Pediatric Radiology

199 Pages·2016·1.02 MB·English

Pediatric radiology
PD001-EB-X
Suspected Acute Appendicitis in Children: MRI Appearances, Alternative Diagnoses, and Lessons Learned
All Day Location: PD Community, Learning Center
Awards
Certificate of Merit
Participants
Jessica R. Leschied, MD, Ann Arbor, MI (Presenter) Nothing to Disclose
Jonathan R. Dillman, MD, Ann Arbor, MI (Abstract Co-Author) Research support, Bracco Group; Research support, Siemens AG
Peter J. Strouse, MD, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
Ethan A. Smith, MD, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
Samir Gadepalli, MD, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
Nicole S. Sroufe, MD, MPH, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
Outline a rapid, non-contrast MRI protocol to identify causes of right lower quadrant pain in pediatric patients in the emergent
setting Identify MRI features of acute non-complicated appendicitis Identify the MRI features of complications of appendicitis
Recognize the MRI appearances of various clinical mimics of acute appendicitis
TABLE OF CONTENTS/OUTLINE
Epidemiology of acute appendicitis in the US Brief review of literature and current imaging algorithm for acute presentation of
abdominal pain in children Outline a rapid, non-contrast MRI appendicitis protocol Case-based approach to identifying MR features
of acute appendicitis Highlight MR appearance of complications of acute appendicitis Demonstrate MR appearance of clinical mimics
of acute appendicitis
PD002-EB-X
Management and Follow-Up of Pediatric Hepatic Tumors
All Day Location: PD Community, Learning Center
Participants
Christopher T. Watterson, MD, W Hollywood, CA (Presenter) Nothing to Disclose
Allen Ardestani, MD, PhD, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
Snehalkumar Patel, MD, PhD, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
Katherine M. Haker, MD, Los Angeles, CA (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
To discuss the radiologic appearance and delineating factors of the hepatic tumors commonly encountered in pediatric patients. To
review the etiology, management, and follow-up considerations of these lesions. To discuss the staging of hepatoblastoma. To
describe the differences between transplant criteria in adults and pediatrics.
TABLE OF CONTENTS/OUTLINE
Benign Tumors: Hemangiomas Hemangioendothelioma Mesenchymal Hamartomas Hepatic Adenoma FNHMalignant Primary:
Hepatoblastoma: Associated with Beckwith-Wiedemann Syndrome, FAP Hepatocellular Carcinoma Secondary: Wilms' Tumor
Neuroblastoma Rhabdomyosarcoma Rhabdoid Lymphoma/Leukemia Adrenal cortical carcinoma
PD004-EB-X
Treatment Planning and MRI Guided Sclerotherapy in Pediatric Patients with Lymphatic Malformations
All Day Location: PD Community, Learning Center
Participants
Sasan Partovi, MD, Cleveland, OH (Presenter) Nothing to Disclose
Lorenna Lourhance M. Vidal, MD, Cleveland, OH (Abstract Co-Author) Nothing to Disclose
Nicholas Bhojwani, MD, Nashville, TN (Abstract Co-Author) Nothing to Disclose
Dean A. Nakamoto, MD, Beachwood, OH (Abstract Co-Author) Research Grant, Galil Medical Ltd; Research agreement, Toshiba
Corporation
Kristine Blackham, MD, Cleveland, OH (Abstract Co-Author) Nothing to Disclose
Indravadan J. Patel, MD, Cleveland, OH (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
1. To understand the classification of lymphatic malformations based on MRI appearance.2. To discuss the advantages of real-time
MRI guided sclerotherapy treatment of lymphatic malformations in the pediatric patient population.3. To become familiar with the
different steps of real-time MRI guided sclerotherapy treatment of lymphatic malformations including lesion localization, needle
placement visualization, depiction of sclerotherapy injection process by using a mixture with Gadolinium based contrast agents. 4.
To appreciate potential complications of the procedure and their appropriate treatment
TABLE OF CONTENTS/OUTLINE
1. Characterization and differentiation of different types of lymphatic malformations based on appearance in MRI2. Advantages of
real-time MRI guided sclerotherapy treatment in the pediatric population including increased safety and lack of radiation exposure3.
Real-time MRI guided treatment of lymphatic malformations including technical aspects of the applied sequences for: Lesion
localizationNeedle placementSclerotherapy-Gadolinium mixture injection processAssessment of treatment success 4. Associated
complications including frequency and treatment approach5. Post-procedure follow-up imaging protocols using MRI
PD006-EB-X
The Role of Ultrasonography on Congenital Malformations Evaluation of the Umbilical-portal-hepatic Venous
System
All Day Location: PD Community, Learning Center
Participants
Bruna B. Bastos, Sao Paulo, Brazil (Presenter) Nothing to Disclose
Diego P. Rodrigues, MD, Sao Paulo, Brazil (Abstract Co-Author) Nothing to Disclose
Mauricio Yamanari, Sao Paulo, Brazil (Abstract Co-Author) Nothing to Disclose
Yoshino T. Sameshima, MD, Sao Paulo, Brazil (Abstract Co-Author) Nothing to Disclose
Miguel J. Francisco Neto, MD, Sao Paulo, Brazil (Abstract Co-Author) Nothing to Disclose
Marcelo B. Funari, MD, Ribeirao Pires, Brazil (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
1. This paper describes the evolution of three cases of congenital malformations of the umbilical-portal-hepatic venous system
diagnosed by ultrasonography in the perinatal period, that illustrate the following malformations: a) persistent vitelline vein
complicated with portal vein thrombosis; b) congenital intrahepatic portosystemic shunt; and c) hepatic arteriovenous
malformation. 2. The hepatic venous system begins its formation around the fifth gestational week. The terminal part of the inferior
vena cava, hepatic veins, and the portal veins is derived from the umbilical and vitelline veins. Malformations and anomalies arising
during the development of this venous network are rare and highly varied, and may result in several pathologies. 3. The Doppler
ultrasonography is the most important tool for congenital malformations evaluation of the umbilical-portal-hepatic venous system
diagnosis.
TABLE OF CONTENTS/OUTLINE
Introduction. Embriology of the umbilical-portal-hepatic venous system. Ultrasonographic anatomy of the umbilical-portal-hepatic
venous system. Persistent vitelline vein complicated with portal vein thrombosis demonstrating early opening of collateral
circulation. Congenital portosystemic shunt: intrahepatic and extrahepatic. Hepatic arteriovenous malformation. Conclusion.
References.
PD007-EC-X
Cloud Based Interactive Training Tool to Improve Diagnostic Skills in Pediatric Musculoskeletal Imaging
All Day Location: PD Community, Learning Center
Participants
Roland S. Talanow, MD, PhD, South Lake Tahoe, NV (Presenter) President, InnoMed LLC;
Shannon L. Tocchio, MD, Pittsburgh, PA (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
This web platform, along with continuing updates, will provide a 1) realistic environment and 2) important resource for residents and
radiologists to improve their diagnostic skillset in pediatric MSK imaging.
TABLE OF CONTENTS/OUTLINE
A. AnatomyThis program provides a collection of MSK cases showing significant anatomical structures that need to be recognized
by the user. B. PathophysiologyProvided is furthermore a case collection with frequent and infrequent pathologies in pediatric MSK
imaging that need to be recognized by the user. C. Diagnostic ImagingIn each module, the user goes through a set of cases and
need to recognize (if) any pathology. This online program offers a modular approach through musculoskeletal imaging, based on
modalities and body regions. D. ROI RecognitionAn intelligent coordinate based algorithm saves the pathology location and the
system calculates if the user pointed out the correct region of interest and recognized the pathology and compares to the 'gold
standard' entered by the authors. E. Outcome (Results with Analytics)After each module, the system calculates the user results
with the true results and provides detailed analytics about user performance and comparison with their peers. Exams can be done in
a timed or untimed matter to prepare for the 'real life' of a busy Radiology practice.
PD008-EB-X
Standardization of the Head Ultrasonography for Usual and Unusual Applicattions
All Day Location: PD Community, Learning Center
Participants
Marielli B. Dal Bo, MD, Sao Paulo, Brazil (Presenter) Nothing to Disclose
Yoshino T. Sameshima, MD, Sao Paulo, Brazil (Abstract Co-Author) Nothing to Disclose
Mauricio Yamanari, Sao Paulo, Brazil (Abstract Co-Author) Nothing to Disclose
Miguel J. Neto, Sao Paulo, Brazil (Abstract Co-Author) Nothing to Disclose
Marcelo B. Funari, MD, Ribeirao Pires, Brazil (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
1.The first experiments with cerebral ultrasound in neonates date back to 1950s when the A mode studies were conducted. Since
then it has remained as a method of choice for the initial evaluation of the neonate brain. 2.This work aims to emphasize the
importance of standardized documentation of head ultrasonography (HUS), showing the main levels of sonographic slices and
demonstrate the major injuries of premature newborns brain such as periventricular leukomalacia (PVL), germinal matrix hemorrhage
(GMH), periventricular hemorrhagic infarction, and congenital CNS malformation as well as infection.3.Unusual applications of HUS
will also be shown such as in tocotraumatism, craniostenosis, scalp disorders, analysis of aqueductal cerebrospinal fluid (ACSF) flow
with color Doppler in grade IV germinal matrix hemorrhage, and guiding neuroendoscopic procedures.
TABLE OF CONTENTS/OUTLINE
1.HUS standardized documentation, sonographic slices, positioning, acoustic windows. 2.Major brain injuries in premature newborns
such as PVL and De Vries grading system. 3.GMH and Papile grading system. 4.Congenital CNS malformation and infection. 5.Unusual
applications of HUS such as in tocotraumatism, craniostenosis, scalp disorders, analysis of ACSF flow with color Doppler, and
guiding neuroendoscopic procedures.
PD009-EB-X
Ultrasonographic Features of Various Thyroid Diseases in Children and Adolescents
All Day Location: PD Community, Learning Center
Participants
Jisun Hwang, MD, Seoul, Korea, Republic Of (Presenter) Nothing to Disclose
Hyun-Sook Hong, MD, PhD, Bucheon, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Eun Hye Lee, MD, Bucheon, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Sun Hye Jung, Bucheon, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
To learn about the normal development of the thyroid gland To be able to distinguish various diseases that can involve the thyroid
health of children and adolescents. To recognize the imaging features of congenital thyroid disorders To review epidemiological
features of imaging findings on various benign or malignant thyroid nodular lesions in children and adolescents To review diffuse
thyroid disease
TABLE OF CONTENTS/OUTLINE
1. Introduction2. Normal development of the thyroid gland3. Congenital hypothyroidism (dysgenesis, [aplasia, ectopy, and
hypoplasia]; dyshormonogenesis; transient hypothyroidism; thyroglossal duct cysts)4. Thyroid nodules Benign thyroid nodules
Malignant nodules5. Diffuse thyroid disease Grave's disease Hashimoto's thyroiditis Suppurative thyroiditis
PD011-EB-X
Cranial Ultrasound for the Diagnosis of Craniosynostosis: Avoiding Radiation Exposure in Young Children
All Day Location: PD Community, Learning Center
Participants
Katya Rozovsky, MD, Jerusalem, Israel (Abstract Co-Author) Nothing to Disclose
Kristin Udjus-Teitelbaum, MD, Ottawa, ON (Abstract Co-Author) Nothing to Disclose
Nagwa M. Wilson, MD, PhD, Montreal, QC (Abstract Co-Author) Nothing to Disclose
Nick Barrowman, Ottawa, ON (Abstract Co-Author) Nothing to Disclose
Natalia Simanovsky, MD, Jerusalem, Israel (Abstract Co-Author) Nothing to Disclose
Elka Miller, MD, Ottawa, ON (Presenter) Nothing to Disclose
TEACHING POINTS
The purpose of this exhibition is:To discuss the advantages of cranial ultrasound (CUS) as a radiation-free and technically simple
technique as a first-line tool for detection or exclusion of craniosynostosis, reducing the use of radiography in young childrenTo
illustrate CUS techniques for suture evaluation, thus improving reader skill and confidence in the confirmation or exclusion of
synostosis using CUSTo discuss the challenges inherent in metopic suture evaluation, where we found disagreement between CUS
and cranial radiography in several cases; to provide imaging "tricks and tips" to improve diagnostic accuracyTo present the next
steps in imaging evaluation in cases where synostosis is diagnosed or cannot be ruled out on CUS
TABLE OF CONTENTS/OUTLINE
CUS technique: how we do itNormal cranial sutures: appearance on CUS, correlation with cranial radiographyCraniosynostosis:
appearance on CUS, correlation with cranial radiographySagittal sutureCoronal sutureLambdoid sutureMetopic sutureCUS
appearance of metopic suturePatentNormally closedAbnormally closed (synostosis)"True positive" and "false positive" cases of
metopic synostosis, correlation with cranial radiographyWhat to do next in cases where synostosis is diagnosed or cannot be ruled
out on CUS?
PD012-EB-X
Sonographic Features of Newborns Umbilical Catheterization: Anatomical Catheter's Pathway, Positioning and
its Complications
All Day Location: PD Community, Learning Center
Participants
Bruna B. Bastos, Sao Paulo, Brazil (Presenter) Nothing to Disclose
Francisco D. Junior, MD, Sao Paulo, Brazil (Abstract Co-Author) Nothing to Disclose
Mauricio Yamanari, Sao Paulo, Brazil (Abstract Co-Author) Nothing to Disclose
Yoshino T. Sameshima, MD, Sao Paulo, Brazil (Abstract Co-Author) Nothing to Disclose
Miguel J. Francisco Neto, MD, Sao Paulo, Brazil (Abstract Co-Author) Nothing to Disclose
Marcelo B. Funari, MD, Ribeirao Pires, Brazil (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
1. This paper aims to illustrate the fundamental role of ultrasonography in the evaluation of umbilical catheter placement and the
detection of its potential complications.2. Ultrasonography is a widely available method, which can be performed at the bedside,
and does not require iodinated contrast or ionized radiation.3. Since the introduction of intravascular catheters and the use of
umbilical vein to exchange transfusions in 1947, the arterial and venous umbilical catheter is routinely used in premature
neonates.4. The umbilical catheter reaches an acceptable position during the first attempt to insert in less than half of the cases.
Considering that most of the complications are related to improper placement of the distal end of the catheter, we face a high risk
of complications.5. Umbilical catheters may be misspositioned in various vascular structures, including the left atrium, and
extraluminal site; another common complication is portal vein thrombosis.
TABLE OF CONTENTS/OUTLINE
Introduction. Ultrasonographic aspects of venous and arterial umbilical catheters anatomical pathways. Usual ultrasonographic
appearance of umbilical catheters. Venous catheterization related complications. Arterial catheterization related complications.
Conclusion. References.