State of the Art: Body and Fetal Imaging

State of the Art:Body and Fetal Imaging

Kristin Fickenscher, MDAssistant Professor RadiologyChildren’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• Guide surgical biopsy,

staging, metastasis, response to therapy, recurrent lesions Coronal post contrast

CT: enlarged mediastinal lymph nodes

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

Nodular Sclerosing Hodgkins Lymphoma

Imaging Inflammatory Bowel Disease

• IBD previously imaged with small bowel follow through, enema, and CT

• High cumulative radiation dose

Small bowel follow through: jejunal stricture secondary to Crohn

Axial post contrast CT: distal ileal bowel wall thickening and inflammation secondary to Crohn

Imaging InflammatoryBowel 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:– Wall thickening

and inflammation– Messenteric

changes– Disease activity

• Restricted diffusion– Dysmotility– Perianal disease

MRI of the liver• 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

10 minute delay

20 minute delay

10 minute delay

20 minute delay

Focal Nodular Hyperplasia

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

NATIVE• Contrast free MR

angiography• Contraindication to

gadolinium• Arterial or venous

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 surgical plan

Coronal: bilateral open lip schizencephaly

Sagittal: agenesis of the corpus callosum, midline cyst

Sagittal: Dandy Walker malformation, agenesis of corpus callosum

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 Malformation

Congenital Diaphragm Hernia

Omphalocele

Extrapulmonary sequestration

Thank you!