state of the art pediatric musculoskeletal imaging
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State of the Art Pediatric Musculoskeletal Imaging
Brenton Reading MDBrenton Reading MD
Assistant Professor, Univ of MO-Kansas CityAssistant Professor, Univ of MO-Kansas City
Pediatric Radiologist, Children’s Mercy Pediatric Radiologist, Children’s Mercy Hospitals & ClinicsHospitals & Clinics
After this talk, learner should be able to:
• Describe the modalities used in musculoskeletal imaging
• Understand the basic utility and benefit of advanced imaging techniques
Learning Objectives
• Radiographs• CT• MRI• Ultrasound• PET/CT
Outline
• Rapid
• Excellent spatial resolution
• CR/DR
• Low dose ionizing radiation
Radiographs
Tibia
Fibula
Fibula
Tibia
Radiographs
10 yo female with trauma 1 yo female with antalgic gait
Computed Tomography
• Volumetric acquisition
• Post Processing
• Good contrast resolution
• Bone detail
• Higher dose ionizing radiation
Med. CuneiformMed. Cuneiform
Lat. CuneiformLat. Cuneiform
22ndnd Metatarsal Metatarsal
44thth Metatarsal Metatarsal
Computed Tomography
14 yo male with trauma
Med. CuneiformMed. Cuneiform
Lat. CuneiformLat. Cuneiform
22ndnd Metatarsal Metatarsal
44thth Metatarsal Metatarsal
Computed Tomography
10 yo male with history of trauma to right hip and acetabular dysplasia
Right Hip Anterior Right Hip PosteriorRight hipRight hip
CoronalCoronal
Right hipRight hip
AxialAxial
Magnetic Resonance Imaging
• Volumetric acquisition
• Excellent contrast resolution
• Soft tissue detail
• No ionizing radiation
Magnetic Resonance Imaging
1.5 Tesla
Source: J MacKenzie and S Vasanawala. State-of-the-Art in Pediatric Body and Musculoskeletal Magnetic Resonance Imaging. Seminars in Ultrasound, CT, and MRI. 2010.
3 Tesla
FemurFemur
PatellaPatella
TibiaTibia
Sagittal T2Sagittal T2 Sagittal T2Sagittal T2
FemurFemur
PatellaPatella
TibiaTibia
Magnetic Resonance Imaging
14 yo old male with knee injury and pain
FemurFemur FemurFemur
FemurFemurFemur
TibiaTibia
PatellaPatella
TibiaTibia TibiaTibia
TibiaTibia
Patella
PatellaPatella
Sagittal PDSagittal PD Sagittal T2Sagittal T2
Sagittal PDSagittal PDBlack Box
Magnetic Resonance Imaging
FemurFemur
PatellaPatella
FemurFemur
PatellaPatella
FemurFemur
PatellaPatella
FemurFemur
PatellaPatella
FemurFemur
PatellaPatella
14 yo male with increasing knee pain and osteochondral lesion
Magnetic Resonance Imaging
13 yo female with left wrist mass
Ultrasound
• Real time dynamic imaging
• Lower resolution
• No ionizing radiation
Ultrasound
16 yo male with anterior lower leg mass
FibulaFibula
FibulaFibulaFibulaFibulaFibulaFibula
FibulaFibulaFibulaFibula
MarkerMarkerMarkerMarker
MarkerMarker
MarkerMarkerMarkerMarkerMarkerMarker
Sagittal T1 GadSagittal T1 Gad
Axial T1 GadAxial T1 GadAxial T2Axial T2AxialT1AxialT1
Sagittal T1Sagittal T1 Sagittal T2Sagittal T2
Ultrasound
16 yo male with anterior lower leg mass
Positron Emission Tomography
• Functional imaging
• CT for anatomical correlation
• Higher dose ionizing radiation
Positron Emission Tomography
2/19/20092/19/2009 10/28/201010/28/2010 1/27/20111/27/20112/19/20092/19/2009 1/27/20111/27/2011
1/20/20111/20/20112/19/20092/19/2009
5 yo female with rhabdomyosarcoma of the right thigh
Sagittal T2Sagittal T2 Coronal T1Coronal T1 Coronal T1 GadCoronal T1 Gad 3D Volume PET3D Volume PET Coronal PET/CTCoronal PET/CT
Coronal T1 GadCoronal T1 GadCoronal T1 GadCoronal T1 Gad
Thank you for your attention
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