Schoeneberg Laura,  Bornemeier Renee,  Reemtsen Brian,  Greiten Lawrence,  Greenberg S Bruce,  Lyons Karen,  Renno Markus

Final Pr. ID: Poster #: CR-001

Limited experience with 3D print technology has been reported for surgical planning in infants with congenital heart disease. We present 5 infants with complex intracardiac anatomy for whom 3D cardiac models from gated cardiac CT angiograms facilitated surgical planning.

Case 1: Term 2-day-old infant with d-transposition of the great arteries (TGA), large anterior malalignment ventricular septal defect (VSD), and severe aortic arch hypoplasia. The 3D cardiac model confirmed feasibility of biventricular repair using a Yasui-type operation, with Norwood arch reconstruction, Rastelli VSD closure, and right ventricle to pulmonary artery (RV-PA) conduit placement.

Case 2: 2-month old, ex-34-week premature infant with double-outlet right ventricle (DORV), side-by-side great arteries, large remote predominantly-subaortic VSD, and pulmonary stenosis (PS). The 3D cardiac model highlighted the remoteness of the VSD from the outflow tracts, prompting right ventricular outflow tract patch augmentation without VSD closure when the patient developed hypercyanotic spells.

Case 3: Term 7-day-old infant with Goldenhar syndrome, D-TGA, large posterior malalignment VSD with inlet extension, and PS. The first 3D cardiac model raised concern that VSD closure would be difficult as a newborn due to VSD size, prompting placement of a BT shunt and pulmonary artery band. The second 3D model at 11 months of age demonstrated feasibility of biventricular repair with Rastelli VSD closure and RV-PA conduit placement.

Case 4: Term 2-day-old infant with 22q11.2 deletion syndrome, type B interruption of a right aortic arch, aberrant left subclavian artery, posterior malalignment VSD, small bicuspid aortic valve, and superior-inferior branch pulmonary artery relationships. The 3D cardiac model demonstrated need for VSD enlargement to enable complete repair with Yasui operation with LeCompte maneuver.

Case 5: Term 3-week-old infant with mesocardia, ventricular inversion, DORV, L-malposed great arteries, subpulmonic VSD, multilevel PS, and mitral chordal attachments to the crest of the ventricular septum. The 3D cardiac model suggested that VSD enlargement might enable a double switch operation with Rastelli VSD baffle. However, during the operation at 20 months old, mitral chordal apparatus prevented VSD enlargement, necessitating bidirectional Glenn instead. Read More

Authors:  Schoeneberg Laura , Bornemeier Renee , Reemtsen Brian , Greiten Lawrence , Greenberg S Bruce , Lyons Karen , Renno Markus

Keywords:  3D model, Congenital heart disease, Surgical Planning

Le David,  Durham Phillip,  Adams Caroline,  Dayton Paul,  Hwang Misun

Final Pr. ID: Poster #: SCI-035

Focused ultrasound (FUS) is a promising non-invasive technique for targeted drug-delivery to the brain through the disruption of the blood-brain barrier (BBB). Preclinical research into FUS-mediated BBB opening is largely limited to dedicated labs as precise imaging and targeting of brain regions is dependent on well-calibrated stereotactic stages. Here, we present a low-cost, portable system that allows for precise and reproducible image-guided FUS using a motorized, consumer-available motion-stage with techniques for calibration. Read More

Authors:  Le David , Durham Phillip , Adams Caroline , Dayton Paul , Hwang Misun

Keywords:  Ultrasound, Surgical Planning

Xu Hongmin,  Gagnon Marie-helene,  Ali Sumera,  Linam Leann

Final Pr. ID: Poster #: EDU-039

The purpose of this educational exhibit is to:
1.Review the embryology, classification, and imaging features of anorectal malformations (ARMs).
2.Review the indications and techniques of Contrast-enhanced colosonography (CeCS) in pediatric patients with ARMs.
3.Provide sample cases and clinical courses of patients with specific ARMs.

Anorectal malformations(ARMs) are a spectrum of congenital anomalies involving abnormal development of the distal rectum and anus, leading to an interruption or misconnection of the normal passage between the rectum and the perineum. The condition occurs in about 1 in 5,000 live births and can range from mild to complex. Children with ARMs require preoperative imaging to assess the presence and location of a fistula. Identifying the location of these fistulas is crucial for surgical planning.

Contrast-enhanced colosonography (ceCS) has emerged as a valuable tool in diagnosing pediatric ARMs, offering superior anatomical visualization and assessment compared to traditional imaging techniques like fluoroscopy, providing more sensitive and specific evaluation of fistula with real-time contrast filling. CeCS avoids ionizing radiation, and ultrasound contrast agents have a high safety profile with low incidence of adverse events compared to other contrast agents.

Contrast-Enhanced colosonography (CeCS) technique should include survey greyscale ultrasound examination of the pelvis to assess for adequate window. Lumason, the ultrasound contrast agent, is prepared and injected into a bag of saline, with a ratio of 1:500 mL. The mucous fistula is examined, and a small Foley catheter is inserted by the radiologist, then balloon is inflated to create a seal. Contrast is then instilled by gravity drip, and perineal structures are imaged through three standard approaches- transabdominal, transperineal and posterior sagittal approaches.

As well as reviewing the topics above, this review will also provide examples of ARM cases demonstrating high, intermediate, and low fistulas seen on CeCS.

Overall, CeCS enhances the diagnostic accuracy and management of pediatric ARMs. By providing detailed anatomical insights and allowing for accurate classification, it plays a critical role in guiding treatment strategies and improving long-term outcomes for affected patients. Read More

Authors:  Xu Hongmin , Gagnon Marie-helene , Ali Sumera , Linam Leann

Keywords:  Anorectal Malformation, Contrast Enhanced Ultrasound, Pre-Surgical Planning

Germaine Colton,  Tocchio Shannon

Final Pr. ID: Poster #: EDU-036

Overview:
Fetal Hydrops is a rare complication of pregnancy, occurring in approximately 1 in 1700 to 3000 pregnancies. Given the generally poor outcomes in neonates with fetal hydrops, including high rates of miscarriage, still birth and neonatal death, early detection in these cases can be essential in helping guide decision making during pregnancy and beyond. While ultrasound is the primary screening tool in these patients, fetal MRI provides vital information in cases of hydrops that can help guide management. Few resident radiologists are exposed to these types of MRIs, many of which often have critical findings essential to guiding patient care. In this educational exhibit we will demonstrate the imaging findings of fetal hydrops on prenatal MRI with a focus on fetal hydrops in suspected trisomy 21, noting that up to 35% of fetuses with hydrops have trisomy 21. Additionally, we will review common ultrasound findings in fetal hydrops and discuss considerations for management in these cases.

Outline:
Overview of Fetal Hydrops
Review of association of fetal hydrops and trisomy 21
Discussion of early detection and screening with Ultrasound
Prenatal MRI evaluation in a case of fetal hydrops in a patient with suspected trisomy 21, using images obtained at the University of New Mexico
Checklist of commonly affected structures and findings to improve detection and patient management
Brief discussion of potential prenatal/fetal surgical interventions in these cases

Goals:
Improve awareness and recognition of the imaging findings in fetal hydrops
Provide a potential search pattern for trainees in tackling these complex cases
Discuss the association of fetal hydrops with trisomy 21
Review the utility of imaging on planning of interventions when hydrops is identified Read More

Authors:  Germaine Colton , Tocchio Shannon

Keywords:  Fetal MRI, Trisomy 21, Surgical Planning

Cao Joseph,  Kuchibhatla Maragatha,  Janos Sara,  Gupta Ananya,  Bache Steve,  Solomon Justin,  Kilpatrick Kayla,  Fadell Michael,  Gaca Ana,  Maxfield Charles,  Carrico Caroline

Final Pr. ID: Poster #: SCI-076

Pectus excavatum is the most common chest wall deformity, often causing psychosocial distress and cardiopulmonary issues when severe. The Haller Index (HI) obtained on CT remains the standard for assessing severity, despite its limitations and reproducibility on radiograph. Photon-counting detector CTs can reduce radiation dose while maintaining image quality. We hypothesize that significantly lowering radiation will not compromise presurgical evaluation of pectus excavatum. Read More

Authors:  Cao Joseph , Kuchibhatla Maragatha , Janos Sara , Gupta Ananya , Bache Steve , Solomon Justin , Kilpatrick Kayla , Fadell Michael , Gaca Ana , Maxfield Charles , Carrico Caroline

Keywords:  Chest Computed Tomography (CT), Surgical Planning, Radiation Reduction