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Society for Pediatric Radiology – Poster Archive

Showing Results from 1 to 30 of 41.

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.


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

Keywords:  Neonate, MRI, Brain

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.
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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.
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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.
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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

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

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.
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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

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

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

Hanquinet Sylviane,  Morice Claire,  Merlini Laura,  Cousin Vladimir,  Mclin Valérie,  Anooshiravani Mehrak

Final Pr. ID: Poster #: SCI-008

The diagnosis of hepatic encephalopathy is mainly detected by neuropsychological tests. These tests, however, do not always apply depending on the status of the child (age, social and cultural environment) and are therfore not reliable for subtle changes. We propose to detect minimal hepatic encephalopathy (minHE) in children with chronic liver disease and/or porto-systemic shunting, using MRI with Diffusion-weighted (ADC) and 1H- spectroscopy in the globus pallidum. Read More

Authors:  Hanquinet Sylviane , Morice Claire , Merlini Laura , Cousin Vladimir , Mclin Valérie , Anooshiravani Mehrak

Keywords:  hepatic encephalopathy, 1H- spectroscopy, brain MRI, chronic liver disease, porto-systemic shunting

W Mustapha Wan Irfan

Final Pr. ID: Poster #: CR-020

Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a distinct CNS inflammatory disease with symptoms and imaging findings that overlap with other neuroinflammatory disorders. We reported a 12-year-old girl with no known medical illness presented with gradually worsening blurring vision, and nearly blindness, associated with headache with a pain score of 2-5/10. The blurring vision started 1 week ago, initially over the right eye, then the left eye 3 days later, and subsequently, visual loss bilaterally. On examination, the pupil is 6 mm but has no perception of light. On fundoscopy, noted in both eyes: swelling, elevated, blurred margin, pink, dilated tortuous blood vessels, normal fovea reflex, no macula star, also no vitiritis or retinitis. The CNS examination is unremarkable. The patient then underwent a CT scan of the brain showed apart from right mastoiditis, no significant abnormality was detected in the brain parenchyma. Noted C3/C4 levels were normal; T4/TSH levels were normal, and ESR was 62 (raised). Since the CT brain finding was normal, we proceeded with an MRI of the brain, which showed leptomeningeal enhancement. Both retrobulbar intra-orbital segments of optic nerves appear symmetrical and swollen until the intracranial compartment just before the optic chiasm with enhancement is observed post-gadolinium. Both optic discs are also bulging in keeping with papilloedema. Both intra-orbital fats were streaky. The patient then had a lumbar puncture, and the result was normal. Serum aquaporin 4 is negative; however, the MOG antibody is detected. The patient was diagnosed with Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) and was given intravenous immunoglobulin (IVIg) for 5 days and steroids. Upon discharge, the patient's vision improves by up to 80%. Other differentials could be neuromyelitis optica spectrum disorder (NMOSD) or multiple sclerosis (MS). It is important to get a correct and early diagnosis of MOGAD because the prognosis and treatment for MOGAD are different from those for NMOSD and MS. Read More

Authors:  W Mustapha Wan Irfan

Keywords:  MOGAD, Brain, MRI

Trofimova Anna,  Reddy Kartik,  Bajaj Manish,  Goldman-yassen Adam

Final Pr. ID: Poster #: EDU-046

A broad spectrum of intracranial cysts and cystic-appearing lesions exist with unique imaging and pathologic characteristics. Some cysts have a predilection for certain intracranial locations, which, in combination with specific imaging features, can help point towards a particular pathology and, in some cases, associated syndromes. Herein, we describe a pattern-based approach for evaluation of intracranial cysts and cystic lesions in order to narrow the differential diagnosis and assist in diagnosing an associated syndrome. Cyst pathologies to be discussed include: Arachnoid cysts, dermoid/epidermoid cysts, subependymal cysts, connatal cysts, cystic encephalomalacia, neuroglial cyst, perivascular spaces, choroid plexus cysts, and choroidal fissure cysts. Syndromes and conditions to be discussed include: Aicardi Syndrome (interhemispheric cysts), congenital muscular dystrophy (cerebellar cysts), congenital CMV (anterior temporal cysts), Zellweger syndrome (caudothalamic groove cysts), Glutaric Aciduria type 1 (middle cranial fossa cysts), and trisomy 18 (choroid plexus cysts). By being familiar with the pattern-based approach to characterization of the intracranial cystic lesions, radiologists can hone their differential diagnoses and differentiate benign/incidental lesions from ones that signify a broader pathology. Read More

Authors:  Trofimova Anna , Reddy Kartik , Bajaj Manish , Goldman-yassen Adam

Keywords:  Cyst, Brain, Neuroradiology

A Ebinesh,  Manchanda Alpana,  Dixit Rashmi,  Das Prince,  Kumar Ajay,  Krishna Ganesh

Final Pr. ID: Poster #: EDU-021

Insult to developing neonatal brain can significantly impair motor, cognitive, language and behavioral functions. MR imaging is an indispensable investigation for the evaluation of neonatal encephalopathy due to its high sensitivity, specificity and prognostic utility. MRI with its recent advancements can yield valuable information on morphology, neuronal connectivity, structural and functional architecture of gray and white matter. Read More

Authors:  A Ebinesh , Manchanda Alpana , Dixit Rashmi , Das Prince , Kumar Ajay , Krishna Ganesh

Keywords:  Neonatal encephalopathy, Neonatal brain, Hypoxic ischemic encephalopathy

Cortes Albornoz Maria,  Calixto Camilo,  Bedoya M. Alejandra,  Jaimes Camilo

Final Pr. ID: Poster #: EDU-068

There is a widespread lack of familiarity with the normal appearance of the fetal brain in the early second trimester (12-18 weeks), particularly in MRI. Interpreting these images is challenging because of the continuous fetal motion, small size of structures, and immature appearance of the brain. This educational exhibit aims to increase awareness of the appearance of the fetal brain between 12- and 18-weeks gestation by presenting images of normal fetuses and establishing a correlation with same day ultrasound. All fetuses included in this exhibit were proven to have normal brains on late gestation fetal and/or post-natal brain MRI.

After viewing this exhibit the reader will (1) recognize the normal appearance of the brain in the early second trimester, (2) understand the specific developmental trajectories of major structures (ventricles, corpus callosum, etc…), (3) establish a correlation between the sonographic appearance and the fetal MRI.
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Authors:  Cortes Albornoz Maria , Calixto Camilo , Bedoya M. Alejandra , Jaimes Camilo

Keywords:  Fetal, Brain, MRI

Acosta-izquierdo Laura,  Dien-esquivel Maria,  Miller Elka,  Ferretti Emanuela,  Martinez-rios Claudia

Final Pr. ID: Poster #: EDU-016 (S)

Extremely low gestational age (ELGA) infants are those born before 23 + 6 weeks of gestation. These infants are prone to multiple complications. Frequent complications affect the brain. Transfontanellar brain ultrasound (US) is the standard of care imaging modality to assess the brain during the first weeks of life. An appropriate ultrasound technique includes assessment of the brain in gray scale, color and spectral Doppler. Doppler US should be interpreted in correlation with the neonate’s clinical and systemic hemodynamic state, postnatal age, blood gas concentrations, respiratory or cardiovascular complications, amongst others. Prior literature focuses on the sonographic characteristics of premature, near term and term infants. However, Doppler US characterization of the intracranial vessels of ELGA infants is lacking. The purpose of this exhibit is to describe the resistive index (RI) and peak systolic velocities (PSV) of the anterior cerebral artery and the PSV of the superior sagittal sinus of a cohort of ELGA infants, and to assess their correlation with complications encountered in these infants. Read More

Authors:  Acosta-izquierdo Laura , Dien-esquivel Maria , Miller Elka , Ferretti Emanuela , Martinez-rios Claudia

Keywords:  Brain Doppler, Resistive index, Prematurity

Acosta-izquierdo Laura,  Dien-esquivel Maria,  Miller Elka,  Ferretti Emanuela,  Martinez-rios Claudia

Final Pr. ID: Poster #: EDU-017 (S)

Extremely low gestational age (ELGA) infants are those born before 23 + 6 weeks of gestation. Continued advances on therapy and supportive care in the neonatal intensive units have allowed for an improved survival of these infants. Transfontanellar brain ultrasound (US) is the standard of care imaging modality to assess the integrity of the brain during the first weeks of postnatal life, as it provides a closer direct look to the brain. The purpose of this exhibit is to illustrate detailed US characteristics of the normal development and complications of the evolving premature brain of ELGA infants. Read More

Authors:  Acosta-izquierdo Laura , Dien-esquivel Maria , Miller Elka , Ferretti Emanuela , Martinez-rios Claudia

Keywords:  Brain anatomy, Prematurity, Neurodevelopment

Harreld Julie,  Ayaz Muhammad,  Hillenbrand Claudia,  Loeffler Ralf,  Patay Zoltan

Final Pr. ID: Poster #: EDU-072

Detection of leptomeningeal metastasis (LM) is critical to staging and prognosis of childhood CNS cancers like medulloblastoma and ependymoma. 1 Though CSF examination is the historical gold standard for diagnosis, technological advances have earned MRI a central role in metastasis detection; recent work finds MRI more predictive of survival than CSF analysis. 2-4 However, not all sequences are created equal for detection of tumor in the CSF, and pediatric MR imaging presents additional unique challenges such as patient motion, acoustic noise and scan time reduction. In this exhibit, we discuss the strengths and weakness of common sequences for LM detection; technical alternatives for reduction of motion, acoustic noise and scan time; and present a suggested targeted imaging protocol based on current best imaging practice.

With visual examples, we will discuss:
1. Signal characteristics of LM and role of complementary sequences for detection
2. Optimizing scan planes and slice thickness for tumor/metastasis location and patient size
3. Strengths and weaknesses of T1 FLAIR, SE, FSE/TSE, gradient echo and ultrafast spoiled gradient echo (VIBE/FAME/LAVA/THRIVE) sequences in terms of time, resolution, SNR and CSF artifact
4. Utility and optimization of post-contrast FLAIR, DWI, TrueFISP/bSSFP, and subtraction images for metastasis detection
5. Reducing imaging time: targeted sequences, k-space undersampling (HASTE, partial Fourier imaging), parallel imaging
6. Reducing acoustic noise: lowering bandwidth, longer echo spacing, modified gradient wave forms, alternate encoding (PETRA, SWIFT, zero-TE)
7. Reducing motion artifact: 2D vs. 3D, non-Cartesian acquisition schemes, motion correction

1. Engelhard HH, Corsten LA. Cancer Treat Res 2005;125:71-85
2. Maroldi R, Ambrosi C, Farina D. Eur Radiol 2005;15:617-626
3. Pang J, Banerjee A, Tihan T. Journal of neuro-oncology 2008;87:97-102
4. Terterov S, Krieger MD, Bowen I, et al. J Neurosurg Pediatr 2010;6:131-136

Figure: Spine imaging at 3 Tesla. (a) Axial post-contrast T1-weighted VIBE images reconstructed at 3mm/0 gap show leptomeningeal metastasis to excellent advantage, without CSF pulsation artifact which obscures the same metastasis on axial (b) T1 TSE (3mm/0.3mm gap) with contrast. Metastasis was confirmed by CSF analysis.
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Authors:  Harreld Julie , Ayaz Muhammad , Hillenbrand Claudia , Loeffler Ralf , Patay Zoltan

Keywords:  Brain tumor, MRI, metastasis

Farkas Amy,  Hooker Jeffrey,  Joyner David

Final Pr. ID: Poster #: EDU-089

Epilepsy can be a progressive, debilitating illness, particularly in the pediatric population. More than half of brain tumors are associated with epilepsy, and 30% of these tumors will not respond to pharmacologic therapy. Recognizing lesions that cause seizures is imperative, as providing an accurate diagnosis can identify patients with surgically treatable disease. In the appropriate patient population, epilepsy surgery can be an effective management option that prevents significant morbidity and mortality from epilepsy and dramatically improves quality of life.
This electronic poster will provide an overview of pediatric epileptogenic tumors including gangliogliomas, dysembryoplastic neuroepithelial tumors, pleomorphic xanthoastrocytoma, papillary glioneuronal tumor, pilocytic astrocytoma, and oligodendroglioma. Cases featuring these tumors and their distinguishing characteristics will be reviewed, as both tumor subtype and location contribute to the epileptogenicity of pediatric brain tumors.
The goal of this poster is to provide a framework for the evaluation of pediatric epileptogenic tumors to establish a focused differential diagnosis when these lesions are identified. This is particularly important for trainees and well as those who do not commonly encounter epileptogenic tumors in their practice.
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Authors:  Farkas Amy , Hooker Jeffrey , Joyner David

Keywords:  Epilepsy, Brain tumor