Recently JACHO proposed to address double scanning in pediatric chest CT, yet there are no data to determine whether this takes place; similarly, there is discussion regarding validity of sending pediatric patients to adult-focused practices for routine imaging by third party payors. Our purpose is to review the technical factors that impact upon radiation dose and image quality in CT scans of children referred from adult-focused practices to a children’s hospital, referenced to pre-Image Gently values. To our knowledge this is the first such review that includes body and neuro scans and extensive technique and exposure data Read More

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

Authors: Parikh Ashishkumar, Pruthi Sumit, Hernanz-schulman Marta

Keywords: ALARA, Image Gently, Radiation

Before the germinal matrix (GM) begins to recede at approximately 26 weeks gestational age (GA), it extends along the floor of the lateral ventricles far posterior to the thalamocaudate grooves. As extremely premature infants (EPIs) as young as 23 weeks GA survive with current advances in neonatology support, germinal matrix hemorrhage (GMH) can occur along these sites from which the GM has not yet involuted and should be recognized. Further, such Grade I posterior GMH may be mistakenly diagnosed as an intraparenchymal grade IV event, particularly on coronal US or other axial images, with parasagittal images demonstrating the correct diagnosis. The aim of this study is to document and describe this phenomenon, differentiate it from traditional GMH findings, and assess its prevalence in this population. Read More

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

Authors: Snyder Elizabeth, Pruthi Sumit, Hernanz-schulman Marta

Keywords: Ultrasound, Germinal Matrix Hemorrhage, prematurity

Although head ultrasound (HUS) is most often used in the neonatal intensive care unit (NICU) setting as a screening exam for emergencies such as hydrocephalus, intracranial hemorrhage, and ischemic injury, a spectrum of congenital brain abnormalities may also be diagnosed, especially with state-of-the-art US technology that enables detection of more subtle malformations. While brain MRI remains the gold standard for comprehensive evaluation of congenital CNS anomalies, knowledge of the appearance of such pathologies on HUS is vital: HUS is often the first exam performed, and some infants are too critically ill to undergo MRI. Identification of congenital anomalies by the radiologist may generate prognostic information that can impact critical medical decision-making and patient/family counseling in the NICU. The goals of this educational poster are to provide a systematic approach to evaluating congenital brain anomalies on HUS and illustrate the ultrasound appearance of common and less common congenital abnormalities with MRI comparisons, as well as highlight potential pitfalls in making these diagnoses. Covered entities include: Posterior fossa malformations: e.g., Chiari II, Dandy-Walker Midline anomalies: e.g., Holoprosencencephaly, agenesis of the corpus callosum, pericallosal lipoma Cortical malformations: e.g., Gray matter heterotopia, schizencephaly, lissencephaly Vascular malformations: e.g., Vein of Galen malformation Congenital infections: e.g., Congenital cytomegalovirus Read More

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

Authors: Snyder Elizabeth, Sarma Asha, Krishnasarma Rekha, Engelstad Holly, Pruthi Sumit

Keywords: Head ultrasound, Congenital anomalies, Ultrasound MRI correlation

Duplication of the pituitary gland (DPG) is an extremely rare malformation, with only 40 reported cases in the medical literature. Phenotypes range from isolated DPG with normal development to cases with additional anomalies leading to morbidity and mortality (“DPG-plus” syndrome). We describe a patient with comprehensive fetal and postnatal imaging detailing known findings of DPG-plus syndrome and previously undescribed brain and body anomalies. An infant male was diagnosed with an obstructive oral cavity mass by fetal MRI. Postnatal neuroimaging showed a fatty oral cavity mass containing dysmorphic mandibular elements. Upon biopsy, pathological assessment showed duplication of the maxillary complex versus mesenchymal hamartoma. Other anomalies included duplicated nasal cavity, absent olfactory bulbs, duplicated sella with sellar spine, optic chiasm and tubomamillary fusion, duplicated basilar artery, persistent falcine sinus, cleft palate, and bifid tongue. In addition, there was an unusual complex brainstem and cerebellar anomaly and extensive anterior cervical vertebral clefting with anterior cervicomedullary junction myelomeningocele. Body imaging showed horseshoe pulmonary sequestration, hiatal hernia, multiple intrathoracic and intraabdominal spleens in a manner inconsistent with heterotaxy, midline liver, duplicated IVC, and vertebral anomalies. Echocardiogram showed double outlet right ventricle. Genetics evaluation revealed variants of unknown significance in CCDC39, TBX5, and ZMYND10 that were considered unlikely to be related to the observed anomalies. Due to poor neurologic prognosis, the patient was transitioned to comfort care and passed away at 4 weeks of age. Read More

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

Authors: Sarma Asha, Knake Lindsey, Whigham Amy, Hernanz-schulman Marta, Anani Uchenna, Pruthi Sumit

Keywords: Duplicated pituitary gland plus, Syndrome