Sarma Asha,  Grant Frederick,  Kwatra Neha

Final Pr. ID: Poster #: EDU-087

Esophageal transit scintigraphy (ETS) complements anatomic imaging studies such as contrast esophagography for the evaluation of esophageal motility disorders. This noninvasive technique provides reliable and reproducible functional data that is useful in the evaluation of both primary and secondary esophageal motility disorders. This image-rich exhibit will provide an overview of this examination using representative examples of ETS studies in children, including technical considerations, imaging features in various disorders, and pitfalls in intepretation, with correlative fluoroscopic and/or CT images. Read More

Authors:  Sarma Asha , Grant Frederick , Kwatra Neha

Keywords:  Functional, Gastrointestinal, Nuclear medicine

Lins De Carvalho Tiago,  Voss Stephan

Final Pr. ID: Poster #: EDU-084

This educational exhibit provides an overview of the role radiotracers play in diagnosing, staging, and treating neuroblastoma and neuroendocrine tumors (NETs) in pediatric patients, particularly those associated with certain cancer predisposition syndromes (CPS), which are linked to an increased incidence of neuroendocrine tumors, including pheochromocytoma, and paraganglioma (PPGL). Read More

Authors:  Lins De Carvalho Tiago , Voss Stephan

Keywords:  Nuclear Medicine, Neuroblastoma, Pediatric Radiology

Berg Sarah,  States Lisa

Final Pr. ID: Poster #: EDU-083

Neuroblastoma, the most common extracranial solid tumor in children, arises from embryonal neural crest progenitor cells. With a common origin of neuroendocrine cytology, this otherwise highly variable disease can be imaged with high sensitivity by exploiting the underlying biochemistry of the nervous system – namely with radiolabeled I-123 metaiodobenzylguanidine (MIBG), a norepinephrine analog. Imaging with MIBG over time can serve several key roles, including providing accurate stage at diagnosis, response assessment following therapy, and detection of recurrent disease. Moreover, when using the Curie score, a standardized and validated assessment of MIBG uptake on planar imaging, valuable prognostic information can be elucidated both at time of diagnosis and following induction therapy. Through the utilization of the same underlying physiologic principles, I-131 MIBG could be administered for an intended therapeutic effect, targeting sites of tracer uptake. The purpose of this educational exhibit is to review the process of quantifying and assigning a Curie score in the evaluation of pediatric neuroblastoma using I-123 MIBG planar imaging. Using a pictorial review of various I-123 MIBG positive cases, we will highlight normal MIBG uptake, distribution, and excretion. Through the inclusion of case examples that demonstrate various stages of disease, differing sites and severity of pathologic activity will be highlighted. Finally, the prognostic significance of the Curie scoring paradigm over time will be illustrated, specifically at the time of diagnosis and post-induction with I-123 MIBG, and in the post-therapy setting with I-131 MIBG. Read More

Authors:  Berg Sarah , States Lisa

Keywords:  Nuclear Medicine, MIBG, Neuroblastoma

Gelfand Michael,  Treves S.

Final Pr. ID: Poster #: EDU-140

The North American and European administered activity recommendations will be reviewed and compared in this educational exhibit. Read More

Authors:  Gelfand Michael , Treves S.

Keywords:  Nuclear medicine, dose reduction

Mannix Laura

Final Pr. ID: Poster #: CR-004 (T)

A three year old child was referred to the Nuclear Medicine Department for bone scintigraphy for staging. This patient was diagnosed with hepatoblastoma. Imaging findings showed no bony disease, however, radiotracer uptake was demonstrated throughout the liver. Read More

Authors:  Mannix Laura

Keywords:  Nuclear Medicine, Heptoblastoma, Paediatric Nuclear Medicine

Berg Sarah,  States Lisa

Final Pr. ID: Poster #: CR-057

Hereditary paraganglioma-pheochromocytoma syndromes (PGL/PCC) are marked by the presence of multiple and/or multifocal neoplasms of neuroendocrine origin, namely paragangliomas and pheochromocytomas. Though considered an overarching familial cancer syndrome, PGL/PCC can be further characterized based on cellular origin, secretory status, and predisposing genetic mutation, comprising at least 6 distinct subtypes of the disease. Because of the unique metabolic features of neuroendocrine neoplasms, distribution of disease in patients with PGL/PCC can often be precisely evaluated via targeted nuclear medicine radiotracers. However, the true extent and burden of disease involvement may be artificially suppressed owing to the variability in tumor differentiation and subsequent metabolic function. We present the case of a 15-year-old with hereditary paraganglioma-pheochromocytoma syndrome who was evaluated with several distinct nuclear medicine radiotracers – DOTATATE, FDG, and MIBG – with synergistic findings. Initial evaluation with DOTATATE PET/CT demonstrated multiple somatostatin-receptor positive lesions in the neck, chest, and abdomen. Further assessment with MIBG SPECT/CT highlighted the previously seen, dominant abdominal mass, though otherwise revealed less abnormal foci of disease than that seen on preceding DOTATATE study. Finally, whole body FDG PET/MRI was utilized, revealing intense gastric avidity corresponding to gastrointestinal stromal tumor, with milder uptake at the other sites of previously characterized malignancy. This case emphasizes the underlying heterogeneity of tumors which may arise in patients with PGL/PCC and lends credence to the value of multi-tracer imaging for true disease staging purposes. Read More

Authors:  Berg Sarah , States Lisa

Keywords:  Nuclear Medicine, PET

Kim Joseph,  Shukla Neal,  Hammer Matthew,  Lozano Richard,  Hajibeygi Ramtin,  Tu Long,  Rao Balaji

Final Pr. ID: Poster #: SCI-024

History:
A 14-year-old female was brought to the emergency department following a self-harm incident. During her assessment, she was found to have elevated blood pressures and a prolonged QTc interval. She reported frequent episodes of palpitations and dizziness over the past year, often occurring immediately after urination.

Findings:
Initial ultrasound showed unremarkable kidneys and normal hemodynamics in the renal vessels. However, a heterogeneously echogenic mass with increased vascularity on color Doppler was visualized in the left bladder wall. MRI confirmed that the mass originated from the bladder base and extended through the left bladder wall, showing avid contrast enhancement and restricted diffusion. Gallium-68 Dotatate PET/CT demonstrated intense radiotracer uptake in the bladder mass, left pelvic sidewall, and left internal iliac lymph nodes.

The patient underwent chemotherapy and partial cystectomy. Pathology revealed neuroendocrine and nested features with infiltration into the smooth muscle bundles consistent with the muscularis propria of the bladder. Tumor cells tested positive for chromogranin and synaptophysin immunostains, while pan-cytokeratin (AE1/AE3) was negative. Genetic testing identified the R242H variant in the SDHB gene.

Discussion:
Bladder paragangliomas are rare neuroendocrine tumors arising from the sympathetic paraganglia present in the bladder wall. They represent 6% of extra-adrenal paragangliomas and 0.05% of all bladder tumors. Typical symptoms include hypertension, hematuria, and catecholamine-associated symptoms like headaches and palpitations during micturition. Up to 63% of bladder paraganglioma patients have a germline mutation, most commonly in the SDHB subunit gene, increasing their risk of developing pheochromocytomas and additional paragangliomas. Therefore, lifelong biochemical and imaging screening from skull base to pelvis are recommended.

Conclusion:
Bladder paragangliomas are a rare variant of extra-adrenal pheochromocytomas. MRI plays an important role in the pretreatment diagnosis of bladder paraganglioma. Gallium-68 Dotatate PET/CT is highly specific and can help diagnose metastatic spread. Lifelong follow-up is recommended due to the risk of recurrence and metastasis, and the potential for developing additional paragangliomas or pheochromocytomas. Read More

Authors:  Kim Joseph , Shukla Neal , Hammer Matthew , Lozano Richard , Hajibeygi Ramtin , Tu Long , Rao Balaji

Keywords:  Bladder, PET/CT, Nuclear Medicine

Hampton Erica,  Fuentealba Cargill Andrea,  Trenbeath Zachary,  Alazraki Adina,  Stence Nicholas,  Milla Sarah

Final Pr. ID: Poster #: EDU-076

Brain death, also known as death by neurologic criteria, (BD/DNC) is the permanent loss of total brain function in individuals who have sustained catastrophic brain injuries. Accounting for approximately 5% of pediatric deaths, BD/DNC remains a clinical diagnosis, which is often emotionally laden and not always straightforward. When results are equivocal or there exist limitations to the safe completion of the clinical assessment, clinicians rely on ancillary testing to make informed decisions. In October 2023, updated adult and pediatric BD/DNC consensus guidelines were published which reinforce differences in the recommendations for testing between the adult and pediatric populations. It is, therefore, crucial for Pediatric Radiologists to understand these guidelines and the critical role radiology plays in supporting this important diagnosis.
In this educational exhibit, we will review the recent consensus guidelines and clinical indications for the use of imaging in BD/DNC evaluation. We will provide a step-by-step guide which will include patient preparation, radionuclide or contrast administration, image acquisition, and image interpretation for the two validated methods of pediatric BD/DNC ancillary testing: Radionuclide Perfusion Scintigraphy and 4-Vessel Catheter Angiography.
Although 4 vessel catheter angiography is considered the gold standard in ancillary BD/DNC testing, as it is believed to be both 100% sensitive and 100% specific, radionuclide scintigraphy is the more widely used modality in the pediatric population, owing to the less invasive nature of the exam. Neither exam is without challenges related to limited availability and technical skill required yet are currently the only validated radiologic tools recommended for use in brain death diagnosis. Our exhibit will review multiple cases of evaluation for BD/DNC, accentuating imaging findings and pearls/pitfalls of acquisition and interpretation. Opportunities for investigation of other available imaging techniques will also be highlighted. Read More

Authors:  Hampton Erica , Fuentealba Cargill Andrea , Trenbeath Zachary , Alazraki Adina , Stence Nicholas , Milla Sarah

Keywords:  Nuclear Medicine, Interventional Radiology