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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.

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state of the art body and fetal imaging

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

imaging inflammatory bowel disease
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 disease1
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 disease2
Imaging Inflammatory Bowel Disease
  • Ulcerative Colitis: contigous colitis
    • Lead pipe colon
  • Complications after colon resection and ileoanalanastomosis
    • pouchitis
imaging inflammatory bowel disease3
Imaging Inflammatory Bowel Disease
  • Crohn Disease:
    • Wall thickening and inflammation
    • Messenteric changes
    • Disease activity
      • Restricted diffusion
    • Dysmotility
    • Perianal disease
mri of the liver
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
MR Urogoraphy
  • Provides excellent anatomic and functional information
  • Suspected urinary tract obstruction, hematuria, and congenital anomalies, surgically altered anatomy
mr angiography
MR Angiography
  • Time resolved dynamic contrast enhanced angiography
  • Excellent temporal and spatial resolution
  • Vascular dynamics and physiology as well as pathology
native
NATIVE
  • Contrast free MR angiography
  • Contraindication to gadolinium
  • Arterial or venous
fetal mri
Fetal MRI
  • Important adjunct to fetal sonography
  • Inconclusive sonographic findings
  • Technically limited ultrasound
  • Additional/ associated anomalies not visible on ultrasound
fetal mri cns
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

fetal mri body
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