Spr 2015.

Pediatr Radiol (2015) 45 (Suppl 1):S1–S246 DOI 10.1007/s00247-015-3297-9

ABSTRACTS

SPR 2015 The Society for Pediatric Radiology introduced its new logo August 15, 2013. The logo communicates both the warmth of the Society community and the strength of the members’ commitment to excellent and thoughtful care of the pediatric patient.

The first official logo for the SPR was designed by Tamar Kahane Oestreich of Cincinnati, Ohio in 1985. Thank you, Mrs. Oestreich.

Founded in 1959 The Society for Pediatric Radiology 58th Annual Meeting & Postgraduate Course Presented by The Society for Pediatric Radiology Hyatt Regency Hotel Bellevue, Washington Postgraduate Course April 27-28, 2015 Annual Meeting April 28-May 1, 2015 Jointly provided by the American College of Radiology

This supplement was not sponsored by outside commercial interests; it was funded entirely by the Society’s own resources.

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Pediatr Radiol (2015) 45 (Suppl 1):S1–S246


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TABLE OF CONTENTS Welcome from SPR President, Brian D. Coley, MD, FACR ............................................................................................................................................ S5 SPR 2015 Organization ....................................................................................................................................................................................................... S6 Continuing Medical Education ........................................................................................................................................................................................... S7 Maintenance of Certification .............................................................................................................................................................................................. S8 Objectives ............................................................................................................................................................................................................................ S8 Disclosure ............................................................................................................................................................................................................................ S9 Acknowledgements ........................................................................................................................................................................................................... S11 Program Schedule ............................................................................................................................................................................................................. S12 Listing of Scientific Exhibits/Posters ............................................................................................................................................................................... S26 General Information .......................................................................................................................................................................................................... S32 Mission Statement ......................................................................................................................................................................................................... S32 Sites of Previous Meetings ........................................................................................................................................................................................... S32 Future Meetings ............................................................................................................................................................................................................ S32 Officers, Directors and Committees ............................................................................................................................................................................. S32 Gold Medalists .............................................................................................................................................................................................................. S39 Pioneer Honorees .......................................................................................................................................................................................................... S40 Presidential Recognition Awards .................................................................................................................................................................................. S40 Honorary Members ....................................................................................................................................................................................................... S40 Past Presidents ............................................................................................................................................................................................................... S42 Singleton-Taybi Award ................................................................................................................................................................................................. S43 John A. Kirkpatrick Young Investigator Award ........................................................................................................................................................... S43 Walter E. Berdon Awards .............................................................................................................................................................................................. S43 The SPR Research and Education Foundation Awards ................................................................................................................................................... S44 Social Events ..................................................................................................................................................................................................................... S45 SPR 2015 Gold Medalist ................................................................................................................................................................................................... S46 SPR 2015 Pioneer Honoree ............................................................................................................................................................................................... S48 SPR 2015 Presidential Recognition Award ...................................................................................................................................................................... S50 SPR 2015 Honorary Members .......................................................................................................................................................................................... S51 SPR 2015 Singleton-Taybi Award .................................................................................................................................................................................... S54 John Caffey Awards ........................................................................................................................................................................................................... S55 Edward B. Neuhauser Lecturers ........................................................................................................................................................................................ S58 Postgraduate Course Abstracts .......................................................................................................................................................................................... S60 Scientific Papers ................................................................................................................................................................................................................ S68 Scientific Exhibits/Posters ............................................................................................................................................................................................... S149 Author Index by Abstract ................................................................................................................................................................................................ S237 Keyword Index by Abstract ........................................................................................................................................................................................... S242


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WELCOME ADDRESS Dear Colleagues, Medicine is changing in response to new science and discovery, better knowledge about healthcare delivery and outcomes, changing government and payor regulations, and patient preferences and demands. Imaging is subject to these same influences and pressures, and our practices will not look the same in the coming years as they have in past decades. This has caused many radiologists to bemoan the demise of medicine and to become dissatisfied and discontent with the practice of radiology. I think that is an unfortunate and overly pessimistic view of the situation. While many of the forces of change are beyond our control, many are not, and we as a specialty have the ability (and even a responsibility) to work to shape our own destiny. This may not be easy or comfortable, but it is necessary and has the potential to place radiology as an even more important and relevant part of medicine than it is today. The theme of this year’s meeting is “Visualize the Future,” because that is what we need to do before making our future happen. To help us with that visualization, Dr. Robert Gillies from the Moffitt Cancer Center will deliver the Neuhauser Lecture and speak to us about radiogenomics, the integration of genetic and imaging data. The postgraduate course organized by Drs. Alex Towbin and Ethan Smith, the educational sessions put together by Drs. Paul Guillerman and Tess Chapman, and the presented academic work by our talented colleagues should also provide inspiration about where we can go, and what we can do to provide the pediatric imaging care of the future. Inspiration can also come during discussion with colleagues, during a good party, and with quiet contemplation. Bellevue and Seattle are in a beautiful setting that deserves to be explored. So at some point get out of the hotel for a walk or run and see the area. Take the time to get together with friends at any one of the many terrific restaurants and entertainment venues in the area. If that isn’t sufficient, then perhaps a pint of local pale ale, glass of fine Washington wine, or other beverage of your choice will lead to insight and inspiration, and maybe the next “big idea.” I hope that you find value in the meeting content and in the interaction with your friends and colleagues, and that you have some fun. Think about what pediatric radiology can be, where we can do more for our patients, and truly change the outcomes in their care. Take what you learn and discuss back home with you and put it to use, and together we can create a bright future for our specialty. Sincerely,

Brian D. Coley, MD, FACR President, The Society for Pediatric Radiology

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SPR 2015 ORGANIZATION 2015 MEETING CURRICULUM COMMITTEE Brian D. Coley, MD, FACR, Chair Dianna M.E. Bardo, MD (3D Sessions) Shelia Berlin, MD (CT Protocol Session) Teresa Chapman, MD, MA (Workshop Director & Potpourri Session) Michael J. Callahan, MD (CT Protocol Session) Nancy A. Chauvin, MD (US Protocol Session) Bairbre L. Connolly, MD (Interventional Radiology Session) Jesse Courtier, MD (MR Protocol Session) Laura Z. Fenton, MD (Hands-On US & US Protocol Session) G. Peter Feola, MD (Interventional Radiology Session) R. Paul Guillerman, MD (Workshop Director & Potpourri Session) Jeffrey C. Hellinger, MD, MBA (3D Sessions) Rajesh Krishnamurthy, MD (MR Protocol Session) Arnold Carl Merrow, MD (Education Session) Jenny McBroom, RT, RDMS (Hands-On US, Consultant) Marguerite T. Parisi, MD, MS (Nuclear Medicine Session) Richard L. Robertson, MD (Neuroradiology Session) Susan E. Sharp, MD (Nuclear Medicine Session) Dennis W. Shaw, MD (Neuroradiology Session) Ethan A. Smith, MD (Postgraduate Course Director) Keith J. Strauss, MSc, FAAPM, FACR (CT Protocol Session) Mahesh M. Thapa, MD (Education Session) Alexander J. Towbin, MD (Postgraduate Course Director) ABSTRACT REVIEW COMMITTEE – PAPERS Brian D. Coley, MD, FACR, Chair Dianna M. E. Bardo, MD Dorothy I. Bulas, MD, FACR Christopher I. Cassady, MD, FAAP Teresa Chapman, MD, MA Taylor Chung, MD Jonathan Dillman, MD James Donaldson, MD, FACR Lynn Fordham, MD, FACR Mark J. Hogan, MD, FSIR Diego Jaramillo, MD, MPH Nadja Kadom, MD Rajesh Krishnamurthy, MD Bernadette Koch, MD Neha Kwatra, MD David B. Larson, MD, MBA M. Beth McCarville, MD Robert Orth, MD, PhD Marguerite T. Parisi, MD, MS John M. Racadio, MD Anil Rao, DMRD, DNB Cynthia K. Rigsby, MD, FACR Maura Ryan, MD Keith J. Strauss, MSc, FAAPM, FACR Peter J. Strouse, MD, FACR Alexander J. Towbin, MD Andrew T. Trout, MD Teresa Victoria, MD, PhD Stephan D. Voss, MD, PhD



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ABSTRACT REVIEW COMMITTEE – SCIENTIFIC EXHIBITS/POSTERS Nadja Kadom, MD, Chair Susan E. Sharp, MD, Vice Chair Anjum Bandarkar, MD Madhan Bosemani, MBBS Michael J. Callahan, MD Maria Calvo-Garcia, MD Michael D’Alessandro, MD Kassa Darge, MD, PhD Steven Don, MD R. Paul Guillerman, MD Fredric Hoffer, MD Thierry A. G. M. Huisman, MD Douglas Jamieson, MD J. Herman Kan, MD Geetika Khanna, MD, MS Neha Kwatra, MD Maria Ladino-Torres, MD Jonathan Loewen, MD M. Beth McCarville, MD Craig Mitchell, DO, MA Jonathan Murnick, MD, PhD Helen R. Nadel, MD, FRCPC Srikala Narayanan, MD Daniel Podberesky, MD Janet Reid, MD Douglas Rivard, DO Ashley Robinson, MBChB Manrita Sidhu, MD Stephen F. Simoneaux, MD AylinTekes-Brady, MD Alexander J. Towbin, MD Jason Tsai, MD Kristen Yeom, MD jSPR Sheryl Tulin-Silver, MD and Matthew Winfeld, MD CONTINUING MEDICAL EDUCATION Accreditation Statement This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint providership of the American College of Radiology and The Society for Pediatric Radiology. The American College of Radiology is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Designation Statement (Postgraduate Course) The American College of Radiology designates this live activity for a maximum of 10.75 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Designation Statement (Annual Meeting) The American College of Radiology designates this live activity for a maximum of 23.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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Technologists The American College of Radiology is approved by the American Registry of Radiologic Technologists (ARRT) as a Recognized Continuing Education Evaluation Mechanism (RCEEM) to sponsor and/or review Continuing Medical Educational programs for Radiologic Technologists and Radiation Therapists. The American College of Radiology designates this educational activity as meeting the criteria for up to 35 Category A credit hours of the ARRT. MAINTENANCE OF CERTIFICATION Qualified on February 4, 2015, the Postgraduate Course as well as the Saturday Interventional, Neuroradiology and Nuclear Medicine sessions meet the ABR’s criteria for a self-assessment (SAM) activity in the ABR Maintenance of Certification (MOC) Program. OBJECTIVES The Society for Pediatric Radiology Annual Meeting and Postgraduate Course will provide pediatric and general radiologists with an opportunity to do the following: 1. Summarize the most current information on state of the art pediatric imaging and the practice of pediatric radiology. 2. Describe and apply new technologies for pediatric imaging. 3. Describe and apply basic principles for implementing quality and safety programs in pediatric radiology. 4. Discuss trends in research concerning the care and imaging of pediatric patients. 5. Identify common challenges facing pediatric radiologists, and possible solutions. 6. Evaluate and apply means of minimizing radiation exposure during diagnostic imaging and image guided therapy. At the conclusion of the experience, participants should have an improved understanding of the technologies discussed, increasing awareness of the costs and benefits of diagnostic imaging in children and of ways to minimize risks, and an improved general knowledge of pediatric radiology, especially as it interfaces with clinical decision making.


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DISCLOSURE In compliance with ACCME requirements and guidelines, the ACR has developed a policy for review and disclosure of potential conflicts of interest, and a method of resolution if a conflict does exist. The ACR maintains a tradition of scientific integrity and objectivity in its educational activities. In order to preserve this integrity and objectivity, all individuals participating as planners, presenters, moderators and evaluators in an ACR educational activity or an activity jointly sponsored by the ACR must appropriately disclose any financial relationship with a commercial organization that may have an interest in the content of the educational activity. The following planners, presenters, and evaluators have disclosed no financial interests, arrangements or affiliations in the context of this activity: Presenters Catherine Amlie-Lefond, MD Paul Babyn, MD Hank Baskin, MD Gregory Bates, MD Richard Benator, MD, FACR Ellen Benya, MD George S. Bisset, III, MD Sarah Bixby, MD Susan Blaser, MD, FRCPC Leah Braswell, MD Alan Brody, MD Stephen Brown, MD Brandon Brown, MD, MA Dorothy I. Bulas, MD, FACR Michael J. Callahan, MD Maria Calvo-Garcia, MD Christopher I. Cassady, MD, FAAP Gulraiz Chaudry, MBChB, MRCP, FRCR Jonathan M. Chen, MD Edith Y. Cheng, MD, MS Jeanne S. Chow, MD Matthew Cooper, MD James E. Crowe, MD Michael Cunningham, MD Heike E. Daldrup-Link, MD, PhD Kassa Darge, MD, PhD Michael DiPietro, MD William B. Dobyns, MD Stephen Done, MD, FAAP Lane F. Donnelly, MD Jerry R. Dwek, MD Monica Epelman, MD Hedieh Eslamy, MD Ken Feldman, MD, FAAP Laura Fenton, MD G. Peter Feola, MD Mark Ferguson, MD Donald Frush, MD, FACR Michael Gelfand, MD Robert Gillies, PhD Adam Goldin, MD, MPH Damien Grattan-Smith, MBBS S. Bruce Greenberg, MD C. Matthew Hawkins, MD Shilpa Hegde, MBBS Richard Heller, MD Marta Hernanz-Schulman, MD, FACR, FAAP Anastasia L. Hryhorczuk, MD Mark J. Hogan, MD, FSIR Richard Hopper, MD David Horn, MD, MS Giselle Ishak, MD Ramesh Iyer, MD Siddharth Jadhav, MD Diego Jaramillo, MD, MPH Geetika Khanna, MD, MS

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Paul Kleinman, MD, FAAP Rajesh Krishnamurthy, MD Kamlesh Kukreja, MD Neha Kwatra, MBBS, MD Edward Lee, MD, MPH Matthew Lungren, MD Prakash Masand, MD Jenny McBroom, RT, RDMS M. Beth McCarville, MD Amy Mehollin-Ray, MD, FAAP Mariana Meyers, MD Arthur Meyers, MD David Mirsky, MD Joelle Moreno, JD Beverley Newman, BSc, MBBCH, FACR Jason Nixon, MD Robert Orth, MD, PhD Hansel Otero, MD Jeffrey Otjen, MD Randolph Otto, MD Siddharth Padia, MD Angelisa Paladin, MD Susan Palasis, MD Harriet Paltiel, MD, CM Ephraim Parent, MD, PhD Marguerite T. Parisi, MD, MS Shawn Parnell, MD Manish Patel, DO Grace Phillips, MD Andrada Popescu, MD John Racadio, MD Cynthia Rigsby, MD, FACR Richard Robertson, MD Eva Rubio, MD Maura Ryan, MD Carrie Schaefer, MD Victor Seghers, MD, PhD Susan Sharp, MD Dennis Shaw, MD Giri Shivaram, MD Manrita Sidhu, MD Akosua Sintim-Damoa, MD Jennifer Soares, MD Arta-Luana Stanescu, MD Lisa States, MD Peter J. Strouse, MD, FACR Jonathan Swanson, MD Paul Thacker, MD Mahesh Thapa, MD Kristen Thomas, MD S. Ted Treves, MD Shreyas Vasanawala, MD, PhD Stephan Voss, MD, PhD Ghassan Wahbeh, MD Daniel Wallihan, MD Edward Weinberger, MD Jason Weinman, MD Sjirk Westra, MD Klane White, MD, MSc Matthew Whitehead, MD Shi-Joon Yoo, MD



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Planning Committee/Presenter Teresa Chapman, MD, MA R. Paul Guillerman, MD Ethan A. Smith, MD Staff Angela R. Davis, CAE The presenters and content reviewer listed below have disclosed the following relevant financial relationships. Potential conflicts have been resolved. Name Disclosure Adam Alessio, PhD GE Healthcare, Research Grants Dianna M.E. Bardo, MD Koninklijke Philips NV, Consultant & Honoraria and Thieme Publishing, Royalties Brian D. Coley, MD, FACR Elsevier, Royalties Jonathan Dillman, MD Siemens Medical Solutions USA, Research Grants and Bracco Imaging, Research Grants Steven Don, MD Carestream, Inc., Research Grants and FUJIFILM Medical Systems, Research Grants Matthew Goette, PhD Philips Healthcare, Salary David B. Larson, MD, MBA Cincinnati Children’s Hospital, Intellectual Property Arnold Carl Merrow, MD Amirsys/Elsevier, Consultant and Royalties Helen Nadel, MD, FRCPC International Atomic Energy Agency, Consultant Michael Riccabona, MD GE, Honoraria and Siemens, Honoraria Mike Richardson, MD Barbones Books, Owenrship Erika Rubesova, MD Siemens, Honoraria Keith J. Strauss, MSc, FAAPM, FACR Philips Medical, Inc., Consultant Alexander J. Towbin, MD Amirsys, Inc, Royalties, Merge Healthcare, Ownership/partnership and Guerbet, Other Andrew T. Trout, MD Philips Healthcare, Honoraria Edward Yang, MD, PhD Corticometrics LLC, Consultant The scientific presenters at the 2015 Annual Meeting have indicated their applicable disclosures at the beginning of their abstracts. ACKNOWLEDGEMENTS The Society for Pediatric Radiology gratefully acknowledges the support of the following companies in presenting the 58th Annual Meeting and Postgraduate Course: Agfa HealthCare Bayer HealthCare Elsevier EOS imaging GE Healthcare Guerbet LLC Imorgon Medical, LLC lifeIMAGE National Decision Support Company Philips Healthcare ScanMed of Resonance Innovations LLC Siemens Healthcare Toshiba America Medical Systems ZONARE Medical Systems As of January 29, 2015


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PROGRAM SCHEDULE The Society for Pediatric Radiology Postgraduate Course 2015 Ethan A. Smith, MD and Alexander J. Towbin, MD, Course Directors Visualize the Future Monday, April 27, 2015 7:00 – 8:00 a.m. 7:00 a.m. – 5:00 p.m. 7:45 – 7:50 a.m. 7:50 – 8:00 a.m. 8:00 – 9:50 a.m. 8:00 – 8:10 a.m. 8:10 – 8:20 a.m. 8:20 – 8:30 a.m. 8:30 – 8:40 a.m. 8:40 – 8:50 a.m. 8:50 – 9:00 a.m. 9:00 – 9:10 a.m. 9:10 – 9:20 a.m. 9:20 – 9:50 a.m. 9:50 – 10:10 a.m. 10:10 a.m. – 12:00 p.m. 10:10 – 10:20 a.m. 10:20 – 10:30 a.m. 10:30 – 10:40 a.m. 10:40 – 10:50 a.m. 10:50 – 11:00 a.m. 11:00 – 11:10 a.m. 11:10 – 11:20 a.m. 11:20 – 11:30 a.m. 11:30 a.m. – 12:00 p.m. 12:00 – 1:15 p.m. 12:00 – 1:15 p.m. 1:15 – 3:05 p.m. 1:15 – 1:25 p.m. 1:25 – 1:35 p.m. 1:35 – 1:45 p.m.

Continental Breakfast Registration Welcome and Introduction Brian D. Coley, MD, FACR Course Overview Ethan A. Smith, MD and Alexander J. Towbin, MD FETAL IMAGING Eva I. Rubio, MD and Mariana L. Meyers, MD, Moderators Cortical Dysplasias and Implications in Postnatal Life David M. Mirsky, MD Sorting Out Posterior Fossa Fluid Collections Matthew T. Whitehead, MD Fetal Orbits and Ears Maria A. Calvo-Garcia, MD Spinal Dysraphism Imaging and Postnatal Correlation: Where Are We Now? Dorothy I. Bulas, MD, FACR CDH: What’s on the Horizon? Amy R. Mehollin-Ray, MD Prenatal Diagnosis of Congenital Chest Anomalies Akosua Sintim-Damoa, MD Fetal Intestinal Obstruction: Prenatal/Postnatal Correlation Eva I. Rubio, MD Prenatal Urinary Tract Dilatation: What to Tell the Pediatricians? Mariana L. Meyers, MD Q&A with RSNA Diagnosis Live™ Break MUSCULOSKELETAL IMAGING Robert Orth, MD, PhD and Mahesh M. Thapa, MD, Moderators Hip Dysplasia: What the Orthopedist Wants to Know Klane K. White, MD Infection Imaging Robert Orth, MD, PhD Ultrasound of Shoulder Dysplasia Mahesh M. Thapa, MD Pediatric Temporomandibular Joint Imaging Arthur Meyers, MD US Guided Joint Injections Jeffrey P. Otjen, MD Skeletal Dysplasia Shawn E. Parnell, MD Posterolateral Corner Injuries Siddharth P. Jadhav, MD Vascular Malformation Intervention Giridhar M. Shivaram, MD Q&A with RSNA Diagnosis Live™ Lunch On Your Own AAWR Lunch Women in Radiology Including Challenges & Climbing the Ladder to Success Jeanne Hill, MD, Meryle Eklund, MD and Melissa Hilmes, MD CARDIAC IMAGING S. Bruce Greenberg, MD and Prakash M. Masand, MD, Moderators Aortopathy Associated with Congenital Heart Disease Prakash M. Masand, MD Cardiopulmonary Disease Shilpa V. Hegde, MD Abdominal complications associated with congenital heart disease Shi-Joon Yoo, MD


1:45 – 1:55 p.m. 1:55 – 2:05 p.m. 2:05 – 2:15 p.m. 2:15 – 2:25 p.m. 2:25 – 2:35 p.m. 2:35 – 3:05 p.m. 3:05 – 3:25 p.m. 3:25 – 5:15 p.m. 3:25 – 3:35 p.m. 3:35 – 3:45 p.m. 3:45 – 3:55 p.m. 3:55 – 4:05 p.m. 4:05 – 4:15 p.m. 4:15 – 4:25 p.m. 4:25 – 4:35 p.m. 4:35 – 4:45 p.m. 4:45 – 5:15 p.m. 5:15 p.m. Tuesday, April 28, 2015 6:00 a.m. 7:00 – 8:00 a.m. 7:00 a.m. – 5:00 p.m. 7:50 – 8:00 a.m. 8:00 – 9:50 a.m. 8:00 – 8:10 a.m. 8:10 – 8:20 a.m. 8:20 – 8:30 a.m. 8:30 – 8:40 a.m. 8:40 – 8:50 a.m. 8:50 – 9:00 a.m. 9:00 – 9:10 a.m. 9:10 – 9:20 a.m. 9:20 – 9:50 a.m. 9:50 – 10:10 a.m. 10:10 a.m. – 12:00 p.m. 10:10 – 10:20 a.m. 10:20 – 10:30 a.m.

The Brain: Prenatal and Postnatal Effects of Congenital Heart Disease Dianna M. E. Bardo, MD Cardiomyopathy in Muscular Dystrophy Daniel Wallihan, MD Pregnancy and Congenital Heart Disease Siddharth P. Jadhav, MD Acquired Heart Disease in Adults with Congenital Heart Disease Andrada R. Popescu, MD Prognostic Imaging in Congenital Heart Disease S. Bruce Greenberg, MD Q&A with RSNA Diagnosis Live™ Break CHEST IMAGING Alan S. Brody, MD and Ramesh S. Iyer, MD, Moderators How to Image and Describe Congenital Lung Malformations Paul Thacker, MD How to Image Pulmonary Hypertension Alan S. Brody, MD How to Evaluate and Interpret BPD in Neonates Matthew L. Cooper, MD How to Dynamically Image the Lungs and Airways in Children Edward Y. Lee, MD, MPH Pediatric Chest Wall Masses Ramesh S. Iyer, MD I Found a Lung Nodule on CT – What is the Chance It Could Be Cancer? Sjirk J. Westra, MD Functional Vascular Imaging with Focus on Ablavar Mark R. Ferguson, MD The Radiologic Work Up of a Child with Suspected Diffuse Lung Disease Jennifer J. Soares, MD Q&A with RSNA Diagnosis Live™ Adjourn SPR Research and Education Foundation Fun Run – Underwritten by Texas Children’s Hospital (Entrance fee is $25 and includes a T-shirt) Continental Breakfast Registration Welcome and Announcements Ethan A. Smith, MD and Alexander J. Towbin, MD ONCOLOGICAL IMAGING I Paul S. Babyn, MD and Andrew T. Trout, MD, Moderators FDG-PET: Techniques, Pediatric Variants Andrew T. Trout, MD Whole Body MR: Techniques and Staging in Oncology Monica Epelman, MD Whole Body MR vs. PET/CT for Staging of Children with Cancer Heike E. Daldrup-Link, MD, PhD Whole Body MRI of Vascular Malformations Arnold Carl Merrow, MD PET-MR: Technique and Clinical Cases Victor J. Seghers, MD, PhD Cancer Predisposition Syndromes Paul S. Babyn, MD NF and MPNST: Evaluation with PET and MR Helen R. Nadel, MD, FRCPC Screening for and Assessment of Osteonecrosis in Oncology Patients Sue C. Kaste, DO Q&A with RSNA Diagnosis Live™ Break & Exhibits ONCOLOGICAL IMAGING II Stephan D. Voss, MD, PhD and Ethan A. Smith, MD, Moderators Abdominal MRI Protocols in Pediatric Oncology Jonathan R. Dillman, MD Update on RECIST and Staging of “Common” Pediatric Tumors Ethan A. Smith, MD

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10:30 – 10:40 a.m. 10:40 – 10:50 a.m. 10:50 – 11:00 a.m. 11:00 – 11:10 a.m. 11:10 – 11:20 a.m. 11:20 – 11:30 a.m. 11:30 a.m. – 12:00 p.m. 12:00 p.m.

Pediatric Renal Tumors – Update from COG Geetika Khanna, MD, MS Pediatric Lymphoma – Update from COG Stephan D. Voss, MD, PhD Quantitative Nuclear Medicine Imaging in Oncology Susan E. Sharp, MD Diffusion and Perfusion MR in Pediatric Oncology Shreyas S. Vasanawala, MD, PhD Contrast Enhanced Ultrasound in Pediatric Oncology M. Beth McCarville, MD Nuclear Medicine Therapy in Pediatric Oncology Neha S. Kwatra, MD Q&A with RSNA Diagnosis Live™ Adjourn Postgraduate Course

The Society for Pediatric Radiology Annual Meeting Program 2015 Brian D. Coley, MD, FACR, Program Director Teresa Chapman, MD, MA and R. Paul Guillerman, MD, Workshop Directors Visualize the Future Wednesday, May 14, 2014 12:05 – 1:15 p.m. 12:05 – 1:15 p.m. 3D 12:05 – 1:15 p.m.

1:20 p.m. 1:30 – 2:30 p.m.

2:30 – 3:00 p.m. 3:00 – 3:30 p.m. 3:50 – 4:10 p.m. 3:50 – 4:10 p.m. 3:50 – 4:10 p.m. 3:50 – 4:10 p.m. 3:30 – 3:50 p.m. 3:50 – 5:10 p.m. 3:50 – 4:10 p.m. 4:10 – 5:10 p.m.

Lunch Read with the Experts Lunch (attendance is limited; first come-first serve basis) Dianna M.E. Bardo, MD and Jeffrey C. Hellinger, MD, Moderators Supported by, Philips Healthcare, Siemens Healthcare, Vital MR Protocol Lunch Session (attendance is limited; first come-first serve basis) Jesse Courtier, MD and Rajesh Krishnamurthy, MD, Moderators Supported by, Philips Healthcare, Siemens Healthcare, Toshiba America Medical Systems Welcome Brian D. Coley, MD, FACR Edward B. Neuhauser Lecture Radiomics and Radiogenomics Robert J. Gillies, PhD Chair, Department of Cancer Imaging and Metabolism H. Lee Moffitt Cancer Center Tampa, Florida Pediatric Ultrasound: An International Perspective Michael Riccabona, MD WFPI Sharing Resources Dorothy I. Bulas, MD, FACR, Moderator WFPI - Diverse Resources, Shared Restraints Dorothy I. Bulas, MD, FACR WFPI - Educational Collaboration Kassa Darge, MD, PhD Radiology Outreach Strategies Hansel Otero, MD Closing Comments Dorothy I. Bulas, MD, FACR Breaks & Exhibits Scientific Session I-A: Oncology & Nuclear Medicine (concurrent) Robert Orth, MD, PhD and Marguerite T. Parisi, MD, MS, Moderators PET/MR – Current State and Future Directions Victor J. Seghers, MD, PhD Scientific Papers - Oncology & Nuclear Medicine

Paper #: 001

4:10

Yang

Paper #: 002

4:20

Sher

Paper #: 003

4:30

Sher

Clinical Equivalence of PET/MRI- and PET/CT-Acquired Brain Exams in Children with Epilepsy. Performance of PET/MR in the Assessment of Pediatric Histiocytoses: A prospective study Comparison of Lesion Detection and Staging in Pediatric Lymphoma between PET/CT and PET/MR in a Tertiary Pediatric Hospital: A Prospective Study

Pediatr Radiol (2015) 45 (Suppl 1):S1–S246 Paper #: 004

4:40

Sher

Paper #: 005

4:50

Tijerin Bueno

Paper #: 006

5:00

Kaste

3:50 – 5:10 p.m.

S15 Comparison of Standardized Uptake Values between PET/CT and PET/MR in Pediatric Lymphoma: A Prospective Study Whole Body MRI in children with Cancer Predisposition Syndromes The Role of Chest Computed Tomography (CT) as a Surveillance Tool in Children with Neuroblastoma

Scientific Session I-B: Gastrointestinal (concurrent) Michael J. Callahan, MD and Kristen Thomas, MD, Moderators Appendicitis: Trends in Diagnosis and Treatment from a Surgeon’s Perspective Daniel J. Ledbetter, MD Scientific Papers – Gastrointestinal

3:50 – 4:10 p.m. 4:10 – 5:10 p.m. Paper #: 007

4:10

Parekh

Paper #: 008 Paper #: 009

4:20 4:30

Dao Leschied

Paper #: 010

4:40

Bailey

4D-flow Imaging of the Portal Venous System in Children and Young Adults – A Feasibility Study Ultrasound as a definitive imaging predictor of midgut volvulus Inter-Radiologist Agreement for CT Scoring of Pediatric Splenic Injuries and Effect on an Established Clinical Practice Guideline Ultrasound Elastography for Diagnosis of Liver Disease in Obese Children


4:50 5:00

Orth Orth

Diagnostic performance and predictive findings of ultrasound for perforated pediatric appendicitis Searching for certainty: Findings predictive of appendicitis in equivocal ultrasound exams

5:10 p.m. 5:15 – 6:15 p.m. 6:15 – 7:30 p.m. Wednesday, April 29, 2015 6:45 – 8:00 a.m. 6:30 a.m. – 5:00 p.m. 7:00 – 8:20 a.m. 7:00 – 7:05 a.m. 7:05 – 7:20 a.m. 7:20 – 7:40 a.m. 7:40 – 8:00 a.m. 8:00 – 8:20 a.m.

7:00 – 7:05 a.m. 7:05 – 7:15 a.m. 7:15 – 7:20 a.m. 7:20 – 7:35 a.m. 7:35 – 7:50 a.m. 7:50 – 8:05 a.m. 8:05 – 8:20 a.m. 7:00 – 7:20 a.m.

Adjourn Awards Ceremony Gold Medalist, Pioneer Honoree, Presidential Recognition Award, Honorary Member Award, Singleton-Taybi Award, Heidi Patriquin Awards and Jack O. Haller Award Welcome Reception

Continental Breakfast Registration Sunrise Sessions (concurrent) TOOLS FOR PROCESS IMPROVEMENT: LEARNING THE ABCs Eva I. Rubio, MD, Moderator Introduction Introduction to QA/PI Terminology and Approaches Hedieh K. Eslamy, MD Concepts of High Reliability David B. Larson, MD, MBA Tools in QA/PI: What Works and What Doesn’t Eva I. Rubio, MD The Role of Leadership in QA/PI Lane F. Donnelly, MD CHILD ABUSE: IN THE COURTROOM Paul K. Kleinman, MD, FAAP, Moderator Introduction Child Abuse in the Courtroom: An Introduction to the Law Joelle Moreno, JD Child Abuse Pediatricians in Court Ken Feldman, MD, FAAP Course Case Vignettes Paul K. Kleinman, MD, FAAP Expert Witness in the Courtroom Stephen L. Done, MD Osteogenesis Imperfecta and Other Diseases Both True and Untrue Jerry R. Dwek, MD Discussion, Question and Answer CONTRAST-ENHANCED ULTRASOUND Kassa Darge, MD, PhD Safety of US Contrast Agents Kassa Darge, MD, PhD


S16

7:20 – 7:40 a.m.

Contrast Enhanced Ultrasound in Pediatric Oncology M. Beth McCarville, MD Application of CEUS in Blunt Abdominal Trauma Harriet J. Paltiel, MD, CM Application of CEUS for Pediatric Inflammatory Bowel Disease Jonathan R. Dillman, MD Question and Answer

7:40 – 8:00 a.m. 8:00 – 8:15 a.m. 8:15 – 8:20 a.m.

IMAGE GENTLY: UPDATE ON RADIATION DOSE RECORDING, REPORTING AND MONITORING: MEANINGFUL USE OR USELESS MEANING? Donald P. Frush, MD, FACR, Moderator Update on Radiation Dose Analytics: Meaningful Use or Useless Meaning? Introduction Donald P. Frush, MD, FACR General Dose Metrics Keith J. Strauss, MSc, FAAPM, FACR Modality Dose Estimation Metrics CT Keith J. Strauss, MSc, FAAPM, FACR New Digital Radiography Exposure Indicators and ACR Dose Index Registry for Digital Radiography Steven Don, MD Fluoroscopy Marta Hernanz-Schulman, MD, FACR, FAAP Interventional Radiology Bairbre Connolly, MD Radiation exposures in Pediatric Nuclear Medicine and Molecular Imaging Updates - S. Ted Treves, MD Risk Benefit Communication R. Paul Guillerman, MD Question and Answer PEDIATRIC THORACIC IMAGING Edward Y. Lee, MD, MPH and Beverley Newman, MBBCH, FACR, Moderators How to Deal with Breathing Motion Artefact and Atelectasis in Pediatric Chest CT Beverley Newman, MBBCH, FACR How to Do and Interpret CT for Interstitial Lung Disease in Childhood Alan S. Brody, MD How to Address the Incidental Pulmonary Nodule in a Child Sjirk J. Westra, MD When and How to Do Non-Cardiovascular Chest MRI in Children Edward Y. Lee, MD, MPH How and When to Use Chest Ultrasound in Children Monica Epelman, MD Question and Answer Scientific Session II-A: Fetal/Neonatal (concurrent) Erika Rubesova, MD and Eva I. Rubio, MD, Moderators Evidenced Based Value of Fetal MRI Edith Y. Cheng, MD, MS Scientific Papers – Fetal/Neonatal

7:00 – 7:10 a.m. 7:10 – 7:15 a.m. 7:15 – 7:23 a.m. 7:23 – 7:31 a.m. 7:31 – 7:39 a.m. 7:39 – 7:47 a.m. 7:47 – 7:55 a.m. 7:55 – 8:10 a.m. 8:10 – 8:20 a.m. 7:00 – 8:20 a.m. 7:00 – 7:12 a.m. 7:12 – 7:24 a.m. 7:24 – 7:36 a.m. 7:36 – 7:48 a.m. 7:48 – 8:00 a.m. 8:00 – 8:20 a.m. 8:30 – 10:40 a.m. 8:30 – 8:50 a.m. 8:50 – 10:40 a.m. Paper #: 013

8:50

Basta

Paper #: 014 Paper #: 015 Paper #: 016

9:00 9:10 9:20

Estroff Estroff Starr


9:30 9:40

Hughes Ponrartana

Paper #: 019 Paper #: 020 Paper #: 021 Paper #: 022

9:50 10:00 10:10 10:20

Rubesova Garel Barnewolt Saul

Paper #: 023

10:30

Neelavalli

Fetal stomach position predicts neonatal outcomes in isolated left-sided congenital diaphragmatic hernia Normative biometrics for fetal ocular growth using volumetric MRI reconstruction Correlation of fetal cerebellar measurements on US and MRI Placenta Accreta: Critical Diagnosis for the Pregnant Patient and Challenging Diagnosis for the Pediatric Radiologist Morbidly Adherent Placenta: An Imaging Score to Improve Antenatal Diagnostic Accuracy Sex-related Differences in the Fetal Programming of the Axial Skeleton Fetal Skeletal Development using Ultrasound Imaging Fetal bronchocele: imaging features and significance Choledochal Cyst in the Fetus: Can we make and accurate diagnosis and what does it mean? Hypoplastic Left Heart Syndrome and the Nutmeg Lung Pattern in Utero: Cause and Effect Relationship or Prognostic Indicator? In vivo Magnetic Resonance Angiography of fetal vasculature


8:30 – 10:40 a.m.

Scientific Session II-B: Cardiovascular (concurrent) Rajesh Krishnamurthy, MD and Daniel Wallihan, MD, Moderators Cardiac Imaging and Decision Making: A Surgeon’s Perspective Jonathan M. Chen, MD Scientific Papers – Cardiovascular

8:30 – 8:50 a.m. 8:50 – 10:40 a.m. Paper #: 024 Paper #: 025

S17

8:50 9:00

Paper #: 026 9:10

Golriz Bahouth

Appiawiah

Paper #: 027

9:20

Noel

Paper #: 028

9:30

Krishnamurthy

Paper #: 029

9:40

Krishnamurthy


9:50 10:00

Vasanawala Lyons

Paper #: 032

10:10

Bardo

Paper #: 033

10:20

Botelho

Paper #: 034

10:30

Ali

8:30 – 10:40 a.m.

Left main-stem bronchus compression after aortic arch Reconstruction Use of CT and MR in Neonatal and Infantile Congenital Heart Disease: Change in Practice Patterns with Advent of New Generation CT Scanner. The role of stress perfusion cardiac MRI in the evaluation of pediatric patients with suspected coronary arterial abnormalities Regadenoson as a Pharmacologic Stressor in Cardiac Magnetic Resonance Imaging in Congenital and Acquired Pediatric Heart Disease: Initial Experience Accurate Quantification of Cardiac Biomechanics in Pediatric population: Respiratory Triggered High Temporal Resolution (RT-HTR) Myocardial Tagging in Cardiac MRI Prospective Evaluation of Circumferential and Longitudinal Strain in Asymptomatic Children with Dual Ventricles who underwent Single Ventricle repair: comparison to Single LV, Single RV and Normal Hearts Freebreathing Cardiovascular MRI with Ferumoxytol Comparison of Respiratory-Triggered (RT) 3D Cine Steady-State Free Precession Cardiac MRI with Standard 2D Cine Imaging and Magnetic Resonance Angiography in Congenital Heart Disease (CHD) Pseudo ECG-gating: a new technique to achieve axial scan mode for dose reduction in cardiac CT Accelerated segmented and real-time aortic flow sequences compared with standard 2D phase contrast MR in children The pitfall of gadofosveset trisodium associated paradoxical negative enhancement on MR steady-state imaging in an animal model

Scientific Session II-C: ALARA (concurrent) Steven Don, MD and Keith J. Strauss, MSc, FAAPM, FACR, Moderators Image Gently: Where We’ve Benn and Where We’re Going Donald P. Frush, MD, FACR Scientific Papers – ALARA

8:30 – 8:50 a.m. 8:50 – 10:40 a.m. Paper #: 035

8:50

Rao

Paper #: 036

9:00

Creeden


9:10 9:20 9:30

Kaplan Goerner Baad


9:40 9:50

Parikh Phelps

Paper #: 042

10:00

Infante

Paper #: 043

10:10

Martinez-Rios

Paper #: 044

10:20

Parikh

Snapshot of radiation exposure contribution of scout abdomen radiograph in common pediatric fluoroscopic procedures. Pre-procedural scout radiographs may be unnecessary for routine pediatric fluoroscopic examinations. Lead Gonad Shields: Good or Bad for Patient Radiation Exposure? Table top Fluoroscopy: To Shield or Not to Shield Effect of comfort pads and incubator design on radiation dose and image quality of chest radiographs in neonates. Radiation Dose Reduction by Indication Directed Focused z-Direction Coverage for Neck CTs Pediatric Chest CT at Chest Radiograph Doses: When is the ultralow-dose chest CT clinically appropriate? Image quality in sinogram affirmed iterative reconstruction (SAFIRE) at low doses – is there a point of diminishing returns? Diagnostic Accuracy of Computed Tomography (CT) using Knowledge-based Iterative Reconstruction (KIR) versus Hybrid Iterative Reconstruction (HIR) in Combination with Reduced Tube Voltage (kV) for the Diagnosis of Acute Appendicitis in Children. Academic Pediatric versus Community General Radiologist Preference and Performance using Reduced Tube Voltage and Hybrid Iterative Reconstruction Protocols in Pediatric Abdominal CT for Appendicitis


S18 Paper #: 035

8:50

Rao

Paper #: 045

10:30

Buchmann

10:40 – 11:00 a.m. 11:00 a.m. -12:00 p.m.

Snapshot of radiation exposure contribution of scout abdomen radiograph in common pediatric fluoroscopic procedures. Image gently lessons for community hospitals performing pediatric abdomen and pelvis computed tomography

11:20 a.m. – 12:00 p.m.

Break & Exhibits Scientific Session III-A: Public Policy, Healthcare, Education, Technology (concurrent) Richard E. Heller, III, MD, MBA and David B. Larson, MD, MBA, Moderators Adult Learning Mahesh M. Thapa, MD Scientific Papers - Public Policy, Healthcare, Education, Technology


11:20 11:30

Fefferman Reid

Paper #: 048

11:40

Nicholas

Paper #: 049

11:50

Zewdneh

11:00 – 11:20 a.m.

11:00 a.m. -12:00 p.m.

Virtual radiology rounds: Adding value in the digital era Learning, Technology and Intellectual Property: A Survey of the Philosophies and Practice of our Trainees and Peers Flipping the Classroom: Preparing Radiology Residents for Independent Pediatric Radiology Call Using the iPad Ultrasound Tutorials in Under 10: The Addis Ababa Experience

11:20 a.m. – 12:00 p.m.

Scientific Session III-B: Genitourinary (concurrent) Michael Riccabona, MD and Damien Grattan-Smith, MBBS, Moderators Is There a Role for MR Urography Without Quantitative Functional Analysis? Damien Grattan-Smith, MBBS Scientific Papers – Genitourinary


11:20 11:30

Chu Grattan-Smith


11:40 11:50

Bedoya Bedoya

11:00 – 11:20 a.m.

12:00 – 1:30 p.m. 12:00 – 1:30 p.m. 12:00 – 1:30 p.m.

Renal iron deposition in pediatric anemia: comparison of sickle and non-sickle groups MR Urography and the Mean Transit Time in the evaluation of hydronephrosis in children Renal Diffusion Weighted MR Imaging in Children with Pelvicalyceal Dilation Can we reproduce the age dependency of the ADC values in patients with various urological abnormalities undergoing functional MR urography?

Lunch On Your Own jSPR Luncheon (advanced registration required) CT Protocol Session (attendance is limited; first come-first serve basis) Michael J. Callahan, MD, Sheila Berlin, MD and Keith J. Strauss, MSc, FAAPM, FACR, Moderators Supported by GE Healthcare, Philips Healthcare, Siemens Healthcare and Toshiba America Medical Systems Scientific Session IV-A : Gastrointestinal (concurrent) Gregory Bates, MD and Ethan A. Smith, MD, Moderators Current Issues and Inflammatory Bowel Disease Ghassan Wahbeh, MD Scientific Papers – Gastrointestinal

1:30 – 3:40 p.m. 1:30 – 1:50 p.m. 1:50 – 3:40 p.m. Paper #: 054 Paper #: 055 Paper #: 056

1:50 2:00 2:10

Orscheln Swenson Trout

Paper #: 057

2:20

Dillman

Paper #: 058

2:30

Bernbeck

Paper #: 059

2:40

Shin

Paper #: 060

2:50

Phelps


3:00 3:10

Starr Mollard

Appendiceal diameter: Are CT and sonographic measurements interchangeable? MRI Findings of the Normal Appendix in Children: New Reference Standard MR as a rapid secondary assessment for suspected appendicitis following equivocal sonography: Feasibility and patient preference assessment Implementation of a Rapid Noncontrast MRI Protocol for Use in Children with Equivocal Appendicitis: a Clinical Effectiveness Study Diffusion and Post Contrast MRI for Evaluation of Acute Appendicitis: The Stanford Experience Comparison of Shear Wave Velocities on Ultrasound Elastography between Different Machines and Acquisition Depths ; A Phantom Study Quantitative Ultrasound Elastography for Pediatric Liver Disease: Can shear wave speed be reliably estimated from a single image? Shear wave Elastography (SWE) of the normal and fibrotic pediatric liver MR Enterography (MRE) Under the Age of 10 Years

Pediatr Radiol (2015) 45 (Suppl 1):S1–S246 Paper #: 054 Paper #: 063

1:50 3:20

Orscheln Ehman

Paper #: 064

3:30

Schweiger

1:30 – 3:40 p.m.

S19 Appendiceal diameter: Are CT and sonographic measurements interchangeable? Fused Color Map Diffusion Weighted and T2 Images versus Contrast Enhanced Imaging for the Detection of Path-Proven Bowel Inflammation in Pediatric MR Enterography MR colonography with diffusion weighted imaging (DWI) in children and adolescents with inflammatory bowel disease (IBD): Do we really need intravenous contrast?

Scientific Session IV-B: Chest (concurrent) Jason Weinman, MD and Edward Y. Lee, MD, MPH, Moderators Update on ChILD R. Paul Guillerman, MD Scientific Papers – Chest

1:30 – 1:50 p.m. 1:50 – 3:40 p.m. Paper #: 065 Paper #: 066

1:50 2:00

Crowe Choi

Paper #: 067

2:10

Martinez-Rios


2:20 2:30 2:40

Stein Singh Yu

Paper #: 071

2:50

Manning

Paper #: 072

3:00

Chan


3:10 3:20

Dodd Lyons

Paper #: 075

3:30

Clarke

3:40 – 4:00 p.m. 4:00 – 5:30 p.m.

The Elusive Right Aortic Arch Comparison of Image Quality and Radiation Dose between High-Pitch and Low-Pitch Spiral Chest CT in Young Children Knowledge-based Iterative Reconstruction versus Hybrid Iterative Reconstruction: Effect on Image Quality and Diagnostic Confidence in Reduced kV Pediatric Oncologic Chest CT. CT characterization of normal pediatric lung parenchymal density Hyperinflation of the left anterior basal segment: a new sign of pectus excavatum severity A Retrospective Review of Pulmonary Hemorrhage in Neonatal Respiratory Distress Syndrome - imaging, course, complications, and long term outcomes High Resolution Computed Tomography of Follicular Bronchiolitis in the Pediatric Population, a 5 Year Review of Imaging Findings with Pathologic Correlation Pediatric Aspirated Foreign Body: Adding digital tomosynthesis improves sensitivity compared to conventional radiographs Dynamic Volume CTA of the Airway and Vasculature in Children: Technical Report Low-dose free breathing dynamic volume CT Angiography in the evaluation of innominate artery compression of the trachea. Safe Performance of MRI in Children with Active Cardiac Devices

Break & Exhibits Scientific Session V-A: Musculoskeletal (concurrent) Sarah D. Bixby, MD and Peter J. Strouse, MD, FACR, Moderators Future Directions in Hip Imaging Sarah D. Bixby, MD Scientific Papers – Musculoskeletal

4:00 – 4:20 p.m. 4:20 – 5:30 p.m. Paper #: 076

4:20

Breen

Bone Age Assessment Practices Among SPR Members: Infants Are Not Just Little Children.

Paper #: 077

4:30

Bulman


4:40 4:50

Jaremko Jaremko


5:00 5:10 5:20

Breen Bixby Chauvin

Pilomatricoma: A Common Clinical and Pathological Entity, yet a Rare Radiological Diagnosis Beyond the central slice: spectrum of 3D ultrasound appearances in normal and dysplastic hips. Inter-scan fidelity of 3D acetabular surface models generated from 3D ultrasound for infant hip dysplasia. Imaging Findings and Clinical Outcomes in Traumatic Hip Dislocation in Pediatric Patients. Osteoid Osteoma of the Hip in Pediatric Patients Detection of Inflammatory Sacroiliitis in Children: Is MR contrast necessary?

4:00 – 5:30 p.m.

Scientific Session V-B: Genitourinary (concurrent) Jonathan R. Dillman, MD and Jeanne S. Chow, MD, Moderators Current Imaging Management of UTI and Future Trends Randolph K. Otto, MD Scientific Papers – Genitourinary

4:00 – 4:20 p.m. 4:20 – 5:30 p.m. Paper #: 083

4:20

Parad

Normal Sonographic Renal Length and Growth in Children without Vesicoureteral Reflux (VUR)


S20 Paper #: 083 Paper #: 084

4:20 4:30

Parad O’Hara

Paper #: 085

4:40

Darge

Paper #: 086

4:50

Thacker

Paper #: 087

5:00

Towbin


5:10 5:20

Phewplung Bruno

5:30 p.m. Thursday, April 30, 2015 6:45 – 8:00 a.m. 6:30 a.m. – 5:00 p.m. 7:00 – 8:20 a.m.

7:00 – 7:10 a.m. 7:10 – 8:20 a.m.

7:00 – 7:15 a.m. 7:15 – 7:45 a.m. 7:45 – 7:55 a.m. 7:55 –8:05 a.m. 8:05 – 8:20 a.m. 7:00 – 8:20 a.m. 7:00 – 7:20 a.m. 7:20 – 7:40 a.m. 7:40 – 8:00 a.m. 8:00 – 8:20 a.m. 7:00 – 7:20 a.m. 7:20 – 7:40 a.m. 7:40 – 8:00 a.m. 8:00 – 8:20 a.m. 7:00 – 7:20 a.m. 7:20 – 7:40 a.m. 7:40 – 8:00 a.m. 8:00 – 8:20 a.m. 8:30 – 10:50 a.m.

Normal Sonographic Renal Length and Growth in Children without Vesicoureteral Reflux (VUR) Feasibility of superb microvascular imaging (SMI), an advanced noninvasive US technique to detect vesicoureteral reflux in pediatric patients without bladder catheterization or contrast use. Contrast Enhanced Voiding Urosonography With Intravesical Administration of Ultrasound Contrast Agent (Optison®) for Vesicoureteral Reflux Detection in Children: regulatory processes, procedural optimization and preliminary safety results Distress during voiding cystourethrograms: objective assessment using the brief behavioral distress scale Does internal complexity predict malignancy in cyctic adnexal lesions in pediatric and adolescent females? Clinical significance of incidentally discovered renal cysts in pediatric patients ARFI Evaluation of the Kidneys in Ex Premature Infants: A Preliminary Study

Adjourn Continental Breakfast Registration Sunrise Sessions (concurrent) WORKSHOP FOR PROCESS IMPROVEMENT Eva I. Rubio, MD, Moderator David B. Larson, MD, MBA and Hedieh K. Eslamy, MD, Speakers Introduction and Explanation of the Workshop A theoretical problem with a department of radiology will be provided. The moderator-led discussion will allow the audience to define/frame the problem, the goal for improvement, the factors to measure and appropriate tools for metric assessment and for achieving goals. REVIEWING FOR PEDIATRIC RADIOLOGY Peter J. Strouse, MD, FACR, Moderator Introduction: Overview of the Review Process Peter J. Strouse, MD, FACR Reviewing for Pediatric Radiology - Evaluation of a Manuscript Geetika Khanna, MD, MS and Cynthia K. Rigsby, MD, FACR From a Reviewer’s Perspective: How I Approach a Review Ethan A. Smith, MD What Happens After Review: How to Make Your Reviews Most Helpful to the Editors Peter J. Strouse, MD, FACR Question and Answer PROFESSIONALISM IN PEDIATRIC RADIOLOGY Stephen D. Brown, MD, Moderator Professionalism in Modern Healthcare Anastasia L. Hryhorczuk, MD Error Disclosure in Radiology: Background, Rationale, and Process Considerations Stephen D. Brown, MD Developing Professionalism in Radiology Training Brandon P. Brown, MD, MA Question and Answer FETAL IMAGING: TRICKS OF THE TRADE Erika Rubesova, MD, Moderator Fetal Lung Volume Measurements - Why, When & How? Amy R. Mehollin-Ray, MD Fetal Echogeniticies - Ultrasound and MRI Mariana L. Meyers, MD Congenital Diaphragmatic Hernia Christopher I. Cassady, MD, FAAP Question and Answer INITIATIVES OF THE ACR COMMISSION AND THE ABR ACR Initiatives Marta Hernanz-Schulman, MD, FACR, FAAP ABR Initiatives Lane F. Donnelly, MD New Horizons in Pediatric Imagin Heike E. Daldrup-Link, MD, PhD Question and Answer Scientific Session VI-A: Interventional Radiology/Gastrointestinal (concurrent) Leah Braswell, MD and Mark J. Hogan, MD, FSIR Moderators


8:30 – 8:50 a.m.

S21

Interventional Oncology Siddharth Padia, MD Scientific Papers – Interventional Radiology/Gastrointestinal

8:50 – 10:50 a.m. Paper #: 090 Paper #: 091 Paper #: 092 Paper #: 093

8:50 9:00 9:10 9:20

Yang Mahboubi Simmons Patel

Paper #: 094

9:30

Teplisky


9:40 9:50

Keller Shellikeri

Paper #: 097

10:00

Moudgil


10:10 10:20

Patel Pugmire


10:30 10:40

Connolly Shellikeri

8:30 – 10:50 a.m.

Intussusceptions occurring less than 6 months of age: An observational study. Failed intussusception reduction in children: Radiologic, surgical and pathologic correlation A Double Balloon Catheter for the Treatment of Intussusception Quality and Readability of Online Patient Information Regarding Sclerotherapy for Venous Malformations Ultrasound, clinical and cholangiographic findings correlation of biliary complications in pediatric liver transplant recipients Plastic Bronchitis Imaging and Intervention: Early Experience Embolization of intracranial arteriovenous malformations is associated with faster rate of perfusion in the peri-nidal region on color-coded quantitative digital subtraction angiography. Diagnostic Utility of Ultrasound-guided Fine Needle Aspiration Biopsy in the Evaluation of Pediatric Thyroid Nodules Experience with Stuck Implantable Venous Port Catheters in Children Percutaneous abscess drainage in young patients with Crohn’s Disease: its role and predictors of treatment success. Pediatric percutaneous nephrostomy – a Multi-Center Experience. Quantification and comparison of renal perfusion in percutaneous renal angioplasty patients with Renal Artery Stenosis and control group using syngo iFlow at a single Pediatric Institution.

Scientific Session VI-B: Musculoskeletal (concurrent) Arthur Meyers, MD and Jerry R. Dwek, MD, Moderators Future Impact of Adolescent Sports Injuries and How Pediatric Radiologists Can Help Mitigate Long Term Effect of Sports Activity When Skeletally Immature Jerry R. Dwek, MD Scientific Papers – Musculoskeletal

8:30 – 8:50 a.m. 8:50 – 10:50 a.m. Paper #: 102

8:50

Winfeld

Paper #: 103

9:00

Kassis

Paper #: 104

9:10

Chauvin

Paper #: 105

9:20

Radhakrishnan


9:30 9:40

Eutsler Winfeld

Paper #: 108

9:50

Bao

Paper #: 109

10:00

Swenson

Paper #: 110

10:10

Bedoya

Paper #: 111

10:20

Kim


10:30 10:40

Francavilla Delgado

10:50 – 11:10 a.m. 11:10 a.m. -12:30 p.m.

Differentiating os acromiale from normal developing acromial ossification center using magnetic resonance imaging Evaluation of Pediatric Long Bone Tumors with a single 3D T2-Weighted Fat-Water Separated Sequence Articular Cartilage Changes within the Medial Femoral Condyle in Obese Children As Compared to Normal Weight Children Characteristic MR imaging findings in patients with cold exposure – making a case for phalangeal microgeodic disease Localized Scleroderma in Children: Musculoskeletal MRI Findings Utilization of chemical shift MRI in the diagnosis of disorders affecting pediatric bone marrow Can bone marrow edema serve as a predictive biomarker for bone collapse in patients with corticosteroid-induced epiphyseal osteonecrosis? Chronic Avulsive Changes of the Inferior Patella in Children with Spastic Diplegia: Frequency and Imaging Appearance. Diffusion-Tensor Imaging and Tractography of the Knee in Children Reveals Changes in Physeal and Metaphyseal Architecture due to Age, Gender, and Height Patellofemoral instability (PFI) in children Part I: T2 relaxation time of the patellar cartilage in PFI, compare with patients without PFI and correlate with morphological grading of cartilage damage Diffusion tensor imaging of vastus muscle injury in children: preliminary data DTI of the femoral and tibial physes and metaphyses. Can it be done at 1.5T?

Break & Exhibits Scientific Session VII-A: Public Policy, Healthcare, Education, Technology (concurrent) Richard M. Benator, MD, FACR and C. Matthew Hawkins, MD, Moderators


S22

11:10 – 11:30 a.m. 11:30 a.m. – 12:30 p.m.

A Pediatric Radiology Perspective on The Affordable Care Act Jonathan O. Swanson, MD Scientific Papers – Public Policy, Healthcare, Education, Technology

Paper #: 114

11:30

Pierce

Paper #: 115

11:40

Sharafinski

Paper #: 116

11:50

Goldfisher

Paper #: 117

12:00

Dasgupta


12:10 12:20

Greer Snow

11:10 a.m. -12:30 p.m.

Pre-authorization Processes Have No Effect on Outcomes in Pediatric Patients Undergoing Knee MRI Ordered by Pediatric Orthopedic Physicians. Pediatric Gastrojejunostomy Tube Replacement: Can Improved Communication Reduce Image Guided Procedures After Hours? Prospective Randomized Study of Utilizing Music Therapy For Reducing Patient Anxiety During Pediatric Ultrasound Utilization of Exposure Index for Dose Optimization in Pediatric Chest and Abdominal Radiography ED/Outpatient X-ray Request Form Audit (How to Make a Good Situation Better!) Assessing the quality of outside institution abdominal CTs performed for pediatric patients presenting to the emergency department of an academic children’s hospital.

11:30 a.m. – 12:30 p.m.

Scientific Session VII-B: Fetal/Neonatal (concurrent) Shawn E. Parnell, MD and Christopher I. Cassady, MD, FAAP, Moderators Fetal Neck Masses Christopher I. Cassady, MD, FAAP Scientific Papers – Fetal/Neonatal

Paper #: 120

11:30

Jones

Paper #: 121

11:40

Saul

Paper #: 122

11:50

Krishnamurthy

Paper #: 123

12:00

Meyers

Paper #: 124

12:10

Victoria

Paper #: 125

12:20

Jones

11:10 – 11:30 a.m.

12:30 – 1:45 p.m. 12:30 – 1:45 p.m. 1:45 – 3:55 p.m.

The inferior cavoatrial junction is located at the T8-T9 disc space level on CT: implications for umbilical venous catheter placement. Ultrasound for Central Vascular Catheter and Endotracheal Tube Position in the NICU A Pilot Study Macrocyclic gadobutrol – Pharmacokinetics, safety and efficacy evaluation of a body weighted standard dose in newborns, infants and toddlers 25 mmHg, or >50% systemic. Secondary PHtn is far more common than idiopathic, but idiopathic PHtn is often rapidly fatal. Most common secondary causes are cardiac disease; persistent pulmonary hypertension or neonatal lung disease; and lung disease or hypoxia. Pulmonary venooclusive disease and pulmonary capillary hemangiomatosis are rare causes that may be suggested by imaging, but require lung biopsy. Echocardiography is the usual screening method. Tricuspid regurgitant velocity >2.5 m/s is often used for further evaluation. RVH further supports the diagnosis. Echocardiography also identifies intracardiac causes of PHtn. Correlation for PAP is fair to good between echocardiographic and angiography which remains the gold standard. In addition to the most


accurate measurement of PAP pulmonary vascular resistance can be measured and pulmonary venous anatomy assessed. CXRs may show increased MPA and pruned vessels. MRI can provide comprehensive evaluation. PAP accuracy on MR is similar to echocardiography. Cardiac MR requires highly expert interpreters. CT also provides a useful assessment. Three suggestions for the reading room: Although the CXR will rarely be the first indication of PHtn, the diagnosis should be suggested if the appearance is suggestive. PHtn requires different treatment from most other cardiac disease. On CT or MRI, the pulmonary artery should be about the same size as the ascending aorta. A ratio of clearly greater than 1:1 suggests possible PHtn. A CT scan that shows mosaic attenuation without air trapping on expiratory images should raise the possibility of PHtn. CDH: What’s on the Horizon? Amy R. Mehollin-Ray, MD

This 10-min presentation will review current prenatal imaging measures of disease severity in congenital diaphragmatic hernia, such as the ultrasound-based lung-head ratio (LHR) and the MRI-based observed-to-expected total fetal lung volume (O/E-TFLV). An overview of the recent literature on prenatal diagnosis of congenital diaphragmatic hernia will conclude the presentation, including prognostic markers in fetal tracheal occlusion (FETO) therapy, the prediction of pulmonary hypertension and the prospective identification of a hernia sac. As fetal tracheal occlusion is employed to improve survival in patients with severe CDH, fetal therapy centers are evaluating imaging findings for their ability to predict survival, including a recent study from four centers in Europe that assessed stomach position in fetuses with CDH with and without FETO. Recent studies have assessed imaging markers for the prediction of pulmonary hypertension both on power Doppler ultrasound (contralateral vascularity index – CVI) and on MRI (modified McGoon index). The presence of a hernia sac covering the herniated abdominal contents has been shown to predict better survival and less frequent ECMO and patch repair. There are prenatal imaging findings which can suggest the presence of a hernia sac, which can be added to the radiologist’s imaging checklist. Prenatal Diagnosis of Congenital Chest Anomalies Akosua Sintim-Damoa, MD

Prenatal diagnosis of fetal chest lesions is important in determining the severity of pulmonary hypoplasia. Early diagnosis enables parents to be adequately counseled and allows for potential avenues for fetal intervention. Several factors are critical in ensuring normal lung development. Adequate thoracic space, intrapulmonary fluid, fetal lung growth factors, amniotic fluid, and unimparied fetal breathing are all necessary for normal lung development. Fetal chest lesions can be subdivided into extrapulmonary and bronchopulmonary masses. Extrapulmonary lesions include congenital diaphragmatic hernia while bronchopulmonary masses can be further differentiated as parenchymal lesions or lesions secondary to tracheal or bronchial obstruction. Parenchymal lesions include congenital pulmonary airway malformation and bronchopulmonary sequestration. Lesions secondary to tracheal or bronchial obstruction include congenital lobar overinflation and congenital high airway obstruction. These intrathoracic lesions exert mass effect on adjacent structures and subsequently can lead to fetal hydrops and pulmonary hypoplasia. A systematic approach should be utilized when evaluating a fetal chest lesion. Although ultrasound is the first line modality in the assessment of fetal anomalies, MR can be helpful in providing additional details. If stomach, peristalsing bowel loops, or abdominal viscera can be discerned in the thoracic cavity, then congenital diaphragmatic hernia can be diagnosed. If discrete cysts are seen, then congenital pulmonary airway


malformation should be considered. With Color Doppler, if pulmonary arterial supply can be demonstrated, then CPAM should be considered. With systemic arterial supply, bronchopulmonary sequestration is the primary differential consideration. If the sonographic findings are unclear, MR may be helpful for further evaluation. Fetal Intestinal Obstruction: Prenatal/Postnatal Correlation Eva I. Rubio, MD

Fetal intestinal obstruction presents in myriad ways and at varying times during prenatal life. There is also a great deal of variability in the sensitivity and specificity associated with prenatal diagnosis of intestinal obstructive processes. This presentation will take a top to bottom approach describing findings by US and MRI, the current medical literature and the imaging pitfalls in assessing the fetal patient with intestinal obstruction. Proximal intestinal obstruction, to include primarily esophageal, gastric and duodenal atresia, may be the most well-described and generally straightforward category in terms of confirming the presence and level of diagnosis, although concomitant diagnoses, such as Down syndrome are VACTERL and are a significant consideration. Rare entities such as pyloric atresia, pyloric membranes and colonic mimics will be reviewed, in addition to the occurrence of false positive and false negative diagnoses. Mid intestinal obstruction diagnosis and counseling may be more complex, owing to difficulties in correctly determining the level of obstruction. The cases are less commonly associated with syndrome or other anomalies. The use of MRI for improved soft issue resolution and assessment of meconium signal is often beneficial, but misdiagnoses still occur, and often it is most prudent to counsel the family about a range of potential outcomes. Distal intestinal obstruction etiologies, defined as occurring at the distal ileum and beyond, are primarily comprised of atresias, cysts and cloacas/ anorectal malformations. MRI T1 weighted imaging, pitfalls and the role of standard measurements of colorectal diameter will be reviewed. Prenatal Urinary Tract Dilatation: What to Tell the Pediatricians? Mariana L. Meyers, MD

Urinary tract dilatation is frequently seen in fetuses by ultrasound and may indicate a spectrum of pathology. Different grading systems for hydronephrosis have been developed by different specialties without unification. Recently, a urinary tract dilatation classification consensus was created to be applied prenatally and postnataly with the objective of universalizing the grading of hydronephrosis. Here we will review the highlights of the new consensus, its importance, and briefly outline the risk- based management of prenatally diagnosed hydronephrosis after birth. Additionally, we will illustrate how prenatal MRI can be useful in identifying additional renal and urinary tract pathology not seen by ultrasound that may alter the prognosis and perinatal management.

MUSCULOSKELETAL IMAGING Hip Dysplasia: What the Orthopedist Wants to Know Keith S. White, MD

The term developmental dysplasia of the hip (DDH) indicates a spectrum of pathologies from stable acetabular dysplasia to frankly dislocated hips. Congruent reduction and stability of the femoral head are necessary for normal growth and development of the hip joint. Failure to diagnose DDH and treat in infancy can result in significant long-term disability. Early diagnosis can often be accomplished through thorough physical examination of all newborns. While universal screening is advocated in many countries, in the United States selective screening by ultrasound is indicated for those children with risk factors for DDH (family history, breech presentation, and unstable hip examination at the initial newborn examina¬tion). Ultrasound screening for infants with risk factors for

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DDH is rec¬ommended at age 6 weeks. Pavlik harness treatment for children with unstable hips or significant dysplasia on ultrasound is continued until the hips stabilize and show concentric reduction on imaging. With time, diagnosis and treatment evolve to ac¬commodate the growing child. Infants who fail to respond to nonoperative manage-ment may require more extensive interventions. Post-operative imaging by CT or MRI is commonly employed to ensure adequate reduction of the hip. In the adolescent evaluation, better definition and localization of bony deficiency as well as evaluation of cartilage and labral integrity are critical to treatment strategies. Infection Imaging Robert Orth, MD, PhD

The clinical presentation of children with musculoskeletal infections is variable, especially in infants and young children. Imaging has an important role in confirming diagnosis, localizing abnormalities, and directing biopsy, aspiration, and debridement. The initial imaging study in children with suspected musculoskeletal infection is radiography, primarily to exclude other abnormalities, most commonly trauma. MRI is the most appropriate definitive imaging study. Ultrasound may be used to screen for joint effusions and to evaluate for fluid collections in cases where soft tissue infection is favored over osteomyelitis. Bone scintigraphy has a very limited role and is reserved for patients with contraindications to MRI. Because localization of involved sites is often difficult on clinical examination, MRI should start with a large field-of-view (FOV) STIR or other fluid-sensitive sequence. For small infants, the FOV can extend from the feet to the upper lumbar spine, which allows evaluation of the lower extremities, pelvis, and lower spine (which can be a source of referred pelvic and lower extremity pain). Once the site and extent of abnormality is localized from the large FOV images, more focused pre-contrast imaging with T1-weighted and fluid-sensitive sequences is performed. Gadolinium-enhanced imaging may be necessary to identify intraosseous, intra-articular, subperiosteal, and soft tissue collections that may benefit from intervention, as well as to identify growth cartilage infection of the unossified epiphyses and apophyses. Except for young infants (below 18–24 months of age) gadolinium-enhanced imaging is unnecessary if bone marrow signal is normal, unless extra-osseous fluid collections are suspected. Ultrasound of Shoulder Dysplasia Mahesh M. Thapa, MD

Cancer predisposition syndromes (CPS) encompass a variety of familial and hereditary cancers and a multitude of gene abnormalities with high risk of cancer. Advances in genetics have led to improved understanding and earlier detection of these syndromes and now offers the potential for preclinical diagnosis of associated tumors. Imaging has become an essential component of the clinical approach to management of many CPSs and the care of children with a confirmed diagnosis or suspected of having a CPS. Some common and uncommon CPSs in children will be reviewed including neurofibromatosis type 1, Beckwith-Wiedemann syndrome, multiple endocrine neoplasia, Li-Fraumeni syndrome, von Hippel– Lindau syndrome, and familial adenomatous polyposis. Radiologists should be familiar with these syndromes, their commonly associated tumors, and the imaging techniques often used, and the current screening and surveillance recommendations to optimize the assessment of affected children. Imaging the Temporomandibular Joint in Pediatric Patients Arthur Meyers, MD

Imaging of the temporomandibular joint (TMJ) in children is most commonly done in the setting of juvenile idiopathic arthritis (JIA). Approximately half of children with JIA have at least one sign or symptom attributable to their TMJs and many more have pathologic findings on

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MRI. The TMJ is a complex synovial joint with a fibro-cartilaginous disc between the mandibular condyle and the glenoid fossa of the temporal bone. As in other synovial joints JIA can cause inflammatory synovial hypertrophy with eventual cartilage loss and osseous erosions. Destructive changes at the TMJ may also cause limited motion and disc subluxation or dislocation. These changes lead to a variety of symptoms including decreased chewing ability, jaw and facial pain, headaches, and malocclusion. Additionally, children with JIA may also develop growth abnormalities at the mandibular condyle causing disfiguring facial deformities which limit jaw opening. MRI of the TMJ allows for detection of synovial hypertrophy, osseous erosions, disc subluxation/dislocation, and allows assessment of joint motion. Using MRI for early detection and monitoring of TMJ disease in children with JIA aids clinicians in the use of local and systemic treatments with the goal of preventing long-standing joint disease and craniofacial deformities. US Guided Joint Injections Jeffrey P. Otjen, MD

Cancer predisposition syndromes (CPS) encompass a variety of familial and hereditary cancers and a multitude of gene abnormalities with high risk of cancer. Advances in genetics have led to improved understanding and earlier detection of these syndromes and now offers the potential for preclinical diagnosis of associated tumors. Imaging has become an essential component of the clinical approach to management of many CPSs and the care of children with a confirmed diagnosis or suspected of having a CPS. Some common and uncommon CPSs in children will be reviewed including neurofibromatosis type 1, Beckwith-Wiedemann syndrome, multiple endocrine neoplasia, Li-Fraumeni syndrome, von Hippel–Lindau syndrome, and familial adenomatous polyposis. Radiologists should be familiar with these syndromes, their commonly associated tumors, and the imaging techniques often used, and the current screening and surveillance recommendations to optimize the assessment of affected children.


needed for optimal long-term postoperative results and knee stability. The structures forming the posterolateral corner include lateral (fibular) collateral ligament, arcuate ligament, popliteus muscle and tendon, popliteofibular ligament, fabellofibular ligament and posterolateral capsule. Fibular collateral ligament, popliteus myotendinous complex and popliteofibular ligament are important stabilizers of the knee. Injuries to these and other structures will be discussed through case examples. Pitfalls of MRI will also be addressed. Conclusion: It is important to recognize posterolateral corner injuries accompanying other internal derangements of the knee so that they can be treated appropriately for optimal long-term surgical results and knee stability.

Vascular Malformation Intervention Giridhar Shivaram, MD

Pediatric vascular tumors (VTs) and vascular malformations (VMs) can be confusing entities both clinically and on imaging. These lesions are commonly misdiagnosed on diagnostic imaging studies, which can lead to inappropriate management, especially when there is additional uncertainty in the clinical diagnosis. However, by using a few simple clinical and imaging rules, the majority of VTs and VMs can be correctly classified and appropriate treatment can be selected. The purpose of this presentation is to present a simple and practical approach to the selection and interpretation of diagnostic imaging studies for VTs and VMs. Basic interventional radiology treatment options for their management will also be outlined.

CARDIAC IMAGING

Skeletal Dysplasias Shawn E. Parnell, MD

Aortopathy Associated with Congenital Heart Disease Prakash Masand, MD

The skeletal dysplasias are a large, complex group of disorders characterized by abnormal bone growth and short stature. The standard imaging modality for the diagnosis of skeletal dysplasias is the skeletal survey, and familiarity with its interpretation is important for the guidance of appropriate treatment and genetic testing. In this brief 10 min discussion, we will review the components of the skeletal survey, highlighting key imaging findings, appropriate nomenclature, and providing examples of several common dysplasias. The goal of this short discussion is to provide an organized approach for imaging interpretation of skeletal dysplasias.

INTRODUCTION: Bicuspid aortic valve is associated with coarctation and ascending aorta dilation. Abnormalities of the ascending aorta and aortic root are prevalent in other types of congenital heart disease such as single ventricle, truncus arteriosus, transposition of the great vessels, and tetralogy of Fallot amongst others. Connective tissue disorders like Marfans and Loeys-Dietz also predispose to aortic dilation and tortuosity which requires frequent follow-up imaging. The concept of aortic dilation related to these entities is rightly referred to as intrinsic aortopathy, rather than so called post-stenotic dilation. The ongoing dilation of the aortic root and ascending aorta may predispose to dissection and rupture . Further, if aortic insufficiency develops, it may lead to ventricular failure. DISCUSSION: Imaging of the aorta in the realm of CHD is usually performed using cross-sectional imaging techniques such as CT and MRI, with angiographic information provided after contrast administration. The recent developments in MR technology have ensured that aortic imaging can be performed using robust non-contrast sequences such as the spoiled gradient-recalled echo and the 3D SSFP (Steady state free precession) sequence , both commonly run with any basic cardiac MRI exam package. Advances in MR angiography allow beautiful images of the aorta to be acquired using free-breathing techniques, and the advent of blood-pool contrast has ensured superior contrast resolution. Whenever MRI cannot be performed, latest developments in scanner hardware allow CT angiography to be done at very low radiation doses. CONCLUSION: Aortic abnormalities are fairly common with underlying CHD and it is important to know the imaging techniques, parameters and criteria for a thorough evaluation of these patients. Further follow-up and surgical decision making is reliant upon the information provided by the Radiologist when intrinsic aortopathy is in question.

Posterolateral Corner Injuries Siddharth P. Jadhav, MD

Posterolateral corner injuries are being seen more commonly in pediatric patients with increased participation in competitive sports. Objectives: 1. To describe anatomy and normal variations of the posterolateral corner 2. To review imaging findings in posterolateral corner injuries through case examples 3. To discuss pitfalls of imaging Discussion: The anatomy of the posterolateral corner of the knee is complex. Normal variations and disagreement over attachments further complicate matters. Posterolateral corner injuries are being increasingly recognized in pediatric injuries with more involvement in competitive and contact sports as well as from increased use of MR imaging. They often accompany other internal derangements of the knee. Clinical evaluation of these at the time of injury may be limited due to significant joint effusion and swelling that results from associated injuries, usually anterior cruciate ligament tear. Repair of posterolateral corner injuries may be

Pediatr Radiol (2015) 45 (Suppl 1):S1–S246 Cardiopulmonary Disease Shilpa V. Hegde, MD

Congenital heart diseases are frequently associated with abnormalities of the airway and lungs. Extrinsic compression of the airway by vascular rings and slings are well known. However intrinsic airway abnormalities such as tracheal stenosis and tracheobronchomalcia are also often seen. Airway compression is also seen as a post-operative complication such as with placement of vascular stents. Lung abnormalities found with congenital heart disease are lung hypoplasia, lobar overinflation and horse shoe lung. Pulmonary artery and vein occlusion and pulmonary arterial hypertension are frequently associated with congenital heart disease. Pleural effusion secondary to abnormal lymphatic drainage is associated with congenital heart disease. Chest wall abnormalities such as scoliosis, pectus excavatum and diaphragmatic palsy effect respiratory function and increase the morbidity. Chest radiographs play an important role as a first line of investigation and demonstrate many of the abnormalities. Contrast enhanced CT and MRI are invaluable in the assessment of the mediastinal structures, pulmonary vasculature and parenchyma. Dynamic pulmonary CT is becomingly increasingly popular in diagnosing abnormalities of airway dynamics. This technique in particularly useful in the assessment of unstable patients and evaluation of severely stenotic airways where invasive procedures such as bronchoscopy is difficult or even impossible. Abdominal Complications Associated with Complex Congenital Heart Disease Shi-Joon Yoo, MD

Gastroenteric complications in patients with congenital heart disease increase morbidity and mortality. Some complications involve the abnormally developed organs, while others are associated with compromised circulation of otherwise normally developed organs. Necrotizing enterocolitis (NEC): NEC is associated with compromised abdominal circulation due to systemic-to-pulmonary arterial shunt, such as patent ductus arteriosus and Blalock-Taussig shunt, particularly in infants with a low birth weight. While abdominal radiographs provide the evidences of developed NEC, Doppler ultrasound or phase-contrast MR provides information regarding compromised abdominal circulation preceding NEC, Hepatic fibrosis: Right-side heart failure including Fontan operation results in hepatic congestion and fibrosis. As the liver function test is often normal despite severe hepatic damage, imaging assessment of the extent of hepatic damage is important. MR angiograms and phase-contrast imaging provide morphologic and hemodynamic changes of the liver. Protein losing enteropathy: Protein losing enteropathy is a catastrophic complication of Fontan operation. It is the result of cardiovascular compromise and lymphatic insufficiency. Phase-contrast MR or Doppler ultrasound may provide information regarding compromised intestinal blood flow, allowing detection of the disease in preclinical stage. Contrast-enhanced lymphangiography is an emerging technique for detection of leaking lymphatics. Midgut volvulus: Heterotaxy syndrome is associated with intestinal malrotation and at a high risk of midgut volvulus. Published data from large series suggest that imaging is required only for symptomatic patients and that prophylactic Ladd procedure is not required. Gastroesophageal reflux and vomiting: Approximately 15% of patients with right isomerism have hiatal hernia. Chest radiographs may prompt the diagnosis by showing the gas-filled gastric fundus in the thorax. When the patient presents with frequent respiratory infection, barium esophagography is recommended. The Brain: Prenatal and Postnatal Effects of Congenital Heart Disease Dianna M. E. Bardo, MD

Early growth and development of the brain begins with neurulation and cellular migration throughout fetal life and continues in stages, during which synapse connections are made, throughout infancy and early

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childhood. Synaptogenesis around the time of birth in the primary sensorimotor cortex is key for normal movement and sensation, at approximately 9 months successful connections in the parietotemporal association cortex are important in language and spatial attention, and those in prefrontal cortex between 2 and 3 years, are crucial in executive and integrative neurocognitive function. It is believed that the brain is most susceptible to injury during these times of peak growth. Growth and development of the brain in a fetus with congenital heart disease (CHD) may be altered perhaps due to inadequate perfusion via the placenta (two vessel umbilical cord), reduced cerebral perfusion limited by an obstructive lesion (HLHS, aortic arch hypoplasia or interruption), or perhaps increased cerebrovascular flow (large R to L shunts, PA atresia or TOF). Infants and young children with CHD may also suffer from poor brain growth and development secondary to a variety of factors including persistent hypoxia, multiple exposures to general anesthesia required for imaging, other diagnostic procedures, or surgical repair/palliation, or intraoperative cardiopulmonary bypass or peri operative ECMO. Insults which occur at crucial times in brain growth and development, from whatever cause, may lead to focal or global injury which may result in learning and mental disability, seizure activity, and behavior and learning problems, in children with CHD. Cardiomyopathy Associated with Muscular Dystrophies Daniel Wallihan, MD

Muscular dystrophy (MD) is a group of genetic disorders resulting in progressive weakness and dysfunction of the musculoskeletal system. Several of these conditions can also result in myocardial dysfunction. MD patients are now living longer due to improved treatment of associated pulmonary complications, historically the leading cause of death. This longer lifespan has resulted in cardiomyopathy becoming a leading cause of morbidity and mortality despite the limited demands placed on the heart due to relative immobility. Treatments exist which have been reported to delay the onset or slow the progression of cardiomyopathy in this population. However, many of the medications may result toxicity to other organs or have limited long term effects. The potential complications make early identification, grading the severity and monitoring progression of cardiac dysfunction of paramount importance. The cardiac pathology occurring in the muscular dystrophies is a dilated cardiomyopathy with pathogenesis depending on the type of cardiomyopathy. In the most common forms of MD, Duchenne and Becker MD, a defect in the synthesis of dystrophin leads to myocardial disease. The assessment of cardiac dysfunction is best performed with MRI. Decreasing left ventricular systolic function and increasing end-diastolic volume are the primary measures used to determine progression of cardiomyopathy. Many studies have suggested that following late gadolinium enhancement is also of great importance as it may be seen before the onset of measurable cardiac dysfunction and may predict a subgroup of patients who will have earlier onset or more rapid progression of cardiac disease. Many centers also use different forms of strain analysis to quantitate regional myocardial dysfunction. The imaging evaluation of cardiomyopathy associated with MD is of critical importance, often guiding care and leading to improved long term outcomes. Pregnancy and Congenital Heart Disease Siddharth P. Jadhav, MD

Background: Pregnant women with congenital heart disease are at increased risk for cardiac and neonatal complications Objectives: 1. To describe how pregnancy affects the cardiovascular system 2. To review congenital heart diseases that increase risk for a cardiac event in pregnancy 3. To discuss role of imaging Discussion: Congenital heart disease has become more prevalent in women of childbearing age. It represents about 75% of the heart disease seen in

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pregnancy in the developed world. During the course of pregnancy, hormonally mediated changes result in an increase in blood volume, red blood cell mass, and heart rate. Systolic subaortic ventricular function decreases near term and early postpartum. Different degrees of chamber enlargement have been observed. The risk of pregnancy depends on the underlying heart disease and factors such as ventricular and valvular function, functional class, and cyanosis. Acyanotic conditions, such as atrial and ventricular septal defects, usually cause no increased maternal or fetal risk. Similarly, surgically repaired cyanotic conditions such as tetralogy of Fallot usually cause no problems. The main problems arising from congenital heart disease are due to obstructive lesions, pulmonary hypertension or Eisenmenger’s syndrome. MRI (without gadolinium) should be considered if echocardiography is insufficient for diagnosis. Imaging is helpful for prognostication and also guides intrapartum and peripartum decision making. Conclusion: Hemodynamic changes during pregnancy can adversely affect maternal and fetal outcome in the setting of congenital heart disease. Imaging plays an important role in making management decisions in accordance with set guidelines. Acquired Heart Disease in Adults with Congenital Heart Disease: What to Image, How to Image, When to Image Andrada R Popescu, MD

Great achievements and major developments in pediatric cardiology, cardiac surgery and critical care have significantly decreased mortality in pediatric population with congenital heart disease. Mortality has shifted from childhood towards adulthood, with steady increase of age at death. Acquired coronary artery disease, arrhythmias, and heart failure are the leading causes of morbidity, hospitalization and mortality in adults with congenital heart diseases (ACHD). This is a review of main congenital heart disease associated acquired heart disease by cross sectional imaging including echocardiogram, computer tomography and cardiac MRI. Acquired heart disease in patients with tetralogy of Fallot, coarctation of aorta, transposition of great vessels, single ventricle physiology and pulmonary hypertension will be discussed. The role of cross sectional imaging with focus on computer tomography and magnetic resonance for detailed assessment and surgical planning will be discussed. Prognostic Imaging in Congenital Heart Disease S. Bruce Greenberg, MD

Surgical and medical management of children with congenital heart disease has resulted in an improved prognosis. Although mortality and morbidity is improved, both remain below that of the general public. Imaging can be used as a prognostic tool to predict increased morbidity and mortality. Ascending aorta size in patients with bicuspid aortic valve and collagen vascular disease guides the timing of future surgery. Children following surgery for coarctation of the aorta are susceptible to re-coarctation and aneurysm formation. CTA and MRA play an important role in detection of coarctation repair complications. Right ventricle progressive enlargement is the result of tetralogy of Fallot repair and pulmonary stenosis treated by valvotomy. Cardiac MRI guides the timing of valved pulmonary conduit placement in patients with chronic pulmonary regurgitation. Right ventricle size is prognostic for survival in patients with single ventricle physiology following Fontan palliation.

CHEST IMAGING How to Image and Describe Congenital Lung Malformations Paul Thacker, MD

Congenital lung anomalies represent a broad spectrum of developmental malformations of the lung parenchyma, venous drainage, and arterial supply. These lesions can present across a wide age range extending from


the prenatal period into adulthood. Thus, it is crucial for the pediatric radiologist to be aware of the most up-to-date imaging evaluation and descriptive terminology to ensure accurate and timely diagnosis, aiding in patient outcome optimization. This presentation aims to demonstrate the spectrum of these lesions which may be encountered in clinical practice. We will first discuss a simple algorithm for imaging as well as the strengths and weaknesses of each modality, emphasizing the latest advanced techniques in multidetector computed tomography and magnetic resonance imaging. We will then discuss each malformation in brief, stressing accurate description of each malformation as well as key findings that should be reported in order to aid treatment planning. Through this discussion, audience members will gain increased knowledge of the nuances of describing and imaging these relatively uncommon congenital anomalies. Imaging Pulmonary Hypertension Alan S. Brody, MD

PHtn can be defined as mean pulmonary arterial pressure (PAP) >25 mmHg, or >50% systemic. Secondary PHtn is far more common than idiopathic, but idiopathic PHtn is often rapidly fatal. Most common secondary causes are cardiac disease; persistent pulmonary hypertension or neonatal lung disease; and lung disease or hypoxia. Pulmonary venooclusive disease and pulmonary capillary hemangiomatosis are rare causes that may be suggested by imaging, but require lung biopsy. Echocardiography is the usual screening method. Tricuspid regurgitant velocity >2.5 m/s is often used for further evaluation. RVH further supports the diagnosis. Echocardiography also identifies intracardiac causes of PHtn. Correlation for PAP is fair to good between echocardiographic and angiography which remains the gold standard. In addition to the most accurate measurement of PAP pulmonary vascular resistance can be measured and pulmonary venous anatomy assessed. CXRs may show increased MPA and pruned vessels. MRI can provide comprehensive evaluation. PAP accuracy on MR is similar to echocardiography. Cardiac MR requires highly expert interpreters. CT also provides a useful assessment. Three suggestions for the reading room: Although the CXR will rarely be the first indication of PHtn, the diagnosis should be suggested if the appearance is suggestive. PHtn requires different treatment from most other cardiac disease. On CT or MRI, the pulmonary artery should be about the same size as the ascending aorta. A ratio of clearly greater than 1:1 suggests possible PHtn. A CT scan that shows mosaic attenuation without air trapping on expiratory images should raise the possibility of PHtn. Bronchopulmonary Dysplasia: How to evaluate and interpret BPD in neonates Matthew L. Cooper, MD

BPD, also known as chronic lung disease of infancy, is a disorder of lung injury and repair originally ascribed to positive pressure ventilation and oxygen toxicity. Since the introduction of surfactant replacement therapy for RDS, antenatal glucocorticoid treatment, and refinements in assisted ventilation, BPD is now uncommon in larger and more mature infants with gestational age exceeding 30 weeks or weighing more than 1200 g at birth, and survival has improved for the extremely low birth weight infants ( 5 cm), invasion of fat planes, heterogeneity, ill-defined margins, and edema surrounding the lesion are more suggestive of MPNSTs. FDG PET CT with dual time point imaging and SUV cut off of greater than 3.5 has been suggested to provide diagnostic and prognostic information in detecting malignant potential and lesions recommended for biopsy. Screening for and Assessment of Osteonecrosis in Oncology Patients Sue C. Kaste, DO

Survivors of childhood cancer are at increased risk for developing chronic conditions as a result of their disease and therapy. Osteonecrosis is a significant toxicity in pediatric oncology with growing recognition of its prevalence, impact on the patient’s life, and lack of standardization of diagnosis and intervention guidelines. Children treated with high dose and/or prolonged glucocorticoids as well as those aged older than 10 years at the time of therapy are the patient populations in whom osteonecrosis most frequently develops. As the glucocorticoid exposure is systemic, multi-joint involvement is typical. Though easily obtained and relatively inexpensive, radiographs are insensitive for identifying osteonecrosis in its earliest stages when interventions may be most effective in ameliorating the process. MR is the most sensitive available modality for detecting osteonecrotic lesions and will be the primary modality discussed in this presentation. Extensive lesions may be present and remain asymptomatic. Thus, recognizing the ‘at risk’ patient populations is necessary to develop screening protocols to identify these lesions early in their development in order to preserve joint function. MR-determined lesions occupying more than 30% of the femoral head frequently progress to collapse, even in young patients. Thus, diagnostic imaging is critical for its detection, characterization, follow-up for progression or healing and to assess the effects of intervention. This presentation is designed to provide a brief review of the pathophysiology of osteonecrosis, describe the ‘at risk’ patient groups, patterns of involvement, imaging characteristics and techniques used for detection.

ONCOLOGICAL IMAGING II Abdominal MRI Protocols in Pediatric Oncology Jonathan R. Dillman, MD

Magnetic resonance imaging (MRI) is increasingly used to evaluate benign and malignant abdominal tumors in children. This increased

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utilization likely relates to multiple factors, including recent increased emphasis on the potential harms of ionizing radiation, superior soft tissue contrast resolution compared to CT, and improving image quality. Roles of MRI in the assessment of pediatric abdominal masses include: initial characterization at the time of diagnosis, assessment of response to therapy, and surveillance for recurrent disease after the completion of treatment. The purpose of this talk is to present stateof-the-art clinical MRI techniques and protocols for the evaluation of pediatric abdominal masses, with an emphasis on liver and renal imaging. Coil selection, pulse sequence choices, artifact reduction, and selection of gadolinium-based contrast agent will be discussed. The roles of certain advanced MRI techniques (such as chemical shift and diffusion-weighted imaging) in assessing pediatric abdominal tumors will be presented as well.

Update on RECIST and Staging of “Common” Pediatric Tumors Ethan A. Smith, MD

Imaging plays a critical role in the care of pediatric oncology patients, especially those with solid tumors. Initial diagnosis and staging of tumors, often based primarily on imaging, assists oncologists and surgeons in establishing a treatment plan and allows for discussions with patient families regarding prognosis. Imaging also plays a vital role in following treatment response in patients undergoing chemotherapy and/or radiation therapy, as well as assessing for tumor recurrence after therapy. As such, staging systems have been developed for several pediatric solid tumors, and specific criteria for objectively measuring treatment response have also been established and revised. The objectives of this session will be to describe specific methods for measuring treatment response, including RECIST (Response Evaluation Criteria In Solid Tumors) and its newer iterations, as well as the World Health Organization (WHO) criteria. Additionally, specific staging systems for certain relatively common pediatric tumors will be presented, including Wilms tumor, neuroblastoma and hepatoblastoma.

Pediatric Renal Tumors - Update from COG Geetika Khanna, MD, MS

Renal tumors are the second most common abdominal malignancy in children. Though Wilms tumor is widely recognized as the most common renal malignancy in children, it is less well known that renal cell carcinoma (RCC) is the second most common renal tumor in children. This is followed by rhabdoid tumors, clear cell sarcomas, mesoblastic nephroma, and cystic nephroma. The presentation will provide a summary of the Children’s Oncology Group imaging experience with pediatric renal tumors. When a renal mass is discovered at sonography, the vasculature should be carefully evaluated for tumor thrombus. However, routine Doppler sonography for tumor thrombus evaluation after CT/MR evaluation is no longer recommended. CT and MR have comparable diagnostic accuracy for local staging of renal tumors, but MR is the preferred modality for children with multifocal, bilateral masses. Ascites beyond cul-de-sac and retroperitoneal hemorrhage have high specificity for tumor rupture, which implies stage III disease. Detection of lymph node metastasis remains limited by imaging. While nephrogenic rests show homogeneous enhancement and Wilms tumors tend to be more heterogeneous, imaging differentiation of the two remains challenging. Translocation morphology RCC is the most common subtype of RCC in children. Lymphatic/hematogenous spread is common at initial presentation of pediatric RCC, even in patients with local T1 disease. The current evidence on implications of pulmonary metastasis in this patient population will be summarized.


S68 Pediatric Lymphoma – Update from COG Stephan D. Voss, MD, PhD

Contrast Enhanced Ultrasound in Pediatric Oncology M. Beth McCarville, MD

Hodgkin lymphoma has served as a paradigm for the use of functional imaging to guide clinical management. Over the past decade, imaging in Hodgkin lymphoma has evolved from simply providing anatomic measurements to offering comprehensive functional imaging and metabolic characterization of sites of disease. This increasing use of functional imaging to guide clinical management necessitates a change in the current definition of response. This presentation will provide an overview of the current response criteria utilized in Hodgkin lymphoma, with emphasis on 18F-FDG PET/CT. In so doing, we will compare response criteria used by cooperative trials groups in Europe and the US. We will also discuss the increasing use of PET/MRI in place of PET/CT, and explore strategies to accomplish CT dose reduction during the multiple PET/CT and CT examinations performed on these patients. At the end of the session, the participant should have an improved understanding of the role functional imaging plays in Hodgkin lymphoma management, the strategies to harmonize response criteria between European and US cooperative groups, and the evolving use of other advanced hybrid imaging techniques to improve our management of these patients.

As cancer therapies become more targeted toward specific tumor markers there is a growing need for imaging modalities that go beyond an assessment of tumor morphology to monitor tumor response. Modalities that provide functional and quantitative information are gaining an increasingly important role in cancer imaging. The conversion of normal tissue to cancer depends on a complex interaction between altered metabolism, hypoxia, angiogenesis, proliferation, apoptosis and metastasis. There are numerous modalities that are available to image these various aspects of tumor biology including FDG PET imaging of tumor glucose metabolism, BOLD MRI of tumor hypoxia and diffusion MRI of tumor proliferation. Tumor angiogenesis can be measured by dynamic contrast enhanced MRI, dynamic contrast enhanced CT or dynamic contrast enhanced ultrasound (CEUS). In the pediatric population the most attractive of these angiogenesis imaging biomarkers is contrast enhanced ultrasound because it avoids exposure to ionizing radiation and the need for sedation. In this talk I will discuss the potential role of CEUS in measuring tumor blood flow in pediatric solid malignancies.

Quantitative Nuclear Medicine Imaging in Oncology Susan E. Sharp, MD

The review aims to provide up-to-date information on nuclear medicine therapy in pediatric cancers focusing on pediatric thyroid cancer and neuroblastoma. Neuroblastoma is the most common malignancy in infancy constituting approximately 30% infantile cancers. The high metaiodobenzylguanidine (MIBG) avidity and known radiosensitivity of neuroblastoma makes 131I-MIBG a potential therapeutic agent. There is objective response to 131I-MIBG therapy in ~30% patients and disease stabilization in another 30-40% of patients. Logistic and radiation safety considerations of MIBG therapy program as well as advances in dosimetry will be discussed. Thyroid cancer is a rare malignancy of childhood and accounts for 0.7% of all pediatric cancers, the vast majority of which are differentiated thyroid cancer. Even though only a few small studies of children treated with radioiodine are available, adult studies have demonstrated reduced risk of recurrence and mortality in patients with differentiated thyroid cancer with postsurgical residual disease. Dosage administration considerations and other practical aspects of radioiodine therapy in children will be outlined. Peptide receptor radionuclide therapy using labeled somatostatin analogues for neuroendocrine tumors and other miscellaneous radionuclide therapies will also be briefly discussed. Radiation risks related to radionuclide therapies, both to the treated children and the bystander risks will be outlined.

Nuclear medicine plays an important role in the evaluation of cancer patients, from initial diagnosis and staging to assessment of treatment response and follow-up after therapy. Standardized approaches for interpreting and reporting nuclear medicine studies are being developed to improve concordance between readers and better quantify treatment response. In FDG PET imaging of lymphoma, Deauville scoring has been shown to be an accurate and reproducible way to report interim scans performed after two cycles of chemotherapy, allowing identification of a cohort of Hodgkin Lymphoma patients with significantly better failure free survival rates. In I-123-MIBG imaging of neuroblastoma, Curie and SIOPEN scoring have been shown to have good interobserver concordance, allowing reproducible assessment of disease extent and response with good correlation to patient outcomes. An important advantage of PET over other imaging modalities is its ability to measure absolute regional radiopharmaceutical concentrations. Quantitative assessments of FDG PET scans (including measurements of SUVmax, percent change in SUVmax, metabolic tumor volume, and/ or tumor-to-non-tumor uptake ratios) have been studied to determine their ability to predict tumor necrosis and patient outcomes. These measurements have been variably shown to provide prognostic information in sarcoma patients.

Nuclear Medicine Therapy in Pediatric Oncology Neha Kwatra, MD

SCIENTIFIC PAPERS Diffusion and Perfusion MR in Pediatric Oncology Shreyas S. Vasanawala, MD, PhD

Qualitative and quantitative assessment of tumors beyond size measurements can be performed with MRI. The two most common techniques are diffusion imaging and perfusion imaging. A synopsis of core concepts of data acquisition and processing for both diffusion and perfusion imaging will be reviewed. For diffusion, impact of echo planar imaging and minimization of resulting artifacts will be covered along with processing of data with multiple diffusion sensitivities. For perfusion imaging, multiphasic data acquisition and the concept of a pharmacokinetic model will be reviewed. Then the most influential recent developments for each method will then be covered. For diffusion, inner volume imaging will be addressed. For perfusion, radial acquisition will be covered.

Authors are listed in the order provided. An author listed in bold identifies the presenting author.

Paper #: 001 Clinical Equivalence of PET/MRI- and PET/CT-Acquired Brain Exams in Children with Epilepsy

Erica Yang, MD, Texas Children’s Hospital, Houston, TX, [email protected]; Ramkumar Krishnamurthy, PhD, Nadia Mahmood, Victor Seghers, Andrew Sher, MD, Michael Paldino, MD.


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Disclosures: Victor Seghers indicated a relationship with Philips Healthcare as a consultant. All other authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: Integrated PET/MR scanners offer the potential to acquire diverse image contrasts - structural, functional, and metabolic - in a single examination. To reach its full potential, this technology will require robust attenuation correction (AC) algorithms based on MR images. The goal of this study was to compare the diagnostic accuracy of FDG-PET images of the brain processed according to an MR-based attenuation algorithm with that of images obtained using traditional CT-based AC. Methods & Materials: IRB approval and informed consent were obtained for this HIPAA-compliant, prospective study. All patients referred for clinical FDG-PET/CT exams of the brain at our institution were prospectively recruited to undergo an additional FDG-PET acquisition on an integrated PET/MR system (Philips Ingenuity). A bootstrap power calculation was performed to determine the number of patients required to detect a 10% difference in diagnostic accuracy (power: 0.8). Raw FDGPET images were processed according to standard, vendor-provided AC algorithms based on either MRI or CT images. Attenuation-corrected images acquired at PET/MR (MRAC) and PET/CT (CTAC) were interpreted by five expert readers. Readers were blinded to the method of attenuation correction as well as all other clinical and imaging data. Consensus between the readers at unblinded re-review of all imaging and clinical data was considered the gold standard. Any potential difference in the accuracy of MRAC compared to CTAC images was assessed using McNemar’s test. Cohen’s kappa was calculated to measure agreement between each reader’s interpretation of MRAC a nd CTAC. Results: The study population comprised 35 patients referred for a diagnosis of epilepsy (mean age: 11 years; range: 2–18 years), each with a paired PET/CT and PET/MR exam. Test characteristics of the blinded interpretation of the PET/MR- and PET/CT acquired AC images compared to gold standard are provided in Table 1. The accuracy of images processed according to an MRAC algorithm did not differ significantly from those obtained using CT-based AC (p>0.3). Overall, there was good intra-reader agreement between the interpretation of MRAC and CTAC (kappa range: 0.55–0.78). Conclusions: The accuracy of FDG-PET images generated by a vendorprovided MR-based AC algorithm was comparable to that of FDG-PET images processed by traditional CT-based AC. These results further support the use of integrated PET/MR systems in clinical practice. Table 1. Diagnostic performance of PET/MR and PET/CT for detection of seizure focus

Sensitivity (%) Specificity (%) Accuracy (%)

PET/MR 71.6 74.7 74.7

PET/CT 70.2 85.1 76.6

Paper #: 002 Performance of PET/MR in the Assessment of Pediatric Histiocytoses: A Prospective Study

Andrew Sher, MD, Radiology, Texas Children’s Hospital, Houston, TX, [email protected]; Victor Seghers, MD, PhD, Karen Lyons, MB, BCh, BAO, BMedSc, MRCPI, FFRRCSI, Matthew Goette, PhD, Ramkumar Krishnamurthy, PhD, Rajesh Krishnamurthy, et al. Disclosures: Victor Seghers indicated a relationship with Philips Healthcare as a consultant. All other authors have disclosed no financial interests, arrangements or affiliations in the context of this activity.

Purpose or Case Report: Analyze the performance of 18F-FDG PET/ MR compared to 18F-FDG PET/CT in Langerhans Cell Histiocytosis (LCH) and Rosai Dorfman Disease (RDD) . Methods & Materials: This prospective study had IRB approval and was HIPAA compliant. Following written informed consent 17 18FFDG PET/CT and 18F-FDG PET/MR examinations were performed on nine patients (six male, three female, mean age six; range: 7 months to 16 years) following a single-injection dual-imaging protocol. The indication was LCH in 10/17 exams and RDD in 7/17 exams. A freebreathing, 3D T1-weighted spoiled gradient echo sequence was used for MR attenuation correction and anatomic localization on PET/MR. Two readers blinded to clinical history assessed the anonymized data for metabolically active disease by consensus read. Lesions, defined as non-physiologic FDG uptake above surrounding normal tissue were classified as either disease or benign by the readers. Lesion detection rates and classification agreement between modalities were analyzed via Cohen’s Kappa statistic. Comparison between the two modalities and the reference standard (all available examinations and clinical history) were analyzed with the exact McNemar’s test. Results: 94 lesions were identified on PET/MR compared to 100 on PET/ CT. Of the 94 lesions identified on both exams there was concordant classification in 93 (99%), representing excellent agreement, κ = 0.97 (p 350 cm/s, inspiratory PSV >150 cm/s, and angle of deflection in the distal celiac >50° during expiration (Fig. 1) as more specific criteria. Other authors suggest assessing PSV in both supine and upright positions. Both sonographic and cross-sectional studies describe post-stenotic dilatation (Fig. 2) and presence of collaterals as supporting evidence. The classic description of a “J” or “hook” shape of the celiac artery was a finding primarily described on cross-sectional imaging (Fig. 2). Conclusions: Diagnosis of MALS is challenging and warrants a systematic imaging evaluation. For children, ultrasound should be the mainstay of radiological diagnosis. Sonographic diagnosis of MALS can be suggested with increased confidence when supine PSV >350 cm/s in expiration and >150 cm/s in inspiration. Velocities should decrease with upright position. Angle of deflection should be >50°. On CT or MR, severe compression and kinking of the proximal celiac artery should be evident. In the appropriate clinical setting, accurate radiological evaluation is key to the selection of candidates who are likely to benefit from surgical repair.

Poster #: EDU-038 Multimodal Review of Pediatric Vascular Variants: Rings and Slings Candace Scace, Hahnemann University Hospital, Philadelphia, PA, [email protected]; Jason Shames, Erica Poletto, Kathryn Jarrett, Eric Faerber, Mea Mallon Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: Many congenital anomalies can occur during aortic arch and pulmonary arterial development that can lead to chronic and sometimes life threatening disease in children. It may be challenging for the radiologist to differentiate among these variants. The purpose of this exhibit is to review, utilizing a multimodal approach, the imaging findings of variant aortic arch and pulmonary arterial development that lead to vascular rings and slings. Methods & Materials: A retrospective review of pediatric vascular variants was performed at St. Christopher’s Hospital for Children. A series of


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cases with abnormal aortic arch and pulmonary arterial anatomy were collected on multiple diagnostic modalities for review and presentation. Results: Examinations with variant aortic arch and pulmonary arterial anatomy in children were collected in multiple modalities, including X-ray, fluoroscopy, computed tomography and magnetic resonance imaging. The distinguishing features of these abnormalities are presented, including double aortic arch, double aortic arch with atretic left aortic arch, right aortic arch with aberrant left subclavian artery, right cervical/circumflex aortic arch with aberrant left subclavian artery, left aortic arch with aberrant right subclavian artery and pulmonary sling. These findings are contrasted with the normal embryologic development and appearance of the aortic arch and pulmonary vessels in children. Conclusions: A variety of congenital anomalies can affect aortic arch and pulmonary vascular anatomy leading to a vascular ring or sling in children. Knowledge of normal vascular development and the distinguishing imaging characteristics of these vascular anomalies can aid the radiologist in timely and accurate diagnosis.

radiologist would undoubtedly satisfy the ACR Imaging 3.0 initiatives and the essence of “meaningful use” in health care practice. Conclusions: Increased use of patient health records will alter the essence of the radiology report and empower patients and their respective families with simple, transparent and meaningful results and recommendations.

Poster #: EDU-039 Patient-and Parent-Facing Radiology Reports for the Pediatric Personalized Health Record Patrick Lai, Wayne State University School of Medicine, Detroit, MI, [email protected]; Matthew O’Brien, Chad Klochko, Marcus MacNealy, Safwan Halabi Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: The American College of Radiology (ACR) Imaging 3.0 initiative includes enhancement of radiology results reporting and patient understanding. With increased health consumer utilization of personalized health records, there is a unique opportunity for pediatric radiologists to provide a structured, image/resource-rich and readable radiology report in addition to developing a direct relationship with the pediatric patient and their family or guardian. This exhibit will discuss ideal and novel reporting practices in keeping with the ACR Imaging 3.0 iniatiatives for pediatric patients and their families. Methods & Materials: 1. Discussion of current radiology reporting requirements 2. Discussion of structured reporting methods based on body systems and imaging modalities 3. Discussion of verbiage that should and should not be included in the patient/parent-facing reports including common grammatical rules of thumb 3. Discussion of key image inclusion and annotation within the radiology report 4. Discussion of report impressions and recommendations including providing references and resources (this section will also include radiation dose reporting and references) 5. Discussion of documenting communication with the patient, family, and referring health provider 6. Discuss how to provide department and radiologist contact information to allow the patient and family to communicate questions and concerns 7. Discuss how radiology departments and radiologists can communicate safely and securely with patients and their families Results: Today’s radiology report will not suffice in the era of the personalized health record and health information transparency to the health consumer. There are numerous reporting structures and customizations that radiologists can implement to provide patients and families with the information they need to make informed decisions in regards to their health care. If executed correctly, the incorporation of structured reporting, simple verbiage and terminologies, key images, links to patient friendly medical resources, explanation of radiation risks, and providing direct communication methods to the radiology department and

Poster #: EDU-040 Pediatric Lucent Lesions of The Squamous Skull Nadja Kadom, MD, Boston University Medical School, Boston, MA, [email protected]; Gregory Fenton Purpose or Case Report: To show the imaging findings in anatomical variants, benign and malignant lucent lesions in the squamous portion of the skull in children Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Methods & Materials: This case series did not meet IRB human subjects research criteria. The presentation is HIPAA compliant. Images were retrieved from pediatric teaching files at our institution, including a historic teaching film-based teaching file that spans from 1950 to 2000 and that was recently digitized. Results: Plain skull radiographs in children are nowadays rarely indicated; therefore, our case collection of radiographic lucent skull lesions is rare. Some cases start with a CT survey image when no radiograph was available, one case starts with a reformatted 3D skull CT image. We are using the following classification for the cases in this series: 1) Anatomic variants, 2) Benign lesions, 3) Malignant lesions. A schematic cartoon of the calvarium illustrating the skin surface, subcutaneous fat, outer table, diploic space, inner table, subarachnoid space, falx and brain is shown. All lesions are presented first as a single image with a short history, followed by an annotated image with description of findings and differential diagnoses, followed by the diagnosis with pertinent clinical and radiographic information, and several cases will have cross-sectional imaging correlations from the same or a companion case. Here is the list of cases in this presentation: (1) Anatomic variants: Parietal foramina, Venous lakes, Arachnoid granulations. (2) Benign lesions: Copper beaten skull, Lückenschädel, Encephalocele, Epidermoid cyst (Figure 13), Leptomeningeal cyst, Eosinophilic granuloma. (3) Malignant lesions: Metastatic neuroblastoma. Conclusions: The differential diagnosis for pediatric lucent skull lesions is broad and includes malignancies, such as metastatic neuroblastoma, leukemia and lymphoma. Skull radiographs can


hold important clues to the diagnosis. Frequently a diagnosis can be made in conjunction with the clinical history. Plain skull radiographs in children are rarely indicated, but understanding plain film lesions can help in identifying them on cross-sectional imaging studies.

Poster #: EDU-041 Pediatric Spectral Doppler Waveforms Simplified Mesha Martinez, Children’s Hospital of Philadelphia, Philadelphia, PA, [email protected]; Richard Bellah, Sabah Servaes Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: Simplify interpretation of pediatric spectral Doppler waveforms and identify technical errors that may simulate pathology or cause an examination to be non-diagnostic/inaccurate. Methods & Materials: Extensive review of the literature was performed to assess the information available to pediatric radiologists pertaining to spectral Doppler waveforms and the pediatric patient. The information was compiled and simplified into a 5-step algorithm created to guide and/ or assist pediatric radiologists in interpreting spectral Doppler waveforms. Technical pitfalls that may mimic pathology or render an examination non-diagnostic/inaccurate are reviewed. Example cases are given to measure retention. Results: This educational exhibit will describe a systematic process for interpretation of Doppler waveforms. We will review the expected Doppler findings for clinical scenarios, including - but not limited to - normal children, children post liver and kidney transplant, children with renal artery stenosis and children with congenital heart disease. Conclusions: Interpretation of spectral Doppler waveforms is important in the care of pediatric patients and this educational exhibit serves to solidify this skill by outlining a five step approach with application of this method through examples cases with interactive questions.

Poster #: EDU-042 Review of Imaging Findings in Pediatric Patients with Auxilary Partial Orthotopic Liver Transplant (APOLT) Rama Ayyala, MD, Columbia University Medical Center, New York, NY, [email protected]; Mercedes Martinez, Tomoaki Kato, Steven Lobritto, Carrie Ruzal-Shapiro Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity.

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Purpose or Case Report: Auxilary partial orthotopic liver transplant (APOLT) is a treatment technique for patients with fulminant hepatic failure who may ultimately recover normal liver function. The patient receives a partial allograft while retaining part of the native liver. The method is devised to allow immunosuppression withdrawal once the native liver recover hepatic function without the patient needing longterm immunosuppression, which is typically needed in the standard posttransplant setting. The post procedure surveillance of vascular complications is complex given the need to evaluate vessels of the native liver as well as the allograft, which may be in an unusual location. The purpose this study is to review the imaging findings in pediatric patients with auxiliary partial orthotopic liver transplant. Methods & Materials: A retrospective review of the electronic medial records of four patients (age range 3 months - 7 years) who underwent APOLT between 2008 and 2014 was conducted. Information obtained includes date of surgery, reason for procedure, and preoperative and postoperative abdominal imaging studies performed. Multimodality imaging approach involving computed tomography (CT), ultrasound (US), and nuclear medicine was implemented to characterize imaging features, including complications. esults: Postoperative imaging in two patients show homogenous appearance of the transplant and native livers, consistent with recovery of native liver function with functioning transplant liver. One patient had failure of recovery of the native liver, resulting in involution, with normal imaging appearance of the functioning transplant liver. The last patient has imaging findings demonstrating rejection of the transplant liver with normal appearance of the functioning native liver. One patient had a postoperative biloma. Conclusions: Patients who have undergone APOLT experience various stages of hepatic function of the native and transplant livers. Postoperative imaging can be challenging given both the native and allograft liver vasculature needs to be optimally visualized. Imaging findings reflect this, therefore it is important to familiarize radiologists with these unique characteristics.

Poster #: EDU-043 Gray Matter Matters: Ultrasonography of Migrational and Organizational Brain Abnormalities Mark Baskin, Indiana University School of Medicine, Indianapolis, IN, [email protected]; Megan Marine, MD, Chang Ho, Boaz Karmazyn, MD Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: To illustrate the sonographic findings of several common migrational and organizational abnormalities affecting the neonatal brain. Methods & Materials: Ultrasonography is frequently used in the neonate to assess for ventricular enlargement and intracranial hemorrhage. Less commonly, sonography may uncover congenital anatomic anomalies such as disorders of neuronal migration and cortical organization. Radiologists at our institution gathered cases in the course of clinical practice that illustrate common migrational abnormalities of the neonatal brain, including heterotopic gray matter, lissencephaly, polymicrogyria, and schizencephaly. Whenever available, comparison prenatal sonograms and both pre- and postnatal MRI examinations were also evaluated. Results: We describe characteristic sonographic findings of several migrational and organizational abnormalities, including heterotopic gray matter, lissencephaly, polymicrogyria, and schizencephaly. We include representative sonographic images. In several cases, prenatal sonograms and/or MRI are included for comparison.


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Conclusions: Ultrasonography can characterize migrational and organizational anomalies during the newborn period. Recognition of some anomalies depends on knowledge of the normal appearance of the brain at different stages of prematurity.

Poster #: EDU-044 Surgical Intervention for Children and Young Adults with Sickle Cell Disease and Femoral Head Osteonecrosis; A Pictorial Essay Heather Gale, MD, Boston Medican Center, Boston, MA, [email protected]; Charles Colip, Bindu Setty, Akira Murakami, Ali Guermazi, Ilse Castro-Aragon

Methods & Materials: From a teaching file collection we chose representative cases demonstrating the use of ultrasound to characterize injuries to bone, cartilage, muscles and tendons. We correlated the ultrasound findings with other imaging modalities when necessary. Results: Illustration of the normal ultrasound anatomy of the immature bone and variety of injuries to the immature bone including injuries to the metaphysis, growth plate and cartilaginous fractures, fascial defect with muscle herniation, and injuries to the muscles and tendons. In selected cases we show correlation with radiographs, CT and MRI. Conclusions: Ultrasound has unique advantages in evaluation of the immature skeleton and can demonstrate injuries not detected by other imaging modalities.

Poster #: EDU-046 Spectrum of Radiologic Findings in Gorlin-Goltz Syndrome

Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: To illustrate the surgical interventions used to treat osteonecrosis in young patients with sickle cell disease and femoral head osteonecrosis. We will discuss current literature regarding surgical treatment and discuss potential complications using cases from our institution. We will show outcomes, including cases of patients who needed multiple procedures and arthroplasty, and those who have only required less invasive intervention such as core decompression and bone marrow grafting. Methods & Materials: This pictorial essay is IRB approved and HIPAA compliant. Informed consent requirements were waived. We reviewed records of patients with SCD ages 0-21 at radiologic diagnosis of femoral head osteonecrosis between January 1999 and December 2013. Demographics, hospital courses, and radiologic and surgical reports were collected. Results: Eight patients ages 16-19 at radiologic diagnosis of osteonecrosis who underwent surgical hip procedure were identified. The eight patients underwent 16 total procedures, including 1 resurfacing arthroplasty, 1 revision of partial hip arthroplasty, 7 total hip arthroplasties, and 7 bone marrow grafts and core decompressions. Five patients had bilateral procedures. The mean length of follow-up after the most recent procedure per hip was 3.38 years. Per current recommendations, bone marrow graft and core decompression were reserved for patients without femoral head collapse. Of the seven hips treated with bone marrow graft, one required subsequent total hip arthroplasty, which was performed within 1 year of initial procedure. Conclusions: Surgical intervention is required in many patients with osteonecrosis of the femoral heads, including young patients with sickle cell disease. In our pictorial review we saw eight such patients, six of whom required at least one arthroplasty for femoral head collapse. Bone marrow grafting was used successfully in patients with osteonecrosis and preservation of the articular surface.

Judyta Loomis, MD, Radiology, Children’s National Medical Center, Washington, DC, [email protected] Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: Gorlin-Goltz or basal cell nevus syndrome is a rare autosomal dominant disorder with variable penetrance and expressivity. We aim to demonstrate radiographic findings of this syndrome with a focus on the variable severity of maxillofacial findings. Methods & Materials: The diagnostic imaging report database at a single academic children’s hospital was retrospectively searched for all studies with keyword variations on Gorlin-Goltz and basal cell nevus syndrome. The search yielded 57 exams, from 27 different patients, with 15 patients excluded on the basis of incorrect categorization of the patient at the time of the study or no corraborative testing or documentation for the diagnosis. All images were reviewed for radiographic findings with a focus on processes either specific or commonly associated with the syndrome. Results: Representative findings specific to the syndrome included multiple odontogenic keratocysts associated with unerupted teeth and intracranial dural and ligamentous calcifications. The spectrum of odontogenic keratocysts varied from subtle cystic lucencies to multiple disfiguring lesions of the mandible and maxilla. Intracranial calcifications were progressive in patients with multiple studies and varied from subtle linear calcifications at the sella to sheetline falcine calcifications. Associated, but nonspecific radiographic findings included rib fusion anomalies and medulolblastoma. Conclusions: Gorlin-Goltz or basal cell nevus syndrome is a rare syndrome with a spectrum of radiographic findings and variable expressivity. Early recognition of this syndrome aids in limiting ionizing radiation to these radiosensitive patients and early dermatologic surveillence.

Poster #: EDU-047 Poster #: EDU-045 Trauma and Transducers - Ultrasonography in the Setting of Pediatric Musculoskeletal Injury Joseph Davis, MD, Indiana University, Indianapolis, IN, [email protected]; Boaz Karmazyn, MD, George Gantsoudes, Christine Caltoum Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: To demonstrate the applicability of ultrasonography in the diagnosis of osseous and soft tissue injury in children

Diaphragmatic Hernia Beyond the Neonatal Period: Imaging Findings Jonathan Rassi, Ellen Park, Neil Vachhani, Sabiha P Karakas, MD, Unni Udayasankar, MD, Radiology, Cleveland Clinic Childrens, Cleveland, OH, [email protected] Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: Diaphragmatic hernias are unusual in children, with congential diaphragmatic hernia (CDH) being the most well described entitity having a high mortaltity rate. CDH is often detected in antenatal imaging and clinically presents as respiratory distress and


pulmonary hypoplasia in the neonatal period. Diaphragmatic hernias are extremely rare in children beyond the neontal period with a few reported cases in the four major categories described in the literature. The purpose of this exhibit is to describe the causes of diaphragmatic hernia in an older child and illustrate the radiological findings. Methods & Materials: Diaphragmatic hernia in an older child: Describe embryology and relevant anatomy State the incidence and common etiologies. Etiologies: 1. Late presentation of Congential Diaphragmatic Hernia 2. Acquired Diaphragmatic Hernia Sliding Paraesophageal Combined 3. Traumatic Diaphragmatic Hernia 4. Delayed Post-surgical Diaphragamatic Hernia Results: Radiological features of diaphragmatic hernia will be explained with relevant radiographic/cross sectional images as well cartoons. Differential diagnostic considerations including diaphragmatic eventeration and other chest/abdominal pathologies will be described with suitable imaging examples. Conclusions: Diaphragmatic hernias are unusual in children beyond the neonatal period. This exhbit will familiarize the authors to potential causes and radiological features that are helpful in identifying this disorder in an older child.

Poster #: EDU-048 Juxtacortical Lesions of the Bone: Beyond Scratching the Surface Ashwin Hegde, MD, FRCPC, Radiology, BC Children’s Hospital, Vancouver, BC, Canada, [email protected]; Heather Bray, MD, Robyn Cairns, MSc Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: 1. To describe the typical imaging appearance of a variety of surface lesions of bone, benign and malignant 2. To describe distinguishing features of particular surface lesions allowing accurate diagnosis from imaging findings Methods & Materials: A retrospective review of our imaging database was performed to identify pediatric patients with various surface lesions of the bone. Representative images were obtained as examples of each lesion. Results: The search of our database yielded surface lesions of multiple different etiologies. The surface lesions include periosteal osteosarcoma, parosteal osteosarcoma, juxtacortical chondroma, parosteal lipoma and mimics (osteochondroma, healing avulsion fracture, Ewing sarcoma of the cortex, soft tissue slow flow venous malformation). Representative cases of each of these lesions were obtained and described along with their multimodality imaging appearance, including pathologic correlation when available. Conclusions: Awide spectrum of surface lesions of the bone exist and are relatively common in pediatric patients. While some of these lesions are malignant, there are many which are benign and can be diagnosed with imaging, which can advise appropriate surgical management of the tumors. Pediatric radiologists should be familiar with these surface lesions and be able to guide the appropriate management.

Poster #: EDU-049 Take the 1 to the 5, then Head to the VI, VII and VIII: A Review of the Major Cranial Nerve Highways and Accidents to Look for in the Pediatric Population Mark Escudero, Radiology, Children’s Hospital Los Angeles, Los Angeles, CA, [email protected]; Rachel Griggs, M.D., Priya Sharma, MD, Skorn Ponrartana, MD, MPH

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Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: Learning Objectives:We will provide a pictorial review of normal anatomy for cranial nerves I, II, III, IV, V, VI and VII/ VIII. We will demonstrate their normal appearance on CT and/or MRI, and supplement this discussion with companion cases to demonstrate congenital and/or pathologic abnormalities related to these cranial nerves. Methods & Materials: Before pediatric neuroradiologists can be accurate in diagnosing cranial nerve abnormalities, they first must be able to recognize normal cranial nerve anatomy and relationships. With this educational exhibit, we present imaging studies which delineate the normal appearance of the selected cranial nerves. We will supplement these normal studies with images demonstrating developmental or pathologic cranial nerve abnormalities seen in the pediatric population. Results: The following cranial nerves will be delineated and accompanied by descriptions and depictions of the the listed anomalies or pathologic entities: CN I: CHARGE syndrome and absence of the olfactory bulbs, Esthesioneuroblastoma. CN II: Septo-optic dysplasia, Optic pathway glioma and gliomatosis/recurrence, Optic nerve drusen, Absence of the optic chiasm in holoprocencephaly, Optic nerve calcification in Coffin Lowry Syndrome. CN III: Miller-Fisher variant of Guillain-Barre, CN III inflammation in multiple sclerosis. CN V: Perineural tumor spread entering Meckel’s cave. CN VII/VIII: Bell’s Palsy, Mobius syndrome, Cochlear nerve hypoplasia/aplasia, Scwhannommas in NF2, Labarynthitis ossificans. Bonus Case: Osteopetrosis with narrowing of multiple neural foramina. Conclusions: Mastery of cranial nerve anatomy is crucial to a neuroradiologist’s fund of knowledge. This understanding facilitates recognition of the complex congenital and pathologic entities afflicting the cranial nerves and enhances our ability to accurately diagnose pathology in the pediatric population.

Poster #: EDU-050 Pictorial Overview of the Multidisciplinary Consensus on the Prenatal and Postnatal Urinary Tract Dilation Classification System Susan Back, MD, Children’s Hospital of Philadelphia, Philadelphia, PA, [email protected]; Jeanne Chow, Beverly Coleman, Kassa Darge Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: Urinary tract dilation (UTD) affects 40-80,000 children annually in the United States. Ultrasound (US) is the most common imaging modality used to detect and monitor urinary tract abnormalities in both fetuses and children. However, there is a lack of consensus and uniformity in the definitions and classifications of grades of UTD within and between prenatal and postnatal periods confounding communication among providers caring for these patients. A multidisciplinary consensus created a classification system with standardized terminology that can be applied to


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prenatal and postnatal US in order to guide future imaging. This overview will familiarize pediatric radiologists with this new classification. Methods & Materials: Representatives from the American College of Radiology, American Institute of Ultrasound in Medicine, American Society of Pediatric Nephrology, Society for Fetal Urology, Society for Maternal-Fetal Medicine, Society for Pediatric Radiology, Society for Pediatric Urology, and Society of Radiologists in Ultrasound held a consensus conference in March 2014. The participants reviewed and summarized current literature and created a UTD classification system and imaging algorithm. Results: Anterior posterior renal pelvic diameter, calyceal dilation, renal parenchymal thickness and appearance, bladder and ureteral abnormalities and amniotic fluid volume were the criteria used to assess the urinary tract. Findings were correlated to postnatal urological pathology. Risk groups were stratified into two prenatal and three postnatal tiers. The statement gave recommendations about further US imaging for all risk groups and voiding cystourethrography, prophylactic antibiotics and functional imaging for postnatal risk groups. Conclusions: A unified classification system for UTD with standardized terminology based on parenchymal quality and associated anomalies will improve communication between medical providers and facilitate outcomes research.

Poster #: EDU-051 Twist and Shout: Common and Unusual Cases of Intestinal Volvulus Jeannine Ruby, MD, Radiology, University of Wisconsin, Madison, WI, [email protected]; Kara Gill, Jie Nguyen, MD Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: Pediatric volvulus is a surgical emergency that can occur anywhere along the gastrointestinal tract. Often the clinical presentation is confusing. Therefore, radiologists play a critical role in prompt diagnosis. The more common midgut volvulus typically occurs in the setting of intestinal malrotation. However, there are other congenital and developmental predisposing factors which can lead to volvulus along any part of the gastrointestinal tract. The purpose of this exhibit is to review the pathophysiology and imaging appearances of bowel volvulus using various imaging modalities. Additionally, we will supplement our cases with a review of the current literature. Methods & Materials: Surgically-confirmed cases of intestinal volvulus from a single children’s hospital over the past five years are retrospectively reviewed by a Pediatric Radiologist and categorized based on their underlying cause: malrotation, lead point, or idiopathic. A literature review was conducted on PubMed for various causes, incidence, and appearance of intestinal volvulus. Results: The most common etiology of pediatric volvulus is midgut volvulus due to malrotation. Upper GI series is well established to be the gold standard for its diagnosis. At times, abnormal relationship of the superior mesenteric vessels and/or the presence of the “whirlpool” or “swirl” sign of twisted mesenteric vessels can be incidentally detected on ultrasound and CT performed for other indications. Prompt recognition of these abnormal signs allows prompt diagnosis and immediate surgical intervention. Intestinal volvulus can occur despite normal positioning of the ligament of Treitz; therefore, in the setting of an extremely sick infant, the less common causes of small bowel volvulus should be considered, including mesenteric cyst, meconium ileus, ileal atresia, extreme stool impaction, and Meckel’s diverticulum. Gastric and colonic sources of volvulus are less common than small bowel sources. Colonic volvulus occurs most

frequently in the sigmoid colon, followed by the cecum and transverse colon. Conclusions: Awareness of the varying presentations, locations throughout the gastrointestinal tract, and underlying etiologies of pediatric volvulus is necessary to aid timely diagnosis of this critical condition. Familiarity of the classic findings of malrotation and volvulus on fluoroscopy, ultrasound, and computed tomography will assist in reaching the correct diagnosis.

Poster #: EDU-052 The Menacing Meckel’s Diverticulum Matthew Christy, MD, Washington University, St. Louis, MO, [email protected]; Rebecca Hulett Bowling, MD Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: After viewing this exhibit, the reader will be more familiar with the findings of Meckel’s diverticulum and be better equipped to make the diagnosis prospectively. Meckel’s diverticulum is the most common congenital abnormality of the small intestine occurring in 2-4% of the population. Due to the varied presentation it can be a diagnostic challenge. In this educational electronic poster we will discuss the embryology of the Meckel’s diverticulum and the various presentations of its subsequent complications. To demonstrate the various imaging findings we have a series of cases in the pediatric age group which include surgical and gross pathological correlates. Modalities include plain film, ultrasound, CT and nuclear imaging. Presenting symptoms include fussiness, fever, abdominal pain, vomiting, GI bleeding and an ingested wedding ring. Our case presentations include partial and closed -loop small bowel obstruction, free intraperitoneal air, a retained foreign body, findings mimicking perforated appendicitis and periumbilical pain in a patent with malrotation who had previously had an appendectomy and Ladd’s procedure. There is also one case of giant Meckel’s diverticulum.

Poster #: EDU-053 Applications of SPECT/CT in Pediatric Oncology and Infection Michael Gelfand, MD, Department of Radiology, Cincinnati Children’s Hospital, Cincinnati, OH; Susan Sharp, MD, Andrew Trout, MD, Crysta Clements, Bessie Ganim, Nicole Mormile Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: To illustrate several applications of SPECT/ CT in pediatric patients with oncologic disease and infection Methods & Materials: From March, 2006 to October, 2014, we have performed 1263 SPECT/CT studies including 750 studies in patients with oncologic disease or possible infectious processes. The first 47 studies were performed using a GE Hawkeye SPECT/CT camera (Waukesha, WI). The remaining 703 studies were performed using a Siemens Symbia 2 SPECT/CT camera (Hoffman Estates, IL). For the Siemens camera, SPECT/CT was acquired using 64 stops at 20-30 sper stop. The SPECT field of view was 38.7 cm in the z-direction, but the CT field of view was reduced to less than 38.7 cm whenever the disease process identified on SPECT and planar imaging permitted a smaller CT volume. Low dose CT was performed at 110 kVp and reference mAs settings varying from 22 to 48 mAs in pediatric patients, depending on body weight. Later in the series, in patients where soft tissue detail was of less concern, the


reference mAs setting was limited to the minimum for the camera (22 mAs). Radiopharmaceuticals that were used included I-123-MIBG, I-131-MIBG, Na-I-123, Na-I-131, filtered Tc-99m-sulfur colloid, Tc99m-MAA, Y-90-Sirspheres, In-111-octreotide and Tc-99m-HMPAO white blood cells. Results: Studies performed included I-123-MIBG and I-131-MIBG imaging for neuroblastoma and pheochromocytoma (including a small number of post-therapy I-131-MIBG scans), Na-I-123 and Na-I-131 imaging in patients with thyroid cancer, filtered (limited particle size) Tc-99msulfur macroaggregated albumin hepatic arterial perfusion studies prior to Y-90 Sirsphere therapy, Y-90 brehmstrahlung imaging of the liver after Y-90 Sirsphere therapy, In-111-octreotide imaging of neuroendocrine tumors and Tc-99m-HMPAO white blood cells imaging of inflammatory processes. Examples of each application will be presented including technical and clinical information. We have found SPECT/CT to be consistently useful in these applications. Conclusions: SPECT/CT imaging is a useful addition to many imaging studies that use single photon emitting radiopharmaceuticals. Additional applications are limited by the availability of appropriate single photon emitting radiopharmaceuticals.

Poster #: EDU-054 MRI Spectrum of Deep Medullary Vein Anatomy and Pathology in Infants at 1.5T and 3T Mark Sturgill, DO, Radiology, Children’s Hospital Colorado, Denver, CO, [email protected]; Nicholas Stence, MD, David Mirsky, Laura Fenton, MD Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: Background The cerebral deep medullary veins (DMV) are an important bridge between the peripheral pial and central subependymal veins. The literature detailing normal MRI anatomy and pathology of DMVs is sparse. Objective Our goals are to demonstrate the normal MRI appearance of DMVs at 1.5T and 3.0T, detail a spectrum of DMV pathology including engorgement, thrombosis, ischemia, hemorrhage, and adjacent white matter injury/volume loss as well as correlate imaging findings with demographics and co-morbidities. Methods & Materials: Materials and methods Following IRB approval, the electronic case file was searched from 2004-2014 for infants with DMV abnormalities. Maternal and fetal demographics and comorbidities were collected from the electronic medical record (EPIC). All neuroimaging was reviewed. A normal comparison group of 25 infants was evaluated. Results: Results 12 infants (10 male) with abnormal DMVs were identified ranging in age from 1 day to 78 days at time of first MRI (9 imaged in the first week). The majority (9/12, 75%) were born at term. Seven (58%) were born via C-section. Average birth weight was 2.57 kg. One infant had complex congenital heart disease and 3 had thrombophilia. The mean maternal age was 28 years (range 16-44). One mother had preeclampsia and one factor V deficiency. All infants had engorged/thrombosed DMVs, more conspicuous at 3T MR imaging, especially susceptibility weighted imaging (SWI), compared to 1.5T. 7/12 (58%) had associated hemorrhage (five parenchymal, four intra-ventricular, three extra-axial; three had hemorrhage at more than one site). 6/12 (50%) had restricted diffusion (five cerebral hemisphere and one thalamic). Right sided frontal predominance of DMV associated abnormalities were noted in 6, followed by diffuse bilateral pattern in 5 and isolated left side in 1. There was coexistent deep venous sinus thrombosis in 2/12. Follow up imaging in 7/12 showed

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periventricular white matter volume loss in 88%. In the two infants without volume loss, DMV engorgement rather than thrombosis was favored. Conclusions: There is increased conspicuity of both normal and pathologically engorged or thrombosed DMV’s on 3T imaging compared to 1.5T. DMV engorgement/thrombosis may be associated with ischemia, hemorrhage, deep venous sinus thrombosis and less often a solitary finding of transient engorgement. There is a continuum between transient engorgement to thrombosis with periventricular white matter injury, the latter is evident on follow up imaging.

Poster #: EDU-055 Who Knows the Pediatric Nose? Rachel Griggs, MD, Children’s Hospital Los Angeles, Los Angeles, CA, [email protected]; Priya Sharma, MD, Mark Escudero, Skorn Ponrartana, MD, MPH Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: Learning Objectives: To review embryology, pathology and associated imaging findings regarding the pediatric nose. Methods & Materials: Background: Pathology of the pediatric nose is not entirely common. Yet, when pathology is suspected, assistance from the pediatric radiologist is frequently requested. Many pathologic entities of the nose are associated with nonspecific clinical features, but have pathognomonic imaging findings, making the radiologist indispensable in the evaluation of these entities. In addition, an observant and descriptive radiologist may also be of assistance in guiding surgical approach and therapy. Pediatric radiologists who are familiar with and cognisant of nasal pathology can also identify clinically unsuspected nasal pathology as a cause of nonspecific symptoms such as respiratory distress. For these reasons the pediatric radiologist should be familiar with the imaging findings associated with pathologic entities affecting the nasal cavity, nasal bones, nasopharynx, and nasofrontal region. Results: Imaging Findings: We review the basic embryology of the nose followed by a presention of the following cases:nasal glioma, nasal dermoid, frontonasal encephalocele, nasal septal perforation, piriform aperature stenosis, choanal atresia, frontonasal dysplasia, nasal polyposis, esthesioneuroblastoma, sinonasal primitive neuroectodermal tumor, juvenile nasal angiofibroma, and nasopharyngeal synovial sarcoma. We describe the classic imaging findings and briefly review the pathologic entities. Conclusions: While pediatric nasal pathology is not frequently encountered, a pediatric radiologist who is cognisant of and familiar with the imaging features of nasal pathology can play a key role in the diagnosis and managment of these entities.

Poster #: EDU-056 Circling the Globe: A Review of Pediatric Orbital Pathology Priya Sharma, MD, Pediatric Radiology, Children’s Hospital Los Angeles, Los Angeles, CA, [email protected]; Rachel Griggs, MD, Mark Escudero, Skorn Ponrartana, MD, MPH Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: Learning Objectives: This educational exhibit will review a variety of pediatric orbital pathology through discussion of the epidemiology, clinical manifestations and specific multimodality


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imaging findings as seen on computed tomography (CT) and magnetic resonance imaging (MRI). Methods & Materials: Background: There are a variety of congenital and acquired conditions of the pediatric orbit that can have a significant impact on morbidity and mortality if left too long unrecognized. While recognition of these orbital pathologies is often times based on history and clinical examination, the pediatric radiologist can play a significant role in facilitating prompt diagnosis and treatment. Characteristic imaging findings on CT and MRI allow for non-invasive evaluation of orbital lesions as well as precise anatomical delineation. This education exhibit will review congenital globe abnormalities, ocular and orbital tumors, as well as inflammatory and infectious processes of the pediatric orbit. Results: Imaging Findings: The following categories of pediatric orbital pathologies and their specific disease processes will be illustrated: Congenital Globe abnormalities: Congenital glaucoma Morning Glory Disk Drusen Anopthalmos Persistent Hyperplastic Primary Vitreous Coat’s Disease Coloboma Staphyloma Ocular tumors Retinoblastoma Medulloepithelioma Retinal Astrocytic Hamartoma Ocular melanoma of the iris Metastatic tumors: ALL relapse to the iris Orbital Tumors Orbital dermoid cyst Eyelid and periorbital hemangiomas Orbital malformation Retrobulbar Yolk Sac Tumor Optic nerve glioma Inflammatory/Infectious involving the orbit Dacrocystocele and dacrocystitis Orbital cellulitis with subperiosteal abscess Orbital pseudotumor Orbital Langerhans cell Histiocytosis Conclusions: There is a large spectrum of orbital pathology found in the pediatric population which can present with various clinical and imaging manifestations. Knowledge of the typical imaging appearance and key features of these lesions will assist the pediatric radiologist in providing important diagnostic information to referring clinicians, and lead to timely referral to eye specialists to prevent vision loss or metastatic spread of tumor/infection.

Poster #: EDU-057 Pediatric Vasculitis: The Role of the Radiologist Through Case Review Tammam Beydoun, DO, Radiology, Phoenix Children’s Hospital, Phoenix, AZ, [email protected]; Tuan Dao, MD, Mittun Patel, MD, David Aria, MD, Richard Towbin Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: Vasculitis is a broad term covering a wide range of entities involving inflammation of the vascular wall. Our aim is to revisit the imaging appearance of vasculitis in the pediatric population. In the same breath we evaluate the role of the radiologist in aiding the diagnosis of vasculitides by presenting an overview of pediatric

vasculitis with an emphasis on imaging through multiple cases and modalities. Methods & Materials: Cases were obtained by search of the radiologic database over the last 14 years. This was followed by a retrospective review with correlative and updated clinical findings. Results: Case representations of the different vasculitides were collected and organized based on the Chapel Hill classification. Many cases initially presented to the radiology department without diagnosis or a working diagnosis on prospective read. When available, multiple imaging modalities are presented with their respective supporting role. In most cases there is overlap in findings and, when possible, distinguishing features are discussed. Conclusions: Radiologists play a critical role in the diagnosis and management of vasculitis through imaging and intervention within a multidisciplinary approach. Although at times the specific diagnosis is radiologically elusive, it is often sufficient to suggest vasculitis as a working diagnosis. This is especially important in cases that present de novo, where recognition of the subtle, and not so subtle, imaging features can narrow the teams focus and effectively expedite treatment.

Poster #: EDU-058 - Withdrawn Poster #: EDU-059 Abdominal Cocoon Syndrome in Pediatric Oncology Patients; Looking for the “Invisible” Sac Atsuko Fujikawa, Radiology, National Center for Child Health and Development, Kawasaki, Japan, [email protected]; Osamu Miyazaki, Kimikazu Matsumoto, Kentaro Matsuoka, Yutaka Kanamori, Shunsuke Nosaka Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: Abdominal cocoon syndrome is a rare disease, which causes recurrent attacks of small bowel obstruction (SBO), and is usually difficult to diagnose with certainty before surgical intervention. Many cases have been reported in the literature. Although it occurs at any age and in various contexts, there has to our knowledge been no prior report in pediatric oncology patients. We encountered three pediatric cases with abdominal cocoon associated with a malignant neoplasm. The purpose of this presentation is to review the findings on imaging of the abdominal cocoon and to inform other pediatric radiologists so that they can identify the condition in similar pediatric oncology patients Methods & Materials: We retrospectively reviewed imaging findings and clinical information in three cases with abdominal cocoon confirmed at surgery performed at the National Children’s Hospital in Tokyo between 2012 and 2014. Contrasting information in the literature and our cases, we considered ways of making a definitive diagnosis before surgery. Results: The characteristics of patients were as follows. Case 1: a 2-yearold boy undergoing chemotherapy for neuroblastoma, and who underwent a laparotomy and biopsy 8 months before SBO developed; Case 2: a 3-year-old girl who had a history of advanced rhabdomyosarcoma with widespread peritoneal dissemination, treated with multimodal therapy. SBO occurred 6 months after surgery; Case 3: a 4-year-old girl treated for advanced neuroblastoma. SBO occurred 1 year after surgery, following neoadjuvant chemotherapy. The tentative CT diagnosis was postoperative small bowel obstruction in all cases. All patients underwent surgical treatment as symptoms did not improve with conservative management, and diagnosis of abdominal cocoon was established based on the intraoperative finding of a fibrous sac encasing the small bowel.


We retrospectively reviewed all CT images after surgical confirmation, and findings were suggestive of abdominal cocoon: dilated loops of small bowel gathered in clusters, the edges of which had sharp margins, and absence of mesenteric strangulation. These findings represented the presence of the membranous sac of the cocoon, as the real membrane is invisible on CT imaging. Conclusions: To make a definitive diagnosis of abdominal cocoon syndrome, it is important to identify the presence of the cocoon membrane, whether it is visible or not. Equally important is to be aware that abdominal cocoon occurs in pediatric oncology patients.

Poster #: EDU-060 Central Nervous System Imaging after Bone Marrow Transplantation in Children: A Review of Complications with an Emphasis on History and Engraftment Status Jonathan Wood, MD, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, [email protected]; Christopher Dandoy, Luke Linscott Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: Bone marrow transplantation (BMT) is a frequently used procedure to restore a patient’s bone marrow after treatment for a wide range of pediatric malignancies and inherited immunologic or hematologic disorders. For imaging professionals, the extremely wide range of possible complications following BMT presents a diagnostic challenge. The usefulness of key clinical information such as time since transplant, neutropenia, and engraftment status are emphasized to help develop an appropriate differential diagnosis. Methods & Materials: Our PACS was queried for CT and MRI examinations of the CNS in patients with history of bone marrow transplants from January, 2004 through September, 2014. The results were recorded and correlated with clinical notes and pathology reports from the electronic medical record. Results: A wide variety of pathology was discovered including infectious (e.g. fungal, viral, and bacterial), vascular (e.g. vasculitis and PRES), metabolic (e.g. Wernicke encephalopathy and osmotic demyelination), drug-induced (Methotrexate encephalopathy), and neoplastic (e.g. PTLD and primary brain tumors) complications. These results were correlated with symptoms and time from engraftment. Conclusions: It is essential that imaging professionals understand the role of clinical history and time from engraftment in developing a differential diagnosis. This educational exhibit is designed to help the imaging professional combine key imaging and clinical features to allow a confident approach to the differential diagnosis in children who have received a bone marrow transplant.

Poster #: EDU-061 Withdrawn Poster #: EDU-062 Don’t Stumble on the Metatarsal Base of the Pinky Toe; Recognize the Variants and Diagnose the Fractures S a r a L a y, M D , I n d i a n a U n i v e r s i t y, I n d i a n a p o l i s , I N , [email protected]; George Gantsoudes, Boaz Karmazyn, MD

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Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: To illustrate the common anatomical variations that can mimic pathology and guide how to diagnose the different types of fractures at the base of the fifth metatarsal. Methods & Materials: From the teaching file and radiology information system we will collect radiographs with normal anatomic variation and variety of fractures at the base of the fifth metatarsal. Results: Presents the anatomy of the three zones of the base of the fifth metatarsal, examples of the apophysis from appearance to fusion, Os Vesalianum, accessory ossicles and Iselin’s apophysitis. We will also show different types of fractures (tuberosity avulsion, Jones, and stress fracture) and review the treatment of each of them. Conclusions: There are unique normal variations in the immature base of the fifth metatarsal that can mimic a fracture. Correct recognition and classification of the fractures direct optimal treatment.

Poster #: EDU-063 The Value of Ultrasound Evaluation of the Right Lower Quadrant for Acute Appendicitis Outside of the Academic Children’s Hospital: Don’t Let it Become a Throwaway Exam Cory Pfeifer, MD, Diagnostic Radiology, University of Kansas-Wichita, Wichita, KS, [email protected] Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: The purpose of this study is to investigate and evaluate the factors which limit the role of ultrasound in diagnosing acute appendicitis as well as to evaluate the usage of the right lower quadrant ultrasound itself in the diagnosis of acute appendicitis in a community hospital. Methods & Materials: A retrospective review of all focused right lower quadrant ultrasound exams ordered from the emergency department between January 1, 2014 and March 31, 2014 was undertaken. The examinations were compared with respect to sonographer experience, time spent scanning the patient, patient age, shift in which the exam was performed, final diagnosis, follow-up testing, and whether or not a radiologist participated in the scan. Results: Of the 42 cases reviewed, a normal or abnormal appendix was seen in only 19% of the cases which is well below that reported in the larger multicenter study by Mittal et al. A final diagnosis of acute appendicitis was rendered in 5 (12%) of the cases, all of which were also suggested by the ultrasonographic findings. A striking difference in scanning practices were noted in which sonographers with greater than 25 years of experience spent an average of 11.3 min scanning the patient while sonographers with less than 2 years of experience spent an average of only 2.9 min scanning the patient. A follow-up CT scan was obtained in only 6 (14%) of the cases with CT confirming the positive ultrasound findings in 2 of these cases, detecting appendicitis in the setting of an equivocal ultrasound in 1 case, and providing a negative result in the remaining 3 cases, all of which were equivocal by ultrasound. In 30 cases (71%), the patient was discharged following an equivocal ultrasound result without further imaging or surgical consultation. Patient age and involvement of the radiologist were not significant contributors. Conclusions: In this retrospective study, glaring differences in the amount of time spent scanning the patient based on sonographer experience were uncovered which undoubtedly had an effect on the sensitivity of ultrasound at our institution and subsequent confidence of our clinicians. Furthermore, an overwhelming majority of patients for which the right lower quadrant ultrasound was ordered were discharged based on equivocal ultrasound findings which may suggest that emergency providers are ordering ultrasounds even when pretest probability is low.


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Poster #: EDU-064 A Stitch in Time Saves Radiation Exposure: Scoliosis Radiographs With Stitching Artifact Result in Distortion of Anatomy Necessitating Further Imaging Studies; A Quality Improvement Project Kathryn Henault, MD, Connecticut Children’s Medical Center, Hartford, CT; Michael Baldwin, Mark Lee, Jenna Downes Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: Scoliosis is an osseous abnormality which requires routine monitoring involving separate exposures of the thoracic and lumbosacral spine that are then stitched together through a computer software program. Errors in this process can result in diagnostic inaccuracies that ultimately cause additional unwarranted medical intervention. At Connecticut Children’s Medical Center (CCMC), one such incident occurred. A scoliosis film revealed a small, irregularly shaped T10 vertebral body, and the subsequent MRI showed it to be completely normal. Scrutiny of the initial spinal radiograph revealed a blurry stitch line present along the superior border of the T10 vertebral body causing anatomical distortion. Methods & Materials: At CCMC, inconstancies and technical procedural errors were resulting in inadequately stitched films. The observed consequences included misaligned anatomy, a blurry horizontal white line across the width of the radiograph, or exposure differences between the separate films resulting in anatomy distortion. The educational quality improvement intervention emphasized the importance of using the ruler/teeth to guide film alignment, making sure the breast plates were not covering the spine or markers, double checking the cassettes before each study to ensure proper alignment, choosing correct exposure settings for individual films, and dealing with mechanical processing problems. Results: The sample size for the pre-educational data was 141 films, 11 (7.8%) had stitching errors with anatomical distortion. The post-training sample size was 171 films, 20 (11.7%) had errors. A two-proportions test was implemented, calculating a P-value of 0.243 - no significant difference between the two samples. Conclusions: Despite re-training on proper stitching techniques, the number of errors did not change significantly. This indicates that perhaps the issue was not necessarily an educational one, but rather a ‘systems-based problem’. Future considerations will include examination of the following: Is there enough time allotted for each exam to allow technicians to reprocess the films if errors occur? By the time the technicians realize they need to repeat an exposure, is the patient still in the department? If the suboptimal study makes it to the PACS system without intervention, are radiologists notifying the technicians and asking them to reprocess it? These are all processes within the system that need to be analyzed to further the quality improvement of scoliosis radiographs at CCMC.

Poster #: EDU-065 Imaging Review of Pediatric Segmental Multicystic Dysplastic Kidney Lillian Lai, MD, T Shawn Sato, University of Iowa Hospitals and Clinics, Iowa City, IA, [email protected]; Yutaka Sato, MD, Simon Kao Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: Segmental multicystic dysplastic kidney (MCDK) is also known as partial or focal MCDK and only involves part of the kidney. While total MDCK affecting the entire kidney is a common and well-known renal dysplasia occurring in 1/4300 children, segmental MCDK is a rare subtype occurring in only 4% of MDCK cases. Segmental MCDK has an overall good prognosis, and management is non-surgical as most cases eventually involute. It is important for radiologists to recognize the imaging features of segmental MDCK to give clinicians insight into the expected management and clinical outcome for patients. The purpose of this exhibit is to elucidate the imaging spectrum, associated anomalies, clinical presentation, management, and outcomes of segmental MCDK in children. Methods & Materials: Retrospective chart analysis of several pediatric cases of segmental MCDK at our institution was performed. All patients had ultrasound examinations, three had voiding cystourethrograms, three had renal scintigraphy, and one had computed tomography. Results: A range of unique cases of pediatric segmental MCDK will be presented, including segmental MCDK involving the upper moiety in duplicated collecting systems with associated ureteroceles/hydroureter and vesicoureteral reflux in the lower pole moiety; segmental MCDK as multiple cysts replacing the lower two-thirds of a kidney; and segmental MCDK involving the upper pole of one of the kidneys in cross-fused ectopia. All cases were managed non-surgically, and the three cases with renal scintigraphy showed differing degrees of function loss in the affected kidney. One case with longer clinical followup showed eventual involution. Comparison will be made to literature review of imaging findings of segmental MCDK. We will also discuss the etiology, clinical presentation, management, and outcomes of this entity. Finally, we will highlight key differences between segmental MCDK and the more common total MCDK.


Conclusions: After reviewing this exhibit, the reader will become familiarized with imaging appearances of segmental MCDK across different modalities and have a good understanding of its expected clinical course and management.

Poster #: EDU-066 Not Your Father’s Lincoln Penny: Xray-Guided Triage and Management of Ingested Foreign Objects in the 21st Century Molly Downey, Oregon Health & Science University, Portland, OR; Sarah Green, Katharine Hopkins, MD Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: While coins have long been the foreign object most frequently ingested by children, ingestions not encountered in past generations are on the rise, and some such ingestions have the potential to cause morbidity or death in a very short period of time. Because early recognition, accurate differentiation, and appropriate triage are key to preventing complications, pediatric radiologists have a critical role. The aim of this educational exhibit is to facilitate their role by reviewing evolving principles of foreign object diagnosis and management. Methods & Materials: Foreign object ingestions from a busy pediatric tertiary referral center serve as illustrative examples from which participants learn distinguishing radiographic features, pitfalls in diagnosis, and potential complications. Endoscopic and surgical correlation is provided when appropriate. Moreover, based on comprehensive literature review, practical algorithms for management and radiographic follow-up are generated and then reinforced by interactive case-based simulations. Results: The following categories of object are discussed: button and cylindrical batteries; rare earth (neodymium) magnets; long or sharp objects; beverage can pull tabs, glass, and other poorly radiopaque objects; illicit drugs; mobile phone subscriber identity module (SIM) cards; and others. Conclusions: Pediatric radiologists play a critical role in prompt diagnosis, effective triage, and appropriate follow-up of foreign object ingestions. This educational exhibit prepares them for that role by providing up-to-date experience in an evolving field.

Poster #: EDU-067 Flaccid Paralysis and the Pediatric Patient: Differentiating Polio-like Viral Myelitis from other Spinal Cord Pathology Rachel Griggs, MD, Children’s Hospital Los Angeles, Los Angeles, CA, [email protected]; Mark Escudero, Priya Sharma, MD, Benita Tamrazi Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: Learning Objectives: In light of recent outbreaks of polio-like viral myelitis, the aim of this presentation is to familiarize the radiologist with pathologic entities affecting the spinal cord and their typical imaging appearances. Methods & Materials: Background: The United States Centers for Disease Control and Prevention reported outbreaks of suspected polio-like viral myelitis in the states of California and Colorado in the year 2014. The clinical diagnosis of this entity can be challenging; these patients present acutely with similar neurologic deficits, including flaccid paralysis. Imaging may be the key to making or confirming the diagnosis. As polio-like viral myelitis is managed differently than other spinal

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pathologies, such as Guillian Barre and acute disseminated encephalomyelitis, and treating with the wrong therapy can be of detriment to the patient, it is important that the radiologist be able to differentiate these entities. In this exhibit we review the pathology and imaging features associated with polio-like viral myelitis as well as other differential pathologic entities involving the spinal cord. Results: Imaging Findings: Here we present cases of Enterovirus myelitis with a review of imaging findings and discussion of the pathology, clinical presentation, and diagnostic work up. So as to readily distinguish this entity from other spinal cord pathology, we also present cases of other spinal infections, as well as inflammatory and demyelinating diseases of the spinal cord, intramedullary neoplasms, neoplastic leptomeningeal disease, and syringohydromyelia. We discuss the typical imaging findings and pathology related to each of these entities. Conclusions: Conclusion: Polio-like viral myelitis is a rare, but emerging entity. Pediatric radiologists should be familiar with the disease process and should be able to differentiate this entity from other pathologic processes involving the spinal cord presenting with similar symptoms warranting emergent imaging.

Poster #: EDU-068 Potpourri of Pediatric Port Problems Priya Sharma, MD, Children’s Hospital Los Angeles, Los Angeles, CA, [email protected]; Mark Escudero, Rachel Griggs, MD, Chadi Zeinati Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: Learning Objectives: This educational exhibit will review the multimodal imaging findings of complications associated with the implantation and use of pediatric chest ports inserted via the subclavian versus the jugular vein approach, as well as discuss therapeutic interventional radiology techniques geared toward preventing these complications. Methods & Materials: Background: The use of chest port-a cath (PAC) devices has allowed for convenient long-term venous access for the administration of cytotoxic medications (chemotherapy or antibiotics), intravenous targeted agents or frequent blood draws. Given the ease of medication delivery, the ability for long term use and decreased infection risks, PACs are sometimes preferred to other forms of central venous access. Pediatric PACs are classically placed via a subclavian vein approach by pediatric surgeons but recently, younger surgeons have adopted the jugular approach. The latter approach has historically been used by interventional radiologists because of the use of image guidance and fewer acute and chronic complications. Although PACs are associated with better quality of life, the use and placement of these devices has not been without complication. In this educational exhibit we will review the imaging findings associated with these complications and the techniques used to alleviate these problems. Results: Imaging Findings: Focusing on the two approaches of PAC placement the following cases will be shown: Early/Short-term complications: Pneumothorax Catheter tip/port malposition Arrhythmia Pocket hematomas Catheter leakage Vein thrombosis Long-term complications Infection Stenosis or occlusion of the host vein Catheter tip thrombosis


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Fibrin sheath formation Pinch off syndrome Catheter fracture, migration and leak Twiddler syndrome Port erosion/Skin breakdown Conclusions: In the pediatric population PACs are still placed by both Surgeons and Interventional Radiologists via different approaches. Despite the success of PACs in providing long-term venous access, complications in both the short and long-term settings do arise. For that reason, it is important for the diagnostic pediatric radiologist to recognize the imaging appearances of the different techniques of port placement and their respective complications. By understanding the interventional radiologist’s role in placement of these ports and management of the complications, the pediatric radiologist will help direct the referring clinician in subsequent steps in management.

Poster #: EDU-069 Problem Solving in MRI: Use of Alternative Contrast Agents Jonathan Loewen, MD, Emory University, Atlanta, GA; Kiery Braithwaite, Sarah Milla, Kelley Marshall, Adina Alazraki Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: Conventional gadolinium based contrast agents (GBCAs) are formed when the paramagnetic ion gadolinium is chelated, producing a gadolinium containing macromolecule. GBCAs have become an essential part of modern imaging by improving sensitivity and/or specificity. The purpose of this educational exhibit is to highlight cases in which less conventional FDA-approved MR contrast agents aided in rendering a diagnosis. In particular, the use of gadoxetate (Eovist) in hepatobiliary imaging and gadofosforveset (Ablavar) in intravascular (blood pool) imaging will be presented. Methods & Materials: An IRB-approved retrospective search at a large free-standing pediatric hospital was performed, in order to isolate clinical MR examinations during which either Eovist or Ablavar was used as the solitary GBCA. Representative cases will be provided. Results: Representative cases will be demonstrated. The use of Eovist in focal liver lesion characterization, biliary trauma, and hepatic transplantation will be presented. The use of Ablavar in cardiac and vascular imaging including thoracic outlet syndrome and popliteal artery entrapment syndrome will similarly be highlighted. Conclusions: Non-conventional GBCAs have a valuable role in clinical diagnostic imaging. Knowledge of anatomic bio-distribution of these contrast agents is important, particularly when clinical MR exams are being protocolled.

Poster #: EDU-070 Different Pathological Appearances of the Large Bowel on Ultrasound Ramdas Senasi, MBBS, FRCR, Radiology, Alberta Children’s Hospital, Calgary, AB, Canada, [email protected]; Semmab Haider, Clara L Ortiz-Neira, Meghan McIvor, Samarjeet Bhandal Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: We are a tertiary paediatric hospital and our imaging department performs an average of 160 bowel ultrasound studies a year. We would like to demonstrate the various ways in which ultrasound can be useful in the evaluation of the large bowel.

Methods & Materials: The indications for bowel ultrasound in our hospital are for inflammatory bowel disease, infection, cystic fibrosis, vasculitic disorders and other conditions that can manifest as bowel abnormalities. Patient preparation is to not have anything to eat or drink for 6 h. Our technologists usually take 45 min for a complete scan which will include the entire abdomen and bowel. We use an appropriate frequency curvilinear probe for an overall abdominal survey and a high frequency linear probe for detailed bowel visualisation. Large bowel visualisation includes the terminal ileum, ilieocecal valve, cecum and its position, the entire colon and rectum. The large bowel is assessed for bowel wall thickness, architectural appearance, hyperemia , surrounding free fluid, echogenic fat stranding and lymphadenopathy. An assessment of the small bowel is made for general appearances and peristalsis. We looked through our database for cases that were referred for a bowel ultrasound study. We reviewed our cases for educational value and selected those that would be useful to others who regularly perform ultrasound investigations. Results: Among the cases to be presented are ulcerative colitis, Crohn’s disease, cystic fibrosis, infection, vasculitic conditions and laxative abuse. Conclusions: The ultrasound is an effective tool in visualising the various presentations of bowel disorders. Its advantages are is that it is cheap and readily accessible. The disadvantages would include the time required and high degree of operator skills.

Poster #: EDU-071 A - Z Imaging Atlas to Pediatric Seizures: A Compilation of Epileptogenic Entities and What the Radiologist Needs to Know Mark Escudero, Radiology, Children’s Hospital Los Angeles, Los Angeles, CA, [email protected]; Priya Sharma, MD, Rachel Griggs, MD, Benita Tamrazi Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: Learning Objectives: We will provide a systematic review of a multitude of seizure causes and seizure related disorders organized in an alphabetical list. The list of entities will encompass the following broad categories: tumors, metabolic/mitochondrial disorders, congenital malformations, phakomatoses and infectious/inflammatory conditions. Methods & Materials: The wide range of etiologies for seizure development can create a diagnostic dilemma for physicians encountering a patient with the new onset of seizures. This dilemma faces clinicians frequently, as according to the Centers for Disease Control, approximately 1 in 10 Americans will suffer from a seizure at some point in their life. Oftentimes, diagnostic imaging plays a key role in the evaluation of new onset seizures and radiologists need to maintain an understanding of the varied causes of epileptogenesis and their potentially characteristic radiographic appearance. With this educational exhibit, we will systematize a wide selection of seizure etiologies into an alphabetic rubric as a means to provide an easily recognizable and organized guide for a spectrum of seizure causes. Results: Each alphabetically listed entity will include a brief definition and background information pertaining to its epileptogenesis characteristics. Representative imaging examples will supplement each epileptogenic entity’s description. Conclusions: The new onset of seizures is a common clinical presentation encountered by many pediatricians and often invokes diagnostic imaging as a means to discover the underlying cause for the seizure. We provide this wide assortment of epileptogenic entities in an alphabetical list in order to aid and inform interpreting radiologists of the multitude of causes for this diagnostic dilemma.


Poster #: EDU-072 Neonatal Gastrointestinal Emergency Imaging Pranav Vyas, Amy Ellenbogen, MD, George Washington University, Washington, DC, [email protected]; Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: This is an educational exhibit aimed at educating providers and trainees in identifying neonatal gastrointestinal emergencies. We discuss perforation and obstruction in both the upper and lower gastrointestinal tract, using cases to illustrate the pathogenesis of such diagnoses, appropriate imaging modalities, associated findings, and whether treatment involves surgery or medical management. We also comment on the prevalence of such diagnoses at our institution in the past 9 years. Many of these neonatal gastrointestinal emergencies require immediate intervention and our hope is to better educate providers and trainees to ensure rapid diagnosis and decrease infant morbidity and mortality due to delays in treatment. Methods & Materials: We used the radiology search engine Montage to determine the frequency of certain gastrointestinal emergencies at our institution as well as to obtain some of our images.

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Purpose or Case Report: Torticollis is often encountered in the pediatric population. Although some etiologies of torticollis have pathognomonic imaging findings, others can be somewhat more challenging to diagnose. A pictorial review of the spectrum of pediatric causes of torticollis is demonstrated. Methods & Materials: A retrospective review of our imaging database over a ten year period was performed to identify studies obtained in pediatric patients presenting with torticollis. Various imaging studies such as ultrasound, CT, and MRI were reviewed when available. Medical records were reviewed and radiologic studies were correlated with clinical history and surgical/pathologic correlation when available. Results: A retrospective study over a ten year period demonstrated multiple causes of torticollis elucidated by Ultrasound, MRI, and CT. Etiologies include: foreign body in the hypopharynx, osteomyelitis, fibromatosis colli, lymphoma, rotary subluxation, CNS infection, Grisel’s syndrome, cervical syrinx, spinal cord tumors, Lemierre’s syndrome, lymphadenitis, and retropharyngeal abscesses. Conclusions: Torticollis is a relatively common complaint in infants and young children. Radiologic evaluation - including CT, Ultrasound, MRI, and even Fluoroscopy - can be very helpful in determining the underlying cause of the patient’s twisted neck and in guiding treatment.

Poster #: EDU-074 Lower Gastrointestinal Obstruction Etiologies Over 9 Year Period Diagnosis Frequency (# of patients) Jejunum Jejunal Atresia 156 Ileum Meconium Ileus 122 fs Colonic Atresia 31 Hirschsprung Disease 232 Post-NEC Colonic Stricture 64 Neonatal Small Left Colon 6 Anus Imperforate Anus 338

Poster #: EDU-073 Torticollis: A Pain in the Neck Erin Horsley, DO, Radiology, St. Christopher’s Hospital for Children, Cherry Hill, NJ; Jacqueline Urbine, Mea Mallon, Erica Poletto, Archana Malik, Eric Faerber Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity.

Ultrasound Tutorials in Under 10: Tour of a Comprehensive Curriculum with Assessment for Hands On Ultrasound Skills Susan Back, M.D., Lawrence Blank, Maria Bedoya, MD, Laura Poznick, Janet Reid, MD, FRCPC, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, [email protected] Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: The radiology trainee must master handson skills and knowledge in multiple modalities and body systems. Skills training is acquired through an apprenticeship model of “see one do one” and often there is no adjunctive material to prepare for this. This web-based program was created to optimize the mastery of hands-on Ultrasound (US) skills by trainees in pediatric radiology. Methods & Materials: The top ten US examinations performed at our hospital were identified as: RUQ, renal/bladder, pylorus, hips, brain, intussusception, thyroid, appendicitis, female pelvis and scrotum. A webbased delivery of US educational tutorials was fully vetted in Version 1.0 as the best choice for ease of access at point of care. The program was linked to the hospital learning management system to enable tracking and provide notification. Real time imaging was incorporated to best simulate the clinical setting. Results: The program was created in Storyline (Articulate)® and housed on the Learning Link® learning management system in our hospital. Each module contains a pretest, posttest, tutorial and posttest survey. Tutorials include instruction on study indications, patient preparation, positioning and draping, transducer selection, scanning technique and planes, image acquisition and optimization. Format includes three simultaneous video feeds showing real time images, US console and patient scan. Scrolling text option describes all aspects of the study, with voiceover to further emphasize the proper steps in performing the study. Skills testing can be conducted on models or patients during the daily workflow. Each tutorial can be completed in 10 min or less. The electronic poster will provide a guided tour of the program.


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Conclusions: Through this electronic presentation, the attendee will learn that this web-based US curriculum includes focused high fidelity tutorials for the top 10 pediatric US studies and is available at point-of-care during daily workflow as a highly effective adjunct to pediatric US skills training.

DECT. Indications for DECT in pediatric patients will be discussed with consideration of radiation exposure implications. Issues involving integrating DECT into routine clinical imaging practice will be considered. Imaging from clinical cases will be presented. Results: DECT can be utilized for artifact reduction in pediatric patients with metallic hardware. One study evaluated DECT in children with spinal fusion hardware demonstrating improved image quality and significant artifact reduction. Similar studies in adults have demonstrated artifact reduction and improved image quality without a radiation exposure penalty. A recently presented study on radiation exposure from DECT using pediatric phantoms showed dose neutrality for CT imaging of the head, but a dose penalty for CT imaging of the chest and abdomen in small patients, specifically those younger than 5 years of age. Despite a dose penalty, DECT may be warranted for some indications where DECT can improve image quality by reducing artifacts or offer information not available with routine CT imaging. Conclusions: DECT does not always maintain “dose neutrality” in small children, however DECT has important potential in pediatric imaging. Specifically DECT can benefit in metallic artifact reduction, renal stone evaluation, bone removal for CTAs, and for virtual non-contrast in CT urography, CT cystography and the evaluation of abdominal tumors with suspicion of calcifications.

Poster #: EDU-076 Fetal MRI of Hemimegalencephaly; A Report of 4 Cases Sherelle Laifer-Narin, Rama Ayyala, MD, Columbia University Medical Center, New York, NY, [email protected]

Poster #: EDU-075 Implementation of Dual-Energy Computed Tomography in Pediatric Imaging William McCullough, MD, MBA, Children’s Hospital of Philadelphia, Philadelphia, PA, [email protected]; Arastoo Vossough, Kassa Darge, MD, PhD, Xiaowei Zhu, Sabah Servaes Disclosures: William McCullough indicated a relationship with General Electric Corporation as a stockholder. All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: The use of dual-energy computed tomography (DECT) for material decomposition was first proposed in the 1970s, but DECT scanners have only been commercially available for clinical use since 2006. Three distinct technologies are used in currently available DECT scanners: sequential acquisition, dual-source dual-energy and fast voltage switching dual-energy. Several specific applications of DECT have been studied in the adult population, to include renal stone composition determination, virtual non-contrast imaging, and the detection of uric acid deposition in the diagnosis of gout. Some of these applications are less appropriate in children, however in certain populations and for some indications, DECT capabilities may benefit the pediatric population. This educational exhibit aims to discuss currently available DECT technology and the implementation of a DECT program for clinical imaging in a pediatric hospital. Methods & Materials: We reviewed the literature regarding DECT in pediatrics and also included our own experience with the Siemens Flash

Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: Ultrasound is the first line imaging modality for performing a structural survey in the pregnant patient. MRI is utilized as a complementary modality for evaluating questionable/suspicious findings seen on ultrasound. This can be particularly helpful in evaluating the fetal central nervous system, with capability for delineating and diagnosing complex CNS anomalies such as cortical dysplasias. Hemimegaloencephaly is a rare congenital disorder manifesting as enlargement and overdevelopment of one cortical hemisphere with other associated CNS abnormalities. The purpose of this exhibit is to review the prenatal imaging findings of this entity. Methods & Materials: A retrospective review of fetal MRI database was performed to identify patients with prenatal imaging diagnosis of hemimegalalencephaly. A total of four patients were identified and imaging findings were reviewed. All patients underwent MRI on a 1.5T system. MR sequences obtained include single shot fast spin echo T2, gradient echo, T1, and diffusion weighted sequences. Results: Pertinent imaging findings in these patients include cerebral hemispheric asymmetry, midline shift, specifically of the occipital lobe across the midline, and abnormal cortical gyration with either increased or decreased gyri. Additional findings identified include ventriculomegaly and the presence of cortical and subependymal tubers. Conclusions: Major clinical features of hemimegalencephaly include intractable seizures, developmental delay, psychomotor retardation, and progressive hemiparesis. Recognition of this entity is crucial for providing accurate patient counseling and management. Early prenatal diagnosis may alter management with decision to terminate the pregnancy. Alternatively, in a pregnancy carried to term, proper care and treatment can be offered to the neonate in a quick and efficient manner.


Poster #: EDU-077 Unusual Cancers of Childhood: Rare Abdominopelvic and Thoracic Tumors Mark Bittman, Cohen Children’s Medical Center of New York, NS-LIJ Health System, New Hyde Park, NY, [email protected]; Andrew Doan, Carolyn Fein Levy Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: The purpose of this exhibit is to present the imaging features of rare types of cancer in children and to increase the awareness of uncommon tumors which are encountered in a busy oncologic practice. We present a diverse group of masses in the thorax, abdomen and pelvis with an emphasis on advanced imaging. Each case highlights the imaging features of the neoplasm and describes the correlative clinical and genetic associations. A practical differential diagnosis on the basis of clinical and imaging findings is provided. Rarely encountered mass lesions which mimic malignancy are described. Methods & Materials: We performed a search of the radiology, oncology and pathology databases to find rare types of childhood cancer and cancer mimics which presented to our facility, a tertiary care children’s hospital. Results: We identified many exceedingly rare childhood cancers of the thorax, abdomen and pelvis all with clinical, histologic and imaging correlation. Cases presented in this exhibit include but are not limited to: thymic carcinoma, small cell lung cancer, type III pleuropulmonary blastoma (PPB), pancreatic cancer, colon cancer, gastric schwannoma, abdominal germ cell tumor, desmoplastic small round cell tumor, ectopic choriocarcinoma, and stage IV ovarian germ cell tumor. Conclusions: Childhood cancer is uncommon, however the incidence is increasing. It is important to be aware of the imaging features and clinical associations of both common and rare forms of childhood cancer.

Poster #: EDU-078 A Spectrum of Pediatric Orbital Imaging: A Real Eye Opener Faaiza Kazmi, MD, Radiology, St. Christopher’s Hospital for Children, Cherry Hill, NJ; Mea Mallon, Archana Malik, Jacqueline Urbine, Erica Poletto, Eric Faerber Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: Radiologists play a key role in aiding clinicians and patients by providing timely and accurate diagnosis of pediatric orbital conditions leading to prompt and appropriate patient management where indicated. The purpose of this presentation is to retrospectively review the spectrum of orbital pathology that can be seen in the pediatric population and that has presented to our institution. Methods & Materials: We retrospectively identified pediatric patients who presented with orbital conditions. Medical records were reviewed and radiologic studies were correlated with clinical history and surgical findings, and pathological results where indicated. Selectively chosen is an array of conditions affecting the eye consisting of congenital, traumatic, inflammatory and neoplastic etiologies. Results: Pertinent imaging findings as well as clinical, epidemiological, and patient management information will be described regarding each entity. In particular, a pictorial review with key CT and MR imaging features necessary to guide timely and accurate radiological diagnosis are discussed and demonstrated in detail.

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Conclusions: Expeditious diagnosis and reporting of orbital pathology in the pediatric population is imperative to avoid delay in treatment or complications that may potentially lead to functional vision loss or physical deformity.

Poster #: EDU-079 The Many Faces of Neurofibromatosis Type I Judit Machnitz, Resident, Pediatric Radiology, St. Christopher’s Hospital for Children, Cherry Hill, NJ; Jacqueline Urbine, Archana Malik, Erica Poletto, Mea Mallon, Eric Faerber Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: Neurofibromatosis Type I (NF-1), also known as von Recklinghausen disease; is the most common inherited phakomatosis, with diverse clinical presentations and radiologic findings. In the absence of a preexisting NF-1 diagnosis, positive family history or typical clinical signs, the diagnosis can be challenging for referring physicians and may not be apparent at the time of initial imaging. This multimodality, pictorial review demonstrates both the typical and less typical findings associated with NF-1. Methods & Materials: We retrospectively identified patients with NF-1 with either known diagnosis of neurofibromatosis or undiagnosed patients with variety of complaints. Medical records were reviewed and correlated with clinical history, radiologic images and, in cases with atypical imaging findings, with pathology results. Results: Our multimodality review illustrated the pathognomonic findings of neurofibromatosis type I; including: plexiform neurofibromatosis, optic pathway glioma, NF bright objects, solitary and multiplex cutaneous and spinal neurofibromas, sphenoid hypoplasia, short segment, and painful scoliosis. Additionally, less common findings related to NF-1 were also discussed, including: solitary intrathoracic/intraabdominal masses, lower extremity bowing, pseudoarthrosis, and lateral meningocele. Conclusions: Neurofibromatosis type I, the most common neurocutaneous syndrome, can present in many ways and can mimic a large variety of disorders. Pediatric radiologists often play a critical role in the early diagnosis of these patients, especially when the clinical picture is atypical.

Poster #: EDU-080 A Radiographic Review of Pediatric Sellar and Parasellar Lesions Amrita Arneja, MD, Radiology, Westchester Medical Center, Valhalla, NY, [email protected]; Priya Krishnarao, MD Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: Lesions of sellar and parasellar regions are a common childhood problem. These lesions represent a variety of unique oncologic, congenital, and vascular lesions. They also display vastly different imaging features compared to adult lesions of this region. An understanding of the anatomy, imaging characteristics and differentials of each particular seller and parasellar lesion is vital in making an accurate diagnosis. Methods & Materials: We present a comprehensive review of the anatomy of the region of the sella turcica. We review common and rare pathologies found in this anatomical region. We further discuss a casebased review of the CT and MR findings of pediatric lesions within the


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sellar and parasellar regions, including pituitary adenoma, craniopharyngioma, rathke’s cleft cyst, arachnoid cyst, germinoma, hypothalamic hamartoma, optic chiasm glioma, and metastatic lesions. Results: We provide an educational radiographic review of pediatric sellar and parasellar lesions. We use a multi-modal approach to evaluating each lesion and its extent, utilizing CT, MR ultrasound and PET imaging. We further discuss the important role of the radiologist in initial imaging, diagnosis, follow-up evaluation and evaluation of potential complications. We evaluate key pre-operative imaging findings and post-operative complications. Conclusions: Pediatric sellar and parasellar lesions present unique radiographic features and result in a complicated constellation of findings. The radiologist’s role in accurate diagnosis of these lesions and understanding of their imaging characteristics plays a crucial role in patient care and management.

Poster #: EDU-081 Neuromuscular Disorders: How Radiologists Have Enabled Neurologists to Go Beyond “Diagnose and Adios” Cindy Miller, MD, Yale New Haven Hospital, New Haven, CT, [email protected]; Cynthia Fleming, MD Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: While therapies for neuromuscular diseases are still in their nascent stages, much has been accomplished in terms of categorization of the diseases based on symptomatology, modes of inheritance, and specific defects underlying the disorders. Imaging has allowed for improved distinction based on specific patterns of e.g. white matter involvement as in the leukodystrophies and in merosin deficient congenital muscular dystrophy; additional features such as occipital encephaloceles in a specific type of congenital muscular dystrophy (Walker Warburg); and patterns of involvement of muscles in the various muscular dystrophies as can be distinguished with ultrasound and with MRI. This exhibit will trace the imaging evaluation from the time of plain film when imaging was used essentially to monitor scoliosis which so often accompanies the disorders to the advent of CT when various patterns of hypomyelination were first recognized allowing for distinction between e.g. congenital muscular dystrophy with merosin deficiency and metachromatic leukodystrophy to the introduction of MRI into the imaging armamentarium with the ability to image mitochondrial disorders and to further assess them with MR spectroscopy to the current time when ultrasound and MRI are being utilized to a greater extent not only to document patterns of involvement of muscle in the various muscular dystrophies, but also to monitor response to experimental therapies. Conclusions: A variety of imaging modalities has greatly improved neurologists’ ability to make specific diagnoses; the value of imaging will also be evident as therapies are developed such that there will be evidence beyond merely manual testing to document their efficacy.

Poster #: EDU-082 Interpretation Pitfalls When Imaging a Child For Headaches Lee Nakamura, MD, Pediatric Neuroradiology, Texas Children’s Hospital/Baylor School of Medicine, Houston, TX, [email protected]; Jeremy Jones, Michael Paldino, MD Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity.

Purpose or Case Report: Imaging in a child presenting with headaches is often normal. However, imaging correlates for certain well described causes of pediatric headache may be more subtle and, therefore, potentially overlooked. Furthermore, overlap of imaging patterns may result in the potential for misinterpretation. The purpose of this exhibit is to highlight some of the entities where findings are subtle and/or misinterpreted in this population of children with headache. Methods & Materials: The topics to be discussed will include: Inferior cerebellar tonsillar ectopia and its mimics, vascular pathologies, and migraine variants. Specific examples of each disease entity will be provided to illustrate the findings in pediatric headache imaging. Results: For cerebellar tonsillar ectopia we will discuss Chiari 1 and “complex Chiari” malformation. In addition, intracranial hypotension and hypertension will be discussed, as these patients are managed very differently, but can present with headaches and cerebellar tonsillar ectopia. For vascular etiologies of headache we will include Moyamoya and dural venous sinus thrombosis. Headache often accompanies the stroke symptoms in patient’s with undiagnosed Moyamoya, which emphasizes the important of evaluating the Circle of Willis on routine imaging. In addition, dural venous sinus thrombosis can easily be missed on routine CT head imaging. For migraine variants, there are specific imaging findings in hemiplegic and ophthalmoplegic migraine which will be discussed and illustrated. Conclusions: This educational exhibit will highlight important disease entities to be aware of when assessing a child presenting with headaches. The knowledge and awareness of what to look for will hopefully aid in accurate diagnoses and appropriate clinical management.

Poster #: EDU-083 Imaging of Pediatric Spinal Abnormalities: Solving the Puzzle Faaiza Kazmi, MD, Radiology, St. Christopher’s Hospital for Children, Cherry Hill, NJ; Archana Malik, Erica Poletto, Mea Mallon, Jacqueline Urbine, Eric Faerber Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: Approaching the intricate realm of pediatric spinal anomalies may seem daunting at first. A solid systematic framework forming the basis of knowledge regarding these complex entities, however, can increase understanding of and ease the difficulty in accurate diagnosis, allowing the radiologist to play a vital role in aiding clinicians in appropriate care. The purpose of this presentation is to provide an educational review of a broad spectrum of pediatric spinal abnormalities that have presented to our institution. Methods & Materials: We retrospectively identified pediatric patients who presented with spinal abnormalities. Medical records were reviewed and radiologic studies were correlated with clinical history, surgical findings, and pathological results where indicated. The specific cases selected for this pictorial review include an array of spinal anomalies spanning from normal variants to closed neural tube defects as well as open neural tube defects, and spinal masses. Multimodality spinal imaging with strong emphasis on sonography and MRI, both prenatal and postnatal, is displayed. Results: Key imaging and anatomic features pertaining to each of the spinal abnormalities discussed in this pictorial essay are demonstrated in detail including relevant facts and pertinent negatives to focus on the most precise interpretation. Common pitfalls in differentiating the wide, complicated range of pediatric spinal normal variants from pathologic conditions are addressed with the advanced tools at hand for the radiologist, in particular focusing on advancements in sonography and MR imaging techniques.


Conclusions: The complexity and variety of congenital malformations affecting the spine and spinal cord can be challenging. An organized approach to radiologic evaluation, however, leads to accurate diagnosis and characterization of pediatric spinal abnormalities guiding appropriate and timely therapeutic intervention.

Poster #: EDU-084 Imaging of Fetal Brain at 3 T: Our Experience Sw at i Mo dy, MD , Way ne St at e Un iv er sit y, Det roi t, MI , [email protected]; Jaladhar Neelavalli, PhD, Ewart Haacke, Sonia Hassan, Roberto Romero Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: The purpose of this educational exhibit is to present our early experiences with imaging of fetal brain on 3 T magnet. Magnetic Resonance Imaging (MRI) is increasingly used for prenatal diagnosis over the last three decades. Traditional fetal MR imaging is performed on 1.5 Tesla (T) magnets although reports of fetal imaging at 3 Tesla (T) are slowly increasing. Imaging at 3 T has advantages including improved signal to noise ratio (SNR) and, as a result, improved resolution and shorter imaging time. This also improves MR Spectroscopy and BOLD (Blood Oxygen Level Dependent) Imaging. However, there are drawbacks to imaging at 3 T including increased susceptibility artifacts and most importantly, increase in radiofrequency energy deposition in tissue measured as SAR (Specific Absorption Rate). We have scanned more than 80 pregnant subjects on a 3 T Siemens Verio system as part of an ongoing research study. Fetal brain and in some cases fetal body as well were imaged using the following sequences: T2 weighted single shot fast spin echo (SSFSE) sequence, T1 weighted spoiled gradient (SPGR) sequences, Diffusion weighted imaging (DWI) and Susceptibility Weighted Imaging (SWI). MR angiography sequences were also applied in some cases. Sequences were adapted and modified for fast imaging and to reflect changing relaxation times of the tissue. High resolution imaging of the brain, compared to conventional 1.5 T scan parameters was possible using these modified sequences. These sequences had a maximum average whole body specific absorption rate (SAR) value of 0.05). Conclusions: This study demonstrates transluminal systemic absorption of doxycycline during catheter sclerotherapy in infants and neonates. The systemic complications of hemolytic anemia, metabolic acidosis, and hypoglycemia in this study was not related to doxycycline dose but should be monitored closely in this population.

Poster #: SCI-014

Age (Years) CTDI FBP (mGy) CTDI iDose (mGy) % Dose Reduction 0-1.5

31.2

22.3

28.6

1.5-7.0

29.8

23.0

22.7

7.0-13

37.0

27.3

26.3

>13

39.5

29.2

26.0

Table 1: Summary of CTDI vol (mGy) measurements between filtered back projection (FBP) and iDose (4th generation, level 2) as a function of age group, along with percent change.

The Efficacy of Propranolol Therapy on the Proliferative Phase of Infantile Hemangiomas David Aria, MD, Phoenix Children’s, Phoenix, AZ; Trevor Davis, DO, Robin Kaye, Carrie Schaefer, Richard Towbin Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: To demonstrate the effectiveness of propranolol therapy in treating infants with infantile hemangiomas in their proliferative phase


Methods & Materials: In a retrospective review over a 6 month period in 2013 at a large, tertiary care pediatric hospital in the Southwest United States, 96 infants less than 1 year of age with infantile hemangiomas diagnosed clinically or via imaging studies were treated with daily oral propranolol. Although no generally accepted standardized protocol has been established, our institution’s protocol is as follows: • Pre-treatment baseline vital signs obtained • Weight based dosage (1-2 mg/kg/day) given orally on the inside of the cheek 3 times/day with feeding • Clinical follow-up at the following predetermined time intervals: • 1 week & 5 weeks post initiation • Then once a month for 2-3 months • Then every 2 months until discontinued • No imaging unless clinical concern for PHACES syndrome • Follow-up monitoring includes: • Evaluating for wheezing and lethargy • Obtaining vital signs • Updating weight to adjust dosing • Dosages adjusted or temporarily discontinued if an upper respiratory infection is present • Treatment terminated at the child’s first birthdate or earlier if significant side effects develop • At completion of therapy, propranolol dose tapered to half dose for 1 week with discontinuation the subsequent week Results: Of the 96 patients, 5 were lost to follow-up. Of the remaining 91 patients, 83 (90%) demonstrated a reduction in size or size stability at the termination of their propranolol treatment regimen. The remaining 8 patients had the following side-effects causing early treatment termination: • Wheeze/cough 4 • Poor perfusion to extremities 1 • Sleep disturbance 1 • Deceased (not therapy related) 1 • Acute life-threatening emergency 1 Conclusions: • Propranolol therapy is safe and effective and has become the first-line therapy for children with infantile hemangiomas • Surgery and embolotherapy are now reserved for failed medical treatment or high-risk lesions

Poster #: SCI-015 Clinician Perception of Radiology Reports and Communication in the Pediatric/Neonatal ICU Setting Cara Morin, Wendy Kim, MD, Nicholas Morin, Jane Kim, University of Maryland Medical Center, Baltimore, MD; Narendra Shet Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: - Assess clinician perception of radiology reports and communication for daily pediatric and neonatal intensive care unit (PICU/NICU) radiographs - Tailor reporting and communication style based on the needs and preferences of the clinicians Methods & Materials: An initial 16 question anonymous survey was distributed electronically to residents, fellows, nurse practitioners, and attendings in the NICU and PICU. Survey questions were aimed to identify the role of radiology reports in clinical management, possible shortcomings in radiology report style and communication of emergent findings, and ways to improve the utility and efficiency of radiology reporting. Radiology reporting style and communication methods were changed to reflect the needs of the clinician for a trial period of 8 months. A 17

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question follow-up survey was distributed to assess change in clinician satisfaction with radiology reports. Results: The initial survey yielded 30 responses: 100% view images every/nearly every time, 84% read at least some portion of the radiology report every/nearly every time, 77% preferred structured reporting, 73% prefer more quantitative measure of describing invasive line position, and 23% were unsatisfied with timeliness of report finalization. An action plan was instituted for 8 months and included structured reporting with quantitative description of invasive lines and timely communication of major critical findings to the team by the radiology attending before clinical rounds. Follow up survey yielded 29 responses: 86% found structured reporting easier to read, 66% were more likely to read the report if structured, and 7/10 people who had participated in both surveys thought communication improved. Conclusions: Our survey demonstrated that in the neonatal/pediatric intensive care setting the majority of clinicians rely on radiology reports and prefer a structured report format, including specific descriptions of invasive line position. In the ICU setting, the clinician is the main client of the radiology department. It is important to provide timely, useful reports to ensure clinician satisfaction and ultimately better patient care. Numerous studies have been published that advocate the need for structured reporting without documenting clinician preference. Our study provides needed data to support that pediatricians prefer structured reports.

Poster #: SCI-016 Imaging Findings in Acute and Chronic Bilirubin Encephalopathy Li-tal Pratt, MD, Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada, [email protected]; Prakash Muthusami, Aideen Moore, William Halliday, Adrian James, Susan Blaser Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: Neonatal hyperbilirubinemia is associated with risk for acute and chronic bilirubin encephalopathy (BE). Long-term BE sequelae include movement disorders and auditory neuropathy. Characteristic neuropathologic damage involves globi pallidi (GP), subthalamic nuclei (STN), substantia nigra (SN), hippocampi (HC), brainstem nuclei and cerebellum [Fig. 1]. Imaging clues are acutely high T1 signal [Fig. 1] and chronically high T2 signal and volume loss within GP, STN and HC. GP findings explain the movement disorders, while imaging confirmation of damage to the auditory apparatus has been difficult. We retrospectively evaluate and describe MRI features in a large cohort of BE patients and illustrate these findings with pathologic specimens. Methods & Materials: Seventy-nine MRI studies of 44 children with acute (group 1) or chronic (group 2) BE were evaluated. Group 1 included 16 neonates (

Twin-core fiber SPR sensor.

SPR and SPR Imaging: Recent Trends in Developing Nanodevices for Detection and Real-Time Monitoring of Biomolecular Events.

Bi-epitope SPR surfaces: a solution to develop robust immunoassays.

Capture-stabilize approach for membrane protein SPR assays.

Surface plasmon resonance (SPR) biosensors in pharmaceutical analysis.

A Flow SPR Immunosensor Based on a Sandwich Direct Method.

Graphene oxide-based SPR biosensor chip for immunoassay applications.

Fragment screening by SPR and advanced application to GPCRs.

Nano Sensing and Energy Conversion Using Surface Plasmon Resonance (SPR).

Reply: SPR Child Abuse Committee response regarding classic metaphyseal lesion.

Near orthogonal launch of SPR modes in Au films.

Facelift 2015.

Editorial 2015.

Neurocon 2015.

Editorial 2015.

Passages 2015.

Residents'corner February 2015. Editorial: 2015 Renewal of the Resident Board.

London Trauma Conference 2015 : London, UK, 8-11 December 2015.

The 2015 Bioinformatics Open Source Conference (BOSC 2015).

Espr 2015.

Neuroanniversary 2015.

Ensembl 2015.

Reviews 2015.

NeuroGASTRO 2015, June 4-6, 2015, Istanbul, Turkey.

Spr 2015.

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Twin-core fiber SPR sensor.

SPR and SPR Imaging: Recent Trends in Developing Nanodevices for Detection and Real-Time Monitoring of Biomolecular Events.

Bi-epitope SPR surfaces: a solution to develop robust immunoassays.

Capture-stabilize approach for membrane protein SPR assays.

Surface plasmon resonance (SPR) biosensors in pharmaceutical analysis.

A Flow SPR Immunosensor Based on a Sandwich Direct Method.

Graphene oxide-based SPR biosensor chip for immunoassay applications.

Fragment screening by SPR and advanced application to GPCRs.

Nano Sensing and Energy Conversion Using Surface Plasmon Resonance (SPR).

Reply: SPR Child Abuse Committee response regarding classic metaphyseal lesion.

Near orthogonal launch of SPR modes in Au films.

Facelift 2015.

Editorial 2015.

Neurocon 2015.

Editorial 2015.

Passages 2015.

Residents'corner February 2015. Editorial: 2015 Renewal of the Resident Board.

London Trauma Conference 2015 : London, UK, 8-11 December 2015.

The 2015 Bioinformatics Open Source Conference (BOSC 2015).

Espr 2015.

Neuroanniversary 2015.

Ensembl 2015.

Reviews 2015.

NeuroGASTRO 2015, June 4-6, 2015, Istanbul, Turkey.

Spr 2015.

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Follow Us