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

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

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

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

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

De Leon-benedetti Laura,  Ramirez Suarez Karen,  Otero Hansel,  Rapp Jordan,  Biko David,  Smith Christopher,  Serai Suraj,  White Ammie

Final Pr. ID: Poster #: EDU-003

Magnetic resonance imaging (MRI) has historically been restricted for patients with pacemakers, defibrillators, or other cardiac implantable electronic devices (CIEDs) due to safety concerns. Despite the introduction of MR conditional pacemakers in 2008, access to MRI in patients with CIEDS remains limited.
MRI remains the diagnostic imaging study of choice for many indications and is necessary to prevent delayed diagnosis and the decision to proceed with MRI should follow a rigorous risk benefit assessment:
Risks of:
Lead heating causing injury at their tips
Increased pacing thresholds
Sudden battery depletion
Inappropriate sensing/pacing
The location of the image should be considered because if the request includes the area of the CIED then potential artifacts may decrease the diagnostic quality. However, an MRI remote from the location of the CIED entails a negligible risk of lead heating and MRI may be performed safely with continuous patient monitoring throughout the scan. In addition, in pediatric patients the necessity of anesthesia or sedation must be well-thought-out as it conveys additional risk to the patient.
There is growing evidence from adult literature that MRI may be performed safely in patients with CIEDs with transvenous leads when appropriate protocols are followed. The Heart Rhythm Society (HRS) 2017 expert consensus statement indicates that MRI is reasonable in patients with MR non-conditional transvenous CIEDs if there are no fractured, epicardial, or abandoned leads. The Pediatric and Congenital Electrophysiology Society (PACES) of 2021 included that MRI may be considered in pediatric patients with epicardial or abandoned leads on a case-by-case basis. However, performing MRI in patients with CIEDs is a resource-intensive service and requires rigorous implant investigation, preparation, and planning as well as close coordination between treating physicians and radiologist.
This educational exhibit summarizes current literature on the safety of MRI in patients with CIEDs and takes examples from our practice to build an evaluation program that allows for safe access to MRI in patients with CIEDs Read More

Authors:  De Leon-benedetti Laura , Ramirez Suarez Karen , Otero Hansel , Rapp Jordan , Biko David , Smith Christopher , Serai Suraj , White Ammie

Keywords:  Cardiac, Magnetic Resonance

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

Cole Elizabeth,  Pauly John,  Vasanawala Shreyas,  Cheng Joseph

Final Pr. ID: Poster #: SCI-059

Convolutional neural networks (CNNs) have proven to be valuable in the fields of image processing and computer vision. Our work applies complex-valued CNNs to magnetic resonance imaging (MRI) to reduce scan times. The reduction of scan times has widespread pediatric benefits. A typical scan requires that patients remain still for up to an hour to produce a clear image, which is difficult for children without inducing anesthesia, which carries risks. A need exists for greatly improved MRI scan times without the loss of diagnostic accuracy. This scan time can be reduced by subsampling in k-space. We use CNNs to reconstruct images from these undersampled acquisitions. Our work investigates complex-valued CNNs for image reconstruction in lieu of two-channel real-valued CNNs. Read More

Authors:  Cole Elizabeth , Pauly John , Vasanawala Shreyas , Cheng Joseph

Keywords:  Magnetic Resonance Imaging, deep learning, Neural network

Raubenheimer Lauren,  Andronikou Savvas,  Kilborn Tracy

Final Pr. ID: Poster #: SCI-053

There is little published research on the wide variation of corpus callosum (CC) morphology in children, the assessment of which is made difficult by the complex alteration of its appearance in childhood. The purpose of our study was to assess the morphology of the CC on mid-sagittal T1-weighted magnetic resonance imaging (MRI) in a large number of children and correlate the findings with demographic and clinical criteria. Read More

Authors:  Raubenheimer Lauren , Andronikou Savvas , Kilborn Tracy

Keywords:  children, magnetic resonance imaging, corpus callous morphology

Matos Rojas Irma,  Lazarte Claudia,  Alpaca Rodriguez Larry

Final Pr. ID: Poster #: CR-04 (R)

Three cases of dermoid cyst will be described with different clinical presentation and location. MRI and CT finding will be reviewed and correlated with pathological finding.
The first case is a 7 year- old child, with suspected diagnosis of stroke which MRI shows a midline posterior fossa tumor with fine occipital dermal sinus, better visualized in CT. The second case is 1 year- old enfant with delayed psychomotor development, a dimple with lock of hair and dorsal hemangioma, which MRI shows a dermal sinus at D4 – D5 level which continues with an intra and extramedullary mass. The last case is 2 year- old child postoperated of mielomeningocele at birth that has neurogenic blader and Chiari II with a cyst mass at conus and low spinal cord insertion. Read More

Authors:  Matos Rojas Irma , Lazarte Claudia , Alpaca Rodriguez Larry

Keywords:  Dermoid cyst, Magnetic resonance imaging, Posterior fossa, spinal

Dong Su-zhen

Final Pr. ID: Poster #: EDU-026

The cardiac system is the part of the fetal anatomy that most frequently suffers from congenital pathology . The fetal heart is routinely studied using first level obstetric ultrasonography. If a fetus is considered to have a cardiac defect, a detailed echocardiographic examination is required. The role of fetal magnetic resonance imaging (MRI) as a tool additional to ultrasound has grown exponentially. Unlike ultrasound imaging, however, MRI is unaffected by maternal and fetal conditions such as obesity and oligohydramnios, which particularly impair sonographic visualization of the fetal heart. In this educational poster, we will provide an overview of fetal cardiac MR imaging methods and their applications in congenital heart disease. This presentation will cover recent technical advances in fetal CMR, the modified anatomic segmental approach to image fetal congenital heart disease, imaging appearances of fetal normal cardiovascular structure and appearances of various structural congenital heart disease on fetal CMR. Multiple imaging examples of fetal congenital heart disease diagnosed by fetal cardiac MR will be presented. Read More

Authors:  Dong Su-zhen

Keywords:  Fetus, Magnetic resonance imaging, Congenital heart disease

Krishnan Vijay,  Kandula Ashrith,  Nikam Rahul

Final Pr. ID: Poster #: EDU-049

Background:
In pediatric patients presenting with neurological deficit in emergency department, special attention should be given to identify the conditions that can mimic a stroke to avoiding unnecessary interventions. There are various pathologies in pediatric populations that can mimic stroke both clinically and radiologically. Radiologists, by identifying specific imaging patterns of classical stroke and also patterns of those stroke mimics, shall aid clinician in deciding treatment options in a timely manner.

Objectives:
In this educational poster we aims at,
1) Discussing typical imaging patterns of ischemic stroke.
2) Discussing common pathologies in pediatric age group which can mimic ischimic stroke and pose challenge to the clinicians as well as radiologists.
3) Describing various imaging findings of those stroke mimics that help to differentiate from ischemic stroke.

We discuss the imaging patterns of following pediatric stroke mimics:
- Infective pathologies, including HSV encephalitis
- Demyelinating lesions.
- Vasculitis
- Migraine.
- Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS).
- Hypoxic ischemic encephalopathy.
- Moya Moya disease.
- Posterior reversible encephalopathy syndrome.
- Drug related pathologies.
- Miscellaneous conditions.

Conclusion:
Differentiation of commonly seen stroke mimics from ischemic stroke in a timely manner helps clinician for proper management and unnecessary interventions. Read More

Authors:  Krishnan Vijay , Kandula Ashrith , Nikam Rahul

Keywords:  stroke mimics, magnetic resonance imaging

Santos Laura,  Jaramillo Diego,  Raya José,  Jambawalikar Sachin,  Nguyen Jie,  Mostoufi-moab Sogol

Final Pr. ID: Poster #: EDU-053

Diffusion tensor imaging (DTI) depicts the anisotropic motion of water molecules limited by tissue microstructure. Images of tractography provide qualitative information about complex tissue architecture, so that diffusion metrics reflect physeal activity.
DTI’s main clinical application is on brain white matter, but it can be used in any tissue in which there is organized tissue structure. Our research group has used tractography of the knee to study the structure of the physis and adjacent metaphysis and investigated the potential of DTI metrics as biomarkers predictive of skeletal growth. DTI parameters include tract count, tract length and tract volume and fractional anisotropy (FA). They can help distinguish between a normal and a dysfunctional physis, predict post-imaging growth and physeal closure, and possibly determine response to growth hormone treatment.
We will demonstrate the techniques for data acquisition, preprocessing, and analysis, and the basis for interpretation, based on our experience of performing DTI in over 900 knees. Each step has its own challenges for the standardization and optimization of DTI of the physis. The goal of this poster is to showcase our experience with the establishment of an efficient DTI pipeline. We will: 1) Discuss the impact of variation of DTI acquisition parameters (e.g. Time to Echo (TE), number of directions, b-value, voxel size…); 2) Describe programs for distortion correction and denoising , as well as the required post-processing software programs; 3) Discuss approaches to standardize the acquisition in the different anatomic areas and cross vendors; 4) Discuss the normal change of tractography data and physeal DTI metrics with age, sex and specific knee physis. We will show how DTI changes due to physeal dysfunction in different pathologies, such as growth hormone deficiency, trauma, arthritis, metabolic disorders and chemotherapy and radiation therapy. Finally, we will show how DTI can be used to predict height gain and final height compared to conventional bone age-based methods and standard growth charts, which are inaccurate and not generalizable to the current child/adolescent population. Read More

Authors:  Santos Laura , Jaramillo Diego , Raya José , Jambawalikar Sachin , Nguyen Jie , Mostoufi-moab Sogol

Keywords:  magnetic resonance imaging, growth plate, diffusion tensor imaging

Hill Ann,  Hirsig Leslie,  Yazdani Milad,  Collins Heather,  Jenkins Dorothea

Final Pr. ID: Poster #: SCI-015

MRS is the best prognostic indicator for hypoxic-ischemic encephalopathy (HIE) but is difficult to obtain early after injury. We investigated whether cerebral blood flow measures of resistive indices (RI) and time average maximum velocities (TAMx) shortly after birth would relate to later degree of neural injury by MRI in hypothermic HIE newborns. We predicted that abnormally high/low blood flow would be associated with poor outcomes. Read More

Authors:  Hill Ann , Hirsig Leslie , Yazdani Milad , Collins Heather , Jenkins Dorothea

Keywords:  Cerebral Blood Flow, Hypoxic Ischemic Encephalopathy (HIE), Magnetic Resonance Spectroscopy (MRS)

Zhong Yumin,  Sun Aimin,  Gao Wei

Final Pr. ID: Poster #: SCI-086

Tracheobronchial anomalies including tracheobronchial stenosis, tracheal bronchus, cardiac bronchus and bronchial isomerism are common in congenital heart disease. Cardiovascular anomaly is the principal extrinsic lesion causing tracheobronchial stenosis. MRI has the advantage of being non-ionizing and providing excellent soft tissue contrast for the diagnosis of congenital heart disease and tracheobronchial anomalies
Purpose: To define diagnostic accuracy of three-dimensional turbo field echo (3D-TFE) to detect tracheobronchial anomalies in patients with congenital heart disease Read More

Authors:  Zhong Yumin , Sun Aimin , Gao Wei

Keywords:  Tracheobronchial Anomalies, congenital heart disease, Magnetic Resonance Imaging Sequence

Dong Su-zhen

Final Pr. ID: Poster #: EDU-010

1. Review the safety, limitations and advantages of fetal cardiac MR (CMR)
2. Discuss potentialindications of fetal CMR
3. Describe the technique of fetal CMR, including imaging sequences, imaging planes, the method
of overcoming motion artifact
4. Illustrate the appearance of normal fetal cardiac structures and present a modified anatomic
segmental approach of congenital heart disease (CHD) at prenatal CMR
5. Demonstrate examples of fetal CMR in the evaluation of various cardiovascular anomalies Read More

Authors:  Dong Su-zhen

Keywords:  Fetus, cardiac magnetic resonance, congenital heart disease

Junhasavasdikul Thitiporn,  Kellenberger Christian,  Tolend Mirkamal,  Doria Andrea

Final Pr. ID: Poster #: EDU-107

Juvenile Idiopathic Arthritis (JIA) is the most common musculoskeletal disorder in children. The temporomandibular joints (TMJs) are involved in majority of cases, and detection of early arthritic changes in these joints relies on contrast enhanced magnetic resonance imaging (MRI). However, with the paucity of evidence and consensus on the normal and pathologic changes in this small but complex joint, interpretation of TMJ MRIs remains to be difficult. This exhibit presents the normal growth related and arthritis related variations in the disease progression in TMJ MRIs of JIA patients. Read More

Authors:  Junhasavasdikul Thitiporn , Kellenberger Christian , Tolend Mirkamal , Doria Andrea

Keywords:  Temporomandibular joint, Juvenile idiopathic arthritis, Magnetic resonance imaging atlas

Duong Phuong,  Mostoufi-moab Sogol,  Raya José,  Jaimes Camilo,  Delgado Jorge,  Jaramillo Diego

Final Pr. ID: Paper #: 057

To compare how 3D MRI measurements of physeal cartilage volume, and DTI measurements (tract volume and length) correlate with growth parameters and detect differences in growth between patients treated with cis-retinoic acid and controls.
Read More

Authors:  Duong Phuong , Mostoufi-moab Sogol , Raya José , Jaimes Camilo , Delgado Jorge , Jaramillo Diego

Keywords:  magnetic resonance imaging, growth plate, short stature

Aslan Mine,  Kalyoncu Ucar Ayse,  Arioz Habibi Hatice,  Namdar Yesim,  Kurugoglu Sebuh,  Adaletli Ibrahim

Final Pr. ID: Poster #: CR-027

Wolman disease is a rare autosomal recessive inherited disease characterized by storage of cholesterol esters and triglycerides in lysosomes due to a deficiency of lysosomal acid lipase. Clinical signs such as persistent vomiting, diarrhea, hepatosplenomegaly, growth retardation and liver dysfunction occur in the first weeks of life. Most cases die in the first year of life. Here, we aim to present radiological findings of Wolman disease.
An asymptomatic girl two months of age was admitted to the pediatric genetic disease service with the history of Wolman disease in two brothers who had died in the neonatal period. Abdominal X-ray imaging displayed calcification of the bilateral adrenal gland regions. Hepatosplenomegaly and bilateral adrenal gland posterior acoustic shadowing due to calcifications were revealed by abdominal sonography. Magnetic resonance imaging showed enlarged hypointense adrenal glands in all sequences and hepatosplenomegaly. The lysosomal acid lipase levels were low compatible with Wolman disease.
Multimodality radiologic imaging methods should be performed to display hepatosplenomegaly, hepatosteatosis, bilateral adrenal gland enlargement and calcification in Wolman disease. Read More

Authors:  Aslan Mine , Kalyoncu Ucar Ayse , Arioz Habibi Hatice , Namdar Yesim , Kurugoglu Sebuh , Adaletli Ibrahim

Keywords:  Wolman Disease, Sonography, Adrenal gland, calcification, magnetic resonance imaging

Yen Christopher,  Bhakta Kavita,  Terzo Madison,  Guleria Saurabh,  Hussaini Shaheen,  Huynh Tommy

Final Pr. ID: Poster #: SCI-014

Non-contrast MRI with focused rapid-acquisition sequences can be used in place of CT for effective diagnosis of pediatric acute appendicitis (PAS). However, higher costs and limited resources are major considerations when considering its use. The goal of this study was to evaluate accuracy, utilization, and cost of MR compared to US and CT in the diagnosis of PAS. Read More

Authors:  Yen Christopher , Bhakta Kavita , Terzo Madison , Guleria Saurabh , Hussaini Shaheen , Huynh Tommy

Keywords:  magnetic resonance, billing, quality

Bareño Sandra,  Pérez-marrero Lizbet,  Fuentealba Isabel,  Pose Georgette,  Soto Gloria,  Silva Claudio,  Salinas Cesar

Final Pr. ID: Poster #: SCI-056

To determine the cause of obstructive hydronephrosis using fMRU in pediatric patients with inconclusive conventional studies. Read More

Authors:  Bareño Sandra , Pérez-marrero Lizbet , Fuentealba Isabel , Pose Georgette , Soto Gloria , Silva Claudio , Salinas Cesar

Keywords:  Hydronephrosis, Magnetic Resonance Urography Scan, Ureteropelvic junction stenosis, Obstructive hydronephrosis, Differential renal function

Goncalves Fabricio,  Pinelli Lorenzo,  Mankad Kshitij,  Alves Cesar Augusto,  Teixeira Sara,  Andronikou Savvas,  Vossough Arastoo

Final Pr. ID: Poster #: EDU-050

Intracranial calcification (ICC) can be either physiological or pathological. Physiological ICC is not an expected neuroimaging finding in the neonatal period but can be seen as children grow older in the pineal gland, habenula, choroid plexus, and occasionally in the dura mater. Pathological ICC can be broadly divided into six groups: infectious, toxic, neurodegenerative, neoplastic, vascular, and syndromic. The first two groups are typically composed of diseases that more commonly result in static encephalopathies, whereas the last four groups are composed of diseases that tend to cause progressive encephalopathy.

Various neuroimaging modalities have distinct utilities and sensitivities in the depiction of ICC. Age at presentation, ICC location, and additional neuroimaging findings are useful information that may be useful to narrow down the differential diagnosis of ICC. Bilateral ICC is commonly due to congenital infections or due to neurodegenerative or infectious diseases. ICC involving the basal ganglia and thalami are commonly seen in neurodegenerative diseases. ICC can be seen in isolation or be associated with other neuroimaging features.

TORCH infections are the most common neonatal causes of ICC. ICC in congenital infections can be associated with clastic changes, hydrocephalus, chorioretinitis, white matter abnormalities, skull changes, and cortical development malformations. Specific non-infectious causes of ICC that mimic TORCH infections are known as pseudo-TORCH. Neurodegenerative diseases causing ICC are mainly due to parathyroid and thyroid hormone dysfunction and inborn errors of metabolism, such as MELAS, Kearns Sayre and Cockayne syndrome, interferonopathies syndrome, and Krabbe disease. Tumoral ICCs are more commonly seen in low-grade tumors. Arteriovenous malformations, arteriovenous fistulas, chronic venous hypertension, and cavernomas are also known causes of ICC. Other vascular causes of ICC include atherosclerosis, healed hematoma, radiotherapy treatment, old infarct, and disorders of the microvasculature such as COL4A1- and COL4A2-related diseases. Down syndrome and phakomatosis are also known causes of ICC.

Clinical information such as age at presentation; maternal exposure to teratogens, such as virus; in addition to the association with chromosomal abnormalities; genetic mutations and postnatal infections, facilitate in the differential diagnosis of the multiple causes of ICC. Read More

Authors:  Goncalves Fabricio , Pinelli Lorenzo , Mankad Kshitij , Alves Cesar Augusto , Teixeira Sara , Andronikou Savvas , Vossough Arastoo

Keywords:  Calcification, Computed Tomography, Magnetic Resonance

Vazquez Elida,  Delgado Ignacio,  Sanchez-montañez Angel,  Barber Ignasi

Final Pr. ID: Poster #: SCI-024

Open spinal dysraphism occurs as a consequence of failed neurulation during embryological development and includes two subtypes, myelomeningocele and myelocele. Intrauterine fetal repair can result in reversal of the associated Chiari II malformation and is now considered a treatment option.
The main imaging method for prenatal detection, management, and monitoring of open neural tube defects is US, but MRI is essential for the preoperative assessment, indications and workup for fetal surgery, and postnatal follow-up. This prospective study describes the contribution of MRI in this clinical scenario. Read More

Authors:  Vazquez Elida , Delgado Ignacio , Sanchez-montañez Angel , Barber Ignasi

Keywords:  Fetal, Neonatal, Magnetic Resonance Imaging, Myelomeningocele, Spina bifida

Betz Lisa,  Dillman Jonathan,  Jones Blaise,  Tkach Jean

Final Pr. ID: Poster #: EDU-029

After reviewing this educational exhibit, radiologists and trainees will have up-to-date knowledge about magnetic resonance imaging (MRI) safety in children with implanted medical devices. The following will be presented: 1) Basic MRI physics relating to safety risks in the presence of implanted (passive and active) medical devices, 2) MR Safety screening challenges specific to children, and 3) Review of newly developed or updated medical devices that present challenging pediatric MRI safety scenarios.

MRI is the imaging modality of choice for assessing many pediatric conditions, providing excellent anatomic and pathologic detail without the use of ionizing radiation. However, there are significant potential hazards in the MR environment related to the static magnetic field and the spatial and time varying gradient fields, as well as the impact of radiofrequency pulses. These concerns may be further complicated/exacerbated by the presence of implanted medical devices.

This educational exhibit will focus on reducing risk for children with implanted medical devices in the MR environment. Such devices may be subject to projectile/torsion forces, induced currents, and heating risks. Barriers to effective screening include limited MRI safety information for new passive and active implanted medical devices, incomplete documentation and patient/family education, and limited referring clinician awareness of potential safety risks. The use of sedation/anesthesia in pediatric patients reduces the ability to detect discomfort during MR imaging. Read More

Authors:  Betz Lisa , Dillman Jonathan , Jones Blaise , Tkach Jean

Keywords:  Implanted medical devices, Magnetic resonance imaging, Pediatric

Chaker Salama,  Reid Janet,  Lopez-rippe Julian

Final Pr. ID: Poster #: EDU-041

The purpose of this educational exhibit is to present a systematic 4-sequence hanging protocol and search pattern as an effective method to initially review a pediatric MR enterography (MRE) study prior to thorough interpretation. By analyzing frequently referenced sequences in MRE reports with positive inflammatory bowel disease findings, we identified novel 4-sequence hanging protocol: coronal T2-weighted HASTE (for anatomic orientation), axial fat-saturated fluid-sensitive sequence (for bowel wall thickening/edema), axial diffusion-weighted high b-value sequences (for bowel inflammation and complications), and coronal gradient-recall echo T1-weighted post-contrast (for enhancement). This structured 4-sequence hanging protocol highlights the most pertinent findings and allows for rapid first-pass evaluation to orient novice readers. The exhibit provides an efficient framework for radiology trainees to streamline review of pediatric MREs before proceeding to full detailed interpretation. Read More

Authors:  Chaker Salama , Reid Janet , Lopez-rippe Julian

Keywords:  inflammatory bowel disease, magnetic resonance enterography, hanging protocol

Loo Jerry,  Iskander Paul,  Chen Johnathan,  Hall Theodore,  Boechat Ines,  Ghahremani Shahnaz

Final Pr. ID: Poster #: EDU-010

Intestinal failure is a rare but devastating condition in pediatric patients that is often caused by short bowel syndrome (SBS) secondary to necrotizing enterocolitis, volvulus, or intestinal atresia. Patients require the use of total parenteral nutrition (TPN) to survive, which can lead to cholestasis and end stage liver disease (ESLD). Treatment of intestinal failure in pediatric patients who have developed subsequent liver failure from TPN with multivisceral (MVTx) transplantation has progressed dramatically in the past two decades as a result of improvements in immunosuppression, surgical technique, and post-transplant care. The number of transplantations has always been relatively low due to a lack of appropriate donors and the rarity of intestinal failure. However, given the high acuity of patients that do ultimately undergo these procedures, recognition of post-operative complications is critical for graft survival and improved outcomes. This educational exhibit will review the indications and relevant anatomy for these types of transplantations. Magnetic resonance (MR) findings related to post-transplantation complications will be presented with imaging correlates from other modalities (CT, PET/CT, US) as needed. Read More

Authors:  Loo Jerry , Iskander Paul , Chen Johnathan , Hall Theodore , Boechat Ines , Ghahremani Shahnaz

Keywords:  intestinal, liver, magnetic resonance

Badachhape Andrew,  Tao Ling,  Joshi Sanshuv,  Devkota Laxman,  Stupin Igor,  Sarkar Poonam,  Annapragada Ananth,  Barbieri Eveline,  Ghaghada Ketan

Final Pr. ID: Paper #: 155

Neuroblastoma (NB) is the most common non-cranial solid tumor in childhood. The MYCN oncogene plays a crucial role in tumorigenesis and angiogenesis in NB and is a strong indicator of poor prognosis. The tyrosine hydroxylase (TH)-MYCN transgenic mouse model of NB is extensively utilized; however, little is known about disease progression in this model. In this work, we use multi-modal imaging to study tumor progression and vascular architecture in TH-MYCN transgenic, allograft, and syngeneic mouse models of NB. Read More

Authors:  Badachhape Andrew , Tao Ling , Joshi Sanshuv , Devkota Laxman , Stupin Igor , Sarkar Poonam , Annapragada Ananth , Barbieri Eveline , Ghaghada Ketan

Keywords:  Neuroblastoma, Magnetic Resonance Imaging, Tumor