LTHOUGH WE WILL concentrate on cardiac and great vessel anomalies in this section, one must remember that congenital cardiac disease is associated with a wide range of noncardiac anomalies. This will affect how we place cross-sectional imaging data in the larger context of the patient’s disease complex. It may seriously impact how we manage the care of the patient in the environment of magnetic resonance scanners and computed tomography (CT) machines. It may affect how we deliver sedative medications, monitor patient safety, administer contrast agents, and how we focus our limited imaging time. In the Baltimore–Washington Infant Study, 27% of patients with cardiac defects had associated anomalies. 1 Single-organ system extracardiac abnormalities will occur with higher frequency than in the normal population, musculoskeletal and central nervous sytem being most common. 1,2 However, many associated defects are well-defined chromosomal abnormalities, heritable syndromes, and associations. Down’s syndrome is most frequent. Approximately 40% of Down’s syndrome patients have cardiac defects (ventricular septal defect, atrioventicular canal defects). Down’s patients also have related clinical problems from pulmonary hypertension and upper airway abnormalities, im

BACKGROUND. The association between Wilms' tumor (WT) and genitourinary (GU) anomalies has long been appreciated; however, associated GU anomalies have been described almost exclusively in males.METHODS. To investigate whether females with WT also have an increased prevalence of GU anomalies, the authors evaluated the uterine anatomy of 24 WT survivors using magnetic resonance imaging and ultrasonography.RESULTS. Two of 24 female survivors (8%) had anomalies. One had a septate uterus, and a limited molecular analysis of her constitutional DNA revealed no mutations or deletions of the tumor suppressor gene WT1. Another survivor with the WAGR syndrome (WT, aniridia, GU anomalies, and retardation), with the characteristic 11p13 deletion including WT1, had a uterine anomaly (hypoplastic vs. unicornuate).CONCLUSIONS. Because uterine malformations are rare in the general population, this finding suggests an association between WT and uterine malformations and also may partially explain the fertility deficit previously demonstrated in adult female WT survivors. Pelvic ultrasonography in adult female WT survivors can alert survivors and clinicians to possible fertility problems that may lead to problem pregnancies and adverse pregnancy outcomes. (C) 1996 American Cancer Society.

We retrospectively reviewed the management of intracranial abscesses associated with sinusitis in 13 children and adolescents by reviewing medical records and computed tomography (CT) scans of a consecutive case series. The mean duration of follow-up was 4.5 years with a range of 1.3 to 8.6 years, and the setting was a major metropolitan children's hospital providing primary as well as tertiary care. All patients received antibiotics (most commonly chloramphenicol, 75 to 100 mg/kg/day, in combination with oxacillin, 150 to 200 mg/kg/day) to which the sinus and intracranial organisms are susceptible. Surgical drainage of loculated infection was done for patients with acute neurologic symptoms or signs and for those patients whose abscesses enlarged during medical therapy. Three patients underwent immediate drainage of intracranial abscesses because of acute neurologic signs and symptoms. Sequential CT scans demonstrated enlargement of the intracranial abscesses in the remaining 10 patients. This apparent failure of medical management could not be explained by duration of symptoms before therapy, size of lesion, choice of antibiotics, or use of steroids. No child was successfully treated with antibiotics alone. Successful management consisted of antibiotic therapy combined with surgical drainage of loculated infection. This approach to therapy is preferred for all children with intracranial abscess associated with sinusitis.

Diagnostic accuracy was evaluated in a signal detection experiment that used low-contrast acute lesions in a living dog model. At the high levels of certainty normally used by radiologists, rare earth screen-film systems provided accuracy comparable to that of a reference calcium tungstate screen-film system. Additionally subjective image quality evaluation for a given imaging task (clinical pediatric anterior-posterior chest films) based on visualization of anatomic landmarks and physical parameters has been conducted for several rare earth and one calcium tungstate screen-film system. The correspondence of subjective physical ranking with physical and psychophysical measurements was investigated. Evaluating the visualization of anatomic parameters can provide a clear and objective distinction among systems with comparable physical and psychophysical properties.