The advent of fast CT scanners with lower radiation doses has resulted in rapid growth in the numbers of cardiac CTs being performed in children. This has also increased the number of CTs interpreted by cardiologists, similar to adult cardiac CT. Pediatric cardiac CT demonstrates multiple potential extracardiac variants and pathology that may occur in conjunction with congenital heart disease (CHD). Prior publications in adult cohorts demonstrate a wide-range and incidence of extracardiac findings (6-39%) but the prevalence in children is unknown. Therefore, the purpose of this abstract is to describe incidence, distribution and significance of the extracardiac findings found in pediatric cardiac CT at a tertiary referral center. Read More

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

Authors: Sassoon Daniel, Malone Ladonna, Weinman Jason, Mcgraw Marty, Barker Alex, Browne Lorna

Keywords: cardiac, extracardiac

4D flow MRI with full coverage of the heart and proximal vessels is a powerful tool to understand hemodynamic pathology arising from congenital heart disease (CHD) and subsequent surgery; however, scan times often exceed 10 minutes thereby limiting widespread adoption in pediatrics. Decreasing scan time using compressed-SENSE (CS), a combination of conventional parallel imaging (SENSE) and randomized spatial undersampling, shows promise over SENSE alone. However, both the feasibility and its effect on accurate flow quantification in pediatrics has not been evaluated. This study investigated the feasibility of CS for pediatric 4D flow MRI to quantify flow indices used in risk stratification of CHD such as coarctation or pulmonary regurgitation, in comparison with SENSE. Read More

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

Authors: Fujiwara Takashi, Browne Lorna, Malone Ladonna, Lu Quin, Fonseca Brian, Dimaria Michael, Barker Alex

Keywords: 4D flow, Compressed SENSE, Congenital heart disease

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