BACKGROUND Paediatric calvarial mass lesions are common and can have prognostic and therapeutic implications based on the type of lesions. The spectrum of lesions can extend from benign lesions like cephalhaematoma, which is a common postnatal swelling in the paediatric scalp to severe lesions like neuroblastoma metastases. Therefore, proper diagnosis of these lesions is of prime importance in day to day practice which can help in accurate management of these lesions. This study was conducted to evaluate the role of computed tomography (CT) in the assessment of paediatric calvarial masses. METHODS In our prospective observational study, during a period of 1 year (October 2019 to October 2020) 26 children with visible swelling on the calvarium were subjected to CT examination. The imaging features of various paediatric calvarial lesions on CT were noted. RESULTS Out of 26 paediatric patients, which included infants from 1 day of life to children of 7 years age, the most common age of presentation was less than one-year age group. The most common type of calvarial mass lesion was cephalhaematoma and the next most common mass lesion was dermoid cyst. CT could diagnose all the lesions based on the image morphology with clear delineation of their extent. 16 cases had isolated soft tissue involvement (cephal haematoma, sub galeal haematoma, lipoma, dermoid cyst) whereas ten lesions like encephalocele, osteomyelitis, Langerhans cell histiocytosis (LCH), fibrous dysplasia, neuroblastoma metastases, lymphoma deposits had both soft tissue and bone involvement. CONCLUSIONS Accurate detection, characterisation and delineation of the lesions are important in management of the various paediatric calvarial masses. CT is a useful imaging tool in confirming the diagnosis and also for anatomical delineation in certain cases requiring surgical management. It also helps in detecting associated intracranial extension of the lesions. KEYWORDS Calvarial Masses, Paediatric, Computed Tomography

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Ultrasound evaluation of neck masses is a noninvasive method with good diagnostic accuracy. A proper knowledge of anatomy of neck with confident anatomical localisation of the masses and the understanding of ultrasound features of each disease entity can help in the diagnosis and at times narrow the differential diagnosis of the various neck masses. AIMS AND OBJECTIVESTo document and study the role of ultrasound in patients with nonthyroidal neck masses. To evaluate the various neck masses and differentiate benign and malignant masses based on their sonomorphology and correlate these with histopathology. MATERIALS AND METHODSIn our study, during a period of 2 yrs. (May 2013 to April 2015) 56 patients admitted in the General Surgery and E.N.T. wards with neck masses other than thyroidal masses were evaluated with ultrasound examination of neck. Our study included patients of age groups 6 months to 67 years with 37 male and 19 female patients. High resolution ultrasound examination of neck was done by 7.5 MHz linear array transducer on Esaote MyLab Classic C. OBSERVATIONS AND RESULTSOut of 56 pts., the most common age of presentation was 21-40 yrs. There were 37 male and 19 female patients. All the 56 patients had neck masses and the common associated symptom was pressure effect due to the mass. On ultrasound, the nature of lesions ranged from solid, cystic to mixed (25). Most of the cases were unilateral neck masses. Out of 56 cases, solitary neck masses (31) were predominant. In this study, the most common neck mass was metastatic lymphadenopathy. The anatomic location and known ultrasound features of the various masses was very helpful in the diagnosis of these lesions. CONCLUSIONUltrasound is a safe noninvasive modality in the diagnosis of neck masses with good diagnostic accuracy.

AIMS AND OBJECTIVESTo emphasize the role of MRI in paediatric inherited metabolic brain disorders and to study the varied spectrum of imaging findings in these disease entities and to highlight the importance of image based classification. MATERIALS AND METHODSIn this study, we reviewed MRI of the brain of 26 paediatric patients (17 male, 9 female; mean age: 7 years, range: 1 month -15 years) with neurological complaints and had clinical suspicion of inherited metabolic brain disorder on MRI. MRI sequences reviewed included axial T1-, T2-weighted, FLAIR, diffusion weighted and sagittal and coronal T2 weighted images. Post-gadolinium T1-weighted and MR Spectroscopy images were also reviewed when available. MRI findings were interpreted in conjunction with clinical and laboratory findings wherever necessary. The varied spectrum of imaging appearances of paediatric inherited metabolic brain disorders noted by methodological and practical image based approach. RESULTSThe distribution of the various inherited metabolic disorders was as follows: 13 cases of Leigh's disease, 4 cases of Metachromatic Leukodystrophy, 2 cases of Pantothenate Kinase Deficiency, 2 cases of Gangliosidosis, 2 cases of Wilson's disease, one case of Alexander's disease, one case of Canavan's disease, one case of Glutaric aciduria diagnosed from the image based pattern in conjunction with the clinical data. Based on the pattern of brain involvement on MRI, these disorders were classified into three categories: disorders with predominant white matter involvement, disorders with predominant gray matter involvement and disorders with involvement of both gray and white matter. There were characteristic metabolic peaks on MRS in cases of Leigh's disease and Canavan's disease. CONCLUSIONAn image based approach to paediatric inherited metabolic brain disorders helps in diagnosis of varied presentation and knowledge of this practical approach is very useful to the radiologist. KEYWORDSImage Based Classification, Pattern Recognition, Periventricular White Matter, Subcortical 'U' Fibres HOW TO CITE THIS ARTICLE: Tirumani SB, Prasad RY, Mudunoor VK, et al. MRI in paediatric inherited metabolic brain disorders.

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