<b>This study implements a practical collimation technique utilizing external body landmarks to produce more consistent and appropriate collimation for portable neonatal intensive care unit (NICU) chest radiographs (CXR).</b> Read More

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

Authors: Schat Robben, Holm Tara, Murati Michael

Keywords: NICU, chest radiograph, collimation

The presacral space is composed of multiple tissue types, including osteochondral, mesenchymal, neurogenic, vascular and lymphatic. The presence of these tissues leads to a long and complex differential for a presacral mass in a pediatric patient. Specifically, the differential also includes anterior sacral meningocele, enteric cyst, vascular malformations, neuroblastoma, ganglioneuroma, schwannoma, neurofibroma, rhabdomyosarcoma, lymphomatous masses, giant cell tumor, aneurysmal bone cyst, osteosarcoma, Ewing sarcoma, and chordoma. Imaging plays a key role in characterizing these masses and treatment planning. Familiarity with the common presacral masses of infancy and childhood is therefore necessary for the pediatric and general radiologist. Once an osteochondral or neurogenic mass is excluded, and a predominantly cystic presacral mass is present, the primary differential consists of a collection of developmental or congenital masses including sacrococcygeal teratoma, anterior meningocele, low flow vascular malformation, and an enteric duplication cyst. We will review the common imaging features and associations of these cystic masses by presenting a series of cases. Additional examples of solid and osteochondral presacral masses will be included where appropriate for comparison in order to avoid characterization pitfalls and highlight teaching points. Read More

Meeting name: SPR 2019 Annual Meeting & Postgraduate Course , 2019

Authors: Murphy Ryan, Murati Michael, Holm Tara, Dietz Kelly

Keywords: anterior meningocele, low flow vascular malformation, enteric cyst

<b>Total pancreatectomy and islet autotransplantation (TPIAT) has become an increasingly utilized option for pain management in pediatric patients with chronic and hereditary pancreatitis. Doppler ultrasound of the liver is routinely used to evaluate patency of the portal vein and assess portal vein and hepatic artery velocities after this procedure. However, to the best of our knowledge no study has established the expected Doppler findings on pediatric patients after TPIAT. This study is intended to establish normal values for velocities in the hepatic artery and portal vein in pediatric patients after TPIAT, and to determine the rate of hepatic vascular complications in these patients.</b> Read More

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

Authors: Holm Tara, Murati Michael, Hoggard Eric, Dietz Kelly

Keywords: Islet Autotransplantation, pancreatitis, Doppler

Portal hypertension in pediatric patients is rare, most commonly caused by extrahepatic portal vein (PV) occlusion. Complications include gastrointestinal bleeding. If obstruction recanalization or surgical shunt is not feasible, a transjugular intrahepatic portosystemic shunt (TIPS) can be placed. Risks of TIPS include encephalopathy, shunt stenosis, or thrombosis. Tipsitis is rare, occurring in less than 1% of TIPS patients, but is serious, with a mortality of 32%. Early diagnosis and treatment are key to preventing the need for liver transplantation, and imaging plays a key role in early detection. We present a case of tipsitis identified with FDG-PET/CT imaging. A 16 year-old-male with prematurity, umbilical vein catheter, and heterozygous prothrombin mutation presented with hematemesis. Imaging identified chronic PV thrombosis. Due to the occlusion involving both the right and left PV, TIPS was placed. 5.5 months post-TIPS, he presented with fever and body aches. Investigations revealed Methicillin-Sensitive Staphylococcus aureus (MSSA) bacteremia and thrombosed TIPS. He completed a 6-week course of IV antibiotics, and the TIPS was revised. Two weeks later, he was readmitted with recurrent MSSA bacteremia. FDG-PET/CT scan was performed, showing increased TIPS uptake, consistent with tipsitis. He completed an additional 8-week IV antibiotic course. Repeat FDG-PET/CT showed decreased but persistent TIPS uptake. IV antibiotics were extended, and he was placed on suppressive oral antibiotics with a plan for FDG-PET/CT in 3 months. Tipsitis is rare, and early infection (&lt;120 days) is associated with gram-positive bacteria caused by seeding during placement. In this case, later infection was suspected to be caused by Staph aureus superinfection during influenza. Low-grade symptoms include malaise, and high-grade symptoms include fever and rigors. Suspicious CT findings include peri-graft gas or fluid. Radiolabeled leukocyte uptake is specific to infection, but spatial resolution is limited. FDG-PET/CT with focal TIPS metabolic activity (SUV &gt; 8.0) correlates with infection source (sensitivity 91-98%, specificity 64–91%). Antibiotic therapy is successful in 53% of cases, and FDG-PET/CT can determine the degree of treatment success. Residual hypermetabolic activity signifies partial response. Aggressive antibiotics are recommended to prevent resistance and the need for liver transplant. FDG-PET/CT plays a vital role in diagnosis and management of tipsitis. Read More

Meeting name: SPR 2025 Annual Meeting , 2025

Authors: Cregg Allison, Nguyen Theo, Holm Tara, Flanagan Siobhan

Keywords: Portal Vein Thrombosis, FDG PET, Interventional Radiology

Chronic pancreatitis (CP) is characterized by permanent damage to the pancreas resulting in endocrine and exocrine deficiencies. CP is often associated with a history of acute recurrent pancreatitis. Pediatric CP is most commonly linked to known genetic mutations, such as <i>PRSS1 </i>or <i>CFTR</i>, and there is an increased risk of pancreatic adenocarcinoma in patients with hereditary pancreatitis. The mainstay of CP management involves controlling chronic pain and preserving quality of life. Total pancreatectomy and islet auto-transplantation (TPIAT) is an option for managing pain in pediatric patients with uncontrollable pain or pancreatitis secondary to genetic causes. TPIAT was first performed at the University of Minnesota in 1971. Currently there are more than 15 academic institutions in the US performing TPIAT and that number continues to rise. TPIAT has been shown to be effective for pain relief as well as maintaining insulin independence in adults and young pediatric patients. The timing of TPIAT in a patient’s disease course is critical because islet cell yield is inversely correlated with pancreatic fibrosis, and postoperative diabetes outcomes depend on islet yield. Imaging prior to transplant is aimed at assessing changes of pancreatitis, vessel patency, and identifying vessel and pancreatic ductal anatomic variants. Preoperative imaging can also confirm adequate liver volume for the procedure and identify postoperative changes from previous procedures such as distal pancreatectomy or Puestow procedure (pancreaticojejunostomy). Routine postoperative imaging consists of liver Doppler ultrasound screening because elevated infusion pressures during autotransplantation can result in endothelial injury and portal vein thrombosis. Delayed gastric emptying and small bowel ileus are common postsurgical complications, and targeted cross-sectional imaging, radiography, and fluoroscopy may be performed based on patient symptoms. Once bowel function has returned, enteral feeds are started via gastrojejunostomy tube and can sometimes be complicated by GJ tube-related intussusception. The largest retrospective review in pediatric patients showed a 20% surgical complication rate, with the most common complication being post-splenectomy thrombocytosis. We present pertinent imaging findings for surgical planning in patients with CP prior to TPIAT, expected postoperative imaging findings, and imaging of postoperative complications. Read More

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

Authors: Ames Jeff, Holm Tara, Murati Michael, Hoggard Eric, Dietz Kelly

Keywords: Chronic pancreatitis, Islet autotransplant, Total pancreatectomy