To retrospectively review the imaging planes performed, the number pyloric layers visible and the location of measurements taken, in infants with suspected (HPS). Read More

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

Authors: Calle Toro Juan, Andronikou Savvas

Keywords: pyloric, ULTRASONOGRAPHY, Children

There is little published research on the wide variation of corpus callosum (CC) morphology in children, the assessment of which is made difficult by the complex alteration of its appearance in childhood. The purpose of our study was to assess the morphology of the CC on mid-sagittal T1-weighted magnetic resonance imaging (MRI) in a large number of children and correlate the findings with demographic and clinical criteria. Read More

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

Authors: Raubenheimer Lauren, Andronikou Savvas, Kilborn Tracy

Keywords: children, magnetic resonance imaging, corpus callous morphology

Dynamic 4D CT (D4DCT) can replace bronchography in the assessment of tracheobronchomalacia (TBM) but setting up a new D4DCT service for infants with TBM poses unique challenges due to their venerability. Simulation prior to implementation is essential as D4DCT involves continuous volumetric CT scanning through the breathing cycle, potentially delivering high radiation doses. Radiation dose, gantry rotation and scan dynamics can be customized. Our purpose is to describe the development and implementation of CT dynamic airway protocol using a 3D printed <i>Infant Dynamic Airway Phantom</i> (phantom) for simulation of D4DCT in tachnypnoea and collapsible airways, thereby validating image quality and estimating radiation dose prior to clinical implementation. Read More

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

Authors: Zhu Xiaowei, Silvestro Elizabeth, Andronikou Savvas

Keywords: dynamic airway, infant, D4DCT

Successful bronchoscope handling requires the skill to orient bronchoscope position and direction in response to the intraluminal view provided by the bronchoscope camera. Additional challenges for pediatric physicians are smaller airways and the physiologically higher breathing frequency and airway collapsibility in babies and toddlers. We aimed to create a set of anatomically accurate 3D printed pediatric static and dynamic airway models that can be further used to teach and train residents/fellows in bronchoscopy and foreign body removal. Read More

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

Authors: Maier Pia, Silvestro Elizabeth, Andronikou Savvas

Keywords: 3D printing, Phantom, Bronchial tree

Nutritional deficiencies in children are prevalent both in the US and abroad often under-diagnosed unless symptomatic. Some nutritional deficiencies have conspicuous imaging findings that might help with diagnosis and/or follow up in a timely manner. Similarly, imaging might be needed to diagnose or follow complications related to malnutrition and eating disorders such as bulimia, anorexia nervosa, binge eating and pica. This educational exhibit will review radiographic, CT and MR imaging of nutritional deficiencies and complications of malnutrition and eating disorders in children Read More

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

Authors: Barrera Christian, Andronikou Savvas, Otero Hansel

Keywords: Nutrition, Children, Eating disorder

3D printed models from MRI scans can effectively demonstrate the surface structure of the brain. Previous workflows focus on adult brains as a basis for prints. Our database of pediatric MRI brains who had perinatal hypoxic ischemic injury and presented late for imaging, with pathology causing cortical surface irregularities and parenchymal cysts. Difficulties arise in accurate depiction of the cortex on 3D print models in these pathologic brains. We aim to demonstrate effective workflows to accurately and efficiently print 3D models of especially pathologic pediatric MRI brains. Also, to critically and empirically test and refine the various steps involved in producing 3D print models which include segmentation of the MRI volume into tissue classes, generation of a surface model from this volume, preparation and final print of a 3D model. Read More

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

Authors: Chacko Anith, Andronikou Savvas, Shearn Andrew, Thai Ngoc Jade

Keywords: 3D Printing, Hypoxic Ischaemic Injury, 3D Models

Effective text-based communication, through radiologist reports, of imaging findings in term Hypoxic Ischemic Injury (HII) to family members, non-radiologist colleagues and members of the legal profession can be extremely challenging. Utilization of 3D printed models, where the actual findings of the brain can be communicated via tactile perception and rotating/grasping the models is a potential solution which has not been tested in practice. We aimed to determine the sensitivity and specificity of different groups, comprising trained radiologists, non-radiologist physicians and non-physicians, in the detection of gross disease of the cerebral cortex from 3D printed brain models derived from MRI scans of children. Read More

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

Authors: Venkatakrishna Shyam Sunder, Chacko Anith, Schoeman Sean, Andronikou Savvas

Keywords: Magnetic Resonance Imaging, 3D Printing, Hypoxic Ischemic Injury

To assess the utility and adaptability of some widely used automated segmentation methods when applied to abnormal pediatric magnetic resonance imaging (MRI) brain scans. Segmentation is an essential component of the workflow when building 3D anatomical models of abnormal pediatric brains to demonstrate surface pathology. Read More

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

Authors: Schoeman Sean, Venkatakrishna Shyam Sunder, Chacko Anith, Andronikou Savvas

Keywords: Segmentation, 3D Printing, MRI Brain

CT can be a powerful tool for the evaluation of the chest and abdominal pathology in children. While not as commonly used as in the USA, CT studies represented approximately 15% of cases received from low- and lower-middle income Countries for expert second opinion by a pediatric radiologist in the WFPI teleradiology platform, over the last 4 years. This pictorial review lists the indications, details the technical parameters, and exemplifies imaging findings of CT studies from this setting. Read More

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

Authors: Nketiah Linda, Taragin Benjamin, Silva Cicero, Andronikou Savvas, Otero Hansel

Keywords: Outreach, teleradiology, CT

To evaluate the utility of quantitative CT in children with neuroendocrine cell hyperplasia of infancy (NEHI) Read More

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

Authors: Barrera Christian, Barrera Ambika, Andronikou Savvas, Tapia Ignacio, Otero Hansel

Keywords: Quantitative, NEHI, Chest

Hypoxic ischemic injury (HII) is a leading cause of neonatal encephalopathy and resultant cerebral palsy. Most studies focus on early magnetic resonance imaging (MRI) findings and patterns of injury, with few studies evaluating patterns in delayed MRI of patients with cerebral palsy. We aim to categorise the delayed imaging MRI findings and distribution of abnormalities in a large cohort of children with cerebral palsy and obtained for medicolegal purposes to determine the causes of cerebral palsy, and to map the frequency of anatomic involvement in those with hypoxic ischemic injury. Read More

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

Authors: Chacko Anith, Andronikou Savvas, Goncalves Fabricio, Vedajallam Schadie, Thai Ngoc Jade

Keywords: hypoxic ischaemic injury, HII, Patterns of hypoxic ischemic injury

The inter-arterial watershed zone in neonates is a geographic area without discernible anatomic boundaries, is difficult to demarcate and usually not featured in atlases. Schematics currently used to depict the areas are not based on any prior anatomic mapping, as compared to adults. Magnetic resonance imaging (MRI) of neonates in the acute to subacute phase with suspected hypoxic ischaemic injury can demonstrate signal abnormality and restricted diffusion in the cortical and subcortical parenchyma of the watershed regions, although this can often be subtle. In contrast, in the chronic stage of evolution of partial prolonged hypoxic-ischaemic injury, atrophy and ulegyria can make the watershed zone more conspicuous as a region. Our aim is to use images extracted from a large medicolegal database (approximately 2000 cases), of delayed MRI scans in children with cerebral palsy, to demonstrate the watershed region. To achieve this, we have selected cases diagnosed on imaging as having sustained a pattern of term, partial-prolonged hypoxic-ischaemic injury affecting the hemispheric cortex, based on the presence of bilateral, symmetric atrophy with ulegyria. From these we have identified those patients demonstrating injury along the entire watershed continuum as well as those demonstrating selective anterior or posterior watershed predominant injury for demonstration. Recognition of this zone is essential for diagnosing partial-prolonged hypoxic-ischaemic injury sustained in term neonates, which also has implications for potential compensation in litigation. The set of images presented in this pictorial review provides a template for identifying the cortical watershed distribution when there is milder regional (anterior, parasagittal, peri-Sylvian and posterior) watershed injury and for more severe injury where multiple regions are injured in combination or as a continuum. Read More

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

Authors: Chacko Anith, Andronikou Savvas, Goncalves Fabricio, Mian Ali, Vedajallam Schadie, Thai Ngoc Jade

Keywords: Cortical Ischemic Patterns, Watershed Zone, Hypoxic Ischemic Injury

To create a three dimensional (3D) ultrasound (US) bowel phantom that simulates bowel sonographic characteristics to aid in education for bowel scanning techniques and for microbubble contrast utilization in bowel. Read More

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

Authors: Dennis Rebecca, Silvestro Elizabeth, Hill Lamont, Andronikou Savvas, Anupindi Sudha, Hwang Misun

Keywords: Bowel Phantom, Bowel Ultrasound, 3D Printing

To describe the normal progression of quantitative CT chest parameters in children Read More

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

Authors: Barrera Christian, Andronikou Savvas, Tapia Ignacio, White Ammie, Biko David, Otero Hansel

Keywords: Quantitative, CT, Lung

Accurate preoperative imaging diagnosis of supratentorial pediatric intraventricular tumors is not always straightforward. Conventional MRI features such as T1- and T2-weighted signal and contrast enhancement may overlap among various choroid plexus tumors and embryonal tumors. This study aimed to perform apparent diffusion coefficient (ADC) histogram analysis, assessing various metrics in different intraventricular for histological classification. Read More

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

Authors: Goncalves Fabricio, Khrichenko Dmitry, Martin-saavedra Juan, Alves Cesar Augusto, Teixeira Sara, Andronikou Savvas, Vossough Arastoo

Keywords: Intranventricular tumors, ADC, Diffusion

Suspected airway compression in symptomatic children with Lymphobronchial Tuberculosis (LBTB) can be diagnosed using modern computed tomography (CT) assisted by coronal minimum intensity projection (MinIP) reconstructions. The accuracy of plain radiographs in detecting airway compression in children with TB has not been evaluated against an imaging gold standard in a dedicated manner. We aimed to compare frontal CXR against thick-slab angled coronal CT MinIP in identifying airway stenosis at ten specific sites and to determine the agreement between the modalities regarding the degree of stenosis. Read More

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

Authors: Calle Toro Juan, Bester Dewald, Venkatakrishna Shyam Sunder, Ali Krim Ahmed, Lucas Susan, Goussard Pierre, Andronikou Savvas

Keywords: Lymphobronchial Tuberculosis, minimum intensity projection, computed tomography

Lymphobronchial TB (LBTB) in children refers to airway narrowing by tuberculous lymphadenopathy. Diagnosis is made invasively using flexible bronchoscopy or noninvasively with CT, which can include minimum intensity projection (MinIP) reconstructions. Our aim was to generate standardized coronal minimum intensity projection CT reconstructions and compare these with flexible bronchoscopy in children with LBTB. Read More

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

Authors: Calle Toro Juan, Ali Krim Ahmed, Venkatakrishna Shyam Sunder, Bester Dewald, Lucas Susan, Goussard Pierre, Andronikou Savvas

Keywords: Trachea, CT, Lymphobronchial TB

Postmortem imaging is increasingly used following stillbirths and neonatal death. Estimating time of death has legal, biological, and ethical implications. This study aims to investigate feasibility of prenatal MRI in estimating time of death in intra-uterine fetal demise (IUFD). Read More

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

Authors: Teixeira Sara, Alves Cesar Augusto, Martin-saavedra Juan, Goncalves Fabricio, Zarnow Deborah, Feygin Tamara, Andronikou Savvas

Keywords: Fetal MRI, Brain, Autopsy

Intracranial calcification (ICC) can be either physiological or pathological. Physiological ICC is not an expected neuroimaging finding in the neonatal period but can be seen as children grow older in the pineal gland, habenula, choroid plexus, and occasionally in the dura mater. Pathological ICC can be broadly divided into six groups: infectious, toxic, neurodegenerative, neoplastic, vascular, and syndromic. The first two groups are typically composed of diseases that more commonly result in static encephalopathies, whereas the last four groups are composed of diseases that tend to cause progressive encephalopathy. Various neuroimaging modalities have distinct utilities and sensitivities in the depiction of ICC. Age at presentation, ICC location, and additional neuroimaging findings are useful information that may be useful to narrow down the differential diagnosis of ICC. Bilateral ICC is commonly due to congenital infections or due to neurodegenerative or infectious diseases. ICC involving the basal ganglia and thalami are commonly seen in neurodegenerative diseases. ICC can be seen in isolation or be associated with other neuroimaging features. TORCH infections are the most common neonatal causes of ICC. ICC in congenital infections can be associated with clastic changes, hydrocephalus, chorioretinitis, white matter abnormalities, skull changes, and cortical development malformations. Specific non-infectious causes of ICC that mimic TORCH infections are known as pseudo-TORCH. Neurodegenerative diseases causing ICC are mainly due to parathyroid and thyroid hormone dysfunction and inborn errors of metabolism, such as MELAS, Kearns Sayre and Cockayne syndrome, interferonopathies syndrome, and Krabbe disease. Tumoral ICCs are more commonly seen in low-grade tumors. Arteriovenous malformations, arteriovenous fistulas, chronic venous hypertension, and cavernomas are also known causes of ICC. Other vascular causes of ICC include atherosclerosis, healed hematoma, radiotherapy treatment, old infarct, and disorders of the microvasculature such as COL4A1- and COL4A2-related diseases. Down syndrome and phakomatosis are also known causes of ICC. Clinical information such as age at presentation; maternal exposure to teratogens, such as virus; in addition to the association with chromosomal abnormalities; genetic mutations and postnatal infections, facilitate in the differential diagnosis of the multiple causes of ICC. Read More

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

Authors: Goncalves Fabricio, Pinelli Lorenzo, Mankad Kshitij, Alves Cesar Augusto, Teixeira Sara, Andronikou Savvas, Vossough Arastoo

Keywords: Calcification, Computed Tomography, Magnetic Resonance

To evaluate the utility of fetal MRI and prenatal ultrasound in establishing an underlying cause in fetuses with suspected arthrogryposis. Read More

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

Authors: Adams Niamh, Teixeira Sara, Alves Cesar Augusto, Goncalves Fabricio, Feygin Tamara, Zarnow Deborah, Andronikou Savvas

Keywords: Arthrogryposis, Fetal, CNS Abnormality

To describe imaging requisition patterns for prospective pediatric research studies at a large academic children’s hospital as insight into the role of radiology services in the current research environment. Read More

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

Authors: De Leon-benedetti Laura, Andronikou Savvas, Serai Suraj, Hailu Tigist, Miranda Schaeubinger Monica, Jalloul Mohammad, Otero Hansel

Keywords: Ethics Committees, Research, Radiology, Medical Imaging

Primary mitochondrial disorders (PMD) in newborns can be misdiagnosed as hypoxic-ischemic encephalopathy (HIE), clinically and radiologically. The purpose of this study is to describe the frequency and patterns of brain MRI findings in children with PMD diagnosed during the neonatal period. Read More

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

Authors: Alves Cesar Augusto, Teixeira Sara, Martin-saavedra Juan, Goncalves Fabricio, Goldstein Amy, Andronikou Savvas, Ganetzky Rebecca, Vossough Arastoo

Keywords: Newborn, mitochondrial disorders, Mitochondrial

Proton MRS (1H-MRS) is a technique to non-invasively study brain metabolites in vivo. 1H-MRS has been shown to detect abnormal brain accumulation of lactate in primary mitochondrial disorders (PMDs). However, differences in lactate concentration among the different PMDs have not been explored. We aimed to explore differences in quantitative 1H-MRS derived metabolite concentrations, particularly of lactate, and their ratios, in PMDs. We analyzed quantitative 1H-MRS data of the brain in pediatric patients with different types of genetically confirmed PMDs to evaluate differences in metabolite concentration and ratios. Read More

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

Authors: Goncalves Fabricio, Wang Dah-jyuu, Goldman-yassen Adam, Martin-saavedra Juan, Alves Cesar Augusto, Teixeira Sara, Andronikou Savvas, Vossough Arastoo

Keywords: MR Spectroscopy, Mitochondrial, LCModel