Background: Juvenile idiopathic arthritis (JIA) is the most common rheumatic condition in the pediatric population, with a prevalence of up to 150 cases per 100,000 children. Although the diagnosis of JIA is clinical, imaging plays a crucial role in the monitoring and stratification of disease, such as detecting growth disturbances, chronic joint structural changes, or treatment response. Conventional radiography has low accuracy for detection of acute synovitis or enthesitis, whereas ultrasound provides real-time assessment of inflammatory changes. Magnetic resonance imaging (MRI) is the most sensitive modality to discern early inflammatory or destructive changes in JIA, with the potential to visualize soft tissue and osteochondral abnormalities. Education goals: 1) To describe the diagnostic criteria for the 7 subtypes of JIA. 2) To illustrate the more common imaging findings in JIA (e.g. swelling, bone mineral density, loss of joint space, erosions, growth disturbances, joint malalignment, ankylosis, enthesitis) using conventional radiography, ultrasound, and MRI. 3) To highlight the importance of early imaging changes that can support the clinical diagnosis of JIA. 4) To present the role of multimodality imaging in the evaluation of complex joint involvement (e.g. atlanto-occipital, atlanto-axial, temporomandibular, spinal, sacroiliac) in JIA. 5) To emphasize the role of imaging in characterizing conditions that can mimic JIA. Read More

Meeting name: SPR 2025 Annual Meeting , 2025

Authors: Tierradentro-garcia Luis, Alizai Hamza

Keywords: Juvenile Idiopathic Arthritis, Multimodality, Rheumatology

Background: Connective tissue disease can affect multiple systems in children. In the central nervous system, these entities can present as cerebrospinal fluid (CSF) disorders, such as CSF leaks, due to dysregulation of collagen and/or other extracellular matrix components. Most patients present with chronic, daily, unremitting headaches that usually improve when lying down. Imaging findings can show classic signs of intracranial hypotension, signs of idiopathic intracranial hypertension, or both. The latter, termed “mixed CSF pressure disorders”, a newer entity described in the literature, can present a diagnostic dilemma as patients can present with atypical symptoms in combination with a clinical history of hypermobility. Conventional CT myelography can confirm capacious thecal sacs, multiple CSF leaks, prominence of perimedullary veins, or multiple dural diverticula. The senior author, a pediatric neurointerventionalist, treated the presented cases. Education goals: 1) To present common heritable (e.g. COL11A2, COL5A2, ADAMTS2, ZNF469, FBN1, FLNA, TNXB) connective tissue diseases that can manifest with CSF disorders in children. 2) To highlight the main findings on conventional CT myelography to detect CSF leaks. 3) To correlate CT myelography findings with brain and spinal MRI in children with CSF disorders. 4) To discuss the options for management from a neurointerventional perspective. Read More

Meeting name: SPR 2025 Annual Meeting , 2025

Authors: Tierradentro-garcia Luis, Martinez Mesha

Keywords: CSF, Interventional

Background: Pediatric acute-onset neuropsychiatric syndrome (PANS) is a rare neuroinflammatory entity that is often associated with infectious and non-infectious triggers. This condition was first associated with recent Streptococcal infections (PANDAS) in the late 1990s. PANS manifests with sudden obsessive-compulsive disorder and/or restricted food intake with additional neuropsychiatric abnormalities. Children with PANS demonstrate generalized increased median diffusivity in the brain, more prominently in the deep gray matter, including the thalami, basal ganglia, and amygdala. Although neuroimaging plays a supportive role in diagnosis, its use is limited by the lack of positive findings in cases with clinically diagnosed PANS. Purpose: We aim to showcase brain MRI findings in a child with a clinical diagnosis of PANS at different time points. Our goal is to build on the potential role of neuroimaging in this condition in the acute and subacute phases. Case description: We discuss the case of an 11-year-old boy who presented with fever and altered mental status two weeks after having an upper respiratory infection. The patient underwent a contrast-enhanced brain MRI, which showed increased T2W/FLAIR signal and swelling of the caudate nuclei and putamina bilaterally, with no abnormal enhancement or restricted diffusion; notably, there was mild increased diffusion in the basal ganglia, likely reflecting vasogenic edema. Five days later, a repeat brain MRI revealed mild, diffuse high T2W/FLAIR signal, which was overall decreased compared to the prior scan. Additionally, diffusion in the caudate relatively decreased compared to the putamina. Twelve days later, there was a continued decrease in the T2W/FLAIR signal in the putamina, caudate nuclei, and possibly the lateral portion of the globi pallidi. Discussion points: -To present common neuroimaging findings in patients with suspicion/diagnosis of PANS/PANDAS over time, including increased T2W/FLAIR signal and mild increased diffusion in the basal ganglia. -To discuss the current roles/limitations of neuroimaging in the workup based on the existing literature. -To illustrate the primary differential diagnoses that can mimic PANS/PANDAS neuroimaging findings in children, including autoimmune encephalitis, Sydenham chorea, mitochondrial disorders, and tic disorders. -To hypothesize the role of glymphatic, CSF, and venous dynamics in neuroinflammation in PANS/PANDAS related to early vasogenic edema. Read More

Meeting name: SPR 2026 Annual Meeting , 2026

Authors: Tierradentro-garcia Luis, Martinez-correa Santiago, Forero-millan Julian, Martinez Mesha

Keywords: Pediatric Neuroradiology, Basal Ganglia, Diffusion Weighted Imaging