Woon Tian Kai,  Fuad Alkhatib Rugaiyah,  Fortier Marielle

Final Pr. ID: Poster #: EDU-011

Partial anomalous pulmonary venous return (PAPVR) consists of a wide spectrum of uncommon congenital anomalies in which one or more pulmonary veins drain directly or indirectly into the right atrium as a result of abnormalities during pulmonary venous embryogenesis. Thus, keen understanding of the underlying embryological origins of the pulmonary venous system is essential to recognize the variations in PAPVR, and radiological assessment is imperative to elucidate the complex anomalous cardiovascular anatomy for subsequent clinical and surgical management. The purpose of this educational exhibit is to provide a brief discussion of the embryological development of pulmonary veins and a detailed review of the diverse array of PAPVR variations with the aid of various case studies and CT imaging findings including sinus venosus atrial septal defect, Scimitar syndrome and anomalous left pulmonary veins. Read More

Authors:  Woon Tian Kai,  Fuad Alkhatib Rugaiyah,  Fortier Marielle

Keywords:  PAPVR ,  Partial anomalous pulmonary venous return ,  Embryology

Veselis Clinton,  Venkatakrishna Shyam Sunder,  Silvestro Elizabeth,  Bennett Brittany,  Srinivasan Abhay,  Acord Michael,  Sze Raymond,  Reid Janet,  Anupindi Sudha

Final Pr. ID: Poster #: EDU-021

Teaching fluoroscopy skills remains an ongoing challenge in pediatric radiology education. Radiologists must be competent to perform a wide range of fluoroscopy procedures and are often required to teach these clinical skills to their peers, junior staff, and students. Teaching procedural skills through frameworks, observation, and feedback, with opportunities for repeated practice, assists in the learner’s acquisition and retention of skills. Fluoroscopy presents patient safety and ethical challenges as “practicing” this skill on patients requires ionizing radiation exposure and often invasive procedures. Through this educational exhibit, we describe a proposed program to improve skill performance, determine competency, and provide feedback. To improve voiding cystourethrogram (VCUG) training two patient models were created for bladder catheterization with different grades of vesicoureteral reflux using 3D printing and silicon rubber. Additional educational materials, including videos and graphical representations, were created to better help the learner understand the steps of the VCUG protocol. A three-component curriculum included 1) Knowledge (indications, contraindications, complications); 2) Communication (with patient and family, with fluoroscopy team); and 3) Performance of the skill (preparation before commencing, steps and dexterity, immediate aftercare of the patient). We modeled our evaluation of the learner from Peyton’s four-step approach to skills teaching (Demonstration, Deconstruction, Formulation, and Performance) to teach the physical performance of the fluoroscopy procedure. Feedback was provided to the learners using the Pendleton Feedback Model. Finally, competency was assessed using the Framework for clinical assessment developed by Miller. This educational exhibit aims to provide radiologists in training with an alternative learning curriculum to better understand and evaluate the steps of the VCUG and its performance on patients in a simulated setting before being performed on patients. Read More

Authors:  Veselis Clinton,  Venkatakrishna Shyam Sunder,  Silvestro Elizabeth,  Bennett Brittany,  Srinivasan Abhay,  Acord Michael,  Sze Raymond,  Reid Janet,  Anupindi Sudha

Keywords:  Voiding cystourethrogram ,  VCUG ,  Fluoroscopy

Ramirez Suarez Karen,  Miranda Schaeubinger Monica,  Barton Katherine,  Riedesel Erica,  Otero Hansel

Final Pr. ID: Poster #: EDU-022

The Choosing Wisely initiative, led by the American Board of Internal Medicine (ABIM) Foundation in collaboration with over 80 medical societies and organizations, was launched in 2012 in the United States and Canada. Choosing Wisely is a response to the estimation that roughly 20% of current medical tests and therapies lack justification, provide no value, and may pose risks. The American Academy of Pediatrics (AAP) became a participant in Choosing Wisely from the start, resulting in 16 pediatric specialty-specific lists designed to assist AAP members in responsible healthcare resource management. While pediatric radiology did not develop its own list, imaging recommendations were included on fully half of the published AAP/Choosing Wisely lists. Read More

Authors:  Ramirez Suarez Karen,  Miranda Schaeubinger Monica,  Barton Katherine,  Riedesel Erica,  Otero Hansel

Keywords:  Pediatric ,  Imaging ,  Radiology

Morales-tisnés Tatiana,  Miranda Schaeubinger Monica,  Yaya Carlos,  Milla Sarah,  Heller Richard,  Otero Hansel

Final Pr. ID: Poster #: EDU-025

Access to healthcare, and in particular to pediatric subspecialties, including pediatric radiology, is limited. Increasingly limited access creates or accentuates preexisting disparities and injustices. However, because of the complexity of the issue, it is difficult to objectively study and quantify it. This exhibit will describe current barriers to pediatric radiology access, available research tools and methodologies that can help us measure the impact of such barriers. Then, we propose a research agenda to systematically approach the problem. Read More

Authors:  Morales-tisnés Tatiana,  Miranda Schaeubinger Monica,  Yaya Carlos,  Milla Sarah,  Heller Richard,  Otero Hansel

Keywords:  Pediatric radiology ,  Access to healthcare ,  Research agenda

Dong Su-zhen

Final Pr. ID: Poster #: EDU-026

The cardiac system is the part of the fetal anatomy that most frequently suffers from congenital pathology . The fetal heart is routinely studied using first level obstetric ultrasonography. If a fetus is considered to have a cardiac defect, a detailed echocardiographic examination is required. The role of fetal magnetic resonance imaging (MRI) as a tool additional to ultrasound has grown exponentially. Unlike ultrasound imaging, however, MRI is unaffected by maternal and fetal conditions such as obesity and oligohydramnios, which particularly impair sonographic visualization of the fetal heart. In this educational poster, we will provide an overview of fetal cardiac MR imaging methods and their applications in congenital heart disease. This presentation will cover recent technical advances in fetal CMR, the modified anatomic segmental approach to image fetal congenital heart disease, imaging appearances of fetal normal cardiovascular structure and appearances of various structural congenital heart disease on fetal CMR. Multiple imaging examples of fetal congenital heart disease diagnosed by fetal cardiac MR will be presented. Read More

Authors:  Dong Su-zhen

Keywords:  Fetus ,  Magnetic resonance imaging ,  Congenital heart disease

Juang Eric,  Parikh Rajan,  Goncalves Luis,  Cornejo Patricia

Final Pr. ID: Poster #: EDU-027

Illustrate the spectrum of imaging findings of prenatal and postnatal diencephalic-mesencephalic junction dysplasia (DMJD). Read More

Authors:  Juang Eric,  Parikh Rajan,  Goncalves Luis,  Cornejo Patricia

Keywords:  Fetal ,  hydrocephalus ,  L1CAM mutation

Martin Camden,  Cassella Katharyn,  Johnstone Lindsey,  Leschied Jessica

Final Pr. ID: Poster #: EDU-028

Anorectal malformations (ARMs) are a heterogenous group of congenital anomalies involving the distal rectum and anus that are often associated with other anomalies. Neonates with ARMs may be identified at birth or prenatally and, upon delivery, receive a myriad of imaging tests to characterize the type of ARM and associated anomalies. Recent literature supports the use of transperineal ultrasound in the initial assessment of neonates with ARMs, with the Society of Pediatric Radiology recommending its use in the imaging algorithm for ARMs. Transperineal ultrasound, if adequately performed, allows evaluation of the location of the distal rectal pouch and the anatomy and location of any rectourogenital fistulas. In this educational poster, we review the clinical presentation and classification ARMs and discuss the role of transperineal ultrasound in the initial assessment of cases. We then describe common sonographic findings of ARMs on transperineal ultrasound using examples from our own institution. Our goal is to familiarize pediatric radiologists with this heterogenous group of congenital anomalies and the clinical utility of transperineal ultrasound in characterizing this pathology. Read More

Authors:  Martin Camden,  Cassella Katharyn,  Johnstone Lindsey,  Leschied Jessica

Keywords:  Gastrointestinal ,  Anorectal ,  Ultrasound

Thomas Aby,  Steiner Michael,  Teague Clint

Final Pr. ID: Poster #: EDU-032

Congenital infections or in utero infections results from a wide variety of pathogens. The most common ones are referred by the mnemonic TORCH infections. The manifestations of congenital infections are diverse, ranging from asymptomatic cases to severe, life-threatening conditions. Common presentations include neurological abnormalities, hearing and vision impairments, developmental delays, and growth problems.

This review aims to discuss the radiological manifestations of the TORCH infections with emphasis on the resurgence of syphilis as a significant concern within the realm of congenital infections. And in by doing so, underscore the critical role of radiology in facilitating early detection and enabling timely intervention. Read More

Authors:  Thomas Aby,  Steiner Michael,  Teague Clint

Keywords:  TORCH ,  Syphilis ,  congenital infection

Gardner Colin,  Hayes Kari,  Life Chelsea,  Milla Sarah

Final Pr. ID: Poster #: EDU-035

Eosinophilic esophagitis (EOE) is the most common esophageal disorder in children and adolescents, with a prevalence of approximately 1 in 1,000. Pathologically characterized by eosinophilic infiltration of the esophageal mucosa, EOE can cause a variety of symptoms, including dysphagia, food refusal, vomiting, and pain. Complications include strictures, dysmotility, and failure to thrive. When clinical providers are concerned for potential EOE, often an Esophagram or Upper GI is the initial imaging study requested before performing the gold standard, but more invasive evaluation, endoscopy with biopsy.

This educational poster will review the background and current standard-of-care imaging for EOE, including fluoroscopic esophagrams and endoscopy. We will review diagnostic tips and tricks for performing and interpreting esophagrams, and highlight the importance and techniques for timed pill-esophagrams, particularly in the evaluation for EOE. We will include emerging information on normative esophageal measurements in pediatric age ranges for reference, as well as highlight subtle fluoroscopic features of EOE to help improve our diagnostic sensitivity and specificity. Our poster will review findings in a case-based format with fluoroscopic and endoscopic images, individual patient treatment plans, with post therapy images in select cases.

Radiologists play an important role in the initial diagnosis and are partners in management and follow-up of patients with EOE. Understanding optimal fluoroscopic techniques and identifying key imaging findings are critical to improving early diagnosis and monitoring response to therapy. Read More

Authors:  Gardner Colin,  Hayes Kari,  Life Chelsea,  Milla Sarah

Keywords:  Eosinophilic esophagitis

Jain Nikshita,  E Vairamathi,  John Reetu

Final Pr. ID: Poster #: EDU-039

The differential diagnoses of pediatric abdominal and pelvic tumors arising in solid organs are generally well known, but the pathologic features of tumors originating outside these organs—from the peritoneum, omentum, mesentery and adnexa—is much less familiar. Also, the histopathological sampling of these masses can be challenging - given the propensity of intervening bowel, risk of tumor seeding. Primary tumors of the peritoneum in children are usually mesenchymal in origin. Knowledge of the tumors that arise in these unusual locations is important in directing appropriate clinical management. Localized masses may be caused by inflammatory myofibroblastic tumor, Castleman disease, mesenteric fibromatosis, or other mesenchymal masses. Inflammatory myofibroblastic tumor is a mesenchymal tumor of borderline biologic potential that appears as a solitary circumscribed mass. Mesenteric fibromatosis, or intra-abdominal desmoid tumor, is a benign tumor of mesenchymal origin associated with familial adenomatous polyposis. Diffuse peritoneal disease may be due to desmoplastic small round cell tumor (DSRCT), non-Hodgkin lymphoma, or rhabdomyosarcoma. Burkitt lymphoma manifests with extensive disease because of its short doubling time. Rhabdomyosarcoma may arise as a primary tumor of the omentum or may spread from a primary tumour in the bladder, prostate, or scrotum. Knowledge of this spectrum of disease allows the radiologist to provide an appropriate differential diagnosis and direct appropriate patient management. Read More

Authors:  Jain Nikshita,  E Vairamathi,  John Reetu

Keywords:  Mass ,  Peritoneum ,  Adnexa

Mchendrie Mariska,  Rasheed Shabana

Final Pr. ID: Poster #: EDU-049

The purpose of this article is to review some of the different causes of scrotal pain in the pediatric population. In the acute setting, the most common cause of testicular pain is testicular torsion, however, the causative etiologies are broad. These include infectious, inflammatory, traumatic, referred pain, idiopathic or chronic causes. Sonography is the imaging modality of choice for the evaluation of scrotal pain in children. We will present various causes of scrotal pain in children, apart from testicular torsion and demonstrate comprehensive ultrasound features of each. Accurate differentiation and a definitive diagnosis without delay, is crucial for the proper management and favourable outcome of the patient. Read More

Authors:  Mchendrie Mariska,  Rasheed Shabana

Keywords:  Scrotal Pain ,  Torsion ,  Other causes

Daggumati Lasya,  Malavia Mira,  Randhawa Hari,  Towbin Richard

Final Pr. ID: Poster #: EDU-057

Acroosteolysis (AO) is a rare manifestation of bone resorption that can occur in both genders and is not limited to a specific population. AO can be familial, idiopathic, occupational or secondary. It is marked by distal phalangeal bone resorption and often arises as a secondary manifestation of underlying musculoskeletal, dermatological, or endocrine conditions. Tuft resorption is often associated with conditions like systemic sclerosis, ischemia, hyperparathyroidism, and neurologic disorders, while the destruction of the distal interphalangeal joint is more frequently observed in inflammatory conditions like psoriatic arthritis. Familial AO affects only the feet and is associated with plantar ulcerations. AO due to vinyl chloride exposure is associated with papules and nodules on the hands and forearms and thickening of the skin of the hands. Clinically, AO is marked by a gradual tapering/thinning of the bones in the distal phalanges, resulting in a narrower appearance compared to normal digits. This process is accompanied by reduced bone density in the affected areas, which can be readily observed on radiographic imaging. It is often associated with distal digital ischemia, digital calcinosis, or severe sensory neuropathy. Nail changes in AO include brachyonychia, anonychia, atrophy, transverse ridges, discoloration, thickening of the nail plate, hyperkeratosis of the cuticles, pincer nail, pitted onycholysis, longitudinal ridging, and pterygium. X-ray images typically reveal distinctive bone resorption at the fingertips and toes, while CT scans may show areas of decreased bone density or erosions in the distal phalanges. MRI can detect soft tissue alterations, joint effusion, and inflammation. Beyond the physical changes, patients may experience pain, joint deformities, and reduced functionality in the affected extremities. Treatment mainly involved managing the primary disease causing AO.

Learning Objectives:
1) To elucidate the clinical and radiological features of AO like the resorption seen in the distal phalanges.
2) To provide insight into the diverse underlying causes of AO, including associated medical conditions.
3) Understand cutaneous changes in AO to assist in the early recognition and prevention of disease progression.

Conclusion:
A comprehensive understanding of acroosteolysis, including its clinical presentation, radiological findings, and associated etiological factors, is crucial for accurate diagnosis and appropriate management. Read More

Authors:  Daggumati Lasya,  Malavia Mira,  Randhawa Hari,  Towbin Richard

Keywords:  Phalanges ,  bone resorption

Malavia Mira,  Randhawa Hari,  Dagumati Lasya,  Towbin Richard

Final Pr. ID: Poster #: EDU-060

Primary Hypertrophic Osteoarthropathy (PHO) is a self-limiting, rare condition that emerges in the pediatric or adolescent years with a predilection for males, especially of African descent. It is often accompanied with symptoms of arthralgias, hyperhidrosis, and acne. PHO manifests in various forms, with the complete presentation being the most severe, characterized by facial coarsening, periostosis, and digital clubbing. In contrast, incomplete PHO spares the scalp, and forme fruste PHO exhibits clubbing and facial coarsening with minimal periostitis, duly setting it apart from secondary hypertrophic osteoarthropathy that is commonly associated with cardiac or pulmonary conditions. Genetic mutations in the 15-hydroxyprostaglandin dehydrogenase (HPDG) and solute carrier organic anion transporter family 2A1 (SLCO2A1) genes introduce variability in the inheritance patterns of PHO. HPDG-related PHO is typically autosomal recessive, while SLCO2A1-related PHO can be either autosomal recessive or dominant. These mutations elevate prostaglandin E2 levels, intensifying osteoclast activity, and causing bone resorption, which, in turn, triggers VEGF release and leads to vascular hyperplasia, bone disturbances, and edema. A common radiographic finding is acroosteolysis, and key features to differentiate PHO from other causes of acroosteolysis include terminal tuft resorption and periostitis. Other distinctive radiographic findings in PHO include terminal tuft resorption in fingers and toes and shaggy periostosis in long bone diaphyses. Treatment options include nonsteroidal anti-inflammatory drugs (NSAIDs) and bisphosphonates for pain relief and cosmetic surgery if desired. We will present a few cases from our institution to review classic imaging findings, diagnostic workup, and management.

Teaching Points:
1. Understand the clinical variability in presentations of Primary Hypertrophic Osteoarthropathy (PHO).
2. Recognize the genetic basis of PHO and appreciate the variable inheritance patterns associated with the HPDG and SLCO2A1 genes.
3. Identify the distinct radiological features of PHO, including terminal tuft resorption and shaggy periostosis, enabling accurate diagnosis and differentiation from other conditions.
4. Emphasize the importance of early diagnosis, highlighting how prompt recognition of clinical and radiographic features can enhance patient outcomes and mitigate complications. Read More

Authors:  Malavia Mira,  Randhawa Hari,  Dagumati Lasya,  Towbin Richard

Keywords:  digital clubbing ,  peristosis

Malavia Mira,  Le Viet,  Rivard Douglas,  Reading Brenton

Final Pr. ID: Poster #: EDU-061

Osteoid osteomas (OO) are benign osteoblastic tumors primarily afflicting individuals aged 5 to 30 years, ranking as the third most prevalent among benign bone tumors at around 10%. Patients typically present with persistent nighttime pain that responds positively to NSAIDs, along with potential complications like progressive discomfort, tenderness, swelling, and limited joint mobility with articular involvement. OO usually forms in the cortex of long bones, measuring less than 2 cm, exhibiting a central radiolucent nidus encased by surrounding sclerosis, best visualized using CT scans. The current standard-of-care entails CT-guided radiofrequency ablation (RFA), while surgery becomes an option for complex locations like the spine, extremities, or craniofacial bones. Moreover, advanced thermoprotective techniques have expanded RFA's applicability to previously unsuitable lesions. Cryoablation is a newly indicated for pediatric OO patients and involves controlled tumor freezing, preserving adjacent healthy tissue. It offers reduced pain, shorter recovery, and minimal scarring, enhancing the quality of life for young patients. This exhibit will discuss 3 cases that underscore the diverse management approaches required for osteoid osteomas in young patients. Case 1 featured initial relief with radiofrequency ablation (RFA) but recurrence, ultimately resolved with cryoablation. In Case 2, a CT-guided cryoablation was performed for an S2 osteoid osteoma, with limited follow-up data. Case 3 highlighted the complexity of treating a C1 osteoid osteoma, initially successful with intra-operative cryoablation, but it was followed by new neck muscular pain post-operation. Cryoablation's accuracy and less invasiveness make it a preferred choice in treating OO patients.


Learning Objectives:
Grasp cryoablation principles for pediatric osteoid osteoma.
Recognize indications and contraindications.
Assess benefits and risks in pediatric cases.
Comprehend the pathophysiology of osteoid osteoma and cryoablation's role in treatment for pediatric patients. Read More

Authors:  Malavia Mira,  Le Viet,  Rivard Douglas,  Reading Brenton

Keywords:  cancer ,  pain management ,  ablation

Manral Kalpana,  Durand Rachelle,  Pandya Nirav,  Kornblith Aaron,  Cort Kayla,  Courtier Jesse

Final Pr. ID: Poster #: EDU-064

According to the current statistics, approximately 1 million children aged 6-14 participated in 11-payer football, more popular as youth football, in the 2021-2022 school year (3). A trend to earlier participation in specialized sports activities in pediatric patients has been observed. Contact sports such as basketball, football, and soccer comprise a considerable proportion of all played sports and are associated with the highest number of injuries, both acute and chronic in nature(9).
Lower extremities are the most common site of injury in pediatric football players, followed by upper extremity. Fractures and sprains/strains are the most common injury patterns (1, 9, 10). With the increasing number of young football athletes, there is a greater need to explore football-associated injuries, which can have a considerable physical, emotional, and psychosocial impact on a young individual.
This educational exhibit aims to explore the most common American football-related pediatric extremity injuries and their imaging characteristics using various modalities and briefly discuss the treatment options for the pediatric population. Read More

Authors:  Manral Kalpana,  Durand Rachelle,  Pandya Nirav,  Kornblith Aaron,  Cort Kayla,  Courtier Jesse

Keywords:  American football ,  Pediatric ,  Extremity injuries

Gual Fabiana,  Lima Natalia,  Matsuoka Marcia,  Sameshima Yoshino

Final Pr. ID: Poster #: EDU-065

Vascular anomalies represent a spectrum of disorders ranging from simple "birthmarks" to life-threatening entities. Incorrect nomenclature and misdiagnosis are common in patients with these anomalies. The objectives of this educational presentation are to provide radiologists with a comprehensive understanding of the ISSVA (International Society for the Study of Vascular Anomalies) classification and to enhance their familiarity with the clinical and imaging features of commonly encountered soft tissue vascular anomalies in pediatric patients. Special emphasis is placed on emphasizing the practicality of ultrasound as an effective diagnostic tool. The ISSVA has been updated with the recognition of causal genetic mutations, most recently revised in May 2018. The main organizational principle of this classification divides vascular lesions into: vascular tumors (neoplastic): benign, locally aggressive/borderline, and malignant; vascular malformations (non-neoplastic): simple, combined, major named vessels, and associated with other anomalies; unclassified anomalies (unclear whether tumor or malformation). Read More

Authors:  Gual Fabiana,  Lima Natalia,  Matsuoka Marcia,  Sameshima Yoshino

Keywords:  vascular anomalies ,  hemangioma ,  vascular malformations

Malavia Mira,  Rivard Douglas

Final Pr. ID: Poster #: EDU-068

Ischial tuberosity avulsion fractures, though not uncommon in adolescent athletes, are often overlooked or misdiagnosed. These fractures occur more frequently in males than females. Primary cause of this fracture type is usually a sudden eccentric load on the proximal hamstrings, typically seen during a kicking action in dance, football, or soccer. Due to the limited use of imaging in the evaluation of such injuries, these fractures often are misdiagnosed or underdiagnosed. Recent injuries warrant more conservative management, including rest and relative immobilization. In cases of late diagnosis, delayed healing, or persistent symptomatology, surgical intervention can be undertaken to restore normal anatomy, alleviate symptoms, and facilitate healing. Minimally invasive CT-guided percutaneous needle fenestration has been introduced for symptomatic delayed union ischial tuberosity fractures in adolescents. This percutaneous procedure involves the creation of multiple channels into the bone at the fracture site with an 18 gauge Chiba needle via image guided needle fenestration to enhance blood flow and promote healing of the target area. Following this, a tailored physical therapy program is implemented based on patient symptomatology, individual tissue healing rates, and the current literature related to proximal hamstring injuries. Outcomes to this minimally invasive approach have been promising including cases of complete pain relief, full functional recovery, and a return to sports without limitations.

Outline of Teaching Points:
Ischial tuberosity avulsion fractures are common in adolescent athletes, with a higher incidence in males, caused by sudden eccentric loads on proximal hamstrings during activities like dance, football, or soccer.
Due to limited imaging use, these fractures are often overlooked or misdiagnosed, leading to delayed healing or persistent symptoms.
Recent injuries may benefit from conservative management, involving rest and relative immobilization.
Surgical intervention becomes necessary for late diagnoses, delayed healing, or persistent symptoms to restore normal anatomy and alleviate symptoms.
Minimally invasive CT-guided percutaneous needle fenestration has shown promising outcomes, facilitating healing with complete pain relief and a return to sports without limitations. Read More

Authors:  Malavia Mira,  Rivard Douglas

Keywords:  fracture ,  interventional radiology

Patel Paras,  Amar Jaspreet,  Poletto Erica

Final Pr. ID: Poster #: EDU-070

Marrow signal changes in the pediatric population are often complex and can appear nonspecific to the inexperienced radiologist. Normal physiological marrow changes from birth to adulthood play a confounding role. A good understanding for diffuse marrow replacing processes that demonstrate T1 hypointense signal on MRI is crucial for the radiologist to correctly identify pathology, provide early and pathology-specific treatment, and ultimately play a profound role in patient care. The purpose of this educational exhibit is to review the various pathological etiologies of diffuse T1 hypointense marrow signal changes in the pediatric patient, including sickle cell anemia, gaucher’s disease, leukemia, diffuse marrow metastasis, osteomyelitis, thalassemia, juvenile inflammatory arthritis, and bone marrow edema syndromes. Additionally, potential pitfalls will be discussed including red marrow hyperplasia, treatment related changes, immobilization/stress reaction, and normal residual red marrow. Case examples will be provided along with pearls that will aid the radiologist in narrowing their differential diagnosis when faced with specific clinical scenarios. Read More

Authors:  Patel Paras,  Amar Jaspreet,  Poletto Erica

Keywords:  Bone ,  Marrow ,  Pathological

Cortes Albornoz Maria,  Machado Rivas Fedel,  Fazio Ferraciolli Suely,  Afacan Onur,  Jaimes Camilo

Final Pr. ID: Poster #: EDU-073

In recent years, 7 Tesla MRI has become a valuable tool in the field of neuroimaging. Ultra-high field strength provides a superior signal-to-noise ratio, which is particularly advantageous for structural and vascular imaging, as well as MR Spectroscopy. Despite the many advantages, artifacts abound at 7T and limit its translation. Furthermore, the high SAR of these scanners and regulatory restrictions imposed by the FDA can limit accessibility for pediatric patients. This educational exhibit aims to delve deeper into these issues and:
1. Review the commercially available hardware.
2. Summarize regulatory and safety constraints.
3. Highlight the advantages of 7T for structural, vascular, and MRS.
4. Illustrate artifacts and limitations.
5. Present examples of brain abnormalities at 7T.

References:

1. Opheim G, van der Kolk A, Markenroth Bloch K, Colon AJ, Davis KA, et al. 7T Epilepsy Task Force Consensus Recommendations on the Use of 7T MRI in Clinical Practice. Neurology. 2021 Feb 16;96(7):327-341. doi: 10.1212/WNL.0000000000011413. Epub 2020 Dec 22. PMID: 33361257; PMCID: PMC8055334. Read More

Authors:  Cortes Albornoz Maria,  Machado Rivas Fedel,  Fazio Ferraciolli Suely,  Afacan Onur,  Jaimes Camilo

Keywords:  7 Tesla ,  Brain ,  MRI

Pelizzari Mario,  Joulia Vulekovich Lara,  Musso Marcos,  Montalvetti Pablo

Final Pr. ID: Poster #: EDU-074

This educational work aims to describe and differentiate possible diagnostic scenarios in crystalline lens pathology. It seeks to showcase the signs that enable differential diagnosis through ultrasound imaging.

The crystalline lens is a transparent, biconvex, flexible, and avascular structure located behind the iris and in front of the vitreous body. Sonographically it is anechoic, with a 3.5 mm thickness in newborns and 4.5 mm in adults. Its primary function is accommodation, to adjust the eye's vision for different distances. It is the site of various pathologies at different stages of life, in which the lens may be absent, altered in shape, or echogenicity.
Clinically, it presents with a loss or decrease in visual acuity, with or without lens opacification. The type of presentation varies according to the patient's age and the underlying anomaly.
Ultrasound is a fast, non-invasive method that does not use radiation or contrast material, does not require anesthesia, and provides valuable information.

Conclussion:
In the presence of visual acuity loss, whether or not associated with lens opacification, the radiologist's essential role is to complement the clinical and ophthalmological examination. The findings in different lens anomalies are characteristic. Ultrasound is the method of choice for their diagnosis and monitoring. Read More

Authors:  Pelizzari Mario,  Joulia Vulekovich Lara,  Musso Marcos,  Montalvetti Pablo

Keywords:  Crystalline lens ,  Orbit ,  Ultrasonography

Osorio Duque Fernando,  Subramanian Subramanian

Final Pr. ID: Poster #: EDU-077

Understand the molecular pathophysiology of SOXopathies, and to become familiar witht the Central Nervous System and Temporal Bone imaging findings of the most common SOXopathies. Read More

Authors:  Osorio Duque Fernando,  Subramanian Subramanian

Keywords:  SOXopathies ,  SOX genes

Jordan Gregory,  Hampton Erica,  Stence Nicholas,  Milla Sarah,  Callen Andrew

Final Pr. ID: Poster #: EDU-078

Intracranial hypotension is a condition caused by the loss of cerebrospinal fluid through either a dural defect, ruptured meningeal diverticulum, or CSF-venous fistula. In the past decade, this condition has been increasingly diagnosed in individuals suffering from orthostatic headaches. In adults, CSF leaks are commonly caused by dural defects due to a degenerative disc osteophyte violating the ventral dura. In the pediatric population, spontaneous leaks may occur in individuals with underlying connective tissue disease, or from venous/lymphatic malformations which approximate the spinal subarachnoid space. Most commonly, a CSF leak results in an “orthostatic headache” characterized by head pain which worsens upon sitting or standing and improves when lying flat. In addition to headache, patients can experience vestibulocochlear symptoms, changes in vision, forgetfulness, or personality changes. CSF leak localization usually requires dynamic myelography, performed using either digital subtraction or CT techniques. However, specific tailored MRI protocols can aid in the detection and characterization of leaks. Treatment options include percutaneous injection of autologous blood or fibrin sealant into the epidural space, embolization of draining veins, or primary surgical repair. The goal of this exhibit is to provide an illustrative review of the various pathologies that can cause CSF leak in the pediatric population. A review of anatomy and pathophysiology followed by a case-based presentation including congenital, iatrogenic, traumatic, and idiopathic causes will be presented. Both noninvasive and invasive imaging protocols will be discussed with a focus on minimizing radiation dose in the pediatric population. Read More

Authors:  Jordan Gregory,  Hampton Erica,  Stence Nicholas,  Milla Sarah,  Callen Andrew

Keywords:  CSF Leak ,  Intracranial hypotension ,  CSF-venous fistula

Pelizzari Mario,  Joulia Vulekovich Lara,  Musso Marcos,  Montalvetti Pablo

Final Pr. ID: Poster #: EDU-082

Ultrasound offers high sensitivity in diagnosing vitreous pathologies in pediatric patients and is increasingly being used as the preferred method for diagnosis since it does not use ionizing radiation.
The vitreous body is a transparent, gelatinous substance found inside the eye cavity and occupies the space between the lens and the retina. It is avascular and its echostructure is anechoic. Its main function is to provide structural stability, giving volume to the eyeball and providing support to the retina.
Different pathologies can affect it, both congenital and acquired. In pediatrics the most common ones are vitreous hemorrhage, vitritis, posterior vitreous detachment, synchysis scintillans and asteroid hyalosis. Clinically, they can present asymptomatically or with various symptoms such as myodesopsias, photopsias and decreased visual acuity, among others.
Ultrasound and Doppler are excellent methods for studying the eyeball, as it is a superficial organ with a liquid component. Furthermore, they are accessible, non-invasive methods that do not require anesthesia and it provide relevant information, especially when opacification of the anterior segment hinders direct ophthalmological examination. Read More

Authors:  Pelizzari Mario,  Joulia Vulekovich Lara,  Musso Marcos,  Montalvetti Pablo

Keywords:  Vitreous ,  orbit ,  Ultrasonography

Singh Navjot,  Dola Venkata,  Schroeder Jason

Final Pr. ID: Poster #: EDU-084

Introduction
Inborn errors of metabolism (IEM) encompass a spectrum of disorders resulting from genetic defects affecting metabolic pathways. These defects can involve deficiencies of enzyme, its cofactor or transporter, leading to either insufficient myelin precursor production or the accumulation of toxic substrates in the brain. Most IEMs follow an autosomal recessive inheritance pattern, although a few are X-linked. In the diagnostic toolkit, alongside genetic testing and newborn metabolic screens, magnetic resonance imaging (MRI) plays a pivotal role in differentiating various metabolic disorders. There may be overlap in the imaging features of different diseases, especially in the advanced stages where white matter changes become more similar. In some cases, neuroimaging is performed before newborn screening results become available, and when interpreted accurately, it can facilitate early intervention.

In this educational exhibit, we will highlight key neuroimaging findings of structural abnormalities that provide valuable clues in diagnosing IEMs. These findings may include corpus callosum abnormalities, cortical dysplasia, cerebellar abnormalities, vascular abnormalities, and enhancement patterns, all of which aid in narrowing down the differential diagnosis of IEMs.

Conclusion
The diagnosis of pediatric IEMs is a complex task that often necessitates a multidisciplinary approach, complemented by metabolic panel testing and genetic analysis. The neuroimaging approach proves to be a valuable tool for refining the list of potential diagnoses based on brain structural abnormalities and guiding clinicians towards specific confirmatory tests. Read More

Authors:  Singh Navjot,  Dola Venkata,  Schroeder Jason

Keywords:  IEM ,  MRI

Priya Lakshmi,  Illimoottil Mathew,  Errampalli Eric,  Kosaraju Sriya,  Orscheln Emily

Final Pr. ID: Poster #: EDU-085

Metachromatic leukodystrophy is an autosomal recessive lysosomal storage disorder that primarily affects the white matter tracts of the central nervous system. This occurs due to the build up of sulfatides, which leads to demyelinating disease in the brain. On T2 weighted MR imaging, this disorder often exhibits hyperintense periventricular white matter sparing of the subcortical U-fibers. One may also see hypointense stripes and dots within the affected areas. This is commonly referred to as the tigroid or leopard pattern and is a result of peri-vascular sparing. Other features include low signal on T1 weighted images and typically no enhancement on contrast-enhanced T1 weighted images. Metachromatic leukodystrophy can also lead to sulfatide buildup in organs outside the central nervous system, such as the gallbladder, and lead to gallbladder polyposis. This educational exhibit will provide a comprehensive review of the imaging features of metachromatic leukodystrophy, discuss the clinical categorization, and will highlight some of the most common differential diagnoses. Read More

Authors:  Priya Lakshmi,  Illimoottil Mathew,  Errampalli Eric,  Kosaraju Sriya,  Orscheln Emily

Keywords:  Metachromatic leukodystrophy

Mousa Abeer,  Ray Alyxandra,  Halderman Kelly,  Pfeifer Cory

Final Pr. ID: Poster #: EDU-088

Differentiation of sutural variants from fractures can be a challenging topic for radiology trainees. Genetic disorders and vascular channels can create the appearance of traumatic injury and potentially suggest the diagnosis of abusive head trauma to the untrained radiologist. Likewise, expert witnesses may use alternate diagnoses to explain findings in which the current evidence basis favors a traumatic mechanism. This exhibit describes the pediatric skull with attention to the differentiation between fractures and mimics as an aid to the trainee. Read More

Authors:  Mousa Abeer,  Ray Alyxandra,  Halderman Kelly,  Pfeifer Cory

Keywords:  Child Abuse ,  Cranial Sutures ,  Wormian Bones

Mejia Leon Andres,  Pérez Hidalgo Juan,  Roa Benavides Jose,  Acosta Izquierdo Laura

Final Pr. ID: Poster #: EDU-089

Caudal Regression Syndrome (CRS) is a rare and severe form of abnormal sacral development, with an estimated frequency in the general population ranging from 0.005% to 0.01%. It exhibits a slightly higher incidence among children born to diabetic mothers. The majority of CRS cases are sporadic, and the clinical presentation varies depending on the extent of the abnormalities. CRS has been associated with other anomalies, including Currarino syndrome, VACTERL (vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, limb abnormalities) association, caudal duplication syndrome, and more.

As radiologists, understanding the key features of Caudal Regression Syndrome and its associated syndromes is essential. This knowledge can aid clinicians in defining the extent of the disease and facilitating early and targeted treatment.

The primary goal of this educational exhibit is to provide a comprehensive review of CRS and its associated syndromes. Using clinical cases and various imaging modalities, we aim to enhance your understanding of these conditions. Read More

Authors:  Mejia Leon Andres,  Pérez Hidalgo Juan,  Roa Benavides Jose,  Acosta Izquierdo Laura

Keywords:  Caudal regression syndrome ,  Currarino syndrome ,  Caudal duplication syndrome

Aviado Randy,  Clark Keaira,  Mahdi Eman,  Nada Ayman,  Mishra Chakradhar,  Jones Kathryn,  Urbine Jacqueline,  Vorona Gregory

Final Pr. ID: Poster #: EDU-090

Brain hypoxic-ischemic injury (HII) is a devastating injury that results in death or profound long-term neurologic disability in both children and adults. Treatment is mostly supportive, including hypothermia and administration of excitatory amino acid antagonists, with a limited window of effectiveness (as little as 6 hours), making early detection of injury critically important. Neuroimaging with Ultrasound, CT, and MRI has become increasingly valuable in the work-up of patients with HII.

In this educational exhibit we will: a) review the pathophysiologic features and factors that influence the pattern of injury, b) discuss the specific imaging patterns in preterm and term neonates, c) review the imaging approach and highlight the role of advanced MRI techniques such as MR spectroscopy, DWI/ADC, and ASL perfusion in the evaluation process. Finally, we will briefly elaborate on the therapeutic hypothermia in HII, and the influence on imaging findings. Read More

Authors:  Aviado Randy,  Clark Keaira,  Mahdi Eman,  Nada Ayman,  Mishra Chakradhar,  Jones Kathryn,  Urbine Jacqueline,  Vorona Gregory

Keywords:  Hypoxic ,  Brain ,  Neonate

Marie Eman,  Navallas María,  Gerrie Samantha,  Olkh Juhi,  Elghamudi Taha,  Inarejos Clemente Emilio J,  Navarro Oscar,  Martinez-rios Claudia,  Vali Reza

Final Pr. ID: Poster #: EDU-094

Thyroid cancer is the most prevalent endocrine malignancy in the pediatric population. Accurate diagnosis and staging of thyroid carcinoma demand a multimodality approach, including anatomic imaging with US, CT, and MRI, alongside functional or metabolic nuclear imaging. Novel imaging techniques such as US elastography, contrast-enhanced US (CEUS), superb microvascular imaging (SMI) and dual-source dual-energy thyroid CT have offered non-invasive tools to assess disease status. Furthermore, the emerging field of radiomics/radiogenomics and artificial intelligence is continuously growing, creating models to classify or predict disease behaviour. We provide a comprehensive overview of the essential imaging characteristics of pediatric thyroid carcinoma using conventional and novel imaging techniques. In addition, we illustrate the multimodality, multidisciplinary, and collaborative approach across pediatric radiology and nuclear medicine in pre-operative, post-operative and post-treatment imaging surveillance of cancer thyroid in children. Read More

Authors:  Marie Eman,  Navallas María,  Gerrie Samantha,  Olkh Juhi,  Elghamudi Taha,  Inarejos Clemente Emilio J,  Navarro Oscar,  Martinez-rios Claudia,  Vali Reza

Keywords:  Thyroid ,  CEUS ,  Nodules

Mcluckey Morgan,  Karmazyn Boaz,  Marine Megan

Final Pr. ID: Poster #: EDU-095

The aim of this exhibit is to familiarize the radiologist with low dose chest CT technique, articulate advantages of CT in detection of fractures that are occult or indeterminate on skeletal surveys, as well as discuss the limitations of chest CT.

Radiologists play a central role in the detection of non-accidental trauma. After bruising and soft tissue trauma, fractures are the most common inflicted injuries seen in children. Rib fractures are one of the most common fractures identified on skeletal surveys and are one of the most specific injuries in child abuse. Chest CT has been shown to increase detection of rib fractures in child abuse and postmortem studies. In addition, new techniques such as the use of tin filter allow performance of very low dose chest CT. This has led some to advocate for increased utilization of chest CT, as head CT and abdominal CT have already well-established indications for evaluation of child abuse.

Chest CT can be considered in children with negative skeletal survey and high clinical suspicion for child abuse, when the diagnosis of rib fractures is indeterminate, and when the finding of additional or more specific fractures may aid in management, such as in children with both anterolateral fractures and recent cardiopulmonary resuscitation.

Chest CT has some limitations. Uncommonly CT can miss acute nondisplaced fractures demonstrated on radiographs due to lower spatial resolution. In addition, developmental variations in the costochondral junction (CCJ) can mimic healed fractures in CT.

We will provide the protocol we use for low dose chest CT technique and discuss the value of axial oblique and 3-D reconstructions in detection of rib fractures. We will show examples of fractures seen on chest CT which are occult or indeterminate on radiography, such as buckle fractures or fractures in challenging locations such as the CCJ. We will further discuss the strengths of CT in the evaluation of other thoracic injuries of abuse including fractures of the sternum, scapula, and vertebral bodies. Cases of fractures found on post-mortem imaging will be included. Finally, we will also show cases demonstrating the utility of CT in identifying false positives and normal variants that may mimic fractures on radiographs. Read More

Authors:  Mcluckey Morgan,  Karmazyn Boaz,  Marine Megan

Keywords:  Nonaccidental Trauma ,  Thoracic