Lall Neil,  Spaeth-cook Douglas,  Ho Mai Lan,  Zucker Evan

Final Pr. ID: Poster #: EDU-002

Artificial Intelligence (AI) holds great promise in pediatric radiology, but its adoption has been slower compared to adult imaging. Although a 2022 special issue of Pediatric Radiology highlighted potential AI applications, the number of FDA-cleared AI algorithms for pediatric radiology remains limited. As of October 2024, out of 333 FDA-cleared AI Software-as-a-Medical-Device (SaMD) tools, only 26 (8%) are applicable to pediatric imaging, despite children comprising 22% of the U.S. population. More strikingly, only three (<1%) of these SaMD tools are specifically designed for pediatric use, focusing on dental cavity detection, bone age assessment, and hip dysplasia. This educational exhibit showcases the different types of FDA-cleared SaMD AI algorithms designated for use in pediatric radiology and identifies the clinical needs being served as well as those that have yet to be addressed. Additionally, the exhibit will explore the discordance in the development of AI imaging tools for the pediatric population compared to adults, highlighting risks created by this gap and addressing the reasons for such a disparity. Read More

Authors:  Lall Neil,  Spaeth-cook Douglas,  Ho Mai Lan,  Zucker Evan

Keywords:  Artificial Intelligence ,  Pediatric Radiology ,  Informatics

Naqvi Iman,  Polk Elizabeth,  Velazquez Guzman Angel,  Silvestro Elizabeth

Final Pr. ID: Poster #: EDU-010

Medical 3D printing is an ever-changing method of medical advancements, including a growing space for developing custom training tools (phantoms). Phantoms have enhanced pediatric medicine, offering improved training, planning, and educational tools tailored to specific patients. This abstract evaluated and explored the application of radio-programmable 3D printing material, RadioMatrix, under both X-ray and CT scans. Read More

Authors:  Naqvi Iman,  Polk Elizabeth,  Velazquez Guzman Angel,  Silvestro Elizabeth

Keywords:  3D Printing ,  Phantom ,  Education

Markowitz Richard

Final Pr. ID: Poster #: EDU-011

This poster reviews the early origins of the SPR, how it came to be, and who were the leaders who were responsible for its creation. These leaders and “giants” went on to train others who carried on their work and expanded it. Today, most pediatric radiologists can trace their professional genealogy back to one of the original founders of the SPR. As the SPR has grown and developed, it has become more inclusive and diverse. Twelve outstanding women have been presidents of the SPR since 1977. From the original goal of sharing a few cases among friends, it has grown into a mature, scientifically based platform for the creation and dissemination of new and cutting-edge developments in the field of pediatric imaging. We owe a debt of gratitude to those who preceded us; we remain inspired by them; and we carry forward their commitment, wisdom, and dedication to advancing the best practices to enhance children’s health. Read More

Authors:  Markowitz Richard

Keywords:  Education ,  Imaging ,  Pediatric Radiology

Grimm Elizabeth,  Law Emily,  Luo Yu

Final Pr. ID: Poster #: EDU-015

Arthritis in pediatric patients presents a range of diagnostic challenges, including conditions such as septic arthritis, inflammatory arthritis, idiopathic chondrolysis, toxic synovitis, Lyme arthritis, and hemophilic arthritis. These conditions often share overlapping clinical and imaging features, complicating accurate diagnosis. However, key differences in clinical presentation and imaging findings can aid in differentiation. For instance, both septic arthritis and inflammatory arthritis may present with joint pain, swelling, and limited range of motion, with ultrasound commonly revealing joint effusion. Septic arthritis is typically characterized by an acute onset, high fever, elevated white blood cell (WBC) count, and significantly increased inflammatory markers. MRI findings often include complex joint effusions, synovial thickening, and periarticular bone marrow edema, with advanced cases showing periarticular myositis or pyomyositis and osteomyelitis involvement. In contrast, inflammatory arthritis usually presents with gradual onset, low-grade fever, and minimal WBC elevation, with MRI findings of symmetric or asymmetric synovial thickening, synovial enhancement, pannus formation, and mild to none surrounding muscular or bony involvement.
This educational exhibit aims to review the epidemiology of pediatric arthritis, including septic arthritis, inflammatory arthritis, idiopathic chondrolysis, toxic synovitis, Lyme arthritis, and hemophilic arthritis. It will discuss appropriate imaging protocols and highlight key clinical and imaging features that distinguish each arthritis, enhancing diagnostic accuracy and optimizing patient management. Read More

Authors:  Grimm Elizabeth,  Law Emily,  Luo Yu

Keywords:  Septic Arthritis ,  MR ,  Infection

Mannuru Sravani,  Hui Jessica,  Lai Lillian

Final Pr. ID: Poster #: EDU-018

Extralobar pulmonary sequestration (EPS) and cystic neuroblastoma (CN) are rare pediatric thoracoabdominal masses with distinct yet sometimes overlapping imaging features, posing diagnostic challenges for radiologists. Accurate differentiation is crucial for guiding clinical management and preventing unnecessary interventions. This review focuses on comparing the imaging characteristics of EPS and CN, with emphasis on key features that aid in distinguishing between these entities. EPS typically presents as a well-defined, homogenous mass located near the lower lobes of the lung, often with systemic arterial supply visualized on contrast-enhanced imaging. It may exhibit smooth margins and is commonly identified in neonates and infants. Conversely, cystic neuroblastoma, while rarer, typically manifests as a retroperitoneal mass, often arising from the adrenal gland, with a more complex appearance, including cystic and solid components. Calcifications, which are frequently seen in neuroblastoma, may provide a critical clue for diagnosis, while the absence of systemic arterial supply differentiates it from EPS. Pitfalls arise from the potential overlap in appearance, such as fluid-filled or cystic components within both lesions, which may lead to confusion. Additionally, both lesions may be incidentally discovered on prenatal or early postnatal imaging, necessitating careful evaluation of ancillary features such as vascular supply, location, and internal characteristics to ensure accurate diagnosis. This review offers radiology residents, fellows, and attending radiologists a comprehensive comparison of EPS and CN imaging findings, with a focus on avoiding common diagnostic traps. Understanding these key differences enhances diagnostic confidence, promotes appropriate management, and improves outcomes for pediatric patients. Read More

Authors:  Mannuru Sravani,  Hui Jessica,  Lai Lillian

Keywords:  Pediatric Radiology ,  Abdominal Imaging ,  Chest

Mutambuze Jean,  Marine Megan

Final Pr. ID: Poster #: EDU-024

Fetal neck masses are a complex and diverse group of anomalies that can present diagnostic and management challenges for clinicians. In addition to prenatal ultrasound, fetal magnetic resonance imaging (MRI) has emerged as a powerful tool for the evaluation of these masses due to its high soft tissue contrast and ability to provide detailed anatomical information, especially with respect to the fetal airway and mediastinum. This educational exhibit explores the use of fetal MRI in the assessment of 7 different head and neck masses encountered at our institution, including providing a diagnostic approach, describing imaging features, and demonstrating the utility of fetal MRI in predicting the level of airway management the fetus may need, providing important implications for prenatal counseling and delivery management. Read More

Authors:  Mutambuze Jean,  Marine Megan

Keywords:  Fetal Imaging ,  Fetal Masses ,  Fetal MRI

Rana Abhilasha,  Mansfield Kori,  Radder Shrinivas,  Razzaq Sania,  Jayappa Sateesh,  Charles Glasier,  Ramakrishnaiah Raghu,  Murphy Janice

Final Pr. ID: Poster #: EDU-028

Dandy-Walker continuum is a group of posterior-fossa malformations which presents as posterior-fossa cyst with variable degree of vermian hypoplasia on antenatal ultrasound. However, evaluation of posterior fossa is limited on antenatal ultrasound. Fetal MRI provides excellent evaluation of posterior fossa including cerebellar vermis and biometric measurements for accurate characterization of Dandy-Walker Continuum which includes classic Dandy-Walker malformation, Vermian hypoplasia, Blake pouch cyst and Mega cisterna magna (in the order of severity).
In this pictorial review we will provide a step-wise approach for accurate characterization of Dandy-Walker continuum on fetal MRI through various case-based illustrations, biometric measurements (tegmentovermian angle, vermian and lateral ventricle size) and position of 4th ventricle choroid plexus. Associated findings like ventriculomegaly, corpus callosal agenesis, cortical migrational anomalies will also be demonstrated. This will aid pediatric radiologists in providing accurate antenatal diagnosis of Dandy-Walker continuum which is helpful for post-natal management as severe cases require immediate shunting and milder cases require only follow-up. Read More

Authors:  Rana Abhilasha,  Mansfield Kori,  Radder Shrinivas,  Razzaq Sania,  Jayappa Sateesh,  Charles Glasier,  Ramakrishnaiah Raghu,  Murphy Janice

Keywords:  Fetal Magnetic Resonance Imaging ,  Dandy-Walker Continuum ,  Neuroradiology

Hwang Jae-yeon,  Choi Young Hun,  Cheon Jung-eun,  Lee Seunghyun,  Cho Yeon Jin,  Choi Jae Won

Final Pr. ID: Poster #: EDU-031

Contrast-enhanced ultrasound (CEUS) is increasingly recognized as an essential imaging tool in pediatric radiology, offering a safe and non-invasive alternative to conventional imaging modalities such as CT and MRI. By eliminating the risks associated with ionizing radiation, CEUS is particularly advantageous for pediatric patients, providing real-time, high-resolution imaging that is both dynamic and versatile. The purpose of this educational exhibit is to present a comprehensive pictorial review of the diverse clinical indications and diagnostic benefits of CEUS in pediatric practice. This exhibit will:
1. Provide a concise overview of the current clinical indications for CEUS, focusing on its expanding role in pediatric imaging.
2. Present case-based examples illustrating the use of CEUS in evaluating liver lesions, bowel pathology, genitourinary conditions, thoracic applications, head and neck lesions, and ultrasound-guided interventions.
3. Discuss the advantages of CEUS, such as its real-time imaging capabilities, high spatial resolution, and ability to perform bedside examinations, especially in critically ill pediatric patients. Read More

Authors:  Hwang Jae-yeon,  Choi Young Hun,  Cheon Jung-eun,  Lee Seunghyun,  Cho Yeon Jin,  Choi Jae Won

Keywords:  Contrast Enhanced Ultrasound ,  Ultrasonography ,  Contrast

Podury Ruchika,  Dagar Saloni,  Weiss Danielle,  Amodio John,  Blumfield Einat,  Levin Terry

Final Pr. ID: Poster #: EDU-035

Intraluminal post bulbar duodenal masses in children may be solid or cystic, congenital, neoplastic or post traumatic. The aim of this educational exhibit is to present the imaging findings of these duodenal masses using fluoroscopy, ultrasonography, computed tomography and magnetic resonance imaging and discuss the role of imaging. In addition, the clinical implications of these entities will be discussed. The cases will include: duodenal duplication cyst, duodenal web, choledochocele, duodenal hematoma, and duodenal adenoma. Read More

Authors:  Podury Ruchika,  Dagar Saloni,  Weiss Danielle,  Amodio John,  Blumfield Einat,  Levin Terry

Keywords:  Duodenum ,  Abdominal Imaging ,  Pediatric Imaging

Silvestro Elizabeth,  Morgan Trudy,  Bennett Brittany,  Brennan Elizabeth,  Back Susan

Final Pr. ID: Poster #: EDU-036

The rapid growth of contrast-enhanced ultrasound research and applications presents the need for cooresponding educational tools and training methods. Hands-on education is an ideal mechanism for learning image techniques, sparking active engagement and curiosity to learn more. Custom pediatric phantoms for ceVUS allow for specific education goals in an engaging and translatable fashion and allow the learner to practice the technique prior to engaging in patient care. Read More

Authors:  Silvestro Elizabeth,  Morgan Trudy,  Bennett Brittany,  Brennan Elizabeth,  Back Susan

Keywords:  Contrast Enhanced Ultrasound ,  3D Printing ,  Simulation

Dykie Adam,  Katzman Philip,  Chaturvedi Apeksha

Final Pr. ID: Poster #: EDU-037

Wilms tumors, also known as nephroblastomas, are overwhelmingly the most common renal tumors in children. While radiologists are abundantly familiar with the imaging appearances of these tumors, their knowledge of underlying histologic features, prognostic variables, and treatment approaches may not be equally robust. Histologically typically triphasic and containing differing proportions of blastemal, epithelial, and stromal components, the prognosis of individual subtypes differs. The “teratoid” variant of Wilms tumor contains components of differentiated tissues such as muscle, bone, cartilage, and fat. Focal and diffuse anaplasia are important histological features with diffuse anaplasia recognized as the most important prognostically unfavorable feature. In addition, there is an intermediate category of “nuclear unrest” which carries some but not all features of anaplasia. Clinical approaches differ between the two major renal tumor clinical research groups: the International Society of Paediatric Oncology (SIOP) Renal Tumor Study Group and the Children's Oncology Group (COG) Renal Tumor Group. This exhibit uses a case-based template of radiologic-pathologic correlation of different Wilms subtypes encountered at our institution, outlining treatment for individual tumor subtypes. We discuss differential diagnoses which may overlap with Wilms tumor on imaging, including nephrogenic rests, mesoblastic nephroma, malignant rhabdoid tumor of the kidney, clear cell sarcoma, and pediatric cystic nephroma (as a mimic of cystic Wilms tumor). We review Wilms tumor classification with known syndromic associations. We provide information on staging through the National Wilms Tumor Study system covering imaging and post-surgical findings. The ultimate goal is to make radiologists more effective members of the interdisciplinary tumor boards through enhancing a holistic understanding of Wilms tumor. Read More

Authors:  Dykie Adam,  Katzman Philip,  Chaturvedi Apeksha

Keywords:  Wilm's Tumor ,  Kidneys ,  Abdominal Imaging

Cheng Jocelyn,  Leesmidt Kantheera,  Liu Amanda,  Young Victoria,  Davda Sunit,  Berger-chen Sloane,  Courtier Jesse

Final Pr. ID: Poster #: EDU-039

Three-dimensional (3D) imaging has emerged as a valuable tool in diagnosing pediatric Müllerian duct anomalies (MDAs), offering superior anatomical visualization and assessment compared to traditional imaging techniques with two-dimensional ultrasound. MDAs are frequently associated with other congenital anomalies of the cervix, vagina, or urinary tract, and are a common cause of infertility and pregnancy loss after adolescence.

In pediatric patients, MDAs are often discovered incidentally during imaging for other conditions. Magnetic resonance imaging (MRI) is the preferred modality for evaluating MDAs in children, providing multiplanar capabilities and detailed soft tissue characterization while avoiding ionizing radiation. MRI protocols for MDAs typically include T2-weighted sequences for visualizing uterine morphology and T1-weighted sequences to detect blood products in cases of associated endometriosis or hematometra .

The use of 3D MRI techniques allows for enhanced depiction of uterine and vaginal anatomy, and is particularly advantageous in differentiating complex anomalies such as septate and bicornuate uteri. Additionally, 3D reconstructions can provide a virtual hysterosalpingogram (MR-HSG), offering a comprehensive assessment of the reproductive tract without the need for invasive procedures. 3D imaging's accuracy extends to the detection of associated renal anomalies, given the concurrent development of the urinary and reproductive systems. Identifying these anomalies early is crucial for planning surgical interventions that may involve both gynecologic and urologic components .

Overall, 3D imaging significantly enhances the diagnostic accuracy and management of pediatric Müllerian duct anomalies. By providing detailed anatomical insights and allowing for non-invasive classification, it plays a critical role in guiding treatment strategies, reducing the need for repeat surgeries, and improving long-term reproductive outcomes for affected patients.

The purpose of this educational exhibit is to:
1. Review the embryology, classification, and imaging features of Müllerian duct anomalies using 3-dimensional imaging
2. Review the indications and techniques for surgical management of Müllerian duct anomalies in pediatric patients
3. Provide sample cases and clinical courses of patients with specific Müllerian duct anomalies with tips for implementation of 3-D imaging
4. Allow learners to test their knowledge with a quiz. Read More

Authors:  Cheng Jocelyn,  Leesmidt Kantheera,  Liu Amanda,  Young Victoria,  Davda Sunit,  Berger-chen Sloane,  Courtier Jesse

Keywords:  MRI ,  Mullerian Duct Anomalies ,  3D Imaging

Mccauley Robert,  Sinha Vikash,  Pierre Kevin,  Morgan Amber,  Yekeler Ensar,  Rodero Cardoso Mariana,  Sharma Priya

Final Pr. ID: Poster #: EDU-046

Fluoroscopic voiding cystourethrograms (VCUG) play a crucial role in pediatric radiology, enabling real-time visualization of the lower genitourinary tract. This educational exhibit summarizes the clinical indications, technique, clinically significant findings, and potential complications associated with VCUG, aiming to provide a strong foundational review for radiologists-in-training.

The lower genitourinary tract, comprising the ureters, bladder and urethra, is implicated in various pediatric pathologies that can lead to long-term morbidity if left undiagnosed or untreated. VCUG is a dynamic study, allowing for visualization of the lower genitourinary tract bladder and urethra during filling and voiding, making it an invaluable tool in pediatric radiology for detection of both functional and structural pathologies.

In this presentation we will review the most common indications for VCUG in the pediatric population as well as use a case-based approach to the discuss the following pathologies associated with the lower genitourinary tract and related conditions of surgical interest.

●Vesicoureteral reflux and its grading
●Congenital Abnormalities
-Posterior Urethral Valves
-Diverticula
-Anorectal malformations
-Prune belly syndrome
-Duplicated renal collecting system
-Congenital Megaureter
●Trauma
-Urethral disruption
-Urethral stricture
-Bladder injury/disruption
●Post-operative evaluation
-Ureteral reimplantation

We will also discuss tips and tricks for the performance of the pediatric VCUG. Additionally, in the face of complications, prompt recognition and intervention remain crucial. We will review commonly encountered challenges faced by the performing radiologist.

Fluoroscopic VCUG remains an invaluable diagnostic tool in pediatric radiology. For radiologists-in-training, mastering the technique, understanding clinical indications, and being able to interpret findings accurately are essential. With patient-centered care and adherence to best practices, VCUG can provide vital insights into pediatric lower urinary tract pathologies. Read More

Authors:  Mccauley Robert,  Sinha Vikash,  Pierre Kevin,  Morgan Amber,  Yekeler Ensar,  Rodero Cardoso Mariana,  Sharma Priya

Keywords:  VCUG ,  Vesicoureteral Reflux ,  Fluoroscopy

Juang Eric,  Collard Michael,  Katz Danielle,  Adams Megan,  Wachs Michael,  Annam Aparna,  Zavaletta Vaz

Final Pr. ID: Poster #: EDU-048

Through a series of cases, this poster demonstrates how to diagnose and treat biliary anastomotic complications with image-guided techniques in infants after liver transplant.

We present several cases to illustrate the variability of biliary anastomoses including location, type, and number of anastomoses. Pediatric interventional radiologists and image-guided procedures are critical in the successful management of post-transplant biliary anastomotic strictures and leaks and minimize the need for invasive reoperation.

The selected cases illustrate complex image-guided percutaneous management of multiple duct anastomotic strictures, anastomotic dehiscence, cut surface leaks, and removal of surgically placed stents that may be malpositioned and/or causing obstruction. The interventional methods used to percutaneously manage these cases include complex biliary access utilizing snares, multiple drain placement, stent placement, and rendezvous procedures with endoscopic retrograde cholangiopancreatography.

The use of image-guided techniques by the pediatric interventional radiologist are invaluable in the management of biliary complications post-liver transplant in infants. Read More

Authors:  Juang Eric,  Collard Michael,  Katz Danielle,  Adams Megan,  Wachs Michael,  Annam Aparna,  Zavaletta Vaz

Keywords:  Transplant Interventions ,  Biliary ,  Image-Guided

Arshad Wajiha,  Igwe Chukwuemeka

Final Pr. ID: Poster #: EDU-050

Introduction:
Children with esophageal atresia, tracheoesophageal fistulas, and Hirschsprung disease often undergo early invasive surgeries to correct these anatomical malformations, ensuring adequate nutritional intake. However, over time, post-surgical anastomotic strictures can develop, leading to mechanical obstructions that impair swallowing or defecation. Traditional treatment for such strictures often involves re-do surgery, but this carries significant risks and recovery time. Our study explores the efficacy of a combined radiological and surgical approach to manage these strictures, aiming to reduce the need for further invasive surgeries.
Methods:
Between September 2022 and May 2023, we performed six procedures involving pediatric patients with symptomatic post-anastomotic strictures (five esophageal, one colorectal). Each patient presented with symptoms suggestive of mechanical obstruction, such as dysphagia or difficulty passing stool. Under general anesthesia, both a surgical consultant and an interventional radiologist performed the procedures. Initial endoscopy was followed by fluoroscopic guidance via a 0.018 wire introduced through the endoscope. Balloon dilatation, using a range of balloon sizes (10mm–27mm), was performed, and the outcomes were assessed via pre- and post-dilatation fluoroscopic imaging with water-soluble contrast. Repeat endoscopy was used to confirm the efficacy of the dilatation.
Results:
Of the six cases, five were successfully treated with balloon dilatation, with no immediate need for further invasive surgery. One case, although initially successful, required subsequent surgical intervention due to recurrent stricture. Post-procedural imaging and endoscopy confirmed patency in the remaining cases, with significant symptom improvement.
Discussion:
This study highlights the efficacy of a combined radiological and surgical approach in managing post-anastomotic strictures. The use of intraoperative endoscopic and fluoroscopic correlation allowed for precise dilatation, reducing the likelihood of recurrence and avoiding immediate re-do surgeries.
Conclusions:
A combined surgical and radiological approach to post-anastomotic strictures offers a less invasive, resource-efficient, and effective alternative to re-do surgery. The success rate of 83% demonstrates that balloon dilatation under fluoroscopic and endoscopic guidance is a valuable adjunct to conventional surgical management of these conditions. Read More

Authors:  Arshad Wajiha,  Igwe Chukwuemeka

Keywords:  Interventional Fluoroscopic

Fanney Dalton,  Yaya Carlos,  Nguyen Ngan,  Yang David,  Gendler Liya,  Zoga Adam,  Nguyen Jie

Final Pr. ID: Poster #: EDU-056

The elbow is a complex joint and a basic understanding of normal developmental variants and maturation-dependent sites of weakness can help improve diagnostic confidence and accuracy. This educational review covers physiologic changes that occur with normal elbow development, imaging considerations, and common elbow pathologies, subdivided into those involving the medial, lateral, and posterior compartments. In the medial elbow, medial epicondylar apophysitis and avulsion factures are more common among the skeletally immature individuals whereas ulnar collateral ligament injury and medial epicondylitis are more common among skeletally mature individuals. In the lateral elbow, radial head subluxation, capitellar osteochondritis dissecans, and Panner’s disease are more common among skeletally immature individuals whereas lateral epicondylitis is more common among skeletally mature individuals. In the posterior elbow, olecranon physeal stress injury is more common among skeletally immature individuals whereas triceps tendon injury is more common among skeletally mature individuals. For completion, this educational review will briefly highlight pathologies in and around the elbow joint, including septic arthritis, juvenile idiopathic arthritis, rheumatoid arthritis, and osteoid osteoma. Read More

Authors:  Fanney Dalton,  Yaya Carlos,  Nguyen Ngan,  Yang David,  Gendler Liya,  Zoga Adam,  Nguyen Jie

Keywords:  Elbow

Kosaraju Sriya,  Errampalli Eric,  Illimoottil Mathew,  Illimoottil Sarah,  Tran Noelle,  Leland Kristin,  Mardis Neil

Final Pr. ID: Poster #: EDU-061

The diagnosis of non accidental trauma (NAT) has significant clinical, therapeutic and social implications for the patient and the family. The recognition of suspicious fractures and fracture patterns, in conjunction with the clinical findings, plays an important role in the accurate diagnosis. However, there are congenital, metabolic and infectious processes that can mimic skeletal findings of NAT. Radiologists must be cognizant of these mimics and recognize the imaging and clinical findings that differentiate them from NAT to ensure accurate diagnosis and appropriate intervention.

This educational exhibit aims to elucidate the key radiographic features and clinical presentations that distinguish NAT from conditions that can mimic its appearance, such as osteogenesis imperfecta, rickets, and metabolic bone diseases.

Through a series of case studies and imaging examples, we will explore the skeletal findings of NAT mimics and compare them with the common fracture patterns associated with NAT, highlighting the imaging and clinical findings that differentiate the two. We will emphasize the importance of a thorough patient history and multidisciplinary approach in evaluating suspected cases of abuse.

By understanding the nuances of NAT mimics, radiologists can improve their diagnostic acumen, reduce the risk of misdiagnosis, and ultimately contribute to better patient outcomes. Read More

Authors:  Kosaraju Sriya,  Errampalli Eric,  Illimoottil Mathew,  Illimoottil Sarah,  Tran Noelle,  Leland Kristin,  Mardis Neil

Keywords:  Fractures ,  Skeletal Survey ,  NAT/Abuse

Bhatia Aashim,  Henry M.,  Feygin Tamara,  Christian Cindy

Final Pr. ID: Poster #: EDU-065

Abusive head trauma is associated with high morbidity and mortality. The evidence-based identification, care, and protection of infants and young children who are victims of AHT is critical. A diagnosis of AHT is made after careful consideration of the history provided, constellation of injuries identified, in conjunction with any additional diagnostic evaluation, as appropriate. This multidisciplinary educational module will focus on the evidence-based evaluation of intracranial findings when abusive head trauma (AHT) is a consideration, highlighting the importance of collaboration between child abuse pediatricians (CAPs) and pediatric neuroradiologists.

Framing the discussion with multiple cases, we will (1) describe the varied clinical presentations of abusive head trauma, (2) describe a general approach to the medical evaluation of abnormal intracranial findings when abuse is a concern; (3) present the differential diagnosis including traumatic and medical causes; (4) discuss appropriate imaging evaluation including neuroimaging (brain, spine) and skeletal imaging approaches; (5) report imaging findings found more commonly in AHT; (6) underscore the importance of collaboration between child abuse pediatricians and neuroradiologists; (7) highlight key literature, including the 2018 SPR-supported AHT consensus statement, to reference in practice, and, finally; (8) discuss consideration of language to include in imaging reports when abuse is a concern.

Following completion of the educational module, the learner will be familiar with the medical and imaging evaluations when AHT is considered, be able to describe imaging findings that are more commonly associated with AHT, and be familiar with references from the literature for self-study. Read More

Authors:  Bhatia Aashim,  Henry M.,  Feygin Tamara,  Christian Cindy

Keywords:  Child Maltreatment ,  Abusive Head Trauma ,  Neuroradiology

Ho Michelle,  Mercan Ezgi,  Evans Kelly,  Sheller Barbara,  Otjen Jeffrey,  Friedman Seth

Final Pr. ID: Poster #: EDU-067

Robin sequence (RS) is a craniofacial condition characterized by micrognathia, glossoptosis, and upper airway obstruction. The primary clinical concerns for infants and children with RS include feeding difficulties and obstructive sleep apnea. Patients with RS often undergo extensive testing to understand the type and severity of upper airway obstruction including flexible fiberoptic laryngoscopy, polysomnography, and computed tomography (CT) imaging.

Historically, surgical options to alleviate airway compromise have included tongue-lip adhesion, mandibular distraction osteogenesis, and tracheotomy, while less invasive treatments, including positioning and nasopharyngeal airways, have been insufficient. An effective non-surgical option is the orthodontic airway plate (OAP), which was initially developed and studied in Tübingen, Germany, and recently introduced in the United States. An OAP is an intraoral appliance comprised of two main components: a palatal base covering the hard palate and a dorsal spur extending just proximal to the epiglottis, thereby positioning the tongue forward to increase airway patency and improve the obstruction.

The design and manufacturing process of an OAP can be time and resource intensive depending upon the complexity and quality of scans and requires a multidisciplinary team and approach. Spur position and length are critical components to the OAP effectiveness. Small variations can cause discomfort and intolerance of the appliance. During the initial fitting and adjustment period, patients are admitted to the hospital for airway support and monitoring. Adjustments to the spur are guided by endoscopic and clinical examinations.

We present patients at our institution who underwent OAP therapy. We will review characteristic imaging findings of patients with RS. We will also summarize the evolving imaging and design workflow for constructing an OAP using intraoral scanning and dynamic 4D CT images. Our workflow is unique in its integration of intraoral scan with dynamic 4D CT images to help define initial spur position and length. By using patient-specific imaging to optimize spur positioning, a well-fitting OAP appliance can be constructed and facilitate rapid transition to outpatient care. Read More

Authors:  Ho Michelle,  Mercan Ezgi,  Evans Kelly,  Sheller Barbara,  Otjen Jeffrey,  Friedman Seth

Keywords:  Pierre-Robin ,  Airway ,  Dynamic Airway CT

Maleki Nazanin,  Amiruddin Raisa,  States Lisa,  Aboian Mariam

Final Pr. ID: Poster #: EDU-075

PET/MRI plays a significant role in Pediatric Oncology, but its implementation in Pediatric Neuro-Oncology has not been well established. PET/MRI addresses a major challenge in pediatrics by providing capability for serial imaging to track disease response to therapy, while minimizing radiation exposure and sedation events. PET/MRI has become a critical imaging modality in the management of pediatric brain neoplasms and metastases, aiding in diagnosis, staging, treatment planning, and follow-up, all while reducing radiation burden, minimizing time spent in the hospital, and reducing the number of sedation events.
At our tertiary center for pediatric care, we have gained extensive experience in utilizing hybrid PET/MRI to manage complex cases referred from multiple institutions. We present a series of cases where hybrid PET/MRI provided critical information for patient management including nasopharyngeal rhabdomyosarcoma, refractory metastatic germ cell tumor, and neuroblastoma. We offer a forward-looking perspective on the current role of FDG PET/MRI and future applications of amino acid PET in improving patient outcomes and its role in distinguishing tumor progression from post-treatment changes. Amino acid PET/MRI use cases were compiled from literature review and demonstrate definitive roles of amino acid PET/MRI in decision making in brain tumor diagnosis, immediate post-surgical assessment, and delayed treatment response assessment.
18F-FDG PET/MRI representative cases from clinical practice:
Case 1.
18 year old male with refractory metastatic germ cell tumor with anterior mediastinal mass and intracranial metastasis
Clinical Problem: Whole body evaluation in addition to detailed analysis of brain metastases in time efficient manner.
Imaging Solution: PET/MRI allowed detailed evaluation of hypermetabolic metastatic disease to the mediastinum and lungs and further detailed delineation of hemorrhagic brain metastases.
Case2.
4 year old boy with history of nasopharyngeal rhabdomyosarcoma with cerebellar metastasis who underwent resection and chemoradiation.
Clincial Problem: How to monitor nasopharyngeal mass after treatment in the setting of extensive postsurgical changes on MRI
Imaging Solution: PET/MRI provides an excellent imaging method for monitoring disease recurrence in the setting of post-treatment changes in nasopharyngeal location. Recurrent tumor was identified as hypermetabolic lesion, while MRI was not definitive. Read More

Authors:  Maleki Nazanin,  Amiruddin Raisa,  States Lisa,  Aboian Mariam

Keywords:  PET-MRI ,  Pediatric Imaging ,  Brain Tumors

Yousef Ayat,  Gerrie Samantha,  Alharbi Khalid,  Saint-martin Christine

Final Pr. ID: Poster #: EDU-076

The clinical presentation of neonatal CNS infections is often non-specific, requiring neuroimaging to narrow the differential diagnoses for prompt treatment and improved outcomes. Congenital infections include TORCH infections (Toxoplasmosis, Others (HIV, parvovirus, syphilis, and others), Rubella, Cytomegalovirus, Herpes simplex). Perinatal and postnatal CNS infections are related to other less common pathogens such as E. coli, Enterobacter, Candida, Parechovirus, and COVID-19 infections.

The imaging pattern of neonatal CNS infections varies depending on the patient’s age and stage of development at the time of exposure. The presentations of neonatal CNS infections include meningitis, encephalitis, leukoencephalopathy and vasculitis with and without complications.

Imaging aids in narrowing the differential diagnosis in complex cases and allows for the recognition of complications. We describe the imaging findings of neonatal CNS infections, ranging from common TORCH infections to rare pathogens.

We provide an educational case-based review of the imaging findings of various neonatal CNS infections while discussing their complications such as arterial stroke, venous thrombosis, hydrocephalus, abscess, and subdural empyema. We will explain the various imaging modalities used in the approach to neonatal infection while highlighting the precautions and need for administering IV contrast.

We aim to establish a systematic approach to the imaging workup of neonatal CNS infections to narrow the correct diagnosis, thereby expediting appropriate subspecialty referral and treatment. Read More

Authors:  Yousef Ayat,  Gerrie Samantha,  Alharbi Khalid,  Saint-martin Christine

Keywords:  CNS Infection ,  Neonatal ,  Education

Oh Saelin,  Lee Yoo Jin

Final Pr. ID: Poster #: EDU-078

Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD) is a recently defined neuroimmune disorder that presents with a wide range of clinical and radiological features. This study aims to describe the diverse brain MRI findings observed in patients with MOGAD and discuss their clinical implications. Read More

Authors:  Oh Saelin,  Lee Yoo Jin

Keywords:  MRI Brain ,  Demyelination

Nichols Joshua,  Schmid Ariel,  O'neill Thomas

Final Pr. ID: Poster #: EDU-081

New cases of epilepsy occur in up to 1 in 500 children, 30% of whom will develop intractable seizures despite medical therapy. The majority of focal epilepsy cases can be attributed to a structural abnormality, although identification of the epileptogenic focus can be challenging and often requires a multimodal approach. Recent developments in neurological imaging have improved localization of epileptogenic foci as well as mapping of eloquent regions of the brain, aiding in treatment decision making, surgical planning, and patient outcomes.
The goal of this educational poster is to present a case-based review of imaging evaluation for drug-resistant focal epilepsy in the pediatric patient with a focus on indications and protocols for neuroimaging techniques including structural brain imaging and fMRI, particularly in an underserved community with resource constraints. An approach to pediatric structural MRI and fMRI will be presented including post-operative imaging follow up.
The pediatric neuroradiologist plays a critical role in localization of epileptogenic foci as well as functional mapping and plays a critical role in the care of children with intractable epilepsy. Read More

Authors:  Nichols Joshua,  Schmid Ariel,  O'neill Thomas

Keywords:  Functional ,  MR ,  Epilepsy

Berg Sarah,  States Lisa

Final Pr. ID: Poster #: EDU-083

Neuroblastoma, the most common extracranial solid tumor in children, arises from embryonal neural crest progenitor cells. With a common origin of neuroendocrine cytology, this otherwise highly variable disease can be imaged with high sensitivity by exploiting the underlying biochemistry of the nervous system – namely with radiolabeled I-123 metaiodobenzylguanidine (MIBG), a norepinephrine analog. Imaging with MIBG over time can serve several key roles, including providing accurate stage at diagnosis, response assessment following therapy, and detection of recurrent disease. Moreover, when using the Curie score, a standardized and validated assessment of MIBG uptake on planar imaging, valuable prognostic information can be elucidated both at time of diagnosis and following induction therapy. Through the utilization of the same underlying physiologic principles, I-131 MIBG could be administered for an intended therapeutic effect, targeting sites of tracer uptake. The purpose of this educational exhibit is to review the process of quantifying and assigning a Curie score in the evaluation of pediatric neuroblastoma using I-123 MIBG planar imaging. Using a pictorial review of various I-123 MIBG positive cases, we will highlight normal MIBG uptake, distribution, and excretion. Through the inclusion of case examples that demonstrate various stages of disease, differing sites and severity of pathologic activity will be highlighted. Finally, the prognostic significance of the Curie scoring paradigm over time will be illustrated, specifically at the time of diagnosis and post-induction with I-123 MIBG, and in the post-therapy setting with I-131 MIBG. Read More

Authors:  Berg Sarah,  States Lisa

Keywords:  Nuclear Medicine ,  MIBG ,  Neuroblastoma

Lins De Carvalho Tiago,  Voss Stephan

Final Pr. ID: Poster #: EDU-084

This educational exhibit provides an overview of the role radiotracers play in diagnosing, staging, and treating neuroblastoma and neuroendocrine tumors (NETs) in pediatric patients, particularly those associated with certain cancer predisposition syndromes (CPS), which are linked to an increased incidence of neuroendocrine tumors, including pheochromocytoma, and paraganglioma (PPGL). Read More

Authors:  Lins De Carvalho Tiago,  Voss Stephan

Keywords:  Nuclear Medicine ,  Neuroblastoma ,  Pediatric Radiology

Ramos Jennifer,  Squires Judy

Final Pr. ID: Poster #: EDU-085

Pneumomediastinum is a radiological finding that may be seen following thoracic trauma, yet its importance and follow-up imaging recommendations are not standardized. Additionally, there is limited evidence linking traumatic pneumomediastinum to injury that will require treatment.

To evaluate the rate of the positivity of esophagrams performed for post-traumatic pneumomediastinum and to determine the appropriate investigative procedures needed. Read More

Authors:  Ramos Jennifer,  Squires Judy

Keywords:  Pneumomediastinum ,  Esophagram ,  Chest Computed Tomography (CT)

Dhami Alysha,  Seekins Jayne

Final Pr. ID: Poster #: EDU-087

Pediatric breast lesions are uncommon and can be a source of alarm to both pediatric patients and their caretakers. Lesions may be incidentally detected on imaging or may be associated with clinical symptoms prompting presentation. Prior to reviewing pathology, it is important for the radiologist to first have a clear understanding of the natural course of breast development in pediatric patients. We provide a multi-modal imaging review of breast bud development from the neonatal period through puberty. Next, we present a breadth of multimodal imaging cases of both benign and malignant lesions within the pediatric breast, including accessory breast tissue, gynecomastia, masses of the breast, masses of the chest wall mimicking breast masses, infection, trauma, and more. Lastly, this exhibit highlights key imaging characteristics that may prompt concern or need for further workup, offers optimization and best practices for imaging, and reviews appropriate management and referral recommendations for common entities. Read More

Authors:  Dhami Alysha,  Seekins Jayne

Keywords:  Breast ,  Ultrasound and MRI ,  Multimodality

Hughes Jordan,  Chowdhary Anisa,  Walczak Edward,  Awan Baarkullah,  Jalili Mohammad

Final Pr. ID: Poster #: EDU-088

Fetal MRI is useful in the detection and evaluation of several fetal pulmonary abnormalities including congenital diaphragmatic hernia, pulmonary hypoplasia and pulmonary airway malformations. MRI offers a noninvasive modality that is complementary to ultrasound for detecting fetal abnormalities. Fetal MRI can also be beneficial in helping to establish the prognosis and assisting in perinatal management. One of the major advantages of MRI is that it allows the quantitative measurement of lung volume thereby providing the observed total fetal lung volume (TFLVo) which can be compared to expected total fetal lung volume. A ratio of observed to expected ratio can be calculated. This can be useful in prognosis and risk stratification, particularly in diaphragmatic hernias. MRI also has the advantage of excellent spatial resolution and evaluation of soft tissues structures that may be present above the diaphragm. In this exhibit we will provide several cases including congenital diaphragmatic hernia, congenital pulmonary airway malformation and bilateral pulmonary hypoplasia to illustrate the benefit and utility of fetal MRI for the evaluation of fetal thoracic abnormalities. Read More

Authors:  Hughes Jordan,  Chowdhary Anisa,  Walczak Edward,  Awan Baarkullah,  Jalili Mohammad

Keywords:  MR ,  Congenital Diaphragmatic Hernia ,  Pulmonary Hypoplasia

Amiruddin Raisa,  Noor Abass,  Sherwani Poonam

Final Pr. ID: Poster #: EDU-090

Recurrent pneumonia in pediatrics is diagnosed when a child develops 2 or more episodes in a year or 3 or more episodes in total, with radiographic clearing of densities in between episodes. It accounts for 7-9% of childhood pneumonia and is the one of leading causes of preventable childhood mortality worldwide. It presents a diagnostic challenge, and management relies on clinical judgement, careful history and physical examination, and features suggestive of underlying conditions.
Identifying the cause of recurrent pneumonia is crucial for early diagnosis and treatment and reducing morbidity and mortality. It can occur due to localized pathology of the respiratory tract or from complications of systemic disease. Chest radiography is one of the most commonly performed imaging studies in pediatric care. It is easy to perform, readily available even in low-resource settings, and is often the first modality of imaging utilized for investigating pneumonia.
We present a case series highlighting the clinical presentations of various pathologies implicated in recurrent pneumonia and the diagnostic role of radiographs and follow up computed tomography (CT) in its management. We finally present a diagnostic algorithm for recurrent pneumonia and emphasize the importance of following a thorough checklist to ensure precise delivery of care.
Readers of this exhibit can expect to learn about the significance of imaging in the diagnosis of recurrent pneumonia due to:
- Foreign bodies
- Tumors
- Congenital malformations
- Immunodeficiency Read More

Authors:  Amiruddin Raisa,  Noor Abass,  Sherwani Poonam

Keywords:  Radiographic Findings ,  Pulmonary ,  CT Chest

Ilivitzki Anat,  Scolnik Michal

Final Pr. ID: Poster #: EDU-095

In this pictorial essay on typical and atypical lung metastases in pediatric patients, we aim to assist radiologists in identifying suspicious features on CT scans. Our goal is to guide decisions regarding follow-up imaging to ensure a timely diagnosis, enabling children to receive prompt and potentially lifesaving treatment. Read More

Authors:  Ilivitzki Anat,  Scolnik Michal

Keywords:  CT Chest ,  Pediatric Radiology ,  Oncology