Cavernous transformation of the portal vein (CTPV) is characterized by the formation of venous channels within and around a previously stenosed or occluded portal vein, serving as portoportal collateral vessels. It is a major cause of portal hypertension in children and requires a multifaceted management approach, including medical therapy, interventional procedures such as portal recanalization, and surgical treatments ranging from shunt creation to liver transplantation in end-stage cases. CT-angiography, in combination with portal venography, is the key imaging modality for determining the optimal treatment strategy. It is essential not only for assessing liver cirrhosis and secondary signs of portal hypertension—such as portosystemic collaterals, splenomegaly, and ascites—but also for providing detailed anatomical mapping critical for surgical planning. This presentation will illustrate various pediatric cases of CTPV and discuss the optimal management approach based on factors including the presence or absence of liver cirrhosis, dominant portal collaterals, intrahepatic portal flow, proper superior mesenteric vein communicating with the porta hepatis, and splenorenal shunts, among others. For each scenario a therapeutic plan will be suggested based upon clinical and imaging criteria. By the end of this presentation, readers will be able to: Optimize CT protocols for evaluating CTPV; enhance reporting using a structured checklist of key findings; and support clinical decision-making in collaboration with multidisciplinary teams. Read More

Meeting name: SPR 2026 Annual Meeting , 2026

Authors: Arenos-abril Jesus, Moreira Maricela, Barnes Navarro Daniel, Padros Fornieles Cristina, Molino Gahete Jose Andres, Riaza Lucía

Keywords: Liver, Portal Vein Thrombosis, Portal Hypertension

Osteonecrosis (ON) is a significant complication in pediatric oncology, characterized by bone tissue death due to impaired blood supply. It most commonly affects poorly vascularized bones, such as the femoral head, distal femur, and proximal tibia. In children with oncohematological diseases, ON is often multifactorial—linked to prolonged corticosteroid therapy, chemotherapy, and underlying systemic conditions. Prevalence can reach up to 40% in high-risk groups. This educational poster aims to equip radiologists with practical imaging strategies for early detection and staging of ON, enhancing diagnostic confidence and multidisciplinary collaboration. This work builds on institutional experience at a high-complexity pediatric hospital, integrating recent imaging protocols and outcome data to refine diagnostic pathways. Early diagnosis is crucial, as ON is frequently asymptomatic and multifocal at onset. Magnetic resonance imaging (MRI) is the gold standard for early detection, with whole-body MRI protocols enabling comprehensive screening of asymptomatic patients. MRI findings include bone marrow edema and geographic areas of necrosis, often surrounded by the characteristic double line sign. Advanced stages show subchondral collapse, loss of sphericity, and cartilage irregularity, which can be graded using systems such as Niinimäki, Ficat and Arlet, or ARCO. The use of whole-body MRI for asymptomatic screening represents a proactive approach that may reduce long-term disability in pediatric oncology patients. Conventional radiography is useful for assessing bone structure and detecting late-stage changes, while computed tomography (CT) is reserved for preoperative planning. Treatment strategies depend on the severity and location, ranging from conservative management (corticosteroid withdrawal, bisphosphonates, load reduction) to surgical interventions such as core decompression or, in severe cases, joint replacement. Imaging plays a key role not only in early diagnosis but also in monitoring treatment response and guiding surgical planning. Imaging also plays an important role in complications, that include acute subchondral fractures and superinfection, which require prompt recognition and management. Radiologists play a pivotal role in early detection. Familiarity with imaging patterns and grading systems is essential to guide timely intervention and improve long-term outcomes. Read More

Meeting name: SPR 2026 Annual Meeting , 2026

Authors: Riera Luis, Moreira Maricela, Arenós Jesús, Perdomo-luna Camilo, Vázquez Elida, Kvist Ola

Keywords: Oncology, Osteonecrosis, MR