Ramirez Suarez Karen,  Miranda Schaeubinger Monica,  Barton Katherine,  Riedesel Erica,  Otero Hansel

Final Pr. ID: Poster #: EDU-022

The Choosing Wisely initiative, led by the American Board of Internal Medicine (ABIM) Foundation in collaboration with over 80 medical societies and organizations, was launched in 2012 in the United States and Canada. Choosing Wisely is a response to the estimation that roughly 20% of current medical tests and therapies lack justification, provide no value, and may pose risks. The American Academy of Pediatrics (AAP) became a participant in Choosing Wisely from the start, resulting in 16 pediatric specialty-specific lists designed to assist AAP members in responsible healthcare resource management. While pediatric radiology did not develop its own list, imaging recommendations were included on fully half of the published AAP/Choosing Wisely lists. Read More

Authors:  Ramirez Suarez Karen , Miranda Schaeubinger Monica , Barton Katherine , Riedesel Erica , Otero Hansel

Keywords:  Pediatric, Imaging, Radiology

Cheng Jocelyn,  Leesmidt Kantheera,  Liu Amanda,  Young Victoria,  Davda Sunit,  Berger-chen Sloane,  Courtier Jesse

Final Pr. ID: Poster #: EDU-039

Three-dimensional (3D) imaging has emerged as a valuable tool in diagnosing pediatric Müllerian duct anomalies (MDAs), offering superior anatomical visualization and assessment compared to traditional imaging techniques with two-dimensional ultrasound. MDAs are frequently associated with other congenital anomalies of the cervix, vagina, or urinary tract, and are a common cause of infertility and pregnancy loss after adolescence.

In pediatric patients, MDAs are often discovered incidentally during imaging for other conditions. Magnetic resonance imaging (MRI) is the preferred modality for evaluating MDAs in children, providing multiplanar capabilities and detailed soft tissue characterization while avoiding ionizing radiation. MRI protocols for MDAs typically include T2-weighted sequences for visualizing uterine morphology and T1-weighted sequences to detect blood products in cases of associated endometriosis or hematometra .

The use of 3D MRI techniques allows for enhanced depiction of uterine and vaginal anatomy, and is particularly advantageous in differentiating complex anomalies such as septate and bicornuate uteri. Additionally, 3D reconstructions can provide a virtual hysterosalpingogram (MR-HSG), offering a comprehensive assessment of the reproductive tract without the need for invasive procedures. 3D imaging's accuracy extends to the detection of associated renal anomalies, given the concurrent development of the urinary and reproductive systems. Identifying these anomalies early is crucial for planning surgical interventions that may involve both gynecologic and urologic components .

Overall, 3D imaging significantly enhances the diagnostic accuracy and management of pediatric Müllerian duct anomalies. By providing detailed anatomical insights and allowing for non-invasive classification, it plays a critical role in guiding treatment strategies, reducing the need for repeat surgeries, and improving long-term reproductive outcomes for affected patients.

The purpose of this educational exhibit is to:
1. Review the embryology, classification, and imaging features of Müllerian duct anomalies using 3-dimensional imaging
2. Review the indications and techniques for surgical management of Müllerian duct anomalies in pediatric patients
3. Provide sample cases and clinical courses of patients with specific Müllerian duct anomalies with tips for implementation of 3-D imaging
4. Allow learners to test their knowledge with a quiz. Read More

Authors:  Cheng Jocelyn , Leesmidt Kantheera , Liu Amanda , Young Victoria , Davda Sunit , Berger-chen Sloane , Courtier Jesse

Keywords:  MRI, Mullerian Duct Anomalies, 3D Imaging

Markowitz Richard

Final Pr. ID: Poster #: EDU-011

This poster reviews the early origins of the SPR, how it came to be, and who were the leaders who were responsible for its creation. These leaders and “giants” went on to train others who carried on their work and expanded it. Today, most pediatric radiologists can trace their professional genealogy back to one of the original founders of the SPR. As the SPR has grown and developed, it has become more inclusive and diverse. Twelve outstanding women have been presidents of the SPR since 1977. From the original goal of sharing a few cases among friends, it has grown into a mature, scientifically based platform for the creation and dissemination of new and cutting-edge developments in the field of pediatric imaging. We owe a debt of gratitude to those who preceded us; we remain inspired by them; and we carry forward their commitment, wisdom, and dedication to advancing the best practices to enhance children’s health. Read More

Authors:  Markowitz Richard

Keywords:  Education, Imaging, Pediatric Radiology

Huang Yungui,  Krishnamurthy Rajesh,  Hu Houchun,  Luna John,  Krishnamurthy Ramkumar,  Lubeley Lacey,  Buskirk Tricia,  Karczewski Arleen,  Garrett Whitney,  Lin Simon,  Mcallister Aaron

Final Pr. ID: Poster #: EDU-040

Background: Image quality in MRI is often degraded by patient motion. To reduce the need for repeat exams, sedation or general anesthesia is used in pediatric patients. This requires additional clinical staff, and leads to increased scheduling wait times and overall procedure times that impact workflow. Many institutions prepare children for MRI using mock-up replicas. While effective in acclimating patients to the MRI environment, the availability of mock-up practices are often limited. Mock-ups also require physical space and do not simulate the full MRI environment and exam experience.

Purpose: We build an affordable, scalable, and portable immersive virtual reality (IVR) platform for simulating MRI exams. Specifically, we designed an IVR environment that accurately mimics a Siemens 3 Tesla suite within our Radiology practice, including intricate details such as room size, color, lighting, ancillary equipment, pulse sequence audio, and background noise. The IVR platform also attempts to simulate the complete sequence of events and environments a child will experience during an exam, including the check-in process, interactions with staff (e.g., nurses, technologists), the waiting area and changing rooms, the positioning and motion of the MRI table, placement of coils, and within-exam instructions, such as breath-holds. Our platform also allows the patient to move around in the VR space and interact with the environment. Additionally, the platform can be easily converted to mimic any other MR suite. We hypothesize that our platform can be easily adopted by Child Life and hospital staff to quickly acclimate a patient and assess whether he/she can suitably undergo an MRI exam without sedation or general anesthesia.

We believe the IVR platform can overcome the limitations of mock-up replicas. First, IVR has a smaller footprint and is scalable and portable across the hospital. This allows multiple IVR sessions to be held in parallel. Second, IVR can give the patient a hospital-specific and scan-specific first-person experience. The patient can interact with realistic 3D representations of the MRI environment and processes. Our current implementation of IVR was developed using HTC VIVE headsets with a dedicated laptop for control. To further improve portability, the IVR setup can be adopted using simple goggles and handheld devices. This will enable future IVR sessions to be conducted at the bedside, in patient’s homes, and in referring physician offices. Read More

Authors:  Huang Yungui , Krishnamurthy Rajesh , Hu Houchun , Luna John , Krishnamurthy Ramkumar , Lubeley Lacey , Buskirk Tricia , Karczewski Arleen , Garrett Whitney , Lin Simon , Mcallister Aaron

Keywords:  magnetic resonance imaging, virtual reality, simulation

Mutambuze Jean,  Marine Megan

Final Pr. ID: Poster #: EDU-024

Fetal neck masses are a complex and diverse group of anomalies that can present diagnostic and management challenges for clinicians. In addition to prenatal ultrasound, fetal magnetic resonance imaging (MRI) has emerged as a powerful tool for the evaluation of these masses due to its high soft tissue contrast and ability to provide detailed anatomical information, especially with respect to the fetal airway and mediastinum. This educational exhibit explores the use of fetal MRI in the assessment of 7 different head and neck masses encountered at our institution, including providing a diagnostic approach, describing imaging features, and demonstrating the utility of fetal MRI in predicting the level of airway management the fetus may need, providing important implications for prenatal counseling and delivery management. Read More

Authors:  Mutambuze Jean , Marine Megan

Keywords:  Fetal Imaging, Fetal Masses, Fetal MRI

Ly Juan Domingo,  Subramanian Subramanian,  Rajan Deepa,  Greene Stephanie,  Zuccoli Giulio

Final Pr. ID: Poster #: CR-010

An 11-year-old female presented with 3-weeks history of intractable vomiting, nausea, blurred vision, vertical nystagmus and ataxia with gait instability. A CT scan revealed a small calcification at the left craniocervical junction (CJJ) and mild effacement of the fourth ventricle (Figure). MRI showed a partially-enhancing medulla oblongata lesion and a non-enhancing cystic exophytic lesion abutting the left pre-medullary cistern. There was avid thick enhancement along the ventrolateral surface of the medulla oblongata. No restricted diffusion was present. MR spectroscopy demonstrated decreased NAA and elevated lactates. Based on imaging findings, a brainstem glioma with exophytic component was suspected. The CBC, CMP, ESR and CRP were normal. The patient underwent suboccipital craniectomy with C1 laminectomy, and an exophytic pale gray mass was identified. Multiple specimens were taken, and frozen diagnosis showed only necrosis. The cyst wall was resected. Resection of the brainstem component was limited by neurophysiology. Histologically, the lesion consisted of a fibrous cyst wall lined by columnar to pseudostratified columnar epithelium, findings reflecting a neuroenteric cyst. No glial tissue was identified. Gram stain and Grocott stain were negative for bacterial and fungal specimens. An empiric treatment with wide spectrum antibiotic was started. Follow-up MRI demonstrated near complete resolution of edema in the medulla oblongata, and substantial decrease in enhancement in anterolateral exophytic component and patient has substantially improved clinically. In retrospect, a sinus tract extended from the cystic lesion at the craniocervical junction into the brainstem causing edema, inflammation and enhancement which resolved once the cyst was surgically decompressed.

Conclusion:
This case shows a neuroenteric cyst connected to the brainstem, through a sinus tract leading to chronic inflammation and infection, resulting in imaging findings resembling a brainstem glioma. Surgical decompression of the cyst and antibiotic treatment resulted in resolution of the brainstem lesion. Read More

Authors:  Ly Juan Domingo , Subramanian Subramanian , Rajan Deepa , Greene Stephanie , Zuccoli Giulio

Keywords:  Neurenteric, magnetic resonance imaging MRI, glioma

Dykie Adam,  Katzman Philip,  Chaturvedi Apeksha

Final Pr. ID: Poster #: EDU-037

Wilms tumors, also known as nephroblastomas, are overwhelmingly the most common renal tumors in children. While radiologists are abundantly familiar with the imaging appearances of these tumors, their knowledge of underlying histologic features, prognostic variables, and treatment approaches may not be equally robust. Histologically typically triphasic and containing differing proportions of blastemal, epithelial, and stromal components, the prognosis of individual subtypes differs. The “teratoid” variant of Wilms tumor contains components of differentiated tissues such as muscle, bone, cartilage, and fat. Focal and diffuse anaplasia are important histological features with diffuse anaplasia recognized as the most important prognostically unfavorable feature. In addition, there is an intermediate category of “nuclear unrest” which carries some but not all features of anaplasia. Clinical approaches differ between the two major renal tumor clinical research groups: the International Society of Paediatric Oncology (SIOP) Renal Tumor Study Group and the Children's Oncology Group (COG) Renal Tumor Group. This exhibit uses a case-based template of radiologic-pathologic correlation of different Wilms subtypes encountered at our institution, outlining treatment for individual tumor subtypes. We discuss differential diagnoses which may overlap with Wilms tumor on imaging, including nephrogenic rests, mesoblastic nephroma, malignant rhabdoid tumor of the kidney, clear cell sarcoma, and pediatric cystic nephroma (as a mimic of cystic Wilms tumor). We review Wilms tumor classification with known syndromic associations. We provide information on staging through the National Wilms Tumor Study system covering imaging and post-surgical findings. The ultimate goal is to make radiologists more effective members of the interdisciplinary tumor boards through enhancing a holistic understanding of Wilms tumor. Read More

Authors:  Dykie Adam , Katzman Philip , Chaturvedi Apeksha

Keywords:  Wilm's Tumor, Kidneys, Abdominal Imaging

Elcic Lana,  Nashawaty Motassem,  Mousa Abeer,  Wermers Joshua

Final Pr. ID: Poster #: CR-014

Twin molar pregnancy featuring a complete hydatidiform mole and a coexisting live fetus is a rare but important condition with unique imaging findings. A 24-year-old pregnant female presented for concern for molar pregnancy on ultrasound at an outside facility. The gestational age of the pregnancy at presentation was 22 weeks and 6 days. MRI was obtained which revealed a single living fetus in cephalic presentation. Along the anterior and left lateral uterine body/fundus was a large lesion with multiple small discrete T2 hyperintense cysts intermixed with more solid T2 isointense components, as well as T2 hypointense, T1 hyperintense foci consistent with hemorrhagic products. The lesion was distinct and did not arise from the placenta. Same day ultrasound revealed a “snowstorm” appearance, consistent with twin molar pregnancy with a complete hydatidiform form and coexistent live fetus. Read More

Authors:  Elcic Lana , Nashawaty Motassem , Mousa Abeer , Wermers Joshua

Keywords:  Ultrasound and MRI, Fetal Imaging, Pregnancy

Rana Abhilasha,  Mansfield Kori,  Radder Shrinivas,  Razzaq Sania,  Jayappa Sateesh,  Charles Glasier,  Ramakrishnaiah Raghu,  Murphy Janice

Final Pr. ID: Poster #: CR-017

Meroanencephaly is an extremely rare open neural tube under anencephaly spectrum with midline superior calvarial defect, herniation of disorganised brain parenchyma through the defect with deficient overlying skin. Anencephaly has an incidence of 0.1% on antenatal ultrasound, meroanencephaly is even rarer accounting for 3.4% cases of anencephaly. MRI is the modality of choice for complete assessment of meroanencephaly and antenatal ultrasonographic findings should be confirmed with fetal MRI.
A 35-year-old female presented for fetal MRI after suspicion of occipital encephalocele on antenatal ultrasound. MRI showed microcephaly with thin and abnormally shaped calvarium, a midline calvarial defect in the region of vertex with brain parenchyma protruding through the defect and deficient overlying skin covering. Meningeal covering was difficult to assess due to oligohydroamnios and close apposition of skull to uterine wall. There was absence of ventricular system and lack of normal supratentorial and infratentorial anatomical landmarks. Fetal face was normal. Persistent fetal thoracic kyphotic curvature was observed throughout the examination, spinal cord and spinal canal were normal with no spinal dysraphism. No other anomalies were demonstrated. Read More

Authors:  Rana Abhilasha , Mansfield Kori , Radder Shrinivas , Razzaq Sania , Jayappa Sateesh , Charles Glasier , Ramakrishnaiah Raghu , Murphy Janice

Keywords:  Fetal Magnetic Resonance Imaging, Brain, Congenital

Noga Michelle,  Tham Edythe,  Punithakumar Kumaradevan

Final Pr. ID: Poster #: SCI-034

Cardiac magnetic resonance imaging (CMR) is commonly used in evaluation of patients with repaired Tetralogy of Fallot (TOF). Impaired peak strain by echocardiography in TOF has been associated with adverse clinical outcome. Assessment of myocardial deformation (strain) using novel CMR software may provide prognostic information in TOF. Because of ventricular interaction, abnormal left ventricle (LV) mechanics are seen in echocardiography speckle tracking. We aimed to determine correlates of right (RV) and LV function using LV diastolic filling analysis in patients with repaired TOF. Read More

Authors:  Noga Michelle , Tham Edythe , Punithakumar Kumaradevan

Keywords:  Cardiac, magnetic resonance imaging, Tetralogy of Fallot

Venkatakrishna Shyam Sunder,  Chacko Anith,  Schoeman Sean,  Andronikou Savvas

Final Pr. ID: Poster #: SCI-029

Effective text-based communication, through radiologist reports, of imaging findings in term Hypoxic Ischemic Injury (HII) to family members, non-radiologist colleagues and members of the legal profession can be extremely challenging. Utilization of 3D printed models, where the actual findings of the brain can be communicated via tactile perception and rotating/grasping the models is a potential solution which has not been tested in practice. We aimed to determine the sensitivity and specificity of different groups, comprising trained radiologists, non-radiologist physicians and non-physicians, in the detection of gross disease of the cerebral cortex from 3D printed brain models derived from MRI scans of children. Read More

Authors:  Venkatakrishna Shyam Sunder , Chacko Anith , Schoeman Sean , Andronikou Savvas

Keywords:  Magnetic Resonance Imaging, 3D Printing, Hypoxic Ischemic Injury

Sawyer David,  Mushtaq Raza,  Vedantham Srinivasan,  Udayasankar Unni

Final Pr. ID: Paper #: 096

Acute appendicitis represents an important cause of abdominal pain in pediatric patients. Although imaging plays an increasingly important role in the rapid diagnosis and management of this condition, there is no universally accepted strategy for imaging children suspected of having acute appendicitis. Ultrasound and computed tomography have been used most commonly, but there is rising interest in the use of magnetic resonance imaging (MRI) due to its lack of ionizing radiation or need for intravenous contrast. Recent research has shown that MRI has high diagnostic performance when employed as a first-line test. However, when considering the generalizability of MRI outside of a specialized tertiary care center, the question of operator dependence arises. To determine the performance of MRI when interpreted by readers with limited experience, we performed a retrospective review of preliminary MRI interpretations rendered by radiology residents at our institution, compared with final (attending radiologist) interpretations. Read More

Authors:  Sawyer David , Mushtaq Raza , Vedantham Srinivasan , Udayasankar Unni

Keywords:  Acute appendicitis, Magnetic resonance imaging

Brahee Deborah,  Towbin Alexander

Final Pr. ID: Poster #: EDU-028

Pediatric pathology involving the jejunum is more common than one might initially expect. Early recognition of the important imaging characteristic, atypical findings, and useful imaging tools/techniques in the evaluation of jejunal pathology is important in prompt diagnosis and management of these patients.

In this educational exhibit we will present a series of cases involving pathology of the jejunum encountered in the pediatric population. We will focus on important pathologies affecting a difficult to image and sometimes forgotten portion of the intestine.

A range of acute, emergent and post-surgical cases are presented. Using an interactive, quiz based approach we will discuss the following pediatric pathologies that may affect the jejunum of pediatric patients from neonates to teenagers with multimodality imaging and pathologic examples:
Atresia
Meconium plug syndrome
Pneumatosis
Enteritis
Foreign body
Small bowel intussusception
Lymphoma
Ischemia/shock
Hernia
Graft versus host disease
Trauma
Vasculitis Read More

Authors:  Brahee Deborah , Towbin Alexander

Keywords:  Gastrointestinal, Pediatric, Imaging

Walcutt Julie,  Love Terri

Final Pr. ID: Poster #: CR-027

Introduction: Acute flaccid myelitis (AFM) is a relatively new subcategory of acute flaccid paralysis affecting children, which has gained increasing attention in the medical community and media in recent years. AFM is characterized by rapid onset acute flaccid limb weakness with spinal cord lesions on magnetic resonance imaging (MRI) predominantly involving the gray matter. Cranial nerve involvement has also been described. The severity of AFM nearly always requires hospitalization for supportive care, which may include mechanical ventilation. Evidence is lacking regarding the utility of specific therapies, although patients have been treated with intravenous immune globulin, steroids, and antiviral therapy. Unfortunately, though neurological improvement may occur, the majority of patients are left with persistent deficits.

We present the imaging findings of three children with varying presentations and outcomes of acute flaccid myelitis treated at a tertiary care children’s hospital.

Case 1: An 11-year-old girl developed severe upper extremity weakness requiring weeks of inpatient rehabilitation with plan for evaluation for nerve transfer. MRI showed abnormal increased T2 signal of nearly the entire spinal cord, most notable in the cervical spinal cord.

Case 2: A 9-year-old boy positive for Enterovirus presented with bilateral upper and lower extremity weakness, whose symptoms ultimately resolved. MRI of the brain and full spine were normal except for a thoracic spinal cord syrinx, which was felt to be incidental.

Case 3: A 2-year-old girl with a history of acute lymphoblastic leukemia developed bilateral upper extremity weakness and lower extremity areflexia during a hospitalization for an acute viral illness, complicated by chronic ventilator-dependent respiratory failure. MRI demonstrated enhancing T2 signal in the brainstem and cervical and thoracic spinal cord.

Discussion: Acute flaccid myelitis is an important pediatric neurological disorder of rapid clinical onset frequently resulting in persistent neurological deficits. Radiologists serve an important role in establishing the diagnosis by identifying this disease’s characteristic MRI findings. Read More

Authors:  Walcutt Julie , Love Terri

Keywords:  weakness, imaging

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

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

Final Pr. ID: Poster #: EDU-089

1) Review the normal development and anatomy of the posterior skull base.
2) Describe the variety of pathologies affecting the posterior 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 posterior cranial fossa pathology. Read More

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

Keywords:  Skull base, Posterior Cranial Fossa, Magnetic resonance imaging

Prince Morgan,  Edwards Emily

Final Pr. ID: Poster #: CR-010

Infantile myofibromatosis (IM) is a rare congenital disease of early childhood. Approximately 50% of cases are diagnosed prenatally, and 90% are diagnosed prior to 2 years of age. Solitary IM, multicentric IM without visceral involvement, and generalized IM with cutaneous and visceral involvement have been described, with generalized IM carrying a poor prognosis and high mortality rate. The following reported case demonstrates an unusually high disease burden.
The patient was a monochorionic diamniotic twin fetus found to have a cystic and solid left facial mass on routine prenatal anatomy scan. Initial differential included congenital hemangioma, as well as lymphatic malformation and teratoma. Multiple prenatal ultrasounds and fetal MRI were obtained between gestational age 22w0d and delivery. At 32w2d, a new large paraspinal mass extending from the thoracic spine to the proximal right lower extremity was noted. During retrospective review, mild soft tissue thickening was noted in this region on fetal MRI. At this point, a vascular malformation was favored, with a differential of congenital rhabdomyosarcoma less likely. Ultrasound surveillance for the remainder of the pregnancy showed enlargement of the paraspinal mass with extension into the right retroperitoneal space.
The patient was delivered at 35w0d gestation via cesarean-section. On physical examination, she was found to have multiple masses involving the face, and the paraspinal, buttock, and bilateral lower extremity soft tissues. While atrophic papules were present, there were no overlying skin changes as would be expected with vascular malformations. Given the firmness of the masses and atrophic papules, the diagnosis of infantile myofibromatosis was suspected.
Whole-body MRI with contrast was obtained, demonstrating extensive heterogeneously enhancing soft tissue masses involving the left check, lower back extending into the retroperitoneal space, bilateral gluteal muscle and lower extremities.
The patient’s clinical status declined, and given the poor prognosis, was transitioned to comfort care and expired at age 2 months. Post-mortem autopsy confirmed the diagnosis of generalized infantile myofibromatosis with innumerable myofibromas of the right atrium, ventricles, intercostal muscle, diaphragm, thyroid, lungs, pancreas, adrenal glands, vertebrae, and paraspinal muscles.
The surviving twin is currently 2 years of age and is screened with whole-body MRI annually without evidence of disease. Read More

Authors:  Prince Morgan , Edwards Emily

Keywords:  Infantile Myofibromatosis, Fetal Imaging, Congenital

Stanley Parker,  Stanley Charles

Final Pr. ID: Poster #: EDU-010 (T)

In 2017, roughly 2 trillion (2,000,000,000,000) medical images were produced, reviewed, reported, archived, and used in the detection and management of disease. Based on historical trends, this number has doubled every 5 years and is accelerating. This explosive growth in imaging data has created major opportunities for the use of Artificial Intelligence (AI). The question is less whether radiologists, and technologists, will be replaced by AI (they will not) and more about whether we could survive without AI. Although intelligent algorithms have been used for some time in segments of the imaging field, new methods of machine learning, based particularly on “deep learning”, are much more powerful. Many of the deep learning publications today point to the promise of significant advances in efficiency, precision, reproducibility, and prognostic abilities.
If AI will not replace radiologists/technologists but rather augment them with tools to meet the rising demands for diagnostic imaging, then it is imperative that we have a basic understanding of the concepts and language that defines this area of knowledge. In the not so distant past the average technologist understood the basics of film processing but wouldn’t even recognize the words DICOM or EMR; we are now at that point of change with AI. Deep learning, machine learning, neural networks, ground truth, the list goes on. The goal of this presentation is to provide a basic framework of the concepts, terminology, and references to how AI has, and likely, will be employed in medical imaging, thus making us better practitioners and partners with this technology.
Read More

Authors:  Stanley Parker , Stanley Charles

Keywords:  Artificial Intelligence, Medical Imaging, Technologist

Tsang Brian,  Gupta Aaryan,  Takahashi Marcelo,  Ola Tolulope,  Baffi Henrique,  Doria Andrea

Final Pr. ID: Poster #: SCI-031

1) To systematically review the uses of AI for magnetic resonance (MR) imaging assessment of primary pediatric cancer and identify common literature topics and knowledge gaps. 2) To assess the adherence of the existing literature to the Checklist for Artificial Intelligence in Medical Imaging (CLAIM) guidelines. Read More

Authors:  Tsang Brian , Gupta Aaryan , Takahashi Marcelo , Ola Tolulope , Baffi Henrique , Doria Andrea

Keywords:  Artificial intelligence, Pediatric cancer, Magnetic resonance imaging

Sarrami Amir Hossein,  Wang Hongzhi,  Baratto Lucia,  Syeda-mahmood Tanveer,  Daldrup-link Heike

Final Pr. ID: Poster #: EDU-078

Medical Imaging has a crucial role in the diagnosis and management of pediatric cancer patients by providing information about tumor location and quantitative measures of tumor size and metabolic activity at baseline as well as during and after therapy. The standard imaging plan for staging and re-staging of pediatric malignancies includes a high-resolution MRI or CT scan of the local tumor and whole body staging for the detection of metastases on CT, MRI and/or PET scans. Children with lymphomas, sarcomas, germ cell tumors and a few other tumor types are referred to whole body 18F-FDG PET scanning, either coupled with CT or MRI. Artificial intelligence (AI) algorithms can facilitate staging and re-staging of cancers in children by providing 1) rapid detection and delineation of tumoral lesions, 2) automated measurements of tumoral size and metabolic activity, 3) relating tumor measurements to internal standard such as liver and blood pool, 4) assigning a score according to tumor-specific staging systems.

Detecting tumors on a whole-body scan is a challenging task, especially in children whose organs undergo changes in size and composition with increasing age. Moreover, the tumors in children can arise from almost anywhere in the body, from head to toe. With successful applications on object detection, AI methods are promising for automatic tumor detection from whole-body scans as well. In this tutorial, we will introduce a few popular AI methods for such purpose. These methods include U-Net, Vision Transformers (ViT), and the hybrid of the above methods such as O-Net Transformer or TransUNet. Read More

Authors:  Sarrami Amir Hossein , Wang Hongzhi , Baratto Lucia , Syeda-mahmood Tanveer , Daldrup-link Heike

Keywords:  Hybrid Imaging, Artificial Intelligence, Cancer

Haddad Sophie,  Foran Ann,  Tierradentro-garcia Luis,  Ho Fung Victor M,  Hwang Misun

Final Pr. ID: Poster #: CR-025

Hypoxic ischemic encephalopathy (HIE) is a significant cause of severe long term neurological impairment and mortality in the newborn. It develops in two stages; the ischemic phase caused by hypoxia leading to cytotoxic edema, followed by the reperfusion phase with the release of reactive oxygen species leading to oxidative damage and vasogenic edema. Imaging plays a key role in diagnosis, management, and treatment of HIE. It also offers important prognostic information. MRI remains the preferred imaging modality.
Microvascular imaging (MVI) is a novel advanced Doppler ultrasound (US) technique that permits visualization of the microvasculature without the administration of contrast agents. It enhances the visualization of flow signal in the microvessels and helps reveal functional insights into the brain at high resolution.

A female newborn of 32 weeks of gestation was delivered by urgent C-section following absent fetal movements and suspected placental abruption. She was born to a mother with a reported exposure to cocaine with a last use the week prior to delivery. At birth, no pulse was detected, and CPR was initiated immediately. O2 saturation remained low during resuscitation despite intubation and a FiO2 of 100%. Return of spontaneous circulation was noted 50 minutes after birth. Following birth, the patient was diagnosed with severe HIE and had multiple seizures. Her physical exam revealed fixed and cloudy pupils with a diameter of 4 mm and no brainstem reflexes. At one day of life, a brain US was done and displayed diffusely increased echogenicity of the parenchyma and crowding of the cortical gyri concerning for cerebral edema. MVI revealed markedly increased microvascular perfusion in the basal ganglia, thalami, and periventricular region consistent with post-ischemic reperfusion in the setting of HIE. MRI showed diffusion restriction throughout the brain including the medial temporal lobes, hippocampi, thalami, basal ganglia, and frontoparietal cortex. Also noted was extensive hyperintense signal abnormality on T2-weighted sequences within both the gray and white matter with loss of the gray-white matter differentiation and moderate sulcal effacement. These findings confirmed the diagnosis of severe HIE.

In our case, MVI demonstrated marked hyperperfusion in the basal ganglia, thalami and periventricular region. Whether this MVI flow signature can prognosticate poor clinical outcomes, it warrants further investigation. Read More

Authors:  Haddad Sophie , Foran Ann , Tierradentro-garcia Luis , Ho Fung Victor M , Hwang Misun

Keywords:  Microvascular Imaging, Hypoxic ischemic encephalopathy

Brahee Deborah,  Chan Andrea,  Emery Kathleen,  Cornwall Roger,  Maloney Thomas

Final Pr. ID: Poster #: SCI-048

Physeal injuries can result in premature physeal fusion. MR imaging is useful for mapping these bony physeal bridges. Resection of the bony bridge does not reliably restore normal physeal function. We have observed subtle loss of the normal low signal intensity line of the zone of provisional calcification (ZPC) extending beyond areas of physeal bar formation in some patients with prior growth plate fractures. This loss is a marker of disrupted endochondral ossification and likely reflects a more extensive region of physeal damage that might be used to better predict treatment outcomes. Given the subjectivity of visual ZPC assessment, we sought to develop a quantitative 3D map of the periphyseal area of the distal radius using a high resolution 3D fast/turbo spin echo sequence. Read More

Authors:  Brahee Deborah , Chan Andrea , Emery Kathleen , Cornwall Roger , Maloney Thomas

Keywords:  Physis, MRI, Imaging

Jin Annie,  Bao Shashan

Final Pr. ID: Poster #: CR-015

Rhabdomyosarcoma is a common pediatric soft tissue cancer with about 31% of cases in the urinary tract and 25% of cases in the head and neck. Although rhabdomyosarcomas are common, primary intrahepatic rhabdomyosarcomas are very rare and have a poor prognosis. In fact, there have only been 20 reported cases from 1956 through 2017, and the mean survival time of 9.25 months.

A 3-year-old male with a history of constipation presented with a 3-days of low-grade fevers of 99-100 F, periumbilical pain, and anorexia. On physical exam, there was a palpable, tender RUQ mass. Labs showed an elevated ALT of 159, AST of 179, and alkaline phosphatase of 748. A radiograph of the abdomen showed a soft tissue opacity in the right upper quadrant which displaced the large and small bowel loops. Further imaging included an ultrasound, CT, and MRI. The ultrasound confirmed a large mostly solid mass in the right hepatic lobe. CT imaging showed a large heterogeneous liver mass measuring 10.5 x 10.0 x 14.0 cm. The mass extended superiorly to the dome of the liver, involved the caudate lobe, and compressed the IVC. An indeterminate lucency of the right femoral neck was also noted. A follow up MRI showed that the liver mass displaced the hepatic veins, main portal vein and right portal vein. Additionally, innumerable lesions were found on the axial skeleton and periportal lymphadenopathy was seen suggesting metastasis. PET scan further confirmed bony metastasis of the right femur. Initially, hepatoblastoma was highest on the differential. However, liver wedge biopsy showed myxoid spindle cell areas and small round blue cell areas. These findings favored the diagnosis of rhabdomyosarcoma as opposed to hepatoblastoma which would have had an epithelial component. Bone marrow biopsy further confirmed metastasis. As a result of this diagnosis, the patient was started on vincristine, dactinomycin, cyclophosphamide. Pain was controlled with morphine and acetaminophen. Nausea was controlled with Ativan, Zofran, Reglan, and Benadryl. The patient’s abdominal distension and constipation responded well to a stool regimen and multiple enemas. The patient was discharged in stable condition with oncology follow up.

Hepatic rhabdomyosarcoma is a rare malignancy, and early diagnosis and treatment has been beneficial in prolongation of mean survival time. Diagnostic imaging modalities and pathology findings are an essential part of the work up and can be used to guide the treatment and management. Read More

Authors:  Jin Annie , Bao Shashan

Keywords:  Hepatic Rhabdomyosarcoma, Spindle Cell, Diagnostic Imaging

Vargas M Cecilia,  Crido Silvina,  Quintero Karina,  Alonso Jose,  Rizzi Ana,  Pibernous J,  Lipsich Jose,  Moguillanky Slvia

Final Pr. ID: Poster #: CR-018

Aortic dissection in children is often associated with congenital heart disease (bicuspid aortic valve or aortic coarctation), collagenopathies or serious injuries. It rarely arises as a differential diagnosis in the presence of thoracic or abdominal pain in an apparently healthy child. Early diagnosis and treatment is crucial to their survival.
Our purpose is describe the clinical and images characteristics that allowed to diagnose . Read More

Authors:  Vargas M Cecilia , Crido Silvina , Quintero Karina , Alonso Jose , Rizzi Ana , Pibernous J , Lipsich Jose , Moguillanky Slvia

Keywords:  aortic dissection, stent-grafts, imaging, Chronic hypertension

Mohamed Ezzelarab Soliman Magdy,  Doria Andrea,  Bouskill Vanessa,  Mohanta Arun,  Zhang Ningning,  Zhou Alex,  Jarrin Jose,  Huo Ai Hua,  Wu Runhui,  Peng Yun

Final Pr. ID: Poster #: SCI-058

POC-US aims at shortening the scanning and interpretation time being easy to use by clinicians and allied health professionals at the time of patients’ physical examination. Our purposes are: 1. To compare POC-US to detailed US and MRI in evaluating hemophilic arthropathy. 2. To point out limitations of POC-US that can decrease its accuracy. 3. To propose strategies to refine protocols. Read More

Authors:  Mohamed Ezzelarab Soliman Magdy , Doria Andrea , Bouskill Vanessa , Mohanta Arun , Zhang Ningning , Zhou Alex , Jarrin Jose , Huo Ai Hua , Wu Runhui , Peng Yun

Keywords:  hemophilic arthropathy, imaging, point of care ultrasound

Matsubara Yoshiko,  Miyazaki Osamu,  Nosaka Shunsuke,  Kosuga Motomichi,  Okuyama Torayuki,  Awai Kazuo

Final Pr. ID: Poster #: SCI-002

Enzyme replacement therapy (ERT) is approved for the treatment of mucopolysaccharidoses (MPS) I: Hurler syndrome (IH), Hurler-Scheie syndrome (IHS) and Scheie syndrome (IS), II: Hunter syndrome, and VI: Maroteaux-Lamy syndrome. However, ERT is thought to have no therapeutic effect on the central nervous system (CNS) because the enzyme could not permeate through the blood-brain barrier (BBB). We aimed to assess CNS involvement in MPS at the start of ERT and to evaluate the interval changes demonstrated on magnetic resonance imaging (MRI) over a long-term follow up. Read More

Authors:  Matsubara Yoshiko , Miyazaki Osamu , Nosaka Shunsuke , Kosuga Motomichi , Okuyama Torayuki , Awai Kazuo

Keywords:  mucopolysaccharidoses, enzymatic replacement therapy, magnetic resonance imaging

Osman Radya,  Ahmed Ilham,  Yagoub Shima,  Bakeit Mohamed Salih,  Mustafa Elrayah,  Gabir Abdalla,  Marine Megan,  Karmazyn Boaz,  Gunderman Richard,  Heitkamp Darel,  Hibbard Roberta,  Miller Aaron,  Mohammed Alaaeldeen,  Satti Satti

Final Pr. ID: Poster #: EDU-053

To assess the awareness and knowledge of Radiologists, Pediatricians, Orthopedists and Emergency Physicians regarding child abuse incidence, imaging, and management in Sudan, Africa. Read More

Authors:  Osman Radya , Ahmed Ilham , Yagoub Shima , Bakeit Mohamed Salih , Mustafa Elrayah , Gabir Abdalla , Marine Megan , Karmazyn Boaz , Gunderman Richard , Heitkamp Darel , Hibbard Roberta , Miller Aaron , Mohammed Alaaeldeen , Satti Satti

Keywords:  Child Abuse, Africa, Imaging

Maleki Nazanin,  Amiruddin Raisa,  States Lisa,  Aboian Mariam

Final Pr. ID: Poster #: EDU-075

PET/MRI plays a significant role in Pediatric Oncology, but its implementation in Pediatric Neuro-Oncology has not been well established. PET/MRI addresses a major challenge in pediatrics by providing capability for serial imaging to track disease response to therapy, while minimizing radiation exposure and sedation events. PET/MRI has become a critical imaging modality in the management of pediatric brain neoplasms and metastases, aiding in diagnosis, staging, treatment planning, and follow-up, all while reducing radiation burden, minimizing time spent in the hospital, and reducing the number of sedation events.
At our tertiary center for pediatric care, we have gained extensive experience in utilizing hybrid PET/MRI to manage complex cases referred from multiple institutions. We present a series of cases where hybrid PET/MRI provided critical information for patient management including nasopharyngeal rhabdomyosarcoma, refractory metastatic germ cell tumor, and neuroblastoma. We offer a forward-looking perspective on the current role of FDG PET/MRI and future applications of amino acid PET in improving patient outcomes and its role in distinguishing tumor progression from post-treatment changes. Amino acid PET/MRI use cases were compiled from literature review and demonstrate definitive roles of amino acid PET/MRI in decision making in brain tumor diagnosis, immediate post-surgical assessment, and delayed treatment response assessment.
18F-FDG PET/MRI representative cases from clinical practice:
Case 1.
18 year old male with refractory metastatic germ cell tumor with anterior mediastinal mass and intracranial metastasis
Clinical Problem: Whole body evaluation in addition to detailed analysis of brain metastases in time efficient manner.
Imaging Solution: PET/MRI allowed detailed evaluation of hypermetabolic metastatic disease to the mediastinum and lungs and further detailed delineation of hemorrhagic brain metastases.
Case2.
4 year old boy with history of nasopharyngeal rhabdomyosarcoma with cerebellar metastasis who underwent resection and chemoradiation.
Clincial Problem: How to monitor nasopharyngeal mass after treatment in the setting of extensive postsurgical changes on MRI
Imaging Solution: PET/MRI provides an excellent imaging method for monitoring disease recurrence in the setting of post-treatment changes in nasopharyngeal location. Recurrent tumor was identified as hypermetabolic lesion, while MRI was not definitive. Read More

Authors:  Maleki Nazanin , Amiruddin Raisa , States Lisa , Aboian Mariam

Keywords:  PET-MRI, Pediatric Imaging, Brain Tumors

Chauhan Ankita,  Dillard Roger

Final Pr. ID: Poster #: EDU-076

Children often present to the emergency room (ER) with painful neck swelling, sore throat, and difficulty breathing. Careful clinical examination and good communication with pediatric physicians help plan the appropriate imaging workup for such pediatric patients. Knowing the various imaging appearances of the many encountered disorders of the neck in children further helps diagnose and plan the most appropriate management. Read More

Authors:  Chauhan Ankita , Dillard Roger

Keywords:  Neck, Pediatric, Imaging

Mannuru Sravani,  Hui Jessica,  Lai Lillian

Final Pr. ID: Poster #: EDU-018

Extralobar pulmonary sequestration (EPS) and cystic neuroblastoma (CN) are rare pediatric thoracoabdominal masses with distinct yet sometimes overlapping imaging features, posing diagnostic challenges for radiologists. Accurate differentiation is crucial for guiding clinical management and preventing unnecessary interventions. This review focuses on comparing the imaging characteristics of EPS and CN, with emphasis on key features that aid in distinguishing between these entities. EPS typically presents as a well-defined, homogenous mass located near the lower lobes of the lung, often with systemic arterial supply visualized on contrast-enhanced imaging. It may exhibit smooth margins and is commonly identified in neonates and infants. Conversely, cystic neuroblastoma, while rarer, typically manifests as a retroperitoneal mass, often arising from the adrenal gland, with a more complex appearance, including cystic and solid components. Calcifications, which are frequently seen in neuroblastoma, may provide a critical clue for diagnosis, while the absence of systemic arterial supply differentiates it from EPS. Pitfalls arise from the potential overlap in appearance, such as fluid-filled or cystic components within both lesions, which may lead to confusion. Additionally, both lesions may be incidentally discovered on prenatal or early postnatal imaging, necessitating careful evaluation of ancillary features such as vascular supply, location, and internal characteristics to ensure accurate diagnosis. This review offers radiology residents, fellows, and attending radiologists a comprehensive comparison of EPS and CN imaging findings, with a focus on avoiding common diagnostic traps. Understanding these key differences enhances diagnostic confidence, promotes appropriate management, and improves outcomes for pediatric patients. Read More

Authors:  Mannuru Sravani , Hui Jessica , Lai Lillian

Keywords:  Pediatric Radiology, Abdominal Imaging, Chest