Table Of Content

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. PD100-ED-X MR Imaging of CNS Inflammatory Demyelinating Disorders in Pediatrics All Day Location: PD Community, Learning Center Participants Ahmed Abdel Razek, MD, Mansoura, Egypt (Presenter) Nothing to Disclose TEACHING POINTS 1-To review basic background about pediatric CNS inflammatory demyelinating disorders (CIDD) 2- To illustrate update proposed classification and Revised McDonald multiple sclerosis criteria in children 3-To discuss typical and atypical imaging appearance of different causes of pediatric CIDD TABLE OF CONTENTS/OUTLINE 2-Review proposed 2012 International Pediatric Multiple Sclerosis Study Group (IPMSSG)3- Illustrate 2010 Revised McDonald multiple sclerosis criteria in children4-Differnet MR pulse sequences applied in children with CIDD5-MR imaging features of clinically isolated syndrome in the children6-MR imaging appearance and different locations of pediatric multiple sclerosis7-Imaging of pediatric neuromyelitis optica8-Imaging of acute disseminated encephalomyelitis and its variants9-Imaging findings used to differentiate pediatric CIDD from other simulating lesions10-Summary and future directions PD101-ED-X Pelvic Puzzlers: Uncommon Pediatric Pelvic Neoplasms with Radiologic, Clinical, and Pathologic Correlation All Day Location: PD Community, Learning Center Awards Certificate of Merit Participants Sara Cohen, MD, Boston, MA (Presenter) Nothing to Disclose Osman Yilmaz, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose Anastasia L. Hryhorczuk, MD, Brookline, MA (Abstract Co-Author) Nothing to Disclose Donald A. Tracy, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose TEACHING POINTS The purpose of this exhibit is to describe the clinical presentation, characteristic radiographic features, pathologic correlates and management for a selection of unusual neoplasms arising in the pelvis of children. Viewers of this exhibit will become familiar with rare tumors that may mimic other neoplasms and that are challenging to diagnose. Viewers will also explore the typical histopathologic features diagnostic of these entities. TABLE OF CONTENTS/OUTLINE Cases include the following: 1. perivascular epithelioid cell tumor (PEC-oma) of the uterus, 2. presacral extragonadal yolk sac tumor, 3. inflammatory myofibroblastic tumor of small bowel, 4. low grade inverted papillary urothelial neoplasm, 5. granulosa cell tumor, 6. Castleman's disease, 7. dermatofibrosarcoma protruberans of the vulva, 8. bilateral ovarian lymphoma metastases PD102-ED-X Ultrasound Evaluation of Radiographically Occult Elbow Injuries in Children and Infants All Day Location: PD Community, Learning Center Participants Jessica R. Leschied, MD, Ann Arbor, MI (Presenter) Nothing to Disclose Ramon Sanchez, MD, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose Lawrence R. Kuhns, MD, Plymouth, MI (Abstract Co-Author) Nothing to Disclose Qian Dong, MD, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose Mark Riederer, MD, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose TEACHING POINTS By completion of this educational exhibit, the learner will be able to: Perform a sonographic evaluation of the pediatric elbow joint for the purposes of detecting traumatic injury Identify normal appearances of non-ossified epiphyses and normal anatomic relationships of the elbow joint Understand the indications for elbow sonography in the setting of clinically suspicious elbow injury Identify the sonographic appearance of common pediatric elbow injuries including supracondylar fracture, lateral condyle fracture, medial epicondyle avulsion fracture, fracture-dislocation, radial neck fracture, nursemaid's elbow and clinical fracture mimics such as osteomyelitis and septic arthritis TABLE OF CONTENTS/OUTLINE Epidemiology of pediatric elbow fractures Anatomy of elbow joint Sonographic techniques for performing elbow ultrasound Case examples of elbow fracture/dislocations and role of ultrasound for specific injury patterns PD103-ED-X "Where do I Draw the Line?': A How-to Guide on Most Commonly Used Measurements in Pediatric Musculoskeletal Radiology All Day Location: PD Community, Learning Center Participants Eric J. Jordan, MD, San Francisco, CA (Presenter) Nothing to Disclose Andrew S. Phelps, MD, San Francisco, CA (Abstract Co-Author) Nothing to Disclose Johanna M. Chang, MD, San Francisco, CA (Abstract Co-Author) Nothing to Disclose John D. MacKenzie, MD, San Francisco, CA (Abstract Co-Author) Research Grant, General Electric Company Jesse L. Courtier, MD, San Francisco, CA (Abstract Co-Author) Nothing to Disclose TEACHING POINTS Accurate measurements are key in the appropriate diagnosis and management in a number of common pediatric conditions. Inappropriate performance of these measurements can lead to missed diagnoses and inappropriate management.Through a series of case examples this exhibit will:1. Provide radiologists with a review of common pediatric musculoskeletal conditions affecting the spine, elbow, knees, hips, and feet.2. Allow viewers to test their knowledge with a quiz on the accurate performance of measurements in these conditions. TABLE OF CONTENTS/OUTLINE Using an interactive quiz format, cases will be presented with emphasis on appropriate placement of measurement lines. Common pitfalls will be highlighted. A discussion of key points on the diagnosis and management will be made of entities including. Spine (trauma and aligment) C-spine (pseudo-subluxation vs abnormal) Scoliosis (cobb angle, coronal/sagittal imbalance Elbow (fall on outstreched hand) anterior humeral line (normal in young versus old) radiocapitellar alignment (considerations in <1yr olds) Hip alpha angle in US acetabular and center-edge angles Klein line in slipped capital femoral epiphysis Knee Mechanical vs Weightbearing Axis Foot Hindfoot alignment PD104-ED-X Pearls and Pitfalls in Imaging of Pediatric and Adolescent Breast Masses All Day Location: PD Community, Learning Center Participants Priya Krishnarao, MD, San Jose, CA (Presenter) Nothing to Disclose Patrick H. Do, MD, San Jose, CA (Abstract Co-Author) Nothing to Disclose Amrita K. Arneja, MD, Hicksville, NY (Abstract Co-Author) Nothing to Disclose Vanessa Starr, MD, San Jose, CA (Abstract Co-Author) Nothing to Disclose Long Trinh, MD, San Jose, CA (Abstract Co-Author) Nothing to Disclose Evan J. Zucker, MD, Stanford, CA (Abstract Co-Author) Nothing to Disclose TEACHING POINTS Review normal breast development Review developmental breast anomalies Review benign lesions of the pediatric breast Review malignant lesions of the pediatric breast TABLE OF CONTENTS/OUTLINE Introduction Methods and Materials- Description of case selection from multiple institutions Overview of normal breast development Review of benign breast lesions such as breast cysts, mastitis, fibroadenomas, juvenile fibroadenomas, and juvenile papillomatosis Review of malignant breast lesions such as malignant phyllodes tumors, primary breast carcinoma, and metastatic disease