The MRI criteria for diagnosis of TBM apply to HIV-infected children. The presence of nodular meningeal disease in all HIV-infected children has not previously been reported and requires further investigation.

Selected radiographers could play an effective screening role, but lacking the sensitivity required for detecting significant abnormality, they could not be the final diagnostician. We recommend that the study be repeated after both radiographers have received formal training in interpretation of paediatric brain CT.

Upper gastrointestinal contrast studies in children may cause false-positive or -negative diagnosis of intestinal malrotation from rotation of the patient. To alleviate this problem, skin markers can be used to reduce rotation of children undergoing this procedure, e.g., two metal markers (sheathed and sealed hypodermic needles) can be fixed onto the skin for gastro-intestinal contrast studies. We reviewed two Katz criteria influenced by patient rotation: duodenojejunal junction on or to the right of the left pedicle and pylorus to the left of the midline. A test group was positioned using markers; a control group without markers was positioned conventionally. Markers during a pilot study were applied, but positioning was done by helpers who had no on-screen visualization. In the test group, only 1 child (3%; n = 39) had a feature of malrotation. In the control group, there were features of malrotation in 12 children (25%; n = 48). No other features of malrotation were seen. The pilot study showed radiographic rotation with markers projecting off the midline in 78% of 58 children. This resulted in 48% of 58 patients having false features of malrotation. The use of metal skin markers results in reduction of rotational errors that could have caused false diagnosis of intestinal malrotation in children.

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