Ocular ultrasound is an excellent tool for diagnosing and monitoring pediatric patients, delivering a reliable assessment and clear visualization of ocular anatomy. It can provide information about ocular irrigation and, consequently, the alterations in ocular pathology that would otherwise be difficult to assess. It is essential that radiologists possess a comprehensive understanding of the anatomy of the eye and understand the different changes associated with various eye diseases. Familiarity with the protocol of these images is crucial for effectively detecting and diagnosing these pathologies. Nevertheless, it's important to recognize ocular ultrasound's limits, especially in extraocular malignancies and orbital pathologies, which may be more appropriately evaluated using alternative imaging techniques. With this in mind, this exhibit aims to teach about pediatric ocular pathologies and how they can be identified using ultrasound. In addition, through imaging cases, recognize the characteristic ultrasound findings for each pathology: - Retinal detachment - Congenital cataracts - Proliferative Vascular Retinopathy of Prematurity - Retinoblastoma - Choroidal hemangioma - Papilledema Read More

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

Authors: De Leon-benedetti Laura, Wesley Lavinia Del Carmen

Keywords: Radiology, Ultrasound

Introduction: Fluoroscopy plays an important role in pediatric diagnostic imaging. However, its use has been replaced by other imaging modalities for some applications. While fluoroscopy offers dynamic evaluations of the airway, gastrointestinal tract, and urinary system, multiple barriers exist. It is an operator-dependent modality that requires expertise and additional training. Furthermore, concerns for radiation exposure and lower reimbursement rates exist, which add safety and financial disincentives. This educational exhibit provides a side-by-side comparison of traditional fluoroscopic studies and their replacement modalities. Fluoroscopy applications and their alternatives: Respiratory system: Foreign body aspiration: Radiography or CT Tracheomalacia: CT Diaphragmatic motion: Ultrasound or MRI Gastrointestinal Tract: Esophageal foreign body: Radiography Gastrostomy tube dislodgement: Radiography Upper GI (Malrotation and volvulus): Ultrasound Enema for intussusception reduction: Ultrasound guided reduction Enema for Hirschsprung diagnosis: Contrast radiograph Urinary Tract: Voiding cystourethrograms (VCUG): Contrast-enhanced vesicourethrosonography (CeVUS) Read More

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

Authors: De Leon-benedetti Laura, Lazarte Claudia, Miranda Schaeubinger Monica, Miliard Derbew Hermon, Jalloul Mohammad, Otero Hansel

Keywords: Radiology, Fluoroscopy

PTEN-related hamartoma tumor syndromes (PHTS) arise from germline pathogenic variants in the Phosphatase and Tensin homolog (PTEN) gene and include a broad spectrum of autosomal dominant clinical phenotypes with overlapping features. Its diagnosis is made through genetic testing prompted by family history or clinical features. In pediatric patients the most common feature leading to genetic testing is macrocephaly, in combination with other clinical findings, presenting in early childhood. PHTS is a multisystem disorder. Imaging findings on pediatric patients have a wide variability, but benign findings are the most common. In this educational exhibit, we will summarize the imaging findings of pediatric patients with confirmed PTEN diagnosis, based on our experience from three large children’s hospitals. The most common findings will be described by anatomical regions: - Central nervous system: white matter lesions, prominence of perivascular spaces, prominence of the ventricles and extra-axial spaces, and a dysplastic gangliocytoma of the cerebellum. - Thyroid/neck: benign lesions such as nodular goiter, follicular adenomas, colloid cysts, and features of thyroiditis and pediatric thyroid carcinoma. - Chest/mediastinum: infrequent lesions such as sclerosing pneumocytoma or chest wall lesions. - Nonvascular soft tissue masses: variable types of hamartomas including polyps, fibromas, and lipomas. - Vascular soft tissue masses: hemangiomas and classic PTEN hamartoma of the soft tissues (PHOST). At the end of our exhibit, we will include current suggested surveillance imaging protocol for these patients. Read More

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

Authors: De Leon-benedetti Laura, Martinez-rios Claudia, Tierradentro-garcia Luis, Kilicarslan Ozge, Caro Domínguez Pablo, Otero Hansel

Keywords: Radiology, Genetics, Pediatrics

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

Magnetic resonance imaging (MRI) has historically been restricted for patients with pacemakers, defibrillators, or other cardiac implantable electronic devices (CIEDs) due to safety concerns. Despite the introduction of MR conditional pacemakers in 2008, access to MRI in patients with CIEDS remains limited. MRI remains the diagnostic imaging study of choice for many indications and is necessary to prevent delayed diagnosis and the decision to proceed with MRI should follow a rigorous risk benefit assessment: Risks of: Lead heating causing injury at their tips Increased pacing thresholds Sudden battery depletion Inappropriate sensing/pacing The location of the image should be considered because if the request includes the area of the CIED then potential artifacts may decrease the diagnostic quality. However, an MRI remote from the location of the CIED entails a negligible risk of lead heating and MRI may be performed safely with continuous patient monitoring throughout the scan. In addition, in pediatric patients the necessity of anesthesia or sedation must be well-thought-out as it conveys additional risk to the patient. There is growing evidence from adult literature that MRI may be performed safely in patients with CIEDs with transvenous leads when appropriate protocols are followed. The Heart Rhythm Society (HRS) 2017 expert consensus statement indicates that MRI is reasonable in patients with MR non-conditional transvenous CIEDs if there are no fractured, epicardial, or abandoned leads. The Pediatric and Congenital Electrophysiology Society (PACES) of 2021 included that MRI may be considered in pediatric patients with epicardial or abandoned leads on a case-by-case basis. However, performing MRI in patients with CIEDs is a resource-intensive service and requires rigorous implant investigation, preparation, and planning as well as close coordination between treating physicians and radiologist. This educational exhibit summarizes current literature on the safety of MRI in patients with CIEDs and takes examples from our practice to build an evaluation program that allows for safe access to MRI in patients with CIEDs Read More

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

Authors: De Leon-benedetti Laura, Ramirez Suarez Karen, Otero Hansel, Rapp Jordan, Biko David, Smith Christopher, Serai Suraj, White Ammie

Keywords: Cardiac, Magnetic Resonance