RPS 2312 - Future directions of paediatric neuroradiology

Author Block: X. Wang¹, Y. Wang¹, M. Yu¹, Y. Li¹, S. Gui², X. Zhang¹, Y. Qin¹, N. Xue¹, Y. Zeng¹; ¹Weifang/CN, ²Shanghai/CN
Purpose: Multimodal magnetic resonance imaging (MRI) combined with multiple histological techniques was employed to investigate the effects of melatonin (Mel) treatment on endogenous neural stem cells (NSCs) regeneration and metabolic conditions in the hippocampal dentate gyrus, and explore the potential neuroprotective effect via the JAK2/STAT3 pathway in neonatal rats with hypoxic-ischemic brain damage (HIBD).
Methods or Background: Cerebral blood flow was dynamically monitored by laser speckle imaging. Multimodal MRI was applied in vivo to assess metabolic alterations in the cerebral microenvironment. Multiple histological techniques were employed to evaluate the effect of endogenous neurogenesis in the dentate gyrus (DG). 28 days post-modeling, the Morris water maze (MWM) was used to assess behavioral and cognitive function.
Results or Findings: Laser speckle imaging revealed that cerebral blood flow decreased most significantly at 24 h after HIBD . T2WI demonstrated a marked reduction in infarct volume following Mel treatment, accompanied by decreased abnormal DWI signals and significantly increased rADC values. Both Amide-CEST and NOE-CEST showed reduced abnormal signals in the injured hemisphere after Mel treatment, with LD-Amide and LD-NOE values significantly elevated MRS indicated a reduction in lactate levels in the Mel group. EdU/Nestin and EdU/DCX immunofluorescence staining revealed that Mel promoted the proliferation and migration of endogenous NSCs. The JAK2 inhibitor (WP1066) and agonist (C-A1) were used and results demonstrated that Mel exerts protective effects by inhibiting the JAK2/STAT3 pathway. MWM further confirmed that Mel improved memory function in neonatal rats with HIBD.
Conclusion: Multimodal MRI offers a visual basis for monitoring metabolic changes and reveals that Mel treatment can improve cerebral microenvironmental metabolism in HIBD neonatal rats. Moreover, Mel promotes endogenous NSC proliferation and migration by inhibiting the JAK2/STAT3 pathway.
Limitations: We recommend conducting further clinical studies.
Funding for this study: This work was supported by grants from the National Natural Science Foundation of China (Grant No. 82071888), the Natural Science Foundation of Shandong Province (Grant No. ZR2024MH067), the 2019 Young Creative Talent Induction Program for Higher Education Institutions, Shandong medical health science and technology project (Grant No. 202309041351)
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was approved by the Ethics Committee for Animal Experiments of Weifang Medical College (reference number: 2019 SDL 024, China).

Author Block: H. Ran, T. Zhang, K. Huang; Zunyi/CN
Purpose: Epilepsy is a common pediatric disease that often leads to cognitive and intellectual impairments, but the relationship between glymphatic system function and cognitive performance in children with focal epilepsy(FE) remains unclear. This study investigated the association between glymphatic system markers and cognitive outcomes in childhood FE.
Methods or Background: 80 FE children and 87 healthy controls(HC) were recruited, all subjects underwent multimodal MRI scan and cognitive performance assessment. And the glymphatic markers were acquired based on MRI data, including choroid plexus(CP) volume, cerebrospinal fluid(CSF) volume, diffusivity along perivascular spaces(ALPS), blood-oxygen-level-dependent(BOLD) signals, and CSF(BOLD-CSF) coupling. Comparisons of glymphatic markers were conducted between the FE and HC groups. The correlation analysis was performed to assess the association between glymphatic markers and cognitive function scores and clinical variables.
Results or Findings: The ratio of CP, CSF volume to intracranial volume was significantly higher in children with FE compared to HC(p<0.05). Additionally, the BOLD-CSF coupling in the whole and middle cortical regions and the left hemisphere and global ALPS index were significantly lower in FE children compared to HC(p<0.05). the ratio of CP volume changes were negatively correlated with PRI and onset age(p<0.05), the ratio of CSF volume changes were negatively correlated with PRI and FSIQ(p<0.05), and the BOLD-CSF coupling in the whole and middle cortical regions were negatively correlated with the age(p<0.05) , while the left hemisphere ALPS index was positively correlated with VCI, PRI, WMI, PSI, FSIQ, respectively(p<0.05), the global ALPS index was positively correlated with VCI, WMI, PSI, FSIQ, respectively(p<0.05) and negatively correlated with the disease duration(p<0.05).
Conclusion: These findings identify an association between glymphatic system dysfunction and cognitive impairment in children with FE.
Limitations: The cross-sectional design limits the ability to track spatiotemporal changes in glymphatic dysfunction.
Funding for this study: This research was supported by the National Natural Science Foundation of China (Grant Nos .82171919) and Intelligent Medical Imaging Engineering Research Center of Guizhou Higher Education Institutions project (Grant No. Qianjiaoji [2023] 038)
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The Ethics Committee of Zunyi Medical University reviewed and granted ethical approval for this study (Ethical Batch Number: lunshen [2021] 1-080).

Author Block: H. Ran, T. Zhang, K. Huang; Zunyi/CN
Purpose: The diffusion tensor imaging analysis along the perivascular space(DTI-ALPS) method has been used to evaluate glymphatic system function in patients with epilepsy. However, since the diffusion tensor model may fail to describe the diffusion coefficient of the nerve fibre crossing region accurately. Thus, this study aimed to combined diffusion kurtosis imaging ALPS(DKI-ALPS) and DTI-ALPS methods to evaluate glymphatic system function in children with focal epilepsy(FE).
Methods or Background: The study finally included 63 children with FE and 58 healthy controls (HC).All participants underwent MRI scans to acquire DKI and DTI data, and they also received a cognitive assessment on the same day as their MRI scan. We calculated the DTI-ALPS and DKI-ALPS indices for the left brain, the right brain and the whole brain. A two-sample t-test was then used to compare the DTI-ALPS and DKI-ALPS indices of the two groups. We examined the correlation between the DTI-ALPS and DKI-ALPS indices and clinical variables. The statistical threshold was set at P < 0.05.
Results or Findings: Both groups were matched for age, sex, and education. Compared to HC, FE children showed decreased DTI-ALPS and DKI-ALPS indices. However, both left, right, mean DKI-ALPS index and only mean DTI-ALPS index was significantly decreased(P < 0.05). Correlation analysis revealed a significant positive correlation between the decreased DTI-ALPS index and the VCI, PRI, WMI, PSI and FSIQ (P < 0.05). Regrettably, there was no significant correlation between DKI-ALPS indices and clinical variables.
Conclusion: This study demonstrates that abnormal glymphatic function in children with FE and associated with cognitive impairment. DKI-ALPS index showed higher sensitivity than DTI-ALPS in detecting group differences, and DTI-ALPS index may be a potential biomarker for cognitive impairment.
Limitations: Due to its cross-sectional design, causal relationships cannot be established.
Funding for this study: This study was supported by National Natural Science Foundation of China (grant No. 82171919), Intelligent Medical Imaging Engineering Research Center of Guizhou Higher Education Institutions project (grant No. Qianjiaoji [2023] 038), and Construction of Scientific and Technological Innovation Talent Team of Functional Imaging and Artificial Intelligence Application Research in Guizhou Province (grant No. QianKeHeRenCai CXTD [2025] 047).
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The Ethics Committee of Zunyi Medical University reviewed and granted ethical approval for this study (Ethical
Batch Number: lunshen [2021] 1-080).

Author Block: M. Schulze¹, P. J. Orbán², C. Keil¹, S. Köhler¹, R. Axt-Fliedner², G. Kasprian³, I. Bedei²; ¹Marburg/DE, ²Giessen/DE, ³Vienna/AT
Purpose: Neural tube defects such as myelomeningocele (MMC) and rachischisis are frequently associated with secondary central nervous system alterations including hindbrain herniation, edema, and aqueductal obstruction. Surgical repair aims to reduce these sequelae, but postoperative radiological outcomes remain incompletely characterized.
Methods or Background: A retrospective cohort of 31 patients with MMC (n=18) or rachischisis/myelocele (n=13) was analyzed using pre- and postoperative foetal MRI. Parameters included atlanto-occipital membrane bulging, extracerebral space size, brain edema, aqueductal patency, and cavum septum pellucidum (CSP) perforation. Statistical methods comprised descriptive analysis, correlation tests, and McNemar’s test for paired pre/post comparisons.
Results or Findings: Preoperatively, 71% of patients demonstrated atlanto-occipital bulging, 68% brain edema, and 74% aqueductal stenosis; mean extracerebral space was 3.1 mm. Postoperatively, bulging decreased to 16%, edema to 16% (McNemar p < 0.001), and extracerebral space increased to 8.2 mm. However, aqueductal obstruction was observed in 39% of cases postoperatively, and CSP findings remained unchanged or worsened in some patients. A very strong correlation was detected between postoperative hindbrain herniation and postoperative brain edema (r ≈ 0.94; Chi² p = 0.0005).
Conclusion: Surgical repair significantly improves edema and hindbrain bulging, with clear enlargement of the extracerebral space. Nevertheless, aqueductal obstruction and CSP changes persist as postoperative risks. The close association between hindbrain herniation and postoperative edema highlights the need for vigilant MRI follow-up and may inform tailored therapeutic strategies.
Limitations: Retrospective design. Clinical endpoints such as neurological function or developmental milestones were not evaluated.
Funding for this study: There was no funding for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Ethics committee approval was obtained.

Author Block: P. H. Tang, W. C. Tan, A. Bhatia, G. Y. H. Ng, J. Y. Kong, A. J. Anand, P. L. Tan, C. L. Ong; Singapore/SG
Purpose: Monochorionic twin pregnancies with single intrauterine foetal demise are reported as having highest risk of cerebral injury. Objective is to review our institution’s foetal MRI cases in the past decade to determine abnormalities seen in monochorionic twin pregnancies with demise of 1 twin.
Methods or Background: Retrospective review of foetal MRI brain performed for monochorionic twin pregnancies for foetal demise / post in utero intervention from 1 Jan 2014 to 31 Dec 2024 was performed. Indication for MRI, gestational age at imaging, type of intervention performed (cord coagulation, ligation of vessel, radiofrequency ablation) were obtained from the radiology report.
Results or Findings: There were 54 MRI done for monochorionic twin pregnancies for foetal demise / post in utero intervention from 1 Jan 2014 to 31 Dec 2024.
MRI was performed at an average 23.0 weeks of gestation (range from 21.0 to 31.1 weeks.)
There were 11 pairs of live twins post intervention with 2 foetuses having mild ventriculomegaly.
Only 1 pregnancy being investigated for demise of 1 twin showed demise of both twins, both showing acute brain infarcts. Of the other 42 pregnancies having demise of 1 twin, 36 (85.7%) of the live twins were normal, 5 (11.9%) live twins had brain abnormalities, 1(2.3%) live twin had isolated pericardial effusion.
Brain abnormalities were acute infarcts in 2 foetuses, smaller cerebral hemisphere in 1 foetus, thin bilateral cerebral parenchyma in 2 foetuses, possible subependymal heterotopia in 1 foetus, giving cerebral abnormality rate of 13.9% (6/43).
Conclusion: Cerebral abnormalities are seen in 13.9% of monochorionic twin pregnancies with demise of 1 twin.
Limitations: Postnatal follow up not available at the time of preparation of this abstract.
Funding for this study: Nil
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: A. Guarnera¹, A. Napolitano², F. Dellepiane², A. Carboni², M. C. Rossi Espagnet², G. Moltoni¹, C. Gandolfo², D. Longo²; ¹Rome/IT, ²Vatican City/VA
Purpose: Pediatric migraine without aura (pmwa) is suspected to cause structural and functional alterations in the brain connectome. MSM (morphometric similarity mapping), which has never been applied to pmwa, is an advanced technique which identifies anomalies of the cerebral cortex and connectivity. The paper aims to: a) identify differences in morphometric similarity networks (MSNs) in pediatric patients affected by mwa compared to controls and in subgroups of patients; and b) correlate these differences in MSNs with patients’ demographic and clinical characteristics.
Methods or Background: 83 patients (6-18 years), and 81 controls were retrospectively recruited from our Institution’s archive if the subjects showed: normal MRI exams and neurological examination, and no comorbidities. 3D T1 MPRAGE and DWI were pre-processed to obtain eleven cortical parameters for the MSN analysis. The global and regional mean morphometric similarities were calculated. We performed separate linear regression models, followed by an ANOVA with an FDR correction and a p-value threshold of 0.05 for all subjects and subgroups of patients in the global and regional models. For significant predictors, a post hoc analysis using the Benjamini-Hochberg method was performed.
Results or Findings: MSM identified significant differences in MSNs in patients based on clinical and demographic parameters, particularly biological sex. The cerebral pathways that showed the most significant alterations encompassed the executive function pathway, the nociceptive pathway, and the default mode network (p<0.001).
Conclusion: Differences in MSNs in the executive function pathway, the nociceptive pathway, and the default mode network demonstrated that migraine shapes the cerebral connectome and favours neuronal plasticity and may lead to chronicity of migraine symptoms. Biological sex is confirmed as a paramount parameter in migraine, supporting the hypothesis of a “sex-specific phenotype”.
Limitations: The key limitation is the retrospective design of the study.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: The study is retrospective.

Author Block: B. Arıkan Ergün, S. Yilmaz, H. Bulut, B. Uçan, S. Seçer, S. Celik, D. Yüksel, Ç. Üner; Ankara/TR
Purpose: Idiopathic intracranial hypertension (IIH) is characterized by elevated intracranial pressure without an identifiable cause. Although headache is the most common symptom, prepubertal children often present with ocular motor nerve involvement, differing from older patients. This study aimed to assess the diagnostic value of oculomotor cistern (OMC) enlargement in pediatric IIH, compare it with established MRI findings, and propose it as a potential biomarker.
Methods or Background: Brain MRI and contrast-enhanced MR venography of patients under 18 years with clinical signs of increased intracranial pressure were retrospectively reviewed independently by two blinded radiologists. Pituitary morphology, perioptic CSF space, optic nerve tortuosity, posterior scleral flattening, Meckel’s cave dimensions, OMC CSF space, and venous sinus narrowing were evaluated. Demographic data, ophthalmologic findings, and CSF pressure measured by lumbar puncture were recorded. Patients with elevated CSF pressure were compared with those with normal pressure.
Results or Findings: A total of 76 children with suspected IIH were evaluated, 10 of whom were excluded due to secondary causes. Among the remaining 66, 44 (67%) had elevated and 22 (33%) normal CSF pressure. In addition to established imaging findings—such as increased perioptic CSF, posterior scleral flattening, and optic nerve tortuosity—increased CSF space in the OMC was also statistically significant.
Conclusion: Neuroimaging is essential in IIH evaluation. Alongside recognized findings such as perioptic CSF widening, optic nerve tortuosity, posterior globe flattening, sellar changes, and venous sinus stenosis, increased OMC CSF space may serve as a novel imaging marker for diagnosing pediatric IIH.
Limitations: The limitations of the study are its retrospective and single-center design, which may limit generalizability, the small sample size, non-homogeneous patient age distribution, and the lack of long-term clinical correlation of oculomotor cistern enlargement with visual outcomes or disease progression.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The study was approved by the Ankara Etlik City Hospital Ethics Committee, Ankara, Turkey (no: 4/12)

Author Block: S. Babapour, A. Demiray, J. M. Johnson; New Haven, CT/US
Purpose: There is an increased risk of neurologic damage, 20- 40%, in the surviving twin if one twin dies in utero. This single-institution retrospective study evaluated the effects of co-twin demise and twin-twin transfusion syndrome (TTTS) on fetal brain and vasculature in monochorionic twin pregnancies.
Methods or Background: Using fetal brain MRI and ultrasound imaging, 16 defects were identified among 53 in utero twins. The study focused on cases within the first 30 days after a demise during the second and third trimesters. The average gestational age at initial MRI evaluation and based on LMP was 23 weeks and 4 days.
Results or Findings: 24 (48%) pregnancies involved a demised twin, most frequently associated with advanced TTTS (stage 3-4) or following radiofrequency ablation. Maternal demographic data were generally unremarkable except for two cases of maternal obesity. The imaging findings of the surviving co-twins, using both ultrasound and MRI, were largely consistent and indicated normal neurodevelopmental growth and cerebral vascular flow. The demise of donor twins occurred within three days post-procedure. In most cases, no evidence of acute brain injury, asymmetric development, or compensatory vascular overflow was detected in the surviving or recipient twins within one month following the co-twin’s demise. Notable exceptions included single cases of asymmetric biometry and increased corpus callosum length.
Other observed abnormalities among co-existing twins with early-stage TTTS included heart enlargement, ventriculomegaly, and Dandy-Walker malformation, although five cases demonstrated intact brain and vascular flow. There was a high concordance (95.35%) between ultrasound and MRI findings.
Conclusion: After advanced TTTS and fetal demise, surviving co-twins generally do not exhibit early brain injury or abnormal vascular compensation within one month; however, comprehensive soft tissue evaluation remains essential.
Limitations: A lack of long-term follow-up beyond one month post-demise.
Funding for this study: Internal Yale funding
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: 2000037822 IRB# informed consent was waived

Author Block: L. Ji, X. Zhang, M. Zhao; Nanjing/CN
Purpose: Fetal growth restriction (FGR) poses challenges in both the timing and detection of altered brain development, particularly in distinguishing pathological FGR from small for gestational age (SGA) fetuses. This study aimed to investigate differences in T1 relaxation times in the fetal brain between FGR and SGA cases.
Methods or Background: STAGE data were collected using two flip angles(15°and 60°, with a TR=600ms) at 1.5T. T1app maps of the fetal brain were generated from the STAGE data. T1 values were measured and compared in the following regions: frontal white matter (FWM), occipital white matter (OWM), centrum semiovale (CSO), thalami (T), cerebellar hemisphere (HC), basal ganglia (BG), and brainstem. T1 values among FGR, SGA, and AGA groups were compared using independent or Welch’s t-tests, as appropriate. A p-value < 0.05 was considered statistically significant.
Results or Findings: Among 50 cases (16 SGA, 13 FGR, 21 AGA), FGR fetuses exhibited significantly higher T1 values in FWM, OWM and CSO compared to the other two groups. FGR showed differences in the BG(1593.21±205.60ms vs 1368.92±233.12ms P=0.006) and brainstem(1315.11±263.57ms vs 1142.69±217.58ms P=0.039) compared to AGA fetuses. The T1 values of AGA fetuses showed negative correlations with gestational weeks in BG (r=-0.660), brainstem (r=-0.603), HC (r=-0.469), FWM (r=-0.646), OWM (r=-0.540) and thalami (r =-0.513).
Conclusion: T1 mapping offers a sensitive, non-invasive method for detecting microstructural brain alterations in FGR fetuses, especially in white matter and subcortical regions.
Limitations: First, some images were of suboptimal quality due to a small gestational age or polyhydramnios. Second, the study did not assess long-term neurodevelopmental outcomes, so the clinical relevance of the observed differences in T1 values remains uncertain.
Funding for this study: Maternal and Child Health Hospital High-level Construction Project(GZL2529)
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: It was approved by the institutional ethics committee of The First Affiliated Hospital of Nanjing Medical University.

Author Block: S. Babapour, J. Pearce, L. Ment, M. Bahtiyar, K. Kohari, E. Dave, J. M. Johnson; New Haven, CT/US
Purpose: To characterize maternal and fetal features quantitatively with a standardized panel of brain MRI biometrics among referrals with suspected corpus callosum (CC) anomalies.
Methods or Background: In this single-center retrospective evaluation of 61 consecutive fetal MRIs (2013-2025) reported as CC abnormality, morphometric variables were reviewed: bilateral ventricular-atria (VA) diameters, CC length, cerebral and bone biparietal diameters (BPD), vermis antero-posterior (AP) diameter & height, coronal cerebellar diameter and pons AP diameter (table 1). Gestational age (GA) was taken from ultrasound dating or, if absent, last menstrual period.
Results or Findings: Mean maternal age at MRI was 31.8 ± 4.7 years (22–42). Median GA was 25 weeks (IQR 22–28).
• CC morphology: complete agenesis in 42 (69 %), partial agenesis or hypoplasia in 10 (16 %), dysgenesis in 9 (15 %).
• CC length (non-agenesis, n = 32): 29.7 ± 6.1 mm (-1.8 SD vs normative medians).
• VA diameters: dilatation ≥ 10 mm in 34/55 measurable cases (62 %). VA_mean inversely correlated with CC length (r = -0.58, p < 0.001).
• Posterior fossa: vermis height < 5th percentile in 10/43 (23 %), predominating in complete agenesis (8/10).
• Parenchyma–skull discordance: cerebral BPD lagged behind bone BPD by ≥ 5 mm in 28/50 (56 %).
No significant association was found between maternal age tier (< 30 vs ≥ 30 yr) and degree of VA dilatation or CC subtype (p > 0.3).
Conclusion: In this in utero second and early third trimester MRI series, CC malformations were assessed in mothers of reproductive age. Ventriculomegaly and posterior-fossa under-development were common co-findings and showed quantifiable relationships to CC size. Routine extraction of these biometric signatures may refine prenatal counselling and prognostication in CC anomaly.
Limitations: Further multicenter validation and collaboration are required.
Funding for this study: Yale internal funding
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: IRB-approved