Willard Scott,  Kaye Robin,  Schaefer Carrie,  Aria David

Final Pr. ID: Poster #: EDU-060

To describe alternative routes of Nusinersen administration in patients in whom traditional lumbar puncture is limited secondary to spinal hardware and bony fusion. Read More

Authors:  Willard Scott , Kaye Robin , Schaefer Carrie , Aria David

Keywords:  Spinraza, Spinal muscular atrophy SMA, nusinersen

Ortiz Carlos,  Chau Alex,  Desai Sudhen,  Kukreja Kamlesh

Final Pr. ID: Poster #: EDU-048

1) Reviewing the pathology and outcomes of children with spinal muscular atrophy (SMA)
2) Learning the procedures available for intrathecal access
3) Understanding the indications for choosing more advanced techniques to deliver nusinersen

Spinal muscular atrophy is an autosomal recessive disease affecting motor neurons and is the most common genetic cause of death in infants. Nuinersen (Spinraza) was recently approved by FDA for intrathecal administration in SMA patients. Commonly administered by lumbar puncture in the clinic or with imaging guidance, this is the initial method of administering nusinersen. Deformities and spinal instrumentation from orthopedic surgeries are common in SMA patients, preventing traditional intrathecal access by lumbar puncture for nusinersen delivery. Transforaminal lumbar sac access, ultrasound or fluoroscopy guided cervical spine access, or subcutaneous catheter placement can be the alternative approaches with failed/difficult lumbar access. Given the potential benefit of nusinersen, understanding all methods to obtain intrathecal access is essential for a pediatric interventional radiology (IR) practice. Read More

Authors:  Ortiz Carlos , Chau Alex , Desai Sudhen , Kukreja Kamlesh

Keywords:  nusinersen, spinal muscular atrophy, intrathecal administration

Manopoulou Evangelia,  Magganas George,  Meleti Christina,  Yarmenitis Spyros,  Tagalakis Panagiotis,  Papaioannou Georgia

Final Pr. ID: Poster #: EDU-021

Our objective is to demonstrate the value of imaging exploration of the lumbar spine and sacrococcygeal region in neonates and young children, when certain clinical indications exist. Read More

Authors:  Manopoulou Evangelia , Magganas George , Meleti Christina , Yarmenitis Spyros , Tagalakis Panagiotis , Papaioannou Georgia

Keywords:  lumbrosacral spine, spinal dysraphism, sacral dimple

Krishnan Venkatram,  Jaganathan Sriram,  Murphy Janice,  Choudhary Arabinda,  Jayappa Sateesh,  Rowell Amy,  Charles Glasier,  Ramakrishnaiah Raghu

Final Pr. ID: Poster #: EDU-073

Caudal regression syndrome (CRS) refers to a rare disorder with varying degrees of agenesis or malformations of the lower thoracic, lumbar, and sacral spine as well as the spinal cord with varying clinico-radiological features. Estimated incidence ranges from 5-10:100,000 births. Imaging is an integral part of the diagnosis and management of this condition. An extensive review of the imaging spectrum of CRS with several case-based examples would enable a complete understanding of the condition.

We reviewed the imaging appearance of several cases of caudal regression, including in utero cases, from our tertiary care university based pediatric hospital. The various associated malformations, especially of the spinal cord, were examined in detail. We also analyzed the clinical symptomatology of these patients and correlated them with the imaging patterns. A detailed review of related literature was performed and consolidated information on the clinico-radiological spectrum of CRS was compiled.

The following aspects of CRS have been discussed in detail:
Predisposing maternal conditions and pathogenesis of CRS in the fetus.
Pang groups 1 and 2 CRS and their imaging features.
Renshaw types 1 to 4 sacral agenesis and their imaging features.
Role of radiographs, ultrasound, and MRI in CRS.
Spectrum of MRI features in the cord including shape of conus, level of termination, presence of cord tethering, associated neural tube defects and associated syrinx.
Clinical manifestations of various types and their correlation with imaging features.
Imaging features correlating with progressive versus static neurological deficits.
Imaging features that could signal potential benefit from surgical treatments.
Prenatal diagnosis of CRS on obstetric ultrasound and fetal MRI: Imaging patterns and importance of antenatal diagnosis.
Associated anomalies and syndromes and necessary additional imaging in CRS cases.
Pitfalls in imaging of CRS.

A complete understanding of CRS including clinico-radiological correlation of symptomatology and imaging appearance in CRS would enable detailed and accurate reporting of these scans. In particular, identifying imaging features that correlate with progressive neurological deficits and those that may benefit from surgical intervention can significantly improve patient management. Read More

Authors:  Krishnan Venkatram , Jaganathan Sriram , Murphy Janice , Choudhary Arabinda , Jayappa Sateesh , Rowell Amy , Charles Glasier , Ramakrishnaiah Raghu

Keywords:  Spine, Spinal Cord, Congenital

Matos Rojas Irma,  Lazarte Claudia,  Alpaca Rodriguez Larry

Final Pr. ID: Poster #: CR-04 (R)

Three cases of dermoid cyst will be described with different clinical presentation and location. MRI and CT finding will be reviewed and correlated with pathological finding.
The first case is a 7 year- old child, with suspected diagnosis of stroke which MRI shows a midline posterior fossa tumor with fine occipital dermal sinus, better visualized in CT. The second case is 1 year- old enfant with delayed psychomotor development, a dimple with lock of hair and dorsal hemangioma, which MRI shows a dermal sinus at D4 – D5 level which continues with an intra and extramedullary mass. The last case is 2 year- old child postoperated of mielomeningocele at birth that has neurogenic blader and Chiari II with a cyst mass at conus and low spinal cord insertion. Read More

Authors:  Matos Rojas Irma , Lazarte Claudia , Alpaca Rodriguez Larry

Keywords:  Dermoid cyst, Magnetic resonance imaging, Posterior fossa, spinal

Patel Manish,  Weiss Judith,  Kandil Ali,  Johnson Neil

Final Pr. ID: Poster #: SCI-034

Patients with Spinal Muscular Atrophy (SMA) may have scoliosis requiring spinal hardware for spinal fixation. The scoliosis in addition to the spinal hardware makes intrathecal access difficult with conventional approaches. With recent FDA approval of nusinersen (SpinrazaÒ) for SMA, intrathecal access is required for administration of this meditation. We describe our experience in these patients using a variety of lumbar puncture approaches (intra-spinous process, trans-pedicle, and trans-foraminal) utilizing conventional fluoroscopy, cone-beam CT (CBCT) with fluoroscopy overlay and/or conventional CT with CT fluoroscopy. Approach to the type of access and image guidance is based on the presence of spinal hardware and degree of scoliosis and spinal fusion. Read More

Authors:  Patel Manish , Weiss Judith , Kandil Ali , Johnson Neil

Keywords:  Spinal Muscular Atrophy, Lumbar Puncture, Spinraza

Steinhardt Nicole,  Marine Megan,  Supakol Nucharin,  Radhakrishnan Rupa,  Lahiri Niloy,  Jennings Greg,  Thompson Shannon,  Karmazyn Boaz

Final Pr. ID: Poster #: SCI-023

The purpose of this poster is to review the imaging findings of spinal fractures in children evaluated for child abuse on radiography, CT, and MRI, and differentiate fractures from vertebral body variations. Read More

Authors:  Steinhardt Nicole , Marine Megan , Supakol Nucharin , Radhakrishnan Rupa , Lahiri Niloy , Jennings Greg , Thompson Shannon , Karmazyn Boaz

Keywords:  Child abuse, spinal fractures, Vertebral variations

Gupta Kanika,  Becker Jennifer,  Chandra Tushar,  Udayasankar Unni

Final Pr. ID: Poster #: EDU-045

Ultrasound continues to be the first line modality for evaluation of spinal disorders in neonates and young children. The developing osseous anatomy of the spine in young infants provides a unique window allowing for a detailed depiction of the spinal canal and its contents. This exhibit will review the clinical indications, sonographic technique, normal anatomy, frequently encountered variants and pathology for imaging of the lumbosacral spine in neonates and young infants. Read More

Authors:  Gupta Kanika , Becker Jennifer , Chandra Tushar , Udayasankar Unni

Keywords:  Pediatric, Spinal Cord, Tethered cord

Park Seungweon,  Sarma Asha,  Dewan Michael,  Leschied Jessica,  Greene Elton,  Pruthi Sumit,  Martin Dann,  Foust Alexandra

Final Pr. ID: Poster #: EDU-081

Spinal cord lipomas are rare benign tumors of adipose tissue that have a range of presentations and management based on size, location, and embryogenesis. Importantly, the intradural lipomatous tissue can act as a tethering lesion placing the cord at risk of vascular compromise, particularly during periods of growth. Since spinal lipomas cause progressive disease and symptoms, early recognition and treatment in the pediatric population is beneficial. Neurosurgical literature supports further classification of spinal lipomas as dorsal, transitional, terminal, and chaotic based on location and imaging features for risk stratification, surgical planning, and prognostication. Although categorization for the purpose of guiding surgical management is based on imaging features, there currently is lack of representation of this classification system for spinal cord lipomas in the radiology literature.

The aim of this exhibit is to educate pediatric radiologists about this classification system for spinal cord lipomas. Relevant anatomy and embryogenesis will be reviewed, and case-based examples will be used to illustrate relevant imaging features of each type of spinal lipoma. Findings impacting surgical planning and prognosis will be specifically highlighted. Read More

Authors:  Park Seungweon , Sarma Asha , Dewan Michael , Leschied Jessica , Greene Elton , Pruthi Sumit , Martin Dann , Foust Alexandra

Keywords:  spinal lipoma, embryogenesis, neuroradiology