Law Emily,  Luo Yu

Final Pr. ID: Poster #: CR-025

Ultrasound is the first line of study of radiolucent foreign bodies, such as wooden or organic foreign bodies. The reported sensitivity is up to 90-100%. However, the orientation, location, and size of such foreign bodies can pose challenges for accurate detection.

Case Presentation: We present a case of a 16-year-old girl who stepped on a small wooden stick, leading to a foreign body penetrating between her fourth and fifth toes, which was removed in the emergency room. Post-removal X-ray and ultrasound failed to identify any residual foreign body, and the patient was discharged home with antibiotics. However, persistent pain and progressive foot swelling prompted a return to the Emergency Room two weeks later. A repeat ultrasound showed increased soft tissue swelling, and hyperemia centered around the webspace of the fourth and fifth digits but failed to detect the foreign body. Subsequent MRI revealed a vertically oriented 1.7 cm long cylindrical structure with a diameter of 0.3cm, demonstrating a hypointense signal in all sequences and hyperintense signal and enhancement in the surrounding tissue compatible with the foreign body. In retrospect, a tiny echogenic focus corresponding to the end of the foreign body is present in a similar location on some of the images of both sonographic exams. The foreign body was surgically removed, and the patient completely recovered within a week.

Discussion: This case highlights the limitations of ultrasound in detecting wooden foreign bodies, particularly when they have a unique orientation, location, and small dimensions; in this case, the foreign body was found vertically oriented (thus perpendicular to the ultrasound probe surface) and between the toes. The ultrasound can only detect the tiny end of the foreign body, which can be easily missed or misinterpreted. With its excellent tissue characterization capabilities, MRI proved to be a valuable tool in this challenging scenario. While ultrasound remains a highly sensitive and specific tool, clinicians should consider additional imaging modalities when faced with challenging cases to avoid missed diagnoses and unnecessary complications. Read More

Authors:  Law Emily , Luo Yu

Keywords:  foreign body, MRI, US

Juang Eric,  Giersch Kristie,  Katz Danielle,  Annam Aparna,  Tutman Jeffrey,  Zavaletta Vaz

Final Pr. ID: Poster #: EDU-049

The purpose of this educational presentation is to delve into the physics of Microvascular Flow Imaging (MVFi) and showcase its significance in the imaging of pediatric vascular anomalies. MVFi complements grayscale and traditional color or power Doppler imaging of vascular malformations.

MVFi is an advanced Doppler ultrasound technique that excels in detecting slow blood flow in smaller vessels and capillaries without the use of a contrast agent. Different vendors utilize proprietary MVFi algorithms to isolate the slow flow signal from tissue artifacts and enhance spatial resolution. However, MVFi algorithms are susceptible to motion and flash artifacts, which can be challenging in young children. Nevertheless, in the appropriate setting, MVFi enables improved delineation of slow-flow lesions through the detection of intravascular slow flow, which may be located in the lesion or in the surrounding tissues.

MVFi can play a vital role in monitoring residual or recurrent disease following intervention. In this work, we will explore the physics through case presentations to illustrate the combined use of MVFi with grayscale and conventional Power Doppler in diagnosing and managing pediatric vascular anomalies with slow flow. Read More

Authors:  Juang Eric , Giersch Kristie , Katz Danielle , Annam Aparna , Tutman Jeffrey , Zavaletta Vaz

Keywords:  Vascular Anomalies, Vascular Imaging, Doppler US

Alhashmi Ghufran,  Gupta Anita,  Trout Andrew,  Dillman Jonathan

Final Pr. ID: Alt #: 001

Ultrasound shear wave elastography (US SWE) can be used to noninvasively measure liver stiffness. US SWE is a potentially useful technique for diagnosing and monitoring liver fibrosis, obviating the need for liver biopsy in some patients. When compared to MR elastography (MRE), US SWE is lower cost, portable, and does not need sedation/anesthesia. US SWE measurements can vary by method (point vs. 2D) and vendor. Few studies have defined cut-off values for detecting fibrosis in pediatric patients using US 2D SWE. This study aims to evaluate the diagnostic performance and define cut-off values of US 2D SWE for the detection of liver fibrosis in pediatric patients, using Toshiba (Canon) Aplio 500 and Aplio i800 systems. Read More

Authors:  Alhashmi Ghufran , Gupta Anita , Trout Andrew , Dillman Jonathan

Keywords:  2D US shear wave elastography, Liver fibrosis, Pediatric