State of the Art: Body and Fetal Imaging

1. State of the Art:Body and Fetal Imaging Kristin Fickenscher, MD Assistant Professor Radiology Children’s Mercy Hospital and University of Missouri, Kansas City

2. What’s new in body imaging? • PET/CT • MR Enterography • MRI of the liver • MR Urography • MR Angiography

3. PET/CT Coronal FDG PET: abnormal activity in mediastinum and left supraclavicular nodes • 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 Nodular Sclerosing Hodgkins Lymphoma

4. 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

5. 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

6. Imaging Inflammatory Bowel Disease • Ulcerative Colitis: contigous colitis • Lead pipe colon • Complications after colon resection and ileoanalanastomosis • pouchitis

7. Imaging Inflammatory Bowel Disease • Crohn Disease: • Wall thickening and inflammation • Messenteric changes • Disease activity • Restricted diffusion • Dysmotility • Perianal disease

8. 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

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

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

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

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

13. 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: Large facial teratoma Sagittal: Dandy Walker malformation, agenesis of corpus callosum

14. Fetal MRI: Body Congenital Pulmonary Adenomatoid Malformation Omphalocele • Evaluation of chest masses • CPAM, sequestration, diaphragmatic hernia • Lung volumes • Chest and abdominal wall defects • Contents in hernia • Abdominal/pelvic masses Congenital Diaphragm Hernia Extrapulmonary sequestration

15. Thank you!