Humeral lesser tuberosity avulsion fractures (LTAF) are rare injuries in children. Limited information is available describing MRI characteristics. We aim to describe demographics, mechanism of injury, and MRI findings of LTAF. Read More

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

Authors: Bedoya Maria, Barrera Christian, Ho-fung Victor

Keywords: Avulsion, MRI

The complete ultrasound (US) evaluation of the urinary tract in a pediatric patient should include both the urinary bladder and kidneys. Evaluation of the bladder as part of that overall US examination, however, can be deemphasized or incomplete due a number of factors, such as one’s neglecting to fully image the bladder from dome to bladder neck, suboptimal bladder distension, incomplete distension due to presence of an indwelling drainage catheter or vesicostomy, or in some instances, because the bladder is not included as part of the routine kidney ultrasound exam. True masses arising from the urinary bladder in children are generally rare, and at times, subtle and non-specific, and potentially mimicked by so-called pseudomasses, so we emphasize that correlation of findings with patient history is of paramount importance. This pictorial review will illustrate and describe the US appearances (along with selective cross-sectional imaging), clinical manifestations, and tumor growth patterns of common and uncommon conditions arising from the pediatric urinary bladder, i.e. path-proven masses that include leiomyosarcoma, pheochromocytoma, nephrogenic adenoma, vascular malformation, low grade urothelial neoplasms, neurofibromatosis, fibroepithelial polyps, rhabdoid tumor, and rhabdomyosarcoma. Pseudomasses of the bladder that will also be illustrated and briefly discussed include hematomas, urachal remnants, complex ureteroceles, Deflux injection sites, foreign bodies, and cystitis (viral, eosinophilic, parasitic). In addition to emphasizing the importance of the complete bladder examination, the purpose of this review is to increase radiologist’s awareness of the US appearances of the common and uncommon conditions which afflict the pediatric urinary bladder, as well as those conditions that can mimic bladder masses, in order to determine proper clinical management. Read More

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

Authors: Gokli Ami, Barrera Christian, Bellah Richard

Keywords: Bladder, Mass, Ultrasound

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

In the diagnosis of acute appendicitis, unenhanced MRI provides an efficient and comprehensive evaluation of the appendix. However, on the daily clinical basis, there are cases that generate a diagnostic dilemma with subtle/indeterminate inflammatory changes. For these questionable cases, the morphology of the appendix could play a role as an aid for the radiologist to increase the confidence diagnosing or ruling out acute appendicitis. The aim of this study is to evaluate the morphology of the appendix as an additional tool for the diagnosis of appendicitis. Read More

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

Authors: Bedoya Maria, Barrera Christian, Ho-fung Victor, States Lisa

Keywords: MRI, Appendicitis

Developmental dysplasia of the hip (DDH) is the leading cause of hip disease in infants. AVN is a potential complication of treatment for DDH, which is traditionally diagnosed on follow-up pelvic radiographs. But classic radiographic findings of AVN may be radiographically-occult for months to years after surgery. To investigate the performance of gadolinium-enhanced magnetic resonance imaging (MRI) for predicting avascular necrosis (AVN) of the femoral head following surgical hip reduction for developmental dysplasia of the hip (DDH) using qualitative and quantitative methods. Read More

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

Authors: Nguyen Jie, Barrera Christian, Back Susan, Patel Maya, Sankar Wudbhav

Keywords: DDH, MRI, AVN

Background: Dual source dual-energy CT scanners (DECT) has allowed for the collection of two data sets with a single scan, opening the potential for functional data acquisition. The technique combines two energy beams at distinct voltages applied concurrently during a single scanning phase. The source data can be combined to generate a single mixed composite image, or iodine can be subtracted to create a contrast map or a virtual non-contrast image. The result is functional information in the setting of decreased radiation dose when replacing a biphasic scan, or dose neutral when compared to conventional single source CT. Post processing lung perfusion software allows for imaging display (qualification) and quantification of iodinated contrast volumes in the lungs, a surrogate for lung perfusion. Purpose: This educational exhibit will demonstrate: 1. How to perform DECT in children, 2. How to use postprocessing software, and 3. How to interpret lung perfusion results through clinical examples of current pediatric clinical indications including pulmonary embolism, lung hypoplasia, pulmonary AV malformation, and pulmonary hypertension. Conclusion: Through this exhibit, readers will gain familiarity with technical aspects of DECT of the lungs in children, understand the basics of post processing and recognize focal or regional perfusion defects, segmented perfusion analysis, and focal lesion perfusion characteristics as well as identify future applications. Read More

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

Authors: Rapp Jordan, Saul David, Kaplan Summer, Barrera Christian, Otero Hansel

Keywords: dual energy, thoracic, perfusion

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

The tibiotalar joint is the third most common location for osteochondritis dissecans (OCD) lesions, which poses the risk of premature osteoarthritis, and often associates with a history of prior ankle sprains and fractures. Unstable lesions require surgical intervention. A 4-stage radiographic classification system has been previously proposed, but this system has a 50% false negative rate when compared to arthroscopic assessment (reference standard). Recently, MRI and arthroscopic findings have been correlated in adults, but no such validation study has been performed in children. Thus, the purpose of our study was to identify MRI findings that predict instability of OCD lesions of the ankle in children. Read More

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

Authors: Patel Maya, Francavilla Michael, Longoria Cruz, Nguyen Michael, Barrera Christian, Nguyen Jie

Keywords: tibiotalar joint, OCD

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

To investigate magnetic resonance (MR) imaging features of sacroiliac joint infections in children with respect to age and with clinical correlation. Read More

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

Authors: Cohen Sara, Biko David, Kaplan Summer, Barrera Christian, Serai Suraj, Nguyen Jie

Keywords: sacroiliitis

To describe CTA findings of children with left pulmonary artery sling (LPA) using the classification proposed by Wells, et al and report associated anomalies and surgical outcomes. Read More

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

Authors: Ugas Charcape Carlos, Nicho-póvez Minorka, Pacheco-cárdenas Claudia, Palomino-alfaro Liz, Barrera Christian, Otero Hansel

Keywords: pulmonary artery sling, children, ct

Gaucher disease is an inherited metabolic disorder due deficiency of the lysosomal enzyme β-glucocerebrosidase that results in the accumulation of abnormal macrophages (“Gaucher cells”) within multiple organs, most conspicuously affecting the liver, spleen and bone marrow. As the diagnosis is increasingly made during childhood and young adulthood, pediatric radiologists should be familiar with imaging features of Gaucher disease and its complications. Visceromegaly consisting of hepatosplenomegaly is a hallmark of Gaucher disease and uniformly present in cohorts of pediatric patients. In addition, bone marrow involvement with ‘Erlenmeyer flasks’ have been long recognized as part of this disease, although the classic radiographic finding is not present until adulthood. Marrow involvement confers significant morbidity for these patients with pain, bone infarcts and pathologic fracture. Traditionally, imaging of disease severity has been based on hepatic and splenic visceral organ enlargement and/or qualitative assessment of bone marrow involvement. However, advances in the understanding of Gaucher disease and observations of elevated ferritin levels and increased risk of hepatic fibrosis emphasize the importance of more comprehensive assessment of liver involvement beyond simple enlargement. Moreover, quantitative MRI assessment of bone fat-fractions also may have a role in assessing marrow involvement. These methods of disease assessment are important in addressing management decisions regarding enzyme replacement and substrate reduction therapy. Read More

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

Authors: Degnan Andrew, Serai Suraj, Ho-fung Victor, Barrera Christian, Wang Dah-jyuu, Ahrens-nicklas Rebecca, Ficicioglu Can

Keywords: Gaucher disease, bone marrow, hepatic involvement

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

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

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

Keywords: quantitative MRI, bone, spine