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Society for Pediatric Radiology – Poster Archive

Showing Results from 1 to 30 of 35.

Patel Akash,  States Lisa

Final Pr. ID: Poster #: EDU-082

With the increased demand and utilization of PET/MRI in oncologic imaging, there is an ever increasing database of non-malignant pathology that has not yet been described on PET/MRI. Furthermore, the pediatric population provides an even more unique breadth of pathology that is often only seen in this age group. It is important to be able to accurately identify these common pathologies so as to not mistake them for malignancy and to prevent unnecessary follow up imaging studies and further invasive diagnostic procedures.

For this educational exhibit we review over 200 clinical pediatric 18F-FDG PET/MRs performed at our institution and highlight the most common and most interesting cases of FDG-avid non-malignant pathology.

Listed below are some of the cases to be included in the poster:
-Benign FDG avid bone tumors including non-ossifying fibromas
-Benign causes of FDG avid lymphadenopathy including cat scratch disease
-Benign causes of FDG avid lung lesions including aspiration pneumonia
-Benign causes of gastro-intestinal FDG uptake including pseudomembranous colitis
-Benign FDG avid infectious pathologies including a liver abscess
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Authors:  Patel Akash , States Lisa

Keywords:  PET/MR, PET/MRI, benign

Southard Richard,  Ellsworth Erik,  Moe Tabitha,  Augustyn Robyn,  Thorkelson Marrit,  Bardo Dianna

Final Pr. ID: Poster #: EDU-090

The structure of the heart is more complex than 4 major chambers, 4 major valves, venous inflow and arterial outflow.

Muscular and soft tissue ridges, perforated membranes, tissue flaps, electrical pathways, external grooves, endocardial surface characteristics, and a core architecture structured of fibrous tissue and embryonic tissue remnants form distinguishing anatomic landmarks. These structures provide insight into cardiac development, serve physiologic purpose, define structural and functional elements, as well as offer prognostic information.

Specific details of cardiac anatomy may not be recognized on cardiac MR and CT examinations. Structural anomalies that affect cardiac function and anatomic or physiologic relationships may be abnormal in hearts with congenital malformations. The fine structural details of the heart are typically not part of an imagers search pattern and are therefore overlooked or underreported. Each minute structure and anatomic characteristic provides clues to errors in cardiac formation and may provide clinically relevant diagnostic information. After palliation of CHD defining anatomic structure may be lost, displaced, interrupted or even restored.

Important processes, corresponding anatomic landmarks, and effects of malformation in defining congenital heart disease anatomy, physiology and functional variation from normal include basal structures such as the central fibrous body of the heart, atrial structures including the crista terminalis, the sinus venarum, and eustacian valve, and ventricular structures such as the crista supraventricularis.

Each structure is described along with its normal location, anatomy functional and physiologic importance, the effect of congenital malformation, and imaging findings as in the example of the central fibrous body (table 1).

Minute cardiac anatomy will be shown in illustration as well as in CT and MR images (figure 1).
Read More

Authors:  Southard Richard , Ellsworth Erik , Moe Tabitha , Augustyn Robyn , Thorkelson Marrit , Bardo Dianna

Keywords:  Cardiac anatomy, Cardiac MR, Cardiac CT, Congenital heart disease, Embryology

Tsitsiou Yvonne,  Rychik Jack,  Biko David,  Cahill Anne Marie,  Serai Suraj,  Durand Rachelle,  Golberg David,  Glatz Andrew,  Rand Elizabeth,  Wilkins Benjamin,  Witschey Walter,  Dodds Kathryn,  Russo Pierre

Final Pr. ID: Paper #: 071

Fontan–associated liver disease (FALD) is associated with increased risk of liver cirrhosis and hepatocellular carcinoma. Liver biopsy is the current gold standard investigation for diagnosing liver fibrosis. Magnetic Resonance Elastography (MRE) is a non-invasive procedure assessing liver stiffness. To date, only limited published studies are available describing the correlation of MRE and biopsy in Fontan-associated pediatric patients. Further, longitudinal changes in MRE require an increase in hepatic stiffness of >22% to indicate true change in stiffness (95% CI). The purpose of this study is to determine the clinical implication of MRE in FALD.

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Authors:  Tsitsiou Yvonne , Rychik Jack , Biko David , Cahill Anne Marie , Serai Suraj , Durand Rachelle , Golberg David , Glatz Andrew , Rand Elizabeth , Wilkins Benjamin , Witschey Walter , Dodds Kathryn , Russo Pierre

Keywords:  MR Elastography, Fontan, Liver Biopsy

Moore Tyler,  Hopkins Katharine

Final Pr. ID: Poster #: EDU-082

Functional magnetic resonance urography (fMRU) provides not only anatomic information but quantitative functional information as well. Several free tools are available to perform functional analysis. One such tool, CHOP-fMRU, is appealing because its creators have provided extensive instructions on their software and scan protocols.

Several barriers were encountered in attempting to implement CHOP-fMRU at OHSU. First, to perform the analysis, the appropriate DICOM files must be acquired from PACS. CHOP-fMRU is compatible with a limited number of transfer syntaxes, so a conversion is required after PACS download if the encoding is incompatible. Second, CHOP-fMRU is incompatible with some types of data elements that can be found in files with valid DICOM formats. Third, only the dynamic series can be included when importing a study into CHOP-fMRU, and every image in the set must be present. If an image from another series is included or an image from the dynamic series is excluded, the user encounters an error. Finally, when the analysis has been performed, it is desirable to send the results to PACS. Unless the user has purchased an Interactive Data Language (IDL) license, the images may only be exported as JPEG files. These files must be packaged into DICOM files with the correct header data before they are sent to PACS using DICOM network protocol.

While these tasks could each be accomplished with any one of many available DICOM tools, some of the tasks are moderately complex, and performing them manually would be time consuming. Instead, an additional piece of software desigend solely to perform these functions as simply and efficiently as possible can be helpful. Such a solution was attempted at OHSU, and the resulting software, CHOP-fMRU Assistant, is presented here.

CHOP-fMRU Assistant is a program written in C# using the Grassroots DICOM (GDCM) library. Current features include automatic transfer syntax conversion, removal of many potentially incompatible data elements, easy exclusion of unwanted series, analysis of the dynamic series for missing images, and conversion of the results from CHOP-fMRU to DICOM files for upload to PACS. CHOP-fMRU Assistant is available at under an open-source license and is offered with an associated wiki to help other institutions who have encountered similar barriers while attempting to implement CHOP-fMRU.
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Authors:  Moore Tyler , Hopkins Katharine

Keywords:  MR, Functional, Renal

Lu Fang,  Anupindi Sudha,  Pollock Avrum,  Johnson Ann,  Adzick N,  Victoria Teresa

Final Pr. ID: Poster #: EDU-075

Duodenal atresia (DA) results from failure of recanalization of the solid core of the duodenum, usually diagnosed as the classic “double bubble”. It may come in solitary or associated with other congenital abnormalities. The aim of this educational exhibit is to describe and demonstrate common and uncommon presentations of prenatal DA and associated anomalies with emphasis on fetal MR findings. Read More

Authors:  Lu Fang , Anupindi Sudha , Pollock Avrum , Johnson Ann , Adzick N , Victoria Teresa

Keywords:  duodenal atresia, Fetal MR

Nyalakonda Ramyashree,  Muehe Anne,  Iles Benjamin,  Theruvath Ashok,  Siedek Florian,  Agarwal Vibhu,  Hawk Kristina,  Jeng Michael,  Daldrup-link Heike

Final Pr. ID: Paper #: 148

To compare the detection of lesions between DW-MRI and 18F-FDG PET/MR for staging and restaging of Langerhans Cell Histiocytosis (LCH), using all clinical outcomes and imaging data as the reference standard. Also, this study will compare the differences between LCH chemotherapy responders and non-responders. Read More

Authors:  Nyalakonda Ramyashree , Muehe Anne , Iles Benjamin , Theruvath Ashok , Siedek Florian , Agarwal Vibhu , Hawk Kristina , Jeng Michael , Daldrup-link Heike

Keywords:  Langerhans Cell Histiocytosis, Diffusion Weighted Imaging, 18F-FDG PET/MR

Davila Jorge,  Highmore Kerri,  Miller Elka

Final Pr. ID: Poster #: SCI-064

The objective of this prospective study was to determine the accuracy of MR Enterography (MRE) in the assessment of mucosal healing in patients with Pediatric Crohn’s Disease (PCD) after starting treatment. MARIA and Clermont scores are MRE scores that were originally developed in adult population for the assessment of severity of Crohn's Disease (CD) in correlation to Crohn's Disease Endoscopic Index of Severity (CDEIS). MARIA score has shown close correlation to disease severity of colonic CD and Clermont score has shown close correlation to terminal ileum disease. A few reports have shown correlation of mucosal heling when assess by MRE scores and CDEIS in Adult population, but not work is available in pediatrics. Read More

Authors:  Davila Jorge , Highmore Kerri , Miller Elka

Keywords:  MR Enterography, pediatric crohn's disease

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)

Lillis Anna,  Krishnamurthy Ramkumar,  Boe Brian,  Setty Bhuvana,  Sena Laureen,  Krishnamurthy Rajesh

Final Pr. ID: Paper #: 018

Dynamic Contrast Enhanced MR Lymphangiography (DCMRL) allows evaluation of the central conducting lymphatics in patients with central lymphatic flow dysfunction. Direct injection of gadolinium contrast into inguinal lymph nodes followed by serial imaging allows visualization of lymphatic channels and lymphodynamics. This study reviews the DCMRLs performed at our institution over a 2 year period including indications, findings and impact on clinical management. Read More

Authors:  Lillis Anna , Krishnamurthy Ramkumar , Boe Brian , Setty Bhuvana , Sena Laureen , Krishnamurthy Rajesh

Keywords:  MR Lymphangiography, Thoracic Duct, Lymphatic

Joshi Aparna,  Grove Jason,  Ladino-torres Maria

Final Pr. ID: Poster #: EDU-005

Dynamic contrast-enhanced MR lymphangiography (DCEMRL) with intranodal injection has emerged as a useful tool in evaluating lymphatic disorders. We share our institutional experience with DCEMRL in infants through a detailed discussion of technique and series of case presentations.

Techniques for nodal access and imaging infants with DCEMRL are explained through text and step-by-step illustrations.

MR lymphangiography images of infants between 22 days and 8 weeks of age are presented with multi-modality correlation, including patients with congenital chylous ascites, non-immune fetal hydrops, and postsurgical chylothorax. Each case discussion includes a review of relevant lymphatic anatomy, explanation of the disease process, and key teaching points regarding DCEMRL in infants.
Read More

Authors:  Joshi Aparna , Grove Jason , Ladino-torres Maria

Keywords:  Lymphangiography, Infant, MR

Bodner Jeffrey,  Khanna Geetika,  Riedesel Erica,  Gill Anne,  Hawkins Matt,  Shah Jay,  Variyam Darshan,  Alazraki Adina

Final Pr. ID: Poster #: EDU-052

Evolution of MR Lymphangiography has expedited diagnosis and advanced potential implications for treatment in lymphatic disorders. In particular, evaluation of the central conducting lymphatic channels with dynamic contrast enhanced MR provides better spatial resolution, while sparing ionizing radiation inherent in lymphangio-scintigraphy and catheter lymphangiography.

We will review indications, technique with pearls and pitfalls, and overall success rates after MR lymphangiography at our institution. To discuss post-imaging clinical outcomes and implications for treatment. To illustrate imaging findings of various lymphatic pathology diagnosed on MR.
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Authors:  Bodner Jeffrey , Khanna Geetika , Riedesel Erica , Gill Anne , Hawkins Matt , Shah Jay , Variyam Darshan , Alazraki Adina

Keywords:  Lymphatic, Lymphangiography, MR

Albers Brittany,  Yang Yiting,  Parikh Ashishkumar,  Shah Chetan

Final Pr. ID: Poster #: SCI-015

Head CT is often performed in the emergency setting to evaluate for new neurologic symptoms. CT is limited in evaluation of acute stroke, brainstem and posterior fossa lesions, demyelinating disease, and diffuse axonal injury. Unremarkable head CT may be falsely reassuring and can delay treatment. Limited sequence MR (LSMR) is a new approach for evaluating a patient with neurologic symptoms. In order for LSMR to be feasible, it must be accurate, efficient, and cost-effective. Read More

Authors:  Albers Brittany , Yang Yiting , Parikh Ashishkumar , Shah Chetan

Keywords:  Emergency, CT, MR

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

Maddocks Alexis,  Ayyala Rama,  Jimenez Jesus,  Miller Russell,  Duron Vincent

Final Pr. ID: Poster #: SCI-006

Giant omphaloceles are large in size and contain a significant portion of liver. Giant omphaloceles are often associated with other co-morbidities, such as pulmonary hypoplasia, which can lead to respiratory insufficiency, prolonged intensive care support, assisted ventilation, and death. The purpose of this study is to develop a prognostic model for prediction of post-natal outcomes in patients with giant omphaloceles using fetal MRI calculated observed to expected total lung volumes (O/E TLV). Read More

Authors:  Maddocks Alexis , Ayyala Rama , Jimenez Jesus , Miller Russell , Duron Vincent

Keywords:  omphalocele, Fetal MR

Du Tianyi,  O'brien William

Final Pr. ID: Poster #: EDU-048

This educational exhibit will provide an illustrative review of the following orbital and intracranial complications of sinusitis in children:
Post-septal orbital cellulitis
Ophthalmic vein thrombosis
Cavernous sinus thrombosis
Epidural abscess
Subdural empyema
Brain abscess
Pott Puffy Tumor
Read More

Authors:  Du Tianyi , O'brien William

Keywords:  CT, MR, MRI

Vey Brianna,  Cho Joo,  Taylor Susan,  Mehollin-ray Amy,  Alazraki Adina,  Khanna Geetika,  Linam Leann

Final Pr. ID: Poster #: EDU-047

MR Urography is an advanced imaging technique with increasing utilization that allows the interpretation of both anatomic and functional urologic data. This allows for a more efficient study of renal parenchymal and collecting system abnormalities, however the complexity and volume of functional data can make for an intimidating task to the interpreting radiologist. Key factors to success include: adequate patient preparation, optimal imaging protocol in conjunction with sedation/anesthesia and complex advanced post-processing techniques.

In this educational poster, we aim to provide an initial overview of MRU with practical points on appropriate patient preparation and study optimization, followed by a detailed overview of the myriad of functional data acquired with each study. Finally, we will review a series of image-rich cases along with the post-processed functional data in order to illustrate the approach to interpretation in the setting of anatomic abnormalities on MRU.
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Authors:  Vey Brianna , Cho Joo , Taylor Susan , Mehollin-ray Amy , Alazraki Adina , Khanna Geetika , Linam Leann

Keywords:  MRU, Functional, MR

Trout Andrew,  Zhang Bin,  Dillman Jonathan,  Anupindi Sudha,  Gee Michael,  Khanna Geetika,  Xanthakos Stavra,  Baikpour Masoud,  Calle-toro Juan,  Ozturk Arinc,  Serai Suraj

Final Pr. ID: Paper #: 008

MR elastography (MRE) is increasingly being used to non-invasively assess diffuse liver disease in children. However, there are limited normal liver stiffness data for MRE in children. The purpose of this study was to determine normal liver stiffness measured by MRE for children and assess for associations with demographic factors, MRI field strength and MRI vendor. Read More

Authors:  Trout Andrew , Zhang Bin , Dillman Jonathan , Anupindi Sudha , Gee Michael , Khanna Geetika , Xanthakos Stavra , Baikpour Masoud , Calle-toro Juan , Ozturk Arinc , Serai Suraj

Keywords:  Elastography, MR, Liver

Nevo Elad,  States Lisa,  Magee Ralph

Final Pr. ID: Poster #: EDU-008 (T)

PET/MRI is a relatively new imaging modality whose efficacy is still being determined. One of the major draws to PET/MR over PET/CT is the reduction in radiation exposure to patients. This is especially desirable in the pediatric population due to the likelihood of multiple exposures during their lifetime, and the increased sensitivity they have to radiation. A typical whole body PET/CT exam can take about 30 minutes, whereas a typical whole body PET/MR exam takes about 90 minutes at our institution. The introduction of a new 3D T2 Dixon technique sequence for PET/MR has the potential of decreasing total scan time significantly, however maintaining current image quality and diagnostic value is critical. Our objective is to test out this new sequence to see whether scan times are reduced and if it is a viable diagnostic replacement for our current T2 sequence. Read More

Authors:  Nevo Elad , States Lisa , Magee Ralph

Keywords:  PET/MR, Optimization

Reddy Nidhi,  Chan Sherwin,  Robinson Amie,  Mardis Neil,  Dahl Amy,  Fickenscher Kristin

Final Pr. ID: Poster #: SCI-017

Inflammatory bowel disease (IBD), including Crohn disease, is a cause of significant morbidity in the pediatric population. Perirectal disease is a Crohn related complication affecting as many as 62% of children. Magnetic resonance enterography (MRE) is being increasingly utilized in characterizing the extent of IBD. Dedicated perirectal disease imaging, such as a T2 SPACE, requires an additional 10-15 minutes of imaging time on an already time constrained modality. The goal of our study was to determine the best imaging protocol for patients without clinically suspicious perirectal disease based on the incidence in this population. Read More

Authors:  Reddy Nidhi , Chan Sherwin , Robinson Amie , Mardis Neil , Dahl Amy , Fickenscher Kristin

Keywords:  Perirectal Disease Imaging, MR Enterography, Pediatric MRI

Chopra Mark,  Watson Tom,  Olsen Øystein

Final Pr. ID: Poster #: CR-023

The incidence of paediatric inflammatory bowel disease (pIBD) is increasing. MR enterography (MRE) is increasingly recognised as the gold standard imaging technique for the small bowel in IBD. The advantages of MRE include the lack of ionising radiation and greater soft tissue definition. It also allows functional information from diffusion sequences and is used for IBD diagnosis, monitoring of disease activity and complications such as abscess, stricture or fistula. Extra-intestinal manifestations can also be identified.

Younger children often need a general anaesthetic (GA) in order to undergo MRI. Excellent distension of the small bowel loops on MRE is essential to aid accurate assessment. As the child cannot drink a large volume of fluid prior to anaesthetic induction, fluid distension is facilitated through insertion of a nasojejunal tube and instillation of fluid via the tube whilst under GA. We present our institutional practice from a large paediatric hospital for performing MR enterography under GA in young children.

A retrospective study of our Radiology Information Service (RIS) was undertaken to identify children under the age of 10 years who underwent MRE under GA between 2010-2015. The anaesthetic charts of these children were obtained and the anaesthetic duration / complications were recorded. The imaging was reviewed to evaluate the MRI quality, degree of distension and report finding. The MR protocol and sequence optimisation will also be discussed.

12 patients were included in the study, aged from 23 months to 10 years.The length of GA time ranged from 110-185 minutes (average 142 minutes) and no significant adverse effects were described. The mean fluoroscopy radiation dosage for NJ insertion was low (8 micrograys) and the success rate was high (91%).
All completed studies were reviewed and oral contrast reached the terminal ileum in 100%. Bowel distension was rated as good or excellent in all cases.

Our institutional experience has shown that MRE under GA with nasojejunal tube enteroclysis is feasible and can safely produce high quality, diagnostic imaging in the young paediatric patient.
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Authors:  Chopra Mark , Watson Tom , Olsen Øystein

Keywords:  MR enterography, Inflammatory bowel disease, general anaesthesia, enteroclysis

Kelleher Michael

Final Pr. ID: Poster #: EDU-035

The purpose of this educational exhibit is to describe the most common pediatric bone marrow patterns, including normal variants and common pathology. Read More

Authors:  Kelleher Michael

Keywords:  MR, Bone marrow

Patel Hanisha,  Mayl Jonathan,  Maheshwari Mohit,  Mohan Suyash,  Chandra Tushar

Final Pr. ID: Poster #: EDU-055

Moyamoya disease (MMD) is an uncommon cerebrovascular disease that is characterized by progressive stenosis of the terminal portion of the internal carotid artery and its main branches, which is accompanied by the development of collateral vessels at the base of the brain. The purpose of this educational exhibit is to provide a succinct review of the imaging findings of MMD and its frequently associated complications, demonstrate the role of various imaging techniques in diagnosis and clinical decision making, and give an overview of surgical approaches and post operative appearances. Read More

Authors:  Patel Hanisha , Mayl Jonathan , Maheshwari Mohit , Mohan Suyash , Chandra Tushar

Keywords:  Moyamoya, MR Angiogram, MR perfusion

Binkovitz Larry,  Sutton Samuel

Final Pr. ID: Poster #: CR-032

To present the first PET/CT and PET/MRI imaging findings of acase of multiple myeloma, MM, in a pediatric patient. Read More

Authors:  Binkovitz Larry , Sutton Samuel

Keywords:  Plasmacytoma, PET/CT, PET/MR

Farrell Crystal,  Pareek Anuj,  Muehe Anne,  Pribnow Allison,  Steffner Robert,  Avedian Raffi,  Daldrup-link Heike

Final Pr. ID: Poster #: EDU-088

PET/MR is a valuable and growing imaging method for the assessment and management of pediatric bone tumors. Although plain radiography remains the first line modality for initial evaluation, cross sectional imaging is often required for further characterization of indeterminate or aggressive appearing lesions. Due to its superior soft tissue contrast resolution compared to CT, MR has become the mainstay in tissue characterization, locoregional staging, and surgical planning of pediatric bone tumors. By adding functional and metabolic information, FDG-PET imaging is useful for “one stop” local tumor and whole-body staging, evaluating response to therapy and surveillance. 18F-FDG PET/MR scans have the benefit of lower radiation and increased patient convenience compared to 18F-FDG PET/CT scans. However, due to the relatively recent development of this technology, many radiologists may be unfamiliar with the technical considerations and interpretation pearls and pitfalls of PET/MR. This educational exhibit reviews the imaging technique, reporting requirements, and imaging characteristics of the most common pediatric bone tumors with 18F-FDG PET/MR. Read More

Authors:  Farrell Crystal , Pareek Anuj , Muehe Anne , Pribnow Allison , Steffner Robert , Avedian Raffi , Daldrup-link Heike

Keywords:  PET/MR, bone tumor, cancer

Maianski Irit,  Ahmad Tahani,  Khan Naeem

Final Pr. ID: Poster #: EDU-127

The purpose of this pictorial review is
* To illustrate the classic MRI characteristics of PA in common and less typical locations in both standard advanced MRI sequences. Special attention to MR Spectroscopy will be provided
* To outline the less specific imaging features
* To discuss the relevant differential diagnosis according to tumor location
Read More

Authors:  Maianski Irit , Ahmad Tahani , Khan Naeem

Keywords:  Pilocytic Astrocytoma, MR spectroscopy

Kelsch Ryan,  Moore Megan,  Krishnan Anant

Final Pr. ID: Poster #: SCI-011

The purpose of this research was to analyze our institution’s large database of fetal magnetic resonance (MR) for cases of ventriculomegaly in order to understand trends in pre and postnatal MR. Read More

Authors:  Kelsch Ryan , Moore Megan , Krishnan Anant

Keywords:  Ventriculomegaly, Fetal, MR

Dopp Matthew,  Lund Matthew,  Bartnik-olson Brenda,  Barnes Samuel,  Udochukwu Oyoyo,  Burns-benggon Jennifer,  Paggie Kim

Final Pr. ID: Poster #: SCI-025

Magnetic Resonance Spectroscopy (MRS) is an important imaging adjunct for the diagnosis of hypoxic ischemic injury and brain death. As the concentration of adenosine triphosphate is depleted, the cell switches from oxidative phosphorylation to anaerobic glycolysis. The byproduct of this metabolic pathway is the creation of lactate from pyruvate. This leads to lactic acidosis, which can be detected with MRS. The presence of a lactate peak on MRS is not specific to the degree of hypoxic injury. In hypoxic conditions, other metabolites are detectable by MRS such as Alanine. Alanine is a product of the glucose-alanine cycle, where Pyruvate is converted to Alanine. We hypothesize the presence of high level of Alanine is seen only in severe hypoxia, and therefore may be a more specific marker for severe HIE and brain death. Read More

Authors:  Dopp Matthew , Lund Matthew , Bartnik-olson Brenda , Barnes Samuel , Udochukwu Oyoyo , Burns-benggon Jennifer , Paggie Kim

Keywords:  Brain Death, MRS, Hypoxia

Goncalves Fabricio,  Wang Dah-jyuu,  Goldman-yassen Adam,  Martin-saavedra Juan,  Alves Cesar Augusto,  Teixeira Sara,  Andronikou Savvas,  Vossough Arastoo

Final Pr. ID: Paper #: 162

Proton MRS (1H-MRS) is a technique to non-invasively study brain metabolites in vivo. 1H-MRS has been shown to detect abnormal brain accumulation of lactate in primary mitochondrial disorders (PMDs). However, differences in lactate concentration among the different PMDs have not been explored. We aimed to explore differences in quantitative 1H-MRS derived metabolite concentrations, particularly of lactate, and their ratios, in PMDs. We analyzed quantitative 1H-MRS data of the brain in pediatric patients with different types of genetically confirmed PMDs to evaluate differences in metabolite concentration and ratios. Read More

Authors:  Goncalves Fabricio , Wang Dah-jyuu , Goldman-yassen Adam , Martin-saavedra Juan , Alves Cesar Augusto , Teixeira Sara , Andronikou Savvas , Vossough Arastoo

Keywords:  MR Spectroscopy, Mitochondrial, LCModel

Portal Daniel,  Neuman Jeremy

Final Pr. ID: Poster #: CR-013

A 12 year old hispanic male with a past medical history of rectal prolapse presented to the ED from the pediatrician with a Hgb of 4.5 on outpatient lab work. The patient’s mother reports a history of constipation, staying in the bathroom for long periods of time and straining. Additionally the patient has been fatigued and pale for the last year with intermittent bloody diarrhea for the last 3 years.
Inpatient testing included defecography which showed evidence of rectal prolapse. MR enterography revealed wall thickening and hyperenhancement of the rectosigmoid colon, consistent with infectious/inflammatory etiology. Colonoscopy with biopsy was performed and histopathology results were consistent with solitary rectal ulcer syndrome.
The patient was successfully treated conservatively with dietary changes, topical medications and education about bathroom habits.

Solitary rectal ulcer syndrome (SRUS), first described in 1829, is an uncommon, benign disease characterized by clinical history, imaging (including defecography, and MR enterography), colonoscopy and diagnosed by histopathological findings. With an annual prevalence of 1 in 100,000, SRUS is most commonly found in young adults, but also seen in pediatric and geriatric populations.
Clinical presentation usually includes a history of prolonged straining, constipation, lower abdominal pain, rectal bleeding, mucous discharge and rarely rectal prolapse. Solitary rectal ulcer syndrome is actually a misnomer as only 40% of cases present with ulcers; even fewer present with a solitary ulcer. The etiology is not completely understood but is likely multifactorial.
Diagnosis of SRUS is often missed or delayed due to low clinical suspicion, inadequate rectal biopsy or failure to recognize histopathological features of the disease. It is therefore important to recognize solitary rectal ulcer syndrome and the diagnostic features and maximize the likelihood of accurately diagnosing SRUS early on.
Read More

Authors:  Portal Daniel , Neuman Jeremy

Keywords:  MR Enterography, Solitary Rectal Ulcer Syndrome, Defecography