Prasher Sparsh,  Wigmore Edward,  Surana Snehal,  Vraka Katerina,  Bonney Denise

Final Pr. ID: Poster #: CR-036

Encephalopathy is a well-recognised complication of intrathecal methotrexate in paediatric acute lymphoblastic leukaemia (ALL), often presenting with seizures, altered consciousness, and motor deficits that typically resolve spontaneously within 24–48 hours. In contrast, methotrexate-induced myelopathy is a far rarer and under-recognised entity, with the potential for lasting neurological sequelae if not diagnosed and treated promptly.
We present an unusual case of methotrexate-induced myelopathy in a child with ALL, featuring an atypical clinical presentation and novel MRI findings that expand the recognised radiological phenotype.

A 4-year-old boy in remission from low-risk B-cell ALL (without CNS involvement) received intrathecal and intravenous methotrexate via an atraumatic lumbar puncture. Within hours, he developed left-sided hemiparesis, progressing to quadriparesis, with predominant weakness on the left and brief truncal involvement. He remained afebrile and haemodynamically stable, and laboratory tests, CSF analysis, and methotrexate clearance were all unremarkable. Brain imaging (CT, MRI, MRA) was normal. However, spinal MRI revealed extensive T2 hyperintensity throughout the cervical, thoracic, and lumbar spinal cord, involving both grey and white matter — a pattern more reminiscent of transverse myelitis than classic methotrexate myelopathy. CSF cytology was negative for malignant cells, and autoimmune and infectious screens, including MOG and AQP4 antibodies, were negative. Treatment with high-dose corticosteroids, folinic acid rescue, and IVIG was initiated within 12 hours of symptom onset. The patient showed marked improvement and was discharged ambulant after six weeks, with only mild residual left-sided weakness.

Classic methotrexate myelopathy typically affects the dorsal columns in a caudal-to-rostral progression. In contrast, this case demonstrated diffuse longitudinal cord involvement with mixed grey and white matter changes. Such imaging findings are not widely reported. Histopathological studies in similar cases support a mechanism of superficial demyelination from CSF-contact toxicity, aligning with this radiological presentation.

This case expands the radiological spectrum of methotrexate-induced myelopathy. Recognition of atypical spinal imaging findings is critical for timely diagnosis and early immunomodulatory treatment, which can significantly improve neurological outcomes. Read More

Authors:  Prasher Sparsh , Wigmore Edward , Surana Snehal , Vraka Katerina , Bonney Denise

Keywords:  ALL, Spinal Cord, Pediatric Neuroradiology

Pinheiro Lima Chandra Sameer,  Ehrlich Lauren

Final Pr. ID: Poster #: SCI-064

Chaotic lipomyelomeningocele (cLMM) is an uncommon and poorly understood closed spinal dysraphism characterized by disorganized lipomatous tissue and atypical placode position. While most dysraphisms are detected in infancy, delayed symptom onset may occur, creating diagnostic and management challenges. We present a rare case highlighting the value of high-resolution MRI in late presentation of cLMM and its implications for neurosurgical decision-making. Read More

Authors:  Pinheiro Lima Chandra Sameer , Ehrlich Lauren

Keywords:  Spinal Cord, MRI

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

Kim Joseph,  Shukla Neal,  Hammer Matthew,  Lozano Richard,  Hajibeygi Ramtin,  Tu Long

Final Pr. ID: Poster #: CR-049

A 16-year-old boy was transferred to our institution after experiencing a week of worsening numbness and weakness in his left lower extremity. Initially diagnosed with sciatica at an outside facility, he was treated with steroids. However, as his symptoms progressed, including difficulties with bowel movements, he returned for further evaluation.

Outside MRI studies of the lumbar spine and brain revealed hyperintensities and enhancement at T11-T12, raising concerns for transverse myelitis. Subsequent MRI of the cervical and thoracic spine and brain demonstrated extensive T2-weighted cord edema extending from C7 to the conus medullaris, along with a long segment of intramedullary hemorrhage, most pronounced from T8-T9. The differential diagnosis based on these findings included long-segment transverse myelitis complicated by cord hemorrhage or an intramedullary neoplasm, such as ependymoma or astrocytoma.

Comprehensive laboratory testing, including serologic and cerebrospinal fluid studies, ruled out infectious, autoimmune, metabolic, and demyelinating causes. Given the presence of intramedullary hemorrhage, a vascular etiology, such as an arteriovenous shunt, was considered; however, a diagnostic spinal angiogram showed no evidence of an aneurysm or vascular malformation.
Multi-specialty conferences involving radiology, infectious diseases, rheumatology, neuroimmunology, and neurosurgery were conducted, but no consensus was reached regarding the underlying etiology of the lesions. Ultimately, the patient was treated empirically for transverse myelitis with steroids, intravenous immunoglobulin (IVIG), and plasmapheresis.

Hemorrhagic transverse myelitis can result from a variety of etiologies, including infectious, neoplastic, demyelinating, vascular, autoimmune, and idiopathic factors. Key MRI sequences for evaluation include T2-weighted and post-contrast images, which are essential for assessing spinal cord edema, inflammation, and hemorrhagic changes. Additionally, gradient echo (GRE) sequences are vital for detecting subtle blood products, as blood degradation products display greater hypointensity and blooming on GRE images compared to T2-weighted images. By understanding this rare condition and its potential underlying causes, radiologists can play a crucial role in guiding clinical teams toward accurate diagnosis and timely management of patients with hemorrhagic transverse myelitis. Read More

Authors:  Kim Joseph , Shukla Neal , Hammer Matthew , Lozano Richard , Hajibeygi Ramtin , Tu Long

Keywords:  Spinal Cord, MRI, Emergency/Acute

Ale Ali Hamideh,  Krishnasarma Rekha,  Sarma Asha

Final Pr. ID: Poster #: EDU-027

Review common indications and modality selection for spinal imaging in neonates, focusing on ultrasound (US) and corresponding magnetic resonance imaging (MRI) findings.
Provide an overview of the normal anatomy of the neonatal spine as visualized by ultrasound and MRI.
Highlight common and uncommon spinal pathologies and syndromic conditions imaged with neonatal spine ultrasound and MRI.
Present representative cases from our institution, showcasing imaging findings of various congenital and acquired spinal abnormalities. Read More

Authors:  Ale Ali Hamideh , Krishnasarma Rekha , Sarma Asha

Keywords:  Spinal Cord, Spina Bifida, Neonatal

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

Khurana Rajat,  Rampal Parikha,  Nasr Youssef,  Eldamalway Dina,  Abdeen Nishard,  Wilson Nagwa

Final Pr. ID: Poster #: EDU-080

Pediatric spine tumors and their mimics present unique diagnostic challenges due to overlapping clinical presentations and imaging features. Accurate differentiation between neoplastic lesions and non-neoplastic conditions such as infections, inflammatory disorders and others is crucial to avoid misdiagnosis and ensure timely, appropriate treatment. This pictorial essay provides a comprehensive visual overview of common and rare pediatric spine tumors, including ependymomas, astrocytoma's, and bone tumors like osteoid osteoma, giant cell tumour as well as their mimics such as vertebral osteomyelitis, spinal tuberculosis, hemangioma and syringomyelia.
Through a series of high-quality case examples, we highlight key imaging characteristics across various modalities, including MRI , CT and US that help distinguish these entities. We emphasize the importance of a systematic approach to spinal imaging, integrating clinical history, radiological findings and pathological correlation to avoid diagnostic pitfalls. This poster aims to equip radiologists and clinicians with a practical framework to enhance diagnostic confidence and optimize management strategies for pediatric patients with spinal pathologies. Read More

Authors:  Khurana Rajat , Rampal Parikha , Nasr Youssef , Eldamalway Dina , Abdeen Nishard , Wilson Nagwa

Keywords:  Spine, Spinal Cord, Tumor

Hammer Matthew,  Kim Joseph,  Shukla Neal,  Hajibeygi Ramtin,  Tu Long

Final Pr. ID: Poster #: CR-043

Spinal arteriovenous malformations (AVMs) are rare vascular lesions within the spinal cord with incidence rates as low as 300 cases per year (Patchana 2020). They are associated with significant neurologic morbidity and are characterized by abnormal connections between arteries and veins, either bypassing the capillary system or passing through a dysplastic capillary bed. Using the Takai classification system, spinal AVMs can be classified into 5 types based on their shunt location. Type 2 spinal AVM, the intradural intramedullary glomus AVM, is typically seen within the thoracolumbar spinal cord and diagnosed in the third decade (Greenberg 2010, Patchana 2020). It is usually treated with resection and/or embolization, with recurrence rates reported as low as 2.3% and 27.7% for resection and embolization respectively (Mamaril-Davis 2023).

Our patient is a 17-year-old male with a history of C4-C7 AVM status post embolization and partial resection, who was post-operatively asymptomatic for 10 years. He initially presented with left upper extremity paresthesia after exercise. His symptoms progressed to bilateral lower extremity paresthesia and upper extremity hyperreflexia and clonus. Labs and vitals were unremarkable. Neurosurgery was consulted and MRI and MRA cervical spine with and without contrast were ordered to further evaluate symptoms. Findings were consistent with: recurrent C3-C4 left-sided type 2 spinal AVM with adjacent dilated vascular channels along the dorsal and ventral aspects of the spinal cord, C3-C4 cord expansion, and C2-C4 cord edema. There was no evidence of intra-nidal aneurysm or hemorrhage within the limitations of non-gradient sequences. Feeding arteries were difficult to identify but likely originated from adjacent left radicular or vertebral artery branches.

Although spinal AVM recurrence is incredibly uncommon after treatment, especially after surgical resection, it should always remain on the differential for patients with contributory history and new onset neurologic symptoms. This case reminds us that type 2 spinal AVMs can occur anywhere along the spinal cord and can manifest at any age. MRI and MRA sequences are best equipped to assess the extent of disease, and additional gradient sequences may be obtained if there is concern for hemorrhage. Read More

Authors:  Hammer Matthew , Kim Joseph , Shukla Neal , Hajibeygi Ramtin , Tu Long

Keywords:  Spinal Cord, Arteriovenous Malformation