Michael Ditchfield

Monash Health · Diagnostic Imaging

This paper investigated cortical thickness and volumetric changes in children to better understand the impact of obstructive sleep disordered breathing (SDB) on the neurodevelopment of specific regions of the brain. We also aimed to investigate how these changes were related to the behavioral and cognitive deficits observed in the condition. Neuroi...

Aim: To evaluate and compare a cranial ultrasound (cUS) scoring system to conventional reporting of cranial ultrasound abnormalities (CUAs) for prediction of early neurodevelopmental outcomes in preterm infants. Materials and methods: This retrospective, single-center study compared cUS scores to results from late ultrasound examination reports for...

This paper investigated cortical thickness and volumetric changes in children to better understand the impact of obstructive sleep disordered breathing (SDB) on the neurodevelopment of specific regions of the brain. We also aimed to investigate how these changes were related to the behavioral, cognitive and autonomic deficits observed in the condit...

Infants born very preterm face a range of neurodevelopmental challenges in cognitive, language, behavioural and/or motor domains. Early accurate identification of those at risk of adverse neurodevelopmental outcomes, through clinical assessment and Magnetic Resonance Imaging (MRI), enables prognostication of outcomes and the initiation of targeted...

Objectives: Cranial ultrasound (cUS) screening is recommended for preterm neonates born before 32 weeks' gestational age (GA). The primary aim of this study was to determine if both a day 3 and day 8 cUS screening examination is necessary for all neonates. Methods: A retrospective observational study was performed at a tertiary-level Australian...

Background The size of the anterior visual pathway (AVP) structures is affected by patient age and pathology. Normative data is useful when determining whether pathology is present. AVP structures do not respect the standard planes of magnetic resonance (MR) imaging. The aim of this study was to produce normative age-related and axis-corrected data...

Fatigue may be among the most profound and debilitating consequences of pediatric traumatic brain injury (TBI); however, neurostructural risk factors associated with post-injury fatigue remain elusive. This prospective study aimed to evaluate the independent value of susceptibility-weighted imaging (SWI) biomarkers, over-and-above known risk factor...

Background Quantifying femoral and tibial torsion is crucial in the preoperative planning for derotation surgery in children and adolescents. The use of an ultra-low-dose computed tomography (CT) protocol might be possible for modern CT scanners and suitable for reliable torsion measurements even though the bones are not completely ossified. Metho...

Background Resorption of magnesium-based alloy bioabsorbable screws produces hydrogen gas, which can be mistaken as a sign of infection and may affect the physis or fixed bone fragment. Objective We evaluated the temporal and spatial occurrence of gas and the occurrence of a breakage of the fixed bone fragment or screw following magnesium screw fi...

Background: Our aims were to evaluate the ultrasound scan (USS) criteria in diagnosing hypertrophic pyloric stenosis (HPS), determine the best diagnostic threshold values for pyloric muscle thickness (PMT) and pyloric canal length (PCL), and assess the accuracy of flow through the pylorus. Methods: All patients who underwent pyloromyotomy at our...

Background and Purpose The aims of this study were to assess the prevalence of multidimensional fatigue symptoms 5 years after pediatric arterial ischemic stroke and identify factors associated with fatigue. Methods Thirty-one children (19 males) with pediatric arterial ischemic stroke, participating in a larger prospective, longitudinal study, we...

Background Organ size is influenced by a number of factors. Age, height, weight, and ethnicity are known influencing factors. Pediatric populations have changed over time, puberty beginning earlier resulting in a changing growth pattern of their organs. Hence, contemporary charts using local data are considered the most appropriate for a given popu...

Therapeutic hypothermia (TH) is standard care in high resource birth settings for infants with neonatal encephalopathy. TH is partially effective and adjuvant therapies are needed. Here we examined whether the antioxidant melatonin (MLT) provides additive benefit with TH, compared to TH alone or MLT alone, to improve recovery from acute encephalopa...

Background and Purpose Childhood and adolescence coincide with rapid maturation of distributed brain networks supporting social cognition; however, little is known about the impact of early ischemic brain insult on the acquisition of these skills. This study aimed to examine the influence of arterial ischemic stroke (AIS) on facial emotion recognit...

There are no publications reporting on scan duration and Doppler use during neonatal cranial ultrasound scans. We investigated current practice of neonatal cranial ultrasound at four large tertiary neonatal intensive care units in Australia. Cranial scans were prospectively recorded between March 2015 and November 2016. Variables, including total n...

Aim To examine the association between brain magnetic resonance imaging (MRI) characteristics and executive function and bimanual performance in children with unilateral cerebral palsy (CP). Method Clinical MRI brain scans were classified as: (1) predominant pathological pattern (normal, white matter injury [WMI]; grey matter injury; focal vascula...

Background Reference charts depicting normal growth are important for the sonographic assessment of the pediatric kidney. Limited charts are available for clinical use in an Australian population. Objective To retrospectively collate sonographic renal length measurements in a cohort of low-risk Australian children aged newborn to 16 years to produ...

Background Fetal growth restriction (FGR) is a serious pregnancy complication associated with increased risk of adverse neurodevelopment and neuromorbidity. Current imaging techniques, including conventional magnetic resonance imaging (MRI), are not sensitive enough to detect subtle structural abnormalities in the FGR brain. We examined whether adv...

Background Intussusception is a common, potentially life‐threatening paediatric condition. Non‐operative treatment with an air enema has been established as the clinical gold standard. There is no validated model for the training of this procedure. Our aim was to produce a novel air enema reduction simulator and validate its use as a training tool....

Background There is a lack of consensus regarding how best to screen children with facial port‐wine stains for Sturge‐Weber syndrome. Many favor brain magnetic resonance imaging, and adjunctive electroencephalography is increasingly used. However, the sensitivity, specificity, and negative and positive predictive value of magnetic resonance imaging...

Aim To describe 5‐year motor and functional outcomes after paediatric arterial ischaemic stroke (AIS) and to explore factors associated with poorer long‐term outcome. Method Thirty‐three children (21 males, 12 females) with AIS were recruited to a single‐site, cross‐sectional study, from a previously reported prospective longitudinal stroke outcom...

Pediatric stroke can result in long-term neurobehavioral impairments including cognitive, language, and motor deficits, all of which may disrupt the normal development of social skills. This study aimed to examine specific components of social function at 5-year poststroke at a group and individual level and explore the contribution of neurobehavio...

Perinatal asphyxia remains a principal cause of infant mortality and long term neurological morbidity, particularly in low resource countries. No neuroprotective interventions are currently available. Melatonin (MLT), a potent antioxidant, anti‐inflammatory, and anti‐apoptotic agent offers promise as an intravenous (IV) or transdermal therapy to pr...

Aim: Fetal growth restriction (FGR) is associated with increased perinatal morbidity, mortality and long-term neurodevelopmental sequelae. The objective of this study was to examine whether information about early neurodevelopmental deficits was evident using three-dimensional head ultrasound and developmental assessments in preterm infants with F...

Study objectives: Children with sleep-disordered breathing (SDB) exhibit behavioral, cognitive, and autonomic deficits, suggestive of neural injury. We assessed whether the tissue alterations resulted from acute or chronic processes, and if alterations correlated with disease severity. Methods: Brain tissue integrity was examined with mean diffu...

Objectives: Ultrasound can lead to thermal and mechanical effects in interrogated tissues. This possibility suggests a potential risk during neonatal cranial ultrasound examinations. The aim of this study was to explore safety knowledge and training of neonatal cranial ultrasound among Australian operators who routinely perform these scans. Metho...

Aim: Little is known about psychological and social outcomes after paediatric stroke. This study aimed to evaluate psychosocial outcomes in children 5 years after paediatric stroke and explore the contribution of early presenting factors. Method: Thirty-one children (19 males and 12 females) with arterial ischemic stroke were involved in this pr...

Background: Neuromotor impairments are common after pediatric stroke, but little is known about functional motor outcomes. We evaluated motor function and how it changed over the first 12 months after diagnosis. We also examined differences in outcome according to age at diagnosis and whether fine motor (FM) or gross motor (GM) function at 12 mont...

Introduction Children with sleep-disordered breathing (SDB) exhibit behavioural, cognitive, and autonomic deficits, suggestive of neural injury. The objective of this study was to assess whether neural tissue alterations underlie such deficits, and whether the tissue changes resulted from acute or chronic injury. Methods We examined brain tissue i...

Objective: To compare information obtained from preterm magnetic resonance imaging (MRI; 31-34 weeks) brain scan to that done at term equivalent age. Study design: Prospective observational study of premature infants with evidence or suspicion of parenchymal brain injury on cranial ultrasound. Brain injury on two scans scored using a scoring sys...

Introduction: There is variable international practice regarding the technique used for image-guided enema reduction in paediatric intussusception. A recent meta-analysis found pneumatic reduction to be more effective than hydrostatic techniques. Clinical practice variation may impact on perforation rates, ionizing radiation exposure and requireme...

Fetal growth restriction (FGR) is a common complication of pregnancy and, in severe cases, is associated with elevated rates of perinatal mortality, neonatal morbidity, and poor neurodevelopmental outcomes. The leading cause of FGR is placental insufficiency, with the placenta failing to adequately meet the increasing oxygen and nutritional needs o...

PurposeThe optimal imaging modality for evaluating cervical spine trauma and optimizing management in the pediatric population is controversial. In pediatric populations, there are no well-established guidelines for cervical spine trauma evaluation and treatment. Currently, there is virtually no literature regarding imaging and management of sympto...

Aim: Childhood stroke disrupts brain development and emerging neural networks. Motor, cognitive, and language deficits are well recognized, yet little is known about psychosocial function after childhood stroke. This study aims to describe psychosocial function within the first year after childhood stroke, and to identify factors associated with o...

This commentary is on the original article by Himmelmann et al.

No abstract is available for this article.

Key points Asphyxia at the time of birth is a significant cause of death or disability in newborns. There is very limited treatment available for these newborns. Autologous umbilical cord blood (UBC) mononuclear cells reduce clinical markers of brain damage following perinatal asphyxia. Autologous UBC mononuclear cells reduce neuroinflammation and...

A previously well 10-year-old girl presented to the hospital on three occasions over a 2-week period with worsening right-sided cheek swelling and pain. Examination was unremarkable apart from obvious swelling of the right cheek and cervical lymphadenopathy (figure 1). An initial diagnosis of suppurative parotitis was made, and she was treated with...

Subdural haematoma (SDH) is rare following spinal anaesthesia and has not been reported previously in an infant. Non-accidental injury is the commonest cause of subdural haematoma in infants. We describe two cases of SDH following spinal anaesthesia in infants. In both cases, forensic investigation was commenced and no evidence of child abuse was f...

In a population cohort of children with white matter injury (WMI) and cerebral palsy (CP), we aimed to describe the magnetic resonance imaging (MRI) characteristics, identify key structure-function relationships, and classify the severity of WMI in a clinically relevant way. Stratified on MRI laterality/symmetry, variables indicating the extent and...

Objectives To evaluate paediatric CT dosimetry in Australia and New Zealand and calculate size-specific dose estimates (SSDEs) for chest and abdominal examinations. Methods Eight hospitals provided data from 12 CT systems for 1462 CTs in children aged 0–15. Imaging data were recorded for eight examinations: head (trauma, shunt), temporal bone, para...

Intra-uterine growth restriction (IUGR) is an important cause for prematurity as well as a significant risk factor for neurodevelopmental deficits. In this study, we aimed to examine the association between IUGR and early brain injury on neonatal cranial ultrasound in preterm infants. This retrospective cohort study examined the relationship betwee...

AimsIn a population cohort of children with grey matter injury (GMI) and cerebral palsy (CP), we aimed to describe and classify magnetic resonance imaging characteristics specific to GMI, and to identify key structure–function associations that serve as a basis for rating GMI in clinically relevant ways.Method Symmetry, extent of cerebral injury, a...

Pediatric stroke outcome studies are often cross sectional in design. Prospective information regarding the clinical course following diagnosis is lacking, but may inform clinical management beyond the acute period. To describe the outcome of arterial ischemic stroke in infants, children and adolescents at one-month and six-months post-stroke acros...

IntroductionDuplex kidneys are common, mostly asymptomatic and of no clinical significance. However, they can be associated with significant pathology, often with long-term morbidity. There is minimal literature on the review of the duplex kidney, its associated anomalies and complications. The purpose of this paper is to review our experience of i...

Sir,I read with great interest the article “Expert opinion: what are the greatest challenges and barriers to applying evidence-based and practical approaches to preclinical and clinical research in the field of pediatric radiology?” [1]. The article sought opinions from researchers in continents and subcontinents throughout the world. One continent...

Childhood and adolescence are critical periods for maturation of neurobiological processes that underlie complex social and emotional behavior including Theory of Mind (ToM). While structural correlates of ToM are well described in adults, less is known about the anatomical regions subsuming these skills in the developing brain or the impact of cer...

Moderate to severe neonatal hypoxic-ischemic encephalopathy remains an important cause of infant death and childhood disability. Early and accurate diagnosis of encephalopathy is difficult but critical for timely intervention. Thus, we have utilized a clinically relevant large animal model of asphyxia in utero, followed by immediate lamb delivery,...

The aim of this study was to describe the distribution of magnetic resonance imaging (MRI) patterns in a large population sample of children with cerebral palsy (CP) and to examine associations between MRI patterns, and antenatal and perinatal variables. Data were retrieved from the Victorian CP Register for 884 children (527 males, 357 females) bo...

The relationship between brain injury and attentional control (AC) long after a childhood traumatic brain injury (TBI) has received limited investigation. The aim of this paper was to investigate the impact that lesion presence, location and severity has on AC in a group of young people that had sustained a moderate to severe TBI 10 years earlier d...

A Diagnostic Imaging Algorithm for Children with Hip Pain

Pediatric whole-body (WB) magnetic resonance imaging (MRI) is an established technique that, with improved accessibility and advances in technology, is being used with increasing frequency for a wide variety of applications. The advantages of WB MRI (over other imaging modalities), particularly its lack of ionizing radiation (of particular concern...

The aim of this study was to review the distribution of neuroimaging findings from a contemporary population cohort of individuals with cerebral palsy (CP) and to facilitate standardization of imaging classification. Publications from 1995 to 2012 reporting imaging findings in population cohorts were selected through a literature search, and review...

Acquired tracheobronchomalacia (TBM) is an uncommon complication of severe lung disease in infancy. We report a case of TBM in an ex-premature infant with severe chronic lung disease (CLD). Multidetector computed tomography (MDCT) was used to dynamically assess the patency of the large airways at different time periods during the infant's hospital...

Bone marrow (BM) assessment is an important aspect of paediatric MRI, with the marrow cavity visible on almost every clinical MR examination. In practice, however, assessment for marrow infiltration in paediatric patients can be challenging. Our aim was to review the MRI appearance of normal BM from 0 to 5 years. Consecutive body MR examinations ov...

The aim of this study was to evaluate the dynamic volumetric CT in the assessment of the paediatric airway. Ethics board approval was obtained for this retrospective review. Eight infants (median age 6 months, range 3 weeks to 1 year, 50% female) at a tertiary paediatric centre with complex clinical respiratory presentation underwent volumetric CT...

Background Urological investigation in children frequently involves high radiation doses; however, the issue of radiation for these investigations receives little attention compared with CT. Objective To compare the radiation dose from paediatric urological investigations with CT, which is commonly regarded as the more major source of radiation exp...

Supratentorial atypical teratoid rhabdoid tumor (ATRT) in many cases has a distinctive appearance on post-gadolinium MRI. OBJECTIVE: We sought to determine whether this is a unique appearance allowing ATRT to be distinguished accurately from other types of pediatric supratentorial tumors. MATERIALS AND METHODS: Retrospective review of all available...

Developmental dysplasia of the hip is an important but poorly understood disorder as evidenced by the vast amount of literature published to date on this topic. The precise definition of hip dysplasia is controversial and it encompasses a spectrum of abnormalities, rather than a single condition, which at one end overlap with normal hip maturation....

Paediatric cerebral sinovenous thrombosis (CSVT) is a rare but serious condition. The imaging signs may be subtle with a number of potential pitfalls. We present a pictorial essay of the pitfalls of diagnosis of CSVT on CT and MRI. We describe, using examples, potential pitfalls on both imaging modalities including anatomical variants of the cerebr...

Introduction: Traumatic brain injury (TBI) sustained during childhood can cause difficulties in a wide range of physical, neurological, cognitive, social and functional domains. However, the ability of health professionals and researchers to accurately predict the outcome of pediatric TBI remains limited. The advent of advanced neuroimaging techni...

Developmental dysplasia of the hip (DDH) is an important but poorly defined entity, the natural history of which is incompletely understood. The term encompasses a disease spectrum ranging from a stable hip with a mildly dysplastic acetabulum to complete hip dislocation. Much controversy surrounds the diagnosis, imaging and management of this condi...

Tracheobronchomalacia is characterised by excessive airway collapsibility due to weakness of airway walls and supporting cartilage. The standard definition requires reduction in cross-sectional area of at least 50% on expiration. However, there is a paucity of information regarding the normal range of central airway collapse among children of varyi...

Abstract Background : Radiation dose administration and its associated risks when performing computed tomography (CT) has been increasingly scrutinised in the recent past. The absorbed dose to organs and tissue in CT is high, therefore risks must be outweighed by benefit when considering a CT examination. This is particularly true when imaging the...

To determine if ossification variants of the femoral condyles involving the subchondral bone plate are associated with osteochondritis dissecans (OCD). The prevalence of ossification variants of the unaffected femoral condyle in 116 patients (aged 9-14 years) with unicondylar OCD on MRI (magnetic resonance imaging) of the knee was compared to a con...

PURPOSE To determine if ossification variants of the femoral condyles involving the subchondral bone plate predispose or progress to osteochondritis dissecans. METHOD AND MATERIALS (a) Follow-up MRI (magnetic resonance imaging) studies of 188 patients with ossification variants of the femoral condyles on the initial MRI of the knee were compared s...

Popular gonad shield designs aim to provide coverage of the true pelvis, which is presumed to be the probable location of the ovaries. Shields are frequently placed inaccurately, especially in children, obscuring important orthopaedic landmarks on pelvic radiographs. We aimed to identify the position of the ovaries and asses how this may vary with...

Higher latitude, lower ultraviolet exposure, and lower serum 25-hydroxyvitamin D (25OHD) correlate with higher multiple sclerosis (MS) prevalence, relapse rate, and mortality. We therefore evaluated the effects of high-dose vitamin D2 (D2) in MS. Adults with clinically active relapsing-remitting MS (RRMS) were randomized to 6 months' double-blind p...

The corpus callosum (CC) can be affected by childhood traumatic brain injury (TBI), through focal lesions, reductions in size and arrested development. Little is known, however, about what constitutes normal CC shape and appearance and how it may be affected in the long-term after early TBI. In this study, the appearance of the CC was investigated...

To determine if MRI (magnetic resonance imaging) of the femoral condyles in children can differentiate variations in ossification from osteochondritis dissecans (OCD). MRI studies of the knee of 315 patients demonstrated ossification defects of the femoral condyles involving the subchondral bone plate. MRI features categorized the defects as ossifi...

Cranial CT scans are at the center of decision making in brain injuries in children because of their speed and ability to detect surgically relevant lesions. However, alternative techniques, such as conventional MRI may have advantages in terms of radiation exposure and sensitivity to detect brain injury. Susceptibility-weighted imaging (SWI), a re...

The knee is the joint which is most commonly imaged by MRI in children and adolescents. With increasing participation in competitive sports, traumatic knee injuries with osteochondral lesions are increasingly common in children. However, it is also important to exclude non traumatic conditions that result in defects of the articular cartilage and/o...

Traumatic brain injury (TBI) in children results in damage to the developing brain, particularly in severely injured individuals. Little is known, however, of the long-term structural aspects of the brain following childhood TBI. This study investigated the integrity of the brain 10 years post-TBI using magnetic resonance imaging volumetrics in a s...

To determine how the magnetic resonance (MR) signal intensity seen with variability in distal femoral epiphyseal ossification in children varies with (a) age, (b) sex, (c) distribution to the medial or lateral condyles, and (d) residual physeal cartilage. Ethics committee approval was obtained, and informed patient consent was waived. Two pediatric...

For the 9% to 16% of children with cerebral palsy (CP) who have normal brain imaging, further testing for metabolic and/or genetic conditions has been recommended. This study aimed to identify a cohort of children with CP with normal magnetic resonance imaging (MRI), clinically review and describe the cases, and assess the value of testing for inhe...

Osteochondritis dissecans (OCD) of the elbow is an uncommon cause of elbow pain in adolescents and occurs at different locations in the elbow joint. Early diagnosis and treatment may prevent surgery. The aim of the study is to describe the MR imaging features of OCD at initial imaging, and to correlate these findings with surgical findings of stabi...

Background: Abnormal airway development mayoccur in preterm infants with BPD and give rise tosymptomatic bronchomalacia in infants with severedisease. This condition may be under recognisedin this population, however, because diagnosis hasto date required highly invasive procedures to beundertaken (bronchoscopy or bronchograms). Thecase we present...

There is growing evidence that inhalants are neurotoxic to white matter, yet limited work has been conducted to investigate the neurobiologic effects of long-term exposure among adolescent users, despite inhalant use being most prominent during this developmental period. We used diffusion tensor imaging to examine white-matter integrity in 11 adole...

DWI reportedly accurately differentiates pediatric posterior fossa tumors, but anecdotal experience suggests limitations. In 3 years, medulloblastoma and JPA were differentiated by DWI alone in 23/26 cases (88%). Ependymoma (n = 5) could not be reliably differentiated from medulloblastoma or JPA. A trend toward increased diffusion restriction in hi...

Crohn disease (CD) is a chronic inflammatory bowel disease that can affect any part of the gastrointestinal tract from the oral cavity to the anal canal. It occurs in all ages and is a significant cause for morbidity in children. Interest in MRI evaluation of CD has increased because of the concern regarding cumulative radiation dose from contrast...

Haemophilic arthropathy of the elbow is a rare cause of elbow pain in children and adolescents. The purpose of this study is to determine the MR appearance of the spectrum of lesions found in haemophilic arthropathy of the elbow at initial MR imaging. It is important to be aware of the early changes in this entity, since early diagnosis and treatme...

Recent evidence has suggested that haemodynamic information obtained from cardiac catheterisation is not essential in pre-operative assessment of children with hypoplastic left heart syndrome (HLHS) undergoing Bidirectional Cavopulmonary Connection (BCPC). Therefore our unit changed to cardiac Magnetic Resonance Imaging (MRI) in 2006. We aimed to c...

Juxta-articular venous malformations (VMs) are uncommon, but may cause early arthropathy of the knee in children and adolescents. We sought to describe the prevalence, extent and initial magnetic resonance imaging (MRI) features of knee arthropathy in children with VM adjacent to the knee joint. Thirty-five patients with VM adjacent to the knee who...