MRI can accurately quantify liver iron concentration (LIC) by using T2* sequences. Vendor based, commercially available 3D multi-echo Dixon sequences provide maps of liver T2*/R2* and allow automated, inline post-processing, avoiding conventional manual post-processing. The purpose of our study was to compare R2*/LIC estimates generated by automated 3D multi-echo Dixon sequence to values generated by GRE-based R2* relaxometry as the reference standard. Read More

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

Authors: Venkatakrishna Shyam Sunder, Otero Hansel, Khrichenko Dmitry, Serai Suraj

Keywords: Liver Iron Concentration, 3D multi-echo Dixon, MRI

Due to the COVID-19 pandemic, after more than 12 years of in-person programming, our educational collaboration with radiology trainees from Tikur Anbessa Specialized Hospital (TASH) in Ethiopia was interrupted. Similar to many US based programs, conferences were transitioned to a virtual format. Since January 2021, we have offered weekly hour-long Friday Case review sessions to residents and fellows from Addis Ababa University. After the first 4 months in which only 2 faculty members presented every week, the opportunity for additional volunteers was offered to all faculty members and the program continued. Here, we describe the results of the last 6 months of the teaching sessions. Read More

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

Authors: Derbew Hermon Miliard, Hailu Tigist, Salah Fathia Omar, Otero Hansel

Keywords: global, education, pediatric radiology

Hepatopulmonary fusion (HPF) is a very rare type of right-sided congenital diaphragmatic hernia (CDH) with a reported prevalence of 3 in 1000 right-sided CDH cases. By June 2020, less than 50 cases have been reported in the literature. Out of 147 patients with right CDH managed at our institution, we found only one case (0.68%) of HPF, which is presented here. HPF is typically not identified preoperatively, and the presence of HPF changes the operative management. It has been reported that a large right CDH without leftward cardiomediastinal shift and atelectatic lung adherent to the liver are imaging features of HPF. This patient was a full-term, newborn girl with a normal prenatal course who developed respiratory distress immediately after birth. Chest radiograph at birth demonstrated a right CDH. On day four of life, the patient underwent surgical repair of right CDH. During the procedure, hepatopulmonary fusion involving the cephalad portion of the liver was discovered. The lung and liver could not be separated safely so the diaphragmatic defect was closed around the portion of the liver that extended into the thorax. Postoperative CT angiography of the chest and abdomen demonstrated no abnormal vascular communication between the lungs and liver; however, anomalies of systemic veins were identified. Follow-up chest radiograph at 9 months of age demonstrated a large right CDH that did not include bowel or right-sided colon and was without leftward mediastinal deviation. Concurrent contrast-enhanced CT images of the thorax at this time confirm the right CDH with herniated liver occupying most of the right hemothorax and expected rightward traction of the liver vasculature. However, no significant leftward mediastinal deviation was noted. A small amount of atelectatic lung overlying the liver was also noted, another imaging sign expected with HPF. Last follow-up at age 4, patient was thriving with normal growth and development. Read More

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

Authors: Stern Joseph, Ramirez Suarez Karen, Victoria Teresa, Otero Hansel

Keywords: Hepatopulmonary Fusion, Congenital diaphragmatic hernia, CTA

The Choosing Wisely initiative, led by the American Board of Internal Medicine (ABIM) Foundation in collaboration with over 80 medical societies and organizations, was launched in 2012 in the United States and Canada. Choosing Wisely is a response to the estimation that roughly 20% of current medical tests and therapies lack justification, provide no value, and may pose risks. The American Academy of Pediatrics (AAP) became a participant in Choosing Wisely from the start, resulting in 16 pediatric specialty-specific lists designed to assist AAP members in responsible healthcare resource management. While pediatric radiology did not develop its own list, imaging recommendations were included on fully half of the published AAP/Choosing Wisely lists. Read More

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

Authors: Ramirez Suarez Karen, Miranda Schaeubinger Monica, Barton Katherine, Riedesel Erica, Otero Hansel

Keywords: Pediatric, Imaging, Radiology

Access to healthcare, and in particular to pediatric subspecialties, including pediatric radiology, is limited. Increasingly limited access creates or accentuates preexisting disparities and injustices. However, because of the complexity of the issue, it is difficult to objectively study and quantify it. This exhibit will describe current barriers to pediatric radiology access, available research tools and methodologies that can help us measure the impact of such barriers. Then, we propose a research agenda to systematically approach the problem. Read More

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

Authors: Morales-tisnés Tatiana, Miranda Schaeubinger Monica, Yaya Carlos, Milla Sarah, Heller Richard, Otero Hansel

Keywords: Pediatric radiology, Access to healthcare, Research agenda

Introduction: Fluoroscopy plays an important role in pediatric diagnostic imaging. However, its use has been replaced by other imaging modalities for some applications. While fluoroscopy offers dynamic evaluations of the airway, gastrointestinal tract, and urinary system, multiple barriers exist. It is an operator-dependent modality that requires expertise and additional training. Furthermore, concerns for radiation exposure and lower reimbursement rates exist, which add safety and financial disincentives. This educational exhibit provides a side-by-side comparison of traditional fluoroscopic studies and their replacement modalities. Fluoroscopy applications and their alternatives: Respiratory system: Foreign body aspiration: Radiography or CT Tracheomalacia: CT Diaphragmatic motion: Ultrasound or MRI Gastrointestinal Tract: Esophageal foreign body: Radiography Gastrostomy tube dislodgement: Radiography Upper GI (Malrotation and volvulus): Ultrasound Enema for intussusception reduction: Ultrasound guided reduction Enema for Hirschsprung diagnosis: Contrast radiograph Urinary Tract: Voiding cystourethrograms (VCUG): Contrast-enhanced vesicourethrosonography (CeVUS) Read More

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

Authors: De Leon-benedetti Laura, Lazarte Claudia, Miranda Schaeubinger Monica, Miliard Derbew Hermon, Jalloul Mohammad, Otero Hansel

Keywords: Radiology, Fluoroscopy

PTEN-related hamartoma tumor syndromes (PHTS) arise from germline pathogenic variants in the Phosphatase and Tensin homolog (PTEN) gene and include a broad spectrum of autosomal dominant clinical phenotypes with overlapping features. Its diagnosis is made through genetic testing prompted by family history or clinical features. In pediatric patients the most common feature leading to genetic testing is macrocephaly, in combination with other clinical findings, presenting in early childhood. PHTS is a multisystem disorder. Imaging findings on pediatric patients have a wide variability, but benign findings are the most common. In this educational exhibit, we will summarize the imaging findings of pediatric patients with confirmed PTEN diagnosis, based on our experience from three large children’s hospitals. The most common findings will be described by anatomical regions: - Central nervous system: white matter lesions, prominence of perivascular spaces, prominence of the ventricles and extra-axial spaces, and a dysplastic gangliocytoma of the cerebellum. - Thyroid/neck: benign lesions such as nodular goiter, follicular adenomas, colloid cysts, and features of thyroiditis and pediatric thyroid carcinoma. - Chest/mediastinum: infrequent lesions such as sclerosing pneumocytoma or chest wall lesions. - Nonvascular soft tissue masses: variable types of hamartomas including polyps, fibromas, and lipomas. - Vascular soft tissue masses: hemangiomas and classic PTEN hamartoma of the soft tissues (PHOST). At the end of our exhibit, we will include current suggested surveillance imaging protocol for these patients. Read More

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

Authors: De Leon-benedetti Laura, Martinez-rios Claudia, Tierradentro-garcia Luis, Kilicarslan Ozge, Caro Domínguez Pablo, Otero Hansel

Keywords: Radiology, Genetics, Pediatrics

Advocacy is the act of supporting or defending a specific cause or issue, with the aim of raising public awareness, garnering support, or influencing policy. Traditionally, it has not been included in the pediatric radiology training curriculum or regarded as a conventional academic pursuit. However, we believe it to be a vital aspect of a pediatric radiologist, regardless of their rank or clinical setting. Research efforts can provide support and validate for advocacy processes by generating evidence and measuring their impact and outcomes. We consider that encouraging these efforts is essential for “demystifying’ and better integrating it into academic life. Read More

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

Authors: Yaya Carlos, Miranda Schaeubinger Monica, Morales-tisnés Tatiana, Otero Hansel, Annam Aparna, Acharya Patricia, Joshi Aparna

Keywords: Pediatric radiology, Advocacy, Public Health

To describe imaging requisition patterns for prospective pediatric research studies at a large academic children’s hospital as insight into the role of radiology services in the current research environment. Read More

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

Authors: De Leon-benedetti Laura, Andronikou Savvas, Serai Suraj, Hailu Tigist, Miranda Schaeubinger Monica, Jalloul Mohammad, Otero Hansel

Keywords: Ethics Committees, Research, Radiology, Medical Imaging

Pediatric kidney abnormalities, such as urinary tract dilation (UTD), are common, and current reporting methods vary significantly. There's a need for more precise evaluation methods. Using automated 3D kidney volume measurements from ultrasound (US) offers an alterantive objective approach. Our aim is to evaluate the diagnostic potential of automated 3D kidney volume measurements for detecting and categorizing UTD, comparing their accuracy with clinical assessment. Read More

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

Authors: Sultan Laith, Morales-tisnés Tatiana, Rouet Laurence, Jago James, Sridharan Anush, Otero Hansel, Darge Kassa, Back Susan

Keywords: Urinary tract dilation, 3D ultrasound, Diagnostic model

Magnetic resonance imaging (MRI) has historically been restricted for patients with pacemakers, defibrillators, or other cardiac implantable electronic devices (CIEDs) due to safety concerns. Despite the introduction of MR conditional pacemakers in 2008, access to MRI in patients with CIEDS remains limited. MRI remains the diagnostic imaging study of choice for many indications and is necessary to prevent delayed diagnosis and the decision to proceed with MRI should follow a rigorous risk benefit assessment: Risks of: Lead heating causing injury at their tips Increased pacing thresholds Sudden battery depletion Inappropriate sensing/pacing The location of the image should be considered because if the request includes the area of the CIED then potential artifacts may decrease the diagnostic quality. However, an MRI remote from the location of the CIED entails a negligible risk of lead heating and MRI may be performed safely with continuous patient monitoring throughout the scan. In addition, in pediatric patients the necessity of anesthesia or sedation must be well-thought-out as it conveys additional risk to the patient. There is growing evidence from adult literature that MRI may be performed safely in patients with CIEDs with transvenous leads when appropriate protocols are followed. The Heart Rhythm Society (HRS) 2017 expert consensus statement indicates that MRI is reasonable in patients with MR non-conditional transvenous CIEDs if there are no fractured, epicardial, or abandoned leads. The Pediatric and Congenital Electrophysiology Society (PACES) of 2021 included that MRI may be considered in pediatric patients with epicardial or abandoned leads on a case-by-case basis. However, performing MRI in patients with CIEDs is a resource-intensive service and requires rigorous implant investigation, preparation, and planning as well as close coordination between treating physicians and radiologist. This educational exhibit summarizes current literature on the safety of MRI in patients with CIEDs and takes examples from our practice to build an evaluation program that allows for safe access to MRI in patients with CIEDs Read More

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

Authors: De Leon-benedetti Laura, Ramirez Suarez Karen, Otero Hansel, Rapp Jordan, Biko David, Smith Christopher, Serai Suraj, White Ammie

Keywords: Cardiac, Magnetic Resonance

Tuberculous meningitis (TBM) causes significant morbidity and mortality in young children. Early treatment can be initiated with MR imaging diagnosis. We present MR detectable miliary meningeal TB in two patients presenting in a developed world setting. Case 1: A 9 y/o girl of Haitian descent, developed fevers, cough, lethargy and seizures. Brain MRI demonstrated multiple, small, T2-dark, rim-enhancing lesions, associated with cranial nerve and leptomeningeal enhancement. Chest CT showed mediastinal lymphadenopathy, multiple small interstitial lung nodules and a splenic hypo enhancing lesion. CSF showed pleocytosis, low glucose, and high protein. She was started on 4-drug treatment for TBM and dexamethasone. Serial bronchoalveolar lavage was Xpert MTB/RIF and acid-fast negative. Contact tracing revealed a remote positive contact with pulmonary tuberculosis from Haiti. Endobronchial US-guided biopsy of a subcarinal lymph node was positive for Xpert MTB PCR. Case 2: A 17 y/o female with Crohn’s disease on adalimumab developed refractory ear infections despite multiple courses of antibiotics and underwent myringotomy, with negative aerobic ear fluid culture. She had two chronic skin lesions. Brain MRI, obtained due to persistent otorrhea, showed multiple, small, round, T2-dark lesions. CSF studies were unremarkable. CT chest, abdomen and pelvis showed left upper lobe tree-in-bud nodules, hypoattenuating splenic lesions and a left obturator internus abscess with adjacent osteomyelitis. She underwent CT guided aspiration of the obturator muscle collection, bronchoscopy with Bronchoalveolar Lavage (BAL), biopsy of her skin lesions and ear fluid aspiration. QuantiFERON Gold was positive. Ear fluid was Xpert MTB/RIF assay and acid-fast stain positive. She was started on 4-drug therapy and prednisone. Cultures from the ear fluid, skin tissue, muscle tissue and BAL showed growth of acid-fast bacilli. TB meningitis is most often due to blood borne spread of the disease from the lungs which may result in miliary nodules in the leptomeninges and brain. The two cases presented illustrate that although TBM is unusual in a developed world, we should suspect it in children of migrants as well as in patients with immunosuppression, where atypical imaging patterns including lack of typical basal enhancement and presence of miliary meningeal nodules may be seen. Read More

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

Authors: Venkatakrishna Shyam Sunder, Vasileiadi Eleana, Siu Navarro Youck Jen, Villavicencio Karen L Hanze, Miranda Schaeubinger Monica, Schoeman Sean, Otero Hansel, Andronikou Savvas

Keywords: Miliary Meningeal Tuberculosis

International clinical observerships in pediatric radiology offer benefits such as academic collaboration and brand recognition. However, they also introduce additional administrative burden, scheduling difficulties, increased faculty workload for the host institution, and regulatory and financial challenges for observers. In January 2021, the observer program at a US-based teaching hospital's radiology department was relaunched following a COVID-19 pandemic hiatus, providing a limited number of scholarships to medical students, residents, fellows, and other colleagues worldwide for 1-6 weeks. During their stay, observers rotated through different divisions, accessed our learning management system (LMS), and were encouraged to attend conferences and to give a lecture or case-based presentation to the department. We aim to evaluate the effectiveness of the program and the impact on the observer’s career. Read More

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

Authors: Derbew Hermon Miliard, Yaya Carlos, Noor Abass, Miranda Schaeubinger Monica, Dennis Rebecca, Jalloul Mohammad, Mekete Yadel, Wang Xinmeng, Otero Hansel

Keywords: International Observership, Pediatric Radiology, Education