ACR Appropriateness Criteria® Orbital Imaging and Vision Loss-Child.

Orbital disorders in children consist of varied pathologies affecting the orbits, orbital contents, visual pathway, and innervation of the extraocular or intraocular muscles. The underlying etiology of these disorders may be traumatic or nontraumatic. Presumed location of the lesion along with the additional findings, such as eye pain, swelling, exophthalmos/enophthalmos, erythema, conjunctival vascular dilatation, intraocular pressure, etc, help in determining if imaging is needed, modality of choice, and extent of coverage (orbits and/or head).

The utility of time resolved magnetic resonance angiography in differentiating vascular malformations.

Purpose: The objective is to show that TR-MRA is a useful non-invasive technique without ionizing radiation of traditional angiography in evaluating VMs.

Materials And Methods: Retrospective search utilizing M-Power for MRA studies done at 3 T (Trio, Siemens) with both 3D contrast enhanced TR-MRA and 3D CE-MRA sequences from 2009 to 2018 were obtained after IRB approval. The images were blindly reviewed by two experienced cardiovascular radiologists for informations regarding vascular malformations with the ability to separate arteries and veins without any overlay or contamination in real time.

ACR Appropriateness Criteria® Ataxia-Child.

Childhood ataxia may be due to multifactorial causes of impairment in the coordination of movement and balance. Acutely presenting ataxia in children may be due to infectious, inflammatory, toxic, ischemic, or traumatic etiology. Intermittent or episodic ataxia in children may be manifestations of migraine, benign positional vertigo, or intermittent metabolic disorders.

Malpositioned Lines and Tubes on Chest Radiograph - A Concise Pictorial Review.

A wide variety of cardiothoracic support devices are used in intensive care units and few of these devices are increasingly being utilized in outpatient settings as well. A meticulous assessment of these lines and tubes by the interpreting radiologist is cardinal since malpositioned lines and tubes can significantly impact the functioning of these devices and may result in potential complications affecting the clinical outcomes. The purpose of this article is to illustrate the normal positioning and malpositioning of the routinely used support lines and tubes identified on chest radiographs.

Intramural Esophageal Abscess Complicated with Pleural Fistula: A Case Report.

Intramural esophageal abscess is a rare entity caused by mucosal injury to the esophagus but without transmural perforation. The mucosal disruption provides access to the intraluminal infectious contents to traverse into the loose submucosal tissue, resulting in an intramural abscess. It is important to be well-versed in the clinical and imaging findings of this pathology in order to make a timely diagnosis.

Olfactory neuroblastoma pulmonary metastasis presenting as a solitary pulmonary mass in an adult: A case report with pathologic correlation.

Pulmonary metastasis of an esthesioneuroblastoma is uncommon. In this report, we present a case of an esthesioneuroblastoma pulmonary metastasis in an adult. A 39-year-old man treated with surgical resection of olfactory neuroblastoma was found to have a solitary pulmonary mass on a surveillance computed tomography scan performed 5 years after undergoing primary surgery and radiation treatment.

Unusual intravascular complication of right internal jugular vein catheter piercing the SVC into the pericardium: Case report.

Iatrogenic superior vena cava pericardial fistula caused by central venous catheterization is rare but can lead to life-threatening condition. Despite the potential risk of pericardial effusion causing pericardial tamponade, a conservative watch and wait management strategy can be safely adopted if such procedural complication is encountered. Herein, we present a case of an incidental finding of a central venous catheter perforating the wall of the superior vena cava into the pericardium, which probably occurred during injection of intravenous contrast agent on computed tomography pulmonary angiogram study.

Dramatic response to alectinib in a lung cancer patient with a novel fusion and an acquired ALK T1151K mutation.

-rearranged lung cancer defines a distinctive molecular cohort of patients whose outcomes are significantly improved by the availability of ALK inhibitors. Thus, it is imperative for clinicians to screen appropriate patients for this driver mutation with a molecular testing platform capable of capturing all fusions. Here, we report a novel fusion and an ALK T1151K resistance mutation detected in a lung cancer patient who had been on crizotinib for over 8 years.

Receptor Tyrosine Kinase Fusions and BRAF Kinase Fusions are Rare but Actionable Resistance Mechanisms to EGFR Tyrosine Kinase Inhibitors.

Introduction: We analyzed a large set of EGFR-mutated (EGFR+) NSCLC to identify and characterize cases with co-occurring kinase fusions as potential resistance mechanisms to EGFR tyrosine kinase inhibitors (TKIs).

Methods: EGFR+ (del 19, L858R, G719X, S768I, L851Q) NSCLC clinical samples (formalin-fixed paraffin-embedded tumor and blood) were analyzed for the presence of receptor tyrosine kinase (RTK) and BRAF fusions. Treatment history and response were obtained from provided pathology reports and treating clinicians.

What the radiologist needs to know about gastrointestinal endoscopic surgical procedures.

Natural orifice transluminal endoscopic surgery (NOTES) is a novel surgical approach, currently performed for an array of conditions. Endoscopic procedures offer significant benefits, including lower cost, no surgical incisions, and shorter hospital stays. These advantages align with the current trends in health care, namely a push for "cost-effective care.

Does the Addition of a "Black Bone" Sequence to a Fast Multisequence Trauma MR Protocol Allow MRI to Replace CT after Traumatic Brain Injury in Children?

Background And Purpose: Head CT is the current neuroimaging tool of choice in acute evaluation of pediatric head trauma. The potential cancer risks of CT-related ionizing radiation should limit its use in children. We evaluated the role of MR imaging, including a "black bone" sequence, compared with CT in detecting skull fractures and intracranial hemorrhages in children with acute head trauma.

Sensitivity of susceptibility-weighted imaging in detecting developmental venous anomalies and associated cavernomas and microhemorrhages in children.

Purpose: Developmental venous anomalies (DVA) are common neuroimaging abnormalities that are traditionally diagnosed by contrast-enhanced T1-weighted images as the gold standard. We aimed to evaluate the sensitivity of SWI in detecting DVA and associated cavernous malformations (CM) and microhemorrhages in children in order to determine if SWI may replace contrast-enhanced MRI sequences.

Methods: Contrast-enhanced T1-weighted images were used as diagnostic gold standard for DVA.

Diffusion Tensor Imaging Detects Occult Cerebellar Injury in Severe Neonatal Hypoxic-Ischemic Encephalopathy.

Background: Despite the benefits of whole-body hypothermia therapy, many infants with hypoxic-ischemic encephalopathy (HIE) die or have significant long-term neurodevelopmental impairment. Prospectively identifying neonates at risk of poor outcome is essential but not straightforward. The cerebellum is not classically considered to be a brain region vulnerable to hypoxic-ischemic insults; recent literature suggests, however, that the cerebellum may be involved in neonatal HIE.

Tumor and Tumorlike Masses in Pediatric Patients that Involve Multiple Spaces.

There are several tumors and tumorlike masses involving multiple spaces in the pediatric brain. Accurate diagnosis of tumors and distinguishing them from tumorlike masses is an important aspect in the diagnostic workup and plays a key role for management and prognosis. Neuroimaging plays an important role in (1) identification of a brain mass, (2) determining its location, (3) demonstrating involvement of a single space versus multiple spaces, and (4) distinguishing a tumor from tumorlike masses.

Pediatric Neurocutaneous Syndromes with Cerebellar Involvement.

Neurocutaneous syndromes encompasses a broad group of genetic disorders with different clinical, genetic, and pathologic features that share developmental lesions of the skin as well as central and peripheral nervous system. Cerebellar involvement has been shown in numerous types of neurocutaneous syndrome. It may help or be needed for the diagnosis and to explain the cognitive and behavioral phenotype of affected children.

Cost and radiation exposure in the workup of febrile pediatric urinary tract infections.

Background: Technetium-99m dimercaptosuccinic acid (DMSA) scans are often used in the evaluation of pediatric patients with febrile urinary tract infections (UTIs). Given the prevalence of febrile UTIs, we sought to quantify the cost, radiation exposure, and clinical utility of DMSA scans when compared with dedicated pediatric renal ultrasounds (RUSs).

Materials And Methods: An institutional review board approved retrospective study of children under the age of 18 years evaluated at our institution for febrile UTIs between the years 2004-2013 was conducted.

Acute Infantile Encephalopathy as Presentation of Succinic Semialdehyde Dehydrogenase Deficiency.

Background: Succinic semialdehyde dehydrogenase deficiency is a rare neurological disorder resulting from impaired gamma-aminobutyric acid metabolism. The syndrome typically presents as a static encephalopathy with developmental delays, hypotonia, and seizures.

Methods: A six-month-old previously healthy girl developed acute choreoathetosis and severe hypotonia in the setting of influenza A infection.

Cerebellar disruptions and neurodevelopmental disabilities.

The vulnerability of the cerebellum during prenatal life to disruptive events such as hemorrhage and infection leads to a wide variety of morphological abnormalities. This review discusses various prenatal cerebellar disruptions including cerebellar agenesis, unilateral cerebellar hypoplasia, cerebellar cleft, global cerebellar hypoplasia, and vanishing cerebellum in Chiari type II malformation. For each entity, we discuss the definition, potential pathomechanism, clinical findings including neurocognitive and behavioral problems, neuroimaging features, and management.

Defining Optimal Head-Tilt Position of Resuscitation in Neonates and Young Infants Using Magnetic Resonance Imaging Data.

Head-tilt maneuver assists with achieving airway patency during resuscitation. However, the relationship between angle of head-tilt and airway patency has not been defined. Our objective was to define an optimal head-tilt position for airway patency in neonates (age: 0-28 days) and young infants (age: 29 days-4 months).

Diffusion tensor imaging suggests extrapontine extension of pediatric diffuse intrinsic pontine gliomas.

Purpose: To apply DTI to detect early extrapontine extension of pediatric diffuse intrinsic pontine glioma along the corticospinal tracts.

Methods: In children with diffuse intrinsic pontine glioma, low-grade brainstem glioma, and age-matched controls, DTI metrics were measured in the posterior limb of the internal capsule and posterior centrum semiovale. Histological examination was available in one patient.

Fetal and maternal manifestations of tuberous sclerosis complex: Value of fetal MRI.

Tuberous sclerosis complex (TSC) is a genetic disorder characterized by benign hamartomas in various organ systems of the body. Prenatal screening of fetuses of mothers affected with TSC using ultrasonography (US) may detect cardiac lesions. Fetal US is not sensitive for evaluation of the brain.

Pseudotumoral hemicerebellitis as a mimicker of Lhermitte-Duclos disease in children: does neuroimaging help to differentiate them?

The clinical presentation and neuroimaging findings of children with pseudotumoral hemicerebellitis (PTHC) and Lhermitte-Duclos disease (LDD) may be very similar. The differentiation between these entities, however, is important because their management and prognosis are different. We report on three children with PTHC.