Showing 10 Abstracts.
Clinical diagnosis of pediatric-onset multiple sclerosis (POMS) is challenging, and MRI diagnostic criteria has imperfect sensitivity and specificity. The central vein sign (CVS) is a promising marker for POMS, however, most literature evaluating the central vein sign in POMS utilizes only the axial fluid attenuated inversion recovery (FLAIR) and susceptibility weigted imaging (SWI) sequences. Many institutions do not perform the SWI routinely or only recently replaced gradient recalled echo (GRE) with SWI in standard protocols. We investigate whether it is possible to detect the CVS with the GRE sequence. Read More
Meeting name: SPR 2024 Annual Meeting & Postgraduate Course , 2024
Authors: Held Heather, Vaidyanathan Vaishnavi, Pfeifer Cory, Bassal Frederick
Keywords: Central Vein Sign, Multiple Sclerosis, POMS
Balamuthia mandrillaris is an amoeba that causes an uncommon but deadly encephalitis, referred to as granulomatous amoebic encephalitis (GAE). The highest incidence reported worldwide has occurred in America, and within the United States, it has been highest in the Southwest affecting predominantly children and young men of Hispanic ethnicity. Clinical presentation of GAE includes fever, headache, nausea, vomiting, lethargy, irritability, stiff neck, hallucinations, photophobia, and seizures. Our patient was a Hispanic male child living in Arizona. The patient presented at 3 years of age for severe encephalitis. Symptoms included difficulty with balance, gait, and sitting up and seizure-like activity. Initial CT showed an area of decreased density consistent with edema in the left frontoparietal lobe. Rapid progression was seen on further imaging over the length of the patient’s hospital stay revealing diffusion restriction, necrosis/blood products, edema, and hemorrhage. The patient expired from tonsillar herniation 22 days after the onset of initial symptoms and 4 days after admission to our institution. While there are multiple biochemical techniques that can test for B. mandrillaris, they are rarely employed for multiple reasons stemming from the rare occurrence of this infection. Balamuthia mandrillaris can cause a lethal brain infection. Because of the fatal nature of this infection, we propose 1) testing should be considered if a patient presents with progressing encephalitis on imaging and other pathogenic etiologies are ruled out and 2) the threshold to treat empirically should be low due to the fatal nature of the infection. Read More
Meeting name: SPR 2024 Annual Meeting & Postgraduate Course , 2024
Authors: Szymanski Kathryn, Pfeifer Cory, Friedman Neil, Kuwabara Michael
Keywords: amoeba, Balamuthia mandrillaris, brain infection
The objective of this exhibit is to illustrate common fetal central nervous system (CNS) abnormalities using high-resolution magnetic resonance imaging at 3.0 Tesla. Read More
Meeting name: SPR 2017 Annual Meeting & Categorical Course , 2017
Authors: Pfeifer Cory, Patel Mittun, Bardo Dianna, Cornejo Patricia
Keywords: fetal, central nervous system
Kenny Caffey syndrome type 2 (KCS2) is a rare genetic syndrome affecting the bones, causing cortical thickening and medullary stenosis of tubular bones. Additional findings include short stature, delayed closure of anterior fontanelle, eye abnormalities, and hypoparathyroidism. Here we discuss a case of this rare disease. The patient was a 4-year-old male with history of intrauterine growth restriction, poor natal growth with relative macrocephaly, and abnormal skeletal findings. Genetic testing revealed a de novo variant of the FAM111A gene, most consistent with Kenny-Caffey syndrome type 2. The patient was followed in the bone dysplasia clinic and was noted to have growth delay (height < 1 percentile, z-score = -6 SD) and poor weight gain. Labs showed low IGF-1 (z-score = -2.5 SD), and growth hormone stimulation test revealed a peak of 9.8 ug/L. MR brain (age 4 years) showed 1) borderline Chiari I malformation, 2) small globes, 3) partially empty, shallow sella, and 4) enlarged posterior ventricular atria. Our patient demonstrated intracranial findings that may be unique when compared to the literature and/or related to the patient's skeletal abnormalities. As KCS2 is a rare disorder, diagnosis may be difficult. The findings presented in this case offer insight into both typical and novel findings that may aid in diagnostic accuracy and undoubtedly warrant further investigation. Read More
Meeting name: SPR 2024 Annual Meeting & Postgraduate Course , 2024
Authors: Szymanski Kathryn, Arnold Cerys, Dhatt Jovan, Pfeifer Cory
Keywords: Kenny Caffey Syndrome
Appendicitis is a common cause of acute abdominal pain requiring surgery in the pediatric population. For this reason, urgent and accurate diagnosis is critical. While ultrasound is the first line diagnostic modality, MRI has emerged as an important adjunct. The purpose of this presentation is to review the use of MRI for appendicitis in Children's hospitals from the perspectives of both the radiology departments and ordering providers using existing literature. Read More
Meeting name: SPR 2024 Annual Meeting & Postgraduate Course , 2024
Authors: Szymanski Kathryn, Wang Lucas, Arnold Cerys, Pfeifer Cory
Keywords: Appendicitis, MRI
Differentiation of sutural variants from fractures can be a challenging topic for radiology trainees. Genetic disorders and vascular channels can create the appearance of traumatic injury and potentially suggest the diagnosis of abusive head trauma to the untrained radiologist. Likewise, expert witnesses may use alternate diagnoses to explain findings in which the current evidence basis favors a traumatic mechanism. This exhibit describes the pediatric skull with attention to the differentiation between fractures and mimics as an aid to the trainee. Read More
Meeting name: SPR 2024 Annual Meeting & Postgraduate Course , 2024
Authors: Mousa Abeer, Ray Alyxandra, Halderman Kelly, Pfeifer Cory
Keywords: Child Abuse, Cranial Sutures, Wormian Bones
The purpose of this exhibit is to demonstrate the characteristic sonographic appearance of benign masses in the pediatric population in order to address the wide variation in management of palpable, hypoechoic, circumscribed masses seen on ultrasound. Currently, management includes fine needle aspiration/core needle biopsy, excision, imaging follow-up, and reassurance. This exhibit proposes guidelines for management of palpable pediatric breast masses with ultrasound findings most suggestive of fibroadenomas. Read More
Meeting name: SPR 2017 Annual Meeting & Categorical Course , 2017
Authors: Gleason Miranda, Sharma Pooja, Omar Lena, Pfeifer Cory, Kwon Jeannie
Kagami-Ogata syndrome (KOS) is a rare and potentially underdiagnosed imprinting disorder caused by paternal uniparental disomy for chromosome 14 or microdeletions and epimutations involving differentially methylated regions (DMRs) at 14q32.2. Depending on phenotypic expression, KOS may mimic trisomy 18 and asphyxiating thoracic dysplasia. Therefore, awareness is essential for prenatal diagnosis. Coat hanger ribs as seen by x-rays have been reported as s pathognomonic sign but have not been reported prenatally. Herein we present images of the coat hanger ribs as seen by low-dose computerized tomography (CT) as well as detailed imaging of the multiple phenotypic features by ultrasound and MRI of KOS in two cases seen prenatally. Case 1: G1P0 singleton pregnancy had fetal echocardiogram at 25 weeks due to concern for congenital heart disease, thickened nuchal fold and thickened skin of the thoracic wall. The exam showed left superior vena cava draining to coronary sinus, dilated right atrium and right ventricle, total anomalous pulmonary venous return, and hydrops. Skin edema was redemonstrated by follow up US at 29 weeks. Fetal MRI and follow-up US at 32 weeks showed polyhydramnios, diffuse skin edema, prominent cheeks and frontal bossing by 3D US, mild shortening of the ulna and right clubfoot, and a bell-shaped thorax by MRI. Chromosomal microarray was positive for terminal deletion of 14q32.2, consistent with KOS. Coat hanger ribs were present on postnatal x-rays. The patient is G-tube and tracheostomy tube dependent, has global developmental delay, neuromuscular scoliosis, left hip subluxation, wrist contractures and planovalgus feet at the age of 2 ½ years. Case 2: G3P1, singleton pregnancy with negative non-invasive prenatal testing (NIPT). US performed at 29 weeks showed polyhydramnios, clenched hands, and bell-shaped small thorax. Multimodality fetal imagin (US, MRI and CT) at 32 weeks showed a narrowed elongated thorax by US and MRI but ribs were poorly visualized. Additional anomalies included polyhydramnios, rhizomelic bone shortening, clenched hands, and prominent cheeks by 3D US. Low-dose CT showed coat hanger ribs. Postnatal x-rays confirmed coat hanger ribs and other abnormalities. Postnatal genetic testing showed paternal uniparental disomy for chromosome 14, consistent with KOS. The patient has restrictive lung disease due to hypoplastic thoracic cage, hypotonia, scoliosis, developmental delay, and umbilical hernia at 13 months. Read More
Meeting name: SPR 2023 Annual Meeting & Postgraduate Course , 2023
Authors: Goncalves Luis, Patel Mittun, Wermers Josh, Simmons Curtis, Vaughn Jennifer, Pfeifer Cory, Cornejo Patricia
Keywords: kagami-ogata, fetal MRI, fetal CT
Growth in our hospital has resulted in multiple new locations opening which has resulted in staffing by ultrasound technologists lesser experienced in appendicitis imaging. Likewise, our ordering providers have increased their push to reduce CT utilization. Our aim was to improve the appendix visualization frequency by 10% over 6 months to reduce exposure to ionizing radiation, reduce cost for families, lower risk to patients, reduce length of stay in the emergency department, and shorten the time to diagnosis. Read More
Meeting name: SPR 2024 Annual Meeting & Postgraduate Course , 2024
Authors: Sousae Sean, Simmons Curtis, Bailey Smita, Cutler Kayci, Youssfi Mostafa, Reynolds Kristine, Oliver Clay, Pfeifer Cory
Keywords: Appendicitis, Quality Improvement, Ultrasound
Accurate tumor measurement is essential in initial assessment of solid tumors. Furthermore, it is vital when evaluating treatment response. Change in tumor size determines whether a treatment course is effective, if treatment should be prolonged, or whether a more aggressive treatment or chemotherapy drug should be administered. Currently endorsed and widely used guidelines for tumor volume measurement include response evaluation criteria in solid tumors (RECIST), a one dimensional measure (cm) of target lesions which is not routinely the longest axis; World Health Organization (WHO), a 2 dimensional measure of the long and one short tumor axis (cm2) but is not a measure of volume; and Childrens Oncology Group (COG), a 3 dimensional ‘volume’ (cm3) measurement but does not account for shape of the tumor. Pediatric oncology patients are almost exclusively cared for in major academic or community hospital settings where modern CT and MR scanners routinely produce direct or reconstructed multiplanar images. Therefore an evolution of tumor measurement, to determine tumor volume, must be forthcoming. Read More
Meeting name: SPR 2017 Annual Meeting & Categorical Course , 2017
Authors: Willard Scott, Barnes Craig, Augustyn Robyn, Thorkelson Marrit, Chatfield Paige, Hu Harry, Towbin Richard, Bardo Dianna, Pfeifer Cory, Dance Logan, Bailey Smita, Southard Richard, Jorgensen Scott, Biyyam Deepa, Patel Mittun, Cassell Ian