Both neuroradiologists and pediatric radiologists require unique skills to confidently manage pediatric neuroradiology cases either in a community setting, or in a specialized pediatric tertiary care hospital. We conducted a needs assessment of pediatric radiologists to define their neuroradiology subspecialty training experience and identify perceived skills and knowledge gaps as well as their attitudes toward a customized pediatric neuroradiology curriculum. Read More

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

Authors: Gokli Ami, Shekdar Karuna, Reid Janet

Keywords: Needs assessment, pediatric neuroradiology, training

The complete ultrasound (US) evaluation of the urinary tract in a pediatric patient should include both the urinary bladder and kidneys. Evaluation of the bladder as part of that overall US examination, however, can be deemphasized or incomplete due a number of factors, such as one’s neglecting to fully image the bladder from dome to bladder neck, suboptimal bladder distension, incomplete distension due to presence of an indwelling drainage catheter or vesicostomy, or in some instances, because the bladder is not included as part of the routine kidney ultrasound exam. True masses arising from the urinary bladder in children are generally rare, and at times, subtle and non-specific, and potentially mimicked by so-called pseudomasses, so we emphasize that correlation of findings with patient history is of paramount importance. This pictorial review will illustrate and describe the US appearances (along with selective cross-sectional imaging), clinical manifestations, and tumor growth patterns of common and uncommon conditions arising from the pediatric urinary bladder, i.e. path-proven masses that include leiomyosarcoma, pheochromocytoma, nephrogenic adenoma, vascular malformation, low grade urothelial neoplasms, neurofibromatosis, fibroepithelial polyps, rhabdoid tumor, and rhabdomyosarcoma. Pseudomasses of the bladder that will also be illustrated and briefly discussed include hematomas, urachal remnants, complex ureteroceles, Deflux injection sites, foreign bodies, and cystitis (viral, eosinophilic, parasitic). In addition to emphasizing the importance of the complete bladder examination, the purpose of this review is to increase radiologist’s awareness of the US appearances of the common and uncommon conditions which afflict the pediatric urinary bladder, as well as those conditions that can mimic bladder masses, in order to determine proper clinical management. Read More

Meeting name: SPR 2018 Annual Meeting & Postgraduate Course , 2018

Authors: Gokli Ami, Barrera Christian, Bellah Richard

Keywords: Bladder, Mass, Ultrasound

Ulnar hemimelia is a rare congenital disorder characterized by absence of the ulna with an estimated incidence of 1/100,000-150,000 live births. The etiology of this disease remains uncertain, however it is thought that the deformity develops between the 4th and 7th week of gestation. The disease can be either partial or complete, and can be found in isolation or in association with other skeletal dysplasias such as Gorlin-Goltz Syndrome, Cornelia de Lange syndrome, Klippel-Feil syndrome, finger anomalies including syndactyly and oligodactyly. The purpose of this educational review is to describe the characteristic imaging findings of ulnar hemimelia with attention paid to clinically important associated features; review the differential diagnosis for ulnar anomalies; and discuss the range of congenital anomalies that can be associated with this condition. We will also perform a brief review of the literature concerning this rare entity, present two cases of complete ulnar hemimelia with oligodactyly from our institution, and review the various treatment options. Read More

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

Authors: Gokli Ami, Koshy June, Neuman Jeremy

Keywords: Hemimelia, Congenital, Pediatric

Pediatric Contrast Enhanced Ultrasound (CEUS) is a safe and patient-friendly imaging modality. It improves the diagnostic capability of gray-scale and Doppler ultrasound without sedation, ionizing radiation and no use of iodinated or gadolinium-based contrast agents. Pediatric CEUS was originally used to detect vesicoureteral reflux, evaluate indeterminate focal liver lesions, assess and follow up solid-organ injuries sustained during blunt abdominal trauma. In 2016, the approval of Lumason® (Bracco Diagnostics Inc., Monroe Township, NJ) by the United States Food and Drug Administration (FDA) marked the beginning of a new era for CEUS imaging. Since then, clinical requests for pediatric CEUS not only increased in number but also for a variety of examinations covering practically every organ system, including pediatric brain, lungs, solid organs and bowel. In addition, intracavitary applications of pediatric CEUS are now extending beyond the urinary tract, to include urogenital and anorectal malformations. Intravenous and intracavitary CEUS is used in pediatric interventional radiology, to confirm enteric tube placement, guide biopsies and drainage procedures and aide organ vascular mapping (e.g. renal, central vessels). Novel pediatric CEUS applications now used include intranodal CEUS lymphangiography for confirmation of needle position preceding MRI lymphagiography. Pediatric CEUS is performed in a number of clinical settings including inpatient units, outpatient radiology, emergency department, and intraoperative. These evolving indications and uses of CEUS combined with continuous advances in ultrasound technology, such as three-dimensional/four-dimensional ultrasound and improved contrast sensitivity, are establishing pediatric CEUS as an important alternative imaging examination that can complement or supplement fluoroscopy, CT and MRI. This presentation reviews the current wide spectrum of pediatric CEUS applications and imaging findings, according to body part, and the associated imaging findings. Read More

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

Authors: Ntoulia Aikaterini, Back Susan, Hwang Misun, Gokli Ami, Anupindi Sudha, Biko David, Srinivasan Abhay, Poznick Laura, Darge Kassa

Keywords: contrast ultrasound, pediatric applications