Abusive head trauma is associated with high morbidity and mortality. The evidence-based identification, care, and protection of infants and young children who are victims of AHT is critical. A diagnosis of AHT is made after careful consideration of the history provided, constellation of injuries identified, in conjunction with any additional diagnostic evaluation, as appropriate. This multidisciplinary educational module will focus on the evidence-based evaluation of intracranial findings when abusive head trauma (AHT) is a consideration, highlighting the importance of collaboration between child abuse pediatricians (CAPs) and pediatric neuroradiologists. Framing the discussion with multiple cases, we will (1) describe the varied clinical presentations of abusive head trauma, (2) describe a general approach to the medical evaluation of abnormal intracranial findings when abuse is a concern; (3) present the differential diagnosis including traumatic and medical causes; (4) discuss appropriate imaging evaluation including neuroimaging (brain, spine) and skeletal imaging approaches; (5) report imaging findings found more commonly in AHT; (6) underscore the importance of collaboration between child abuse pediatricians and neuroradiologists; (7) highlight key literature, including the 2018 SPR-supported AHT consensus statement, to reference in practice, and, finally; (8) discuss consideration of language to include in imaging reports when abuse is a concern. Following completion of the educational module, the learner will be familiar with the medical and imaging evaluations when AHT is considered, be able to describe imaging findings that are more commonly associated with AHT, and be familiar with references from the literature for self-study. Read More

Meeting name: SPR 2025 Annual Meeting , 2025

Authors: Bhatia Aashim, Henry M., Feygin Tamara, Christian Cindy

Keywords: Child Maltreatment, Abusive Head Trauma, Neuroradiology

Pediatric diffuse midline gliomas (DMG) are a leading cause of cancer-related deaths in children. Conventional proton (1H)-MRI is limited in differentiating tumor progression from radiotherapy-associated pseudoprogression (vasogenic edema), which leads to clinical uncertainty regarding treatment planning and efficacy. Sodium (23Na)-MRI is a novel imaging approach which reflects cell integrity, tissue viability, and tumor Na concentration, thereby serving as an effective marker of tumor proliferation and treatment response. Plasma liquid biopsy to measure circulating tumor DNA (ctDNA) with H3K27M mutation offers another minimally invasive method of quantifying disease burden and response to treatment. There is growing interest in the use of 23Na-MRI combined with ctDNA plasma liquid biopsy as a multimodal biomarker of tumor activity in pediatric DMGs. Our exhibit will focus on demonstrating the clinical utility of this multimodal approach as follows: 23Na-MRI maps: Directly quantify tumor Na concentration, a marker of cell integrity and tumor viability, providing insight into cellular microenvironment H3K27M ctDNA measurement: Molecular burden of the pathognomonic mutation of pediatric diffuse midline gliomas, providing insight into biological disease activity Through case-based examples, we will highlight how 23Na-MRI and ctDNA levels change in tumors with positive response to radiotherapy and tumors refractory to radiotherapy. These patterns may provide radiologists with a more reliable index for differentiating true tumor progression from pseudoprogression than conventional 1H-MRI alone for pediatric glioma patients. Take-home message: 23Na-MRI and H3K27M circulating tumor DNA are sensitive, non-invasive biomarkers to study the biological activity of pediatric diffuse midline gliomas and differentiate between true progression and pseudoprogression after radiotherapy. Read More

Meeting name: SPR 2026 Annual Meeting , 2026

Authors: Amiruddin Raisa, Yilmaz Necla Ece, Williams L. Tyler, Bhatia Aashim

Keywords: Brain Tumors, Brain MRI, Innovation