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

Cheng Jocelyn,  Chung Taylor,  Davda Sunit,  Sridhar Shravan

Final Pr. ID: Poster #: EDU-005

Cardiovascular MRI is an invaluable tool used for clinical decision-making in children with congenital heart disease (CHD). The variable anatomy and physiology encountered in this cohort of patients challenges radiologists to integrate morphologic understanding with precise imaging metrics that drive management. Developing a solid understanding of common workflows used in CHD MRI can make the imager more confident and efficient in conducting the appropriate assessments in each case. This exhibit employs a skills-based method designed to make MRI evaluation of CHD more approachable, structured, and clinically impactful.

This course is not focused on assessment of any one congenital heart disease nor is it a simple case compendium, but rather, is aimed at teaching specific skills and demonstration of the use of MRI analytical techniques that can be applied to the spectrum of CHD ranging from simple shunts to simple obstructive lesions such as aortic coarctation to complex congenital heart diseases such as double outlet right ventricle. Learners will gain fluency with commonly employed CHD MRI workflows including morphologic characterization, angiography, volumetric analysis, gradient measurement, semilunar valve assessment, atrioventricular valve assessment, collateral flow quantification (systemic arterial, aortopulmonary, and venovenous), shunt quantification, internal consistency analysis, and myocardial tissue characterization. Each workflow will be paired with a sample case(s) that highlights the clinical utility of the associated workflow and addresses pearls and pitfalls associated with each workflow.

Following completion of this educational course, the learner will have gained experience exercising both interpretive and quantitative skills needed to conduct the different workflows that may be required for a particular CHD MRI case he or she encounters, understand when a certain analysis should be considered, and be able to perform quality checks that ensure generation of accurate clinical data to help guide the patient’s management. Read More

Authors:  Cheng Jocelyn , Chung Taylor , Davda Sunit , Sridhar Shravan

Keywords:  Congenital Heart Disease, Magnetic Resonance Imaging MRI

Rao Jhanavi,  Thakor Dipakkumar,  Schroeder Jason

Final Pr. ID: Poster #: EDU-072

INTRODUCTION:
Leukocoria or the white eye reflex is an abnormal pupillary light reflection on ocular examination and is usually indicative of serious intraocular pathology. It is most often seen in children. Immediate diagnosis and management are mandatory as most conditions are vision threatening, and some like retinoblastoma life threatening. It is important to identify underlying pathologies early, especially conditions such as retinoblastoma with immediate referral to a pediatric ophthalmologist.
An interdisciplinary liaison with a pediatric radiologist, retina specialist, and ocular oncologist will help in the management of eyes with leukocoria in an appropriate manner. Imaging also plays a critical role in assessing treatment response.
In this educational exhibit, we will highlight key cross-sectional imaging findings of ocular abnormalities associated with leukocoria that provide valuable clues in diagnosing the important pathologies in the pediatric population. These findings may include calcific masses, microphthalmia, vascular abnormalities, hemorrhage and enhancement patterns, all which aid in narrowing down the differential diagnosis of leukocoria.

Conclusion:
The diagnosis of intra-ocular pathologies commonly resulting in pediatric leukocoria is a complex task that often necessitates a multidisciplinary approach, complemented by multimodality imaging and often genetic analysis. Cross-sectional imaging proves to be a valuable tool for refining the list of potential diagnoses based on structural abnormalities and guiding clinicians towards specific confirmatory tests. Read More

Authors:  Rao Jhanavi , Thakor Dipakkumar , Schroeder Jason

Keywords:  Orbit, CT, Magnetic Resonance Imaging MRI

Galvis Ingrid,  Kvist Ola,  Perdomo-luna Camilo,  Jaramillo Diego

Final Pr. ID: Poster #: EDU-065

Learning Objectives:
-To recognize characteristic MRI features of chronic recurrent multifocal osteomyelitis (CRMO) that distinguish it from infectious osteomyelitis and malignancy
-To understand common imaging mimics including focal periphyseal edema zones, developmental variants, and physiologic bone marrow changes
-To appreciate the clinical-imaging discordance in CRMO and the role of whole-body MRI in detecting subclinical disease
Background: CRMO is a rare autoinflammatory bone disorder in children that poses diagnostic challenges due to overlapping features with infection, malignancy, and benign conditions. Early recognition of characteristic imaging patterns is crucial to avoid unnecessary biopsies, inappropriate antibiotic therapy, and diagnostic delays that may lead to skeletal complications. Read More

Authors:  Galvis Ingrid , Kvist Ola , Perdomo-luna Camilo , Jaramillo Diego

Keywords:  Paediatric Radiology, Musculoskeletal, Magnetic Resonance Imaging MRI

Gupta Kanika,  Chandra Tushar,  Bajaj Manish,  Silva Gleidson,  Kucera Jennifer

Final Pr. ID: Poster #: EDU-033

Neonatal and perinatal infections pose diagnostic challenges due to nonspecific clinical presentations, necessitating prompt neuroimaging to guide management and predict outcomes. We aim to review the spectrum of imaging findings in congenital, perinatal, and postnatal infections affecting the central nervous system (CNS) in neonates. By illustrating characteristic patterns, we seek to establish a systematic approach for radiologists to narrow differentials, recognize complications, and facilitate multidisciplinary care. Read More

Authors:  Gupta Kanika , Chandra Tushar , Bajaj Manish , Silva Gleidson , Kucera Jennifer

Keywords:  Congenital Infection, Neonatal, Magnetic Resonance Imaging MRI

Harris Debra,  Maniyar Jenny,  Dixon Rachel,  Kapadia Tejas

Final Pr. ID: Poster #: EDU-054

Endometriosis remains an important cause of pelvic pain in menstruating individuals. At our tertiary Paediatric hospital, we have seen a year-on-year rise in requests to exclude endometriosis using MRI scan. This rise is reflective of the increased awareness around endometriosis widely published recently which includes the importance of the MDT to reach diagnosis and shape treatment i.e. medical and/or surgical. As a result of this, our institution has optimised the paediatric gynaecology MR protocols to better align with that of our adult colleagues to support the benign teenage gynaecology clinic recently merged within our services since 2022 to achieve smooth transition from paediatric to adult services. The limitations of diagnosing endometriosis are widely published, and scans are performed to detect those signal changes which directly but also indirectly indicate endometriosis. For instance, direct signs may be adenomyosis, focal plaques or endometriotic deposits whilst indirect signs would be those related to adhesions, ovarian position, haematosalpinx etc. Out of this cohort we present salient findings in adolescent endometriosis using our enhanced imaging protocol which includes narrow field of view, axial, coronal and sagittal fast spin echo T2, axial T1 with and without fat saturation, an axial T2 fat saturated sequence and diffusion weighted imaging. The latter added to characterise any suspicious adnexal lesions. In comparison to the adult service, we do not use intravaginal gels in children. We do not include contrast or buscopan to facilitate scan time, reduce potential side effects and eliminate needle usage in younger patients. As reporters, we regularly attend the Endometriosis MDTs held at our institution to develop our skills. Using our inbuilt secure chat and messaging system we are now in better contact with our gynaecology colleagues. To build on this soon we aim to set up our own adolescent benign gynaecology meeting. Read More

Authors:  Harris Debra , Maniyar Jenny , Dixon Rachel , Kapadia Tejas

Keywords:  Magnetic Resonance Imaging MRI, GU, Improvement