Tourette Syndrome (TS) is characterized with chronic motor and vocal tics beginning in childhood. Abnormality of both gray (GM) and white matter (WM) has been observed in cortico-striato-thalamo-cortical circuits and sensory-motor cortex of adult TS patient. It is not clear if these morphological changes are also present in TS children and if there are any microstructural changes of WM. To understand the developmental cause of such changes, we investigated volumetric changes of GM and WM using VBM and microstructural changes of WM using DTI, and correlated these changes with tic severity and duration. T1 images and Diffusion Tensor Images (DTI) from 21 TS children were compared with 20 age and gender matched health control children using a 1.5T Philips scanner. All of the 21 TS children met the DSM-IV-TR criteria. T1 images were analyzed using DARTEL-VBM in conjunction with statistical parametric mapping (SPM). Diffusion tensor imaging (DTI) analysis was performed using Tract-Based Spatial Statistics (TBSS). Brain volume changes were found in left superior temporal gyrus, left and right paracentral gyrus, right precuneous cortex, right pre- and post- central gyrus, left temporal occipital fusiform cortex, right frontal pole, and left lingual gyrus. Significant axial diffusivity (AD) and mean diffusivity (MD) increases were found in anterior thalamic radiation, right cingulum bundle projecting to the cingulate gurus and forceps minor. Decreases in white matter volume (WMV) in the right frontal pole were inversely related with tic severity (YGTSS), and increases in AD and MD were positively correlated with tic severity and duration, respectively. These changes in TS children can be interpreted as signs of neural plasticity in response to the experiential demand. Our findings may suggest that the morphological and microstructural measurements from structural MRI and DTI can potentially be used as a biomarker of the pathophysiologic pattern of early TS children.

Objective The purpose of this study was to retrospectively analyze the outcomes of the combination of ultrasound-guided percutaneous external drainage (US-PED) and subsequent definitive operation to manage complicated choledochal cyst in children. Methods This study included 6 children with choledochal cyst who underwent initial US-PED and subsequent cyst excision with Roux-en-Y hepaticojejunostomy between January 2021 and September 2022. Patient characteristics, laboratory findings, imaging data, treatment details, and postoperative outcomes were evaluated. Results Mean age at presentation was 2.7 ± 2.2 (0.5–6.2) years, and 2 patients (2/6) were boys. Four patients (4/6) had a giant choledochal cyst with the widest diameter of ≥ 10 cm and underwent ultrasound-guided percutaneous biliary drainage on admission or after conservative treatments. The other 2 patients (2/6) underwent ultrasound-guided percutaneous transhepatic cholangial drainage and percutaneous transhepatic gallbladder drainage due to coagulopathy, respectively. Five patients (5/6) recovered well after US-PED and underwent the definitive operation, whereas 1 patient (1/6) had liver fibrosis confirmed by Fibroscan and ultimately underwent liver transplantation 2 months after US-PED. The mean time from US-PED to the definitive operation was 12 ± 9 (3–21) days. The average length of hospital stay was 24 ± 9 (16–31) days. No related complications of US-PED occurred during hospitalization. At 10.2 ± 6.8 (1.0–18.0) months follow-up, all patients had a normal liver function and US examination. Conclusions US-PED is technically feasible for choledochal cyst with giant cysts or coagulopathy in children, which can provide suitable conditions for subsequent definitive operation with a good overall prognosis. Trial registration: Retrospectively registered

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