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Saint-André-lez-Lille, France

Bazot M.,Tenon Hospital | Stivalet A.,Tenon Hospital | Darai E.,Tenon Hospital | Coudray C.,General Electric | And 2 more authors.
Clinical Radiology | Year: 2013

Aim: To evaluate image quality and diagnostic accuracy of two- (2D) and three-dimensional (3D) T2-weighted magnetic resonance imaging (MRI) for the evaluation of deep infiltrating endometriosis (DIE). Materials and methods: One hundred and ten consecutive patients with suspicion of endometriosis were recruited at two institutions over a 5-month period. Twenty-three women underwent surgery, 18 had DIE at histology. Two readers independently evaluated 3D and 2D MRI for image quality and diagnosis of DIE. Descriptive analysis, chi-square test for categorical or nominal variables, McNemar test for comparison between 3D and 2D T2-weighted MRI, and weighted " statistics" for intra- and interobserver agreement were used for statistical analysis. Results: Both readers found that 3D yielded significantly lower image quality than 2D MRI (p < 0.0001). Acquisition time for 3D was significantly shorter than 2D MRI (p < 0.01). 3D offered similar accuracy to diagnose DIE compared to 2D MRI. For all locations of endometriosis, a high or variable intra-observer agreement was observed for reader 1 and 2, respectively. Conclusions: Despite a lower overall image quality, 3D provides significant time saving and similar accuracy than multiplanar 2D MRI in the diagnosis of specific DIE locations. © 2012 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Devriendt A.,Erasme Hospital | Cassart M.,Ixelles Hospital | Massez A.,Erasme Hospital | Donner C.,Erasme Hospital | Avni F.E.,Jeanne de Flandre Hospital
Prenatal Diagnosis | Year: 2013

Objective: The aim of this study was to establish objective criteria for the evaluation of cortical echogenicity (CE), cortical thickness (CT), and medullary thickness (MT), as well as the corticomedullary ratio (CMR), throughout gestation. Method: In this prospective single-center study, CE, MT, CT, and CMR were evaluated in a group of singleton pregnancies examined by ultrasound during the second and third trimesters. Results: The CE evolved from a hyperechoic pattern compared with the liver or spleen during early second trimester to a hypoechogenic pattern in the third trimester, with no fetus displaying cortical hyperechogenicity after 32weeks. CT increased from 1.8 to 2.5mm (p<0.05) from 21 to 25 to 34 to 37weeks; MT from 2.7 to 5.1mm (p<0.0001), and the CMR decreased from 0.7 to 0.5 (p<0.001). Conclusion: The CE, CT, and MT evolve with gestation. Cortical hyperechogenicity compared with the liver or spleen after 32weeks or a CMR above 0.7 in the third trimester should raise the suspicion of a fetal nephropathy. © 2013 John Wiley & Sons, Ltd.

Leroy S.,University of Oxford | Leroy S.,Institute Pasteur Paris | Fernandez-Lopez A.,Joan de Deu Hospital | Nikfar R.,Abuzar Children Medical Center Hospital | And 14 more authors.
Pediatrics | Year: 2013

BACKGROUND AND OBJECTIVE: Urinary tract infections (UTIs) are common childhood bacterial infections that may involve renal parenchymal infection (acute pyelonephritis [APN]) followed by late scarring. Prompt, high-quality diagnosis of APN and later identification of children with scarring are important for preventing future complications. Examination via dimercaptosuccinic acid scanning is the current clinical gold standard but is not routinely performed. A more accessible assay could therefore prove useful. Our goal was to study procalcitonin as a predictor for both APN and scarring in children with UTI. METHODS: A systematic review and meta-analysis of individual patient data were performed; all data were gathered fromchildren with UTIs who had undergone both procalcitonin measurement and dimercaptosuccinic acid scanning. RESULTS: A total of 1011 patients (APN in 60.6%, late scarring in 25.7%) were included from 18 studies. Procalcitonin as a continuous, class, and binary variable was associated with APN and scarring (P < .001) and demonstrated a significantly higher (P < .05) area under the receiver operating characteristic curve than either C-reactive protein or white blood cell count for both pathologies. Procalcitonin ≥0.5 ng/mL yielded an adjusted odds ratio of 7.9 (95% confidence interval [CI]: 5.8-10.9) with 71% sensitivity (95% CI: 67-74) and 72% specificity (95% CI: 67-76) for APN. Procalcitonin ≥0.5 ng/mL was significantly associated with late scarring (adjusted odds ratio: 3.4 [95% CI: 2.1-5.7]) with 79% sensitivity (95% CI: 71-85) and 50% specificity (95% CI: 45-54). CONCLUSIONS: Procalcitonin was a more robust predictor compared with C-reactive protein or white blood cell count for selectively identifying children who had APN during the early stages of UTI, as well as those with late scarring. Copyright © 2013 by the American Academy of Pediatrics.

The European Society of Paediatric Radiology Uroradiology Task Force and the ESUR Paediatric Work Group jointly publish guidelines for paediatric urogenital imaging. Two yet unaddressed topics involving patient safety and imaging load are addressed in this paper: renal biopsy in childhood and imaging of the neonatal genital tract, particularly in girls. Based on our thorough review of literature and variable practice in multiple centers, procedural recommendations are proposed on how to perform renal biopsy in children and how to approach the genital tract in (female) neonates. These are statements by consensus due to lack of sufficient evidence-based data. The procedural recommendation on renal biopsy in childhood aims at improving patient safety and reducing the number of unsuccessful passes and/or biopsy-related complications. The recommendation for an imaging algorithm in the assessment of the neonatal genital tract focuses on the potential of ultrasonography to reduce the need for more invasive or radiating imaging, however, with additional fluoroscopy or MRI to be used in selected cases. Adherence to these recommendations will allow comparable data and evidence to be generated for future adaptation of imaging strategies in paediatric uroradiology. © 2014 Springer-Verlag Berlin Heidelberg.

Grimaldi-Bensouda L.,French Institute of Health and Medical Research | Grimaldi-Bensouda L.,A+ Network | Abenhaim L.,French Institute of Health and Medical Research | Abenhaim L.,London School of Hygiene and Tropical Medicine | And 6 more authors.
European Journal of Clinical Pharmacology | Year: 2010

Objective: This population-based survey was conducted to provide a formal description of upper gastrointestinal bleeding (UGIB) in children on a nationwide basis and assess the contribution of risk factors, principally nonsteroidal anti-inflammatory drugs (NSAID). Methods: A case-crossover study of UGIB patients aged between 2 months and 16 years was conducted in France. Medical data were collected by physicians, and personal risk factors and exposure to drugs during the month preceding the onset of the bleeding was ascertained by a standardised telephone interview with parents. The odds ratios for UGIB and NSAID was assessed by comparing exposure during the 7 days preceding the date of hospitalisation and the 21st to the 28th days before that date. Results: A total of 177 children with UGIB were included over 2 years. Eighty-three children had taken at least one NSAID before the index date, among which 58 were ibuprofen, 26 aspirin and nine others. The adjusted odds ratio (OR) of exposure was 8.2 [95% confidence interval (CI) 2.6-26.0] for NSAIDs altogether, and this was 10.0 (95% CI 2.0-51.0) for ibuprofen and 7.3 (95% CI 0.9-59.4) for aspirin. There was no increased risk associated with NSAIDS for oesophageal lesion [OR∈=∈1.0 [(5% CI:0.2-7.2)]. Conclusion: The study confirms that UGIB is rare but that some cases may be avoided, as one third of the cases was attributable to exposure to NSAID at doses used for analgesic or antipyretic purposes, which may be attained with alternative therapy. The findings from this study call for more caution in prescribing NSAIDS to children. © 2010 Springer-Verlag.

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