Cheng Jocelyn,  Leesmidt Kantheera,  Liu Amanda,  Young Victoria,  Davda Sunit,  Berger-chen Sloane,  Courtier Jesse

Final Pr. ID: Poster #: EDU-039

Three-dimensional (3D) imaging has emerged as a valuable tool in diagnosing pediatric Müllerian duct anomalies (MDAs), offering superior anatomical visualization and assessment compared to traditional imaging techniques with two-dimensional ultrasound. MDAs are frequently associated with other congenital anomalies of the cervix, vagina, or urinary tract, and are a common cause of infertility and pregnancy loss after adolescence.

In pediatric patients, MDAs are often discovered incidentally during imaging for other conditions. Magnetic resonance imaging (MRI) is the preferred modality for evaluating MDAs in children, providing multiplanar capabilities and detailed soft tissue characterization while avoiding ionizing radiation. MRI protocols for MDAs typically include T2-weighted sequences for visualizing uterine morphology and T1-weighted sequences to detect blood products in cases of associated endometriosis or hematometra .

The use of 3D MRI techniques allows for enhanced depiction of uterine and vaginal anatomy, and is particularly advantageous in differentiating complex anomalies such as septate and bicornuate uteri. Additionally, 3D reconstructions can provide a virtual hysterosalpingogram (MR-HSG), offering a comprehensive assessment of the reproductive tract without the need for invasive procedures. 3D imaging's accuracy extends to the detection of associated renal anomalies, given the concurrent development of the urinary and reproductive systems. Identifying these anomalies early is crucial for planning surgical interventions that may involve both gynecologic and urologic components .

Overall, 3D imaging significantly enhances the diagnostic accuracy and management of pediatric Müllerian duct anomalies. By providing detailed anatomical insights and allowing for non-invasive classification, it plays a critical role in guiding treatment strategies, reducing the need for repeat surgeries, and improving long-term reproductive outcomes for affected patients.

The purpose of this educational exhibit is to:
1. Review the embryology, classification, and imaging features of Müllerian duct anomalies using 3-dimensional imaging
2. Review the indications and techniques for surgical management of Müllerian duct anomalies in pediatric patients
3. Provide sample cases and clinical courses of patients with specific Müllerian duct anomalies with tips for implementation of 3-D imaging
4. Allow learners to test their knowledge with a quiz. Read More

Authors:  Cheng Jocelyn , Leesmidt Kantheera , Liu Amanda , Young Victoria , Davda Sunit , Berger-chen Sloane , Courtier Jesse

Keywords:  MRI, Mullerian Duct Anomalies, 3D Imaging

Kumar Tushar,  Romberg Erin,  Otjen Jeffrey

Final Pr. ID: Poster #: EDU-114

Dynamic and four-dimensional computed tomography (4D-CT) of the airways and lungs is an advanced imaging technique designed to identify dynamic pathologies across various levels of airway, including the oropharynx, larynx, trachea, bronchi, and lungs. This modality enables detailed assessment of airway motion and functional abnormalities that are intermittently absent on conventional static imaging. At the oropharyngeal level, Robin sequence (Pierre Robin syndrome) represents congenital anomalies resulting from abnormal development of the first pharyngeal arch, leading to mandibular hypoplasia, failure of normal tongue descent, non-fusion of the palatal shelves, and resultant upper airway obstruction. At the laryngeal level, vocal cord dysfunction is a cause of feeding difficulties and vocal dysfunction in the pediatric population, most frequently resulting from prolonged intubation or iatrogenic injury to the recurrent laryngeal nerve following cardiac surgery. In such cases, dynamic CT serves as a valuable, non-invasive alternative to nasal endoscopy for evaluating glottic motion. Tracheomalacia, defined as excessive expiratory collapse of the tracheal lumen, may be congenital—such as with cystic fibrosis or Mounier-Kuhn syndrome—or acquired secondary to prolonged intubation, chronic or recurrent infections, or idiopathic. Similarly, bronchomalacia refers to the weakening of bronchial cartilage, resulting in airway collapse or significant luminal narrowing during expiration, and may also occur congenitally or as a sequela of chronic inflammation. Dynamic CT of the lung parenchyma can demonstrate areas of air trapping during the expiratory phase, such as with bronchiolitis obliterans secondary to recurrent inflammation, although the precise clinical implications of the CT findings remain undefined. Importantly, many of these entities are challenging to detect on traditional inspiratory and expiratory CT imaging. Dynamic low-dose CT protocols not only enhance diagnostic accuracy by providing real-time functional assessment but also reduce overall radiation exposure by eliminating the need for separate phase acquisitions. This pictorial essay aims to review the spectrum of airway and lung pathologies detectable by dynamic and 4D-CT, emphasizing optimal imaging techniques, interpretative considerations, and risk-based diagnostic strategies relevant to pediatric radiologists. Read More

Authors:  Kumar Tushar , Romberg Erin , Otjen Jeffrey

Keywords:  3D Imaging, Airway, CT Dynamic Airways

Loken Delaney,  Goncalves Luis,  Patel Mittun

Final Pr. ID: Poster #: CR-011

Prenatal diagnosis of esophageal atresia (EA) remains challenging, with indirect signs such as polyhydramnios, a small or absent stomach bubble, and a dilated upper esophageal pouch often being nonspecific. Only 10-40% of EA cases are diagnosed prenatally. Fetal MRI can overcome ultrasound limitations; however, constraints like motion can hinder evaluation of the esophagus. One approach to improve image quality is super-resolution imaging with slice-to-volume reconstruction (SVR). This technique enhances diagnostic accuracy by generating high-resolution 3D images from standard fetal MRI slices. We present two instances where super-resolution imaging with SVR was employed to accurately diagnose EA and assess the presence or absence tracheoesophageal fistulas (TEF).

Case 1: A 30 3/7-week gestation male fetus was referred for fetal MRI following ultrasonographic findings of a dilated right atrium, a single umbilical artery, a small fetal stomach, and a urinary tract dilation observed at 27 2/7 weeks. Fetal MRI revealed a dilated upper esophageal pouch with a small amount of fluid in the distal esophagus, and a diminutive stomach. 3D-rendered super-resolution images demonstrated a dilated atretic upper esophageal pouch and a TEF originating from the left mainstem bronchus. The application of super-resolution imaging with SVR was crucial to determine the precise origin of the TEF from the left mainstem bronchus, findings that were later confirmed by bronchoscopy and surgery.

Case 2: A 33 2/7-week gestation male fetus was referred for fetal MRI due to polyhydramnios and inability to visualize the stomach on an ultrasound performed at 31 weeks. Fetal MRI confirmed polyhydramnios with a distended, fluid-filled proximal esophagus, consistent with EA. The stomach was decompressed, and the distal esophagus was not visualized. 3D-rendered super-resolution imaging with SVR confirmed the dilated upper esophagus and revealed that it ended 0.5 cm below the level of the carina. The imaging also demonstrated a gap between the distal end of the esophageal pouch and the gastroesophageal junction at the level of the diaphragm, supporting the absence of the distal esophagus.

The use of super-resolution imaging with SVR provided detailed, pre-surgical 3D anatomical depictions in both cases of EA, with and without TEF. This technique demonstrates significant potential for accurately delineating the relevant surgical anatomy, which can improve surgical planning and outcomes. Read More

Authors:  Loken Delaney , Goncalves Luis , Patel Mittun

Keywords:  3D Imaging, Esophageal Atresia, Tracheoesophageal Fistula

Rendon Kathleen,  Rigsby Cynthia

Final Pr. ID: Poster #: EDU-002 (T)

Purpose: The long-term effects from gadolinium tissue deposition in organs and the brain is unknown especially in children who may need repeated contrast studies for necessary follow-up of cardiovascular abnormalities. We aim to show the utility of a non-contrast MRA sequence in older children and young adults undergoing chest and/or abdominal MRA. Read More

Authors:  Rendon Kathleen , Rigsby Cynthia

Keywords:  Non-contrast, 3D imaging, Cardiac