Pediatric pathology involving the jejunum is more common than one might initially expect. Early recognition of the important imaging characteristic, atypical findings, and useful imaging tools/techniques in the evaluation of jejunal pathology is important in prompt diagnosis and management of these patients. In this educational exhibit we will present a series of cases involving pathology of the jejunum encountered in the pediatric population. We will focus on important pathologies affecting a difficult to image and sometimes forgotten portion of the intestine. A range of acute, emergent and post-surgical cases are presented. Using an interactive, quiz based approach we will discuss the following pediatric pathologies that may affect the jejunum of pediatric patients from neonates to teenagers with multimodality imaging and pathologic examples: Atresia Meconium plug syndrome Pneumatosis Enteritis Foreign body Small bowel intussusception Lymphoma Ischemia/shock Hernia Graft versus host disease Trauma Vasculitis Read More

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

Authors: Brahee Deborah, Towbin Alexander

Keywords: Gastrointestinal, Pediatric, Imaging

Neuroblastoma is the most common extracranial solid malignancy in children. It can have a variety of clinical outcomes, ranging from spontaneous resolution without therapy to fatal outcomes resistant to maximal therapy. Historically, neuroblastoma has been staged using the International Neuroblastoma Staging System (INSS). While this staging system has been used in clinical trials since its introduction in 1989, its reliance on surgical staging is problematic. Surgical resection can vary between surgeons and between tumors and occurs at an interval from diagnosis. This method complicates the process of standardizing therapy. Additionally, some patients have a disease that spontaneously regresses and does not require surgical management and thus cannot be staged. To combat these problems, the International Neuroblastoma Risk Group (INRG) created a new staging system for use in clinical trials in 2009. This staging system relies on preoperative imaging for up-front staging. This helps standardize neuroblastoma staging and helps to guide a more standard approach to management. The INRG staging system is comprised of twenty image-defined risk factors (IDRF), across multiple organ systems, which help predict surgical outcomes and can be combined with clinical data to provide up-front risk stratification. Even though the INRG staging system has been in use since 2009, many pediatric radiologists remain unfamiliar with its definitions and application. Additionally, MR has now become an essential imaging tool for diagnosis, staging, and follow-up of patients with neuroblastoma. The purpose of this poster is to compare the INSS and INRG staging system, describe the limitations of each system, and illustrate the definitions and IDRFs that comprise the INRG staging system. Read More

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

Authors: Chen Alan, Trout Andrew, Towbin Alexander

Keywords: neuroblastoma, IDRF, staging

Pancreatic neoplasms are rare in children and young adults, with an incidence of 0.46 per million under 30 years of age. Fortunately, children with a pancreatic neoplasm have a better prognosis than adults. The better prognosis and rarity of disease both contribute to the fact that pancreatic malignancies account for less than 0.2% of cancer-related deaths. Ultrasound is often the initial imaging modality to identify a pancreatic neoplasm due to its use for evaluation of symptoms such as upper abdominal pain, a palpable epigastric mass, or jaundice. Known pancreatic masses, or those detected initially by ultrasound should be imaged with CT or MRI to best characterize the mass and its relationship to adjacent structures, particularly the vasculature. Nuclear medicine plays a role in imaging of some pancreatic neoplasms depending on histology. Once a pancreatic neoplasm is identified, the radiologist is tasked with making a diagnosis from a differential diagnosis list of rare tumors. Primary pancreatic neoplasms are divided into epithelial and nonepithelial types. The epithelial tumors are more common and may be further subdivided into exocrine or endocrine subtypes. Epithelial exocrine tumors are the most common in children. Examples of these tumors include the two most common pediatric pancreatic neoplasms pancreatoblastoma and solid-pseudopapillary neoplasms. Endocrine tumors are uncommon. While functioning endocrine tumors can occur, non-functioning tumors are more common and are associated with syndromes such as von Hippel Lindau, multiple endocrine neoplasia type 1, and tuberous sclerosis. Nonepithelial tumors are also rare and include a number of different entities such as lymphoma, neurofibroma, and teratomas. Finally, the pancreas is an extremely rare site of metastasis. Pancreatic metastases can occur with multiple primary malignancies including neuroblastoma, rhabdomyosarcoma, and osteosarcoma. This exhibit will describe the imaging work-up of pancreatic tumors in children. We will illustrate the different clinical manifestations and imaging appearances of the various pediatric pancreatic neoplasms. Read More

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

Authors: Hasweh Reem, Trout Andrew, Towbin Alexander

Keywords: pancreas

Cystic liver lesions in the pediatric population are relatively uncommon but encompass a wide range of pathologies. It is important for radiologists to be familiar with the differential diagnosis and imaging characteristics of each entity because prognosis and treatment vary widely. This educational exhibit will review the appearance of various cystic liver lesions in the pediatric population by ultrasound, CT, and MRI and will review clinical presentation and genetic/biologic causes. Read More

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

Authors: Mcbee Morgan, Towbin Alexander, Dillman Jonathan, Trout Andrew

Keywords: hepatic cyst, Cystic mass, Fluid lesion

Epidermolysis bullosa (EB) is a group of rare genetic disorders that arise from at least 19 gene mutations for proteins that are involved in skin integrity. EB affects 1 out of 20,000 births in the United States and results in fragile skin that easily blisters from any minor friction or mechanical trauma. Other organ systems can also be seriously affected. The chronic skin inflammation and infections also places patients at risk for developing squamous cell carcinoma. Unfortunately, there is currently no cure for EB. The standard of care is supportive therapy and includes daily wound care, specialized dressings, and pain control. Because of the wide spectrum of systemic symptoms, there are numerous imaging findings that can be seen in patients with EB. These radiologic features can be categorized by body system including: 1) cardiac; 2) respiratory; 3) gastrointestinal; 4) genitourinary; 5) musculoskeletal; and 6) prenatal/fetal. There are various precautions that must be taken when performing any type of imaging study or anesthetic procedure for a patient with EB. These include but are not limited to: avoiding adhesives on the skin, providing special care when moving a patient, supporting pressure points on the imaging table, using large amounts of sterile water-based gel for ultrasound probes, and taking special care to protect the patient’s skin, airway and oral cavity during anesthesia or sedation events. The purpose of this poster is to: 1) review the various clinical presentations, pathologies, and associated imaging findings involved in EB, 2) examine imaging and anesthetic concerns when dealing with patients with EB, and 3) discuss the imaging and anesthesia approach used when evaluating EB patients. Read More

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

Authors: Sheriff Samar, Lucky Anne, Abbasian Niekoo, Towbin Alexander

Keywords: Epidermolysis bullosa

Diffuse serosal and soft tissue enhancement (SSTE) is a unique pattern of contrast enhancement seen on abdominal radiographs after cardiac catheterization in newborns. While thought to be benign, SSTE can be misdiagnosed as pneumoperitoneum, resulting in unnecessary and potentially invasive diagnostic procedures. The purpose of this study is to describe the incidence of SSTE on abdominal radiograph performed in infants within 2 days of cardiac catheterization and identify clinical features associated with this imaging finding. Read More

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

Authors: Wermers Joshua, Batlivala Sarosh, Li Yinan, Zhang Bin, Towbin Alexander

Keywords: Radiography, Contrast, Renal

At our institution, airway radiographs are routinely checked by the radiologist to ensure diagnostic image quality prior to the technologist completing the examination. These checks interrupt the workflow for both the technologist and radiologist. In this study, we develop and validate a deep learning algorithm to detect non-diagnostic lateral airway radiographs. Read More

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

Authors: Somasundaram Elanchezhian, Brady Samuel, Crotty Eric, Trout Andrew, Anton Christopher, Towbin Alexander, Coley Brian, Dillman Jonathan

Keywords: Deep learning, Airway, Xray