Cielma Tara,  Hill Cara,  Mirza Sobia,  Sanchez Ramon

Final Pr. ID: Poster #: EDU-004

Venous thromboembolism (VTE) is a multifactorial disease and a significant source of morbidity. Though the incidence of VTE, composed of deep venous thrombosis (DVT) and pulmonary emobolism (PE), is more common in adults, an increasing number of children are being diagnosed. Children who are critically ill are at greatest risk of developing VTE.

Duplex sonography is a critical front line tool in the detection and evaluation of venous thrombosis. Serial surveillance examinations allow real-time assessment of thrombosis including propagation and progression.

Recognizing the presentation and sonographic appearance of venous thrombosis assists the clinician in timely therapeutic decision-making and clinical management.

The goals of this exhibit are:

1. Describe the technical approach of performing duplex vascular ultrasound, including tips and technology that assist in optimizing studies.
2. Discuss the incidence, risk factors, and clinical characteristics of pediatric VTE.
3. Depict the sonographic appearance of thrombosis with emphasis on correlation to other modalities.
4. Discuss prognosis and long-term outcomes of VTE in children.
5. Describe future techniques and applications. Read More

Authors:  Cielma Tara,  Hill Cara,  Mirza Sobia,  Sanchez Ramon

Keywords:  Deep venous thrombosis ,  Venous thromboembolism ,  Pulmonary embolism

Joshi Aparna,  Grove Jason,  Ladino-torres Maria

Final Pr. ID: Poster #: EDU-005

Dynamic contrast-enhanced MR lymphangiography (DCEMRL) with intranodal injection has emerged as a useful tool in evaluating lymphatic disorders. We share our institutional experience with DCEMRL in infants through a detailed discussion of technique and series of case presentations.

Techniques for nodal access and imaging infants with DCEMRL are explained through text and step-by-step illustrations.

MR lymphangiography images of infants between 22 days and 8 weeks of age are presented with multi-modality correlation, including patients with congenital chylous ascites, non-immune fetal hydrops, and postsurgical chylothorax. Each case discussion includes a review of relevant lymphatic anatomy, explanation of the disease process, and key teaching points regarding DCEMRL in infants. Read More

Authors:  Joshi Aparna,  Grove Jason,  Ladino-torres Maria

Keywords:  Lymphangiography ,  Infant ,  MR

Bardo Dianna,  Lindblade Christopher,  Wishah Fidaa,  Cornejo Patricia,  Patel Mittun,  Ellsworth Erik,  Awerbach Jordan,  Goncalves Luis

Final Pr. ID: Poster #: EDU-006

The purpose of this educational exhibit is to show FCMR images of congenital heart disease (CHD) and anatomical findings associated with CHD. We will describe currently available FCMR image acquisition techniques and use a case-based approach to show a variety of CHD diagnosis with teaching points to highlight the added value of FCMR in diagnosis and prognosis. Read More

Authors:  Bardo Dianna,  Lindblade Christopher,  Wishah Fidaa,  Cornejo Patricia,  Patel Mittun,  Ellsworth Erik,  Awerbach Jordan,  Goncalves Luis

Keywords:  Fetal cardiac MRI ,  congenital heart disease

Machado-rivas Fedel,  Jaimes Camilo,  Kirsch John E,  Gee Michael

Final Pr. ID: Poster #: EDU-007

Fetal MRI has transformed prenatal patient care, allowing for earlier and better detection of complex congenital anomalies. However, fetal MRI’s diagnostic utility is often limited by technical barriers that introduce artifacts and reduce image quality.

The main determinants of fetal MRI image quality are speed of acquisition, spatial resolution and SNR. Optimization of imaging is a challenge because improvements in one aspect generally leads to a tradeoff in the others. Moreover, the recent introduction of 3T fetal MRI to achieve better SNR adds to the complexity. Motion, banding artifacts, and aliasing artifacts impact the quality of fetal acquisitions at any field strength. High SAR and artifacts from inhomogeneities in the RF field are important limitations of high field strength imaging.

Fetal and maternal motion create the need for rapid image acquisition. This generally limits imaging to SST2w, bSSFP, T1w spoiled-GRE, and EPI sequences. Acquisitions can be degraded by low SNR, resulting in grainy images. This can be improved by increasing the number of coil elements or increasing the field strength. Blurry images can be a result of low resolution and can be improved by decreasing the FOV (at expense of SNR) or increasing the field strength. Most strategies to improve quality will also increase SAR, which can be controlled by decreasing the number of slices, lowering the excitation or refocusing flip angles, increasing the TR or lowering the field strength.

Fast sequences can prevent some motion artifacts, other strategies include decreasing the number of slices, swapping the PE and FE directions, maternal breath hold or oral sedatives, and image reconstruction by motion correction algorithms. Aliasing artifacts can be effectively addressed by phase-oversampling (at expense of SAR in SST2w sequences) or rotating the long axis of the PE direction. Banding artifacts of bSSFP sequences can be minimized by decreasing TR (at expense of SAR) or lowering field strength. High field strength imaging can be severely limited by shading secondary to RF field inhomogeneities. Multichannel field transmit and complex field strength shaping show promising results to address this issue.

In this educational exhibit we will use visual examples to discuss: 1) fetal MRI quality optimization tradeoffs, 2) technical barriers and artifacts that impact image quality, and 3) solutions to improve quality and reduce artifacts. Read More

Authors:  Machado-rivas Fedel,  Jaimes Camilo,  Kirsch John E,  Gee Michael

Keywords:  Prenatal

Aboughalia Hassan,  Dighe Manjiri

Final Pr. ID: Poster #: EDU-010

Fetal lung maturity is a key factor determining perinatal morbidity and mortality. Clinicians can perform amniocentesis and evaluate the amniotic fluid for certain surfactant byproducts such as lethicin, sphingomyelin, and phosphatidylglycerol to assess lung maturity. However, amniocentesis is invasive, and its results can be prone to errors. Imaging can offer a reliable non-invasive alternative that can be used for prognostication as well as suggestion of further follow up. Ultrasound is the imaging modality of choice to assess fetal development. It is readily available on widespread scale to assess for various abnormalities that can occur during pregnancy. Parameters used to assess fetal lung maturity on ultrasound include lung to head ratio as well as the observed/expected lung to head ratio. However, ultrasound parameters can be subjective, have inter- and intra-observer variability and depend highly on the imaging technique and quality. The advent of ultrafast MRI sequences expanded its use in fetal imaging offering an alternative to ultrasound. It is generally used as a problem-solving tool due its excellent soft tissue resolution. Two parameters are gaining acceptance as means to assess fetal lung development on MRI: lung volume measurements and lung/liver signal intensity ratio. Our exhibit aims at familiarizing pediatric radiologists with parameters used to assess lung development on both ultrasound and MRI. Read More

Authors:  Aboughalia Hassan,  Dighe Manjiri

Keywords:  Lung maturity ,  Fetal Imaging

Mcclure Meghan,  Beavers Angela

Final Pr. ID: Poster #: EDU-011

Trisomy 18 (Edwards Syndrome) and trisomy 13 (Patau Syndrome) are the second and third most common chromosomal trisomy disorders, respectively, and their characteristic syndromic features have been well described; however, to our knowledge, no prenatal studies have reported the fetal MR findings of trisomy 13 and trisomy 18. For this reason, typical fetal MR features of trisomy 13 and 18 remain incompletely characterized and its role and limitations in its prenatal evaluation and diagnosis are not established in the literature.

In this cased-based, pictorial educational exhibit, we review the syndromic features of trisomy 13 and 18, and present the prenatal MR findings of six cases of trisomy 18 and three cases of trisomy 13, all confirmed by pre and/or postnatal genetic testing. We will discuss the strengths and weaknesses of prenatal MR imaging in the evaluation of trisomy 13 and 18 by comparing to prenatal ultrasound and utilizing postnatal imaging as a reference standard.

After reviewing this presentation, the learner will: (1) Be able to recognize not only the individual fetal MR appearance of abnormalities associated with trisomy 13 and 18, but recognize them as part of a trisomy syndrome. (2) Understand the strengths, limitations, and pitfalls of prenatal MR in evaluation and diagnosis of trisomy 13 and 18. (4) Become familiar with the key points and measurements that should be used in the assessment and diagnosis of the fetus with trisomy 13 and 18 and be included in the radiology report to best assist the multidisciplinary care teams in counseling the pregnant patient and providing care of the fetus and neonate with trisomy 13 and 18. Read More

Authors:  Mcclure Meghan,  Beavers Angela

Keywords:  Trisomy ,  Patau syndrome ,  Edwards Syndrome

Snyder Elizabeth,  Sarma Asha,  Krishnasarma Rekha,  Engelstad Holly,  Pruthi Sumit

Final Pr. ID: Poster #: EDU-012

Although head ultrasound (HUS) is most often used in the neonatal intensive care unit (NICU) setting as a screening exam for emergencies such as hydrocephalus, intracranial hemorrhage, and ischemic injury, a spectrum of congenital brain abnormalities may also be diagnosed, especially with state-of-the-art US technology that enables detection of more subtle malformations.

While brain MRI remains the gold standard for comprehensive evaluation of congenital CNS anomalies, knowledge of the appearance of such pathologies on HUS is vital: HUS is often the first exam performed, and some infants are too critically ill to undergo MRI. Identification of congenital anomalies by the radiologist may generate prognostic information that can impact critical medical decision-making and patient/family counseling in the NICU.

The goals of this educational poster are to provide a systematic approach to evaluating congenital brain anomalies on HUS and illustrate the ultrasound appearance of common and less common congenital abnormalities with MRI comparisons, as well as highlight potential pitfalls in making these diagnoses.

Covered entities include:
Posterior fossa malformations: e.g., Chiari II, Dandy-Walker
Midline anomalies: e.g., Holoprosencencephaly, agenesis of the corpus callosum, pericallosal lipoma
Cortical malformations: e.g., Gray matter heterotopia, schizencephaly, lissencephaly
Vascular malformations: e.g., Vein of Galen malformation
Congenital infections: e.g., Congenital cytomegalovirus Read More

Authors:  Snyder Elizabeth,  Sarma Asha,  Krishnasarma Rekha,  Engelstad Holly,  Pruthi Sumit

Keywords:  Head ultrasound ,  Congenital anomalies ,  Ultrasound MRI correlation

Kalsi Ishar

Final Pr. ID: Poster #: EDU-015

Fetal Magnetic Resonance Imaging (MRI) scanning techniques have caused concern in both the general population and scientific community about their safety. Studies published in the past have called to question the current techniques and sequences used in fetal MRI from a safety perspective. Namely, noise of scanning sequences, specific absorption rate, heating of the fetus, and utility of MRI to detect Zika virus induced malformations in relation to practices of safety in the recent Zika virus outbreak. Read More

Authors:  Kalsi Ishar

Keywords:  MRI ,  Safety ,  Fetal

Groene John,  Ong Seng,  Feinstein Kate,  Slater Bethany,  Zaritzky Mario

Final Pr. ID: Poster #: EDU-017

Purpose:
A new minimally invasive procedure, the use of magnets (Flourish™) for the treatment of esophageal atresia will be described. The invention’s background, patient selection criteria, procedure details and complications are the subject of this exhibit.

Background:
Esophageal atresia is a rare congenital defect where the proximal esophagus does not connect to the distal esophagus. Classically, this defect has been treated by surgery to reconnect the ends and reestablish esophageal continuity, however a small subset may be treated with a magnetic catheter-based system. The primary goal of this procedure is to form an anastomosis while avoiding a major thoracic surgery and its complications.
The Flourish™ device uses bullet-shaped rare earth magnets which are inserted into the upper esophagus and lower esophagus. Included in these magnets is the rare earth element neodymium, which along with iron and boron create an alloy with a strength of up to 1.2 Tesla.
When the magnets are placed in close proximity at the ends of the esophageal pouches, they will attract over several days, eventually connecting the ends of the esophagus and causing an anastomosis via pressure necrosis.

Criteria:
Selection is based on absence of tracheoesophageal fistula, esophageal gap shorter than 4 cm and a mature gastrostomy tract.

Procedure:
Under fluoroscopy, the gastric catheter is advanced superiorly through the gastrostomy to the most superior end of the distal esophageal pouch. The oral catheter is then advanced in order to bring the magnets to closest proximity. Daily radiographs are obtained to evaluate magnet positions.

Complications/outcomes:
Thirteen patients that have undergone placement of the magnetic catheter-based system at six institutions. Twelve patients had an average time to achieve anastomosis of six days and progressed to full oral feeds. The most common complication was magnetic anastomosis stenosis requiring dilatation. Currently, Flourish is approved as a Humanitarian Device Exemption (HDE).
Read More

Authors:  Groene John,  Ong Seng,  Feinstein Kate,  Slater Bethany,  Zaritzky Mario

Keywords:  Esophageal Atresia ,  Atresia ,  Flourish

Ghouri Maaz,  Myers Ross,  Voss Stephan,  Tsai Andy

Final Pr. ID: Poster #: EDU-021

Gastrojejunostomy (GJ) tubes play an essential role in the management of individuals with poor gastric function, chronic vomiting and respiratory problems. Small-bowel intussusception around the GJ tube is uncommon with reported incidence of ~16% (likely to be higher in younger patients and with the use of large bore tubes). Complications associated with GJ tube intussusceptions are typically sub-acute and resolve spontaneously, but in some instances can lead to more severe complications such as bowel obstruction, ischemia and perforation. Read More

Authors:  Ghouri Maaz,  Myers Ross,  Voss Stephan,  Tsai Andy

Keywords:  Intussuception ,  Gastrojejenostomy ,  coiled-spring

Henry M Katherine,  Bennett Colleen,  Servaes Sabah

Final Pr. ID: Poster #: EDU-032

Intra-abdominal injuries are a less common manifestation of child abuse, but can be associated with high mortality. These injuries may be difficult to detect on physical exam alone, as many children do not have external cutaneous signs of abdominal injury, and symptomatology may be non-specific. Once detected, no specific intra-abdominal injury is pathognomonic for abuse, though some are more common in physical abuse. Determination of the likelihood of abuse as a mechanism relies on the plausibility of the history provided in the context of the constellation of identified injuries.

In this multidisciplinary educational presentation made in collaboration with pediatric radiologists and child abuse pediatricians, we will: (1) review physical exam and laboratory indicators to obtain abdominal imaging; (2) review imaging examples of intra-abdominal solid organ injuries; (3) review imaging examples of hollow viscus injuries; (4) discuss the types of trauma that causes solid organ and hollow viscus injuries; (5) review imaging modalities available, and (6) briefly discuss medical management. Read More

Authors:  Henry M Katherine,  Bennett Colleen,  Servaes Sabah

Keywords:  Child Abuse ,  Trauma ,  Abdominal

Gillman Jennifer,  Bedoya Maria,  Kim Sung

Final Pr. ID: Poster #: EDU-034

Through our institution’s established relationship with the Princess Marina Hospital in Gabarone, Botswana, we pioneered a radiology resident global health elective with a special focus in pediatric imaging. Our 5-week global health elective consisted of four major categories of activities: reading clinical cases (primarily CT and radiographs), bedside rounds and clinic tumor boards, didactic lectures and case conferences (to medical students, residents, technologists and faculty), and hands-on ultrasound training. For these activities, we primarily partnered with the departments of pediatrics, internal medicine, surgery and radiation oncology.

The purposes of this educational exhibit are:
1. To discuss the inherent challenges to practicing and teaching radiology in a Botswana government hospital.
2. To describe our initial needs assessment and evaluation of the departmental work flow.
3. To explain how we developed a cranial ultrasound workshop targeting pediatric and radiology residents, faculty and technologists. This workshop consisted of multiple didactic lectures and bedside hands-on ultrasound in the neonatal intensive care unit.
4. To explore the relevant resources and available grants for residents, in order to help other programs support similar efforts.
5. To present interesting cases to conclude our educational exhibit.

Experiencing radiology in Botswana was an extremely rewarding experience, and as residents we had the capability to make a clinical impact on a daily basis. Our efforts have paved the way for more residents at our institution to have similar meaningful and impactful experiences. Read More

Authors:  Gillman Jennifer,  Bedoya Maria,  Kim Sung

Keywords:  Global Health

Mowrer Gregory,  Jaramillo Diego,  Restrepo Ricardo,  Imundo Lisa,  Flemming Don,  Chauvin Nancy

Final Pr. ID: Poster #: EDU-038

Chronic nonbacterial osteomyelitis (CNO) is an aseptic auto-inflammatory condition that affects children and presents with insidious bone pain. Children present with a variable clinical spectrum of disease with either unifocal or multifocal pain and acute (duration < 6months) or chronic (>6 months) symptoms. The disease course may be recurrent. In some cases, patients endure multiple lesions over a course of exacerbations and remissions. Bone lesions are often in symmetrical regions. Interestingly, clinically asymptomatic bone lesions are discovered during the imaging evaluation. Patient symptoms and clinical course may mimic other diseases, making CNO often difficult to diagnose with a consequent delay in diagnosis. Children with CNO may also develop arthritis and demonstrate similar cytokine profiles with children with juvenile idiopathic arthritis (JIA), suggesting at least a partial common disease pathway. Read More

Authors:  Mowrer Gregory,  Jaramillo Diego,  Restrepo Ricardo,  Imundo Lisa,  Flemming Don,  Chauvin Nancy

Keywords:  chronic nonbacterial osteomyelitis ,  osteitis ,  CRMO

Bruce Cristian,  De Barbieri Florencia,  Zegpi Maria Soledad,  Sergio Gonzalez

Final Pr. ID: Poster #: EDU-039

The purpose of this exhibit is to show a number of unusual skin lesions that can be seen in children, emphasizing the sonographic appearance and clinical and pathological correlation. We have found this barely described in the literature. Read More

Authors:  Bruce Cristian,  De Barbieri Florencia,  Zegpi Maria Soledad,  Sergio Gonzalez

Keywords:  skin ,  sonography ,  children

Brady Darragh

Final Pr. ID: Poster #: EDU-044

Learning muculoskeletal ultrasound is challenging. We provide an interactive, problem based approach to learning how to ultrasound the shoulder in a pediatric patient, focusing on key anatomy, static positioning, and dynamic maneuvres, using a stepwise logical approach. Photographs with tranducer positions are provided. Cine images are provided for dynamic maneuvers. This approach may provide a framework for musculoskeletal ultraound workhops that can be adapted for the pediatric radiology trainee, or ultrasound technician. Read More

Authors:  Brady Darragh

Keywords:  ultrasound ,  shoulder

Chacko Anith,  Andronikou Savvas,  Goncalves Fabricio,  Mian Ali,  Vedajallam Schadie,  Thai Ngoc Jade

Final Pr. ID: Poster #: EDU-048

The inter-arterial watershed zone in neonates is a geographic area without discernible anatomic boundaries, is difficult to demarcate and usually not featured in atlases. Schematics currently used to depict the areas are not based on any prior anatomic mapping, as compared to adults. Magnetic resonance imaging (MRI) of neonates in the acute to subacute phase with suspected hypoxic ischaemic injury can demonstrate signal abnormality and restricted diffusion in the cortical and subcortical parenchyma of the watershed regions, although this can often be subtle.

In contrast, in the chronic stage of evolution of partial prolonged hypoxic-ischaemic injury, atrophy and ulegyria can make the watershed zone more conspicuous as a region. Our aim is to use images extracted from a large medicolegal database (approximately 2000 cases), of delayed MRI scans in children with cerebral palsy, to demonstrate the watershed region.

To achieve this, we have selected cases diagnosed on imaging as having sustained a pattern of term, partial-prolonged hypoxic-ischaemic injury affecting the hemispheric cortex, based on the presence of bilateral, symmetric atrophy with ulegyria. From these we have identified those patients demonstrating injury along the entire watershed continuum as well as those demonstrating selective anterior or posterior watershed predominant injury for demonstration.

Recognition of this zone is essential for diagnosing partial-prolonged hypoxic-ischaemic injury sustained in term neonates, which also has implications for potential compensation in litigation. The set of images presented in this pictorial review provides a template for identifying the cortical watershed distribution when there is milder regional (anterior, parasagittal, peri-Sylvian and posterior) watershed injury and for more severe injury where multiple regions are injured in combination or as a continuum. Read More

Authors:  Chacko Anith,  Andronikou Savvas,  Goncalves Fabricio,  Mian Ali,  Vedajallam Schadie,  Thai Ngoc Jade

Keywords:  Cortical Ischemic Patterns ,  Watershed Zone ,  Hypoxic Ischemic Injury

Krishnan Vijay,  Kandula Ashrith,  Nikam Rahul

Final Pr. ID: Poster #: EDU-049

Background:
In pediatric patients presenting with neurological deficit in emergency department, special attention should be given to identify the conditions that can mimic a stroke to avoiding unnecessary interventions. There are various pathologies in pediatric populations that can mimic stroke both clinically and radiologically. Radiologists, by identifying specific imaging patterns of classical stroke and also patterns of those stroke mimics, shall aid clinician in deciding treatment options in a timely manner.

Objectives:
In this educational poster we aims at,
1) Discussing typical imaging patterns of ischemic stroke.
2) Discussing common pathologies in pediatric age group which can mimic ischimic stroke and pose challenge to the clinicians as well as radiologists.
3) Describing various imaging findings of those stroke mimics that help to differentiate from ischemic stroke.

We discuss the imaging patterns of following pediatric stroke mimics:
- Infective pathologies, including HSV encephalitis
- Demyelinating lesions.
- Vasculitis
- Migraine.
- Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS).
- Hypoxic ischemic encephalopathy.
- Moya Moya disease.
- Posterior reversible encephalopathy syndrome.
- Drug related pathologies.
- Miscellaneous conditions.

Conclusion:
Differentiation of commonly seen stroke mimics from ischemic stroke in a timely manner helps clinician for proper management and unnecessary interventions. Read More

Authors:  Krishnan Vijay,  Kandula Ashrith,  Nikam Rahul

Keywords:  stroke mimics ,  magnetic resonance imaging

Oros Joseph,  Moredock Elisabeth,  Parish David,  Pfeifer Cory

Final Pr. ID: Poster #: EDU-053

The goals of this educational exhibit are to: 1. Explain the basis for the cause of diffusion restriction on brain MRI in children. 2. Discuss the broad differential diagnosis for diffusion restriction in pediatric emergency neuroradiology. 3. Emphasize causes of diffusion restriction unrelated to vascular occlusive disease in the brain. 4. Describe patterns of diffusion restriction commonly encountered in post-ictal states and posterior reversible encephalopathy syndrome. Read More

Authors:  Oros Joseph,  Moredock Elisabeth,  Parish David,  Pfeifer Cory

Keywords:  Diffusion Restriction ,  Posterior Reversible Encephalopathy Syndrome ,  Seizure

Farkas Amy,  Joyner David

Final Pr. ID: Poster #: EDU-054

Encephaloceles are neural tube defects less commonly encountered in clinical practice. While often sporadic, genetic causes and TORCH infections are factors that predispose patients to encephaloceles. The majority of encephaloceles present at birth; however, some encephaloceles may demonstrate a more delayed presentation with cerebrospinal fluid rhinorrhea, nasal obstruction, or feeding difficulties.
This electronic exhibit reviews various encephaloceles--occipital, sincipital, parietal, and basal encephaloceles--including antenataland postnatal cases. The distinction between nasoethmoidal,nasofrontal, and naso-orbital encephaloceles will be reviewed. The differential diagnosis of encephaloceles, especially of the sincipitallesions, will be detailed. Atretic cephaloceles will also be discussed. Read More

Authors:  Farkas Amy,  Joyner David

Keywords:  Encephalocele

Shah Chetan

Final Pr. ID: Poster #: EDU-055

Chairi 1.5 malformation is different than usual Chair i1 malformation. Neuroisurgery treatment depends on certain specific measurements performed on MRI. Purpose of this presentation is to illustrate the method to perform these measurements. Read More

Authors:  Shah Chetan

Keywords:  Chiari 1.5 ,  Clivoaxial angle ,  pB-C2 line

Nikam Rahul,  Kandula Ashrith,  Kumbhar Sachin,  Krishnan Vijay,  Donuru Achala

Final Pr. ID: Poster #: EDU-056

The inner ear anomalies are a complex group of disorders, the radiologic findings of which may be difficult to interpret. This exhibit details the basic embryology of inner ear with stress on correlation of timing of insult or arrest of development to patho-morphology, the classification schema of inner ear anomalies and various salient features aiding in accurate diagnosis. Read More

Authors:  Nikam Rahul,  Kandula Ashrith,  Kumbhar Sachin,  Krishnan Vijay,  Donuru Achala

Keywords:  Inner Ear ,  CHARGE Syndrome ,  Waardenburg Syndrome

Clifford Simon,  Colleran Gabrielle

Final Pr. ID: Poster #: EDU-057

Melanocytic nevi which present either at birth or soon after are known as congenital melanocytic nevi. Neurocutaneous melanosis is a rare sporadic phakomatosis caused by pigment cell tumours of the leptomeninges; These can be seen in association with giant congenital melanocytic nevi. Unfortunately, giant congenital melanocytic nevi with neurocutaneous melanosis has a poor prognosis.

This pictorial review aims to present and describe the imaging features on MRI and CT of children with melanocytic nevi and neurocutaneous melanosis. These changes affect both the brain and the spine.
Read More

Authors:  Clifford Simon,  Colleran Gabrielle

Keywords:  Leptomeninges ,  Melanoma

Tominna Marie,  Patel Sneha,  Noujaim Samir

Final Pr. ID: Poster #: EDU-058

Crouzon syndrome is an autosomal dominant hereditary craniosynostosis.

Although rare it is the most common syndrome seen within craniosynostosis. It is thus important for a pediatric radiologist to be aware of this condition and the imaging findings that can be seen.

This presentation will provide an illustrative imaging review of the neuro findings one will encounter in cases of Crouzon Syndrome.

Neuroimaging CT and MR images will be reviewed including shallow orbits with exophthalmos, hypoplastic maxilla, mandibular prognathia, premature fusion of sutures, kissing carotid canals, cervical fusion anomalies, and Chiari I malformations.

Some of the non-neuro findings which can also be seen include stylohyoid ligament calcification, various musculoskeletal deformities, and visceral anomalies. Read More

Authors:  Tominna Marie,  Patel Sneha,  Noujaim Samir

Keywords:  Crouzon syndrome

Brady Darragh

Final Pr. ID: Poster #: EDU-063

The anatomy of the temporal bone is complex and dense. Learning its complexity provides a challenge. One method to facilitate its learning is the 'method of loci' method. It is a method of memory enhancement which uses visualizations with the use of spatial memory, familiar information about one's environment, to quickly and efficiently recall information. This educational exhibit uses a simple story and imagery superimposed on the multiplanar CT images to impose a natural structure and sequence that will aide in learning how to read, and detect normal, and abnormal anatomy of the temporal bone. Read More

Authors:  Brady Darragh

Keywords:  temporal bone ,  education

Rodríguez Garza Claudia,  Guillen Gutierrez Cinthia,  Elizondo Riojas Guillermo

Final Pr. ID: Poster #: EDU-064

Review the causes of cerebral hemorrhage in the pediatric patient based on clinical cases.

Stroke is a major cause of morbidity and mortality in children worldwide. The reported annual incidence ranges from 2.3 to 13 per 100,000 children per year in developed countries. In contrast to the adult, in children, diagnosis is not as straightforward, because when children present with acute neurological deficits, stroke is often not the first diagnosis considered by the medical providers.

Neuroimaging is essential for diagnosis and differentiation of stroke from stroke mimics that can present similarly.

Stroke in children can be ischemic or hemorrhagic, referring to the term hemorrhagic stroke as a intracerebral hemorrhage that is nontraumatic and whose most common etiology is secondary to a vascular malformation (Arteriovenous Malformation (AVM), Dural/Pial Arteriovenous Fistula (Dural AVF/Pial AVF), Cavernous Malformation, Vein of Galen Aneurysmal Malformation (VGAM), Developmental Venous Anomaly (DVA), Capillary telangiectasia, Sinus Pericranii, Aneurysms).

The most commonly used classification of vascular malformation is based on angioarchitectural and histomorphological characteristics. To differentiate these classic types, in a first step, shunting lesions have to be discerned from nonshunting lesions, as well as other features of the vascular contribution that will be evaluated by image.

We cannot forget the hemorrhage associated with coagulopathy, haematological disorders, brain tumors and cerebral sinovenous thrombosis (CSVT) which in the latter case can be found as venous infarction or hemorrhage; and other less common causes of hemorraghe in pediatrics as the intracranial aneurysms, in 15% of all pediatric aneurysms are secondary to an infection (micotic aneurysm).

Read More

Authors:  Rodríguez Garza Claudia,  Guillen Gutierrez Cinthia,  Elizondo Riojas Guillermo

Keywords:  vascular malformations ,  hemorrhage ,  pediatric stroke

Mirza Sobia,  Shalaby-rana Eglal,  Kovats Catalina,  Loomis Judyta,  Vyas Pranav,  Shet Narendra,  Fricke Stanley,  Cielma Tara,  Bush Ebony,  Grecco Krystal

Final Pr. ID: Poster #: EDU-068

This electronic poster discusses the various clinical and imaging features of pediatric hyperthyroidism, including Graves’ disease and toxic nodule. Imaging modalities reviewed include ultrasound and molecular imaging. We will provide an overview of I-131 hyperthyroid therapy with focus on guideline-based practices of patient preparation, I-131 dosing and post-therapy radiation precautions. A pressing concern for patients and families following I-131 therapy is how long radiation precautions must be followed and when the patient may return to school or work. We have developed and implemented a table listing the appropriate duration of post-therapy radiation precautions based on the administered I-131 dose. We propose the use of such tables for ease of consultation and standardization of discharge procedures. Read More

Authors:  Mirza Sobia,  Shalaby-rana Eglal,  Kovats Catalina,  Loomis Judyta,  Vyas Pranav,  Shet Narendra,  Fricke Stanley,  Cielma Tara,  Bush Ebony,  Grecco Krystal

Keywords:  hyperthyroid ,  I-131 ,  iodine

Tang Elizabeth,  Menashe Sarah,  Romberg Erin,  Perez Francisco,  Otjen Jeffrey

Final Pr. ID: Poster #: EDU-070

CT with 4D cine imaging can non-invasively and dynamically characterize airways for various pathologies, such as airway caliber fluctuations in tracheobronchomalacia, intermittent compression by cardiovascular or other mediastinal structures, or constriction from anatomic anomalies like those associated with craniofacial syndromes. However, optimal interpretation of dynamic airway CT studies requires an understanding of the impact of such extrinsic factors as the presence of support apparatus (e.g., endotracheal tube, enteric tube), level of required respiratory support (e.g., positive end-expiratory pressure), and differences in positioning (e.g., with jaw thrust). We have performed more than 100 pediatric cases of dynamic airway CT under a variety of conditions, in patients who range from free-breathing to ventilator-dependent, and for a variety of pathologies. In this educational exhibit, we will consider how to balance and tailor extrinsic factors when using dynamic CT for the guidance of airway management, in order to meet diagnostic considerations and supplement other cardiopulmonary investigations, including cases with bronchoscopic and surgical correlates. Read More

Authors:  Tang Elizabeth,  Menashe Sarah,  Romberg Erin,  Perez Francisco,  Otjen Jeffrey

Keywords:  Airway ,  Cine ,  CT

Thakrar Pooja,  Boyd Kevin,  Wideburg Eric,  Kumbhar Sachin

Final Pr. ID: Poster #: EDU-072

The incidence of e-cigarette, or vaping, product use associated lung injury (EVALI) has been increasing since the summer of 2019. At least seven distinct patterns of lung injury have been described with this emerging disease (1). A recent report from the United States Centers for Disease Control and Prevention indicates that approximately 15% of patients diagnosed with EVALI have been in the pediatric age group (2). Because of the potential legal and social repercussions of vaping and cannabis use, pediatric patients may be disinclined to admit to use of electronic cigarettes. As such, recognition of the potential imaging patterns of this disease may allow the pediatric radiologist to raise the possibility of EVALI to facilitate timely diagnosis and appropriate management of the disease.

This educational exhibit will review the imaging findings seen in the various patterns of lung injury identified with this increasingly common lung disease. We will also discuss the indications for obtaining imaging studies in patients with suspected EVALI. In addition, we will describe the potential clinical presentations in these patients.

References:
1. Henry TS, Kligerman SJ, Raptis CA, et al. (2019) Imaging findings of vaping-associated lung injury. AJR 1-8. 10.2214/AJR.19.22251
2. Centers for Disease Control and Prevention. (2019) Severe pulmonary disease associated with electronic cigarette product use—interim guidance. https://www.cdc.gov/mmwr/volumes/68/wr/mm6836e2.htm Read More

Authors:  Thakrar Pooja,  Boyd Kevin,  Wideburg Eric,  Kumbhar Sachin

Keywords:  EVALI ,  vaping-associated lung injury ,  adolescent

Kinariwala Dhara,  Daugherty Reza

Final Pr. ID: Poster #: EDU-078

Although rare, CLOVES syndrome, a PIK3CA-related congenital overgrowth disorder, presents radiologists with opportunity for vital diagnostic and treatment planning. CLOVES syndrome is characterized by Congenital Lipomatous Overgrowth of the trunk, Vascular malformations, Epidermal naevi, and Skeletal and Spinal anomalies. Multimodal imaging findings can help distinguish CLOVES from other overgrowth syndromes such as Proteus syndrome and Klippel-Trenauny syndrome. We present multimodal imaging of four patients with CLOVES syndrome which demonstrate characteristic findings:

- Thoracic lipomatous hyperplasia, a key sign of CLOVES syndrome in which predominantly thoracic lipomatous masses grow in the subcutaneous tissues and invade the pleura, mediastinum, and upper abdomen, often with superficial vascular malformations
- Renal anomalies, including agenesis, hypoplasia, hydronephrosis, and cysts.
- Vascular malformations, including venous, venolymphatic, and lymphatic malformations
- Spinal cord defects, including spina bifida, medullary arteriovenous shunts, and congestive myopathy of the paravertebral venous plexus

Management of CLOVES syndrome focuses on debulking of lipomatous masses, treatment of clinically significant vascular malformations, and medical management of renal and neurologic sequelae. To that end, the role of the radiologist is accurate diagnosis of the syndromic pattern, isolation of the extent of lipomatous masses for pre-operative planning, and identification of renal and spinal cord anomalies.

The purpose of the poster is to:

1. Briefly review the types of congenital overgrowth disorders as demonstrated in various imaging modalities.
2. Focus on characteristic imaging findings of CLOVES syndrome.
3. Review the benefits and disadvantages of various imaging modalities.
4. Identify the most relevant radiologic findings for surgical, interventional and medical management.


Read More

Authors:  Kinariwala Dhara,  Daugherty Reza

Keywords:  Congenital ,  Thoracic ,  Vascular Malformations

Defendi Larissa,  Yokoo Patricia,  Shoji Hamilton,  Balancin Marcelo,  Chate Rodrigo

Final Pr. ID: Poster #: EDU-079

Congenital lung malformations are a heterogeneous group of developmental disorders whose etiology is not well stablished. Since they represent a spectrum of anomalies, diverse imaging appearance and clinical manifestations can be found. Although rare, their clinical importance is remarkable. Some of them can be a source of important morbidity and mortality in infants and children. Others, however, remain asymptomatic and may be incidentally detected in adulthood. Nowadays, these malformations are usually diagnosed in utero by prenatal imaging. In order to optimize diagnostic accuracy and disease management, it is imperative for radiologists to be familiar with the imaging characteristics of each lesion and the proper methods employed in their evaluation.

The purpose of this exhibit is:
- To describe the postnatal radiological appearance of some congenital lung diseases on conventional radiography, ultrasound (when available) and cross-sectional imaging methods;
- To conduct a brief review of the literature regarding etiology, epidemiology, clinical features and adequate diagnostic approach;
- To highlight the key imaging findings of each abnormality and their differential diagnoses;
- To briefly discuss management and follow-up of each condition.

Illustrative cases from our Radiology Department will be used to demonstrate the following entities:

1. Parenchymal anomalies:
- Lung hypoplasia;
- Congenital bronchial atresia;
- Congenital lobar emphysema;
- Congenital pulmonary airway malformation (previously known as congenital cystic adenomatoid malformation);
- Pulmonary bronchogenic cysts;
- Tracheal bronchus;
- Accessory cardiac bronchus.

2. Vascular anomalies:
- Interruption of a main pulmonary artery;
- Pulmonary artery stenosis;
- Anomalous pulmonary venous drainage.

3. Combined parenchymal and vascular anomalies:
- Bronchopulmonary sequestration;
- Hypogenetic lung (scimitar) syndrome. Read More

Authors:  Defendi Larissa,  Yokoo Patricia,  Shoji Hamilton,  Balancin Marcelo,  Chate Rodrigo

Keywords:  Congenital ,  Vascular ,  Lung