Fetal lung maturity is a key factor determining perinatal morbidity and mortality. Clinicians can perform amniocentesis and evaluate the amniotic fluid for certain surfactant byproducts such as lethicin, sphingomyelin, and phosphatidylglycerol to assess lung maturity. However, amniocentesis is invasive, and its results can be prone to errors. Imaging can offer a reliable non-invasive alternative that can be used for prognostication as well as suggestion of further follow up. Ultrasound is the imaging modality of choice to assess fetal development. It is readily available on widespread scale to assess for various abnormalities that can occur during pregnancy. Parameters used to assess fetal lung maturity on ultrasound include lung to head ratio as well as the observed/expected lung to head ratio. However, ultrasound parameters can be subjective, have inter- and intra-observer variability and depend highly on the imaging technique and quality. The advent of ultrafast MRI sequences expanded its use in fetal imaging offering an alternative to ultrasound. It is generally used as a problem-solving tool due its excellent soft tissue resolution. Two parameters are gaining acceptance as means to assess fetal lung development on MRI: lung volume measurements and lung/liver signal intensity ratio. Our exhibit aims at familiarizing pediatric radiologists with parameters used to assess lung development on both ultrasound and MRI. Read More

Meeting name: SPR 2020 Annual Meeting & Postgraduate Course , 2020

Authors: Aboughalia Hassan, Dighe Manjiri

Keywords: Lung maturity, Fetal Imaging

Chronic recurrent multifocal osteomyelitis (CRMO) is a relatively new autoinflammatory pediatric musculoskeletal diagnosis. It was first discovered by Giedion et al 1972, who described “an unusual form of multifocal bone lesions with subacute and chronic symmetrical osteomyelitis”. CRMO can be a problematic diagnosis due to its variable presentation. Clinical, laboratory, and imaging findings must be aggregated to arrive at a CRMO diagnosis. Imaging plays a central role in CRMO diagnosis and management. Typical imaging findings that are generally but not necessarily multifocal, and exhibit changes over time, are crucial to CRMO management plan. Many pathologic entities can mimic CRMO because of its diverse clinical and imaging manifestations. These conditions include infectious processes such as septic arthritis and osteomyelitis, other inflammatory conditions such as psoriatic arthritis, metabolic disturbances such as rickets and scurvy, traumatic injuries such as acute fractures and osteonecrosis from repetitive microtrauma, neoplastic entities such as metastasis and lymphoma, and neoplastic-like entities like Langerhans cell histiocytosis. In our exhibit, we will review the classic imaging manifestations of CRMO and present a spectrum of lesions in which CRMO was an initial consideration, but ultimately proved to be a different pathology. Read More

Meeting name: SPR 2020 Annual Meeting & Postgraduate Course , 2020

Authors: Aboughalia Hassan, Iyer Ramesh

Keywords: CRMO, Mimickers

A whirlpool describes rotating water created by opposing currents or upon an encounter with an obstacle. On imaging, it refers to a twist of the vascular pedicle of an organ, with a subsequent characteristic appearance on color Doppler images. Multiple abdominal pediatric emergencies are associated with a whirlpool sign, including midgut and other intestinal volvulus, testicular torsion, and ovarian torsion. This exhibit aims to review the underlying embryologic mechanism predisposing to this characteristic appearance, the role of this sign in the diagnosis of these conditions, the supporting imaging features that can help further define the diagnosis, as well as some pitfalls and differential diagnoses that can lead to a fallacious diagnosis. Read More

Meeting name: SPR 2022 Annual Meeting & Postgraduate Course , 2022

Authors: Aboughalia Hassan, Oztek Murat Alp, Noda Sakura

Keywords: Whirlpool sign, Midgut malrotation, Testicular torsion

Nuclear medicine, which encompasses a variety of body functions assessment, offers valuable complementary functional information to that provided by anatomic imaging. Scintigraphy is often underutilized in pediatric radiology. Thus, trainees may be less comfortable interpreting a pediatric scintigraphic study, especially when requested urgently after hours, given the varying degree of comfort reading nuclear medicine studies amongst faculty. Common pediatric scintigraphic studies encountered in this context are performed to evaluate for CSF shunt dysfunction, gastrointestinal bleeding, brain death, and Meckel’s diverticulum. Other less commonly encountered studies are done to assess for bile leak, post-renal transplant complications, and pulmonary embolism. The aim of this exhibit is to provide a brief overview of the nuclear medicine studies that may be encountered after hours to familiarize trainees with appropriate indications, imaging techniques, normal and abnormal scintigraphic findings, and pitfalls to be avoided when interpreting these studies with emphasis on the unique challenges in the pediatric population, such as the need for sedation. Read More

Meeting name: SPR 2022 Annual Meeting & Postgraduate Course , 2022

Authors: Aboughalia Hassan, Cheeney Safia, Oztek Murat Alp, Iyer Ramesh

Keywords: Scintigraphy, On-call, Resident education