State of the Art: Body and Fetal Imaging

Kristin Fickenscher, MD Assistant Professor Radiology Children’s Mercy Hospital and University of Missouri, Kansas City

What’s new in body imaging?

• PET/CT • MR Enterography • MRI of the liver • MR Urography • MR Angiography

PET/CT • Measures the metabolic activity of lesion • Superimposed on anatomic CT image

Coronal FDG PET: abnormal activity in mediastinum and left supraclavicular nodes

• Guide surgical biopsy, staging, metastasis, response to therapy, recurrent lesions

Coronal post contrast CT: enlarged mediastinal lymph nodes Nodular Sclerosing Hodgkins Lymphoma

Imaging Inflammatory Bowel Disease • IBD previously imaged with small bowel follow through, enema, and CT • High cumulative radiation dose Axial post contrast CT: distal ileal bowel wall thickening and inflammation secondary to Crohn Small bowel follow through: jejunal stricture secondary to Crohn

Imaging Inflammatory Bowel Disease • MR Enterography – Lack of ionizing radiation – Easy to identify multifocal disease – DWI and cine give real information regarding disease activity – Superior depiction of perirectal disease

Imaging Inflammatory Bowel Disease •

Ulcerative Colitis

: contigous colitis – Lead pipe colon • Complications after colon resection and ileoanal anastomosis – pouchitis

Imaging Inflammatory Bowel Disease •

Crohn Disease:

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Wall thickening and inflammation

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Messenteric changes

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Disease activity

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Restricted diffusion

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Dysmotility

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Perianal disease

MRI of the liver 10 minute delay • EOVIST: gadolinium based contrast agent – Dynamic phase for morphologic and vascular information – Hepatocyte specific uptake gives additional information about lesion composition

EOVIST (gadoxetate disodium)

Portal venous 20 minute delay 10 minute delay

Focal Nodular Hyperplasia

20 minute delay

MR Urogoraphy • Provides excellent anatomic and functional information • Suspected urinary tract obstruction, hematuria, and congenital anomalies, surgically altered anatomy

MR Angiography • Time resolved dynamic contrast enhanced angiography • Excellent temporal and spatial resolution • Vascular dynamics and physiology as well as pathology

• Contrast free MR angiography • Contraindication to gadolinium • Arterial or venous NATIVE

Fetal MRI • Important adjunct to fetal sonography • Inconclusive sonographic findings • Technically limited ultrasound • Additional/ associated anomalies not visible on ultrasound

Fetal MRI: CNS • CNS anomalies most common indication • Further evaluation of ventriculomegaly • Associated abnormalities • Delivery and

malformation, agenesis of corpus callosum Coronal: bilateral open lip schizencephaly Sagittal: agenesis of the corpus callosum, midline cyst Sagittal: Large facial teratoma

Fetal MRI: Body • Evaluation of chest masses – CPAM, sequestration, diaphragmatic hernia – Lung volumes • Chest and abdominal wall defects – Contents in hernia • Abdominal/pelvic masses

Congenital Pulmonary Adenomatoid Omphalocele Malformation Congenital Diaphragm Hernia Extrapulmonary sequestration

Thank you!