ASPNR INTERESTING CASE SESSION ASNR 54Th Annual Meeting May 24,23, 2016

ASPNR INTERESTING CASE SESSION ASNR 54th Annual Meeting May 24,23, 2016

Erin Simon Schwartz, MD, President Susan Palasis, MD, Vice-President Ashok Panigrahy, MD, Secretary Arastoo Vossough, MD, PhD, Treasurer and Laurence Eckel, MD, Treasurer IN WHAT YEAR WAS THE ASPNR FOUNDED?

A.1992 B. 1993 C.1994 D.1995 E. 1996 IN WHAT YEAR WAS THE ASPNR FOUNDED?

A.1992 B. 1993 C.1994 D.1995 E. 1996 ESS CASE 1

11 year old girl “progressively obtunded and vomiting” WHAT IS THE DIAGNOSIS?

A. Subdural hygromas B. Subarachnoid hemorrhage C. Anemia D. Iatrogenic effect

WHAT IS THE DIAGNOSIS?

A. Subdural hygromas B. Subarachnoid hemorrhage C. Anemia D. Iatrogenic effect

Additional history we found in the medical record: Patient with seizures and rapidly declining mental status after local anesthetic (mepivicaine) injected for dental procedure INTRAVASCULAR LIPID ADMINISTRATION

• Lipid infusions increasingly being used to treat local anesthetic systemic toxicity (LAST) • Possible antidotal effect of intravenous lipid emulsion on action of lipophilic drugs, including local anesthetics, first discovered in 1962 • First case reports of success in human in 2006 • Controversial, however, as efficacy and safety not clearly proven

Lipid Rescue - Efficacy and Safety Still Unproven. Höjer J, Jacobsen D, Neuvonen PJ, Rosenberg PH. Basic Clin Pharmacol Toxicol. 2016 May 2. doi: 10.1111/bcpt.12607. [Epub] PMID: 27136445

SP CASE 1

• 7 month old previously healthy full term male

• Found unresponsive in daycare

• Caregiver stated that the baby choked while taking the bottle Non C+ CT + Retinal hemorrhages Negative skeletal survey

3D Volume rendering T2 FSE T2 FSE FS TOF MRA TOF MRV WHAT IS THE DIAGNOSIS?

A. Abusive head trauma B. Vitamin K deficiency C. Osler-Weber-Rendu syndrome D. Menkes disease WHAT IS THE DIAGNOSIS?

A. Abusive head trauma B. Vitamin K deficiency C. Osler-Weber-Rendu syndrome D. Menkes disease OSLER-WEBER-RENDU SYNDROME

• Osler–Weber–Rendu syndrome (Hereditary hemorrhagic telangiectasia (HHT)) • Autosomal dominant genetic disorder that leads to abnormal blood vessel formation in the skin, mucous membranes, and organs OSLER-WEBER-RENDU SYNDROME

Digital Subtraction Angiography ABUSIVE HEAD TRAUMA

SUBDURALS • Mixed intensity SDH • Hematohygromas

T2 FSE VITAMIN K DEFICIENCY

• Early (within 24 hrs), Classic (1-7 days of life), and Late (2-24 weeks) • Neonates and infants at risk because Vit K transfer through the placenta is limited

T2 T1 MENKES DISEASE

• X-linked recessive disorder of transmembrane copper (Cu) transport • Rapid CNS degeneration • Elastin collagen formation • Fragile, tortuous vessels • Predisposition to ischemia • Rapid brain atrophy leads to SDH

WHO WAS THE FIRST ASPNR PRESIDENT?

A.Thomas P Naidich B. Robert A Zimmerman C.James A Brunberg D.A James Barkovich E. Patrick D Barnes WHO WAS THE FIRST ASPNR PRESIDENT?

A.Thomas P Naidich B. Robert A Zimmerman C.James A Brunberg D.A James Barkovich E. Patrick D Barnes AP CASE 1

SECOND SIBLING

WHAT IS THE MOST LIKELY DIAGNOSIS? A. TORCH Infection B. Zika Infection C. Aicardi-Goutieres Syndrome D. Chorioamnionitis

AUTOSOMAL RECESSIVE PSEUDO-TORCH SYNDROME

• Phenotypic overlap with AGS (Aicardi-Goutieres syndrome) • Failure to determine causative intrauterine infectious agent • CSF leukocytosis with elevated interferon-alpha, neuropterins • Hepatic transaminases and thrombocytopenia AV CASE 1 Child with right leg weakness WHAT IS THE DIAGNOSIS?

A. RF213 mutation (inherited moyamoya) B. COL3A1 mutation C. ACTA2 mutation D. PHACES (unknown mutation) WHAT IS THE DIAGNOSIS?

A. RF213 mutation (inherited moyamoya) B. COL3A1 mutation C. ACTA2 mutation D. PHACES (unknown mutation) ACTA2 MUTATION

Multisystem smooth muscle dysfunction Straight and narrow intracranial vessels – occlusions and ischemia No moyamoya collaterals Small corkscrew distal vessels with tiny aneurysms HX of gastric dysmotility and congenital mydriasis. Several weeks of intermittent R hand numbness, progressively worsening slurred speech and expressive aphasia

Courtesy of Michelle Silvera PHACES Posterior fossa malformations Segmental hemangiomas Arterial anomalies (narrowing, occlusions, primitive connections, dilatation, collaterals, anomalous course, later aneurysms, etc.) Cardiac defects Eye abnormalities Sternal or ventral defects WHO WAS THE FIRST FEMALE ASPNR PRESIDENT?

A.Tina Young Poussaint B. Jill V Hunter C.Nancy K Rollins D.Patricia Davis E. Mary K Edwards-Brown WHO WAS THE FIRST FEMALE ASPNR PRESIDENT?

A.Tina Young Poussaint B. Jill V Hunter C.Nancy K Rollins D.Patricia Davis E. Mary K Edwards-Brown ESS CASE 2

12 year old obese female, headache for one week, nausea/vomiting for one day WHAT IS THE DIAGNOSIS?

A. Pseudotumor cerebri B. Normal MRI C. Acute infarction D. Venous Sinus Thrombosis WHAT IS THE DIAGNOSIS?

A. Pseudotumor cerebri B. Normal MRI C. Acute infarction D. Venous Sinus Thrombosis PSEUDOTUMOR CEREBRI

• Lumbar puncture: • Opening pressure: >60cm H20 • Headaches improved • Discharged on: Methylprednisone taper, Acetazolamide, Gabapentin, Metoclopramide prn EXCEPT… • One week after discharge, patient abruptly worsened • 10/10 occipital headache, blurry vision, confusion, weakness, emesis, enuresis, encopresis, fall and seizure • Sluggish 3mm pupils, bilateral papilledema, right CN VI palsy, hyporeflexia, unsteady gait, psychomotor slowing, and delayed, slurred speech • Lumbar puncture:

• Opening pressure: >36cm H20

• Repeat 5 days later, opening pressure: 48cm H20 • All viral, toxicology, and rheumatological laboratory tests normal, aside from mild anemia Raised papules on extremities Progressive deterioration with bulbar signs, urinary retention, acutely decreased responsiveness 40lb weight loss since onset of illness (two months) Over one week, mental status substantially declined Minimally responsive to sternal rub, only able to communicate by blinking, progressed to complete unresponsiveness WHAT IS THE DIAGNOSIS?

A. Inborn error of metabolism B. Vasculitis C. Pseudotumor cerebri D. Toxic exposure WHAT IS THE DIAGNOSIS?

A. Inborn error of metabolism B. Vasculitis C. Pseudotumor cerebri D. Toxic exposure

p-Dichlorobenzene: 2.8mcg/mL (normal = 0, reporting limit 0.020) 2,5-Dichlorophenol (DCB metabolite): 200mg/L (normal = 0, reporting limit 5.0) LEUKOENCEPHALOPATHY SECONDARY TO PARADICHLOROBENZENE TOXICITY

• Paradichlorobenzene in many forms of mothballs • Patient kept many boxes in her poorly ventilated room for >3 years, “reminded her of her grandmother” • Excessive inhalation or ingestion can cause a progressive leukoencephalopathy with ichthyotic rash and anemia, reports of intracranial hypertension • Toxin stored & released from fat, acute worsening during catabolic stress (patient decompensated during stress & when NPO) Twin Girls with Neurocutaneous Symptoms Caused by Mothball Intoxication. http://www.nejm.org/doi/full/10.1056/NEJMc060329 Hernandez SH, Wiener SW, Smith SW. Case files of the New York City poison center: paradichlorobenzene-induced leukoencephalopathy. J Med Toxicol. 2010 Jun;6(2):217-29 SP CASE 2

• 3 yr old female with intermittent vomiting for 2.5 weeks • Headache • No fever • Diagnosed with abusive head trauma at 5mos of age

T2 at 5mos 3 years later

Cor Non C+ CT Ax Non C+ CT Ax T2 FSE

Cor T1 C+

Ax T1 C+ DWI ADC WHAT IS THE DIAGNOSIS?

A. Post-traumatic encephalomalacia B. Intracranial epidermoid cysts C. Malignant myxoid glial tumors D. Abscesses WHAT IS THE DIAGNOSIS?

A. Post-traumatic encephalomalacia B. Intracranial epidermoid cysts C. Malignant myxoid glial tumors D. Abscesses MALIGNANT MYXOID GLIAL TUMORS

• Very rare • Meningeal glial rests • Low grade and high grade histology BRAIN ABSCESS

T2 T1 C+ DWI ADC INTRACRANIAL EPIDERMOID CYST

ADC T1 C+ DWI WHAT IS THE NAME OF THE ASPNR BEST PAPER PRESENTATION AWARD?

A. The Really Great Paper Award B. The Golden Brain Award C. The Derek Harwood-Nash Award D. The ASPNR Gold Medal Award WHAT IS THE NAME OF THE ASPNR BEST PAPER PRESENTATION AWARD?

A. The Really Great Paper Award B. The Golden Brain Award C. The Derek Harwood-Nash Award D. The ASPNR Gold Medal Award

Derek Harwood-Nash was one of the fathers of pediatric neuroradiology and a former President of the ASNR. In addition to his many tremendous contributions to our field, he was instrumental in establishing the ABR CAQ in Neuroradiology. The ASPNR is proud to honor his memory with this award. AP CASE 2 Ophthalmoplegia (non-painful) INTRAOPERATIVE ULTRASOUND

WHAT IS THE MOST LIKELY DIAGNOSIS? A. Meningioma B. Hemangiopericytoma C. Hemangioendothelioma D. Schwannoma WHAT IS THE MOST LIKELY DIAGNOSIS? A. Meningioma B. Hemangiopericytoma C. Hemangioendothelioma D. Schwannoma HEMANGIOENDOTHELIOMA (VASCULAR TUMORS)

• Differentiation from hemangioma based on infiltrative growth pattern and predominant Kaposi sarcoma-like content (fascicles of spindle cells) • Tumor can also have fibrogenic thrombi in the capillaries, hemorrhage, areas of lymphangiomatosis AV CASE 2

5 year old with progressive mental decline, swallowing problems, and weakness MRS, TE=135ms

WHAT IS THE DIAGNOSIS?

A. Leigh syndrome B. LBSL C. Listeria with rhombencephalitis D. Late-onset Alexander disease WHAT IS THE DIAGNOSIS?

A. Leigh syndrome B. LBSL C. Listeria with rhombencephalitis D. Late-onset Alexander disease LEUKOENCEPHALOPATHY WITH BRAINSTEM AND SPINAL CORD INVOLVEMENT AND HIGH LACTATE (LBSL)

• Childhood or adolescent onset and slow disease course. Patients develop insidious pyramidal, cerebellar, and dorsal column dysfunction

• Recessive mutations in DARS2, which encodes mitochondrial aspartyl-transfer ribonucleic acid synthetase

MS van der Knaap et al. A new leukoencephalopathy with brainstem and spinal cord involvement and high lactate. Ann Neurol. 2003 LEUKOENCEPHALOPATHY WITH BRAINSTEM AND SPINAL CORD INVOLVEMENT AND HIGH LACTATE (LBSL) Revised 2012 MRI criteria

Major criteria

Cerebral white matter (relative sparing of the subcortical white matter) Dorsal columns and lateral corticospinal tracts of the spinal cord Pyramids at the level of the medulla or decussation of the medial lemniscus

Minor criteria

Splenium of the corpus callosum Posterior limb of the internal capsule Superior and inferior cerebellar peduncles Intraparenchymal part of the trigeminal nerve Mesencephalic trigeminal tracts Anterior spinocerebellar tracts in the medulla oblongata Cerebellar white matter Steenweg et al. Neuropediatrics, October, 2012 LEIGH SYNDROME

Subacute necrotizing encephalomyelopathy

SURF1 Mutation LISTERIA INFECTION AND RHOMBENCEPHALITIS

Listeria monocytogenes – gram+ bacillus May lead to abscess ALEXANDER DISEASE

- GFAP Mutation - Often large head - Initially anterior white matter involvement - Late onset disease often has brainstem findings WHO WAS THE FIRST WINNER OF THE DEREK HARWOOD- NASH AWARD IN PEDIATRIC NEURORADIOLOGY? A. A James Barkovich, MD B. Aria Tzika, PhD C. Charles Fitz, MD D. William Ball, MD WHO WAS THE FIRST WINNER OF THE DEREK HARWOOD- NASH AWARD IN PEDIATRIC NEURORADIOLOGY? A. A James Barkovich, MD B. Aria Tzika, PhD C. Charles Fitz, MD D. William Ball, MD

Derek Harwood-Nash Outstanding Pediatric Neuroradiology Paper: Tzika AA, Barnes PD (mentor), Tarbell NJ, Nelson SJ, Scott RM. “Multivoxel proton spectroscopy of childhood brain tumors", presentation at ASNR 33rd Annual Meeting, Chicago, IL. 1995

ESS CASE 3 WHAT IS THE DIAGNOSIS?

A. Hunter Syndrome (MPS II) B. Achondroplasia C. Osteopetrosis D. Morquio Syndrome (MPS IV) WHAT IS THE DIAGNOSIS?

A. Hunter Syndrome (MPS II) B. Achondroplasia C. Osteopetrosis D. Morquio Syndrome (MPS IV) 23 Months

9 Years HUNTER SYNDROME MUCOPOLYSACCHARIDOSIS TYPE II

Imaging Findings: Brain: Enlarged perivascular spaces, delayed myelination, white matter ↓T1/↑T2, volume loss Spine: Beaking of cervical vertebrae, foramen magnum and/or cervical stenosis, cervical myelomalacia MORQUIO SYNDROME MUCOPOLYSACCHARIDOSIS TYPE IV

• Dysostosis with dwarfism, dental anomalies, corneal clouding, no direct CNS involvement (intellectually normal) Spine Imaging Findings: Platyspondyly with “ovoid” vertebral bodies, odontoid hypoplasia +/- cervical subluxation, cervical stenosis and myelomalacia ACHONDROPLASIA

• Most frequent form of rhizomelic dwarfism

Imaging Findings: Caudal narrowing of interpediculate distance, notch-like sacroiliac groove, exaggerated lumbar lordosis, cervical stenosis

Fetal CT courtesy of Teresa Victoria OSTEOPETROSIS

Imaging Findings: Hyperdense bones AD I - calvarium with sparing of spine AD II - skull base, spine, pelvis AR forms - more aggressive with systemic manifestations SP CASE 3

• 7 mos old girl with decreased leg movement since 4 mos of age • Difficulty with urination and bowel movements

Sag T2 Sag T1 Sag T1 C+ Cor T2 SP CASE 3

Ax T2

DWI ADC WHAT IS THE DIAGNOSIS?

A. Plexiform neurofibroma B. Myxopapillary ependymoma C. Differentiating neuroblastoma D. Atypical teratoid rhabdoid tumor WHAT IS THE DIAGNOSIS?

A. Plexiform neurofibroma B. Myxopapillary ependymoma C. Differentiating neuroblastoma D. Atypical teratoid rhabdoid tumor DIFFERENTIATING NEUROBLASTOMA

• Seven subtypes of neuroblastic tumors according to degree of neuroblastic maturation

MIBG MYXOPAPILLARY EPENDYMOMA

T1 T1 C+ ATYPICAL TERATOID RHABDOID

T2 FSE

3 weeks later T1 C+ post excision PLEXIFORM NEUROFIBROMA

DWI

STIR ADC WHO PLAYED NIKOLA TESLA IN THE MYSTERY THRILLER DRAMA “THE PRESTIGE”? A. Johnny Depp B. Robert Downey Jr. C. David Bowie D. Justin Timberlake

Question courtesy of Susan Palasis WHO PLAYED NIKOLA TESLA IN THE MYSTERY THRILLER DRAMA “THE PRESTIGE”? A. Johnny Depp B. Robert Downey Jr. C. David Bowie D. Justin Timberlake

pubs.acs.org selvedgeyard.com Fetal CT courtesy of Teresa Victoria AP CASE 3 Acute Flaccid Paralysis

Axial T2

Sagittal T2 WHAT IS THE MOST LIKELY DIAGNOSIS? A. Spinal Cord Infarct B. Demyelination Lesion C. Enterovirus myelitis D. Metastatic disease WHAT IS THE MOST LIKELY DIAGNOSIS? A. Spinal Cord Infarct B. Demyelination Lesion C. Enterovirus myelitis D. Metastatic disease ENTEROVIRUS D68 AND CNS DISEASE

2005 EV-D68 isolated from CSF in “a young adult” with flaccid paralysis1

2008

2012 EV-D68 isolated from nasal swabs of two children w “polio-like” syndrome2

2014

1Khetsuriani et al, MMWR, 2006 2Roux et al, Neurology. 2014;83(10):Supplement P3.335. 6

2 Affected individuals

0 0 2 4 6 8 0 2 4 6 8 0 2 4 6 8 0 2 3 1 1 1 1 1 2 2 2 2 2 3 3 7 - 3 3 Age (years) TAKE HOME POINTS

• Enterovirus myelopathy has fairly nonspecific imaging features • T2 prolongation in central gray, cervical >thoracolumbar, variable nerve root enhancement

• Consistent clinical features help make diagnosis of Acute Flaccid Myelitis

• Motor recovery is usually incomplete

• Enterovirus species are the predominant AFM associate AV CASE 3

WHAT IS THE DIAGNOSIS?

A. Fetal Teratoma B. NF-1 with optic pathway glioma C. Pallister-Hall syndrome D. Orofaciodigital Syndrome WHAT IS THE DIAGNOSIS?

A. Fetal Teratoma B. NF-1 with optic pathway glioma C. Pallister-Hall syndrome D. Orofaciodigital Syndrome PALLISTER-HALL SYNDROME

Hypothalamic hamartoma (5% of all cases) Polydactyly - syndactyly Anal atresia Renal anomalies Bifid epiglottis PALLISTER-HALL SYNDROME FETAL INTRACRANIAL TERATOMA WHAT WAS THE FIRST NEUROIMAGING TECHNIQUE DEVELOPED? A. Pneumoencephalography B. Functional MRI C. Human Circulation Balance D. Cerebral angiography WHAT WAS THE FIRST NEUROIMAGING TECHNIQUE DEVELOPED? A. Pneumoencephalography B. Functional MRI C. Human Circulation Balance D. Cerebral angiography

Italian neuroscientist Angelo Mosso who invented the 'human circulation balance', which could non-invasively measure the redistribution of blood during emotional and intellectual activity.

Sandrone, S.et al. (2014). Weighing brain activity with the balance: Angelo Mosso’s original manuscripts come to light. Brain, 137(2), 621–633. ESS CASE 4

Former 26 week premature infant, now 5 months old, paraspinal lesion incidentally detected on Chest CTA Cor STIR Sag T2 Sag T1 Post Gad T1 Fat Sat

Ax T2 I123 MIBG/CT Fusion I-123 MIBG SPECT/CT SCAN CAN BE NEGATIVE IN NEUROBLASTOMA

A. True B. False I-123 MIBG SPECT/CT SCAN CAN BE NEGATIVE IN NEUROBLASTOMA

A. True B. False I-123 MIBG SPECT/CT FOR NEUROBLASTOMA

Primary Tumor: • Sensitivity 67-100% • Specificity 68% Metastases: • Sensitivity 79-100% • Specificity 33-89% ~10% False Negative Rate

Bleeker G, et al. 123I-MIBG scintigraphy and 18F-FDG-PET imaging for diagnosing neuroblastoma. Cochrane Database Syst Rev. 2015 Sep 29;9:CD009263 WHAT IS THE DIAGNOSIS?

A. Neuroblastoma B. Hematoma C. Hemangioma D. Neurenteric Cyst WHAT IS THE DIAGNOSIS?

A. Neuroblastoma B. Hematoma C. Hemangioma D. Neurenteric Cyst INFANTILE CAPILLARY HEMANGIOMA

• Most common soft tissue tumor of infancy • Incidence has steadily increased over past 35 years, correlating with decreasing gestational age at birth as well as birth weight

Anderson KR, et al. Increasing incidence of infantile hemangiomas (IH) over the past 35 years: Correlation with decreasing gestational age at birth and birth weight. J Am Acad Dermatol. 2016 Jan;74(1):120-6 GASTRULATION

From Carlson, Human Embryology and Developmental Biology, 2014 NEURENTERIC CYST SP CASE 4

• 6yr old with increasing seizures • Fever

Ax T2 Cor T2 WHAT IS THE DIAGNOSIS?

A. Hypertrophic olivary degeneration (HOD) B. Adrenomyeloneuropathy C. Enterovirus rhombencephalitis D. Neuromyelitis optica (NMO) WHAT IS THE DIAGNOSIS?

A. Hypertrophic olivary degeneration (HOD) B. Adrenomyeloneuropathy C. Enterovirus rhombencephalitis D. Neuromyelitis optica (NMO) HOD SECONDARY TO MITOCHONDRIAL DISORDER

• Hypertophy and increased signal in the inferior olivary nucleus • Palatal tremor • Rare in children but can be seen following posterior fossa surgery • Disruption of triangle of Guillain-Mollaret

Goyal M et al. AJNR 2000 ADRENOMYELONEUROPATHY (AMN)

• Form of adrenoleukodystrophy • Long chain fatty acids deposited damage myelin • Symmetric signal abnormalities along corticospinal tracts • Atrophy

Axial T2 Courtesy of TAGM Huisman and A Poretti ENTEROVIRUS RHOMBENCEPHALITIS

• Fever, flaccidity • Dorsal brainstem, dentate nuclei, cord gray matter

Sag T1 Ax T1 Ax T2 Courtesy of TAGM Huisman and A Poretti NEUROMYELITIS OPTICA (NMO)

• 70% test positive for aquaporin 4 • Involve periventricular structures, periaqueductal gray, medulla at obex • Optic neuritis

FLAIR Ax T2 Sag T2 IN WHAT YEAR WAS THE FIRST JOINT ASFNR-ASPNR SYMPOSIUM? A. 2000 B. 2004 C. 2008 D. 2012 E. 2016 IN WHAT YEAR WAS THE FIRST JOINT ASFNR-ASPNR SYMPOSIUM? A. 2000 B. 2004 C. 2008 D. 2012 E. 2016 AP CASE 4

ACUTE RIGHT HEMIPARESIS RECENT BIOPSY OF SKIN LESION

Thanks to Dr Andre Furtado

ONE YEAR LATER WHAT IS THE MOST LIKELY DIAGNOSIS? A.Diffuse Axonal Injury B. Hereditary Hemorrhagic Telangiectasia (HHT) C. Sturge-Weber D. Parry-Romberg Syndrome WHAT IS THE MOST LIKELY DIAGNOSIS? A.Diffuse Axonal Injury B. Hereditary Hemorrhagic Telangiectasia (HHT) C. Sturge-Weber D. Parry-Romberg Syndrome AJNR 36:1355-61, Jul 2015 PARRY-ROMBERG SYNDROME

• Rare, self-limiting progressive hemiatrophy of the face (but brain abnormalities can present first) • Skin lesion = Scleroderma • Intracranial findings: parenchymal calcifications, hemorrhage, white matter lesions, atrophy • Etiology unknown (autoimmune?) AV CASE 4 Intermittent exotropia, headache, and papilledema

T2 T1 T1 Gad T2

SWI Magnitude SWI Phase ADC DWI

WHAT IS YOUR DIAGNOSIS?

A. Choroid plexus carcinoma B. Supratentorial PNET C. Meningioma D. Cavernous Malformation WHAT IS YOUR DIAGNOSIS?

A. Choroid plexus carcinoma B. Supratentorial PNET C. Meningioma D. Cavernous Malformation GIANT CAVERNOUS MALFORMATION (CAVERNOMA)

T2 T1 T1 Gad INTRAVENTRICULAR MENINGIOMA

CT T2 T1 Post SUPRATENTORIAL PNET

T2 T2* GRE T1 Post DWI CHOROID PLEXUS CARCINOMA

T2 DWI

FLAIR T1 Post WHAT WAS YOUR FAVORITE SESSION AT THE 2016 ASNR ANNUAL MEETING? A. Session 2A B. Lunch C. Session 3D D. The Annual Business Meeting E. THE ASPNR INTERESTING CASE SESSION WHAT WAS YOUR FAVORITE SESSION AT THE 2016 ASNR ANNUAL MEETING? A. Session 2A B. Lunch C. Session 3D D. The Annual Business Meeting E. THE ASPNR INTERESTING CASE SESSION www.aspnr.org

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