The effect of NIDCAP (Newborn Individualized Developmental Care and Assessment Program) was examined on the neurobehavioral, electrophysiological and neurostructural development of preterm infants with severe intrauterine growth restriction (IUGR). A total of 30 infants, 27–33 weeks gestation, were randomized to control (C; N=17) or NIDCAP/experimental (E; N=13) care. Baseline health and demographics were assessed at intake; electroencephalography (EEG) and magnetic resonance imaging (MRI) at 35 and 42 weeks postmenstrual age; and health, growth and neurobehavior at 42 weeks and 9 months corrected age (9 months). C and E infants were comparable in health and demographics at baseline. At follow-up, E infants were healthier, showed significantly improved brain development and better neurobehavior. Neurobehavior, EEG and MRI discriminated between C and E infants. Neurobehavior at 42 weeks correlated with EEG and MRI at 42 weeks and neurobehavior at 9 months. NIDCAP significantly improved IUGR preterm infants' neurobehavior, electrophysiology and brain structure. Longer-term outcome assessment and larger samples are recommended.

PURPOSE:To evaluate the additional value of the color coding of dynamic data using the 3TP method in the evaluation of contrast-enhanced breast MRI for readers with different levels of experience.MATERIALS AND METHODS:A total of 52 lesions were included in this study, 25 malignant and 27 benign. All lesions were evaluated by four readers on two different workstations for the evaluation of dynamic breast MRI; one displaying the subtracted images and relative enhancement versus time curves and one displaying the subtracted images together with the 3TP color coding projected onto pre-contrast T1 images. Readers with different levels of experience were used. The diagnostic performance of both workstations was evaluated using ROC curve analyses. Interobserver variations were evaluated using kappa statistics.RESULTS:All lesions were detected by all four readers on both workstations. The diagnostic performance found in the inexperienced readers improved significantly when using the 3TP evaluations (p=0.04 and p=0.03). No significant difference was found for the more experienced readers (p=0.94 and p=0.54). The level of agreement between the readers improved significantly when using the 3TP evaluation method (p=0.01).CONCLUSION:Even though the 3TP color coding did not improve the diagnostic performance of the more experienced readers, this study clearly shows its value for inexperienced readers. The use of 3TP color coding is therefore recommended for inexperienced readers.

Changes in society and developments within emergency care affect imaging in the emergency department. It is clear that radiologists have to be pro-active to even survive. High quality service is the goal, and if we are to add value to the diagnostic (and therapeutic) chain of healthcare, sub-specialization is the key, and, although specifically patient-oriented and not organ-based, emergency and trauma imaging is well suited for that. The development of emergency radiology in Europe and the United States is compared with emphasis on how different healthcare systems and medical cultures affect the utilization of Acute Care imaging.

Objective: This study investigates the effectiveness of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) on neurobehavioral and electrophysiological functioning of preterm infants with severe intrauterine growth restriction (IUGR). Study Design: Thirty IUGR infants, 28 to 33 weeks gestational age, randomized to standard care (control/C=18), or NIDCAP (experimental/E=12), were assessed at 2 weeks corrected age (2wCA) and 9 months corrected age (9mCA) in regard to health, anthropometrics, and neurobehavior, and additionally at 2wCA in regard to electrophysiology (EEG). Result: The two groups were comparable in health and anthropometrics at 2wCA and 9mCA. The E-group at 2wCA showed significantly better autonomic, motor, and self-regulation functioning, improved motility, intensity and response thresholds, and reduced EEG connectivity among several adjacent brain regions. At 9mCA, the E-group showed significantly better mental performance. Conclusion: This is the first study to show NIDCAP effectiveness for IUGR preterm infants.

The aim of this study was to summarize the extent of variation in imaging strategies in patients clinically suspected of having appendicitis. By means of a written survey, the policies for the imaging management of patients clinically suspected of having appendicitis in the Netherlands were inventoried. A questionnaire was sent to the departments of surgery and radiology of all 105 Dutch hospitals, including the 8 academic medical centres, in March 2006. Questionnaires were returned from 98 hospitals. It was found that, in the work-up of patients suspected of having appendicitis, ultrasound or CT was performed in a minority of hospitals for 50% or more of these patients. In the majority of hospitals, it was carried out for less than 50% of these patients. There is a widespread variability in pre-operative imaging regardless of hospital type. This survey shows that, despite the ubiquitous presence of ultrasound and CT in Dutch hospitals, the pre-operative imaging work-up in patients clinically suspected of having acute appendicitis does not reflect this, being performed in only a minority of patients suspected of having acute appendicitis. Radiologists and surgeons alike should be aware of the positive impact of adjunctive imaging in this group of patients - most importantly lowering the negative appendicectomy rate and also lowering total hospital costs.

The value of pharmacokinetic parameters derived from fast dynamic imaging during initial enhancement in characterizing breast lesions on magnetic resonance imaging (MRI) was evaluated. Sixty-eight malignant and 34 benign lesions were included. In the scanning protocol, high temporal resolution imaging was combined with high spatial resolution imaging. The high temporal resolution images were recorded every 4.1 s during initial enhancement (fast dynamic analysis). The high spatial resolution images were recorded at a temporal resolution of 86 s (slow dynamic analysis). In the fast dynamic evaluation pharmacokinetic parameters (K(trans), V(e) and k(ep)) were evaluated. In the slow dynamic analysis, each lesion was scored according to the BI-RADS classification. Two readers evaluated all data prospectively. ROC and multivariate analysis were performed. The slow dynamic analysis resulted in an AUC of 0.85 and 0.83, respectively. The fast dynamic analysis resulted in an AUC of 0.83 in both readers. The combination of both the slow and fast dynamic analyses resulted in a significant improvement of diagnostic performance with an AUC of 0.93 and 0.90 (P = 0.02). The increased diagnostic performance found when combining both methods demonstrates the additional value of our method in further improving the diagnostic performance of breast MRI.

Aims Invasive lobular carcinoma of the breast (ILC) is known to be substantially underestimated by mammography, which makes correct planning of treatment difficult. MRI has been proposed as a valuable adjunct to mammography. The purpose of the current study is to evaluate its value, compare it to mammography and assess the possible causes of over- and underestimation of lesion size on MRI. Method The mammograms and MRI scans of 67 consecutive patients with ILC were retrieved and re-evaluated. Size measurements were correlated to the sizes extracted from the pathology report. Results MRI measurements correlated better to pathologic size (r = 0.85) than mammographic measurements (r = 0.27). Underestimation of tumour size was more common on mammography (p < 0.001); overestimation occurred with equal frequency (p = 0.69). Overestimation on MRI, caused by non-malignant findings, was attributed to enhancing lobular carcinoma in situ. Conclusion MRI is a more accurate modality for determining tumour size in patients with ILC than mammography. The typical underestimation of lesion size by mammography can be prevented with the aid of MRI, without increasing the risk of lesion overestimation.

AIM:To identify and to evaluate predictors that determine whether chest computed tomography (CT) is likely to reveal relevant injuries in adult blunt trauma patients. METHODS:After a comprehensive literature search for original studies on blunt chest injury diagnosis, two independent observers included studies on the accuracy of parameters derived from history, physical examination, or diagnostic imaging that might predict injuries at (multidetector row) CT in adults and that allowed construction of 2x2 contingency tables. For each article, methodological quality was scored and relevant predictors for injuries at CT were extracted. For each predictor, sensitivity, specificity, positive and negative likelihood ratio and diagnostic odds ratio (DOR) including 95% confidence intervals were calculated. RESULTS:Of 147 articles initially identified, the observers included 10 original studies in consensus. Abnormalities at physical examination (abnormal respiratory effort, need for assisted ventilation, reduced airentry, coma, chest wall tenderness) and pelvic fractures were significant predictors (DOR: 2.1-6.7). The presence of any injuries at conventional radiography of the chest (eight articles) was a more powerful significant predictor (DOR: 2.2-37). Abnormal chest ultrasonography (four articles) was the most accurate predictor for chest injury at CT (DOR: 491-infinite). CONCLUSION:The current literature indicates that in blunt trauma patients with abnormal physical examination, abnormal conventional radiography, or abnormal ultrasonography of the chest, CT was likely to reveal relevant chest injuries. However, there was no strong evidence to suggest that CT could be omitted in patients without these criteria, or whether these findings are beneficial for patients.

The appearance of malignant lesions in BRCA1 and BRCA2 mutation carriers (BRCA-MCs) on mammography and magnetic resonance imaging (MRI) was evaluated. Thus, 29 BRCA-MCs with breast cancer were retrospectively evaluated and the results compared with an age, tumor size and tumor type matched control group of 29 sporadic breast cancer cases. Detection rates on both modalities were evaluated. Tumors were analyzed on morphology, density (mammography), enhancement pattern and kinetics (MRI). Overall detection was significantly better with MRI than with mammography (55/58 vs 44/57, P=0.021). On mammography, lesions in the BRCA-MC group were significantly more described as rounded (12//19 vs 3/13, P=0.036) and with sharp margins (9/19 vs 1/13, P=0.024). On MRI lesions in the BRCA-MC group were significantly more described as rounded (16/27 vs 7/28, P=0.010), with sharp margins (20/27 vs 7/28, P<0.001) and with rim enhancement (7/27 vs 1/28, P=0.025). No significant difference was found for enhancement kinetics (P=0.667). Malignant lesions in BRCA-MC frequently have morphological characteristics commonly seen in benign lesions, like a rounded shape or sharp margins. This applies for both mammography and MRI. However the possibility of MRI to evaluate the enhancement pattern and kinetics enables the detection of characteristics suggestive for a malignancy.

Background: A 70-year-old woman, with medical history of coronary artery disease treated by coronary aortic bypass grafting (CABG) 10 years ago, was admitted because of recurrence of anginous complaints. After evaluation of the cardiac function, a repeated CABG was indicated. This procedure was carried out without complications.

This special issue is not about the latest technical wizardry in digital imaging, PACS, CT or MR, but to illustrate that pediatric radiology is the last remaining general radiology practice today.When we were asked to put together this special issue, we thus decided that our focus should be on pediatric imaging topics that are not generally found in general radiology journals, but some every day issues that radiologists in a general practice may run up against in the few pediatric cases that they are asked to manage.In looking at a pediatric imaging practice, it soon becomes very clear that one cannot work as imagers alone. Even more so than in adult practice, cooperation with clinical colleagues is essential to ensure that the necessary imaging in children is kept to an effective and safe minimum.This endeavor sometimes clashes with a number of clinical questions that pediatric imaging is asked to deal with:1.It had come to our attention that our pediatric surgical colleagues wrestled with the question of which imaging modalities can be used for pancreatic injury due to blunt abdominal trauma, in particular when it comes to shortening hospital stay. Bosboom et al. reviewed our medical centers experience to this end.2.We do not think there is a single radiologist that has not looked at a pediatric abdominal radiograph with some trepidation. It seemed to us that a review of the value of the abdominal radiograph in children with functional GI-disorders might be useful. Our clinical colleagues (Bongers et al.) helped us in trying to formulate key points to keep in mind.3.Similarly, over the years we were asked a number of times to demonstrate the presence or absence of colonic duplications. As we had limited experience with this anomaly, we (Blickman et al.) were interested in its frequency and what the imaging features would be. It turned out there are two separate age groups in which this anomaly presents.4.It is always good to review ones habits after a period of time has elapsed in which certain conditions were managed in a certain way. As we are reassessing the definition of malposition of the pediatric intestinal tract, and are looking at repairing malposition endoscopically, we here at the UMC Nijmegen reviewed what the implications might be of these changes to streamline the imaging process.5.Interventional radiology in the pediatric age group is on the increase. The advantages of the minimally invasive approach are progressively being acknowledged. The indications however are slightly different as compared to the adult population, although gastrointestinal tract bleeding also appears on the differential diagnostic list in children. That not all causes are clear-cut is shown by Aarts and colleagues.6.Finally, a variety of strictures undergo balloon dilatation, even in pediatrics. Esophageal stenoses are commonly dilated, on the other hand colonic strictures secondary to necrotizing enterocolitis are not successfully treated by balloon dilatation. Van Rijn et al. described their experience in their initial four cases with membranous duodenal stenosis and balloon dilatation.We believe that this issue will be very useful in illustrating that pediatric imaging is not just the imaging of small adults. We also hope that an appreciation is generated for special considerations that need to be kept in mind when imaging children.View Large Image Figure ViewerDownload (PPT) This special issue is not about the latest technical wizardry in digital imaging, PACS, CT or MR, but to illustrate that pediatric radiology is the last remaining general radiology practice today. When we were asked to put together this special issue, we thus decided that our focus should be on pediatric imaging topics that are not generally found in general radiology journals, but some every day issues that radiologists in a general practice may run up against in the few pediatric cases that they are asked to manage. In looking at a pediatric imaging practice, it soon becomes very clear that one cannot work as imagers alone. Even more so than in adult practice, cooperation with clinical colleagues is essential to ensure that the necessary imaging in children is kept to an effective and safe minimum. This endeavor sometimes clashes with a number of clinical questions that pediatric imaging is asked to deal with:1.It had come to our attention that our pediatric surgical colleagues wrestled with the question of which imaging modalities can be used for pancreatic injury due to blunt abdominal trauma, in particular when it comes to shortening hospital stay. Bosboom et al. reviewed our medical centers experience to this end.2.We do not think there is a single radiologist that has not looked at a pediatric abdominal radiograph with some trepidation. It seemed to us that a review of the value of the abdominal radiograph in children with functional GI-disorders might be useful. Our clinical colleagues (Bongers et al.) helped us in trying to formulate key points to keep in mind.3.Similarly, over the years we were asked a number of times to demonstrate the presence or absence of colonic duplications. As we had limited experience with this anomaly, we (Blickman et al.) were interested in its frequency and what the imaging features would be. It turned out there are two separate age groups in which this anomaly presents.4.It is always good to review ones habits after a period of time has elapsed in which certain conditions were managed in a certain way. As we are reassessing the definition of malposition of the pediatric intestinal tract, and are looking at repairing malposition endoscopically, we here at the UMC Nijmegen reviewed what the implications might be of these changes to streamline the imaging process.5.Interventional radiology in the pediatric age group is on the increase. The advantages of the minimally invasive approach are progressively being acknowledged. The indications however are slightly different as compared to the adult population, although gastrointestinal tract bleeding also appears on the differential diagnostic list in children. That not all causes are clear-cut is shown by Aarts and colleagues.6.Finally, a variety of strictures undergo balloon dilatation, even in pediatrics. Esophageal stenoses are commonly dilated, on the other hand colonic strictures secondary to necrotizing enterocolitis are not successfully treated by balloon dilatation. Van Rijn et al. described their experience in their initial four cases with membranous duodenal stenosis and balloon dilatation. We believe that this issue will be very useful in illustrating that pediatric imaging is not just the imaging of small adults. We also hope that an appreciation is generated for special considerations that need to be kept in mind when imaging children.

The aim of the study was to evaluate mammography in detecting and staging of invasive lobular carcinoma (ILC) in order to assess the performance and impact of observer variability. Forty-two cases of ILC were retrospectively evaluated twice by two breast radiologists. Mammographic performance as well as intra- and interobserver variations was evaluated. Thirty-five percent to 37% of the cases were understaged. The largest differences between radiologists were found in the breast imaging reporting and data system (BIRADS) classification and staging performance. These results can have serious influence on patient management.

Diagnosis of colonic duplication can pose a potential problem even for those familiar with gastro-intestinal tract duplications in general but unaware of the condition due to its rarity and its apparently bimodal clinical presentation. In this report of five cases of surgically proven pediatric colonic duplication, we illustrate how the condition manifests clinically and describe the imaging features in an attempt to illustrate this bimodal presentation of the condition. The possible etiology, associated congenital anomalies and modes of clinical presentation are reviewed based on literature review as well as on our own experience.

Background: The role imaging studies play in the choice of treatment in traumatic pancreas damage remains unclear. This study was performed to gain insight into the role of radiological studies in children 16 years of age or younger admitted to our hospital with pancreatic damage due to a blunt abdominal trauma.Method: Retrospectively, the radiological as well as patient clinical records were reviewed of all children admitted to our hospital between 1975 and 2003 with a pancreatic lesion due to blunt abdominal trauma.Results: Thirty-four children with ages ranging from 3 to 14 years old were admitted with traumatic pancreas damage. Initially 33 children were treated conservatively for the pancreatic damage and only one had immediate surgery of the pancreas with a Roux-y pancreaticojejunostomy. Five other children had immediate surgery for other reasons. Overall, five children proved to have a pancreas transection on CT scans or during laparotomy. One child had a pancreas hematoma and 28 a pancreas contusion. In total 15 children developed a pseudocyst (44%), nine of which resolved spontaneously while six were treated by intervention. None of the children had residual morbidity, and there were no deaths.Considering the pancreas, the 11 available CT's were re-evaluated by two radiologists independently. Grade 3 pancreas damage (distal transection of the pancreatic duct) was diagnosed in five patients by radiologist A and four patients by radiologist B (80% match); Grade I was diagnosed in, respectively six and one patients (15% match). An US was performed on 19 children with 82 follow-up examinations, mostly for follow-up of the pseudocysts.Conclusion: Traumatic pancreas damage is a rare and difficult diagnosis. There is no straightforward answer for diagnostic imaging in blunt abdominal trauma in children. The diagnostic relevance of CT is limited. CT in combination with MRCP may be a better option for exclusion of pancreatic duct lesions. (C) 2006 Elsevier Ireland Ltd. All rights reserved.

Purpose : Magnetic resonance imaging (MRI) can detect occult breast lesions clinically and mammographically. Several techniques have been developed to allow localisation and selective tissue sampling of these lesions. In this study we report the results of MRI-guided needle localisation of suspicious breast lesions by using a freehand technique in a 0.5-T open magnet. Materials and methods : Preoperative MRI-guided single needle localisation was performed in 220 patients with 304 breast lesions at our hospital between January 1997 and July 2004. All localisation procedures were performed in an open 0.5-T Signa-SP imager, with the patient in prone position by using a phased array breast coil. In all patients MRI compatible hookwires were placed in a non-compressed breast by using a freehand technique. MRI findings were correlated with pathology and follow-up. Results : Histopathologic analysis of these 304 lesions showed 104 (34%) malignant lesions, 51 (17%) high risk lesions, and 149 (49%) benign lesions. The overall lesion size ranged from 2.0 to 65.0 mm (mean 11.2 mm). No direct complications occurred. Follow-up MRI in 54 patients showed that two (3.7%) lesions were missed by surgical biopsy. Conclusion : MRI-guided freehand needle localisation is simple and accurate, the detection rate of malignant lesions (34%) is in accordance with the results of mammographically or US-guided needle localisations. An advantage of the freehand technique compared to grid localisation is the ability to localise lesions in the anterior breast, the axillary region and near the chest wall.

Three women aged 45, 37 and 56 underwent MRI imaging of the breast for: breast-cancer screening, pre-operative staging and for monitoring the response on chemotherapy. Breast cancer at an early stage for which breast-saving surgery was possible was discovered in the first woman. In the second woman, the tumour was larger than was seen with mammography or ultrasound and other tumour sites were seen, leading to a more extensive treatment plan. In the year thereafter no metastases were found. In the third woman the response to chemotherapy was monitored. 8 months after therapy she appeared to have skeletal metastases. Mammography and ultrasound are the most commonly used modalities in breast imaging. Over the past few years MRI has been making an increasingly large contribution to the screening, staging and follow-up of patients with breast cancer. MRI can be an important supplementary study but its exact role still needs to be defined.