Introduction: Juvenile Idiopathic Arthritis (JIA) is the most common rheumatic entity in children and the second most common cause of musculoskeletal symptoms in pediatric patients. Treatment of JIA largely depends on frequently managing inflammation within the joints, and as such, ultrasound is a prime imaging modality that can be used for detection and monitoring of inflammation. Ultrasound is more sensitive than plain films in the early detection of JIA, and ultrasound is more sensitive than clinical examinations alone. As a low-cost, high-resolution imaging modality, ultrasound allows visualization of the joint spaces, can be used to detect joint effusions, and can monitor synovial proliferation and joint hyperemia, all while not exposing the patient to radiation. We will present ultrasound images of various joints in children such as knees, ankles, wrists, hands and feet. Ultrasound technique, imaging planes, choice of probes frequencies and ultrasound settings are analyzed for optimization of the images. This presentation will highlight the diagnostic imaging findings of JIA on ultrasound, such the presence of joint effusions, synovial proliferation, capsular thickening, tendinitis as well as provide information on common pitfalls associated with age-specific appearances of pediatric musculoskeletal structures on ultrasound. Familiarity with JIA and musculoskeletal ultrasound findings will allow timely diagnosis and implementation of appropriate treatment strategies. Read More

Meeting name: SPR 2019 Annual Meeting & Postgraduate Course , 2019

Authors: Stanley Parker, Rubesova Erika

Keywords: Juvenile Arthritis, Ultrasound, Musculoskeletal

Placenta, one of the least understood human organs, is external to fetal body with genetic characteristics identical to the fetus. Placenta is made up of its parenchyma, membranes, and umbilical cord (UC). It involved in the transfer blood gases and nutrients, act as immune barrier, secrete hormones and other substances. Ultrasound, Doppler, and MRI are used to evaluate placental configuration and predict adverse outcomes. MR adds value to fetal and placental sonographic evaluation thanks to its wide field of view and high tissue contrast. Single shot fast spin echo (SSFSE), balanced steady state and T1-W, occasionally DWI, are the most used sequences. We present the spectrum of morphologies and pathologies of the placenta and UC on ultrasound and MRI. Placental location and shape: Placental location is based on its relationship with the uterus and cervix. The placenta tends to migrate toward the fundus throughout pregnancy. Placental thickness ranges from 2-4 cm. It can be a single structure, bilobed or have an accessory lobe. Variations include circumvallate and placenta membranacea. Placental signal: Normal parenchyma is intermediate to hyperintense on fluid sensitive images, more homogenous in the second trimester and progressively becoming lobulated and septated. Increased number and size of cotyledons make the placenta more heterogenous. Placental hemorrhage: Blood pooling and hemorrhage are another cause of placental heterogeneity. Placental-myometrial Interface: Best seen on steady state, displaying a trilaminar appearance. Chorionicity: Chorionicity and amnionicity are determined on the first trimester ultrasound. MRI offers a larger field of view for evaluation of the membranes’ attachment and UC in the second and third trimesters. UC insertion: UC inserted to the center of the placenta. Eccentric insertions, and velamentous insertions can be identified on MRI. UC structure: The UC contains two umbilical arteries, a single umbilical vein, allantois duct and Wharton's jelly and is enclosed within the outer layer of amnion. UC varix: This refers to the dilation of the fetal umbilical veins as it runs through the fetal abdomen. UC cysts: Uncommon, differential diagnosis includes pseudocysts, omphalomesenteric duct cysts, vascular disorders, abdominal wall defects, bladder exstrophy and urachal anomalies. Placental Tumors. Placental tumors are categorized in trophoblastic and non-trophoblastic. The latter include chorioangiomas, teratomas, and hemangiomas. Read More

Meeting name: SPR 2024 Annual Meeting & Postgraduate Course , 2024

Authors: Sarrami Amir Hossein, Rubesova Erika

Keywords: Placenta, Fetal MRI, Ultrasound

Contrast-Enhanced ultrasound (CEUS) is being increasingly used in children as it offers the advantage over CT/MRI of real time imaging, low cost, lack of radiation, easy access, and no need for anesthesia. In our study, we evaluate CEUS for characterization of liver lesions in children and compared the enhancement patterns and diagnosis based on CEUS to MRI/CT in the pediatric population with liver lesions. Read More

Meeting name: SPR 2020 Annual Meeting & Postgraduate Course , 2020

Authors: Iles Benjamin, Rubesova Erika, Neumann Brittney, Barth Richard

Keywords: Ultrasound

Although ultrasound remains main modality for prenatal diagnosis of fetal anomalies, fetal MRI has been increasingly recognized to provide additional information in various congenital pathologies. Usually, fetal MRI is performed at the time of diagnosis of the anomaly. Since fetal anomalies may evolve during pregnancy, a late 3rd trimester MRI may provide additional information, impacting postnatal management. This study aimed to evaluate the added value of repeat late 3rd trimester for diagnosis and patient management. Read More

Meeting name: SPR 2024 Annual Meeting & Postgraduate Course , 2024

Authors: Kim Yoel, Rubesova Erika, Barth Richard, Jayapal Praveen

Keywords: fetal MRI

The purpose of this study is to determine the reliability of sonographic (US) lung measurements compared with Fetal MR in fetuses with congenital diaphragmatic hernia. The sonographic lung head ratio (LHR) is a widely used prognostic tool in CDH, but can be difficult to obtain due to shifted mediastinum and fetal position. To our knowledge, comparison of MRI measured LHR with US has not been previously reported. Read More

Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016

Authors: Alford Raphael, Rubesova Erika, Halabi Safwan, Blumenfeld Yair, Hintz Susan, Barth Richard

Keywords: Congenital diaphragmatic hernia, Lung head ratio, LHR, Fetal MRI, Lung volumes

Congenital Pulmonary Airway Malformation Volume Ratio (CVR) is widely used during prenatal ultrasound to predict outcome of fetuses with bronchopulmonary malformations (BPM). Since fetal MRI is often performed in fetuses with BPM, the aim of our study is to correlate CVR measurements by MRI and US, to compare inter-observer agreement of CVR measured by area-based MRI volume, diameter-based volume and to assess whether large lesions would be prone to more variability in CVRs among observers. Read More

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

Authors: Emerson Miriam, Barth Richard, Rubesova Erika, Halabi Safwan, Rosenberg Jarrett, Hintz Susan, Blumenfeld Yair, Girsen Anna, Neves Stephanie, Homeyer Margaret

Keywords: Bronchopulmonary malformation, CVR, lung