Myers Ross,  Dietsche Eric,  Gnerre Jeffrey,  Lecompte Leslie,  Gilet Anthony

Final Pr. ID: Poster #: EDU-011

The pediatric population is not immune to the various types of cancer encountered by the adult population in terms of the organs and organ systems affected. Despite advances in treatments and detection, cancer is still the number 2 cause of death within the pediatric population. The types of tumors encountered in the younger population are often composed of more uniquely immature cellular lineages and only a small percentage have preventable causes. The goal of our single institution presentation is to provide the interested viewer with a comprehensive review of several uniquely encountered immature pediatric tumors. Our presentation will include imaging examples utilizing multiple modalities demonstrating examples of pancreaticoblastoma , immature lipoblastoma, neuroblastoma, hepatoblastoma, a case of biopsy confirmed small cell undifferentiated renal rhabdoid tumor, and a unique case of pleuropulmonary blastoma. Explanations pertaining to the key imaging features of each entity as reported in the literature will be provided to supplement the case examples from our institution. Read More

Authors:  Myers Ross , Dietsche Eric , Gnerre Jeffrey , Lecompte Leslie , Gilet Anthony

Keywords:  Oncology, Gastrointestinal, Thoracic

Ilivitzki Anat,  Scolnik Michal

Final Pr. ID: Poster #: EDU-095

In this pictorial essay on typical and atypical lung metastases in pediatric patients, we aim to assist radiologists in identifying suspicious features on CT scans. Our goal is to guide decisions regarding follow-up imaging to ensure a timely diagnosis, enabling children to receive prompt and potentially lifesaving treatment. Read More

Authors:  Ilivitzki Anat , Scolnik Michal

Keywords:  CT Chest, Pediatric Radiology, Oncology

Petrosyan Lilit,  Ayvazyan Sona

Final Pr. ID: Poster #: CR-008

Nasopharyngeal carcinoma (NPC) is a rare malignancy in the pediatric population, comprising less than 1% of all pediatric malignancies. NPC typically occurs in older children and adolescents, with the highest incidence between ages 10-19, and there may be a slight male predominance.
A 14-year-old boy presented with a 2-week history of earache, hearing loss, headache, fever, neck pain, and palpable enlarged lymph nodes in the neck. Ultrasound revealed bilateral cervical lymphadenitis. Upon physical examination, the throat appeared hyperemic. Blood tests showed moderately elevated inflammatory markers. Initially, the patient was diagnosed with cervical lymphadenitis, right-sided otitis, and eustachitis. Antibiotic therapy was initiated, resulting in mild improvement; however, the primary symptoms persisted.
Serological testing for Epstein-Barr virus (EBV) was negative. A contrast-enhanced CT scan was performed due to the suspicion of an abscess. The CT revealed a hypervascular mass measuring 4.3x3.3cm in the nasopharynx, extending into the parapharyngeal and retropharyngeal spaces from the right side, significantly narrowing the nasopharyngeal airway. Cervical lymphadenopathy was also noted, particularly on the right side.
Given the imaging findings, a differential diagnosis was considered between lymphoma and nasopharyngeal carcinoma. A pediatric oncology consultation was obtained, and biopsies of both the retropharyngeal mass and cervical lymph nodes were performed. Histopathological analysis confirmed the diagnosis of nasopharyngeal carcinoma.
Nasopharyngeal carcinoma in pediatric patients often presents with non-specific symptoms, contributing to diagnostic delays. Cervical lymphadenopathy is frequently the primary clinical finding, typically manifesting as painless enlarged neck lymph nodes. Other common symptoms include nasal obstruction, nasal discharge, and ear-related issues such as otitis media with effusion, hearing loss, or tinnitus due to eustachian tube dysfunction. In cases presenting with these symptoms, imaging with CT or MRI has an important role for early diagnosis. Read More

Authors:  Petrosyan Lilit , Ayvazyan Sona

Keywords:  Lymphadenopathy, Oncology, Paediatric Radiology

Joya Sosa Yocelin,  Madden Joseph,  Fadell Michael,  Carrico Caroline,  Maxfield Charles,  Cao Joseph

Final Pr. ID: Poster #: CR-026

Background:
Conventional medullary osteosarcoma is a malignant bone-forming tumor characterized by the production of osteoid matrix by malignant mesenchymal cells. Although it is the most common primary malignant bone tumor in children, primary osteosarcoma of the spine is exceptionally rare, accounting for less than 5% of pediatric osteosarcomas. Symptoms are frequently nonspecific, and early radiographic clues may be subtle. Due to its rarity and nonspecific presentation, spinal osteosarcomas are often diagnosed late, typically after structural destruction or neurologic compromise has occurred.

Case Report:
A 12-year-old female presented with two months of progressive low back pain and an unintentional 15-pound weight loss. She denied weakness, sensory loss, or bowel/bladder dysfunction. Lumbar spine radiographs revealed a lucency of the left L2 pedicle, producing a “winking owl sign.” Follow-up CT demonstrated a lytic, destructive lesion with asymmetric enlargement of the left psoas and paraspinal musculature. Additionally, CT was useful in demonstrating the presence of osseous matrix within the primary tumor. MRI revealed an expansile, enhancing lesion centered in the left posterior elements of L2, with paraspinal soft-tissue extension and circumferential epidural involvement causing moderate to severe canal stenosis. Biopsy confirmed the diagnosis of conventional medullary osteosarcoma. The patient remained neurologically intact and was referred for multidisciplinary oncologic management. Read More

Authors:  Joya Sosa Yocelin , Madden Joseph , Fadell Michael , Carrico Caroline , Maxfield Charles , Cao Joseph

Keywords:  Oncology, Osteosarcomas, Radiographic Findings

Baheti Akshay,  Bhaladhare Prachi,  Patil Vasundhara,  Gala Kunal,  Shetty Nitin,  Kulkarni Suyash,  Ramadwar Mukta,  Panjawani Poonam,  Qureshi Sajid

Final Pr. ID: Poster #: SCI-034

Desmoplastic small round cell tumor (DSRCT) is a rare, aggressive sarcoma of the Ewing’s sarcoma family with the presence of EWSR1 gene mutation. It predominantly affects adolescent males. DSRCT typically arises from peritoneal or pelvic serosal surfaces and often presents at an advanced stage. Because symptoms are vague, imaging plays a crucial role in early recognition. We review the CECT findings of pediatric patients of DSRCT who were managed at our institute. Read More

Authors:  Baheti Akshay , Bhaladhare Prachi , Patil Vasundhara , Gala Kunal , Shetty Nitin , Kulkarni Suyash , Ramadwar Mukta , Panjawani Poonam , Qureshi Sajid

Keywords:  Oncology, Sarcomas, Small Round Blue Cell Tumors

Arenos-abril Jesus,  Gonzalo Marta,  Coblenzt Ailish

Final Pr. ID: Poster #: EDU-006

Lymphoma is the third most frequent pediatric cancer after leukemia and brain tumors and can involve different organs with multiple imaging presentations and characteristics. Given that, pediatric radiologists must be familiar with the different imaging patterns that this disease represents in order to come up with the proper diagnosis at every moment. However, sometimes lymphoma imaging presentation can be challenging and simulate other diseases (historically called the great mimicker), which can mislead us to make a wrong diagnosis with consequent inappropriate or delayed treatment. On account of that, we have selected several cases throughout different years presenting at two institutions with imaging presentations resembling pediatric lymphoma, some of them resulting in true lymphoproliferative processes and others turning out to be simulating pathologies. We display the different cases on this educational poster and show what are the clues (if present) to properly distinguish between lymphomatous and simulating diseases from the imaging point of view and always with clinical correlation. In summary, the main purpose of this poster is to represent the imaging differences between pediatric lymphoma and its possible mimickers through the presentation of different teaching cases and to highlight the clues that can help pediatric radiologists to distinguish adequately the different diseases. Read More

Authors:  Arenos-abril Jesus , Gonzalo Marta , Coblenzt Ailish

Keywords:  Lymphoma, Oncology

Baheti Akshay,  Patil Vasundhara,  Towbin Alexander,  Chavhan Govind,  Gala Kunal,  Shetty Nitin,  Kulkarni Suyash,  Qureshi Sajid

Final Pr. ID: Poster #: EDU-042

Hepatoblastoma exemplifies how a multidisciplinary approach involving all stake-holders is key for appropriate management. The Pretreatment Extent of Tumor (PRETEXT) classification remains the cornerstone of staging, treatment planning, and prognostication. The 2017 revision addressed many ambiguities and improved standardization of hepatoblastoma staging, providing a common language across disciplines and institutions. However, certain interpretative and practical challenges persist in daily practice. For example, large tumors often compress the IVC, which is not well opacified on cross-sectional imaging. This makes it difficult to confidently categorize venous involvement V + or V-. The precise role of ultrasound in clarifying such equivocal cases also requires further evaluation. Classification of tumors limited to one section and tumor thrombus extending to another section is another source of confusion. The surgical plan in case the tumor thrombus resolves is also unclear. Sectional compression vs involvement, which may cause overstaging, differentiating contiguous spread from multifocality, overcalling rupture in the presence of perihepatic fluid, and more clear definition of extrahepatic extension are other examples of areas which need more clarity. Each of these can lead to staging discrepancies that impact patient management. In this exhibit, we discuss the current PREXTEXT classification, its current utility, pitfalls and limitations, and discuss future directions in PRETEXT classification updates. This educational exhibit revisits the fundamentals of the PRETEXT classification, its current utility, and its pitfalls and limitations through practical, case-based discussions. It highlights common interpretative dilemmas and provides practical strategies to enhance reproducibility and confidence in staging. Finally, it explores emerging directions for future PRETEXT updates. The ultimate goal is to make radiologists more effective members of the interdisciplinary tumor boards through a holistic understanding of PRETEXT classification and discuss areas for future updates. Read More

Authors:  Baheti Akshay , Patil Vasundhara , Towbin Alexander , Chavhan Govind , Gala Kunal , Shetty Nitin , Kulkarni Suyash , Qureshi Sajid

Keywords:  Oncology, Heptoblastoma, Liver Tumor

Mcquinn Garland,  Stanescu A. Luana,  Iyer Ramesh,  Nadel Helen,  Parisi Marguerite

Final Pr. ID: Poster #: EDU-041

The general pediatric radiologist is well aware of the classic scintigraphic findings of common malignancies. However, atypical presentations, appearances, and complications related to treatment and resultant immunosuppression may confound diagnosis. We present a series of interesting cases to help our non-nuclear medicine trained colleagues develop a systematic approach to nuclear medicine image interpretation in atypical cases. Read More

Authors:  Mcquinn Garland , Stanescu A. Luana , Iyer Ramesh , Nadel Helen , Parisi Marguerite

Keywords:  Oncology, Staging

Lionberg Alex,  Ong Seng

Final Pr. ID: Poster #: EDU-096

Neuroblastoma is recognized as having a broad spectrum of clinical behavior in children diagnosed with the disease. Some tumors exhibit aggressive characteristics and portend a poor prognosis, while others that appear aggressive spontaneously regress. Accurately identifying high risk neuroblastoma is important in determining which patients will benefit most from intense chemotherapy, which unfortunately carries a risk of significant adverse effects later in life. Historically this has been difficult, as the classification schemes vary in different parts of the world, limiting the ability to pool data and improve prognostication. In recent years, efforts among experts around the globe have led to a consensus on the most evidenced based approach to staging. The aim of this educational exhibit is to describe the new standardized language for radiology reports, which will contribute to accurate staging and improve treatment for patients with neuroblastoma. Additionally, key imaging features highlighting image defined risk factors will be presented. Read More

Authors:  Lionberg Alex , Ong Seng

Keywords:  Neuroblastoma, Oncology, Tumor Staging

Baheti Akshay,  Sarmah Shivali,  Patil Vasundhara,  Gala Kunal,  Shetty Nitin,  Kulkarni Suyash,  Ramadwar Mukta,  Panjawani Poonam,  Qureshi Sajid

Final Pr. ID: Poster #: SCI-045

Pediatric adrenocortical carcinomas (ACCs) are less common than neuroblastomas, but have worse prognosis. Early identification and differentiation from neuroblastomas helps allow prompt management. We describe the imaging features of primary and metastatic ACCs. Read More

Authors:  Baheti Akshay , Sarmah Shivali , Patil Vasundhara , Gala Kunal , Shetty Nitin , Kulkarni Suyash , Ramadwar Mukta , Panjawani Poonam , Qureshi Sajid

Keywords:  Adrenal, Oncology, Adrenocortical

Rathore Bhagyashree,  Wang Harris,  Miles Kimberley,  Berklite Lara,  Schneider Kristin,  Morin Cara

Final Pr. ID: Poster #: EDU-005

Teaching Points:
1. Review the imaging approach and differential diagnosis for cardiac masses in children
2. Illustrate the characteristic imaging findings of benign and malignant pediatric cardiac tumors and understand the spectrum of pseudotumors that may be encountered in pediatric cardiac disease.
3. Discuss the screening guidelines and management approach to cardiac masses in children with predisposition syndromes.
4. Review radiologic-pathologic correlation for cardiac masses and pseudomasses in children.

Outline:
1. Review our institutional experience, including the relative frequency of cardiac masses and pseudomasses
2. Describe the recommended imaging protocols for screening, surveillance, and characterization of cardiac masses on echocardiography, CT, and MRI
3. Describe the imaging findings at echocardiography, CT, and MRI in the spectrum of pediatric cardiac tumors and pseudotumors in:
a. Predisposition syndromes: Tuberous sclerosis, Nevoid basal cell carcinoma syndrome, Carney complex, etc.
b. Primary malignant cardiac tumors: Rhabdomyosarcoma, angiosarcoma, malignant fibrous histiocytoma, fibrosarcoma, etc.
c. Secondary cardiac tumors: Osteosarcoma, hepatoblastoma, neuroblastoma, Ewing sarcoma, synovial cell sarcoma, etc.
d. Benign cardiac masses: Mature teratoma, vascular malformations, lipoma, myxoma, fibroma, etc.
e. Cardiac pseudomasses and mimics: Thrombus, Epicardial/myocardial fat necrosis, pseudoaneurysms, granulomatous disease, etc.
4. Provide radiologic-pathologic correlation for cardiac masses and pseudomasses in children Read More

Authors:  Rathore Bhagyashree , Wang Harris , Miles Kimberley , Berklite Lara , Schneider Kristin , Morin Cara

Keywords:  cardiac, oncology, pseudomasses

Weber Jonathon,  May Parker

Final Pr. ID: Poster #: EDU-043

Cancer places the body in a state which predisposes patients to certain complications, both related to the cancer itself and its treatment. Pediatric cancers differ from those in adults in their type and behaviors; therefore, prior knowledge of these cancers is crucial to diagnose complications. The pathophysiology and associated imaging of oncologic emergencies in pediatric patients will be discussed. We anticipate this discussion to be of particular interest for pediatric radiologists who care for this group of patients, as many of these conditions require the radiologist to be consciously considering them to be promptly diagnosed.
Imaging plays a necessary role in the workup of oncology patients, both in initial staging and evaluation of emergent complications. Complications can be categorized into the natural course of disease and related to treatment, including both chemotherapy- and interventional-related. This review will take a systems format to discuss neurologic, trunk, and hematologic emergencies, both of iatrogenic and cancer-related pathologies with a range of imaging modalities. Imaging diagnosis of life-threatening conditions of the nervous system (spinal cord compression, cerebral herniation, meningitis), thoracic (vascular and pulmonary), and abdominal (bowel obstruction, perforation, and ischemia; urinary tract obstruction; intussusception; arterial injury; venous thrombosis) systems will be discussed with a multi-imaging modality approach.
Equipped with this information, we expect attendees to recognize “do not miss” imaging findings for oncologic emergencies and to provide prompt, effective diagnoses for the treatment of this special group of patients. Read More

Authors:  Weber Jonathon , May Parker

Keywords:  Cancer, Oncology, Emergency/Acute

Sanders Vanessa,  Khanna Geetika,  Mhlanga Joyce,  Ponisio Maria

Final Pr. ID: Poster #: SCI-060

To determine if diffusion weighted imaging (DWI) adds value to PET/MRI in pediatric solid tumors. Read More

Authors:  Sanders Vanessa , Khanna Geetika , Mhlanga Joyce , Ponisio Maria

Keywords:  PET/MRI, DWI, Oncology

Del Campo Braojos Fernanda,  Donnelly Lane

Final Pr. ID: Poster #: EDU-105

Because of issues with the reliability of the previous staging system, the International Neuroblastoma Risk Group Staging System (INRG-SS) was created in 2009. Like with the introduction of any new tool, there has been some resistance to the embracing of the INRG-SS staging system by radiologists. This educational poster offers a practical approach to learning and utilizing the INRG system, emphasizing use of the descriptive terms which determine the presence or absence of imaging defined risk factors (IDRFs). Read More

Authors:  Del Campo Braojos Fernanda , Donnelly Lane

Keywords:  neuroblastoma, staging, oncology

Errampalli Eric,  Kosaraju Sriya,  Illimoottil Mathew,  Priya Lakshmi,  Orscheln Emily

Final Pr. ID: Poster #: EDU-038

Hepatocellular carcinoma is the second most common pediatric liver tumor. Metabolic disorders, hepatitis B or C infection, and certain genetic mutations have been implicated in the development of HCC, and adolescents are the most commonly affected age group. The prevalence of this disease has decreased with increased hepatitis B immunization efforts, but approximately 50-70% of all pediatric hepatocellular carcinoma develops in the absence of underlying liver disease or genetic predisposition. Five-year survival outcome ranges between 13% and 28% with the best outcomes seen in the setting of complete surgical resection. Therefore, imaging plays an important role in diagnosis as well as in guiding management of these patients. Through this educational exhibit, we will discuss the imaging findings of hepatocellular carcinoma, initial imaging evaluation and staging, the role of imaging in ongoing management, and briefly review locoregional treatment options which can play a role in palliation, bridge to liver transplant, or potentially in downstaging disease. Read More

Authors:  Errampalli Eric , Kosaraju Sriya , Illimoottil Mathew , Priya Lakshmi , Orscheln Emily

Keywords:  Hepatocellular Carcinoma, oncology

Martinez-rios Claudia,  Malkin David,  Vali Reza,  Shammas Amer,  Tijerin Bueno Marta,  Greer Mary-louise,  Doria Andrea

Final Pr. ID: Poster #: EDU-123

Whole-body (WB) magnetic resonance (MR) imaging in children is of special interest because it is radiation free and can be used to evaluate systemic conditions, exploiting the advantage of the superior soft-tissue contrast provided by MR imaging. An important clinical application of whole-body MR imaging in children is its use for screening of oncologic conditions, tumor characterization, and staging. However, the list of non-oncologic applications of WB MRI has recently expanded to include the evaluation of numerous multisystemic conditions.

This is a pictorial review of different oncologic applications of WB MRI including cancer predisposition syndromes, solid neoplasias and lymphomas, as well as of non-oncologic applications of WB MRI including chronic recurrent osteomyelitis (CRMO), enthesitis related arthritis (ERA), vascular malformations and benign tumors. In this review we discuss the advantages and challenges of conventional and functional MRI sequences including the use of diffusion weighted imaging (DWI), color-encoded DWI enhanced with iron supplement Ferumoxytol as blood pool contrast agent, as well as the advantages and disadvantages of the recently introduced WB positron emission tomography (PET)/MRI. Read More

Authors:  Martinez-rios Claudia , Malkin David , Vali Reza , Shammas Amer , Tijerin Bueno Marta , Greer Mary-louise , Doria Andrea

Keywords:  MRI, DWI, STIR, PET/MRI, oncology

Riera Luis,  Moreira Maricela,  Arenós Jesús,  Perdomo-luna Camilo,  Vázquez Elida,  Kvist Ola

Final Pr. ID: Poster #: EDU-074

Osteonecrosis (ON) is a significant complication in pediatric oncology, characterized by bone tissue death due to impaired blood supply. It most commonly affects poorly vascularized bones, such as the femoral head, distal femur, and proximal tibia. In children with oncohematological diseases, ON is often multifactorial—linked to prolonged corticosteroid therapy, chemotherapy, and underlying systemic conditions. Prevalence can reach up to 40% in high-risk groups.

This educational poster aims to equip radiologists with practical imaging strategies for early detection and staging of ON, enhancing diagnostic confidence and multidisciplinary collaboration. This work builds on institutional experience at a high-complexity pediatric hospital, integrating recent imaging protocols and outcome data to refine diagnostic pathways.

Early diagnosis is crucial, as ON is frequently asymptomatic and multifocal at onset. Magnetic resonance imaging (MRI) is the gold standard for early detection, with whole-body MRI protocols enabling comprehensive screening of asymptomatic patients. MRI findings include bone marrow edema and geographic areas of necrosis, often surrounded by the characteristic double line sign. Advanced stages show subchondral collapse, loss of sphericity, and cartilage irregularity, which can be graded using systems such as Niinimäki, Ficat and Arlet, or ARCO.

The use of whole-body MRI for asymptomatic screening represents a proactive approach that may reduce long-term disability in pediatric oncology patients. Conventional radiography is useful for assessing bone structure and detecting late-stage changes, while computed tomography (CT) is reserved for preoperative planning. Treatment strategies depend on the severity and location, ranging from conservative management (corticosteroid withdrawal, bisphosphonates, load reduction) to surgical interventions such as core decompression or, in severe cases, joint replacement. Imaging plays a key role not only in early diagnosis but also in monitoring treatment response and guiding surgical planning.
Imaging also plays an important role in complications, that include acute subchondral fractures and superinfection, which require prompt recognition and management.

Radiologists play a pivotal role in early detection. Familiarity with imaging patterns and grading systems is essential to guide timely intervention and improve long-term outcomes. Read More

Authors:  Riera Luis , Moreira Maricela , Arenós Jesús , Perdomo-luna Camilo , Vázquez Elida , Kvist Ola

Keywords:  Oncology, Osteonecrosis, MR

Hampilos Perry,  Friedmann Alison,  Gee Michael

Final Pr. ID: Poster #: SCI-048

Whole-body magnetic resonance imaging (WB-MRI) is an increasingly important tool in pediatric oncology. Optimized WB-MRI protocols allow for abbreviated imaging of young patients with excellent tissue contrast/resolution and without ionizing radiation exposure. Recent data suggest a role for WB-MRI in pediatric cancer staging, cancer predisposition syndrome (CPS) surveillance and evaluation for chemotherapy-related osteonecrosis. The purpose of this study is to evaluate the performance of WB-MRI in these populations. Read More

Authors:  Hampilos Perry , Friedmann Alison , Gee Michael

Keywords:  MRI, Oncology, Osteonecrosis

Antil Neha,  Gatidis Sergios,  Nadel Helen

Final Pr. ID: Poster #: EDU-110

PET/MRI (Positron Emission Tomography–Magnetic Resonance Imaging) is a powerful hybrid imaging modality that has gained increasing clinical relevance in pediatric and neonatal imaging over the past decade. It combines the molecular imaging strengths of PET with the superior soft tissue contrast and functional capabilities of MRI, enabling both whole-body and targeted imaging in a single session. In pediatric imaging, where minimizing radiation exposure is critical and conditions often involve subtle functional or metabolic changes, PET/MRI has emerged as a powerful problem-solving modality. Additional advantage of PET/MRI in pediatric patients is reduction in the number of necessary single examinations and thus reducing the number of sedations and radiation exposure when compared with PET/CT.
PET/MRI has been established as a clinical imaging modality with a wide range of applications across pediatric oncology, neurology, cardiology, infectious/ inflammatory disorders, and rheumatology. It can be utilized for presurgical planning for epilepsy, detection and staging of tumors. Beyond detection and characterization of tumor lesions, PET/MRI is highly effective in providing relevant secondary information about tumor-related or therapy-related complications. Additionally, PET/MRI is helpful diagnostic tool in unusual or challenging clinical situations such as discrepant findings from other diagnostic tests, nonspecific clinical findings, or inconclusive prior imaging findings, especially in children with fever of unknown origin. In such settings, PET/MRI can be used as a problem-solving tool to provide guidance regarding patient management when identifying disease foci or biopsy targets or when ruling out the presence of macroscopic malignancy or active inflammatory processes.
This exhibit demonstrates the unique diagnostic value of hybrid PET/MRI in complex pediatric imaging and to highlight its role as a comprehensive, multiparametric tool in evaluating a wide spectrum of challenging pediatric conditions through clinical cases. The exhibit will be educational for radiologists, nuclear medicine physicians, and pediatric specialists on the strengths, clinical applications, and practical considerations of PET/MRI in children. Read More

Authors:  Antil Neha , Gatidis Sergios , Nadel Helen

Keywords:  Paediatric Nuclear Medicine, Pet/MRI, Oncology

Stephen Steve,  Carlock Hunter,  Chen Irene,  Chaturvedi Apeksha

Final Pr. ID: Poster #: CR-060

A 3-year-old male presented to the emergency department with a 3-day history of wheezing, dyspnea, and mild hypoxia. Patient was afebrile with diminished left-sided breath sounds. Chest radiograph demonstrated expansile opacification of left upper lung, raising concern for pneumonia and prompting ceftriaxone administration. Patient did not improve on antibiotics, and laboratory findings remained inconclusive for infection. A contrast-enhanced chest CT revealed a large left upper lung mass with associated airway compression and atelectasis. Subsequent biopsy and histology initially proposed unspecified sarcoma and malignant spindle cell neoplasm; later refined to pleuropulmonary blastoma (PPB) type III. Fluorodeoxyglucose (FDG) PET-MRI and bone marrow biopsy confirmed localized disease. Molecular genetic testing revealed DICER1 mutation. Patient completed 12 cycles of IVADo (ifosamide, vincristine, actinomycin-D, and doxorubicin) chemotherapy and underwent left lung pneumonectomy, now 2 years in remission.

PPB is a rare embryonal lung neoplasm in children (ages 0-6) classified into cystic (type I/Ir), mixed cystic and solid (type II), and purely solid (type III). Pathogenic germline DICER1 variations have been seen in PPB, as well as cystic nephroma, botryoid-type embryonal rhabdomyosarcoma, and ovarian sex cord-stromal tumors. Diagnosis of PPB can be initially challenging as they may present as pneumonia with nonspecific respiratory symptoms including dyspnea, chest pain, cough, and fever. Pathologic subtype is the only independent prognostic factor (with types II and III having worse outcomes). Treatment varies depending on the type and location of PPB. Given this tumor’s aggressive nature, accurate diagnosis and early treatment with surgical resection and/or concurrent chemotherapy is critical. Read More

Authors:  Stephen Steve , Carlock Hunter , Chen Irene , Chaturvedi Apeksha

Keywords:  Oncology, Thoracic, Blastomas

Tang Elizabeth,  Zavaletta Vaz,  Acord Michael,  Escobar Fernando,  Monroe Eric,  Gill Anne

Final Pr. ID: Poster #: EDU-052

The role of locoregional therapy options (percutaneous thermal ablation, chemoembolization, and/or radioembolization) continues to gain traction in the pediatric oncology world, particularly with the management of primary and metastatic liver lesions. Post-treatment imaging of the liver must clearly differentiate between treatment response, residual untreated disease and progressive disease in order to guide the future therapeutic options.
The post-treatment imaging appearance of pediatric liver lesions can be affected by multiple factors (tumor type, tumor vascularity, radiation vs non-radiation therapy, background liver characteristics, time lapse from the interventional oncology procedure, imaging technique, e.g.). The understanding and interpretation of such factors continues to evolve, as seen with the most recent ACR LI-RADS Treatment Response Assessment Update in 2024. This case cohort presents illustrative examples from multiple pediatric interventional oncology programs, using various imaging modalities to demonstrate post-treatment liver imaging findings following locoregional therapy for both primary and metastatic liver lesions in pediatric patients. Read More

Authors:  Tang Elizabeth , Zavaletta Vaz , Acord Michael , Escobar Fernando , Monroe Eric , Gill Anne

Keywords:  Liver, Pediatric MRI, Interventional Oncology

Mhlanga Joyce,  Siegel Marilyn

Final Pr. ID: Poster #: EDU-056

The Response Evaluation Criteria in Solid Tumors (RECIST, version 1.1) have gained widespread use in oncology clinical trials. RECIST 1.1 provides a standardized set of rules for response assessment in solid tumors using tumor shrinkage, based on standard imaging modalities. Standardized tumor response criteria are critically important in comparing results among clinical trials.

1) Review the steps in using the RECIST 1.1 guidelines
2) Present representative case examples

Baseline study: First step is identifying target (measurable) and non-target (non-measurable) lesions. Non-nodal target lesions need to be > 10 mm in long axis in axial plane only, while lymph nodes need to >15 mm in short axis. Target lesions include up to 2 measurable lesions per organ and 5 total lesions. Intravenous contrast is mandatory. CT is preferred imaging study but MRI can be substituted. All other lesions are categorized as non-target lesions. Finally, sum of the diameters for all target lesion is recorded.
Of note, bone lesions are not measurable, although an associated soft tissue mass is measurable. Sclerotic and lytic bone lesions are included as non-measurable disease. Nodes < 10 mm in short axis, pleural effusion, ascites and simple cysts are totally excluded from imaging response assessment.

Follow up studies: Sum of the diameters of all unequivocal target lesions is recorded and percent change from baseline or nadir is calculated. Non-target lesion status is recorded as absent, present or unequivocal progression. New lesions are also reported.
Overall response for target and nontarget lesions with or without new lesions is evaluated. RECIST 1.1 assigns four categories of response: complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD).

Future directions: Although increase in tumor size remains an important parameter for evaluating disease response, response may occur after an initial increase in tumor burden and regression of initial lesions may occur despite development of new lesions, especially with use of immunotherapy. This has led to new immunotherapy response criteria: Immune-related response criteria (irRC) and Immune-response RECIST (irRECIST).

Image-based outcome measures are commonly used to assess treatment response in clinical trials and have played a role in the regulatory drug approval of oncologic therapies. Therefore, it is imperative that radiologists understand the application of image-based response criteria. Read More

Authors:  Mhlanga Joyce , Siegel Marilyn

Keywords:  RECIST 1.1, Oncology, Clinical Trials

Nunes João,  Pinto Daniela,  Melão Lina,  Bom Sucesso Maria

Final Pr. ID: Poster #: EDU-080

Paediatric soft-tissue sarcomas encompass a diverse group of malignant mesenchymal tumours with overlapping imaging features. Although differing in molecular background, these tumours often appear radiologically similar, posing diagnostic challenges even to experienced radiologists. Rhabdomyosarcoma, the most frequent subtype, illustrates the broad radiologic spectrum of these lesions.
Radiologic evaluation is pivotal—not only for staging and therapy planning, but also for distinguishing viable tumour from post-treatment fibrosis or benign mimics. MRI remains the cornerstone of assessment, providing superior soft-tissue contrast and functional information through diffusion-weighted and contrast-enhanced sequences, which improve the detection of subtle tumour viability and therapy response.

Rhabdomyosarcomas usually manifest as heterogeneous soft-tissue masses that are isointense to muscle on T1 and hyperintense on T2-weighted imaging, reflecting variable amounts of necrosis, haemorrhage, and myxoid stroma. Embryonal rhabdomyosarcoma, the most frequent subtype, predominates in younger children and typically arises in the head and neck, genitourinary tract, or biliary system. It appears as an ill-defined, infiltrative mass with heterogeneous enhancement and restricted diffusion in solid components. The botryoid subtype, a variant of the embryonal form, develops in mucosa-lined cavities such as the biliary tree, bladder, or vagina, presenting as a grape-like polypoid intraluminal mass often causing luminal or ductal dilatation. Alveolar rhabdomyosarcoma, more frequent in adolescents and in the extremities or trunk, tends to be better defined, sometimes producing osseous erosion or fascial invasion, and often demonstrates more pronounced diffusion restriction due to its higher cellularity. These anatomic and morphologic distinctions provide essential clues for biopsy targeting, staging, and multidisciplinary planning.

By integrating current literature and representative institutional cases, this poster offers a focused visual guide to the MRI hallmarks and interpretative challenges of paediatric rhabdomyosarcoma, highlighting the radiologist’s role in tumour characterisation and multidisciplinary care. Read More

Authors:  Nunes João , Pinto Daniela , Melão Lina , Bom Sucesso Maria

Keywords:  Rhabdomyosarcoma, Oncology

Telleria Jessica,  Pudela Caileigh,  Zaritzky Mario,  Cohn Susan,  Feinstein Kate

Final Pr. ID: Poster #: EDU-069

In this exhibit, we will outline the revised International Neuroblastoma Response Criteria (INRC) used to assess treatment response in children with neuroblastoma, particularly high risk patients, in the context of clinical relevance to their treatment plan. Neuroblastoma is the most common extracranial solid malignancy in children, accounting for approximately 12% of deaths in children younger than 15 years of age affected with cancer. Up to 50% of children with neuroblastoma are found to have a high-risk phenotype with poor long-term survival and risk of therapy-related toxicity. Due to a lack of consensus regarding the definition of disease response, the development of more effective therapy treatment of high-risk disease has been hindered. The revised INRC consensus integrates modern, functional imaging techniques and quantitative assessment of bone marrow disease. It is anticipated that the revised INRC will enable a more precise assessment of treatment response that can be used to inform treatment decisions. This exhibit will delve into these modalities which are more sensitive and specific for Neuroblastoma detection. This exhibit will also demonstrate how the revised response criteria are used in the clinical setting in the Children’s Oncology Group clinical trials. Read More

Authors:  Telleria Jessica , Pudela Caileigh , Zaritzky Mario , Cohn Susan , Feinstein Kate

Keywords:  Neuroblastoma, INRC, Oncology

Obermark Tyler,  Debnath Pradipta,  Trout Andrew,  Ayyala Rama,  Myers Kasiani,  Tanimoto Aki,  Danzinger-isakov Lara,  Otto William,  Morin Cara

Final Pr. ID: Poster #: SCI-043

Children undergoing hematopoietic stem cell transplantation (HSCT) are at high risk for infectious and non-infectious complications after transplant. While computed tomography (CT) is commonly used to identify asymptomatic infections or other abnormalities before transplant, there are limited data to support routine pre-transplant imaging with CT. We aimed to investigate the frequency of CT findings of infection, air trapping, or other unexpected abnormalities pre-HSCT. Read More

Authors:  Obermark Tyler , Debnath Pradipta , Trout Andrew , Ayyala Rama , Myers Kasiani , Tanimoto Aki , Danzinger-isakov Lara , Otto William , Morin Cara

Keywords:  Oncology, Bronchiolitis Obliterans, Chest Radiographs

Mceniery Jane,  Corness Jonathan

Final Pr. ID: Poster #: CR-015

To report an unusual case of synchoronous primary brain tumours of two different histological subtypes in the posterior fossa of a 13 year old girl. Read More

Authors:  Mceniery Jane , Corness Jonathan

Keywords:  Neuroradiology, Oncology, MRI

Carlock Hunter,  Kelly Anna,  Chess Mitchell

Final Pr. ID: Poster #: EDU-033

Undifferentiated embryonal sarcomas of the liver (UESL) and mesenchymal hamartomas are rare pediatric tumors. Mesenchymal hamartomas are benign and often seen in children under two years of age, while UESL are malignant tumors often seen in children six to ten years of age; however, age ranges are not universally true. There is an unclear relationship between these two tumors. Prior studies have hypothesized that mesenchymal hamartomas may evolve into UESL given reports of UESL within portions of mesenchymal hamartomas; however, few cases of this exist in the literature. There is a common relationship of 19q13.4 chromosomal alterations between these two lesions, the MHLB1 gene locus.

These tumors are difficult to differentiate on imaging alone, and biopsy is often required for diagnosis. Shared imaging features between these two tumors include large size, cystic with solid components, patchy enhancement, and occasional fluid-fluid levels. UESL occasionally present with poor margins and are fast growing (mesenchymal hamartomas are typically well-defined). These features are not universally consistent, which can make diagnosis difficult.

In this educational exhibit, we present three cases highlighting the clinical presentation, imaging features, treatments, and outcomes of patients with UESL and mesenchymal hamartomas. We showcase multi-modal imaging appearances of these lesions (ultrasound, CT, MRI, angiography) and their post-treatment changes. In particular, one case describes a 5-year-old female presenting with a hemorrhaging UESL which was subsequently resected. Follow-up imaging showed a new hepatic lesion concerning for recurrence. Histopathology of this new lesion showed findings consistent with mesenchymal hamartoma without evidence of UESL recurrence or other malignancy. Through these cases, we highlight similarities and differences between mesenchymal hamartomas and UESL, hoping to further explore a potential association between these two tumors. Read More

Authors:  Carlock Hunter , Kelly Anna , Chess Mitchell

Keywords:  Sarcomas, Liver, Oncology