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Montalto S, Di Filippo M, Capra V, Manzitti C, Sementa AR, De Marco P, Ognibene M, Sertorio F, Sorrentino S. Abdominal rhabdoid tumor presenting with symptomatic spinal epidural compression in a newborn. A case report. Front Pediatr 2024; 11:1337760. [PMID: 38283400 PMCID: PMC10811000 DOI: 10.3389/fped.2023.1337760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/28/2023] [Indexed: 01/30/2024] Open
Abstract
The occurrence of an abdominal tumor invading the spinal canal and causing symptoms of epidural compression is rare in an infant, and exceptional at birth. Peripheral neuroblastic tumors are by far the most common cause. Emergency chemotherapy is commonly curative, though permanent sequelae are possible. Although other malignancies may be involved, no case of rhabdoid tumors at birth has been reported. We describe the case of a neonate who presented symptoms of spinal epidural compression at birth secondary to a rhabdoid tumor. As expected with this highly malignant tumor, the patient experienced a rapidly progressive clinical course and died within three months of diagnosis.
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Affiliation(s)
- Shana Montalto
- Pediatric Infectious Diseases Unit, IRCCS IstitutoGianninaGaslini, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Michela Di Filippo
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Valeria Capra
- Genomics and Clinical Genetics Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Carla Manzitti
- Oncology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Patrizia De Marco
- Medical Genetics Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marzia Ognibene
- Medical Genetics Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Sertorio F, Pacetti M, Schiaffino S, Secci F, Cama A, Consales A, Magnano GM. Ultrasonography as first line imaging for the diagnosis of positional plagiocephaly. Minerva Pediatr (Torino) 2023; 75:557-560. [PMID: 30916518 DOI: 10.23736/s2724-5276.19.05424-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND In the last years, numerous studies evaluated different tools for the diagnosis of positional plagiocephaly (PP). The purpose of this study was to evaluate ultrasonography (US) as a first line screening test of lambdoid sutural patency in child with PP and to compare our results with the literature. METHODS All consecutive patients who referred to our Institute from January 2016 to October 2017 with the suspicion of PP, were included in the study and performed US examination of the lambdoid sutures. A 3-6-month clinical follow-up was performed by a pediatric neurosurgeon or a pediatrician to confirm the diagnosis of PP. RESULTS Thirty-five children performed US examination and in all cases the diagnosis of PP was confirmed. No cases of anticipated suture fusion were examined during this period. The concordance between US findings and clinical exam follow-up was 100%. CONCLUSIONS Ultrasonography of the lambdoid sutures represents an ideal first-line screening test and reliable alternative to other diagnostic techniques for lambdoid sutural patency in child with PP, being radiation free, fast and cheap.
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Affiliation(s)
- Fiammetta Sertorio
- Department of Radiology, IRCCS Istituto Giannina Gaslini, Genoa, Italy -
- Department of Radiology, University of Genoa, Genoa, Italy -
| | - Mattia Pacetti
- Department of Neurosurgery, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Francesca Secci
- Department of Neurosurgery, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Armando Cama
- Department of Neurosurgery, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Gian M Magnano
- Department of Radiology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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3
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Perrone A, Lakatos K, Pegoraro F, Trambusti I, Fotzi I, Selvi V, Prosch H, Sertorio F, Pötschger U, Favre C, Conte M, Minkov M, Sieni E. Whole-body magnetic resonance imaging for staging Langerhans cell histiocytosis in children and young adults. Pediatr Blood Cancer 2023; 70:e30064. [PMID: 36317710 DOI: 10.1002/pbc.30064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/19/2022] [Accepted: 09/20/2022] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Radiographic skeletal survey (R-SS) is the standard imaging technique for the initial staging of Langerhans cell histiocytosis (LCH). Whole-body magnetic resonance imaging (WB-MRI) has been proposed as an effective, radiation-free alternative. METHODS We prospectively assessed patients with LCH followed at three tertiary centers in Italy and Austria. Two national study protocols were independently designed, and data were then pooled to increase the power of their findings. R-SS and WB-MRI were performed at diagnosis and repeated at the follow-up to confirm the nature of the identified lesions and to study their evolution. RESULTS Data from 67 patients were analyzed (52 from Italy and 15 from Austria). Compared to R-SS, WB-MRI identified 29 additional skeletal lesions in 14 patients (including two false-positive lesions). Two skeletal lesions were detected at R-SS and missed at WB-MRI (false negative). Per-lesion sensitivity rates were 78.6% (95% CI: 71.0-85.9) for R-SS and 98.4% (95% CI: 94.4-99.8) for WB-MRI, respectively. Based on WB-MRI findings, six patients would have been upstaged to a higher risk class than staging with R-SS. CONCLUSIONS WB-MRI had a significantly higher detection rate for skeletal lesions compared to R-SS. Clinical and radiology expertise is required to avoid upstaging and overtreatment.
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Affiliation(s)
- Anna Perrone
- Paediatric Radiology, Meyer Children's University Hospital, Florence, Italy
| | - Karoly Lakatos
- Paediatric Radiology, St. Anna Children's Hospital, Vienna, Austria
| | - Francesco Pegoraro
- Paediatric Haematology/Oncology Department, Meyer Children's University Hospital, Florence, Italy.,Department of Health Sciences, University of Firenze, Florence, Italy
| | - Irene Trambusti
- Paediatric Haematology/Oncology Department, Meyer Children's University Hospital, Florence, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ilaria Fotzi
- Paediatric Haematology/Oncology Department, Meyer Children's University Hospital, Florence, Italy
| | - Valeria Selvi
- Paediatric Radiology, Meyer Children's University Hospital, Florence, Italy
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Fiammetta Sertorio
- Paediatric Radiology, Gaslini Children's University Hospital, Genoa, Italy
| | | | - Claudio Favre
- Paediatric Haematology/Oncology Department, Meyer Children's University Hospital, Florence, Italy
| | - Massimo Conte
- Paediatric Haematology/Oncology Department, Gaslini Children's University Hospital, Genoa, Italy
| | - Milen Minkov
- Paediatric Haematology/Oncology Department, St. Anna Children's Hospital, Vienna, Austria
| | - Elena Sieni
- Paediatric Haematology/Oncology Department, Meyer Children's University Hospital, Florence, Italy
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Montalto S, Sertorio F, Podda M, Sorrentino S, Di Cataldo A, Provenzi M, Nonnis A, D'Ippolito C, Corrias MV, De Bernardi B. Bilateral adrenal primary tumor in Stage 4S neuroblastoma: The Italian experience and review of the literature. Pediatr Hematol Oncol 2022; 39:441-452. [PMID: 35139733 DOI: 10.1080/08880018.2021.2013368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Bilateral adrenal neuroblastoma (NB) is rare and is mainly stage 4S. Its incidence, presenting features, management, and outcome have not been fully defined yet. We searched the Italian NB Registry (RINB) for stage 4S NB infants with bilateral adrenal primary tumor to compare them with stage 4S NB with unilateral tumor. Between 1979 and 2016, the RINB enrolled 3731 NB patients aged 0-18 years including 317 infants (8.5%) diagnosed with stage 4S NB. Eleven/317 (3.5%) had a bilateral adrenal primary tumor (Group 1) and 190/317 (59.9%) had a unilateral tumor (Group 2). Group 1 infants were significantly younger (51 vs. 89 days) but were comparable with Group 2 for any other presenting features. In the absence of specific protocols, upfront treatment was based on symptoms, size of adrenal tumors, and biology, and consisted of observation in 5 cases, radiotherapy in one, chemotherapy in 2, and surgery in 3. Five/11 developed progression and 2 of them, both with MYCN amplification, died. The 5-year EFS rates of Group 1 and 2 were 54.5% vs. 73.3% (P=.14) and 5-year OSs were 81.8% and 89.4%, respectively (P=.44). Our data support the hypothesis that 4S NB infants with bilateral adrenal tumors can have favorable outcome with personalized therapeutic approach. The three patients with MYCN amplified tumor benefited from upfront aggressive chemotherapy, in accordance with current protocols. Because of the rarity of this intriguing form of neuroblastoma, collaborative prospective studies are warranted, especially in view of gaining a better insight on its biological and genetic features.
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Affiliation(s)
- Shana Montalto
- Oncology Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | | | - Marta Podda
- Department of Pediatric Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Andrea Di Cataldo
- Department of Pediatrics, Hematology-Oncology Unit, University Hospital, University of Catania, Catania, Italy
| | - Massimo Provenzi
- Pediatric Oncology Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Antonella Nonnis
- Pediatric Onco-Hematology Unit, Microcitemic Pediatric Hospital, Cagliari, Italy
| | | | - Maria Valeria Corrias
- Laboratory of Experimental Therapy in Oncology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Campo I, Sertorio F, Wong M, Anfigeno L, Bertolotto M, Mattioli G, Damasio MB. Magnetic resonance urography of congenital abnormalities - what the radiologist needs to know. Pediatr Radiol 2022; 52:985-997. [PMID: 34839376 DOI: 10.1007/s00247-021-05233-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 08/27/2021] [Accepted: 10/20/2021] [Indexed: 10/19/2022]
Abstract
Congenital abnormalities of the kidney and urinary tract include a wide range of malformations ranging from asymptomatic to life-threatening conditions. Although pediatric urogenital system imaging is based on the use of US (pre- and postnatal), voiding cystourethrography and scintigraphic study, magnetic resonance (MR) urography plays a fundamental role in the classification and management of congenital abnormalities of the kidney and urinary tract, giving an overview of the different clinical pictures, thanks to its panoramicity and high anatomical detail. In fact the anomalies of the urinary tract are phenotypically variable because they can affect simultaneously several segments of different embryonic derivation, with complex clinical pictures; they can appear both as isolated phenotypes or as complex malformative conditions, involving renal parenchyma, collecting system and bladder. A deep knowledge of this complex embryogenesis and its possible phenotypic patterns allows a correct interpretation of MR urography images. We describe the embryology and pathophysiology of congenital abnormalities of the kidney and urinary tract as well as MR urography technique and findings. Congenital abnormalities of the kidney and urinary tract are classified into four groups: (1) obstruction (proximal, middle and distal), (2) budding with respect to the Wolffian duct (site and number of ureter), (3) ascent and rotation (ectopia, malrotation and fusion of kidney) and (4) anomaly of metanephric differentiation (dysplasia, megapolicalycosis).
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Affiliation(s)
- Irene Campo
- Department of Radiology, Ospedale Civile Di Conegliano, ULSS 2 Marca Trevigiana, Via Brigata Bisagno, 2, 31015, Conegliano, TV, Italy.
| | | | - Michela Wong
- Pediatric Surgery Department, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Lorenzo Anfigeno
- Department of Radiology, IRCCS Istituto Giannina Gaslini, Genova, Italy.,Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Michele Bertolotto
- Department of Radiology, University of Trieste, Ospedale Di Cattinara, Trieste, Italy
| | - Girolamo Mattioli
- Pediatric Surgery Department, IRCCS Istituto Giannina Gaslini, Genova, Italy.,Pediatric Surgery Department, IRCCS Gaslini, DINOGMI, University of Genoa, Genoa, Italy
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Wong MCY, Incerti F, Avanzini S, Palo F, Sertorio F, Damasio MB, Arrigo S, Gandullia P, Mattioli G. Cholelithiasis management in a third-level pediatric center: case series and literature review. Updates Surg 2022; 74:963-968. [DOI: 10.1007/s13304-021-01227-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/22/2021] [Indexed: 01/26/2023]
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Sertorio F, Delfino L, Wong MC, Palo F, Carlucci M, Fiorenza V, Basso L, Anfigeno L, Piaggio G, Damasio MB, Mattioli G. Surgical validation of functional magnetic resonance urography in the study of ureteral anomalies distal to the uretero-pelvic junction in a pediatric cohort. Minerva Pediatr (Torino) 2022:S2724-5276.22.06462-X. [PMID: 35084148 DOI: 10.23736/s2724-5276.22.06462-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Ureteral anomalies distal to the Uretero-Pelvic Junction (UPJ) belong to the wide spectrum of congenital anomalies of the kidney and urinary tract (CAKUT). They can cause severe obstruction requiring a detailed anatomical depiction to define the surgical approach. Up to date, ultrasonography, voiding cystourethrography and scintigraphy are considered the gold-standard diagnostic tools to study obstructive anomalies of the urinary tract, however, they do not provide accurate ureteral anatomical details. The aim of our study was to evaluate the concordance between functional magnetic resonance urography (fMRU) and intraoperative findings to define ureteral anomalies distal to UPJ. METHODS Pediatric patients with ureteral anomalies distal to the UPJ who underwent surgery after performing fMRU were retrospectively collected. Surgical data were compared with radiological results. The concordance was assessed considering both pathological and non-pathological urinary tracts and was calculated by means of the Cohen's kappa coefficient. fMRU diagnostic accuracy was defined by sensitivity, specificity, and binomial exact confidence intervals. RESULTS We included 46 patients. The sensitivity and specificity of fMRU were 98.0% and 83,3%; positive predictive value 90,4%, negative predictive value 96.2%. The concordance between surgical findings and fMRU was 92,3%, with a k Cohen's coefficient of 0.83 (excellent). CONCLUSIONS Our study demonstrates the excellent agreement between fMRU and surgical findings in the definition of ureteral anomalies distal to the UPJ in children. Thus, it could be considered a valid imaging technique in the preoperative planning as it provides the surgeon with important information regarding the etiology and site of the obstruction.
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Affiliation(s)
| | - Lorenza Delfino
- Department of Health Sciences (DISSAL), Radiology Department, University of Genoa, Genoa, Italy
| | - Michela Cy Wong
- Pediatric Surgery Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- DINOGMI, University of Genoa, Genoa, Italy
| | - Federico Palo
- Pediatric Surgery Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- DINOGMI, University of Genoa, Genoa, Italy
| | - Marcello Carlucci
- Pediatric Surgery Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Venusia Fiorenza
- Pediatric Surgery Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- DINOGMI, University of Genoa, Genoa, Italy
| | - Luca Basso
- Radiology Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Lorenzo Anfigeno
- Radiology Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Health Sciences (DISSAL), Radiology Department, University of Genoa, Genoa, Italy
| | - Giorgio Piaggio
- Nephrology and Renal Transplantation Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Maria B Damasio
- Radiology Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Girolamo Mattioli
- Pediatric Surgery Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Damasio MB, Sertorio F, Wong MCY, Campo I, Carlucci M, Basso L, Anfigeno L, Bodria M, Pistorio A, Piaggio G, Ghiggeri GM, Mattioli G. Functional Magnetic Resonance Urography in Ureteropelvic Junction Obstruction: Proposal for a Pediatric Quantitative Score. Front Pediatr 2022; 10:882892. [PMID: 35783310 PMCID: PMC9243529 DOI: 10.3389/fped.2022.882892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/10/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Ureteropelvic junction obstruction (UPJO) is one of the most frequent causes of congenital hydronephrosis. It is essential to distinguish UPJO which needs surgical treatment. fMRU combines high quality morphological details of the kidney and excretory pathways with functional data. OBJECTIVE This study aims to introduce a new radiological score based on fMRU findings to be able to differentiate surgical from non-surgical kidneys. MATERIALS AND METHODS We retrospectively selected patients with hydronephrosis due to UPJO who underwent fMRU (January 2009-June 2018). A multidisciplinary team identified a list of fMRU morpho-functional predictive variables to be included in the analysis. To evaluate the role of different independent variables in predicting the outcome, a multivariable logistic regression model has been performed; the outcome variable was the surgical intervention. For each predictive variable, Odds Ratio and 95% Confidence Intervals were calculated. The likelihood ratio test was used to assess the significance of the variables. Using the regression model, we assigned a numerical value to each predictive variable, rounding up the beta-coefficients. The cut-off value of the total score was obtained from the ROC curve analysis. RESULTS A total of 192 patients were enrolled, corresponding to 200 pathological kidneys. All of them underwent fMRU; 135 were surgically treated, while 65 underwent ultrasound or MRU follow-up. Predictive variables significantly associated with surgery resulted to be the urographic phase, the presence of abnormal vessels, and a baseline anterior-posterior pelvic diameter >23 mm. Beta coefficients of the logistic regression model were then converted in scores. The ROC curve of the score showed high sensitivity (84.3%) and specificity (81.3%) with a cut-off > 2.5. CONCLUSIONS We propose a new fMRU score able to identify surgical vs. non-surgical kidneys with UPJO.
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Affiliation(s)
- Maria Beatrice Damasio
- Radiology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Fiammetta Sertorio
- Radiology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Michela Cing Yu Wong
- Pediatric Surgery Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Irene Campo
- Radiology Department, Ospedale di Conigliano - Unità Locale Socio-Sanitaria (ULSS) 2 Marca Trevigiana, Conegliano, Italy
| | - Marcello Carlucci
- Pediatric Surgery Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Luca Basso
- Radiology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Lorenzo Anfigeno
- Radiology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy.,Department of Health Sciences, Radiology Department, University of Genoa, Genoa, Italy
| | - Monica Bodria
- Nephrology and Renal Transplantation Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Angela Pistorio
- Epidemiology and Biostatistics Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Giorgio Piaggio
- Nephrology and Renal Transplantation Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Gian Marco Ghiggeri
- Nephrology and Renal Transplantation Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Girolamo Mattioli
- Pediatric Surgery Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
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Sorrentino S, Ash S, Haupt R, Plantaz D, Schiff I, Hero B, Simon T, Kachanov D, Shamanskaya T, Kraal K, Littooij A, Wieczoreck A, Balwierz W, Laureys G, Trager C, Sertorio F, Erminio G, Fragola M, Beck Popovic M, De Bernardi B, Trahair T. Presenting features of neuroblastoma with spinal canal invasion. A prospective study of the International Society of Pediatric Oncology Europe - Neuroblastoma (SIOPEN). Front Pediatr 2022; 10:1023498. [PMID: 36299690 PMCID: PMC9589152 DOI: 10.3389/fped.2022.1023498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/14/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Between 5 and 15% of children with neuroblastoma (NB) present with or develop spinal canal invasion (SCI). The majority of these children have symptoms of epidural compression of spinal cord and/or spinal nerves. Treatment of NB-SCI is considered an emergency but its modalities are not yet well-established. Independently of treatment, NB-SCI may result in significant long-term disabilities. We report on the first prospective study of NB-SCI focused on presenting characteristics of both symptomatic and asymptomatic patients and correlation between SCI-related symptoms and imaging features. MATERIALS AND METHODS This SIOPEN prospective NB-SCI study opened in June 2014. Patient data including SCI symptoms evaluated by standardized measures and spinal cord imaging studies were collected for each patient. For the purpose of this study data entry was locked on July 2021. RESULTS Of the 208 NB-SCI patients registered, 196 were evaluable for this analysis of whom 67% were symptomatic and 33% asymptomatic. Median age was 11 months. The thorax was the commonest primary tumor site. The median intervals between initial symptoms and diagnosis and between first medical visit and diagnosis were 14 and 3 days, respectively. The was no statistical difference in frequency of presenting characteristics between symptomatic and asymptomatic patients. Presenting features of NB-SCI patients differed from other NBs for older median age, prevalence of thoracic vs. abdominal primary site, prevalence of localized vs. metastatic disease and lower incidence of MYCN gene amplification. The most common SCI features were motor deficit in the younger and pain in the older patients that correlated on imaging with both transverse and longitudinal extent but not with the level of intraspinal tumor. Spinal cord T2-hyperintensity was more frequently detected in symptomatic patients (not significant). CONCLUSION This prospective study confirms that children with NB-SCI differ from NBs without SCI. Compared to previous studies, it provides more detailed information regarding presenting symptoms, time intervals between SCI symptoms, medical visit and diagnosis, and correlations between symptoms and imaging features.
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Affiliation(s)
| | - Shifra Ash
- Joan and Sanford Weill Paediatric Haematology Oncology and Bone Marrow Transplantation Division, Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Riccardo Haupt
- DOPO Clinic, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Dominique Plantaz
- Department de Paediatrics, Hôpital Couple Enfants, CHU Grenoble, Grenoble, France
| | - Isabelle Schiff
- Department de Paediatrics, Hôpital Couple Enfants, CHU Grenoble, Grenoble, France
| | - Barbara Hero
- Department of Paediatric Haematology and Oncology, Children's Hospital, University of Cologne, Cologne, Germany
| | - Thorsten Simon
- Department of Paediatric Haematology and Oncology, Children's Hospital, University of Cologne, Cologne, Germany
| | - Denis Kachanov
- Department of Clinical Oncology, Dmitry Rogachev National Medical Research Center of Paediatric Haematology, Oncology and Immunology, Moscow, Russia
| | - Tatyana Shamanskaya
- Department of Clinical Oncology, Dmitry Rogachev National Medical Research Center of Paediatric Haematology, Oncology and Immunology, Moscow, Russia
| | - Katheljine Kraal
- Princess Màxima Centre for Paediatric Oncology, Utrecht, Netherlands
| | | | - Alexsandra Wieczoreck
- Paediatric Oncology and Haematology Department, Institute of Paediatrics, Jagiellonian University, Krakow, Poland
| | - Walentyna Balwierz
- Paediatric Oncology and Haematology Department, Institute of Paediatrics, Jagiellonian University, Krakow, Poland
| | - Geneviève Laureys
- Department of Paediatric Haematology-Oncology, Prinses Elisabeth Kinderziekenhuis, University Hospital, Gent, Belgium
| | - Catherine Trager
- Women's and Childrens Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Giovanni Erminio
- Scientific Directorate, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Martina Fragola
- Scientific Directorate, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Maja Beck Popovic
- Centre Hospitalier Universitaire Vaudois, Unité d'Hémato-Oncologie Pédiatrique, Lausanne, Switzerland
| | - Bruno De Bernardi
- Paediatric Oncology Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Toby Trahair
- Kids Cancer Center, Sydney Children's Hospital, Randwick, NSW, Australia.,Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales, Kensington, NSW, Australia.,School of Women's and Children's Health, University of New South Wales, Kensington, NSW, Australia
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10
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Anfigeno L, Sertorio F, Basso L, Fontana A, Bodria M, Pistorio A, Ghiggeri GM, Damasio MB. Diffusion-Weighted MRI in the Evaluation of Renal Parenchymal Involvement during Febrile Urinary Tract Infections in Children: Preliminary Data. J Clin Med 2021; 10:jcm10112239. [PMID: 34064114 PMCID: PMC8196731 DOI: 10.3390/jcm10112239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/03/2021] [Accepted: 05/14/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Urinary tract infection (UTI) is the most common infection in pediatric-age patients. Acute pyelonephritis (PNA) represents a worrying situation in pediatric patients due to the risk of sepsis and long-term cicatricial consequences. The purpose of this retrospective study is to evaluate the diagnostic role of DW-MRI in relation to clinical data, to understand if there are any clinical parameters useful in identifying which patients should undergo it. Methods: According to inclusion and exclusion criteria, we enrolled 51 patients ≤15 years old admitted to our Institute between September 2012 and April 2020 with a febrile UTI who underwent DW-MRI evaluation. Clinical, laboratory and imaging data were collected. Statistical analysis was performed. Results: 34 of 51 patients with an fUTI (66.7%) showed signs of acute parenchymal involvement at DW-MRI evaluation. In 27 of these 34 (79.4%), DW-MRI showed multiple areas of pyelonephritis. A statistically significant relationship (p = 0.0004) between older age at admission and pyelonephritis was demonstrated. No statistically significant relationship was found between the other clinical, anamnestic and laboratory parameters and the outcome of DWI. Only two ultrasound examinations allowed the identification of pathological areas on the renal parenchyma. Conclusions: From these preliminary investigations, we can say that selecting the patients with fUTI on whom to perform a DW-MRI is difficult. Nevertheless, thanks to the low cost, the very rare need for sedation and the accuracy in identifying pyelonephritic areas, the use of DW-MRI in patients with febrile UTI seems recommendable.
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Affiliation(s)
- Lorenzo Anfigeno
- Department of Health Sciences (DISSAL), Università degli Studi di Genova, 16132 Genova, Italy
- Radiology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Giannina Gaslini, 16147 Genova, Italy; (F.S.); (L.B.); (M.B.); (M.B.D.)
- Correspondence:
| | - Fiammetta Sertorio
- Radiology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Giannina Gaslini, 16147 Genova, Italy; (F.S.); (L.B.); (M.B.); (M.B.D.)
| | - Luca Basso
- Radiology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Giannina Gaslini, 16147 Genova, Italy; (F.S.); (L.B.); (M.B.); (M.B.D.)
| | - Andrea Fontana
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy;
| | - Monica Bodria
- Radiology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Giannina Gaslini, 16147 Genova, Italy; (F.S.); (L.B.); (M.B.); (M.B.D.)
| | - Angela Pistorio
- Epidemiology and Biostatistics Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Giannina Gaslini, 16147 Genova, Italy;
| | - Gian Marco Ghiggeri
- Nephrology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Giannina Gaslini, 16147 Genova, Italy;
| | - Maria Beatrice Damasio
- Radiology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Giannina Gaslini, 16147 Genova, Italy; (F.S.); (L.B.); (M.B.); (M.B.D.)
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Wong MCY, Sertorio F, Damasio MB, Incarbone V, Beati F, Bodria M, Pistorio A, Ghiggeri GM, Magnano GM, Mattioli G. Surgical validation of functional magnetic resonance urography in the study of ureteropelvic junction obstruction in a pediatric cohort. J Pediatr Urol 2019; 15:168-175. [PMID: 30553558 DOI: 10.1016/j.jpurol.2018.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 11/13/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Ureteropelvic junction obstruction (UPJO) is one of the most common urological diseases in children. The etiology can be intrinsic, extrinsic (crossing vessel [CV] or adhesions), or mixed. To date, ultrasonography and scintigraphy are considered gold-standard imaging techniques for the study of UPJO. Functional magnetic resonance urography (fMRU) combines anatomical and functional information and has been recently evaluated for the detection of CVs in UPJO. OBJECTIVE The objective of the study was to evaluate the concordance between fMRU and surgery in determining the etiology of UPJO and the presence of obstructing/non-obstructing CVs. STUDY DESIGN Patients with unilateral hydronephrosis who underwent surgery after an fMRU were included in the sample. Surgical data regarding the etiology of UPJO were compared with radiological results. The etiology was divided into intrinsic, extrinsic due to CV, extrinsic due to adhesions, and mixed or cicatricial (postoperative). The concordance was calculated by means of the Cohen's kappa coefficient. RESULTS The observed agreement between fMRU and surgical findings regarding the etiology and the presence of CV were 83.2% and 89.4%, respectively (with substantial Cohen's kappa coefficient). The sensitivity and specificity of fMRU were 0.84 and 0.93, respectively; the positive predictive value (PPV) and negative predictive value (NPV) were 0.889 and 0.897, respectively. The observed agreement regarding the type of vessel was 88.3% with a Cohen's kappa coefficient of 0.787 (substantial). DISCUSSION In children with hydronephrosis, it is very important for the surgeon to quantify the extent of dilation, define the etiology of the obstruction, and the presence or absence of CVs. fMRU is a 'one-stop-shop' technique which provides both anatomical and functional information showing a high concordance with surgical findings, avoiding radiation exposure. CONCLUSIONS fMRU should be considered a valid imaging technique in the study of pediatric UPJO, as it provides the surgeon with important information regarding the etiology of the obstruction for the preoperative planning.
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Affiliation(s)
- M C Y Wong
- Pediatric Surgery Department, IRCCS, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy; DINOGMI, University of Genoa, Genoa, Italy.
| | - F Sertorio
- Radiology Department, IRCCS, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy; University of Genoa, Via Balbi 5, 16126, Genoa, Italy.
| | - M B Damasio
- Radiology Department, IRCCS, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy.
| | - V Incarbone
- Radiology Department, IRCCS, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy.
| | - F Beati
- Pediatric Surgery Department, IRCCS, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy; DINOGMI, University of Genoa, Genoa, Italy.
| | - M Bodria
- Nephrology, Dialysis and Renal Transplantation Department, IRCCS, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy.
| | - A Pistorio
- Epidemiology and Biostatistics Service, IRCCS, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy.
| | - G M Ghiggeri
- Nephrology, Dialysis and Renal Transplantation Department, IRCCS, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy.
| | - G M Magnano
- Radiology Department, IRCCS, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy.
| | - G Mattioli
- Pediatric Surgery Department, IRCCS, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy; DINOGMI, University of Genoa, Genoa, Italy.
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Sertorio F, Pacetti M, Schiaffino S, Secci F, Cama A, Consales A, Magnano GM. Ultrasonography as first line imaging for the diagnosis of positional plagiocephaly: our experience and literature review. Minerva Pediatr 2019:S0026-4946.19.05424-0. [PMID: 30916518 DOI: 10.23736/s0026-4946.19.05424-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In the last years, numerous studies evaluated different tools for the diagnosis of positional plagiocephaly (PP). The purpose of this study was to evaluate ultrasonography (US) as a first line screening test of lambdoid sutural patency in child with PP and to compare our results with the literature. MATERIALS AND METHODS All consecutive patients who referred to our Institute from January 2016 to October 2017 with the suspicion of PP, were included in the study and performed US examination of the lambdoid sutures. A 3-6 month clinical follow up was performed by a paediatric neurosurgeon or a paediatrician to confirm the diagnosis of PP. RESULTS Thirty-five children performed US examination and in all cases the diagnosis of PP was confirmed. No cases of anticipated suture fusion were examined during this period. The concordance between US findings and clinical exam follow-up was 100%. CONCLUSIONS Ultrasonography of the lambdoid sutures represents an ideal first-line screening test and reliable alternative to other diagnostic techniques for lambdoid sutural patency in child with PP, being radiation free, fast and cheap.
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Affiliation(s)
- Fiammetta Sertorio
- Department of Radiology, IRCCS Istituto Giannina Gaslini, Genoa, Italy - .,Department of Radiology, University of Genoa, Genoa, Italy -
| | - Mattia Pacetti
- Department of Neurosurgery, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Francesca Secci
- Department of Neurosurgery, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Armando Cama
- Department of Neurosurgery, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Damasio MB, Bodria M, Dolores M, Durand E, Sertorio F, Wong MCY, Dacher JN, Hassani A, Pistorio A, Mattioli G, Magnano G, Vivier PH. Comparative Study Between Functional MR Urography and Renal Scintigraphy to Evaluate Drainage Curves and Split Renal Function in Children With Congenital Anomalies of Kidney and Urinary Tract (CAKUT). Front Pediatr 2019; 7:527. [PMID: 32047727 PMCID: PMC6997479 DOI: 10.3389/fped.2019.00527] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 12/05/2019] [Indexed: 12/31/2022] Open
Abstract
Background: Obstructive congenital anomalies of the kidney and urinary tract have a high risk of kidney failure if not surgically corrected. Dynamic renal scintigraphy is the gold standard technique to evaluate drainage curves and split renal function (SRF). Objectives: To compare functional magnetic resonance (MR) urography with dynamic renal scintigraphy in measuring volumetric SRF and in the classification of drainage curves in patients with congenital anomalies of the kidney and urinary tract. Materials and Methods: We retrospectively collected patients with hydroureteronephrosis or pelvicalyceal dilatation at renal ultrasound, who underwent both functional MR urography and dynamic renal scintigraphy (DRS) within 6 months. DRS studies were evaluated by a single nuclear medicine physician with a double reading. Functional MR urography renograms were blind evaluated twice by two radiologists. The functional MR urographyintra- and inter-reading agreements as well as the agreement between the two imaging techniques were calculated. SRF was evaluated by Area Under the Curve and Rutland-Patlak methods. Drainage curves were classified as normal, borderline or accumulation patterns by both the techniques. Results: Fifty-two children were studied, 14 with bilateral involvement. A total of 104 kidney-urinary tracts were considered: 38 normal and 66 dilated. Considering Area Under the Curve and Rutland-Patlak for SRF, the intra- and inter-reader agreements of functional MR urography had excellent and good results, respectively, and the two techniques demonstrated a good concordance (r2: 67% for Area Under the Curve and 72% for Rutland-Patlak). Considering drainage curves, the inter-readers agreement for functional MR urography and the concordance between the two techniques were moderate (Cohen's k, respectively, 55.7 and 56.3%). Conclusions: According to our results, there are no significant differences between functional MR urography and DRS in measuring volumetric SRF and in the classification of drainage curves in patients with congenital anomalies of the kidney and urinary tract.
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Affiliation(s)
| | - Monica Bodria
- Nephrology and Renal Transplantation Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Michael Dolores
- CHU C. Nicolle, Service de Radiopédiatrie, Rouen University Hospital, Rouen, France
| | - Emmanuel Durand
- Department of Nuclear Medicine, University of Strasbourg ICube (UMR7537), Strasbourg, France
| | - Fiammetta Sertorio
- Radiology Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Department of Health Sciences, Radiology Department, University of Genoa, Genoa, Italy
| | - Michela C Y Wong
- Pediatric Surgery Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Science, School of Medical and Pharmaceutical Sciences, University of Genoa, Genoa, Italy
| | - Jean-Nicolas Dacher
- CHU C. Nicolle, Service de Radiopédiatrie, Rouen University Hospital, Rouen, France
| | - Adnan Hassani
- CHU C. Nicolle, Service de Radiopédiatrie, Rouen University Hospital, Rouen, France
| | - Angela Pistorio
- Epidemiology, Biostatistics and Committees Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Girolamo Mattioli
- Pediatric Surgery Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Pierre H Vivier
- CHU C. Nicolle, Service de Radiopédiatrie, Rouen University Hospital, Rouen, France.,Ramsay - Générale de Santé, HôpitalPrivé de l'Estuaire, Radiology, Le Havre, France
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Verrotti A, Sertorio F, Matricardi S, Ferrara P, Striano P. Electroclinical features of epilepsy in patients with InvDup(15). Seizure 2017; 47:87-91. [PMID: 28343008 DOI: 10.1016/j.seizure.2017.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 03/07/2017] [Accepted: 03/08/2017] [Indexed: 01/14/2023] Open
Abstract
PURPOSE InvDup(15) syndrome is one of the most common chromosomal abnormalities associated with epilepsy. Here we review the seizure types described in InvDup(15) patients and the main electroclinical, therapeutic, and prognostic aspects of the syndrome. METHODS A literature search of PubMed, MEDLINE, and EMBASE was performed to identify papers examining InvDup(15) syndrome and epilepsy. RESULTS About 65% of the InvDup(15) patients described in the literature had multiple seizure types with a predominance (40.4%) of tonic-clonic seizures. Age at seizure onset was before 10 years in more than half of them. Patients suffered from a variety of EEG abnormalities, generalized spike activity being the most frequent. Brain MRI was unremarkable in the majority of patients. Treatment was with several anticonvulsant drugs used as mono- or polytherapy. Valproic acid was the most common treatment against generalized seizures and was often effective, although drug resistance was a major concern in a large number of cases. Finally, more than 30% of the children suffered from infantile spasms, and status epilepticus was described in nearly 20% of patients, occasionally resulting in death. CONCLUSION Seizures are very common in InvDup(15) patients, who suffer from a variety of seizure types. Information about EEG and brain MRI findings, seizure treatment, and prognosis is often poor. The overall prognosis is fair. Prospective studies of larger samples are needed, to gain further insights into the natural history of InvDup(15) syndrome.
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Affiliation(s)
- Alberto Verrotti
- Department of Pediatrics, University of L'Aquila, L'Aquila, Italy.
| | | | - Sara Matricardi
- Department of Pediatrics, University of Chieti, Chieti, Italy.
| | - Pietro Ferrara
- Institute of Pediatrics, Catholic University, Roma, Italy.
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, G. Gaslini Institute, Genova, Italy.
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