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The aim of this study was to evaluate the ability of high-resolution computerized tomography (HRCT) of the chest and chest x-rays (CXR) to determine efficacy of inhaled recombinant human DNase (rhDNase) in cystic fibrosis (CF) patients younger than 5 years of age. A randomized, double-blind, placebo-controlled pilot study of 12 patients with CF younger than 5 years of age, attending the University of Michigan Cystic Fibrosis Center (Ann Arbor, MI) was conducted. The changes in the HRCT and CXR score from baseline to day 100 of therapy were assessed using a previously validated scoring system. The mean changes of HRCT scores between the rhDNase and placebo groups were found to be significant at the 95% level, with mean change +/- SE mean of - 1.00 +/- 0.53 and 0.58 +/- 0.24 for rhDNase and placebo groups, respectively (P = 0.02). The difference in CXR score was not significant between the two groups. An analysis was performed to relate HRCT subscores to CXR score; only thickening of the intra-interlobular septae was significantly correlated with the total CXR score (r = - 0.7, P < 0.01). There was improvement in the parents' assessments of the patients' well-being, with improvement in physical activity, decreased cough, sleep quality, and appetite in those subjects receiving rhDNase. We conclude that the administration of rhDNase was associated with improvement in the HRCT scan in CF patients younger than 5 years of age. Findings indicate that HRCT of the chest is useful and sensitive in studying responses to therapy in patients with CF lung disease. To our knowledge, this is the first report of the use of HRCT to assess the effectiveness of a therapeutic modality in so young a CF patient population.

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Computed tomography facilitates the diagnosis of children with choanal atresia. This modality defines the full anatomic abnormality of bony choanal atresia: medial bowing and thickening of the lateral wall of the nasal cavity, enlargement of the vomer, and fusion of these elements. Bony atresia patients can be clearly separated from those with membranous choanal atresia. In membranous atresia, the lateral wall of the nasal cavity is minimally affected and the vomer is normal. This precise anatomic evaluation aids in determining the surgical approach.

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linical instability of the spine after trauma occurs when the spinal ligaments and bones lose their ability to maintain normal alignment between vertebral segments while they are under a physiologic load. Instability can lead to further injury, pain, or deformity and can require surgical stabilization. MR imaging has been shown to be helpful in the detection of ligamentous injury [1]. The purpose of this study is to familiarize the reader with the MR imaging appearance of these injuries. This article is divided into three sections. The first illustrates injuries to the complex craniocervical junction. The second reviews the remainder of the spine, and the third addresses the technical factors that optimize the detection of spinal ligamentous injury. The importance of these MR findings is increasing as clinicians begin to compare outcomes and treatments for specific types of ligamentous injury detected on MR imaging