The purpose of this educational presentation is to delve into the physics of Microvascular Flow Imaging (MVFi) and showcase its significance in the imaging of pediatric vascular anomalies. MVFi complements grayscale and traditional color or power Doppler imaging of vascular malformations. MVFi is an advanced Doppler ultrasound technique that excels in detecting slow blood flow in smaller vessels and capillaries without the use of a contrast agent. Different vendors utilize proprietary MVFi algorithms to isolate the slow flow signal from tissue artifacts and enhance spatial resolution. However, MVFi algorithms are susceptible to motion and flash artifacts, which can be challenging in young children. Nevertheless, in the appropriate setting, MVFi enables improved delineation of slow-flow lesions through the detection of intravascular slow flow, which may be located in the lesion or in the surrounding tissues. MVFi can play a vital role in monitoring residual or recurrent disease following intervention. In this work, we will explore the physics through case presentations to illustrate the combined use of MVFi with grayscale and conventional Power Doppler in diagnosing and managing pediatric vascular anomalies with slow flow. Read More

Meeting name: SPR 2025 Annual Meeting , 2025

Authors: Juang Eric, Giersch Kristie, Katz Danielle, Annam Aparna, Tutman Jeffrey, Zavaletta Vaz

Keywords: Vascular Anomalies, Vascular Imaging, Doppler US

Through a series of cases, this poster demonstrates how to diagnose and treat biliary anastomotic complications with image-guided techniques in infants after liver transplant. We present several cases to illustrate the variability of biliary anastomoses including location, type, and number of anastomoses. Pediatric interventional radiologists and image-guided procedures are critical in the successful management of post-transplant biliary anastomotic strictures and leaks and minimize the need for invasive reoperation. The selected cases illustrate complex image-guided percutaneous management of multiple duct anastomotic strictures, anastomotic dehiscence, cut surface leaks, and removal of surgically placed stents that may be malpositioned and/or causing obstruction. The interventional methods used to percutaneously manage these cases include complex biliary access utilizing snares, multiple drain placement, stent placement, and rendezvous procedures with endoscopic retrograde cholangiopancreatography. The use of image-guided techniques by the pediatric interventional radiologist are invaluable in the management of biliary complications post-liver transplant in infants. Read More

Meeting name: SPR 2025 Annual Meeting , 2025

Authors: Juang Eric, Collard Michael, Katz Danielle, Adams Megan, Wachs Michael, Annam Aparna, Zavaletta Vaz

Keywords: Transplant Interventions, Biliary, Image-Guided

Generalized Lymphatic Anomaly (GLA) is a rare multisystem congenital disorder originating from the abnormal development of the lymphatic system which occur under the spectrum of Complex Lymphatic Anomaly (CLA). In addition to GLA, other CLAs include Kaposiform Lymphatic Anomaly (KLA) and Gorham-Stout Disease (GSD). Lymphatic malformations (LM) associated with GLA are usually apparent at birth or by two years of age. GLA can affect almost any organ of the body but is most commonly associated with lymphatic abnormalities in the skin, abdominal/thoracic viscera and bone. Multisite soft tissue LM can occur in all CLAs, with macrocystic lymphatic malformations being most common in GLA. These lesions can be found in the mediastinum, retroperitoneum, and subcutaneous tissue. Abdominal viscera involved include the spleen and liver. The frequency of focal splenic lesions is higher with GLA and KLA in comparison to GSD. On MRI, the lesions exhibit marked T2 hyperintensity with no discernable enhancement. In patients with larger splenic lesions, areas of T1 hyperintensity have been documented. Liver lesions in GLA have a similar appearance to the previously described splenic lesions. Nakamura et al. found that more than 30 focal splenic lesions and/or focal splenic lesions with maximum diameters greater than >10 mm were observed only in patients with GLA. On contrast enhanced CT, the lesions are generally well-circumscribed and hypodense. Within the thorax, mediastinal LMs can be seen in GLA but are more common in KLA and GSD. Chylous effusions can occur in all of the CLAs, although it has been reported that effusions in GLA were more likely to be associated with mediastinal involvement. Osseus involvement is common in patients with GLA. GLA has a predilection for the appendicular skeleton, in which the ribs are most affected although cranial, vertebral and lower extremity lesions have been reported. The lesions are usually non-contiguous with medullary destruction and sparing of the cortex. This is in contrast to GSD where cortical destruction, progressive osteolysis, contiguous lesions, and soft tissue infiltration are more common. Educational Goals: 1) Illustrate the most common imaging characteristics by each organ system affected by GLA and how to differentiate GLA from other CLAs. 2) Raise awareness of the optimal imaging evaluation in patients with GLA. 3) Outline an approach to multidisciplinary management of patients with GLA through a vascular anomalies center. Read More

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

Authors: Jordan Gregory, Zavaletta Vaz, Malone Ladonna, Katz Danielle, Nakano Taizo, Kulungowski Ann, Annam Aparna

Keywords: Generalized Lymphatic Anomaly, Lymphatic Malformations, Complex Lymphatic Anomaly