Chronic non-infectious osteomyelitis (CNO) is an autoinflammatory disorder of unknown etiology that is characterized by sterile, painful, and destructive bone lesions and has its peak incidence in childhood. Its presentation can be highly variable, and when children present with solitary lesions having an indolent course, the clinical picture and imaging features at presentation can overlap with those of Ewing sarcoma (EWS), a rare, highly malignant, primary pediatric bone tumor with a poor prognosis. Osteomyelitis is a known imaging mimic of EWS, but CNO poses a particular problem because a lack of clinical markers usually indicative of infection can cause the disease to be mistaken for a malignancy at clinical workup as well as imaging. A misdiagnosis between these two diseases may have serious repercussions for treatment and clinical course with potentially devastating effects on patient outcomes. Read More

Meeting name: SPR 2022 Annual Meeting & Postgraduate Course , 2022

Authors: Lankester Evelyn, Graeber Brendon

Keywords: CNO, Ewing´s Sarcoma

Although juvenile inflammatory arthritis is one of the most common atraumatic joint pathologies in children, many other infectious, vascular, and hemorrhagic lesions, benign and malignant neoplasms, and tumor-like conditions are known to affect the pediatric synovium and periarticular soft tissues. In a child with suspected joint pathology, radiographs are an essential part of the initial imaging assessment, followed by MRI for more definitive characterization of the synovial lesion. Ultrasound is also an important adjunct modality in the imaging of these entities. In this educational poster, we highlight the diagnostic imaging features of some of the common and uncommon pediatric synovial pathologies with emphasis on the specific MRI characteristics that aid in accurate diagnoses, such as presence of a solid or cystic mass, thick enhancing synovium, rice bodies, cartilaginous and osseous loose bodies, vascular channels, hemosiderin staining, articular erosions and marrow edema. Synovial sarcoma and vascular malformations, while not truly synovial lesions, are also considered because they are sometimes located near the joints and because they can have clinical and imaging overlap with synovial lesions. The following entities will be illustrated and reviewed: 1. Baker cyst 2. Ganglion cyst 3. Oligo-articular JIA (knee and wrist) 4. Tuberculous arthritis 5. Tenosynovial giant cell tumor 6. Hemophilic arthropathy 7. Synovial chondromatosis 8. Low-flow vascular malformation 9. Synovial sarcoma (knee, ankle and elbow) We also propose an MRI-based diagnostic algorithm for accurate characterization of pediatric synovial pathologies based on morphology (localized versus diffuse, cystic versus solid); signal characteristics on T2-weighted images, gradient sequences and post-gadolinium images; and associated osseous changes, in addition to certain highly specific radiological features of each entity. Read More

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

Authors: Rajani Heena, Graeber Brendon

Keywords: Synovial lesions, MRI

Limiting radiation exposure while obtaining diagnostic-quality imaging is an essential goal of diagnostic radiology. This is particularly true for computed tomography (CT) scanning in children, who are more susceptible than adults to stochastic effects of radiation exposure. High-pitch technique with iterative reconstruction using modern dual-source CT scanners can reduce CT dose. This method uses some combination of peak kilovoltage (kVp) reduction and tube current modulation while also leveraging dual-source geometry to increase the pitch at which the images are acquired. Our institution recently transitioned to this method of performing CT scans. As part of a quality assurance study, we reviewed the dose exposure to our patients pre- and post-implementation. Read More

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

Authors: O'connor Seán, Graeber Brendon

Keywords: Dose Reduction, dual-source, high-pitch