Malavia Mira,  Rivard Douglas

Final Pr. ID: Poster #: EDU-068

Ischial tuberosity avulsion fractures, though not uncommon in adolescent athletes, are often overlooked or misdiagnosed. These fractures occur more frequently in males than females. Primary cause of this fracture type is usually a sudden eccentric load on the proximal hamstrings, typically seen during a kicking action in dance, football, or soccer. Due to the limited use of imaging in the evaluation of such injuries, these fractures often are misdiagnosed or underdiagnosed. Recent injuries warrant more conservative management, including rest and relative immobilization. In cases of late diagnosis, delayed healing, or persistent symptomatology, surgical intervention can be undertaken to restore normal anatomy, alleviate symptoms, and facilitate healing. Minimally invasive CT-guided percutaneous needle fenestration has been introduced for symptomatic delayed union ischial tuberosity fractures in adolescents. This percutaneous procedure involves the creation of multiple channels into the bone at the fracture site with an 18 gauge Chiba needle via image guided needle fenestration to enhance blood flow and promote healing of the target area. Following this, a tailored physical therapy program is implemented based on patient symptomatology, individual tissue healing rates, and the current literature related to proximal hamstring injuries. Outcomes to this minimally invasive approach have been promising including cases of complete pain relief, full functional recovery, and a return to sports without limitations.

Outline of Teaching Points:
Ischial tuberosity avulsion fractures are common in adolescent athletes, with a higher incidence in males, caused by sudden eccentric loads on proximal hamstrings during activities like dance, football, or soccer.
Due to limited imaging use, these fractures are often overlooked or misdiagnosed, leading to delayed healing or persistent symptoms.
Recent injuries may benefit from conservative management, involving rest and relative immobilization.
Surgical intervention becomes necessary for late diagnoses, delayed healing, or persistent symptoms to restore normal anatomy and alleviate symptoms.
Minimally invasive CT-guided percutaneous needle fenestration has shown promising outcomes, facilitating healing with complete pain relief and a return to sports without limitations. Read More

Authors:  Malavia Mira , Rivard Douglas

Keywords:  fracture, interventional radiology

Zhu Xiaowei,  Whitaker Jayme,  Shellikeri Sphoorti,  Cahill Anne Marie

Final Pr. ID: Poster #: EDU-046

It is important for radiologists to recognize and discuss with patients and families the potential risks and clinical manifestations of high Peak Skin Dose. In children undergoing complex Interventional procedures accurate Peak Skin Dose estimates are complicated and time consuming despite reference point doses being available. The availability of the Dose Structure Report (SR) on modern fluoroscopic equipment allows such estimates to be timely and consistent. The process of creating a Peak Skin Dose estimate using a validated radiation data management system (RDMS), capable of collecting detailed acquisition data and modeling will be discussed. Read More

Authors:  Zhu Xiaowei , Whitaker Jayme , Shellikeri Sphoorti , Cahill Anne Marie

Keywords:  Peak Skin Dose Estimation, Interventional fluoroscopic, Radiation Data Management System

Shellikeri Sphoorti,  Setser Randolph,  Acord Michael,  Srinivasan Abhay,  Vatsky Seth,  Escobar Fernando,  Whitaker Jayme,  Cahill Anne Marie

Final Pr. ID: Poster #: EDU-047

Percutaneous interventions are increasingly being performed under MR-guidance due to the absence of ionizing radiation, the ability to visualize target lesion and the capability to monitor real-time treatment effect. Here we outline our experience with developing an interventional MRI (iMRI) service at a pediatric institution. Read More

Authors:  Shellikeri Sphoorti , Setser Randolph , Acord Michael , Srinivasan Abhay , Vatsky Seth , Escobar Fernando , Whitaker Jayme , Cahill Anne Marie

Keywords:  Interventional MRI, MR-guided procedures

Ritchie David,  Negrete Lindsey,  Naheedy John

Final Pr. ID: Poster #: EDU-045

Trauma poses significant challenges to the pediatric emergency provider. From 1 to 14 years of age, traumatic injuries remain the leading cause of death for children in the United States. The majority of total mortality is attributable to motor vehicle collisions followed by bicycle accidents, falls, burns, and physical assaults. While the practice of interventional radiology (IR) in adults is undergoing considerable growth and expansion, so too are the techniques in their application to children.

We first review techniques that are more commonly encountered in pediatric IR trauma such as minimally invasive control of hemorrhage, percutaneous stenting, and arterial embolization. We then present cases that are less commonly encountered such as: hepatic laceration with pseudoaneurysm formation, pelvic fracture with CT-guided iliofixation, and humeral contusion with pseudoanuerysm formation of the anterior humeral circumflex artery. In all cases, the initial imaging performed in the emergency department will be highlighted throughout for each patient prior to showing any of the corresponding interventions.

After reviewing this exhibit, an attendee should be familiar with frequently encountered and less commonly encountered trauma in the pediatric IR setting. We hope the learner will gain comfort in the prompt recognition of acute traumatic pediatric imaging that may go on to subsequently require the intensivist’s attention. Read More

Authors:  Ritchie David , Negrete Lindsey , Naheedy John

Keywords:  Interventional, Trauma, Pseudoaneurysm

Metz Terrence,  Richer Edward,  Vellody Ranjith

Final Pr. ID: Poster #: EDU-094

To present nine classic pediatric diagnostic imaging cases and their subsequent interventional managements in order to emphasize the interventionalist's role in caring for the child and educate the pediatric radiologist to guide further care. Read More

Authors:  Metz Terrence , Richer Edward , Vellody Ranjith

Keywords:  Interventional, biopsy, drain, angiography

Kleedehn Mark,  Witt Jessica,  Laeseke Paul,  Woods Michael,  Monroe Eric

Final Pr. ID: Poster #: SCI-009

To evaluate patient and procedural variables for association with clinical outcomes in pediatric patients receiving IR drains. Read More

Authors:  Kleedehn Mark , Witt Jessica , Laeseke Paul , Woods Michael , Monroe Eric

Keywords:  Abscess, Interventional Radiology

Acord Michael,  Termine Carl,  Cahill Anne Marie,  Escobar Fernando

Final Pr. ID: Poster #: SCI-037

To assess the rate of dislodgement of posteriorly tunneled central lines, over-the-shoulder, in children. Read More

Authors:  Acord Michael , Termine Carl , Cahill Anne Marie , Escobar Fernando

Keywords:  venous access, back, interventional radiology

Hampton Erica,  Fuentealba Cargill Andrea,  Trenbeath Zachary,  Alazraki Adina,  Stence Nicholas,  Milla Sarah

Final Pr. ID: Poster #: EDU-076

Brain death, also known as death by neurologic criteria, (BD/DNC) is the permanent loss of total brain function in individuals who have sustained catastrophic brain injuries. Accounting for approximately 5% of pediatric deaths, BD/DNC remains a clinical diagnosis, which is often emotionally laden and not always straightforward. When results are equivocal or there exist limitations to the safe completion of the clinical assessment, clinicians rely on ancillary testing to make informed decisions. In October 2023, updated adult and pediatric BD/DNC consensus guidelines were published which reinforce differences in the recommendations for testing between the adult and pediatric populations. It is, therefore, crucial for Pediatric Radiologists to understand these guidelines and the critical role radiology plays in supporting this important diagnosis.
In this educational exhibit, we will review the recent consensus guidelines and clinical indications for the use of imaging in BD/DNC evaluation. We will provide a step-by-step guide which will include patient preparation, radionuclide or contrast administration, image acquisition, and image interpretation for the two validated methods of pediatric BD/DNC ancillary testing: Radionuclide Perfusion Scintigraphy and 4-Vessel Catheter Angiography.
Although 4 vessel catheter angiography is considered the gold standard in ancillary BD/DNC testing, as it is believed to be both 100% sensitive and 100% specific, radionuclide scintigraphy is the more widely used modality in the pediatric population, owing to the less invasive nature of the exam. Neither exam is without challenges related to limited availability and technical skill required yet are currently the only validated radiologic tools recommended for use in brain death diagnosis. Our exhibit will review multiple cases of evaluation for BD/DNC, accentuating imaging findings and pearls/pitfalls of acquisition and interpretation. Opportunities for investigation of other available imaging techniques will also be highlighted. Read More

Authors:  Hampton Erica , Fuentealba Cargill Andrea , Trenbeath Zachary , Alazraki Adina , Stence Nicholas , Milla Sarah

Keywords:  Nuclear Medicine, Interventional Radiology

Yen Christopher,  Kukreja Kamlesh,  Masand Prakash

Final Pr. ID: Poster #: CR-010

Female conjoined throraco-omphalopagus twins were delivered via cesarean section at 35 weeks 5 days gestational age to a 38-year-old mother who received standard prenatal care. After resuscitation, the twins were transferred to the neonatal ICU, where they remained for monitoring and growth as they were assessed for potential separation.
CT angiography was performed at 3-4 months of life using a staged approach. Selective IV and oral contrast administration was used over two visits to delineate shared and non-shared structures. Most significantly, there was a single shared liver with anomalous hepatic venous drainage. Twin A had three normal caliber hepatic veins draining into a normal IVC, but a large branch of the middle hepatic vein traversed midline into Twin B and received hepatic venous drainage from Twin B via numerous anomalous vessels. Twin B had a normal IVC but three diminutive hepatic veins, thought to be due to reduced venous drainage as a result of the anomalous shared vasculature.
After multidisciplinary discussion, interventional radiology was consulted for hepatic venogram and intervention as needed. The anomalous communicating vessels were identified on hepatic venogram via Twin A femoral approach. Occlusion of the anomalous branches was achieved with serial embolization of the primary draining vessel on the Twin A side using Amplatzer vascular plugs. Successful occlusion was confirmed on venography after the final embolization procedure.
Follow-up Doppler ultrasound exams confirmed improved hepatic venous outflow in Twin B, initially with reversal of flow in the anomalous veins back toward the IVC of Twin B, followed by nonvisualization of the anomalous veins on later exams. CT angiography later showed enlarged caliber of the native Twin B hepatic veins. Following the optimization of hepatic venous outflow, the multispecialty surgical team proceeded with separation. The twins were separated at 13 months of age without complication. In addition to restoring venous outflow to allow for a successful surgical outcome, it was noted that the Amplatzer devices were used as surgical landmarks during separation for identification of shared anatomy. Through careful planning and execution, diagnostic and interventional radiology techniques played a critical role in this successful outcome. Read More

Authors:  Yen Christopher , Kukreja Kamlesh , Masand Prakash

Keywords:  Conjoined twins, Interventional Radiology, CT Angiography

Patel Falguni

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

To demonstrate the finding of a Femoral artery Pseudoaneurysm on a Left Lower extremity venous and arterial doppler ultrasound and under Interventional Radiology sonographically guided compression of the neck of the Pseudoaneurysm and guided injection of thrombin into the Pseudoaneurysm resulted in successful thrombosis of a Pseudoaneurysm. Follow up ultrasounds to document resolving of a Left Femoral artery Pseudoaneurysm in an infant. Read More

Authors:  Patel Falguni

Keywords:  Doppler Lower extremity Ultrasound, Pseudoaneurysm, Interventional procedure.

Shum Thomas,  Cleveland Heather,  Chau Alex,  Ashton Daniel,  Hernandez Alberto

Final Pr. ID: Poster #: SCI-038

Stenosis of the inferior vena cava or the hepatic veins is an underlying cause for hepatic compromise in liver transplant patients and in patients with inflammatory diseases of the liver, leading to considerable morbidity. CT-guided or ultrasound-guided minimally invasive vessel recanalization procedures can reverse liver failure in these patients by restoring vessel patency. However, it can be difficult to employ these techniques using traditional guidewire tips against fibrotic obstructions associated with vessels that have undergone repeated stenosis. Sharp recanalization offers an alternative strategy to gain access through these obstacles by utilizing needles or the sharp end of the guidewire tip to penetrate the vessel obstruction. This technique has been well-described and employed successfully in adult patients, but has not yet been reported in the pediatric setting. Read More

Authors:  Shum Thomas , Cleveland Heather , Chau Alex , Ashton Daniel , Hernandez Alberto

Keywords:  interventional

Hailu Tigist,  Ginader Abigail,  Bodo Nicole,  Sze Alyssa,  Corder William,  Thompson Lynn,  Escobar Fernando,  Sze Raymond,  Balmer Dorene

Final Pr. ID: Paper #: 144

Little is known about how families of children undergoing interventional radiology (IR) procedures experience their interactions with IR teams; therefore, we conducted a qualitative study to explore and learn from families experience with IR teams in order to educate pediatric IR staff and ultimately improve delivery of care. Read More

Authors:  Hailu Tigist , Ginader Abigail , Bodo Nicole , Sze Alyssa , Corder William , Thompson Lynn , Escobar Fernando , Sze Raymond , Balmer Dorene

Keywords:  Interventional Radiology, patient experience