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
Final Pr. ID: Poster #: EDU-030
In preterm infants, caudothalamic lesions on ultrasound usually evoke the presence of a recent germinal matrix bleed. Intraventricular bleeds may also be seen in term infants but usually located near the glomus of the choroid plexus. Because germinal matrix has involuted in term infants, caudothalamic bleeds are infrequent and other possibilities should be considered when caudothalamic lesions are seen. Previous literature has described germinolytic cysts as indistinguishable from lesions resulting from germinal matrix hemorrhage. The pathologic process underlying development of these cysts is not well known and may result from intrauterine injury due to a vascular insult, congenital infections or chromosomal abnormalities. In our practice, we have seen many cases of germinolytic cysts in term infants mimicking germinal matrix bleed but acting as “red flag” raising the suspicion of other pathology, such as CMV infection and Zellweger syndrome. Although germinal matrix bleed and germinolytic cysts appear similar on ultrasound, we believe that key differentiating feature between these lesions is gestational age of the infant at presentation.
Purpose of our educational exhibit is to emphasize these facts and encourage both radiologists and sonologists to consider unusual but important possibilities such as CMV infections or Zellweger syndrome whenever caudothalamic lesions are encountered in a term baby. We discuss other abnormalities and findings to support these diagnoses. Early suspicion and detection of intracranial CMV infection is essential for prompt treatment and better outcome. Read More
Final Pr. ID: Poster #: EDU-021
There are a variety of masses in neonates, infants and young children that may disappear spontaneously without active intervention. However, there has been no published review of what type of masses could disappear and what the spectrum of their imaging features is. It is essential for radiologists to understand imaging features of these entities in order to provide pediatrician and pediatric surgeons with critical information that will enable them to manage these patients expectantly without surgical intervention.
The entities that will be illustrate in this review include, among others: multicystic dysplastic kidneys, suprarenal masses (including intraabdominal sequestration, neuroblastoma and adrenal hemorrhage), ovarian cyst and torsion, duplication cyst of gastrointestinal tract, cyst of liver and kidneys. We will:
1. Review the clinical and imaging features of these masses including their changes during follow-up imaging studies.
2. Emphasize the imaging features that are helpful in differentiating these entities from other entities that require active intervention
3. Describe an appropriate approach to deal with uncertain diagnoses. Read More
Final Pr. ID: Paper #: 123
Timely intracranial imaging enables diagnosis, directs treatment, and provides prognostic information of infant malformation or injury. MRI is the gold standard for neuroimaging, but can be inhibited by transportation risk and incompatible support devices. Ultrasound (US) is portable, rapid, and inexpensive, but limited by lower sensitivity and specificity. Contrast-enhanced ultrasound (CEUS) improves diagnostic accuracy of US in other clinical applications. Our aim was to prospectively compare CEUS of the neonatal brain to MRI. Read More
Final Pr. ID: Poster #: EDU-037
Ultrasound is the most accessible and reliable modality to evaluate the kidneys in neonates and young infants. The sonographic appearance of the kidneys in the immediate postnatal period can differ significantly from that in older children and adults. In clinical practice, radiologists encounter a full spectrum of renal pathology, with some appearing as hyperechogenicity on ultrasound. The purpose of this case-based educational exhibit is to provide a review of normal and abnormal causes of increased echogenicity of the kidneys in neonates and young infants, and common sonographic pitfalls that can artificially increase renal echogenicity Read More
Final Pr. ID: Poster #: EDU-083
To delineate the spectrum of intra cranial imaging findings in infants with late hemorrhagic disease of newborn (late HDN) Read More
Final Pr. ID: Poster #: EDU-034
Bowel obstruction in newborns are divided into high and low obstruction. High obstruction occurs before the proximal jejunum and comprise congenital causes including: atresia of the esophagus, stomach, duodenum or jejunum, duodenal stenosis from annular pancreas, duodenal web, malrotation without or without midgut volvulus and congenital abdominopelvic cysts or masses. Low obstruction occurs distal to the proximal jejunum and consist of congenital causes such as ileal and colonic atresia, anorectal malformation, Hirschsprung’s diseasem, congenital abdominopelvic cysts or masses. Other causes include meconium ileus or functional immaturity of the colon.
Bowel obstruction in older neonates and children includes congenital causes such as Meckel’s diverticulum, malrotation, congenital hernia as well as inflammatory conditions such as appendicitis and Inflammatory bowel disease. Other causes include hypertrophic pyloric stenosis, intussusception, adhesions, sigmoid volvulus and ingested foreign bodies.
Plain radiographs are often the first-line imaging modality for neonates and children presenting with suspected gastrointestinal pathology. A comprehensive radiographic approach along with sound knowledge of the common causes and imaging features of bowel obstruction in the various pediatric demographics will help facilitate timely and appropriate management and also prevent unnecessary further investigations. Additionally, differentiating between high and low bowel obstruction will help guide the next step in management.
The purpose of this education exhibit are to:
1. Review normal and abnormal bowel gas pattern on plain radiographs and associated intepretation pitfalls in newborns, older neonates and children.
2. Familiarise radiologists with common causes and radiographic features of bowel obstruction in newborns, older neonates and children. Illustrative cases for the above conditions will be shown. Relevant further investigations are also discussed. Read More
Final Pr. ID: Poster #: CR-005
Fetal abdominopelvic cystic lesions have various etiologies but are most commonly ovarian or gastrointestinal in origin. Congenital pancreatic cysts are rare entities that typically arise from the pancreatic body and tail, more often in females. In contrast, pancreatic heterotopia or an ectopic pancreas is defined as pancreatic tissue found outside the normal region of the pancreas without a vascular or anatomic connection to the pancreas. It is most commonly associated with the gastrointestinal tract, with >90% of cases located in the stomach, duodenum, or jejunum, and has been known to form cystic structures. We describe an unusual case of a term female neonate with a prenatal diagnosis of an abdominopelvic cyst. The patient had episodes of hypoglycemia secondary to hyperinsulinism requiring a continuous glucose infusion. On surgical resection, the cyst was found to extend from the retroperitoneum towards the left colon without connection to the pancreas or gastrointestinal tract. Histopathological evaluation showed components of pancreatic heterotopia including islets of Langerhans surrounded by acinar cells and dilated pancreatic ducts. The immunostain for Chromogranin showed numerous alpha and beta cells confirming pancreatic tissue. Hypoglycemic episodes improved following cyst resection.
This is the first reported case of retroperitoneal cystic pancreatic heterotopia in a neonate in the English literature. We will present the ultrasound findings as well as surgical and histopathologic images. Read More
Final Pr. ID: Paper #: 120
Neonates with prolonged hospitalization often require PICCs. The concern for PICC-related complications, including venous thrombosis, infection, catheter migration and breakage, often prompts Doppler ultrasound (US) evaluation. However, peri-catheter thrombus in a neonate can be challenging to evaluate, as the accessed peripheral veins in neonates are small, some less than 1mm in luminal diameter. Small-bore catheters may occupy the entirety of the vessel lumen, which can produce absence of peri-catheter flow, which is confounding for thrombus. This distinction has implications for hematologic management. Read More
Final Pr. ID: Poster #: CR-073
We report a case of a term neonate who shortly after birth developed respiratory distress and left-sided pneumothorax. The pneumothorax was drained by a chest tube and the patient was referred to our institution. On day 17 of life a chest Xray and chest CT were performed demonstrating a multiloculated cystic lesion compromising the left upper lobe, most likely representing congenital pulmonary airway malformation (CPAM) type II (Figure 1). No abnormal systemic vessels were identified. At that time the patient was diagnosed with B influenza infection and the surgical intervention was deferred. Over the next several days the patient demonstrated improvement of the respiratory distress and progressive decrease of supplementary oxygen need. On day 25 of life the patient presented significant clinical improvement and, at physical examination, breath sounds were found on the left hemithorax. A follow-up chest xray demonstrated spontaneous resolution of the prior visualized cystic lesion that was confirmed with a chest CT (Figure 2).
Postnatal spontaneous resolution of CPAM have been reported in only few cases, with resolution of the malformation in few months or years. Although we do not have pathologic confirmation, we postulate that our case represent CPAM type II that resolved spontaneously before the first month of life. The management of CPAM diagnosed during the neonatal period remains controversial, some authors recommend postpone surgical intervention in asymptomatic neonates and in patients with prompt resolution of respiratory distress without other significant anomalies.
Our case illustrates the possibility of spontaneous resolution of CPAM and adds to the few reported cases that recommend conservative treatment. Read More
Final Pr. ID: Paper #: 119
Hypoxic Ischemic Encephalopathy (HIE) occurs in 1-6/1000 livebirths often leading to death or neurological disability. Neonatal brain magnetic resonance imaging (MRI) is used to assess severity of brain injury and provide prognostic information in the newborn period. However, 20-50% HIE patients do not have early abnormal MRI findings detected by qualitative neuroradiologic evaluation and yet have adverse outcomes evident by 2 years of age. Our aim was to investigate whether quantitative MRI analysis can find subtle abnormalities that help improve prognostication and reduce the incidence of falsely reassuring neonatal MRI among infants with HIE. Read More
Final Pr. ID: Poster #: EDU-138
1) To make the reader aware of imaging features in neonatal respiratory disterss.
2) Multimodality imaging of infants with respiratory distress.
3) Role of antenatal imaging, especially fetal MRI in multidisciplinary approach in management of respiratory disorders of infants. Read More
Final Pr. ID: Poster #: SCI-017
The radiology report is a tool to communicate information to the referring physician and record data for follow-up or research purposes. With structured reporting templates information becomes uniform, comprehensive and easily manageable. In collaboration with neonatologists and information technologists we developed a structured MRI reporting template for neonatal hypoxic-ischemic encephalopathy (HIE). Read More
Final Pr. ID: Poster #: EDU-040
We will discuss how to perform voiding cystourethrography (VCUG). We will illustrate typical imaging features of genitourinary pathologies in a neonate. Read More