Bilateral renal masses in children are uncommon but can have stakes. Entities such as nephrogenic rests and nephroblastomatosis, bilateral Wilms tumor (Stage V), hereditary renal cell carcinoma associated with von Hippel Lindau and tuberous sclerosis, DICER1 related cystic neoplasms, and lymphoma often overlap in appearance on imaging. Management pathways can differ widely and can range from surveillance to more aggressive surgical managements. Therefore, radiologists need to integrate imaging findings with clinical and genetic clues to protect renal function and optimize outcomes This exhibit is designed to help participants recognize multimodality imaging features of uncommon bilateral renal masses beyond simple cysts, angiomyolipomas, infection, and metastases. It also highlights key syndromic associations and epidemiology, including WAGR, Denys Drash, Beckwith Wiedemann, von Hippel Lindau, tuberous sclerosis, and DICER1. Finally, it presents a structured, stepwise framework for refining the differential. It guides recommendations for next steps, such as surveillance, biopsy, or chemotherapy first. The approach emphasizes nephron preservation and close collaboration across the care team. Read More

Meeting name: SPR 2026 Annual Meeting , 2026

Authors: Tabor Biniyam Beyene, Belachew Bethelhem, Noor Abass

Keywords: Renal Lesions, Pediatric

Abstract: Sacral development is a key determinant of bowel and bladder function in children with anorectal malformations (ARM) and sacral agenesis. Accurate radiologic assessment of the sacrum provides essential prognostic information, guiding both surgical planning and long-term management. We aim to review the imaging-based metrics used to evaluate sacral development, highlighting their significance in predicting continence outcomes. ARM result from abnormal development of the hindgut and cloacal membrane between weeks 6 and 9 of gestation. These malformations can vary significantly, ranging from minor anal displacement to complex defects that involve the rectum, vagina, and urethra. Both the anorectal structures and the sacrum develop from the caudal mesoderm during the same period, which means that sacral anomalies, such as hypoplasia or agenesis, often occur alongside ARM. Due to this close embryologic origin, the sacrum can provide important insights into the prognosis of ARM, and specific metrics can offer objective information for assessment. The sacral ratio (SR), derived from anteroposterior (AP) and lateral pelvic radiographs, is the most widely used quantitative measure. It stratifies patients into prognostic categories, with SR ≥ 0.7 indicating good continence potential and SR < 0.4 associated with poor outcomes. However, SR is subject to variability due to patient positioning, pelvic tilt, and image quality. Additional metrics such as the sacral index (SI) and sacral curvature (SC) offer complementary insights. SI reflects sacral width and height and has been correlated with ARM severity. SC provides a qualitative measure of sacral shape and is associated with continence outcomes. These measurements are often limited by the constraints of conventional radiography and the technical challenges of MRI, including non-isotropic data and restricted field of view. This educational exhibit will provide a comprehensive review of sacral measurements in ARM and sacral agenesis. We encourage a standardized and multimodal approach to sacral assessment, and provide information for a deeper understanding of: - Sacral and anorectal malformations embryology - Key radiologic metrics (SR, SI, SC) and their interpretation - Limitations and considerations in measurement techniques - The prognostic significance of sacral development Read More

Meeting name: SPR 2026 Annual Meeting , 2026

Authors: Belachew Bethelhem, Silva De Campos Meneses Marcus Otavio, Moreira Vidal Lorenna

Keywords: Anorectal Malformation, Sacrococcygeal, Xray

Self-resolving ileocolic intussusception (ICI) represents a variant of intussusception. Although this transient form is encountered clinically on a sporadic basis, descriptive imaging criteria summarizing a cohort of self-resolving intussusceptions is lacking. This study aimed to characterize the imaging features of spontaneously resolving ICI and to assess inter-rater agreement among pediatric radiologists. Read More

Meeting name: SPR 2026 Annual Meeting , 2026

Authors: Lopez-rippe Julian, Lemessa Natae, Belachew Bethelhem, Akhoundi Neda, Sim Jeffrey, Claiborne Mary Kate, Riedesel Erica, Kaplan Summer

Keywords: Ultrasound, Intussusception