Chiari Type I deformity (C1) is associated with bony deformity of the skull base and herniation of cerebellar tonsils. MRI is used for diagnosis and surgery is advised for symptomatic children. We present a case series using MR imaging including CSF flow, in a variety of children with C1 to demonstrate a variety of outcomes both surgical and non-surgical: spontaneous resolution, spontaneous worsening, post-surgical improvement. Case 1: A 6-year-old (y) girl referred for imaging with short stature and growth hormone deficiency demonstrated incidental findings of C1 without syringomyelia. No surgery (Sx) was performed, and follow-up (F/U) MRI at age 7 y demonstrated spontaneous resolution of the tonsillar ectopia and expansion of the CSF spaces at craniocervical junction (CCJ). Case 2: A 7 y boy with headaches and staring spells underwent an MRI demonstrating 6 mm protrusion of pointed cerebellar tonsils and CSF space reduction at CCJ. No Sx was performed, and F/U imaging at age 9 y demonstrated spontaneous improvement in cerebellar tonsillar position and increased bidirectional CSF flow at CCJ. Case 3: A 2-week-old girl underwent brain MRI demonstrating an ectopic neurohypophysis, under opercularization suggesting brain immaturity and a normal CCJ. F/U MRI at 6 y of age showed interval spontaneous development of C1 with decreased CSF spaces at CCJ. Case 4: A 17-month-old boy underwent brain MRI for unsteady gait and poor vestibular response, which showed C1 and narrow CSF spaces at the foramen magnum and with reduced CSF flow. At age 3 y, after posterior fossa decompression, F/U MRI showed post-surgical improvement of the position of the cerebellar tonsils and increased CSF space at CCJ. Case 5: A 8 y girl with headaches and intermittent dizziness underwent MRI demonstrating 15 mm protrusion of the pointed cerebellar tonsils and marked decrease in the CSF at CCJ. After suboccipital craniotomy, MRI at age 8 y demonstrated a post-surgically improved CSF space and improved bidirectional CSF flow, at CCJ. Read More

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

Authors: Venkatakrishna Shyam Sunder, Andronikou Savvas

Keywords: Chiari Type I deformity (C1), CSF space, CSF flow

MRI can accurately quantify liver iron concentration (LIC) by using T2* sequences. Vendor based, commercially available 3D multi-echo Dixon sequences provide maps of liver T2*/R2* and allow automated, inline post-processing, avoiding conventional manual post-processing. The purpose of our study was to compare R2*/LIC estimates generated by automated 3D multi-echo Dixon sequence to values generated by GRE-based R2* relaxometry as the reference standard. Read More

Meeting name: SPR 2023 Annual Meeting & Postgraduate Course , 2023

Authors: Venkatakrishna Shyam Sunder, Otero Hansel, Khrichenko Dmitry, Serai Suraj

Keywords: Liver Iron Concentration, 3D multi-echo Dixon, MRI

Perinatal Hypoxic Ischemic Injury (HII) has a higher prevalence in the developing world. One of the primary concepts for suggesting that an imaging pattern reflects a global insult to the brain is when the injury is noted to be bilateral and symmetric in distribution. In the context of HII in term neonates, this is either bilateral symmetric (a) peripheral/watershed injury (WS) or (b) bilateral symmetric Basal-ganglia-thalamus (BGT) pattern, often with the peri-Rolandic and hippocampal injury. Unilateral, asymmetric or unequal distribution of injury may therefore be misdiagnosed as perinatal arterial ischemic stroke. This has been previously reported in the typical distribution patterns, without a clear indication of the prevalence. We aimed to determine the prevalence of unilateral, asymmetric and unequal degree HII and to characterize the distribution on MRI in a large database of patients with Cerebral Palsy (CP) from South Africa. Read More

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

Authors: Venkatakrishna Shyam Sunder, Elsingergy Mohamed, Worede Fikadu, Andronikou Savvas

Keywords: Hypoxic Ischemic Injury (HII), Basal-ganglia-thalamus and Watershed, Unilateral, Asymmetric or Unequal distribution

Effective text-based communication, through radiologist reports, of imaging findings in term Hypoxic Ischemic Injury (HII) to family members, non-radiologist colleagues and members of the legal profession can be extremely challenging. Utilization of 3D printed models, where the actual findings of the brain can be communicated via tactile perception and rotating/grasping the models is a potential solution which has not been tested in practice. We aimed to determine the sensitivity and specificity of different groups, comprising trained radiologists, non-radiologist physicians and non-physicians, in the detection of gross disease of the cerebral cortex from 3D printed brain models derived from MRI scans of children. Read More

Meeting name: SPR 2023 Annual Meeting & Postgraduate Course , 2023

Authors: Venkatakrishna Shyam Sunder, Chacko Anith, Schoeman Sean, Andronikou Savvas

Keywords: Magnetic Resonance Imaging, 3D Printing, Hypoxic Ischemic Injury

To assess the utility and adaptability of some widely used automated segmentation methods when applied to abnormal pediatric magnetic resonance imaging (MRI) brain scans. Segmentation is an essential component of the workflow when building 3D anatomical models of abnormal pediatric brains to demonstrate surface pathology. Read More

Meeting name: SPR 2023 Annual Meeting & Postgraduate Course , 2023

Authors: Schoeman Sean, Venkatakrishna Shyam Sunder, Chacko Anith, Andronikou Savvas

Keywords: Segmentation, 3D Printing, MRI Brain

Upper gastrointestinal studies are used for the diagnosis of intestinal malrotation, and the configuration of the duodenum and position of the DJ flexure are used for diagnosis. There are various challenges associated with diagnosing malrotation on the AP view, and obtaining a lateral view is recommended for diagnosis. To be useful, the lateral view must be of adequate quality. In addition, radiologists must be aware of the normal appearance and configuration of duodenal variants such as duodenum redundum, on the lateral view, as misdiagnosis of these may lead to unnecessary surgery. We aim to determine the proportion of lateral views considered of adequate quality for diagnosis, as well as the prevalence of a not previously described sign, the 'descending stair' and its correspondence to a diagnosis of duodenum redundum. Read More

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

Authors: Venkatakrishna Shyam Sunder, Elsingergy Mohamed, Calle Toro Juan, Dennis Rebecca, Andronikou Savvas

Keywords: Descending stair, Upper gastrointestinal studies (UGI), Duodenum redundum

Risk stratification of the most common pediatric primary liver malignancies, hepatoblastoma and hepatocellular carcinoma, is dependent on imaging criteria that ultimately inform work-up and clinical management. The Pediatric Liver Reporting and Data System (LI-RADS) Working Group recommends use of the PRETEXT (PRE-Treatment EXTent of tumor) staging system, which is utilized in the ongoing Pediatric International Tumor Trial (1). PRETEXT staging is first performed by dividing the liver into four sections. Based on how many contiguous sections are free of tumor, a group is assigned from I-IV. Second, annotations factors are assessed depending on the presence of vessel involvement, rupture, multifocality, extrahepatic spread, or metastatic disease, which portend higher risk (2). Understanding and applying the PRETEXT system should be a core competency for all current and aspiring pediatric radiologists. The PRETEXT system has some barriers to learning, namely in discerning the anatomical liver sections from the functional ‘Couinaud’ segments and accurately determining vessel involvement. We saw the opportunity to combine our diagnostic pediatric radiologic experience/expertise with the application of 3D printing technology. Through the segmentation of post-contrast T1 fat-saturated MRI images, we were able to build 3D models of different PRETEXT stage disease. The aim of this educational exhibit is to provide pediatric radiologists with an alternative learning tool to appreciate the PRETEXT system and its application. It will combine the proficiency of a 3D pediatric additive manufacturing lab and diagnostic pediatric radiologists with expertise in oncologic imaging and fellowship teaching. Models and their representative 3D renderings will demonstrate the differences between PRETEXT stages, with and without the presence of various annotation factors. 1. Schooler GR, Squires JH, Alazraki A, Chavhan GB, Chernyak V, Davis JT, et al. Pediatric Hepatoblastoma, Hepatocellular Carcinoma, and Other Hepatic Neoplasms: Consensus Imaging Recommendations from American College of Radiology Pediatric Liver Reporting and Data System (LI-RADS) Working Group. Radiology. 2020 Sep;296(3):493–7. 2. Towbin AJ, Meyers RL, Woodley H, Miyazaki O, Weldon CB, Morland B, et al. 2017 PRETEXT: radiologic staging system for primary hepatic malignancies of childhood revised for the Paediatric Hepatic International Tumour Trial (PHITT). Pediatr Radiol. 2018 Apr;48(4):536–54. Read More

Meeting name: SPR 2023 Annual Meeting & Postgraduate Course , 2023

Authors: Schoeman Sean, Venkatakrishna Shyam Sunder, Silvestro Elizabeth, Cajigas-loyola Stephanie, Acord Michael

Keywords: PRETEXT Staging, 3D Printing, MRI

Suspected airway compression in symptomatic children with Lymphobronchial Tuberculosis (LBTB) can be diagnosed using modern computed tomography (CT) assisted by coronal minimum intensity projection (MinIP) reconstructions. The accuracy of plain radiographs in detecting airway compression in children with TB has not been evaluated against an imaging gold standard in a dedicated manner. We aimed to compare frontal CXR against thick-slab angled coronal CT MinIP in identifying airway stenosis at ten specific sites and to determine the agreement between the modalities regarding the degree of stenosis. Read More

Meeting name: SPR 2023 Annual Meeting & Postgraduate Course , 2023

Authors: Calle Toro Juan, Bester Dewald, Venkatakrishna Shyam Sunder, Ali Krim Ahmed, Lucas Susan, Goussard Pierre, Andronikou Savvas

Keywords: Lymphobronchial Tuberculosis, minimum intensity projection, computed tomography

Lymphobronchial TB (LBTB) in children refers to airway narrowing by tuberculous lymphadenopathy. Diagnosis is made invasively using flexible bronchoscopy or noninvasively with CT, which can include minimum intensity projection (MinIP) reconstructions. Our aim was to generate standardized coronal minimum intensity projection CT reconstructions and compare these with flexible bronchoscopy in children with LBTB. Read More

Meeting name: SPR 2023 Annual Meeting & Postgraduate Course , 2023

Authors: Calle Toro Juan, Ali Krim Ahmed, Venkatakrishna Shyam Sunder, Bester Dewald, Lucas Susan, Goussard Pierre, Andronikou Savvas

Keywords: Trachea, CT, Lymphobronchial TB

Artificial intelligence (AI) has the potential to improve many aspects of pediatric radiology. AI solutions have emerged to perform a wide range of tasks, including facilitating the workload of radiologists, improving image quality, performing motion correction, and reducing contrast dose. While a myriad of courses for learning AI are available, most resources lack the necessary radiology perspective required for clinical application. Few interactive resources are available to teach a systematic approach for pediatric radiologists when analyzing AI literature. Since AI methodologies in pediatric radiology research fundamentally differ from classical statistical analyses, an educational poster dedicated to interpreting pediatric radiology AI literature would assist in bridging this gap. The purpose of this education exhibit is to provide a resource for pediatric radiologists that teaches a systematic approach for the interpretation of AI research publications. Knowledge delivery will be made by eLearning slide-based presentation. The major topics regarding AI literature will focus on: problem identification; data curation; data annotation, artificial intelligence models; validation and performance. Next, we review prior literature on important criteria for AI publications, including Checklist for Artificial Intelligence in Medical Imaging (CLAIM), the AI version of the Standards for Reporting of Diagnostic Accuracy Studies (STARD-AI), Transparent Report of Multivariable Prediction Model of Individual Prognosis and Diagnosis for AI (TRIPOD-AI) and Prediction Model Risk of Bias Assessment Tool for AI (PROBAST-AI). Lastly, we present these criteria in the context of pediatric AI research applications. AI research methodology in pediatric radiology differs from classical research methodologies. Therefore, this education exhibit is intended to teach the systematic interpretation of the primary AI literature to pediatric radiologists in order to translate scientific knowledge into meaningful clinical information. Read More

Meeting name: SPR 2023 Annual Meeting & Postgraduate Course , 2023

Authors: Rafful Patricia, Alkhulaifat Dana, Lopez Rippe Julian, Khalkhali Vahid, Welsh Michael, Venkatakrishna Shyam Sunder, Wieczkowski Sydney, Reid Janet, Sotardi Susan

Keywords: Artificial Intelligence, Radiology, Research