Final Pr. ID: Paper #: 174
Both neuroradiologists and pediatric radiologists require unique skills to confidently manage pediatric neuroradiology cases either in a community setting, or in a specialized pediatric tertiary care hospital. We conducted a needs assessment of pediatric radiologists to define their neuroradiology subspecialty training experience and identify perceived skills and knowledge gaps as well as their attitudes toward a customized pediatric neuroradiology curriculum. Read More
Final Pr. ID: Poster #: EDU-005
Recognize the clinical features of vascular lesions of the orbit that occur in children.
Describe classification schemes of vascular lesions of the orbit that occur in children.
Identify the imaging features that permit differentiation among lesions.
Highlight new treatment modalities in which interventional radiologists can intercede. Read More
Final Pr. ID: Poster #: EDU-062
The number of reconstruction surgeries of the anterior cruciate ligament (ACL) in pediatric patients has risen dramatically over the past two decades as a result of changes in treatment philosophy and perhaps frequency of injury. It is therefore important for pediatric radiologists to recognize the normal postoperative appearance of the different surgeries as well as their complications. This educational exhibit will review the types of reconstructive methods used in both skeletally immature and mature patients (physeal-sparing, partial transphyseal and transphyseal), complications (growth disturbances, graft failure, impingement, arthrofibrosis, intra-articular bodies) and relevant imaging findings on plain radiography and MRI. Read More
Final Pr. ID: Poster #: EDU-028
Pediatric pathology involving the jejunum is more common than one might initially expect. Early recognition of the important imaging characteristic, atypical findings, and useful imaging tools/techniques in the evaluation of jejunal pathology is important in prompt diagnosis and management of these patients.
In this educational exhibit we will present a series of cases involving pathology of the jejunum encountered in the pediatric population. We will focus on important pathologies affecting a difficult to image and sometimes forgotten portion of the intestine.
A range of acute, emergent and post-surgical cases are presented. Using an interactive, quiz based approach we will discuss the following pediatric pathologies that may affect the jejunum of pediatric patients from neonates to teenagers with multimodality imaging and pathologic examples:
Meconium plug syndrome
Small bowel intussusception
Graft versus host disease
Vasculitis Read More
Final Pr. ID: Poster #: SCI-029
To evaluate the effect of different levels of adaptive statistical iterative reconstruction (ASIR) in pediatric lower extremity CT scan to compare the radiation dose, objective imaging parameters and subjective diagnostic image quality ratings. Read More
Final Pr. ID: Poster #: EDU-063
With the expansion of the internet and the development of new media tools, learning methods among medical students and residents in all specialties particularly Radiology have changed. While didactic lectures and personal interaction with mentors each play an important part in education, self learning via a variety of internet sources has gained a significant role and has come to replace the use of standard textbooks. Existing online modules are minimally interactive and present radiographic images concurrently with text. In most, users use the cursor to hover over the image in order to display the abnormality. Read More
Final Pr. ID: Poster #: SCI-031
1) To systematically review the uses of AI for magnetic resonance (MR) imaging assessment of primary pediatric cancer and identify common literature topics and knowledge gaps. 2) To assess the adherence of the existing literature to the Checklist for Artificial Intelligence in Medical Imaging (CLAIM) guidelines. Read More
Final Pr. ID: Poster #: EDU-068
Dual-energy CT (DECT) refers to the acquisition of CT datasets at two different energy spectra, which allows differentiation and classification of tissues. The purpose of this this poster is to describe post-processing algorithms and clinical applications of DECT in children on a dual-source CT system. Read More
Final Pr. ID: Poster #: EDU-012 (S)
The objective of this review is to summarize the earliest radiological findings of AMC (arthrogryposis multiplex congenital), detail the most frequently affected joints, identify associated syndromes, and expose the radiological findings in children whose therapy was delayed. Read More
Final Pr. ID: Poster #: CR-074
Juvenile Granulosa Cell Tumor of the Testis is a rare testicular tumor that falls within the category of stromal cord neoplasms. There have been less than 50 cases described in the literature with all cases being described as having a cystic component (1, 2). We present a case of a 6 month old boy presenting with unilateral scrotal swelling. Ultrasound evaluation revealed an entirely solid, hypervascular, intratesticular mass. Alpha-fetoprotein levels were negative. At surgery, radical orchiectomy was performed and pathology revealed a Juvenille Granulosa Cell Tumor.
Testicular tumors arising in the neonatal and prepubescent period are a unique set of tumors distinct from their adult counterparts. In this younger age group, germ cell tumors predominate. Of the germ cell tumors, Yolk Sac tumors are the main tumor of clinical significant, and the reason why alpha-fetoprotein is such a relevant marker (3). Stromal cell tumors account for only a small percentage of testicular tumors within this age group. When they do occur, Juvenile Granulosa Cell Tumors (JGC) predominate, particularly if the child is under 1 year of age, with this tumor type being the most common testicular tumor present at birth (3,4). JGC tumors are associated with genetic and structural anomalies of the Y chromosome, ambiguous genitalia, and contralateral undescended testis. One of their defining pathologic characteristics is positive staining with Inhibin (3).To date there are no cases of metastatic JGC tumors. In all reported cases, Sonographic evaluation demonstrates a grossly multicystic tumor (2). The adult variant of Granulosa Cell tumors can appear as a solid mass with little or no cystic component and carries the risk of metastasis of approximately 20% (2). Surgical management of testicular JGC tumors has largely been radical orchiectomy but, some studies have shown tumor sparing excision to be curative in cases with salvageable testicular parenchyma (2). This finding highlights the importance of including stromal cell tumors, particularly JGC, in the differential for solid appearing testicular masses in the neonate. With more reported cases of JGC tumors of the testes, surgical management could include a more conservative approach. Although JGC tumor of the testis is not known to be malignant, given the atypical features of this tumor and similarities with its more malignant adult counterpart, close surveillance is warranted to ensure benign course. Read More
Final Pr. ID: Poster #: EDU-055
The purpose of the exhibit is: 1. Illustrate the presence of multiple and accessory ossification centers about the hip that can make it challenging to diagnosis fractures on radiographs in adolescence. 2. Demonstrate that posterior acetabular fractures are typically hidden behind the femoral head on radiographs. 3. Review variant os acetabuli that are commonly encountered in patients with hip pain and demonstrate that the orientation of the fragments compared with posterior acetabular fractures can help to make a distinction. 4. Highlight that a complete pelvis radiograph (AP or AP/Frog leg lateral) in trauma patients or hip pain NOS can aid in the detection of fractures and assess for asymmetry of normal variants. Read More
Final Pr. ID: Poster #: EDU-017
To summarize our experience using Computed Tomography Angiography (CTA) of the liver as an imaging tool for pre-living donor liver transplantation (LDLT) evaluation in biliary atresia (BA) patients. This pictorial review will illustrate and discuss several aspects of imaging techniques and the important findings that clinician need to know before LDLT.
Key imaging findings for vascular anatomy/collateral vessels will be made, emphasizing what clinicians need to know. Correlation with intraoperative findings will also be provided.
Authors: Supakul Nucharin
Final Pr. ID: Poster #: EDU-108
Accidents remain a top cause of morbidity and mortality in pediatric patient. Assessment for blunt trauma to the abdomen is difficult in the trauma patient and findings of bowel injury can be subtly or confounded by visceral injuries. The most specific finding of free air in blunt hollow visceral organ is often minimally present, or entirely unseen. The pediatric radiologist must be familiarity with the more often seen and less specific secondary signs on CT, including free fluid, bowel wall thickening, and mesenteric contusion injury. We present, by case example, bowel injuries in the traumatic pediatric patient and their management and outcomes, while addressing common pearls and pitfalls. As many of these patients do well with non-operative treatment the radiologist must also be familiar with findings that would allow such option, to appropriately advice referring providers and manage potential re-image of the pediatric patient. Read More
Final Pr. ID: Poster #: CR-023
We present novel brain MRI findings in 2 children presenting with seizures due to TMCO1 mutation. Both children had absent olfactory bulbs and olfactory tracts and hippocampal malrotation. EEG demonstrated right temporal slow waves and intermittent focal slowing. One child had pontine hypoplasia, hypoplasia of bilateral optic nerves/chiasm, and an absent right cochlear nerve. In both children, there was increased mineralization in bilateral globi pallidi and bilateral substantia nigra on SWI sequence, possibly from excessive calcium. Ventriculomegaly and cavum septum pellucidum were also present in both children. Spine MRI revealed segmentation abnormalities including partial fusion of T2/T3 vertebral bodies and fusion of the posterior elements of T3-T5. Both children exhibited dysplastic and bifid ribs, demonstrating partial posterior fusion. Right renal agenesis was also noted in one child.
TMCO1 mutation results in cerebro-facio-thoracic dysplasia (CFTD) due to abnormal calcium homeostasis. The transmembrane and coiled-coil domains 1 protein directs formation of endoplasmic reticulum calcium leak channels which facilitate calcium leak upon overload of the endoplasmic reticulum. Failure of calcium leak results in abnormal cell function resulting in delayed osteogenesis, reduced mitochondrial volume, reduced mitochondrial respiration, and decreased endoplasmic reticulum stress mediated apoptosis. These children have distinctive craniofacial dysmorphism, global developmental delay, and skeletal anomalies. Previous studies have demonstrated only mild ventriculomegaly, corpus callosum abnormalities, frontotemporal atrophy, and three cases of associated epilepsy. Olfactory bulb agenesis may be due to abnormal development of the cribriform plate of the ethmoid and failure of olfactory nerves to induce development of the olfactory bulb from the telencephalon. We demonstrate that TMCO1 may play a more extensive and previously undescribed role in neurodevelopment, specifically in the formation of the hippocampus, optic nerve, and pons. Read More
Final Pr. ID: Poster #: SCI-005
To investigate of imaging findings of brain computed tomography (CT) and demographic findings of children with head trauma under 2 years. Read More
Final Pr. ID: Poster #: SCI-003
Pediatric carotid artery Intima-Media Thickness (IMT) is a non-invasive ultrasound marker of early atherosclerosis. Obesity in children is associated with increased IMT. The objective of this meta-analysis is to report IMT values in children living with overweight/obesity in the literature. Read More
Final Pr. ID: Poster #: EDU-007 (T)
To describe and discuss some of the challenges of performing DEXA scans on pediatric patients including positioning, technical obstacles, reference data and post-processing and describing how to overcome some of these challenges.
1. Positioning: Many patients with syndromes, have scoliosis, para or quadriplegia, or contractures that make placing the patient on the table difficult. In these patients, imaging has to be adapted to the patients’ abilities and some components may need to be eliminated. With cerebral palsy and muscular dystrophy for example, the whole body and AP spine might have to be deferred and only a hip and forearm obtained.
2. Technical obstacles: There are many technical obstacles that can present challenges when performing DEXA scans on pediatric patients. Patients who have prostheses or metal rods present technical obstacles. There is no way to remove the metal artifacts in a whole body scan on these patients, so a hip or forearm might be the most accurate way to obtain the patient’s bone density due to this technical factor.
3. Reference Data: The reference data for pediatrics is limited in national data bases. For example, a total Z-score will not be factored for children under the age of 5 because there is not enough information in the national database for comparison. There is also not enough information on children of certain ethnicities. This presents a problem when diagnosing and treating children with abnormal bone density.
4. Post-processing could be different for each user. It can also be different for machines manufactured by different companies. For example, a machine made by Hologic might produce different numbers than a machine made by General Electric. Also, if the user does not place the post-processing tools the exact same way the prior user did, the results can vary.
Overcoming some of these challenges has presented opportunities to grow. Sedation is used for children who may not be able to be perfectly still for a Dexa and positioning tools help on some of the more challenging patients. Learning how to work around prostheses and working with the ordering physicians and radiologists with the limited amount of reference data are a few ways of growing from these challenges. Placement of post-processing tools are the key to providing key information in comparing Dexa scans for patients who have them regularly for evaluations. Staff Education is the largest challenge to overcome. Read More
Keywords: Dexa, pediatric
Final Pr. ID: Poster #: EDU-007
Computed tomography with its excellent spatial and temporal resolution remains valuable diagnostic modality in pediatrics. On the other hand there has been increasing attention placed on the radiation risks associated with CT imaging, especially in children.
In recent years many advances in CT hardware and software, for example automatic exposure control tools and iterative reconstruction techniques allowed for the reduction of applied radiation dose while maintaining image quality.
The aim of our educational exhibit is:
- to present optimal protocols for chest CT in the youngest age group of children, scanned according to body weight protocols (0-10kg; 10-30kg) with assesement of image quality and dose indices (CTDIvol and DLP; SSDE)
- to present pictorial review of the pediatric chest pathologies in low dose chest CT Read More
Final Pr. ID: Poster #: SCI-008
Diseases of the coronary arteries are rare in children, but can present as unexpected catastrophic events without preceding symptoms. It is essential to identify patients at risk to prevent potentially serious cardiovascular events. Coronary CT angiography (CCTA) has been widely studied in adults, but its clinical applications are not well established in children. Read More
Final Pr. ID: Paper #: 077
To analyze the effect of point-of-care ACR-clinical decision support (CDS) software embedded in the electronic health records (EHR) on CT ordering patterns in a quaternary care pediatric emergency center (EC). Read More
Final Pr. ID: Poster #: SCI-061
Colonic volvulus in the pediatric population is very rare with 40% mortality making timely diagnosis imperative. Radiologists should operate with a high degree of clinical suspicion in patients with risk factors for large bowel volvulus. Recognition of colonic volvulus on plain film, contrast enema and CT is paramount to work-up and definitive management. This case series is the largest from any single institution and describes the clinical course and imaging findings in cases of volvulus, with the goal of familiarizing the radiologist with the appearance of this disease entity on several imaging modalities. Read More
Final Pr. ID: Poster #: EDU-076
Children often present to the emergency room (ER) with painful neck swelling, sore throat, and difficulty breathing. Careful clinical examination and good communication with pediatric physicians help plan the appropriate imaging workup for such pediatric patients. Knowing the various imaging appearances of the many encountered disorders of the neck in children further helps diagnose and plan the most appropriate management. Read More
Final Pr. ID: Poster #: SCI-056
1. To compare the effective dose of dual energy CT with plain films in the pediatric population.
2. To compare effective dose using Turbo Flash scanning technique with that of standard scanning technique on single energy CT. Read More
Authors: Brandt Ryan
Final Pr. ID: Poster #: EDU-061
The purpose of this educational presentation is to provide a pictorial review to promote recognition and understanding of the embryology, anatomy and spectrum of congenital pulmonary artery anomalies in children Read More
Authors: Alkhori Noor
Final Pr. ID: Poster #: SCI-042
Developmental dysplasia of the hip (DDH) is a common congenital problem affecting up to 3% of the the population. If untreated, DDH may lead to hip dislocation and premature osteoarthritis. Current DDH diagnosis is highly operator-dependent as it relies on 2D ultrasound. 3D ultrasound offers more complete, and potentially more reliable, imaging of infant hip geometry. However, it is unclear whether 3D ultrasound images, noisy with artifacts and reconstructed by proprietary algorithms from non-parallel beams, give accurate 3D shape information. We sought to validate the fidelity of acetabular surface models obtained by 3D ultrasound by comparison with those obtained concurrently from MRI. Read More
Final Pr. ID: Poster #: EDU-067
This review describes the CT and MRI features of developmental variants and pathological lesions that involve the skull base, excluding those centered in the nasal cavity, nasopharynx, sinuses and orbits.
Normal anatomy of developing bony skull base will be illustrated. The lesions are categorized by pathology rather than locations, and the following entities will be covered.
Congenital and developmental lesions - arrested pneumatization, aberrant arachnoid granulations, dermoid/epidermoid cysts, ecchordosis physaliphora, encephaloceles, persistent craniopharyngeal canal
Inflammatory/Infectious lesions - skull base osteomyelitis, petrous apicitis, cholesterol granuloma
Benign lesions - Fibrous dysplasia, aneurysmal bone cyst, osteoma, osteochondroma, meningioma
Malignant lesions - Langerhans cell histiocytosis, lymphoma, neuroblastoma metastasis, Ewing’s sarcoma, osteosarcoma, chordoma, chondrosarcoma Read More
Final Pr. ID: Poster #: EDU-027
Cystic pelvic masses can represent a diagnostic challenge with its broad spectrum of differentials ranging from benign to malignant. Ultrasound is often the preliminary evaluation with MRI a next step when more information is needed. Proper diagnosis provides guidance to the clinical team with management ranging from watchful waiting to surgery. This poster will use a case-based approach to review the variety of cystic pelvic masses in pediatric patients, discuss salient imaging features, an approach to imaging workup, and treatment and prognosis. Read More
Final Pr. ID: Poster #: SCI-064
The objective of this prospective study was to determine the accuracy of MR Enterography (MRE) in the assessment of mucosal healing in patients with Pediatric Crohn’s Disease (PCD) after starting treatment. MARIA and Clermont scores are MRE scores that were originally developed in adult population for the assessment of severity of Crohn's Disease (CD) in correlation to Crohn's Disease Endoscopic Index of Severity (CDEIS). MARIA score has shown close correlation to disease severity of colonic CD and Clermont score has shown close correlation to terminal ileum disease. A few reports have shown correlation of mucosal heling when assess by MRE scores and CDEIS in Adult population, but not work is available in pediatrics. Read More
Final Pr. ID: Poster #: SCI-002
Pectus excavatum (PEx) is a chest wall deformity that leads to sternal depression and can impair cardiopulmonary function. CT imaging is used for surgical planning but exposes children to a significant radiation dose. Ultra-low dose CT enables PEx assessment in children with radiation exposure comparable to plain radiographs. The purpose of this study is to evaluate image quality and detection of thoracic pathology on ultra-low dose CT in children with PEx. Read More
Final Pr. ID: Poster #: SCI-044
1) Determine differences in characteristics of studies published within high impact radiology and medical journals journals in comparison to a Pediatric Radiology journal.
2) Outline factors that may have contributed to differences in quality of design of studies and components that could be incorporated into the design of future pediatric radiology research studies in order to improve their quality. Read More