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