Contrast-enhanced ultrasound (CEUS) for the evaluation of the neonatal brain provides additional diagnostic information when compared to conventional gray scale ultrasound through the detection of perfusion abnormalities associated with injury. When compared to cross-sectional imaging, CEUS has many advantages given its relative low cost and ability to be performed at the bedside, without the need for sedation or exposure to ionizing radiation. Diagnostic information is yielded through the qualitative evaluation of parenchymal enhancement patterns as well as quantification of microbubble perfusion kinetics from which time intensity curves are derived and additional perfusion parameters can be extrapolated. Given the 2-dimensional nature of the modality, a strategically designed scanning protocol is necessary to obtain the aforementioned quantitative values. The purpose of this exhibit is to demonstrate the current understanding of brain CEUS and educate on the brain CEUS protocol used for the diagnosis of neonatal brain pathology. Read More

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

Authors: Cort Kayla, Piskunowicz Maciej, Hwang Misun

Keywords: hypoxic ischemic injury

Pediatric hydrocephalus is a common disease in the United States, accounting for more than 39,000 annual admissions and a healthcare cost of $1.4-2.0 billion. Timely detection and intervention of intracranial hypertension (ICP), a complication of hydrocephalus, is associated with an improved neurologic outcome. This research aims to evaluate the feasibility of assessing the movement of the floor of the third ventricle and intracranial arterial pulsations on mid sagittal view of the grayscale brain ultrasound for predicting ICP in neonates and infants. Read More

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

Authors: Lemessa Natae, Martinez-correa Santiago, Lerebo Wondwossen, Hwang Misun

Keywords: intracranial arterial pulsation, intracranial hypertension, gray scale ultrasound

To survey active members of the Society for Pediatric Radiology regarding their utilization of various cranial ultrasound techniques and reporting practices in neonates. Read More

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

Authors: Leschied Jessica, Horst Kelly, Lampl Brooke, Hwang Misun

Keywords: SPR survey, neurosonography, neonatal imaging

Ultrasound (US) is a powerful imaging tool in the evaluation of neonates with suspected hypoxic-ischemic encephalopathy (HIE). US evaluation of the neonatal brain has been mainly performed qualitatively, comparing intracranial structures with different echotextures. Qualitative US analysis of the neonatal HIE brain may vary according to technical variations, the severity of the injury and the presence of coexistent complications. Quantitative analysis of the neonatal brain echotexture has been seldom attempted. Our aim was to compare the echotextures of specific brain regions between HIE patients and controls. Read More

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

Authors: Goncalves Fabricio, Khrichenko Dmitry, Zheng Qiang, Hwang Misun

Keywords: Ultrasound, Hypoxic-ischemic encephalopathy

To provide radiologic-pathologic correlation of brain injury in the Papez circuit in neonates with hypoxic-ischemic encephalopathy (HIE) and correlate radiologic findings with long-term neurodevelopmental outcomes. Read More

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

Authors: Zheng Qiang, Viaene Angela, Freeman Colbey, Hwang Misun

Keywords: papez circuit, arterial spin labeling, pathology

Hypoxic ischemic encephalopathy (HIE) is a significant cause of severe long term neurological impairment and mortality in the newborn. It develops in two stages; the ischemic phase caused by hypoxia leading to cytotoxic edema, followed by the reperfusion phase with the release of reactive oxygen species leading to oxidative damage and vasogenic edema. Imaging plays a key role in diagnosis, management, and treatment of HIE. It also offers important prognostic information. MRI remains the preferred imaging modality. Microvascular imaging (MVI) is a novel advanced Doppler ultrasound (US) technique that permits visualization of the microvasculature without the administration of contrast agents. It enhances the visualization of flow signal in the microvessels and helps reveal functional insights into the brain at high resolution. A female newborn of 32 weeks of gestation was delivered by urgent C-section following absent fetal movements and suspected placental abruption. She was born to a mother with a reported exposure to cocaine with a last use the week prior to delivery. At birth, no pulse was detected, and CPR was initiated immediately. O2 saturation remained low during resuscitation despite intubation and a FiO2 of 100%. Return of spontaneous circulation was noted 50 minutes after birth. Following birth, the patient was diagnosed with severe HIE and had multiple seizures. Her physical exam revealed fixed and cloudy pupils with a diameter of 4 mm and no brainstem reflexes. At one day of life, a brain US was done and displayed diffusely increased echogenicity of the parenchyma and crowding of the cortical gyri concerning for cerebral edema. MVI revealed markedly increased microvascular perfusion in the basal ganglia, thalami, and periventricular region consistent with post-ischemic reperfusion in the setting of HIE. MRI showed diffusion restriction throughout the brain including the medial temporal lobes, hippocampi, thalami, basal ganglia, and frontoparietal cortex. Also noted was extensive hyperintense signal abnormality on T2-weighted sequences within both the gray and white matter with loss of the gray-white matter differentiation and moderate sulcal effacement. These findings confirmed the diagnosis of severe HIE. In our case, MVI demonstrated marked hyperperfusion in the basal ganglia, thalami and periventricular region. Whether this MVI flow signature can prognosticate poor clinical outcomes, it warrants further investigation. Read More

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

Authors: Haddad Sophie, Foran Ann, Tierradentro-garcia Luis, Ho Fung Victor M, Hwang Misun

Keywords: Microvascular Imaging, Hypoxic ischemic encephalopathy

The purpose of this experiment was to evaluate the correlation between the doppler and intracranial pressure (ICP) and mean arterial pressure (MAP) in a pediatric porcine model of asphyxia-associated cardiac arrest. Read More

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

Authors: Khaw Kristina, Sridharan Anush, Poznick Laura, Kilbaugh Todd, Hwang Misun

Keywords: Contrast Enhanced Ultrasound, Intracranial Pressure

The purpose of this experiment was to evaluate the correlation between the doppler and intracranial pressure (ICP) and mean arterial pressure (MAP) in a pediatric porcine model of asphyxia-associated cardiac arrest. Read More

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

Authors: Khaw Kristina, Sridharan Anush, Poznick Laura, Kilbaugh Todd, Hwang Misun

Keywords: Doppler, Intracranial Pressure

To create a three dimensional (3D) ultrasound (US) bowel phantom that simulates bowel sonographic characteristics to aid in education for bowel scanning techniques and for microbubble contrast utilization in bowel. Read More

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

Authors: Dennis Rebecca, Silvestro Elizabeth, Hill Lamont, Andronikou Savvas, Anupindi Sudha, Hwang Misun

Keywords: Bowel Phantom, Bowel Ultrasound, 3D Printing

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