Bao Rina,  Grant Ellen,  Ou Yangming

Final Pr. ID: Poster #: SCI-030

Hypoxic Ischemic Encephalopathy (HIE) is a brain injury caused by a lack of blood and oxygen supply to the brain. HIE affects 4,000,000 term-born neonates per year worldwide, with an estimated 2 billion/year cost in the US, let alone family burdens. Therefore, reducing mortality and morbidity for HIE patients remains an important public health concern. Therapeutic hypothermia (TH) was established in 2005 as a standard therapy by cooling patients to 33-34°C in the first six postnatal hours for 72 hours. However, 35–50% of the patients still experience adverse outcomes, defined as death or cognitive Bayley Scales of Infant Development by age two years. Ongoing HIE-related trials worldwide are testing whether new therapies can supplement TH and further reduce adverse outcomes. However, therapeutic innovation is slow and inconclusive, for 1) before therapy, patients at high risk of developing adverse outcomes cannot be identified; 2) after therapy, outcomes cannot be measured until age two years. Besides, public MRI data exists for hundreds of patients with brain tumors, Alzheimer’s Disease, and other diseases, fueling AI’s success in MRI-based diagnosis and prognosis of brain tumor, Alzheimer’s Disease, and other disorders. In contrast, annotated MRIs with linked clinical and bio-marker data do not exist publicly for HIE. Our previous work has collected multi-site HIE MRI data. Therefore, to fill the gap in HIE diagnosis with MRI data, target high-risk patients, increase efficiency, evaluate therapeutic effects early, and expedite therapeutic innovations, in this work, we propose to predict 2-year neurocognitive outcomes in neonates using brain MRIs by deep learning methods. Read More

Authors:  Bao Rina , Grant Ellen , Ou Yangming

Keywords:  Brain MRIs, Brain injury, Hypoxic Ischemic Encephalopathy

Cortes Albornoz Maria,  Machado Rivas Fedel,  Fazio Ferraciolli Suely,  Afacan Onur,  Jaimes Camilo

Final Pr. ID: Poster #: EDU-073

In recent years, 7 Tesla MRI has become a valuable tool in the field of neuroimaging. Ultra-high field strength provides a superior signal-to-noise ratio, which is particularly advantageous for structural and vascular imaging, as well as MR Spectroscopy. Despite the many advantages, artifacts abound at 7T and limit its translation. Furthermore, the high SAR of these scanners and regulatory restrictions imposed by the FDA can limit accessibility for pediatric patients. This educational exhibit aims to delve deeper into these issues and:
1. Review the commercially available hardware.
2. Summarize regulatory and safety constraints.
3. Highlight the advantages of 7T for structural, vascular, and MRS.
4. Illustrate artifacts and limitations.
5. Present examples of brain abnormalities at 7T.

References:

1. Opheim G, van der Kolk A, Markenroth Bloch K, Colon AJ, Davis KA, et al. 7T Epilepsy Task Force Consensus Recommendations on the Use of 7T MRI in Clinical Practice. Neurology. 2021 Feb 16;96(7):327-341. doi: 10.1212/WNL.0000000000011413. Epub 2020 Dec 22. PMID: 33361257; PMCID: PMC8055334. Read More

Authors:  Cortes Albornoz Maria , Machado Rivas Fedel , Fazio Ferraciolli Suely , Afacan Onur , Jaimes Camilo

Keywords:  7 Tesla, Brain, MRI

Rozenfeld Michael,  Garcia Sebastian,  Nelson Paige,  Burrowes Delilah

Final Pr. ID: Poster #: EDU-070

Gadolinium based contrast agents (GBCAs) are widely used in medical imaging with 10 million annual doses given in the US alone. There is a very low 0.03% risk of serious adverse reactions. GBCAs were thought entirely safe until 2006 when reports of nephrogenic system fibrosis (NSF) surfaced. NSF was nearly eliminated by 2009 through careful screening and reducing dosage. In 2014, it was reported that GBCAs may deposit in the brains of patients. The purpose of this review is to examine the literature to date. Read More

Authors:  Rozenfeld Michael , Garcia Sebastian , Nelson Paige , Burrowes Delilah

Keywords:  Brain, Gadolinium

Sato T Shawn,  Sato Yutaka

Final Pr. ID: Poster #: EDU-084

The 2016 World Health Organization Classification of Tumors of the Central Nervous System has now incorporated molecular and genetic parameters in addition to histology to define many tumor entities. Significant restructuring has occurred for pediatric CNS tumors. For example, medulloblastomas are classified into four genetic subtypes. Other embryonal tumors such as embryonal tumor with multilayered rosettes (ETMR) and atypical teratoid/rhabdoid tumor (ATRT) are further defined by their molecular features. Also new entities have been added defined by both histology and molecular signatures including H3 K27M-mutant diffuse midline glioma, RELA fusion-positive ependymoma and diffuse leptomeningeal glioneuronal tumor (DLGNT).
These more homogeneous and narrowly defined entities are expected to facilitate better classification, prognostication and patient stratification for precision therapy. This also improves the design of clinical trials and experimental models.
In this presentation, we will review the new WHO classification scheme and review the imaging and as well as molecular/genetic features of pediatric CNS tumors.
Radiologists must keep up to date with updates to the WHO classification scheme to be able to better communicate with clinicians ensure optimal patient care and relevant research collaboration.
Read More

Authors:  Sato T Shawn , Sato Yutaka

Keywords:  WHO, Brain tumors

Ben-david Eliel,  Zharkov Elena,  Pais Adi,  Kasirer Yair,  Bin-nun Alona

Final Pr. ID: Poster #: CR-029

A novel 1T MRI scanner, previously compared to a 1.5T Siemens scanner, was placed in our NICU. The 5-gauss safety line is inside the magnet, rendering standard magnetic safety precautions unnecessary and allowing maintaining ongoing critical care. Scans included near-term equivalent stable neonates and neonates in an acute / sub-acute setting of disease. Through the following cases we present the capabilities of the 1T in-NICU scanner to evaluate the neonatal brain throughout different phases of injury.

Case 1–Chronic. A 28 5/7 week infant born to mother with chorioamnionitis, developed sepsis. Cranial US showed bilateral IVH Grade III (L) / IV (R) on DOL 2. At DOL 49, ventriculomegaly and porencephalic cysts were detected on US. MRI at term equivalent age demonstrated the post hemorrhagic cystic degeneration and ventriculomegaly. Follow up MRI was performed at 4 months of age due to increasing head circumference. Presence of prior MRI images increased diagnostic confidence.

Case 2–Sub-acute. A term infant with moderate encephalopathy treated with therapeutic hypothermia, after absent fetal movements for two days. Complicated NICU course, with multi-system organ failure, seizures and severe hypoglycemia. MRI scan on DOL 14 showed punctate rim-T1 hyperintense foci with a hypointense center, opposite T2 signal and restricted diffusion, in the centrum semi-ovale and periventricular white matter. Sub-acute hemorrhage with suspected ischemic etiology was the working diagnosis.

Case 3–Acute. A term infant delivered by stat C-section for non-reassuring fetal heart rate and low Apgar scores. Complicated NICU course, including multisystem organ failure, seizures, and burst suppression on cerebral monitoring. MRI scan on DOL 6 showed diffuse abnormal cortical T1 and white-matter T2 signal. Restricted diffusion was seen diffusely in a posterior distribution. Diffuse hypoxic ischemic injury was diagnosed.

Case 4–Hyper-Acute. A 31 week infant was delivered by stat C-section after major maternal trauma, with extremely severe hypovolemic shock. An MRI scan was performed at 8 hours of life, to determine direction of care while intubated and on vasopressor support. Extra-axial and intraventricular hemorrhage were seen, as well as diffuse restricted diffusion. The scan assisted family and physicians to reach a decision regarding discontinuing of care. Read More

Authors:  Ben-david Eliel , Zharkov Elena , Pais Adi , Kasirer Yair , Bin-nun Alona

Keywords:  Neonate, MRI, Brain

Rana Abhilasha,  Mansfield Kori,  Radder Shrinivas,  Razzaq Sania,  Jayappa Sateesh,  Charles Glasier,  Ramakrishnaiah Raghu,  Murphy Janice

Final Pr. ID: Poster #: CR-017

Meroanencephaly is an extremely rare open neural tube under anencephaly spectrum with midline superior calvarial defect, herniation of disorganised brain parenchyma through the defect with deficient overlying skin. Anencephaly has an incidence of 0.1% on antenatal ultrasound, meroanencephaly is even rarer accounting for 3.4% cases of anencephaly. MRI is the modality of choice for complete assessment of meroanencephaly and antenatal ultrasonographic findings should be confirmed with fetal MRI.
A 35-year-old female presented for fetal MRI after suspicion of occipital encephalocele on antenatal ultrasound. MRI showed microcephaly with thin and abnormally shaped calvarium, a midline calvarial defect in the region of vertex with brain parenchyma protruding through the defect and deficient overlying skin covering. Meningeal covering was difficult to assess due to oligohydroamnios and close apposition of skull to uterine wall. There was absence of ventricular system and lack of normal supratentorial and infratentorial anatomical landmarks. Fetal face was normal. Persistent fetal thoracic kyphotic curvature was observed throughout the examination, spinal cord and spinal canal were normal with no spinal dysraphism. No other anomalies were demonstrated. Read More

Authors:  Rana Abhilasha , Mansfield Kori , Radder Shrinivas , Razzaq Sania , Jayappa Sateesh , Charles Glasier , Ramakrishnaiah Raghu , Murphy Janice

Keywords:  Fetal Magnetic Resonance Imaging, Brain, Congenital

Villanueva Fernando,  Barragan Eduardo,  Suarez Pilar,  Hidalgo-tobon Silvia

Final Pr. ID: Poster #: SCI-006 (S)

Los problemas en el desarrollo del lenguaje se han incrementado en anios recientes, se estima que solo en Mexico el siete por ciento de los ninios presenta alteraciones del lenguaje. La caracterizacion de los valores de ADC y FA asociados al area de Broca y Wernicke propuestas por el modelo clasico pueden permitir en un mediano plazo detectar anomalias en el sistema del lenguaje pudiendose utilizar para un diagnostico temprano. Por esta razon nuestro primer objetivo es caracterizar ambos parametros en pacientes sanos que permita establecer valores de control. Read More

Authors:  Villanueva Fernando , Barragan Eduardo , Suarez Pilar , Hidalgo-tobon Silvia

Keywords:  mri, brain, Language

Aviado Randy,  Clark Keaira,  Mahdi Eman,  Nada Ayman,  Mishra Chakradhar,  Jones Kathryn,  Urbine Jacqueline,  Vorona Gregory

Final Pr. ID: Poster #: EDU-090

Brain hypoxic-ischemic injury (HII) is a devastating injury that results in death or profound long-term neurologic disability in both children and adults. Treatment is mostly supportive, including hypothermia and administration of excitatory amino acid antagonists, with a limited window of effectiveness (as little as 6 hours), making early detection of injury critically important. Neuroimaging with Ultrasound, CT, and MRI has become increasingly valuable in the work-up of patients with HII.

In this educational exhibit we will: a) review the pathophysiologic features and factors that influence the pattern of injury, b) discuss the specific imaging patterns in preterm and term neonates, c) review the imaging approach and highlight the role of advanced MRI techniques such as MR spectroscopy, DWI/ADC, and ASL perfusion in the evaluation process. Finally, we will briefly elaborate on the therapeutic hypothermia in HII, and the influence on imaging findings. Read More

Authors:  Aviado Randy , Clark Keaira , Mahdi Eman , Nada Ayman , Mishra Chakradhar , Jones Kathryn , Urbine Jacqueline , Vorona Gregory

Keywords:  Hypoxic, Brain, Neonate

You Sun Kyoung,  Lee So Mi,  Cho Hyun-hae

Final Pr. ID: Poster #: SCI-005

To investigate of imaging findings of brain computed tomography (CT) and demographic findings of children with head trauma under 2 years. Read More

Authors:  You Sun Kyoung , Lee So Mi , Cho Hyun-hae

Keywords:  brain, computed tomography, brain trauma, pediatric

Ramirez-flores Hector,  Barragan Eduardo,  Suarez Pilar,  Hidalgo-tobon Silvia

Final Pr. ID: Poster #: SCI-005 (S)

Caracterizar y comparar los parámetros de difusión de la región córtico-talámica, para estudiar su desarrollo en edades tempranas y su posible aplicación en el diagnóstico clínico de enfermedades. Read More

Authors:  Ramirez-flores Hector , Barragan Eduardo , Suarez Pilar , Hidalgo-tobon Silvia

Keywords:  MRI, DTI, brain

Bhargava Ravi,  Anderson Scott,  Chari Radha

Final Pr. ID: Poster #: SCI-019

Fetal demise (FD) occurs in 1/1000 pregnancies after 20 weeks gestation. MRI is increasingly being used after ultrasound to assess fetal pathology. FD may occur in the interval between ultrasound and MRI, and various organ systems have been described as having changes on fetal MRI. Although ultrasound findings of FD have been well described, criteria for FD on MRI have not. Diffusion MRI evaluates Na⁺/K⁺ channel viability and can be used to evaluate tissue death. Flowing blood produces signal loss on MRI, and along with fetal heart activity results in MRI signal loss of the cardiac chambers. FD with no heart motion and increased signal within non-flowing blood in the heart should result in increased signal in the chambers relative to the myocardium. Either of these findings can be seen with different fetal pathology, but the combination of brain and cardiac changes may allow for a diagnosis of FD. We hypothesize that restricted brain diffusion in certain brain lobes along with increased signal within heart chambers is specific for FD. Read More

Authors:  Bhargava Ravi , Anderson Scott , Chari Radha

Keywords:  Fetal MRI, Brain, Cardiac

Ayvazyan Sona,  Petrosyan Lilit

Final Pr. ID: Poster #: CR-052

Pediatric stroke is a relatively rare disease, but remains one of the most common causes of death in childhood.
A higher homocysteine level raises the risk of vascular disease, including stroke.
In the setting of heavy alcohol consumption, the risk for all major types of strokes is increased, especially those of ischemic etiology.
A 17-year-old boy who had used a large amount of cigarettes and alcohol the previous evening, presented to our clinic. Upon admission, the patient’s condition was critical, with impaired consciousness. Left-sided facial nerve paresis and left-sided hemiparesis were observed. An CT examination of the brain was performed, no gross changes were found and was indicates an urgent MRI. On MRI there was irregular configuration of the dorsal posterior limb of the internal capsule and ventrolateral parts of the right thalamus, with a focus of diffusion restriction and increased MR signal intensity on T2-weighted FLAIR sequences. MR findings are consistent with an acute ischemic stroke in the territory of the right anterior choroidal artery. No neurological deficits were detected after treatment.
Alcohol intoxication and hyperhomocysteinemia are significant risk factors for ischemia.
The combination of hyperhomocysteinemia with alcohol and nicotine abuse presents an even higher and more persistent risk for ischemia. Read More

Authors:  Ayvazyan Sona , Petrosyan Lilit

Keywords:  Stroke, Acute, Brain

Holz Emily,  Fisher Paul

Final Pr. ID: Poster #: CR-050

Neurocysticercosis (NCC) is the result of infection of the nervous system by the larvae of Taenia solium—the pork tapeworm. It is endemic in regions of Latin America, Sub-Saharan Africa, and Asia, however, is also of concern in non-endemic regions as a result of immigration and travel to endemic regions. NCC is a major cause of seizures, however disease presentation varies based on the number, growth, and location of lesions as well as the inflammatory response of the host. In addition to seizures, other common clinical manifestations are headaches, intracranial hypertension, focal deficits, and altered mental status. Case Presentation: A 13-year old female with a history of intermittent headaches presented to the emergency department with severe headache, nausea and vomiting, and altered mental status. Upon evaluation, the patient had a Glasgow Coma Scale score of 8, indicative of a severe level of brain injury. A brain MRI revealed a non-enhancing “cystic” ovoid lesion filling much of the third ventricle. A subsequent CT revealed a scolex (anterior end of the tapeworm) with obstructive hydrocephalus at the level of the third ventricle and cerebral aqueduct. NCC has 3 stages—vesicular, colloidal or granular, and calcified—each with characteristic findings on imaging. In the vesicular stage, imaging shows cysts with central hyperdensity on CT representing the scolex. In the colloidal or granular stage, imaging shows cysts with surrounding enhancement and edema, and in the calcified stage, calcifications are visible. In this case, the patient appeared to be at the end of the vesicular stage, transitioning into the colloidal or granular stage as there was evidence of a scolex on CT and a cystic lesion with interstitial edema, however it was non-enhancing. Additionally, in NCC parenchymal lesions are most common, and with antiparasitic treatment, have a generally benign prognosis. Extraparenchymal disease, which includes ventricular cysts as seen in this patient, is less common and is not benign, often resulting in obstructive hydrocephalus, also evident in this patient, and may even result in death. Based on imaging findings, the patient underwent fenestration of the cyst and biopsy, which revealed fragments of a parasitic organism. NCC can result in life-threatening consequences including hydrocephalus, herniation, and edema, so while treatment generally consists of anti-inflammatory and antiparasitic medications, surgery may be indicated in some patients. Read More

Authors:  Holz Emily , Fisher Paul

Keywords:  Pediatric Neuroradiology, Hydrocephalus, Brain MRI

Schoeman Sean,  Venkatakrishna Shyam Sunder,  Chacko Anith,  Andronikou Savvas

Final Pr. ID: Poster #: SCI-026

To assess the utility and adaptability of some widely used automated segmentation methods when applied to abnormal pediatric magnetic resonance imaging (MRI) brain scans. Segmentation is an essential component of the workflow when building 3D anatomical models of abnormal pediatric brains to demonstrate surface pathology. Read More

Authors:  Schoeman Sean , Venkatakrishna Shyam Sunder , Chacko Anith , Andronikou Savvas

Keywords:  Segmentation, 3D Printing, MRI Brain

Maleki Nazanin,  Amiruddin Raisa,  States Lisa,  Aboian Mariam

Final Pr. ID: Poster #: EDU-075

PET/MRI plays a significant role in Pediatric Oncology, but its implementation in Pediatric Neuro-Oncology has not been well established. PET/MRI addresses a major challenge in pediatrics by providing capability for serial imaging to track disease response to therapy, while minimizing radiation exposure and sedation events. PET/MRI has become a critical imaging modality in the management of pediatric brain neoplasms and metastases, aiding in diagnosis, staging, treatment planning, and follow-up, all while reducing radiation burden, minimizing time spent in the hospital, and reducing the number of sedation events.
At our tertiary center for pediatric care, we have gained extensive experience in utilizing hybrid PET/MRI to manage complex cases referred from multiple institutions. We present a series of cases where hybrid PET/MRI provided critical information for patient management including nasopharyngeal rhabdomyosarcoma, refractory metastatic germ cell tumor, and neuroblastoma. We offer a forward-looking perspective on the current role of FDG PET/MRI and future applications of amino acid PET in improving patient outcomes and its role in distinguishing tumor progression from post-treatment changes. Amino acid PET/MRI use cases were compiled from literature review and demonstrate definitive roles of amino acid PET/MRI in decision making in brain tumor diagnosis, immediate post-surgical assessment, and delayed treatment response assessment.
18F-FDG PET/MRI representative cases from clinical practice:
Case 1.
18 year old male with refractory metastatic germ cell tumor with anterior mediastinal mass and intracranial metastasis
Clinical Problem: Whole body evaluation in addition to detailed analysis of brain metastases in time efficient manner.
Imaging Solution: PET/MRI allowed detailed evaluation of hypermetabolic metastatic disease to the mediastinum and lungs and further detailed delineation of hemorrhagic brain metastases.
Case2.
4 year old boy with history of nasopharyngeal rhabdomyosarcoma with cerebellar metastasis who underwent resection and chemoradiation.
Clincial Problem: How to monitor nasopharyngeal mass after treatment in the setting of extensive postsurgical changes on MRI
Imaging Solution: PET/MRI provides an excellent imaging method for monitoring disease recurrence in the setting of post-treatment changes in nasopharyngeal location. Recurrent tumor was identified as hypermetabolic lesion, while MRI was not definitive. Read More

Authors:  Maleki Nazanin , Amiruddin Raisa , States Lisa , Aboian Mariam

Keywords:  PET-MRI, Pediatric Imaging, Brain Tumors

Henault Kathryn,  Kanev Paul,  O'loughlin Michael

Final Pr. ID: Poster #: CR-054

Congenital glioblastoma multiforme (cGBM) is the rarest type of congenital brain tumors, constituting approximately 3.5% of cases according to the latest literature, with roughly 60 cases published worldwide. This specific presentation can be defined as ‘definitely congenital’, based on the 1964 classification of congenital tumors by Solitare and Krigman. The case report discusses the clinical presentation, radiologic and histologic findings, treatment, and prognosis of cGBM.

The tumor was first detected on an ultrasound at 31 weeks gestation, performed for a clinical diagnosis of mild oligohydramnios, revealing an unexpected large intracranial lesion. Prior to this finding, the pregnancy course was uneventful - the fetus was naturally conceived by a 30-year-old G2P1001 without history of infection, radiation, or trauma. No concerning maternal past medical history or use of drugs/alcohol during pregnancy. No family history of CNS malignancy was documented. MRI performed at 31 3/7 weeks confirmed a large complex cystic and solid mass lesion, bigger than previously measured on the aforementioned ultrasound, with mixed T1 and T2 signal within the left parietal/occipital lobe. Findings were concerning for a mass lesion, specifically a GBM given the size and complex signal characteristics. A second ultrasound preformed 12 days later showed even further growth, raising suspicion for a rapidly enlarging tumor. A pediatric neurosurgeon and maternal fetal medicine team following the patient had preemptively decided to deliver the fetus at 36 weeks due to increasing macrocephaly, with a plan for postnatal biopsy to establish pathology before a definitive treatment plan was ascertained. Unfortunately the mother presented to the clinic at 33 1/7 weeks with no fetal movement and an ultrasound confirmed intrauterine demise. After a classic Cesarean section, an autopsy confirmed a diagnosis of cGBM. No other congenital abnormalities were revealed.

Although fetal brain tumors are exceedingly rare, it is imperative to diagnose them in-utero due to potential prenatal and postnatal complications. Co-morbidities such as polyhydramnios, spontaneous intracranial hemorrhage, dystocia during delivery, and immediate postnatal heart failure should be continually evaluated for. Knowledge of an intracranial mass will allow providers to appropriately plan the mood of delivery and immediate postnatal course with necessary specialists available for immediate intervention. Read More

Authors:  Henault Kathryn , Kanev Paul , O'loughlin Michael

Keywords:  congential brain tumor, glioblastoma multiforme

Didier Ryne,  Martin-saavedra Juan,  Sridharan Anush,  Larson Abby,  Coons Barbara,  Coleman Beverly,  Davey Marcus,  Hedrick Holly,  Flake Alan

Final Pr. ID: Paper #: 118

Assessment of fetal brain perfusion with contrast-enhanced ultrasound (CEUS) has not been performed in vivo in congenital diaphragmatic hernia (CDH). The development of the EXTra-uterine Environment for Neonatal Development allows investigation of CEUS and fetal brain perfusion parameters. The purpose of this study was to assess for aberrations in brain perfusion using CEUS in fetal lambs with CDH and correlate with cardiac output data. Read More

Authors:  Didier Ryne , Martin-saavedra Juan , Sridharan Anush , Larson Abby , Coons Barbara , Coleman Beverly , Davey Marcus , Hedrick Holly , Flake Alan

Keywords:  Congenital Diaphragmatic Hernia, Brain Perfusion, Contrast Enhanced Ultrasound

Harding Jaclyn

Final Pr. ID: Poster #: EDU-14 (R)

The purpose of this exhibit is to educate sonographers on proper technique when performing cranial ultrasounds as well as present abnormalities they may encounter. I will present detailed scenarios when scanning pediatric heads which will discuss proper parameters including proper orders, technique, transducers, and limitations of patients. Age appropriate scanning will be addressed in order to ensure an adequate, diagnostic, and meaningful study. Normal and abnormal anatomy and pathology will be addressed and discussed. Patient positioning and transducer placement will be reviewed. Read More

Authors:  Harding Jaclyn

Keywords:  Ultrasound, Cranial, Head, Brain

Oh Saelin,  Lee Yoo Jin

Final Pr. ID: Poster #: EDU-078

Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD) is a recently defined neuroimmune disorder that presents with a wide range of clinical and radiological features. This study aims to describe the diverse brain MRI findings observed in patients with MOGAD and discuss their clinical implications. Read More

Authors:  Oh Saelin , Lee Yoo Jin

Keywords:  MRI Brain, Demyelination

Kim Taehoo,  Faingold Ricardo,  Daneman Alan

Final Pr. ID: Poster #: CR-009

A preterm male infant born at 28+2 weeks from twin pregnancy was admitted to Neonatal Intensive Care Unit post urgent cesarean section for placental abruption. Postnatal echocardiogram confirmed multiple cardiac abnormalities including double outlet right ventricle with D-transposition of great arteries, requiring an arterial switch operation. His hospital course was complicated by seizure with previous documentation of left grade 1 germinal matrix hemorrhage and multifocal thromboembolic stroke on brain MRI. At 2 months of life, he required a chest tube insertion during which he had a cardiac arrest requiring venoarterial extracorporeal membrane oxygenation (ECMO).

Head US at 2 hours post-cannulation showed new bilateral symmetrical linear hyperechoic abnormalities in the periventricular supratentorial regions predominantly in the watershed areas, extending peripherally reaching the cortices. Similar new hyperechoic linear foci were seen in the right thalamus. While the clinical diagnosis at this time included watershed infarcts, the pattern of hyperechogenicity with dirty shadowing suggested air emboli, less likely hemorrhage or calcifications.

Follow-up head US at 5 hours post-cannulation was arranged which showed near-complete resolution of the previously seen bilateral parenchymal hyperechoic abnormalities. Thus, we concluded resolving cerebral intravascular air emboli secondary to recent ECMO cannulation, rather than watershed infarcts. No evidence of new evolving infarct nor intracranial hemorrhage was noted.

The patient unfortunately sustained a fulminant septic shock and end-organ injuries despite maximum medical therapies. His family elected to withdraw all life-sustaining therapies the day after his head US.

Systemic air embolism is a rare but potentially fatal complication of ECMO. Rapid recognition is important for reducing morbidity and mortality. Head ultrasound is usually the first brain imaging study performed in neonates for screening. Bilateral periventricular increased echogenicity can be seen in a wide range of different pathologies, including but not limited to periventricular leukomalacia, infarcts, hemorrhages and neonatal encephalitis. This case report highlights important sonographic features distinguishing intracranial air embolism from other confounding diagnosis. Read More

Authors:  Kim Taehoo , Faingold Ricardo , Daneman Alan

Keywords:  Brain Ultrasound, Neonatal, ECMO

Martinez-sicari Jorge,  Shahid Mehreen,  Mahdi Eman,  Canissario Ryan,  Richard Hope,  Sisler India,  Jones Kathryn,  Mishra Chakradhar,  Vorona Gregory

Final Pr. ID: Poster #: CR-042

Fanconi anemia (FA) is a rare genetic disorder characterized by impaired DNA repair, leading to bone marrow failure, physical abnormalities, and a heightened cancer risk. A severe neurological complication, Fanconi anemia neuroinflammatory syndrome (FANS), involves progressive neuroinflammation and brain lesions, resulting in cognitive and motor impairments. We present the case of a 12-year-old male with FANS and its neuroimaging findings over an 8-year period.

The patient, with a history of stem cell transplant and graft-versus-host disease, initially presented with developmental delays at age 10, progressing to slurred speech and diplopia by age 12. Serial brain MRIs from 2016 to 2024 revealed the evolving features of FANS, but initially posed significant diagnostic challenges due to the rarity of this entity.

Key imaging findings included multiple scattered foci of abnormal T2/FLAIR hyperintensity and enhancement throughout the brain, progressing to numerous ring-enhancing lesions with associated calcifications. Late-stage imaging showed large destructive lesions with significant mass effect, including a 3.6 cm rim-enhancing lesion causing 1.2 cm midline shift and ventricular entrapment.

Early radiological differentials included infection, neurological manifestations of chronic graft-versus-host disease, cerebrovascular disease, and even aggressive brain tumors.

Biopsy revealed necro-inflammation, with tumor analysis identifying a significant ESR1/CCDC170 gene variant. The clinical course was marked by relentless progression including cognitive decline, weakness, imbalance, and seizures. Multiple immunosuppressive therapies were attempted with limited success.

This case emphasizes the importance of recognizing FANS imaging patterns, which progress from small enhancing lesions to large, destructive ones. The distinctive imaging features, combined with a history of Fanconi anemia, should prompt consideration of FANS in the differential diagnosis, even when other causes may seem more likely.

Awareness of FANS as a complication in Fanconi anemia patients is crucial for timely diagnosis and management. Emphasis needs to be placed on researching effective treatments, as current options have limited success in halting progression. Recognizing FANS is essential to prevent unnecessary and harmful treatments for misdiagnosed conditions. Read More

Authors:  Martinez-sicari Jorge , Shahid Mehreen , Mahdi Eman , Canissario Ryan , Richard Hope , Sisler India , Jones Kathryn , Mishra Chakradhar , Vorona Gregory

Keywords:  Genetics, Brain, Inflammation

Yoon Hye-kyung,  Yoon Hee-mang

Final Pr. ID: Poster #: EDU-049

Our purpose is to show representative cases of CNS (Central Nervous System) embryonal tumors in children with discussion of the new WHO (World Health Organization) classification system recently issued in 2016. Read More

Authors:  Yoon Hye-kyung , Yoon Hee-mang

Keywords:  Pediatric, Brain tumor, Medulloblastoma

Szymanski Kathryn,  Pfeifer Cory,  Friedman Neil,  Kuwabara Michael

Final Pr. ID: Poster #: CR-033

Balamuthia mandrillaris is an amoeba that causes an uncommon but deadly encephalitis, referred to as granulomatous amoebic encephalitis (GAE). The highest incidence reported worldwide has occurred in America, and within the United States, it has been highest in the Southwest affecting predominantly children and young men of Hispanic ethnicity. Clinical presentation of GAE includes fever, headache, nausea, vomiting, lethargy, irritability, stiff neck, hallucinations, photophobia, and seizures. Our patient was a Hispanic male child living in Arizona. The patient presented at 3 years of age for severe encephalitis. Symptoms included difficulty with balance, gait, and sitting up and seizure-like activity. Initial CT showed an area of decreased density consistent with edema in the left frontoparietal lobe. Rapid progression was seen on further imaging over the length of the patient’s hospital stay revealing diffusion restriction, necrosis/blood products, edema, and hemorrhage. The patient expired from tonsillar herniation 22 days after the onset of initial symptoms and 4 days after admission to our institution. While there are multiple biochemical techniques that can test for B. mandrillaris, they are rarely employed for multiple reasons stemming from the rare occurrence of this infection. Balamuthia mandrillaris can cause a lethal brain infection. Because of the fatal nature of this infection, we propose 1) testing should be considered if a patient presents with progressing encephalitis on imaging and other pathogenic etiologies are ruled out and 2) the threshold to treat empirically should be low due to the fatal nature of the infection. Read More

Authors:  Szymanski Kathryn , Pfeifer Cory , Friedman Neil , Kuwabara Michael

Keywords:  amoeba, Balamuthia mandrillaris, brain infection

Teixeira Sara,  Alves Cesar Augusto,  Martin-saavedra Juan,  Goncalves Fabricio,  Zarnow Deborah,  Feygin Tamara,  Andronikou Savvas

Final Pr. ID: Paper #: 105

Postmortem imaging is increasingly used following stillbirths and neonatal death. Estimating time of death has legal, biological, and ethical implications. This study aims to investigate feasibility of prenatal MRI in estimating time of death in intra-uterine fetal demise (IUFD). Read More

Authors:  Teixeira Sara , Alves Cesar Augusto , Martin-saavedra Juan , Goncalves Fabricio , Zarnow Deborah , Feygin Tamara , Andronikou Savvas

Keywords:  Fetal MRI, Brain, Autopsy

Parthasarathy Jayanthi,  Gedela Satya,  Ostendorf Adam,  Pindrik Jonathan,  Jones Jeremy,  Mcallister Aaron,  Selvaraj Bhavani,  Long Alexander

Final Pr. ID: Poster #: SCI-058

Establish and evaluate a process for 3DPrinting (3DP) patient specific functional anatomical models of the brain from multiple MRI sequences in patients with epileptic focal lesions.The second objective was to evaluate the clinical utility of the models. Read More

Authors:  Parthasarathy Jayanthi , Gedela Satya , Ostendorf Adam , Pindrik Jonathan , Jones Jeremy , Mcallister Aaron , Selvaraj Bhavani , Long Alexander

Keywords:  Brain model, MRI brain, 3D Printing

Iordanou James,  Kelsch Ryan

Final Pr. ID: Poster #: EDU-077

Hypoxic ischemic encephalopathy (HIE) is one of the most common causes of neurological injury in neonates. Given the variability of clinical manifestations, ranging from normal neurological outcomes to profound neurocognitive impairment or death, precise characterization is critical in prognostication. Evaluation is made more challenging by the unique morphologic features of the neonatal brain which constantly evolve as the nervous system matures. With this in mind, the timing of disease and duration of insult can produce characteristic imaging patterns. The timing of imaging is also crucial, as typical patterns may become occult or obscure in the subacute/chronic setting. Unexplained signal abnormalities seen in the neonate may also be erroneously attributed to HIE, when in fact another underlying disease process may be the etiology. The goal after viewing this exhibit is to have a clear and concise pattern based approach for the diagnosis and prognostication of HIE while highlighting important differentials that may mimic this disease.

The exhibit will review the most common morphologic patterns of hypoxic ischemic encephalopathy in neonates with perinatal HIE using sample brain MRI and ultrasound studies from our institution over the last 3 years. Initially focus will be placed on discussing subtypes and mechanisms of classic HIE based on the severity of the insult and duration of ischemia (mild/moderate acute, mild/moderate prolonged, severe acute, and severe prolonged). Characteristic schematic and imaging examples will be provided for each category. Additionally, for each pattern of injury several alternative diagnoses will be discussed which can mimic HIE in the term neonate, and imaging examples will be provided. The potential mimics will include developmental, vascular, infectious, metabolic, and congenital etiologies.

Understanding the variable patterns of HIE is paramount in providing both an accurate report and aiding in prognostication. Equally important is knowing and considering differential diagnoses for common mimics of HIE, which may dramatically alter management. Read More

Authors:  Iordanou James , Kelsch Ryan

Keywords:  Hypoxic Ischemic Encephalopathy (HIE), Neonatal Outcomes, MRI Brain

Lara Nunez Denny,  Harder Sheri,  Tshuma Makabongwe,  Azma Roxana

Final Pr. ID: Poster #: CR-056

Fulminant demyelinating diseases include acute disseminated encephalomyelitis (ADEM), myelin oligodendrocyte glycoprotein antibody associated disease (MOGAD), multiple sclerosis (MS) and neuromyelitis optica-spectrum disorders (NMOSD), among others.
The purpose of this case report is to present the evolving MRI/MRS findings in a patient with fulminant MS.

A seven year old female presented with a 3 day history of progressive encephalopathy, gait disturbance and urinary incontinence. She had a recent viral upper respiratory tract infection. Interestingly, family history revealed the diagnosis of multiple sclerosis in the patient’s mother. Brain MRI revealed extensive T2/FLAIR hyperintense lesions, predominantly related to the cerebral and cerebellar white matter, with associated incomplete rim and central enhancement and marginal diffusion restriction. MRS showed decreased NAA, elevated choline and a prominent lactate peak. Accompanying bilateral anterior optic neuritis and papillitis was noted with T2 hyperintensity, enhancement and diffusion restriction.
Immune suppressive treatment was initiated. Short interval serial follow up demonstrated progressive confluence of the lesions with increasing edema. While overall enhancement and diffusion restriction decreased, there was a new leading edge of diffusion restriction and enhancement, mainly in the bifrontal region. A persistent inflammatory signature was demonstrated on MRS. Subsequent follow up demonstrated some cerebral volume loss with resolving edema, enhancement and diffusion restriction.
An extensive autoimmune panel was negative, including aquaporin 4 antibodies, NMO and MOG antibodies. Although CSF was sent for oligoclonal bands (OCBs), the sample volume was inadequate for testing on the first lumbar puncture (LP). OCBs were not identified on subsequent LP obtained after initiation of treatment.

Pediatric MS is defined when the onset is before the age of 16 with less than 1% of patients presenting under the age of 10. Marburg variant is a rare, rapidly progressive, fulminant form of multiple sclerosis with high morbidity and mortality rates. Fulminant ADEM typically presents as a monophasic demyelinating disease and is often preceded by a viral or bacterial infection. In this case, the patient fulfilled Mc Donald diagnostic criteria 2024 for MS with initial typical MS lesions in ≥4 central nervous system topographies. Read More

Authors:  Lara Nunez Denny , Harder Sheri , Tshuma Makabongwe , Azma Roxana

Keywords:  Brain MRI, Pediatric Neuroradiology

Aldraihem Ahmed,  Abdeen Nishard

Final Pr. ID: Poster #: SCI-047

To determine the inter-observer agreement in measurement of relative cerebral blood volume (rCBV) in pediatric brain tumors, using normal grey matter as a control. Read More

Authors:  Aldraihem Ahmed , Abdeen Nishard

Keywords:  brain tumor, T2* perfusion, interobserver agreement

Bao Rina,  Grant Ellen,  Ou Yangming

Final Pr. ID: Poster #: SCI-027

Hypoxic ischemic encephalopathy (HIE) is a brain injury that occurs in 1 ∼ 5/1000 term-born neonates. HIE lesion detection is a crucial step in clinical care of HIE. It could lead to a more accurate estimation of prognosis, a better understanding of neurological symptoms, and a timely prediction of response to therapy in this population. In addition, the rise of Artificial Intelligence (AI) brings hope to objectively and accurately finding HIE lesions. With public MRI data for brain tumors, Alzheimer’s Disease, and other diseases, AI has achieved significant success in MRI-based diagnosis and prognosis of these diseases. To facilitate the early prognosis and diagnosis of HIE, in this work, we focus on HIE lesion detection with MRI data using deep learning methods. Read More

Authors:  Bao Rina , Grant Ellen , Ou Yangming

Keywords:  Brain MRIs, Brain injury, Hypoxic Ischemic Encephalopathy

Boucher Marc-antoine,  Lippé Sarah,  El-jalbout Ramy,  Dupont Caroline,  Knoth Inga Sophia,  Damphousse Amelie,  Kadoury Samuel

Final Pr. ID: Poster #: SCI-005

In neonates, ultrasound is the initial neuroimaging modality used to detect and follow intracranial pathologies, since MRI is challenging due to immobilization, costs and sedation issues. Ultrasound is typically acquired in 2D and interpretations are performed slice by slice. However, recent reports suggest a longitudinal follow-up of structure volumes and shapes may be relevant for investigation of neurodevelopmental disorders. The objective of this study is to test the diagnostic efficiency of the 3D ultrasound technology to measure total brain volume as well as lateral ventricular volume compared to volumetric measurements obtained from MRI. Read More

Authors:  Boucher Marc-antoine , Lippé Sarah , El-jalbout Ramy , Dupont Caroline , Knoth Inga Sophia , Damphousse Amelie , Kadoury Samuel

Keywords:  Infants brain, 3D Ultrasound, MRI