Despite significant advances in delivering dose-intensive and myeloablative therapy with hematopoietic stem cell support, the survival for patients presenting with metastatic neuroblastoma remains poor, with a 3 year event free survival (EFS) of about 60%. Modern treatment protocols are based on risk stratification which incorporates age of diagnosis, tumor stage, tumor histology, and molecular and cytogenetics including MYCN amplification. ¹⁸F-FDG PET/CT can play a role in disease staging and follow up. The purpose of this study was to report FDG PET findings in a cohort of children with neuroblastoma and assess for predictive associations with MYCN amplification status. Read More

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

Authors: Sung Andrew, Weiss Brian, Trout Andrew

Keywords: Neuroblastoma, PET, Genetics

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

Lipoblastomas are rare benign soft tissue tumors (6% of all pediatric soft tissue tumors) that are composed of immature lipoblasts and mature adipocytes. Lipoblastomas primarily occur in infants and children younger than three years of age and most frequently occur in the extremities. Less than 10 case reports exist of pelvic lipoblastomas. We report two children with pelvic lipoblastoma with the typical presentation of a rapidly enlarging, painless, fat-containing mass. A 30-month-old girl presented with an enlarging gluteal mass over a period of four months. CT performed at an outside institution showed a large fat-containing intra-pelvic lesion anterior to the sacrum that extended to the perineum. An atypical sacrococcygeal teratoma was suspected. Subsequently, MRI demonstrated a large fairly-well-circumscribed intra-pelvic lesion that followed fat on all sequences with the exception of a few thin, enhancing septations. A 14-year-old boy presented with a large firm scrotal/inguinal mass during a wellness visit. The child reported the lesion had been rapidly increasing in size over the past two months. Ultrasound showed a >15 cm inguinal mass that extended both into the pelvis and left hemiscrotum. The mass was homogeneous in echotexture and displaced but did not involve the epididymis and testicle. Based on concern for a malignant lesion, subsequent evaluation with PET-CT showed the lesion to be predominantly composed of fat with only low level F-18-FDG uptake in a few internal septations. In both cases, lipoblastoma was confirmed after surgical excision with pathologic examination and immunohistochemistry. Imaging serves to demonstrate the macroscopic fat content of lipoblastomas but cannot reliably differentiate lipoblastoma from liposarcoma. Therefore, imaging primarily contributes information about size and anatomic relationships relevant to surgical approach. Surgical excision is the treatment of choice; however, the lack of a capsule makes complete excision difficult and local recurrence is common. Close clinical follow-up is recommended for a minimum of five years, with imaging follow-up by MRI or CT utilized when the tumor’s anatomic location precludes or limits detection by physical examination. Read More

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

Authors: Ledbetter Karyn, Leino Daniel, Trout Andrew

Keywords: Lipoblastoma, Pelvic, Scrotal

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

Ultrasound shear wave elastography (US SWE) can be used to noninvasively measure liver stiffness. US SWE is a potentially useful technique for diagnosing and monitoring liver fibrosis, obviating the need for liver biopsy in some patients. When compared to MR elastography (MRE), US SWE is lower cost, portable, and does not need sedation/anesthesia. US SWE measurements can vary by method (point vs. 2D) and vendor. Few studies have defined cut-off values for detecting fibrosis in pediatric patients using US 2D SWE. This study aims to evaluate the diagnostic performance and define cut-off values of US 2D SWE for the detection of liver fibrosis in pediatric patients, using Toshiba (Canon) Aplio 500 and Aplio i800 systems. Read More

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

Authors: Alhashmi Ghufran, Gupta Anita, Trout Andrew, Dillman Jonathan

Keywords: 2D US shear wave elastography, Liver fibrosis, Pediatric

In this study, we trained two convolutional neural networks to automatically identify the third vertebral level and segment the abdominal muscle in contrast enhanced abdominal CT images. In the future, these models will be used to determine reference ranges for skeletal muscle mass in children by age for the purpose of identifying patient characteristics associated with differences in skeletal muscle mass. Read More

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

Authors: Castiglione James, Gilligan Leah, Somasundaram Elanchezhian, Trout Andrew, Brady Samuel

Keywords: Neural Network, Segmentation, Deep Learning

Compressed SENSE (CS) facilitates significantly shorter MRI acquisition times. There is a paucity of data comparing quantitative MRI with regularly under-sampling schemes like SENSE to pseudorandom under-sampling schemes like CS. The purpose was to compare measurements of liver proton density fat fraction (PDFF), T2*, and stiffness between SENSE and CS techniques with identical MR acquisition parameters. Read More

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

Authors: Boyarko Alexander, Dillman Jonathan, Pednekar Amol, Tkach Jean, Trout Andrew

Keywords: Under-sampling, mDixon-Quant, Elastography

Portal hypertension is a manifestation of Fontan-related venous congestion and hepatic fibrosis. We studied the prevalence of radiologic evidence of portal hypertension (RP) and its association with Fontan hemodynamics and adverse outcomes. We also tested the validity of the VAST score, used in a prior study, in our population. Read More

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

Authors: Zafar Faizeen, Trout Andrew, Palermo Joseph, Alsaied Tarek, Dillman Jonathan

Keywords: Fontan, Portal Hypertension, Congenital Heart Disease

Multiple noninvasive magnetic resonance imaging (MRI) methods have been described to detect liver fibrosis, including diffusion-weighted imaging (DWI). The purpose of our study was to evaluate predictors of liver MRI DWI apparent diffusion coefficient (ADC) measurements in pediatric patients with autoimmune liver disease, including the relationship between ADC measurements and liver stiffness. Read More

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

Authors: Abu Ata Nadeen, Dillman Jonathan, Gandhi Deep, Dudley Jonathan, Trout Andrew, Miethke Alexander

Keywords: Liver fibrosis, Liver stiffness

To determine the diagnostic performance of renal ultrasound for diagnosing nephrolithiasis in children using a clinical effectiveness approach. Read More

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

Authors: Roberson Nathaniel, Dillman Jonathan, O'hara Sara, Defoor William, Reddy Pramod, Giordano Richard, Trout Andrew

Keywords: nephrolithiasis

Acute kidney injury (AKI) remains a concern in hospitalized children undergoing computed tomography (CT) examinations with intravenous (IV) iodinated contrast material (ICM). Adult studies have shown frequencies of AKI after CT with IV ICM to be similar to propensity score-matched ICM unexposed cohorts. The purpose of this study is to evaluate the association between IV ICM exposure and AKI in hospitalized pediatric patients with stable kidney function undergoing computed tomography (CT). Read More

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

Authors: Gilligan Leah, Davenport Matthew, Trout Andrew, Su Weizhe, Zhang Bin, Goldstein Stuart, Dillman Jonathan

Keywords: contrast induced nephropathy, acute kidney injury, iodinated contrast material

The Fontan operation, used to palliate single ventricle congenital heart disease, increases venous pressure in the liver and is associated with Fontan associated liver disease (FALD), for which liver fibrosis is the final common pathway. Elastography (ultrasound [US] or MRI) can be used to non-invasively measure liver stiffness associated with liver fibrosis. However, these measures are confounded in Fontan patients due to venous congestion. The purpose of this study was to prospectively document the stiffening effect of passive hepatic congestion following the Fontan operation and track changes in liver stiffness over the post-operative period. Read More

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

Authors: Trout Andrew, Dillman Jonathan, Alsaied Tarek, Lubert Adam, Palermo Joseph, Lorts Angela, Khoury Philip

Keywords: Fontan, Liver, Ultrasound

Though pediatric use of both ⁶⁸Gallium Dotatate and ¹⁷⁷Lutetium is off label, the advantages they offer over FDA approved agents has led to their preliminary use in a variety of pediatric clinical scenarios. The purpose of this poster is to present the range of potential diagnostic and therapeutic applications of ⁶⁸Gallium Dotatate in children. Read More

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

Authors: Mcelroy Kevin, Czachowski Michael, Trout Andrew, Seghers Victor, States Lisa, Ahmed Safia, Laack Nadia, Binkovitz Larry

Keywords: Dotatate, Neuroendocrine tumor, Lutathera

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

To compare liver shear stiffness estimates obtained by Automatic Liver Elasticity Calculation (ALEC) processing of two-dimensional (2D) gradient-recalled echo (GRE) magnetic resonance elastography (MRE) data to stiffness values obtained from standard-of-care manual processing. Read More

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

Authors: Gandhi Deep, Lake David, Dillman Jonathan, Braimah Adebayo, Dudley Jonathan, Tkach Jean, Pednekar Amol, Trout Andrew, Miethke Alexander, Heilman Jeremiah, Dzyubak Bogdan

Keywords: Elastography, MRI, Elasticity

MR elastography (MRE) is increasingly being used to non-invasively assess diffuse liver disease in children. However, there are limited normal liver stiffness data for MRE in children. The purpose of this study was to determine normal liver stiffness measured by MRE for children and assess for associations with demographic factors, MRI field strength and MRI vendor. Read More

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

Authors: Trout Andrew, Zhang Bin, Dillman Jonathan, Anupindi Sudha, Gee Michael, Khanna Geetika, Xanthakos Stavra, Baikpour Masoud, Calle-toro Juan, Ozturk Arinc, Serai Suraj

Keywords: Elastography, MR, Liver