Abelian Khoren,  Kaleem Musa,  Mclennan Kerrie,  Edwards Harriet

Final Pr. ID: Poster #: EDU-100

Abusive head trauma (AHT) is the leading cause of death in cases of physical child abuse. It primarily affects infants under two years of age, with the highest incidence in those younger than six months. Mortality may reach 30%, and approximately half of survivors suffer long-term neurological disability. Early and accurate differentiation of AHT from other causes of brain injury is therefore essential for safeguarding and appropriate management.
We present six cases of bilateral and three cases of unilateral intracranial haemorrhage in infants and children under the age of two years with confirmed child abuse. Of these, five had associated spinal injuries, two had associated retinal haemorrhages and features of hypoxic–ischaemic injury, and one had a skull fracture.
Using illustrations and findings from each case, we aim to (1) revisit abusive head trauma guidelines and imaging recommendations in both America and Europe, (2) the varied patterns of clinical presentation, and (3) outline the associated neuroimaging features which, either in isolation or in combination, can favour a shaking mechanism of injury rather than an isolated impact injury, as is more commonly seen in accidental head trauma. (4) We shall highlight how clinical outcomes can vary between cases due to factors such as cerebral ischaemia and raised intracranial pressure, (5) consider the importance of additional findings on spinal imaging and skeletal surveys, and (6) discuss the medicolegal implications of abusive head trauma.
After review, both the paediatric and general radiologist will have increased knowledge and confidence to raise suspicion to the paediatrician of potential abusive head trauma and suggest the correct next imaging steps to protect our vulnerable patients when presented with these neuroimaging findings. Read More

Authors:  Abelian Khoren , Kaleem Musa , Mclennan Kerrie , Edwards Harriet

Keywords:  Abusive Head Trauma, Intracranial Hemorrhage, Child Abuse

Abelian Khoren,  Kaleem Musa,  Mclennan Kerrie,  Edwards Harriet

Final Pr. ID: Poster #: SCI-063

Abusive head trauma (AHT) is the leading cause of death in physical child abuse, predominantly affecting infants under two years. Early recognition of injury patterns inconsistent with reported mechanisms is critical for safeguarding and clinical management. This study reviewed neuroimaging findings in children under two presenting with head injury or altered neurological behaviour, focusing on the distribution and laterality of intracranial haemorrhage. Read More

Authors:  Abelian Khoren , Kaleem Musa , Mclennan Kerrie , Edwards Harriet

Keywords:  Abusive Head Trauma, Intracranial Hemorrhage, Child Abuse

Kim Kevin,  Nowrangi Rajeev,  Mcgehee Arianna,  Joshi Neil,  Acharya Patricia

Final Pr. ID: Paper #: 020

To assess whether a convolutional neural network (CNN) can be trained via transfer learning to accurately diagnose germinal matrix hemorrhage-intraventricular hemorrhage (GMH-IVH) on cranial ultrasound (CUS) by comparing its performance to that of a board-certified radiologist. Secondary endpoints will include the ability of CNN to grade GMH-IVH severity, identify GMH-IVH on MRI, and assess low-grade GMH-IVH on CUS that cannot reliably be seen by a radiologist. Read More

Authors:  Kim Kevin , Nowrangi Rajeev , Mcgehee Arianna , Joshi Neil , Acharya Patricia

Keywords:  AI, Cranial ultrasound, germinal matrix hemorrhage

Thompson Matthew,  Davis Joseph,  Thompson Atalie,  Hull Nathan,  Schooler Gary

Final Pr. ID: Poster #: SCI-055

The purpose of this study is to determine whether a decrease in hematocrit is predictive of an intracranial hemorrhage (ICH) on neonatal head ultrasound (HUS). Read More

Authors:  Thompson Matthew , Davis Joseph , Thompson Atalie , Hull Nathan , Schooler Gary

Keywords:  intracranial hemorrhage, head ultrasound, hematocrit

Arceo Salvador,  Christopher Ross,  Milla Sarah,  Riedesel Erica

Final Pr. ID: Paper #: 165

Head trauma is a significant cause of morbidity and mortality in pediatrics. Non-contrast Head CT is the accepted gold standard imaging study to evaluate for suspected acute intracranial hemorrhage (ICH), however small acute extra-axial hemorrhage may be easily missed due to size and similar density to the bony calvarium. In Dual Energy CT (DECT), materials within the body such as bone/calcium and hemorrhage can be more easily discriminated based on differential attenuation at high and low peak voltage image acquisitions. This allows for advanced post-processing including automated bone removal which has been shown to improved visualization of acute ICH in the adult radiology literature, but has not yet been described in pediatrics. We report a retrospective review of DECT with automated bone removal for detection of acute ICH in the pediatric population. Read More

Authors:  Arceo Salvador , Christopher Ross , Milla Sarah , Riedesel Erica

Keywords:  Dual Energy, Trauma, Intracranial Hemorrhage

Snyder Elizabeth,  Pruthi Sumit,  Hernanz-schulman Marta

Final Pr. ID: Paper #: 121

Before the germinal matrix (GM) begins to recede at approximately 26 weeks gestational age (GA), it extends along the floor of the lateral ventricles far posterior to the thalamocaudate grooves. As extremely premature infants (EPIs) as young as 23 weeks GA survive with current advances in neonatology support, germinal matrix hemorrhage (GMH) can occur along these sites from which the GM has not yet involuted and should be recognized. Further, such Grade I posterior GMH may be mistakenly diagnosed as an intraparenchymal grade IV event, particularly on coronal US or other axial images, with parasagittal images demonstrating the correct diagnosis. The aim of this study is to document and describe this phenomenon, differentiate it from traditional GMH findings, and assess its prevalence in this population. Read More

Authors:  Snyder Elizabeth , Pruthi Sumit , Hernanz-schulman Marta

Keywords:  Ultrasound, Germinal Matrix Hemorrhage, prematurity

Dayton Orrin,  Sharma Priya,  Rajderkar Dhanashree

Final Pr. ID: Poster #: EDU-119

In this educational exhibit we will present a series of neonatal head ultrasound cases from our institution and present the correlative magnetic resonance imaging (MRI) which followed. We will describe a wide variety of pathologies that are often encountered but under-reported. We will also review imaging pitfalls encountered when interpreting neonatal head ultrasound and provide suggestions on how to improve the quality of these challenging examinations. Read More

Authors:  Dayton Orrin , Sharma Priya , Rajderkar Dhanashree

Keywords:  Neurosonography, Germinal Matrix Hemorrhage, MRI

Rodríguez Garza Claudia,  Guillen Gutierrez Cinthia,  Elizondo Riojas Guillermo

Final Pr. ID: Poster #: EDU-064

Review the causes of cerebral hemorrhage in the pediatric patient based on clinical cases.

Stroke is a major cause of morbidity and mortality in children worldwide. The reported annual incidence ranges from 2.3 to 13 per 100,000 children per year in developed countries. In contrast to the adult, in children, diagnosis is not as straightforward, because when children present with acute neurological deficits, stroke is often not the first diagnosis considered by the medical providers.

Neuroimaging is essential for diagnosis and differentiation of stroke from stroke mimics that can present similarly.

Stroke in children can be ischemic or hemorrhagic, referring to the term hemorrhagic stroke as a intracerebral hemorrhage that is nontraumatic and whose most common etiology is secondary to a vascular malformation (Arteriovenous Malformation (AVM), Dural/Pial Arteriovenous Fistula (Dural AVF/Pial AVF), Cavernous Malformation, Vein of Galen Aneurysmal Malformation (VGAM), Developmental Venous Anomaly (DVA), Capillary telangiectasia, Sinus Pericranii, Aneurysms).

The most commonly used classification of vascular malformation is based on angioarchitectural and histomorphological characteristics. To differentiate these classic types, in a first step, shunting lesions have to be discerned from nonshunting lesions, as well as other features of the vascular contribution that will be evaluated by image.

We cannot forget the hemorrhage associated with coagulopathy, haematological disorders, brain tumors and cerebral sinovenous thrombosis (CSVT) which in the latter case can be found as venous infarction or hemorrhage; and other less common causes of hemorraghe in pediatrics as the intracranial aneurysms, in 15% of all pediatric aneurysms are secondary to an infection (micotic aneurysm).

Read More

Authors:  Rodríguez Garza Claudia , Guillen Gutierrez Cinthia , Elizondo Riojas Guillermo

Keywords:  vascular malformations, hemorrhage, pediatric stroke

Binette Maliyan,  Dean Haley,  Barton Katherine

Final Pr. ID: Poster #: CR-007

Ultrasound is frequently utilized to screen for intracranial pathologies in neonates, including intracranial hemorrhage. There are several risk factors that predispose to neonatal intracranial hemorrhage including prematurity and bleeding diathesis (Tan 2018). Intracranial hemorrhage typically appears hyperechoic on ultrasound, although very rare cases of hypoechoic hemorrhage have been reported in patients receiving anticoagulation in the setting of ECMO (Bulas 1991, Svrckova 2020). Here we present a case of multifocal hypoechoic acute intracranial hemorrhages in a premature neonate with thrombocytopenia of unclear etiology. Though a connection between anticoagulation and echogenicity of hemorrhage has not been firmly established, this raises the question of how coagulation status can affect the ultrasound characteristics of hemorrhage.

Our patient is a premature female infant born at 35w1d via uncomplicated cesarean delivery to a 30-year-old G1P0 mother with routine prenatal care. Gestation was complicated by intrauterine growth restriction. Mother also had Covid-19 during the pregnancy and exposure to Zika virus without confirmed infection. After birth, APGAR scores were 8 and 8. A head ultrasound performed on the first day of life was unremarkable. Initial labs were notable for a platelet count of 13k requiring seven platelet transfusions. On day of life 12 the infant was found to have an increasing head circumference with full fontanelles. Follow up head ultrasound at this time revealed multifocal hypoechoic lesions in the brain parenchyma but no hyperechoic hemorrhage. On MRI obtained the same day those hypoechoic foci demonstrated heterogenous T1 isointensity and increased susceptibility consistent with intraparenchymal hemorrhage. Platelets at that time were 69k. Delayed head ultrasound 5 weeks later revealed significant cystic encephalomalacia with parenchymal volume loss and ventriculomegaly. Read More

Authors:  Binette Maliyan , Dean Haley , Barton Katherine

Keywords:  Neurosonography, Hemorrhage

Ramegowda Rajath,  Prabhu Sanjay

Final Pr. ID: Poster #: EDU-022

Neonatal intracranial hemorrhage (ICH) represents a significant challenge in perinatal neuroimaging due to its variable etiology, presentation, and long-term impact on neurodevelopmental outcomes. This pictorial review aims to provide a comprehensive review of the magnetic resonance imaging (MRI) characteristics of hemorrhagic lesions in the neonatal brain. This includes detailing the appearance and evolution of blood products in neonates, the familiar sites and etiologies of ICH, and how these findings differ between preterm and term infants. The presentation will also address the unique imaging features of hemorrhagic lesions in the immature brain and discuss their neurodevelopmental outcomes.
Key objectives include:
1. Explore the typical MRI appearances of blood products at different stages of a neonatal brain hemorrhage..
2. Analyze the evolution of parenchymal and extra-axial hemorrhages, noting differences in imaging findings based on gestational age.
3. Understand the common causes of neonatal ICH, including perinatal trauma, hypoxic injury, and clotting disorders, and their multifactorial nature.
4. Discuss the neurodevelopmental implications of neonatal ICH, including the potential for impaired outcomes related to the location and size of hemorrhagic lesions.

This abstract emphasizes the critical role of early and accurate imaging in diagnosing and managing neonatal hemorrhagic lesions, contributing to improved outcomes in affected infants. Read More

Authors:  Ramegowda Rajath , Prabhu Sanjay

Keywords:  Hemorrhage, Neonatal, Brain

Bandarkar Anjum,  Cielma Tara,  Holley Danyelle,  Adeyiga Adebunmi

Final Pr. ID: Poster #: EDU-042

Background: Hemophilia is a rare X-linked recessive bleeding disorder characterized by the absence of one of the coagulation factors including factor VIII in hemophilia A and factor IX in hemophilia B. Amongst the complications, muscle hemorrhage is the second most common type of hemorrhage in hemophilia, second only to hemarthrosis. Bleeding may be precipitated by trauma or fractures or may be spontaneous. Hemorrhage into the large muscle groups of the upper and lower extremities, can cause tissue compartment syndrome, nerve compression, and potential tissue death. A child with hemophilia and muscle hemorrhage may present with focal swelling, pain, or refusal to use the affected body part. Early recognition and treatment of muscle hemorrhages can prevent compartment syndrome and longterm complications, reduce pain, and allow a quick return to normal function and activity.
Aims:
1. To describe utility of rapid ultrasound in detecting muscle hemorrhages in children with hemophilia.

2. To illustrate sonographic appearances of muscle hemorrhages in various locations in the body. Read More

Authors:  Bandarkar Anjum , Cielma Tara , Holley Danyelle , Adeyiga Adebunmi

Keywords:  Hemophilia, Muscle hemorrhage, Hematoma

Sahu Asutosh,  Prabhu Sanjay

Final Pr. ID: Poster #: EDU-086

Purpose
Post-hemorrhagic ventricular dilatation (PHVD) is a common sequela of severe neonatal intraventricular hemorrhage (IVH), often necessitating cerebrospinal fluid (CSF) shunt placement. Despite advances in shunt technology and neonatal neurosurgical care, shunt malfunction remains a leading cause of morbidity and repeat surgical intervention in this population.
After reviewing this exhibit, participants will be able to:
1. Describe the pathophysiologic mechanisms and imaging manifestations of shunt failure following neonatal intraventricular hemorrhage.
2. Apply a structured, multimodality diagnostic algorithm integrating ultrasound, MR ventricular check examinations, and rapid MRI techniques for shunt assessment.
3. Recognize imaging considerations for programmable and nonprogrammable shunt valves and identify key features predicting recurrent or multiloculated hydrocephalus.
Content Organization
- Pathophysiologic mechanisms unique to the post-IVH brain—including septations and ependymal scarring, predispose to both mechanical and functional shunt failure. Common causes include proximal or distal obstruction, valve dysfunction, and secondary complications such as infection or pseudocyst formation.
- Multimodality examples (ultrasound, MRI, CT) are used to illustrate key imaging findings and subtle differentiating features.
- A stepwise diagnostic algorithm is presented, beginning with cranial ultrasound in newborns and younger infants, followed by rapid-sequence MRI (single-shot T2, 3D DRIVE/CISS) for ventricular morphology and catheter assessment, with CT reserved for problem solving. Phase-contrast MRI assists in evaluating CSF flow and shunt patency.
- Programmable and non-programmable shunt valves are reviewed, highlighting imaging appearance, verification techniques, and implications for longitudinal surveillance. Recommended imaging intervals and markers of evolving multiloculated hydrocephalus are summarized.
Conclusion
Early, accurate recognition of shunt malfunction after neonatal IVH depends on understanding its imaging signatures and etiologies. This exhibit provides a step-by-step, multimodality algorithm, anchored in rapid MRI vent checks and informed by shunt hardware variability with illustrative cases to guide pediatric radiologists in assessment and follow-up, and to support coordinated care with neurosurgery and neonatology. Read More

Authors:  Sahu Asutosh , Prabhu Sanjay

Keywords:  Intracranial Hemorrhage, Shunts

Molto Garcia Jose Francisco,  Cielma Tara,  Rao Jhanavi,  Czarniecki Marcin B.,  Sanchez Ramon

Final Pr. ID: Poster #: EDU-042

The main purpose is to depict sonographic features of the subpial hemorrhage of the neonate. Secondary purposes are: (1) Review the anatomy of the subpial space, (2) Review proposed pathophysiology, (3) Demonstrate CT and MR correlates of subpial hemorrhages. Read More

Authors:  Molto Garcia Jose Francisco , Cielma Tara , Rao Jhanavi , Czarniecki Marcin B. , Sanchez Ramon

Keywords:  Hemorrhage, Ultrasound, Brain

Sahu Asutosh,  Prabhu Sanjay

Final Pr. ID: Poster #: EDU-091

Background:
The germinal matrix (GM) is a transient, highly vascular zone that involutes between 24–34 weeks’ postmenstrual age. In extremely preterm infants (≈22–28 weeks), maturational changes in size, echogenicity, and symmetry can mimic or mask hemorrhage, leading to grading variability and inconsistent follow-up.
Purpose:
To present a developmentally tuned, imaging atlas enabling radiologists to distinguish physiologic GM maturation from germinal matrix hemorrhage (GMH) using standardized cranial ultrasound (US) and MRI techniques and terminology.
Educational Objectives
1. Summarize GM anatomy, vascular “hot spots,” and week-by-week involution.
2. Standardize US across anterior, posterior, and mastoid windows for optimal assessment of the caudothalamic groove and posterior fossa.
3. Specify age-related normal variants vs hemorrhage on US and MRI (T1/T2, SWI, DWI), with key sequence-specific pitfalls.
4. Provide a concise measurement/reporting lexicon to improve reproducibility and inter-reader agreement.
Content Highlights:
- Anatomy & Maturation Map: Caudothalamic groove, subependymal region, ganglionic eminence; gestational-week echogenicity charts.
- Acquisition Essentials: Minimal-variance US (required planes, cine sweeps, gain/depth); a 12–15-minute, sedation-sparing MRI set (3D T2, axial T2/T1, DWI/ADC, SWI) with neonatal parameter tips.
- US Pattern Library: Early symmetric subependymal echogenicity; benign choroid plexus prominence; venous plexus near the foramen of Monro; beam-angle/anisotropy effects that simulate clot.
- MRI Pattern Library: Age-appropriate T1/T2 at the caudothalamic notch; SWI venous blooming vs microbleed; diffusion pitfalls along the ventricular wall.
- Mimics & Traps: Choroid plexus lobulations, mineralizing vasculopathy speckles, dependent ventricular debris, partial-volume at the groove, posterior fossa venous plexus on mastoid views.
- Consistency Toolkit: Correct caliper placement for ventricular indices; elements (location, side, extent, confidence).
Conclusion
Germinal matrix appearance is gestation-dependent; interpretations must be age-calibrated. Meticulous acquisition, appropriate window selection and optimized probe technique, including routine posterior/mastoid views reduces posterior fossa misses. Sequence-aware MRI reading (3D T2, SWI, DWI) limits venous and anisotropy misclassification. Standardized terminology and measurements improve report clarity, interobserver agreement, and reliability of follow-up imaging. Read More

Authors:  Sahu Asutosh , Prabhu Sanjay

Keywords:  Intracranial Hemorrhage, Ultrasound and MRI

Soker Tom,  Wien Michael

Final Pr. ID: Poster #: EDU-062

Objectives:
To review normal neonatal brain anatomy as seen on ultrasound.
To review the pathophysiology of common brain injuries in premature neonates.
To detail the utility of ultrasound and MRI in evaluation of common neonatal brain injuries.

Table of contents:
US evaluation of the neonatal brain
–Review standard views
–Review normal neonatal brain anatomy
Pathophysiology of Germinal Matrix Hemorrhage (GMH)
Review of ultrasound and MRI findings in GMH
–Initial injuries, and how they evolve over time
–Sample cases and mimics
Pathophysiology of Periventricular Leukomalacia (PVL)
Review ultrasound and MRI findings in PVL
–Initial injuries, and how they evolve over time
–Sample cases
Summary and key facts Read More

Authors:  Soker Tom , Wien Michael

Keywords:  Germinal Matrix Hemorrhage, Brain Ultrasound, Pediatric Neuroradiology