Specialized Pediatric Imaging Techniques

Some of the specialized imaging techniques used for pediatric patients at UCSF Benioff Children’s Hospital include:

High Resolution Ultrasound in Children

Ultrasound is a powerful imaging tool that is pain-free, radiation-free, sedation-free, and can even be brought to the patient’s bedside. For many medical problems, ultrasound is the best test, and at UCSF Benioff Children’s Hospital we continue to research new uses for ultrasound by collaborating with ultrasound manufacturers to take advantage of the latest technological developments. For example, we are looking into ways of using ultrasound as a noninvasive alternative to certain types of biopsies. When biopsies are required, however, we can use ultrasound to provide real-time image guidance, making sure our procedure is right on target.  For radiologists, pediatricians, and surgeons, ultrasound plays an indispensable role in taking care of children across a broad spectrum of illnesses, in both the outpatient and inpatient setting.

pediatric ultrasoundHere are some examples of high resolution ultrasound images in pediatric patients that show what physicians in pediatric imaging can diagnose and then recommend for treatment:

(A) Normal neonatal brain. Head ultrasounds are commonly performed to look for the possibility of brain hemorrhage, which is an unfortunate, common complication of prematurity. This pediatric patient fortunately was normal.
(B) Intratesticular mass. Surgical excision/removal of tissue was performed and showed embryonal cell carcinoma needing to be treated.
(C) Acute appendicitis. Emergency surgery was performed, and patient went home the next day.
(D) Mandibular mass. Biopsy was performed and showed a metastatic neuroblastoma needing immediate treatment.

3-D Reconstructions Generated from MRI or CT Scans

We are using 3-D reconstructions of CT or MRI images, to greatly enhance patient studies and allow our pediatric radiologists to observe a young patient's virtual anatomy from various angles and views. They can assign colors to certain areas, to yield better views of organs and focus on certain body parts like bones or muscles. The image data enables the pediatric radiologists to place markers for surgical planning for the patient. The 3-D reconstructions also allow the physicians to remove some of the image to better display and view details of other structures like the lungs or skeleton, for instance.

3-D applications for pediatric patients are useful in:

Viewing the detail of fractures
Pediatric Fractures in 3D
3D reformatted image from CT of the ankle in a 14-year-old patient with a complex fracture of the distal fibula (yellow arrows) and distal tibia (yellow arrowheads).

Identifying an airway narrowing
lungs airway narrowing
3D volume rendering of the lungs and airways in a patient with a long segment of narrowing of the left mainstem bronchus (red arrows).

Images of the biliary system
MRI shows the bile ducts that drain the biliary system (including liver, gallbladder and pancreas). This special type of MRI is very helpful to see blockages, narrow areas, or diffuse disease of the biliary tree.

biliary system
3D representation of a normal biliary tree and gallbladder.

biliary system
Disease in the bile duct system. 3D reformatted image from MRCP study shows the biliary tree and gallbladder. Multiple saccular dilations (yellow arrows) are present in the biliary tree in this patient with primary sclerosing cholangitis.

Images of vessels and a mass
Images show detail of vessels that supply blood flow to masses in children – this imaging provides crucial map that helps our pediatric surgical specialists plan their operations.

3D vessels
3D vessels
3D reconstructed image from Chest CT in a 5-month-old infant with pulmonary sequestration. A sequestration is a portion of lung that is separated from the remaining normal lung and is susceptible to recurrent infections. Reconstructed images show the sequestration (white arrows) and its feeding artery (yellow) arising from the aorta.

3D reconstructed image from Chest CT in the same 5-month-old patient with pulmonary sequestration (white arrows) shows the draining vein (yellow arrow) into the pulmonary venous system.

Magnetic Resonance Cholangiopancreatography (MRCP)

This type of MRI is used to examine the biliary system for problems such as bile duct narrowing (strictures), pancreatic cysts, and biliary tract stones. Eovist® (Gadoxetate Disodium), a specialized type of IV contrast that is taken up and excreted by the liver, is used in MRCP to provide information on liver function.

Coronal Lava MIP
Coronal LAVA MIP images from Eovist MRCP showing the T1 bright contrast material filling the biliary system (arrow).

Whole Body MRI

Whole Body MRIThis specialized imaging technique captures a view of the entire body with an advanced (3T) scanner. The capability to efficiently image the entire body with MRI offers an effective method to image disease processes that involve multiple body parts without using radiation. This also may serve as the surveillance method of choice for patients with syndromes that carry a higher risk of cancer.

Coronal STIR whole body MRI image of an 11-year-old patient with a cancer predisposition syndrome obtained for screening.









MR Enterography

At UCSF, we use magnetic resonance (MR) enterography imaging for the diagnosis of gastrointestinal tract bleeding and small bowel diseases such as Crohn’s disease, an inflammatory bowel disease that especially affects young people. MR enterography is particularly effective for evaluating and monitoring the treatment of young patients with Crohn's Disease without exposing them to radiation.

MR Enterography procedure
Coronal LAVA post contrast image from MR Enterography procedure in a patient with Crohn’s disease showing multiple thickened loops of bowel (red arrows).

Pediatric Spectroscopy

Our world-renown pediatric neuroradiologists use MR spectroscopy to help evaluate traumatic brain injuries, developmental delays, speech delays, creatinine deficiency syndromes, and mood disorders in children.

Cardiac Imaging

World-renowned radiologists at UCSF help diagnose and monitor congenital heart defects and cardiac abnormalities using advanced imaging techniques. We can produce very accurate images of the inside and outside of the heart, allowing many patients to avoid more invasive procedures as part of needed evaluation for complex conditions. Our advanced cardiac MRI and CT imaging program provides a complete and noninvasive cardiac evaluation that is complementary to echocardiography.

Pediatric Orthopedic Imaging

At UCSF we take a very sophisticated approach to pediatric orthopedic imaging in the techniques we use to visualize bone and joint problems in children. Ultrasound, X-rays, CT and MRI all have special roles in diagnosing problems with the bones and joints in children. Our subspecialist radiologists are experts in using these techniques to identify abnormalities and assist with treatment.

TMJ Pediatric orthopedic imaging
CT guided biopsy of TMJ.
The temporomandibular joint (TMJ) connects your jaw to the side of your head.

Fetal MRI

Fetal MRI is an extremely specialized, noninvasive imaging study that is helpful for evaluating many aspects of fetal health. It is used, for example, to study the fetal airways, lungs, cardiovascular system, brain, spine and abdominal region--without using radiation. In many cases, ultrasound serves as both the initial and final diagnostic tool in the imaging evaluation of the fetus. However, in certain conditions MRI helps clarify a suspected diagnosis, and may sometimes refute or modify it. Fetal MRI is carefully monitored and reviewed by our team of fetal radiologists, and the added information is used to help plan the remainder of the pregnancy and potentially the delivery and prognosis of the child.

Fetal MRI
Fetal MRI