Vijapura Charmi,  Dennhardt Joel,  Fuortes Michaelangelo,  Policeni Bruno,  Sato Yutaka,  Sato T Shawn

Final Pr. ID: Poster #: EDU-103

1. Review the normal development and anatomy of the anterior skull base.
2. Describe the variety of pathologies affecting the anterior cranial fossa in the pediatric age group with a focus on the typical computed tomography (CT) and magnetic resonance imaging (MRI) characteristics.
3. Discuss clinical management and imaging follow up of anterior cranial fossa pathology. Read More

Authors:  Vijapura Charmi , Dennhardt Joel , Fuortes Michaelangelo , Policeni Bruno , Sato Yutaka , Sato T Shawn

Keywords:  Anterior Cranial Fossa, magnetic resonance imaging, computed tomography

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

Barr Lori,  Coticchia James

Final Pr. ID: Poster #: CR-022

Exudative tracheitis is the most common life-threatening acute airway abnormality in children and is usually associated with infections. Post-extubation obstructive fibrinous tracheal pseudomembrane is a rare early complication following intubation with less than 53 reports in the literature, the majority in adults.
A 12-year-old was intubated in the field when found unresponsive. The patient was transferred to the pediatric Intensive care unit where a drug overdose was diagnosed and the patient was soon extubated. Five days later, the patient experienced acute respiratory distress. Soft tissue neck radiographs demonstrated nodularity and narrowing of the subglottic portion of the trachea. A subsequent neck CT and MRI also demonstrated subglottic/tracheal irregularity and a cylindrical filling defect. The intraluminal membrane was removed via bronchoscopy with subsequent tracheal debridement. Pathologic examination revealed a fibrinous pseudomembrane.
The imaging appearance of exudative tracheitis is not specific and can be seen with infectious tracheitis, necrotizing tracheitis, and, as in this case, obstructive fibrinous tracheal pseudomembrane. Obstructive fibrinous tracheal pseudomembrane occurs following tracheal intubation with cuffed or cuffless tubes, tracheostomy tubes, and after tracheal stenting. It has also been reported in patients with gastroesophageal reflux disease. It usually presents in the early days following extubation in cases associated with endotracheal tubes. It is thought to be a very early post-traumatic response and precursor to tracheal stenosis. Since patients are often weak following recent illnesses requiring airway intervention, their symptoms may be minimal until the airway is critical and the condition is life-threatening. This is a surgical emergency. Diagnostic confirmation by flexible bronchoscopy is followed by treatment with rigid bronchoscopy. This should not be delayed by the performance of imaging studies. If diagnostic imaging is performed, the findings of airway wall irregularity and subglottic or deeper intraluminal soft tissue density material, especially if the shape mimics the endotracheal device (cylindrical), are diagnostic of exudative tracheitis including infectious, iatrogenic and reflux-related post-traumatic causes. A high index of suspicion on the part of the radiologist has the potential to decrease time-to-treatment and thus decrease complications such as tracheal stenosis and death. Read More

Authors:  Barr Lori , Coticchia James

Keywords:  pseudomembranous, tracheitis, computed tomography

Calle Toro Juan,  Bester Dewald,  Venkatakrishna Shyam Sunder,  Ali Krim Ahmed,  Lucas Susan,  Goussard Pierre,  Andronikou Savvas

Final Pr. ID: Poster #: SCI-036

Suspected airway compression in symptomatic children with Lymphobronchial Tuberculosis (LBTB) can be diagnosed using modern computed tomography (CT) assisted by coronal minimum intensity projection (MinIP) reconstructions. The accuracy of plain radiographs in detecting airway compression in children with TB has not been evaluated against an imaging gold standard in a dedicated manner.

We aimed to compare frontal CXR against thick-slab angled coronal CT MinIP in identifying airway stenosis at ten specific sites and to determine the agreement between the modalities regarding the degree of stenosis. Read More

Authors:  Calle Toro Juan , Bester Dewald , Venkatakrishna Shyam Sunder , Ali Krim Ahmed , Lucas Susan , Goussard Pierre , Andronikou Savvas

Keywords:  Lymphobronchial Tuberculosis, minimum intensity projection, computed tomography

Xia Christina,  Das Prasnjeet,  Thomen Robert,  Woods Jason,  Fleck Robert

Final Pr. ID: Poster #: SCI-050

The indications for high resolution CT (HRCT) and bronchoscopy often coincide in patients
with recurrent respiratory tract infections, chronic cough and wheezing, symptoms often related to tracheomalacia (TM). However, the efficacy for detecting TM in young children by HRCT has not been investigated. The aim of this investigation is to evaluate the ability to detect TM on clinical HRCT relative to bronchoscopy as a reference standard and compare several quantitative methods of determining the presence of TM on CT. Read More

Authors:  Xia Christina , Das Prasnjeet , Thomen Robert , Woods Jason , Fleck Robert

Keywords:  Tracheomalacia, Bronchoscopy, Computed Tomography

Deboer Emily,  Deterding Robin,  Lynch David,  Humphries Stephen,  Jacob Joseph,  Devaraj Anand,  Ley-zaporozhan Julia,  Griese Matthias,  Schiwek Marilisa,  Stowasser Susanne,  Clerisme-beaty Emmanuelle

Final Pr. ID: Paper #: 034

Children’s interstitial lung diseases (chILD) comprise a large spectrum of rare diffuse lung disorders, with a subset of patients developing chronic fibrosing lung disease. While imaging criteria for lung fibrosis are established for adults and correlate with prognosis and outcome, there are limited data on imaging for diagnosis, prognosis, and outcomes in children with fibrotic lung disease. To fill this gap, a group of ILD specialists aimed to define the imaging features for diagnosis of lung fibrosis for a forthcoming randomized trial of nintedanib versus placebo in pediatric patients with fibrosing ILD (1199-0337; NCT04093024). Read More

Authors:  Deboer Emily , Deterding Robin , Lynch David , Humphries Stephen , Jacob Joseph , Devaraj Anand , Ley-zaporozhan Julia , Griese Matthias , Schiwek Marilisa , Stowasser Susanne , Clerisme-beaty Emmanuelle

Keywords:  childhood interstitial lung disease, computed tomography, fibrosis criteria

Lodwick Daniel,  Krishnamurthy Rajesh,  Deans Katherine,  Cooper Jennifer,  Groner Jonathan,  Gonzalez Dani,  Lee Choonsik,  Kelleher Kelly,  Minneci Peter,  Shah Summit,  Stanley Rachel

Final Pr. ID: Poster #: SCI-054

Computed tomography (CT) imaging protocols and prescribing practices vary across institutions. Pediatric trauma patients treated at a pediatric trauma center (PTC) may receive less radiation if their CT imaging is performed at a PTC rather than at non-PTCs prior to transfer. The objective of the study was to determine differences in radiation exposure from CT imaging in pediatric trauma patients initially treated at a PTC center compared to non-PTCs. Read More

Authors:  Lodwick Daniel , Krishnamurthy Rajesh , Deans Katherine , Cooper Jennifer , Groner Jonathan , Gonzalez Dani , Lee Choonsik , Kelleher Kelly , Minneci Peter , Shah Summit , Stanley Rachel

Keywords:  Radiation, Computed Tomography, Trauma

Tan Timothy Shao Ern,  Woon Tian Kai,  Fortier Marielle

Final Pr. ID: Poster #: EDU-007

Congenital coronary artery (CA) anomalies can be classified into abnormalities pertaining to origin, course and termination, which can serve as important prognostic factors. Some of these anomalies are asymptomatic with a benign clinical course, while others can give rise to symptoms of chest pain and even sudden death (e.g. malignant interarterial CA course). Acquired CA abnormalities such as coronary arterial aneurysms associated with Kawasaki disease may result in thrombi development, necessitating a change in patient management. Early and accurate diagnosis of these abnormalities is therefore crucial but can be technically challenging owing to the small size of the coronary arteries, rapid heart rate, and limited cooperation of children. Whilst the proximal aspect of the coronary arteries can be visualized with echocardiography, computed tomography angiography (CTA) provides a more comprehensive assessment of the coronary arteries even without ECG-triggering. Moreover, CTA offers the flexibility of customizing acquisition parameters for the individual patient. As such, CTA is rapidly becoming the imaging modality of choice for evaluating complex congenital and acquired CA abnormalities in children.

The aims of this educational exhibit are to review the embryology of coronary arteries, outline congenital and acquired CA abnormalities, and discuss the utility of optimizing low-dose CTA to evaluate these abnormalities in children. Determining the origin and course of CAs is key for pre-operative planning in some types of congenital heart disease, for example, the arterial switch procedure for transposition of great arteries and in Taussig Bing anomaly. Identifying the malignant interarterial intramural CA course can be lifesaving. Evaluating for co-existing abnormalities, such as CPAM, is also an integral part of these studies. Read More

Authors:  Tan Timothy Shao Ern , Woon Tian Kai , Fortier Marielle

Keywords:  Coronary artery, Computed tomography, Aneurysm

Colleran Gabrielle,  Callahan Michael,  Chow Jeanne

Final Pr. ID: Poster #: EDU-041

Pediatric urolithiasis is an important and increasingly prevalent cause of pediatric morbidity and hospital admission.

Ultrasound is the recommended primary imaging modality for suspected urolithiasis in children and this view is endorsed by all of the largest pediatric and urological societies.

There is however widespread use of CT as a first line study for abdominal pain in many institutions involved in pediatric care, many of whom are free standing hospitals delivering predominantly adult care.

The purpose of this educational review is to outline the state-of-the-art imaging modalities and methods for diagnosing urolithiasis in children and to suggest an imaging algorithm for best practice. Read More

Authors:  Colleran Gabrielle , Callahan Michael , Chow Jeanne

Keywords:  Urolithiasis, Ultrasound, Computed Tomography, ALARA, Dose optimized

Goncalves Fabricio,  Pinelli Lorenzo,  Mankad Kshitij,  Alves Cesar Augusto,  Teixeira Sara,  Andronikou Savvas,  Vossough Arastoo

Final Pr. ID: Poster #: EDU-050

Intracranial calcification (ICC) can be either physiological or pathological. Physiological ICC is not an expected neuroimaging finding in the neonatal period but can be seen as children grow older in the pineal gland, habenula, choroid plexus, and occasionally in the dura mater. Pathological ICC can be broadly divided into six groups: infectious, toxic, neurodegenerative, neoplastic, vascular, and syndromic. The first two groups are typically composed of diseases that more commonly result in static encephalopathies, whereas the last four groups are composed of diseases that tend to cause progressive encephalopathy.

Various neuroimaging modalities have distinct utilities and sensitivities in the depiction of ICC. Age at presentation, ICC location, and additional neuroimaging findings are useful information that may be useful to narrow down the differential diagnosis of ICC. Bilateral ICC is commonly due to congenital infections or due to neurodegenerative or infectious diseases. ICC involving the basal ganglia and thalami are commonly seen in neurodegenerative diseases. ICC can be seen in isolation or be associated with other neuroimaging features.

TORCH infections are the most common neonatal causes of ICC. ICC in congenital infections can be associated with clastic changes, hydrocephalus, chorioretinitis, white matter abnormalities, skull changes, and cortical development malformations. Specific non-infectious causes of ICC that mimic TORCH infections are known as pseudo-TORCH. Neurodegenerative diseases causing ICC are mainly due to parathyroid and thyroid hormone dysfunction and inborn errors of metabolism, such as MELAS, Kearns Sayre and Cockayne syndrome, interferonopathies syndrome, and Krabbe disease. Tumoral ICCs are more commonly seen in low-grade tumors. Arteriovenous malformations, arteriovenous fistulas, chronic venous hypertension, and cavernomas are also known causes of ICC. Other vascular causes of ICC include atherosclerosis, healed hematoma, radiotherapy treatment, old infarct, and disorders of the microvasculature such as COL4A1- and COL4A2-related diseases. Down syndrome and phakomatosis are also known causes of ICC.

Clinical information such as age at presentation; maternal exposure to teratogens, such as virus; in addition to the association with chromosomal abnormalities; genetic mutations and postnatal infections, facilitate in the differential diagnosis of the multiple causes of ICC. Read More

Authors:  Goncalves Fabricio , Pinelli Lorenzo , Mankad Kshitij , Alves Cesar Augusto , Teixeira Sara , Andronikou Savvas , Vossough Arastoo

Keywords:  Calcification, Computed Tomography, Magnetic Resonance

Wang Megan,  Snyder Elizabeth,  Schulman Marta,  Luo Yu

Final Pr. ID: Poster #: CR-012

Gastric teratomas are exceedingly rare tumors derived from one or more germ layers. These tumors predominantly occur in sacrococcygeal-gonadal locations but can occasionally manifest in midline regions such as the mediastinum, retroperitoneum, and the head/neck.

Case Presentation: A 1-day-old male infant, born at 36 weeks and 4 days via a cesarean section due to multiple fetal anomalies, including large for gestational age (LGA), new-onset polyhydramnios and significant bilateral hydroceles, presented with a significantly distended and firm abdomen. The initial X-ray revealed extensive amorphous calcifications throughout the abdomen, suggestive of meconium peritonitis. However, a subsequent ultrasound examination revealed a large heterogeneous mass in the upper and mid abdomen, characterized by calcifications, cysts, and soft tissue components. In retrospect, the large mass was detected on the prenatal sonographic exam but misinterpreted as echogenic bowel loops. A subsequent CT scan unveiled a 13.4 x 7.6 x 9.9 cm mass originating from the gastric wall, extending into the gastric lumen as well as the peritoneal cavity.
Interestingly, endoscopy revealed a normal mucosa covering the mass. The tumor was resected, including partial gastrectomy, and histology confirmed the presence of native gastric mucosa and an underlying mass composed of endodermal, ectodermal, and mesodermal tissues, consistent with mature teratomas.

This case report presents a large mature teratoma within the gastric wall, exhibiting exophytic and endoluminal growth, which led to polyhydramnios, abdominal distention, and the development of large hydroceles in the newborn, feeding difficulty. Additionally, it emphasizes the importance of thorough prenatal and postnatal imaging evaluations for timely diagnosis and management. Read More

Authors:  Wang Megan , Snyder Elizabeth , Schulman Marta , Luo Yu

Keywords:  Gastric teratoma, computed tomography

Luhar Aarti,  Vu Dan,  Holmes Nathan,  Renella Pierangelo

Final Pr. ID: Poster #: SCI-069

Computed Tomography Angiography (CTA) is a valuable non-invasive tool for assessment of congenital heart disease in neonates. Though it requires less radiation, contrast and sedation than catheter angiography, which is the current standard of care, traditional CTA can still necessitate significant radiation dose, sedation, breath-holding and/or low heart-rates to achieve diagnostic studies. In this frequently imaged neonatal patient population, it is imperative to minimize cumulative radiation to limit the lifetime risk of cancer. At our institution, we have successfully used a new fast-acquisition FLASH CTA protocol to achieve high quality imaging of neonates with complex congenital heart disease with minimal radiation dose and without sedation. Read More

Authors:  Luhar Aarti , Vu Dan , Holmes Nathan , Renella Pierangelo

Keywords:  Computed Tomography Angiography, Congenital Heart Disease, Radiation Dose Reduction

Shet Narendra,  Chen Wengen,  Strauch Eric,  Kim Jane

Final Pr. ID: Poster #: EDU-046

Meckel’s diverticulum is the most common congenital gastrointestinal tract abnormality, with a small minority of patients presenting with symptoms related to complications. The aim of this educational exhibit is to provide a pictorial overview of the common and uncommon imaging manifestations of symptomatic Meckel’s diverticulum, with an emphasis on CT findings, though scintigraphic, sonographic, radiographic, and fluoroscopic features will also be detailed. Read More

Authors:  Shet Narendra , Chen Wengen , Strauch Eric , Kim Jane

Keywords:  Meckel's diverticulum, Computed Tomography, Scintigraphy

Garcia Evelyn,  Mcelroy Kevin

Final Pr. ID: Poster #: SCI-037

Determine the most effective method of computed tomography (CT) dose reduction that maintains diagnostic imaging quality, relative to individual patient size characteristics, such as Body Mass Index (BMI) and maximal girth. Read More

Authors:  Garcia Evelyn , Mcelroy Kevin

Keywords:  Dose reduction, Iterative reconstruction, Computed tomography

Newman Beverley

Final Pr. ID: Poster #: EDU-091

BPM’s are often identified prenatally; while some have more detailed imaging and description, many are loosely called congenital pulmonary airway malformations (CPAM). A chest radiograph is usually obtained at birth, but CT imaging is often deferred until 3-6months of age in asymptomatic babies, when surgical removal is being considered. Participation in a presurgical conference has indicated that there is poor standardization of both performance and interpretation of CT for BPM’s. High quality studies are most often hampered by poor timing of imaging, poor vascular opacification and obscuration of pathology due to atelectasis. There are four key internal feature of BPM’s that help with lesion characterization, differential diagnosis and management decisions. These include: systemic arterial supply; bronchial mucoid impaction; overinflated lung and macroscopic cysts. Reliable recognition and description of these features in all cases is essential for guiding surgical decisions since some lesions can be treated conservatively, especially those with just hyperinflation and mucoid impaction. A feature that tends to be overlooked is mucoid impaction, indicative of bronchial atresia. Cystic changes and overinflated lung may be mischaracterized. Small systemic arteries can be missed. Multiplanar reconstructions and interaction with maximum intensity projections and a 3D dataset are very helpful. This poster aims to educate by providing multiple illustrative imaging examples and a standardized report template useful for radiologists, clinicians, research and registries. Read More

Authors:  Newman Beverley

Keywords:  standardization, bronchopulmonary malformation, computed tomography

Steinberg Zach,  Rein Julia,  Scanlan James,  Carlson Alex,  Weinsheimer Robert,  Finch Lisa

Final Pr. ID: Poster #: SCI-055

In the past Computed Tomography (CT), has been the preferred diagnostic modality in appendicitis diagnosis. Due to increasing radiation and cancer concerns, ultrasound (US) has been promoted as a safer alternative. Despite the US benefits, some pediatric providers have reluctance to use US due to its lower appendicitis sensitivity. Attempting to increase the use and efficacy of US in suspected appendicitis, our US department performed three annual interventions consisting of lectures and hands-on sonographer training during 2012-2014. Additionally, a clinical pathway for appendicitis diagnosis was developed in 2014 to promote US as the primary diagnostic modality in acute appendicitis evaluation. Read More

Authors:  Steinberg Zach , Rein Julia , Scanlan James , Carlson Alex , Weinsheimer Robert , Finch Lisa

Keywords:  Appendicitis, Ultrasound, Computed Tomography

Groth Nicholas,  Williams Avery,  Southard Richard

Final Pr. ID: Poster #: EDU-023

PURPOSE: Trauma is a leading cause of death and disability in children ages 1-18, with abdominal trauma accounting for a significant patient population. Prompt identification of bowel and mesenteric injury in the setting of blunt trauma and penetrating injuries is important to avoid significant complications that may arise from delayed diagnosis. Spectral Dual-Energy Computed Tomography (DECT) obtains raw data at two energy spectra which by virtue of material decomposition can identify, isolate and or quantify iodine, pure calcium, and uric acid. Multiple image sets can be generated from a single scan allowing both anatomic and material-specific analysis. The use of DECT can improve detection and accurate grading of solid organ injury, aid in defining active hemorrhage, and increase visibility of altered bowel wall enhancement, ischemia, necrosis, and inflammation which provides critical information to inform the course of treatment in emergent settings. Read More

Authors:  Groth Nicholas , Williams Avery , Southard Richard

Keywords:  Dual Energy, Computed Tomography, Bowel Injury