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

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

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

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

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

Patel Rajan

Final Pr. ID: Poster #: EDU-066

(1) To review basic pathophysiology of the Mitochondria and Energy Production.
(2) To review Genetic and Inheritance patterns of Primary Mitochondrial Disorders, primarily affecting Central
Nervous System (CNS).
(3) To discuss the role of MR imaging in the evaluation of Pediatric Neuromitochondrial Disorders.
(4) To review imaging patterns of the Pediatric Neuromitochondrial Disorders with several illustrative examples. Read More

Authors:  Patel Rajan

Keywords:  Brain MRI, Mitochondrial Disease

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. Read More

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

Keywords:  Fetal, Brain, MRI

Kathiria Deepti

Final Pr. ID: Poster #: EDU-070

(1) To review the embryology of the temporal bone with emphasis of the inner ear.
(2) To review the detailed cross-sectional CT and MRI anatomy of the inner ear of the temporal bone.
(3) To discuss the role of CT and MR imaging in the evaluation of congenital sensorineural hearing loss.
(4) To describe the cross-sectional imaging findings of common and uncommon pathologies of congenital sensorineural hearing loss.
(5) To discuss common indications, relative as well as absolute contraindications for cochlear implantation pertinent to imaging findings. Read More

Authors:  Kathiria Deepti

Keywords:  Brain CT, Brain MRI, Temporal Bone

Ibrahim Mohamed,  Desilet-dobbs Debra

Final Pr. ID: Poster #: EDU-071

Introduction

Autism Spectrum Disorder (ASD): A neurodevelopmental disorder characterized by challenges in social communication and repetitive behaviors. Approximately 1 in 44 children are affected (CDC, 2023). Common delays include language, social skills, and cognition.

Importance of MRI in ASD: MRI helps identify neuroanatomical differences in ASD, improving diagnostic accuracy and guiding clinical management. It is useful for distinguishing ASD from other conditions and identifying syndromic cases.

Indications for MRI in ASD

1. Neurological Signs: Seizures, macrocephaly, motor delays.
2. Regression: Loss of language or social skills.
3. Atypical Physical Features: Congenital anomalies or dysmorphisms suggestive of syndromic ASD.
4. Diagnostic Uncertainty: Significant developmental delays with unclear diagnosis.

Common MRI Findings in ASD

1. Macrocephaly and Brain Volume: Enlarged brain volume, especially in the frontal lobes during early childhood. (MR image of showing macrocephaly)
Example: MRI shows increased brain volume.

2. Ventricular Enlargement: A most significant known linked finding was increased ventricular volume, which was notably higher in patients with ASDs, especially those with comorbidities.

3. Corpus Callosum and cerebellar Abnormalities: Thinning or absence of the corpus callosum, affecting brain hemisphere communication. Reduced cerebellar vermis size, may be linked to motor and cognitive issues.
Example: MRI shows corpus callosum thinning. (MR image showing thin corpus callosum and another one with dysgenesis)

4. White Matter Connectivity: Altered white matter tracts, including reduced connectivity in the corpus callosum.
Example: DTI shows disrupted white matter pathways.

5. Cortical Thickness and Gyrification: Abnormal cortical thickness and gyrification patterns.
Example: MR image of Polymicrogyria in an autistic child.

Impact on Clinical Management
MRI helps differentiate ASD from other neurological conditions, informs prognosis, and guides early interventions. It also advances the understanding of ASD’s neurobiology for future treatments.

Limitations: Many children with ASD have normal MRI findings, so imaging should complement clinical assessments for a comprehensive diagnosis.

Conclusion
MRI is critical for assessing developmental delays in ASD, particularly when neurological or syndromic features are present. Further research is needed to identify MRI biomarkers and neuroradiological features for ASD, enabling more targeted interventions. Read More

Authors:  Ibrahim Mohamed , Desilet-dobbs Debra

Keywords:  Brain MRI, Corpus Callosum Morphology, Development

Kathiria Deepti

Final Pr. ID: Poster #: EDU-069

1) To review the embryology of the temporal bone with emphasis of the external and middle ear.
2) To review the detailed cross sectional CT anatomy of the temporal bone.
3) To describe the cross-sectional imaging findings of common and uncommon pathologies of congenital conductive hearing loss. Read More

Authors:  Kathiria Deepti

Keywords:  Brain CT, Brain MRI, Temporal Bone

Park Ji Eun,  Choi Young Hun,  Cheon Jung-eun,  Kim Woo Sun,  Kim In-one,  Cho Hyun Suk

Final Pr. ID: Poster #: SCI-023

Brain MRI in children is often limited by motion artifacts. Radial k-space sampling techniques have been shown to reduce motion artifacts.
To compare a contrast-enhanced radial volumetric interpolated brain examination (radial VIBE) sequence with a magnetization-prepared rapid acquisition gradient echo (MP-RAGE) sequence in pediatric brain MR imaging.
Read More

Authors:  Park Ji Eun , Choi Young Hun , Cheon Jung-eun , Kim Woo Sun , Kim In-one , Cho Hyun Suk

Keywords:  VIBE, radial VIBE, MPRAGE, Brain MRI

Llorens-salvador Roberto,  Veiga-canuto Diana

Final Pr. ID: Poster #: EDU-026

The fetal ganglionic eminence (GE) is a transient structure in the developing human brain, playing a crucial role in the formation of the cerebral cortex and other critical brain regions. The GE is primarily responsible for the production of GABAergic interneurons, which are essential for the proper functioning of the cerebral cortex.
Understanding its anatomy and pathology is essential for identifying potential developmental disorders that may arise during prenatal life.
Fetal MRI has emerged as a powerful tool in the assessment of brain development, offering high-resolution images that can reveal subtle changes in the anatomy of the GE.
Through the use of fetal MRI radiologists can identify various alterations in the GE, such as cystic cavitations, enlargement, and other morphological changes that may indicate serious malformations in brain development, such as hemimegalencephaly or other cortical malformations. One of the significant advantages of fetal MRI is its ability to provide a comprehensive view of the fetal brain, enabling the identification of not only the GE but also its relationship with surrounding structures such as the lateral ventricles or the thalamus, which can further complicate the clinical picture.
By utilizing fetal MRI to study the GE, it becomes possible to detect these disruptions early in gestation, potentially allowing for timely interventions and better parental counseling. Read More

Authors:  Llorens-salvador Roberto , Veiga-canuto Diana

Keywords:  Malformation, Fetal Brain MRI, Congenital

Mendoza Venegas Diego,  Herrera Ernesto,  Rodríguez Garza Claudia,  Elizondo Riojas Guillermo

Final Pr. ID: Poster #: CR-054

Mitochondrial Encephalomyopathy with Lactic Acidosis and Stroke-like Episodes (MELAS) is a rare mitochondrial disorder primarily affecting children and young adults, typically presenting between the ages of 2 and 40. It is characterized by tRNA mutations that lead to deficiencies in respiratory chain protein complexes, resulting in disrupted intracellular energy production and impaired cellular function. Common clinical manifestations include stroke-like episodes, hemiparesis, seizures, recurrent headaches, and muscle weakness, with progressive cerebral atrophy and cognitive decline occurring over time. Diagnosis often relies on magnetic resonance imaging (MRI), which frequently shows cortical lesions that do not follow vascular territories.
This case report details an 11-year-old girl who presented in early 2023 with severe new-onset headaches and blurred vision. After multiple consultations with pediatricians and neurologists, a brain MRI was ordered, revealing chronic stroke-like lesions in various regions, predominantly in the posterior brain, along with calcified basal ganglia and a lactate doublet on spectroscopy. Lactic acidosis was detected, and genetic testing confirmed MELAS syndrome due to a mutation in the MT-TL1 gene (m.3243A>G). Following her diagnosis, she began treatment with Coenzyme Q10, L-Arginine, and L-Carnitine. However, earlier this year, she was hospitalized again due to right-sided hemiparesis. A follow-up MRI showed a new stroke-like lesion in the left precentral gyrus, characterized by cortical diffusion restriction and high signal intensity on the FLAIR sequence, exemplifying the characteristic migrating stroke-like lesions associated with MELAS. In conclusion, this case highlights the critical importance of early recognition and diagnosis of MELAS, a rare mitochondrial disorder characterized by complex neurological manifestations. Key MRI findings, including stroke-like lesions that migrate without adhering to vascular territories, a lactate doublet on MR spectroscopy, and calcified basal ganglia, are vital for diagnosis. Ultimately, confirming the diagnosis through genetic testing is essential for effective management and treatment. Read More

Authors:  Mendoza Venegas Diego , Herrera Ernesto , Rodríguez Garza Claudia , Elizondo Riojas Guillermo

Keywords:  Mitochondrial Disease, Neuroradiology, Brain MRI