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

We will present imaging findings of segmental spinal dysgenesis in a series of 3 cases of this rare congenital abnormality. We will also describe the embryological basis and pertinent clinical features. Case 1: 8-year-old female recently adopted from China with history of severe scoliosis, neurogenic bladder, and chronic kidney disease. Plain radiographs demonstrate severe destroscoliosis in thoracolumbar region with associated kyphosis. MRI reveals multiple segmentation/formation anomalies in the lumbosacral region. The coccyx was not identified, likely representing associated partial sacrococcygeal dysgenesis. The spinal cord was severely dysgenetic in the lower thoracic region (Figure 1, white outlined arrow). The superior segment of the spinal cord extends from the cervicomedullary junction to the level of T8, where it ends abruptly. No intervening cord tissue is seen between the T8 level and lumbar region. There is an enlarged spinal cord segment at the level of the sacrum in the spinal canal, separate from the superior segment (Figure 2, solid white arrow). CT with 3D reconstruction better demonstrated multiple segmentation/formation anomalies in the thoracic and lumbosacral region, including butterfly vertebrae, hemivertebrae, and block vertebrae. There were 10 ribs on the right noted with the superior 2 ribs fused. Read More

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

Authors: Taylor Susan, Bajaj Manish, Sato Yutaka, Policeni Bruno

Keywords: Congenital, Spine, Scoliosis

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

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