At our institution and in general practice, we have observed that ultrasound is an underutilized modality in the field of pediatric musculoskeletal imaging, particularly when compared to its body imaging counterparts and the adult population. Within the spectrum of musculoskeletal radiology, ultrasound can be an especially helpful tool in evaluating the peripheral nervous system (PNS), which can often be challenging to assess on other imaging modalities. For instance, ultrasound offers the ability to carefully trace small nerves and easily allows for comparison to the other, often unaffected or normal extremity, as well as dynamic imaging. This advantage is often not possible on magnetic resonance imaging (MRI), which is currently the primary modality being utilized to assess for nerve pathology. In small children, nerves are often difficult to visualize on MRI, which can be limited by artifact and motion and may require sedation. Due to its superior axial resolution, ultrasound can better visualize the intra-neural architecture, sometimes better than MRI, especially in the case of small nerves. Also, as was demonstrated by one of the cases at our institution, ultrasound was superior in evaluation when there was adjacent surgical hardware which resulted in artifact on MRI. Additionally, we as radiologists, can aid our peripheral nerve surgeon colleagues intra-operatively with ultrasound. Some of the hesitance in using the modality may be a reflection of a lack of familiarity on the part of both radiologists and technologists with respect on how to image the PNS and uncertainty about the normal and abnormal appearance of these structures. The objective of this educational exhibit is to provide the knowledge necessary to successfully acquire and interpret ultrasound images of the PNS. The topics addressed in the review will include an introduction on how to appropriately obtain images of the major peripheral nerves, how to distinguish between the normal and abnormal appearance of nerves on ultrasound, and the spectrum of pathology affecting the peripheral nervous system. The exhibit will feature a variety of cases from our institution, including examples of neuropathy, post-traumatic focal neuroma, nerve laceration resulting in transection, ulnar nerve subluxation/dislocation, and nerve sheath tumors, among others, with some intraoperative and pathologic correlation.<b> </b> Read More

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

Authors: Krauss Jillian, Samet Jonathan

Keywords: Ultrasound, Peripheral Nervous System

Depending on the age of the patient, knee MRI may be a daunting exam. Physicians may have a higher threshold to order MRI in the pediatric setting compared to the adult setting. Few if any studies are available which attempt to predict the prevalence of MRI findings based on the patient’s presenting history in the sports medicine setting. Our objective was to determine the prevalence of knee pathology using MRI in two groups of pediatric patients: those with an acute event, and those with knee pain without history of acute event. Read More

Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016

Authors: Oneill Sean, Carl Rebecca, Labella Cynthia, Samet Jonathan

Keywords: knee MRI, knee pain, patellofemoral instability, sports medicine

Aneurysmal bone cysts are benign expansile osseous lesions which may behave locally aggressively, leading to growth plate destruction, angular deformity, and pathologic fracture. Current treatments such as curettage and bone graft reconstruction, sclerosis, and intra-arterial embolization have high recurrence rates and morbidity. Percutaneous cryoablation is a promising new treatment modality. Three patients with ABCs underwent cryoablation at our institution and follow-up MRIs over the span of a year were obtained. This is the first study of its kind to elucidate the imaging findings post-cryoablation of ABCs, which may help the radiologist interpret response to treatment. Read More

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

Authors: Weber Jonathon, Samet Jonathan, Green Jared, Donaldson James, Rajeswaran Shankar

Keywords: Cryoablation, ABC, Aneurysmal Bone Cyst