Evaluation of pediatric abdominal vasculature is typically performed with contrast enhanced cross-sectional imaging or catheter angiography. Concern over radiation exposure and the safety of intravenous contrast agents in patients with impaired renal function has led to increased interest in non-contrast MR angiography. Recent advances in MRI pulse sequence design now allow for non-invasive high resolution imaging of pediatric abdominal vasculature without the use of radiation or intravenous contrast. Read More

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

Authors: Edwards Emily, Lee Marsha, Phelps Andrew, Kim Jane, Courtier Jesse

Keywords: MRA, vasculature, Technique

According to the current statistics, approximately 1 million children aged 6-14 participated in 11-payer football, more popular as youth football, in the 2021-2022 school year (3). A trend to earlier participation in specialized sports activities in pediatric patients has been observed. Contact sports such as basketball, football, and soccer comprise a considerable proportion of all played sports and are associated with the highest number of injuries, both acute and chronic in nature(9). Lower extremities are the most common site of injury in pediatric football players, followed by upper extremity. Fractures and sprains/strains are the most common injury patterns (1, 9, 10). With the increasing number of young football athletes, there is a greater need to explore football-associated injuries, which can have a considerable physical, emotional, and psychosocial impact on a young individual. This educational exhibit aims to explore the most common American football-related pediatric extremity injuries and their imaging characteristics using various modalities and briefly discuss the treatment options for the pediatric population. Read More

Meeting name: SPR 2024 Annual Meeting & Postgraduate Course , 2024

Authors: Manral Kalpana, Durand Rachelle, Pandya Nirav, Kornblith Aaron, Cort Kayla, Courtier Jesse

Keywords: American football, Pediatric, Extremity injuries

In recent years, the applications of artificial intelligence in radiology have increased exponentially. Randomized controlled trials demonstrating the potential of AI in radiology have been centered around deep learning techniques with artificial neural networks, such as convolutional neural networks (CNNs). Current applications of CNNs include the detection, segmentation and quantification of pathologic conditions. These tasks use deductive AI, which uses discriminative models to identify discrepancies between images. Generative AI is an emerging technique that has a number of exciting novel applications in the field of Pediatric Radiology. This exhibit will provide a practical overview to familiarize pediatric radiologists with this topic and review current and potential future use cases. Generative adversarial networks (GAN) require two opposing networks, a generator that synthesizes new images, and a discriminator that differentiates between real and synthesized images. Through an iterative process, GAN creates highly realistic images that have exciting applications in image creation, translation between imaging modalities, acceleration of image synthesis and identification of pathologic abnormalities. ChatGPT is a popular generative AI model that generates coherent responses to queries, and uses a Generative Pre-trained Transformer (GPT) network to encode and decode language data. ChatGPT is pre-trained on large volume text data to learn how language is used in different contexts. An encoder processes the input sequence and a decoder generates the output sequence. Both encoder and decoder have a multi-head self-attention mechanism allows differential weighing of the sequence to infer meaning and context. Potential applications in pediatric radiology are broad, including patient communication, providing appropriate imaging recommendations, report generation and review of radiologic safety guidelines and regulations. However, generative AI models require careful implementation, training and validation to reduce potential pitfalls in unintentionally synthesizing content that does not exist, or conversely, removing clinically relevant information from an image. The purpose of this exhibit is to: (1) provide an introduction to Generative AI (GAN) and ChatGPT (2) review use cases of GAN and ChatGPT in pediatric radiology (3) provide practical methods for evaluating the performance of artificial intelligence algorithms in pediatric radiology applications. Read More

Meeting name: SPR 2024 Annual Meeting & Postgraduate Course , 2024

Authors: Cheng Jocelyn, Leesmidt Kantheera, Durand Rachelle, Mongan John, Cort Kayla, Courtier Jesse

Keywords: Generative Artificial Intelligence, Artificial Intelligence, ChatGPT

Late-presenting or recurrent diaphragmatic defects can pose a diagnostic challenge due to varying clinical presentations. Current diagnostic approaches include plain film radiograph for initial assessment, with other imaging modalities such as fluoroscopy, ultrasound, CT and MRI mainly employed for troubleshooting. As a radiation-free modality, MRI can provide a more definitive diagnosis in particular cases due to its ability to visualize discontinuity of the diaphragm (distinguishing it from eventration), hernia contents, defect location and size. In this exhibit, we will: 1. Review the normal appearance of the diaphragm. 2. Share our institutional MRI protocol for optimal evaluation of the diaphragm, including use of CINE steady state free precession sequences and use of negative slice spacing in T2 weighted images. 3. Discuss important postnatal MR imaging findings of late presenting and recurrent diaphragmatic hernias in children. 4. Describe potential diagnostic pitfalls in the imaging of the diaphragm. Read More

Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016

Authors: Kim Wendy, Courtier Jesse, Morin Cara, Shet Narendra, Strauch Eric, Kim Jane

Keywords: Diaphragmatic hernia, MRI, Hiatal hernia, Bochdalek hernia, Morgagni hernia

Abdominal Magnetic Resonance Angiography (MRA) has gained favor in pediatric patients due to its lack of ionizing radiation and noninvasive nature. Reports exist regarding incidental findings on body MRA in adult patients. However, the incidental findings in pediatric abdominal MRA have not been previously reported. Our study aims to determine the frequencies, characteristics and categories of incidental findings in pediatric patients undergoing abdominal MRA. Read More

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

Authors: Leelakanok Nattinee, Zapala Matthew, Edwards Emily, Phelps Andrew, Mackenzie John, Courtier Jesse

Keywords: MRA, Pediatric, MRI

MRI of the abdomen faces several technical challenges owing to respiratory motion, bowel peristalsis, and the need for large volumetric coverage. In adult patients, imaging is typically performed during multiple breath holds to avoid motion artifact; however pediatric patients may be unable to perform consistent breath holds or remain motionless during MRI acquisition. Although techniques such as child life specialists, MRI video goggles, and dedicated MR suite environments have reduced the need for anesthesia in MRI, general anesthesia may be necessary in some patients. Simulating breath holds in anesthetized patients is a technically difficult procedure requiring timed ventilation of the patient's abdomen during MRI acquisition, and results in progressive image degradation due to retained air artifact. Dynamic Scan Optimization (DISCO) combines 3D DCEMRI + 2 pt Dixon + Parallel Imaging + Temporal Acceleration to provide high spatiotemporal resolution while drastically reducing scan time. Because pediatric patients have relatively low respiratory volumes, this technique enables acquisition of diagnostic quality images without breath-holding. The purpose of this exhibit is to: (1) provide a guide for successful application of navigated spontaneous breathing multiphase DISCO sequence (2) review common use cases of the DISCO sequence (3) provide practical suggestions for troubleshooting DISCO Read More

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

Authors: Cheng Jocelyn, Durand Rachelle, Zapala Matthew, Cort Kayla, Bhuller Jeanie, Courtier Jesse

Keywords: Dynamic contrast enhanced MRI, DIfferential Sub-sampling with Cartesian Ordering, pediatric abdominal MRI

Bladder masses are periodically encountered in the pediatric population, yet there are few resources to guide appropriate imaging assessment of pediatric bladder masses. A pediatric bladder mass may be encountered in a wide variety of clinical settings, ranging from investigation of a specific symptom or laboratory abnormality to an incidental finding during routine evaluation. Familiarity with the spectrum of benign and neoplastic processes that may give rise to pediatric bladder masses increases the likelihood of timely and accurate diagnosis and management. Read More

Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016

Authors: Edwards Emily, Zapala Matthew, Copp Hillary, Mackenzie John, Phelps Andrew, Courtier Jesse

Keywords: Bladder

Determine the incidence of occult malignancy detected by ¹⁸F-FDG PET-CT and whole body (WB) MRI in children. Read More

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

Authors: Kato Kambrie, Mackenzie John, Phelps Andrew, Courtier Jesse, Behr Spencer, Zapala Matthew

Keywords: whole body MRI, PET CT, paraneoplastic syndrome

Accurate diagnosis of venous malformations can be challenging, and confidently diagnosing them is important for accurate treatment. A thorough understanding of the etiology, imaging appearance, and important mimickers of venous malformations is critical for the radiologist to provide an accurate assessment for the clinician. Read More

Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016

Authors: Hughes Nicole, Phelps Andrew, Meyer Anna, Courtier Jesse, Mackenzie John, Zapala Matthew

Keywords: MRI, venous malformation, Whole body MRI, Blood pool MRI contrast agent

Virtual reality (VR) has been used successfully as a psychological preparation tool in the pediatric patient population for elective surgery, oncological procedures and pain management. MRI exams require patients to remain motionless in a small, confined space for extended periods of time creating nervousness and an inability to hold still. VR offers a new way to prepare pediatric patients for MRI through simulations to reduce nervousness and decrease motion, resulting in more successful imaging outcomes. This study is designed to assess if VR simulations of an MRI exam can increase anticipatory knowledge and reduce nervousness in a pediatric cohort. Read More

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

Authors: Zapala Matthew, Li Yi, Belisario Jennifer, Phelps Andrew, Courtier Jesse, Vlasses Christopher

Keywords: Virtual Reality, MRI, Child Life

Cat-Scratch Disease (CSD) is an infectious disease that predominantly affects pediatric patients, usually ages 4-9 years old. The annual incidence is estimated at 4.5 patients per 100,000 population. CSD is primarily caused by B. henselae, an intracellular gram-negative bacillus; it is transmitted via scratch, lick, or bite from a cat. It presents with lymphadenopathy proximal to the site of inoculation; most commonly, this is axillary, epitrochlear, cervical, or inguinal lymphadenopathy. While CSD can be diagnosed clinically and has objective findings on histopathology, the imaging findings are unclear and have been debated in the literature. As such, we sought to clarify the multimodal imaging findings associated with CSD. We performed a review of the literature to highlight the existing radiological consensus. We also contribute several of our own new cases from our institution. Read More

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

Authors: Baig Farhan, Zapala Matthew, Kim Jane, Durand Rachelle, Cohen Pierre-alain, Wattier Rachel, Courtier Jesse

Keywords: Cat Scratch Disease, CSD, lymphadenopathy