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

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

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

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

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

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

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

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

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