Radiology Pediatric Imaging

[Pediatric Imaging] Gastrostomy and Gastrojejunostomy Tube Placements: Outcomes in Children with Gastroschisis, Omphalocele, and Congenital Diaphragmatic Hernia

2008-06-19

Purpose: To retrospectively evaluate the technical success, safety, and outcomes of radiologically guided retrograde percutaneous gastrostomy and gastrojejunostomy tube placements in terms of weight gain and growth in children with gastroschisis, omphalocele, and/or congenital diaphragmatic hernia (CDH).

Materials and Methods: Research ethics board approval, with waived informed patient consent, was obtained for review of the data of 37 children (17 male, 20 female; age range, 1–20 months; mean age, 4.3 months) in whom gastrostomy or gastrojejunostomy tubes were inserted between 1995 and 2004. Twenty-two patients had CDH, eight had gastroschisis, five had omphalocele, and two had both CDH and omphalocele. The technical success and complications of the procedures were recorded. Tube maintenance problems were analyzed separately from postprocedural complications. Initial and final patient growth percentiles were compared by using a one-sided paired Student t test.

Results: Thirty-six of the 38 procedures performed in the 37 patients were successful. There were three intraprocedural complications (two cases of access difficulty, one case of bleeding) and three major complications (one skin and prosthetic material infection, one track loss during tube replacement, one delayed gastrostomy track closure necessitating surgery). Sixteen patients had at least one minor complication (cellulitis, feeding intolerance, skin-site bleeding, intussusception). Twenty-two patients had at least one tube maintenance problem. All patients gained weight (mean weight gain, 4.7 kg) after the procedure, with a significant increase in growth percentile (average increase, 6.5%; P = .029).

Conclusion: Radiologically guided percutaneous gastrostomy and gastrojejunostomy tube placements in children with gastroschisis, omphalocele, and/or CDH are associated with high success rates and low major complication rates. Although tube maintenance problems and minor complications are common, use of gastrostomy and gastrojejunostomy tubes effectively improves nutritional support.

[Pediatric Imaging] Anterior and Posterior Cruciate Ligaments at Different Patient Ages: MR Imaging Findings

Kim, H. K., Laor, T., Shire, N. J., Bean, J. A., Dardzinski, B. J. — 2008-05-16

Purpose: To retrospectively compile normative data on the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL) in children and young adults.

Materials and Methods: This HIPAA-compliant study was approved by the institutional review board. The requirement for informed patient consent was waived. Knee MR imaging examinations (n = 324) were performed in 168 female and 156 male patients (age range, 1–20 years) at 1.5 and 3.0 T, and the image findings were retrospectively evaluated by two blinded radiologists separately. One radiologist reviewed all images twice at two sessions, and the other reviewed a random subset of half the images during one session. Discordant assessments were resolved by consensus. The sagittal and coronal ACL-tibial angles, Blumensaat line–ACL angle, angle of inclination of the intercondylar roof, ACL-tibial insertion site, and PCL angle and horizontal component–to–vertical component ratio were measured. The associations between these values and patient age, patient sex, and physeal patency were assessed. Linear and fractional polynomial regression models were used to evaluate the relationships between measurements.

Results: ACL-tibial angles became significantly larger (P < .001) with increasing age during skeletal growth and approached adult values after physeal fusion. The Blumensaat line–ACL angle was constant after age 2 years. The inclination of intercondylar roof angle became significantly smaller (P < .001) with increasing age. The ACL-tibial insertion site was constant at the junction of the anterior and middle thirds of the tibial anteroposterior diameter and was not age dependent. The PCL angle became significantly larger (P < .001) with advancing age and in children who had fused as opposed to open physes. The horizontal component–to–vertical component PCL ratio became significantly smaller with advancing age (P < .001).

Conclusion: During growth, angulation of the ACL is age dependent. The angle and morphologic changes of the PCL are age dependent throughout skeletal maturation.

[Pediatric Imaging] Is Propofol a Safe Alternative to Pentobarbital for Sedation during Pediatric Diagnostic CT?

Zgleszewski, S. E., Zurakowski, D., Fontaine, P. J., D'Angelo, M., Mason, K. P. — 2008-04-22

Purpose: To prospectively compare the incidence of adverse respiratory events, the need for airway interventions, and the recovery time after propofol sedation with similar data from a retrospective review of data obtained in patients who underwent pentobarbital sedation.

Materials and Methods: This HIPAA-compliant study was conducted with institutional review board approval and parental informed consent. The hospital sedation committee approved a 2-month pilot program of propofol sedation as a potential alternative to pentobarbital sedation. Parents were given the choice of having their child sedated with intravenously administered propofol or pentobarbital. Fifty-two patients (18 female, 34 male; mean age, 2.9 years ± 2.4 [standard deviation]) received propofol. An equal number of patients (21 female, 31 male; mean age, 2.5 years ± 1.7) who previously received pentobarbital were included. The sample sizes provided 80% power to detect differences in airway manipulations, adverse respiratory events, and recovery time between the groups by using the Fisher exact test and the Student t test. A two-tailed P value of less than .05 indicated a significant difference.

Results: Patients sedated with propofol underwent significantly more airway manipulations to relieve obstruction than did patients sedated with pentobarbital (23% vs 0%, P < .001). More adverse respiratory events occurred in the propofol group than in the pentobarbital group (12% vs 0%, P = .03). Patients in the propofol group had a faster recovery profile than did patients in the pentobarbital group (34 minutes ± 17 vs 100 minutes ± 30, P < .001).

Conclusion: Propofol is associated with a significantly greater incidence of adverse respiratory events than is pentobarbital.