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Article: Minimizing neurovascular complications during image-guided percutaneous cryoablation of a cervical spinal aneurysmal bone cyst using protective doxycycline sclerotherapy: a case report.

Radalov, Igor / Páez-Carpio, Alfredo / Macías Rodríguez, Napoleón / Inarejos Clemente, Emilio J / Gómez, Fernando M

2024 Volume 10, Issue 1, Page(s) 159–164

Abstract: Background: Aneurysmal bone cysts (ABC) are rare, locally aggressive bone tumors primarily observed in pediatric patients. Surgical curettage is the treatment of choice. Image-guided percutaneous cryoablation (CYOA) is a recently implemented alternative ...

Abstract	Background: Aneurysmal bone cysts (ABC) are rare, locally aggressive bone tumors primarily observed in pediatric patients. Surgical curettage is the treatment of choice. Image-guided percutaneous cryoablation (CYOA) is a recently implemented alternative technique in cases not amenable to surgery. CYOA may be limited if the lesion is close to critical neurovascular structures. In this case report, a cervical spinal ABC was successfully treated using CYOA in combination with complementary and protective image-guided percutaneous doxycycline sclerotherapy (DS) to dissect and treat the portion of the lesion in contact with critical structures. Case description: A 4-year-old male presented with a symptomatic ABC within the C5 vertebral body, which encompassed the right vertebral artery and contacted the right C5-C6 spinal cord and nerve roots. After ruling out surgery due to the proximity of critical neurovascular structures, treatment with CYOA was performed. However, subsequent follow-up showed recurrence in the part of the lesion contacting critical structures. A second approach was then decided, using DS to dissect and treat the most vulnerable portion and CYOA to treat the remaining tumor. Follow-up showed almost complete sclerosis of the lesion and total resolution of symptoms 3 years after treatment. Conclusions: Using DS to dissect and treat the portion of the lesion in contact with critical neurovascular structures during CYOA treatment of a cervical spinal ABC allowed for a safe and effective approach in our case.
Language	English
Publishing date	2024-03-14
Publishing country	China
Document type	Case Reports
ZDB-ID	2874556-5
ISSN	2414-4630 ; 2414-469X
ISSN (online)	2414-4630
ISSN	2414-469X
DOI	10.21037/jss-23-147
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Ankle and Foot Deformities in Children.

Inarejos Clemente, Emilio J / Aparisi Gómez, Maria Pilar / Catala March, Jordi / Restrepo, Ricardo

Seminars in musculoskeletal radiology

2023 Volume 27, Issue 3, Page(s) 367–377

Abstract: Ankle and foot deformity is one of the most common musculoskeletal disorders in children and a leading cause of functional impairment and diminished quality of life when not treated. A spectrum of conditions may produce foot and ankle deformities, with ... ...

Abstract	Ankle and foot deformity is one of the most common musculoskeletal disorders in children and a leading cause of functional impairment and diminished quality of life when not treated. A spectrum of conditions may produce foot and ankle deformities, with congenital disorders the most frequent cause, followed by acquired conditions. Congenital disorders include congenital talipes equinovarus or congenital clubfoot, metatarsus adductus, skewfoot, congenital vertical talus, and tarsal coalition.Some of these deformities are frequent and easily diagnosed based on clinical features, but clinical overlap between pathologies can be challenging. Thus imaging plays a paramount role in evaluating these patients. Radiographs are the first imaging modality of choice, but they may not be sufficient in infants due to the lack of ossification of the tarsal bones. Ultrasonography allows not only a detailed visualization of the cartilaginous structures but also permits a dynamic study of the foot and ankle. Computed tomography may be necessary in certain conditions such as tarsal coalitions.
MeSH term(s)	Infant ; Humans ; Child ; Ankle/diagnostic imaging ; Quality of Life ; Clubfoot/diagnostic imaging ; Clubfoot/therapy ; Flatfoot ; Ankle Joint ; Foot Deformities, Congenital/diagnostic imaging
Language	English
Publishing date	2023-05-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	1360919-1
ISSN	1098-898X ; 1089-7860
ISSN (online)	1098-898X
ISSN	1089-7860
DOI	10.1055/s-0043-1766099
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Article ; Online: Postsurgical Evaluation of the Pediatric Foot and Ankle.

Aparisi Gómez, Maria Pilar / Bazzocchi, Alberto / Simoni, Paolo / Inarejos Clemente, Emilio J

Seminars in musculoskeletal radiology

2023 Volume 26, Issue 6, Page(s) 755–776

Abstract: This article reviews situations in which surgical treatment is required in the context of different types of pathology in the foot and ankle of children, focusing on the role of imaging in surgical planning and postsurgical assessment. The types of ... ...

Abstract	This article reviews situations in which surgical treatment is required in the context of different types of pathology in the foot and ankle of children, focusing on the role of imaging in surgical planning and postsurgical assessment. The types of pathology analyzed from this perspective are congenital pathology, neuromuscular disorders, osteochondral lesions, fractures and infection, ligament injuries, and tumors.We address the most common pitfalls of postsurgical imaging of the ankle and foot in children. With some exceptions, postsurgical follow-up focuses on clinical assessment, with imaging follow-up only needed in patients where complications are suspected or symptoms recur. Postoperative assessment of the foot and ankle in children and adolescents requires knowing the indications for surgery and the most common types of interventions, along with their imaging characteristics. The radiologist needs to be aware of the normal sequence of development of structures and how to select adequate imaging techniques to assess anatomy at various stages or in different postsurgical scenarios.
MeSH term(s)	Adolescent ; Humans ; Child ; Ankle/diagnostic imaging ; Ankle/surgery ; Magnetic Resonance Imaging/methods ; Ankle Joint/diagnostic imaging ; Ankle Joint/surgery ; Joint Diseases/pathology ; Fractures, Bone/surgery ; Foot Injuries
Language	English
Publishing date	2023-02-15
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	1360919-1
ISSN	1098-898X ; 1089-7860
ISSN (online)	1098-898X
ISSN	1089-7860
DOI	10.1055/s-0042-1760244
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Article ; Online: MRI of the temporomandibular joint in children with juvenile idiopathic arthritis: protocol and findings.

Inarejos Clemente, Emilio J / Tolend, Mirkamal / Navallas, Maria / Doria, Andrea S / Meyers, Arthur B

Pediatric radiology

2023 Volume 53, Issue 8, Page(s) 1498–1512

Abstract: Contrast-enhanced magnetic resonance imaging (MRI) is the technique of choice for diagnosis and monitoring of temporomandibular joint (TMJ) disorders in patients with juvenile idiopathic arthritis (JIA), as it is able to visualize both soft tissue and ... ...

Abstract	Contrast-enhanced magnetic resonance imaging (MRI) is the technique of choice for diagnosis and monitoring of temporomandibular joint (TMJ) disorders in patients with juvenile idiopathic arthritis (JIA), as it is able to visualize both soft tissue and osteochondral changes. Approximately 40% of children with JIA develop inflammatory and chronic osteochondral changes observable on imaging, which if left untreated can lead to significant facial growth impairment, including facial asymmetry and retrognathia. MRI of the TMJ plays a paramount role in diagnosis and treatment monitoring in JIA since early signs of TMJ involvement are difficult to detect clinically and with physical examination. Findings of TMJ arthritis may be classified into acute and chronic domains. Early or acute manifestations include joint effusion, bone marrow edema, synovial thickening, and increased joint enhancement. With disease progression, there are characteristic osteochondral changes, including deformity of the mandibular condyle with shortening of the mandibular ramus, bone erosions, and disk abnormalities. In this pictorial essay, we describe a consensus MRI protocol for the study of the TMJ and illustrate the degree of normal and pathological MRI findings using currently available MRI scoring systems of the TMJ developed for JIA.
MeSH term(s)	Humans ; Child ; Arthritis, Juvenile/pathology ; Temporomandibular Joint/diagnostic imaging ; Temporomandibular Joint Disorders/diagnostic imaging ; Temporomandibular Joint Disorders/pathology ; Synovitis/pathology ; Magnetic Resonance Imaging/methods
Language	English
Publishing date	2023-03-22
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	124459-0
ISSN	1432-1998 ; 0301-0449
ISSN (online)	1432-1998
ISSN	0301-0449
DOI	10.1007/s00247-023-05616-7
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Article ; Online: Radiologic and Clinical Features of Infantile Hemangioma: Potential Pitfalls and Differential Diagnosis.

Inarejos Clemente, Emilio J / Diaz Leyva, Joana / Karakas, S Pinar / Duarte, Ana Margarita / Mas, Thomas R / Restrepo, Ricardo

Radiographics : a review publication of the Radiological Society of North America, Inc

2023 Volume 43, Issue 11, Page(s) e230064

Abstract: Infantile hemangioma (IH) is the most common neoplasm in children, but it may mimic other types of vascular anomalies or nonvascular benign and malignant tumors. In most cases, the clinical appearance, time of onset, and pattern of involution facilitate ... ...

Abstract	Infantile hemangioma (IH) is the most common neoplasm in children, but it may mimic other types of vascular anomalies or nonvascular benign and malignant tumors. In most cases, the clinical appearance, time of onset, and pattern of involution facilitate its diagnosis. Imaging evaluation is not always needed since the IH features at clinical presentation are usually characteristic, but when needed, US and frequently MRI are the imaging modalities of choice. Clinical photography or photographic documentation plays a central role in monitoring these lesions over their clinical course. Photographic documentation can also add confidence and alert the radiologist when interpreting imaging studies. Some vascular anomalies, especially vascular malformations, are a frequent source of confusion, as these may resemble IHs clinically and at imaging. The lack of uniform terminology also hinders an accurate diagnosis. To unify the terminology and minimize confusion, the International Society for the Study of Vascular Anomalies created a helpful classification in 1994. In addition, radiologists need to be aware of and become familiar with other neoplasms in children that may resemble IH to avoid misdiagnosis and unnecessary procedures. Fibrous and lipomatous tumors are examples of benign tumors that can mimic IHs clinically and at imaging, whereas rhabdomyosarcoma, infantile fibrosarcoma, neuroblastoma, and lymphoproliferative disorders are examples of malignant neoplasms. The authors review the features of IH at clinical presentation and imaging evaluation, highlighting its different phases of evolution and stressing the importance of photographic documentation. The authors also review pitfalls of IH with helpful pearls for differentiation.
MeSH term(s)	Child ; Humans ; Infant ; Diagnosis, Differential ; Vascular Malformations ; Diagnostic Imaging ; Diagnostic Errors ; Hemangioma/diagnostic imaging
Language	English
Publishing date	2023-10-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	603172-9
ISSN	1527-1323 ; 0271-5333
ISSN (online)	1527-1323
ISSN	0271-5333
DOI	10.1148/rg.230064
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Article: Sono-Elastography: An Ultrasound Quantitative Non-Invasive Measurement to Guide Bacterial Pneumonia Diagnosis in Children.

Huerta-Calpe, Sergi / Salas, Bárbara / Inarejos Clemente, Emilio J / Guitart, Carmina / Balaguer, Mònica / Jordan, Iolanda

Children (Basel, Switzerland)

2023 Volume 10, Issue 8

Abstract: Lung ultrasound (LUS) is, at present, a standard technique for the diagnosis of acute lower respiratory tract infections (ALRTI) and other lung pathologies. Its protocolised use has replaced chest radiography and has led to a drastic reduction in ... ...

Abstract	Lung ultrasound (LUS) is, at present, a standard technique for the diagnosis of acute lower respiratory tract infections (ALRTI) and other lung pathologies. Its protocolised use has replaced chest radiography and has led to a drastic reduction in radiation exposure in children. Despite its undeniable usefulness, there are situations in which certain quantitative measurements could provide additional data to differentiate the etiology of some pulmonary processes and thus adapt the treatment. Our research group hypothesises that several lung processes such pneumonia may lead to altered lung tissue stiffness, which could be quantified with new diagnostic tests such as lung sono-elastography (SE). An exhaustive review of the literature has been carried out, concluding that the role of SE for the study of pulmonary processes is currently scarce and poorly studied, particularly in pediatrics. The aim of this review is to provide an overview of the technical aspects of SE and to explore its potential usefulness as a non-invasive diagnostic technique for ALRTI in children by implementing an institutional image acquisition protocol.
Language	English
Publishing date	2023-08-01
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2732685-8
ISSN	2227-9067
ISSN	2227-9067
DOI	10.3390/children10081335
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Article: Ankle and Foot Deformities in Children

Inarejos Clemente, Emilio J. / Aparisi Gómez, Maria Pilar / Catala March, Jordi / Restrepo, Ricardo

Seminars in Musculoskeletal Radiology

(Imaging of the Ankle and Foot)

2023 Volume 27, Issue 03, Page(s) 367–377

Series title	Imaging of the Ankle and Foot
Abstract	Ankle and foot deformity is one of the most common musculoskeletal disorders in children and a leading cause of functional impairment and diminished quality of life when not treated. A spectrum of conditions may produce foot and ankle deformities, with congenital disorders the most frequent cause, followed by acquired conditions. Congenital disorders include congenital talipes equinovarus or congenital clubfoot, metatarsus adductus, skewfoot, congenital vertical talus, and tarsal coalition. Some of these deformities are frequent and easily diagnosed based on clinical features, but clinical overlap between pathologies can be challenging. Thus imaging plays a paramount role in evaluating these patients. Radiographs are the first imaging modality of choice, but they may not be sufficient in infants due to the lack of ossification of the tarsal bones. Ultrasonography allows not only a detailed visualization of the cartilaginous structures but also permits a dynamic study of the foot and ankle. Computed tomography may be necessary in certain conditions such as tarsal coalitions.
Keywords	pediatric foot ; congenital ; clubfoot ; metatarsus adductus ; tarsal coalition
Language	English
Publishing date	2023-05-25
Publisher	Thieme Medical Publishers, Inc.
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	1360919-1
ISSN	1098-898X ; 1089-7860
ISSN (online)	1098-898X
ISSN	1089-7860
DOI	10.1055/s-0043-1766099
Database	Thieme publisher's database

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Article ; Online: Bacterial osteomyelitis in pediatric patients: a comprehensive review.

Restrepo, Ricardo / Park, Halley J / Karakas, S Pinar / Cervantes, Luisa F / Rodriguez-Ruiz, Felipe G / Zahrah, Anna Maria / Inarejos-Clemente, Emilio J / Laufer, Marcelo / Shreiber, Verena M

Skeletal radiology

2024

Abstract: Bacterial osteomyelitis, an inflammatory response in the bone caused by microorganisms, typically affects the metaphysis in the skeletally immature. Bacterial osteomyelitis possesses a significant diagnostic challenge in pediatric patients due to its ... ...

Abstract	Bacterial osteomyelitis, an inflammatory response in the bone caused by microorganisms, typically affects the metaphysis in the skeletally immature. Bacterial osteomyelitis possesses a significant diagnostic challenge in pediatric patients due to its nonspecific clinical presentation. Because the metaphysis is the primary focus of infection in skeletally immature patients, understanding the normal physiologic, maturation process of bones throughout childhood allows to understand the pathophysiology of osteomyelitis. Timely and accurate diagnosis is crucial to initiate appropriate treatment, and prevent long-term sequelae and efforts must be made to isolate the causative organism. The potential causative organism changes according to the age of the patient and underlying medical conditions. Staphylococcus Aureus is the most common isolated bacteria in pediatric pyogenic osteomyelitis whereas Kingella Kingae is the most common causative agent in children aged 6 months to 4 years. Imaging plays a pivotal role in the diagnosis, characterization, evaluation of complications, and follow up of bacterial osteomyelitis. Imaging also plays a pivotal role in the evaluation of potential neoplastic and non-neoplastic mimickers of osteomyelitis. In children, MRI is currently the gold standard imaging modality when suspecting bacterial osteomyelitis, whereas surgical intervention may be required in order to isolate the microorganism, treat complications, and exclude mimickers.
Language	English
Publishing date	2024-03-20
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	527592-1
ISSN	1432-2161 ; 0364-2348
ISSN (online)	1432-2161
ISSN	0364-2348
DOI	10.1007/s00256-024-04639-x
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Article ; Online: Subcutaneous fat necrosis of the newborn: a pictorial essay of an under-recognized entity.

Restrepo, Ricardo / Inarejos Clemente, Emilio J / Corral, Gonzalo / Mas, Thomas R / Fenlon, Edward P / Jaramillo, Diego

Pediatric radiology

2022 Volume 53, Issue 2, Page(s) 313–323

Abstract: Subcutaneous fat necrosis of the newborn is a self-limited disorder predominantly affecting full-term and post-term neonates during the first 6 weeks after birth. Subcutaneous fat necrosis can be focal or multifocal and affect one or both sides with a ... ...

Abstract	Subcutaneous fat necrosis of the newborn is a self-limited disorder predominantly affecting full-term and post-term neonates during the first 6 weeks after birth. Subcutaneous fat necrosis can be focal or multifocal and affect one or both sides with a predilection for areas of pressure in certain anatomical areas. Subcutaneous fat necrosis of the newborn is associated with perinatal asphyxia and other neonatal and maternal risk factors. Subcutaneous fat necrosis of the newborn presents as a self-limited area of dermal edema followed by indurated subcutaneous plaques, or nontender and mobile nodules, sometimes with skin discoloration [1-3]. The diagnosis is based on the child's history and physical examination, but when in doubt, imaging is helpful. US is the imaging modality of choice to confirm the diagnosis of subcutaneous fat necrosis of the newborn because it provides the best resolution of superficial lesions, requires no sedation and lacks ionizing radiation. US can also help evaluate and characterize other pathologies affecting the superficial subcutaneous soft tissues at this age. Familiarity with subcutaneous fat necrosis of the newborn is important to make a prompt and precise diagnosis and avoid unnecessary imaging tests or invasive procedures.
MeSH term(s)	Infant, Newborn ; Child ; Humans ; Subcutaneous Fat/diagnostic imaging ; Fat Necrosis/diagnostic imaging ; Anesthesia/adverse effects ; Emotions
Language	English
Publishing date	2022-09-24
Publishing country	Germany
Document type	Journal Article
ZDB-ID	124459-0
ISSN	1432-1998 ; 0301-0449
ISSN (online)	1432-1998
ISSN	0301-0449
DOI	10.1007/s00247-022-05509-1
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Article: Postsurgical Evaluation of the Pediatric Foot and Ankle

Aparisi Gómez, Maria Pilar / Bazzocchi, Alberto / Simoni, Paolo / Inarejos Clemente, Emilio J.

Seminars in Musculoskeletal Radiology

(Postoperative Ankle)

2022 Volume 26, Issue 06, Page(s) 755–776

Series title	Postoperative Ankle
Abstract	This article reviews situations in which surgical treatment is required in the context of different types of pathology in the foot and ankle of children, focusing on the role of imaging in surgical planning and postsurgical assessment. The types of pathology analyzed from this perspective are congenital pathology, neuromuscular disorders, osteochondral lesions, fractures and infection, ligament injuries, and tumors. We address the most common pitfalls of postsurgical imaging of the ankle and foot in children. With some exceptions, postsurgical follow-up focuses on clinical assessment, with imaging follow-up only needed in patients where complications are suspected or symptoms recur. Postoperative assessment of the foot and ankle in children and adolescents requires knowing the indications for surgery and the most common types of interventions, along with their imaging characteristics. The radiologist needs to be aware of the normal sequence of development of structures and how to select adequate imaging techniques to assess anatomy at various stages or in different postsurgical scenarios.
Keywords	postsurgical imaging ; pediatric foot ; pediatric ankle ; congenital ; fractures
Language	English
Publishing date	2022-12-01
Publisher	Thieme Medical Publishers, Inc.
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	1360919-1
ISSN	1098-898X ; 1089-7860
ISSN (online)	1098-898X
ISSN	1089-7860
DOI	10.1055/s-0042-1760244
Database	Thieme publisher's database

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