Chiari Type I deformity (C1) is associated with bony deformity of the skull base and herniation of cerebellar tonsils. MRI is used for diagnosis and surgery is advised for symptomatic children. We present a case series using MR imaging including CSF flow, in a variety of children with C1 to demonstrate a variety of outcomes both surgical and non-surgical: spontaneous resolution, spontaneous worsening, post-surgical improvement. Case 1: A 6-year-old (y) girl referred for imaging with short stature and growth hormone deficiency demonstrated incidental findings of C1 without syringomyelia. No surgery (Sx) was performed, and follow-up (F/U) MRI at age 7 y demonstrated spontaneous resolution of the tonsillar ectopia and expansion of the CSF spaces at craniocervical junction (CCJ). Case 2: A 7 y boy with headaches and staring spells underwent an MRI demonstrating 6 mm protrusion of pointed cerebellar tonsils and CSF space reduction at CCJ. No Sx was performed, and F/U imaging at age 9 y demonstrated spontaneous improvement in cerebellar tonsillar position and increased bidirectional CSF flow at CCJ. Case 3: A 2-week-old girl underwent brain MRI demonstrating an ectopic neurohypophysis, under opercularization suggesting brain immaturity and a normal CCJ. F/U MRI at 6 y of age showed interval spontaneous development of C1 with decreased CSF spaces at CCJ. Case 4: A 17-month-old boy underwent brain MRI for unsteady gait and poor vestibular response, which showed C1 and narrow CSF spaces at the foramen magnum and with reduced CSF flow. At age 3 y, after posterior fossa decompression, F/U MRI showed post-surgical improvement of the position of the cerebellar tonsils and increased CSF space at CCJ. Case 5: A 8 y girl with headaches and intermittent dizziness underwent MRI demonstrating 15 mm protrusion of the pointed cerebellar tonsils and marked decrease in the CSF at CCJ. After suboccipital craniotomy, MRI at age 8 y demonstrated a post-surgically improved CSF space and improved bidirectional CSF flow, at CCJ. Read More

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

Authors: Venkatakrishna Shyam Sunder, Andronikou Savvas

Keywords: Chiari Type I deformity (C1), CSF space, CSF flow

Background: Malrotation is an important diagnosis that needs to be identified on routine imaging and in the emergency setting. In our institution it is always surgically corrected and therefore accurate diagnosis is essential. Current teaching, supported by research, states that a lateral view on an upper gastrointestinal contrast study (UGIS) can satisfactorily demonstrate normal anatomy and a diagnosis of malrotation. The diagnosis must be made with confidence in this position because any delay in turning the patient into the AP plane can result in contrast progressing into the jejunum with overlapping bowel loops compromising the diagnosis. Read More

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

Authors: Lambert Elena, Andronikou Savvas

Keywords: Malrotation, Midgut volvulus

Perinatal Hypoxic Ischemic Injury (HII) has a higher prevalence in the developing world. One of the primary concepts for suggesting that an imaging pattern reflects a global insult to the brain is when the injury is noted to be bilateral and symmetric in distribution. In the context of HII in term neonates, this is either bilateral symmetric (a) peripheral/watershed injury (WS) or (b) bilateral symmetric Basal-ganglia-thalamus (BGT) pattern, often with the peri-Rolandic and hippocampal injury. Unilateral, asymmetric or unequal distribution of injury may therefore be misdiagnosed as perinatal arterial ischemic stroke. This has been previously reported in the typical distribution patterns, without a clear indication of the prevalence. We aimed to determine the prevalence of unilateral, asymmetric and unequal degree HII and to characterize the distribution on MRI in a large database of patients with Cerebral Palsy (CP) from South Africa. Read More

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

Authors: Venkatakrishna Shyam Sunder, Elsingergy Mohamed, Worede Fikadu, Andronikou Savvas

Keywords: Hypoxic Ischemic Injury (HII), Basal-ganglia-thalamus and Watershed, Unilateral, Asymmetric or Unequal distribution

Diagnosing paediatric TB can be challenging due to non-specific signs and symptoms and difficulties in getting a microbiological confirmation. Diagnosis relies mainly on symptoms and chest X-ray (CXR), with hilar or mediastinal lymphadenopathy as the most common finding. However, CXR has poor inter- and intra-reader agreement for mediastinal lymphadenopathy. Ultrasound (US) does not expose children to ionizing radiation; is repeatable and due to the recent development of portable, low-cost US machines it can be used at the point of care and is cost-effective. We investigated clinician-performed mediastinal US, comparing with CXR, for the detection of lymphadenopathy in children with suspected pulmonary TB. Read More

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

Authors: Heuvelings Charlotte, Belard Sabine, Andronikou Savvas, Grobusch Martin, Zar Heather

Keywords: mediastinal, ultrasound, tuberculosis

Upper gastrointestinal studies are used for the diagnosis of intestinal malrotation, and the configuration of the duodenum and position of the DJ flexure are used for diagnosis. There are various challenges associated with diagnosing malrotation on the AP view, and obtaining a lateral view is recommended for diagnosis. To be useful, the lateral view must be of adequate quality. In addition, radiologists must be aware of the normal appearance and configuration of duodenal variants such as duodenum redundum, on the lateral view, as misdiagnosis of these may lead to unnecessary surgery. We aim to determine the proportion of lateral views considered of adequate quality for diagnosis, as well as the prevalence of a not previously described sign, the 'descending stair' and its correspondence to a diagnosis of duodenum redundum. Read More

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

Authors: Venkatakrishna Shyam Sunder, Elsingergy Mohamed, Calle Toro Juan, Dennis Rebecca, Andronikou Savvas

Keywords: Descending stair, Upper gastrointestinal studies (UGI), Duodenum redundum