Final Pr. ID: Poster #: EDU-080
The skeletal dysplasias are a large diverse group of several hundred disorders which are marked by abnormal bone and cartilage growth with resultant short stature. Dysplasias have been divided into larger groups according to common radiographic and/or genetic mutations. The purpose of this educational exhibit is to highlight one of these major groups, which are characterized by mutations of type 2 collagen. Read More
Authors: Parnell Shawn
Final Pr. ID: Poster #: CR-011 (S)
A four-year-old girl was referred to our service to investigate a mass in her left forearm. About a year before she had cellulitis in the same place which was treated and resolved with antibiotics. A month previous to our consult she notices a soft tissue swelling in her left forearm and a pediatrician referred her to an oncologist for investigation.
On physical examination, she presented with a medial bulging in her left forearm with local pain and no inflammatory signs. There was no history of fever.
The plain radiograph showed a lytic lesion oriented along the axis of the ulna surrounded by fading sclerosis. In the Computed Tomography there was a lytic lesion with periosteal new bone formation.
The diagnosis was Brodie’s abscess which is a form of subacute osteomyelitis. It is a collection of purulent material surrounded by granulation tissue and reparative sclerotic bone. Staphylococcal Aureus is the most common organism to lead to this entity but any pyogenic organism can cause it. Osteomyelitis is the result of bone infection being the trabecular and cortical involved. It can be spread by exogenous and contiguous or endogenous due to hematogenous spread. Read More
Final Pr. ID: Poster #: EDU-054
Current musculoskeletal MR imagiing utilizes multiple imaging planes and multiple weightings of two-dimensional turbo spin echo (2D TSE) to precisely delineate and characterize intra-articular abnormalities. Three-dimensional (3D) TSE sequences are currently available on most MRI vendor platforms. High resolution isotropic 3D imaging of the small joints reduces partial volume artifacts and allows for the reconstruction in any orientation, thus eliminating the need to acquire additional scans of different orientations with identical tissue contrast. However, the typical trade off of achieving very high resolution (under 0.5mm isotropic) is long acquisition time. Scan time reduction can be achieved with parallel imaging at the expense of reducing the signal-to-noise ratio (SNR) and with increasing the echo train length at the expense of image blurring. The addition of compressed sensing (CS), a recently commercially available acceleration technique, allows for decrease in acquisition time without the significant loss of SNR experienced with identical acceleration factors achieved with parallel imaging alone. CS exploits (1) image data sparsity via application of a sparsity transform of the image data; (2) pseudo-random-type of k-space sampling; (3) non-linear iterative reconstruction. We utilized CS to decrease scan time (range 4:55 to 5:35 minutes) of 3D PD FS TSE sequences to obtain high resolution (voxel size 0.45 x 0.45 x 0.45) imaging of the fingers, toes, wrist and feet. In this educational exhibit, we will review the normal anatomy and pathology of small joints Read More
Final Pr. ID: Poster #: CR-014
The case report will present imaging findings from two companion cases of adolescent athletes presenting with palpable thigh masses. Patient A underwent ultrasound and MR and was diagnosed with a degloving injury of the rectus femoris. Patient B also presented with a thigh mass, and following MR underwent attempted aspiration and biopsy. The patient was then diagnosed with inflammatory myositis based on pathology from the biopsy and subsequently evaluated by rheumatology. Following review of the imaging by pediatric radiologists, a degloving injury was then diagnosed and the patient was referred to orthopedics for further management. The exhibit will review the imaging features of this uncommon injury as well as review the complex anatomy of the rectus femoris muscle.
A degloving injury represents an injury to the rectus femoris in which the inner bipennate portion of the indirect myotendinous complex is separated from the surrounding outer unipennate portion of the muscle, which results in separation and retraction of the inner muscle belly from the outer muscle belly. It differs from typical injury to the indirect myotendinous junction in in which there is no dissociation of the inner and outer components of the muscle. Awareness of this injury will help avoid misdiagnosis of soft tissue mass and unnecessary interventions. Images included in the case report will include ultrasound and two MRs. Read More
Final Pr. ID: Poster #: SCI-021
Wrist trauma is common in children and generally requires radiography for diagnosis. Many children who receive radiographs do not have fractures and are thus subjected to unnecessary radiation exposure along with increased wait times in the emergency department (ED). Ultrasound (US) is safe, cost-effective, portable and sensitive in visualizing cortical disruption, potentially making it a valuable tool for bedside assessment of fractures. This study aims to determine the feasibility of using US to detect distal radius fractures (DRF) in children and to contrast the accuracy of hand-held device compatible 2D transducers to 3D transducers that can only be used with traditional US machines. In order to address difficulties in US image interpretation by inexperienced users, we investigated the utility of an artificial intelligence (AI) network. Read More
Final Pr. ID: Poster #: SCI-043
There is limited understanding and utilization of dynamic contrast enhancement MRI of marrow, periosteum and cartilage for diagnosis of musculoskeletal (MSK) disease in children. This is partly due to limited availability of pediatric disease models of marrow inflammation, infection, infiltration, or involvement by tumor. Herein we explore signal intensity time curves of relevant MSK targets using a 3D Golden-angle RAdial Sparse Parallel (GRASP) MRI technique. GRASP is an accelerated, free-breathing dynamic acquisition that has been shown to reduce the need for sedation. We aim to establish a baseline for normal enhancement characteristics of marrow, cartilage, synovium and periosteum of the growing skeleton in a sheep model as a precursor to translation to children. Read More
Final Pr. ID: Poster #: EDU-013 (T)
Introduction: Juvenile Idiopathic Arthritis (JIA) is the most common rheumatic entity in children and the second most common cause of musculoskeletal symptoms in pediatric patients. Treatment of JIA largely depends on frequently managing inflammation within the joints, and as such, ultrasound is a prime imaging modality that can be used for detection and monitoring of inflammation. Ultrasound is more sensitive than plain films in the early detection of JIA, and ultrasound is more sensitive than clinical examinations alone. As a low-cost, high-resolution imaging modality, ultrasound allows visualization of the joint spaces, can be used to detect joint effusions, and can monitor synovial proliferation and joint hyperemia, all while not exposing the patient to radiation. We will present ultrasound images of various joints in children such as knees, ankles, wrists, hands and feet. Ultrasound technique, imaging planes, choice of probes frequencies and ultrasound settings are analyzed for optimization of the images. This presentation will highlight the diagnostic imaging findings of JIA on ultrasound, such the presence of joint effusions, synovial proliferation, capsular thickening, tendinitis as well as provide information on common pitfalls associated with age-specific appearances of pediatric musculoskeletal structures on ultrasound. Familiarity with JIA and musculoskeletal ultrasound findings will allow timely diagnosis and implementation of appropriate treatment strategies. Read More
Final Pr. ID: Poster #: EDU-102
Illustrate pathologies encountered in our early experience of whole body fetal micro-CT, with respect to congenital skeletal anomalies. Read More
Final Pr. ID: Poster #: EDU-073
The purpose of educational exhibit is to summarize the radiological appearances of various conditions causing basal ganglia (BG) calcification in children. The pathogenesis for symmetric BG calcification is diverse and ranges from benign physiological calcifications to a variety of pathological disorders including metabolic, infectious and genetic diseases. We present a practical approach to further narrow the differential diagnosis based on associated musculoskeletal imaging findings in patients with BG calcification.
Parathyroid disorders are the most common causes of pathological BG calcification. In hyperparathyroidism, distinctive subperiosteal bone resorption can be seen in phalanges on hand radiographs. Tapering of the clavicles, brown tumors and salt-and-pepper appearance of the skull are also classic radiographic features. In the Albright hereditary osteodystrophy phenotype of pseudohypoparathyroidism, shortening of the fourth and fifth metacarpals as well as advanced bone age can aid in diagnosis. Tumoral calcinosis is another radiographically distinct disease that can cause BG calcification, characterized in the extremities by periarticular calcific deposits. Cockayne syndrome is a rare autosomal recessive (AR) disorder with 4 overlapping subtypes, all with BG calcification as well as diffuse skeletal abnormalities that become apparent in the toddler years. Carbonic anhydrase deficiency type 2 is another rare AR disorder with intracranial calcification including the BG, as well as osteopetrosis and pathologic fractures. Coat’s plus syndrome has characteristic rock-like intracranial calcifications paired with leukodystrophy and brain cysts. It manifests skeletally with osteopenia, delayed fracture healing, bowing of long bones, scoliosis, midface hypoplasia and femoral head avascular necrosis. Other common conditions such a Down syndrome and HIV, and rare disorders such Fahr's disease, malignant phenylketonuria, and Aicardi-Goutieres syndrome are in the differential diagnosis of BG calcifications. Read More
Final Pr. ID: Poster #: EDU-117
Intra-articular osteoid osteomas are uncommon and occur in only 10-13% of cases. Intra-articular osteoid osteomas may not demonstrate typical clinical features and feature subtle radiographic differences when compared to extra-articular osteoid osteomas. Radiofrequency ablation (RFA) has been found to be a safe and reliable method of treating osteoid osteomas. The possible complications of RFA include bleeding, muscle burn, and in cases of intra-articular osteoid osteoma, septhic arthritis. In this study, we evaluated the efficacy of radiofrequency ablation (RFA) of intra-articular osteoid osteomas at a single tertiary pediatric center. Read More
Final Pr. ID: Poster #: EDU-074
We describe a method of rapidly viewing age- and gender-matched normal musculoskeletal radiographic images for comparison during routine reading at the workstation. We created a plugin for the Picture Archiving and Communications System (PACS) that added a new option in the contextual menu. When the new option was selected, the plugin obtains information about the currently displayed exam. The patient’s gender and age (in years and months) and the type of study (e.g. humerus or ankle) are extracted and the plugin opens a new window. The window displays age- and gender-matched studies of the same body part from a database of normal images for rapid review by the user. The database consists of 35,514 images from 10,540 musculoskeletal examinations that were interpreted as normal by staff radiologists. Patients younger than two years of age are matched by months. The user may adjust the desired age and study type. The window displays the images in a grid with thumbnails. Users may choose to review the normal examples in full resolution. The images are displayed in a window adjacent to the PACS, permitting side-by-side comparison. Typical use cases display around 30 comparison examinations with approximately 90 images as a result. Read More
Authors: Francavilla Michael
Final Pr. ID: Poster #: EDU-050
Sterile pyogenic arthritis, pyoderma gangrenosum, and acne (PAPA syndrome) is a rare autosomal dominant inherited entity due to a missense mutation in the proline serine threonine phosphatase-interacting protein 1 (PSTPIP1/CD2BP1) gene, characterized by typical recurrent episodes of sterile pyogenic arthritis, either spontaneous or following a trauma, and skin manifestations characterized by pyoderma gangrenosum and acne. The articular manifestation is seen in the first decade of life, where most of the initial episodes are treated as septic arthritis. Cutaneous manifestations appear in early adulthood. Although uncommon, the potential therapeutic and clinical implications due to the rapidly destructive nature of PAPA syndrome warrant a prompt diagnosis. We present two unrelated pediatric patients from different institutions with genetically confirmed PAPA syndrome. The purpose of this study was to illustrate the musculoskeletal radiologic spectrum of findings of PAPA syndrome, and to discuss the differential diagnostic entities commonly seen in children. A second objective was to review the clinical and laboratory findings that allow diagnosis of PAPA syndrome Read More
Final Pr. ID: Poster #: CR-013
As a flat and irregular bone of the appendicular skeleton, the scapula has a zonal classification of anatomy that is both useful for surgical planning as well as for distinctive locations of common and uncommon bone neoplasms (1). The acromion and glenoid together are grouped into the S2 zone of the scapula with the remaining scapular blade and spine comprising zone S1. This unique anatomy of the scapula may present a challenge to radiologists when distinguishing between benign and malignant bone tumors that are more commonly seen in long bones. As the S2 zone is much like a metaphyseal equivalent in long bones, the more common lesions encountered there will include giant cell tumors, aneurysmal bone cysts, chondroid neoplasms, and osteomyelitis. Bone lesions of zone S1 will more commonly include tumors such as osteochondromas, Ewings sarcoma, and Lymphoma (2).
We present a case series of osteoid osteoma, chondroblastoma, osteomyelitis, T-cell Lymphoma, and Ewings sarcoma of the scapula and shoulder girdle in children aged 7 weeks to 17 years of age. The purpose of this case series is to present a variety of common and uncommon bone lesions of the scapula and shoulder girdle in children. Through the description and defining features of these lesions, radiologists may better familiarize themselves with the surgical anatomy of the scapula to develop a narrowed and accurate differential diagnosis of pediatric scapular tumors. Read More
Final Pr. ID: Poster #: EDU-068
While radiographs, and to a lesser extent MRI, remain the mainstay imaging techniques for the evaluation of pediatric musculoskeletal emergencies, ultrasound can be a useful modality for problem solving. The purpose of this educational exhibit is to provide several illustrative cases in which ultrasound was helpful in clinical/diagnostic problem-solving in order to emphasize the importance of ultrasound in these scenarios and to ultimately improve diagnostic accuracy and efficiency.
Keywords: ultrasound, musculoskeletal
Final Pr. ID: Poster #: EDU-084
The purpose of this educational poster is to describe and illustrate our technique to perform Ultrasound Guided Botulinum Toxin A muscle injections in children. We explain the pre-procedural preparation including clinical assessment, injection planning and obtaining informed consent. Intra-procedure we describe limb positioning and preparation on the procedure table; showing and explaining in detail the equipment that we use. We illustrate muscle schematics with ultrasound correlation. The identification of different muscle groups on ultrasound is the main goal of this educational poster. Additionally, we will provide technical tips and potential pitfalls, which an interventional radiologist may encounter performing this procedure. The post-procedural management will wrap up our educational poster. Read More