Shellikeri Sphoorti,  Back Susan,  Poznick Laura,  Darge Kassa

Final Pr. ID: Poster #: EDU-050

ceVUS is a radiation-free and sensitive examination to detect vesicoureteral reflux and image the urethra in children using ultrasound (US) and intravesical administration of an ultrasound contrast agent (UCA). Due to the growing interest to perform ceVUS in children, a urinary bladder phantom was developed to teach the technical aspects of the ceVUS examination. Here we describe the preparation and utility of this reusable phantom as a tool to simulate the UCA administration, distribution and the effect of different US parameters on the UCA appearance in the bladder. Read More

Authors:  Shellikeri Sphoorti , Back Susan , Poznick Laura , Darge Kassa

Keywords:  Ultrasound contrast, bladder phantom, contrast enhanced voiding urosonography

Venkatakrishna Shyam Sunder,  Sultan Laith,  Gabbert Morgan,  Morgan Trudy,  Anupindi Sudha

Final Pr. ID: Poster #: SCI-014

Pediatric chronic liver disease (CLD) poses a significant clinical challenge, necessitating precise diagnostic tools for comprehensive evaluation. Microvascular perfusion abnormalities play a pivotal role in disease progression. Contrast-enhanced ultrasound (CEUS) detects the flow in the micro-vessels, however, objective means are needed for better understanding. In this study we evaluate a novel quantitative method utilizing CEUS for assessing microvascular perfusion in pediatric patients with CLD. Read More

Authors:  Venkatakrishna Shyam Sunder , Sultan Laith , Gabbert Morgan , Morgan Trudy , Anupindi Sudha

Keywords:  Liver microvasculature, Contrast enhanced ultrasound, image analysis

Barhaghi Krystle,  Schuchardt Eleanor,  Schafer Michal,  Meyers Mariana,  Behrendt Nicholas,  Barker Alex,  Cuneo Bettina,  Friesen Richard,  Browne Lorna

Final Pr. ID: Paper #: 102

Previous studies show that phase contrast MRI (PC-MRI) can successfully measure fetal blood flow in late gestation singleton fetuses. To date there is a paucity of data quantifying fetal blood flow of twin or early gestational age pregnancies (~19 weeks). Twin-twin transfusion syndrome (TTTS) is a rare complication of monochorionic pregnancies that is believed to result from inequal flow distribution between fetuses. In this novel investigation, we utilized PC-MRI to investigate fetal aortic flow in early gestational age fetuses with TTTS or selective Intrauterine Growth Restriction (sIUGR). We compared flow distribution between the smaller and larger fetus in each twin pair. Read More

Authors:  Barhaghi Krystle , Schuchardt Eleanor , Schafer Michal , Meyers Mariana , Behrendt Nicholas , Barker Alex , Cuneo Bettina , Friesen Richard , Browne Lorna

Keywords:  Fetal MRI, Twins, Phase Contrast MRI

Afonya Boma,  Kandil Ali,  Mahmoud Mohamed,  Das Bobby,  Fleck Robert

Final Pr. ID: Paper #: 079

Administering oral contrast less than two hours before sedation/anesthesia is often needed for computed tomography (CT) studies of the abdomen in children, but violates the American Society of Anesthesiologists (ASA) nothing-by-mouth guidelines and may increase the risk of aspiration pneumonia. ASA guidelines are based on gastric aspiration. Oral contrast is best administered 1 hour prior to imaging for optimal abdominal CT evaluation. The aim of our study was to measure residual gastric fluid volume (RGV) by CT and with manual aspiration in subjects undergoing general anesthesia (GA) less than 2 hours after oral contrast. Read More

Authors:  Afonya Boma , Kandil Ali , Mahmoud Mohamed , Das Bobby , Fleck Robert

Keywords:  Anesthesia, Enteric Contrast, Safety

Benya Ellen,  Prendergast Francis,  Liu Dennis,  Wyers Mary

Final Pr. ID: Paper #: 001

Contrast enhanced voiding urosonography (CEVUS) uses intravesically administered microbubble contrast to detect vesicoureteral reflux (VUR) and urethral anomalies with ultrasound. Multiple studies have suggested CEVUS can replace voiding cystourethrogram (VCUG) as a radiation free alternative. Analysis of ureterovesical junction (UVJ) and ureters on VCUG documenting UVJ position, ureteral duplication, periureteral diverticula and ureteroceles is important as anatomic variations may affect management and surgical approach. Our purpose was to assess UVJ region visualization in children with VUR detected on CEVUS. Read More

Authors:  Benya Ellen , Prendergast Francis , Liu Dennis , Wyers Mary

Keywords:  contrast enhanced voiding urosonography, vesicoureteral reflux, ureterovesical junction

Wermers Joshua,  Batlivala Sarosh,  Li Yinan,  Zhang Bin,  Towbin Alexander

Final Pr. ID: Poster #: SCI-004

Diffuse serosal and soft tissue enhancement (SSTE) is a unique pattern of contrast enhancement seen on abdominal radiographs after cardiac catheterization in newborns. While thought to be benign, SSTE can be misdiagnosed as pneumoperitoneum, resulting in unnecessary and potentially invasive diagnostic procedures. The purpose of this study is to describe the incidence of SSTE on abdominal radiograph performed in infants within 2 days of cardiac catheterization and identify clinical features associated with this imaging finding. Read More

Authors:  Wermers Joshua , Batlivala Sarosh , Li Yinan , Zhang Bin , Towbin Alexander

Keywords:  Radiography, Contrast, Renal

Handa Atsuhiko,  Bedoya M. Alejandra,  Iwasaka-neder Jade,  Johnston Patrick,  Bixby Sarah

Final Pr. ID: Poster #: SCI-019

To assess the equivalence of MRI without Gd-based contrast and MRI with contrast in the evaluation of synovitis in pediatric patients with juvenile idiopathic arthritis (JIA).

Contrast-enhanced imaging has been the gold-standard for MR evaluation of synovitis in patients with JIA (JAMRIS system). Conventional 2D MRI sequences did not allow reliable differentiation between synovium vs joint fluid. With higher field-strength magnets (1.5T or 3T), and high-resolution 3D sequences, the synovium may be differentiated from joint fluid on noncontrast MRI. Read More

Authors:  Handa Atsuhiko , Bedoya M. Alejandra , Iwasaka-neder Jade , Johnston Patrick , Bixby Sarah

Keywords:  arthritis, MRI, contrast

Poznick Laura,  Morgan Trudy,  Back Susan,  Darge Kassa

Final Pr. ID: Poster #: EDU-007 (T)

Contrast enhanced voiding urosonography (ceVUS) is a radiation free, highly sensitive imaging modality for vesicoureteral reflux (VUR) detection and urethral imaging in children. CeVUS uses ultrasound (US) technology and an US contrast agent (UCA) that is instilled in the bladder via a catheter. This educational exhibit provides step-by-step instructions of our institutional protocol for performing ceVUS exams.
Read More

Authors:  Poznick Laura , Morgan Trudy , Back Susan , Darge Kassa

Keywords:  Ultrasound, Contrast, VoidingContrast

Lee Seunghyun,  Hur Saebeom,  Choi Young Hun,  Cho Yeon Jin,  Cheon Jung-eun,  Kim Woo Sun,  Kim In-one

Final Pr. ID: Poster #: SCI-032

The recent advances of the lymphatic intervention, has prompted progress in imaging of the lymphatic system. We would describe the clinical usefulness of the dynamic contrast-enhanced (DCE) magnetic resonance (MR) lymphangiography for imaging of the lymphatic system in pediatric patients. Read More

Authors:  Lee Seunghyun , Hur Saebeom , Choi Young Hun , Cho Yeon Jin , Cheon Jung-eun , Kim Woo Sun , Kim In-one

Keywords:  lymphangiography, MRI, dynamic contrast-enhanced

Zapala Matthew,  Zurakowski David,  Lee Edward

Final Pr. ID: Poster #: SCI-071

To compare hand versus mechanical administration of intravenous (IV) contrast on the quality of CT pulmonary angiography in the pediatric population. Read More

Authors:  Zapala Matthew , Zurakowski David , Lee Edward

Keywords:  CT, Pulmonary artery, Contrast

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

Colleran Gabrielle,  Barnewolt Carol,  Chow Jeanne,  Paltiel Harriet

Final Pr. ID: Poster #: EDU-122

Fluoroscopic voiding cystourethrography (VCUG) and radionuclide cystography (RNC) are conventional techniques used for the diagnosis of vesicoureteral reflux (VUR) in children. Contrast-enhanced voiding urosonography (ceVUS) is a radiation-free alternative to the traditional VCUG. ceVUS has gained acceptance in Europe, but has not yet been widely adopted in the USA.

The purpose of this educational review is to describe our initial experience with ceVUS using the second generation US contrast agent Optison™, with a focus on optimization of examination technique, utility in the depiction of a variety of pathological entities, and a discussion of potential pitfalls. Read More

Authors:  Colleran Gabrielle , Barnewolt Carol , Chow Jeanne , Paltiel Harriet

Keywords:  contrast enhanced voiding urosonography, VCUG, ALARA, ultrasound contrast, Optison

Davis Laura,  Morales-tisnés Tatiana,  Lerebo Wondwossen,  Barz Leahy Allison,  Ntoulia Aikaterini,  Dennis Rebecca,  Anupindi Sudha,  Darge Kassa,  Back Susan

Final Pr. ID: Poster #: CR-013

Infantile myofibromatosis is rare. The generalized form affects the integument and musculoskeletal system as well as multiple visceral organs and can impair organ function, thus requiring prompt diagnosis and treatment at an early age. As a disease that presents before the age of two years, minimizing use of CT and MRI is imperative to reduce radiation and gadolinium contrast use, respectively.
We present a case of a neonate in whom multiple cutaneous and an appendiceal lesion raised the suspicion of infantile myofibromatosis. Multiple liver lesions were seen on gray-scale ultrasound. On contrast-enhanced ultrasound (CEUS), there were multiple, differently-enhancing liver lesions, a finding which was confirmed on MRI with hepatocyte specific contrast. These were all thought to represent myofibromas with complete involution following low dose chemotherapy. Read More

Authors:  Davis Laura , Morales-tisnés Tatiana , Lerebo Wondwossen , Barz Leahy Allison , Ntoulia Aikaterini , Dennis Rebecca , Anupindi Sudha , Darge Kassa , Back Susan

Keywords:  myofibromatosis, contrast ultrasound, CEUS

Rees Mitch,  Milks Kathryn,  Krishnamurthy Ramkumar,  Krishnamurthy Rajesh,  Hu Houchun

Final Pr. ID: Poster #: SCI-043

There is limited understanding and utilization of dynamic contrast enhancement MRI of marrow, periosteum and cartilage for diagnosis of musculoskeletal (MSK) disease in children. This is partly due to limited availability of pediatric disease models of marrow inflammation, infection, infiltration, or involvement by tumor. Herein we explore signal intensity time curves of relevant MSK targets using a 3D Golden-angle RAdial Sparse Parallel (GRASP) MRI technique. GRASP is an accelerated, free-breathing dynamic acquisition that has been shown to reduce the need for sedation. We aim to establish a baseline for normal enhancement characteristics of marrow, cartilage, synovium and periosteum of the growing skeleton in a sheep model as a precursor to translation to children. Read More

Authors:  Rees Mitch , Milks Kathryn , Krishnamurthy Ramkumar , Krishnamurthy Rajesh , Hu Houchun

Keywords:  radial MRI, dynamic contrast enhancement, musculoskeletal

Khaw Kristina,  Sridharan Anush,  Poznick Laura,  Kilbaugh Todd,  Hwang Misun

Final Pr. ID: Paper #: 129

The purpose of this experiment was to evaluate the correlation between the doppler and intracranial pressure (ICP) and mean arterial pressure (MAP) in a pediatric porcine model of asphyxia-associated cardiac arrest. Read More

Authors:  Khaw Kristina , Sridharan Anush , Poznick Laura , Kilbaugh Todd , Hwang Misun

Keywords:  Contrast Enhanced Ultrasound, Intracranial Pressure

Squires Judy,  Beluk Nancy,  Yanowitz Toby,  Kephart Morie,  Panigrahy Ashok

Final Pr. ID: Paper #: 123

Timely intracranial imaging enables diagnosis, directs treatment, and provides prognostic information of infant malformation or injury. MRI is the gold standard for neuroimaging, but can be inhibited by transportation risk and incompatible support devices. Ultrasound (US) is portable, rapid, and inexpensive, but limited by lower sensitivity and specificity. Contrast-enhanced ultrasound (CEUS) improves diagnostic accuracy of US in other clinical applications. Our aim was to prospectively compare CEUS of the neonatal brain to MRI. Read More

Authors:  Squires Judy , Beluk Nancy , Yanowitz Toby , Kephart Morie , Panigrahy Ashok

Keywords:  contrast-enhanced ultrasound, neonates, neuroimaging

Albers Brittany,  Shah Chetan

Final Pr. ID: Poster #: EDU-081

Gadolinium based contrast agents have been used in pediatric neuroradiology for years and are thought to be safe when administered appropriately. However, it has been discovered that gadolinium used in routine clinical practice results in gadolinium deposition in the even in patients with normal renal function. No studies have addressed gadolinium deposition in the soft tissues of pediatric patients or its potential ill-effects. The potential for harm may exist. We reviewed our gadolinium use in the follow up of pediatric primary intracranial neoplasms. Read More

Authors:  Albers Brittany , Shah Chetan

Keywords:  contrast, safety, malignancy, gadolinium, follow-up

Morgan Trudy,  Poznick Laura,  Back Susan,  Darge Kassa

Final Pr. ID: Poster #: EDU-004 (T)

Contrast enhanced ultrasound is a radiation free, highly sensitive imaging modality for detection of focal liver lesions in children. CEUS uses ultrasound (US) technology and an US contrast agent (UCA) that is administered intravenously. This educational exhibit provides step-by-step instructions of our institutional protocol for performing CEUS exams. Read More

Authors:  Morgan Trudy , Poznick Laura , Back Susan , Darge Kassa

Keywords:  Ultrasound, Liver, Contrast

Mangona Kate Louise,  Hammer Matthew,  Kwon Jeannie

Final Pr. ID: Poster #: EDU-038

Voiding cystourethrography (VCUG) has long been utilized in the diagnosis of vesicoureteral reflux in children with urinary tract infections. Sonographic techniques have been developed to make the same diagnosis without exposing the child to ionizing radiation. This presentation describes the implementation steps of a new service including: pharmacy approval and formulary addition; sonographer training and coordination with fluoroscopy technologists; referring clinician education and outreach. This exhibit educates the reader on how ceVUS can be performed, how it can be established at a children’s hospital, and the benefits it provides.

Correct technique and acquisition of images is shown using clinical case examples. Relevant anatomy is reviewed. Correlation of ultrasound abnormalities with VCUG results is provided. The process of training technologists and radiologists is highlighted. Pitfalls and tips to improve imaging are described. We will present results on how our new service has been accepted and utilized by the urologists and referring physicians. We have now performed over 50 ceVUS studies this year. Read More

Authors:  Mangona Kate Louise , Hammer Matthew , Kwon Jeannie

Keywords:  ceVUS, ultrasound, contrast

Cheng Jocelyn,  Durand Rachelle,  Zapala Matthew,  Cort Kayla,  Bhuller Jeanie,  Courtier Jesse

Final Pr. ID: Poster #: EDU-024

MRI of the abdomen faces several technical challenges owing to respiratory motion, bowel peristalsis, and the need for large volumetric coverage. In adult patients, imaging is typically performed during multiple breath holds to avoid motion artifact; however pediatric patients may be unable to perform consistent breath holds or remain motionless during MRI acquisition. Although techniques such as child life specialists, MRI video goggles, and dedicated MR suite environments have reduced the need for anesthesia in MRI, general anesthesia may be necessary in some patients. Simulating breath holds in anesthetized patients is a technically difficult procedure requiring timed ventilation of the patient's abdomen during MRI acquisition, and results in progressive image degradation due to retained air artifact.

Dynamic Scan Optimization (DISCO) combines 3D DCEMRI + 2 pt Dixon + Parallel Imaging + Temporal Acceleration to provide high spatiotemporal resolution while drastically reducing scan time. Because pediatric patients have relatively low respiratory volumes, this technique enables acquisition of diagnostic quality images without breath-holding.

The purpose of this exhibit is to: (1) provide a guide for successful application of navigated spontaneous breathing multiphase DISCO sequence (2) review common use cases of the DISCO sequence (3) provide practical suggestions for troubleshooting DISCO Read More

Authors:  Cheng Jocelyn , Durand Rachelle , Zapala Matthew , Cort Kayla , Bhuller Jeanie , Courtier Jesse

Keywords:  Dynamic contrast enhanced MRI, DIfferential Sub-sampling with Cartesian Ordering, pediatric abdominal MRI

Kring Donna,  Suman Garima,  Morrison Jessica,  Krishnamurthy Rajesh

Final Pr. ID: Paper #: 080

To report a single institutional experience with intravenous iodinated contrast extravasations (ICE) occurring during CT at a free-standing academic pediatric medical center. Read More

Authors:  Kring Donna , Suman Garima , Morrison Jessica , Krishnamurthy Rajesh

Keywords:  extravasation, pediatrics, contrast

Bryant Audrey,  Kandil Ali

Final Pr. ID: Poster #: CR-002 (T)

Gadolinium, a type of MRI contrast is typically used when imaging pediatric cardiac patients. Gadolinium enhances the images to give more clarity to the radiologists when distinguishing normal tissue from abnormal tissue. Further, contrast also allows for better visualization of the great vessels.

Gadolinium alters the magnetic properties of nearby water molecules in the tissue. While contrast itself does not alter the tissue composition, it does affect how the scanner takes the picture. Accordingly, images can differ between pre- and post-contrast administration. While IV contrast can be administered safely, it is not without logistic implications and/or risks.

MRI contrast can be given to pediatric cardiac patients intravenously, but IV access is oftentimes challenging in pediatric cardiac patients. In an effort to reduce the number of unsuccessful IV attempts and quantity of contrast administered, a novel non-contrast MR sequences is being utilized to better depict the great vessels in these children. If IV access is unsucessful or the patient cannot complete the MRI, this modality is employed to obtain more information on the patient's cardiact vasculature.

This purpose of this case report paper is to show the MR imaging when using a non-contrast sequence to identify cardiac vessels in pediatric patients who cannot recieve IV contrast. Read More

Authors:  Bryant Audrey , Kandil Ali

Keywords:  Pediatric, Contrast, Vasculature

Infante Juan

Final Pr. ID: Poster #: CR-002

INTRODUCTION
Renal artery stenosis is a common complication after transplantation. In our institution, we have unfortunately found a high rate of false-positive Doppler ultrasound and non-contrast time-of-flight MRA studies that go to invasive catheterization which turn out negative for renal artery stenosis. We present one of many of our cases which show the utility of high-quality 3D MRA using another non-contrast technique, NATIVE True-FISP, which is appears better apt at achieving adequate signal even when the acquisition plane is not perpendicular to the vessel of interest.

CASE DESCRIPTION
A 13-year-old male with a history of idiopathic dilated cardiomyopathy and end-stage renal disease from presumed ischemic injury during cardiac catheterization underwent a combined cardiac transplant and deceased donor kidney transplant. Two months after the transplant, the patient was admitted for respiratory distress, pulmonary edema, and worsening cardiac function, the latter documented by routine outpatient echocardiography.

On admission, a Doppler ultrasound showed elevated peak systolic velocity of the transplant renal artery anastomosis, up to 434 cm/sec. To confirm the sonographic suspicion of renal artery stenosis, a non-contrast 3D MRA was requested which showed tight juxta-anastomic stenosis (see Figure 1).

The interventional radiology service was consulted who brought the patient to their angiography suite on the basis of the clinical and imaging findings. A diagnostic angiogram confirmed the pre-angiographic imaging findings with nearly one-to-one correlation with the MR 3D-volume-rendered images (see Figure 2). Angioplasty of this lesion was performed, and follow-up ultrasounds up to six-months post angioplasty show interval normalization of the renal artery velocities and blood pressure. Read More

Authors:  Infante Juan

Keywords:  MRA, Non-contrast, NATIVE

Rendon Kathleen,  Rigsby Cynthia

Final Pr. ID: Poster #: EDU-002 (T)

Purpose: The long-term effects from gadolinium tissue deposition in organs and the brain is unknown especially in children who may need repeated contrast studies for necessary follow-up of cardiovascular abnormalities. We aim to show the utility of a non-contrast MRA sequence in older children and young adults undergoing chest and/or abdominal MRA. Read More

Authors:  Rendon Kathleen , Rigsby Cynthia

Keywords:  Non-contrast, 3D imaging, Cardiac

Ntoulia Aikaterini,  Back Susan,  Hwang Misun,  Gokli Ami,  Anupindi Sudha,  Biko David,  Srinivasan Abhay,  Poznick Laura,  Darge Kassa

Final Pr. ID: Poster #: EDU-023

Pediatric Contrast Enhanced Ultrasound (CEUS) is a safe and patient-friendly imaging modality. It improves the diagnostic capability of gray-scale and Doppler ultrasound without sedation, ionizing radiation and no use of iodinated or gadolinium-based contrast agents. Pediatric CEUS was originally used to detect vesicoureteral reflux, evaluate indeterminate focal liver lesions, assess and follow up solid-organ injuries sustained during blunt abdominal trauma. In 2016, the approval of Lumason® (Bracco Diagnostics Inc., Monroe Township, NJ) by the United States Food and Drug Administration (FDA) marked the beginning of a new era for CEUS imaging. Since then, clinical requests for pediatric CEUS not only increased in number but also for a variety of examinations covering practically every organ system, including pediatric brain, lungs, solid organs and bowel. In addition, intracavitary applications of pediatric CEUS are now extending beyond the urinary tract, to include urogenital and anorectal malformations. Intravenous and intracavitary CEUS is used in pediatric interventional radiology, to confirm enteric tube placement, guide biopsies and drainage procedures and aide organ vascular mapping (e.g. renal, central vessels). Novel pediatric CEUS applications now used include intranodal CEUS lymphangiography for confirmation of needle position preceding MRI lymphagiography. Pediatric CEUS is performed in a number of clinical settings including inpatient units, outpatient radiology, emergency department, and intraoperative. These evolving indications and uses of CEUS combined with continuous advances in ultrasound technology, such as three-dimensional/four-dimensional ultrasound and improved contrast sensitivity, are establishing pediatric CEUS as an important alternative imaging examination that can complement or supplement fluoroscopy, CT and MRI. This presentation reviews the current wide spectrum of pediatric CEUS applications and imaging findings, according to body part, and the associated imaging findings. Read More

Authors:  Ntoulia Aikaterini , Back Susan , Hwang Misun , Gokli Ami , Anupindi Sudha , Biko David , Srinivasan Abhay , Poznick Laura , Darge Kassa

Keywords:  contrast ultrasound, pediatric applications

Jaganathan Sriram,  Rowell Amy,  Ali Sumera,  Krishnan Venkatram,  Jayappa Sateesh,  Murphy Janice,  Ramakrishnaiah Raghu,  Wong Kevin,  Schmitz Kelli,  Choudhary Arabinda,  Buchmann Robert

Final Pr. ID: Poster #: EDU-032

Objectives:
Acute appendicitis is one of the common emergent indications for imaging in the hospital setting. Though ultrasound and/or CT remains the primary imaging modality, MRI with rapid sequence imaging is also gaining credence at multiple pediatric institutions to replace CT or even replacing Ultrasound in specific settings, as the first line imaging modality. Our aim in this exhibit is to present our initial experience on implementation of a limited rapid sequence MRI appendix, at our tertiary care pediatric hospital, to evaluate for acute RLQ pain. We also detail the advantages of MRI over CT scan, pitfalls of MRI, the appearance of acute appendicitis and complications including perforation/ abscess, and other pathologies, which we found on MRI during the evaluation for acute abdominal pain.
Learning points:
Our exhibit includes:
Role of MRI appendix – emerging as an alternative to CT in diagnostic dilemma and avoids radiation
Logistics of setting up MRI appendix protocol and managing expectations
Decision on when to use MRI for evaluation of suspected appendix
Describe rapid sequence tailored protocol developed at our institution
In the context of increasing supply chain disruption issues such as CT contrast shortage, the advantages and disadvantages of MRI
Normal appearance of the appendix and peri-appendiceal region
Classical appearances on MRI appendix
1. Acute Appendicitis
2. Inflammatory mass
3. Contained appendiceal perforation
4. Abscess
5. Identifying appendicolith
6. Perforated appendicitis with abscesses in extraperitoneal spaces
Alternate pathologies which we may mimic appendicitis and was identified on MRI
1. Terminal ileitis
2. Colitis
3. Ovarian pathology
Discussion:
Acute appendicitis is one of the common pathologies encountered in pediatric emergency setting and needs prompt attention. Ultrasound is the cheapest and most easily available imaging modality, but is operator dependent, and may be limited by patient body habitus, and location of the appendix. MRI is emerging as an alternative to CT in the evaluation of appendicitis in the pediatric population. Our initial experience with implementation of the MRI appendix protocol is promising in terms of acceptance by the clinical teams, image resolution, diagnostic confidence, logistical support from the administrators, sensitivity and patient outcome. We had the added benefit of being able to utilize this protocol during CT service disruptions and contrast shortage. Read More

Authors:  Jaganathan Sriram , Rowell Amy , Ali Sumera , Krishnan Venkatram , Jayappa Sateesh , Murphy Janice , Ramakrishnaiah Raghu , Wong Kevin , Schmitz Kelli , Choudhary Arabinda , Buchmann Robert

Keywords:  MRI Appendix, Rapid sequence imaging, iodinated contrast shortage

Smitthimedhin Anilawan,  Sridharan Anush,  Darge Kassa,  Back Susan,  Cahill Anne Marie

Final Pr. ID: Paper #: 142

Conventional Doppler US is known to have low sensitivity for the diagnosis of renal artery stenosis (RAS), in particular segmental renovascular disease. This study aims to determine if contrast-enhanced US (CEUS) can quantitatively provide assessment of renal arterial and parenchymal perfusion pre- and post- renal artery angioplasty in children and potentially be used as a follow-up imaging tool. Read More

Authors:  Smitthimedhin Anilawan , Sridharan Anush , Darge Kassa , Back Susan , Cahill Anne Marie

Keywords:  CEUS, Renal Artery Stenosis, Contrast-Enhanced Ultrasound

Gilligan Leah,  Davenport Matthew,  Trout Andrew,  Su Weizhe,  Zhang Bin,  Goldstein Stuart,  Dillman Jonathan

Final Pr. ID: Paper #: 089

Acute kidney injury (AKI) remains a concern in hospitalized children undergoing computed tomography (CT) examinations with intravenous (IV) iodinated contrast material (ICM). Adult studies have shown frequencies of AKI after CT with IV ICM to be similar to propensity score-matched ICM unexposed cohorts. The purpose of this study is to evaluate the association between IV ICM exposure and AKI in hospitalized pediatric patients with stable kidney function undergoing computed tomography (CT). Read More

Authors:  Gilligan Leah , Davenport Matthew , Trout Andrew , Su Weizhe , Zhang Bin , Goldstein Stuart , Dillman Jonathan

Keywords:  contrast induced nephropathy, acute kidney injury, iodinated contrast material

Poznick Laura,  Morgan Trudy,  Kozak Brandi,  Madara Kate

Final Pr. ID: Poster #: EDU-009 (R)

Contrast enhanced ultrasonography (CEUS) is a radiation free, highly sensitive imaging modality for pathology detection in children. CEUS uses ultrasound (US) technology in combination with US contrast agent (UCA). The UCA is administered intravenously via an IV catheter. The UCA is composed of gas-filled microbubbles. This educational exhibit has the aim to describe the procedure and imaging in CEUS from the sonographers’ perspective.
Read More

Authors:  Poznick Laura , Morgan Trudy , Kozak Brandi , Madara Kate

Keywords:  Ultrasound, Contrast, CEUS

Poznick Laura,  Morgan Trudy,  Kozak Brandi,  Madara Kate

Final Pr. ID: Poster #: EDU-007 (R)

Contrast enhanced voiding urosonography (ceVUS) is a radiation free, highly sensitive imaging modality for vesicoureteral reflux (VUR) detection and urethral imaging in children. CeVUS uses ultrasound (US) technology in combination with US contrast agent (UCA). The UCA is administered intravesically via a bladder catheter. These are composed of gas-filled microbubbles. This educational exhibit has the aim to describe the procedure and imaging in ceVUS from the sonographers’ perspective.
Read More

Authors:  Poznick Laura , Morgan Trudy , Kozak Brandi , Madara Kate

Keywords:  Ultrasound, Contrast, ceVUS