Chen Alan,  Kucera Jennifer

Final Pr. ID: Poster #: CR-035

A 10-year-old female with neurofibromatosis type 1 and severe dysplastic scoliosis, presented with a two-month history of difficulty ambulating due to lower back pain. The patient did not have neurological symptoms. An MRI of the thoracolumbar spine demonstrated subluxation of the right tenth and eleventh ribs through the neural foramina, causing mass effect on the thecal sac, but at T9-T10 without abnormal cord signal or cord compression. Several clusters of neurofibromas were present along the right ribs and paravertebral soft tissues at these levels. CT evaluation was performed for greater osseous definition, which confirmed the findings. The patient underwent complex posterior spine fusion and segmental spinal instrumentation, which included T9-T10 thoracoplasty, rib resections, and multiple Ponte osteotomies.
Cases of rib head protrusion into the central canal in the setting of dystrophic scoliosis have been documented in only a limited sample of case reports. The angulated short-segment curvature in dystrophic scoliosis causes vertebral body rotation, foraminal enlargement, spindling of transverse process, and penciling of the apical ribs. These changes can alter the articulation of the rib along the spinous process. The enlarged foramina also create a space into which a rib may displace. As a result, in most reported cases, the subluxed ribs were on the convex apex of the curve in the mid-to-lower thoracic region. The risk of cord injury makes complete depiction of the anatomy crucial for surgical management. Read More

Authors:  Chen Alan , Kucera Jennifer

Keywords:  rib head protrusion, dystrophic scoliosis, spine

Akbari Yasmin,  Kralik Stephen

Final Pr. ID: Paper #: 159

Cervical spine trauma, particularly at the craniocervical junction, can produce significant morbidity and mortality in the pediatric population. Although normative pediatric cervical spine CT measurements have been reported, the accuracy of these measurements for predicting ligamentous injury remains unknown. The purpose of this study is to evaluate the sensitivity and specificity of normative pediatric CT measurements for prediction of traumatic ligamentous injury at the craniocervical junction, using MRI as gold standard. Read More

Authors:  Akbari Yasmin , Kralik Stephen

Keywords:  Cervical spine, Trauma, CT

Poot Jeffrey,  Subramanian Subramanian,  Gumus Serter,  Squires Judy

Final Pr. ID: Poster #: EDU-078

Ultrasound is a common screening examination performed in infants prior to closure of osseous posterior elements. Although radiologists with pediatric neuroradiology subspecialty training may be very familiar with many abnormalities encountered sonographically, pediatric radiologists without pediatric neuroradiology subspecialty training are often less familiar. Further, the ultrasound appearance of abnormalities of infant spine may be less well known than appearance on MRI. The purpose of this educational review is to demonstrate normal appearance of infant spine and illustrate abnormalities that are frequently and infrequently encountered during screening ultrasound evaluation, with MRI for comparison. Read More

Authors:  Poot Jeffrey , Subramanian Subramanian , Gumus Serter , Squires Judy

Keywords:  Spine, Ultrasound, MRI

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

Weisel Scott,  Jones Richard,  Palasis Susan

Final Pr. ID: Poster #: EDU-004 (R)

Diffusion Weighted Imaging (DWI) of the spine is used to identify and characterize the spinal cord, and in particular diagnose drop metastases whose subtle appearance may cause them to be missed on conventional imaging. It has also proved useful for characterization of spinal cord lesions. Proper positioning and technique by the technologist are crucial in obtaining images suitable for an accurate assessment of disease. Read More

Authors:  Weisel Scott , Jones Richard , Palasis Susan

Keywords:  Diffusion, Spine, RESOLVE

Alsharief Alaa,  El-hawary R.,  Schmit P.

Final Pr. ID: Poster #: EDU-030

To review the radiological findings of different orthopaedic implants and techniques used to treat Adolescent Idiopathic Scoliosis (AIS) and Early Onset Scoliosis (EOS).
To present the imaging findings of their most frequent post-operative complications. Read More

Authors:  Alsharief Alaa , El-hawary R. , Schmit P.

Keywords:  Scoliosis, Spine, implant, surgery

Eksioglu Secil,  Nasto Luigi,  Miyanji Firoz,  Bray Heather

Final Pr. ID: Poster #: EDU-106

The major concern for scoliosis in young children is the potential for poor pulmonary function and increased mortality. Early arthrodesis as well as severe spinal deformities can lead to ‘thoracic insufficiency syndrome’ by arresting spine growth and altering the shape of the thorax which results in restrictive lung disease. Several growth friendly instrumentation systems have been introduced to allow for growth until the timing is appropriate for spinal fusion for early onset scoliosis. The terminolgy of ‘growth friendly procedures ‘ is used for those which guide the growth of the spine. Growth modulation procedures are different from growth friendly procedures in the sense that vertebral growth is modulated and not guided. We aim to familiarize the radiologist by reviewing the types of ‘growing spine’ procedures performed at our hospital with an emphasis on what the radiologists should know and include in their reports. Read More

Authors:  Eksioglu Secil , Nasto Luigi , Miyanji Firoz , Bray Heather

Keywords:  Scoliosis, Growing spine, Growth friendly

Intwala Devanshi,  Colglazier Roy,  Kang Paul,  Gridley Dan,  Connell Mary

Final Pr. ID: Poster #: SCI-003

Understanding normal parameters of pediatric cervical spine is imperative for early detection of cervical spine injury by computed tomography (CT) post trauma. Young children have a higher biomechanical fulcrum, incomplete ossification, and increased soft tissue laxity which minimizes anatomical distortion on CT [1,2]. The first part of this two part study aims to establish normal cervical joint spaces measurements in non-traumatic pediatric population with particular attention to the lateral atlantodental interval (ADI). Read More

Authors:  Intwala Devanshi , Colglazier Roy , Kang Paul , Gridley Dan , Connell Mary

Keywords:  Cervical spine, Atlantodental, Normal parameters

Thomas Anna

Final Pr. ID: Poster #: EDU-077

1. Review frequency, relative severity, and age-related mechanisms of pediatric C-spine injuries.
2. Explore peculiarities of the pediatric cervical spine that predispose to different injury patterns than seen with adults.
3. Examine postnatal pattern of cervical spinal ossification.
4. Inspect the craniocervical junction anatomy, its ligamentous support and classic injury patterns.
5. Discuss available imaging recommendations in the workup of pediatric patients with suspected C-spine trauma.
6. Consider select patient scenarios of classic pediatric c-spine injuries. Read More

Authors:  Thomas Anna

Keywords:  pediatric C-spine trauma, craniocervical junction, C-spine development

Akbari Yasmin,  Subramanian Subramanian,  Furtado Andre,  Panigrahy Ashok,  Zuccoli Giulio

Final Pr. ID: Poster #: EDU-090

Pediatric cervical spine trauma, although rare with an incidence of only 1-2%, can have very high morbidity and mortality. The leading causes are motor vehicle collision, sports related injury and child abuse in infants. The incidence of upper cervical spine injury is more common in children than adults due to differences in biomechanics, with the pediatric head size being proportionally larger when compared to adults. Although conventional radiographs remain the standard initial imaging evaluation, CT has become an important modality to detect bony injury and subtle signs of underlying ligamentous injury and hemorrhage (although consideration must be made for the increased radiation exposure). The presence of ligamentous injury, dens synchondrosis fracture, spinal cord evaluation, and spinal cord injury without radiographic abnormality (SCIWORA), meanwhile, are better evaluated with MRI. We will review the normal appearance of the pediatric cervical spine including normal measurements on radiographs and CT, including the importance of the basion-dens interval, powers ratio, and atlanto-occipital distance with illustrations. The normal development of the cervical spine as well as CT and MRI anatomy of cervical spine ligaments will be reviewed with illustrations. Imaging findings of atlanto-occipital and atlanto-axial distraction and pediatric cervical spine fractures including clay shoveler's fracture and dens synchondrosis fractures will be illustrated with CT and MRI. Finally, a review of clinical decision criteria for pediatric cervical spine trauma and imaging approach will be presented. The importance of obtaining MRI in children under 5 years and appropriate use of imaging will also be discussed.

Image 1: Sagittal CT image demonstrates increased basion to dens distance and normal atlanto-dental interval, consistent with atlanto-occipital dissociation.
Image 2: T2-weighted sagittal MR image demonstrates injuries to the tectorial and posterior atlanto-occipital membranes with atlanto-occipital dissociation. There is associated epidural hemorrhage.
Image 3: Sagittal CT reconstruction demonstrates a powers ratio greater than 1, raising suspicion for anterior atlanto-occipital dissociation. Read More

Authors:  Akbari Yasmin , Subramanian Subramanian , Furtado Andre , Panigrahy Ashok , Zuccoli Giulio

Keywords:  Spine, Trauma, Pediatric

Meyer Dustin,  Chandra Tushar,  Hayes Laura,  Neville Kucera Jennifer

Final Pr. ID: Poster #: EDU-011

Neural tube defects affect approximately 1/1000 pregnancies; left untreated these defects may lead to devastating consequences. The purpose of this presentation is to: 1) familiarize the reader with the normal anatomy seen on neonatal spine ultrasound, 2) describe normal variants often encountered on spine ultrasound, 3) provide an illustrated summary of spine embryology, and 4) discuss the various pathologies/disorders that may occur during each phase of spine embryology. Read More

Authors:  Meyer Dustin , Chandra Tushar , Hayes Laura , Neville Kucera Jennifer

Keywords:  Spine, Embryology, Ultrasound

Mchendrie Mariska,  Tshuma Makabongwe

Final Pr. ID: Poster #: CR-005

Birth related brain and spinal cord injury is uncommon. The pediatric cervical spine has ligamentous laxity, poor muscular development and a cartilaginous predominant vertebral column. This in combination with a large head relative to body size predisposes them to craniocervical junction injuries, especially during instrumented delivery using forceps or vacuum extraction. These injuries cause significant parental and physician distress as it can result in permanent neurological deficit or even death in a previously well fetus.

Clinical suspicion for brain or spinal cord injury should be raised when there is diminished spontaneous movement, apnea, no deep tendon reflexes or no response to painful stimuli. There can be co-existing hypoxic ischemic encephalopathy that can mask the clinical signs of cord injury or intracranial hemorrhage and result in diagnostic delay. It can also worsen the neurologic prognosis if not appropriately managed.

Magnetic resonance imaging findings of cranio-cervical junction injuries and associated extra-axial or cerebral parenchymal hemorrhage has been reported. We present a case series of four patients presenting typically with forceps assisted birth related cervical spine trauma and unexpected associated posterior fossa findings. Read More

Authors:  Mchendrie Mariska , Tshuma Makabongwe

Keywords:  Trauma, Birth related, Spine and posterior fossa

Taylor Susan,  Bajaj Manish,  Sato Yutaka,  Policeni Bruno

Final Pr. ID: Poster #: CR-012

We will present imaging findings of segmental spinal dysgenesis in a series of 3 cases of this rare congenital abnormality. We will also describe the embryological basis and pertinent clinical features.

Case 1: 8-year-old female recently adopted from China with history of severe scoliosis, neurogenic bladder, and chronic kidney disease. Plain radiographs demonstrate severe destroscoliosis in thoracolumbar region with associated kyphosis. MRI reveals multiple segmentation/formation anomalies in the lumbosacral region. The coccyx was not identified, likely representing associated partial sacrococcygeal dysgenesis. The spinal cord was severely dysgenetic in the lower thoracic region (Figure 1, white outlined arrow). The superior segment of the spinal cord extends from the cervicomedullary junction to the level of T8, where it ends abruptly. No intervening cord tissue is seen between the T8 level and lumbar region. There is an enlarged spinal cord segment at the level of the sacrum in the spinal canal, separate from the superior segment (Figure 2, solid white arrow). CT with 3D reconstruction better demonstrated multiple segmentation/formation anomalies in the thoracic and lumbosacral region, including butterfly vertebrae, hemivertebrae, and block vertebrae. There were 10 ribs on the right noted with the superior 2 ribs fused. Read More

Authors:  Taylor Susan , Bajaj Manish , Sato Yutaka , Policeni Bruno

Keywords:  Congenital, Spine, Scoliosis

Defendi Larissa De Andrade,  Nishimura Victor Dyego Mena Romeiro,  Yamanoe Claudio Massayuki Nakao,  Camargo Marcos,  Silva Frederico Adolfo Benevides,  Pozzi Iona Grossman,  Regacini Rodrigo,  Lederman Henrique

Final Pr. ID: Poster #: EDU-039

Masses of both benign and malignant origin can occur in the spine and vertebrae, as well as in the paravertebral region, with subsequent vertebral and/or spine invasion. Although definitive diagnosis is established through anatomopathological evaluation, imaging appearance may help narrow the diagnosis and allow prompt management.
The aims of this presentation are:
- To discuss the several entities affecting the spine and vertebrae regarding their pathophysiology, clinical presentation and treatment;
- To demonstrate their radiological appearance, mainly in computed tomography (CT) and magnetic resonance (MR) imaging;
- To propose an illustrative guide for reference, highlighting their differential diagnoses in imaging.
The following teaching cases from our radiology department will be presented:
- Medullary Ganglioneuroblastoma;
- Medullary Astrocytoma;
- Medullary Myxopapillary Ependymoma;
- Medullary Lipoma;
- Medullary Epidermoid Cyst;
- Spinal Canal Shwannoma;
- Spinal Canal Metastasis of Ependymoma;
- Spinal Canal Relapse of Medulloblastoma;
- Vertebral Ewing Sarcoma;
- Vertebral Osteoid Osteoma;
- Vertebral Chordoma;
- Vertebral Aneurysmal Bone Cyst;
- Vertebral Osteochondroma;
- Vertebral Fibrous Dysplasia;
- Osteoblastoma;
- Vertebral Hemangioma;
- Paravertebral Extrarenal Rabdoid Tumor;
- Paravertebral Plexiform Neurofibroma;
- Paravertebral Osteosarcoma Relapse;
- Neuroblastoma with spinal canal invasion. Read More

Authors:  Defendi Larissa De Andrade , Nishimura Victor Dyego Mena Romeiro , Yamanoe Claudio Massayuki Nakao , Camargo Marcos , Silva Frederico Adolfo Benevides , Pozzi Iona Grossman , Regacini Rodrigo , Lederman Henrique

Keywords:  Spine

Cielma Tara,  Bandarkar Anjum

Final Pr. ID: Poster #: EDU-006 (R)

Background:
Lumbar puncture (LP) is used during the initial work-up of a febrile infant for diagnosis of central nervous system (CNS) abnormalities such as neoplasm, and infectious processes. In children, the L3-L4 and L4-L5 intervertebral space can be used to access the subarachnoid space. Collection of cerebral spinal fluid (CSF) is then tested for any markers of infection. At times, a lumbar puncture may fail and create a leak of CSF and hematoma within the meningeal space.

Purpose:
Through this case series, we will describe normal sonographic anatomy of the spinal canal and effective techniques to best demonstrate epidural hematoma post lumbar puncture. Retrospective review of ultrasound B-mode and cine loop images was performed with respect to the three cases. Typical imaging features include heterogenously echogenic material within the dorsal and ventral epidural space that may move with real-time patient motion. Additionally, the collection of material may compress the thecal sac, obliterating flow of CSF.
High frequency linear sonography of the spinal canal and epidural space after unsuccessful lumbar puncture in experienced hands can adequately demonstrate anatomic detail of the spine and meningeal spaces and identify the epidural hematoma. Ultrasound allows expedited diagnosis of traumatic epidural hematoma after failed lumbar puncture and facilitates ultrasound-guided CSF collection. Read More

Authors:  Cielma Tara , Bandarkar Anjum

Keywords:  Spine Ultrasound, Epidural Hematoma, Lumbar Puncture

Gowali Neha,  Anand Neil,  Murphy Robyn

Final Pr. ID: Poster #: EDU-003

The purpose of the presentation is to educate the audience of the uses of ultrasound in evaluation of the neonatal spine. By viewing this presentation, the audience will learn the importance of ultrasound in evaluation of the spine. We will review the process of performing the ultrasound examination to acquire suitable images. Assessment of the normal spine structures under ultrasound and discussion of the indications for the use of ultrasound as a primary source of evaluation of the spine are to be reviewed. Performance of the examination in terms of patient positioning, labeling of the vertebral bodies, and evaluation of the important structures will be discussed. Indications for acquiring an ultrasound of the spine will also be reviewed. Lastly, we aim to review distinct disease entities associated with the neonatal spine, with attention to their ultrasound imaging characteristics. Read More

Authors:  Gowali Neha , Anand Neil , Murphy Robyn

Keywords:  Ultrasound, Spine, Neonatal

Gebarski Kathleen,  Gebarski Stephen

Final Pr. ID: Poster #: EDU-064

Sonography of the neonatal spine can be challenging and difficult to interpret. We composed a pictorial guide of a wide variety of variants and diseases for education and reference. Read More

Authors:  Gebarski Kathleen , Gebarski Stephen

Keywords:  spine, sonography, neonatal

Tsutsumi Yoshiyuki,  Okamoto Reiko,  Miyasaka Mikiko,  Miyazaki Osamu,  Ishii Masaya,  Muto Ayako,  Okada Haruka,  Hara Hiroko,  Nosaka Shunsuke

Final Pr. ID: Poster #: SCI-012

To assess the level of the conus medullaris using spinal ultrasonography, bony landmarks such as the lowest ribs, the most caudal ossification center (MCOC) of the vertebral body, and angulation in the lumbosacral region are used. However, determining the level of the conus medullaris is sometimes difficult because of the variations of these landmarks.
Purpose of this study was to analyze the variation of these landmarks. However, it is difficult to evaluate these variations using ultrasonography, because this method allows a narrow field of view. To supplement this limitation, we tried to evaluate these landmarks retrospectively using (1) whole spine CT or (2) lumbosacral CT in combination with chest radiography. Read More

Authors:  Tsutsumi Yoshiyuki , Okamoto Reiko , Miyasaka Mikiko , Miyazaki Osamu , Ishii Masaya , Muto Ayako , Okada Haruka , Hara Hiroko , Nosaka Shunsuke

Keywords:  spine, CT, ultrasound, variation

Nguyen Jie,  Hong Shijie,  Nguyen Michael,  Venkatesh Tanvi,  Serai Suraj,  Carson Robert,  Barrera Christian,  Cahill Patrick,  Rajapakse Chamith

Final Pr. ID: Paper #: 053

Anatomic changes during bone growth and skeletal maturation are under-studied and incompletely understood, partially attributed to the sparing use of ionizing radiation in children. Recently, a clinically-feasible UTE (ultra-short echo time) MRI technique has emerged, enabling the direct visualization of bone. Although validated in adults, its spatial resolution and reproducibility have not been fully investigated in children. Therefore, the purpose of this study is 1) to determine the feasibility of UTE MRI to quantify changes in vertebral porosity and disc hydration along the thoracolumbar spine and 2) to investigate inter-rater reproducibility. Read More

Authors:  Nguyen Jie , Hong Shijie , Nguyen Michael , Venkatesh Tanvi , Serai Suraj , Carson Robert , Barrera Christian , Cahill Patrick , Rajapakse Chamith

Keywords:  quantitative MRI, bone, spine