Otjen Jeffrey,  Phillips Grace,  Khatri Garvit,  Kanal Kalpana,  Kim Helen Hr,  Stanescu A. Luana

Final Pr. ID: Poster #: EDU-002

Pediatric head CT examinations remain a mainstay imaging modality, frequently utilized to evaluate a wide spectrum of pediatric pathology. Current pediatric head CT protocols aim to use the least amount of radiation while providing imaging of diagnostic quality. Lower radiation doses, along with other factors, can occasionally cause CT artifacts that can affect the quality and the interpretation of images.
In this exhibit, we review examples of physics-based, patient-based and scanner-based CT artifacts on head CT exams, while also providing a brief explanation of the underlying physics and ways to mitigate the artifact. Imaging examples include among others: apparent posterior fossa masses due to beam hardening, apparent extra-axial fluid collections due to cupping artifact, apparent brain parenchymal hypodensities concerning for infarct, and apparent beading of intracranial vessels due to lower radiation doses administered.
Awareness of these artifacts is critical for radiologists, as they can potentially lead to misdiagnosis. Read More

Authors:  Otjen Jeffrey,  Phillips Grace,  Khatri Garvit,  Kanal Kalpana,  Kim Helen Hr,  Stanescu A. Luana

Keywords:  Artifacts ,  CT ,  Head

De Leon-benedetti Laura,  Ramirez Suarez Karen,  Otero Hansel,  Rapp Jordan,  Biko David,  Smith Christopher,  Serai Suraj,  White Ammie

Final Pr. ID: Poster #: EDU-003

Magnetic resonance imaging (MRI) has historically been restricted for patients with pacemakers, defibrillators, or other cardiac implantable electronic devices (CIEDs) due to safety concerns. Despite the introduction of MR conditional pacemakers in 2008, access to MRI in patients with CIEDS remains limited.
MRI remains the diagnostic imaging study of choice for many indications and is necessary to prevent delayed diagnosis and the decision to proceed with MRI should follow a rigorous risk benefit assessment:
Risks of:
Lead heating causing injury at their tips
Increased pacing thresholds
Sudden battery depletion
Inappropriate sensing/pacing
The location of the image should be considered because if the request includes the area of the CIED then potential artifacts may decrease the diagnostic quality. However, an MRI remote from the location of the CIED entails a negligible risk of lead heating and MRI may be performed safely with continuous patient monitoring throughout the scan. In addition, in pediatric patients the necessity of anesthesia or sedation must be well-thought-out as it conveys additional risk to the patient.
There is growing evidence from adult literature that MRI may be performed safely in patients with CIEDs with transvenous leads when appropriate protocols are followed. The Heart Rhythm Society (HRS) 2017 expert consensus statement indicates that MRI is reasonable in patients with MR non-conditional transvenous CIEDs if there are no fractured, epicardial, or abandoned leads. The Pediatric and Congenital Electrophysiology Society (PACES) of 2021 included that MRI may be considered in pediatric patients with epicardial or abandoned leads on a case-by-case basis. However, performing MRI in patients with CIEDs is a resource-intensive service and requires rigorous implant investigation, preparation, and planning as well as close coordination between treating physicians and radiologist.
This educational exhibit summarizes current literature on the safety of MRI in patients with CIEDs and takes examples from our practice to build an evaluation program that allows for safe access to MRI in patients with CIEDs Read More

Authors:  De Leon-benedetti Laura,  Ramirez Suarez Karen,  Otero Hansel,  Rapp Jordan,  Biko David,  Smith Christopher,  Serai Suraj,  White Ammie

Keywords:  Cardiac ,  Magnetic Resonance

Dennison Chelsea,  Taylor Susan,  Wilson Hunter,  Slesnick Timothy,  Riedesel Erica

Final Pr. ID: Poster #: EDU-005

Over the last twenty years there has been a rapid expansion in the vast array of implantable cardiac devices utilized in pediatric patients. Imaging plays a key role in the management of patients with these devices. It is important for the pediatric radiologist to recognize the specific type of cardiac device visualized on radiographic images in order to make an accurate assessment of the appropriate position and any potential complications. With new cardiac devices entering the market it can be very perplexing and daunting for the radiologist to stay familiar with them all.

We will seek to review old and new pediatric cardiac devices currently used at our institution and their radiographic appearance.

These devices will be divided into categories of pacing devices, prosthetic heart valves, stents, closure devices, ventricular assist devices, extracorporeal membrane oxygenation systems (ECMO), and external monitoring devices.

Pacing devices: a) Epicardial and transvenous pacing systems b) Leadless pacemakers
Prosthetic heart valves: a) Surgically implanted valves b) Transcatheter valves
Cardiac stents
Closure devices: a) Patent ductus arteriosus closure device, b) Atrial septal defect closure device c) Vascular plugs and coils
Ventricular assist devices: a) Left ventricular assist device, b) Right ventricular assist device, c) Bi-ventricular assist device
Extracorporeal membrane oxygenation (ECMO) cannulas: a) Venous-arterial ECMO, b) Venous-venous ECMO
External monitoring devices: a) Holter monitor, b) Loop recorder Read More

Authors:  Dennison Chelsea,  Taylor Susan,  Wilson Hunter,  Slesnick Timothy,  Riedesel Erica

Keywords:  Cardiac Devices ,  Radiograph

Acosta-izquierdo Laura

Final Pr. ID: Poster #: EDU-006

Abdominal aortic pathology is uncommon in the pediatric population. It is a complex clinical condition that can range from aneurysms to stenosis and can present in the emergency department as a life-threatening condition or as an incidental finding in elective studies. As radiologists, knowing the underlying conditions of abdominal aortic pathology can help clinicians narrow the differential diagnosis and provide early and focused treatment, as most of these cases represent a therapeutic dilemma. The purpose of this educational exhibit is to overview the embryology and normal anatomy of the abdominal aorta and to provide a comprehensive review, through cases, of the different causes of abdominal aortic aneurysms and middle aortic syndrome. Read More

Authors:  Acosta-izquierdo Laura

Keywords:  Aneurysm ,  Stenosis ,  Aorta

Gupta Neetika,  Snyder Elizabeth,  Victoria Teresa,  Arthurs Owen,  Miller Elka

Final Pr. ID: Poster #: EDU-007

The purpose of this exhibit is to describe the expected physiological post-mortem changes in the fetus and children using different imaging modalities. These post-mortem changes are affected by a variety of antemortem and postmortem factors, amongst all, the age of the fetus or child, the organ system in question, and the extent of fluid shifts and tissue changes are the most crucial and help to guide the imaging modality of choice in post-mortem period. It is imperative to understand organ-system-specific post-mortem changes for satisfactory reporting of post-mortem imaging in children. When in doubt, a review of perimortem clinical details and a correlation with antemortem/antenatal imaging findings may assist in reaching the final diagnosis. Read More

Authors:  Gupta Neetika,  Snyder Elizabeth,  Victoria Teresa,  Arthurs Owen,  Miller Elka

Keywords:  Postmortem Imaging ,  Physiological changes ,  Expected changes

Noda Sakura,  Otjen Jeffrey,  Koti Ajay,  Schlatter Adrienne,  Blessing Matthew,  Feldman Ken,  Menashe Sarah

Final Pr. ID: Poster #: EDU-013

Faulty fetal packing is a concave depression of the skull caused in utero by external pressure (such as by the maternal pelvic bone, a fetal limb, or uterine fibroid). It has an incidence of approximately 1 in 10,000 births. Its main differential diagnosis is acquired ping-pong-type fracture of the malleable neonatal skull, which can raise suspicion for nonaccidental trauma if there is no history of accidental trauma. Most recent literature on faulty fetal packing describes only single case reports. This educational exhibit reviews a series of faulty fetal packing and neonatal calvarial fracture cases. After reviewing this educational exhibit, readers will be able to 1) describe the mechanism of faulty fetal packing, 2) describe the appearance of faulty fetal packing on multiple modalities including radiographs and CT, and 3) distinguish between prenatal faulty fetal packing, perinatal skull trauma, and neonatal accidental and non-accidental trauma. Read More

Authors:  Noda Sakura,  Otjen Jeffrey,  Koti Ajay,  Schlatter Adrienne,  Blessing Matthew,  Feldman Ken,  Menashe Sarah

Keywords:  nonaccidental trauma ,  Skull ,  child abuse

Chauhan Ankita,  Maller Vijetha

Final Pr. ID: Poster #: EDU-027

Biliary atresia is a progressive, fibro-obliterative disease of the intra- and extrahepatic bile ducts in infancy. This exhibit outlines the pathophysiology, diagnostic pathways, and current and emerging management strategies for biliary atresia in the pediatric age group. Read More

Authors:  Chauhan Ankita,  Maller Vijetha

Keywords:  Biliary Atresia ,  Kasai ,  HIDA

Singh Jasmeet,  Milks Kathryn

Final Pr. ID: Poster #: EDU-033

Ultrasound carries high sensitivity in diagnosing acute appendicitis in pediatric patients and is increasingly being used as the preferred method of diagnosis since it does not use ionizing radiation. Although an enlarged diameter of the appendix and non-compressibility are the primary indicators of appendicitis, they do not have perfect specificity. Therefore, secondary features of appendicitis are crucial in supporting the diagnosis of appendicitis. The most sensitive secondary finding of appendicitis is inflammatory echogenic periappendiceal fat. Other secondary signs of appendicitis are either infrequently present, like wall hyperemia, or entirely nonspecific, like periappendiceal free fluid. Improving diagnostic accuracy of appendicitis with additional secondary supportive signs would be helpful. We have subjectively observed that appendix shape may be a helpful secondary sign of appendicitis, and that in certain cases it forms a C-shape or curved appearance when inflamed. It mimics the appearance of the letter ‘C’ and hence, we termed it, the “C sign.” Retrospective review of 999 ultrasound appendix studies that were conducted in our hospital from January 1, 2022, to March 31, 2022, with 150 sonographically positive acute appendicitis cases, we found 10 patients with the positive C sign and deemed positive by US and pathologically to be acute appendicitis. It seems by observation that this sign is not sensitive but specific when found, for acute appendicitis. One probable explanation for this configuration is loop separation that occurs when the proximal and distal ends of the appendix are separated either by inflamed fat or wall thickening. Herein, we show a few examples of the appendiceal “C-sign”, describe our observations, and suggest its potential use as an additional secondary sign of appendicitis. Read More

Authors:  Singh Jasmeet,  Milks Kathryn

Keywords:  Appendicitis ,  Ultrasound ,  C sign

Pouzar Adela,  Tominna Marie,  Brazier Allan

Final Pr. ID: Poster #: EDU-036

The vulva can be affected by various pathologies in the pediatric population. The location results in this area being at the “edge of the film” and findings could be easily overlooked. The spectrum of pathologies ranges from benign causes such as trauma and infection to neoplasm and more rare diagnoses. For example, childhood asymmetry labium majus enlargement (CALME) is one entity which may not be as well recognized. Familiarity with these pathologies and their imaging characteristics is crucial for radiologists to provide guidance in clinical management and optimizing clinical outcomes. Imaging modalities such as ultrasound, CT and MRI are often essential in order to establish a diagnosis. The goal of this exhibit is to provide an illustrative review of the various pathologies that can be seen in the vulvar region in the pediatric population. A brief review of anatomy followed by a case-based presentation including congenital, infectious, inflammatory, trauma, neoplastic and idiopathic causes.

Cases:
Congenital - Inguinal hernia through canal of Nuck
Infectious - Labial abscess, Labial cellulitis, Infected Bartholin cyst
Inflammatory - Recto cutaneous fistula within labium majus in patient with Crohn disease, Labial abscess with fistula
Trauma - Labial hematoma, Labial hematoma with active extravasation, Labial laceration
Tumors - Vulvar rhabdomyosarcoma
Idiopathic - Childhood asymmetrical labium majus enlargement Read More

Authors:  Pouzar Adela,  Tominna Marie,  Brazier Allan

Keywords:  vulvar region pathology ,  external genitalia

Ahn Ju Hee,  Hook Marcus,  Swenson Zachary,  King Cody

Final Pr. ID: Poster #: EDU-037

Ultrasound is the most accessible and reliable modality to evaluate the kidneys in neonates and young infants. The sonographic appearance of the kidneys in the immediate postnatal period can differ significantly from that in older children and adults. In clinical practice, radiologists encounter a full spectrum of renal pathology, with some appearing as hyperechogenicity on ultrasound. The purpose of this case-based educational exhibit is to provide a review of normal and abnormal causes of increased echogenicity of the kidneys in neonates and young infants, and common sonographic pitfalls that can artificially increase renal echogenicity Read More

Authors:  Ahn Ju Hee,  Hook Marcus,  Swenson Zachary,  King Cody

Keywords:  Ultrasound ,  Neonate ,  Kidney

Desai Sudhen,  Steve Mccaulley,  Vaidya Vinay

Final Pr. ID: Poster #: EDU-041

Patients requiring enteral support typically have not had a primary provider for the maintenance of their enteral tubes and at many institutions are only seen on an as-needed basis. Specifically, patients with gastrojejunal feeding tubes tend to present acutely (e.g. tube occlusion, dysfunction or accidental removal) to Interventional Radiology (IR) departments with need for exchange. Standard patient presentation is via the ED or their GI offices after significant time investment on the part of the families and involved providers to arrange the IR visit. Read More

Authors:  Desai Sudhen,  Steve Mccaulley,  Vaidya Vinay

Keywords:  Data Management ,  AI ,  Gastrojejunal feeding tube

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

Final Pr. ID: Poster #: EDU-044

Artificial intelligence (AI) has the potential to improve many aspects of pediatric radiology. AI solutions have emerged to perform a wide range of tasks, including facilitating the workload of radiologists, improving image quality, performing motion correction, and reducing contrast dose. While a myriad of courses for learning AI are available, most resources lack the necessary radiology perspective required for clinical application. Few interactive resources are available to teach a systematic approach for pediatric radiologists when analyzing AI literature. Since AI methodologies in pediatric radiology research fundamentally differ from classical statistical analyses, an educational poster dedicated to interpreting pediatric radiology AI literature would assist in bridging this gap.

The purpose of this education exhibit is to provide a resource for pediatric radiologists that teaches a systematic approach for the interpretation of AI research publications. Knowledge delivery will be made by eLearning slide-based presentation. The major topics regarding AI literature will focus on: problem identification; data curation; data annotation, artificial intelligence models; validation and performance. Next, we review prior literature on important criteria for AI publications, including Checklist for Artificial Intelligence in Medical Imaging (CLAIM), the AI version of the Standards for Reporting of Diagnostic Accuracy Studies (STARD-AI), Transparent Report of Multivariable Prediction Model of Individual Prognosis and Diagnosis for AI (TRIPOD-AI) and Prediction Model Risk of Bias Assessment Tool for AI (PROBAST-AI). Lastly, we present these criteria in the context of pediatric AI research applications.
AI research methodology in pediatric radiology differs from classical research methodologies. Therefore, this education exhibit is intended to teach the systematic interpretation of the primary AI literature to pediatric radiologists in order to translate scientific knowledge into meaningful clinical information. Read More

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

Keywords:  Artificial Intelligence ,  Radiology ,  Research

Lopez Rippe Julian,  Velez Florez Maria,  Sompayrac Anne,  Reid Janet

Final Pr. ID: Poster #: EDU-046

Our primary goal is to study individual narratives of career pathways to provide insight into the crucial turning points in one’s journey from becoming to being a physician. Read More

Authors:  Lopez Rippe Julian,  Velez Florez Maria,  Sompayrac Anne,  Reid Janet

Keywords:  professional development ,  curriculum

Alkhulaifat Dana,  Rafful Patricia,  Lopez Rippe Julian,  Khalkhali Vahid,  Welsh Michael,  Wieczkowski Sydney,  Reid Janet,  Sotardi Susan

Final Pr. ID: Poster #: EDU-047

Artificial intelligence (AI) applications for radiology have undergone exponential growth in recent years, owing to the development of large datasets for use in machine learning algorithms and technological advancements in the field of imaging informatics. However, the advancement of AI algorithms in pediatric radiology has lagged behind adult applications. Currently, only seven commercially-available AI algorithms have received FDA approval for use in the pediatric population [1]. One of the major factors limiting the use of AI in pediatric radiology is the lack of the requisite large pediatric imaging datasets.
In AI research and implementation, pediatric radiologists serve as stewards of imaging data. As such, pediatric radiologists should be trained in AI data management, including best practices for the selection, curation, de-identification, and storage of radiology data. Since a necessary first step in the development of AI algorithms requires the curation of large datasets, pediatric radiologists should have a basic understanding of how to archive imaging data for AI research and validation. However, few resources are currently available to provide targeted education for pediatric radiologists with respect to AI data curation..
The aim of this educational exhibit is to provide an educational resource specifically for pediatric radiologists which teaches best practices for data management in AI research, including the selection of patient cohorts, data anonymization techniques, image annotation and segmentation methods, and data storage tools. This exhibit integrates our professional experience, with a thorough literature review of prior AI research, into an educational resource to teach data science methodologies for the management of AI research and clinical implementation to the pediatric radiology community.

References
1. AI Central. https://aicentral.acrdsi.org/. Accessed 18 Oct 2022 Read More

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

Keywords:  Artificial Intelligence ,  Education ,  Data Management

Zember Jonathan

Final Pr. ID: Poster #: EDU-048

In 2021, the European Society of Radiology published its whitepaper: “ESR white paper: blockchain and medical imaging”. Blockchain provides trustful information on how, who, and when data was generated. While blockchain has become familiar to the public due to the cryptocurrency markets, there are many applications in health care and medical imaging that blockchain technology can be used. The purpose of this exhibit is to provide radiologists a background to understand blockchain by highlighting the technological aspects, history, and applications in healthcare and radiology.
The exhibit will be divided as follows:
1. Underlying technology of blockchain and what separates it from traditional databases.
2. Historical overview of blockchain.
3. Potential use cases of blockchain in healthcare and deep learning/AI.
4. Specific use cases of blockchain in medical imaging (and pediatric radiology?)
5. Challenges and Limitations. Areas for the radiology community to engage and collaborate in the development and implementation of blockchain technologies in research and patient care. Read More

Authors:  Zember Jonathan

Keywords:  cryptography ,  Informatics

Jordan Gregory,  Zavaletta Vaz,  Malone Ladonna,  Katz Danielle,  Nakano Taizo,  Kulungowski Ann,  Annam Aparna

Final Pr. ID: Poster #: EDU-051

Generalized Lymphatic Anomaly (GLA) is a rare multisystem congenital disorder originating from the abnormal development of the lymphatic system which occur under the spectrum of Complex Lymphatic Anomaly (CLA). In addition to GLA, other CLAs include Kaposiform Lymphatic Anomaly (KLA) and Gorham-Stout Disease (GSD). Lymphatic malformations (LM) associated with GLA are usually apparent at birth or by two years of age. GLA can affect almost any organ of the body but is most commonly associated with lymphatic abnormalities in the skin, abdominal/thoracic viscera and bone.

Multisite soft tissue LM can occur in all CLAs, with macrocystic lymphatic malformations being most common in GLA. These lesions can be found in the mediastinum, retroperitoneum, and subcutaneous tissue. Abdominal viscera involved include the spleen and liver. The frequency of focal splenic lesions is higher with GLA and KLA in comparison to GSD. On MRI, the lesions exhibit marked T2 hyperintensity with no discernable enhancement. In patients with larger splenic lesions, areas of T1 hyperintensity have been documented. Liver lesions in GLA have a similar appearance to the previously described splenic lesions. Nakamura et al. found that more than 30 focal splenic lesions and/or focal splenic lesions with maximum diameters greater than >10 mm were observed only in patients with GLA. On contrast enhanced CT, the lesions are generally well-circumscribed and hypodense. Within the thorax, mediastinal LMs can be seen in GLA but are more common in KLA and GSD. Chylous effusions can occur in all of the CLAs, although it has been reported that effusions in GLA were more likely to be associated with mediastinal involvement. Osseus involvement is common in patients with GLA. GLA has a predilection for the appendicular skeleton, in which the ribs are most affected although cranial, vertebral and lower extremity lesions have been reported. The lesions are usually non-contiguous with medullary destruction and sparing of the cortex. This is in contrast to GSD where cortical destruction, progressive osteolysis, contiguous lesions, and soft tissue infiltration are more common.

Educational Goals:
1) Illustrate the most common imaging characteristics by each organ system affected by GLA and how to differentiate GLA from other CLAs.
2) Raise awareness of the optimal imaging evaluation in patients with GLA.
3) Outline an approach to multidisciplinary management of patients with GLA through a vascular anomalies center. Read More

Authors:  Jordan Gregory,  Zavaletta Vaz,  Malone Ladonna,  Katz Danielle,  Nakano Taizo,  Kulungowski Ann,  Annam Aparna

Keywords:  Generalized Lymphatic Anomaly ,  Lymphatic Malformations ,  Complex Lymphatic Anomaly

Bodner Jeffrey,  Khanna Geetika,  Riedesel Erica,  Gill Anne,  Hawkins Matt,  Shah Jay,  Variyam Darshan,  Alazraki Adina

Final Pr. ID: Poster #: EDU-052

Evolution of MR Lymphangiography has expedited diagnosis and advanced potential implications for treatment in lymphatic disorders. In particular, evaluation of the central conducting lymphatic channels with dynamic contrast enhanced MR provides better spatial resolution, while sparing ionizing radiation inherent in lymphangio-scintigraphy and catheter lymphangiography.

We will review indications, technique with pearls and pitfalls, and overall success rates after MR lymphangiography at our institution. To discuss post-imaging clinical outcomes and implications for treatment. To illustrate imaging findings of various lymphatic pathology diagnosed on MR. Read More

Authors:  Bodner Jeffrey,  Khanna Geetika,  Riedesel Erica,  Gill Anne,  Hawkins Matt,  Shah Jay,  Variyam Darshan,  Alazraki Adina

Keywords:  Lymphatic ,  Lymphangiography ,  MR

Santos Laura,  Jaramillo Diego,  Raya José,  Jambawalikar Sachin,  Nguyen Jie,  Mostoufi-moab Sogol

Final Pr. ID: Poster #: EDU-053

Diffusion tensor imaging (DTI) depicts the anisotropic motion of water molecules limited by tissue microstructure. Images of tractography provide qualitative information about complex tissue architecture, so that diffusion metrics reflect physeal activity.
DTI’s main clinical application is on brain white matter, but it can be used in any tissue in which there is organized tissue structure. Our research group has used tractography of the knee to study the structure of the physis and adjacent metaphysis and investigated the potential of DTI metrics as biomarkers predictive of skeletal growth. DTI parameters include tract count, tract length and tract volume and fractional anisotropy (FA). They can help distinguish between a normal and a dysfunctional physis, predict post-imaging growth and physeal closure, and possibly determine response to growth hormone treatment.
We will demonstrate the techniques for data acquisition, preprocessing, and analysis, and the basis for interpretation, based on our experience of performing DTI in over 900 knees. Each step has its own challenges for the standardization and optimization of DTI of the physis. The goal of this poster is to showcase our experience with the establishment of an efficient DTI pipeline. We will: 1) Discuss the impact of variation of DTI acquisition parameters (e.g. Time to Echo (TE), number of directions, b-value, voxel size…); 2) Describe programs for distortion correction and denoising , as well as the required post-processing software programs; 3) Discuss approaches to standardize the acquisition in the different anatomic areas and cross vendors; 4) Discuss the normal change of tractography data and physeal DTI metrics with age, sex and specific knee physis. We will show how DTI changes due to physeal dysfunction in different pathologies, such as growth hormone deficiency, trauma, arthritis, metabolic disorders and chemotherapy and radiation therapy. Finally, we will show how DTI can be used to predict height gain and final height compared to conventional bone age-based methods and standard growth charts, which are inaccurate and not generalizable to the current child/adolescent population. Read More

Authors:  Santos Laura,  Jaramillo Diego,  Raya José,  Jambawalikar Sachin,  Nguyen Jie,  Mostoufi-moab Sogol

Keywords:  magnetic resonance imaging ,  growth plate ,  diffusion tensor imaging

Hu Anna,  Kim Jane,  Peck Jeffrey,  Haroyan Harutyun

Final Pr. ID: Poster #: EDU-059

Idiopathic hip chondrolysis (ICH) is a rare pediatric musculoskeletal disorder characterized by rapid and extensive loss of articular cartilage at the femoral head and acetabulum. Symptoms of ICH, such as pain, stiffness, and limping, are often nonspecific and may overlap with other pathologies. Diagnosis of ICH is multifactorial and relies on the correlation of imaging with the clinical presentation. Due to both the rarity of this entity and nonspecific clinical symptoms, ICH may be underdiagnosed.
In this educational poster, we will review the clinical presentation, describe the imaging findings of ICH with a special emphasis on MRI features using examples from our own institution, and discuss the treatment options as well as the natural progression of disease. Recognition of the imaging features is vital in early identification of ICH which may help prevent further irreversible cartilage loss. Read More

Authors:  Hu Anna,  Kim Jane,  Peck Jeffrey,  Haroyan Harutyun

Keywords:  idiopathic ,  hip chondrolysis ,  MRI

Tan Timothy Shao Ern,  Teo Eu Leong Harvey James

Final Pr. ID: Poster #: EDU-062

Bone dysplasias comprise a group of congenital disorders characterized by anomalies in the development or texture of bone and cartilage, which can cause significant morbidity and mortality. Achondroplasia is the commonest bone dysplasia associated with rhizomelic dwarfism and is non-lethal. Other commonly encountered bone dysplasias include pseudoachondroplasia, hypochondroplasia, the mucopolysaccharidoses as well as disorders of disorganized bone development (i.e. diaphyseal aclasia, Trevor disease, enchondromatosis) and of abnormal bone density (i.e osteogenesis imperfecta, osteopetrosis, osteopoikilosis, osteopathia striata and melorheostosis).

The radiological diagnosis of bone dysplasias relies heavily on pattern recognition of established skeletal changes, which is often made on plain radiographs or skeletal survey. Whilst the radiographic features of bone dysplasias are generally well described in the axial and appendicular skeleton, its appearances in the lower limb, particularly of the foot and ankle, are usually less conspicuous compared to the rest of the skeleton. Moreover, the radiographic features may also overlap between dysplasia subtypes or mimic metabolic conditions. As such, accurate detection of these features can be challenging. Hence, knowledge and recognition of the radiographic features of bone dysplasias and its mimics presenting in the foot and ankle is crucial in aiding timely diagnosis, especially when interpreted together with other skeletal changes occurring elsewhere. Moreover, as bone dysplasias may be associated with other congenital disorders, radiologists play an essential role in directing further investigations for definitive diagnosis.

Thus, the purpose of this educational exhibit is to review and familiarize radiologists with the radiographic features and pattern recognition of commonly encountered bone dysplasias occurring in the paediatric foot and ankle, so as to guide appropriate management, aimed at preventing disabling deformities.The radiographic features of the above conditions presenting in the paediatric foot and ankle will be discussed and illustrated. Read More

Authors:  Tan Timothy Shao Ern,  Teo Eu Leong Harvey James

Keywords:  Bone Dysplasia ,  Foot ,  Ankle

Mcluckey Morgan,  Forbes-amrhein Monica

Final Pr. ID: Poster #: EDU-063

Osteopetrosis is a rare disorder characterized by osteosclerosis throughout the axial and appendicular skeleton. Abnormally functioning osteoclasts lead to deficient osseous remodeling and overly dense, brittle bones with crowding of the bone marrow space. Multiple different genetic abnormalities underlie this condition, resulting in varying penetrance and heterogeneous disease patterns. Imaging is critical to diagnosis and characterization. The aim of this exhibit is to familiarize the pediatric radiologist with this rare disease through a discussion of the clinical presentation, characteristic imaging findings (with special attention paid to the differences among infantile, adolescent, and adult forms), complications, and available forms of management. We will emphasize the central role of imaging in diagnosis, as well as detection of complications and monitoring changes after treatment. Read More

Authors:  Mcluckey Morgan,  Forbes-amrhein Monica

Keywords:  Osteopetrosis

Rajani Heena,  Graeber Brendon

Final Pr. ID: Poster #: EDU-064

Although juvenile inflammatory arthritis is one of the most common atraumatic joint pathologies in children, many other infectious, vascular, and hemorrhagic lesions, benign and malignant neoplasms, and tumor-like conditions are known to affect the pediatric synovium and periarticular soft tissues. In a child with suspected joint pathology, radiographs are an essential part of the initial imaging assessment, followed by MRI for more definitive characterization of the synovial lesion. Ultrasound is also an important adjunct modality in the imaging of these entities.

In this educational poster, we highlight the diagnostic imaging features of some of the common and uncommon pediatric synovial pathologies with emphasis on the specific MRI characteristics that aid in accurate diagnoses, such as presence of a solid or cystic mass, thick enhancing synovium, rice bodies, cartilaginous and osseous loose bodies, vascular channels, hemosiderin staining, articular erosions and marrow edema. Synovial sarcoma and vascular malformations, while not truly synovial lesions, are also considered because they are sometimes located near the joints and because they can have clinical and imaging overlap with synovial lesions.

The following entities will be illustrated and reviewed:
1. Baker cyst
2. Ganglion cyst
3. Oligo-articular JIA (knee and wrist)
4. Tuberculous arthritis
5. Tenosynovial giant cell tumor
6. Hemophilic arthropathy
7. Synovial chondromatosis
8. Low-flow vascular malformation
9. Synovial sarcoma (knee, ankle and elbow)

We also propose an MRI-based diagnostic algorithm for accurate characterization of pediatric synovial pathologies based on morphology (localized versus diffuse, cystic versus solid); signal characteristics on T2-weighted images, gradient sequences and post-gadolinium images; and associated osseous changes, in addition to certain highly specific radiological features of each entity. Read More

Authors:  Rajani Heena,  Graeber Brendon

Keywords:  Synovial lesions ,  MRI

Bhalla Deeksha,  Jana Manisha,  Manchanda Smita,  Bhalla Ashu,  Naranje Priyanka

Final Pr. ID: Poster #: EDU-069

Teaching points:

The spectrum of neck masses in neonates and infants (< 2 years) differs considerably from those in older children
Understand characteristic imaging appearances, particularly recognise entities that do not require sampling for diagnosis
Learn algorithmic approach to differential diagnosis based on age and lesion morphology with case based examples

Table of contents:
Introduction: Incidence, clinical considerations
Classification:
Age: Neonate
Cystic
Branchial cleft cyst
Dermoid cyst
Thyroglossal duct cyst
Solid:
Germ cell tumor
Congenital hemangioma
Neuroblastoma
Mixed
Primitive myxoid mesenchymal tumor (PMMT)
Teratoma

Age: Older infants
Cystic
Branchial cleft cyst
Dermoid cyst
Thyroglossal duct cyst

Solid:
Lymphoma
Granulocytic sarcoma
Rhabdomyosarcoma
Multinodular vacuolating tumor of infancy (MNTI)
Solitary fibrous tumor (SFT)
Fibrous tumors: Fibrous hamartoma of infancy, infantile fibrosarcoma

Vascular malformation (microcystic lymphatic, venolymphatic, arteriovenous)

Infections
Ludwig angina
Zygomycosis

Practical diagnostic algorithms based on age, location (involved neck space) and morphology
Conclusion Read More

Authors:  Bhalla Deeksha,  Jana Manisha,  Manchanda Smita,  Bhalla Ashu,  Naranje Priyanka

Keywords:  Neck tumor ,  congenital ,  vascular malformation

Jaganathan Sriram,  Krishnan Venkatram,  Jayappa Sateesh,  Murphy Janice,  Phillips Paul,  Ramakrishnaiah Raghu,  Charles Glasier,  Choudhary Arabinda

Final Pr. ID: Poster #: EDU-070

Objective:
The optic nerves are covered by the meningeal sheath and the nerve is surrounded by the fluid which communicates with the CSF space intracranially. Any variations in the CSF pressure can alter the perioptic space fluid and cause pressure effects on the optic nerve head. The optic disc does not possess cells of muller which hold nerve fibers together unlike other retinal cells, and hence swells up easily with increasing CSF pressure resulting in papilledema. Conversely, a decrease in intracranial pressure can cause perioptic space to collapse. Our aim in this exhibit is to present the normal appearance of the perioptic space on MRI, normal optic nerve sheath diameter, our institutional MRI protocol for optic nerve/ perioptic space evaluation, pathologies that cause changes in the perioptic space, and how perioptic space variations can be a clue to look for pathologies.
Learning points:
Our exhibit includes:
Our institutional protocol for evaluation of the perioptic space and the optic nerve
Normal appearance of perioptic space on different MRI sequences including high resolution T2W coronal, T2W axial and BFFE sequences
Interesting case reports with altered perioptic space fluid including
1. Idiopatic intracranial hypertension
2. Shunt malfunction
3. Shunt over drainage
4. An interesting case of pseudotumor progressing to intracranial hypotension
5. Foster Kennedy syndrome
6. Intracranial hypotension
7. Differentiation of papilledema versus drusen
The importance of looking at perioptic space and how it gives clue to the underlying pathology
Associated findings to be evaluated on MRI
Discussion:
Perioptic spaces can give a clue to underlying intracranial pathologies. It is imperative for the radiologists to carefully evaluate the perioptic spaces and to look for additional findings if there is a variation. If there is dilatation of the perioptic space, it is important to look at the additional features including tortuosity of the optic nerves, protrusion of the optic disc, partial empty sella, enlarged meckel’s cave and bilateral transverse sinuses for stenosis. When there is collapse of the peri-optic space, other associated findings should be looked at including pachymeningeal enhancement, venous distention sign, cerebral edema, tonsillar ectopia, and other quantitative features like mamillopontine distance. Also, it is important to evaluate for tumors which can also result either in perioptic space distention or collapse. Read More

Authors:  Jaganathan Sriram,  Krishnan Venkatram,  Jayappa Sateesh,  Murphy Janice,  Phillips Paul,  Ramakrishnaiah Raghu,  Charles Glasier,  Choudhary Arabinda

Keywords:  Perioptic space ,  distention and collapse ,  intracranial CSF pressure changes

Gerrie Samantha,  Rosenbaum Daniel,  Hughes Emily

Final Pr. ID: Poster #: EDU-071

Pediatric calvarial lesions are uncommon and range in significance from incidental developmental variants to life-threatening disorders. Lesions often come to attention as nonspecific palpable abnormalities and initial imaging work-up may vary. A structured approach is therefore critical to differentiate between non-aggressive and aggressive lesions, between lesions germane to bone and those with secondary calvarial involvement, as well as between truly localized lesions and focal manifestations of multifocal or systemic disease. Lesions with a characteristic imaging appearance include atretic cephalocele, occipital encephalocele, parietal foramina, calcified cephalohematoma, dermoid cyst and fibrous dysplasia. Other lesions may require further imaging of other body regions in conjunction with clinical features and laboratory tests including pathology, laboratory markers and genetic testing. These include chronic non-bacterial osteomyelitis, Langerhans cell histiocytosis, sarcoidosis and neoplastic lesions such as Ewing sarcoma, osteosarcoma, lymphoma and metastasis. The aim of this pictorial essay is to illustrate the multi-modality imaging appearance of the most common focal pediatric calvarial lesions to aid in narrowing the differential diagnosis and to direct subspecialty referral where appropriate. Read More

Authors:  Gerrie Samantha,  Rosenbaum Daniel,  Hughes Emily

Keywords:  Calvarial ,  focal ,  mass

Krishnan Venkatram,  Jaganathan Sriram,  Murphy Janice,  Choudhary Arabinda,  Jayappa Sateesh,  Rowell Amy,  Charles Glasier,  Ramakrishnaiah Raghu

Final Pr. ID: Poster #: EDU-073

Caudal regression syndrome (CRS) refers to a rare disorder with varying degrees of agenesis or malformations of the lower thoracic, lumbar, and sacral spine as well as the spinal cord with varying clinico-radiological features. Estimated incidence ranges from 5-10:100,000 births. Imaging is an integral part of the diagnosis and management of this condition. An extensive review of the imaging spectrum of CRS with several case-based examples would enable a complete understanding of the condition.

We reviewed the imaging appearance of several cases of caudal regression, including in utero cases, from our tertiary care university based pediatric hospital. The various associated malformations, especially of the spinal cord, were examined in detail. We also analyzed the clinical symptomatology of these patients and correlated them with the imaging patterns. A detailed review of related literature was performed and consolidated information on the clinico-radiological spectrum of CRS was compiled.

The following aspects of CRS have been discussed in detail:
Predisposing maternal conditions and pathogenesis of CRS in the fetus.
Pang groups 1 and 2 CRS and their imaging features.
Renshaw types 1 to 4 sacral agenesis and their imaging features.
Role of radiographs, ultrasound, and MRI in CRS.
Spectrum of MRI features in the cord including shape of conus, level of termination, presence of cord tethering, associated neural tube defects and associated syrinx.
Clinical manifestations of various types and their correlation with imaging features.
Imaging features correlating with progressive versus static neurological deficits.
Imaging features that could signal potential benefit from surgical treatments.
Prenatal diagnosis of CRS on obstetric ultrasound and fetal MRI: Imaging patterns and importance of antenatal diagnosis.
Associated anomalies and syndromes and necessary additional imaging in CRS cases.
Pitfalls in imaging of CRS.

A complete understanding of CRS including clinico-radiological correlation of symptomatology and imaging appearance in CRS would enable detailed and accurate reporting of these scans. In particular, identifying imaging features that correlate with progressive neurological deficits and those that may benefit from surgical intervention can significantly improve patient management. Read More

Authors:  Krishnan Venkatram,  Jaganathan Sriram,  Murphy Janice,  Choudhary Arabinda,  Jayappa Sateesh,  Rowell Amy,  Charles Glasier,  Ramakrishnaiah Raghu

Keywords:  Spine ,  Spinal Cord ,  Congenital

Chauhan Ankita,  Dillard Roger

Final Pr. ID: Poster #: EDU-076

Children often present to the emergency room (ER) with painful neck swelling, sore throat, and difficulty breathing. Careful clinical examination and good communication with pediatric physicians help plan the appropriate imaging workup for such pediatric patients. Knowing the various imaging appearances of the many encountered disorders of the neck in children further helps diagnose and plan the most appropriate management. Read More

Authors:  Chauhan Ankita,  Dillard Roger

Keywords:  Neck ,  Pediatric ,  Imaging

Sarrami Amir Hossein,  Wang Hongzhi,  Baratto Lucia,  Syeda-mahmood Tanveer,  Daldrup-link Heike

Final Pr. ID: Poster #: EDU-078

Medical Imaging has a crucial role in the diagnosis and management of pediatric cancer patients by providing information about tumor location and quantitative measures of tumor size and metabolic activity at baseline as well as during and after therapy. The standard imaging plan for staging and re-staging of pediatric malignancies includes a high-resolution MRI or CT scan of the local tumor and whole body staging for the detection of metastases on CT, MRI and/or PET scans. Children with lymphomas, sarcomas, germ cell tumors and a few other tumor types are referred to whole body 18F-FDG PET scanning, either coupled with CT or MRI. Artificial intelligence (AI) algorithms can facilitate staging and re-staging of cancers in children by providing 1) rapid detection and delineation of tumoral lesions, 2) automated measurements of tumoral size and metabolic activity, 3) relating tumor measurements to internal standard such as liver and blood pool, 4) assigning a score according to tumor-specific staging systems.

Detecting tumors on a whole-body scan is a challenging task, especially in children whose organs undergo changes in size and composition with increasing age. Moreover, the tumors in children can arise from almost anywhere in the body, from head to toe. With successful applications on object detection, AI methods are promising for automatic tumor detection from whole-body scans as well. In this tutorial, we will introduce a few popular AI methods for such purpose. These methods include U-Net, Vision Transformers (ViT), and the hybrid of the above methods such as O-Net Transformer or TransUNet. Read More

Authors:  Sarrami Amir Hossein,  Wang Hongzhi,  Baratto Lucia,  Syeda-mahmood Tanveer,  Daldrup-link Heike

Keywords:  Hybrid Imaging ,  Artificial Intelligence ,  Cancer

Chilukuri Sanjeev,  Karmazyn Boaz,  Wanner Matthew,  Brown Brandon,  Gray Brian,  Marine Megan

Final Pr. ID: Poster #: EDU-081

Bronchopulmonary sequestration (BPS) is a rare congenital abnormality of the lower airway resulting in a mass of nonfunctional lung tissue. Our purpose is to present the prenatal and postnatal imaging findings of a spectrum of BPS cases and to correlate with pathology findings.

We present a series of BPS evaluated with prenatal imaging (US and MRI) and postnatal imaging (radiographs, US, CT, and MRI). Pathology will be reviewed.

Our series includes isolated BPS, hybrid BPS associated with cystic pulmonary airway malformation (CPAM), BPS associated with diaphragmatic hernia, and challenging cases of intradiaphragmatic, subdiaphragmatic, and mediastinal sequestrations that can mimic other masses. We also include a case of sequestration with an associated communication to the GI tract (bronchopulmonary foregut malformation) and a case of isolated BPS that spontaneously involutes over time. Read More

Authors:  Chilukuri Sanjeev,  Karmazyn Boaz,  Wanner Matthew,  Brown Brandon,  Gray Brian,  Marine Megan

Keywords:  Sequestration ,  Fetal ,  Bronchopulmonary

Shah Jignesh,  Chauhan Ankita,  Sandhu Preet

Final Pr. ID: Poster #: EDU-082

1. To discuss etiologies of unilateral hyperlucent hemithorax in children.
2. To discuss radiographic and cross-sectional imaging features of various conditions leading to unilateral hyperlucent hemithorax. Read More

Authors:  Shah Jignesh,  Chauhan Ankita,  Sandhu Preet

Keywords:  Unilateral hyperlucent hemithorax ,  congenital lobar overinflation ,  congenital pulmonary airway malformation