Dhami Alysha,  Seekins Jayne

Final Pr. ID: Poster #: EDU-087

Pediatric breast lesions are uncommon and can be a source of alarm to both pediatric patients and their caretakers. Lesions may be incidentally detected on imaging or may be associated with clinical symptoms prompting presentation. Prior to reviewing pathology, it is important for the radiologist to first have a clear understanding of the natural course of breast development in pediatric patients. We provide a multi-modal imaging review of breast bud development from the neonatal period through puberty. Next, we present a breadth of multimodal imaging cases of both benign and malignant lesions within the pediatric breast, including accessory breast tissue, gynecomastia, masses of the breast, masses of the chest wall mimicking breast masses, infection, trauma, and more. Lastly, this exhibit highlights key imaging characteristics that may prompt concern or need for further workup, offers optimization and best practices for imaging, and reviews appropriate management and referral recommendations for common entities. Read More

Authors:  Dhami Alysha , Seekins Jayne

Keywords:  Breast, Ultrasound and MRI, Multimodality

Tierradentro-garcia Luis,  Alizai Hamza

Final Pr. ID: Poster #: EDU-058

Background:

Juvenile idiopathic arthritis (JIA) is the most common rheumatic condition in the pediatric population, with a prevalence of up to 150 cases per 100,000 children. Although the diagnosis of JIA is clinical, imaging plays a crucial role in the monitoring and stratification of disease, such as detecting growth disturbances, chronic joint structural changes, or treatment response. Conventional radiography has low accuracy for detection of acute synovitis or enthesitis, whereas ultrasound provides real-time assessment of inflammatory changes. Magnetic resonance imaging (MRI) is the most sensitive modality to discern early inflammatory or destructive changes in JIA, with the potential to visualize soft tissue and osteochondral abnormalities.

Education goals:

1) To describe the diagnostic criteria for the 7 subtypes of JIA.
2) To illustrate the more common imaging findings in JIA (e.g. swelling, bone mineral density, loss of joint space, erosions, growth disturbances, joint malalignment, ankylosis, enthesitis) using conventional radiography, ultrasound, and MRI.
3) To highlight the importance of early imaging changes that can support the clinical diagnosis of JIA.
4) To present the role of multimodality imaging in the evaluation of complex joint involvement (e.g. atlanto-occipital, atlanto-axial, temporomandibular, spinal, sacroiliac) in JIA.
5) To emphasize the role of imaging in characterizing conditions that can mimic JIA. Read More

Authors:  Tierradentro-garcia Luis , Alizai Hamza

Keywords:  Juvenile Idiopathic Arthritis, Multimodality, Rheumatology

Ocal Selin,  Tivnan Patrick,  Alizadeh Houman

Final Pr. ID: Poster #: CR-039

Infantile myofibromatosis (IM) is rare and often enigmatic. We present the case of a 4mo ex-33-week male with a history of twin-twin transfusion syndrome, recurrent intussusception, rectal prolapse, and pancreatic insufficiency who was transferred to our hospital for persistent failure to thrive. Initial radiograph shortly after transfer revealed focal lytic lesions in the proximal bilateral femurs. This prompted a review of a CT done 2 months earlier at an outside hospital which revealed subtle mildly expansile lytic lesions within the ribs, iliac bones, and proximal femurs. On follow up CT and MRI at our hospital, these lesions had increased in size and number with newly apparent multilevel thoracolumbar spinal lesions with associated fractures. There was also bowel wall thickening and new hepatomegaly, suggestive of visceral involvement. Biopsy of a lesion in the left tibia was consistent with infantile myofibromatosis. After treatment with vinblastine/methotrexate and imatinib, CT demonstrated decrease in extent of osseous lytic disease, improvement in bowel wall thickening, and reduced hepatomegaly. About 90% of IM cases occur within the first two years of life and are subdivided into three categories: 1. solitary (50-80% of cases); 2. multicentric without visceral involvement; or 3. Generalized/multicentric with visceral disease. The most commons sites of solitary disease are the head/neck or trunk, and multicentric disease typically involves additional regions of skin/subcutaneous tissue, muscle, or bone (skull, femur, tibia, spine, ribs). One third of multicentric IM also manifests with visceral involvement, or generalized IM, like in this patient with osseous as well as bowel/visceral involvement. Though most cases are sporadic, IM can also rarely be familial. Though solitary and multicentric IM are considered benign and typically regress over 1-2 years, visceral involvement in generalized IM is associated with poor outcomes with reported mortality rates as high as 76%; it is usually treated with chemotherapy, as done here. Radiologist suspicion is critical for diagnosis, as in this case with the lytic bone lesions on radiograph. Imaging detection is thus also critical for accurately describing the extent of disease and to help direct treatment. With variable imaging findings described in past reports, we elucidate the imaging characteristics of IM seen on radiography, CT, MRI, and ultrasound. Read More

Authors:  Ocal Selin , Tivnan Patrick , Alizadeh Houman

Keywords:  Musculoskeletal, Multimodality Guidance, Rare Neoplasms

Sharma Karun,  Yadav Bhupender,  Vellody Ranjith,  Plishker William,  Shekhar Raj

Final Pr. ID: Poster #: SCI-039

Percutaneous CT-guided biopsy and ablation are established techniques to diagnose and treat solid tumors. However, some tumors are not adequately visualized with CT, even after IV contrast administration, because of transient enhancement. Many of these “CT-occult” tumors are optimally seen on preprocedural MRI or PET scans. To enable targeting of such tumors, we developed software that fuses MRI/PET images to intraprocedural CT in real time. The software corrects for soft-tissue deformations which occur due to differences in patient positioning or motion. The fusion imaging is generated after each intraprocedural CT scan and takes advantage of all available imaging data. We report retrospective evaluation of this fusion method for pediatric interventional radiology procedures. Read More

Authors:  Sharma Karun , Yadav Bhupender , Vellody Ranjith , Plishker William , Shekhar Raj

Keywords:  multimodality guidance, image fusion, CT-occult tumor

Silva De Campos Meneses Marcus Otavio,  Braojos Fernanda,  Prodigios Joice,  Guarilha Taísa,  Rodrigues Santos Luiz Antonio,  Souza Antonio

Final Pr. ID: Poster #: EDU-034

The spleen is frequently involved in a wide range of pathological processes, yet is insufficiently addressed in the radiology literature for the pediatric population. Understanding the embryological development of the spleen – originating as a mesodermal derivative that initially manifests as a condensation of mesenchymal cells within the dorsal mesogastrium and later translocates to the left side of the abdominal cavity as the stomach rotates – and recognizing its normal appearance in imaging methods are crucial for the accurate diagnosis of pathological processes. These processes vary from focal to diffuse spleen involvement and include anatomical variants (e.g., splenunculus), variations in size (e.g., splenomegaly), in number (e.g., polysplenia and asplenia), and in location (e.g., wandering spleen), as well as vascular (e.g., hemangioma and infarction), traumatic (e.g., lacerations), infectious (e.g., abscess), genetic (e.g., sickle cell disease) and neoplastic abnormalities (e.g., lymphoma and metastasis). Ultrasound is typically the first imaging modality in evaluating the spleen and its lesions; however, CT can provide detailed information in some contexts (e.g., trauma), and MRI offers excellent soft tissue contrast and is useful in cases requiring etiology differentiation (e.g., tumor). Therefore, it is important to understand how these different entities present in different imaging modalities, and what makes them unique. We aim to provide a comprehensive overview of spleen embryological development, and a visual differentiation of both common and uncommon splenic lesions in the pediatric population, highlighting high-yield clinical cases that illustrate key findings. Read More

Authors:  Silva De Campos Meneses Marcus Otavio , Braojos Fernanda , Prodigios Joice , Guarilha Taísa , Rodrigues Santos Luiz Antonio , Souza Antonio

Keywords:  Spleen, Multimodality, Splenic