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Biomedical subjects

E Weinberger

Publications and source records attributed to E Weinberger.

At least 55 records · Page 3Linked to original sources

Misleading appearances of the bladder on pediatric genitourinary imaging.

The authors reviewed images of the bladder on 100 consecutive Tc-99m DTPA pediatric renograms for any abnormal distribution of radionuclide or asymmetry suggestive of anatomic bladder abnormality. The results were correlated with radiographic contrast voiding cystourethrograms and ultrasound examination. Of 81 patients with adequate bladder imaging, 50 (62%) had symmetric and uniform distribution of radioactivity within the bladder. Thirty-one patients (38%) had a sufficiently abnormal bladder appearance to suggest anatomic abnormality. Of these 31 patients, 27 had contrast cystograms and ultrasound evaluation; only one (4%) had a proven bladder abnormality which correlated with the abnormal scintigraphic appearance. The appearance of the bladder on pediatric genitourinary imaging is a nonspecific and unreliable indicator of anatomic bladder abnormality.

Child↗

Sonographic diagnosis of hypertrophic pyloric stenosis.

In many pediatric centers, sonography has become the primary imaging method for the diagnosis of hypertrophic pyloric stenosis, but investigators have disagreed about which dimension of the gastric outlet is most useful and accurate. We analyzed 326 consecutive sonograms in 319 infants who presented with vomiting in order to further evaluate the sonographic criteria for the diagnosis of hypertrophic pyloric stenosis. Four observers retrospectively measured three parameters: (1) the thickness of the muscle in the wall of the gastric outlet, (2) the length of that muscle, and (3) the length of the pyloric channel. In the patients with hypertrophic pyloric stenosis, muscle thickness was 4.8 +/- 0.6 mm, muscle length was 2.1 +/- 0.3 cm, and channel length was 1.8 +/- 0.3 cm. In the patients without hypertrophic pyloric stenosis, muscle thickness was 1.8 +/- 0.4 mm, muscle length was 1.3 +/- 0.3 cm, and channel length was 1.1 +/- 0.3 cm. The mean measurement for each parameter was significantly larger in patients who had hypertrophic pyloric stenosis than in those who did not (p less than .01). However, histograms of the three parameters show significant overlap in the measurements of muscle length and channel length between the patients with and those without hypertrophic pyloric stenosis. The thickness of the muscle is the most discriminating and accurate criterion for hypertrophic pyloric stenosis.

Female↗

Massive congenital intracranial teratoma: a report of two cases.

Although intracranial teratoma is a well-recognized entity in the differential diagnosis of pediatric brain tumors, massive congenital intracranial teratoma replacing the cerebral hemispheres of a neonate has seldom been reported. We describe two such instances that histologically exhibit predominantly neuroepithelial differentiation. In 1 case serial prenatal ultrasonography revealed ventricular dilatation prior to identification of the lesion. Theories of pathogenesis are briefly discussed.

Brain Neoplasms↗

Anorectal atresia: prenatal sonographic diagnosis.

To determine the prenatal sonographic findings of anorectal atresia (ARA), we retrospectively reviewed 12 proven cases. Sonography showed abnormally dilated bowel segments in five cases (42%), four of which were identified prospectively; at autopsy, two other cases showed mild colon dilatation not evident on sonograms. Bowel dilatation was not associated with the location of atresia or the presence of a fistula, but was possibly related to menstrual age. Eleven fetuses (92%) had significant other anomalies primarily related to the VACTERL syndrome (vertebral defects, anal atresia, tracheoesophageal fistula with esophageal atresia, radial and renal dysplasia, and limb malformations) and/or the caudal regression syndrome; of these, sonography identified one or more concurrent anomalies in seven cases. In two cases, bowel dilatation was the primary sonographic finding. Death in nine cases resulted from termination of pregnancy (four cases) or perinatal demise (five cases); three patients are still alive. We conclude that some cases of ARA can be suspected on prenatal sonograms by demonstration of dilated colon, and that the sensitivity of this finding may be related to menstrual age at the time of the examination. Distinguishing ARA from other causes of fetal-bowel dilatation is important because of the frequency of concurrent anomalies associated with ARA.

Abnormalities, Multiple↗

Estimating fetal weights less than 2000 g: an accurate and simple method.

An accurate estimated fetal weight in the low-birth-weight infant can provide valuable information for the obstetrician faced with a decision concerning mode and time of delivery. Four existing equations for calculating fetal weight were analyzed and compared with data consisting entirely of infants with birth weights of 500-2000 g. A new formula, birth weight-grams = 10.1 (abdominal circumference-cm X biparietal diameter-cm) - 481, is proposed as a simple yet accurate alternative. This equation has a standard deviation of 99 g/kg.

Birth Weight↗

Three-dimensional fast spin-echo imaging: pulse sequence and in vivo image evaluation.

Three-dimensional (3D) magnetic resonance imaging allows thin-section acquisition and therefore more accurate multiplanar reconstruction than conventional two-dimensional spin-echo imaging. Unfortunately, addition of a third acquisition plane extends imaging time greatly. With gradient-echo techniques, 3D acquisitions have become clinically useful. These techniques are limited, however, by susceptibility and other field inhomogeneity artifacts and decreased signal-to-noise ratios compared with spin-echo techniques. The authors describe implementation of a true spin-echo 3D technique that, by using fast spin-echo parameters, reduces acquisition time to a clinically useful level. Potential applications of the technique are demonstrated.

Brain↗

Multislab three-dimensional T2-weighted fast spin-echo imaging of the hippocampus: sequence optimization.

Three-dimensional (3D) fast spin-echo (FSE) imaging can produce contiguous thin sections for high-quality multiplanar reconstructions. Such reformatted images may be useful in the evaluation of three-dimensionally complex, curvilinear anatomic structures such as the hippocampus. The authors describe a 3D FSE protocol for T2-weighted imaging of the hippocampus. The protocol uses an overlapping-multiple-slab imaging strategy to decrease imaging times and a modified refocusing radio-frequency pulse train to improve the reformatted images. The authors describe their parameter optimization, discuss the benefits and limitations of the new sequence, and present representative images of healthy volunteers.

Artifacts↗

Magnetic resonance imaging and spectroscopy in fetal ethanol exposed Macaca nemestrina.

Magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy (1H-MRS) offer noninvasive ways to observe structural and biochemical changes which might serve as valuable diagnostic markers for detecting brain damage from prenatal ethanol teratogenesis. Cranial MR imaging and spectroscopy were performed on 20 nonhuman primates (Macaca nemestrina) with known prenatal ethanol exposures and well-documented cognitive and behavioral levels of performance. The choline: creatine ratio detected by 1H-MRS in the brain increased significantly with increasing duration of in utero ethanol exposure. These signal alterations occurred in the absence of gross structural brain anomalies (detectable by MRI) and were significantly correlated with alcohol-related cognitive and behavioral dysfunction. These observations are consistent with reports of elevated choline: creatine ratios associated with various neurologic insults and disease states. The association observed between brain choline:creatine ratios and in utero ethanol exposure suggest a role for 1H-MRS in elucidating mechanisms of ethanol teratogenicity.

Analysis of Variance↗

Cranial MR in phenylketonuria.

Phenylketonuria (PKU) is an autosomal recessive disease in which defects in phenylalanine metabolism result in hyperphenylalaninemia. Untreated patients generally have poor motor function and are profoundly retarded. We report a patient with PKU whose cranial magnetic resonance abnormalities correlate with known histopathologic changes. The ability to image the pathologic changes in PKU may have important implications regarding treatment and prognosis of these patients.

Adult↗