The 2016 World Health Organization Classification of Tumors of the Central Nervous System has now incorporated molecular and genetic parameters in addition to histology to define many tumor entities. Significant restructuring has occurred for pediatric CNS tumors. For example, medulloblastomas are classified into four genetic subtypes. Other embryonal tumors such as embryonal tumor with multilayered rosettes (ETMR) and atypical teratoid/rhabdoid tumor (ATRT) are further defined by their molecular features. Also new entities have been added defined by both histology and molecular signatures including H3 K27M-mutant diffuse midline glioma, <i>RELA </i>fusion-positive ependymoma and diffuse leptomeningeal glioneuronal tumor (DLGNT). These more homogeneous and narrowly defined entities are expected to facilitate better classification, prognostication and patient stratification for precision therapy. This also improves the design of clinical trials and experimental models. In this presentation, we will review the new WHO classification scheme and review the imaging and as well as molecular/genetic features of pediatric CNS tumors. Radiologists must keep up to date with updates to the WHO classification scheme to be able to better communicate with clinicians ensure optimal patient care and relevant research collaboration. Read More

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

Authors: Sato T Shawn, Sato Yutaka

Keywords: WHO, Brain tumors

Review the unique features of pediatric oncologic emergencies using case review of neurological, spinal, thoracic and abdominal pathologies, covering complications due to the malignancy or its treatment. Read More

Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016

Authors: Sato T Shawn, Lai Lillian, Sato Yutaka

Keywords: Pediatric, Oncologic, Tumor, Emergency, Radiology

Chronic Recurrent Multifocal Osteomyelitis (CRMO) is a multifocal auto-inflammatory disease that has gained increased recognition in recent years. Because CRMO is a diagnosis of exclusion, clinical history and imaging findings are important in suggesting a diagnosis. While imaging features of CRMO have been described, other disease processes can have a similar appearance to CRMO. We review some diseases that can mimic the radiographic appearance of CRMO and discuss features that can suggest alternative diagnoses. Read More

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

Authors: Sato T Shawn, Bajaj Manish, Ferguson Polly

Keywords: CRMO, MRI, Lymphoma

In pediatric patients with inflammatory arthritis, steroid injections of the joints are an important therapeutic tool to help augment or avoid systemic steroid treatment. In adult patients, fluoroscopy is often used for diagnostic and therapeutic joint injections. In pediatric patients, ultrasound is an excellent modality for joint injections as resolution is very good for superficial structures, there is no radiation, real time imaging can be performed with non-cooperative patients, and steroid dosage can be maximized in small joints without wasting space in the joint with confirmatory contrast, as with fluoroscopy. Pediatric ultrasound guided joint injections are not commonplace at every radiology practice, but with some training, it can be performed safely and effectively to provide patient care. The purpose of this exhibit is to familiarize the reader with proper technique for ultrasound-guided joint injections. Read More

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

Authors: Faruqui Sami, Lucin Michael, Sato T Shawn

Keywords: Ultrasound, joint, injection

The management of acute appendicitis is most often surgical with appendectomy; the blind-ending, inflamed appendix is removed, usually laparoscopically. There is growing awareness of the potential for a delayed complication if only the tip or otherwise subtotal length is removed. A remnant portion of the base of the appendix, referred to as a stump, if long enough can become obstructed and symptomatic similar to the etiology of acute appendicitis. In cases of recurrent right lower quadrant pain in a patient with a surgical history of appendectomy, appendicitis remains on the differential diagnosis alongside non-appendiceal causes such a colitis and epiploic appendagitis. Imaging diagnosis by computed tomography or ultrasound of stump appendicitis is similar to acute appendicitis with right lower quadrant inflammation and stump distension and wall thickening. In this educational exhibit we will review the imaging features of stump appendicitis as well as developments in surgical techniques relevant to this delayed complication. Relevant anatomy and differential diagnosis for right lower quadrant pain will also be summarized. Read More

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

Authors: Essenmacher Alex, Kao Simon, Sato T Shawn

Keywords: appendix, surgery, appendicitis

Chronic Recurrent Multifocal Osteomyelitis (CRMO) is an auto-inflammatory disease that can affect multiple locations. Whole body MRI is an important tool to help identify subclinical multifocal disease and help monitor disease. As a referral center for CRMO, we have developed a successful CRMO whole body MRI imaging protocol which maximizes diagnostic information while minimizing scanner time. Read More

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

Authors: Sato T Shawn, Bajaj Manish, Ferguson Polly

Keywords: Rheumatology, CRMO, Whole Body MRI

Hydrosalpinx can be difficult to differentiate from other cystic lesions in the pelvis - especially when large. However, there are imaging characteristics that may help narrow the differential diagnosis and initiate appropriate management earlier in the clinical course. Read More

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

Authors: Lucin Michael, Becker Robert, Sato T Shawn

Keywords: hydrosalpinx

1. Review of structural and metabolic imaging findings across various classes of FCD based on recent ILAE classification. 2. Review of correlation between imaging findings and pathologic features in different FCD groups. Read More

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

Authors: Watal Pankaj, Priya Sarv, Sato T Shawn, Bathla Girish

Keywords: focal cortical dysplasia, FCD

Because of the consequences of missed non-accidental trauma, it is essential for pediatric radiologists to have a high index of suspicion for injuries related to non-accidental trauma. Certain patterns of fracture raise suspicion for non-accidental trauma and are often considered pathognomonic. We present several cases of fractures that are typically considered pathognomonic for non-accidental trauma that had other non-abuse etiologies. These cases include classic metaphyseal lesions, subdural hematomas and long bone fracture in non-ambulatory patients among others. While there may be non-abuse etiologies of fractures that are classically considered pathognomonic for child abuse, the illustrative cases demonstrate the severe magnitude of injury necessary to produce these findings. This is why it is essential to evaluate the patient history and identify if the resulting injuries are consistent with the history. Read More

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

Authors: Lucin Michael, Faruqui Sami, Sato Yutaka, Sato T Shawn

Keywords: Non-accidental trauma, Fracture

Neurocristopathies are a group of disorders characterized by a common origin in aberrant neural crest development. These include common pediatric disorders such as Hirschsprung’s disease, Treacher Collins syndrome, Di George syndrome, MEN type 2A/2B as well as common pediatric tumors such as neuroblastoma, pheochromocytoma, Ewing’s sarcoma, neurofibromatosis, medullary carcinoma of the thyroid and melanoma. Neural crest cells are derived from discrete cell masses that arise at the junction between the neural and epidermal ectoderm in neurula-stage vertebrate embryos. Neural crest cells migrate extensively in an organized manner and spread widely throughout the body. Derivatives of neural crest cells include Schwann cells in the leptomeninges, nerve root ganglia in the central nervous system, thyroid C cells, bone formation in the mandible and skull base, dermis of the head and neck, myenteric nerve plexuses of the intestines, pigment cells of the skin, paravertebral sympathetic ganglia, and adrenal medulla cells. Developmental disturbances of the neural crest cells give rise to a variety of disorders as listed above and have collectively been termed neurocristopathies by Bolande in 1974. Patients with one neurocristopahty have an increased risk of having other neurocristopathies. Familial inheritance has also been shown. There is a variability in the combinations of lesions found in the same patient or family. Recent advances in genetics and developmental biology have provided deeper insights into these collection of conditions. New technologies in biology including iPS cell technology are expected to further advance our understanding of neurocristopathies. Read More

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

Authors: Handa Atsuhiko, Priya Sarv, Sato T Shawn, Sato Yutaka

Keywords: neurocristopathy, neural crest cells, embryology

The prevalence of fibrosing diseases is uncommon in adult patients, and significantly more rare in the pediatric population. The spectrum of fibrosing diseases may be subdivided into two sub-categories: Inflammatory pseudotumors (IMT) and multifocal fibrosclerotic diseases. IMT has a predilection for visceral soft tissues and the most common sites of involvement include lung, abdominopelvic region, but virtually any site may be involved, including the somatic soft tissues, bone, larynx, uterus and CNS. Multifocal fibrosclerotic diseases encompasses retroperitoneal fibrosis, mediastinal fibrosis, reidel’s thyroiditis, orbital pseudotumor, and sclerosing cholangitis to name a few. IMT’s are predominantly neoplastic but may be post-traumatic or post-infectious. Fibrosclerosing diseases may be associated with inflammatory diseases (inflammatory bowel disease), autoimmune conditions (juvenile rheumatoid arthritis, systemic lupus erythematosus), malignant tumors (lymphoma), vasculitis and may arise secondary to drugs, toxins, trauma or radiation. Some may be idiopathic with no underlying cause. The clinical presentation can be quite variable and often depends upon the site of involvement as well which adjacent structures are affected by the fibrosis. Initial diagnosis can be suggested by imaging, but imaging findings are often non-specific. They can appear as mass forming and may be mistaken for more aggressive malignancy. Tissue is often needed for confirmation. Histopathology shows evidence of lymphocytic infiltration, activated fibroblasts, spindle shaped cells and granulation tissue. The key issue for the pediatric radiologist is to be aware of these rare conditions and thus include them in their differential diagnosis. This diagnosis should be considered to avoid over aggressive biopsy, operation and chemotherapy. In addition, it may warrant work up for other associated fibrosing diseases in the appropriate clinical scenario. In this presentation, we will provide a case based review of the features of pediatric inflammatory pseudotumors and fibrosclerotic diseases including myofibroblastic tumors, fibromatosis, fibrosarcomas, nodular and cranial fascitis as well as fibrotic conditions involving mediastinum, retroperitoneum, biliary tract and thyroid gland with their appropriate diagnostic work-up. Our aim is to make people aware of these rare presentations, so that they are not lost in the long differential! Read More

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

Authors: Priya Sarv, Watal Pankaj, Sato T Shawn, Sato Yutaka

Keywords: Fibrosclerosis, inflammatory pseudotumors

Retroclival hematomas most often occur in pediatric patients following high speed motor vehicle accidents. Hematomas may involve the epidural, subdural, or subarachnoid spaces. Of these hematoma patterns, retroclival epidural hematomas are often associated with ligamentous injury to the tectorial membrane, transverse ligament, or alar ligament resulting in instability. Children’s relatively large head size in proportion to their bodies, less muscular support and more superior fulcrum point of cranial vertebrae (C2-C3 in young children) relative to adults predispose pediatric patients to ligamentous injury. Retroclival subdural hematomas are the most often to be associated with non-accidental brain injuries. Therefore, when young non-ambulatory children present without significant trauma, it is not only imperative to recognize the radiographic findings of retroclival subdural hematomas, but to be cognizant of its association with child abuse. Radiological evaluation should include reconstructed sagittal CT images in soft tissue window as well as bone window. Special attention should be paid to the soft tissue window since hematomas often show low or intermediate attenuation on CT and can be easily missed on bone window. If only CT of the head is performed, extension to the craniocervical junction should be included. MRI, especially T2 weighted thin cut images are best suited for evaluation of ligamentous injury. STIR sequence can also provide ligamentous details as well as bone marrow edema. Read More

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

Authors: Handa Atsuhiko, Becker Robert, Sato Yutaka, Sato T Shawn

Keywords: Retroclival hematoma, ligamentous injury, abusive injury

1. Describe the variety of pathologies affecting the chest wall and breast in the pediatric male. 2. Explain the ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) characteristics of pediatric chest well including breast masses. 3. Recognize pitfalls on ultrasound imaging in evaluation of male chest wall and breast. 4. Discuss follow up and management of these lesions. Read More

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

Authors: Vijapura Charmi, Kao Simon, Amarneh Mohammad, Sato Yutaka, Sato T Shawn

Keywords: Male Breast, Chest Wall, Ultrasound

This educational exhibit aims to : 1. Discuss the pathogenesis of Chronic Recurrent Multifocal Osteomyelitis (CRMO) with enumeration of Diagnostic Clinical Criteria 2. Describe pertinent findings on whole body Short tau Inversion Recovery (STIR) MR Imaging. 3. Illustrate evolution of MR findings on follow up imaging. 4. Identify common imaging differentials to be considered and pitfalls to be avoided Read More

Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016

Authors: Baja Manish, Sato T Shawn, Sato Yutaka, Kao Simon, Ferguson Polly

Keywords: Recurrent, Multifocal, Osteomyelitis

Interpretation of chest radiographs requires a good understanding of anatomy, the physiology of the lungs and cardiovascular system as well as good pattern recognition. Additionally, it requires a systematic approach to search for pathologies and pertinent clinical details for interpretation. With frequent use of CT / MRI, the residents (and even practicing radiologists) have become less skilled in the interpretation of chest x-rays, making one of the most commonly ordered exams the most challenging. With challenges of decreasing radiation exposure (especially in pediatric population), it is important that the relatively lost skill set of chest radiographs interpretation be revisited, for trainees (radiology and non-radiology services) and the practitioners. <b>OUTLINE</b> ● Historical perspective. ● Overall approach towards a chest x-ray and importance of clinical details. ● PA/AP and lateral radiograph anatomy and radiographic lines and stripes. ● Fleischer society standard terminology for radiographs. ● Radiographic appearance of abnormalities and pearls for differentiation. The abnormalities to be categorized as: ○ Pneumonia ○ Effusion ○ Atelectasis ○ Big heart ○ Pulmonary vascularity (plethora and oligemia) ○ Lucencies (Pneumo: thorax, mediastinum and cardia) ○ Masses Read More

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

Authors: Ferreira Da Silva Renato, Nagpal Prashant, Priya Sarv, Sato T Shawn, Sato Yutaka

Keywords: chest, radiograph, interpretation

Immunoglobulin4 related disease (IgG4RD) is an inflammatory condition involving multiple regions of the body resulting in fibrosis which can lead to eventual organ failure. This entity was originally described with autoimmune pancreatitis. Recently many other previously described lesions have been brought under the umbrella of IgG4RD. These include a spectrum of conditions involving the head and neck region (orbits, salivary and lacrimal glands), thyroid gland (Riedel’s thyroiditis), vasculature (periaortitis), kidneys, lungs, retroperitoneum, mesentery, pituitary gland, biliary tract, pericardium, lymph nodes and pachymeninges. Reports of IgG4RD are quite rare in the pediatric literature, however this may be due to potential unawareness about the condition as well as the variable presentations and non-specific imaging features of IgG4RD. The prevalence in pediatric population is poorly described. The exact pathophysiology of IgG4RD is yet to be completely elucidated. The imaging manifestations are non-specific, and primarily consist of tumefactive enlargement of involved organs and homogenous contrast enhancement and associated lymphadenopathy. IgG4RD may manifest in single organ or may present as widespread disease involving multiple organs. These features overlap with other mass forming conditions like malignancy or lymphoma. However, the presence of multifocal disease with more than one organ involvement may point towards possible IgG4 related disease. Other than IgG4 related autoimmune pancreatitis, there is no consensus on diagnostic criteria based upon imaging. Definitive diagnosis of IgG4RD is made with biopsy and the histology characterized by infiltration of lymphocytes and IgG4 plasma cells with storiform fibrosis and obliterative phlebitis. According to Boston consensus, the ratio of IgG4 /IgG in tissue should be more than 0.4 with more than 10 IgG4+ cells per high power field. Serum IgG4 levels range from normal to elevated. Steroids are effective as first line treatment in majority of patients. Our aim in this presentation is to familiarize radiologists with the spectrum of imaging features, and areas of involvement in IgG4 related disease using cases of IgG4RD collected at three different pediatric hospitals. It is important for pediatric radiologists to be familiar with this relatively newly described disease entity and be aware of the spectrum of manifestations of IgG4RD, ensuring prompt recognition and early treatment. Read More

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

Authors: Priya Sarv, Handa Atsuhiko, Ferreira Da Silva Renato, Lai Lillian, Khanna Geetika, Sato T Shawn

Keywords: IgG4, fibrosis

1. Review the normal development and anatomy of the anterior skull base. 2. Describe the variety of pathologies affecting the anterior cranial fossa in the pediatric age group with a focus on the typical computed tomography (CT) and magnetic resonance imaging (MRI) characteristics. 3. Discuss clinical management and imaging follow up of anterior cranial fossa pathology. Read More

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

Authors: Vijapura Charmi, Dennhardt Joel, Fuortes Michaelangelo, Policeni Bruno, Sato Yutaka, Sato T Shawn

Keywords: Anterior Cranial Fossa, magnetic resonance imaging, computed tomography

1) Review the normal development and anatomy of the middle cranial fossa. 2) Describe the variety of pathologies affecting the middle cranial fossa in the pediatric age group with a focus on the typical computed tomography (CT) and magnetic resonance imaging (MRI) characteristics. 3) Discuss clinical management and imaging follow up of middle cranial fossa pathology. Read More

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

Authors: Fuortes Michaelangelo, Vijapura Charmi, Dennhardt Joel, Policeni Bruno, Sato Yutaka, Sato T Shawn

Keywords: skull base anatomy, skull base pathology, middle cranial fossa

1) Review the normal development and anatomy of the posterior skull base. 2) Describe the variety of pathologies affecting the posterior cranial fossa in the pediatric age group with a focus on the typical computed tomography (CT) and magnetic resonance imaging (MRI) characteristics. 3) Discuss clinical management and imaging follow up of posterior cranial fossa pathology. Read More

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

Authors: Dennhardt Joel, Fuortes Michaelangelo, Vijapura Charmi, Policeni Bruno, Sato Yutaka, Sato T Shawn

Keywords: Skull base, Posterior Cranial Fossa, Magnetic resonance imaging

In the pediatric population, lymphadenopathy may be caused by a variety of diseases including lymphoma. Accurate differentiation of a non-lymphomatous lymphoproliferative disorder from lymphoma and other lymphoproliferative disorders is important in determining appropriate management. Radiologic imaging including assessment of cervical, mediastinal, and hilar lymphadenopathy can often provide the critical clue needed for accurate diagnosis. Read More

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

Authors: Lucin Michael, Faruqui Sami, Watal Pankaj, Sato Yutaka, Price Nathan, Sato T Shawn

Keywords: Lymphadenopathy, Lymphoproliferative

Pediatric radiologists encounter a variety of focal skull lesions and often the diagnosis is not easy to achieve. The spectrum of the skull lesions in children is broad and encompasses pathologies that can be congenital, acquired, benign, malignant, infectious, or posttraumatic. The purpose of this exhibit is to review the imaging findings of both common and rare focal skull lesions in the pediatric age group. Read More

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

Authors: Amarneh Mohammad, Sato Yutaka, Watal Pankaj, Vijapura Charmi, Faruqui Sami, Fuortes Michaelangelo, Sato T Shawn

Keywords: Skull, Calvarium, Pediatric