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

Jaganathan Sriram,  Krishnan Venkatram,  Jayappa Sateesh,  Murphy Janice,  Phillips Paul,  Ramakrishnaiah Raghu,  Charles Glasier,  Choudhary Arabinda

Final Pr. ID: Poster #: EDU-070

Objective:
The optic nerves are covered by the meningeal sheath and the nerve is surrounded by the fluid which communicates with the CSF space intracranially. Any variations in the CSF pressure can alter the perioptic space fluid and cause pressure effects on the optic nerve head. The optic disc does not possess cells of muller which hold nerve fibers together unlike other retinal cells, and hence swells up easily with increasing CSF pressure resulting in papilledema. Conversely, a decrease in intracranial pressure can cause perioptic space to collapse. Our aim in this exhibit is to present the normal appearance of the perioptic space on MRI, normal optic nerve sheath diameter, our institutional MRI protocol for optic nerve/ perioptic space evaluation, pathologies that cause changes in the perioptic space, and how perioptic space variations can be a clue to look for pathologies.
Learning points:
Our exhibit includes:
Our institutional protocol for evaluation of the perioptic space and the optic nerve
Normal appearance of perioptic space on different MRI sequences including high resolution T2W coronal, T2W axial and BFFE sequences
Interesting case reports with altered perioptic space fluid including
1. Idiopatic intracranial hypertension
2. Shunt malfunction
3. Shunt over drainage
4. An interesting case of pseudotumor progressing to intracranial hypotension
5. Foster Kennedy syndrome
6. Intracranial hypotension
7. Differentiation of papilledema versus drusen
The importance of looking at perioptic space and how it gives clue to the underlying pathology
Associated findings to be evaluated on MRI
Discussion:
Perioptic spaces can give a clue to underlying intracranial pathologies. It is imperative for the radiologists to carefully evaluate the perioptic spaces and to look for additional findings if there is a variation. If there is dilatation of the perioptic space, it is important to look at the additional features including tortuosity of the optic nerves, protrusion of the optic disc, partial empty sella, enlarged meckel’s cave and bilateral transverse sinuses for stenosis. When there is collapse of the peri-optic space, other associated findings should be looked at including pachymeningeal enhancement, venous distention sign, cerebral edema, tonsillar ectopia, and other quantitative features like mamillopontine distance. Also, it is important to evaluate for tumors which can also result either in perioptic space distention or collapse. Read More

Authors:  Jaganathan Sriram , Krishnan Venkatram , Jayappa Sateesh , Murphy Janice , Phillips Paul , Ramakrishnaiah Raghu , Charles Glasier , Choudhary Arabinda

Keywords:  Perioptic space, distention and collapse, intracranial CSF pressure changes

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

Jordan Gregory,  Hampton Erica,  Stence Nicholas,  Milla Sarah,  Callen Andrew

Final Pr. ID: Poster #: EDU-078

Intracranial hypotension is a condition caused by the loss of cerebrospinal fluid through either a dural defect, ruptured meningeal diverticulum, or CSF-venous fistula. In the past decade, this condition has been increasingly diagnosed in individuals suffering from orthostatic headaches. In adults, CSF leaks are commonly caused by dural defects due to a degenerative disc osteophyte violating the ventral dura. In the pediatric population, spontaneous leaks may occur in individuals with underlying connective tissue disease, or from venous/lymphatic malformations which approximate the spinal subarachnoid space. Most commonly, a CSF leak results in an “orthostatic headache” characterized by head pain which worsens upon sitting or standing and improves when lying flat. In addition to headache, patients can experience vestibulocochlear symptoms, changes in vision, forgetfulness, or personality changes. CSF leak localization usually requires dynamic myelography, performed using either digital subtraction or CT techniques. However, specific tailored MRI protocols can aid in the detection and characterization of leaks. Treatment options include percutaneous injection of autologous blood or fibrin sealant into the epidural space, embolization of draining veins, or primary surgical repair. The goal of this exhibit is to provide an illustrative review of the various pathologies that can cause CSF leak in the pediatric population. A review of anatomy and pathophysiology followed by a case-based presentation including congenital, iatrogenic, traumatic, and idiopathic causes will be presented. Both noninvasive and invasive imaging protocols will be discussed with a focus on minimizing radiation dose in the pediatric population. Read More

Authors:  Jordan Gregory , Hampton Erica , Stence Nicholas , Milla Sarah , Callen Andrew

Keywords:  CSF Leak, Intracranial hypotension, CSF-venous fistula

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

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

Final Pr. ID: Paper #: 129

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

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

Keywords:  Contrast Enhanced Ultrasound, Intracranial Pressure

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

Final Pr. ID: Paper #: 130

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

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

Keywords:  Doppler, Intracranial Pressure

Lemessa Natae,  Martinez-correa Santiago,  Lerebo Wondwossen,  Hwang Misun

Final Pr. ID: Poster #: SCI-009

Pediatric hydrocephalus is a common disease in the United States, accounting for more than 39,000 annual admissions and a healthcare cost of $1.4-2.0 billion. Timely detection and intervention of intracranial hypertension (ICP), a complication of hydrocephalus, is associated with an improved neurologic outcome. This research aims to evaluate the feasibility of assessing the movement of the floor of the third ventricle and intracranial arterial pulsations on mid sagittal view of the grayscale brain ultrasound for predicting ICP in neonates and infants. Read More

Authors:  Lemessa Natae , Martinez-correa Santiago , Lerebo Wondwossen , Hwang Misun

Keywords:  intracranial arterial pulsation, intracranial hypertension, gray scale ultrasound

Yadav Vikas,  Ealai Parthasarathy

Final Pr. ID: Poster #: EDU-083

To delineate the spectrum of intra cranial imaging findings in infants with late hemorrhagic disease of newborn (late HDN) Read More

Authors:  Yadav Vikas , Ealai Parthasarathy

Keywords:  Hemorrhagic disease, neonate, Infant, Intracranial bleed, Vitamin K

Ramírez Tamara,  Abdeen Nishard

Final Pr. ID: Poster #: SCI-027

The optic nerve sheath diameter (ONSD) has been noted to distend in patients with increased intracranial pressure. There is relatively little data on the sensitivity of dilated optic nerve sheath on initial CT or MRI as a sign of raised Intracranial pressure (ICP) in children with ventriculoperitoneal (VP) shunt malfunction. This pilot study aims to establish if there is a significant difference in ONSD pre- and postshunt revision surgery. Read More

Authors:  Ramírez Tamara , Abdeen Nishard

Keywords:  Optic nerve sheath diameter, Intracranial pressure, Ventriculoperitoneal shunt

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

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

Farris Chad,  Setty Bindu,  Mian Asim,  Wachman Elisha,  Castro-aragon Ilse

Final Pr. ID: Poster #: SCI-025

To determine if brain MRI is of added value in babies with neonatal abstinence syndrome (NAS) in addition to a head US, and to elucidate the findings observed in each modality. Read More

Authors:  Farris Chad , Setty Bindu , Mian Asim , Wachman Elisha , Castro-aragon Ilse

Keywords:  Brain, Intracranial

Biscaye Stephanie,  Albertario Marco,  Guesmi Myriam,  Leloutre Beatrice,  Occelli Aurelie,  Boyer Corinne

Final Pr. ID: Poster #: CR-02 (R)

the aim of the study is to report the importance of the link between intracranial bleeding (ICB) and biliary atresia in neonates. Nowadays, the incidence of bleeding secondary to vitamin K deficiency has well-decreased, thanks to systematic vitamin K prophylaxis in neonates. However, ICB remains a severe complication of Vitamine K deficiency, with a high mortality rate and possible neurological disabilities.
Biliary atresia (BA) is a life-threatening condition in neonates, commonly diagnosed in the first 2 months of life, based on jaundice, cholestasis, pale-colored stools and dark urine. Occasionally, BA can be revealed later (25 to 65 days after birth), with severe symptoms such as intracranial, nasal or gastrointestinal bleedings. Read More

Authors:  Biscaye Stephanie , Albertario Marco , Guesmi Myriam , Leloutre Beatrice , Occelli Aurelie , Boyer Corinne

Keywords:  biliary atresia, intracranial bleeding