations. 4 - To address the issues surrounding the postnatal management of prenatally recognized CLL, both in terms of imaging and treatment.

P46 MRI of stress related physeal changes in adolescents Sarah Milla1, Herman Kan2, Paul Kleinman1 1- Childrens Hospital Boston. 2- Vanderbilt University Purpose: To present the spectrum of MRI abnormalities associated with stress changes involving the physes in active adolescents. Material and Methods: MRI examinations and clinical records were reviewed in a group of adolescents with stress changes involving the physes at a variety of anatomic sites. Results: In the upper extremity, in addition to the familiar pattern of medial epicondylitis, little league shoulder manifests characteristic MR features in the physis and adjacent metaphysis. Gymnast’s wrist may be assessed with MR for diagnosis, response to therapy, as well as for complications such as physeal arrest. In the pelvis and lower extremity, chronic stress changes may be seen at the iliac crest apophyses as well as in the knee, with physeal widening and extension of physeal cartilage into the adjacent metaphysis. The MRI patterns noted in these entities bear some resemblance to those seen in calcaneal and tibial tubercle apophysitis, conditions which will also be illustrated in this exhibit. Conclusions: MR imaging has elucidated a number of classic orthopedic disorders manifesting chronic physeal stress changes in active adolescents. An appreciation of

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these patterns of injury, and a high index of suspicion in the appropriate clinical context, should aid in prompt diagnosis and management.

P47 Diffusion tensor imaging parameters of white matter tracts in very low birth weight infants Jeroen Dudink, Maarten Lequin, Nikk Conneman, Arjen van Zwol, Paul Govaert Sophia Childrens Hospital, ErasmusMC Rotterdam Purpose: Early detection of white matter injury in very low birth weight (VLBW) infants is important. The use of diffusion-tensor imaging (DTI) however, is still restrained by the lack of normal reference standards. Our objective was to provide these reference values and evaluate different ways of region of interest (ROI) placement. Material and Methods: We retrospectively analysed DTI images of 28 VLBW infants (26–32 weeks gestation) with no evidence of white matter abnormalities, scanned within the first 4 days of life. Images were acquired using a MRcompatible incubator (LMT) on a 1,5 Tesla (GE) MR scanner (single shot EPI, 25 direction diffusion gradients and b=1000 s/mm2). With ‘FuncTool 2000’ we analysed different DTI parameters of white matter tracts and compared different ways of ROI placement (confirmed with fiber tracking and colormaps). Results: (Figures) Conclusion: Among our results we found a significant agerelated trend in fractional anisotropy for white matter development in pyramidal tracts and the feasibility of using maximum pixel values instead of standard size ROI’s. The relevance of these findings mainly comes from the fact that these data may approach as close as feasible the normal status of white matter tracts of VLBW infants in the first week.

P48 Radiological treatment of neonatal hepatic arteriovenous malformation (HAVM) Ganesh Krishnamurthy, Philip John The Hospital For Sick Children, University of Toronto, Toronto, Canada Hepatic AVM (HAVM) is a rare high flow vascular anomaly in neonates and is usually associated with a high mortality from cardiac failure as a result of AV shunting. We report the interventional radiology (IR) management of 2 term neonates (2.8 & 3.7 kg body weight, one in a family

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with HHT- Hereditary hemorrhagic telangectasia) with HAVMs causing cardiac failure. Glue embolisation was undertaken 7 and 9 days respectively after birth using a coaxial superselective catheter technique from a brachial artery approach. Immediately following embolisation, clinical improvement was evident and both were weaned from cardiac support. Both patients (discharged at 30 & 50 days), are well and now aged 3.7 and 4.3 months. These 2 cases add to the rare reports of hepatic AVMs in the neonatal period. IR can be technically successful in very young infants with HAVMs and stabilizes such life threatening events. Genetic testing for HHT and long-term follow-up is recommended in neonatal HAVMs.

P49 Chest wall masses in children: a pictorial review Gye Yeon Lim, Jee Young Kim, Soo Ah Im, Seong Tae Hahn Dept of Radiology, St. Mary’s Hospital, The Catholic University of Korea Chest wall masses arise from a variety of different causes. The chest wall contains a number of distinct tissues, including skin, fat, muscle, bone, cartilage, lymphatic vessels, and fascia. Each of these components tissues can give rise to either a benign and malignant chest wall mass. Chest wall masses, whether primary or secondary, are relatively uncommon in clinical practice. Often this unfamiliarity leads to inappropriate selection of diagnostic studies and delays in treatment. This exhibit is to illustrate the spectrum of radiologic appearance and review the causes of chest wall masses in children. The US, CT and MR findings of benign tumors such as lipoma, lipoblastoma, desmoid and harmatoma will be presented, as well as malignant lesions such alveolar rhabdomyosaromca, Ewing sarcoma and PNET. The imaging appearances of non-tumorous conditions including traumatic /inflammatory origin and developmental variant presenting palpable mass such as hematoma, fungal abscess, asymmetric costal cartilage and tilted sternum will also reviewed.

P50 Rachitic bone deformities in toddlers — an increasing problem in Armenia Narine Manukyan1, Ashot Sarkissian1, Nina Arikyants1, Ara Babloyan1, Garen Koloyan2, Ernst Leumann3 1- Arabkir Joint Medical Centre, Yerevan, Armenia. 2- University Hospital #3, Yerevan, Armenia. 3- University Children’s Hospital, Zurich, Switzerland

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Background: Early diagnosis and distinction of vitamin D deficient (classical) rickets from atypical forms are important. The increasing number of rachitic children seen in 2006 at the Arabkir hospital in Yerevan prompted this study. Patients and methods: All patients had X-rays of the wrist and additional films depending on bone deformity. Serum chemistry was done in Yerevan and further analysis, if needed, in Zurich. Patients with rickets due to renal insufficiency were excluded. Results: We saw 22 patients (12 boys) with rachitic bone deformities aged (at diagnosis) 1746 months. 17 patients had classical rickets (8 florid and 9 healed with sequelae) and five had rare forms: X-linked hypophosphataemia (XLH; 2), vitamin D dependant rickets type1 (1), and Fanconi syndrome (2) due metabolic disease. Conclusions: 1) Children with classical rickets came late for radiological evaluation and were in the same age range as patients with atypical rickets, 2) Due to the larger number of rachitic children, an increased awareness of radiologists and paediatricians is needed in order not to overlook other forms of rickets, 3) The comeback of vitamin D deficient rickets due to negligent prophylaxis is of concern.

P51 ACUTE necrotizing encephalitis: neuroimaging review in two cases Natalia Madroñal, Francisco Menor, Monserrat Tellez, Fernando Gómez, María Guasp Hospital Infantil La Fe Acute necrotizing encephalitis (ANE) is a rare acute encephalopathy with high mortality rates and severe neurologic sequelae affecting its survivors. A mild antecedent illness (fever and upper respiratory infection) is present in more than 90% of affected patients. Althought some viruses have been implicated in its pathogenesis, it is believed that the most likely causes are immune-mediated and metabolic. Neuroimaging shows bilateral and symmetrical thalamic involvement with variable participation of the others brain regions and the cerebellum. Thalamic lesions typically cavitate and become hemorrhagic but lesions in other sites not exhibit hemorrhage and tend to resolve. We describe the imaging and clinical findings in two infants, aged two years and five months respectively, with acute necrotizing encephalitis (ANE). Both cases clinically presented with seizures and rapid impaired consciousness. In the first one computerized tomography (CT) and magnetic resonance imaging (MRI) were done in the acute phase and several MRI studies were made on

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follow-up. The second patient had CT, MRI, and also brain ultrasonography (US) in the acute phase. To our knowledge sonographic findings were no previously reported in ANE. Differential diagnosis with viral encephalitis and acute disseminated encephalomyelitis, specially with its hemorrhagic variant, is discussed.

P52 CT and MR imaging of the pediatric orbital pathology Ma Eugenia Guillen, Joaquín Martín, Ana Carmen Vela, Luis Mazas, Miguel Angel Marín, Esteban Mayayo Miguel Servet Hospital Purpose: Review the most common orbital disorders in our pediatric population that differs from those found in adult patients and to describe their radiological features. Material and Methods: We have reviewed 13 cases of orbital pathology in children from January 2005 to December 2006. 9 patients were studied with US, CT was performed in 4 patients and MRI in 13. Results: We describe some examples of congenital anomalies like coloboma, persistent hyperplastic primary vitreous and a patient with osteopetrosis and encephalocele. As example of intraocular tumour of childhood, the retinoblastoma, the most serious intraocular tumour, was diagnosed in 3 patients, one of them was bilateral. We have 3 patients with neurofibromatosis and optic nerve glioma. We also found a rhabdomyosarcoma, the most common primary malignant tumour of the orbit in children, an osteosarcoma and a capillary hemangioma whose occurrence in children is common. Conclusion: CT and MR have improved the assessment of congenital anomalies, inflammatory, infectious processes, primary and secondary tumours and mass-like lesions. Also, these modalities evaluate the extent of infections and neoplasms, which determine their treatment.

P53 Role of imaging in complications following pediatric renal transplantation Amit Maniyar, Abdu Shabani, R Prabhakar Royal Manchester Children’s Hospital, Manchester Aim: Renal transplantation has reduced morbidity in children with chronic renal failure but not without its complications. Ours is a regional tertiary referral pediatric centre with second largest renal transplant unit in the U.K. This pictorial review illustrates the role of imaging in management of early and late complications following renal

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transplantation in children caused by the procedure and immunosuppression. Imaging findings: Various pathologies demonstrated using ultrasound, doppler, nuclear medicine, CT, MR and MR angiography include rejection, ATN, cyclosporine & tacrolimus toxicity, infection, lymphocele, urinoma, hematoma, abscess, renal vascular stenosis, renal vein thrombosis, AV fistula, renal obstruction, opportunistic infections, post transplant lymphoproliferative disorders following immunosuppression and peripheral vascular calcification leading to amputation in young children. Imaging guided intervention was peformed for drainage procedures and treatment of vascular complications. Conclusion: Imaging in children is crucial for diagnosis and management of early and late complications post renal transplantation.

P54 Endoscopic retrograde cholangiopancreatography (ERCP) a useful diagnostic supplement in infants with suspected biliary obstruction Ingegerd Aagenaes, Lars Aabakken, Kristin Bjoernland, Truls Sanengen Rikshospitalet University Hospital Purpose: To assess the value of ERCP in infants. Material and Methods: Twenty-three ERCP’s were performed in 22 children <1 year (0.7–8.5 mo, mean 2.4) with suspected biliary obstruction when ultrasonography, scintigraphy and magnetic resonance cholangiopancreatography (MRCP) were inconclusive. Results: ERCP was succesfully completed in 20 of 23 cases (87%). Of the 6 with normal bile ducts (BD’s), 5 had Neonatal Hepatitis Syndrome (NHS) and 1 liver failure. Two of those with NHS had hypoplastic intra-/extrahepatic BD’s. Another 6 patients had biliary atresia. In two of these ERCP showed no BD’s, while four had no intrahepatic BD’s while the extrahepatic BD’s were hypoplastic. Of the three patients with dilatation of the BD’s, two had a choledochal cyst. Two children had extrahepatic bile duct leakage, one was spontaneous, and one after liver TX. One of the patients had choledochal stones. The diagnoses in the 3 children with unsuccsessful ERCP were biliary atresia, choledochal stones and inspissated bile plug syndrome. There were two minor complications. One patient experienced increased amylase levels, while another displayed signs of infection that responded to antibiotics. Conclusions: If the non-invasive examinations (ultrasonography, MRCP and scintigraphy) are inconclusive, ERCP is a valuble diagnostic procedure with few complications.

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P55 Paraovarian cyst: a cause of adnexal torsion in pediatric patients Carmina Durán, M. Teresa Veintenillas, Amaya Martín, Ana Alguersuari, César Martín, Neus Combalia SDI- UDIAT CD Institut Universitari Parc Tauli, UAB Objective: To draw attention to paraovarian cyst, a rare pathology in children, and to describe its embryologic origin. To describe ultrasonographic and MRI features of adnexal torsion as a complication of paraovarian cyst. Material and Methods: From 2001 to 2005, three patients aged 10 to 14 years with acute abdominal pain were diagnosed with paraovarian cyst and adnexal torsion at our hospital. All patients underwent ultrasound and emergency MR examinations; all diagnoses were confirmed at surgery. Results: Doppler ultrasound showed a cystic lesion (mean diameter=4.5 cm) behind the bladder attached to the uterus. Although the cystic lesions were separated from the ovary in two cases, signs of torsion were present in one of these. In the third case, Doppler-US showed a septated cystic lesion with a fluid level inside, adjacent to the normal ovary and MR showed Fallopian tube infarction. Histological examination after surgery confirmed the mesothelial nature of one lesion and the paramesonephric nature of the others.

P56 Sonographic evaluation of post radiation thyroid gland changes in pediatric patients with Hodgkin’s disease M.G. Papadaki, M. Vakaki, E. Chalatsi, P. Papantoniou, A. Simopoulos, C. Koumanidou Department of Radiology, “A. Kyriakou” Children’s Hospital, Athens, Greece Purpose: Thyroid disease is frequently encountered as a sequelae of treatment for Hodgkin’s disease. The aim of the study is to present sonographically detected post radiation thyroid gland abnormalities in pediatric patients. Materials and Methods: The study included 32 pts aged 10–22 yrs treated with neck irradiation for Hodgkin’s disease. Median time after radiotherapy (RT) was 5 yrs (range 1–11). We used 5–12 MHz linear transducers. The entire gland was examined and volume measurements were estimated. Results: Ultrasonography (US) revealed a normal thyroid gland in 20 pts (62, 5%). Diffuse enlargement with reduction in reflectivity was noticed in 3 pts, with fibrotic septations in 1/3. 4 pts had normal gland volume with

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multiple echo-poor micronodules (1–6 mm) and fibrotic septations in 2/4. US revealed a small gland with ill defined margins and heterogeneous texture in 3 cases. One patient was found to have thyroid nodular disease and one thyroid carcinoma 10 years after the end of radiation. Conclusions: A significant proportion of pts had an abnormal US study. Knowledge of possible alterations in the echo-texture of the thyroid gland after RT and serial thyroid function measurements are needed in the long term followup recommended for these pts.

P57 Radiologic findings of omphalomesenteric duct anomalies: imaging and pathologic correlation Choon-Sik Yoon, Jin Hur, Myung-Joon Kim Dept. of Diagnostic Radiology, Yongdong Severance Hospital, Yonsei University College of Medicine Purpose: To understand the various radiologic findings of omphalomesenteric duct anomaly and to correlate them with pathologic findings. Materials and Methods: We retrospectively evaluate radiologic and pathologic findings of cases of omphalomesenteric duct anomaly, confirmed by surgery and histopathology. Clinical common symptoms were abdominal pain and GI bleeding. Results: We will demonstrate various radiologic manifestations of omphalomesenteric duct anomaly, which was investigated by Meckel¡¯s scan, barium examination, ultrasonography and/or CT scan. We will also correlate them with the gross specimen if possible. Conclusion: omphalomesenteric duct anomaly can have various clinical manifestations as well as various radiologic findings according to the imaging modalities.

P58 Imaging in mucopolysaccharidosis Charuta Dagia, Murray Bartlett, Kieren Gara The Royal Children’s Hospital, Melbourne Objectives: The mucopolysaccharidoses are an uncommon group of inherited metabolic disorders caused by deficiency of specific lysosomal enzymes. There is deposition of mucopolysaccharides in the cells and connective tissues of multiple organs in the body. Progressive accumulation of these substances results in permanent cellular damage that affects organ and system functioning with a wide range of radiological findings. The purpose of the study was to

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outline a tertiary paediatric institution’s experience of the imaging characteristics of these conditions. Methods: A retrospective review of 30 patients with mucopolysaccharidosis identified from the radiology information system database between 1998 & 2006 was performed. The abnormalities seen on correlative serial imaging, including plain films, ultrasound, CT and MRI, were documented by two paediatric radiologists and a radiology fellow. Results: The spectrum of imaging findings ranged from typical appearances in the skeletal system and the commonly encountered brain abnormalities to unusual manifestations of scleral infiltrates and airway involvement. Conclusion: A wide range of radiologic abnormalities is encountered with the mucopolysaccharidoses. Imaging is useful in delineating the extent of involvement and the evolution of lesions over time. It may have a role in determining the implications with respect to functional impairment and neurological development.

P59 The application of 3.0 T magnetic resonance angiography in the evaluation of paediatric intracranial vascular malformations Mark Walsh, Mark Phillips, John Earwaker, John Williams, Anthony Lamont Mater Children’s Hospital, Mater Health Services Brisbane, Queensland, Australia Purpose: To illustrate and promote the value of 3D timeof-flight magnetic resonance angiography at 3.0 T (3D TOF MRA) in the detection, characterisation and treatment planning of paediatric intracranial vascular malformations. Background: Paediatric intracranial vascular malformations encompass a heterogeneous group of developmental disorders which include arteriovenous malformations, cavernous malformations, venous malformations, dural arteriovenous fistulas, capillary telangiectasias and vein of Galen malformations. Magnetic resonance imaging (MRI) offers high-resolution, non-ionizing and non-invasive evaluation of intracranial vascular malformations avoiding the risks of catheter angiography in the paediatric age group. The advent of high-field strength 3D TOF MRA at 3.0 T has led to substantial improvements in spatial and temporal resolution and offers anatomic and haemodynamic information rivaling traditional angiographic techniques. Results: We present and illustrate our experience of 3D TOF MRA at 3.0 T in the characterization, risk stratification and treatment planning for a wide spectrum of

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paediatric intravascular malformations. Correlative findings at interventional angiography and surgery are included to validate the appearances at MRI. Conclusion: The application of 3D TOF MRA at 3.0 T in the evaluation of paediatric intracranial vascular malformations reinforces the key role of the clinical radiologist in the multidisciplinary management of this challenging clinical area.

P60 Intraperitoneal hemorrhage in abdominal neuroblastoma Owen Arthurs, Penelope Brock, Antony Michalski, Julia Chisholm, Oystein Olsen, Derek Roebuck 1- Department of Radiology, University of Cambridge, Cambridge. 2- Department of Oncology, Great Ormond Street Hospital, London. 3- Department of Radiology, Great Ormond Street Hospital, London Intraperitoneal hemorrhage is an apparently rare but serious complication in children with abdominal neuroblastoma. We performed a retrospective analysis of a radiology database and present the incidence and imaging findings of this complication. Over a 5-year period, we identified three boys aged 25 years who presented with abdominal symptoms during chemotherapy for advanced neuroblastoma. All were 46 months into chemotherapy, and presented with acute anaemia, acute pyrexia, abdominal pain & distension, in one patient mimicking appendicitis. All patients underwent urgent abdominal ultrasound, then either CT or MRI. In one patient, free fluid was seen on ultrasound with an enlarging tumor mass confirmed on CT; one patient showed free fluid with septations, which was confirmed on CT, and a repeat ultrasound 5 days later showed organizing hematoma within the tumour. The third patient had a large subdiaphragmatic hematoma (without generalized fluid) on ultrasound, with septations seen within the hematoma on MRI. All 3 patients were treated conservatively, and made a good clinical recovery from these episodes. Imaging findings can confirm clinically suspected intraperitoneal hemorrhage in children receiving chemotherapy for neuroblastoma, and in some children may suggest the diagnosis when hemorrhage is not clinically suspected.

P61 Treatment-induced paediatric bone lesions: a differential diagnosis in evolution Mark Walsh, Mark Phillips, John Earwaker, John Williams, Anthony Lamont Mater Children’s Hospital, Mater Health Services Brisbane, Queensland, Australia

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Purpose: To illustrate a radiological spectrum of treatmentinduced skeletal abnormalities for a range of benign and malignant paediatric conditions encountered at our institution. We hope to promote awareness of this evolving differential diagnosis and to provide a radiological template to aid in their characterization. Background: Advances in the medical and surgical management for an increasing range of benign and malignant paediatric conditions has led to an increased prevalence of iatrogenic skeletal abnormalities. The paediatric radiologist has a key role in their characterization and follow-up which often necessitates a multimodality approach to imaging. Results: We present our experience of a wide variety of treatment-induced skeletal abnormalities which are presented under the following categories: Osteopaenia — corticosteroids, methotrexate therapy; Rickets — Ifosfamide therapy; Bone Sclerosis — bisphosphonate therapy and hypervitaminosis D; Periosteal reaction — Hypervitaminosis A; Biomechanical abnormalities — stress fractures and growth deformity secondary to surgery and post spinal irradiation; Bone Infarcts — corticosteroids, post-BMT and radiotherapy; Skeletal radiotherapy — radiation osteitis, growth plate injury and radiation induced bone tumours. Conclusion: Familiarity with this evolving spectrum of skeletal abnormalities is important in the differentiation between benign changes, complications of treatment and disease recurrence.

P62 Ultrasonography of normal and pathological scrotum in children: pictorial essay Jean-François Chateil1, Muriel Brun1, Pascale Pietrera1, Françoise Mallemouche1, Leon Rausin2, Carole Le Manh1 1- Unité Radiopediatrie, Pellegrin Bordeaux, France. 2- CHR Liège, Belgium Learning Objectives: the purpose of this scientific exhibit is to emphasize role of ultrasonography (US) to evaluate scrotal disorders. Material and Methods: US represents the method of choice for scrotal imaging. Gray-scale, color Doppler US can be perform in all cases when clinical evaluation fails to clearly demonstrate pathology. Results: normal aspects and most frequent diseases are illustrate. Migration disorders and abnormalities of the processus vaginalis (hydrocele, inguinoscrotal hernia) are mainly seen in babies and infants. Acute scrotal disease are acute epididimo-orchitis, torsion of testicular appendage or twist of the spermatic cord with

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testis ischemia. US helps for diagnosis but has to be performed within the first hours to avoid delayed surgery. Extravaginal neonatal testicular torsion can be recognized. Other diseases include Henoch-Schönlein disease, idiopathic scrotal edema. US is useful in scrotal trauma to rule out a testicular fracture. Scrotal tumors are rare. Testicular tumors are divided into germ cell and non-germ cells tumors. Yolk sac tumor is the most frequent. Localisation of lymphoma or leukaemia can also be encountered. Extratesticular tumors include rhabdomyosarcoma. Testicular microlithiasis is usually an incidental finding; follow-up is discussed. Conclusion: Knowledge of normal and pathological US aspects is mandatory for scrotal disorders evaluation in children.

P63 Fetal lung intensity may serve as the prediction of prognosis for congenital diaphragmatic hernia Shigeko Kuwashima, Tatsuo Kohno, Yasushi Kaji Dokkyo University School of Medicine Background: Prenatal diagnosis of congenital diaphragmatic hernia (CDH) relies mainly upon ultrasound (US). No antenatal sign has been shown to predict prognosis in fetus with CDH. Signal intensity of the fetal lung in an MRI may be useful in diagnosing pulmonary hypoplsia. Therefore, signal intensity may be predictable of prognosis for CDH. Objective: To evaluate the value of fetal lung intensity in the prediction of prognosis for CDH. Materials and Methods: We studied Fetal MRI examination in 12 patients who were diagnosed with a congenital diaphragmatic hernia by US. Signal intensity of lungs was analyzed and the lung-to liver signal intensity ratio was calculated. We compared lung intensity with prognosis for CDH. Results: In all subjects, low lung signal intensity in fetuses resulted in a poor prognosis. High lung intensity in fetuses was divided into good prognosis and poor prognosis. Conclusion: Low lung intensity may be useful for the prediction of a poor prognosis. High lung intensity dose not exclude poor prognosis.

P64 Processus vaginalis related disorders: high-resolution sonographic review Anna Marín, Victòria Garriga, Santiago Medrano, Lara Berrocal, Deysi Garcia, Núria Roson, Rosa Pineda, Miguel Cuadrado, Sònia Carbó, Xavier Pruna Hospital General De Granollers

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To review the high-resolution sonography (HRUS) of processus vaginalis (PV) related disorders in childhood. To highlight the ability of HRUS in the differential diagnosis of groin masses. To correlate the HRUS findings with embryonic development of PV. The PV is an embryological outpouching of parietal peritoneum through which the testis descends to the scrotum. Abnormal closure of the PV results in an increased risk for cryptorchidism, indirect inguinal hernia, hydrocele and spermatic cord cyst. The study includes 16 pediatric cases with PV disorders. Patients were 0–2 years old (14 boys, 1 girl and 1 intersex patient).All of them were studied by high-multifrequency linear-array transducer using color Doppler to identify vascular anatomy. Our results showed 1 ovarian hernia, 4 spermatic cord cyst (one with proximal omentum and distal scrotal hydrocele), 4 cryptorchidism (one with inguinal hernia), 3 hydrocele (one containing an atrophic testis), 3 isolated inguinal hernia (one containing bowel) and 2 ovotestis hernia in an intersex patient. Inguinal hernias are the most common cause of a pediatric groin mass which requires surgical management. Knowledge of its contents may aid to plan surgery. Although routine sonographic evaluation is not necessary, it represents an easy, safe and fast technique in cases suspicious for other related conditions.

P65 Baby hips — a decade of experience Shonit Punwani, Magali Taylor, Paul Humphries, Mark Sellwood, Penny Shaw University College London Hospital Introduction: The follow up and assessment of the outcome of those babies identified as possessing ‘abnormal’ hips on ultrasound can provide an invaluable source for guiding future clinical practice. Methods: At our institution over a 10 year period a total 2588 baby hips were scanned. Retrospective analysis of the scan results was conducted. Reports were searched for words that were likely to signify abnormality. Scans selected by word search criteria were classified as abnormal, indeterminate or normal. For the babies identified as having abnormal scans patient notes were retrieved and treatment evaluated. Results: A total of 845 scans reports were highlighted by word search criteria. The vast majority of these scans reported underdevelopment of the hips - normal for age. ‘Abnormal’ hips were found in 22 babies. Nineteen of the patient records were recoverable. From these 7 received no treatment and 6 of the 7 were recorded as achieving clinical normality at 1 year.

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Discussion: A significant proportion of ultrasound ‘abnormal’ hips reported to receive no treatment were recorded as clinically normal at 1 year. Given the risks of treatment, the findings would suggest that the current criteria used for selection of babies for treatment could be further improved.

P66 Rabdomyosarcoma in children: review from head to toe Liliana Henao Gomez, Andres Rodriguez, Fernando Flores, Lina Jaramillo Fundación Hospital De La Misericordia Our purpose is describe the utility of imaging tools for diagnosis, staging and pursuit to rabdomyosarcoma in children. We describe too, the clinical, radiologic and pathologic findings in this entity. We present a series of 20 pacients who were seen in Foundation Hospital de la Misericordia. The principal finding en physical examination was a mass in different anatomic localization who were evaluated with ultrasonography, CT an MRI. Most of cases were surgical and pathological confirmation. The rhabdomyosarcoma is a mesenchymal neoplasm accounting for 8% of malignancies in children, is the third most common extra cranial solid tumors and almost half of cases are diagnosed in children less than 5 years. The primary presentation is extend compromise the head and neck, in 40% including the orbits, genitourinary tract in 30% and the extremities in 19%, other sites like gallbladder and stomach are unusual. In our patients we have elevated frequency in head and neck localization and genitourinary tract, the CT an MRI are imaging election for evaluation and staging for this tumor.

P67 The vesical trigonal unit in children: a complex structure. Interactive tutorial on anatomy, physiology and related pathologies Pablo Valdés Solís1, Luisa Ceres Ruiz2 1- Hospital Costa Del Sol (Marbella, Spain) 2- Hospital Carlos Haya (Málaga, Spain) Learning Objectives: 1. To review the embriology, anatomy and phisiology of the vesical trigonal unit. 2. To understand the anatomical and functional relationships between the trigonal unit and adjacent structures. 3. To review the main pathologies (both functional and morfological) and treatments in the trigonal unit. 4. To understand the postoperative changes. Material and Methods: The poster includes the following content: 1. Embriology, anatomy and phisiology of the

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trigonal unit and its relationships with adjacent structures. 2. Imaging techniques for studying the trigonal unit. 3. The normal trigonal unit. 4. The abnormal trigonal unit: functional anterograde and retrograde pathologies (reflux, incontinence, vesical voiding impairment); morphologic anomalies (ureteroceles, masses, etc). 5. The postoperative trigonal unit (ureteral reimplant surgery, endoscopic techniques, etc). Conclusion: The trigonal unit is a complex structure hard to understand. If dysfunctional, it causes both retrograde (reflux) and anterograde (incontinence, voiding malfunction) anomalies that can be studied with different imaging techniques. With this poster, the user can learn the anatomy, phisiology, pathologies and postoperative changes.

P68 Anomalies of ureter, bladder, urethra and cloaca in children Ahyoung Jung, In-One Kim, Jung-Eun Cheon, Woo Sun Kim, Kyung Mo Yeon Seoul National University Childrens’ Hospital Learning Objectives: To demonstrate the radiographic findings of congenital anomalies involving the distal ureter, bladder, urethra and cloaca. Material and Methods: Review of radiologic studies including VCU, RGU, loopogram, fistulagraphy, genitography and IVP from 2000 to 2006. Review of clinical records including surgical findings. Conclusion: The identification of genitourinary tract anomalies and providing anatomic detail is important for the patient management and surgical intervention. Knowledge of the variety of conditions will aid in correct diagnosis of children with genitourinary tract anomalies.

P69 Clinical applications of advanced MR imaging techniques in the diagnosis and follow-up of pediatric CNS tumors Núria Mayolas1, Élida Vazquez1, Ignacio Barber1, Juli Alonso1, Joaquim Piqueras1, Josep Maria Poch2, Goya Enríquez1 1- Pediatric Radiology. Vall D’Hebron Hospital. 2- Pediatric Neurosurgery. Vall D’Hebron Hospital Purpose: This exhibit highlights the use in clinical practice of the new MR imaging techniques, MR perfusion (MRP), MR diffusion (MRD) and MR spectroscopy (MRS), in the evaluation of the pediatric brain tumors. This techniques can improve the diagnosis and follow-up of these patients

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by adding information on hemodynamics, cellularity, and metabolism, respectively. Material and Methods: We present a prospective study performed in a big tertiary children’s hospital over the last three years. MR exams were performed using a 1.5-T magnet after previous informed consent from patient’s parent or guardian. MRP, MRD and MRS together with conventional MR imaging were used in the evaluation of CNS tumors. Results: Several relevant data can be obtained: 1.Reduced mean apparent diffusion coefficient (ADC) map and elevated taurine are characteristic of medulloblatoma. 2. Pilocytic astrocytoma can mimic high-grade gliomas.3.They can help in assesing high grade astrocytomas, particularly in Neurofibromatosis type I. 4.They improve the differential diagnosis between recurrence and radionecrosis during the follow-up. Conclusion: Advanced MR imaging techniques, MRP, MRD and MRS have numerous applications in children with CNS tumors and should be used together with conventional MR imaging. They are particularly important in the diagnosis, guide surgery, monitor therapy response, predict the prognosis and follow-up.

P70 Study to evaluate the spectrum of multidetector CT (MDCT) findings in paediatric acute abdominal pain Susan Freeman, Anna Gomez, Patricia Set Addenbrooke’s Hospital Purpose: This study aims to demonstrate the diagnostic and clinical value of 16- and 64-slice multi-detector CT (MDCT) in paediatric acute abdominal pain. We aim to demonstrate the clinical value of improved Z-axis resolution in multi-planar reformats obtained with MDCT and the increased coverage speed. Materials and Methods: All paediatric patients presenting with acute abdominal pain during the period of 1.4.05– 1.1.07 were included in a retrospective study. All patients were imaged with either 16- or 64-slice MDCT and independently reported by three radiologists using multiplanar reconstructions. The CT protocol and any previous imaging were recorded. Correlation was made with clinical outcome, including surgical and histopathological findings. Results: 63 patients were imaged with 16- or 64-slice MDCT during a 21 month period. 45% of cases were trauma related. The remaining cases represented a spectrum of non-traumatic acute abdominal pain. We illustrate our findings with representative cases. Conclusion: MDCT allows comprehensive evaluation of the acute abdomen, aiding clinical management. Multiplanar reformats improves detection and evaluation in the

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extent of solid organ injury, vascular and skeletal abnormalities, particularly in trauma.

P71 Patterns of brain MRI injury in a preterm population with necrotising enterocolitis (NEC) Claire Miller1, Mary Rutherford2, Linda De Vries4, Serena Counsell2, Joanna Allsop2, Frances Cowan3 1- Birmingham Children’s Hospital. 2- Imaging Science Department, Mrc Clinical Science Centre, Imperial College, Hammersmith Campus. 3- Department of Paediatrics, Imperial College, Hammersmith Campus. 4- Department of Neonatology, Room Ke 04.123.1, Lundlaan 6,3584ea, Utrecht Aim: Infants with intrauterine growth restriction (IUGR) have been shown to have higher rates of NEC, probably due to endorgan damage secondary to placental insufficiency. We hypothesise that in a group of preterm neonates with NEC, the more mature infants will have more extensive brain injury. Method: We reviewed admissions with NEC to two neonatal units: Hammersmith Hospital and Wilhelmina Children’s Hospital, Utrecht who had a cranial MRI performed (1997–2006). Results: Thirty-one neonates met inclusion criteria. Twelve neonates had a birth weight below the 3rd centile for gestation based on Gairdner-Pearson charts. Twice as many neonates had IUGR in the more mature group (>28 weeks); 26% versus 13%, and significant white matter (WM) abnormality (79% versus 24%) was also more common. Germinal matrix haemorrhage was seen only in those born at or before 28 weeks gestation. Of these 10, 2 had IUGR and these both had more severe WM abnormality (cystic or infarct) than the other eight (7 had non-specific WM abnormality and one had periventricular leukomalacia). Conclusion: This supports the theory that more mature neonates and those with IUGR are more susceptible to WM injury. The distribution of haemorrhagic lesions is in keeping with a more immature germinal matrix.

P72 Partial ureteral obstruction in newborn mice: MRI appearance with pathological correlation Robin Azoulay1, Florent Guérin2, Dominique Berrebi3, Yves Aigrain2, Michel Peuchmaur3, Alaa El-Ghoneimi2, Guy Sebag1 1- Department of Pediatric radiology, Hôpital Robert Debré. 2- Department of Pediatric surgery and Urology, Hôpital Robert Debré. 3- Department of Pathology, Hôpital Robert Debré

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Introduction: Congenital ureteropelvic junction (CUPJ) is a frequent antenatal diagnosis. Most of CUPJ obstructions are partial with an impredictive loss of kidney function. The predictive role of MRI is currently discussed. We developed a knew model of partial unilateral ureteral obstruction in newborn mice. Materials and Methods: 107 newborn mice were operated on within their fifth day of life. They were divided into 3 groups: a partial unilateral ureter obstruction (PUUO), a complete unilateral ureter obstruction (CUUO) and a control group (sham. 67 mice had an in-vivo MRI study. Inflammation, apoptosis and fibrosis were studied and correlated to MRI findings. Results: Compared to CUUO and sham groups, PUUO group had an intermediate kidney phenotype in MRI:

youngest patient was examined 5 hour after birth, the oldest was 6 weeks old. The MR examination was perfomed with Hitachi Airis 0, 3 T, and Siemens Magnetom 1,5 T, with help of NICU. Results: Thanks to it excellent tissue contrast resolution and large field of view MRI provides complementory information to US. The MRI helps to define the nature and extension of the anomalies detected by US. CNS is undoubtedly the main field of investigation. We’ll discuss about the indications of MRI. Conclusion: MRI may help better characterize some anomalies in neonate wich sonografy is inconclusive.

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37 cases of mitochondrial disorders in children: review of MRI, including diffusion imaging and monovoxel spectroscopy François Chalard1, Elmaleh Monique1, Schiff Manuel2, Ogier de Baulny Hélêne2, Sebag Guy1 1- Hôpital Robert DebréRadiopediatric Department. 2- Hôpital Robert DebréNeuropediatric and Metabolic Diseases Department

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lose of zonal differentiation with intermediate thinned parenchyma intermediate height decrease intermediate pelvis enlargement

Parenchyma lesions (atrophy, apoptosis, leukocyte infiltration, and fibrosis) were also intermediate in severity to. In PUUO, the loss of height of the obstructed kidneys was significantly correlated with apoptosis. Conclusion: Typical kidney intermediate lesions can be assessed in MRI and pathology in PUUO. With the availability of knocked out mice, different factors of the pathogenesis of renal lesions secondary to obstruction can be now studied.

P73 The role of MRI in examination of neonate with acute diseases Krisztina Urbanek, János Gyarmati HUNIKO Imaging Center Pest County Hospital Bimbó Purpose: This presentation will focus on MRI in the evalution of the following diseases in central nervous system: HIE following hypoxia, PVL, stroke, inflammatory, and congenital diseases. Also we will discuss about connatal CNS tumors (PNET, neurofibromatosis, neuroblastoma, e.c.t.) and child abuses too. More recently it has been applied in abdomen and chest, for vizualisation congenital diseases and tumors. Material and Methods: We examined 96 neonates between 2000–2006 with acute diseases. There were performed in 95 patients 105 examinations (74 head,18 spine,6 abdomen, 6 chest,1 orbit).F/M rate was 50/46. The

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Purpose: We retrospectively analysed the MRI of 37 cases of mitochondrial disorders (complexe 1, 2, 3 or 4 deficiency, Kearns-Sayre syndrome), in order to determine what information it could provide. Material and Methods: 37 children (3 months–20 yearsold) suffering from respiratory chain disorder, benefited from brain MR examination, including conventionnal sequences and diffusion imaging systematically. Monovoxel spectroscopy was done in about 50% of cases. Biochemical and MRI results were then correlated. Results: We could not assess a precise biochemical-MRI correlation but determined different pattern: symetrical lesions delineating the anatomy of basal ganglia and brainstem gray matter or rarer lesions occurring predominantly in the cerebral white matter or the cerebellar. Diffusion allowed distinction between recent and old lesions. Spectroscopy inconstantly provided more precise information. Conclusion: MRI is very usefull to suggest the diagnosis of mitochondrial disorder at initial phase and to assess acute decompensation during folllow-up and rarely to provide more specific data. MRI results always have to be correlate to clinical and biochemichal data, no MRI presentation being specific of any type of mitochondrial disorder. Some MRI aspects are highly suggestive of the diagnosis of mitochondrial disorders but rarer presentations have to be

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known (pseudo leucodystrophy, predominant cerebellar lesions). P75 Non-accidental injury to the CNS: the “human shield” phenomenon Manana Pienaar, Andrew Brandt, Savvas Andronikou, Brand Louw, Gerrit Dekker, Sibusiso Hlongwane, Dirk Van der Merwe Tygerberg Academic Hospital, University of Stellenbosch Purpose: We are constantly confronted by a high rate of non-accidental injury (NAI) in children in South Africa. CT and MRI are effective imaging techniques to demonstrate the extent of the injury in the CNS. Our poster is an attempt to maintain awareness of NAI by depicting the serious injuries that can occur. Methods: Selection of two cases referred from our Trauma Unit. In both cases the child was an infant and not the intended victim, but was injured during a domestic dispute, the so-called “human shield” phenomenon. These cases share almost all the attributes similar to NAI’s and in particular, to “human shield” cases. Case 1: an uncontrasted CT head following a stab to the left frontal area. Case 2: CT Thorax and MRI spine following a stab to the back. Results: Case 1: shows a slot fracture, haemorrhagic tract and blood in the lateral ventricle. Case 2: shows a contralateral haemopneumothorax on CT and transection of the cord with a CSF leak on MRI. Conclusion: NAI and shield injuries continue to occur at astonishing rates, our job remains to stay vigilant in detecting the incidents and to accurately define the injury for medical management, legal and social reasons. P76 Intravascular ultrasound of non-coronary arterial pathology in children Derek Roebuck, Clare McLaren, Matt Fenton, Michael Burch Great Ormond Street Hospital Purpose: Intravascular ultrasound (IVUS) is usually used in the evaluation of coronary artery disease in adults, and occasionally in children. The purpose of this poster is to illustrate various pathological processes in non-coronary arteries in children. Methods: IVUS was performed in 16 patient aged 12 months to 16 years. Nine patients were hypertensive, and four had vasculitis of some type. Nine patients

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underwent angioplasty and/or stenting. All procedures were carried out under general anaesthesia, using 4 Fr to 7 Fr femoral arterial access. Intraarterial heparin (56 to 114 U/kg) was given in all cases. 25 MHz or 40 MHz monorail probes were introduced over 0.014-inch guidewires. There was one minor complication (small groin haematoma). Results: Various forms of arterial pathology were demonstrated, including aneurysm and arterial wall abnormalities associated with fibromuscular dysplasia, neurofibromatosis type 1 and large-vessel vasculitis. Iatrogenic lesions included pseudoaneurysm, dissection, stent fracture and in-stent restenosis. Conclusion: This preliminary study shows that IVUS has great potential in the evaluation of non-coronary arterial pathology in children. IVUS shows abnormalities of the arterial wall that can not be seen at angiography. A weakness of this study is that direct comparison with pathological specimens is not currently available. P77 Wondering spleen in differential diagnosis of acute abdomen Manuela De Vivo1, Miriam Pasqualini1, Enrico Paci1, Bianca Lattanzi2, Gianfranco D’Angelo3, Giancarlo Fabrizzi1 1- Ospedali Riuniti Di AnconaPresidio Materno Infantile. 2- Università Politecnica delle MarcheScuola di Specializzazione in Pediatria. 3- Università Politecnica delle MarcheClinica di Pediatria Purpose: The aim of this study is to emphasize the wandering spleen as a rare but possible cause of acute abdomen in childhood. The congenital form of WS is due to the failed development of its primary ligamentous attachment; the spleen may be anywhere within the intraperitoneal cavity and may twist on its pedicle. Material and Methods: We report three cases of 2– 10 month old babies presenting with crying spells, anorexia and vomiting for some days. US and Doppler US were used for diagnosis. dCT detected WS and delineated other anatomic relations; Tc 99 scans showed splenic displacement as well as its functional state. Results: US examination performed during a fit of pain showed displacement of splenic hilum, being opposite to kidney hilum, a thickened capsule and fluid collection. Doppler Ultrasonography showed blood flow preserved only in splenic hilum. Definitive treatment was surgical, requiring splenopexy after detorsion or splenectomy.

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Conclusion: WS is rare in children but should be considered in the differential diagnosis of acute abdomen because its treatment is surgical and cannot be deferred. Doppler US examination and CT are the safest tests for diagnosing a WS and its complications.

P78 Utility of US in childhood abdominal trauma due to not significant causes Miriam Pasqualini1, Manuela de Vivo1, Valeria Bolli1, Cecilia Lanza1, Vittoria Galeazzi1, Alessandra Mazzantini2, Giancarlo Fabrizzi1 1- Ospedali Riuniti Di AnconaPresidio Materno Infantile “Salesi”. 2- Università Politecnica delle MarcheAncona Purpose: We carried out a retrospective analysis of unexpected abdominal injuries shown by our study; all patients were examined for slight abdominal pain or minimal hematuria. In all patients we found posttraumatic lesions, often due to not significant causes and sometimes untraceable in anamnestic data. Material and Methods: Over a period of two years we treated 18 patients aged 6 days 13 years, who had been sent to our pediatric emergency department after playing accidents; only three had already been admitted to hospital for recurrent abdominal painful and septic state. MRI or, in few cases, CT scan was performed following sonography. They all were admitted to the surgical or intensive care department and had a highly successful non-operative management. We used sonography to identify minimal lesions and to control therapy. Results: We found 5 cases of pancreatic injuries, with complete or incomplete fracture, 4 patients with liver injuries, 1 childbirth hematoma, 5 renal traumas, 1 suprarenal hemorrhage, 1 pancreatic macrocyst and 1 spleen abscess. Conclusions: Ultrasonography, as a first-choice examination, has proven highly helpful in the diagnosis and follow up of patients with minimal blunt abdominal trauma.

P79 Malignant bone tumors in pediatric age — spectrum of imaging findings Ana Almeida1, Pedro Madaleno2, Fernando Pires3, Miguel Castro1, Catarina Silva4, Anabela Braga1, Alberto Vieira1 1- Hospital de São João, Porto. 2- Hospital Infante D. Pedro, Aveiro. 3- IPOFG, Porto. 4- Hospital Pedro Hispano, Matosinhos

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The purpose of this educational exhibit is to review the imaging findings, with emphasis in MRI, of malignant bone tumors in the pediatric population. Malignant bone tumors are a relatively uncommon clinical problem in pediatric age. The most common primary tumors of the bone in this population are osteosarcoma and Ewing’s sarcoma; it may also be affected by metastasis from solid or hematogenic neoplasms. Clinical symptoms are not very helpful in the differential diagnosis of this group of tumors; awareness of the typical location, age of onset, associated diseases and the spectrum of findings in the different imaging methods may help the radiologist to predict the histologic diagnosis. MR has a crucial role in the evaluation of the local extension of the disease, allowing the planning of a more appropriate treatment. The authors present a pictorial essay of the imaging findings of the most frequent malignant bone tumors in children. An accurate knowledge of the clinical and imaging findings of pediatric malignant bone tumors allows the radiologist to predict the definitive diagnosis and is essential to the correct staging of these tumors.

P80 Radiologic-pathologic correlation in congenital mesoblastic nephroma (CMN) Gulraiz Chaudry, Munire Gundogan, Bo Ngan, Alan Daneman The Hospital for Sick Children, Toronto, Canada Purpose: To define imaging findings in CMN more consistent with certain histological varieties. Materials & Methods: Review of imaging and pathology in 20 infants (14M, 6F). Results: Age range 1 d–23 m (Mean 3.7 m). All tumors were unilateral. Sonography (US) in 18 revealed a mass that was mixed solid and cystic in 8; predominantly cystic in 2; predominantly solid in 3 and completely solid in 4. A well-defined hypoechoic rim was seen in 5. CT correlated well with the US appearances, and central hemorrhage was better demonstrated in 5. MRI in 1 showed a well defined mass with central loss of signal due to hemorrhage. Pathology findings were consistent with typical CMN in 8, whilst the more aggressive cellular variant was diagnosed in 11. One tumor was described as ‘mixed’. A hypoechoic vascular ring and solid or predominantly solid tumors were much more common in the typical group. No metastases seen in any, but recurrence of tumor noted in 2 with the cellular variant. Conclusions: CMN varies markedly in appearance. Findings more suggestive of the typical variety include a vascular

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ring and a greater solid component. Local recurrence of the tumor is more consistent with the cellular variant. P81 Correlation between echosonographic and pathohistological findings in children with acute appendicitis Polina Pavicevic, B. Vucinic, V. Vukadinovic, Z. Smoljanic, Dj. Saranovic University Childrens Hospital Purpose: To correlate the echosonographic appendicular and periappendiceal parametars with pathohistological findings in children with appendicitis and to evaluate the sensitivity, specifity, negative and positive predictive value of achosonography in diagnosis of acute appendicitis. Material and Methods: For this prospective comparative study, 61 children(male/female 32/29; mean age 9,1 years)with suspected acute appendicitis were examined. Echosonography of appendix was performed in all children preoperatively and appendectomy carried out. The final diagnosis was based on histological examination of appendix. Different appendicular and periappeniceal parametars were evaluated and than correlated with patohostological results in all 61 children wich were operated. Results: In 58 children (95%)different stage of acute appendicitis was histologically confirmed, and the dominant ph result was appendicitis phlegmonosa in 46,7%,. The correlation between echo and ph findings revealed: the diametar of appendix above 9 mm highly sugestive for progressive stage of inflamation, the structurale changes of the appendiceal wall and hiperechogenity of the mesenteric fat are caracteristic findings for gangrenose and perforating appendicitis, appendicolith indicated phlegmonose and gangrenose, loculated fluid sugesting phlegmonose and gangrenose appendicitis, and visualisation of focal collection is indicating perforation. The overall sensitivity was 92%,specifity 96%, positive predictive value 96% and negative predicitive value 88%. Conclusion: Echosonography should be the primary imaging modality in all children with suspected appendicitis.

P82 Fibromatosis colli (FC): sonographic findings and clinical correlation Gulraiz Chaudry, Rita Damignani, Kamaldine Oudjhane The Hospital for Sick Children, Toronto, Canada

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Purpose: To correlate sonographic (US) appearances of FC with clinical assessment and length of physiotherapy treatment. Materials and Methods: Review of US findings in 24 infants (10F, 14 M, age 2–13 w) with FC referred to physiotherapy. Clinical assessment was assessed as size of mass on palpation (graded 0–4), and passive range of motion (graded 0–4). The type and total length of treatment was recorded. Results: A well defined mass was seen in 13 infants, with hypoechoic surrounding muscle in 5 (Group I) and speckled areas of increased echogenicity in 8 (Group II). Fusiform enlargement and diffusely increased echogenicity was seen in 10 (Group III). In one a contracted muscle with echogenic fibrotic strand was noted (Group IV). The grading on palpation correlated well with the US findings, averaging 1.6 for Group I and 3.1 for Group 3 (p=0.008). There was no significant correlation of US findings with degree of rotational deficit or length of treatment. Conclusions: There is significant variability in the US appearances of fibromatosis colli, which correlate well with the initial clinical palpation. However, the findings do not appear to have any significant predictive value in assessing the length of treatment.

P83 Sonographic imaging of thyroid disease in childhood: a pictorial review Marina Vakaki, Anna Hountala, Michalis Leodis, Pandora Papadoniou, Asteroula Papathanasiou, Charalabos Chatziathanasiou, Chris Koumanidou Children’s Hospital Although thyroid disease is more common in adults, it does occur in childhood and sonography plays an important role in its evaluation. Purpose of this exhibit is to present the embryology and sonographic features of a wide spectrum of pediatric thyroid disorders. To highlight the role of sonography in their imaging evaluation and to familiarize young Pediatric Radiologists with their key imaging features. The sonographic features of various thyroid disorders, supplemented by embryologic correlation or/and other imaging methods when necessary, are illustrated. They include congenital thyroid disorders (ectopic or absent thyroid, infantile goiter, thyroglossal duct remnants etc), benign thyroid masses (adenoma, degenerative nodules, colloid and thyroid cysts), malignant masses (follicular, papillary and medullary carcinoma) and diffuse thyroid disease (inflammatory conditions, such as acute suppurative thyroiditis, and autoimmune processes, including Hashimoto’s thyroiditis and Grave’s disease). The sonographic

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pitfalls, key imaging features and differential diagnoses are discussed. In conclusion, thyroid disease does occur in young patients, from birth to adolescence. Sonography is the primary imaging method in its evaluation. Knowledge of the normal sonographic appearance, the differential diagnosis and sonographic features of the various thyroid disorders in children is of outmost importance to arrive at the prompt diagnosis and proper treatment.

P84 Thyroid and cricoid cartiladge in childhood: sonographic patterns Marina Vakaki, Anna Hountala, Andreas Simopoulos, Rodanthi Sfakiotaki, Chris Koumanidou Children’s Hospital Purpose: To present the different sonographic patterns of cricoid (CC) and thyroid cartilage (TC) in healthy children. To familiarize Pediatric Radiologists with them to avoid misdiagnosis or diagnostic dilemmas. Material and Methods: The TC and CC of 118 healthy children, aged 2–14 years were prospectively evaluated in sagittal and transverse planes during the sonographic examination of the thyroid gland/neck using high-definition 5–12 MHz transducers. Results: In sagittal sections, the CC was demonstrated as a round/oval slightly hypoechoic structure, 1–2 cm in diameter, with a thin anechoic peripheral layer adjacent to the upper part of each thyroid lobe. The TC appeared as an ovoid slightly more echogenic structure in a higher level than CC. In transverse sections, CC and TC were depicted as thin echogenic layers between each thyroid lobe and the infraglottic air column or on either side of the air, respectively. Various patterns of calcification were seen within the CC in 48 children (40%), 7–14-y old. Their number and size increased with age. No calcifications were detected within the TC. Conclusion: Both sides of CC and TC are readily seen on sonography. Awareness of their sonographic patterns in childhood should prevent a potential diagnostic pitfall and further unnecessary investigation.

P85 Internal jugular venous ectasia in children: sonographic evaluation Marina Vakaki, Rodanthi Sfakiotaki, Eugenia Dagiakidi, Chris Koumanidou Children’s Hospital

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Internal jugular venous ectasia represents a rare benign vascular anomaly. It may present with intermittent lateral cervical swelling increasing in size on coughing or crying. The aim of this study is to present the sonographic findings of this clinical condition. During a 4-year period, 19 children, 1- to 13-year-old with intermittent lateral cervical swelling, varying in size, were sonographically evaluated with high-frequency 5–12 MHz transducers. Parents had noted that swelling enlarged on crying or coughing. The children had no dysphagia, hoarseness of voice, or shortness of breath. In all cases, sonography supplemented by Color and pulsed Doppler examination showed marked fusiform dilatation of the ipsilateral internal jugular vein (right n=13, left n=6), corresponding to internal jugular venous ectasia. The anteroposterior diameter of the ectatic vein was greater than that of the contralateral one. No extrinsic compression or internal thrombus was revealed. The vessel size increased at least to 1.5 times during Valsava maneuver or on crying/coughing due to increased intrathoracic pressure. To the best of our knowledge, the sonographic findings of internal jugular venous ectasia haven’t yet been emphasized. Pediatric Radiologists, when aware of this unusual entity, performing the sonographic neck examination, hold the key of the diagnosis.

P86 Computed tomographic angiography of the anomalies of the aorta in children Márcia Andreia Teixeira de Holanda Cabral, Lisa Suzuki, Silvia Maria Sucena Rocha, Bety Karpovas Chisman, Márcio Ricardo Taveira, Luciana Tutida, Marcelo Valente, Luis Carlos Nogueira Bogus, Ricardo Lange, Luis Antônio Nunes Oliveira Instituo Da Criança HcFmusp Objectives: To demonstrate cases of congenital and acquired vascular anomalies of aorta in children, identified in computed tomographic angiography (CTA). Material and Methods: CTA examinations of aorta, performed at “Instituto da Criança of the Hospital das Clínicas of the Universidade de São Paulo (Brazil)” from January 2005 to January 2007 have been evaluated retrospectively. All the examinations have been carried through in device Computed Tomography of four canals, (LightSpeed QX/i- GE Medical Systems, EUA), after the injection of non-ionic iodized contrast, according to standardized protocol. The images had been postprocessed in workstation Advantage Windows Workstation, version 4.2, GE Medical Systems, Milwaukee, EUA.

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Result: Cases of congenital and acquired anomalies of aorta, surch as coarctation of the aorta, anomalies of the arc, Takayasu arteritis and its respective prevalence are presented in the studied population. Conclusion: CTA is a method of excellent diagnostic quality in the evaluation of aorta diseases in children and represents an advantageous alternative to Angiography in pediatric population, once CTA is less invasive and of quicker execution than Angiography.

P87 Imaging of anorectal malformations Choon-Sik Yoon, Jin Hur, Myung-Joon Kim Dept. of Diagnostic Radiology, Yongdong Severance Hospital, Yonsei University College of Medicine Purpose: To understand the complex embryonic development and anatomy of anorectal region and types of anorectal malformation, and to know imaging findings of anorectal malformation and associated anomalies according to the imaging modality. Materials and Methods: Many developmental anomalies are depicted at anorectal region due to the complex embryonic development. The classification and differentiation between high and low types of anorectal malformation are important. Babies with anorectal malformation may have associated anomalies esp. in lumbosacral spine and urinary tract and fistular tracts. We used various imaging modalities including contrast enema study, ultrasonography, and MRI. Results: We will exhibit the anatomy of anorectal region and many findings from various imaging modalites according types of anorectal malformation. Also we will demonstrate various other anomalies accompanied with anorectal malformation. Conclusion: Understanding of complex development and anatomy of anorectal region is important. Various imaging modalities including constrast study, ultrasonography, and MRI are essential to define the types of anorectal malformation and evaluate total extent of associated anomalies.

P88 Post traumatic abdominal aneurysms in four pediatric cases Mehrak Anooshiravani1, Luca Spadola1, Pierre-Alain Schneider1, Laura Merlini1, Yasmine Sayegh1, Georgio Lascala2, Sylviane Hanquinet1 1- Dept of Radiology Geneva University Hospital. 2- Dept of Pediatric Surgery Geneva University Hospital

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Purpose: Although abdominal aneurysms are uncommon in the pediatric population, they must be carefully searched for on follow-up US studies performed in children with severe abdominal trauma. Material and Methods: In the past three years we have observed four cases of arterial aneurysms in children aged between 3 and 16 years having undergone high-energy traumas: two intrarenal aneurysms, one splenic artery, and one case of aortic abdominal aneurysm. US (+doppler) and CT were performed in all and one child underwent abdominal angiography with embolization. Results: Aneurysms were discovered on ultrasounds performed one to two weeks after the traumatic event. They were all relatively small in size varying between 10 to 15 mm and none was complicated by a rupture. The two renal lesions were treated conservatively and were no longer found on follow-up US studies. The splenic aneurysm was treated successfully by selective embolization. The abdominal aortic aneurysm, also treated conservatively, decreased in size on follow-up. Conclusions: In the pediatric population, US is a valuable tool in depicting post traumatic abdominal aneurysms, a relatively rare but serious condition. In our series three out of four cases were treated conservatively and did well on follow-up.

P89 Imaging findings of Burkitt lymphoma in children Jee-Eun Kim, Yu Mi Jeoung Department Radiology, Gachon University of Medicine And Science, Gil Medical Center Purpose/Aim: 1. To review the pathological and clinical behavior of Burkitt lymphoma. 2. To know the imaging findings of Burkitt lymphoma according to the involvement site. 3. To afford an accurate assessment of disease extent and provide important prognostic information Materials & Methods: We retrospectively reviewed histologically proven cases of pediatric Burkitt’s lymphoma from 2000 to 2006. We analysed presenting sites of tumors, clinical and pathological presentations, and radiologic findings of Burkitt’s lymphoma. Results: 1. Type of pediatric NHL. 2. Review of clinical presentations and pathologic findings of Burkitt lymphoma.

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3. Imaging findings of Burkitt lymphoma –

Head and Neck involvement – – –

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Intracranial involvement – –

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Cervical lymphadenopathy, PNS with extension to orbit and maxilla Adenoid involvement

compared to other cross-sectional imaging. In particular, perianal abnormalities and fistulous communications were more confidently identified. Conclusion: MRI is a sensitive modality in the diagnosis of Crohn’s Disease. It is better at characterising the abnormalities and delineating the extent of involvement. It has the additional advantages of not requiring radiation and can screen the rest of the abdomen for co-existing pathology.

Cavernous sinus, PNS with extension to infratemporal fossa

Thoracic involvement Abdominal involvement

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MR imaging of soft tissue tumours in children Pedro Madaleno 1 , Ana Almeida 2 , Fernando Pires 3 , Conceição Guerra2, Alberto Vieira2 1- Hospital Infante D Pedro, Aveiro. 2- Hospital de São João, Porto. 3- IPOFG, Porto.

Mesenteric LNs, pancreas, kidney, appendix

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Other sites

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Paraspinal area

Conclusion: 1. Typical clinical presentation of Burkitt lymphoma is one of a rapidly enlarging mass. 2. Most common presenting site is abdomen. 3. Familiarity with the usual and unusual findings of Burkitt lymphoma facilitates accurate differential diagnosis.

P90 MRI of Crohn’s disease in children Charuta Dagia, Michael Ditchfield, Anthony Catto-Smith, Michael Kean, Kieren Gara The Royal Children’s Hospital

Objectives: To review the utility of abdominal MR in the management of Crohn’s Disease and correlate the MR findings with conventional imaging modalities and surgery. Methods: A retrospective review of 28 consecutive patients [ages 7–21 years] with suspected Crohn’s Disease was performed. The cases were identified from the radiology information system database of a tertiary paediatric institution. All patients underwent an abdominal MRI between 2005 & 2007. The studies were performed following bowel preparation and oral Sorbitol. T1, T2 and post-contrast sequences were obtained. The imaging was reviewed by two paediatric radiologists. The findings were correlated with conventional imaging including GI contrast studies, ultrasound and CT and operative findings. Results: There was a high correlation of conventional imaging and MRI findings. MRI demonstrated more disease than gastrointestinal contrast studies and was superior at characterisation and extent of involvement when

The purpose of this educational exhibit is to illustrate MR imaging findings of soft tissue tumours in children. Soft tissue tumours are a heterogeneous group of lesions and a relatively common problem in children. The clinical presentation is often not helpful in the correct diagnosis, and frequently needs further evaluation. The differential diagnosis of soft tissue tumours in children is wide, and although most lesions are benign (the malignant soft tissue tumours are rare, and account for about 6% of all pediatric malignancies), an accurate clinical history and examination, as well as imaging studies can aid in determining the correct diagnosis. MR, with its multiplanarity and highresolution capabilities, plays a major role in the characterization and evaluation of the disease. The authors present a comprehensive review of the different types and MR imaging features of soft tissue tumours in children. Awareness of the most characteristic MR imaging findings can make the difference in the study of pediatric soft tissue tumours, since MR is becoming the imaging modality of choice in the diagnosis, staging and follow-up of these tumours.

P92 MR imaging of osteoid osteoma in children Zeynep Yazici, Naile Bolca, Ercan Tuncel Uludag University, Faculty of Medicine, Department of Radiology Purpose: Pediatric cases of osteoid osteoma with nonspecific symptoms and/or inconspicuous roentgenograms usually undergo MR imaging. The aim of the study is to evaluate the MR features of osteoid osteoma. Materials and Methods: MR images of 14 patients (age range, 6–16 years) were retrospectively reviewed. Location

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of the lesions was the femoral neck (n=5), tibia (n=2), fibula (n=2), talus (n=2), vertebra (n=1), acetabulum (n=1), and calcaneus (n=1). Results: The nidus located within the cortex of tibia and fibula could clearly be identified on MR images. Those within femoral neck and vertebra could not be demonstrated. However, three of femoral neck lesions could retrospectively be identified with enhanced MR images. In the other bones, T2-weighted and/or enhanced MR images demonstrated the nidus with greater conspicuity than T1-weighted images. There were perinidal marrow edema in all cases and soft tissue edema in some. Lesions in the femoral neck and talus accompanied with synovitis. Conclusion: Demonstrating the nidus may be difficult with MR. Besides; nonspecific, reactive surrounding tissue changes are usually present. Therefore, MR imaging may be misleading. In children with these MR findings, more effort should be made to identify the nidus with MR imaging or the patients should undergo CT scanning.

P93 Practical ultrasonographic approach in differential diagnosis of biliary atresia and neonatal hepatitis Jung-Eun Cheon, Woo Sun Kim, In-One Kim, Ahyoung Jung, Su Mi Shin, Kyung Mo Yeon Seoul National University Children’s Hospital Purpose: To assess the usefulness of practical US approach in differential diagnosis of BA from NH. Materials and Methods: Seventy neonates and young infants who were suspected of having BA or NH were evaluated (mean age: 60.3 days, M:F=37:33). US examination was performed using 7–12 MHz transducers by two pediatric radiologists. We defined US findings suggesting BA as atretic GB, triangular cord sign, biliary cyst or enlargement of the hepatic artery (>1.5 mm) in the porta hepatis. Visualization of the CBD was thought to be a finding excluding BA. If the findings of the GB and the porta hepatis were discordant, we followed the findings of the porta hepatis. Final diagnosis was BA in 39 patients and NH in 31 patients. Results: In 39 patients with BA, 30 patients showed concordant US findings between GB and the porta hepatis. Among 7 patients with non-atretic GB, porta hepatis showed US findings suggesting BA. When we combined US findings of GB and porta hepatis suggesting BA weighted on US findings of the porta hepatis, diagnostic performance was enhanced up to 94%. Conclusion: When US findings of the GB and the porta hepatis are discordant, follow the findings of the porta hepatis.

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P94 Volume organ rendering by interactive image segmentation (VORIS) improves reproducibility in the volume calculation of fetal cerebral structures (FCS) Nelly Fabiola Padilla Gomes, Juan Carlos Bello Muñoz, Andres Benavides Serralde, Edgar Hernandez Andrade, Eduardo Gratacos Hospital Clinic Objective: To evaluate the reproducibility of measuring 3-D volumes of FCS using Virtual Organ Assisted Computerized Analysis (VOCAL®), and Volume Organ Rendering by Interactive Image Segmentation (VORIS) based on the itk-SNAP tool for segmentation and registration of the Visible Human Project. Methods: Volumes of the thalamus and cerebellum were obtained and stored twice in 40 normal fetuses at 24 weeks of gestation by two operators. VOCAL and VORIS were applied to calculate the volume of these structures. Limits of agreement (LA), and intra (Intra-CC) and inter (InterCC) class-correlation coefficients, with 95% confidence intervals (95% CI) were calculated. Results: Thalamus: Intra-CC, VORIS 0.83 (0.720.93), VOCAL 0.48 (0.120.60); Inter-CC, VORIS 0.70 (0.410.95), VOCAL 0.40 (0.050.71). 95% LA, VORIS −0.05 (−0.3–0.29), VOCAL −0.11 (−1.06–0.84). Cerebellum: Intra-CC, VORIS 0.87 (0.720.93), VOCAL 0.78 (0.320.89); Inter-CC, VORIS 0.71 (0.580.85), VOCAL 0.68 (0.380.81). 95% LA, VORIS 0.21 (−0.74–1.17), VOCAL −0.23 (−1.31–0.85). Conclusion: VORIS shows a better reproducibility and agreement than VOCAL in the volume calculation of FCS.

P95 Non tumoral ovarian diseases in teenagers: benefit of MRI Céline Falip, Anne-Elodie Millischer Bellaïche, Valérie Merzoug, Catherine Adamsbaum, Gabriel Kalifa Saint Vincent De Paul Hospital Purpose: The aim of this poster is to propose a pictorial review of the main US and MRI findings of some non tumoral ovarian entities seen in teenagers. Material and Methods: In teenagers, functional disorders represent the great majority of ovarian diseases: this group includes mainly functional cysts (luteal or follicular), and, less frequently, ovarian hyperandrogenism (polycystic ovary syndrome). Endometriosis has also to be considered in this age group. Too often, dysmenorrhea is considered as « functional » and the correct diagnosis

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of endometriosis is made later if the patient presents with infertility. As in adults, pelvic ultrasonography is the first diagnostic method but in this age group, is restricted to suspubic approach. Results and Conclusion: When polycystic ovary syndrome (increased volume of spheric ovaries, obesity and hirsutism) or endometriosis (hemorrhagic cyst in a context of dysmenorrhea) are suspected, MRI is very contributing to confirm the diagnosis and modify the management of these patients. Differential diagnosis will be presented. These diseases which are not enough considered by paediatric radiologists deserve a better attention.

P96 Feasability of dynamic MRI for evaluating velopharyngeal insufficiency Cyrine Drissi1, Marc Mitrofanoff2, Chantal Tallandier3, Céline Falip1, Vincent le Couls4, Catherine Adamsbaum1 1- St Vincent De PaulRadiology. 2- St Vincent de PaulSurgery. 3- St Vincent de PaulOrthophony. 4- Siemens France

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P97 Video display terminal syndrome and radiologist; why is it important? Seong Su Hwang The Catholic University of Korea, Depart. of Radiology, St. Vincent hospital, Suwon, Korea Learning Objectives: To review potential risk and prevention of video display terminal (VDT) syndrome for radiologists under PACS environemnt. Material and Methods: 1. Introduction of VDT syndrome 2. what is VDT syndrome? 3. Radiologist Potential risk of VDT syndrome under modern PACS environment 4. Prevention of VDT syndromeadjusting radiologist’s work habit causing VDT syndromeimproving working place environmentdemostration for recommanded physical excersises to prevent VDT syndrome. Conclusion: Many radiologists may have potential risk of VDT syndrome under modern PACS workplace. Awareness of VDT syndrome with its pervention may be essential to radiologists.

P98 Purpose: To demonstrate the feasibility of dynamic MRI with near-real-time temporal resolution for analyzing the velopharyngeal closure. Materials and Methods: Five patients (5–7 years old, mean: 6.4) with suspected velopharyngeal insufficiency, and one healthy volunteer underwent MRI (1,5 Tesla, Siemens) using T2 HASTE and TRUFI sequences. Imaging was done at rest and during various phonations in transversal and sagittal planes. The images were analyzed by two radiologists, a plastic surgeon and an orthophonist. Results: The MRI examinations were well tolerated by even the youngest patient. Sagittal HASTE sequences were of good quality and enabled correct positioning for the orthogonal TRUFI sequences. A qualitative analysis found that the sagittal dynamic sequences during phonation were in relation to the clinical data in all patients. A quantitative analysis enabled calculation of the velar eminence angle in relation to the hard palate and the percentage of reduction of the antero-posterior diameter of the pharyngeal lumen. Conclusion: Currently, functional visualization of the velopharynx requires tests that are either invasive (endoscopy) or that impose radiation exposure (videofluoroscopy). This preliminary study confirms the previous data by showing that MRI is a non invasive and repeatable method for examination of velopharynx for decision-making for surgery.

Cardiac findings in anorexic girls and after a refeeding period of 6 months Martine K.F. Docx1, Cecile Hoskens2, Philippe Vandenberghe1, Jose Ramet3, Luc Mertens4 1- Koningin Paola Kinderziekenhuis Department of Paediatric Cardiology. 2- Koningin Paola Kinderziekenhuis Department of Paediatric Radiology. 3- Koningin Paola Kinderziekenhuis Department of Paediatrics. 4- Gasthuisberg Leuven, Belgium Department of Paediatric Cardiology Introduction: Anorexia nervosa (AN) is a life-threatening disease and 1/3 of the deaths are due to cardiac complications. Aim: Compare heart abnormalities in 18 anorectic adolescents at diagnosis and after 6 months special eating education. Methods: 18 AN girls (11,3–17,9 year) who fulfilled the DMS-IV criteria for AN were evaluated at admission and after 6 months. The inclusion of the study was a clinical history that was anamnestically negative for known cardiac diseases, a physical examination, a 12-lead ECG and a echocardiogram (2D, Doppler). Left ventricular mass (LVM) was calculated according to the Penn Convention (Devereux et al. 1986). The same cardiac examinations were repeated after 6 months therapy. Results: AN Admission 6 Months P-value Number 18 18 BMI (kg/m2) 14,76±1,53 17,08±1,40<0,001 Heart rate (bpm) 60,06±22,27 70,5±11,01 0,04 LVM(g) 75,61±18,70 97,33±27,05 0,004 LVM/height2,7(g/m2,7) 25,70±5,22

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31,63± 5,40 0,001 QTc dispersion(msec) 43,56± 25,70 24,89±17,41 0,008 Summary: After 6 months treatment and weight recovery, there is a significant increase in LVM, LVM/height 2,7 and heart rate (p=0,04) and a decrease in QTc dispersion (p:0,008). Conclusion: Although the short term findings are positive, we recommend a long term follow-up for these patients who are on a continuous risk for relapse. Especially the cumulative effect of “jojo”AN episodes on the myocardium is unknown.

P99 Neonatal group B Y – â-hemolytic streptococcus meningitis: clinical and neuroimaging findings Soo Ah Im1, Jee Young Kim1, Gye-Yeon Lim1, Jung Hyun Lee2 1- Department of Radiology, Kangnam St. Mary’s Hospital. 2- Department of Pediatrics, Kangnam St. Mary’s Hospital Purpose: We investigated the clinical and US, CT and MR manifestations of neonatal GBS meningitis, and focused on the clinical course and imaging characteristics of proven GBS meningitis. Materials and Methods: We collected 12 cases of proven GBS meningitis in neonates in our hospital from Jan 2000 to June 2006 (M:F=5:7, mean age; 24 days, 9–63 days). All cases had normal birth weight with full term delivery. Associated GBS sepsis was present in 5 patients (42%). US (n=3), CT (n=11), and MR (n=24) images obtained from 12 patients were retrospectively reviewed. Correlation of imaging findings was done with clinical outcome. Results: There were abnormal brain US, CT, or MR findings in 9 cases (75%), such as infarction (42%), hemorrhage (42%), effusion (33%), ventriculitis (8%), and hydrocephalus (8%). All cases were alive with (n=8) or without (n=4) neurologic complications. Cerebral infarction was commonly related with neurologic complication and other findings were improved or resolved without neurologic sequela. Conclusion: In Korea, neonatal GBS meningitis was developed in full term and normal birth weight infant with late onset type. Common imaging findings of GBS meningitis were cerebral infarction, hemorrhage, and effusion. Among them, cerebral infarction was key finding related to neurologic outcome.

P100 Ovarian disorders involving the pediatric population: clinical-radiologic-pathologic correlation PAB Albuquerque, DA Morales, C Bernard, I Maiansky, L Carpineta, C Saint-Martin, R Faingold The Montreal Children’s Hospital

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Purpose: To review and illustrate the clinical, radiological and pathological findings of the most common ovarian disorders in the pediatric population. Methods and Materials: A review of our Medical Record data of ovarian abnormalities between 1999 and 2006, and a review of the medical literature of ovarian disorders involving the pediatric age group. The imaging, clinical and pathological features described in the literature were reviewed and correlated well with the respective findings on our database. Results: Several conditions are described to affect the ovaries in the pediatric population. These include nonneoplastic and neoplastic pathologies, such as functional and hemorrhagic, dermoid cysts, tuboovarian abscess, torsion, cystadenofibromas, mature cystic teratomas, germ cell tumors, mucinous and serous papillary cystadenomas. In most cases, the data correlated well with the features described in the current literature. Conclusion: Ovarian pathologies is described from the fetal to the adolescent age group. Some have typical clinical and radiological presentations and the diagnosis can be made based on these features only. However, others have similar clinical and radiological findings and can only be definitively differentiated based in the postoperative pathological findings. Knowledge of the different clinical, radiological and pathological characteristics treatment increases the diagnostic accuracy and improves the outcome.

P101 Restrictive dermopathy and oligohydramnios: two case reports with radiologic and pathologic correlation Anil Rao, English Flack, Michael Caplan, Jeanne Hill, Paula Keslar Medical University of South Carolina Restrictive dermopathy (RD) is a rare, but lethal form of skin dysplasia. Abnormal rigid skin causes dysmorphic facies, arthrogryposis and pulmonary hypoplasia. Case reports in the literature mention polyhydramnios. We present two cases of RD with oligohydramnios. Materials and Methods: First baby was born at 28 weeks gestation to a 31-year old G1, P0 woman. Second baby was born at 35 weeks gestation to a 32-year old G4, P2 woman. Both pregnancies were complicated by oligohydramnios and intrauterine growth retardation (IUGR). Both babies had multiple abnormalities involving the skin, face and joints. Autopsy and cytogenetics confirmed RD in the first case. Genetic tests on the second case will be available shortly. We will discuss antenatal sonography findings and fetal MRI (second case) in correlation with radiography, autopsy, pathology and cytogenetics. Results: Rib and clavicle abnormalities were seen in both babies with arthrogryposis and pulmonary hypoplasia. The

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first baby was thought to have renal failure which could explain oligohydramnios. The second baby had calcifications in the liver of uncertain significance yet. Findings differ from oligohydramnios sequence. Conclusion: Oligohydramnios can be associated with RD. Even though diagnosis is by pathology and genetics, radiologists can raise the possibility of this condition.

P102 Pictorial review of the imaging of Gorham’s disease Timothy Higgins, Steven Fishman, Harry Kozakewich, Ahmad Alomari, Horacio Padua, Gulraiz Chaudry Children’s Hospital Boston Learning Objectives: Gorham’s disease is a rare disorder characterized by osteolysis and angiomatous proliferation. Initial diagnosis of the condition is often delayed due to lack of awareness of the condition amongst radiologists. A comprehensive review of the imaging findings is therefore presented. Material and Methods: Retrospective analysis of 39 cases of Gorham’s disease evaluated in the Vascular Anomalies Clinic at Children’s Hospital Boston. Typical imaging findings are reviewed, both at initial presentation and following clinical progression. Modalities studied include plain film, CT, MRI and nuclear medicine. Characteristic clinical presentation, natural history, pathology and treatment options are also briefly reviewed. Results: Pictorial review of the imaging of Gorham’s disease. Conclusion: Gorham’s disease is a rare but potentially devastating condition. This review will outline the typical imaging appearances, aiming to raise awareness and aid in the early recognition of the disease

P103 Relationships between socioeconomic status, body mass index and bone age Kathia Chaumoitre1,4, Saloua Lamtali2, B Essadki3, A Lahman3, Abdellatif Baali2, Gilles Boëtsch4, Michel Panuel1,4 1- Sce d’Imagerie Hopital Nord CHU Marseille, France. 2- Laboratoire d’Ecologie Humaine, Marrakech, Maroc. 3- Sce de Radiologie, Hopital Mohamed VI, Marrakech, Maroc. 4- UMR 6578 CNRS Anthropologie Biologique, Marseille, France Objectives: Evaluation of the relationship between Socioeconomic status (SES), body mass index (BMI) and skeletal maturation in children of Marrakech (Morocco). Material and Methods: Socioeconomic status (SES), body mass index ((BMI; weight (kg)/height2 (m2)) and bone age

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(BA) were analysed in a cohort study of 628 Moroccan children (283 boys and 346 girls ranged 6.6 to 21 y, mean 14.1 y). Bone age estimation was done with the Greulich and Pyle Atlas. Two social groups (privileged and unfavourable SES) were defined according to parents ‘professions and parents ‘study level. Results: BMI in girls was significantly greater than in boys (mean BMI 18.3). There was a global delay of maturation especially in boys. Privileged SES children had a greater BA than unfavourable ones. BMI and BA were significantly linked with increase of maturation in case of overweight. BMI and SES were also linked with high prevalence of favourable SES in case of overweight and high prevalence of non favourable SES in case of underweight. Conclusion: BA was linked with BMI and with SES. Elevated BMI is associated with advanced skeletal maturation probably due to hormonal phenomenon. In developing countries like Morocco, overweight is associated with high SES.

P104 LOW-dose sixty-four slice multidetector computed tomography (64-MDCT) in pediatric patients: technique, applications, limitations Guadalupe Garrido, Ignasi Barber, Pilar García-Peña, Amparo Castellote, Elida Vazquez, Xavier Lacaya, Goya Enríquez. Pediatric Radiology. Vall D’Hebron Hospital Purpose: 1. To describe 64-MDCT technique with its basic principles and modifications in pediatric population. 2. To discuss advantages and disadvantages of the technique and illustrate various examples from children of different age groups. Material and Methods: 169 patients underwent 64-MDCT chest and/ or abdominal examinations during last year. MDCT was performed with an age and weight adjusted lowdose protocol: 120 or 80 kV; 80 to 20 mAs; collimation, 0′ 625 mm; gantry rotation, 0′5 second. Automatic dose modulation was used in all examinations. The radiation dose was evaluated by using the computed tomography dose index (CTDI) and the dose-lengh product (DLP). Results: The age range of the study group was few days to twenty years. At our institution most MDCT examinations were requested for chest evaluation (congenital diseases, broncho-vascular anomalies, mediastinum evaluation and metastatic disease). Helical MDCT has reduced the time of scanning and the need for sedation.

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We used children protocols to improve the optimization of this high-dose imaging modality. Automatic dose modulation provided a slight reduction of the radiation dose. Conclusion: Selection of patients with appropiate indications and cautious determination of CT parameters make MDCT a practical diagnostic tool in pediatric population.

P105 MR brain imaging with periodically rotated overlapping parallel lines with enhanced reconstruction in the neonate: our initial experience Thais Agut, Xavier Krauel, Puy Ramon, Massaguer Sara, Capdevila Antoni Hospital Sant Joan De Déu, Barcelona Learning Objectives: MR brain data acquisition in the non sedated neonates can be technically difficult due to movement. Motion causes image artefacts, a loss of resolution, and a reduction in the signal-to-noise ratio. On the other hand, systematic sedation of all neonates ongoing MR imaging is not free of adverse events. Our aim is to determine whether MR brain imaging with periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) sequence can be useful in MR imaging of the brain in unsedated neonates. Material and Methods: Since we have available 1.5-T magnet at our institution we perform MR for neuroimage assesment for all premature infants with birth weight <1500 g at term equivalent. We have evaluated the MR brain images obtained from 30 consecutive unsedated neonates without sedation. We included T1, T2 and diffusion sequences and PROPELLER T2 FSE. Results: The image quality we obtained with PROPELLER T2 FSE and the conventional T2 FSE did not differ significantly. MR imaging PROPELLER is effective for compensating for head motion and improves grey matterwhite matter differentiation as well as spatial resolution. Conclusions: Propeller sequence might be an alternative for MR imaging brain of the unsedated neonate when we find motions artefacts.

P106 Extensor mechanism injuries of the pediatric knee Carolyn Dupuis1, E Christine Wallace1, Joseph Makris1, Sjirk Westra2 1- UMass Memorial Medical Center. 2- Massachusetts General Hospital

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Learning Objectives: To illustrate the pathological processes affecting the extensor mechanism of the pediatric knee. Material and Methods: The authors retrospectively reviewed images of pediatric knee extensor mechanism conditions that have been collected in two large trauma centers. Imaging included radiographs and/or MRI at first presentation and during treatment and follow up. Results: Pathologic processes can be subdivided into those that involve the patellar tendon attachments (traumatic tibial tubercle avulsion +/− tibial plateau avulsion, Osgood-Schlatter disease, Sinding-Larsen and Johansson syndrome), disruptions of the patellar tendon, pathological conditions of the patella (patellar sleeve fracture, recurrent patellar dislocation/relocation syndrome, delayed ossification/hypoplasia of the patella), conditions of the quadriceps muscle (myositis, synovitis secondary to juvenile rheumatoid arthritis) and avulsion of the superior attachments of the quadriceps (anterior inferior iliac spine avulsion injury). In all cases where MRI was performed, this added important information to the degree of the soft tissue injury associated with the bony and tendinous disruption. Conclusion: The extensor mechanism of the knee is essential to ambulation and is subject to a number of traumatic, congenital and inflammatory processes. MRI is helpful to evaluate associated soft tissue injury in selected cases, which may influence the decision to proceed with surgical intervention.

P107 In vivo targeting of macrophagic activity with MRI contrast agent (USPIO) in an experimental model of neonatal brain lesions Marianne Alison, Robin Azoulay, Pierre Gressens, François Chalard, Guy Sebag Department of Paediatric Imaging, Hôpital Robert Debré, AP-HP, Inserm Unit U 676, Paris VII University Purpose: Ultrasmall Superparamagnetic Iron Oxid (USPIO) have been used for in-vivo MR targeting of macrophage activity in adult animals experimental models and in human brain lesions. The aim of the study is to target in-vivo macrophagic activity of inflammatory neonatal rat brain lesion, mimicking periventricular leukomalacia, on MRI, using USPIO. Material and Methods: Newborns rats (n=10) with right cerebral lesion created by intracranial ibotenate injection at postnatal day 4 (P4) underwent cerebral 1.5 T MRI before (P4) and 72 hours after intraperitoneal ferumoxtran injection (P7) with T1,T2 andT2* weighted sequences and were then sacrificed (P7). Signal to Noise Ratio (SNR)

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of the lesion and Relative Enhancement ratio (RE) of the lesion, before and after injection, were measured and results were correlated with histology. Results: A significant (p<0.05) increased SNR on T1 (mean+300%), decreased SNR on T2 (mean-200%), T2* (mean-450%) and a significant (p<0.05) increase of negative RE of the lesion on T2 (mean-300%) were measured in the lesion after injection. Conclusion: Delayed positive enhancement on T1 and negative enhancement on T2/T2* of neonatal rat brain lesion were disclosed 72 hours after USPIO intraperitoneal injection, consistent with macrophagic imaging.

P108 Prenatal diagnosis of congenital laryngocele: fetal MRI and postnatal follow-up. Case report Claudio Fonda, Tiziana Pellegrini, Cecilia Cesarini, Bruno Noccioli, Ettore Cariati Meyer Children’s University Hospital Introduction: The larynx develops from the fourth and fifth branchial arches. The laryngeal ventricle is a fusiform fossa bound by local folds and the false vocal folds. The saccule is a cecal pouch of mucous membrane found in the anterior roof of the ventricle. Laryncocele is an abnormal dilatation of the saccule which communicates with the lumen of the larynx and is filled by air or mucous. Case report: Fetal MRI was performed at 29th G.A. for diagnostic US suggestion of neck cystic mass. SS-TSE ECHOPLANAR imaging was obtainded on the three fetal orthogonal planes. ADC map confirm the cystic nature of the neck mass, 3 cm large, with dislocation of trachea and neck and thoracic inlet vessels. Birth delivery with EXIT procedure. MRI and MDCT after birth, evidence the mass with air fluid level indicating the communication with upper airways. CT virtual endoscopy suggest the origin and comunication with laryngeal lumen at the level of saccule differentiating the cystic mass from other branchial remnants. Conclusion: Congenital Laryngocele are a rare abnormality of development of laryngeal structure. Prenatal diagnosis, in particular MRI, may suggests the correct diagnosis in order to avoid upper ways compression during delivery and scheduling EXIT procedures.

P109 Radiologic findings in digestive tract duplications Enrique Marcos, Hector Cortina, Natalia Madroñal, Amparo Moreno Hospital Infantil La Fe

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Aim: To demonstrate the usefulness of the different imaging techniques in diagnosis and management of digestive tract duplications. Material and Methods: Retrospective study of 19 patients with digestive tract duplications in the last 34 years in our hospital. Imaging studies of 11 boys and 8 girls aged between two days and 7 years old were reviewed. Simple radiography was the first imaging technique realized, going on with abdominal ultrasound (US) or barium studies in function of location of the initial findings. Computed tomography (CT) was performed in 10 patients. Results: The most frequent location found for duplications was the small bowell (6 patients), following by the stomach (5), the esophagus (4), the colon (3) and duodenum (1 case). US proved the cystic nature and location of the mass with an inner echogenic mucosal layer and an adjacent hypoechoic muscle layer (the double ring sign). Duplications appeared on CT like masses smoothly rounded without enhancing walls. Conclusions: Simple radiography suggests the diagnosis and the following imaging technique to be permofed. CT and MR are not indicate in the screening, but they provide useful anatomic information. Ecography is useful in diagnosis of enteric duplications if the typical double ring sign is identified.

P110 Correlation between HRCT lung abnormalities and clinical GVHD after allogenic versus autologus hematopoietic stem cell transplantation in children Irene Borzani1, Laura Merlini1, Isabelle Rochat2, Mehrak Anooshiravani1, Ayse Hulya Ozsahin3, Sylviane Hanquinet1 1- Pediatric Radiology Unit, University of Geneva Children’s Hospital. 2- Pediatric Pneumology Unit, University of Geneva Children’s Hospital. 3- Pediatric Oncology Unit, University of Geneva Children’s Hospital Objective: To investigate the correlation of late-onset noninfectious pulmonary complications (LONIPs) with graftversus-host-disease (GVHD) after allogenic hematopoietic stem cell transplantation (HSCT). Comparison between allogenic versus autologus HSCT. Patients and Methods: We performed 67 HRCT in 19 children after HSCT, 13 allogenic and 6 autologous. The two groups of patients were similar for stage of disease at transplantation, and all received a standard conditioning prior to HSCT. We recorded the presence and the clinical outcome of pulmonary abnormalities at HRCT (consolidation, ground-

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glass-opacity interstitial thickening and nodules) in the two groups, and the presence and the gravity of GVHD in the allogenic one. Patients with infectious disease were excluded after bronchoalveolar lavage (BAL). Results:

revealed characteristic or even specific/pathognomonic findings, however, histology was mandatory in order to establish the final diagnosis.

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Allogenic: 6/13 patients with had LONIPs and amongs them only one did not have GVHD. Only 1/7patients without LONIPs had severe GVHD Autologus: only 1/6 patients, had LONIPS. In the two patients without GVHD (one with autologus and one with allogenic HSCT) the clinical course of LONIPs was favourable.

Conclusions: LONIPs are almost exclusive of patients with allogenic HSCT. LONIPs is significantly associated with GVHD. In the absence of infections, pulmonary complications in allogenic transplants may be a presentation of GVHD.

P111 Vertebral column in children: The spectrum of osteolytic lesions Christiana Hadjigeorgi1, Maria Zarifi1, George Pitsoulakis1, Kalliopi Stefanaki2 1- Department of Imaging, Aghia Sophia Children’s Hospital. 2- Department of Pathology, Aghia Sophia Children’s Hospital A wide range of benign and malignant entities may cause osteolytic lesions in the pediatric vertebral column. Purpose: To demonstrate the broad differential diagnosis of pediatric vertebral osteolytic lesions and discuss the imaging findings. Methods and Materials: The x-rays, CT and MRI scans of 74 children (45 boys–29 girls, aged 3–16 years) that showed osteolytic vertebral lesions during the last 16 years were retrospectively analyzed. The imaging findings were correlated with clinical data and histopathological findings. Results: Pediatric vertebral column was uncommonly involved by osteolytic lesions in this series. Of the 74 children, 56 were diagnosed with primary bone lesions: 14 with osteoid osteoma, 11 with Langerhans’ cell histiocytosis (LCH), 8 with osteoblastoma, 7 with bone infection, 4 with aneurysmal bone cyst, 5 with Ewing’s sarcoma/PNET, 4 with primary bone lymphoma, 1 with chondrosarcoma and 18 with secondary malignancies (neuroblastoma: 6, rhabdomyosarcoma: 5, leukemia: 5, lymphoma: 2, Ewing tumor: 1, Wilm’s tumor: 1. The most common complaint was worsening back pain. Conclusion: Metastatic disease, osteoid osteoma, LCH, osteoblastoma, infection and Ewing’s sarcoma were the most frequent entities in decreasing order. CT and MRI

Duodenal injury with wall rupture due to blunt trauma: The importance of rentgenographic study Živa Zupancic University Medical Centre Ljubljana Purpose: To stress the importance of the contrast study in the diagnostics of the duodenal wall injuries in blunt abdominal trauma as the contrast examination may be the only imaging method to diagnose the wall injury correctly. Material: Three boys suffered blunt abdominal trauma to the upper abdomen. As injury of the duodenum was suspected, contrast examination of the duodenum was ordered. Method: Rentgenographic contrast study was performed to examine the duodenum during fluoroscopy and to document the findings. Results: Contrast examination demonstrated evidence of partial duodenal wall rupture with intramural contrast deposits in two boys and perforation of the wall with extravasated contrast in one. Conclusion: In blunt abdominal trauma, the injuries to all the organs have to be diagnosed and properly treated. The injuries of the duodenal wall can be correctly diagnosed by rentgenographic contrast study.

P113 Retrospective study of cumulative radiation exposures in children with oncological disorders Bilal Ahmed2, Puneet Shroff5, Amy Leechong4, Rahim Moineddin3, Karen Thomas1, Christopher Gordon1, Mark Greenberg4, Ronald Grant4, Bairbre Connolly1 1- Department of Medical Imaging, The Hospital For Sick Children. 2- Faculty of Medicine, University of Toronto. 3- Department of Family and Community Medicine, The Hospital for Sick Children. 4- Department of Haematology/ Oncology, The Hospital for Sick Children. 5- York University Purpose: To assess radiation burden from diagnostic and follow-up imaging in a cohort of 150 children diagnosed with cancer in 2001, and followed to 2006. Materials & Methods: Retrospective analysis was performed of radiation exposure [Xrays, CT scans, Nuclear Medicine(NM)] from imaging histories of children, 30 each with leukemia(LK), lymphoma(LY), brain tumours

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(CNS), neuroblastoma(NB) and assorted solid tumors (ST). Results: There were 89 boys, 61 girls, aged 1 month– 17.5 years. The radiation exposure from imaging for each group included: LK: 1–50 Xrays (mean = 9.3, median = 7), 0–11 CTs (mean=7.7, median=0), 0–3 NM (mean=0.5, median=0). LY: 0–42 Xrays (mean=11.9, median=10.5), 2–28CTs (mean=8.3, median=7), 0–24 NM (mean=5.5, median=3). CNS: 0–24 Xrays (mean=5, median=4), 0–13CTs (mean= 4.43, median=4), 0–2 NM (mean=0.3, median=0). NB: 3–63Xrays (mean=17.1, median=13.5), 2–31CTs (mean 13.8, median=11.5), 0–39 NM (mean=16.3, median=13.5). ST: 1–63 Xrays (mean18.9, median=12.5), 1–38CTs (mean 13, median=13), 0–24 NM (mean=5.5, median=2). The radiation burden varied between groups. The distribution is skewed towards the low end for exposures. One ‘worse case scenario’ (38 Xrays, 39CTs, 15 NM, in a 14 year old girl) reached effective dose >220 mSv. Dose estimates, based on imaging parameters per study, are presented. Conclusion: Radiation burden from imaging for children diagnosed with cancer varies considerably based on diagnosis and on individual clinical course.

P114 Abdominal radiology in necrotizing enterocolitis: review of 20 cases Diana Martin Hernandez, Pablo Prieto Matos, Maria Teresa Carbajosa, Jose Antonio Gutierrez Diez, Montserrat Martin, Montserrat Berrocal Hospital Universitario de Salamanca. España Objetives: We analyzed radiological finding in neonates with necrotizing enterocolitis and the correlation of abdominal images and fatal evolution. We tried to determine the finding that could influence at the beginning of the NEC. Material and Methods: We reviewed the records of 18 infants with 20 (NEC). The radiographic findings are pneumatosis intestinalis, portal vein gas, bowel dilatation, dilated loops, fixed loops, free intraperitoneal gas... Results: The middle gestational age was 29,2 week. We made 8,6 plain films per newborn. The more frequently found is dilated loops (100%) and the lesser one portal vein gas (10%). Other radiological finding were: pneumatosis intestinalis (45%), fixed loops (20%), free intraperitoneal gas (40%). The mortality rates in the group were 33,3%. The mortality rates in the pneumoperitoneum group were 75%. Is free intraperitoneal gas associated with a worse prognosis. Other test: 6 echographies and 3 barium study.

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Conclusion: Abdominal radiograph is the best test for diagnosis and evolution of NEC. Radiologist should recognize early signs in aim to administrate treatment before perforation happens.

P115 Clinical outcome and management of hydronephrosis detected by fetal ultrasonography Young Ah Cho, Kue Heyng Lee, Hae Won Park, Jun ho Lee Bundang CHA General Hospital, Department of Diagnostic Radiology The widespread use of prenatal ultrasound results in an increased recognition of fetal hydronephrosis. Despite extensive clnical and scientific research much controversy still exists about the assessment and management of hydronephrosis. The goal of this study is to determine clinical characteristics and postnatal outcome of fetal hydronephrosis diagnosed as having fetal hydronephrosis between 2001 and 2006 in out hospital. Dilatation of the renal pelvis was caused by primary ureteropelvic junction obstruction, multicystic kidney, vesicoureteral reflux, duplex system, ureterovesical junction obstruction, posterior urethral valve. Hydronephrosis resolved spontaneously in some patient. Mild hydronephrosis appears to be relatievly benign without surgical intervention. On the other hand, moderate to severe hydronephrosis results in poor outcome and requires surgical intervention and thus requires close follow-up both pre and postnatally.

P116 Pediatric pelvic masses: a diagnostic dilemma Julio Mata, Ron Gefen Robert Wood Johnson School of Medicine And Dentistry, Camden, NJ Purpose and Learning Objectives: Pelvic masses in the female pediatric population may be difficult to accurately diagnose from one imaging modality alone. Often a combination of ultrasound, CT, and MRI are required to fully characterize lesions. This poster displays four cases with findings that were not initially specific to a particular diagnosis. Follow up imaging demonstrates the necessity for a thorough investigation, as the final diagnosis differed from the first impressions. Materials and Methods: Images of four pelvic masses are shown from ultrasound, CT and MRI, all performed at our institution. Pathologic confirmation was made in each case. A brief discussion shows the importance of maintaining a broad differential until specific findings can suggest a diagnosis. In two cases the diagnosis was not correctly made compared to pathol-

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ogy, further illustrating the difficulty in pediatric pelvic imaging. Conclusion: Female pediatric pelvic masses often are nonspecific or mimic differing pathology on initial examination. Further work up with additional modalities can help, but the diagnosis may remain elusive.

P117 Correlation of radiography and histopathology of dissecting sign with failed enema reduction of intussusception in children Soroosh Mahboubi, Jose Hidalgo, Leonardo Gonzalez, Juan Marquez, Edwardo Ruchelli Children Hospital of Philadelphia Purpose: To identify and establish the significance of the dissecting sign and the etiology of failed enema reduction of intussusceptions in children. Method and Materials: A restrospective radiograph and pathology analysis of 165 children age 3 months to 3 years (mean 16.5 months) with 185 ileocolic intussusceptions presenting from January 2000 to December 2005. Results: Forty one patients failed enema reduction (water soluble contrast (n=27/100), air (n=9/68), air and water soluble contrast (n=2) and barium (n=2)). Histopathologic analysis of surgical specimen showed as follows: Sixteen without pathologic findings, ten with bowel ischemia, necrosis or hemorrhage; seven with lead points, five with inflammation of the appendix; and three reactive lymphoid hyperplasia. The dissecting sign was present in 21 of 41 of failed enema reduction cases, 72% with pathologic findings: nine were associated with necrosis or ischemia, three related to lead points, three with inflammation of the appendix and six (28%) without pathologic findings. Ninety percent of patients with bowel ischemia or necrosis presented the dissecting sign. Conclusion: Identification of dissecting sign at enema reduction should alert the possibility of a failed procedure with underlying presence of bowel ischemia or necrosis, infiltration of appendix and Meckel’s diverticula.

P118 Extracorporeal membrane oxygenation (ECMO) therapy in neonates with congenital diaphragmatic hernia: 2-year follow-up MRI evaluating carotid artery re-occlusion and neurologic outcome Karen A Büsing1, A Kristina Kilian1, Thomas Schaible2, Sabrina Sumargo1, K Wolfgang Neff1 1- University Hospital Mannheim, Department of Clinical Radiology. 2- University Hospital Mannheim, Department of Pediatrics

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Purpose: To assess the cerebral and vascular status of 2year-old children with congenital diaphragmatic hernia (CDH) in whom carotid artery reconstruction was performed following neonatal extracorporeal membrane oxygenation (ECMO) therapy and to compare the neurologic development of children with vascular re-occlusion to that of CDH children with successful repair and to non-ECMO controls. Subjects and Methods: 18/30 (60%) neonates received ECMO therapy with reconstruction of the right common carotid artery (RCCA). Two years postoperatively, the children were examined by cerebral MRI including MRA of the intra- and extracranial brain-supplying arteries. Results: The RCCA was occluded or highly stenotic in 13/18 children (72%). All infants demonstrated intraand extracranial collaterals and a patent internal carotid artery. The ECMO group showed a significantly greater incidence of cerebral injuries (p = 0.007) but no relevant impairment in neurologic development compared to controls (p = 0.26). Unsuccessful RCCA repair had no predictive value for a poor neurologic outcome (p = 1). Conclusion: The outcome of RCCA repair is possibly poorer than expected. Although re-occlusion of the RCCA does not increase the risk for cerebral lesions or an impaired neurologic development within the first 2 years postoperatively, the overall benefit of RCCA repair remains doubtful.

P119 The Stewart Ultrasound Score (SUSS): a new tool for the quantitative assessment of cystic fibrosis liver disease Louise Stewart1, Helen Alton1, Maya Desai2, Indra van Mourik3 1- Radiology Department, Birmingham Children’s Hospital. 2- Respiratory Department, Birmingham Children’s Hospital. 3- Liver Unit, Birmingham Children’s Hospital Introduction: Cystic Fibrosis (CF) is the commonest genetically inherited disease. Abnormal bile composition causes biliary stasis & CF liver disease (CFLD). Increased longevity means CFLD is associated with significant morbidity. Many patients present with established CFLD, limiting therapeutic options. Current tests are insufficiently sensitive for earlier diagnosis. Detailed ultrasound (US) may improve early detection rates. Aims: To describe a new US scoring system-the Stewart Ultrasound Score (SUSS), in CF children +/− clinical/ biochemical evidence of liver disease.

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Methods: Annual review of 241 CF children: 66 patients CFnoLD (4 m–16 yrs) & 175 CFLD (3 m– 17 yrs). CFnoLD was defined by normal LFTs & clinical examination. Data collected & analysed for each patient, included US, LFTs, lung function, height/ weight & clinical examination. SUSS was used to evaluate all US scans. Areas evaluated included liver parenchyma (category A=normal, B=increased echogenicity, C=coarse). Numerical scores (1=normal, 2=abnormal) were assigned to hepatic Doppler traces, portal tracts & spleen size. Score range A5 (normal)-C11 (max abnormal). Results: 64% of the CFLD group had abnormal parenchyma & 42% abnormal scores. In the CFnoLD group this was 19% and 9% respectively, whilst 27% and 74% had mild changes. Conclusion: Preliminary results suggest SUSS is useful for early detection of CFLD, before LD becomes clinically/ biochemically evident and may facilitate defining the natural history of CFLD.

P120 Validation of a new classification system for congenital scoliosis and segmentation disorders of the spine Amaka Offiah1, Ben Alman2, Alberto Cornier3, Philip Giampietro4, Oliver Tassy5, Peter Turnpenny6 1- Great Ormond Street Hospital For Children, London, UK. 2- University of Toronto, Toronto, Canada. 3- San Juan Bautista University, Puerto Rico. 4- Marshfield Clinic, Wisconsin, USA. 5- Stowers Institute, Kansas City, USA. 6- Royal Devon & Exeter Hospital, Exeter, UK Purpose: This work in progress aims to validate a new classification system for congenital scoliosis and segmentation defects of the spine (Poster #), developed by a taskforce of the International Consortium for Vertebral Anomalies and Scoliosis (ICVAS). Materials/Methods: Ten radiographs of foetuses and infants with congenital spinal disorders have been presented to ten radiologists (of varying experience) for independent review. Subsequently the radiologists will be taught the classification system and will then independently re-evaluate all radiographs accordingly. They will be asked to rate the system on a three point scale; 1 = Poor, too complicated to apply 2 = Adequate, applicable to some cases only 3 = Good, simplifies the diagnosis of these conditions Radiologists will also be given the opportunity to comment freely on the system.

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Results: Study results will include; – – –

Percentage of correct diagnoses reached before and after exposure to the classification system (gold standard according to ICVAS members) Interobserver reliability (Cohen’s kappa) before and after exposure to the classification system Observers’ subjective analysis of the quality of the classification system

Conclusion: It is hoped that the new ICVAS classification will eliminate the current confusion surrounding the nomenclature of congenital spinal disorders.

P121 Langerhans’ cell histiocytosis: a pictoral review of paediatric skeletal manifestations Samuel Stafrace, Deepak Prasad, Lesley Gomersall Aberdeen Royal Infirmary Key Learning Objectives: To demonstrate the typical skeletal paediatric manifestations in Langerhans’ cell histiocytosis. Description: Langerhans’ cell histiocytosis is an infrequently seen condition with very variable appearances (incidence of 2–5/1,000,000). It most commonly affects the paediatric bony skeleton but extra osseous manifestations in most soft tissues are also seen. Bones involved typically include the skull, ribs, pelvis, femur, vertebrae and occasionally the mandible. There have been a number of recent cases in our local paediatric institution. Conclusion: A pictoral review of the typical paediatric manifestations is presented.

P122 The diagnosis of abdominal pain in children with renal disease: what is the role of imaging? Netta Blitman, Shari Friedman, Victoriya Paroder, Calvin Sy, Roberto Gordillo, Joseph Flynn, Terry Levin Children’s Hospital At Montefiore, Albert Einstein College of Medicine Purpose: To evaluate the role of imaging in children with nephrotic syndrome (NS) or those on peritoneal dialysis (PD) in differentiating spontaneous bacterial peritonitis (SBP) from other causes of abdominal pain. Materials+Methods: We retrospectively reviewed imaging and laboratory findings in 20 children with NS(1.5–

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21 years) and 14 children with PD(3–19 years) presenting with abdominal pain(12/99–8/06). There were 46 total hospital visits (NS=24, PD=22). Results: Eighteen CT scans(11NS,7PD) and 14 US (12NS,2PD) were reviewed. Final diagnosis was SBP in 21/ 46 visits (46%; 9PD,12NS)appendicitis in 2/46 visits(4%;1 PD,1NS) and non acute in the remainder. Imaging accurately differentiated SBP from appendicitis in two patients. SBP CT findings included peritoneal/bowel wall thickening, ascites and mesenteric soft tissue stranding and were similar in NS and PD. There was significant increase (p<0.5) in mesenteric adenopathy in the PD group. Positive predictive value (PPV) in diagnosing SBP by CT was 84%. Presence of ascites on US had a 64% PPV. Patients with SBP were treated based on clinical and laboratory findings including WBC, fever, ascites on US and PD fluid culture rather than CT findings. Conclusion: A minority of renal patients with abdominal pain have a diagnosis other than peritonitis. CT is of limited value. US may be useful to confirm ascites.

P123 The limping child: differential diagnosis and imaging features Hugo Ferreira1, Maria Arellano2 1 - Clínica Colsanitas S.A. 2 - Clinica Palermo Purpose: The purpose of this work is to describe the spectrum of causes and imagenological findings of the limping child. Material and Methods: Fifteen pediatric cases with limping were retrospectively reviewed. The causes and the imagenological features were describe in the every diagnostic imaging modalities that include plain radiography, ultrasound (US), computed tomography (TC) and magnetic resonance imaging (MRI). The radiological literature was reviewed. Results: The most common causes of the limping child were reviewed. The imagenological features of our patients were compared with the radiological literature. The clinical and radiological features of our patients were very characteristic and similar to those described in the radiological literature. Conclusion: The differential diagnosis of the limping child is extensive. The pediatric radiologist should consider congenital, traumatic, infectious, developmental and neoplastic causes. The choice of further imaging modalities like ultrasonography, magnetic resonance imaging, computed tomography and bone scan should be guided by the history and clinical findings. The Appropriateness Criteria of the American College of Radiology in limping child are very useful in the radiological practice.

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P124 CT with IV contrast only (CT IV) for clinically equivocal pediatric appendicitis Madelyn Garcia 1 , George Drugas 2 , Lynn Cimpello Babcock1, Erik Rueckman1, Luann Teschmacher3 1- University of Rochester School of Medicine & Dentistry, Department of Emergency Medicine. 2- University of Rochester School of Medicine & Dentistry, Department of SurgeryDivision of Pediatric Surgery. 3- University of Rochester School of Medicine & Dentistry, Department of Imaging SciencesDivision of Pediatric Radiology Purpose: 1) Determine CT IV performance in diagnosing appendicitis in children with clinically equivocal abdominal pain; 2) Prospectively compare CT IV performance amongst readers of varying experience (resident vs. faculty radiologists); 3) Determine time saved in the Emergency Department (ED) by elimination of oral contrast. Methods: Pediatric ED patients with clinically equivocal abdominal pain were prospectively enrolled and imaged. CT interpretations were appendicitis, no appendicitis/ indeterminate. Pathology/phone follow up established final diagnoses. Test performance and inter observer agreement were determined. Time to CT was compared to a retrospective cohort imaged using CT with IV and oral contrast. Results: 250 patients were enrolled (122 ‰; 128 Š); mean age 12.7 years (range 3.1–18.9). Incidence of appendicitis was 30%; negative appendectomy rate 13.8%. CT IV performed well, independent of reader experience (resident vs. faculty): sensitivity (83% vs. 79%); specificity (96% vs. 90%); accuracy (92% vs. 90%). Reader agreement was high (weighted kappa=0.72). Mean time to CT IV was 4 hours vs. 5.6 hours for CT with IV and oral contrast (p<0.0001). Conclusions: CTIV is a reliable diagnostic test for excluding appendicitis in children with clinically equivocal abdominal pain. It performs well, independent of reader experience. P125 Color Doppler with US contrast agent in the diagnosis of gastroesophageal reflux in children Mauro La Rosa2, Renato Farina1, Francesco Pennisi1, Vincenzo Ricceri2, Giancarlo Ettorre1 1- Azienda Policlinido Dell’università Di Catania. 2- Ospedale Ss Maria Degli Addolorati, Biancavilla, Catania Objectives: The aim of this study is to assess the accuracy of Color Doppler with US contrast agent in the early

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diagnosis of gastroesophageal reflux in children.. In all patients the Color Doppler examination was followed by barium esophagram and the data obtained were compared Methods: 50 children were recruited for the study. Color Doppler with US contrast agent was performed, followed by barium esophagram. The US examination consists in the oral administration of a US contrast agent, SHU 508 A (Levovist, Schering, Ag. Berlin), and the following color Doppler test to show or exclude the presence of reflux into the esophagus. The ultrasonographic investigations were perfomed with an AU-5 IDEA US scanner (Esaote Biomedica, Genova) with a 3.5 MHz convex probe. Results: After the oral administration of the US contrast agent, reflux occurred in 36 patients (72%). Compared with barium fluoroscopy, the ultrasound examination has showed sensibility of 93% (one false negative) and specificity of 100% (0 false positive), positive predictive value 100%, negative predictive value 97%. Conclusions: The comparison between the data obtained with ultrasound examination and barium esophagram would seem to confirm the value of Color Doppler in the diagnosis of gastroesophageal reflux.

P126 A new sonographic signs of hypertrophic pyloric stenosis in paediatric age group Vassil Zefov, AbdulRahim Mustafawi, Hassan Nougood 1- Al Wasl Maternity Hospital, Dubai Radiology. 2- Al Wasl Maternity Hospital, Dubai Paediatric Surgery. 3- Al Wasl Maternity Hospital, Dubai Paediatric Surgery Purpose: The Sonography of suspected Hypertrophic Pyloric Stenosis (HPS) is well establishing primary method of choice. We did attempt to find a more detailed sonographic images focusing on circular muscle bundles using the latest achievement in the field of High Resolution US. Material and Methods: During the last two years (Jan2005–Jan2007) we had 20 cases of HPS diagnosed with US and proved surgically. Male/ Female ratio=19/1. The patient’sage varies between 18 days and 70 days. The last 5 cases are diagnosed with a high resolution linear transducer L12–5 MHz of Philips iU22. Results: We found additional sonographic signs not mentioned officially till now. The hypertrophied spiral muscle showed hypoechoic bands located perpendicularly to the length of the pyloric canal in sagital scanning. The bands are separated by hyperechoic lines which coincide with the blood vessels applying Doppler. The blood vessels show “sunrise” appearance in longitudinal scanning.

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Conclusions: We believe our findings will contribute to better understanding and more precise sonographic diagnosis of HPS.

P127 Ventriculoperitoneal shunt migration. A shunt too far Harun Gupta, Lesley Gomersall, David Currie Royal Aberdeen Childrens Hospital Learning Objectives: Ventriculoperitoneal shunt (VP shunt) is one of the most common neurosurgical operations and a variety of complications can occur following procedure. Imaging analysis is an essential adjunct to the clinical evaluation of such patients and therefore radiologists should be familiar with these potential problems. Materials and Method: Two cases aged 4 and 6 years from our hospital, Royal Aberdeen Children’s Hospital, Aberdeen, UK. Results/Description: VP shunt complications are usually due to mechanical failure. Migration of shunt is an infrequent complication and may affect the proximal or distal tubing. We show rare cases of distal shunt migration. The children had VP shunt insertion for hydrocephalous at one week after birth. The first one presented with the distal tubing emerging through the anus (Image 1). This required surgical correction. The second child was 6 years old and presented with distal tubing emerging from mouth (Images 2 and 3). Conclusion: It is known that the distal catheter tip can erode and perforate various abdominal viscera, however protrusion through the mouth and anus is rare. The potential complication of migration should be brought to mind when reporting radiological investigations in such patients.

P128 Cavitating pulmonary tuberculosis in children; correlating radiology with pathogenesis Stephanie Barbara Griffith-Richards1,2, Pierre Goussard1,3, Savvas Andronikou1,2, Robert Gie1,3, Stefan Przybojewski1,2, Melanie Strachan1,2, Yousuf Vadachia1,2, David Kathan1,2. 1- University of Stellenbosch. 2- Department of Radiology, Tygerberg Hospital. 3- Department of Paediatrics, Tygerberg Hospital Purpose: By evaluating the clinical and radiological findings of children with PTB and cavities, group them into categories according to possible pathogenesis. Materials and Methods: Ten random cases of children with PTB and cavitations on chest radiograph were

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retrospectively reviewed and evaluated according to clinical and radiological findings. Results: Three categories emerged; – Category 1 Four children presented with cavities, usually single and unilateralin the classic upper lobe distribution of postprimary PTB. They responded well to treatment and had unremarkable recoveries. – Category 2 Three children developed progressive primary spread of disease with extensive and bilateral pulmonary cavities. This group were all below 2 years of age with complicated recoveries. – Category 3 Three children developed cavities secondary to airway obstruction by mediastinal lymph nodes with consequent distal collapse and consolidation. This group had frequent complications resulting in 1 fatality. Conclusions: Cavities in paediatric PTB may arise by one of three possible mechanisms with relatively equal incidence. A study is underway to determine the incidence of cavity formation associated with mediastinal lymphadenopathy and airway obstruction.

P129 Role of whole-body MRI in suspected infant abuse Jeannette Perez-Rossello, Susan Connolly, Kelly Zou, Alice Newton, Paul Kleinman Children’s Hospital Boston

Purpose: To assess the role of whole-body (WB) MRI in suspected infant abuse. Methods and Materials: We retrospectively compared coronal and sagittal WB STIR images with skeletal surveys (SS) in 21 infants (mean 5.4 months) with suspected abuse. All infants had SS within 5 days of MRI. Follow up SS were available in 15 patients. Our institutional review board approved the study. Results: A total of 162 osseous abnormalities were detected radiographically and with MRI; 28% seen on both, 32% only on MRI and 41% only on SS. There was fair agreement between SS and MRI (89% agreement, k=0.37) and intermodality agreement (p<.001). WB-MRT had high specificity 95%, but low sensitivity 60% when compared to SS. Specifically, WB-MRI had low sensitivity for detecting classic metaphyseal lesions (31%) and rib fractures (57%). The skeletal abnormalities seen on MRI could not be dated. MRI identified a large number of muscle/subcutaneous signal abnormalities and joint effusions.

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Conclusion: Whole Body MRI is insensitive to the common highly specific indicators of infant abuse and at present it cannot replace SS. WB-MRI may complement the skeletal survey and has the unique ability to identify soft tissue injuries. P130 Underlying network patterns of injury in white cerebrum following birth asphyxia Maarten H Lequin1, Susanne JPM van Engelen1, Renate MC Swarte1, R Jeroen Vermeulen2, Alexandra Zecic3, Paul P Govaert1 1- ErasmusMC-Sophia Childrens Hospital. 2- VU medisch centrum. 3- Ghent University Hospital Purpose: We have observed a variety of MR-scans in severely asphyxiated neonates which fit the description of White Cerebrum. Our purpose is to describe in detail underlying network patterns of injury in White Cerebrum in relation to time of imaging. Material and Methods: Retrospectively 19 neonates with severe hypoxic-ischaemic encephalopathy with DWI/DTI fulfilled the criteria of White Cerebrum by Vermeulen et al. (2003). All scans were obtained on day 3 to 7. One patient was scanned on the first and also on the 4th day. ADCvalues were obtained. Results: Four distinct patterns were recognized based on the appearance of PLIC, basal ganglia, thalamus and brainstem on DWI/DTI and ADC-maps. ADC-values were calculated. Contrary to previous reports some of our patients had involvement of the cerebellum. The patient with an early scan had brainstem damage on the first day, thereafter developing into White Cerebrum on day 4. Conclusion: It seems that the four patterns within the White Cerebrum depend on the day of scanning. The evolution of hypoxic-ischaemic injury into White Cerebrum may tell us something about the underlying network patterns of injury. P131 Fibro-osseus lesions of craniofacial bones. A case report Vicente Ibarra Cap Poblenou. Barcelona. Ics

Purpose: Description of radiologic findings and diferential diagnosis in fibro â€″osseus craniofacial lesions. Material and Methods: Asymptomatic 11-year old male who in a routine radiologic study for dental malposition, an orthopantomography reveals a high density lesion in the left maxillary sinus. A plain radiograph (Waters projection) and a sinus TC were made in order to complete the radiologyc study.

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Results: The sinus plain radiography shows a complete left maxillary sinus opacification. TC study confirms the presence of a expansile intraosseus lession with fibrous and ground glass osteoid matrix. Cortical bone is not afected and there are no lytic lesions associated. There is no lession involving the rest of paranasal sinuses. Conclusion: Fibro-osseus lesions of craniofacial bones are a group of tumors that share similar characteristics making it difficult for a definitive diagnosis. The differential diagnoses includes fibrous dysplasia, eosinophilic granuloma, giant cell tumor and fibro-osseus lesions of periodontal ligament. Besides we have to include some inflammatry conditions like chronic sclerosing osteitis and chronic granulomatous inflammatory reaction. In all those cases, adequate clinical information and radiological findings can avoid unnecessary procedures, like biopsy or surgical excision.

P132 Torsion of the appendix testis ultrasound diagnosis Amaya Martin, Carmina Duran, Cesar Martin, Ana Alguersuari, Sandra Perez, Maite Veintenillas, Mario Prenafeta, Alex Lüttich, Mariona Vilagra, Afons Valera UDIAT, Hospital Parc Taulí Learning Objectives: To illustrate the characteristic ultrasound findings for torsion of the hydatid in its acute stage and during its spontaneous involution. Background: Torsion of the appendix testis is considered to be the most common cause of acute scrotum in children. Pain and scrotal edema can hinder the diagnosis or simulate testicular torsion. It is in these cases that ultrasound examination is most useful. It is noteworthy that many authors continue to recommend surgical diagnosis and treatment. However, there is ample evidence that this condition is self-limiting and resolves spontaneously. Results: We reviewed 16 cases of torsion of the appendix testis in children aged 5–13 years. One case was confirmed at surgery; the remaining 15 had characteristic ultrasound findings and showed clinical improvement after conservative treatment. Weekly follow-up ultrasound examinations performed in 11 cases over one month demonstrated the involution of the torted hydatid. All echo-doppler studies were performed using a high-frequency (14-12-8 MHz) linear probe. Conclusions: In cases of acute scrotum, ultrasound examination should aim not only to rule out testicular torsion and ochiepididymitis but also to consider the diagnosis of torsion of the appendix testis and the possibility of avoiding unnecessary surgery and/or antibiotic therapy.

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P133 Utility of chest computed tomography in diagnosing tuberculosis infection in small children Neus Altet-Gómez1, Teresa Pascual-Sanchez2, Pilar García-Peña3, Xavier Lacaya-Layret3 1- Institut Catalá De La Salut. Unidad de Prevención y control de la Tuberculosis. 2- Neumología pediátrica. Hospital Sant Joan (Reus). 3- Institut Diagnóstic per la Imatge. Hospital Materno-Infantil de la Vall d’Hebrón Purpose: Differentiating between tuberculosis (TB) infection and TB disease is difficult in children. The study aim was to determine if thoracic computed tomography (CT) could help in diagnosing active TB. Material and Methods: A prospective study of 73 TB infected children (0–7 years) with recent close contact with clinical pulmonary bacillary TB. All were tuberculin skin test (TST) positive and had normal chest Xrays. Chest Multidetector CT (MDCT) scans were performed. Data was compared with scans from 73 age matched controls without pulmonary infections or TB contact. All were TST negative and had TB negative chest X-rays. Results: 73 TB infection patients were studied. 43/73 (58.9%) showed TB disease. 38 (88.4%) had enlarged lymph nodes (mean diameter 14.3 mm), 27 (62.8%) pulmonary granulomas and 14 (32.5%) pulmonary infiltrates. In 5 of 7 children, M. tuberculosis was identified by sputum culture or gastric aspirate and one by granuloma biopsy. Conclusions: Chest CT differentiated TB infection from TB disease thus allowing initiation of appropriate therapy. CT scans should be performed in small children when TST is positive and chest X-ray normal. CT is not recommended when chest X-ray is TB diagnostic because of radiation dosage.

P134 Effects of reducing radiation dose on lung nodule detection Shonit Punwani, Rebecca Greenhalgh, Paul Humphries University College London Hospital Purpose: This study investigates the effects on CT lung nodule detection of reducing the CNR across a range of lung nodule sizes. Methods: A simulated nodule was placed at the periphery of the lung on axial CT slices using image editing software. Copies of the manipulated image were saved at varying

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levels of superimposed noise. This process was repeated for a range of nodule sizes. Output images were analysed in order of noise level by an experienced and less experienced operator. Each operator located the lung nodule and to indicated a level of certainty of its correct identification for each image. The experiment was repeated for varying nodule sizes. Results: For nodule detection at a given confidence level, the relationship between CNR and lesion size varied between operators. However, for both operators increasing operator confidence levels occurred with increasing CNR. The experienced operator was able to identify nodules with the same certainty as the less experienced operator at lower CNR levels. Conclusion: Reducing paediatric radiation dose is of paramount importance, but this is counterbalanced by the reduced sensitivity and increased uncertainty of CT lung lesion detection. Experience allows for a lower CNR and therefore a lower radiation dose.

P135 Follow-up imaging after laparoscopic heminephrectomy in children Waseem Mazrani, Melanie Hiorns, Kieran McHugh Great Ormond Street Hospital For Children Purpose or Learning Objectives: To review the post operative ultrasound features of children who have undergone laparoscopic heminephrectomy. Material and Methods: We searched our database for children who had undergone laparoscopic heminephrectomy. Results: There were 35 patients (24 females, 11 males). The mean age at surgery was 3.5 years. The indication for surgery was a duplex kidney with a poorly functioning moiety in all but two cases. The sites of surgery comprised 12 right upper, 5 right lower, 18 left upper and 3 left lower heminephrectomies. These numbers include 3 patients who had bilateral procedures. The most consistent post-operative finding was that of a cyst related to the site of surgery, seen in 23 cases. This cyst was simple in 13 cases and septated and/or containing echogenic debris in 10. The cyst was present on the most recent follow-up ultrasound in 21/23 cases. The mean unidimensional maximum diameter of these cysts, on initial ultrasound scan, was 3.9 cm (range 1.3 cm–12 cm). Conclusion: A cyst in relation to the site of surgery post laparoscopic heminephrectomy is a frequent post-operative occurrence. No patients have required intervention for this to date.

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P136 Cancelled P137 Abdomen sonography in liver glycogen storage disease Kamaldine Oudjhane, Arun Mohanta Diagnostic Imaging. Hospital For Sick Children Purpose: Inherited enzyme defects interfere with the degradation of glycogen, which is accumulated in the organs. Localization in various viscera determines the symptomatology of the disorder. This paper aims at reviewing the role of abdomen sonography in Liver Glycogen Storage Disease(GSD). Material/Methods: Patients were retrospectively identified via a radiology textword search program. Sonography of the liver, spleen, kidneys including High Resolution images of the kidneys was reviewed. Results: 23 Children formed the series. Age at presentation was 1 month to 17.5 years (mean 6 y 8 m).GSD type 1 was seen in 15 patients versus 8 cases of GSD type 3. GSD type 1 was associated with hepatomegaly, increased liver echogenicity, splenomegaly, liver adenoma in 13, 12, 7 and 2 cases respectively. In GSD type 3, hepatomegaly was seen in all 8 patients, whereas abnormal liver echogenicity and splenomegaly were present in 7 and 4 cases repectively. Only patients with GSD type 1 presented nephromegaly (8/15) and abnormal renal echogenicity (6/15). Conclusion: Abdomen sonography can predict organ symptomatology in GSD. Liver adenoma, cirrhosis, renal insufficiency (from focal glomerular sclerosis and interstitial fibrosis) are the main complications.

P138 Pericerebral fluid collections in children: differential diagnosis by using MR and ultrasonography Núria Mayolas, Élida Vázquez, Ignacio Barber, Susana Boronat, Manuel Roig, Goya Enríquez. Pediatric Radiology. Vall D’Hebron Hospital Purpose: Extracerebral fluid collections in children are a common finding in daily practice. Benign enlargement of subarachnoid spaces (BESS) occurs due to failure of arachnoid villi for CSF absorption. Differential diagnosis is mainly based on imaging findings, in order to rule out subdural hematoma secondary to non-accidental trauma.

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Material and Methods: We retrospectively reviewed our studies performed in a big tertiary children’s hospital over the last 10 years. We selected the 30 most representative patients with notorious pericerebral fluid collections, who were imaged by color Doppler US and MR, including diffusion imaging (DI). Imaging findings were correlated with clinical symptoms and physical examination, including head circumference percentile. Results: Several relevant data can be obtained: Subdural hematomas can appear in asymptomatic children with BESS due to stretching of the bridging veins; Color Doppler US helps to identify the cortical veins on BESS; DI is useful for differential diagnosis and follow-up, mainly in subdural collections; Different chronology of subdural collections together with intraretinal hemorrhage assess the diagnosis of non-accidental trauma. Conclusion: Pericerebral fluid collections in children have different pathophysiologycal mechanisms. The modern imaging techniques used in US and MR help to improve differential diagnosis with serious implications in therapy and prognosis.

P139 Bone mineral density in children and adolescents with cystic fibrosis: measurements with quantitative computed tomography Eléonore Blondiaux1, Cecile Cellier1, Eric Mallet2, Patrick Le Dosseur1, Jean-Nicolas Dacher1 1- Department of pediatric radiology, Rouen University Hospital, Rouen, France. 2- Department of pediatrics, Rouen University Hospital, Rouen, France The aim of this preliminary study was to evaluate bone mineral density (BMD) in children and adolescents with cystic fibrosis with quantitative CT (QCT). Volumetric vertebral (L1–L3) trabecular bone mineral density was measured using QCT in 36 patients aged 2– 16 years with cystic fibrosis. Comparisons were made with values of BMD obtained by dual-energy X-ray absorptiometry (DXA). Multiple indices of disease severity and anthropometric variables were investigated. The mean BMD z score was 0.25 in lumbar vertebrae with QCT and −0.59 in lumbar spine with DXA. The results in DXA and QCT were positively correlated (rs=0.7; p<10-4) but the results in DXA were significantly lower with a mean difference of -0.84 (p<10-4). Height and weight z score were normal in children and adolescents. Bone age was significantly lower than chronological age (p=0.001). More accurate but with higher irradiation doses than DXA, QCT is a valuable technique to assess BMD in children as it is not influenced by skeletal growth and development. Our project is to establish normal reference values on thoracic vertebrae in normal children with QCT. In cystic fibrosis

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annual follow-up, the pulmonary disease and the bone accrual could be evaluated in a single CT acquisition. P140 Clinical applications of musculoskeletal ultrasound in children and adolescents: technique description, diagnosis and therapeutic relevance Jose Angel Jimenez-Lasanta, Clara Roque-Pages, David Hernandez-Morales, Ivan Urra-Martinez, Santiago Mourelo-Lopez, Laura Castro-Frias Radiology Dept. Hospital Universitario Germans Trias I Pujol Purpose: To emphasize the role of diagnostic and/or therapeutic ultrasonography (US) in diverse congenital and acquired musculoskeletal diseases in children and adolescents. Material and Methods: A total of 120 patients who underwent sonographic evaluation in our tertiary center during the last 5 years were retrospectively evaluated. US examination was carried out with a Sequoia 512 or an Aspen (SiemensAcuson), using high resolution technique, dynamic manouvres, contralateral comparison, Color and power Doppler, extended FOV function, 3D US and interventional procedures. Other imaging techniques such as MRI, CT or bone scintigraphy were also performed when diagnosis was unconclusive. Results: Congenital, traumatic, inflammatory, infectioustoxic (transitory sinovitis, arthritis, pyomyositis, infectious bursitis, cat-scratch disease, subperiosteal abscess, infectious lymphadenitis, osteomyelitis), neoplastic (benign and malignant tumors of bones or soft tissues), foreign bodies, and vascular malformations will be presented with a selection of the most representative cases. Conclusion: US is a powerful diagnostic tool for evaluation of musculoskeletal disorders owing to low cost, availability, non-invasiveness, multiplanar capability and real-time studies, which allow dynamic imaging. It also offers the possibility of performing aspiration or biopsy procedures with diagnostic relevance. The absence of ionizing radiation is particularly valuable in children, but proper training is required in the pediatric patient.

P141 Cost-effectiveness analysis of different imaging strategies for diagnosis of hemophilic arthropathy Conor Bogue1, Umar Khan1, Wendy Ungar2, Pamela Hilliard3, Victor Blanchette4, Andrea S. Doria1 1- Diagnostic Imaging, The Hospital For Sick Children, Toronto. 2- Child Health Evaluative Sciences, The Hospital for Sick Children. 3- Rehabilitation Services, The Hospital for Sick Children. 4- Dept of Haematology/Oncology, The Hospital for Sick Children

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Objective: To compare costs and effectiveness (diagnostic test performance) of radiography and ultrasonography with MRI (intervention strategy, IS) versus radiography with MRI (standard care strategy, SCS) for diagnosing soft tissue and osteocartilaginous changes in hemophilic joints (Ministry of Health perspective). Methods: We retrospectively compared costs and effectiveness of the IS versus the SCS in knees, ankles and elbows of 34 children (age range 1–18 years) with hemophilia A or B (IS, N=12; SCS, N=22). Direct health care costs were measured from the provincial health program perspective. Effectiveness was measured by false-negative (FN) rate in each arm. Results: The IS was more costly (incremental cost/patient, $110) but more effective with fewer FNs (incremental FN rate, −0.5). Whereas the FN rate for radiography compared with MRI was 0.5 (50%), the FN rate for conjoint radiography and ultrasonography compared with MRI was 0 (0%). The incremental cost-effectiveness ratio for the IS was $219 per FN averted per 100 patients. Conclusion: In the short-term, adding ultrasonography for diagnosis of hemophilic arthropathy increased the cost of imaging, but significantly improved diagnostic performance. Further investigation is required to determine the long-term costs for the health care system.

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SUA has an incidence ranging from 0.3% to 2.13%. It is a clinical marker associated with a wide variety of congenital abnormalities with an incidence of renal abnormalities between 4.5% and 16%.The majority of these are self-limiting. Materials and Methods: Neonates were identified from Aberdeen maternity hospital database, to have SUA at birth between calendar years 2003–2005. A review of radiology results was done with a clinical case note review in neonates with abnormal examinations. Results: Over the 3–year period a total of 67 neonates were found to have SUA of which 37 (79%) neonates underwent RUS. Of these 7 patients had abnormal RUS out of which 4 patients had major renal anomalies previously detected on abnormal antenatal 20 week scans, 2 patients had selflimiting abnormalities and 1 patient died in the neonatal period due to multiple congenital anomalies. Conclusion: In neonates with SUA as the primary sole indication and whose mothers have had a 20-week scan, RUS at birth offered no additional clinical information.

P143 Pediatric scrotal sonography: a pictorial essay Richard Bellah, Michael Carr, Jonathan Loewen The Childrens Hospital of Philadelphia

P142 Renal ultrasound in neonates with single umbilical artery. Is it necessary in all neonates? Deepak Prasad, Samuel Stafrace, Lesley Gomersall Aberdeen Royal Infirmary Purpose: To assess the clinical benefit of performing RUS in neonates with single umbilical artery(SUA) as the primary indication and whose mothers had a 20 week detailed antenatal scan.

Sonography plays a critical role in the evaluation of disorders affecting the pediatric scrotum. Standard applications include classification of disorders of a patent processus vaginalis, evaluation of the acute scrotum, and characterizing intratesticular versus paratesticular masses. A comprehensive pictorial review of both common and more rare pediatric scrotal pathology, as seen in our large tertiary care medical center will be provided, with emphasis on the sonographic features and differential considerations.