In our experience, the use of 40% ASIR with a 38% decrease in mA lowers the radiation dose for children undergoing enhanced abdominal examinations by an average of 33%, while maintaining diagnostically acceptable images.

BACKGROUND AND PURPOSE:Iterative reconstruction techniques facilitate CT dose reduction; though to our knowledge, no group has explored using iterative reconstruction with pediatric head CT. Our purpose was to perform a feasibility study to assess the use of ASIR in a small group of pediatric patients undergoing head CT.

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Autosomal Recessive Spastic Ataxia of Charlevoix-Saguenay (ARSACS) is a rare, progressive, neurodegenerative disease characterized by ataxia, spasticity and polyneuropathy. First described in the French-Canadian population of Quebec in 1978, ARSACS has since been identified in multiple patients worldwide. In this clinical case report, we describe the evaluation of an 11-years-old African-American male who presented to neuromuscular clinic for assessment of a gait abnormality. He had a history of gross motor delay since early childhood, frequent falls and a below average IQ. Chromosomal microarray revealed a 1.422 megabase loss in the 13q12.12 region, which includes the SACS gene. Next Generation Sequencing then showed a novel, predicted to be pathogenic missense mutation (c.11824dup) of this gene. His clinical presentation and neurological imaging further confirmed the diagnosis of ARSACS. To our knowledge, this is the first reported case of this disease in the African-American population of the United States. This case report further highlights the growing trend of identifying genetic diseases previously restricted to single, ethnically isolated regions in many different ethnic groups worldwide.

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Objective: To describe clinical characteristics, imaging findings, morbidity, and mortality in a single-center cohort of 12 pediatric cavernous sinus thrombosis cases and to review all cases available in recent English literature.Methods: Clinical data and radiographic studies on 12 cases from our institution were analyzed retrospectively. A literature search and review was conducted, with additional cases pooled with the new cohort for an aggregate analysis.Results: Twelve cases of cavernous sinus thrombosis in children from the Children's Hospital of Philadelphia between January 1, 2000, and December 31, 2013, were reviewed. All patients survived to discharge; 3 of 12 (25%) experienced neurologic morbidity. Contrast-enhanced MRI and contrast-enhanced head CT were 100% sensitive for detecting cavernous sinus thrombosis, while noncontrast time-of-flight magnetic resonance venography (TOF MRV) and noncontrast head CT were 0% sensitive. Literature review produced an additional 40 cases, and the aggregate mortality rate was 4 of 52 (8%) and morbidity rate was 10 of 40 (25%). Outcomes did not vary by treatment or with unilateral vs bilateral cavernous sinus involvement. There was a trend toward worse outcomes with fungal infections. Conclusion:Our case series demonstrates low morbidity and mortality with early, aggressive surgical, antimicrobial, and anticoagulation therapies. Although anticoagulation and surgery were not associated with significantly different outcomes, more study is needed. Neurology ® 2015;85:763-769 GLOSSARY CST 5 cavernous sinus thrombosis; ICA 5 internal carotid artery; MRA 5 magnetic resonance angiography; MRV 5 magnetic resonance venography; TOF MRV 5 time-of-flight magnetic resonance venography without contrast.

Diffusion MRI is an imaging technique that uses the random motion of water to probe tissue microstructure. Diffusion tensor imaging (DTI) can quantitatively depict the organization and connectivity of white matter. Given the non-invasiveness of the technique, DTI has become a widely used tool for researchers and clinicians to examine the white matter of children. This review covers the basics of diffusion-weighted imaging and diffusion tensor imaging and discusses examples of their clinical application in children.

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