Wallace Andrew,  Raptis Demetrios,  Bhalla Sanjeev

Final Pr. ID: Poster #: EDU-001

This case-based, pictorial, educational exhibit will:
1. Examine the predisposing conditions of thoracic aortic aneurysm (TAA) in children
2. Illustrate the histopathologic and imaging features of these conditions
3. Demonstrate proper technique for measuring and reporting aortic dimensions in children
4. Review treatment options for TAA and how treatment depnds on the underlying disease and imaging findings Read More

Authors:  Wallace Andrew,  Raptis Demetrios,  Bhalla Sanjeev

Keywords:  Aneurysm ,  Aorta ,  Thoracic

Cort Kayla,  Piskunowicz Maciej,  Hwang Misun

Final Pr. ID: Poster #: EDU-008

Contrast-enhanced ultrasound (CEUS) for the evaluation of the neonatal brain provides additional diagnostic information when compared to conventional gray scale ultrasound through the detection of perfusion abnormalities associated with injury. When compared to cross-sectional imaging, CEUS has many advantages given its relative low cost and ability to be performed at the bedside, without the need for sedation or exposure to ionizing radiation. Diagnostic information is yielded through the qualitative evaluation of parenchymal enhancement patterns as well as quantification of microbubble perfusion kinetics from which time intensity curves are derived and additional perfusion parameters can be extrapolated. Given the 2-dimensional nature of the modality, a strategically designed scanning protocol is necessary to obtain the aforementioned quantitative values. The purpose of this exhibit is to demonstrate the current understanding of brain CEUS and educate on the brain CEUS protocol used for the diagnosis of neonatal brain pathology. Read More

Authors:  Cort Kayla,  Piskunowicz Maciej,  Hwang Misun

Keywords:  hypoxic ischemic injury

Murphy Ryan,  Murati Michael,  Holm Tara,  Dietz Kelly

Final Pr. ID: Poster #: EDU-012

The presacral space is composed of multiple tissue types, including osteochondral, mesenchymal, neurogenic, vascular and lymphatic. The presence of these tissues leads to a long and complex differential for a presacral mass in a pediatric patient. Specifically, the differential also includes anterior sacral meningocele, enteric cyst, vascular malformations, neuroblastoma, ganglioneuroma, schwannoma, neurofibroma, rhabdomyosarcoma, lymphomatous masses, giant cell tumor, aneurysmal bone cyst, osteosarcoma, Ewing sarcoma, and chordoma. Imaging plays a key role in characterizing these masses and treatment planning. Familiarity with the common presacral masses of infancy and childhood is therefore necessary for the pediatric and general radiologist.

Once an osteochondral or neurogenic mass is excluded, and a predominantly cystic presacral mass is present, the primary differential consists of a collection of developmental or congenital masses including sacrococcygeal teratoma, anterior meningocele, low flow vascular malformation, and an enteric duplication cyst. We will review the common imaging features and associations of these cystic masses by presenting a series of cases. Additional examples of solid and osteochondral presacral masses will be included where appropriate for comparison in order to avoid characterization pitfalls and highlight teaching points. Read More

Authors:  Murphy Ryan,  Murati Michael,  Holm Tara,  Dietz Kelly

Keywords:  anterior meningocele ,  low flow vascular malformation ,  enteric cyst

Becker Richard,  Rubio Eva,  Bulas Dorothy,  Blask Anna,  Loomis Judyta,  Oetgen Matthew

Final Pr. ID: Poster #: EDU-014

Congenital anomalies causing lower extremity shortening can result from dysgenesis or agenesis of the bones of the thigh, leg or foot; they are generally a very uncommon occurrence, with an incidence on the order of one case per 1,000,000 to one case per 100,000 births. These conditions result in varying degrees of morbidity, ranging from gait dysfunction to complete lack of the ability to ambulate. The accurate characterization of such an anomaly may be challenging prenatally, but can have significant impact on prognosis and treatment planning.
We present a collection of cases depicting the spectrum of prenatally diagnosed anomalies of limb development, including proximal focal femoral deficiency, multiple cases of varying degrees of fibular and tibial hemimelia, amniotic band syndrome, benign uterine packing, neurofibromatosis, clubfoot anomaly and rocker bottom foot, all of which were evaluated on prenatal ultrasound and/or fetal MRI.
Accurate prenatal diagnosis is extremely important for prognosis, treatment planning and risk-stratification for associated congenital anomalies. The purpose of this poster will be to highlight the imaging features by both fetal MRI and prenatal US, discuss potential diagnostic pitfalls and review the clinical implications of this interesting spectrum of congenital disorders. We will describe a methodical approach to assessment of these patients. Our recommendations include: prenatal US to include a complete set of bilateral long bone and foot length measurements; lateral and footprint views of the fetal foot; views of both tibiae and fibulae bilaterally; views of the spine and upper extremities, a thorough search for other abnormalities; fetal MRI for complex cases or when US findings are limited; and a complete family and maternal history, including notation of family stature.
Examples of the classic appearance of these conditions will be presented. Several missed diagnoses and the lessons learned will also be discussed. Counseling points addressed by the orthopedic surgeon will be included. Outcome management will be reviewed. Read More

Authors:  Becker Richard,  Rubio Eva,  Bulas Dorothy,  Blask Anna,  Loomis Judyta,  Oetgen Matthew

Keywords:  extremity ,  anomaly ,  fetal

Karmazyn Boaz,  Marine Megan,  Wanner Matthew,  Billmire Deborah

Final Pr. ID: Poster #: EDU-020

Intestinal rotation abnormality (IRA) can lead to catastrophic events from midgut volvulus. In a child that presents with bilious vomiting, urgent surgery should be performed. Ladd’s surgery is associated with complications in 10% to 20% of the patients. In this review we will show that in selected asymptomatic children with IRA, imaging can help decide if observation should be considered rather than surgery. Read More

Authors:  Karmazyn Boaz,  Marine Megan,  Wanner Matthew,  Billmire Deborah

Keywords:  Malrotation ,  Nonrotation ,  Atypical malrotation

Shet Narendra,  Flynn John,  Maloney Ezekiel,  Iyer Ramesh

Final Pr. ID: Poster #: EDU-021

The purpose of this review is to provide an overview of applications of Eovist in the pediatric population, as well as pitfalls. We will begin with an introduction on the origins of Eovist and how it and other hepatocyte specific contrast agents (HSCAs) differ from conventional gadolinium based contrast agents (GBCAs). We will then provide a sample of imaging protocols when Eovist is used for hepatic mass evaluation and for biliary indications. We will review benefits of Eovist in characterizing a variety of pediatric hepatic neoplasms, including hepatoblastoma, hepatocellular carcinoma, focal nodular hyperplasia, hepatic adenomas, and regenerative nodules, with mention of pathologies that do not follow traditional patterns (i.e., inflammatory adenomas). After this, we will cover biliary applications, including choledochal cysts, biliary obstruction, and postoperative bile leak. Finally, we will review some limitations of Eovist; notably, we will mention several scenarios where the hepatobiliary phase could not be achieved, and recommendations for how to approach these cases. Read More

Authors:  Shet Narendra,  Flynn John,  Maloney Ezekiel,  Iyer Ramesh

Keywords:  Liver ,  Biliary ,  MRI

Brahee Deborah,  Towbin Alexander

Final Pr. ID: Poster #: EDU-028

Pediatric pathology involving the jejunum is more common than one might initially expect. Early recognition of the important imaging characteristic, atypical findings, and useful imaging tools/techniques in the evaluation of jejunal pathology is important in prompt diagnosis and management of these patients.

In this educational exhibit we will present a series of cases involving pathology of the jejunum encountered in the pediatric population. We will focus on important pathologies affecting a difficult to image and sometimes forgotten portion of the intestine.

A range of acute, emergent and post-surgical cases are presented. Using an interactive, quiz based approach we will discuss the following pediatric pathologies that may affect the jejunum of pediatric patients from neonates to teenagers with multimodality imaging and pathologic examples:
Atresia
Meconium plug syndrome
Pneumatosis
Enteritis
Foreign body
Small bowel intussusception
Lymphoma
Ischemia/shock
Hernia
Graft versus host disease
Trauma
Vasculitis Read More

Authors:  Brahee Deborah,  Towbin Alexander

Keywords:  Gastrointestinal ,  Pediatric ,  Imaging

Huang Yungui,  Krishnamurthy Rajesh,  Hu Houchun,  Luna John,  Krishnamurthy Ramkumar,  Lubeley Lacey,  Buskirk Tricia,  Karczewski Arleen,  Garrett Whitney,  Lin Simon,  Mcallister Aaron

Final Pr. ID: Poster #: EDU-040

Background: Image quality in MRI is often degraded by patient motion. To reduce the need for repeat exams, sedation or general anesthesia is used in pediatric patients. This requires additional clinical staff, and leads to increased scheduling wait times and overall procedure times that impact workflow. Many institutions prepare children for MRI using mock-up replicas. While effective in acclimating patients to the MRI environment, the availability of mock-up practices are often limited. Mock-ups also require physical space and do not simulate the full MRI environment and exam experience.

Purpose: We build an affordable, scalable, and portable immersive virtual reality (IVR) platform for simulating MRI exams. Specifically, we designed an IVR environment that accurately mimics a Siemens 3 Tesla suite within our Radiology practice, including intricate details such as room size, color, lighting, ancillary equipment, pulse sequence audio, and background noise. The IVR platform also attempts to simulate the complete sequence of events and environments a child will experience during an exam, including the check-in process, interactions with staff (e.g., nurses, technologists), the waiting area and changing rooms, the positioning and motion of the MRI table, placement of coils, and within-exam instructions, such as breath-holds. Our platform also allows the patient to move around in the VR space and interact with the environment. Additionally, the platform can be easily converted to mimic any other MR suite. We hypothesize that our platform can be easily adopted by Child Life and hospital staff to quickly acclimate a patient and assess whether he/she can suitably undergo an MRI exam without sedation or general anesthesia.

We believe the IVR platform can overcome the limitations of mock-up replicas. First, IVR has a smaller footprint and is scalable and portable across the hospital. This allows multiple IVR sessions to be held in parallel. Second, IVR can give the patient a hospital-specific and scan-specific first-person experience. The patient can interact with realistic 3D representations of the MRI environment and processes. Our current implementation of IVR was developed using HTC VIVE headsets with a dedicated laptop for control. To further improve portability, the IVR setup can be adopted using simple goggles and handheld devices. This will enable future IVR sessions to be conducted at the bedside, in patient’s homes, and in referring physician offices. Read More

Authors:  Huang Yungui,  Krishnamurthy Rajesh,  Hu Houchun,  Luna John,  Krishnamurthy Ramkumar,  Lubeley Lacey,  Buskirk Tricia,  Karczewski Arleen,  Garrett Whitney,  Lin Simon,  Mcallister Aaron

Keywords:  magnetic resonance imaging ,  virtual reality ,  simulation

Payne Erin,  Martin-saavedra Juan,  Victoria Teresa,  Robinson Amie,  Fickenscher Kristin,  Chan Sherwin

Final Pr. ID: Poster #: EDU-042

Many diseases in pediatrics are relatively uncommon and imaging of these diseases is difficult to study due to small patient numbers at a single site. This limits the ability of single institutions to adequately power a study. Thus, there is a pressing need for a multi-site structure to combine data for rare diseases to appropriately power outcome studies. Our goal is to create an infrastructure to support pooling of imaging and clinical data across institutions to facilitate multi-institutional studies. Read More

Authors:  Payne Erin,  Martin-saavedra Juan,  Victoria Teresa,  Robinson Amie,  Fickenscher Kristin,  Chan Sherwin

Keywords:  Registry ,  Multi-Institutional ,  imaging trials

Lall Neil,  Mcgee Jack,  Sarkar Korak

Final Pr. ID: Poster #: EDU-043

Fluoroscopy of the upper GI tract (UGI) can be difficult to master given the time-sensitive nature of the examination, the necessary hand-eye coordination, the complex button layout and broad featureset of the fluoroscopic equipment, the desire for minimizing radiation dose, and the required understanding of normal anatomy. Additionally, encountering abnormal findings for the first time, particularly before one is familiar with normal findings, can lead to confusion and increased difficulty in performing the examination. The use of 3D printed models of normal anatomy in pediatric fluoroscopic UGI training simulation has previously been demonstrated as a viable alternative to learning on live patients; however, such a technique has not previously been used with known pathological anatomic configurations. Read More

Authors:  Lall Neil,  Mcgee Jack,  Sarkar Korak

Keywords:  3D printing ,  fluoroscopy ,  simulation

Ortiz Carlos,  Chau Alex,  Desai Sudhen,  Kukreja Kamlesh

Final Pr. ID: Poster #: EDU-048

1) Reviewing the pathology and outcomes of children with spinal muscular atrophy (SMA)
2) Learning the procedures available for intrathecal access
3) Understanding the indications for choosing more advanced techniques to deliver nusinersen

Spinal muscular atrophy is an autosomal recessive disease affecting motor neurons and is the most common genetic cause of death in infants. Nuinersen (Spinraza) was recently approved by FDA for intrathecal administration in SMA patients. Commonly administered by lumbar puncture in the clinic or with imaging guidance, this is the initial method of administering nusinersen. Deformities and spinal instrumentation from orthopedic surgeries are common in SMA patients, preventing traditional intrathecal access by lumbar puncture for nusinersen delivery. Transforaminal lumbar sac access, ultrasound or fluoroscopy guided cervical spine access, or subcutaneous catheter placement can be the alternative approaches with failed/difficult lumbar access. Given the potential benefit of nusinersen, understanding all methods to obtain intrathecal access is essential for a pediatric interventional radiology (IR) practice. Read More

Authors:  Ortiz Carlos,  Chau Alex,  Desai Sudhen,  Kukreja Kamlesh

Keywords:  nusinersen ,  spinal muscular atrophy ,  intrathecal administration

Bhatt Malay,  Kirsch Alyssa,  Metz Terrence

Final Pr. ID: Poster #: EDU-049

To familiarize the audience with our institution’s technique utilizing ultrasound (US) and electrocardiogram (ECG) for anatomic localization and technical guidance for PICC placement in a pediatric intensive care unit (PICU) procedure suite utilizing intravenous (IV) sedation without general anesthesia to eliminate patient and operator radiation exposure and decrease sedation specifically in a pediatric population. Read More

Authors:  Bhatt Malay,  Kirsch Alyssa,  Metz Terrence

Keywords:  PICC ,  Vascular Access

Hook Marcus,  Higgins Timothy,  Hildebrand Andrea,  Sussman Betsy,  Burke Leah

Final Pr. ID: Poster #: EDU-051

Objectives:
1. Present the use of a published algorithm for the evaluation and diagnosis of the pediatric patient with congenital skeletal dysplasia and abnormal skeletal survey.
2. Review usefulness of accurate, narrowed differential diagnosis or suspected single diagnosis in terms of confirmatory testing, treatment implications, and genetic counseling.
3. Demonstrate the utility of the algorithm when applied to recent, rare cases of congenital skeletal dysplasia at our institution, a tertiary trauma center and children’s hospital in the Northeastern United States.

Content:
We present a refined, algorithm-based approach to the evaluation and diagnosis of the pediatric patient with congenital skeletal dysplasia and abnormal skeletal survey. The algorithm optimizes evaluation of the skeletal survey in cases of congenital skeletal dysplasia, aiding in timely, accurate diagnosis. The utility of the refined algorithm is demonstrated as it was applied to recent, confirmed cases of rare skeletal dysplasias at our institution, including metatropic dysplasia and cleidocranial dysplasia.

Teaching Message:
Evaluation of the pediatric patient with congenital skeletal dysplasia and abnormal skeletal survey can be challenging, even for the subspecialty-trained radiologist. By assessing the presence or absence of discriminating imaging features and findings on skeletal survey, the interpreting radiologist can significantly shorten the differential diagnosis or in many cases suggest a single, most-likely primary diagnosis. Narrowing the differential diagnosis is helpful in guiding confirmatory molecular or genetic testing. Timely, accurate diagnosis may have significant treatment and prognostic implications for patients and their families. Read More

Authors:  Hook Marcus,  Higgins Timothy,  Hildebrand Andrea,  Sussman Betsy,  Burke Leah

Keywords:  genetic ,  dysostosis ,  dwarfism

Krauss Jillian,  Samet Jonathan

Final Pr. ID: Poster #: EDU-053

At our institution and in general practice, we have observed that ultrasound is an underutilized modality in the field of pediatric musculoskeletal imaging, particularly when compared to its body imaging counterparts and the adult population. Within the spectrum of musculoskeletal radiology, ultrasound can be an especially helpful tool in evaluating the peripheral nervous system (PNS), which can often be challenging to assess on other imaging modalities. For instance, ultrasound offers the ability to carefully trace small nerves and easily allows for comparison to the other, often unaffected or normal extremity, as well as dynamic imaging. This advantage is often not possible on magnetic resonance imaging (MRI), which is currently the primary modality being utilized to assess for nerve pathology. In small children, nerves are often difficult to visualize on MRI, which can be limited by artifact and motion and may require sedation. Due to its superior axial resolution, ultrasound can better visualize the intra-neural architecture, sometimes better than MRI, especially in the case of small nerves. Also, as was demonstrated by one of the cases at our institution, ultrasound was superior in evaluation when there was adjacent surgical hardware which resulted in artifact on MRI. Additionally, we as radiologists, can aid our peripheral nerve surgeon colleagues intra-operatively with ultrasound.

Some of the hesitance in using the modality may be a reflection of a lack of familiarity on the part of both radiologists and technologists with respect on how to image the PNS and uncertainty about the normal and abnormal appearance of these structures. The objective of this educational exhibit is to provide the knowledge necessary to successfully acquire and interpret ultrasound images of the PNS. The topics addressed in the review will include an introduction on how to appropriately obtain images of the major peripheral nerves, how to distinguish between the normal and abnormal appearance of nerves on ultrasound, and the spectrum of pathology affecting the peripheral nervous system. The exhibit will feature a variety of cases from our institution, including examples of neuropathy, post-traumatic focal neuroma, nerve laceration resulting in transection, ulnar nerve subluxation/dislocation, and nerve sheath tumors, among others, with some intraoperative and pathologic correlation. Read More

Authors:  Krauss Jillian,  Samet Jonathan

Keywords:  Ultrasound ,  Peripheral Nervous System

Padua Eric,  Kammen Bamidele,  Karakas S Pinar,  Hitt Dave,  Tai Chau,  Pandya Nirav,  Lu Quin,  Chung Taylor

Final Pr. ID: Poster #: EDU-054

Current musculoskeletal MR imagiing utilizes multiple imaging planes and multiple weightings of two-dimensional turbo spin echo (2D TSE) to precisely delineate and characterize intra-articular abnormalities. Three-dimensional (3D) TSE sequences are currently available on most MRI vendor platforms. High resolution isotropic 3D imaging of the small joints reduces partial volume artifacts and allows for the reconstruction in any orientation, thus eliminating the need to acquire additional scans of different orientations with identical tissue contrast. However, the typical trade off of achieving very high resolution (under 0.5mm isotropic) is long acquisition time. Scan time reduction can be achieved with parallel imaging at the expense of reducing the signal-to-noise ratio (SNR) and with increasing the echo train length at the expense of image blurring. The addition of compressed sensing (CS), a recently commercially available acceleration technique, allows for decrease in acquisition time without the significant loss of SNR experienced with identical acceleration factors achieved with parallel imaging alone. CS exploits (1) image data sparsity via application of a sparsity transform of the image data; (2) pseudo-random-type of k-space sampling; (3) non-linear iterative reconstruction. We utilized CS to decrease scan time (range 4:55 to 5:35 minutes) of 3D PD FS TSE sequences to obtain high resolution (voxel size 0.45 x 0.45 x 0.45) imaging of the fingers, toes, wrist and feet. In this educational exhibit, we will review the normal anatomy and pathology of small joints Read More

Authors:  Padua Eric,  Kammen Bamidele,  Karakas S Pinar,  Hitt Dave,  Tai Chau,  Pandya Nirav,  Lu Quin,  Chung Taylor

Keywords:  musculoskeletal

Boyd Kevin,  Thakrar Pooja

Final Pr. ID: Poster #: EDU-055

The purpose of the exhibit is: 1. Illustrate the presence of multiple and accessory ossification centers about the hip that can make it challenging to diagnosis fractures on radiographs in adolescence. 2. Demonstrate that posterior acetabular fractures are typically hidden behind the femoral head on radiographs. 3. Review variant os acetabuli that are commonly encountered in patients with hip pain and demonstrate that the orientation of the fragments compared with posterior acetabular fractures can help to make a distinction. 4. Highlight that a complete pelvis radiograph (AP or AP/Frog leg lateral) in trauma patients or hip pain NOS can aid in the detection of fractures and assess for asymmetry of normal variants. Read More

Authors:  Boyd Kevin,  Thakrar Pooja

Keywords:  Acetabular Fractures ,  Pediatric Hip ,  Hip variant

Eliades Sarah,  Pomeranz Christy,  Baad Michael,  Roytman Michelle,  Kovanlikaya Arzu

Final Pr. ID: Poster #: EDU-056

Ultrasound is typically the first-line imaging modality for the evaluation of superficial soft tissue masses in the pediatric population. While certain superficial soft tissue masses have a classic appearance on ultrasound, others may have a nonspecific appearance and may vary in their sonographic characteristics. This can make a definitive diagnosis and follow-up recommendations difficult, especially for trainees.

We aim to provide a basic overview of some of the common and less common superficial soft tissue masses that may be encountered in pediatric imaging, and introduce a novel, structured algorithmic approach for evaluating these lesions on ultrasound. The algorithm will assist the radiologist in reaching a definitive diagnosis or narrowing the differential such that a helpful recommendation for further workup can be made. For example, the algorithm will include internal vascularity, border distinctness, cystic or solid components, presence or absence of calcifications, and location in the body and within the superficial soft tissue layers. Pictorial examples of each sonographic feature in the algorithm will provide further assistance.

Pathologies will include but not be limited to: pilomatricoma, glanuloma annulare, epidermal inclusion cyst, ganglion cyst, abscess/infection, lipoma, hematoma, lymph nodes, vascular anomalies, and soft tissue sarcomas. When a definitive diagnosis is not achievable, this algorithm will help the radiologist determine the likelihood of benignity, a short differential diagnosis, and a recommendation for any further imaging workup. Read More

Authors:  Eliades Sarah,  Pomeranz Christy,  Baad Michael,  Roytman Michelle,  Kovanlikaya Arzu

Keywords:  Soft tissue mass ,  Ultrasound ,  Superficial

Marie Eman,  Perez Manuela,  Aquino Michael,  Stimec Jennifer

Final Pr. ID: Poster #: EDU-060

Although rare, fibular hemimelia or congenital fibular deficiency (CFD), is the most common congenital long bone deficiency, with an approximate incidence of 7.4- 20 per 1 million live births. The clinical presentation of CFD represents a broad spectrum of manifestations, ranging from mild fibular deficiency with limb length discrepancy to a significantly short limb with multiple associated foot, ankle and knee deformities.
Traditional FH classification such as Achterman and Kalamchi described the amount of fibular deficiency, which is today known to be unrelated to length discrepancy and foot deformity. Current classifications are based on the associated deformities of the ankle and subtalar joint, as the foot deformity is the main prognostic factor.
Treatment should be tailored for each patient to maximize the lower limb function - this involves predicting the limb length discrepancy and then coming up with a surgical plan to correct these in the fewest number of surgeries spread out as much as possible throughout the child’s growing years, so that by skeletal maturity the child has achieved equal leg length, a functional plantigrade foot, excellent alignment of the hip, knee and ankle and, as needed, a stable knee joint.
Multimodal imaging provides detailed evaluation of the osteochondral and extraosseous malformations. In-utero identification can be accomplished with prenatal ultrasonography. After birth, radiographs often show striking bony anomalies. Detailed information regarding associated crucial cartilaginous, articular, soft tissue, and vascular abnormalities required for preoperative planning necessitates the use of magnetic resonance (MR) imaging.
The purpose of this poster is to: 1) review the various types of osteochondral and extra-osseous abnormalities of CFD as depicted by different imaging modalities, 2) describe the limitations of each of these modalities, 3) outline the image-based classification of CFD, 4) describe the options for treatment, and 5) discuss the post-operative imaging evaluation of CFD. Read More

Authors:  Marie Eman,  Perez Manuela,  Aquino Michael,  Stimec Jennifer

Keywords:  hemimelia ,  congenital fibular deficiency

Albertson Megan,  Powers Andria,  Beavers Angela

Final Pr. ID: Poster #: EDU-063

Background:
AVID is an acronym describing a triad of findings including 1) asymmetric ventriculomegaly, 2) interhemispheric cyst, and 3) dysgenesis of the corpus callosum. This entity accounts for one of the presentations of callosal dysgenesis along a wide spectrum. Because midline anomalies occur with many processes, including holoprosencephaly and aqueductal stenosis, it may appear to have overlapping features on initial glance. However, by focusing attention on the secondary findings, a specific diagnosis may be determined.

Objectives:
By the end of this presentation the learner will: 1) Become familiar with the imaging characteristics of AVID. 2) Describe the differential diagnosis of AVID and the important distinguishing features. 3) Understand the clinical implications of interhemispheric cysts and similar diagnoses.

Cases/Differential Diagnosis:
Through several case examples of mistaken diagnoses, we will describe key findings to differentiate brain disorders with midline anomalies including AVID, holoprosencephaly, and aqueductal stenosis. Holoprosencephaly creates a monoventricle, but may also be associated with a dorsal midline cyst which can be confused for an interhemispheric cyst. Features that differentiate holoprosencephaly from AVID are the presence of fused cerebral hemispheres, thalamic fusion, and a true monoventricle. Aqueductal stenosis may also show severe hydrocephalus, but lacks the cystic component which is seen with the other mentioned entities. Aqueduct stenosis usually causes symmetric ventriculomegaly of the lateral and 3rd ventricles as well as upward displacement of anterior cerebral arteries and inferior displacement of internal cerebral veins. The hydrocephalus from all of these entities may be treated with ventricular shunt placement, but AVID is an important diagnosis to consider because the wall of the interhemispheric cyst could be imperceptible by imaging and may not improve if the tip of the drainage catheter is not within the cyst.

Conclusion:
When evaluating cases of true ventriculomegaly it is important to consider a differential including AVID, holoprosencephaly, aqueductal stenosis, among other less common congenital syndromes. Careful attention to additional imaging findings is necessary to distinguish the correct diagnosis from look-alikes. Making an accurate diagnosis is important as there are differences in medical decision making, treatment outcomes, and long-term prognosis. Read More

Authors:  Albertson Megan,  Powers Andria,  Beavers Angela

Keywords:  AVID ,  Holoprosencephaly ,  Aqueductal Stenosis

Karuppiah Viswanathan Ashok Mithra,  Wilson Nagwa

Final Pr. ID: Poster #: EDU-064

A number of acquired non-traumatic diseases of myriad aetiologies involve the temporal bone in children. While some of these are also noted in adults, many diseases are specific to the pediatric age group. These can be grouped into infectious/inflammatory, neoplastic, vascular and other miscellaneous disorders.

Anatomy of the temporal bone is complex. It forms the lateral aspect of skull base and comprises of five osseous parts viz. squamous, mastoid, petrous, tympanic and styloid segments. Specific disease processes afflict each part of the temporal bone, largely dictated by its anatomy and constituent structures. Hence a structured approach to image interpretation and reporting is especially useful in this region to localise the lesion and subsequently generate differential diagnoses.

Traditionally CT has been the imaging modality of choice in assessing temporal bone lesions. However, currently, CT and MRI are deemed complimentary. CT provides exquisite details of anatomy, characterises osseous lesions, determines bony involvement/destruction and extension while MRI is highly useful in assessing intrinsic lesion characteristics due to its superior contrast resolution. In certain aetiologies such as cholesteatoma MRI is diagnostic.

This poster aims to review the anatomy of temporal bone and various common, uncommon acquired non traumatic temporal bone lesions in children.

The lesions that will be discussed in this poster are listed below:
Infectious / Inflammatory:
1. Otitis externa
2. Otitis media
3. Coalescent mastoiditis with orbital involvement
4. Bell’s Palsy
5. Guillain-Barre’ syndrome with facial palsy
Neoplastic Lesions:
1. Vestibular schwannoma
2. Rhabdomyosarcoma
3. Ewing’s sarcoma
4. Langerhan’s cell histiocytosis
5. Osteoblastoma
6. Osteoma
7. Aggressive Myofibromatosis
Vascular:
1. Carotid vasculitis secondary to petrous abscess
Miscellaneous Lesions:
1. Cholesteatoma (congenital and acquired)
2. Cholesterol granuloma Read More

Authors:  Karuppiah Viswanathan Ashok Mithra,  Wilson Nagwa

Keywords:  Temporal Bone ,  Children ,  Acquired lesions

Masum Rukya,  Dixon Chanae,  Ryan Maura,  Jaju Alok

Final Pr. ID: Poster #: EDU-067

This review describes the CT and MRI features of developmental variants and pathological lesions that involve the skull base, excluding those centered in the nasal cavity, nasopharynx, sinuses and orbits.
Normal anatomy of developing bony skull base will be illustrated. The lesions are categorized by pathology rather than locations, and the following entities will be covered.
Congenital and developmental lesions - arrested pneumatization, aberrant arachnoid granulations, dermoid/epidermoid cysts, ecchordosis physaliphora, encephaloceles, persistent craniopharyngeal canal
Inflammatory/Infectious lesions - skull base osteomyelitis, petrous apicitis, cholesterol granuloma
Benign lesions - Fibrous dysplasia, aneurysmal bone cyst, osteoma, osteochondroma, meningioma
Malignant lesions - Langerhans cell histiocytosis, lymphoma, neuroblastoma metastasis, Ewing’s sarcoma, osteosarcoma, chordoma, chondrosarcoma Read More

Authors:  Masum Rukya,  Dixon Chanae,  Ryan Maura,  Jaju Alok

Keywords:  Skull base ,  Pediatrics ,  skull base lesion

Molto Jose,  Loomis Judyta,  Cielma Tara,  Whitehead Matthew

Final Pr. ID: Poster #: EDU-070

Dermoid cysts are a sequestration of ectoderm containing secondary skin structures, usually at characteristic locations of embryologic fusion lines. The midventral suprasternal fusion line is one such location in the developing embryo with both simple and complicated dermoids of this region reported in the literature. We reviewed our academic pediatric institutional experience with dermoid cysts of the suprasternal notch, focusing on the initial presentation as a palpable nodule referred for sonographic evaluation.

The purpose of this educational exhibit is to depict the ultrasound imaging features of suprasternal notch dermoid cysts in the pediatric population.

Secondary purposes are to describe the anatomy of the suprasternal notch, demonstrate CT and MR correlates of the these dermoids, and depict regional inflammatory complications. Read More

Authors:  Molto Jose,  Loomis Judyta,  Cielma Tara,  Whitehead Matthew

Keywords:  Dermoid ,  neck ,  Suprasternal

Chan Alex,  Laughlin Brady,  Abid Waqas,  Latshaw Rachael,  Iaia Alberto,  Moftakhar Parham,  Nikam Rahul,  Kandula Vinay,  Choudhary Arabinda

Final Pr. ID: Poster #: EDU-071

The goal of this educational exhibit is to use a graphical and image heavy Powerpoint presentation to familiarize the reader with the background necessary to understand common clinical ASL-PWI imaging techniques along with displaying a pictorial assay of different normal and abnormal ASL perfusion findings within the field of Pediatric Neuroradiology.

To introduce our topic, we will briefly discuss the physiology of cerebral blood flow and how it is measured with and without an exogenous tracer. Next, to serve as an overview, we will show the general ASL experiment, namely, labeling, post label delay, and readout. Following, we will discuss each of the above components, beginning with showing the different main labeling methods, CASL, PCASL, and PASL. Finally, the concept of post label delay will be illustrated respective to each of the main labeling methods.

In the second section, we will discuss the image acquisition component by first describing and illustrating two common readout methods, such as 2D-EPI and 3D-GRASE methods along with their advantages and disadvantages. Additionally, we will illustrate the process of background suppression along with its significance. Finally, we will review the process of obtaining perfusion weighted images through the subtraction between tagged and control images.

The third section will illustrate an assortment of clinical examples beginning with showing normal physiological hyper- and hypoperfusion and newborn perfusion characteristics. Following, we will highlight a spectrum of clinical cases including: moyamoya, HIE, medullary infarct with luxury perfusion, arteriovenous malformation, PRES, infections (intracerebral abscess, toxoplasmosis, cerebellitis), characteristics of headache, intracranial tumors (juvenile astrocytoma, hemangioblastoma, ATRT, and choroid plexus papilloma), cortical dysplasia, tuberous sclerosis with seizures, and variations presentations of methotrexate toxicity. Lastly, we will discuss cerebral blood reserve imaging utilizing acetazolamide challenge. All cases will contain pertinent clinical information and images from other sequences/modalities that aid in the diagnosis of disease. Read More

Authors:  Chan Alex,  Laughlin Brady,  Abid Waqas,  Latshaw Rachael,  Iaia Alberto,  Moftakhar Parham,  Nikam Rahul,  Kandula Vinay,  Choudhary Arabinda

Keywords:  Arterial Spin Labeling ,  Physics

Farkas Amy,  Patel Niki,  Joyner David

Final Pr. ID: Poster #: EDU-072

Epilepsy can be a progressive and debilitating illness in the pediatric population. There is a large range of congenital conditions that present with seizures in neonatal patients, which are essential for the radiologist to accurately characterize on imaging. Accurately diagnosing the cause of epilepsy can not only allow appropriate treatment, but also provide important information on prognosis and associated abnormalities.

The goal of this educational poster is to provide an overview of different congenital etiologies of epilepsy. This case based review includes congenital malformations of the brain such as focal cortical dysplasia, schizencephaly, heterotopias, hemimegalencephaly, and polymicrogyria. Cases highlighting neurocutaneous conditions associated with epilepsy including tuberous sclerosis and Sturge-Weber are reviewed. Cortical injuries from insults such as congenital infection, hypoxic-ischemic injury, or hemorrhage are also included.

Familiarity with the imaging findings of epilepsy is essential for the radiologist, especially the trainee and those with less experience with pediatric neuroimaging. After reviewing this educational poster, viewers will be able to describe the imaging features of congenital causes of epilepsy and understand the treatment and prognoses of these conditions. Read More

Authors:  Farkas Amy,  Patel Niki,  Joyner David

Keywords:  Epilepsy ,  Congenital ,  Seizures

Patel Akash,  States Lisa

Final Pr. ID: Poster #: EDU-082

With the increased demand and utilization of PET/MRI in oncologic imaging, there is an ever increasing database of non-malignant pathology that has not yet been described on PET/MRI. Furthermore, the pediatric population provides an even more unique breadth of pathology that is often only seen in this age group. It is important to be able to accurately identify these common pathologies so as to not mistake them for malignancy and to prevent unnecessary follow up imaging studies and further invasive diagnostic procedures.

For this educational exhibit we review over 200 clinical pediatric 18F-FDG PET/MRs performed at our institution and highlight the most common and most interesting cases of FDG-avid non-malignant pathology.

Listed below are some of the cases to be included in the poster:
-Benign FDG avid bone tumors including non-ossifying fibromas
-Benign causes of FDG avid lymphadenopathy including cat scratch disease
-Benign causes of FDG avid lung lesions including aspiration pneumonia
-Benign causes of gastro-intestinal FDG uptake including pseudomembranous colitis
-Benign FDG avid infectious pathologies including a liver abscess Read More

Authors:  Patel Akash,  States Lisa

Keywords:  PET/MR ,  PET/MRI ,  benign

Shannon Leann,  Singh Sudha

Final Pr. ID: Poster #: EDU-085

With research pushing ever onward, it is often difficult to keep pace with the dynamic landscape of pediatric abdominal tumors and their classification systems. However, it is imperative that we, as radiologists, remain vigilant of these changes, as our initial and follow-up imaging assessments often have the potential to drive clinical intervention in widely differing directions.

In this educational poster, we will review the most up-to-date risk stratification and staging criteria for neuroblastoma, hepatoblastoma, and Wilms tumor in order to:

1. Educate about the most recent criteria for categorizing pediatric abdominal tumors such as neuroblastoma, hepatoblastoma, and Wilms tumor.

2. Provide imaging examples of these pediatric abdominal tumors and describe how the above-mentioned criteria might change radiology reports and patient management.

3. Encourage accurate risk stratification of these tumors so that radiologists are better equipped to assist in directing appropriate patient care. Read More

Authors:  Shannon Leann,  Singh Sudha

Keywords:  neuroblastoma ,  hepatoblastoma ,  Wilms

Moredock Elisabeth,  Fulmer J.,  Collard Michael,  Pfeifer Cory

Final Pr. ID: Poster #: EDU-086

Congenital Central Hypoventilation Syndrome (CCHS) is a rare disorder that can cause respiratory arrest during sleep. It is sometimes referred to as "Ondine's Curse" in reference to a fictional character who had to remember to breathe based on a spell cast by a jilted lover. The number of cases has been reported to be near 1,000. The purpose of this educational exhibit is to describe CCHS and emphasize its implications for pediatric radiology. Read More

Authors:  Moredock Elisabeth,  Fulmer J.,  Collard Michael,  Pfeifer Cory

Keywords:  CCHS ,  neuroblastoma ,  diaphragm pacer

Coleman Jay,  Collard Michael,  Pfeifer Cory

Final Pr. ID: Poster #: EDU-087

Molecular biology has come to the forefront of modern oncology. Knowledge of specific genetic mutations within tumors drives prognostic information and can guide therapy. Keeping up with new terminology in oncology can be difficult for pediatric radiologists who often host oncology conferences and present regularly at grand rounds. The purpose of this educational exhibit is to describe DICER1 syndrome and discuss its implications for pediatric radiology. Read More

Authors:  Coleman Jay,  Collard Michael,  Pfeifer Cory

Keywords:  cystic nephroma ,  DICER1 ,  pleuropulmonary blastoma

Liang Teresa,  Lee Edward

Final Pr. ID: Poster #: EDU-090

Childhood interstitial (diffuse) lung disease (chILD) in infants consists of a rare and heterogeneous group of disorders previously classified with clinical, radiologic, and pathologic features. The purpose of this article is to discuss imaging techniques and provide a pattern-based approach for chILD in infants. Read More

Authors:  Liang Teresa,  Lee Edward

Keywords:  childhood interstitial lung disease ,  Lung ,  Infants

Gaballah Marian,  Goldfisher Rachelle

Final Pr. ID: Poster #: EDU-096

Lymphatic malformations (LMs) are low-flow vascular malformations which are composed of dilated lymphatic channels, forming septated cyst-like structures (2). LMs are the second most common type of vascular malformation, second to venous malformations (1). The most common locations are in the neck, followed by the axillary region. On MRI, LMs are multiloculated, T2 hyperintense lesions, which may have fluid-fluid levels, and are without flow voids (1, 2). They can involve multiple tissue planes and do not regard anatomical and fascial boundaries (2). Cystic lymphatic malformations are further divided into microcystic, macrocystic, or mixed, based on the size of their cystic components. Macrocystic LMs are composed of larger cysts, while microcystic LMs are composed of smaller cysts and may appear solid on imaging.

We present ten cases of microcystic, macrocystic, and mixed lymphatic malformations in a variety of anatomical locations. In addition to demonstrating the imaging findings, we present a review of the literature in regards to each anatomical region. Lymphatic malformations in this presentation include right orbit (n=1), mediastinum (n=2), pulmonary bronchovascular bundles/pleural space (n=1), retroperitoneum (n=1), mesentery (n=2), perirectal and scrotal (n=1), lower extremity (n=2). 6 of these children also had additional sites of T2 hyperintense disease involving the bones or spleen, suggestive of additional lymphangiomas.

This presentation summarizes ten cases of lymphatic malformations in a variety of less common anatomical locations and a review of the pertinent literature.

References:

1. Flors L, Leiva-Salinas C, Maged IM et al. (2011) MR Imaging of Soft-Tissue Vascular Malformations: Diagnosis, Classification, and Therapy Follow-up. Radiographics 31:1321-1340.
2. White CL, Olivieri B, Restrepo R et al. (2016) Low-flow vascular malformation pitfalls: from clinical examination to practical imaging evaluation- part 1, lymphatic malformation mimickers. AJR 206: 940 – 951. Read More

Authors:  Gaballah Marian,  Goldfisher Rachelle

Keywords:  Lymphatic malformation ,  Vascular Malformation