Purpose To compare and evaluate the usefulness of MRI with CT as radiation free alternative To compare the reproducibility of CT and MRI scores To compare MRI and CT scores with pulmonary function tests (PFT) To evaluate the role of DWI in bronchiectasis. Methods In this prospective study, 25 patients between 7-21 years of age with a clinical/radiological diagnosis of bronchiectasis underwent MDCT (with HRCT reconstruction) and MRI chest. MRI and CT scoring was performed using modified Bhalla score -Helbich’s score by two independent radiologists for all parameters. A final consensus score was recorded. both in CT and MRI. The overall image quality of different MRI sequences to identify the pathologies was also assessed. Appropriate statistical tests were used for inter-observer agreements, and correlation amongst CT and MRI; as well as CT, MRI and PFT. Results Strong agreement (ICC 0.80-0.95) between CT and MRI was seen for extent and severity of bronchiectasis, number of bullae, sacculation/abscess, emphysema, collapse/ consolidation, mucus plugging, and mosaic perfusion. Overall CT and MRI scores had perfect concordance (ICC 0.978). Statistically significant (p-value <0.01) intraobserver and interobserver agreement for all CT and MRI score parameters was seen. A strong negative correlation was seen between total CT and MRI severity scores and FEV1, FVC, FEF 25-75%. DWI MR, with an ADC cut-off of 1.62 x 10 -3 mm 3/sec had a sensitivity of 70% and specificity of 75% in detecting true mucus plugs. Conclusion MRI with DWI can be considered in the diagnostic algorithm for assessment of lung changes in bronchiectasis as a radiation-free non-invasive method of imaging in children, especially in follow-up.

Proptosis is a frequent presenting symptom/ sign of many pediatric malignancies. Acute onset proptosis is an oncological emergency that can endanger vision if not treated promptly. Appropriate treatment must be instituted only after investigating for the underlying etiology. Here we report a 6-year-old developmentally delayed boy who presented with recent onset bilateral proptosis. Clinical examination followed by radiological evaluation suggested scurvy to be the underlying cause and vitamin C supplementation lead to prompt reversal of proptosis. The relevant literature has been reviewed and presented here to apprise the pediatric oncologists about this rare but easily treatable cause of proptosis.

Background: Recent SIOPEL studies have shown cisplatin monotherapy to be equally effective in management of Standard risk Hepatoblastoma (SRHB) as compared to PLADO. Aim: To study the chemotherapy, response and outcomes in children with SRHB in a Resource Challenged Nation (RCN). Material and Methods: A retrospective study was conducted and all children with SRHB who were treated by us from June 2007 to December 2017 were included. All patients with standard risk hepatoblastoma who had received at least 2 courses of chemotherapy were included. Data regarding the demographics, PRETEXT stage, chemotherapy, response to chemotherapy and outcomes were recorded. Kaplan Meier survival analysis was performed to calculate 5-year overall survival (OS) and event free survival (EFS). Results: Thirty-two children were included in the study. Nineteen children (59.4%) received Cisplatin monotherapy and of these 6 patients (all PRETEXT III) had poor response and were upgraded to PLADO. The remaining 13 (40.6%) received upfront PLADO. The 5-year OS and EFS was 100% in the monotherapy group (n=13), 92% and 69% in the upfront PLADO group (n=13), and 62% and 22% in the upgraded to PLADO group (n=6). Patients in upgraded to PLADO group had significantly lower 5-year EFS (70% vs 22%; p= 0.036) compared to upfront PLADO group. Conclusion: Two thirds of SRHB patients with PRETEXT stage III who received cisplatin monotherapy showed poor response and were upgraded to PLADO chemotherapy. These patients had a significantly poorer outcome compared to the rest of the cohort. PRETEXT stage III standard-risk hepatoblastoma may benefit from PLADO chemotherapy instead of cisplatin monotherapy.