Rostad Bradley,  Richer Edward,  Riedesel Erica,  Alazraki Adina

Final Pr. ID: Paper #: 026

Foreign body ingestion is common in children. Timely diagnosis of the nature and location of the foreign body is important. A button battery which lodges in the esophagus can quickly cause severe esophageal and mediastinal injury. Machine learning that can detect anatomical regions of interest is an important step in computerized foreign body localization and may result in prioritization of radiographs with mediastinal foreign bodies. The purpose of this study is to develop a machine learning model to identify anatomical regions of interest on pediatric foreign body series radiographs. Read More

Authors:  Rostad Bradley , Richer Edward , Riedesel Erica , Alazraki Adina

Keywords:  Machine learning, Artificial intelligence, Foreign body

Chan Alvin,  Lin Jonathan,  Ghahremani Shahnaz,  Chawla Soni

Final Pr. ID: Poster #: EDU-039

Children, especially toddlers, are the most frequent victims of foreign body (FB) ingestion because of their natural curiosity, tempting them to put everything into their mouths. Anything within arm’s reach is fair game, from simple coins to the more dangerous button batteries and magnets. This study aims to provide a thorough review of plain radiographic findings of a myriad of foreign bodies (FBs) and associated complications. With the “Rule of 3–5”, we aim to help radiologists and clinicians develop a rationale and systematic approach in managing FB ingestions. Read More

Authors:  Chan Alvin , Lin Jonathan , Ghahremani Shahnaz , Chawla Soni

Keywords:  Foreign Body

Youssfi Mostafa

Final Pr. ID: Poster #: CR-062

Esophageal radiolucent foreign bodies can be overlooked in infants since the symptoms are usually nonspecific. Chest X-Rays are often the initial diagnostic tool. The lateral view is key since it may reveal anterior bowing and/or focal narrowing of the intra-thoracic trachea which should alert the radiologist to the possibility of radiolucent esophageal foreign body and the need for an Esophagram. We present two cases that illustrate the importance of this radiographic finding. Read More

Authors:  Youssfi Mostafa

Keywords:  Esophageal, Radiolucent, Foreign Body

Hull Nathan,  Frush Don,  Strauss Keith,  Vock Peter

Final Pr. ID: Poster #: SCI-006

Pediatric body CT is an invaluable imaging tool. There is increasing focus to manage and monitor radiation dose estimations from CT, especially in children. One approach, set forth by the International Commission on Radiological Protection (IRCP) is the establishment of diagnostic reference levels (DRLs). Consensus DRLs have recently been established for body CT in Canada, and are in the final stages in Europe (Diagnostic Reference Levels for Pediatric Imaging-PiDRL), but not in the US. Region-specific determinations (which may vary) are worth assessing. The purpose of this study was two-fold: to define what exists in literature for US pediatric body CT DRLs, and to define what metrics should be considered for inclusion in DRL determination. Read More

Authors:  Hull Nathan , Frush Don , Strauss Keith , Vock Peter

Keywords:  Diagnostic Reference Levels, Body CT, SSDE

Epelman Monica,  Dinan David,  Ngo Thang,  Johnson Craig,  Weber-guzman Fabiola,  Chandra Tushar,  Podberesky Daniel

Final Pr. ID: Poster #: EDU-046

The purpose of this exhibit is:
-To discuss the role of DWIBS (diffusion-weighted whole body imaging with background body signal suppression) in the evaluation of pediatric body imaging pathology and to identify common indications for its use
-To review normal DWIBS findings in various body organs and to understand imaging pitfalls
-To provide examples of pathological conditions seen on DWIBS Read More

Authors:  Epelman Monica , Dinan David , Ngo Thang , Johnson Craig , Weber-guzman Fabiola , Chandra Tushar , Podberesky Daniel

Keywords:  DWIBS, DWI, Body, MRI

Lin Jonathan,  Chawla Soni

Final Pr. ID: Poster #: EDU-040

Fidget spinners (FS) have become an increasingly popular toy among children of all ages since April 2017. This toy comprises of a central bearing attached to two or more prongs made of plastic or metal and is designed to be spun between a user’s fingers. With its popularity, FS have grown diverse in design, featuring additional components including light-emitting diode units, Bluetooth speakers, and button batteries. With its multiple small components, FS pose a risk of ingestion and aspiration among young children. This may be incidental or accidental due to the rapidly spinning nature of the toy. Since May 2017, there has been a growing number of cases of FS ingestions among young children internationally. Recognition of the different components of a FS on imaging, especially plain radiography, is important in the early diagnosis and prompt and accurate management of foreign body ingestion. To date, there is no available educational resource to aid and guide radiologists and clinical providers in identifying FS as a foreign body. The purpose of this educational exhibit is to assist radiologists and clinicians to identify the imaging findings associated with FS-related foreign body ingestions. Read More

Authors:  Lin Jonathan , Chawla Soni

Keywords:  Foreign Body, Fidget Spinner

Finkle Joshua,  Feinstein Kate

Final Pr. ID: Poster #: EDU-026

Kids put all sorts of things in their mouths. Foreign body ingestion is a common occurrence in children, and diagnostic imaging plays an important role in determining the nature of the foreign body and the need for emergent removal.

This presentation uses a question and answer format to provide high-yield clinically relevant information on the most commonly encountered foreign bodies including management guidelines for things like coins, batteries, and magnets. Both GI and airway foreign bodies are discussed. The presentation is catered mostly to trainees, but even experienced radiologists will enjoy challenging themselves to identify uncommon foreign bodies on imaging. Read More

Authors:  Finkle Joshua , Feinstein Kate

Keywords:  Foreign Body

Mcallister Aaron,  Lall Neil

Final Pr. ID: Poster #: CR-075

An 18 month old male presents with fever and green discharge from the right external auditory canal. A temporal bone CT demonstrated an 8mm cylinderical structure 3cm in length isointense to muscle with linear central hypoattenuation. An MRI demonstrated a cylindrical signal void on all sequences performed; including T1, T2, and FLAIR sequences; within the masticator space corresponding to the foreign body on CT, although the dimensions appeared slightly larger. There was considerable surrounding edema with findings consistent with osteomyelitis of the mandible with right mastoid and middle ear effusions. In the operating room a small opening on the buccal mucosa was identified and a 3 cm green crayon fragment was removed. Upon further questioning the mother reports the child running with a green crayon, and tripping approximately 3 weeks prior to presentation. The child was treated with IV antibiotics following foreign body removal and is recovering well.

Given the common understanding of a crayon as a solid stick of parafin wax, the imaging appearance as a foreign body on CT and MRI was unexpected. On CT the overall density was isointense to soft tissues and demonstrated a central linear area of hypoattenuation. The central hypoattenuation corresponds to a central air channel in some crayons by the method of manufacture. On MRI the low signal with apparent blooming is related to the pigments. In modern crayons these pigments are transition metal compounds. Iron oxide complexes are the most important and are responsible for the yellow, orange, red, brown, and black color families and their various permutations and mixtures. Other transition metal compounds such as titanium dioxide for white, and copper for blue are also used. Pigments make up to 10% of a crayon. In our case of a green crayon, the iron oxide particles responsible for the yellow portion of the green would explain the abscence of signal on routine MRI sequences with apparent blooming. Understanding the appearance of crayons can help positively identify them as foreign bodies, and may help identify small retained fragments. Read More

Authors:  Mcallister Aaron , Lall Neil

Keywords:  foreign body, Crayon, MRI, CT, masticator space

Law Emily,  Luo Yu

Final Pr. ID: Poster #: CR-025

Ultrasound is the first line of study of radiolucent foreign bodies, such as wooden or organic foreign bodies. The reported sensitivity is up to 90-100%. However, the orientation, location, and size of such foreign bodies can pose challenges for accurate detection.

Case Presentation: We present a case of a 16-year-old girl who stepped on a small wooden stick, leading to a foreign body penetrating between her fourth and fifth toes, which was removed in the emergency room. Post-removal X-ray and ultrasound failed to identify any residual foreign body, and the patient was discharged home with antibiotics. However, persistent pain and progressive foot swelling prompted a return to the Emergency Room two weeks later. A repeat ultrasound showed increased soft tissue swelling, and hyperemia centered around the webspace of the fourth and fifth digits but failed to detect the foreign body. Subsequent MRI revealed a vertically oriented 1.7 cm long cylindrical structure with a diameter of 0.3cm, demonstrating a hypointense signal in all sequences and hyperintense signal and enhancement in the surrounding tissue compatible with the foreign body. In retrospect, a tiny echogenic focus corresponding to the end of the foreign body is present in a similar location on some of the images of both sonographic exams. The foreign body was surgically removed, and the patient completely recovered within a week.

Discussion: This case highlights the limitations of ultrasound in detecting wooden foreign bodies, particularly when they have a unique orientation, location, and small dimensions; in this case, the foreign body was found vertically oriented (thus perpendicular to the ultrasound probe surface) and between the toes. The ultrasound can only detect the tiny end of the foreign body, which can be easily missed or misinterpreted. With its excellent tissue characterization capabilities, MRI proved to be a valuable tool in this challenging scenario. While ultrasound remains a highly sensitive and specific tool, clinicians should consider additional imaging modalities when faced with challenging cases to avoid missed diagnoses and unnecessary complications. Read More

Authors:  Law Emily , Luo Yu

Keywords:  foreign body, MRI, US

Johansen Andrew,  Lee Jacob,  Robinson Amie,  Chan Sherwin

Final Pr. ID: Poster #: SCI-045

Foreign body (FB) ingestion can be a life threatening event for pediatric patients. The imaging for suspected FB is an esophagram. This procedure requires radiologist involvement, patient cooperation and has a higher dose of radiation than chest digital tomosynthesis (DTS). We want to describe usage of DTS in the pediatric population to aid in detection of radiolucent esophageal FB. Read More

Authors:  Johansen Andrew , Lee Jacob , Robinson Amie , Chan Sherwin

Keywords:  Digital Chest Tomosynthesis, Esophageal Foreign Body, Esophagram

Zhang Zhongwei,  Barhaghi Krystle,  Tao Ting,  Murray Kari

Final Pr. ID: Poster #: EDU-017

Pediatric body MRI is a highly effective imaging modality that enables precise characterization of diverse medical conditions. However, it comes with daily challenges, including accommodating variations in patient size, managing breath-hold difficulties, potential sedation needs, addressing patient comfort and anxiety, and the importance of minimizing RF energy deposition and contrast agent use. To become proficient in interpreting body MRI, it is essential to understand the techniques and clinical applications of each pulse sequence and learn how to use them for accurate tissue characterization.

In this ABC guide, we employ the structured approach of “clinical images - techniques – physics” to bridge the gap between practical application and the theoretical foundation of pediatric body MRI. It serves as a comprehensive roadmap, helping learners gain a profound understanding of not only what they are observing in the images but also the underlying reasons and mechanisms that give rise to these images.

We will present body MRI techniques in 4 categories: qualitative MRI sequences, quantitative MRI sequences, artifact recognition, and “how to”. In each category, our approach will encompass data acquisition, fundamental physical principles, imaging characteristics, and the essential groundwork for interpretation. These teachings are firmly grounded in our institutional MRI protocol for pediatric body MRI, providing a comprehensive and practical understanding of the subject.
The education poster will be divided as follows:
1. Qualitative MRI Sequences:
- T2-Weighted and Heavy T2-Weighted Imaging
- Pre- and Post-Contrast T1-Weighted Imaging
- Mixed T2/T1 Contrast Imaging:
- Cartesian, Radial, or Spiral-based k-space data acquisition: Detailed explanations of various k-space sampling methods will be provided.
- The Role of Magnetization Preparation Techniques
- The Role of Physiological Control
2. Quantitative MRI Sequences:
- Measurement of T1 and T2 Relaxation Times
- Measurement of ADC and Diffusion MRI Techniques
- Measurement of Stiffness of Liver and MR Elastography Techniques
- Liver Iron Quantification
3. Common Body MRI Artifacts in Pediatric Patients: A wide array of artifacts, including motion artifacts, susceptibility artifacts, and aliasing artifacts, among others, will be thoroughly covered.
4. How to…
- Address Body MRI Image Quality Issues
- Safely Scan Pediatric Patients with Implants Read More

Authors:  Zhang Zhongwei , Barhaghi Krystle , Tao Ting , Murray Kari

Keywords:  Body MRI, Physics, Pediatric Imaging

Chin Nicole,  Weisel Melissa,  Alazraki Adina,  Milla Sarah

Final Pr. ID: Poster #: EDU-005 (R)

Whole body MR imaging is now widely utilized in the diagnosis and staging of pediatric patients with systemic disorders and diseases such as Chronic nonbacterial osteomyelitis (CNO), Neuroblastoma, Langerhans cell histocytosis (LCH) and fever of unknown origin (FUO). This technique allows the radiologist to visualize the entire body thereby, providing information regarding the full extent of disease allowing clinicians to direct the patient’s treatment. As an alternative to CT and Nuclear medicine, MR whole body imaging produces superior results without exposing the patient to ionizing radiation. We present an educational guide to practical positioning of the patient, coil positioning and protocol optimization. Read More

Authors:  Chin Nicole , Weisel Melissa , Alazraki Adina , Milla Sarah

Keywords:  Whole Body Imaging, MRI, Technologist

Methratta Sosamma,  Brian James

Final Pr. ID: Poster #: EDU-064

Case based pictorial review of use of CT in identification of foreign bodies in the pediatric aerodigestive tract with plain film/GI comparison/correlation. Review CT technique and radiation dose considerations. Review normal anatomy as it relates to common locations of airway and esophageal foreign bodies with examples. Describe anatomic anomalies that increase risk for retained foreign body with examples. Describe/demonstrate associated imaging findings of complications associated with foreign bodies. Describe how information obtained by CT can direct management of children with foreign body of the aerodigestive tract. Read More

Authors:  Methratta Sosamma , Brian James

Keywords:  Foreign body, CT, aerodigestive

Deaver Pamela,  Masand Prakash

Final Pr. ID: Poster #: CR-048

In a child with escalating hemoptysis, negative TB testing, and history of penetrating thoracic trauma, chronic inflammation and vascular injury as a result of radiolucent foreign body should be considered. Read More

Authors:  Deaver Pamela , Masand Prakash

Keywords:  Foreign Body, Pseudoaneurysm, Tuberculosis

Kato Kambrie,  Mackenzie John,  Phelps Andrew,  Courtier Jesse,  Behr Spencer,  Zapala Matthew

Final Pr. ID: Poster #: SCI-033

Determine the incidence of occult malignancy detected by ¹⁸F-FDG PET-CT and whole body (WB) MRI in children. Read More

Authors:  Kato Kambrie , Mackenzie John , Phelps Andrew , Courtier Jesse , Behr Spencer , Zapala Matthew

Keywords:  whole body MRI, PET CT, paraneoplastic syndrome

Hughes Nicole,  Phelps Andrew,  Meyer Anna,  Courtier Jesse,  Mackenzie John,  Zapala Matthew

Final Pr. ID: Poster #: EDU-042

Accurate diagnosis of venous malformations can be challenging, and confidently diagnosing them is important for accurate treatment. A thorough understanding of the etiology, imaging appearance, and important mimickers of venous malformations is critical for the radiologist to provide an accurate assessment for the clinician. Read More

Authors:  Hughes Nicole , Phelps Andrew , Meyer Anna , Courtier Jesse , Mackenzie John , Zapala Matthew

Keywords:  MRI, venous malformation, Whole body MRI, Blood pool MRI contrast agent

Nichat Vaibhav,  Matzinger Mary Ann

Final Pr. ID: Poster #: EDU-052

Bones are frequent targets of various neoplastic and non-neoplastic disorders, which often present with focal bone pain. Clinicians should be familiar with the workup of a challenging symptom such as focal bone pain, in order to make appropriate referrals to various specialists, order appropriate investigations and tissue sampling workup, and avoid unnecessary prolonged antibiotics course, thereby preventing delay in diagnosis and antibiotics resistance.

Sometimes, results of various investigations are not always discriminatory among infectious, inflammatory, neoplastic and non-neoplastic etiologies. Some of these disorders can be a source of important morbidity and mortality in infants and children. In order to optimize diagnostic accuracy, early detection of diseases, detection of clinically silent lesions, and disease management, it is imperative for radiologists to be familiar with the imaging characteristics of each entity and the proper methods employed in their evaluation. In light of this, whole body imaging may be performed to get highest yield and cost effectiveness.

The purpose of this exhibit is:

■ To discuss the indications and highlight the role of Whole body MRI and Whole Body Bone Scan
■ To describe scan protocols of Whole body MRI and Whole Body Bone Scan
■ To describe the imaging appearance of some of the oncologic and non-oncologic diseases presenting as bone pain
■ To briefly compare Whole body MRI and Whole Body Bone Scan

Illustrative cases from our Radiology Department will be used to demonstrate various entities such as chronic recurrent multifocal osteomyelitis, infections, Langerhans cell histiocytosis, hematological malignancies, and bony metastases. Read More

Authors:  Nichat Vaibhav , Matzinger Mary Ann

Keywords:  Whole Body MRI, Whole Body Bone Scan, Bone Pain

Sato T Shawn,  Bajaj Manish,  Ferguson Polly

Final Pr. ID: Poster #: EDU-058

Chronic Recurrent Multifocal Osteomyelitis (CRMO) is an auto-inflammatory disease that can affect multiple locations. Whole body MRI is an important tool to help identify subclinical multifocal disease and help monitor disease. As a referral center for CRMO, we have developed a successful CRMO whole body MRI imaging protocol which maximizes diagnostic information while minimizing scanner time. Read More

Authors:  Sato T Shawn , Bajaj Manish , Ferguson Polly

Keywords:  Rheumatology, CRMO, Whole Body MRI