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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. - PowerPoint PPT Presentation
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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!