Lee Rachel,  Beckhorn Catherine,  Cao Joseph

Final Pr. ID: Poster #: CR-038

Keratin-positive giant cell-rich tumor is a very rare subset of giant cell-rich tumors characterized by keratin-positive cells and HMGA2::NCOR2 gene fusion. First described in 2021, fewer than 40 cases have been reported in the English literature. Reported cases have shown a strong predilection for females in their 20s-30s and occur in both soft tissue and bone. The youngest reported case thus far has been a 13-year-old female.

A 4-year-old previously healthy male presented to clinic with leg pain and a limp after falling on his right leg. Initial X-ray showed a lytic lesion on the right proximal tibia. Follow up MRI showed a 2 x 2.5 x 4.3 cm solid lesion in the proximal tibial metaphysis extending into the epiphysis. The mass was T1 and T2 hyperintense and demonstrated homogenous enhancement after contrast. No periostitis was noted on radiograph and no subperiosteal collection was present. No soft tissue component was identified. CT chest, abdomen, pelvis was ordered to rule out other sites of disease and showed multi-station lymphadenopathy throughout the right groin. Biopsy revealed tumor cells negative for H3G34W and H3K36M histone markers, specific for giant cell tumor of bone and chondroblastoma respectively. The cells were focally positive for AE1/AE3, a stain for keratin. Next-generation sequencing revealed an HMGA2::NCOR2 fusion confirming the diagnosis of keratin-positive giant cell-rich tumor. He underwent complete curettage of the lesion as well as excision of 2 inguinal lymph nodes that were negative for disease. Read More

Authors:  Lee Rachel , Beckhorn Catherine , Cao Joseph

Keywords:  Bone Tumor, Musculoskeletal

Parnell Shawn

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

Keywords:  skeletal dysplasia, musculoskeletal, type 2 collagen, skeletal survey, dwarfism

Guarilha Taísa,  Di Puglia Elazir

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

Authors:  Guarilha Taísa , Di Puglia Elazir

Keywords:  Osteomyelitis, Brodie's abscess, musculoskeletal

Padua Eric,  Kammen Bamidele,  Karakas S Pinar,  Hitt Dave,  Tai Chau,  Pandya Nirav,  Lu Quin,  Chung Taylor

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

Authors:  Padua Eric , Kammen Bamidele , Karakas S Pinar , Hitt Dave , Tai Chau , Pandya Nirav , Lu Quin , Chung Taylor

Keywords:  musculoskeletal

Papaioannou Georgia,  Tagkalakis Panagiotis,  Tzarouchi Loukia,  Manopoulou Evangelia,  Oikonomoulas George

Final Pr. ID: Poster #: SCI-049

To present the results and evaluate the added value of applying CT-like sequences in the MRI examinations of the musculoskeletal system in children and adolescents with clinical suspicion of overuse stress injury. Read More

Authors:  Papaioannou Georgia , Tagkalakis Panagiotis , Tzarouchi Loukia , Manopoulou Evangelia , Oikonomoulas George

Keywords:  MR, Adolescent, Musculoskeletal

Galvis Ingrid,  Kvist Ola,  Jarrett Delma

Final Pr. ID: Poster #: EDU-064

Bowing of the lower extremities is a common presentation in pediatric patients and may represent either normal physiologic development or an underlying pathologic process requiring medical or surgical intervention. Radiologists play an essential role in distinguishing between benign developmental variants and serious bone disorders, including nutritional deficiencies, metabolic bone disease, and skeletal dysplasias. Conditions such as rickets, scurvy, and Blount's disease have distinct etiologies but often present with overlapping radiologic features—most notably metaphyseal abnormalities, osteopenia, and angular deformities—that can obscure diagnosis and delay appropriate treatment.

This educational poster presents a structured, pattern-based approach to evaluating pediatric bowing disorders, integrating clinical presentation, age, and characteristic imaging findings. Key radiographic parameters include the metaphyseal-diaphyseal angle, tibiofemoral angle measurements, and assessment of the Drennan angle for differentiating infantile Blount's disease from physiologic bowing. Age-specific thresholds guide management: physiologic bowing typically resolves by 18-24 months, whereas progression beyond age 2 years or asymmetric involvement warrants investigation for pathologic etiologies. Age-specific diagnostic criteria and systematic assessment of metaphyseal morphology form the foundation of our approach. We highlight key differentiating features for scurvy, rickets (including hypophosphatemic forms), Blount's disease, and other mimickers such as osteogenesis imperfecta and skeletal dysplasias. Emphasis is placed on early recognition of red flags, interpretation of radiographic and MRI findings, and understanding imaging pitfalls that can lead to misdiagnosis. Using comparative imaging examples and diagnostic algorithms, this poster aims to enhance the radiologist's ability to confidently diagnose and differentiate pediatric bowing deformities, improving clinical outcomes and reducing unnecessary interventions. Read More

Authors:  Galvis Ingrid , Kvist Ola , Jarrett Delma

Keywords:  Musculoskeletal, Metabolic Disorder, Paediatric Radiology

Steinberg Julie,  Kristeva Mariya,  Barhaghi Krystle,  Tao Ting

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

Authors:  Steinberg Julie , Kristeva Mariya , Barhaghi Krystle , Tao Ting

Keywords:  myotendinous injury, rectus femoris, musculoskeletal

Knight Jessica,  Jaremko Jacob,  Zhou Yuyue,  Keen Christopher,  Rakkundedeth Abhilash,  Ghasseminia Siyavash,  Wichuk Stephanie,  Brilz Alan,  Alves Pereira Fatima,  Kirschner David

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

Authors:  Knight Jessica , Jaremko Jacob , Zhou Yuyue , Keen Christopher , Rakkundedeth Abhilash , Ghasseminia Siyavash , Wichuk Stephanie , Brilz Alan , Alves Pereira Fatima , Kirschner David

Keywords:  Artificial Intelligence, Ultrasound, Musculoskeletal

Rees Mitch,  Milks Kathryn,  Krishnamurthy Ramkumar,  Krishnamurthy Rajesh,  Hu Houchun

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

Authors:  Rees Mitch , Milks Kathryn , Krishnamurthy Ramkumar , Krishnamurthy Rajesh , Hu Houchun

Keywords:  radial MRI, dynamic contrast enhancement, musculoskeletal

Rutten Caroline,  Panwar Jyoti,  Man Carina,  Moineddin Rahim,  Mohanta Arun,  Stimec Jennifer,  Doria Andrea

Final Pr. ID: Poster #: EDU-062

To evaluate the diagnostic accuracy of point-of-care ultrasound (POCUS) in detecting joint changes in children with hemophilic arthropathy when compared to comprehensive US and MRI. Read More

Authors:  Rutten Caroline , Panwar Jyoti , Man Carina , Moineddin Rahim , Mohanta Arun , Stimec Jennifer , Doria Andrea

Keywords:  Musculoskeletal, Ultrasound, Point-Of-Care

Rawlings Emily,  Milks Kathryn

Final Pr. ID: Poster #: EDU-069

In an effort to reduce contrast related risk and time constraints, FLAIR FS MR sequence continues to gain support as an alternative to contrast enhanced imaging for evaluating the synovium. Building on the original concept proposed by Yoo et al. and validated in children by Milks et al., our institution has found some techniques to improve the sequence in the knee.
Homogeneous fluid and fat suppression remain challenges to obtaining diagnostic quality images, and our institution continues to expand the use of FLAIR FS beyond the knee. In this educational exhibit we show examples of image quality failures and present our techniques for troubleshooting these. FLAIR FS can serve as a useful alternative to contrast in the evaluation of synovitis though an understanding of how to troubleshoot common problems with quality is helpful in ensuring success. Read More

Authors:  Rawlings Emily , Milks Kathryn

Keywords:  Image Quality, Musculoskeletal, MRI

Galvis Ingrid,  Kvist Ola,  Vo-phamhi Jenny,  Perdomo-luna Camilo,  Jarrett Delma

Final Pr. ID: Poster #: EDU-066

Learning Objectives:
-To recognize age-specific radiographic manifestations of rickets and understand how imaging features evolve from infancy through adolescence.
-To distinguish between nutritional, genetic, and systemic causes of rickets using characteristic imaging patterns.
-To identify common mimics of rickets and differentiate them from true metabolic bone disease.
-To understand the complementary roles of radiography and MRI in challenging cases.

Background: Rickets is a pediatric metabolic bone disorder characterized by imaging features that change according to the patient's age and underlying cause. Some conditions may mimic rickets due to similar radiologic features; therefore, accurate recognition of hallmark radiographic signs—including metaphyseal fraying, cupping, widening, and angular deformities—is critical for timely diagnosis, appropriate management, and differentiation from mimics. Nutritional rickets remains the most prevalent cause, particularly among exclusively breastfed infants without adequate vitamin D supplementation. However, older children with rickets frequently have genetic and systemic causes, such as renal and phosphate metabolism disorders. Although radiographs remain the principal imaging modality for evaluation, MRI may provide enhanced diagnostic precision in challenging or unclear cases. Clinical red flags warranting imaging evaluation include persistent or worsening bowing beyond expected physiologic ages, motor delays, pathologic fractures, failure to thrive, and lack of response to vitamin D supplementation in older children, which suggests genetic or renal etiologies rather than simple nutritional deficiency.

This educational poster presents an age-based approach to diagnosing rickets, illustrating classic radiographic features across different age groups and etiologies. Key imaging findings in nutritional rickets, hypophosphatemic rickets, and renal osteodystrophy are systematically compared. Common mimics—including scurvy, non-accidental trauma, Blount's disease, osteogenesis imperfecta, and physiologic variants—are reviewed with comparative imaging to enhance diagnostic accuracy. Emphasis is placed on pattern recognition, and the role of advanced imaging in equivocal cases. Read More

Authors:  Galvis Ingrid , Kvist Ola , Vo-phamhi Jenny , Perdomo-luna Camilo , Jarrett Delma

Keywords:  Metabolic Disorder, Musculoskeletal, Paediatric Radiology

Rullan Varela Valeria,  Woodruff Ronald,  Johnstone Lindsey,  Sarma Asha,  Leschied Jessica

Final Pr. ID: Poster #: CR-037

Fibrolipomatous hamartoma (FLH) of the median nerve, also known as perineural lipoma or lipomatous hamartoma, is a rare, slow-growing, benign neoplasm that arises from proliferation of fibrofatty tissue that infiltrates epineural and perineural elements and results in thickening of the axonal bundles. It is thought to be congenital, which is why many patients present in childhood, typically with painless enlargement of the distal forearm or volar wrist. Some patients may present with carpal tunnel syndrome because of median nerve compression. Macrodactyly of the involved region has been reported in rare cases. MRI is considered the preferred modality for diagnosis of FLH; however, ultrasound, computed tomography, and rarely, radiography also play important roles in diagnosis. Imaging allows for accurate differentiation of FLH from other disease processes such as peripheral nerve sheath tumor (PNST) and lipoblastoma. In symptomatic patients, treatment of FLH includes carpal tunnel decompression, fibrofatty sheath debulking, and microsurgical dissection of the neural elements. In asymptomatic patients, observation may be appropriate. This case series aims to describe multi-modality imaging manifestations of FLH presenting in children and highlight imaging features that are key to achieving a definitive diagnosis, sparing the need for surgical exploration and biopsy.

Case 1
11-year-old patient found to have a nontender, palpable mass in the right wrist. Radiographs revealed no abnormalities. Ultrasound of the palpable abnormality demonstrated an ovoid echogenic mass with internal hypoechoic fascicles contiguous with the median nerve, consistent with fibrolipomatous hamartoma of the median nerve. Patient has remained asymptomatic since diagnosis.

Case 2
12-year-old patient with numbness and tingling in the median nerve distribution. Ultrasound demonstrated an indeterminate heterogenous lesion in the wrist. MRI revealed a collection of enlarged cylindrical fascicles surrounded by fat along the course of the median nerve. The patient underwent carpal tunnel release with symptomatic relief. The patient developed enlargement of her thumb and soft tissue hypertrophy along the ulnar aspect from the thumb tip down into the webspace. Most recent MRI demonstrated stability of hamartoma; however, the patient has developed recurrent carpal tunnel syndrome and is scheduled to undergo neurolysis of the median nerve and debulking of the thumb tumor. Read More

Authors:  Rullan Varela Valeria , Woodruff Ronald , Johnstone Lindsey , Sarma Asha , Leschied Jessica

Keywords:  Musculoskeletal, Wrist Ultrasound, Neurosonogram

Osinska Aleksandra,  Materniak Andrzej,  Wozniak Magdalena

Final Pr. ID: Poster #: CR-032

Malignant ectomesenchymoma (MEM) is a rare, rapidly growing soft tissue tumor composed of mesenchymal and neuroectodermal elements. It usually develops in the pelvis, retroperitoneum, or genitourinary tract of children. According to WHO, MEM is classified among skeletal muscle tumors containing embryonal rhabdomyosarcoma mixed with neuroblastic components, typically positive for desmin, myogenin, and synaptophysin. The tumor most often occurs during the first years of life and is characterized by aggressive behavior. Fewer than one hundred cases have been described worldwide. Read More

Authors:  Osinska Aleksandra , Materniak Andrzej , Wozniak Magdalena

Keywords:  Musculoskeletal

Stanley Parker,  Rubesova Erika

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

Authors:  Stanley Parker , Rubesova Erika

Keywords:  Juvenile Arthritis, Ultrasound, Musculoskeletal

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

Vakaki Marina,  Pitsoulaki Evangelia,  Fezoulidi Georgia,  Zamparas Athanasios,  Atsali Erato

Final Pr. ID: Poster #: SCI-048

Juvenile localized scleroderma (JLS) is a rare chronic autoimmune connective tissue disorder characterized by inflammation and fibrosis of the skin and underlying subcutaneous tissues. It may affect the trunk, extremities or, less frequently, the face and head. Early diagnosis and close monitoring are essential to prevent functional impairment and cosmetic sequelae. However, clinical examination alone may underestimate disease activity, particularly in deep or subtle lesions. Aim of this study is to highlight the role of high-frequency Ultrasound (US) in detecting and monitoring JLS, emphasizing its value in assessing disease activity, depth of involvement, and response to treatment. Read More

Authors:  Vakaki Marina , Pitsoulaki Evangelia , Fezoulidi Georgia , Zamparas Athanasios , Atsali Erato

Keywords:  Scleroderma, Ultrasonography, Musculoskeletal

Shelmerdine Susan,  Hutchinson J.,  Suich Joseph,  Calder Alistair,  Sebire Neil,  Arthurs Owen

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

Authors:  Shelmerdine Susan , Hutchinson J. , Suich Joseph , Calder Alistair , Sebire Neil , Arthurs Owen

Keywords:  Postmortem, micro-CT, musculoskeletal

Donuru Achala,  Kandula Vinay,  Averill Lauren

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

Authors:  Donuru Achala , Kandula Vinay , Averill Lauren

Keywords:  basal ganglia, calcification, musculoskeletal

Alucozai Doonyah,  Marine Megan,  Karmazyn Boaz,  Newman Christopher

Final Pr. ID: Poster #: EDU-060

Fractures are among the most common injuries detected radiologically in cases of suspected child abuse. However, normal developmental variants may resemble fractures on imaging and can pose a challenge for accurate diagnosis. The aim of this educational exhibit is to review normal anatomic variants that can mimic child abuse injuries and outline key imaging features that help distinguish these normal variants from traumatic injuries.

Examples from the skull include include accessory sutures and vascular channels, which can mimic linear calvarial fractures. Examples from the thorax include accessory ossification centers, bifid ribs, pseudarthroses, costochondral junction variants, and sternal ossification centers, which can mimic healing rib fractures. Examples from the long bones include metaphyseal collars, cortical stepoffs, metaphyseal spurs, and metaphyseal fragmentation, all of which can mimic classic metaphyseal lesions.

Anatomic variants are presented alongside the injuries that they often mimic in order to demonstrate the key imaging features that permit improved discrimination. Further imaging and clinical correlation are provided to demonstrate the benign nature of anatomic variations. A diagnostic checklist is provided for differentiating these variants from fractures in unknown cases.

Understanding normal developmental patterns and the radiological appearance of common variants in the pediatric skeleton is critical for the accurate interpretation of imaging studies in order to avoid overdiagnosing fractures that would otherwise cause high concern for child abuse. Read More

Authors:  Alucozai Doonyah , Marine Megan , Karmazyn Boaz , Newman Christopher

Keywords:  NAT/Abuse, Musculoskeletal, Anatomy

Akhter Talal,  Cahill Anne Marie,  Vatsky Seth,  Krishnamurthy Ganesh,  Keller Marc,  Shellikeri Sphoorti,  Srinivasan Abhay

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

Authors:  Akhter Talal , Cahill Anne Marie , Vatsky Seth , Krishnamurthy Ganesh , Keller Marc , Shellikeri Sphoorti , Srinivasan Abhay

Keywords:  Osteoid osteoma, Radiofrequency ablation, Musculoskeletal

Namireddy Meera,  Kan J.,  Ditzler Matthew,  Schallert Erica,  Ngan Esther,  Bell Bryce

Final Pr. ID: Poster #: SCI-021

Percutaneous ultrasound-guided fenestration of ganglia (PUGG) of the pediatric wrist is a minimally invasive, safe alternative to surgical excision which does not require sedation or leave a scar. The purpose of this study is to assess relative risk for recurrence based on pre-procedural ultrasound imaging variables and procedural factors. Read More

Authors:  Namireddy Meera , Kan J. , Ditzler Matthew , Schallert Erica , Ngan Esther , Bell Bryce

Keywords:  Musculoskeletal, Ultrasound, Pediatric

Bhat Vipul,  Motlak Miriam,  Germaine Pauline,  Poletto Erica

Final Pr. ID: Poster #: EDU-083

Osteochondromas are the most common bone tumor, accounting for 10-15% of all bone tumors. They are prevalent in the pediatric population and are hypothesized to be a developmental anomaly rather than a true neoplasm, frequently asymptomatic and found incidentally. Although usually sporadic and benign, osteochondromas can be associated with Multiple Hereditary Exostoses (MHE) and Trevor disease or can arise after trauma or radiation treatment. In such cases, complications are more common. A good understanding of these complications and their associated radiologic findings is crucial to identify and differentiate variants that will guide treatment. The purpose of this educational exhibit is to review the typical radiologic presentation of osteochondromas using a variety of imaging modalities including X-Ray, MRI, CT, ultrasound, and nuclear medicine scans. Additionally, imaging appearances of complications and variants of osteochondromas such as MHE, malignant degeneration, associated fracture, bursa formation, and tendon or nerve impingement will be discussed. Case examples will be used to highlight these findings and correlate them to patient presentation. Read More

Authors:  Bhat Vipul , Motlak Miriam , Germaine Pauline , Poletto Erica

Keywords:  Osteochondral, Musculoskeletal

Francavilla Michael

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

Keywords:  plugin, normal, musculoskeletal

Omran Danah,  Ziehe Luis,  Sng Jonathan,  Doria Andrea

Final Pr. ID: Poster #: CR-028

Scurvy is a disease resulting from vitamin C (ascorbic acid) deficiency. While uncommon among children in economically developed countries, its recognition remains crucial for appropriate clinical management.

The clinical presentation of scurvy is variable, including cutaneous, dental, musculoskeletal, and systemic manifestations. Initial symptoms are frequently non-specific, such as irritability, anorexia, low-grade fever, and limb pain. The presence of coexisting neurodevelopmental disorders may further complicate history-taking and physical examination, leading to potential delays in diagnosis.

Magnetic Resonance Imaging (MRI) is frequently used in children with unclear symptoms. The differential diagnosis for this non-specific imaging appearance is broad and considerations include malignancy, infectious and inflammatory conditions.

Although previous case reports exist on imaging of scurvy, MRI findings have not been scrutinized in detail within the broad spectrum of abnormalities identifiable in different body parts. Scurvy should remain a key consideration in the differential diagnosis for children presenting with non-specific symptoms and multifocal MRI abnormalities. Early recognition with different imaging modalities, including MRI, can guide appropriate management and minimize unnecessary invasive procedures, including tissue sampling.

Our case series evaluates 4 pediatric patients with laboratory-confirmed scurvy and reviews the literature to outline the types and frequency of MRI findings associated with the condition. Our objective is to educate clinicians and radiologists about both common and rare MRI features of scurvy, aiming at reducing the rate of unnecessary invasive procedures (e.g. biopsy) for diagnosis of this entity, particularly when the clinical history is inconclusive.

Content organization:
1. Summary of clinical and imaging characteristics associated with scurvy.
2. Types and prevalence of MRI findings observed in pediatric scurvy.
3. Proposed decision-making algorithm for clinicians and radiologists to utilize when scurvy is suspected in pediatric patients.

Summary:
The main teaching points of this case review include:
1. Imaging findings of scurvy can be subtle; recognizing early signs is crucial.
2. Considering scurvy early can facilitate timely evaluation and reduce unnecessary procedures.
3. Timely diagnosis and treatment of scurvy improves outcomes and prevents complications. Read More

Authors:  Omran Danah , Ziehe Luis , Sng Jonathan , Doria Andrea

Keywords:  Scurvy, Magnetic Resonance Imaging, Musculoskeletal

Huetter Konstanze,  Butter Sophie,  Tschauner Sebastian,  Kraus Tanja

Final Pr. ID: Poster #: SCI-031

Current radiological parameters for evaluating the growing hip, including the acetabular angle (AC), centre-edge angle (CE), and Reimer’s migration index (MI), are based on data from a small, decades-old patient cohort. This study aims to determine whether these parameters remain valid by analysing pelvic radiographs from a more contemporary and larger population. Read More

Authors:  Huetter Konstanze , Butter Sophie , Tschauner Sebastian , Kraus Tanja

Keywords:  Musculoskeletal, Radiographic Findings, Hip

Sahajwalla Divya,  Ata Hareem,  Methratta Sosamma

Final Pr. ID: Poster #: EDU-081

Critically ill infants in the neonatal intensive care unit undergo life sustaining treatment and receive frequent chest and abdominal radiographs. The heart, lungs and abdomen are key targets for assessment. While neonates may present with clinical findings prompting investigation of the musculoskeletal system, others quietly develop progressive changes in the bones which may be overlooked on routine daily radiographs. This exhibit describes the differences between the preterm and term skeleton and reviews the imaging findings of MSK disorders in the newborn nursery and NICU. Using a multi-modality case-based format, covered diagnoses include: congenital anomalies, birth related trauma, acquired and congenital infection, and systemic/metabolic disorders (including metabolic bone disease of prematurity, prostaglandin induced cortical hyperostosis etc). Read More

Authors:  Sahajwalla Divya , Ata Hareem , Methratta Sosamma

Keywords:  Musculoskeletal, Congenital Skeletal Anomaly, Neonatal

Law Emily,  Crane Gabriella,  Luo Yu

Final Pr. ID: Poster #: EDU-084

Lumps and bumps in the pediatric hands and feet are frequently encountered in pediatric imaging. While certain lesions demonstrate characteristic imaging features that allow for confident diagnosis, others present with nonspecific findings and require tissue sampling for definitive diagnosis. After reviewing this case and imaging-based discussion of benign and malignant lesions in the pediatric hands and feet, viewers will be able to:
1. Identify common benign and malignant bone and soft tissue lesions of the hands and feet in children.
2. Recognize imaging features of aggressive lesions that warrant biopsy.
3. Diagnose characteristic lesions based on their imaging appearance.
Lesions discussed in this exhibit include:
1. Aggressive Bone Lesions: Osteomyelitis, undifferentiated sarcoma.
2. Benign Bone Lesions: Aneurysmal bone cyst, simple bone cyst, giant cell reparative granuloma, giant cell tumor, hemangioma, enchondroma, Trevor’s disease (dysplasia epiphysealis hemimelica), osteoid osteoma, osteoblastoma, abscess.
3. Malignant Soft Tissue Tumors: Infantile fibrosarcoma, rhabdomyosarcoma, synovial sarcoma, other soft tissue sarcomas, including malignant peripheral nerve sheath tumor (MPNST).
4. Benign Soft Tissue Lesions: Ganglion cyst, desmoid tumor, giant cell tumor of tendon sheath, infantile digital fibromatosis, myofibroma, nerve sheath tumor, dermatofibroma, granuloma annulare.
5. Calcified Lesions: Synovial sarcoma, soft tissue chondroma, venous malformation, chondro-osseous lipoma.
6. Vascular Lesions: Arteriovenous malformation (AVM), venous malformation, lymphatic malformation, hemangioma, Kaposiform hemangioendothelioma.
7. Fatty lesions: Lipoma, fibrolipomatous hamartoma of nerve. Read More

Authors:  Law Emily , Crane Gabriella , Luo Yu

Keywords:  Tumor, Musculoskeletal, Malignancy

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

Martinez-rios Claudia,  Jariwala Mehul,  Highmore Kerri,  Watanabe Duffy Karen,  Laxer Ronald,  Stimec Jennifer

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

Authors:  Martinez-rios Claudia , Jariwala Mehul , Highmore Kerri , Watanabe Duffy Karen , Laxer Ronald , Stimec Jennifer

Keywords:  PAPA, syndrome, arthritis, musculoskeletal, gene-mutation