There is significant variation in the approach to diagnosing PCOS (polycystic ovarian syndrome), particularly in adolescents. PCOS, more recently referred to as hyperandrogenic anovulation, is a classic tried of oligomenorrhea and/or anovulation, hirsutism, and obesity. The Rotterdam criteria are widely used in the adult population, with diagnostic criteria including 2 of the following 3: ovulatory dysfunction, clinical and/or biochemical signs of hyperandrogenism, polycystic ovarian morphology on ultrasound. Although it is acknowledged that ultrasound is not necessary for diagnosing PCOS in adults if the first 2 criteria are met, there is sufficient controversy in adolescent literature that classic morphologic appearance in addition to one other criterion may not be diagnostic. Polycystic ovarian morphology (PCOM), the imaging correlate typically associated with the clinical diagnosis of PCOS, can be a normal finding in adolescents. Given that the criteria for the polycystic ovarian morphology (PCOM) remains controversial, it is important for a pediatric radiologist to understand the significance of PCOM in adolescents, and how radiology can best and most significantly add to the clinical picture. This presentation will provide a review of consensus guidelines for PCOS and PCOM, and best practices of describing findings of PCOM in adolescents. Novel approaches will also be discussed, including ongoing research in follicle counts and stromal volume with 3D ultrasound. Read More

Meeting name: SPR 2022 Annual Meeting & Postgraduate Course , 2022

Authors: Pradhan Nisha, Trenbeath Zachary, Tutman Jeffrey, Milla Sarah

Keywords: PCOS, PCOM, adolescent

Brain death, also known as death by neurologic criteria, (BD/DNC) is the permanent loss of total brain function in individuals who have sustained catastrophic brain injuries. Accounting for approximately 5% of pediatric deaths, BD/DNC remains a clinical diagnosis, which is often emotionally laden and not always straightforward. When results are equivocal or there exist limitations to the safe completion of the clinical assessment, clinicians rely on ancillary testing to make informed decisions. In October 2023, updated adult and pediatric BD/DNC consensus guidelines were published which reinforce differences in the recommendations for testing between the adult and pediatric populations. It is, therefore, crucial for Pediatric Radiologists to understand these guidelines and the critical role radiology plays in supporting this important diagnosis. In this educational exhibit, we will review the recent consensus guidelines and clinical indications for the use of imaging in BD/DNC evaluation. We will provide a step-by-step guide which will include patient preparation, radionuclide or contrast administration, image acquisition, and image interpretation for the two validated methods of pediatric BD/DNC ancillary testing: Radionuclide Perfusion Scintigraphy and 4-Vessel Catheter Angiography. Although 4 vessel catheter angiography is considered the gold standard in ancillary BD/DNC testing, as it is believed to be both 100% sensitive and 100% specific, radionuclide scintigraphy is the more widely used modality in the pediatric population, owing to the less invasive nature of the exam. Neither exam is without challenges related to limited availability and technical skill required yet are currently the only validated radiologic tools recommended for use in brain death diagnosis. Our exhibit will review multiple cases of evaluation for BD/DNC, accentuating imaging findings and pearls/pitfalls of acquisition and interpretation. Opportunities for investigation of other available imaging techniques will also be highlighted. Read More

Meeting name: SPR 2024 Annual Meeting & Postgraduate Course , 2024

Authors: Hampton Erica, Fuentealba Cargill Andrea, Trenbeath Zachary, Alazraki Adina, Stence Nicholas, Milla Sarah

Keywords: Nuclear Medicine, Interventional Radiology