The structure of the heart is more complex than 4 major chambers, 4 major valves, venous inflow and arterial outflow. Muscular and soft tissue ridges, perforated membranes, tissue flaps, electrical pathways, external grooves, endocardial surface characteristics, and a core architecture structured of fibrous tissue and embryonic tissue remnants form distinguishing anatomic landmarks. These structures provide insight into cardiac development, serve physiologic purpose, define structural and functional elements, as well as offer prognostic information. Specific details of cardiac anatomy may not be recognized on cardiac MR and CT examinations. Structural anomalies that affect cardiac function and anatomic or physiologic relationships may be abnormal in hearts with congenital malformations. The fine structural details of the heart are typically not part of an imagers search pattern and are therefore overlooked or underreported. Each minute structure and anatomic characteristic provides clues to errors in cardiac formation and may provide clinically relevant diagnostic information. After palliation of CHD defining anatomic structure may be lost, displaced, interrupted or even restored. Important processes, corresponding anatomic landmarks, and effects of malformation in defining congenital heart disease anatomy, physiology and functional variation from normal include basal structures such as the central fibrous body of the heart, atrial structures including the crista terminalis, the sinus venarum, and eustacian valve, and ventricular structures such as the crista supraventricularis. Each structure is described along with its normal location, anatomy functional and physiologic importance, the effect of congenital malformation, and imaging findings as in the example of the central fibrous body (table 1). Minute cardiac anatomy will be shown in illustration as well as in CT and MR images (figure 1). Read More

Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016

Authors: Southard Richard, Ellsworth Erik, Moe Tabitha, Augustyn Robyn, Thorkelson Marrit, Bardo Dianna

Keywords: Cardiac anatomy, Cardiac MR, Cardiac CT, Congenital heart disease, Embryology

Spectral or multi-energy CT (MECT), obtains raw data at more than one energy spectra which allows the decomposition of materials into their constituent elements. As opposed to conventional CT which yields data based on linear attenuation, MECT yields both structural and material-specific information. Only limited experience and literature are available regarding use and applications of MECT in the pediatric patient population. Our institution has recently installed a spectral MECT scanner which uses a single x-ray source modified multilayered detector CT, in our emergency department (ED). It is currently the only such scanner used for routine clinical pediatric imaging in the US, and 4^th such unit in a children’s hospital in the world. In this educational exhibit we will review the basic physics of MECT, the benefits and limitations of the single-source multi-layered detector geometry, and clinical applications of MECT and our experience to date in the pediatric population. Read More

Meeting name: SPR 2018 Annual Meeting & Postgraduate Course , 2018

Authors: Bardo Dianna, Southard Richard, Williams Carla, Augustyn Robyn, Thorkelson Marrit, Curran John, Miller Jeffrey, Chen Lingyun

Keywords: Spectral CT, Multi-Energy CT

Accurate tumor measurement is essential in initial assessment of solid tumors. Furthermore, it is vital when evaluating treatment response. Change in tumor size determines whether a treatment course is effective, if treatment should be prolonged, or whether a more aggressive treatment or chemotherapy drug should be administered. Currently endorsed and widely used guidelines for tumor volume measurement include response evaluation criteria in solid tumors (RECIST), a one dimensional measure (cm) of target lesions which is not routinely the longest axis; World Health Organization (WHO), a 2 dimensional measure of the long and one short tumor axis (cm2) but is not a measure of volume; and Childrens Oncology Group (COG), a 3 dimensional ‘volume’ (cm3) measurement but does not account for shape of the tumor. Pediatric oncology patients are almost exclusively cared for in major academic or community hospital settings where modern CT and MR scanners routinely produce direct or reconstructed multiplanar images. Therefore an evolution of tumor measurement, to determine tumor volume, must be forthcoming. Read More

Meeting name: SPR 2017 Annual Meeting & Categorical Course , 2017

Authors: Willard Scott, Barnes Craig, Augustyn Robyn, Thorkelson Marrit, Chatfield Paige, Hu Harry, Towbin Richard, Bardo Dianna, Pfeifer Cory, Dance Logan, Bailey Smita, Southard Richard, Jorgensen Scott, Biyyam Deepa, Patel Mittun, Cassell Ian

Keywords: RECIST, WHO, COG