Faculty Bibliography

The term "congenital vascular anomalies" encompasses those vascular lesions present at birth. Many of these lesions may be detected in utero. This review serves to apprise the readership of newly identified diagnoses and updated classification schemes. Attention is focused on clinical features, patterns of presentation, clinical manifestations and behavior, diagnostic tools, and treatment modalities. It is an invigorating period for this field, with a surge in vascular anomalies-related basic and clinical research, genetics, pharmacology, clinical trials, and patient advocacy. A large number of professional conferences now include vascular anomalies in the agenda, and trainees in multiple specialties are gaining expertise in this discipline. We begin with a summary of classification schemes and introduce the updated classification adopted by the International Society for the Study of Vascular Anomalies. Disease entities are described, with liberal use of photographs, as many diagnoses can be established based on a thorough history and visual appearance and it is thus essential to develop a familiarity with diagnosis-specific physical features. Peripheral (non-central nervous system) vascular anomalies are the focus of this review. We focus on those entities in which diagnostic radiology is routinely used and accentuate when histologic confirmation is essential. We also underscore some differences in approach to the pediatric vs adolescent or adult patient. A list of Internet-based resources is included, with hyperlinks to informative sites. References are limited to seminal discoveries and review articles. We hope that our enthusiasm in writing this review will be shared by those who read this review.

Osteosarcoma (OS) and the Ewing sarcoma family of tumors (ESFT) are the most common malignant bone tumors in children and adolescents. While significant improvements in survival have been seen in other pediatric malignancies the treatment and prognosis for pediatric bone tumors has remained unchanged for the past 3 decades. This review and update of pediatric malignant bone tumors will provide a general overview of osteosarcoma and the Ewing sarcoma family of tumors, discuss bone tumor genomics, current challenges, and emerging drug targets.

Magnetic resonance cholangiopancreatography (MRCP) is commonly performed in the evaluation of known or suspected pancreaticobiliary disease in children. The administration of a negative oral contrast agent can improve the quality of the examination without significant additional cost. We describe our experience with certain brands of acai juice, blueberry juice and pineapple juice as negative oral contrast agents in children. We believe these fruit juices are safe, palatable and may improve MRCP image quality.

The differential diagnosis of renal masses in pediatric patients includes benign and malignant tumors, as well as nonneoplastic mass-like lesions mimicking tumors. Although the spectrum of renal masses in children has some overlap with that of adults, it is important to understand the renal pathologic processes specific to the pediatric population, as well as their characteristic imaging appearances and clinical presentations. This article reviews benign and malignant renal masses in children, with an emphasis on magnetic resonance imaging and clinical features that are specific to each lesion type.

PURPOSE: To characterize fast and slow diffusion components in diffusion-weighted magnetic resonance imaging (DW-MRI) of pediatric Crohn's disease (CD). Overall diffusivity reduction as measured by the apparent diffusion coefficient (ADC) in patients with CD has been previously demonstrated. However, the ADC reduction may be due to changes in either fast or slow diffusion components. In this study we distinguished between the fast and slow diffusion components in the DW-MRI signal decay of pediatric CD. MATERIALS AND METHODS: We acquired MRI from 24 patients, including MR enterography (MRE) and DW-MRI with 8 b-values (0-800 s/mm(2)). We characterized fast and slow diffusivity by intravoxel incoherent motion (IVIM) model parameters (f, D*, D), and overall diffusivity by ADC values. We determined which model best described the DW-MRI signal decay. We assessed the influence of the IVIM model parameters on the ADC. We evaluated differences in model parameter values between the enhancing and nonenhancing groups. RESULTS: The IVIM model described the observed data significantly better than the ADC model (P = 0.0088). The ADC was correlated with f (r = 0.67, P = 0.0003), but not with D (r = 0.39, P = 0.062) and D* (r = -0.39, P = 0.057). f values were significantly lower (P < 0.003) and D* values were significantly higher (P = 0.03) in the enhancing segments, while D values were not significantly different between the groups (P = 0.14). CONCLUSION: For this study population the IVIM model provides a better description of the DW-MRI signal decay than the ADC model. The reduced ADC is related to changes in the fast diffusion rather than to changes in the slow diffusion.