Timely intracranial imaging enables diagnosis, directs treatment, and provides prognostic information of infant malformation or injury. MRI is the gold standard for neuroimaging, but can be inhibited by transportation risk and incompatible support devices. Ultrasound (US) is portable, rapid, and inexpensive, but limited by lower sensitivity and specificity. Contrast-enhanced ultrasound (CEUS) improves diagnostic accuracy of US in other clinical applications. Our aim was to prospectively compare CEUS of the neonatal brain to MRI. Read More

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

Authors: Squires Judy, Beluk Nancy, Yanowitz Toby, Kephart Morie, Panigrahy Ashok

Keywords: contrast-enhanced ultrasound, neonates, neuroimaging

Pediatric cervical spine trauma, although rare with an incidence of only 1-2%, can have very high morbidity and mortality. The leading causes are motor vehicle collision, sports related injury and child abuse in infants. The incidence of upper cervical spine injury is more common in children than adults due to differences in biomechanics, with the pediatric head size being proportionally larger when compared to adults. Although conventional radiographs remain the standard initial imaging evaluation, CT has become an important modality to detect bony injury and subtle signs of underlying ligamentous injury and hemorrhage (although consideration must be made for the increased radiation exposure). The presence of ligamentous injury, dens synchondrosis fracture, spinal cord evaluation, and spinal cord injury without radiographic abnormality (SCIWORA), meanwhile, are better evaluated with MRI. We will review the normal appearance of the pediatric cervical spine including normal measurements on radiographs and CT, including the importance of the basion-dens interval, powers ratio, and atlanto-occipital distance with illustrations. The normal development of the cervical spine as well as CT and MRI anatomy of cervical spine ligaments will be reviewed with illustrations. Imaging findings of atlanto-occipital and atlanto-axial distraction and pediatric cervical spine fractures including clay shoveler's fracture and dens synchondrosis fractures will be illustrated with CT and MRI. Finally, a review of clinical decision criteria for pediatric cervical spine trauma and imaging approach will be presented. The importance of obtaining MRI in children under 5 years and appropriate use of imaging will also be discussed. Image 1: Sagittal CT image demonstrates increased basion to dens distance and normal atlanto-dental interval, consistent with atlanto-occipital dissociation. Image 2: T2-weighted sagittal MR image demonstrates injuries to the tectorial and posterior atlanto-occipital membranes with atlanto-occipital dissociation. There is associated epidural hemorrhage. Image 3: Sagittal CT reconstruction demonstrates a powers ratio greater than 1, raising suspicion for anterior atlanto-occipital dissociation. Read More

Meeting name: SPR 2018 Annual Meeting & Postgraduate Course , 2018

Authors: Akbari Yasmin, Subramanian Subramanian, Furtado Andre, Panigrahy Ashok, Zuccoli Giulio

Keywords: Spine, Trauma, Pediatric

Transfontanelle cranial ultrasound is widely used in the neonatal setting to screen for abnormalities, particularly in the neonatal and cardiac intensive care unit settings. Radiologists and sonographers are typically very familiar with the ultrasound appearance of germinal matrix hemorrhage in premature infants. However, other abnormalities can also be very well seen sonographically, but may be underappreciated and therefore underreported. Under recognition may delay appropriate therapy these infants. The purpose of this educational review is to demonstrate the sonographic findings in a variety of neonatal intracranial abnormities including ischemia, hemorrhage, as well as developmental and anatomical anomalies, and to compare them with what may be the more familiar cross sectional appearance, including CT and MRI. Read More

Meeting name: SPR 2017 Annual Meeting & Categorical Course , 2017

Authors: Squires Judy, Zuccoli Giulio, Lynda Flom, Subramanian Subramanian, Panigrahy Ashok

Keywords: MRI, Ultrasound

To evaluate the effect of different levels of adaptive statistical iterative reconstruction (ASIR) in pediatric lower extremity CT scan to compare the radiation dose, objective imaging parameters and subjective diagnostic image quality ratings. Read More

Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016

Authors: Shah Amisha, Rees Mitchell, Kar Erica, Bolton Kimberly, Panigrahy Ashok, Lee Vince

Keywords: ASIR, Radiation dose, CT scan, pediatric, extremity

Understanding anatomy and embryology is crucial for evaluation of olfactory epithelium, olfactory nerve, olfactory bulb and olfactory cortex pathology. We will discuss various imaging modalities available to evaluate olfactory system and discuss role of fMRI and Diffusion tensor imaging of olfactory system. Fetal MRI can identify olfactory bulb and olfactory sulci after 30weeks of gestation consistently and can be helpful in diagnosis of charge syndrome. Various congenital CNS malformations associated with olfactory system abnormalities like CHARGE, Holoprosencephaly, Kallmann syndrome, Acrocallosal syndrome, frontal encephalocele and sphenoidal encephalocele will be presented. Traumatic injury to cribriform plate of ethmoid can result in transection of olfactory nerve resulting in anosmia. Primary tumors of olfactory epithelium, esthesioneuroblastoma and secondary involvement of olfactory epithelim by rhabdomyosarcoma will be presented. Various tumors that can involve olfactory cortex namely DNET, ganglioglioma and pilocytic astrocytoma will be presented. References: Booth TN, Rollins NK. Spectrum of clinical and associated MR findings in children with olfactory anomalies. Am J Neuroradiol.2016; 37:1541-48 Blustajn J, Krisch CFE, Panigrahy A, Netchine I. Olfactory anomalies in CHARGE syndrome: Imaging findings of a potential major diagnostic criterion. Am J Neuroradiol.2008; 29:1266-69. Read More

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

Authors: Lori Schoenbrun, Subramanian Subramanian, Rajan Deepa, Gaesser Jenna, Lo Cecilia, Schmithorst Vincent, Panigrahy Ashok

Keywords: Olfactory system, Olfactory sulcus, Olfactory Bulb