Ectopic thymic tissue may be found in the neck in up to 20% of the general population. Intrathyroidal thymic rest has been described as a rare entity, present in as many as 1% of children. The course of thymic migration parallels the thyroid and parathyroid glands, which explains their similar ectopic locations. While the natural history of these lesions has not been well studied, it is likely that there is involution of thymic rests with age. A few individual case reports have described the imaging features of intrathryoidal thymic rests confirmed by histopathology and flow cytometry. The aim of this case series is to raise awareness of the characteristic sonographic appearance of this entity to the radiology community. Read More

Meeting name: SPR 2019 Annual Meeting & Postgraduate Course , 2019

Authors: Alazraki Adina, Milla Sarah

Keywords: Thymic rest, TiRAD, Thyroid

Patients with Von Hippel Lindau are predisposed to develop neuroendocrine tumors (NET) such as pheochromocytoma. These tumors are known to be somatostatin receptor positive and therefore can be imaged with specific radiotracers that target these receptors like ¹¹¹In-octreotide and ⁶⁸Ga-Dotatate. In addition to NET’s, 80% of these patients will also develop hemangioblastomas in the brain and spinal cord which have been shown to harbor somatostatin receptor subtypes including SSTR-2a, one of the target receptors for DOTATATE. We present a case of a teenager with suspected NET in the adrenal gland who underwent ⁶⁸Ga-DOTATATE PET/CT. The PET confirmed uptake in the adrenal lesion, but also highlighted a focus of uptake in the spine. Correlative MRI of the spine demonstrates classic imaging features of hemangioblastoma. This finding has not previously been described in the published literature in children. This case report will discuss the mechanism and utility of ⁶⁸Ga-Dotatate PET/CT and emphasize the manifestations of Von Hippel Lindau disease. We will review the normal pattern of Dotatate uptake and the significance of somatostatin receptors in neoplasms in the VHL patient population. Read More

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

Authors: Chen Jennifer, Milla Sarah, Alazraki Adina

Keywords: hemangioblastoma, dotatate, von hippel lindau

Ulcerative colitis (UC) and Crohn disease are chronic, immune-mediated, inflammatory disorders of the gastrointestinal tract collectively referred to as inflammatory bowel disease (IBD). As many of 20-25% of patients with IBD initially present in childhood or adolescence, and the incidence of pediatric IBD is increasing. IBD primarily affects the bowel, but other organs can be involved. Nearly one-third of patients will have at least one extra-intestinal manifestation. Some extra-intestinal manifestations, such as that between UC and primary sclerosing cholangitis (PSC), are well-established. Others are less understood and may mimic more common pathology, particularly infection. Therefore, pediatric radiologists must become familiar with these extra-intestinal manifestations and consider the diagnosis of IBD as the etiology for their pathology. Read More

Meeting name: SPR 2018 Annual Meeting & Postgraduate Course , 2018

Authors: Joshi Hena, Alazraki Adina, Rostad Bradley

Keywords: inflammatory bowel disease, ulcerative colitis, Crohn disease

Fetal MRI is a unique method which allows clinicians to diagnose or exclude abnormalities during pregnancy. MR images are acquired when details from an ultrasound may not be sufficient to make a complete prenatal diagnosis or when there are concerns for additional findings. This method of imaging is optimal due to the diagnostic quality of the images and the absence of ionizing radiation. We present an educational exhibit to discuss the methodology in performing a fetal MRI as well as demonstrating common findings in fetal MRI. Read More

Meeting name: SPR 2017 Annual Meeting & Categorical Course , 2017

Authors: Elliott Lauren, Alazraki Adina, Milla Sarah

Keywords: Fetal, MRI, Technologist

A 16 year old previously healthymale patient who initially presented with daily recurrent fevers and chills lasting 5-10 minutes. His parents brought him to a tertiary care hospital after developing vomiting and weight loss in the setting of progressively worsening fevers. Initial work up was remarkable for elevated CRP and a negative infectious workup. An MR enterography ordered to evaluate for a cause of weight loss demonstrated incidental lung base lesions. Follow up CTA revealed a lesion within the right ventricle and multiple lung nodules, concerning for endocarditis and septic emboli. He underwent two surgical resections over two months for the ventricular mass. Pathology revealed findings consistent with necrotizing endocarditis. During his hospital course, he was found to have a left cephalic venous thrombosis and was placed on Xarelto, later developing a right subclavian vein thrombus while on anticoagulation. He was readmitted 1 month later after presenting for right chest and right upper quadrant pain. Initial chest X-ray revealed right lower lobe mass and follow up CTA revealed two large right pulmonary artery pseudo-aneurysms. He underwent cardiac catheterization for pre-operative coiling of the pseudo-aneurysms and subsequent right lower lobectomy. Pathology revealed necrotizing arteritis and pulmonary artery pseudo-aneurysms. Based on clinical presentation and further work up, he was diagnosed with Hughes Stovin Syndrome and started on Cytoxan and Apixaban. While not yet considered in remission, his symptoms have improved since initiating treatment. Hughes Stovin Syndrome (HSS) is a rare disorder characterized by thrombophlebitis as well as multiple pulmonary and/or bronchial aneurysms. There is a male predilection, usually presenting between 12-48 years. There have been less than 40 cases published in the English literature. HSS is thought to be a variant of Bechet’s but does not present with oral or genital ulcers. The lack oral and genital ulcers in this patient excluded a diagnosis of Bechet’s. The underlying cause of HSS is unclear but is believed to be due to angiodysplasia or infection. Since there is no formally described diagnostic criteria, the clinical presentation of thrombophlebitis with pulmonary artery aneurysms characterize the disease. We present this case to illustrate the clinical presentation of a rare and possibly under recognized syndrome. Read More

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

Authors: Gagnon Marie-helene, Richer Edward, Alazraki Adina

Keywords: Vasculitis, Aneurysm, Thrombophlebitis

Foreign body ingestion is common in children. Timely diagnosis of the nature and location of the foreign body is important. A button battery which lodges in the esophagus can quickly cause severe esophageal and mediastinal injury. Machine learning that can detect anatomical regions of interest is an important step in computerized foreign body localization and may result in prioritization of radiographs with mediastinal foreign bodies. The purpose of this study is to develop a machine learning model to identify anatomical regions of interest on pediatric foreign body series radiographs. Read More

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

Authors: Rostad Bradley, Richer Edward, Riedesel Erica, Alazraki Adina

Keywords: Machine learning, Artificial intelligence, Foreign body

Timely diagnosis of foreign body ingestion in children is important, particularly in the case of an ingested button battery. A button battery which lodges in the esophagus can quickly cause severe esophageal and mediastinal injury. It is also important to distinguish an ingested button battery from a coin; a button battery may be misdiagnosed a coin because of its similar radiographic appearance. The purpose of this study is to develop a machine learning model to identify button batteries and coins on pediatric foreign body series radiographs. Read More

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

Authors: Rostad Bradley, Richer Edward, Riedesel Erica, Alazraki Adina

Keywords: Machine learning, Artificial intelligence, Button battery

Prior studies have suggested that patients undergoing fetal MRI have a high level of anxiety, while other studies have indicated that patients have a limited understanding of the role of the radiologist in patient care. Further, many patients would prefer to learn their results immediately after the examination rather than wait to meet with their obstetrician. Our objective is to assess patient perception of what fetal MRI is and the role of the radiologist. Read More

Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016

Authors: Golden Eleza, Alazraki Adina, Milla Sarah, Desai Nilesh

Keywords: fetal MRI, radiologist, consultation

Whole body MR imaging is now widely utilized in the diagnosis and staging of pediatric patients with systemic disorders and diseases such as Chronic nonbacterial osteomyelitis (CNO), Neuroblastoma, Langerhans cell histocytosis (LCH) and fever of unknown origin (FUO). This technique allows the radiologist to visualize the entire body thereby, providing information regarding the full extent of disease allowing clinicians to direct the patient’s treatment. As an alternative to CT and Nuclear medicine, MR whole body imaging produces superior results without exposing the patient to ionizing radiation. We present an educational guide to practical positioning of the patient, coil positioning and protocol optimization. Read More

Meeting name: SPR 2017 Annual Meeting & Categorical Course , 2017

Authors: Chin Nicole, Weisel Melissa, Alazraki Adina, Milla Sarah

Keywords: Whole Body Imaging, MRI, Technologist

Ninety percent of biliary atresia cases occur with no associated anomalies. Ten percent of cases of biliary atresia are considered syndromic, occurring in association with a variety of congenital anomalies including heterotaxy, polysplenia, asplenia, congenital cardiac defects, intestinal malrotation, interrupted IVC, hepatic artery anomalies, and portal vein anomalies, including pre-duodenal portal vein. The incidence of hepatopulmonary syndrome is also increased in this group. Images from CT, MR, radiography, nuclear medicine, ultrasound and fluoroscopy will illustrate the variety of imaging appearances of the biliary atresia/splenic malformation syndrome. Read More

Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016

Authors: Patrick Ellen, Dickson Paula, Alazraki Adina, Romero Rene

Keywords: Biliary atresia, Splenic malformations

A trend of increased utilization of pediatric breast ultrasound has been suggested in our pediatric healthcare system. Despite this perceived increase in cases, the number of concerning breast findings in our population remains extremely low. Our hypothesis is that there has been significant increase in the number of pediatric breast ultrasounds, yet examinations remain overwhelmingly benign. Read More

Meeting name: SPR 2017 Annual Meeting & Categorical Course , 2017

Authors: Thompson Allison, Alazraki Adina, Tade Funmilayo, Loewen Jonathan, Dickson Paula, Milla Sarah

Keywords: Ultrasound, Breast, Pediatric

Brain death, also known as death by neurologic criteria, (BD/DNC) is the permanent loss of total brain function in individuals who have sustained catastrophic brain injuries. Accounting for approximately 5% of pediatric deaths, BD/DNC remains a clinical diagnosis, which is often emotionally laden and not always straightforward. When results are equivocal or there exist limitations to the safe completion of the clinical assessment, clinicians rely on ancillary testing to make informed decisions. In October 2023, updated adult and pediatric BD/DNC consensus guidelines were published which reinforce differences in the recommendations for testing between the adult and pediatric populations. It is, therefore, crucial for Pediatric Radiologists to understand these guidelines and the critical role radiology plays in supporting this important diagnosis. In this educational exhibit, we will review the recent consensus guidelines and clinical indications for the use of imaging in BD/DNC evaluation. We will provide a step-by-step guide which will include patient preparation, radionuclide or contrast administration, image acquisition, and image interpretation for the two validated methods of pediatric BD/DNC ancillary testing: Radionuclide Perfusion Scintigraphy and 4-Vessel Catheter Angiography. Although 4 vessel catheter angiography is considered the gold standard in ancillary BD/DNC testing, as it is believed to be both 100% sensitive and 100% specific, radionuclide scintigraphy is the more widely used modality in the pediatric population, owing to the less invasive nature of the exam. Neither exam is without challenges related to limited availability and technical skill required yet are currently the only validated radiologic tools recommended for use in brain death diagnosis. Our exhibit will review multiple cases of evaluation for BD/DNC, accentuating imaging findings and pearls/pitfalls of acquisition and interpretation. Opportunities for investigation of other available imaging techniques will also be highlighted. Read More

Meeting name: SPR 2024 Annual Meeting & Postgraduate Course , 2024

Authors: Hampton Erica, Fuentealba Cargill Andrea, Trenbeath Zachary, Alazraki Adina, Stence Nicholas, Milla Sarah

Keywords: Nuclear Medicine, Interventional Radiology

MR Urography is an advanced imaging technique with increasing utilization that allows the interpretation of both anatomic and functional urologic data. This allows for a more efficient study of renal parenchymal and collecting system abnormalities, however the complexity and volume of functional data can make for an intimidating task to the interpreting radiologist. Key factors to success include: adequate patient preparation, optimal imaging protocol in conjunction with sedation/anesthesia and complex advanced post-processing techniques. In this educational poster, we aim to provide an initial overview of MRU with practical points on appropriate patient preparation and study optimization, followed by a detailed overview of the myriad of functional data acquired with each study. Finally, we will review a series of image-rich cases along with the post-processed functional data in order to illustrate the approach to interpretation in the setting of anatomic abnormalities on MRU. Read More

Meeting name: SPR 2024 Annual Meeting & Postgraduate Course , 2024

Authors: Vey Brianna, Cho Joo, Taylor Susan, Mehollin-ray Amy, Alazraki Adina, Khanna Geetika, Linam Leann

Keywords: MRU, Functional, MR

Evolution of MR Lymphangiography has expedited diagnosis and advanced potential implications for treatment in lymphatic disorders. In particular, evaluation of the central conducting lymphatic channels with dynamic contrast enhanced MR provides better spatial resolution, while sparing ionizing radiation inherent in lymphangio-scintigraphy and catheter lymphangiography. We will review indications, technique with pearls and pitfalls, and overall success rates after MR lymphangiography at our institution. To discuss post-imaging clinical outcomes and implications for treatment. To illustrate imaging findings of various lymphatic pathology diagnosed on MR. Read More

Meeting name: SPR 2023 Annual Meeting & Postgraduate Course , 2023

Authors: Bodner Jeffrey, Khanna Geetika, Riedesel Erica, Gill Anne, Hawkins Matt, Shah Jay, Variyam Darshan, Alazraki Adina

Keywords: Lymphatic, Lymphangiography, MR

Pediatric stomach tumors encompass a broad range of pathologies. These tumors are rare in the pediatric and adolescent population and can be easily misdiagnosed. In addition, approach to imaging diagnosis in this population may differ from adults. In this educational exhibit, we will focus on stomach tumors. This exhibit will provide viewers with: 1. A visual differential diagnosis of common and uncommon tumors in each section of the stomach with a focus on multi-modality imaging. 2. Review of common imaging findings for each tumor, highlighting high-yield characteristic findings of each. 3. Key findings and tips that can help the practicing radiologist differentiated between benign and malignant tumors. Read More

Meeting name: SPR 2024 Annual Meeting & Postgraduate Course , 2024

Authors: Mulvey Tom, Gagnon Marie-helene, Richer Edward, Loewen Jonathan, Alazraki Adina, Khanna Geetika, Mitchell Sarah, Riedesel Erica

Keywords: Stomach, Tumor, Malignancy