Bao Rina,  Grant Ellen,  Ou Yangming

Final Pr. ID: Poster #: SCI-030

Hypoxic Ischemic Encephalopathy (HIE) is a brain injury caused by a lack of blood and oxygen supply to the brain. HIE affects 4,000,000 term-born neonates per year worldwide, with an estimated 2 billion/year cost in the US, let alone family burdens. Therefore, reducing mortality and morbidity for HIE patients remains an important public health concern. Therapeutic hypothermia (TH) was established in 2005 as a standard therapy by cooling patients to 33-34°C in the first six postnatal hours for 72 hours. However, 35–50% of the patients still experience adverse outcomes, defined as death or cognitive Bayley Scales of Infant Development by age two years. Ongoing HIE-related trials worldwide are testing whether new therapies can supplement TH and further reduce adverse outcomes. However, therapeutic innovation is slow and inconclusive, for 1) before therapy, patients at high risk of developing adverse outcomes cannot be identified; 2) after therapy, outcomes cannot be measured until age two years. Besides, public MRI data exists for hundreds of patients with brain tumors, Alzheimer’s Disease, and other diseases, fueling AI’s success in MRI-based diagnosis and prognosis of brain tumor, Alzheimer’s Disease, and other disorders. In contrast, annotated MRIs with linked clinical and bio-marker data do not exist publicly for HIE. Our previous work has collected multi-site HIE MRI data. Therefore, to fill the gap in HIE diagnosis with MRI data, target high-risk patients, increase efficiency, evaluate therapeutic effects early, and expedite therapeutic innovations, in this work, we propose to predict 2-year neurocognitive outcomes in neonates using brain MRIs by deep learning methods. Read More

Authors:  Bao Rina , Grant Ellen , Ou Yangming

Keywords:  Brain MRIs, Brain injury, Hypoxic Ischemic Encephalopathy

Ben-david Eliel,  Zharkov Elena,  Pais Adi,  Kasirer Yair,  Bin-nun Alona

Final Pr. ID: Poster #: CR-029

A novel 1T MRI scanner, previously compared to a 1.5T Siemens scanner, was placed in our NICU. The 5-gauss safety line is inside the magnet, rendering standard magnetic safety precautions unnecessary and allowing maintaining ongoing critical care. Scans included near-term equivalent stable neonates and neonates in an acute / sub-acute setting of disease. Through the following cases we present the capabilities of the 1T in-NICU scanner to evaluate the neonatal brain throughout different phases of injury.

Case 1–Chronic. A 28 5/7 week infant born to mother with chorioamnionitis, developed sepsis. Cranial US showed bilateral IVH Grade III (L) / IV (R) on DOL 2. At DOL 49, ventriculomegaly and porencephalic cysts were detected on US. MRI at term equivalent age demonstrated the post hemorrhagic cystic degeneration and ventriculomegaly. Follow up MRI was performed at 4 months of age due to increasing head circumference. Presence of prior MRI images increased diagnostic confidence.

Case 2–Sub-acute. A term infant with moderate encephalopathy treated with therapeutic hypothermia, after absent fetal movements for two days. Complicated NICU course, with multi-system organ failure, seizures and severe hypoglycemia. MRI scan on DOL 14 showed punctate rim-T1 hyperintense foci with a hypointense center, opposite T2 signal and restricted diffusion, in the centrum semi-ovale and periventricular white matter. Sub-acute hemorrhage with suspected ischemic etiology was the working diagnosis.

Case 3–Acute. A term infant delivered by stat C-section for non-reassuring fetal heart rate and low Apgar scores. Complicated NICU course, including multisystem organ failure, seizures, and burst suppression on cerebral monitoring. MRI scan on DOL 6 showed diffuse abnormal cortical T1 and white-matter T2 signal. Restricted diffusion was seen diffusely in a posterior distribution. Diffuse hypoxic ischemic injury was diagnosed.

Case 4–Hyper-Acute. A 31 week infant was delivered by stat C-section after major maternal trauma, with extremely severe hypovolemic shock. An MRI scan was performed at 8 hours of life, to determine direction of care while intubated and on vasopressor support. Extra-axial and intraventricular hemorrhage were seen, as well as diffuse restricted diffusion. The scan assisted family and physicians to reach a decision regarding discontinuing of care. Read More

Authors:  Ben-david Eliel , Zharkov Elena , Pais Adi , Kasirer Yair , Bin-nun Alona

Keywords:  Neonate, MRI, Brain

Walters Courtney,  Pfeifer Cory,  Long Clayton,  Retson Laura,  Vaughn Jennifer

Final Pr. ID: Poster #: CR-037

Neurotoxicity is a potential adverse effect from chemotherapeutic agents such as cytarabine (Ara-C) when treating children with acute myeloid leukemia (AML). Ara-C is an antineoplastic antimetabolite that, once activated by deoxycytidine kinase, mimics and competes with natural nucleosides to disrupt DNA synthesis. If present in the nervous system, Ara-C can lead to central nervous system (CNS) (e.g., cerebellar syndrome, encephalopathy, necrotizing leukoencephalopathy, and seizures), spinal cord (e.g., myelopathy), and peripheral nerve (e.g., sensory polyneuropathy) symptoms. Although neuroradiologic literature is sparse and variable, unique cases of neurotoxicity continue to occur.
We present a 2-year-old male with a history of recurrent infections, leg pain at night, weight loss, and night sweats, who was diagnosed with AML and started on an intrathecal (IT) and intravenous chemotherapy regimen (i.e., Ara-C, daunorubicin, etoposide, and methotrexate). During Intensification II, several days after receiving their fourth dose of IT Ara-C and two weeks after IT methotrexate, the patient developed acute altered mental status, ataxia, and right-sided weakness. MRI brain with and without intravenous contrast showed an atypical expansile region of abnormal signal in the left thalamus, brainstem, temporal lobe, and cerebellum with asymmetric increased perfusion, patchy enhancement, and patchy faint restricted diffusion. There were also patchy non-enhancing areas of white matter signal abnormality and tiny microhemorrhage. MRI of the spine, MR angiography and venography of the brain were normal. The patient’s symptoms gradually improved without intervention with mild residual right-sided weakness and ataxia. Infectious workup was negative. A follow-up brain MRI showed a reduction in the size of lesions. Ara-C was held from the subsequent chemotherapy regimen and symptoms did not recur. This case highlights a unique thalamic and brainstem finding not previously reported in the literature for Ara-C neurotoxicity in pediatric AML. Of the other chemotherapeutic agents, methotrexate (MTX)-induced neurotoxicity remains on the differential, however, such radiographic features are typically characterized by MTX-related leukoencephalopathy of the central white matter, which we do not see in this case. Altogether, Ara-C neurotoxicity should remain on the differential for children with neurological symptoms after receiving this agent. Read More

Authors:  Walters Courtney , Pfeifer Cory , Long Clayton , Retson Laura , Vaughn Jennifer

Keywords:  MRI Brain, Neuroradiology, Central Nervous System

Villanueva Fernando,  Barragan Eduardo,  Suarez Pilar,  Hidalgo-tobon Silvia

Final Pr. ID: Poster #: SCI-006 (S)

Los problemas en el desarrollo del lenguaje se han incrementado en anios recientes, se estima que solo en Mexico el siete por ciento de los ninios presenta alteraciones del lenguaje. La caracterizacion de los valores de ADC y FA asociados al area de Broca y Wernicke propuestas por el modelo clasico pueden permitir en un mediano plazo detectar anomalias en el sistema del lenguaje pudiendose utilizar para un diagnostico temprano. Por esta razon nuestro primer objetivo es caracterizar ambos parametros en pacientes sanos que permita establecer valores de control. Read More

Authors:  Villanueva Fernando , Barragan Eduardo , Suarez Pilar , Hidalgo-tobon Silvia

Keywords:  mri, brain, Language

Bhargava Ravi,  Anderson Scott,  Chari Radha

Final Pr. ID: Poster #: SCI-019

Fetal demise (FD) occurs in 1/1000 pregnancies after 20 weeks gestation. MRI is increasingly being used after ultrasound to assess fetal pathology. FD may occur in the interval between ultrasound and MRI, and various organ systems have been described as having changes on fetal MRI. Although ultrasound findings of FD have been well described, criteria for FD on MRI have not. Diffusion MRI evaluates Na⁺/K⁺ channel viability and can be used to evaluate tissue death. Flowing blood produces signal loss on MRI, and along with fetal heart activity results in MRI signal loss of the cardiac chambers. FD with no heart motion and increased signal within non-flowing blood in the heart should result in increased signal in the chambers relative to the myocardium. Either of these findings can be seen with different fetal pathology, but the combination of brain and cardiac changes may allow for a diagnosis of FD. We hypothesize that restricted brain diffusion in certain brain lobes along with increased signal within heart chambers is specific for FD. Read More

Authors:  Bhargava Ravi , Anderson Scott , Chari Radha

Keywords:  Fetal MRI, Brain, Cardiac

Schoeman Sean,  Venkatakrishna Shyam Sunder,  Chacko Anith,  Andronikou Savvas

Final Pr. ID: Poster #: SCI-026

To assess the utility and adaptability of some widely used automated segmentation methods when applied to abnormal pediatric magnetic resonance imaging (MRI) brain scans. Segmentation is an essential component of the workflow when building 3D anatomical models of abnormal pediatric brains to demonstrate surface pathology. Read More

Authors:  Schoeman Sean , Venkatakrishna Shyam Sunder , Chacko Anith , Andronikou Savvas

Keywords:  Segmentation, 3D Printing, MRI Brain

Oh Saelin,  Lee Yoo Jin

Final Pr. ID: Poster #: EDU-078

Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD) is a recently defined neuroimmune disorder that presents with a wide range of clinical and radiological features. This study aims to describe the diverse brain MRI findings observed in patients with MOGAD and discuss their clinical implications. Read More

Authors:  Oh Saelin , Lee Yoo Jin

Keywords:  MRI Brain, Demyelination

Teixeira Sara,  Alves Cesar Augusto,  Martin-saavedra Juan,  Goncalves Fabricio,  Zarnow Deborah,  Feygin Tamara,  Andronikou Savvas

Final Pr. ID: Paper #: 105

Postmortem imaging is increasingly used following stillbirths and neonatal death. Estimating time of death has legal, biological, and ethical implications. This study aims to investigate feasibility of prenatal MRI in estimating time of death in intra-uterine fetal demise (IUFD). Read More

Authors:  Teixeira Sara , Alves Cesar Augusto , Martin-saavedra Juan , Goncalves Fabricio , Zarnow Deborah , Feygin Tamara , Andronikou Savvas

Keywords:  Fetal MRI, Brain, Autopsy

Parthasarathy Jayanthi,  Gedela Satya,  Ostendorf Adam,  Pindrik Jonathan,  Jones Jeremy,  Mcallister Aaron,  Selvaraj Bhavani,  Long Alexander

Final Pr. ID: Poster #: SCI-058

Establish and evaluate a process for 3DPrinting (3DP) patient specific functional anatomical models of the brain from multiple MRI sequences in patients with epileptic focal lesions.The second objective was to evaluate the clinical utility of the models. Read More

Authors:  Parthasarathy Jayanthi , Gedela Satya , Ostendorf Adam , Pindrik Jonathan , Jones Jeremy , Mcallister Aaron , Selvaraj Bhavani , Long Alexander

Keywords:  Brain model, MRI brain, 3D Printing

Banaz Tuba,  Omaç Birinci Aysegül,  Ayaz Ercan,  Akyel Nazli Gülsüm

Final Pr. ID: Poster #: CR-038

Introduction: Hereditary spastic paraplegias (HSP) are heterogeneous neurodegenerative disorders causing progressive lower limb spasticity. MRI findings are variable but crucial for differential diagnosis. Classic radiological features include spinal cord atrophy (most common), corpus callosum thinning, and T2/FLAIR hyperintensities in the corticospinal tracts, such as the posterior limb of the internal capsule and the " ears of the lynx" sign (periventricular frontal signal). We present a case demonstrating both typical and significant atypical MRI findings.
Case Report: A 16-year-old male patient presented to our clinic with a three-year history of "finger-tip walking." Neurological examination revealed mild mental retardation, increased deep tendon reflexes (DTR) in the lower extremities, and mild spasticity in the feet. The patient's history indicated normal developmental milestones, and there was no known family history of neurological disease. Clinical findings were primarily consistent with HSP, and radiological evaluation was planned.
Radiological Findings: Cranial MRI showed findings typical for HSP: symmetric T2 hyperintensities in the posterior limbs of both internal capsules and in the frontal periventricular white matter (the " ears of the lynx" sign). The corpus callosum was markedly thin, especially the genu and body. Atypical findings were also present: diffuse symmetric T2 signal changes in the bilateral temporoparietal white matter and prominent cerebral sulcal spaces (cerebral atrophy) for his age.
Discussion and Conclusion: This case highlights the classic radiological triad of complicated HSP: corpus callosum thinning, posterior internal capsule signal changes, and the "ears of the lynx" sign, all reflecting corticospinal tract involvement. However, the presence of significant cerebral atrophy and widespread temporoparietal white matter abnormalities are atypical. These atypical features expand the differential diagnosis, necessitating clinical correlation to rule out overlapping conditions such as periventricular leukomalacia (PVL) sequelae or a hypomyelination disorder. This case underscores that while MRI can reveal characteristic signs of HSP, it may also present a mixed picture with unexpected findings, emphasizing its role in characterizing the full scope of white matter pathology.. Read More

Authors:  Banaz Tuba , Omaç Birinci Aysegül , Ayaz Ercan , Akyel Nazli Gülsüm

Keywords:  Neuroradiology, MRI Brain, Paediatric Radiology

Iordanou James,  Kelsch Ryan

Final Pr. ID: Poster #: EDU-077

Hypoxic ischemic encephalopathy (HIE) is one of the most common causes of neurological injury in neonates. Given the variability of clinical manifestations, ranging from normal neurological outcomes to profound neurocognitive impairment or death, precise characterization is critical in prognostication. Evaluation is made more challenging by the unique morphologic features of the neonatal brain which constantly evolve as the nervous system matures. With this in mind, the timing of disease and duration of insult can produce characteristic imaging patterns. The timing of imaging is also crucial, as typical patterns may become occult or obscure in the subacute/chronic setting. Unexplained signal abnormalities seen in the neonate may also be erroneously attributed to HIE, when in fact another underlying disease process may be the etiology. The goal after viewing this exhibit is to have a clear and concise pattern based approach for the diagnosis and prognostication of HIE while highlighting important differentials that may mimic this disease.

The exhibit will review the most common morphologic patterns of hypoxic ischemic encephalopathy in neonates with perinatal HIE using sample brain MRI and ultrasound studies from our institution over the last 3 years. Initially focus will be placed on discussing subtypes and mechanisms of classic HIE based on the severity of the insult and duration of ischemia (mild/moderate acute, mild/moderate prolonged, severe acute, and severe prolonged). Characteristic schematic and imaging examples will be provided for each category. Additionally, for each pattern of injury several alternative diagnoses will be discussed which can mimic HIE in the term neonate, and imaging examples will be provided. The potential mimics will include developmental, vascular, infectious, metabolic, and congenital etiologies.

Understanding the variable patterns of HIE is paramount in providing both an accurate report and aiding in prognostication. Equally important is knowing and considering differential diagnoses for common mimics of HIE, which may dramatically alter management. Read More

Authors:  Iordanou James , Kelsch Ryan

Keywords:  Hypoxic Ischemic Encephalopathy (HIE), Neonatal Outcomes, MRI Brain

Bao Rina,  Grant Ellen,  Ou Yangming

Final Pr. ID: Poster #: SCI-027

Hypoxic ischemic encephalopathy (HIE) is a brain injury that occurs in 1 ∼ 5/1000 term-born neonates. HIE lesion detection is a crucial step in clinical care of HIE. It could lead to a more accurate estimation of prognosis, a better understanding of neurological symptoms, and a timely prediction of response to therapy in this population. In addition, the rise of Artificial Intelligence (AI) brings hope to objectively and accurately finding HIE lesions. With public MRI data for brain tumors, Alzheimer’s Disease, and other diseases, AI has achieved significant success in MRI-based diagnosis and prognosis of these diseases. To facilitate the early prognosis and diagnosis of HIE, in this work, we focus on HIE lesion detection with MRI data using deep learning methods. Read More

Authors:  Bao Rina , Grant Ellen , Ou Yangming

Keywords:  Brain MRIs, Brain injury, Hypoxic Ischemic Encephalopathy

Yadav Ratan,  Subramanian Subramanian

Final Pr. ID: Poster #: CR-041

Leigh disease is a mitochondrial encephalopathy characterized by bilateral symmetric involvement of the brainstem and basal ganglia. SURF1 variants demonstrate restricted diffusion and symmetric T2/FLAIR hyperintensity of the substantia nigra, periaqueductal gray, and inferior olivary nuclei. MORC2 mutations, though primarily affecting the peripheral nervous system (causing Charcot–Marie–Tooth disease, spinal muscular atrophy–like features, and DIGFAN syndrome), can present with Leigh-like MRI patterns, leading to diagnostic uncertainty. Distinguishing these entities on MRI is essential for targeted genetic testing and counseling.
The purpose of this study is to compare MRI findings of a child with a confirmed MORC2 mutation to those of SURF1-variant Leigh disease, highlighting overlapping and distinguishing brainstem features that aid differential diagnosis. Read More

Authors:  Yadav Ratan , Subramanian Subramanian

Keywords:  Genetics, MRI Brain, Mitochondrial Disease

Robles Morales Carlos,  Carmant Laurence,  Amirabadi Afsaneh,  Shinar Shiri,  Miller Elka

Final Pr. ID: Poster #: CR-010

Fetal anemia is a severe condition with diverse etiologies that can lead to complications, including fetal hypoxia, heart failure, hydrops fetalis and intrauterine fetal death if left untreated. In severe cases, intrauterine transfusion (IUT) is a life-saving intervention. The impact of fetal anemia on brain development remains unclear. This study aimed to evaluate neuroimaging findings in fetuses diagnosed with anemia using magnetic resonance imaging (MRI). Read More

Authors:  Robles Morales Carlos , Carmant Laurence , Amirabadi Afsaneh , Shinar Shiri , Miller Elka

Keywords:  Anemia, Fetal Imaging, MRI Brain

Soun Jennifer,  Ayyala Rama,  Maddocks Alexis,  Miller Russell,  Simpson Lynn,  Laifer-narin Sherelle

Final Pr. ID: Poster #: SCI-048

Monochorionic multiple gestations are at risk for complications related to a shared placenta. In utero therapies such as fetoscopic laser and radiofrequency ablation (RFA) are used to treat these complications. Previous work at our institution demonstrated a low rate of neuroanatomical abnormalities on post-therapy fetal imaging. The purpose of this study was to evaluate postnatal neurological outcomes within the same cohort.
Read More

Authors:  Soun Jennifer , Ayyala Rama , Maddocks Alexis , Miller Russell , Simpson Lynn , Laifer-narin Sherelle

Keywords:  Fetal, MRI, Brain

Kolleri Jouhar,  Jaganathan Sriram,  Razzaq Sania,  Rana Abhilasha,  Glasier Charles,  Murphy Janice,  Ramakrishnaiah Raghu

Final Pr. ID: Poster #: EDU-103

Recurrent Painful Ophthalmoplegic Neuropathy (RPON), formerly known as ophthalmoplegic migraine, is a rare pediatric disorder characterized by recurrent episodes of headache followed by ophthalmoplegia involving one or more ocular motor nerves. The International Classification of Headache Disorders (ICHD-3, 2018) now classifies this entity as a cranial neuropathy rather than a migraine variant, reflecting its inflammatory and demyelinating features. This educational exhibit highlights the clinical presentation and MRI features of RPON, emphasizing the imaging role in diagnosis and in distinguishing it from other causes of painful ophthalmoplegia. Read More

Authors:  Kolleri Jouhar , Jaganathan Sriram , Razzaq Sania , Rana Abhilasha , Glasier Charles , Murphy Janice , Ramakrishnaiah Raghu

Keywords:  Neuroradiology, MRI, Brain

Goncalves Fabricio,  Serai Suraj,  Alves Cesar Augusto,  Teixeira Sara,  Zuccoli Giulio

Final Pr. ID: Poster #: EDU-078

Synthetic magnetic resonance imaging (SyMRI) is a new imaging technique that permits generating multiple contrast-weighted images based on relaxivity measurements of tissue properties in a single acquisition using a multi-echo, multi-delay saturation recovery spin-echo sequence of approximately 6 minutes. Read More

Authors:  Goncalves Fabricio , Serai Suraj , Alves Cesar Augusto , Teixeira Sara , Zuccoli Giulio

Keywords:  Synthetic MRI, BRAIN, Quantitative MRI

Gardner Kyle,  Kuwabara Michael

Final Pr. ID: Poster #: EDU-108

Objective:
Describe the embryologic origin and developmental anatomy of the torcular pathology.
Identify the key MRI and MR venography characteristics of torcular pseudomass that distinguish it from dural venous sinus thrombosis and other posterior fossa lesions.
Recognize the typical clinical scenarios in which torcular pseudomass is discovered and understand its benign, self-limiting natural history.
Learning Points:
Torcular pseudomass is a benign, self-limiting developmental variant in infants, not true mass.
Appears midline, as a non-enhancing, extra-axial soft-tissue prominence posterior to the torcular Herophili on MRI
Differential diagnoses include dural venous sinus thrombosis, dermoid cyst, and neoplasm.
No enhancement or venous obstruction on MRV distinguishes it from thrombosis.
Follow-up is rarely required unless associated abnormalities are suspected.
Recognition of this entity prevents unnecessary imagination or surgical intervention.
Most cases resolve spontaneously by 12–18 months of age.
Discussion:
Torcular pseudomass is a non-pathologic developmental variant located posterior to the torcular Herophili, the confluence of dural venous sinuses. It represents persistent mesenchymal tissue that fails to fully regress after birth. While uncommon, it is increasingly recognized with the wider use of MRI in infants. This benign entity typically appears between 2–6 months of age and resolves spontaneously within the first year of life. The overall prevalence is unknown, but literature shows on MRI series estimate Torcular pseudomass is found an incidental in up to 1–2% of pediatric neuroimaging studies.
Awareness of this variant is essential, as it can be mistaken for dural venous sinus thrombosis, dermoid cyst, or posterior fossa tumor. Misdiagnosis may lead to unnecessary interventions such as anticoagulation or biopsy. Read More

Authors:  Gardner Kyle , Kuwabara Michael

Keywords:  Congenital, MRI Brain

Paradise Charles,  Ellenbogen Jonathan,  Kurzbuch Arthur,  Avula Shivaram

Final Pr. ID: Poster #: EDU-092

Neuroimaging plays a vital role in the diagnosis of epileptogenic foci and directing subsequent ongoing multi-disciplinary team approach pathways in paediatric epilepsy. Our centre is one of four tertiary level paediatric epilepsy surgery centres in England & Wales. The different epileptogenic pathologies can have similar imaging features and this educational review discusses the typical MRI findings of the commonly encountered epileptogenic foci in the paediatric population with an emphasis on advanced MRI features looking to demonstrate further typical patterns in our cohort which can help in cases of diagnostic uncertainty. Read More

Authors:  Paradise Charles , Ellenbogen Jonathan , Kurzbuch Arthur , Avula Shivaram

Keywords:  MRI Brain, Epilepsy, Cancer

Harris Chris

Final Pr. ID: Poster #: SCI-001 (R)

Background: Brain MRI has become an integral tool in the diagnosis and management of neonates with possible brain injury. In a large quaternary care neonatal intensive care unit (NICU), MRIs are routinely performed for the identification of white matter lesions in preterm infants, prognostication in hypoxic ischemic encephalopathy, peri-operative evaluation of patients with meningomyeloceles and hydrocephalus among other indications. Patients are often sedated in order to obtain high quality images, but sedation comes with complications. As these studies become an integral part of our practice in the NICU, we have identified a need to minimize the use of sedation to obtain clinically acceptable neonatal brain MRIs. Read More

Authors:  Harris Chris

Keywords:  Quality Improvements, Reduce Sedation, MRI brains