Showing 9 Abstracts.
Shunts are near-ubiquitous in the world of pediatric neuroimaging, and it is incumbent on radiologists who interpret pediatric neuroimaging to have a basic understanding of the different shunt types and components. In this educational poster we will review the appearance of a shunt with its three parts. We will correlate this to the imaging appearance of different shunt valves (programmable and non-programmable), and appropriate proximal and distal catheter positioning. We will describe the more common complications (i.e. shunt failure, subdural collections, slit ventriclular syndrome, etc.) associated with shunts in pediatric patients. The poster will also briefly highlight some of the relative advantages and disadvantages of computed tomography (CT) and magnetic resonance (MR) imaging in the assessment of hydrocephalus. Read More
Meeting name: SPR 2018 Annual Meeting & Postgraduate Course , 2018
Authors: Hallaji Shareh, Collins John, Ritter Ann, Tye Gary, Vorona Gregory
Keywords: shunts, ventriculoperitoneal
Aspergillus species are ubiquitous environmental molds that healthy humans encounter daily without any adverse effects. However, these molds can cause a range of diseases in immunocompromised individuals, collectively known as invasive aspergillosis. These diseases can affect the sinuses, tracheobronchial tree, lungs, skin, or disseminate. The most common form of invasive aspergillosis is invasive pulmonary aspergillosis, which has high morbidity and mortality rates and requires prompt diagnosis and treatment. A severe form, known as angioinvasive pulmonary aspergillosis, occurs when mold hyphae invade the pulmonary arteries and cause necrosis and hemorrhage of the lung parenchyma. We present such a case in a 17-year old boy with acute myeloid leukemia who developed pulmonary pseudoaneurysms as a complication. The patient was initially admitted to the hospital for scheduled chemotherapy. Several complications occurred, including neutropenic fevers, cough, and pleuritic chest pain, despite broad-spectrum antibiotics. Initial imaging with CT pulmonary angiography showed multifocal nodules and masses with surrounding groundglass opacities. Serum aspergillosis galactomannan and Fungitell were strongly positive. Bronchoalveolar lavage was not performed due to profound anemia and thrombocytopenia. Initial treatment included dual-antifungal therapy with continued treatment upon discharge. Follow-up CT exams demonstrated complications with multiple pseudoaneurysms necessitating repeat hospitalizations, coil embolization, and lobectomy. This case demonstrates classic CT findings of angioinvasive pulmonary aspergillosis, including the "halo" and “air crescent” signs. In our case, the patient developed complications with pulmonary pseudoaneurysms that required multiple interventions. Prompt diagnosis and treatment of this condition is important due to the life-threatening implications. Read More
Meeting name: SPR 2024 Annual Meeting & Postgraduate Course , 2024
Authors: Cristobal Alberto, Martinez-sicari Jorge, Vorona Gregory, Jones Kathryn, Austin Frances, Mahdi Eman
Keywords: Invasive aspergillosis, Pseudoaneurysm, Immunocompromised
Magnetic resonance imaging (MRI) is a robust imaging modality. However, the necessity for patients to hold still commonly requires pediatric patients to be sedated (which carries its own risks), or limits the useful scan time window in some nonsedated pediatric patients. In some circumstances, there is no way to control the movement of the imaging target (i.e. fetal MRI). MRI is also very customizable, and there are number of options currently available to accelerate MR imaging. It is important for pediatric radiologists supervising pediatric MRI examinations to have a broad understanding of the technology that is currently available, in order to optimize imaging quality and mitigate sedation use. In this educational exhibit, we will briefly review a number of acceleration techniques available on the Siemens platform, noting that other vendors have very similar options available for their customers. These techniques will include single-shot fast spin echo , balanced steady-state gradient echo, parallel imaging, radial imaging, and simultaneous multislice imaging. Our review will focus on the relative advantages and disadvantages of these techniques, rather than on the physics of image generation. Read More
Meeting name: SPR 2019 Annual Meeting & Postgraduate Course , 2019
Authors: Loken Eric, Cho Joo, Bessom David, Corwin Frank, Metts Brent, Vorona Gregory
Keywords: MRI, parallel imaging, radial imaging
The purpose of our case series is to review the imaging, clinical, and pathologic findings of two adolescent patients that presented to our medical center who were ultimately found to have the juvenile/young adult (Prust Type II) form of Alexander Disease. The first patient was an eleven year old male with presumed conversion disorder who was transferred from a pediatric residental mental health clinic after a suspected aspiration event. The parents reported that the patient had difficulty swallowing for years, that had worsening significantly over the preceding six months. A non-enhanced head CT was performed shortly after the patient was admitted due to a change in mental status, which revealed a focal abnormality at the cervicomedullary junction. Subsequent assessment with MRI confirmed the lesion, which demonstrated corresponding T2/FLAIR signal hyperintensity and enhancement, with the presumptive initial diagnosis of a cervicomedullary tumor. The patient was biopsied at an outside institution, and was diagnosed with Alexander Disease by that institution. The second patient was a twelve year old male with history of cleidocranial dysplasia, in which extensive signal abnormality and enhancement was first identified throughout the posterior fossa structures on an outpatient MRI of brain obtained for paroxysmal episodes of dizziness. A small amount of signal abnormality in the periventricular white matter was also present. The patient was initially worked up and treated for a neuroinflammatory disorder, and a biopsy was performed when there was further worsening of the patient’s symptoms. A mutation in the patient's GFAP gene was subsequently identified of “uncertain significance”. Juvenile/young adult (Prust Type II) Alexander Disease is a rare leukodystrophy, which is associated with a different set of imaging characteristics compared with the more classic infantile/juvenile (Prust Type I) form. Radiologists who regularly interpret pediatric neuroimaging studies should be aware of its existence and its spectrum of associated imaging findings, in the interest of both arriving at the correct diagnosis and in avoiding unnecessary brain biopsy. Read More
Meeting name: SPR 2022 Annual Meeting & Postgraduate Course , 2022
Authors: Vorona Gregory, Mahdi Eman, Ritter Ann, Henry Chrisopher, Rao Sanjai, Richard Hope, Urbine Jacqueline
Keywords: Alexander, leukodystrophy
Congenital absence of the internal carotid artery (ICA) is a rare vascular anomaly, with a prevalence below 0.01%. This case report presents an unusual instance of idiopathic intracranial hypertension (IIH) and migraine, for which the workup revealed the unexpected absence of the bilateral ICAs. A 13-year-old female, previously healthy, experienced severe, persistent bilateral occipital headaches, neck pain, blurry vision, photophobia, and visual aura. Ophthalmological findings showed optic disc swelling, particularly in the right eye. Pediatric Neurology assessed the patient, finding papilledema (predominantly in the right eye) with no other neurological deficits. Lumbar puncture yielded an elevated opening pressure (34 cm H2O). MRI brain demonstrated imaging characteristics indicating IIH. MRV head/neck excluded dural venous sinus narrowing or thrombosis. MRA head/neck revealed congenital bilateral ICA absence. Both vertebral arteries were patent, and the basilar artery supplied the anterior cerebral circulation. The patient was diagnosed with IIH and migraine. She was discharged with Diamox and Topamax, with ongoing management by pediatric neurology. This case report will review the clinical background and the advanced imaging findings associated with an uncommon intracranial vascular anomaly in pediatric neurology, including arterial spin labeling (ASL). Bilateral ICA absence, though exceptionally rare, can contribute to neurological manifestations, including IIH and migraine. Co-occurring IIH and migraine, alongside congenital bilateral ICA absence, pose a unique diagnostic challenge. A multidisciplinary approach and heightened awareness among healthcare providers are essential for managing such complex presentations. Read More
Meeting name: SPR 2024 Annual Meeting & Postgraduate Course , 2024
Authors: Patel Shital, Aviado Randy, Way Ewa, Bingham Jobeth, Strauss Lauren, Mahdi Eman, Vorona Gregory
Wilm’s tumor (nephroblastoma) is the most common pediatric renal mass, with rare reports of extra-renal Wilm’s tumors which primarily arise elsewhere in the retroperitoneum. We present a small series of patients who have recently been treated at our institution with histologically-proven extra-renal Wilm’s tumors. The first patient is a six year old female who initially presented to an outside hospital with a draining “perianal abscess”, who on subsequent workup was found to have a large infiltrative pelvic mass and multiple pulmonary metastases (image 1). The second patient is a six year old female who initially presented with abrupt onset of right-sided abdominal pain which woke her from sleep, and who was found on imaging to have a large right-sided retroperitoneal hemorrhage originating from a hemorrhagic suprarenal mass (images 2 and 3). We will review the pertinent imaging and histological findings from these patients, as well as briefly review what has been previously published about this rare rumor. The imaging features of extra-renal Wilm’s tumor are heterogeneous and not specific, making it important that the radiologist consider this etiology when presented with a retroperitoneal mass in a pediatric patient within the first decade of life. Read More
Meeting name: SPR 2018 Annual Meeting & Postgraduate Course , 2018
Authors: Kolluri Akhil, Smith Stephen, Gowda Madhu, Austin Frances, Bagwell Charles, Oiticica Claudio, Vorona Gregory
Keywords: Wilm's tumor, nephroblastoma, extra-renal
Brain hypoxic-ischemic injury (HII) is a devastating injury that results in death or profound long-term neurologic disability in both children and adults. Treatment is mostly supportive, including hypothermia and administration of excitatory amino acid antagonists, with a limited window of effectiveness (as little as 6 hours), making early detection of injury critically important. Neuroimaging with Ultrasound, CT, and MRI has become increasingly valuable in the work-up of patients with HII. In this educational exhibit we will: a) review the pathophysiologic features and factors that influence the pattern of injury, b) discuss the specific imaging patterns in preterm and term neonates, c) review the imaging approach and highlight the role of advanced MRI techniques such as MR spectroscopy, DWI/ADC, and ASL perfusion in the evaluation process. Finally, we will briefly elaborate on the therapeutic hypothermia in HII, and the influence on imaging findings. Read More
Meeting name: SPR 2024 Annual Meeting & Postgraduate Course , 2024
Authors: Aviado Randy, Clark Keaira, Mahdi Eman, Nada Ayman, Mishra Chakradhar, Jones Kathryn, Urbine Jacqueline, Vorona Gregory
The spectrum of imaging findings associated with intracranial germ cell tumors extends well beyond the typical suprasellar and/or pineal region masses. It is imperative that radiologists who interpret pediatric neuroimaging studies be familiar with the range of imaging findings associated with intracranial germ cell tumors, particularly as the appropriate suggestion of germ cell tumor as a diagnosis can have a significant impact on the initial surgical plan. In our case series we will review the typical imaging (CT and MRI) findings of both germinoma and nongerminomatous germ cell tumors, including metastasis and local invasion/extension. We will also review how intracranial germ cell tumors can be multifocal and how they can involve unusual areas such as the basal ganglia, cerebellum, and septal leaflets. MR spectroscopic findings associated with pediatric intracranial germ cell tumors will also be reviewed, including how these findings can be very helpful to differentiate from other similar-appearing pathologies. Finally, we will briefly discuss the treatment and prognosis of intracranial germ cell tumors. Read More
Meeting name: SPR 2023 Annual Meeting & Postgraduate Course , 2023
Authors: Aviado Randy, Vorona Gregory, Tye Gary, Ritter Ann, Wang Zhihong, Mahdi Eman, Mishra Chakradhar, Jones Kathryn, Urbine Jacqueline
Keywords: Germ cell tumor, germinoma, teratoma
In our case series, we highlight the imaging findings of two patients with rare “neuroblastoma” tumors in which the diagnosis was not considered preoperatively, emphasizing the importance of pediatric radiologists being aware of these unusual etiologies for accurate diagnosis and management. A 17-year-old with blurry vision presented with progressive visual deterioration. MRI revealed a 5.5 cm mass in the inferior left frontal lobe, impacting the prechiasmatic optic nerve and optic chiasm. A CTA confirmed the lesion's encasement of the circle of Willis's left aspect. The patient underwent a craniotomy for tumor resection, revealing a primary CNS neuroblastoma FOXR2-activated, WHO grade 4. Another patient, a 13-year-old female, reported vomiting, abdominal pain, and diarrhea. The past medical history included Lyme disease and "cat scratch" fever. Severe hyponatremia was discovered, initially attributed to viral sequelae, necessitating prolonged hospitalization. An incidental nasal cavity/maxillary sinus "polyp" was identified and excised, diagnosed as olfactory neuroblastoma (Esthesioneuroblastoma), Hyam grade 3, Kadish stage 2. Post multiple surgeries and radiation, the hyponatremia, a result of SIADH, resolved with tumor treatment. Neuroblastomas, typically arising from the adrenal gland or retroperitoneum, are the most common extracranial solid pediatric tumors. They are usually sporadic, but sometimes associated with specific syndromes. Primary intracranial neuroblastomas are rare, with ambiguous classification and no distinct imaging characteristics or established adjuvant treatment protocols, contributing to high recurrence rates. CNS neuroblastomas more commonly affect the spine, with intracranial instances being rare but important differential diagnoses for pediatric brain tumors. Similarly, esthesioneuroblastomas, originating from olfactory neuroepithelial cells, are rare, constituting only 0.6% of all upper aerodigestive tract tumors. Ectopic cases are even rarer, with some inducing paraneoplastic syndromes like ectopic Cushing’s or SIADH. Particularly, esthesioneuroblastomas with SIADH-related euvolemic hyponatremia have a mere 2% prevalence and should be considered in atypical/refractory hyponatremia cases with incidental sinus masses. Read More
Meeting name: SPR 2024 Annual Meeting & Postgraduate Course , 2024
Authors: Blundo Gianna, Jones Kathryn, Mishra Chakradhar, Vorona Gregory, Hinh Lylie, Mahdi Eman, Wang Zhihong, Tye Gary, Ritter Ann, Petersson Rajanya, Richard Hope, Al-samarraie Mohannad
Keywords: neuroblastoma, enthesioneuroblastoma