PET/CT plays an important role in assessing response to therapy in patients undergoing treatment for Hodgkin’s lymphoma (HL). A negative PET/CT following completion of chemotherapy has a high negative predictive value (>95%) for disease progression, relapse, or recurrence. Thus treatment decisions, including the decision to pursue radiation therapy or to alter chemotherapy regimens, are often made based on PET/CT results. Given the treatment implications, obtaining accurate PET/CT results is of the utmost importance. Read More

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

Authors: Foust Alexandra, Voss Stephan

Keywords: Abnormal FDG uptake in white fat, gluconeogenesis, Hodgkin lymphoma therapy implications

An afebrile 23-month-old boy with history of VSD, PFO and GERD who presented with one day of acute left sided abdominal pain, nausea and vomiting. Following a benign clinical work-up only significant for mild leukocytosis and transient small bowel to small bowel intussusception on abdominal US, he was discharged home. He re-presented a few days later with worsening abdominal pain and low grade fever and was found to have increased leukocytosis and elevated CRP. KUB demonstrated a new left lower lobe opacity. Non-contrast CT abdomen showed a well circumscribed ovoid hyperdense soft tissue mass in the inferomedial left lower lobe, a small left pleural effusion, and adjacent passive atelectasis. On chest MRI , the left lower lobe soft tissue mass demonstrated T1 isointense to hyperintense and STIR hypointense signal with mild restricted diffusion and no enhancement on post-contrast images. MRA of the chest was negative for any feeding vessel extending to the lesion. Video-assisted thoracotomy surgery revealed a torsed, bluish left lower lobe mass adherent to the mediastinum with thrombosed vessels at its pedicle. Pathology results confirmed the suspected diagnosis of an infarcted and hemorrhagic extralobar pulmonary sequestration. Pulmonary sequestration is a rare congenital malformation of the foregut, where a nonfunctional supranumary segment of the lung lacking a normal connection to the tracheobronchial tree develops below the normal lung bud. The sequestration can be intralobar or extralobar, depending on the pleural investment, has arterial supply from systemic circulation, and venous drainage via pulmonary and/or systemic venous drainage. Torsed pulmonary sequestrations are extremely rare and occur when the sequestration twists around the axis of its vascular pedicle resulting in ischemia or infarction of the non-functional lung tissue. In the case of a full torsion, the vascular supply may not be visualized at imaging. Thus it is important to consider pulmonary sequestration as a differential diagnosis in a pediatric patient presenting with lower chest or abdominal pain with a circumscribed lower lobe pulmonary mass, even without characteristic feeding vessels on MRI/MRA. Read More

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

Authors: Ebai Jerky, Nicholas Jennifer, Foust Alexandra

Keywords: Pulmonary, Sequestration, Torsed

To determine the accuracy and significance of a fetal diagnosis of midface hypoplasia. Read More

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

Authors: Foust Alexandra, Barnewolt Carol, Poorvu Tabitha, Parad Richard, Estroff Judy

Keywords: Fetal MRI, Fetal Sonography

Scurvy (vitamin C deficiency) was largely considered to be historical until recent years. The current prevalence of scurvy in the United States is approximately 7.1% and is thought to be increasing due to growing awareness of neurodiverse populations. Neurodiverse individuals show patterns of thought or behavior that are different from those of most people, but are still considered within normal range of human behavior. Interchangeable terms include neurodivergent, neurodifferent, and neurominority. While these terms traditionally refer to individuals with autism spectrum disorder (ASD), they also include individuals with attention-deficit/hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), Trisomy 21, dyslexia, sensory disorders, and others. In the ASD population alone, the incidence increased from 1 in 150 children in 2000 to 1 in 36 children in 2020. Neurodiverse individuals are at risk for vitamin C deficiency as a result of a tendency towards extreme restricted diets. Clinically, vitamin C deficiency causes dermatologic symptoms (hyperkeratosis, corkscrew hair, poor wound healing), hemorrhagic symptoms (petechiae, ecchymoses, gingival bleeding), and skeletal symptoms (leg swelling/pain). It is largely a clinical diagnosis that can be supplemented or confirmed by laboratory, radiographic, and MRI investigations. This case review will highlight the typical presentation of scurvy with comments on the clinical presentation, associated neurodivergent behaviors contributing to the disease, and the radiographic and clinical diagnosis. In sum, vitamin C deficiency is becoming more prevalent in children that fall within the spectrum of neurodiversity and should be considered in the appropriate clinical context. Pediatricians and pediatric radiologists should be aware of the clinical emergence of scurvy, be able to recognize the imaging manifestations of the disease, and be sensitive to the unique needs of neurodiverse children. Read More

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

Authors: Hatcher Lauren, Cassella Katharyn, Foust Alexandra, Johnstone Lindsey, Leschied Jessica

Keywords: Vitamin C deficiency, Neurodivergent, Neurodiverse

Spinal cord lipomas are rare benign tumors of adipose tissue that have a range of presentations and management based on size, location, and embryogenesis. Importantly, the intradural lipomatous tissue can act as a tethering lesion placing the cord at risk of vascular compromise, particularly during periods of growth. Since spinal lipomas cause progressive disease and symptoms, early recognition and treatment in the pediatric population is beneficial. Neurosurgical literature supports further classification of spinal lipomas as dorsal, transitional, terminal, and chaotic based on location and imaging features for risk stratification, surgical planning, and prognostication. Although categorization for the purpose of guiding surgical management is based on imaging features, there currently is lack of representation of this classification system for spinal cord lipomas in the radiology literature. The aim of this exhibit is to educate pediatric radiologists about this classification system for spinal cord lipomas. Relevant anatomy and embryogenesis will be reviewed, and case-based examples will be used to illustrate relevant imaging features of each type of spinal lipoma. Findings impacting surgical planning and prognosis will be specifically highlighted. Read More

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

Authors: Park Seungweon, Sarma Asha, Dewan Michael, Leschied Jessica, Greene Elton, Pruthi Sumit, Martin Dann, Foust Alexandra

Keywords: spinal lipoma, embryogenesis, neuroradiology