Patil Kedar,  Gorelik Natalia,  Kumalo Zonah,  Bure Lionel,  Albuquerque Pedro,  Faingold Ricardo

Final Pr. ID: Poster #: SCI-059

There is no standardized evidence-based neonatal head ultrasound (HUS) training guidelines within the literature. Simulation models have previously shown to improve resident proficiency in performing ultrasound-guided procedures. We developed an ultrasound-compatible neonatal brain phantom from polyvinyl alcohol cryogel (Figure 1) with the relevant cross-sectional anatomy.

The purpose of this study was to determine whether resident performance in HUS improves with the use of this novel brain phantom training model. Read More

Authors:  Patil Kedar , Gorelik Natalia , Kumalo Zonah , Bure Lionel , Albuquerque Pedro , Faingold Ricardo

Keywords:  Neonatal Head Ultrasound

Critser Paul,  Higano Nara,  Kingma Paul,  Fleck Robert,  Lang Sean,  Hirsch Russel,  Taylor Michael,  Woods Jason

Final Pr. ID: Paper #: 017

BPD is associated with pulmonary hypertension (PH) and patients with BPD-associated PH (BPD-PH) have increased morbidity and mortality. Noninvasive assessment of BPD-PH has traditionally relied on echocardiograms. However, recent advances have allowed the use of MRI in the assessment of respiratory and cardiac disease in infants with BPD. In adults and older pediatric patients, increased left ventricular eccentricity index (MR-EI) and decreased MRI septal curvature correlate with increased mean pulmonary artery pressure and pulmonary vascular resistance. The current study sought to determine the relationship of MR-EI and septal curvature in neonates with BPD and BPD-PH with short term respiratory outcomes and need for pulmonary vasodilator therapies. Read More

Authors:  Critser Paul , Higano Nara , Kingma Paul , Fleck Robert , Lang Sean , Hirsch Russel , Taylor Michael , Woods Jason

Keywords:  Outcomes, Neonatal, lungs

Siu Navarro Youck Jen,  Poletto Erica,  Malik Archana,  Koenigsberg Robert

Final Pr. ID: Poster #: EDU-053

Congenital tumors represent only 1.5–2% of all pediatric tumors, with a prevalence of 1:12,500 to 1:27,500 live births. Tumors are considered congenital when detected during pregnancy or in the first 3 months of life (1). Nowadays, with more accessible prenatal care and fetal imaging, these tumors can be detected very early during fetal period. Some lesions are benign, while others carry high risk of morbidity and mortality postnatally. As a radiologist, it is important to be familiar with these tumors by recognizing their imaging features, imaging modality work up and differential diagnosis. Doing so, we contribute to a proper imaging evaluation, early diagnosis and management.

The objectives of this educational exhibit are:
-To describe the imaging features of some congenital tumors on different image modalities.
-To recognize and emphasize the key radiologic findings of each tumor and their differential diagnoses.
-To briefly review the literature, including etiology, epidemiology, cytopathology characteristics, diagnosis and treatment.

Pictorial cases from our Radiology Department will be used to describe the imaging features of the following entities:

1) Head/Neck:
● Atypical teratoid/rhabdoid tumor (ATRT)
● Cervical teratoma
● Hemangioma

2) Chest:
● Neuroblastoma
● Cardiac rhabdomyoma

3) Abdomen- Pelvis:
● Hepatic hemangioendothelioma
● Hepatic hemangioma
● Neuroblastoma
● Mesoblastic nephroma
● Sacrococcygeal teratoma

4) Soft tissues:
● Infantile fibrosarcoma

5) Systemic:
● Leukemia Read More

Authors:  Siu Navarro Youck Jen , Poletto Erica , Malik Archana , Koenigsberg Robert

Keywords:  congenital tumor, neonatal tumors

Burger Matthew,  Lindsay Aaron

Final Pr. ID: Poster #: EDU-011

Educational goals: Highlight epidemiology, clinical presentation, radiographic findings, and treatment for common neonatal obstructions considered high in the intestinal tract including malrotation with midgut volvulus, duodenal atresia, duodenal web, annular pancreas, and proximal jejunal atresia.

Malrotation with midgut volvulus occurs when abnormally rotated and fixated small bowel twists about the superior mesenteric artery. This often presents with bilious vomiting in the first month of life and requires emergent surgical repair. Abdominal radiographs may be normal or show distention of the stomach and proximal duodenum with some distal bowel gas seen. An upper GI fluoroscopy exam (UGI) demonstrates a spiral/corkscrew sign or abrupt beaking with small bowel malrotation. Duodenal atresia is usually the result of incomplete recanalization of the duodenum. This presents at birth with abdominal distention and bilious or non-bilious vomiting depending on the segment of duodenum affected. Treatment is surgical resection of the atresia and reanastomosis. Classically on radiograph there is a double bubble sign, which may be seen on an antenatal ultrasound. Duodenal web results from an incomplete diaphragm/web within the lumen which causes intermittent complete or partial obstruction. There may be mild symptoms, or it may present similarly to duodenal atresia. It usually presents after the first week of life but may present in any age. Treatment is usually surgical or endoscopic resection. Abdomen radiographs may show mild proximal dilation or a double bubble sign distal bowel gas. UGI classically shows a windsock sign or duodenal dimple sign. Annular pancreas results from incomplete rotation of the ventral pancreatic bud leading to pancreatic tissue encasing the descending duodenum. The presentation and age of onset varies, in neonates and children it causes similar symptoms of duodenal obstruction. Cross-sectional imaging shows the duct draining the pancreatic head encircling the duodenum. Symptomatic cases of annular pancreas are usually treated surgically to alleviate obstructive symptoms. Jejunal atresia results from a vascular injury in utero causing one or more areas of stenosis/atresia. Proximal jejunal atresia presents with abdominal distention and bilious emesis. Abdominal radiographs classically show a triple bubble sign. Treatment is surgical resection of the involved segments of bowel. Read More

Authors:  Burger Matthew , Lindsay Aaron

Keywords:  Bowel obstruction, Neonatal

Marin Concha Julio,  Qu Feifei,  Hernandez Andrade Edgar,  Jella Pavan,  Mody Swati,  Subramanian Karthikeyan,  Ghassaban Kiarash,  Romero Roberto,  Haacke E.

Final Pr. ID: Poster #: SCI-006

Magnetic Resonance Imaging is a powerful tool for the detection of ferromagnetic components. This property can be used for the early detection of pathologic conditions related to liver iron overload. Neonatal hemochromatosis and hemosiderosis are conditions associated with severe liver disease. Infections like parvovirus and cytomegalovirus, metabolic conditions and gestational allo-immune liver disease can produce neonatal hemochromatosis phenotype.
Fetal iron overload can be detected early by using T₂* multi-echo gradient sequence.
There are only few studies reporting standard T₂* values of the fetal liver at 1.5 T.
The aim of this study is to evaluated the standard T₂* values of the fetal liver using prenatal MRI with 3.0 T. Read More

Authors:  Marin Concha Julio , Qu Feifei , Hernandez Andrade Edgar , Jella Pavan , Mody Swati , Subramanian Karthikeyan , Ghassaban Kiarash , Romero Roberto , Haacke E.

Keywords:  Fetal MRI, T2* mapping, Neonatal hemochromatosis

Wolf Joel,  Remon Juan,  Myers Eliza,  Blumfield Einat

Final Pr. ID: Poster #: EDU-034

Iatrogenic upper gastrointestinal (GI) injuries are rare occurrences with predisposition in premature births, low birth weight, multiple attempts at OGT placement. Medical literature on the topic consists of case reports and mostly has been from the perspective of management with very limited literature on diagnostic evaluation. As the clinical presentation of such iatrogenic injuries is nonspecific, the radiographic appearance may be the only clue for diagnosis and the typical findings should be recognized and diagnosed by radiologists and neonatologists. The purpose of this presentation is to describe the radiographic findings and a diagnostic approach to guide the radiologist. A retrospective case-review was performed from 2009-2017, of neonates with upper GI injuries associated with naso/orogastric tube placement or with pharyngeal auctioning at birth ( a single case). Seven cases were found comprising of five females and two males. Six of seven neonates were premature with gestational ages ranging from 24 weeks and 2 days to 28 weeks, and birth weights spanning 515-1085 grams. The 38 week neonate weiged 3500 grams. We report three types of injury: 1) posterior pharyngeal rupture, 2) non-complicated esophageal rupture with formation of a false lumen, 3) complicated esophageal rupture with penetration into the right pleural space. Management has evolved over time from a primarily surgically oriented approach to a more conservative approach involving TPN and antibiotics. Read More

Authors:  Wolf Joel , Remon Juan , Myers Eliza , Blumfield Einat

Keywords:  iatrogenic injury, neonatal upper gi rupture

Collard Michael,  Kwon Jeannie,  Mangona Kate Louise,  Pfeiffer Cory

Final Pr. ID: Poster #: EDU-068

Head ultrasound has long been utilized in the first few months of life to screen neonates for hemorrhage, assess midline anatomy, characterize extra-axial fluid collections, elucidate causes for suspected ventriculomegaly, and serially evaluate parenchymal echotexture without exposing the child to ionizing radiation or the expense of MRI. Less commonly utilized in a routine fashion is Doppler interrogation of the midline vasculature as part of the inpatient routine head ultrasound protocol. This exhibit will educate the reader on how and when transfontanelle Doppler can be utilized and the benefits it can provide. Read More

Authors:  Collard Michael , Kwon Jeannie , Mangona Kate Louise , Pfeiffer Cory

Keywords:  Doppler, Cranial, Neonatal

Vazquez Elida,  Delgado Ignacio,  Sanchez-montañez Angel,  Barber Ignasi

Final Pr. ID: Poster #: SCI-024

Open spinal dysraphism occurs as a consequence of failed neurulation during embryological development and includes two subtypes, myelomeningocele and myelocele. Intrauterine fetal repair can result in reversal of the associated Chiari II malformation and is now considered a treatment option.
The main imaging method for prenatal detection, management, and monitoring of open neural tube defects is US, but MRI is essential for the preoperative assessment, indications and workup for fetal surgery, and postnatal follow-up. This prospective study describes the contribution of MRI in this clinical scenario. Read More

Authors:  Vazquez Elida , Delgado Ignacio , Sanchez-montañez Angel , Barber Ignasi

Keywords:  Fetal, Neonatal, Magnetic Resonance Imaging, Myelomeningocele, Spina bifida

Kennedy Patrick,  Baad Michael,  Kovanlikaya Arzu,  Cohen Sara,  Collins Lee,  Pomeranz Christy

Final Pr. ID: Poster #: EDU-029

Langerhans cell histiocytosis (LCH) is rare in the neonatal period and has a different distribution of disease and prognosis compared to older cohorts, requiring extensive imaging evaluation and familiarity of the radiologist with potential sites of involvement. Treatment and prognosis is dependent on accurate pretreatment evaluation. In this educational poster, we first describe histiocystic disorders, the current and prior classification schema, and the role of imaging in pretreatment evaluation of LCH. Utiliziing cases at our institution, we explore the imaging findings in neonatal LCH organized by organ system and the role of imaging in risk organ identification. We discuss the affect on treatment and prognosis, and the differences in imaging and prognosis between neonatal presentation and other age groups. Finally, we review current guidelines for posttreatment imaging follow up. Read More

Authors:  Kennedy Patrick , Baad Michael , Kovanlikaya Arzu , Cohen Sara , Collins Lee , Pomeranz Christy

Keywords:  Neonatal, lymphoproliferative, neoplasia

A Ebinesh,  Manchanda Alpana,  Dixit Rashmi,  Das Prince,  Kumar Ajay,  Krishna Ganesh

Final Pr. ID: Poster #: EDU-021

Insult to developing neonatal brain can significantly impair motor, cognitive, language and behavioral functions. MR imaging is an indispensable investigation for the evaluation of neonatal encephalopathy due to its high sensitivity, specificity and prognostic utility. MRI with its recent advancements can yield valuable information on morphology, neuronal connectivity, structural and functional architecture of gray and white matter. Read More

Authors:  A Ebinesh , Manchanda Alpana , Dixit Rashmi , Das Prince , Kumar Ajay , Krishna Ganesh

Keywords:  Neonatal encephalopathy, Neonatal brain, Hypoxic ischemic encephalopathy

Stanescu A. Luana,  Otjen Jeffrey,  Parisi Marguerite

Final Pr. ID: Poster #: SCI-075

Purpose
Ovarian torsion is rare in neonates and infants. Clinical diagnosis is challenging in the setting of lack of specific symptoms and the limitations in assessing pain in infants. Torsed ovaries in this patient population are also a diagnostic dilemma on imaging. In this study we reviewed the spectrum of imaging findings with pathologic correlation in a large series of patients. Read More

Authors:  Stanescu A. Luana , Otjen Jeffrey , Parisi Marguerite

Keywords:  Neonatal, infantile, Ovarian Torsion

Saguintaah Magali,  Taleb Arrada Ikram,  Prodhomme Olivier,  Bolivar Perrin Julie,  David Stephanie,  Sevette Nancy,  Couture Alain,  Baud Catherine

Final Pr. ID: Poster #: EDU-067

To review the imaging appearances of neonatal bowel obstruction, focusing on the sonographic findings.
To describe the etiologies and the indication for other imaging modalities Read More

Authors:  Saguintaah Magali , Taleb Arrada Ikram , Prodhomme Olivier , Bolivar Perrin Julie , David Stephanie , Sevette Nancy , Couture Alain , Baud Catherine

Keywords:  neonatal bowel obstruction, ultrasonography

Leschied Jessica,  Horst Kelly,  Lampl Brooke,  Hwang Misun

Final Pr. ID: Poster #: SCI-003

To survey active members of the Society for Pediatric Radiology regarding their utilization of various cranial ultrasound techniques and reporting practices in neonates. Read More

Authors:  Leschied Jessica , Horst Kelly , Lampl Brooke , Hwang Misun

Keywords:  SPR survey, neurosonography, neonatal imaging

Biko David,  Johnstone Jordan,  Dori Yoav,  Itkin Maxim,  Oliver Edward,  Victoria Teresa

Final Pr. ID: Poster #: SCI-004

Clinical signs of the Neonatal Lymphatic Flow Disorder (NLFD) are a combination of the congenital chylothorax, chylous ascites and body edema. It can present as neonatal chylothorax (NC), neonatal chylous ascites, or congenital lymphatic dysplasia (CLD). The prenatal appearance of lymphangiectasia has been described as nutmeg lung. The purpose of this study is to describe prenatal and postnatal imaging features and outcomes of neonates with NLFD.
Read More

Authors:  Biko David , Johnstone Jordan , Dori Yoav , Itkin Maxim , Oliver Edward , Victoria Teresa

Keywords:  lymphatic imaging, nutmeg lung, neonatal lymphatic flow disorder

Aslan Mine,  Arioz Habibi Hatice,  Kalyoncu Ucar Ayse,  Namdar Yesim,  Adaletli Ibrahim,  Kurugoglu Sebuh

Final Pr. ID: Poster #: CR-026

Sacrococcygeal teratoma (SCT) is one of the most common tumors of the newborn. SCT is seen frequently in the presacral region and in forms of solid or mixed solid and cystic masses. Only 10-15 % of all sacrococcygeal teratomas are in pure cystic form. Here, in this case, we aimed to present sonographic and magnetic resonance images (MRI) of a newborn with pelvic cystic mass and bilateral hydronephrosis that were seen on prenatal ultrasonography.
An operation was planned for two days of age girl patient for cystic pelvic mass and bilateral hydronephrosis detected by prenatal sonography during the third trimester. On her abdominal X-ray radiography, there was no bowel gas at the midline pelvis. The patient was referred to the sonography unit with the suspicion of a duplication cyst. Abdominal sonography revealed bilateral hydroureteronephrosis, bladder wall thickening, and a 75x55x32 mm pure cystic mass located between the rectum and bladder. The mass had a fine septa at the inferior site. Abdominal MRI showed that the mass had no connection with the spinal canal or solid component. The patient was operated and the diagnosis of purely cystic sacrococcygeal teratoma was confirmed histopathologically.
Anterior meningocele, tail gut cyst, rectal duplication cyst, and cystic sacrococcygeal teratomas are common lesions of the presacral region diagnosed in the prenatal or antenatal period. Sacrococcygeal teratoma should be kept in mind in patients with presacral cystic mass in the neoatal period and radiologic methods are helpful for displaying the extent and content of a cystic mass. Read More

Authors:  Aslan Mine , Arioz Habibi Hatice , Kalyoncu Ucar Ayse , Namdar Yesim , Adaletli Ibrahim , Kurugoglu Sebuh

Keywords:  Sacrococcygeal teratoma, Sonography, Magnetic resonance imaging, Neonatal

Taori Abhijeet,  Ferretti Emanuela,  Miller Elka,  Martinez-rios Claudia

Final Pr. ID: Poster #: EDU-010

Advances in Neonatal Intensive Care have led to substantial improvement in survival of preterm infants of extremely low gestational age (ELGA) between 22+0 and 23+6 weeks gestation. ELGA newborns are more susceptible to several complications of prematurity. Recognition of the sonographic features of the normal brain and identification of potential short and long-term complications of these infants is paramount.
High resolution transfontanellar ultrasonography is the baseline “gold standard” of care imaging modality to assess the integrity of the neonatal brain and potential complications encountered in ELGA newborns. Color and spectral Doppler US allows high reliability and precision in the evaluation of the intracranial vasculature.
The purpose of this exhibit is
1. To illustrate a spectrum of the sonographic features of the normal developing brain in ELGA infants.
2. To characterize the sonographic findings of short and long-term brain anatomical complications.
3. To describe common pitfalls when imaging these infants. Read More

Authors:  Taori Abhijeet , Ferretti Emanuela , Miller Elka , Martinez-rios Claudia

Keywords:  Ultrasound, Neonatal, Brain

Kurian Jessica,  Liszewski Mark,  Gomes William,  Hoffman Thomas,  Taragin Benjamin

Final Pr. ID: Poster #: EDU-052

The purpose of this exhibit is to describe 3D ultrasonography (3DUS) of the head in neonates. Traditionally, 2D ultrasonography has been used for evaluation of the neonatal brain. 3DUS is a more recent advanced technique in which a volume of tissue is scanned in a single acquisition, and the 3D data set is subsequently manipulated using specialized software. This exhibit reviews current literature relating to 3DUS, demonstrates basic technical aspects of 3DUS, describes 3DUS of normal brain, and illustrates 3DUS features of acquired and congenital neonatal brain disorders. Read More

Authors:  Kurian Jessica , Liszewski Mark , Gomes William , Hoffman Thomas , Taragin Benjamin

Keywords:  Three-dimensional ultrasound, Neurosonography, Neonatal

Bojicic Katherine,  Hamman Susan,  Hryhorczuk Anastasia

Final Pr. ID: Poster #: EDU-006

TEACHING POINTS
1. Inform radiologists of new paradigms of care for patients with Trisomy 18, emphasizing significant management changes over the past decade as well as the expanding indications for patient interventions.
2. Describe imaging findings and diagnoses encountered among patients with Trisomy 18, including CNS, cardiothoracic, gastrointestinal, genitourinary, and musculoskeletal abnormalities.
3. Explore the value of patient and family centered care while treating children with Trisomy 18, emphasizing family encounters in the radiology department.

TABLE OF CONTENTS/OUTLINE

I. Management of Trisomy 18
A. Historical background
B. Current emphasis on family-centered care
C. Expanding indications for interventions

II. Common manifestations of Trisomy 18
A. CNS: Dandy-Walker spectrum, corpus callosal abnormalities, choroid plexus cysts
B. Cardiothoracic: Cardiac anomalies, tracheobronchomalacia, diaphragmatic hernia
C. GI: Swallowing abnormalities, tracheoesophageal fistula, malrotation and omphalocele, solid organ tumors
D. GU: Horseshoe kidney, renal and ureteral obstructions, reflux
E. Musculoskeletal: Foot abnormalities, hip dysplasia, spinal segmentation abnormalities

III. Future directions
A. Evolving imaging recommendations
B. Opportunities for positive interventions with patients and families within radiology Read More

Authors:  Bojicic Katherine , Hamman Susan , Hryhorczuk Anastasia

Keywords:  Trisomy 18, Neonatal

Gowali Neha,  Anand Neil,  Murphy Robyn

Final Pr. ID: Poster #: EDU-003

The purpose of the presentation is to educate the audience of the uses of ultrasound in evaluation of the neonatal spine. By viewing this presentation, the audience will learn the importance of ultrasound in evaluation of the spine. We will review the process of performing the ultrasound examination to acquire suitable images. Assessment of the normal spine structures under ultrasound and discussion of the indications for the use of ultrasound as a primary source of evaluation of the spine are to be reviewed. Performance of the examination in terms of patient positioning, labeling of the vertebral bodies, and evaluation of the important structures will be discussed. Indications for acquiring an ultrasound of the spine will also be reviewed. Lastly, we aim to review distinct disease entities associated with the neonatal spine, with attention to their ultrasound imaging characteristics. Read More

Authors:  Gowali Neha , Anand Neil , Murphy Robyn

Keywords:  Ultrasound, Spine, Neonatal

Gebarski Kathleen,  Gebarski Stephen

Final Pr. ID: Poster #: EDU-064

Sonography of the neonatal spine can be challenging and difficult to interpret. We composed a pictorial guide of a wide variety of variants and diseases for education and reference. Read More

Authors:  Gebarski Kathleen , Gebarski Stephen

Keywords:  spine, sonography, neonatal