Sung Andrew,  Weiss Brian,  Trout Andrew

Final Pr. ID: Paper #: 147

Despite significant advances in delivering dose-intensive and myeloablative therapy with hematopoietic stem cell support, the survival for patients presenting with metastatic neuroblastoma remains poor, with a 3 year event free survival (EFS) of about 60%. Modern treatment protocols are based on risk stratification which incorporates age of diagnosis, tumor stage, tumor histology, and molecular and cytogenetics including MYCN amplification. ¹⁸F-FDG PET/CT can play a role in disease staging and follow up. The purpose of this study was to report FDG PET findings in a cohort of children with neuroblastoma and assess for predictive associations with MYCN amplification status. Read More

Authors:  Sung Andrew , Weiss Brian , Trout Andrew

Keywords:  Neuroblastoma, PET, Genetics

Patel Akash,  States Lisa

Final Pr. ID: Poster #: EDU-082

With the increased demand and utilization of PET/MRI in oncologic imaging, there is an ever increasing database of non-malignant pathology that has not yet been described on PET/MRI. Furthermore, the pediatric population provides an even more unique breadth of pathology that is often only seen in this age group. It is important to be able to accurately identify these common pathologies so as to not mistake them for malignancy and to prevent unnecessary follow up imaging studies and further invasive diagnostic procedures.

For this educational exhibit we review over 200 clinical pediatric 18F-FDG PET/MRs performed at our institution and highlight the most common and most interesting cases of FDG-avid non-malignant pathology.

Listed below are some of the cases to be included in the poster:
-Benign FDG avid bone tumors including non-ossifying fibromas
-Benign causes of FDG avid lymphadenopathy including cat scratch disease
-Benign causes of FDG avid lung lesions including aspiration pneumonia
-Benign causes of gastro-intestinal FDG uptake including pseudomembranous colitis
-Benign FDG avid infectious pathologies including a liver abscess Read More

Authors:  Patel Akash , States Lisa

Keywords:  PET/MR, PET/MRI, benign

Alzaher Asrar,  Busaeed Fajir,  Alsayegh Hassan

Final Pr. ID: Poster #: SCI-033

In the background of this limited data, this study aims to analyze and compare the size significance of right iliac fossa lymph nodes in pediatric patients in relation to metabolic activity on (18F-FDG PET/CT), scan in tertiary center managing oncological and non-oncological cases. Read More

Authors:  Alzaher Asrar , Busaeed Fajir , Alsayegh Hassan

Keywords:  Lymph node size, PET/CT, CT

Maleki Nazanin,  Amiruddin Raisa,  States Lisa,  Aboian Mariam

Final Pr. ID: Poster #: EDU-075

PET/MRI plays a significant role in Pediatric Oncology, but its implementation in Pediatric Neuro-Oncology has not been well established. PET/MRI addresses a major challenge in pediatrics by providing capability for serial imaging to track disease response to therapy, while minimizing radiation exposure and sedation events. PET/MRI has become a critical imaging modality in the management of pediatric brain neoplasms and metastases, aiding in diagnosis, staging, treatment planning, and follow-up, all while reducing radiation burden, minimizing time spent in the hospital, and reducing the number of sedation events.
At our tertiary center for pediatric care, we have gained extensive experience in utilizing hybrid PET/MRI to manage complex cases referred from multiple institutions. We present a series of cases where hybrid PET/MRI provided critical information for patient management including nasopharyngeal rhabdomyosarcoma, refractory metastatic germ cell tumor, and neuroblastoma. We offer a forward-looking perspective on the current role of FDG PET/MRI and future applications of amino acid PET in improving patient outcomes and its role in distinguishing tumor progression from post-treatment changes. Amino acid PET/MRI use cases were compiled from literature review and demonstrate definitive roles of amino acid PET/MRI in decision making in brain tumor diagnosis, immediate post-surgical assessment, and delayed treatment response assessment.
18F-FDG PET/MRI representative cases from clinical practice:
Case 1.
18 year old male with refractory metastatic germ cell tumor with anterior mediastinal mass and intracranial metastasis
Clinical Problem: Whole body evaluation in addition to detailed analysis of brain metastases in time efficient manner.
Imaging Solution: PET/MRI allowed detailed evaluation of hypermetabolic metastatic disease to the mediastinum and lungs and further detailed delineation of hemorrhagic brain metastases.
Case2.
4 year old boy with history of nasopharyngeal rhabdomyosarcoma with cerebellar metastasis who underwent resection and chemoradiation.
Clincial Problem: How to monitor nasopharyngeal mass after treatment in the setting of extensive postsurgical changes on MRI
Imaging Solution: PET/MRI provides an excellent imaging method for monitoring disease recurrence in the setting of post-treatment changes in nasopharyngeal location. Recurrent tumor was identified as hypermetabolic lesion, while MRI was not definitive. Read More

Authors:  Maleki Nazanin , Amiruddin Raisa , States Lisa , Aboian Mariam

Keywords:  PET-MRI, Pediatric Imaging, Brain Tumors

Nyalakonda Ramyashree,  Muehe Anne,  Iles Benjamin,  Theruvath Ashok,  Siedek Florian,  Agarwal Vibhu,  Hawk Kristina,  Jeng Michael,  Daldrup-link Heike

Final Pr. ID: Paper #: 148

To compare the detection of lesions between DW-MRI and ¹⁸F-FDG PET/MR for staging and restaging of Langerhans Cell Histiocytosis (LCH), using all clinical outcomes and imaging data as the reference standard. Also, this study will compare the differences between LCH chemotherapy responders and non-responders. Read More

Authors:  Nyalakonda Ramyashree , Muehe Anne , Iles Benjamin , Theruvath Ashok , Siedek Florian , Agarwal Vibhu , Hawk Kristina , Jeng Michael , Daldrup-link Heike

Keywords:  Langerhans Cell Histiocytosis, Diffusion Weighted Imaging, 18F-FDG PET/MR

Aboagye Rosemond,  Bajno Lydia,  Nadel Helen,  Potts James,  Bray Heather

Final Pr. ID: Poster #: SCI-063

Purpose: ¹⁸F-FDG Positron Emission Tomography (PET-CT) has been shown to be superior to other imaging modalities in assessment of soft tissue involvement with Langerhans Cell Histiocytosis (LCH) and is now commonly included in the staging workup of LCH. Our purpose is to analyze the utility of skeletal survey in addition to PET-CT scan for detecting bone lesions in children with LCH and to evaluate if skeletal survey can be eliminated from the staging workup of LCH in order to reduce radiation exposure. Read More

Authors:  Aboagye Rosemond , Bajno Lydia , Nadel Helen , Potts James , Bray Heather

Keywords:  Langerhans Cell Histiocytosis, PET-CT, Skeletal Survey

Davis James,  Servaes Sabah,  Nevo Elad,  States Lisa

Final Pr. ID: Paper #: 139

We aim to evaluate qualitative and quantitative image quality of low-dose PET-MRI in young patients. Read More

Authors:  Davis James , Servaes Sabah , Nevo Elad , States Lisa

Keywords:  PET/MRI, dose reduction

Salman Rida,  Sher Andrew

Final Pr. ID: Poster #: CR-041

3-year-old female with history of Aromatic l-amino acid decarboxylase (AADC) deficiency presented for direct intra-putaminal Dopa decarboxylase (DDC) gene therapy infusion.
Pre-therapy 18F-DOPA PET brain study fused to MRI demonstrates absence of normal radiotracer uptake in the basal ganglia/putamen, consistent with history of AADC deficiency and inability to uptake and convert 18F-DOPA to 18F fluorodopamine. MRI Brain demonstrates normal appearance of the putamen. Intraoperative images from intra-putaminal DDC gene therapy infusion via a frame-based stereotactic approach. Following frame placement, 4 gene vectors delivered in a adeno-associated viral vector are infused to the putamen bilaterally. Intraoperative T2 Axial MRI confirms appropriate localization with increased signal seen in the anterior and posterior aspects of the putamen bilaterally. Post-therapy 18F-DOPA PET brain study, fused to MRI 10 weeks following intraputaminal infusions of the DDC genes coding for AADC, demonstrates development of robust 18F-DOPA uptake in the putamen, indicative of successful AADC production following gene therapy.
AADC enzyme deficiency is a debilitating autosomal recessive disease due to a mutation in the Dopa decarboxylase gene (DDC). Subsequent dopamine deficiencies result in profound motor and autonomic dysfunction, developmental delay and early mortality. Mean age of diagnosis is 3.5 years, severe cases often die before age 7. While currently no cure, novel gene therapy treatments utilizing direct infusion of the DDC gene into the basal ganglia/putamen have shown promising clinical results. While anatomic imaging such as MRI are typically normal, 18F-DOPA PET scans measure the uptake of the tracer and its conversion to 18F-fluorodopamine, indicating appropriate DDC function in the basal ganglia dopaminergic nerve terminals. 18F-DOPA PET scans can be used to assess the efficacy of gene therapy by demonstrating the successful development of striatal uptake prior to improvement of clinical symptoms. Read More

Authors:  Salman Rida , Sher Andrew

Keywords:  18F-DOPA PET, gene therapy, AADC

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

Chan Alex,  Laughlin Brady,  Latshaw Rachael,  Abid Waqas,  Iaia Alberto,  Moftakhar Parham,  Kandula Vinay,  Nikam Rahul,  Choudhary Arabinda

Final Pr. ID: Poster #: EDU-066

PET/MRI has recently become a clinical realization after overcoming complex hardware and image reconstruction issues. The goal of this educational exhibit is to provide a comprehensive, yet understandable, introduction to these aspects of PET/MRI along with displaying a pictorial assay of different normal and abnormal metabolic findings within the field of Pediatric Neuroradiology.

The first part of this presentation will begin by highlighting the basic hardware components of the PET/CT contrasting with the interactions between the main components of the PET/MRI scanner along with their associated solutions. In general, these issues include how MRI can affect PET in terms of their magnetic field and RF properties and how PET affect MRI due to the scintillator/electronic components.

The second part will begin by discussing some soft tissue and hardware attenuation correction techniques that are currently in use, such as: Segmentation and atlas-based methods along with attenuation map generation and coil localization methods. Additionally, we will show the consequence of field-of-view (FOV) mismatch between the PET and MRI acquisitions and partial volume effects along with their solutions.

The final part will showcase clinical applications of PET/MRI to Pediatric Neuroradiology, featuring imaging protocol details and a pictorial guide of normal distributions and pathologic conditions. Clinical examples range from seizure localization, cortical malformations, manifestations of Phakomatoses, perinatal stroke, tumor recurrence, and Flutriciclamide (¹⁸F-GE180) imaging in the setting of neuroinflammation. Read More

Authors:  Chan Alex , Laughlin Brady , Latshaw Rachael , Abid Waqas , Iaia Alberto , Moftakhar Parham , Kandula Vinay , Nikam Rahul , Choudhary Arabinda

Keywords:  PET/MRI, Physics

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

Poliachik Sandra,  Alessio Adam,  Friedman Seth,  Wright Jason

Final Pr. ID: Poster #: SCI-043

Purpose: The evaluation of epileptic foci with FDG PET can be challenging, particularly when epileptic foci are subtle. We sought to determine if an age-matched database of normative cerebral FDG PET uptake can be used to automatically identify epileptic foci. Read More

Authors:  Poliachik Sandra , Alessio Adam , Friedman Seth , Wright Jason

Keywords:  FDG PET, Epilepsy, Normative atlas

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

Nevo Elad,  States Lisa,  Magee Ralph

Final Pr. ID: Poster #: EDU-008 (T)

PET/MRI is a relatively new imaging modality whose efficacy is still being determined. One of the major draws to PET/MR over PET/CT is the reduction in radiation exposure to patients. This is especially desirable in the pediatric population due to the likelihood of multiple exposures during their lifetime, and the increased sensitivity they have to radiation. A typical whole body PET/CT exam can take about 30 minutes, whereas a typical whole body PET/MR exam takes about 90 minutes at our institution. The introduction of a new 3D T2 Dixon technique sequence for PET/MR has the potential of decreasing total scan time significantly, however maintaining current image quality and diagnostic value is critical. Our objective is to test out this new sequence to see whether scan times are reduced and if it is a viable diagnostic replacement for our current T2 sequence. Read More

Authors:  Nevo Elad , States Lisa , Magee Ralph

Keywords:  PET/MR, Optimization

Nahl Daniel,  Nelson Marvin,  Berkovich Rachel,  Goodarzian Fariba,  Lai Lillian

Final Pr. ID: Poster #: EDU-094

The goal of this educational exhibit is to explore the utility of interictal FDG PET brain imaging in the evaluation of intractable, drug-resistant cases of pediatric epilepsy and to clarify its role in pre-surgical seizure focus localization. We will also explore the salient pearls and pitfalls of FDG PET brain imaging. Read More

Authors:  Nahl Daniel , Nelson Marvin , Berkovich Rachel , Goodarzian Fariba , Lai Lillian

Keywords:  FDG PET, Epilepsy, seizure

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

Leake James,  Pfeifer Cory

Final Pr. ID: Poster #: EDU-089

Lymphoma (including both Hodgkin’s and non-Hodgkin’s) is the third most common pediatric malignancy. Treatment requires distinct definitions of bulky disease, response to therapy, and organ involvement. In this way, pediatric radiologists form a center role in the medical care of affected children. This educational exhibit examines pediatric lymphoma diagnosis and response to therapy by detailing the varying classification systems, including the newer PET-related Deauville and Lugano classification systems.

The Ann Arbor staging classification system for Hodgkin’s lymphoma was initially developed in the 1970’s and anatomically classifies lymphoma by site and number of lymph nodes affected, cross-diaphragmatic disease, and extralymphatic organ dissemination. More recently, after the introduction of PET/CT, newer classification systems which incorporated tumor metabolism were developed - including Deauville and Lugano. Notably, these systems are commonly applied to both Hodgkin’s and non-Hodgkin’s lymphoma. This educational exhibit includes a discussion of these various systems as well as annotated examples. Additionally, risk stratification is discussed using strata defined by the Children’s Oncology Group (COG), EuroNet, and Pediatric Hodgkin Consortium.

After review, the pediatric radiologist should feel more comfortable staging and classifying response to treatment of lymphoma using PET assessment principles. Read More

Authors:  Leake James , Pfeifer Cory

Keywords:  lymphoma, PET, lugano

Binkovitz Larry,  Sutton Samuel

Final Pr. ID: Poster #: CR-032

To present the first PET/CT and PET/MRI imaging findings of acase of multiple myeloma, MM, in a pediatric patient. Read More

Authors:  Binkovitz Larry , Sutton Samuel

Keywords:  Plasmacytoma, PET/CT, PET/MR

Farrell Crystal,  Pareek Anuj,  Muehe Anne,  Pribnow Allison,  Steffner Robert,  Avedian Raffi,  Daldrup-link Heike

Final Pr. ID: Poster #: EDU-088

PET/MR is a valuable and growing imaging method for the assessment and management of pediatric bone tumors. Although plain radiography remains the first line modality for initial evaluation, cross sectional imaging is often required for further characterization of indeterminate or aggressive appearing lesions. Due to its superior soft tissue contrast resolution compared to CT, MR has become the mainstay in tissue characterization, locoregional staging, and surgical planning of pediatric bone tumors. By adding functional and metabolic information, FDG-PET imaging is useful for “one stop” local tumor and whole-body staging, evaluating response to therapy and surveillance. 18F-FDG PET/MR scans have the benefit of lower radiation and increased patient convenience compared to 18F-FDG PET/CT scans. However, due to the relatively recent development of this technology, many radiologists may be unfamiliar with the technical considerations and interpretation pearls and pitfalls of PET/MR. This educational exhibit reviews the imaging technique, reporting requirements, and imaging characteristics of the most common pediatric bone tumors with 18F-FDG PET/MR. Read More

Authors:  Farrell Crystal , Pareek Anuj , Muehe Anne , Pribnow Allison , Steffner Robert , Avedian Raffi , Daldrup-link Heike

Keywords:  PET/MR, bone tumor, cancer

Jayapal Praveen,  Baratto Lucia,  Rashidi Ali,  Daldrup-link Heike

Final Pr. ID: Poster #: EDU-055

Children with cancer typically require a local MRI scan for primary tumor staging, which is often supplemented by a whole-body PET scan for whole-body staging. Over the past decade, PET-CT was the most widely used modality for whole-body staging across the world. Seven years ago, our team pioneered whole-body 18F-FDG PET-MRI of children with cancer as a "one-stop" alternative with 80% reduced radiation exposure and optimized child-tailored fast and efficient Whole-Body PET/MRI protocols. We then replaced all whole-Body PET/CT studies at our Institution with whole-body PET-MRI as the standard of care for our patients and have performed over 800 Pediatric Whole Body PET MRIs in the last three years.

The purpose of this educational exhibit is to provide a comprehensive review of whole-body PET/MRI technique, imaging patterns in common pediatric malignancies.

The first aim is to briefly explain our Institution's protocol for simultaneous PET/MRI acquisitions. Such simultaneous acquisition results in a convenient, faster, and safer approach for local and whole-body staging in one session. Furthermore, it avoids the need for repetitive anesthesia and imaging and also avoids potential ionizing radiation from PET CTs. The excellent contrast resolution in the MRI provides superior diagnostic detail compared to the CT.

The second aim will present PET/MRI case examples, where either the PET component added value to the MRI or the MRI component added value to the PET, thereby confirming the importance of this integrated hybrid imaging technology. We will present PET/MRI case examples of the following pediatric tumors:
1. Lymphomas:
2. Osseous Sarcomas including Osteosarcoma and Ewing Sarcoma
3. Soft-tissue Sarcomas such as Rhabdomyosarcoma, Desmoplastic small round blue cell tumor. Synovial Sarcoma, Fibrosarcoma, Epithelioid Sarcoma, Alveolar Soft part sarcoma, and Liposarcoma
4. Neuroblastoma
5. Neuroendocrine tumors
6. Malignant Peripheral Nerve Sheath Tumor
7. Germ cell tumors
8. Renal tumors
9. Malignant Liver tumors
10. Langerhan Cell Histiocytosis

As a result of this educational presentation, participants will be able to prescribe a PET/MRI exam for children with cancer, implement tumor-specific protocol modifications, and improve their tumor diagnoses' sensitivity, specificity, and accuracy. Read More

Authors:  Jayapal Praveen , Baratto Lucia , Rashidi Ali , Daldrup-link Heike

Keywords:  PET-MRI, PET, 18F-FDG PET-MRI

Cregg Allison,  Nguyen Theo,  Holm Tara,  Flanagan Siobhan

Final Pr. ID: Poster #: CR-059

Portal hypertension in pediatric patients is rare, most commonly caused by extrahepatic portal vein (PV) occlusion. Complications include gastrointestinal bleeding. If obstruction recanalization or surgical shunt is not feasible, a transjugular intrahepatic portosystemic shunt (TIPS) can be placed. Risks of TIPS include encephalopathy, shunt stenosis, or thrombosis. Tipsitis is rare, occurring in less than 1% of TIPS patients, but is serious, with a mortality of 32%. Early diagnosis and treatment are key to preventing the need for liver transplantation, and imaging plays a key role in early detection. We present a case of tipsitis identified with FDG-PET/CT imaging.
A 16 year-old-male with prematurity, umbilical vein catheter, and heterozygous prothrombin mutation presented with hematemesis. Imaging identified chronic PV thrombosis. Due to the occlusion involving both the right and left PV, TIPS was placed. 5.5 months post-TIPS, he presented with fever and body aches. Investigations revealed Methicillin-Sensitive Staphylococcus aureus (MSSA) bacteremia and thrombosed TIPS. He completed a 6-week course of IV antibiotics, and the TIPS was revised.
Two weeks later, he was readmitted with recurrent MSSA bacteremia. FDG-PET/CT scan was performed, showing increased TIPS uptake, consistent with tipsitis. He completed an additional 8-week IV antibiotic course. Repeat FDG-PET/CT showed decreased but persistent TIPS uptake. IV antibiotics were extended, and he was placed on suppressive oral antibiotics with a plan for FDG-PET/CT in 3 months.
Tipsitis is rare, and early infection (<120 days) is associated with gram-positive bacteria caused by seeding during placement. In this case, later infection was suspected to be caused by Staph aureus superinfection during influenza. Low-grade symptoms include malaise, and high-grade symptoms include fever and rigors. Suspicious CT findings include peri-graft gas or fluid. Radiolabeled leukocyte uptake is specific to infection, but spatial resolution is limited. FDG-PET/CT with focal TIPS metabolic activity (SUV > 8.0) correlates with infection source (sensitivity 91-98%, specificity 64–91%).
Antibiotic therapy is successful in 53% of cases, and FDG-PET/CT can determine the degree of treatment success. Residual hypermetabolic activity signifies partial response. Aggressive antibiotics are recommended to prevent resistance and the need for liver transplant. FDG-PET/CT plays a vital role in diagnosis and management of tipsitis. Read More

Authors:  Cregg Allison , Nguyen Theo , Holm Tara , Flanagan Siobhan

Keywords:  Portal Vein Thrombosis, FDG PET, Interventional Radiology

Kato Kambrie,  Mackenzie John,  Phelps Andrew,  Courtier Jesse,  Behr Spencer,  Zapala Matthew

Final Pr. ID: Poster #: SCI-033

Determine the incidence of occult malignancy detected by ¹⁸F-FDG PET-CT and whole body (WB) MRI in children. Read More

Authors:  Kato Kambrie , Mackenzie John , Phelps Andrew , Courtier Jesse , Behr Spencer , Zapala Matthew

Keywords:  whole body MRI, PET CT, paraneoplastic syndrome