Pediatric chronic liver disease (CLD) poses a significant clinical challenge, necessitating precise diagnostic tools for comprehensive evaluation. Microvascular perfusion abnormalities play a pivotal role in disease progression. Contrast-enhanced ultrasound (CEUS) detects the flow in the micro-vessels, however, objective means are needed for better understanding. In this study we evaluate a novel quantitative method utilizing CEUS for assessing microvascular perfusion in pediatric patients with CLD. Read More

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

Authors: Venkatakrishna Shyam Sunder, Sultan Laith, Gabbert Morgan, Morgan Trudy, Anupindi Sudha

Keywords: Liver microvasculature, Contrast enhanced ultrasound, image analysis

Although Tuberculosis (TB) is very common in early childhood, we see an increased incidence of TB in adolescents due to increased susceptibility. It is also important to note that adolescent TB affects those living in low/middle income countries where TB is very common. There is a paucity of literature regarding the sequelae of TB disease in adolescents based on advanced cross-sectional imaging. We aimed to review the imaging features seen on CT imaging of the chest post adolescent TB in a cohort of patients from Peru. Read More

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

Authors: Venkatakrishna Shyam Sunder, Chiang Silvia S., Lecca Leonid, Byrne Anthony L., Andronikou Savvas

Keywords: Tuberculosis, Adolescent, CT

Current guidelines for initial cross-sectional imaging in pediatric lymphomas involves CT (Computed Tomography) of the chest, abdomen, and pelvis, ensuring that the radiation dose is As Low As Reasonably Achievable (ALARA). Whole-body MRI is favored over CT in this regard for diagnosing and staging the disease given its additional advantage of maximizing contrast resolution. Imaging characteristics of lymphoid tissue on MRI includes high T2 and STIR signal. Low and intermediate signal of lymphadenopathy on T2 and STIR is an unexpected finding noted anecdotally in nodular sclerosing Hodgkin’s lymphoma. These signal characteristics may be characteristic of histological subtype of the disease and may in future be used to avoid a biopsy diagnosis. In this study we aimed to review signal characteristics of lymphadenopathy in biopsy-confirmed nodular sclerosing Hodgkin’s lymphoma. Read More

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

Authors: Venkatakrishna Shyam Sunder, Rigsby Devyn, Amiruddin Raisa, Schoeman Sean, Jalloul Mohammad, Andronikou Savvas

Keywords: MRI, Nodular Sclerosing Hodgkin Lymphoma

Tuberculous meningitis (TBM) causes significant morbidity and mortality in young children. Early treatment can be initiated with MR imaging diagnosis. We present MR detectable miliary meningeal TB in two patients presenting in a developed world setting. Case 1: A 9 y/o girl of Haitian descent, developed fevers, cough, lethargy and seizures. Brain MRI demonstrated multiple, small, T2-dark, rim-enhancing lesions, associated with cranial nerve and leptomeningeal enhancement. Chest CT showed mediastinal lymphadenopathy, multiple small interstitial lung nodules and a splenic hypo enhancing lesion. CSF showed pleocytosis, low glucose, and high protein. She was started on 4-drug treatment for TBM and dexamethasone. Serial bronchoalveolar lavage was Xpert MTB/RIF and acid-fast negative. Contact tracing revealed a remote positive contact with pulmonary tuberculosis from Haiti. Endobronchial US-guided biopsy of a subcarinal lymph node was positive for Xpert MTB PCR. Case 2: A 17 y/o female with Crohn’s disease on adalimumab developed refractory ear infections despite multiple courses of antibiotics and underwent myringotomy, with negative aerobic ear fluid culture. She had two chronic skin lesions. Brain MRI, obtained due to persistent otorrhea, showed multiple, small, round, T2-dark lesions. CSF studies were unremarkable. CT chest, abdomen and pelvis showed left upper lobe tree-in-bud nodules, hypoattenuating splenic lesions and a left obturator internus abscess with adjacent osteomyelitis. She underwent CT guided aspiration of the obturator muscle collection, bronchoscopy with Bronchoalveolar Lavage (BAL), biopsy of her skin lesions and ear fluid aspiration. QuantiFERON Gold was positive. Ear fluid was Xpert MTB/RIF assay and acid-fast stain positive. She was started on 4-drug therapy and prednisone. Cultures from the ear fluid, skin tissue, muscle tissue and BAL showed growth of acid-fast bacilli. TB meningitis is most often due to blood borne spread of the disease from the lungs which may result in miliary nodules in the leptomeninges and brain. The two cases presented illustrate that although TBM is unusual in a developed world, we should suspect it in children of migrants as well as in patients with immunosuppression, where atypical imaging patterns including lack of typical basal enhancement and presence of miliary meningeal nodules may be seen. Read More

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

Authors: Venkatakrishna Shyam Sunder, Vasileiadi Eleana, Siu Navarro Youck Jen, Villavicencio Karen L Hanze, Miranda Schaeubinger Monica, Schoeman Sean, Otero Hansel, Andronikou Savvas

Keywords: Miliary Meningeal Tuberculosis

Teaching fluoroscopy skills remains an ongoing challenge in pediatric radiology education. Radiologists must be competent to perform a wide range of fluoroscopy procedures and are often required to teach these clinical skills to their peers, junior staff, and students. Teaching procedural skills through frameworks, observation, and feedback, with opportunities for repeated practice, assists in the learner’s acquisition and retention of skills. Fluoroscopy presents patient safety and ethical challenges as “practicing” this skill on patients requires ionizing radiation exposure and often invasive procedures. Through this educational exhibit, we describe a proposed program to improve skill performance, determine competency, and provide feedback. To improve voiding cystourethrogram (VCUG) training two patient models were created for bladder catheterization with different grades of vesicoureteral reflux using 3D printing and silicon rubber. Additional educational materials, including videos and graphical representations, were created to better help the learner understand the steps of the VCUG protocol. A three-component curriculum included 1) Knowledge (indications, contraindications, complications); 2) Communication (with patient and family, with fluoroscopy team); and 3) Performance of the skill (preparation before commencing, steps and dexterity, immediate aftercare of the patient). We modeled our evaluation of the learner from Peyton’s four-step approach to skills teaching (Demonstration, Deconstruction, Formulation, and Performance) to teach the physical performance of the fluoroscopy procedure. Feedback was provided to the learners using the Pendleton Feedback Model. Finally, competency was assessed using the Framework for clinical assessment developed by Miller. This educational exhibit aims to provide radiologists in training with an alternative learning curriculum to better understand and evaluate the steps of the VCUG and its performance on patients in a simulated setting before being performed on patients. Read More

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

Authors: Veselis Clinton, Venkatakrishna Shyam Sunder, Silvestro Elizabeth, Bennett Brittany, Srinivasan Abhay, Acord Michael, Sze Raymond, Reid Janet, Anupindi Sudha

Keywords: Voiding cystourethrogram, VCUG, Fluoroscopy