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

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

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

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