The incidence of paediatric inflammatory bowel disease (pIBD) is increasing. MR enterography (MRE) is increasingly recognised as the gold standard imaging technique for the small bowel in IBD. The advantages of MRE include the lack of ionising radiation and greater soft tissue definition. It also allows functional information from diffusion sequences and is used for IBD diagnosis, monitoring of disease activity and complications such as abscess, stricture or fistula. Extra-intestinal manifestations can also be identified. Younger children often need a general anaesthetic (GA) in order to undergo MRI. Excellent distension of the small bowel loops on MRE is essential to aid accurate assessment. As the child cannot drink a large volume of fluid prior to anaesthetic induction, fluid distension is facilitated through insertion of a nasojejunal tube and instillation of fluid via the tube whilst under GA. We present our institutional practice from a large paediatric hospital for performing MR enterography under GA in young children. A retrospective study of our Radiology Information Service (RIS) was undertaken to identify children under the age of 10 years who underwent MRE under GA between 2010-2015. The anaesthetic charts of these children were obtained and the anaesthetic duration / complications were recorded. The imaging was reviewed to evaluate the MRI quality, degree of distension and report finding. The MR protocol and sequence optimisation will also be discussed. 12 patients were included in the study, aged from 23 months to 10 years.The length of GA time ranged from 110-185 minutes (average 142 minutes) and no significant adverse effects were described. The mean fluoroscopy radiation dosage for NJ insertion was low (8 micrograys) and the success rate was high (91%). All completed studies were reviewed and oral contrast reached the terminal ileum in 100%. Bowel distension was rated as good or excellent in all cases. Our institutional experience has shown that MRE under GA with nasojejunal tube enteroclysis is feasible and can safely produce high quality, diagnostic imaging in the young paediatric patient. Read More

Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016

Authors: Chopra Mark, Watson Tom, Olsen Øystein

Keywords: MR enterography, Inflammatory bowel disease, general anaesthesia, enteroclysis

Ductus Arteriosus calcification is a poorly comprehended pathology occasionally reported on chest radiographs, more commonly on CT. The purpose of this educational abstract is to present the concepts surrounding ductal arteriosus (DA) calcification and reviews the literature to date. We retrospectively searched the main medical literature (PubMed, MEDLINE, CINAHL and Google scholar databases) using the following keywords: “ductus arteriosus”, “ligamentum arteriosum”, “calcification”, “ductal”, “patent ductus arteriosus”, “children”, “paediatric”. Articles regarding ductus arteriosus calcification were further evaluated for citations. Sixteen articles were found which dated back over nearly a century. Of these eight concerned a paediatric population and very few had histological confirmation. The majority highlighted that ductal calcification is more prevalent than previously thought. Ductal calcification was initially reported on the chest roentgen-ray in 1931 by Weiss. The increasing prevalence has been compounded by the use of the greater spatial resolution offered by modern CT scanners. A study in 2012 showed up to a third of children have ductal calcification on CT, with peak incidence is towards the end of the first decade in girls. There is conflicting opinion regarding the pathophysiology of ductal calcification, which may be either ductal aneurysmal thrombus regression, or more likely ligamentum arteriosum intimal and medial wall calcification. This literature review illustrates the general paucity of histological data and suggests that the autopsy evidence favours intimal and medial wall calcification. Read More

Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016

Authors: Chopra Mark, Barrett Hannah, Hutchinson J., Kiho Liina, Arthurs Owen

Keywords: Ductus arteriosus calcification, ligamentum arteriosum

Ductus Arteriosus calcification is a relatively common, typically unreported feature on plain film radiography. The more recent literature quotes a prevalence on unenhanced CT of between 37-61% of children and a peak at the age of 6-10 years. Adult studies have shown that calcification of the ligamentum arteriosum can occur alone or be associated with atherosclerotic and/or granulomatous calcification. We report two cases in whom they were identified as incidental findings on forensic post mortem CT, for whom we obtained histological confirmation. Case 1: An 8 month old child who died in non-suspicious circumstances had incidental ductal arteriosus calcification reported on post mortem CT, following unremarkable skeletal survey. Intimal mural calcification was reported on histology at autopsy. Case 2: A 19 month old child who died of aspiration underwent full skeletal survey and PMCT as part of the pre-autopsy imaging assessment. The skeletal survey revealed incidental ductus arteriosus calcification, initially reported as PDA clip, with correlation at CT. Intimal and medial mural calcification was reported on histology at autopsy. These cases showed that ductal calcification was intimal and medial in nature. This is consistent with the current literature regarding mural calcification rather than thrombus regression calcification. Read More

Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016

Authors: Chopra Mark, Barrett Hannah, Hutchinson J., Kiho Liina, Arthurs Owen

Keywords: Ductus arteriosus calcification, Post mortem, Non-accidental injury