CScientifi c and Educational Exhibits
Abdominal Viscera (Solid Organs) ...... 332 Breast ...... 350 Cardiac ...... 362 Chest ...... 375 Computer Applications ...... 389 Contrast Media ...... 394 Genitourinary ...... 397 GI Tract ...... 410 Head and Neck ...... 425 Interventional Radiology ...... 437 Molecular Imaging ...... 447 Musculoskeletal ...... 450 Neuro ...... 465 Pediatric ...... 479 Physics in Radiology ...... 490 Radiographers ...... 497 Vascular ...... 502
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Abdominal Viscera (Solid Organs) C-003 Common bile duct pulsation synchronized with inferior vena cava anterior Biliary Tract wall motion observed by cine-segmented true fast imaging with steady- state precession magnetic resonance imaging C-001 S. Morita1, N. Saito2, K. Suzuki2, T. Suzuki1, N. Mitsuhashi2; 1Saitama/JP, 2Tokyo/JP Contrast-enhanced magnetic resonance cholangiography (CE-MRC) using Purpose: To clarify the concept of common bile duct (CBD) pulsation, which might gadolinium-EOB-DTPA (Primovist®): Preliminary experience and clinical affect CBD imaging, accompanied by inferior vena cava (IVC) wall motion depend- applications ing on the cardiac cycle with cine-segmented true fast imaging with steady-state K. Holzapfel, E.J. Rummeny, J. Gaa; Munich/DE ([email protected]) precession (trueFISP). Methods and Materials: Institutional review board approval and informed consent Learning Objectives: To demonstrate our initial experience with contrast-enhanced were obtained. A breath-hold axial cine-segmented trueFISP sequence was pro- magnetic resonance cholangiography (CE-MRC) using Gd-EOB-DTPA (Primovist®). spectively performed on 11 healthy volunteers to observe CBD pulsation and IVC To present potential clinical applications of this method. wall motion during the cardiac cycle. Changes in IVC anterior-posterior diameter Background: T2-weighted MRCP has proven effective in evaluating the morphol- and CBD location were compared using Spearman rank correlation analysis. Each ogy of the biliary system. However, it is limited in providing functional information. cardiac phase of the pulsation was recorded. Gd-EOB-DTPA is taken up by hepatocytes and excreted into the bile. Thus, dynamic Results: Nine of 11 CBDs (81.8%) pulsated back and forth in complete synchronicity studies providing additional functional information can be performed by CE-MRC with IVC anterior wall motion depending on the cardiac cycle; the mean maximum using Gd-EOB-DTPA. and minimum IVC diameter were 16.2 ± 2.7 and 12.9 ± 3.1 mm, respectively. Imaging Findings: We describe imaging fi ndings obtained in 20 patients [8 with Two of 11 CBDs and IVC walls (18.2%) did not move; the mean unchanged IVC sphincter of Oddi dysfunction (SOD), 7 with biliodigestive anastomoses (BDA) and diameter was 5.3 ± 2.1 mm. There were signifi cant correlations between the mean clinical suspicion of stenosis, 5 with suspected post-surgical bile leakage] who change in IVC diameter and distance of CBD movement (2.7 ± 2.1 and 1.8 ± 1.4, were examined 10, 20, 30, 40 and 50 min after the i.v. administration of a bolus r = 0.911, P <.0001). The mean cardiac phases with the CBD located most ven- of Gd-EOB-DTPA using a T1-weighted 3D FLASH breath-hold sequence. In all trally, most dorsally, and second most dorsally were 2.2% ± 3.0, 34.1% ± 7.4, and SOD patients, CE-MRC revealed dilated bile ducts and a delay of the passage of 69.4% ± 11.8, respectively. Gd-EOB-DTPA into the duodenum. After papillotomy, these fi ndings normalized. Conclusion: Most CBDs pulsate back and forth in synchronicity with IVC anterior CE-MRC clearly depicted leakage of Gd-EOB-DTPA from intrahepatic bile ducts wall motion depending on the cardiac cycle; this is quite likely to affect static CBD in post-surgical patients. In 5 patients with a BDA stenosis, delayed fi lling of the imaging and cause motion artifacts. proximal jejunum was observed. The stenosis was subsequently confi rmed by ERCP/PTCD. Conclusion: According to our initial experience, CE-MRC with Gd-EOB-DTPA al- C-004 lows a comprehensive assessment of both anatomy and function of the hepatobiliary Magnetic resonance cholangiopancreatographic (MRCP) spectrum of system. In particular, CE-MRC provides useful additional information in patients biliary complications after orthotopic liver transplantation (OLT) with SOD, BDA-stenosis and post-surgical bile leakage that cannot be obtained R. Girometti, G. Como, L. Cereser, A. Linda, C. Zuiani, M. Bazzocchi; Udine/IT by conventional MRCP sequences (RARE/HASTE). ([email protected]) Learning Objectives: To review MRCP fi ndings of biliary complications in liver C-002 transplanted patients, including features after interventional procedures. High b-value diffusion-weighted MR images of biliary tumors and tumor- Background: OLT is a widely accepted treatment for end-stage liver disease and like lesions: Clinical applications and pitfalls in benign and malignant selected cases of hepatocellular carcinoma. Despite technical progresses, biliary pathologies complications after OLT remain a serious cause of morbidity, mortality and graft M. Takeuchi, K. Matsuzaki, H. Uehara, H. Nishitani, H. Kubo, M. Harada; dysfunction or failure in recipients. Early complications occur within few weeks after Tokushima/JP ([email protected]) OLT and are mainly represented by bile leakage. Late complications, which become evident from 3 months to years, include strictures, stones, intraductal debris or Learning Objectives: To demonstrate the role of high b-value diffusion-weighted sludge formation, kinking and ampullary dysfunction. Donor-to-recipient common MR images (DWI) for detecting and differentiating benign and malignant patholo- bile duct disproportion has been reported as a borderline condition. Diagnosis is gies of the biliary system with pathologic correlation. challenging because of the low specifi city of clinical and biologic fi ndings. Sonogra- Background: DWI is a non-invasive, useful new diagnostic tool for the detection, phy does not provide projectional images of the biliary tract or direct evaluation of the grading and differentiation of various benign and malignant pathologies. Some anastomoses. Moreover, conventional direct cholangiography has an unacceptable benign pathologies such as chronic cholecystitis, adenomyomatosis, xanthogranu- complication rate in patients with low clinical suspicion. Some evidences suggest lomatous cholecystitis, and benign strictures of bile ducts may mimic malignant that MRCP, also as the only imaging modality, plays a key role in the diagnosis and lesions such as gallbladder cancers or bile duct cancers, and preoperative diagnosis management of biliary complications after OLT. is often diffi cult. Imaging Findings: High quality heavy T2-weighted MRCP images lead to a Imaging Findings: Gallbladder cancers show very high intensity mass or thickened panoramic evaluation of the biliary tract, showing OLT complications as a variable wall on DWI, while chronic cholecystitis and adenomyomatosis show thickened wall combination of bile ducts dilatation, stenoses, fi lling defects, fl uid collections and without signal increase. Thickened wall of xanthogranulomatous cholecystitis show morphologic changes, as reviewed in this exhibit. Main features after therapeutic inhomogeneous high intensity with very high intense abscesses. Malignant biliary interventional procedures are illustrated too. obstructions show very high intensity on DWI, while benign strictures of bile ducts Conclusion: MRCP is a safe and highly accurate tool in the assessment of bili- do not show high intensity. Maximum intensity projection (MIP) of DWI can clearly ary complications after OLT, and provides for adequate planning and follow-up of demonstrate tumor extent. MR cholangiopancreatography (MRCP) in combination therapeutic procedures. with DWI can provide the three-dimensional biliary truct imaging with the extension of tumor. Metastases to the liver and lymphnodes also show high intensity, which is useful in the staging of the diseases. C-005 Conclusion: High b-value DWI is useful in detection and staging of malignant Functional MRI cholangiopancreatography pathologies of the biliary system, and in differentiation of malignant tumors from V. Kuplevatskiy, D. Kuplevatskaya; St. Petersburg/RU ([email protected]) benign tumor-like pathologies. The combination of MIP of DWI and MRCP is useful Purpose: The aim of this study is to develop an algorithm for MRI abdominal in tumor detection and in evaluation of tumor extent in the biliary system, and in examinations, to provide differential diagnosis of strictures of intrapancreatic differentiation from benign bile duct strictures. choledoch in cicatricial artrophic changes of head of the pancreas and functional strictures in chronic pancreatitis. Methods and Materials: Our study includes a complex clinical and MR examination of 120 patients with biliary hypertension and narrowing of intrapancreatic choledoch. MR imaging was performed on a Magneton Vision 63SP scanner (Siemens) with a hypersensitive 1.5T magnet. MR cholangeo-pancreatography was performed in 2 stages; before and after administration.of antispasmodics.
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BDEF Tc-PMT). All patients presented abnormal Tc-PMT). 99m cant bile collection. cant bile collection. Doha/QA A Kanagawa/JP To illustrate the imaging features of odd and rare diseases of odd and rare the imaging features illustrate To To investigate if the use of SPECT images of the hepatobili- if investigate To The gall bladder abnormalities presented in this exhibit include abnormalitiesThe gall bladder in this exhibit presented Eighteen patients were admitted to our hospital for liver trauma trauma liver for admitted to our hospital Eighteen patients were Acute and chronic cholecystitis are the commonest diseases of the Acute and chronic cholecystitis are the commonest Hepatobiliary scintigraphy is a useful examination to detect biloma. to detect biloma. examination is a useful Hepatobiliary scintigraphy The use of SPECT and SPECT-CT hybrid imaging can differentiate imaging can differentiate hybrid The use of SPECT and SPECT-CT Modern imaging modalities may be useful in diagnosis of gall bladder be useful in diagnosis of gall bladder Modern imaging modalities may Learning Objectives: and MR imaging. CT, multidetector on ultrasonography, of the gall bladder Background: The present is wide. disease the spectrum of gall bladder However, gall bladder. this spectrum to its oddest end. explores educational exhibit Findings: Imaging xanthogranuloma- cholecystitis, emphysematous acute hemorrhagic cholecystitis, ganglioneuroma- adenomyomatosis, eosinophilic cholecystitis, tous cholecystitis, cyst in the bile duct ruptured hydatid endocrinetosis in multiple neoplasia type IIb, ruptured gall duplicated gall bladder, in the gall bladder, with the cyst membrane and ruptured carcinoma with peritoneal calcular gall bladder metastases, bladder of these abnormalities will be The imaging features with peritoneal gall stones. including ultrasonography, types of imaging modalities, presented on different and MR imaging. CT, multi-detector Conclusion: particularlydisease, and odd disease entities. in unusual Gall bladder disease: The odd end of the spectrum The odd disease: Gall bladder Morad; N. Sherif, H. Mahfouz, A.E. C-008 of (SPECT) images tomography emission computed Single photon with computed and its fusion images the hepatobiliary scintigraphy bile leak active to diagnose the accuracy improve tomographic (CT) scans transarterial hepatic trauma treated with in patients of severe embolization Kakita, S. Takaya, Kataoka, M. Y. Nishimaki, H. Asano, Y. Kawamura, S. Hayakawa; K. Anamura, S. Learning Objectives: bile leak. of active the detection improves ary scintigraphy Background: because image is sometimes questioned of its conventional the accuracy However, After transarterial lesions hypoattenuating embolization, of its poor anatomic detail. decide whether such To as bilomas. in the CT scans are often suspected in the liver is important bile leak treatment. active lesions contain for hypoattenuating Findings: Imaging in performed was Hepatobiliary scintigraphy 2006. 2005 and June July between after transarterial trauma liver embolization with technetium- 8 patients of severe ( 99m-N-pyridoxyl-5-methyltryptophan C-009 radiotracer accumulation in the liver. The radiotracer accumulation in the early accumulation The radiotracer liver. in the accumulation radiotracer images. compared to that of delayed images was hybrid SPECT or SPECT-CT in accumulation radiotracer Group 1 (5 cases) presented the enlargement of the interpreted bile which was an indication of active as SPECT images, the delayed (5/5), abdominal pain (2/5), and jaundice Clinical symptoms included fever leak. (2/5) or con- treated either with percutaneus drainage The bile leaks were (1/5). accumulation Group 2 (3 cases) presented decreased radiotracer (3/5). servatively interpreted which was the pooling of radiotracer as SPECT images, in the delayed not signifi Clinical symptoms were in the damaged bile duct, not bile leak. the Group 2 patients. Conclusion: bile leak from clinically insignifi active
Barcelona/ES cant proportion of subjects t from the execution of the MRCP t from the execution ndings of the Bismuth type-V biliaryndings of the Bismuth Scientific and Educational Exhibits Scientific and Educational addressed to medical patients were ndings, ndings in 11/17 cases (64.7%) (C.I.95%:[0.41; ndings in 11/17 cases (64.7%) (C.I.95%:[0.41; In the period October 2004-July 2006, 17 liver trans- 2006, 17 liver In the period 2004-July October 1) To review the main anatomic variants of the biliary the main anatomic variants review To 1) We reviewed the MR and MRCP examinations performed in performed the MR and MRCP examinations reviewed We 3
Due to MRCP fi 0.05).
< d d MRCP is becoming the modality of choice for noninvasive evalua- noninvasive MRCP is becoming the modality of choice for The algorithm MRI, which includes the use of of the abdominal n MRCP is an effective imaging diagnostic technique in the detection imaging diagnostic technique in the detection MRCP is an effective MRCP is a safe and reliable tool in addressing the adequate manage- and reliable MRCP is a safe i . N I To assess the results of MRCP as the only imaging modality in the man- assess the results of MRCP as the only imaging To ([email protected]) F In 100% of cases native MRI revealed intra-and extra-hepatic dilatation extra-hepatic intra-and MRI revealed native In 100% of cases MRCP detected pathologic fi
- c u d 0.05), especially 11/17 cases with pathologic fi ndings. ndings. 0.05), especially 11/17 cases with pathologic fi E i < c S ndings - and evaluation of Bismuth type-V bile duct injuries and its complications. type-V bile duct injuries of Bismuth and its complications. and evaluation ment of patients with biliary complications after orthotopic liver transplantation. ment of patients with biliary complications after orthotopic transplantation. liver C-007 and MRCP imaging Spectrum of MRI injuries: type-V bile duct Bismuth fi Pineda-Sanchez, V. Dominguez-Oronoz, Merino-Casabiel, R. X. Castella-Fierro; E. Olsina-Kissler, J.J. Gispert-Herrero, S. type-V injury 2003, selecting Bismuth our center since January of the biliary ducts Vi- T scanner (Magnetom on a 1.5 performed were All examinations (5 patients). the MR examination The clinical indications for or Avanto). Symphony sion-plus; abdominal pain, pathologic suspected cholangitis, fever, included unexplained analytical results or ictericia. Conclusion: therapy or clinical follow-up in 10 cases (58.8%) and to surgery or interventional or clinical follow-up therapy ac- PPV and overall a sensitivity, MRCP showed procedures in 7 cases (41.2%). All patients appeared to benefi of 100%. curacy (p Conclusion: ([email protected]) Learning Objectives: describe the MRI and MRCP fi To 2) tract. injuries/strictures. Background: hepatic biliary with segmental and its anatomy Familiarity tion of the biliary tract. system According to the Bismuth the radiologist. is essential for potential variations the right duct to those lesions affecting (anatomic location), type-V lesions refer Strictures of the main hepatic duct. with or without involvement segmental variant rightof the aberrant posterior hepatic duct lead to atypical patterns of segmental biliaryintrahepatic dilatation and/or segmental cholangitis. Details: Procedure planted patients with clinical suspicion of biliary MRCP complications underwent T2-weighted body coil, using a heavy a surface T system equipped with on a 1.5 The clinical history of subjects technique. TSE 3D sequence with the multislice to determine of MRCP the diagnostic accuracy evaluated has been retrospectively rmation of MRCP Diagnostic confi on the patient management. and the effects (n=7) and clinical direct cholangiography with therapeutic obtained ndings was fi (n=10). follow-up Results: 35.3%) (p (6/17; C-006 (MRCP) resonance cholangiopancreatographic of magnetic Effects patients with in liver-transplanted management on clinical evaluation yield study A diagnostic biliary complications: Bazzocchi; De Candia, M. Zuiani, A. C. Cereser, L. Como, Girometti, G. R. Udine/IT Purpose: suspected biliary patients with transplanted complications. agement of liver Methods and Materials: 0.87]), changing the initial clinical diagnosis in a signifi of biliary choledoch on the border of the abrupt funnel-shaped narrowings ducts, of the intermediate third and intheriorof the of visualizatilon third and absence the lumen of demonstrated MR cholangiopancreatography duct. intrapancreatic the tortuousmm in part 1 intrapancreatic of the choledoch which did not exceed 30 the second examination of antispasmodics, min after the administration diameter. dilatation of the intrapancreatic demonstrated 45% of the patients performed. was decrease to 2-3 mm of the pre-stenotic dilatation. choledoch up to 2 mm and Conclusion: the revealing allows the second MR cholangiography, antispasmodic probes with diag- of differential and the performing of the choledoch of pathologic narrowings cicatricial atrophic of the choledoch caused by organic narrowings nosis between of pancreas and functional strictureschanges in the head of - manifestations chronic pancreatitis. Results: C - 7 0 R C EECR07-C-SciEduc-FIN.indd 3 Scientific and Educational Exhibits
Abdominal Viscera (Solid Organs) role of different imaging modalities to characterize them accurately. Different liver lesions were evaluated with multiphasic CT, MRI after contrast injection and dynamic Liver contrast enhanced ultrasonography. Some of these are benign lesions like focal nodular hyperplasia, hemangioma and hepatocellular adenoma, primary malignant lesions like hepatocellular carcinoma, fi brolamellar carcinoma, and metastatic islet C-010 cell tumors, melanoma, renal, medullary thyroid and breastEPOS carcinoma. Discussion MRI and CT fi ndings of sarcomatoid HCC: 11 cases and clinical features centers around the characteristic appearance of these lesions on ultrasound, CT and H. Koo, M.-S. Park, J. Lim, M.-J. Kim, J.S. Yu, J.-J. Chung, K. Kim; Seoul/KR MR, and application of principles of tumor angiogenesis. Correlation with histological ([email protected]) fi ndings is available for many cases. An algorithm has been described to formulate the differential diagnoses and narrow those down based on the appearance in Learning Objectives: To illustrate the imaging fi ndings of sarcomatoid hepatocel- different imaging modalities. The diagnosis based on imaging fi ndings revealed a lular carcinoma, 11 cases and clinical features. high accuracy making unnecesary liver biopsy to defi ne benign or malignant nature Background: Sarcomatoid type of hepatocellular carcinoma is unusual variant of lesions and in most of cases lead us to the exact diagnosis. of HCC. The diagnosis of sarcomatoid HCC is important because of the poor No Material Submitted to Conclusion: Hypervascular liver lesions showed a intense contrast uptake in arte- prognosis. From July 1997 to June 2006, 11 patients (9 men; 2 women, mean age rial phase. Different patterns of contrast uptake and wash out give us the diagnosis 57 years) were histologically confi rmed with sarcomatoid HCC in our department clues in most of the cases. (fi ve were surgically resected; six were proven by biopsy). The CT and MR images of sarcomatoid HCC were retrospectively reviewed. Imaging Findings: Among 11 histologically confi rmed sarcomatoid type of HCCs, C-013 10 cases were single lesion and 6 of them had daughter nodules. The tumors ranged Frequency and radiological fi ndings of the complications of hepatic from 4.2 cm to 14.0 cm and averaged 8.2 cm in maximum diameter. 72% of tumors hydatid cyst (8 of 11 patients) exhibited delayed enhancement; 28% of tumors (3 of 11) exhibited M. Garcia-Hidalgo, Y. Herrero, P. Calvo, E. Fandiño, I. Herrera, C. Cereceda; early arterial enhancement with delayed washout. Central necrosis was seen in the Toledo/ES ([email protected]) seven of eleven tumors (63%). Direct invasion of adjacent bile duct, vessel or other organ was observed in 54% (6 of 11 patients); distant metastasis in 36% (4 of 11 Purpose: The aim of this teaching exhibit is to illustrate a wide spectrum of unusual patients); paraaortic lymph node metastasis in 18% (2 of 11). Six of eleven patients presentations and complications of the hepatic hydatid cyst (HC). had history of B- or C-viral hepatitis. Liver cirrhosis with splenomegaly was seen in Methods and Materials: A retrospective study of 420 patients with hydatid cysts three patients at the time of initial examination. Elevated serum level of alpha-feto performed in our hospital from January 1999 to July 2006 is reported. The imag- protein (AFP) revealed in 9 patients (from 5.6 to 18911 ng/mL). ing fi ndings of patients with HC were reviewed from our database, and those Conclusion: Sarcomatoid HCC usually appears as single large mass with delayed who presented complications were selected. All patients were studied with plain enhancement, frequently with central necrosis. fi lms, ultrasonography and computed tomography. Magnetic resonance and other examinations were performed in selected patients. Findings were correlated with pathology (biopsy or surgery) in all the cases. C-011 Results: Of the 420 patients with hydatid disease, 46 presented complications Multimodality evaluation of normal fi ndings and complications after living (10.95%). The spectra of complications included Intrahepatic complications liver donor transplantation (rupture and infection): 30%; exophytic growth: 12%; transdiaphragmatic thoracic G. Zamboni, I. Pedrosa, J.B. Kruskal, D.D. Brennan, V. Raptopoulos; involvement: 9%; peritoneal seeding: 15%; biliary communication: 24%; portal vein Boston, MA/US ([email protected]) involvement: 6%; hematogenous dissemination: 24% [heart, mediastinum, lung, spleen, kidneys, bone (ribs and iliac), muscle, colon]. Learning Objectives: To review the imaging fi ndings of normal and abnormal Conclusion: HC of the liver is frequent in our country, but the complications are transplanted liver parenchyma, and of vascular and biliary post-transplantation not so usual. Because many of these disorders have characteristic imaging appear- complications. ances, this exhibit will help practicing radiologists to better understand, recognize Background: Living-donor liver transplantation is increasingly used in response and differentiate complications of hydatid cysts. to the constant increase in number of patients eligible for transplantation, and to the critical shortage of cadaveric livers. Imaging Findings: Postoperative evaluation of the transplanted liver is routinely C-014 performed by US, with grayscale assessment of the parenchyma and biliary tree Predictive value of Tc-99m galactosyl human serum albumin (GSA) and Doppler study of the vasculature. liver scintigraphy on the assessment of functional recovery after partial The differential diagnosis for diffuse parenchymal abnormalities includes rejection, hepatectomy ischemia, hepatitis and cholangitis. There is no imaging fi nding specifi c for rejection, H. Wakamatsu1, S. Nagamachi1, R. Nishii1, S. Fujita2, S. Futami1, S. Tamura1; and the diagnosis is based on liver biopsy. The differential diagnosis for focal liver 1Kiyotake-cho, Miyazaki/JP, 2Miyakonojo/JP lesions includes benign and malignant lesions (primary, recurrent or metastatic) and the parenchymal manifestations of arterial abnormalities, infarcts and abscesses. Purpose: Preoperative evaluation of reserve hepatic function is important for safe 99m CT angiography (CTA) or MR angiography (MRA) can be used in the evaluation of hepatectomy. Tc-Galactosyl Human Serum Albumin (GSA) scintigraphy and the vascular complications, the most common of which is hepatic artery thrombosis parameters, HH15 and LHL15, are well known and useful indexes. Furthermore, (60% of all posttransplantation vascular complications). MRA is especially sensitive maximal removal rate (GSA-Rmax) by compartmental analysis is also reported to be for the detection of hepatic artery complications, although it may overestimate the an effective index. We report an additional hepatic uptake index, T1/2. Our purpose is amount of disease. In the presence of normal MRA fi ndings, signifi cant arterial to evaluate the usefulness of T1/2 for predicting postoperative liver function recovery; stenosis can be reliably excluded. MR Cholangio Pancreatography (MRCP) is useful we compared T1/2, HH15, LHL15, GSA-Rmax and ICG15 through observation of in the assessment of biliary complications, ischemic or non-ischemic, which occur serum albumin (Alb) and cholinesterase (ChE) before and after surgery. in up to 25% of transplant recipients. Methods and Materials: We evaluated 58 patients with liver tumor (s). All patients 99m Conclusion: In this comprehensive review, we describe postoperative fi ndings received Tc-GSA liver scintigraphy before surgery. T1/2 is the half time from RI after living donor liver transplantation. administration to hepatic uptake peak time. We calculated HH15 and LHL15 using standard formula. GSA-Rmax was calculated using a radiopharmacokinetic model. To compare the predictive value of scintigraphy for assessing postoperative liver C-012 function recovery, we investigated the values achieved using scintigraphy and those Hypervascular liver lesions: Imaging features and diagnosis clues achieved by checking recovery periods of Alb and ChE (rec-Alb, rec-ChE). We also F. González, E. Ruiz, M. Torres, C. Juanco, M. Lopez, M. Silvian; Santander/ES evaluated Alb and ChE over a period of 3 months (3M-Alb, 3M-ChE). Results: We found signifi cant correlation between T1/2 and rec-Alb, rec-ChE, 3M- Learning Objectives: 1) To describe the clinico-pathological features of the hy- Alb and 3M-ChE. The correlation was almost as good as those between HH15, pervascular hepatic focal lesions both benign and malignant. LHL15 and GSA-Rmax, but more signifi cant than ICG15. 2) To illustrate the imaging appearances with special emphasis to characteristic Conclusion: T1/2 was able to predict postoperative hepatic function recovery as diagnostic features. 3) To discuss the principles of tumor angiogenesis. 4) To rec- effectively as HH15 and LHL15 and GSA-Rmax. T1/2 is a simple and useful index ognize the strength, pitfalls and limitations of different imaging modalities. in the evaluation of postoperative reserve hepatic function. Background: The purpose of this pictorial essay is to illustrate the radiology and pathology of the various hypervascular hepatic focal lesions and to discuss the
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Creteil/FR, 1 , D. Cherqui , D. ; 2 1 imaging fi ow Madrid/ES , O. Seror , O. 1 , A. Luciani , A. 1 C ow imaging are useful for differentiation differentiation are useful for imaging ow BDEF , M. Djabbari , M. 1 , C. Duvoux , C. 1 A ndings on explanted livers, especially regarding livers, ndings on explanted , B. Zegai , B. 1 , H. Kobeiter , H. 1 To illustrate the wide spectrum of radiological features of the wide spectrum features illustrate of radiological To To illustrate and compare the post-radiofrequencey ablation ablation and compare the post-radiofrequencey illustrate To We have retrospectively reviewed the radiological fi the radiological reviewed retrospectively have We Out of 85 patients with HCC treated with RF during the study Hydatid disease is a parasitic disease that is endemic in many parts disease that is endemic in many Hydatid disease is a parasitic MR is increasingly being used to assess the success of RF ablation of MR is increasingly being used to assess the success of RF ablation Radiologists should be familiarized with the imaging fi ndings of ndings of with the imaging fi Radiologists should be familiarized Even using high resolution sequences, the presence of satellite of satellite the presence sequences, using high resolution Even Hepatic hemodynamic abnormalities types of he- often cause various , A. Rahmouni , A. 1 , J. Tran-Van-Nhieu , J. 1 Bondy/FR patients with hydatid disease pathologically proven by biopsy or surgery by in the last 10 disease pathologically proven patients with hydatid with CT studied All patients were cases. stressed on torpid evolution have We years. supplementary underwent and several CT) and ultrasounds, with multislice (last year on this and the literature our institutional experience From magnetic resonance. of HD. manifestations of unusual a pictorial will provide review subject, we Conclusion: since prompt diagnosis is essential to disease, of hydatid manifestations unusual further complications. avoid ([email protected]) ([email protected]) Learning Objectives: disease (HD). locations in hydatid complications and atypical Background: most common location (75%), HD can occur is the liver Although the of the world. secondaryThe process can spread by hematogenous in the body. almost anywhere The classical direct extension. dissemination or contiguously to adjacent organs by ndings related to disease complications fi however known, ndings in HD are well fi In frequently described anatomic locations are less and unusual in the literature. rupture complications as communicating (biliary different found we our casuistic, or cavity pleural peritonealstula), direct rupture cavity, (into subcapsular space, fi have We and postsurgical problems. (hepatic abscess) infection abdominal wall), secondary locations gathered cases of unusual to hematogenous dissemination spinal cord, and spleen). bone, brain, kidney, (pulmonary, Details: Procedure Learning Objectives: of hepatocellular carcinoma (HCC) with pathologic fi (RF) MR appearance livers. on explanted Background: MR and pathological fi on a correlation between focused studies have Few HCC. included all patients with HCC treated retrospectively We livers. ings on explanted January 2001 and April post-ablation with RF between 2006 and who underwent MR fi transplantation. MR less than 5 months prior to liver high resolution liver confronted to pathological fi were and/or of satellite nodules. involvement the presence of microvascular Findings: Imaging MR studies systematically period, 8 with 15 HCC nodules met the inclusion criteria. WI sequences (VIBE = volumetric T1 echo included high resolution 3D gradient prior performed interpolated and repeated 4 times following breathhold examination) depicted Coagulation necrosis was of gadolinium chelated. the bolus administration with absent enhancement of cases, T2-WI in 75% signal-intensity areas on as low complete necrosis in 50% of all showed examinations Pathological in all cases. No in 50% of all nodules. invasion and satellite nodules and/or vascular cases, clearly correlated with either the presence of satellite ndings was c MR fi specifi invasion. nodules or of microvascular Conclusion: of HCC can the RF ablation following invasion nodules and/or of microvascular be misdiagnosed on MR. F. Pigneur F. C-019 radiofrequency following MR appearance of hepatocellular carcinoma Radiopathological pictorial essay ablation: Nassar I. 2 C-018 of our A pictorial review disease: of hydatid manifestations Unusual in the last 10 years experience Diez Martínez, Martínez P. González, Ortiz M.M. de Mendivil Arrate, A. Espejo; Navas Borruel Nacenta, R. S. Alonso, Cano R. helpful to differentiate hepatic parenchymal change and true hepatic neoplasm. change and true hepatic neoplasm. parenchymal hepatic helpful to differentiate abnormalities are as follows: hepatic atrophy and hypertrophy, zonal differentiation differentiation zonal and hypertrophy, hepatic atrophy abnormalitiesas follows: are them mimic hepatic Some of change. or hyperplastic regenerative focal of the liver, cell imaging and portal fl Both Kupffer tumor. changes and true hepatic tumors. parenchymal hepatic between Conclusion: and portal cell imaging fl Kupffer changes. patic parenchymal ndings ed into the Rotterdam/NL, 1 ; Kanazawa/JP Kanazawa/JP 1 ndings of the various por- ndings of the various cation of portosystemic col- , G.P. Krestin , G.P. 1 ndings on ultrasound, computed computed on ultrasound, ndings ow and non-cirrhotic portalow hyperten- Scientific and Educational Exhibits Scientific and Educational ndings vary considerably, with large variation with large variation ndings vary considerably, , R.A. De Man , R.A. 2 1) To review the classifi cation of primary hepatocellular the classifi review To 1) 1. To illustrate multidetector CT fi multidetector illustrate To 1. To provide an overview of hepatic hemodynamic abnormali- an overview provide To Hepatic hemodynamic abnormalities are classifi In an interactive way, all of the portosystemic vessels collateral way, In an interactive On US, imaging fi On US, 5 , S.M. Hussain , S.M.
([email protected]) ([email protected])
1
d d Hepatic hemodynamic abnormalities, including abnormal portal Primary liver nodules are categorized according to regenerative or Primary according to regenerative nodules are categorized liver Portosystemic collateral vessels constitute the direct imaging features constitute the direct imaging features vessels collateral Portosystemic n Understanding of the etiology and pathology of primary lesions liver This MDCT feature atlas provides an exhaustive illustration of the illustration an exhaustive atlas provides This MDCT feature i . ([email protected]) ([email protected])
N I F - c u d E i c S Omaha, NE/US - ties especially focused on abnormal portalties especially focused fl C-017 observed changes with various of hepatic parenchymal Pictorial review abnormalities types of hepatic hemodynamic Sanada; J. Terayama, Gabata, N. T. Matsui, O. Kobayashi, S. Learning Objectives: and histopathological fi and classify the radiological demonstrate To sion. congenital and acquired changes observed with various of hepatic parenchymal hepatic hemodynamic abnormalities. Background: and non-cirrhotic portalow hypertension, sometimes cause hepatic parenchy- fl cation of hepatic the classifi are going to review we In this exhibit, mal change. hemodynamic abnormalities and histopathological radiological and demonstrate changes observed with hepatic hemodynamic ndings of hepatic parenchymal fi abnormalities. Findings: Imaging Learning Objectives: portal categories: hypertension, non-cirrhotic portal four hypertension, con- following histopathologi- Radiological and miscellaneous. genital anomaly of hepatic vessels, changes observed hemodynamic with hepatic ndings of hepatic parenchymal cal fi C-016 MDCT atlas of portosystemic collateral vessels in liver cirrhosis Aubé; Oberti, C. F. Ridereau-Zins, Isselin, C. Lebigot, G. J. Moubarak, E. Angers/FR Primary hepatocellular lesions: Imaging fi Imaging Primary lesions: hepatocellular with pathologic correlation resonance imaging, and magnetic tomography den Bos Van I.C. 2 C-015 Learning Objectives: provide To and 3) CT and MRI; on US, imaging features illustrate To 2) lesions; correlation. - pathology radiology Background: Most and anatomic characteristics of adjacent hepatic stroma. dysplastic nature, hepatocellular adenoma (FNH), nodular hyperplasia common lesions are focal most frequently occur FNH and HCA carcinoma (HCC). (HCA) and hepatocellular FNH and HCA is important, between and in whom differentiation women, in young in larger HCA. transformation and potential malignant is related to risk of bleeding non-cirrhotic whilst HCC in in a stepwise fashion, HCC typically occurs in cirrhosis, is very large at presentation. liver Findings: Imaging primary strong arterial lesions typically show liver enhance- On CT, in echogenicity. benign lesions and hypodensity for phase isodensity delayed by ment, followed On MRI, signal intensity of benign lesions typically malignant lesions. for (washout) FNH is distinguished T2w. T1w and on pre-contrast from liver much does not differ enhancement. T2w-signal and delayed high and septa, which have scar central by fatty steatosis and intratumoral HCA occurs frequently in combination with liver of HCC can be observed on MRI, with differ- Stepwise development ltration. infi Smaller compared small or large HCC. dysplastic nodules, ent characteristics for T2w-signal, increased arterial enhancement and less lower to larger HCC show washout. pronounced delayed Conclusion: ndings. the interpretationfacilitates of imaging fi are presented using numerous illustrations MIP (Maximum Intensity Projections) MIP (Maximum illustrations are presented using numerous An anatomical classifi Renderings). VR (Volume and/or of portal hypertension. They are numerous and various because the visceral and because the visceral and various are numerous They of portal hypertension. the portal between parietal and the systemicstructures abdominal can be a pathway and be recognized and must are frequently seen in clinical practice They circulation. predicting the potential complications. identify their location allows To analyzed. Details: Procedure tosystemic collateral vessels related to portal hypertension in liver cirrhosis. 2. To To 2. related to portal cirrhosis. vessels tosystemic collateral hypertension in liver frequency indicate their respective To 3. anatomical ways. understand their different and their principal complications. Background: consequences and potential complications Frequency, is provided. vessels lateral of portosystemic are pinpointed. groups vessels collateral of the different Conclusion: cirrhosis. portosystemic in liver vessels collateral C - 7 0 R C EECR07-C-SciEduc-FIN.indd 5 Scientific and Educational Exhibits
C-020 Three percent patients underwent liver transplantation. Results: According to the Michel classifi cation, 68% of recipients had normal Functional CT in a rabbit model: Evaluation on the perfusion vascular anatomy, the variants noted were: replaced LHA (type II) 13%, replaced characteristics before and after Ar-He cryoablation therapy RHA (type III) 5%, replaced RHA and LHA (type IV) 3%, accessory LHA (type V) C. Sun1, C. Liu1, J. Chen2, R. Merges2, Y. Liu1, D. Wang1, S. Lin1; 1Jinan/CN, 2%, accessory RHA (type VI), 1%, and accessory RHA and LHA (type VII) 1%. We 2Beijing/CN ([email protected]) have noted variations not included in the Michel classifi cation in 8%. Furthermore, Purpose: To investigate the perfusion characteristics of rabbit liver tumors pre- in 29% of recipients, we observed trifurcation of common hepatic artery into gas- and post-Ar-He (argon-helium) cryoablation on functional CT and evaluate the troduodenal, right and left hepatic arteries. therapeutic effect of Ar-He cryoablation. Conclusion: Knowledge of variant vascular anatomy in candidates for liver Methods and Materials: Two weeks after VX-2 tumor implanted into the livers of transplantation greatly assists the surgeon in planning and management. Trained 30 New Zealand white rabbits, Ar-He cryoablation was performed. Functional CT radiologists easily manipulate MDCT data on interactive viewing to produce virtual was applied before and after treatment on days 1, 5, 14, 21 and 35. Five rabbits anatomic mapping, replacing conventional angiography. In our series, all Michel were sacrifi ced for histopathology at each time point. Perfusion characteristics of variations were confi rmed at the time of transplantation. As far as trifurcation is tumor and hot spot such as blood fl ow (BF), blood volume (BV) and permeability concerned, our study could suggest a further subtype of Michel classifi cation. were analyzed. Histopathological studies corresponding to functional CT were observed, and the therapeutic effects on the extent of tumor necrosis were judged. C-023 Two-tailed student t test was used to compare the differences between pre- and Enhancement of hepatocellular carcinomas with harmonic ultrasonography post-cryoablation on tumor perfusion parameters. after intravenous administration of sulfur hexafl uoride (SF ) Results: After treatment, the number of completed necrotic tumor was 13 (52%), 6 A. Cuñat, E. Belloch, E. Ponce, A. Julve, V. Perez, M. Pina; Valencia/ES and perfusion parameters were signifi cantly lower than that of pre-treatment ([email protected]) (P < 0.05). The number of incomplete necrotic tumor was 12 (48%). In the ear- lier stage (within 14 days of treatment), the whole tumor perfusion parameters Purpose: We describe the enhancement characteristics of biopsy-proven hepato- were signifi cantly lower than those of pre-treatment (P < 0.05). In the late stage cellular carcinomas in patients with chronic hepatitis using low mechanical index (more than 14 days of treatment), the whole tumor perfusion parameters had no harmonic ultrasonography after i.v. administration of SF6 microbubbles. signifi cant difference compared with pre-treatment (P> 0.05). The hot spot perfu- Methods and Materials: Fifty patients, 30 men and 20 women, with ages ranging sion parameters of incomplete necrotic tumors had no signifi cant difference with 41-90 years (mean: 68.2 years) with chronic hepatitis or hepatic cirrhosis presented pre-treatment (P> 0.05). 57 hepatocellular carcinomas. The diameter of the nodules ranged 18-170 mm Conclusion: Functional CT can measure the perfusion characteristics of hepatic tu- (mean: 48.26 mm). After i.v. injection of 2.4 mL of SF6 we observed the lesion mor and might be accurate in judging the therapeutic effect of Ar-He cryoablation. enhancement during the next 300 s. A second injection of contrast ultrasound was needed in 8 patients. C-021 Results: 54 nodules (94.7% of the lesions) enhanced more than the surrounding parenchyma during the arterial phase (0-49 s), while 3 nodules (5.3%) did not Utility of new protocol in abdominal MDCT for simultaneous demonstration enhance. 28 nodules (49.1%) presented irregular enhancement during the portal for hepatocellular carcinoma, intrahepatic portal vein, and hepatic vein on phase (50-179 s), and 29 nodules (50.9%) became hypoechoic. During the late the real-time virtual sonography venous phase (180-300 s), 40 lesions (70.2%) were completely hypoechoic and F. Tatsugami1, K. Miyaji1, M. Matsuki2, G. Nakai1, M. Tanikake1, I. Narabayashi1; 17 nodules (29.8%) were still irregularly enhanced. Capsular enhancement was 1Takatsuki/JP, 2Habikino/JP ([email protected]) observed in 23 nodules (40.3%). We observed enhanced vessels inside 38 lesions Purpose: Real-time Virtual Sonography (RVS) is a new technique that provides a (66.6%). There was no correlation between alfa-fetoprotein serum levels and size real-time display of the reconstructed CT images corresponding to the ultrasound of the lesions, nor enhancement during arterial phase. images. This technique is useful in the percutaneous treatment for hepatocellular Conclusion: The most frequent pattern of enhancement of hepatocellular carci- carcinoma (HCC). Usually, we have to compare the tumor stains of HCC in the nomas was hyperechoic nodules during arterial phase that become hypoechoic in arterial phase to intrahepatic portal and hepatic veins in the hepatic phase under late venous phase, with intranodal vessels. Almost half of the nodules presented RVS. Then, we developed a new protocol to visualize the tumor stains of HCC in the irregular enhancement during the portal phase. Capsular enhancement occurred hepatic phase by adding the contrast material injection just before the scanning. in 40% of the cases. Methods and Materials: Twelve patients with 12 HCC who underwent hepatic MDCT before treatment with radio-frequent ablation (RFA) were enrolled. All patients C-024 received 2.5 ml/kg of contrast material. Initially, the amount of 60% of total contrast Characteristics of well-differentiated neuro-endocrine and carcinoid liver material volume was injected with fi xed duration of 25 sec. Then, 50 sec after the metastases on CT and MRI completion of this contrast material injection, the remaining 40% was injected with D. Olivié, P. Audet, J.-S. Billiard, J. Murphy-Lavallee, L. Lepanto; Montreal, QC/ a fi xed duration of 15 sec. The hepatic phase was performed 100 sec after the CA ([email protected]) initiation of the injection. Results: All tumors (mean diameter: 15.5 mm), portal and hepatic veins were clearly Purpose: To determine the characteristics of well-differentiated neuro-endocrine (NE) visualized with no statistically signifi cant difference in the hepatic phase (139.8, and carcinoid liver metastases on enhanced CT and MRI. 152.5, and 145.5 HU). Using RVS, all tumors were easy to detect and suffi ciently Methods and Materials: We retrospectively (2000-2005) reviewed all patients diag- ablated by RFA without a complication. nosed with well-differentiated neuro-endocrine and carcinoid liver metastases who Conclusion: Simultaneous demonstration of HCC, portal and hepatic veins on underwent CT and/or MRI. The imaging appearance of the lesions was analyzed by two MDCT is useful for detecting the relationship between the tumor and intrahepatic independent readers. Lesion characteristics were assessed for its enhancement pattern portal or hepatic veins under RVS, and for accurate and safe performance of (heterogeneous, homogeneous, annular and none) as well as its vascular dynamic treatment for HCC. profi le. We evaluated the unenhanced images for the signal and presence of a cystic component. Thirthy-three patients were reviewed, of which 9 were well-differentiated NE C-022 tumors and 26 carcinoid tumors. The average lesion diameter was 48 mm on MR and 52 mm on CT. The number of lesions identifi ed were 381 on CT and 401 on MRI. Evaluation with multidetector CT in candidates for liver transplantation Results: With CT, only 57% of metastases were hyper-attenuating during the arterial M. Cristofaro, G.M. Ettorre, E. Busi Rizzi, V. Schininà, L. Rovighi, C. Bibbolino; phase, and 75% were hypo-attenuating during the portal phase. With MRI, 55% of Rome/IT ([email protected]) lesions were hyper-intense during the arterial phase and 60% were hypo-intense dur- Purpose: To evaluate the role of MDCT in delineating hepatic vascular anatomy ing the portal phase. Lesion enhancement was heterogeneous (CT 53%, MR 13%), in patients undergoing liver surgery as recipients. homogeneous (CT 27%, MR 45%), annular (MR 33%) and none (MR 9%). On the Methods and Materials: 111 patients, followed up for chronic liver disease, under- unenhanced T1 weighted images, 97% of lesions were hypo-intense. On T2 weighted went abdominal multiphase MDCT for presurgical planning of liver transplantation. In images, 13% fewer lesions were seen (348 vs.410) as compared to the enhanced all patients, CT scans were obtained with a four-channel multidetector CT scanner. sequences; the lesions were generally hyper-intense and homogeneous. A cystic Raw data were processed on workstation for multiplanar reformations, maximum component was identifi ed in 5%. intensity projection, shaded surface display, and volume rendering technique. The Conclusion: In this study, over 40% of hepatic metastases from neuro-endocrine 3D CT angiographic imaging was produced from the data of the early arterial phase. tumors are not hyper vascular on CT or MRI.
336 A BDEFC G
EECR07-C-SciEduc-FIN.inddCR07-C-SciEduc-FIN.indd 6 112.02.20072.02.2007 17:03:4117:03:41 2 4 : 3
Abdominal Viscera (Solid Organs) 0 : 7 1
7 0 0 2 . 2 337 0 . 2 112.02.2007 17:03:42 ndings G ow. rst line of treatment. However, However, rst line of treatment. ([email protected]) ([email protected]) reportedush has been useful to be ush. Late-arterial and portalush. phase C ([email protected]) ([email protected])
ush technique using MDCT provided ush technique using MDCT provided BDEF ed in most of the cases. On angiography, On angiography, ed in most of the cases. ed in all cases. Extravasation of the contrast of the contrast Extravasation ed in all cases. A Okinawa/JP dence. The coronal plane, commonly used by the commonly used by The coronal plane, dence. To review the morphological of the and functional anatomy review To To recognize the characteristic imaging features of ruptured the characteristic imaging features recognize To Patients received 125 mL of contrast media (300 mgI/mL) at media (300 contrast mL of 125 received Patients 200 patients were evaluated using a 64-slice MDCT. Coronal using a 64-slice MDCT. evaluated 200 patients were We reviewed the cases of ruptured HCCs. Multi-phase dynamic the cases of ruptured HCCs. reviewed We ed in two cases on CT and in one on angiography. We conclude We cases on CT and in one on angiography. ed in two ndings enable to distinguish ruptured to distinguish HCCs from unruptured ndings enable ones There is an increasing demand for an accurate localization of focal localization of focal an accurate There is an increasing demand for Spontaneous rupture of HCC is usually a fatal complication. Com- complication. Spontaneous rupture of HCC is usually a fatal 3D CT-P assisted by saline fl by assisted 3D CT-P that ruptured CT demonstrated HCCs located in the periphery of The combined evaluation of transverse and coronal images has been of transverse The combined evaluation nally encountered during surgery. To improve this challenging situation, new this challenging situation, new improve To nally encountered during surgery. Learning Objectives: To on imaging comparing obtained in axial and coronal planes. the information liver using anatomy of the hepatic vascular information preoperative accurate provide cation patterns of the most recent CT technology centered specially on the ramifi the hepatic and portal the relation between and the hepatic veins veins. Background: of living the evaluation as for to plan their resection as well lesions in order liver from patterns differ vein liver radiological Not infrequently, transplantation. donor liver those fi MDCT is proving images and details. improve CT) dramatically MDCT (multidetector to contributing of the liver anatomy of the vascular in the evaluation to be valuable about the hepatic vascular information comprehensive and providing donor safety segmentation. and the liver anatomy Details: Procedure re- radiologists Two generated. and MIP images were VRT 3D inSpace reformats, the anatomical and established the axial and coronal images simultaneously viewed and portal also assessed hepatic venous They landmarks to divide the segments. cation patterns and its implication in the segmentary division. ramifi Conclusion: cantly signifi anatomy, of liver in the evaluation an additional value to have found the diagnostic confi improving VIII with important V and regarding segments information relevant offers surgeons, implications. therapeutic C-029 CT (MDCT) on multidetector on hepatic anatomybased focus New González-Crespo, I. Cano, D. Alonso-Burgos, A. Herraiz, Díaz, M.J. L. Vivas, I. Pamplona/ES Bilbao Jaureguizar; J.-I. Benito, A. Precise images of portal vein and collateral pathways are very important the man- of portalPrecise images for pathways and collateral vein Saline fl cirrhosis. with liver agement of patients cirrhosis. with liver this technique to patients applied We CT portography. for Details: Procedure mL saline fl 30 by followed mL/sec, of 4 a rate after 100 respectively 40 seconds, scans are obtained at 20 and threshold time HU 16-channel multidetector-row by All images are obtained in the abdominal aorta. intensity projection (MIP) images maximum images, Volume-rendering CT (MDCT). late Both image workstation. mm) MIP images are created by and thin slab (15 including arterial phase and portal very precise 3D CT-P, images provided phase images of 40 seconds delay cirrhosis, In patients with liver pathways. collateral Portal to be better than those of 20 seconds delay. after the threshold time tended of return of portal the delay hypertension might explain fl Conclusion: with liver in patients very precise images of both portal vessels and collateral vein cirrhosis. C-028 fi Characteristics of imaging Ruptured hepatocellular carcinoma: Murayama; S. Gibo, M. Yogi, A. Learning Objectives: ruptured distinguish HCCs from unruptured To hepatocellular carcinoma (HCC). dysfunction. especially with underlyingones, liver Background: an important and transcatheter (CT) plays role in the diagnosis, puted tomography as the fi is often performed arterial embolization (TAE) liver HCCs and whose multiple who have sometimes encounter such patients we should critically we Therefore, functions are not good enough to treat all HCCs. and which need embolization. select HCCs with bleeding Details: Procedure assessed We in all patients. performed were and angiography CT of the entire liver location, enhanced pattern, and protru- number, of the tumor (size, ndings CT fi of the contrast and extravasation ascites, presence of bloody sion out of the liver), and estimated the vascularity we On angiography, medium on CT or angiography. the embolization TAE, after anemia improved If the patient’s shape of tumor stain. as successful. cathegorized was Conclusion: or total less-en- Partial margin in all cases. and protruded the liver out of the liver identifi hanced areas of the tumors were identifi heterogeneous tumor stain was identifi medium was that these CT fi embolization. before ) 2 , 1 0.02) for for 0.02) ush diffusion- < 2 neoplasms. neoplasms.
patients with
, G. Simonetti , G. 1 .01). Among 13 pa- .01). <
mobility, and correlate it to mobility,
Gdansk/PL 3 evalu- were cm in diameter ush technique is very useful. ush technique is very useful. < (p cant differences , V. Cozzolino , V. 2 Ehime/JP ([email protected]) ([email protected]) cantly from before RF-ablation to RF-ablation cantly from before
rapid changes in tumor diffusivity after rapid
cantly higher than that in patients with Scientific and Educational Exhibits Scientific and Educational diffusion-weighted MR imaging in the dif- diffusion-weighted
Milan/IT , M. Cadioli , M. 2 1 marker of treatment response in marker
cient value (ADC) was calculated for each tumors calculated for (ADC) was cient value value diffusion-weighted MR imaging after elimina- MR imaging after diffusion-weighted value - Rome/IT, Rome/IT, 1 ; Twenty-two patients with 28 tumors (18 metastases patients with 28 tumors (18 metastases Twenty-two , M. Carlani , M. 1 ) were performed before and during fi rst 24-hours after and during fi before performed ) were 1 .01). 2 Histologically proved HCCs Histologically proved < To depict three-dimensional CT portography (3D CT-P) (3D CT-P) portography depict three-dimensional CT To .01). A signifi cant increase in ADC from before RFA to after RFA before cant increase in ADC from A signifi .01). . In the completely ablated tumors, ADCs (b= 300, 500s/mm tumors, In the completely ablated . < 2 7
d d cantly lower than in residual neoplasms. For b=2000s/mm For than in residual neoplasms. cantly lower Collateral vessels frequently develop in patients with liver cirrhosis. cirrhosis. in patients with liver frequently develop vessels Collateral early decrease after therapy with signifi early therapy decrease after n Our preliminary results reveal
Hepatic choline levels and ADCs may allow monitoring of therapeutic allow and ADCs may Hepatic choline levels i . , A. Orlacchio , A. , B. de Angelis , B. 1 N 1 I a hypervascular rim around the RFA defect being residual defect rim RFA around the a hypervascular To prospectively investigate the apparent diffusion coeffi cient (ADC) the apparent diffusion coeffi investigate prospectively To To evaluate the usefulness of evaluate To
measures of therapeutic response. Successful disease control rate was was Successful disease control rate response. measures of therapeutic F In 18 patients, 22 tumors were completely destroyed. Six tumors dem- completely destroyed. 22 tumors were In 18 patients,
The median preoperative choline level in patients with HCC was 3.8 in patients with HCC was choline level mmol/ The median preoperative - c u d E i c S - standard and 10 HCC) treated with RFA underwent MR imaging at 1.5 T system, using a MR imaging at 1.5 underwent RFA and 10 HCC) treated with trans- SE, FSE sequences and T2-weighted T1 and 3-planes coil. phased array (b= b value different with MR examinations diffusion-weighted verse-echo-planar 15, 300, 500, 2000s/mm ferentiation between complete treatment effect and residual tumor in patients after and residual complete treatment effect between ferentiation of hepatic neoplasms. (RFA) ablation radiofrequency Methods and Materials: Apparent diffusion coeffi therapy. before and after treatment to observe and after changes in water before hepatic tumors. hepatic tumors. Purpose: (MR) 1 ((1)H) magnetic resonance at hydrogen measured and choline levels carcinoma (HCC) responses of hepatocellular to monitor therapeutic spectroscopy, to RF ablation. Methods and Materials: ated in 16 patients (10 men and six women; mean age, 63 years) before RF-ablation RF-ablation before 63 years) mean age, ated in 16 patients (10 men and six women; (four subjects of six healthy A control group after the RF-ablation. and 2-3 days with normal 42-78 years) livers range, 62 years; mean age, women; men and two measured were Hepatic choline levels using the same protocol. by examined was phantom replacement method, quantifying the peak at means of an external by used to compare test was sum rank Wilcoxon A 3.2 ppm at (1)H MR spectroscopy. HCCs and normal and ADCs at baseline between choline concentrations relative and before and ADCs in the tumors Changes in choline levels parenchyma. liver test. signed rank Wilcoxon using the by analyzed were after RF-ablation Results: signifi 0.0-16 which was mmol/L), L (range, P mmol/L; 0.0-1.7 range, mmol/L; normal median, 1.6 livers ([email protected]) Learning Objectives: optimal scan timing is important and saline fl clearly, cases of and representative the details of our method will show we In this exhibit, of the portal and anatomical variations vessels vein. collateral Background: C-027 saline fl three-dimensional CT portography assisted by Intravenous technique in patients with liver cirrhosis technique Mochizuki; T. Hirata, M. Kajiwara, T.H. Tsuda, T. C-026 Choline levels RF ablation: to response of hepatocellular carcinoma Early and MR diffusion constants Bolacchi F. ADC showed Diffusion-weighted MR imaging in monitoring of the early effect of of effect the early in monitoring of MR imaging Diffusion-weighted Work- of malignant hepatic tumors: ablation radiofrequency percutaneous in-progress Adamonis, W. Zadrozny, D. Pienkowska, J. Szurowska, E. Gorycki; T. Studniarek, M. Izycka-Swieszewska, E.C. ([email protected]) Purpose: C-025 weighted images had low quality. In interpretable 15 cases, high ADC’s differences differences high ADC’s In interpretable 15 cases, quality. images had low weighted neoplasms. active treated and four 11 successfuly noted between were Conclusion: defi ned as inactive liver tumor by multislices mutliphases CT scans performed 6 CT scans performed mutliphases multislices tumor by liver ned as inactive defi after RFA. and 24- weeks Results: onstrated A. Mancini A. RFA and suggest than high-b RFA tion of artifacts will provide an earlytion of artifacts will provide were not signifi were b=300 and 500s/mm tients with HCC, choline levels decreased signifi choline levels tients with HCC, (P after RF-ablation (P also found was RFA Conclusion: responses of HCC to RFA. C - 7 0 R C EECR07-C-SciEduc-FIN.indd 7 Scientific and Educational Exhibits
C-030 of HDN on CTAP was counted in each group. Results: Totally, 13 livers showed HDN on CTAP (4.2%). Background liver at- Follow-up of orthotopic liver transplant recipients: Multimodal non tenuation pattern of HDN were as follows: type A, 0%; type B, 100% (p < 0.005). invasive diagnostic approach for the early detection and treatment plan of Background liver conditions of HDN were as follows: LC (n=10), primary biliary hepatic artery stenosis cirrhosis (n=2), normal liver (n=1). The normal liver case showed intrahepatic portal M.A. Politi, P. Rinaldi, A. Biscaglia, C. Di Stasi, G. Maresca, L. Bonomo; fl ow irregularity due to insertion of percutaneous biliary drainage tube. Rome/IT ([email protected]) Conclusion: The occurrence rate of HDN on CTAP was 4.2%, and intrahepatic Learning Objectives: 1. To describe incidence and causes of hepatic artery stenosis portal fl ow irregularity might contribute to the occurrence of focal increase of (HAS) in orthotopic liver transplant (OLT) recipients. 2. To review indications for differ- portal blood fl ow. ent imaging techniques (US, CTA, MRA, DSA) in the suspicion of HAS. 3. To propose a multimodal non invasive diagnostic approach. 4. To discuss radiological fi ndings and C-033 pitfalls. 5. To depict indications and feasibiity of endovascular treatment. The diagnostic effi cacy of Ferucarbotran-enhanced MR imaging in patients Background: HAS is the most frequent vascular complication in OLT recipients (11- with hepatic metastasis from colorectal cancer after chemotherapy in 13% of patients). It can be caused by clamp injury, intimal injury, anastomotic ischemia, comparison with multidetector CT HA kinking (due to vascular redundancy) and rejection. Disruption of hepatic artery C. Balassy, A. Ba-Ssalamah, A. Stadler, W.K. Matzek, C.J. Herold, W. Schima; fl ow may result in HA thrombosis, biliary ischemia and necrosis, hepatic infarction, Vienna/AT ([email protected]) fulminant hepatic failure, bacteremia and sepsis. Timely diagnosis and treatment are of extreme importance for graft and patient survival. Purpose: To compare the sensitivity of non-enhanced and Ferucarbotran (Reso- Procedure Details: Doppler US is used to screen HAS but it usually lacks in the direct vist®) enhanced MRI and triphasic MDCT in the detection and characterization of evulation of surgical anastomosis so that hemodynamically signifi cant HAS results in hepatic metastases from colorectal cancer after chemotherapy. intrahepatic arterial tardus parvus waveform morphology. In those cases, integration Methods and Materials: Thirty patients who had undergone chemotherapy for with CTA or MRA allows to depict HA anatomy, to defi ne the exact site and extent of colorectal cancer (54-73 years, mean 62.6) were prospectively investigated by MRI HAS and to choose the treatment plan. PTA is the treatment of choice in HAS; HA (1.5 T) and triphasic MDCT. MRI was performed pre- and post-bolus injection of stenting is indicated only in in PTA complications and in restenosis after PTA. 1.4 ml Ferucarbotran. Dynamically enhanced T1wGRE, T2wTSE fat-sat, and after Conclusion: Early and accurate multimodal non-invasive detection of HAS is fea- 10 minutes STIR and T2*GRE sequences were performed. MDCT was carried out sible, it is suitable to choose the most adequate treatment plan and it allows to avoid non-enhanced, and biphasic after injection of the contrast material. MTCD and MRI devastating clinical sequelae. were performed within 1 week. MRI and MDCT images were evaluated separately and independently in a consensus reading by two radiologists. Chi-square and k- C-031 coeffi cient were used to compare the diagnostic effi cacy of Ferucarbotran-enhanced MRI and MDCT. We evaluated the number, size and histological type of lesions Hepatic chemoembolisation - revisited identifi ed by the two methods. P. Rajiah1, M. Sylven2, M. Al Moaiqel2, Y. Assiri2, A.N. Khan2; 1Manchester/UK, Results: MDCT revealed 62 lesions (62 metastases), MRI showed further 46 lesions 2Riyadh/SA ([email protected]) (total 108), 53/108 were verifi ed by histology, 55/108 were followed-up by imaging. Learning Objectives: 1. To review the indications, contraindications, advantages Non-contrast MRI showed 36 additional lesions to MDCT (6 haemangioma, 2 cysts, and disadvantages and limitations of hepatic arterial chemoembolisation. 2. To dis- 28 metastases/diameter: 0.5-2.6 cm). Ten lesions (0.4-1.8 cm) were depicted only cuss the role of chemoembolisation in management of hepatocellular carcinoma and after Ferucarbotran application, and were classifi ed as metastases; however, 2 liver metastasis. 3. To review the technique of chemoembolisation. 4. To illustrate the lesions were histologically proven as FNH. Statistical analysis showed signifi cant common and uncommon complications of hepatic arterial chemoembolisation. improvement in the detection of focal liver lesions using Ferucarbotran-enhanced Background: Hepatocellular carcinoma is the most common primary liver tumour. MRI compared to MDCT (P < 0.05). Liver metastasis is seen in 30-70 % of malignancies. Transcatheter arterial chemo- Conclusion: Ferucarbotran-enhanced MRI is superior to triphasic MDCT in de- embolisation is a very useful minimally invasive therapy which is particularly useful tection and characterization of focal liver lesions in patients with colorectal cancer in unresectable hepatocellular carcinomas and metastatic liver disease. after chemotherapy. Imaging Findings: Routine preprocedural investigation includes ultrasound, CT and MRI. Imaging should identify presence of ascites, lymph nodal metastases C-034 and thrombosis of portal and or hepatic veins. Portal vein thrombosis, ascites, high Splenic volume/body weight measured by CT volumetry: An indicator for blirubin, low albumin, hepatic encephalopathy are contraindications for embolisa- concurrent splenectomy in liver transplantation tion. The review describes the embolisation procedure in detail. Sample cases are M. Ishifuro, J. Horiguchi, K. Ito, T. Asahara, H. Ohdan, M. Kiguchi, C. Fujioka, discussed with illustrations. Complications of the procedure are also discussed. T. Furukawa; Hiroshima/JP ([email protected]) Conclusion: Hepatic arterial chemoembolisation is a very important minimally invasive technique used in treatment of primary and metastatic hepatic neoplasms. Purpose: Interferon therapy after liver transplantation is sometimes interfered with Patient selection and good preprocedural work up are essential for good results. thrombocytopenia caused by hypersplenism. Splenectomy during liver transplanta- Embolisation is performed by superselective technique. Portal vein patency should tion, however, is known to have a potential risk for serious infection. The purpose of be confi rmed before treatment. Follow-up CT is done to assess response to the this study is to investigate whether we might predict the indication of the concurrent procedure. splenectomy by CT volumetry data. Methods and Materials: Splenic volumes were retrospectively measured by CT C-032 volumetry before liver transplantation, and 1 month and 6 months after liver trans- plantation for non-compensatory liver cirrhosis. Platelet cell counts were recorded Prevalence and background liver conditions of focal hepatic lesion with during the course of this study. Before liver transplantation, patients (n=33) were increased portal blood fl ow classifi ed into two groups: splenic volume/body weight ratio (SBR), defi ned as the S. Kobayashi, O. Matsui, T. Gabata, N. Terayama, J. Sanada; Kanazawa/JP value of splenic volume (ml) divided by body weight (kg), being < 7 ml/kg and ≥ Purpose: Portal blood fl ow of the hepatic lesions is usually decreased compared 7 ml/kg). to surrounding liver parenchyma. However, some of the focal hepatic lesions may Results: In the group SBR< 7 ml/kg (n=16), platelet counts (x104) were 9.7±8.6, show an increase of portal blood fl ow compared to background liver. Such lesions 18.1±6.3 and 17.4±2.4 before the operation, and 1 month and 6 months after the are depicted as high-density nodular lesion (HDN) on CT during arterial portogaphy operation, respectively. In the group of SBR≥7 ml/kg, the platelet counts were (CTAP), and most of them are diagnosed as regenerative or dysplastic nodules. 6.4±3.2, 11.3±5.7 and 10.5±4.8 before the operation, and 1 month and 6 months The purpose of this study is to establish the prevalence of HDN on CTAP and to after the operation, respectively. The platelet counts increased in both groups; examine the infl uence of background liver condition. however, those in the group of SBR≥7 ml/kg had clinically signifi cant low levels. Methods and Materials: 310 consecutive cases that received CTAP for closer SBRs were not statistically different during the course in each group (SBR< 7 ml/kg; examination of hepatic disease are included in this study. Background liver condi- p=0.19 and SBR≥7 ml/kg; p=0.66). tions are as follows: liver cirrhosis (LC, n=160), chronic hepatitis (CH, n=37), mis- Conclusion: Splenic volume/body weight ratio measured by CT volumetry has the cellaneous liver disease (n=11), normal liver (n=102). Background liver attenuation potential to be an indicator for concurrent splenectomy during liver transplantation. patterns on CTAP are categorized into the following two types: uniform attenuation type (type A) and inhomogeneous attenuation type (type B). The occurrence rate
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7 0 , 0 1 2 . cant 2 339 cance 0 . 2 112.02.2007 17:03:42 eld units of G , G. Simonetti , G. , 1 2 0.05) when the b value 0.05) when the b value brosis, especially when brosis, < cation of hepatic , S. Ziegler , S. 2 , V. Cozzolino , V. 2 cant early enhance- postcontrast brosis. C , J.S. Bauer , J.S. BDEF cients (ADCs) were calculated. Correlation calculated. cients (ADCs) were c liver uptake and slow excretion via the excretion and slow uptake c liver 1 cation of hepatic fi , M. Cadioli , M. -ATP in total volume of phosphorus chemi- in total volume -ATP 1 San Francisco, CA/US, CA/US, San Francisco, 1 α ; A 2 ([email protected]) ([email protected])
and when the measurements are performed 1-hour and when the measurements are performed 2 cantly lower in cirrhotic patients 1-h after a standard cantly lower , E.J. Sutton , E.J. 2 uence of hepatic perfusion changes on the relationship Hepatic apparent diffusion coeffi cients (ADCs) were cients (ADCs) were Hepatic apparent diffusion coeffi , M. Carlani , M. Fifteen female C3H mice were investigated before and before investigated were C3H mice Fifteen female 1 Milan/IT 2 0.05), and between serum hyaluronate concentrations and concentrations serum0.05), and between hyaluronate < , E.J. Rummeny , E.J. 1 Our study indicates that 31P-MRS can show us biochemical us biochemical 31P-MRS can show Our study indicates that , A.W. Weber , A.W. Rome/IT, Rome/IT, Fenestra LC shows characteristics of a blood pool agent, providing pool agent, providing characteristics of a blood LC shows Fenestra Our preliminary that the measurement of ADCs has study showed 1 1 , A. Orlacchio , A. ; 1 1 0.05). To study the kinetics of contrast enhancement by Fenestra LC, a new a new LC, Fenestra enhancement by study the kinetics of contrast To To assess the infl To < ADCs were signifi ADCs were Fenestra LC caused a marked and signifi LC caused a marked Fenestra and quantifi uence of perfusion on the diagnosis Munich/DE ([email protected]) Munich/DE ([email protected]) brosis with diffusion weighted MR imaging imaging with diffusion weighted MR brosis ment of blood in the IVC, which slowly declined to baseline values within 90 min. min. within 90 declined to baseline values which slowly in the IVC, ment of blood a signifi agent accumulation, contrast a slow showed parenchyma The liver agent ex- contrast and a subsequent 2 and 3 h p.i. peak enhancement between observed in the enhancement was a contrast 5h p.i. cretion via the biliary system. while agent into the bowel, of contrast corresponding to biliaryduodenum, excretion of cant renal excretion No signifi a persistent enhancement. still showed the liver noticed. agent was the contrast Conclusion: characteristics of a It also shows enhancement. contrast prolonged intravascular hepatobiliary agent with specifi contrast biliary system. was 200 s/mm2. Signifi cant correlations were observed between Child-Pugh Child-Pugh observed between cant correlations were Signifi 200 s/mm2. was scores and ADCs (p ADCs (p Conclusion: diagnosis and quantifi good potential for sec/mm of 200 using b values in fatty liver. Products of membrane cell breakdown include phospholipids, which include phospholipids, cell breakdown Products of membrane liver. in fatty liver. in fatty accumulate nd that part of PME and fi we Also, cal compounds in patients was lower compared with control group. Furthermore, group. compared with control lower was cal compounds in patients higher compared with the healthy cantly signifi in patients was the PDE/Pi ratio volunteers. Conclusion: and help us to understand the mechanism liver fatty changes in patients with of pathological process. Purpose: CT. hepatobiliary agent for contrast Methods and Materials: phantom measure- Based on additional and kidneys. IVC bladder, gall the liver, Differences curves. to concentration-versus-time converted these data were ments, signifi for tested were agent concentrations pre- and postcontrast between for up to 48h after injection of Fenestra LC (20microliter/g body weight). Fenestra Fenestra LC (20microliter/g body weight). to 48h after injection of Fenestra up for taken agent, which is selectively hepatobiliary pool contrast LC is a new and blood imaged using a microCT All mice were apoE receptor. hepatocytes via the up by was agent effect The contrast with 103micrometer isotropic spacial resolution. measuring hounsfi pre- and postcontrast determined by quantitatively analysis of variance. by Results: Purpose: diffusion measurements and hepatic fi between Methods and Materials: and after an 8-h fast volunteers measured in 13 cirrhotic patients and in 10 healthy and hepatic sinusoidal ow 1-h after a standard meal (which increases portal fl vein of 750, 500 and 200 s/mm perfusion) using a breath-hold technique at b-values (2) TR 5000 Apparent diffusion coeffi and ms. and ADCs were concentrations serum hyaluronate Child-Pugh scores, between the cirrhotic patients. for performed Results: meal (1,650 10-3) compared to controls (2,830 10-3) (p H.E. Daldrup-Link H.E. A. Mancini A. C-039 Infl after a standard meal. C-038 and hepatobiliary contrast enhancement using a intravascular Prolonged microCT for contrast agent hepatocyte-selective new Henning T.D. 2 fi Bolacchi F. ca-
([email protected]) Modena/IT
0.05) between patients and 0.05) between < Moscow/RU Scientific and Educational Exhibits Scientific and Educational cantly higher part of PDE in total volume St. Petersburg/RU St. rmed of dismethabolic diseases, the diagnosis city were 89.0 and 100.0% for US, 93.0 and US, 89.0 and 100.0% for city were cation of hepatic iron overload overload cation of hepatic iron In 52 patients with various degrees of elevated serum of elevated degrees In 52 patients with various nd signifi cant changes (p nd signifi A total of 56 patients (35 men and 21 women; mean age: mean age: and 21 women; A total of 56 patients (35 men Twenty patients with steatosis of the liver were examined examined were patients with steatosis of the liver Twenty 9
0.0001). d < d n MR imaging is a useful and noninvasive diagnostic tool for quantifi diagnostic tool for MR imaging is a useful and noninvasive Our preliminary is the most accurate data suggest that MRI of the liver i . N I To examine MRS abnormalities in patients with fatty liver. MRS abnormalities in patients with fatty examine To To assess the role of MR imaging in the diagnosis, therapeutic plan- therapeutic assess the role of MR imaging in the diagnosis, To To compare the effectiveness of US, MDCT and MRI in the detection of MDCT and MRI in the detection of US, compare the effectiveness To As the data were not normally As the data were non-parametric statistical distributed, F In 37 patients, EC, MR-LIC and sF were well correlated (r=0.79, with well MR-LIC and sF were EC, In 37 patients, Totally, 318 metastases were discovered during surgery in 56 patients. during surgery discovered in 56 patients. metastases were 318 Totally, - c u d E i MR has confi In 10 patients, 0.01). c < S - reference populations. reference the signifi was The most interesting feature of phosphorus chemical compounds in patients with fatty liver compared with the liver of phosphorus chemical compounds in patients with fatty As the PDE 0.37), respectively. 0.44) and 0.33 (0.32; 0.43 (0.39; control group: of phospholipid resonance includes signal from intermediates pathway on the that these changes indicate that catabolic processes prevail think we breakdown, Purpose: Methods and Materials: with 31P-MRS, which was performed in the right hepatic lobe. Reference data Reference in the right performed hepatic lobe. which was with 31P-MRS, T acquired using a 1.5 were Spectra volunteers. acquired from 30 healthy were of phosphomonoesters (PME), inorganic area rates Peak system. spectroscopy were phosphate (Pi), phosphodiesters (PDE), and adenosine triphosphate (ATP) calculated part we of phosphorus of each metabolite in total volume Also, calculated. chemical compounds. Results: used We 75%). dates are presented as Me (25%; applied and analysis was U test to fi Mann-Whitney In vivo phosphorus-31 magnetic resonance spectroscopy in patients with resonance spectroscopy phosphorus-31 magnetic In vivo fatty liver Fokin; V.A. Trufanov, G.E. Bagnenko, S.S. C-037 ([email protected]) Purpose: in patients with hereditary hemochromatosis (EC) using the ning and follow-up (MR-LIC) and its correlation with serum iron concentration measurement of liver (sF). ferritin Methods and Materials: carried measurements were out with a 1.5 ferritin, a combination of T MR unit, with protocol. according to Gandon’s T2** weighted T2*, T2, T1, DP, 5 GRE sequences dividing mean liver (L/M) ratio, calculated the Liver/Muscle we sequence, every For placing 3 regions of interest on by signal intensity, mean muscle signal intensity by L/M of the same slice. muscles the right on the paraspinous and two hepatic lobe algorithm. used to calculate MR-LIC with Gandon’s was ratio Results: p Role of 1.5 T MRI in the quantifi T MRI in Role of 1.5 Torricelli; P. Gallo, E. Cerofolini, Martinelli, E. Baroni, S. F. C-036 58 years) were included in the study. MDCT with three-phase contrast enhancement MDCT with three-phase contrast included in the study. were 58 years) enhancement dynamic contrast with liver T) of the (1.5 (n=56), US (n=56), and MRI were US) ndings (including intraoperative fi Intraoperative performed. (n=17) were hepatic metastases. the detection of standard for considered as a reference Results: 22 - more than 22 - from 2 to 4 lesions, Nine patients had solitary metastasis, liver cancer; synchronous with colorectal metastases were In 32 patients, 5 lesions. segments of affected the number On an average, metachronous. were in 24 they The sensitivity and specifi 3.9. was was value predictive Positive MRI. and 97.0 and 100.0% for MDCT, 100.0% for 76.0%, 87.0%, and 96.0%, were values predictive Negative all methods. 100.0% for of metastases the numbers correlation between strong There was respectively. (0.78, 0.79, and 0.72, MDCT and MRI compared to IOUS US, by discovered p respectively, Conclusion: colorectal metastases compared to MDCT and US. diagnostic test for Comparative assessment of current imaging methods in the detection methods imaging assessment of current Comparative to liver patients with colorectal cancer referred of hepatic metastases in surgery Skipenko; O.G. Morozov, Sinitsyna, S.P. S.V. Purpose: surgery. liver before metastases in patients with colorectal cancer liver Methods and Materials: C-035 excluding iron hepatic overload. In 5 patients with negative genetic tests, MR has genetic tests, with negative In 5 patients hepatic overload. iron excluding biopsy. suggesting liver iron overload, detected liver Conclusion: tion of LIC, and is an alternative to liver biopsy in patients with an elevated level level biopsy in patients with an elevated to liver and is an alternative tion of LIC, MR determines and it is is needed when phlebotomy In patients with EC, of sF. also useful in follow-up. C - 7 0 R C EECR07-C-SciEduc-FIN.indd 9 Scientific and Educational Exhibits
C-040 pared. Progression-free survival rate and overall survival rate were calculated with Kaplan-Meier methods. Intraoperation radio-frequency thermal ablation: Effect of vascular Results: Age, gender, and size of the HCC were not signifi cantly different be- occlusion on thermal necrosis zone - animal study tween the two groups. There was no statistical difference in overall survival rates M. Retkowski, M. Studniarek, D. Zadrozny, W. Adamonis, A. Szarmach; (P=.1771) between the two groups. In a subgroup analysis according to tumor Gdansk/PL ([email protected]) stage, the survival rate of the HR group was signifi cantly higher than the TACE Purpose: The aim of the study was evaluation of effi cacy of liver perfusion reduc- group (P=.0141) in the UICC T3N0M0 subgroup. However, there was no signifi cant tion in enlargement of necrosis zone in time of radiofrequency ablation in animals difference in UICC T1-2N0M0 (P=.6304), CLIP0 (P=.3403), and CLIP1-2 (P=.3249) and comparison of results to literature. subgroups. Although the HR group had a longer median progression-free survival Methods and Materials: RF-ablation was performed in mature, healthy, female rate than the TACE group (24.25 vs 22.2 months), there was no signifi cant differ- mini pigs. After laparotomy, under general anaesthesia, using cooled needles, 8 ence (P=.4448). (two with full perfusion - group 1, the next three pair adequately with hepatic artery Conclusion: TACE is effective in treating solitary HCC as HR in the subpopulations - group 2, portal vein - group 3 and the both - group 4 occlusion) independent ther- with UICC T1-2N0M0 or CLIP 0~2 HCC. In the subgroup with UICC T3N0M0 HCC, mocoagulation foci in the liver of each animal were performed. Immediately after HR is preferable for the treatment. death, the animals’ livers were resected. The liver was cut and the largest size of each coagulated place was measured. C-043 Results: Mean diameter of foci was 11 mm ± 1.67 for group 1, 11.5 mm ± 1.05 CT fi ndings of hepatic capsular enhancement for group 2, 13.5 mm ± 1.05 for group 3 and 14.5 mm ± 1.38 for group 4. Mean D. Yang, H. Kim, W. Jin, C. Ryu; Seoul/KR ([email protected]) volume of necrotic tissue was 3318 mm³ ± 1506 for group 1, 3656 mm³ ± 988 for group 2, 5882 mm³ ± 1359 for group 3 and 7342 mm³ ± 2057 for group 4. There Learning Objectives: To become familiar with the imaging appearance of various were no statistical differences in diameters and volumes in groups 1 and 2. Sig- causes of hepatic capsular enhancement. nifi cantly larger in diameter and volume than group 1 were group 3 (p = 0.0112) Background: Capsular enhancement of the liver on CT scan is seen as a linear and group 4 (p = 0.0027). contrast enhancement of the surface of the liver, and occurred as a result of in- Conclusion: During intraoperation RF-ablation, we can obtain the largest size creased blood fl ow at the infl amed hepatic capsule. Capsular enhancement of the and volume of ablated tissue by temporal, simultaneous occlusion of hepatic liver on CT is described in Fits-Hugh-Curtis syndrome characterized by right-sided artery and portal vein. abdominal pain and perihepatitis associated with pelvic infl ammatory disease. However, this fi nding is not a fi nding specifi c with a Fits-Hugh-Curtis syndrome, C-041 but may be seen in patients with various causes of diseases. Imaging Findings: A retrospective review was performed in patients with various Infl uence of heterogeneity of microvessel and mature vessel in causes of hepatic capsular enhancement. All cases were confi rmed by surgery, hepatocellular carcinoma over tumor metabolism detected with 31P-MRS biopsy, clinical, or radiological follow-up study. Various causes of capsular enhance- at 3.0 Tesla ment of the liver were identifi ed including Fits-Hugh-Curtis syndrome, peritonitis D. Yu, C. Li, X. Ma, X. Zhang; Jinan/CN ([email protected]) caused by intraperitoneal rupture of liver abscess, CAPD (continuous ambulatory Purpose: To investigate the infl uence of angiogenesis in hepatocellular carcinoma peritoneal dialysis), postoperative infection, acute cholangitis, peritoneal carcino- (HCC) over tumor metabolism detected with 31P-MRS. matosis, systemic lupus erythematosus, and parasitic infection (paragonimiasis, Methods and Materials: A single voxel 31P-MRS scanning was carried out in 31 shistosomiasis). In addition, mimickers of hepatic capsular enhancement were patients with HCC. The intracellular pH value (pHi), phosphomonoester (PME), described. When the liver has diffuse fatty infi ltration, the diaphragm may mimic phosphodiester (PDE), inorganic phosphate (Pi), γ-ATP, β-ATP, α-ATP, lower en- capsular enhancement of the liver, because the diaphragm has high attenuation ergy phosphate, and the ratios of PME/ATP, Pi/ATP, PME/PDE, PME/Pi, PDE/Pi, compared with the liver. Furthermore, the drainage catheter inserted during opera- PDE/ATP in the lesion and adjacent hepatic tissue were calculated. After operation, tion may mimic capsular enhancement of the liver. some vessel parameters were evalulated including the extracellular space (ES), Conclusion: Knowledge of CT fi ndings of various hepatic capsular enhancements extracellular extravascular space (EES), expressions of VEGF and Flk-1, PCNA may be helpful for differential diagnosis. index (PI), mean vessel number, diameter, circumference, area, and distance between adjacent vessels, total vessel area, variety index, little arteries and veins, C-044 mature vessel index and mean perfused fraction (mPF). All these vessel parameters Multimodality preoperative evaluation of living liver donor transplantation were compared with the fi ndings from 31P-MRS. G. Zamboni, I. Pedrosa, J.B. Kruskal, V. Raptopoulos; Boston, MA/US Results: The pHi, Pi, β-ATP and PME/PDE in HCC were more than those in liver, ([email protected]) while the PDE/ATP and PDE/Pi were opposite (P < 0.05). pHi was correlated positively to the number of veins and the negative correlation of PME and EES Learning Objectives: 1) To describe the relevant anatomy of living donor liver was gotten (P < 0.05). The positive correlations between Pi and microvessel total transplantation; 2) To describe appropriate imaging protocols for MDCT and MRI area, and between γ-ATP and the number of arteries were obtained (P < 0.05). preoperative evaluation of recipients and donors. The vessel parameters related to β-ATP consisted of ES, diameter, circumference, Background: The constantly increasing number of patients eligible for transplanta- mean area of microvessel and PI (P < 0.05). PME/Pi was correlated to the PI and tion, and the critical shortage of cadaveric livers have led to the use of living-donor the microvessel variety index (P < 0.05). liver transplantation. Conclusion: Some metabolites in HCC are higher than those in liver, and the tumor Imaging Findings: Preoperative imaging of the liver transplant recipient should metabolism may be infl uenced by heterogeneities of angiogenesis. depict in detail the relevant vascular anatomy, revealing the presence of variants that are important for surgical planning: the most common relevant arterial vari- C-042 ants include replaced or accessory hepatic arteries from the superior mesenteric artery. The portal vein should be evaluated for thrombosis or hypertension with Comparison of survival rates between transcatheter arterial porto-systemic collateral vessels; the anatomy of the confl uence of the hepatic chemoembolization and hepatic resection for treating solitary (< 10 cm) veins should be described. Donor safety is a primary concern: preoperative imaging hepatocellular carcinoma plays a crucial role in donor selection and workup, providing information on liver Y. Baba, S. Hayashi, K. Ueno, M. Nakajo; Kagoshima/JP parenchyma and its volumes, bilary and vascular anatomy, and reducing surgical ([email protected]) and postoperative surgical morbidity and mortality. Potential donors should be as- Purpose: To analyze our results of transcatheter arterial chemoembolization sessed for presence of focal liver disease and steatosis. The relevant intrahepatic (TACE) compared with surgical resection for the treatment of solitary (< 10 cm) vascular anatomy must be evaluated, especially for variants involving the resection hepatocellular carcinoma (HCC). plane. MDCT and MRI examinations of the potential donor allow performance of Methods and Materials: By a retrospective review of patients from July 1990 to detailed 3D reconstructions of the vascular anatomy, and accurate assessment of October 2001, 334 patients with HCC (Child-Pugh class A/B and International Union the ideal surgical plane. A virtual hepatectomy can be performed. Against Cancer [UICC] stage T1~3N0M0) were enrolled. 204 patients received Conclusion: In this comprehensive review, we address the issue of multimodality hepatic resection (HR) and 130 patients, who refused the operation, received preoperative evaluation for living liver donor transplantation, discussing imaging TACE. After stratifi cation according to the tumor stage (UICC, Cancer of the Liver protocols and post-processing techniques. Italian Program [CLIP]), the survival rates of the two treatment groups were com-
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Abdominal Viscera (Solid Organs) 0 : 7 1
7 0 ;
1 0 2 . 2 341 0 . 2 112.02.2007 17:03:43 cation G , S. Colagrande , S. 1 Toon-city, Ehime/JP Toon-city, cant decrease in the SUV , N. Villari , N. ow diversion. THPEs without THPEs diversion. ow 1 C 3.7 and the mean post treatment SUV ± BDEF nd out a guideline classifi cation. nd out a guideline classifi , G.M. Fazzolari , G.M. 2 A cult for conventional methods. We have noticed have We methods. conventional cult for cant improvement (p=0.01). CT imaging showed CT imaging showed (p=0.01). improvement cant thrombosis or fl ltration, ([email protected]) ([email protected]) To evaluate THPEs at MRI study. To show their range of their range show To THPEs at MRI study. evaluate To To demonstrate branching variations of the portal variations of branching demonstrate veins To
, A. Ragozzino , A. 1 The fi rst ascertainable feature of THPE is presence/absence of rst ascertainable feature The fi Ninety-four patients underwent CTAP by MDCT/angio system by CTAP underwent patients Ninety-four Liver parenchyma arterial phenomena are well known at CT study; arterial at CT study; parenchyma known phenomena are well Liver To understand variations in portal understand variations of caudate lobe is essen- branching To Though branching variations of portal variations is not frequent, it is Though branching vein ow decreases because of a large variety of liver disorders. We will We disorders. of liver decreases because of a large variety ow FDG-PET imaging has an integral role in the assessment of patients integral FDG-PET imaging has an THPEs are frequently visualized at MRI as a consequence of acqui- at MRI as a THPEs are frequently visualized Naples/IT 2 , N. Centi , N. 1 3.7 indicating a signifi 3.7 indicating 86% of patients showed decreased PET activity on FDG-PET scan at 6 activity on FDG-PET scan decreased PET showed 86% of patients ± ammation, percutaneous treatment outcome; diffuse, by Budd-Chiari syndrome, Budd-Chiari syndrome, by diffuse, ammation, percutaneous treatment outcome; Firenze/IT, Firenze/IT, progressive disease in 27% patients and stable liver disease in 60% patients. liver patients and stable disease in 27% progressive Conclusion: signifi There is a treated with yttrium-90 SIR-Spheres. on CT. in the appearances after treatment, where there is little change value was 9.3 9.3 was value (SUV). CT response was assessed by RECIST criteria. by assessed CT response was (SUV). value Results: a partial on CT scan. of tumour while only 13% showed weeks the size response in 12.2 SUV was The mean pre treatment C-049 enhancement Arterial phenomena or transient hepatic parenchymal of guideline classifi and proposal Evaluation (THPE) at MRI study: 1 C-048 three-dimensional Demonstration by veins of the caudate lobe: Portal CT during arterial MDCT/angio using integrated 16-channel portography system Mochizuki; T. Tanaka, H. Hirata, M. Tsuda, T. Kajiwara, T.H. Duranti B. ([email protected]) ([email protected]) Learning Objectives: three-dimensional CT during arterialthe caudate lobe by (3D-CTAP) portography MDCT/angio system. 16-channel using integrated Background: evaluation preoperative However, hilar tumors. hepatic surgical planning for tial for has been diffi vessels of such tiny us to depict very precise 3D images of enable data of CTAP that isotropic voxel We portalthe introduction of the MDCT/angio system in our institute. since veins of the portal variations of the caudate lobe could branching that veins expected technique. this be assessed by Findings: Imaging Most of the ex- 2006). 2005 and August during period a 10-month (November and/or treatment of hepatocelullar the evaluation for performed aminations were rendering intensity projection (MIP) and (VR) and maximum Volume carcinoma. data sets. isotropic voxel created by multiplanar-reconstructed (MPR) images were clearly directions were visualized the caudate lobe in various of branches Portal and anatomic branches of detectable The number 3D-reconstructed images. by 3D-CT portography The depiction of intravenous in this exhibit. are shown variants also referred. 16-channel MDCT was by Conclusion: created 3D-CTAP important of caudate lobe. of branches variations to recognize of portal of veins the evaluation be a useful tool for MDCT/angio system may by caudate lobe. FLL have three appearances: sectorial, by thrombosis, arterio-portal-shunt thrombosis, sectorial, by three appearances: and FLL have supply, blood compression, aberrant parenchymal polimorphous, by cholangitis; infl cirrhosis or portal biliary trunk thrombosis, tree dilation. Conclusion: Their shape or patternhelp understand pathogenetic can sition time shortening. be considered important must disorders; They signs of underlying liver mechanisms. even at MRI study as well, be performed the hepatic arterial always phase must if no FLL is expected. Learning Objectives: trying lesions (FLL), liver to correlate when connected or not to focal appearance, morphology fi to etio-pathogenesis and Background: is less studied at MRI and there is no comprehensive their appearance however, supply due THPEs are related to dual hepatic blood types. organization of various increases ow Arterial fl ows. infl to compensatory liver two relationships between when portal fl In the 2001-2006 period, all THPEs. of describe MR appearance and organize 11% of the patients arterial-phase received examinations evaluation: MR-liver THPE. at least one showed Findings: Imaging sump effect by lobar, THPE morphologies: FLL are associated with two of FLL. due to supported benign/malignant lesions, large benign FLL and sectorial, by by portal compression, infi branch
ow 1 cm. 1 cm. ≤ time-saving Tokyo/JP Tokyo/JP
Sevilla/ES Sevilla/ES 2 cm (7%; 58%; 69%). 69%). 58%; 2 cm (7%; 30 % of HCC were not % of HCC were 30 < ndings using ndings > London/UK 20 % of HCC-preOLT. 20 % of HCC-preOLT. > ow, and eventually could end up in and eventually ow, ndings in explanted liver (eL) after liver ndings in explanted Scientific and Educational Exhibits Scientific and Educational 2 cm and uninodular. < 2 cm, vs 7.7% of i-HCC. The sensitivity of US, CT, CT, The sensitivity of US, cm, vs 7.7% of i-HCC. 2 > Between July 2002 and October 2005, 28 patients with July Between From 2004, 21 patients received yttrium-90 microspheres 2004, 21 patients received From To recognize that venous outfl ow evaluation prior to liver prior to liver evaluation ow outfl that venous recognize To We demonstrate, using a new software, 3D CT venography 3D CT venography software, using a new demonstrate, We 1 1
d d Postoperative hepatic venous congestion is a serious congestion complication, hepatic venous Postoperative n Most i-HCC were Most i-HCC were Our subtraction CT hepatic venography is not just quick, easy and is not just quick, CT hepatic venography Our subtraction i . N I Selective internal radiation therapy (SIRT) with yttrium-90 labelled resin (SIRT) internal therapy Selective radiation To evaluate the accuracy of US, CT and MRI to detect Hepatocellular of US, the accuracy evaluate To F 13 nodules were i-HCC: 5 uninodular, and 2 multinodular (3 and 5 nodules). (3 and 5 nodules). and 2 multinodular 5 uninodular, i-HCC: 13 nodules were - c u d E i c 2 cm was (78%; 94%; 94%); 1-2 cm (44%; 60%; 91%); 91%); 60%; cm (44%; 1-2 94%); 94%; (78%; cm was 2 S - The fi ndings in eL exceeded the Milan criteria in ndings in eL exceeded The fi and MRI was 68%, 72%, and 84%. US failed to detect all the nodules in 57%, CT US failed and 84%. 68%, 72%, and MRI was 14% of i-HCC and 24% of HCC-preOLT in 48% and MRI in 36% of the patients. CT and MRI in nodules of US, The sensitivity the Milan criteria in eL. exceeded ≥ to diagnose diffuse HCC. All the techniques failed Conclusion: MRI had the higher sensitivity (84 %) especially in nodules US. detected by ([email protected]) ([email protected]) Purpose: This study aims tumours. liver unresectable micropheres is a treatment option for the use of FDG-PET and correlate with the with to assess the response of SIRT (CT). response on computed tomography Methods and Materials: Most patients treatments. two One patient received at the Hammersmith Hospital. metastasis had colorectal metastases (n=10), while the others (n=11) had liver up with FDG-PET imaging and then followed were Patients primaries. from different Pre- and and 6 monthly thereafter. CT scans of abdomen and pelvis at 6 weeks assessed visually and in the case of PET CT and PET scans were post-therapy made using the standardised uptake were assessments semi-quantitative scans, C-047 as a with 90 yttrium microspheres Selective internal radiation therapy A comparison of CT and liver tumours: unresectable treatment option for PET imaging Al-Nahhas; A. Wasan, H. Jiao, L. Tait, P. Szyszko, T. C-046 of hepatocellular carcinoma: in the diagnosis Radiological accuracy liver Correlation with explanted J.- Garzón, Gutiérrez, M. Castell, C. F.-J. Talegón, A. Vargas-Serrano, B. Sayago; Gómez, M. M.-Á. Gavilán, Sousa, F. J. Pascasio, M. Purpose: Carcinoma (HCC) and correlate it with the fi analyse the frequency of incidental HCC To orthotopic (OLT). transplantation liver (i-HCC). Methods and Materials: HCC underwent OLT: in 21, HCC was diagnosed before OLT (HCC-preOLT), and (HCC-preOLT), OLT diagnosed before in 21, HCC was OLT: HCC underwent 1-3 months performed CT and MRI were US, in the eL. present in 7, i-HCC were The according to the Milan criteria. was OLT The eligibility for to surgery. previously correlated with imaging. of HCC-nodules in eL were and size number Results: and 5% diffuse. 43% multinodular 52% uninodular, HCC-preOLT: 34 nodules were were 46.2% of HCC-preOLT subtraction 3D CT hepatic venography venography subtraction 3D CT hepatic Kohda; E. Terada, S. Terada, H. Nagamoto, M. Gomi, T. Tsunoo, M. important determiningand hemodynamics is extremely and the resection line for has been taking part, 3D CT venography Conventional reconstructions. venous skill-dependent in obtaining clear images of the it is time-consuming and but peripheral branches. Findings: Imaging subtraction This arterial procedure from with subtraction phase to portal phase. to estimate also allows minutes, is easy and spares only few 3D CT venography including inferior order or more, up to third branch even branches, peripheral venous or caudate lobe vein. right hepatic vein Conclusion: depiction, which anatomy detailed venous option for also an excellent cient, but effi the surgeons. areas for drainage hepatic venous to evaluate is a key Hepatic vein anatomy and hemodynamics: Imaging fi Imaging hemodynamics: and anatomy Hepatic vein C-045 Learning Objectives: of the and hemodynamics that anatomy be aware To surgery is clinically important. demonstrate We planning. the design of surgical affect hepatic vein imaging which is an easier and faster CT hepatic venography, method, subtraction 3D CT hepatic venography. option compared with conventional Background: combined or hepatectomy living transplantation result after living donor which may disrup- congestion, venous if there is no venous Even resection. with hepatic vein of the portaltion could lead to regurgitation fl fl of hepatic venous detailed evaluation preoperative Therefore, atrophy. liver C - 7 0 R C EECR07-C-SciEduc-FIN.indd 11 Scientific and Educational Exhibits
C-050 Abdominal Viscera (Solid Organs) Focal liver lesions: Detection and characterisation with microbubble contrast agents Pancreas F. González, C. Juanco, L. Martin, J. Izquierdo, M. Lopez, M. Silvan; Santander/ES
Learning Objectives: 1. To learn how to perform a contrast-enhanced ultrasound C-051 examination of the liver. 2. To understand how the interaction of the contrast agent The role of 16-slice MDCT with 3D reconstructions in the pre-surgical with the ultrasound system helps in the evaluation of suspected liver lesions. 3. To evaluation of periampullary carcinoma: Correlation with surgical fi ndings learn the enhancement characteristics of benign and malignant liver lesions. M. Kang, V. Ragavendran, T. Yadav, S. Sinha, R. Gupta, A.K. Kudari, J. Wig, Background: Microbubble ultrasound contrast agents can be used to improve N. Khandelwal; Chandigarh/IN ([email protected]) detection and characterization of focal liver lesions. This poster details how to per- EPOS Purpose: Periampullary carcinomas exhibit a poor prognosis due to early spread form an enhanced ultrasound of the liver utilizing sulfur hexafl uoride microbubbles to surrounding vessels and viscera. Accurate pre-surgical assessment of resect- (SonoVue, Bracco). The preparation and administration of the contrast agent is ability is important to avoid unnecessary laparotomy. This prospective study was discussed with practical pointers. The requirements of the ultrasound equipment and undertaken (approved by the institute board) to evaluate the accuracy of 16-slice settings required for optimal imaging are discussed. Common pifalls in enhanced MDCT in assessing the resectability of periampullary carcinoma and defi ning ultrasound liver imaging are reviewed. peripancreatic vascular anomalies. Imaging Findings: Using a pictorial essay, the multiphasic enhancement patterns Methods and Materials: Thirty-three patients (M:F 23:10, mean age: 52.03years) of both benign and malignantNo Material focal lesionsSubmitted of the liver to are presented with empha- with clinical or radiological features suspicious of periampullary carcinoma under- sis on unique characteristics for each lesion (cyst, hemangioma, adenoma, focal went a biphasic scan on a 16-slice MDCT. Axial and 3D reconstructed (maximum nodular hyperplasia, focal pseudotumoral esteatosis, hypervascular metastatic intensity projection, multiplanar reformatted and volume rendered) images were disease and hypovascular metastatic disease, intrahepatic cholangiocarcinoma evaluated for assessing resectability and identifying vascular anomalies. CT fi ndings and hepatocellular carcinoma). A summary table of the enhancement patterns were correlated with the intra-operative fi ndings with respect to tumour, vascular of each type of lesion is provided to enable the rapid recognition of characteristic invasion, distant metastasis and vascular anomalies. enhancement patterns. Results: Eighteen patients were preoperatively assessed on MDCT as resect- Conclusion: Contrast-enhanced real-time ultrasonography is a promising ap- able. Twenty-four patients underwent surgical exploration, either curative resection proach in the noninvasive characterization of focal liver lesions and can be useful (n=17) or palliative procedures (n=7). One patient with liver metastases on MDCT as a fi rst-line imaging technique clinically when a focal liver lesion is detectable had a neuro-endocrine tumour and therefore underwent curative resection. MDCT on ultrasonography. yielded a sensitivity, specifi city, positive predictive value, negative predictive value and accuracy of 100%, 75%, 98.9%, 100% and 98.97%, respectively, for predicting resectability of the tumour with respect to vascular invasion (p value=0.001); 94.12%, 71.43%, 88.89%, 83.3%and 87.5%, respectively, for determining overall resect- ability (p value=0.003) and 71.4%, 94.1%, 83.3%, 88.8% and 87.5%, respectively, for assessing unresectability. Vascular anomalies were detected in 7 patients and confi rmed in 5 on surgery. Conclusion: 16-slice MDCT is an effi cacious and accurate tool for the pre-surgi- cal evaluation of periampullary carcinoma, which allows successful planning of surgical strategies. C-052 Multidetector CT evaluation of the retroportal pancreatic margin: Correlation with histopathological fi ndings G. Caproni, S. Mazzeo, C. Cappelli, V. Battaglia, A. Belcari, F. Forasassi, C. Bartolozzi; Pisa/IT ([email protected])
Purpose: The role of multidetector CT in the assessment of the retroportal pancre- atic margin by correlating CT fi ndings with histopathological results. Methods and Materials: We evaluated 43 patients affected by ductal adenocarci- nomas of the pancreatic head or uncinate process, submitted to surgical resection. The suspicion of infi ltration (microinfi ltration or macroinfi ltration) of the retroportal margin arose at CT when the fatty layer localized between the medial surface of the pancreatic head and uncinate process and the mesenteric artery appeared obliterated, irregular or with abnormal density. Results: CT suggested the infi ltration of the retroportal lamina in 19 cases (8 microinfi ltration, 11 macroinfi ltration) and the absence of infi ltration in 24 cases. At histopathology, the presence of infi ltration was confi rmed in 14/19 (74%) cases and the absence of infi ltration was demonstrated in 21/24 (88%) cases. In all CT cases of microinfi ltration the retroperitoneal resection margin was not infi ltrated, while all cases (5) with infi ltration of the retroperitoneal margin were macroinfi ltrated at CT. The sensitivity of CT was 82%, specifi city of 81% with an overall diagnostic accuracy of 81%. Conclusion: Neoplastic infi ltration of the retroportal fatty tissue represents a critical factor in tumor staging and in surgical planning because it frequently represents a site of persistence and recurrence of disease. Multidetector CT is accurate in the assessment of the neoplastic infi ltration of the retroportal fatty tissue. C-053 Pancreatic graft early complications in pancreas-kidney transplant A. Alcala-Galiano, L. Herráiz, A. Hilario, P. Martín Medina, A.B. Delgado, S. Jimenez Arranz; Madrid/ES ([email protected])
Learning Objectives: To briefl y review normal radiologic appearance of postopera- tive imaging anatomy. To illustrate image fi ndings of the main early complications of pancreatic transplant. To discuss the optimal imaging technique for the diagnosis
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Yufu city/JP Yufu Jette/BE 2 manifesta- ndings of the unusual ndings of unusual manifestation manifestation ndings of unusual , F. Vandenbroucke , F. C 1 BDEF ndings. To discuss the spectrum of mucin- To ndings. Edegem/BE, A 1 ; 1 guration of the pancreatic parenchyma/pancreatic of the pancreatic parenchyma/pancreatic guration , K. de Jongh , K. 1 ciently diagnose the anomalous pancreatobiliary system. ciently diagnose the anomalous pancreatobiliary system. To review the unusual manifestation of ductal adenocarci- manifestation the unusual review To 1. To demonstrate the multidetector CT (MDCT) imaging of CT (MDCT) imaging the multidetector demonstrate To 1. To describe the variety of cystic pancreatic lesions. To identify To describe of cystic pancreatic lesions. the variety To , D. Ysebaert , D. Anomalous pancretobiliary duct system could be almost identi- 1 The differential diagnosis of a neoplastic cystic lesion of the pan- The differential ([email protected]) ([email protected]) , R. Salgado , R.
1 guration of the pancreatic duct and biliaryguration duct, and anomalous Unusual manifestation of ductal adenocarcinoma may lead to false lead to false of ductal adenocarcinoma may manifestation Unusual Pseudocysts are the most common cystic lesions of the pancreas. Pseudocysts are the most common cystic lesions of the pancreas. ndings of cystic pancreatic lesions: How to differentiate from from to differentiate How pancreatic lesions: ndings of cystic Thin-slice reconstructed images using MDCT allow the detailed ana- Thin-slice reconstructed allow images using MDCT The major teaching points of this exhibit are: 1. Knowledge of the Knowledge 1. are: The major teaching points of this exhibit MDCT imaging with thin-slice reconstruction or advanced postprocess- MDCT imaging with thin-slice reconstruction or advanced Seoul/KR guration of the pancreatic parenchyma (anular pancreas, agenesis of the pan- pancreas, (anular of the pancreatic parenchyma guration ndings and pathologic correlation ed by thin-slice reconstructed MDCT images. Especially, CPR and MinIP were CPR and MinIP were Especially, thin-slice reconstructed MDCT images. ed by C-058 CT and MRI fi pseudocysts Op de Beeck B.J. C-056 Imaging adenocarcinomas: of the pancreatic manifestation Unusual fi Han, J. Park, Choi, H. Kim, H. Chang, I. Kim, S. S. Lee, Choi, J. Kim, J. S. Choi; B. Learning Objectives: correlate the imaging fi To noma of the pancreas. pathologic fi of ductal carcinoma with of the pancreas. producing adenocarcinoma Background: the imaging and pathologic fi exhibit We diagnosis. tions of the ductal adenocarcinomas. adenocarcinoma usually presents as vaguely ductal Typical Imaging Findings : Atypical ltration. peripancreatic mass with or without infi hypovascular ned defi within the tumor, of the ductal carcinoma includes cystic change appearance mass without ductal enhancement, well-marginated or delayed iso-attenuating ductal multifocal pancreatic cancer, groove cations, calcifi dilatation, intratumoral non-cystic ductal carcinomas include mucinous unusual Pathologically carcinoma. ductal carcinoma associ- (colloid) ductal carcinoma, adenosquamous carcinoma, ated with IPMT. Conclusion: its dif- be useful for observed in ductal adenocarcinoma would features variable Mucinous 2. other pancreatic neoplasm and correct diagnosis. from ferentiation calcifi ned margin and well-defi have noncystic adenocarcinoma may C-057 by demonstration Imaging Anomalous pancreatobiliary system: embryology CT and its multidetector Mori; H. Hongo, N. Yamada, Y. Matsumoto, S. Takaji, R. Learning Objectives: anomalies of the pancretobiliaryvarious system such as malfusion of the pancreato- biliary ducts and anomalous confi and limits of the postprocessing techniques of outline the advantages To 2. duct. (CPR) curved reformation planar reformations, including coronal oblique MDCT, understand the embryology of To 3. (MinIP). intensity projection and minimum pancreatobiliary system. Background: will demonstrate we In this exhibit, of the pancretobiliarytomical information system. the MDCT imaging of the anomalous pancretobiliary system including the malfusion of the pancreatobiliary ducts (anomalous pancreatobiliary junction, pancreas divism), anomalous confi confi Furthermore, postprocessing techniques. with advanced creas body and tail, etc). the embryology schematic of pancreatobiliary will illustrate we system with attractive understanding of the CT imaging of anomalous pan- in order to facilitate drawings creatobiliary system. Findings: Imaging fi diagnosing the anomalous pancreatobiliary junction, pancreas divism, anduseful for complicated anomalous pancreatic ducts. Conclusion: ing techniques can suffi ductal dilatation. 3. Ductal adenocarcinoma is sometimes accompanied by IPMT. IPMT. Ductal adenocarcinoma is sometimes accompanied by 3. ductal dilatation. F.M. Vanhoenacker F.M. ([email protected]) ([email protected]) Learning Objectives: the discuss To of these masses. the most common CT and MR imaging features and histopathological fi importance clinical, radiological, of differentiating based on a series of 40 patients. Background: All other cystic lesions including cystic neoplasms represent only 10 to 15% of pancreatic pseudocysts from nonpseudocysts is Differentiating pancreatic cysts. important determining treatment. for Findings: Imaging creas includes serous cystadenoma (microcystic and macrocystic type), mucin-pro- 0.9; 0.9; ± 2.1. There was 2.1. ± ed assessment of
cations (exocrine drainage, drainage, (exocrine cations EPOS causes of the disease. able 1.3, and a MCTSI of 2.5 ± rm vascular complications and allows rm complications and allows vascular rst referral transplant centers in Spain. centers in Spain. transplant rst referral Scientific and Educational Exhibits Scientific and Educational 2.9 and a MCTSI of 6.4 ± correlation ndings and clinical ve consecutive acute pancreatitis patients (29 m, consecutive ve ed computed tomography severity index for the for index severity ed computed tomography Thirty-fi 0.001) between the individual values of the two scores. scores. of the two the individual values 0.001) between 1. To pictorially review the MRI-MRCP imaging features the MRI-MRCP imaging features pictorially review To 1.
([email protected]) ([email protected])
< No Material Submitted to Submitted Material No aged 19- men and 8 women, 12 In our series, (20 patients: Mean patient age at time of transplantation was 38.5 years. 38.5 years. was of transplantation Mean patient age at time 3 1
d d Our institution is one of the fi Our institution ammation and necrosis as well as an assessment of extrapancreatic of extrapancreatic as an assessment ammation and necrosis as well n The MCTSI correlates more closely with patient outcome than the Although most people with pancreas divisum are asymptomatic, our Although most people with pancreas divisum are asymptomatic, Radiologists must be familiarized with transplantation procedure and with transplantation be familiarized Radiologists must Pancreas divisum occurs if there is lack of fusion of the dorsal and ventral pan- of fusion of the dorsal and ventral divisum occurs if there is lack Pancreas i . ([email protected]) ([email protected])
Athens/GR N I Balthazar criteria (CTSI) are used to assess the severity of acute pancre- Balthazar criteria (CTSI) are used to assess the severity F Mild acute pancreatitis had a CTSI of 1.8 - c u d E i c S - a high correlation (P of acute pancreatitis better than to detect the clinical severity able MCTSI was CTSI (P=0.04). Conclusion: index. severity Balthazar-computed tomography Ptohis, N. Tsimitselis, G. Pontikis, J. Chalazonitis, A.N. Lachanis, S.B. Tzovara; I. C-055 MRI-MRCP fi divisum: Pancreas Learning Objectives: abdominal pain or mild pancreatitis, cases of unexplained that many data show become familiar must All radiologists can be found. patients, especially in young ndings of this entity. with the imaging fi 77 mean age 39 yrs, as unexplained manifested clinically divisum was yrs) pancreas (60%), as mild pancreatitis 3.2 years) episodes of abdominal pain (mean duration non-communicat- demonstrated MR pancreatography, (30%), or incidentally (10%). and a dominant dorsal sites, drainage independent ducts, ing dorsal and ventral and after secretin injection showed before MRCP performed pancreatic duct. abnormal persistent poststimulatory dilatation, a sign of ampullary dysfunction. Conclusion: According to the Atlanta criteria, and 14 21 patients (60.0%) had mild pancreatitis disease of the 14 patients (35.7%) with severe Five disease. (40.0%) had severe disease (21.4%) died. severe 3 patients with necrosis; infected for on operated were test and chi-squared test. signed ranks Wilcoxon Statistical analysis: Results: correlate clinical characteristics with MRI-MRCP To 2. of pancreas divisum. ndings. imaging fi Background: 4-10% of the population, and is considered to be an anatomic variant. It affects creas. Findings: Imaging 6 f, mean age 57.0 years) underwent contrast-enhanced multidetector computed multidetector contrast-enhanced underwent 57.0 years) mean age 6 f, of bili- The pancreatitis was of the onset of symptoms. within 1 week tomography ary in 8 (22.9%), due to other origin in 20 patients (57.1%), due to alcohol abuse causes in 4 (11.4%), 3 patients (8.6%) had no identifi complications. We assessed the correlation with patient clinical outcome and the We complications. indexes. computed severity two Methods and Materials: assessment of acute pancreatitis Gavelli; Zanini, G. N. Fantini, Casadei, L. R. Pezzilli, Fiscaletti, R. Calculli, M. L. Bologna/IT Purpose: evaluating has been proposed for (MCTSI) index ed severity if a modifi atitis even a simplifi the pancreatitis (AJR 2004;183:1261-5) that includes pancreatic infl pancreatitis had a CTSI of 5.0 severe C-054 severity tomography between Balthazar-computed Comparative study and Mortele-modifiindex of each of these complications. of each of these Background: Pancreatic transplantation is to this date the only effective treatment for type 1 diabe- type treatment for effective is to this date the only transplantation Pancreatic transplant. kidney with simultaneously and is in most cases performed tes mellitus, modifi surgical intervention with different It is a complex retrospectively We complications. to numerous subject etc). anastomoses, vascular 5 years. 55 cases attended in our institution in the last reviewed Findings: Imaging seromas, of hematomas, follow-up US is a good tool for therapy. endovascular pseudocysts and abscesses. Most common complications were graft necrosis due to arterial necrosis due graft throm- were Most common complications or venous Other complications were (8 patients). pancreatitis bosis (9 patients) and graft bleeding and enteric drainage, anastomoses in both bladder leakage of exocrine stula. tissues and arterio-venous or surrounding of graft fi or hematoma, infection 25 patients (45.5%) of the graft. required explantation 11 of these patients (20%) presented no serious complications. Conclusion: complications is diagnosis of graft-related Prompt postsurgical imaging anatomy. most CT is the technique which allows Multidetector survival. graft essential for and enteric/bladder and its vascular pancreatic graft of the complete evaluation to confi is used Angiography anastomoses. C - 7 0 R C EECR07-C-SciEduc-FIN.indd 13 Scientific and Educational Exhibits
ducing tumours (mucinous cystadenoma and cystadenocarcinoma, and intraductal C-061 papillary mucinous tumour IPMT), solid-pseudopapillary tumour, cystic endocrine Intraductal papillary mucin-producing tumors (IPMT) of the pancreas: Role pancreatic tumour and some more rare cystic tumours. The purpose of this exhibit of MR in predicting malignancy is to illustrate the spectrum of imaging fi ndings of cystic pancreatic lesions and R. Manfredi, R. Graziani, S. Baltieri, A. Tognolini, R. Salvia, R. Pozzi Mucelli; highlight the roles, advantages, and limitations of CT and MRI in the differential Verona/IT ([email protected]) diagnosis of pancreatic cystic lesions, with particular emphasis on pseudocysts versus nonpseudocysts. The most useful signs for differentiating cystic pancreatic Purpose: To determine those MR imaging criteria of IPMTs that are indicative lesions are: the location of the lesion (parenchymal or intraductal), the size of the of malignancy. cysts, and the chemical nature of the contents (mucinous or serous). The best sign Methods and Materials: Thirty-three consecutive patients with histologically- for predicting malignancy is a solid mural nodule with contrast uptake. proven IPMT, both of the main pancreatic duct and of the side branches, were Conclusion: If you see a cystic pancreatic lesion, fi rst exclude a pseudocyst. If there is enrolled. All patients underwent Gd-enhanced MR imaging and MRCP. Qualitative no pseudocyst, differentiate the tumour by: age, gender, location and morphology. image analysis included: presence/absence of pancreatic duct dilation; type of duct involved (MPD/side branches (SB)/both); site of ductal dilation (head, body, C-059 tail)(MPD/side branches/both); dependant/non-dependant endoductal fi lling de- fects; ductal wall enhancement. Quantitative image analysisEPOS included: maximal Which indexes are appropriate among arterial stimulating venous diameter of the MPD/side branches. All patients underwent surgery. Tumors sampling (ASVS) derived indexes for diagnosing pancreatic insulinomas? were subdivided in malignant/benign according to pathologic examination. A Evaluation using receiver operating characteristic analyses multivariate statistical analysis was performed to identify parameters indicative Y. Baba, S. Hayashi, K. Ueno, M. Nakajo; Kagoshima/JP of malignancy. ([email protected]) Results: Ductal dilation was observed in all patients. The dilation involved the Purpose: To determine retrospectively the appropriate indexes among the arterial MPD in 9/33 (27%), the SB in 6/33 (18%), both ducts in 18/33 (55%). Ductal stimulating venous sampling (ASVS) derived indexes for diagnosing pancreatic dilation was localizedNo in Materialthe head in Submitted 5/33 (15%) patients, to in the body-tail in 13/33 insulinomas. (40%), and in both sites in 15/33 (45%). Overall, endoductal fi lling defects were Methods and Materials: Between 1994 and 2005, 23 patients with hypoglycemia observed in 25/33 (76%): 12/25 (48%) in the MPD and 7/25 (28%) in the SB, and hyperinsulinemia (6 m and 17 f, average age: 55 yrs) were referred to our de- 6/25 (24%) in both ducts. Dependant endoductal fi lling defects were observed in partment and underwent the ASVS test to determine whether they had pancreatic 15/25 (60%); ductal wall enhancement was observed in 19/33 (58%) with nodular insulinoma. In the ASVS test, blood samples were obtained from the hepatic vein pattern in 14/19 (74%) and diffuse pattern in 5/19 (26%). The mean size of MPD at baseline, 30 s, 60 s, and 120 s after calcium injection into an artery supplying was 32 mm (10-120 mm) of the SB 28 mm (10-50 mm). Dilation of the MPD in the the tumour and a control artery supplying pancreatic and hepatic tissues, which did tail or diffuse as well as ductal wall enhancement were signifi cantly associated not contain the tumor in 17 patients with evidence of an insulinoma. The ASVS test with malignancy (respectively p < 0.05). was also performed in 6 patients initially suspected of having an insulinoma, but Conclusion: The main distinctive feature of malignancy is dilation of the MPD in fi nally confi rmed not to have it. Receiver operating characteristics (ROC) analyses the tail and ductal wall enhancement. were conducted to determine the appropriate indexes among the ASVS-derived indexes for diagnosing pancreatic insulinomas. C-062 Results: Among insulin concentration indexes, the index at 30 s (Az 0.872, Intravenous Glucagon as a premedication for 3D-MRCP in patients with 95%CI=0.769-0.926) was the best diagnostic index for pancreatic insulinomas. contraindication of scopolamine butyl-bromide (Buscopan) Among insulin gradient indexes, the index at 30 s (Az 0.947, 95%CI=0.875-0.983) T. Yamagishi, H. Shindo, T. Kawai, T. Itoi, K. Abe; Tokyo/JP was the best diagnostic index for pancreatic insulinomas. Both the ASVS-derived ([email protected]) indexes at 30 s were confi rmed to provide the best diagnostic accuracy (insulin concentration at 30 s> 98.8: sensitivity 94.1%, specifi city 80.2%, insulin gradient Purpose: Three-dimensional (3D) MRCP tends to be affected by the motion artifacts at 30 s> 1.6: sensitivity 100%, specifi city 81.4%). of gastrointestinal peristalses because of its relatively longer examination time Conclusion: Insulin concentration and gradient at 30 s were the best two indexes than 2D method. In this paper we evaluate the effi cacy of intravenous Glucagon for diagnosing pancreatic insulinomas among the ASVS-derived indexes. chloride (IVGC) for improving the delineating capabilities of 3D-MRCP in patients with contraindication of anti-cholinergic agents. C-060 Methods and Materials: Thirty-two patients (55-70 years, glaucoma=8, cardiac arrhythmia=14, prostate hyperplasia=10) scheduled for MRCP were allocated to this Demonstration of pancreatic lipomatosis using the three-point Dixon study. Before and after 1 mg of IVGC, the source slice data (0.8 mm, 96 slices) were MRI in children with exocrine pancreatic dysfunction and mutations in acquired in coronal planes with navigator gated respiratory-triggering (Prospective carboxyl-ester lipase Acquisition Correction: PACE) using a commercially available super-conducting I.S. Haldorsen, H. Raeder, L. Ersland, R. Grüner, T. Taxt, P.R. Njolstad; 1.5 T MR system. Qualitative assessment was performed with maximum intensity Bergen/NO ([email protected]) projection (MIP) images by four-point scoring by board-certifi ed radiologists and Purpose: Pancreatic atrophy and fatty replacement of the normal parenchyma, endoscopists immediately after examination (without any segmentation). Quantita- or lipomatosis, have been observed in subjects with diabetes. The underlying tive analysis was performed with the source images by calculating contrast-to-noise molecular and pathological mechanisms are, however, poorly known, and it has ratio (CNR). The data after IVGC were compared with those before statistically. The been speculated that both features are secondary to diabetes. We have recently profi t for reducing the burden of fi lm reading was also investigated. described pancreatic atrophy and lipomatosis of diabetic subjects in two Norwegian Results: The meantime of examination was 28.1 min (no signifi cant difference families with a novel syndrome of diabetes and exocrine pancreatic insuffi ciency between before and after IVGC). All investigators scored the MIP after IVGC as caused by heterozygous carboxyl-ester lipase (CEL) mutations. To explore the more excellent than before. The mean value of CNR after IVGC was signifi cantly early pathological events in this syndrome, we performed MRI of the pancreas higher than before (P < 0.05) in all cases. in non-diabetic children with signs of exocrine-dysfunction-carrying mutations in Conclusion: Resultant images after IVGC could reduce the motion artifacts due these families. to spasmodic movements and facilitated an accurate grasp of the entire pancre- Methods and Materials: Non-diabetic mutation carriers and age- and sex-matched aticobiliary system, even in the degraded segments, by overlaid ghost of motion controls were evaluated with MRI using the three-point Dixon MRI to estimate artifact in the direction of phase-encoding. pancreatic fat content. Results: The pancreas in the non-diabetic mutation carriers had increased fat/water C-063 ratios in the Dixon series, indicating pancreatic lipomatosis. Pancreatic volume MDCT in the evaluation of pancreatic tumor adjusted for body-surface area (BSA) was not signifi cantly altered. L. Saba, G. Caddeo, G. Mallarini; Cagliari/IT Conclusion: Non-diabetic carriers of heterozygous CEL mutations have pancreatic lipomatosis that precedes the anticipated development of diabetes. Our fi ndings Learning Objectives: To review the anatomy of the pancreas and its vascular and implicate that fatty replacement of the normal pancreas structure could refl ect a lymphatic system. To review the current indications for performing multidetector row process involved in the early stages of pancreatic disease development. CT in the diagnosis and in the staging of pancreatic cancer, underlining radiation exposure and diagnostic effi cacy. To learn the CT technical parameter and proto- col to be used in order to detect and stage pancreatic cancer. To understand the
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0 ed. No No ed. . 2 112.02.2007 17:03:44 24 months, 24 months, ≤ G able. Our aim Our aim able.
Rome/IT to EPOS to edin OP. Pancreatic parenchyma parenchyma Pancreatic edin OP. nition of thin slice images; MPR nition of thin slice images; C ed in 12/13 cases; ductal injuries in ed in 12/13 cases; BDEF ([email protected])
A ed and homogeneous. Pancreatic parenchyma parenchyma Pancreatic ed and homogeneous. ndings in 6 cases; all cases were evaluated with with evaluated all cases were ndings in 6 cases; Retrospective analysis CT features of thirteen CT features analysis solid- Retrospective 22 Patients with GMAP and 20 with OP were retrospec- with GMAP and 20 with OP were 22 Patients We retrospectively evaluated MSCT examination of 827 examination MSCT evaluated retrospectively We
Shanghai/CN No Material Submitted Submitted Material No MSCT allows a better detection of low-grade injuries than single a better detection of low-grade MSCT allows In early normal of pancreatic paren- stage, or enlarged thickness ([email protected]) ([email protected]) 25 months. Qualitative analysis: presence/absence, calcifi ed/non-calci- calcifi presence/absence, analysis: Qualitative 25 months. Pancreatic involvement is not rare (until 12%) in the settings of blunt (until 12%) in the settings of blunt is not rare involvement Pancreatic Solid-pseudopapillary benign pan- is a very tumor of the pancreas rare, To describe initial and follow-up CT imaging changes in pancreatic pa- describefollow-up initial and To
≥ Parenchymal lesions were identifi lesions were Parenchymal In thirteen located in the head and solid-pseudopapillary seven tumors, Group A: endoluminal calculi were present in 4/11 OP and in 1/9 GMAP; and in 1/9 GMAP; present in 4/11 OP endoluminal calculi were Group A: pancreatitis compared to associated ndings in gene mutation addictional fi ndings were imaged by coronal MPR. imaged by ndings were addictional fi Conclusion: The main diag- partial for is still a challenge lesions. ductal evaluation slice-CT; seems related to high defi nostic improvement not clear. role is yet ([email protected]) ([email protected]) Purpose: of BAT; CT is the main diagnostic tool in evaluation (BAT). abdominal trauma be very subtle (reported lesions may pancreatic sensitivity = 80%) and however, not identifi a major prognostic item, are considered Wirsung injuries, MSCT impact on pancreatic injury evaluation. is to evaluate Methods and Materials: June 2004 to from June BAT admissed for 4-79) consecutively patients (age range surgical or CT by affected 13 patients were 2006 in our Emergency Department; slice (1 Axial thin images mm) and coronal reformatted pancreatic injuries. proven looking for evaluated acquisition were volumetric pre and post-contrast following transec- contusion, laceration, (diffuse edema, trauma direct sings of parenchymal were of serum amylase Clinical data, including the value Wirsung injuries. tion) and surgical fi in all cases; available and/or CT in the follow-up. sonography Results: by affected was negative the only false Regarding parenchimal involvement, 2/13. misdi- was Wirsung lesion surgically proven A partial pancreatitis. post-traumatic correctly identifi were Wirsung transections all patients with agnosed on CT; Purpose: Our purpose of the solid-pseudopapillary is to describe CT features creatic tumor. CT. of the diagnosis value and to investigate tumor, Methods and Materials: women, men and eleven Two pseudopapillary all pathologically proved. tumors were CT All patients performed old. 33 years old with average from 21-50 years ranging plain scan and enhanced scan (pancreatic phase and hepatic phase). Results: from 3 The tumors ranged cm-15 six located in the body or tail of the pancreas. cm, solid and cystic partsThere were inside the cm. 3×4 one malignant tumor was Purpose: C-068 of pancreatic solid-pseudopapillary tumor CT diagnosis Feng; Liang, X.-Y. Z.-H. C-066 pancreatic trauma of blunt MSCT evaluation Miele; V. Trinci, M. Galluzzo, M. Cuneo, Cortese, G. A. Stasolla, A. C-067 CT fi obstructive pancreatitis Mucelli; Pozzi R. Frulloni, Quattrocchi, L. S. Cicero, C. Graziani, Manfredi, R. R. Verona/IT associated pancreatitis (GMAP) compared in gene mutation ducts, and renchyma pancreatitis (OP). to obstructive Methods and Materials: subdivided in were Patients CT. underwent All Patients included in this study. tively Group A symptoms onset and CT: according to time between 2 groups Group B enhancement. pancreatic parenchyma ed and structure of endoductal calculi; fi of pancreatic parenchyma. thickness analysis: Quantitative Results: calcifi all calculi were in both groups of pan- Thickness GMAP and in 8/11 OP. in 6/9 hypovascular enhancement was in mm respectively 25.6, 16.9, 15.7 tail - was - head, body, creatic parenchyma endoluminal calculi Group B: respectively. mm in OP, GMAP and 13.3, 12.7, 8.6 9/10 endoluminal calculi in GMAP (2/9 and in 10/13 GMAP; present in 8/9 OP, were all calcifi eye"), core "bull’s hypodense with central of pan- Thickness in 10/13 GMAP and in 8/9 OP. hypovascular enhancement was mm respectively 14.8, 12.6 16.0, in head, body and tail was creatic parenchyma respectively. 19.0, 14.8, 11 mm in OP, in GMAP, Conclusion: in of GMAP; absence of endoluminal calculi are indicative normal MPD, chyma, morphology and diameter of endoductal calculi suggest eye" "bull’s late stage, GMAP etiology.
ndings in ndings Rome/IT contrast rate ow 0.04) by using the 0.04) by < cacy of multi-detector-row ow rate, and for the other 35 we used the other 35 we and for rate, ow Scientific and Educational Exhibits Scientific and Educational ow rate. For each patient, the image quality of For rate. ow Cagliari/IT ow rate, the overall value obtained was markedly markedly obtained was value the overall rate, ow ow rate, a total value of 116 was obtained, and we and we obtained, of 116 was a total value rate, ow In-DTPA-octreotide can help in a correct evaluation and can help in a correct evaluation In-DTPA-octreotide We studied retrospectively pancreatic arterial studied retrospectively in vessels We 111 1) To analyze localization and morphological features of pan- localization and morphological analyze features To 1) ndings are atypical, with a different behaviour after contrast after contrast behaviour ndings are atypical, with a different Exams were performed by using a multi-detector row CT (So- row using a multi-detector by performed Exams were These tumors can be uni or multi- focal. Typical CT appear- Typical focal. These tumors can be uni or multi- 5 0.001) with the 5 mL/sec fl ow technique and also the visibility technique and also ow mL/sec fl 0.001) with the 5 1
<
d d ow rate in the study of pancreatic vessels by using multi- using of pancreatic vessels by rate in the study ow Cancer of the pancreas is the fourth Cancer of the pancreas is leading cause of cancer death Neuroendocrine tumors of pancreas are relatively rare, and represent rare, Neuroendocrine tumors of pancreas are relatively n Combined reading of anatomic and functional imaging help to recog- Combined reading of anatomic and functional imaging MDCTA shows good results in the arterial pancreatic vascular study; good results in the arterial shows study; pancreatic vascular MDCTA MDCT detects with precision pancreatic cancer and allows to ad- pancreatic cancer and allows MDCT detects with precision i . N I In many pathological conditions, pancreatic vascular study is very impor- vascular pancreatic pathological conditions, In many F By using 5 mL/sec fl By using 5 - c u d E i c S - diagnosis of pancreatic neuroendocrine tumors, especially in atypical cases. diagnosis of pancreatic neuroendocrine tumors, Background: Endocrine tumors are divided into non- just 1-2% of all pancreatic neoplasms. according to the type of islet-cells involved in this case, functional and functional; and the consequently hormonal will be different, production, clinical appearance symptom. whereas in no-functioning tumors there isn’t any Findings: Imaging lesion on CT arterial typical MRI appear- ance is a hyper-vascularizated phase; after T2 and hyper-vascularizated in T1, hyper-intense in ance is a hypo-intense In some in pancreatic body. most lesions are localized lesion; Gd administration fi radiological cases, a neuroendocrineneoplasm, sug- SRS reveal and just a positive administration, exams. of radiological gesting a re-valuation Conclusion: positive pattern atypical radiological of SRS false and to reduce the number nize with the highest diagnostic impact. cases, 3 medium injection fl mL/sec contrast 2 poor quality; 1 for bad quality; the pancreatic arterial scored as 0 for was vessels quality images. excellent good quality and 4 for 3 for quality; acceptable for Results: 70 patients (41 males; 29 females, mean age: 59 years), by using multi-detector-row using multi-detector-row by 59 years), mean age: 29 females, 70 patients (41 males; used 5 In 35 patients we mL/sec fl CT scanner. observed pancreatico-duodenal artery 95% CI in 33 patients (94.3% sensitivity; By using 3 0.866-1.020). mL/sec fl 88, and the pancreatico-duodenal artery in 26 patients (77.1% lower: visible was statisti- showed The visibility of pancreatic vessels 95% CI 0.632-0.911). sensitivity; (p cal difference Value of the fl Value CT detector-row Mallarini; G. Caddeo, Saba, G. L. Purpose: to assess the diagnostic effi The aim of this study was tant. derived and the effects in the study of pancreatic vessels (MDCTA) CT Angiography medium injection. contrast rate ow from the use of a high fl Methods and Materials: rate. ow higher fl Conclusion: good quality images when a high fl this method shows in particular, medium injection is used. C-065 B. Barbaro, V. Ruffi ni, L. Di Vito, C. Tebala, P. Castaldi, L. Bonomo; Bonomo; tumors in pancreatic neuroendocrine of imaging The role Castaldi, L. P. Tebala, C. Vito, Di ni, L. Ruffi V. Barbaro, B. C-064 ([email protected]) Learning Objectives: creatic neuroendocrine tumors individuating typical and atypical imaging fi MRI and somatostatin receptor CT, of the integration how evaluate To 2) CT and MRI. (SRS) with scintigraphy in the United States. Multi-detector row Computed Tomography is widely accepted Tomography Computed Multi-detector row in the United States. pancreatic cancer. of staging and follow-up the diagnosis, diagnostic technique for who underwent 23 patients analyzed retrospectively we this educational exhibit, For 2004 November pancreatic cancer between stage and follow-up MDCT to study, 2006. and August Details: Procedure mAs, 260-320 kV, 120 technical parameters: following matom MX 8000) with the and parenchymal each patient, vascular For and 1.6 increment. 1.6 slice thickness performed. study was Conclusion: with evaluate MDCT may Moreover, this cancer type. equately stage and follow-up involvement. potential vascular high accuracy locations of the most common regions usually involved in cancer. To understand understand To in cancer. usually involved most common regions locations of the of surgical intervention the potential type and how treatment options, the various treatment. following appearance the imaging to recognize Background: of the pancreatico-duodenal artery was signifi cantly better (p of the pancreatico-duodenal artery signifi was C - 7 0 R C EECR07-C-SciEduc-FIN.indd 15 Scientific and Educational Exhibits
tumors. The solid parts were slightly low density or iso-density in the plain scan, Abdominal Viscera (Solid Organs) slightly enhanced in the pancreatic phase and markedly enhanced in the hepatic phase. The cystic parts were low density and had no enhancement. There were Miscellaneous septa between the cysts and the septa enhanced somewhat. There were hemor- rhage or calcifi cations inside the cysts, and the calcifi cations were patchy which was characteristic. The tumors were mostly with pancreatic origin, round or oval. C-069 Commonly there were no dilatations of the bile ducts or the pancreatic ducts. The 64-MDCT perfusion study of neoplasia in abdomen and pelvis huge tumors oppressed the adjacent structures, and the malignant tumor could P. Paolantonio, F. Iafrate, R. Ferrari, M. Rengo, P. Lucchesi, A. Laghi; Latina/IT not separate from the adjacent structures. ([email protected]) Conclusion: The solid-pseudopapillary tumors were mainly in adult women and the CT features were characteristic which had most important diagnosis value. Learning Objectives: To describe principles of CT perfusion studies. To describe standard perfusion protocol for 64-MDCT in abdominal and pelvic neoplasia. To show theoretical deconvolution model for perfusion analysis. Background: 64-MDCT enables an adequate anatomic coverage and temporal resolution for perfusion analysis of solid tumor of abdomen and pelvis. Perfusion studies offer an in vivo evaluation of tumor neo-vascularity. Perfusional parameters evaluated by means of CT perfusion are blood volume, blood fl ow, mean transit time and permeability surface area product. Procedure Details: In our experience, we evaluated some cases of pancreatic tuomr, recatal cancer, urinary bladder and prostate cancer using a 64-MDCT scanner (VCT; GE). Using the follwing parameters: 650 mA, 120 Kv, 0.5 sec gantry rotation time, 5 mm slice thickness acquired for 50 seconds during i.v. administration of iodinated contrast medium (Xenetix 350; Guerbet). The anatomic coverage of the scan was of 4 cm. Image analysis was performed on off-line workstation (adw 4.2; GE) using a dedicated software based on deconvolution alghorithm. Software calculate a colored map pf different perfusional parameters and quantitative data of the same parameters in a region of interest. Perfusional index may correlate with cancer response to neoadjuvant treatments. Conclusion: CT perfusion studies represent a feasible and non invasive tool for in vivo evaluation of tumour neovascularity. 64-MDCT offer the adequate temporal and spatial resolution for the application of perfusion study to solid tumor of the abdomen and pelvis. C-070 3 T MRI of the abdomen: Challenges and solutions for clinical application M. Kataoka1, T. Koyama2, H. Isoda2, A. Kido2, K. Tamai2, S. Umeoka3, Y. Nakamoto2, Y. Maetani2, N. Morisawa2, K. Fujimoto2, K. Togashi2; 1Cambridge/UK, 2Kyoto/JP, 3 Wakayama/JP ([email protected])
Learning Objectives: 1. To outline some challenges and solutions for 3 T MRI of the abdomen. 2. To illustrate some promising areas where 3 T MRI has a clinical impact, with the use of emerging techniques. Background: Theoretical doubling effect of SNR is the main reason of improving images at 3 T MRI. However, 3 T MRI of the abdomen seems challenging; suscep- tibility artifact is more prominent in abdomen due to abundant air-non air interface. Weak RF penetration and RF inhomogeneity at 3 T degrades image quality in body trunk. With fourfold increase of specifi c absorption rate (SAR), SAR limit and heat- ing effect can be critical. In this exhibit, solutions to these diffi culties are proposed. Then potentially useful clinical applications of 3 T are discussed. Procedure Details: MR images of abdomen were obtained by 3 T (Trio:Siemens) unit using phased array coil. For solutions, a more homogeneous RF fi eld can be obtained by using dielectric pads. SAR reduction can be achieved by modifying parameters or using specially-designed sequence. Furthermore, the emerging technique of variable fl ip angle Turbo-Spin echo sequences can reduce the SAR and provides high-resolution 3D images in the order of millimeter. Promising tech- niques for 3 T include MRCP, breath-holding images. High-resolution images for the pelvis can provide better depiction for carcinomas of the uterine cervix, prostate and bladder. Experimental techniques such as DWI /DTI of abdominal organs can also take advantage of increased SNR at 3 T. Conclusion: Despite some challenges, 3 T MRI of the abdomen has a potential to improve image quality in a clinical setting. C-071 Extranodal manifestations of lymphoma: A review A. Domingo, M. Andreu, J. Vives, T. Sempere, A. Saurí; Tarragona/ES ([email protected])
Learning Objectives: 1. To review extranodal manifestations of lymphoma. 2. To differentiate between primary and systemic disease. 3. To describe the radiological appearances that may mimic infectious or other neoplasms at different sites. 4. To highlight the importance of different imaging techniques in the diagnosis, staging, and follow-up of the disease. Background: Since any organ system may be affected by extranodal lymphoma, it is important to differentiate between primary manifestation and dissemination of
346 A BDEFC G
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, ndings in patients Burton-on-Trent/UK 2 C BDEF ([email protected]) ndings Burkholderia psuedomallei A Stoke-on-Trent/UK, Stoke-on-Trent/UK, 1 ndings of emphysematous infections in the abdo- infections ndings of emphysematous ; 2 To illustrate the spectrum illustrate of imaging fi To 1. To understand the normal anatomy of the many struc- the normal understand of the many anatomy To 1. 1. Review the clinical features and risk factors of develop- and risk factors the clinical features Review 1. Between the abdominal aorta Between and the superior mesenteric Within this exhibit, the clinical manifestations together with the the clinical manifestations Within this exhibit, Melioidosis is a multiorgan disease characterized by multiple multiple by disease characterized Melioidosis is a multiorgan It is also associated with a very high mortality, especially in acute It is also associated with a very high mortality, Emphysematous infections in the abdomen and pelvis are rare but but are rare in the abdomen and pelvis infections Emphysematous Melioidosis is an endemic disease in Southeast Asia, with multi- Melioidosis is an endemic disease in Southeast Although the anatomic space between the abdominal aorta Although the anatomic space between and Many pathologic conditions can occur in the space between the pathologic conditions can occur in the space between Many The wide spectrum of presentation of melioidosis, makes it a great it a great makes The wide spectrum of presentation of melioidosis, Emphysematous infections of the gallbladder, stomach, of the gallbladder, infections Emphysematous . ([email protected]) ([email protected]) , M. Palaniappan , M.
1 ndings of emphysematous cholecystitis, emphysematous pancreatitis, pancreatitis, emphysematous cholecystitis, ndings of emphysematous ([email protected]) Learning Objectives: recognise and To 2. the abdomen or pelvis. in infection ing an emphysematous describe the typical imaging fi men and pelvis. Background: diagnosis so that appropriate conditions that need a prompt treat- life-threatening diagnostic, are rarely Presenting features instigated. ment can be immediately highlighting the importance of imaging in the management of these conditions. Findings: Imaging imaging fi gastritis and emphysematous cystitis, emphysematous pyelitis, emphysematous thereby are shown, signs on radiographs Characteristicradiological are illustrated. CT remains the most accurate However, a prompt diagnosis to be made. for allowing the optimal modality modality to identify and locate abnormal therefore, gas and is, of the conditions Predisposing conditions and basic pathophysiology diagnosis. for of these diseases. a more complete understanding are also discussed to provide Conclusion: ing diabetics will describe organ systems that will be we the various In this exhibit, septicaemia. in patients with meliodosis. involved Findings: Imaging mediasti- lungs, include brain, involved were The organs that abscesses formation. ndings are also very fi Thoracic and soft tissues. prostate spleen, kidney, liver, num, includes septic arthritis and osteomyelitis. involvement Musculoskeletal variable. Conclusion: diagnosis of a diabetic with multiple be included in the differential It must mimicker. of suspicion is needed, since an early intervention with A high index abscesses. correct antibiotics is crucial to reduce morbidity and mortality. with melioidosis. To educate physicians about the various presentations of me- the various about educate physicians To with melioidosis. liodosis. Background: It is caused by system involvement. Learning Objectives: C-076 The space between the abdominal aorta and the superior mesenteric Normal anatomic structures and pathologies artery: Jinju/KR Choi; Jeon, H.-Y. K.-N. Bae, K. Learning Objectives: 2. the abdominal aortatures located between and the superior mesenteric artery. describe the distance pathologies that either increase or decrease the various To the superiorbetween mesenteric artery and the abdominal aorta. Background: the superior mesenteric artery only limited attention, the knowledge has received prompt and accurate pathologic entities will facilitate and expected of its anatomy diagnosis. Details: Procedure artery anatomic structures, many be occupied by (SMA), there is a space that may including the third portion uncinate process of the left renal vein, of the duodenum, In this of the superior lymph nodes. and branches mesentericpancreas, vessels the pathologies arising the normal from and show anatomy will review we exhibit, 1) conditions that decrease The disease entities will be divided into: the space. the abdominal aortathe distance between and the SMA and 2) conditions that ultrasound, CT, the abdominal aortaincrease the distance between and the SMA. in terms of patient and their value and barium will be shown studies angiographic management will be discussed. Conclusion: C-074 and pelvis conditions of the abdomen Emphysematous Lapsia S.K. genitourinary are associated with signifi but system are uncommon, and the armed knowledge with the appropriate background However, and mortality. allowing diagnosis can be offered, a prompt ability to recognise the imaging signs, sepsis results. overwhelming before window therapeutic the clinician a maximum C-075 fi spectrum of imaging Melioidosis, Che Ahmad; Abd Rahman, A. J. How, S. Md Ralib, Abd Rashid, A. M. Pahang/MY ve species of ve
ndings using multiple ndings using multiple rmation of the disease ne-needle punction or methods cance of procedural Recife/BR ([email protected]) ([email protected]) Scientific and Educational Exhibits Scientific and Educational
Athens/GR 1. To review the pathophysiology of this disease. 2. To il- To 2. of this disease. the pathophysiology review To 1. 1. To provide the inexperienced examiner with basic knowl- examiner the inexperienced provide To 1. This medical e-book is a multimedia DVD Rom-based teach- DVD This medical e-book is a multimedia Nowadays, CT is the most extended and preferred diagnosis and preferred CT is the most extended Nowadays, The purpose of this essay is to discuss and illustrate the large is to discuss and illustrate The purpose of this essay 7 1
d ndings with pathologic correlation are presented in some cases. ndings with pathologic correlation are presented in some cases. d Schistosomiasis is one of the most important tropical infectious User-friendly DVD Rom-based visual teaching guide with step-by-step Rom-based visual teaching guide with step-by-step User-friendly DVD This e-book teaches physicians and sonographers the basics of and sonographers This e-book teaches physicians n The role of imaging techniques is: 1. distinction between extranodal extranodal distinction between 1. techniques is: The role of imaging Schistosomiasis is considered to be the most important helminthic i . N I F - c u d E i c S - abdominal ultrasound. abdominal ultrasound. C-073 Rom- DVD Step-by-step of the upper abdomen: Ultrasound examination guide guideching based visual teaching Leli, D. Pahou, K. Tsiakouri, C. Tragea, H. Theotokas, I. Irakleous, adi, E. Vafi I. Zoumpoulis; P.S. Salvanou, A. Learning Objectives: underline the signifi To 2. physics. edge of ultrasound probe manipulation and anesthesia administration. probe protection, such as probe, of the anatomy semiology and hemodynamic behavior present echoanatomy, To 3. and credible a safe establish To 4. and pathology of all organs in the upper abdomen. results. complications and ensures true positive procedure that minimizes Background: abdomen of the upper examination an ultrasound instructions to perform on how diagnosis. of US image and credible and attain the proper formation Details: Procedure of the examination an ultrasound to perform the steps taken le that illustrates ing fi the detection of A detailed description of organ echoanatomy, upper abdomen. are and color Doppler mapping appearance sonographic and their organ disease, step by The proper technique is demonstrated in a user-friendly manner. provided presentation video presentations including a simultaneous Educational double step. from the beginning of exam technique and real-time ultrasound of the examiner’s An image and video database is included, aiding to the end are included. the exam image to the user to reach the correct diagnosis and to compare his sonographic database. images of the histologically proven Conclusion: C-072 of the typical and A review mansoni: faces of schistosomiasis The many atypical manifestations Carneiro, C. Aguiar, Correia, A. T. Albuquerque, A. Filho, Borba P. Manzella, A. Gomes; A. Dourado, Zelaquett, M. C. Kaercher, J. by using CT or US guidance to obtain tissue samples with fi using CT or US guidance to obtain tissue samples by detection 5. treatment monitoring of residual masses. and demonstration 4. biopsy. of systemic spread. ([email protected]) Learning Objectives: modality for detecting and staging lymphoma. However, depending on the site of depending However, lymphoma. detecting and staging modality for also be MRI, and PET may presentation and the characteristics of the lesion, US, can of lymphoma Radiological appearances follow-up. helpful in the diagnosis and or infections. mimic other neoplasms which may of appearances, a variety have Conclusion: confi anatomopathological 3. staging. 2. and systemic disease. the broad spectrumlustrate of typical and atypical imaging fi systemic disease. The anatomic region where the tumor was initially detected is initially detected was region where the tumor The anatomic systemic disease. is effective treatment of lymphoma Nowadays, be the primaryconsidered to site. histological type and the by treatment is dictated However, curable. and potentially a major role in the modalities play radiological The different stage of the disease. in the choice of treatment. staging, and consequently, Findings: Imaging It is estimated that around 200 to 300 million people are diseases in the world. acquiring the infec- additional 600 million to 1 billion are at risk and an for infected The term of acute and chronic clinical schistosomiasis encompasses a group tion. or more of fi with one infection and pathological disorders caused by imaging modalities. 3. To identify common and unusual complications. 4. To discuss To 4. complications. identify common and unusual To 3. imaging modalities. condition. recently reported of this complex manifestations Background: The species of major global importance digenetic worms schistosoma. of the genus more some areas, In japonicum. haematobium and s. are schistosoma mansoni, s. than one species coexist. Findings: Imaging of the of schistosomiasis mansoni including involvement spectrum of manifestations heart, breast, bone, and gastrointestinal genital tract, kidney eye, skin, lung, CNS, Imaging fi tract. This review addresses topic forms, as well as atypical and acute manifestations as atypical and acute manifestations well as addresses topic forms, This review MRI and CT US, chest CT and radiograph, include: Illustrations and ectopic forms. MRI of the spine and brain. of the abdomen, barium studies, Conclusion: disease in man constituting a huge public health problem, and radiologists should and radiologists health problem, disease in man constituting a huge public ndings. fi of its broad spectrum of radiographic be aware C - 7 0 R C EECR07-C-SciEduc-FIN.indd 17 Scientific and Educational Exhibits
abdominal aorta and the superior mesenteric artery. Some conditions may splay one isotropic and three orthogonal anisotropic images were created. ADCs were the aorta and the SMA; the other conditions can occur by narrowing of aorta-SMA calculated for liver (four segments), spleen, pancreas (head, body, tail), and renal angle. Therefore, radiologists should pay attention to anatomy and abnormalities parenchyma. Image quality for each organ part was scored visually. We estimated in this space. the correlation between ADC and image quality and evaluated the feasibility of using anisotropic images. Results: ADCs and image quality were affected by motion probing gradient direc- C-077 tions in the liver and pancreas. A signifi cant inverse correlation was found between Utility of whole body MRI for metastases screening ADC and image quality. The r values for isotropic images were -0.46, -0.48, -0.70, J. Singh, D.S. Kelkar, S. Pingley; Pune/IN ([email protected]) and -0.28 for the liver, spleen, pancreas, and renal parenchyma, respectively. Learning Objectives: To illustrate the utility of whole body MRI combined with Anisotropic images had the best quality and lowest ADC in at least one organ dedicated body-part imaging and contrast enhanced imaging for metastases part in 17 patients. screening. Conclusion: DWI with the best quality among isotropic and anisotropic images Background: Whole body MRI has emerged as a new tool in onco-imaging. It is should be used in the liver and pancreas. effective for metastatic screening in follow-up of patients with known carcinoma to determine when and whether they develop metastases as well as for TNM staging. C-080 In this exhibit, we depict the accuracy of whole body MRI for liver, brain and bone Uncommon localisation of echinococcosis in the humans metastases, its combination with CT chest for better lung metastases detection D. Passomenos, A. Athanassopoulou, M. Michalakou, K. Dalamarinis, L. Fois; as well as discuss cases where we found it to be non-contributory necessitating Athens/GR ([email protected]) other investigations. Procedure Details: We divided our patients into three groups: 1. Asymptomatic Purpose: We retrospectively reviewed the fi les of patients who have been hospital- follow-up group, 2. Symptomatic follow-up group (clinical signs and symptoms sug- ized with the diagnosis of hydatid disease (HD) for the past 6 years in order to fi nd gesting disease progression or rising tumor markers) and 3.TNM staging group. unusual sites on the human body hosting this disease. Whole body MRI was performed using the following protocol: FLAIR or T2 TSE Methods and Materials: 294 patient fi les were checked out and patients’ mean axial brain, T1 SE axial-neck, HASTE- dark blood or T1GRE axial-chest, T2 TSE age was 56.3 years. All patients had a computed tomography study while MRI study and TrueFISP axial-abdomen, 3D T1W FLASH (VIBE) - upper abdomen, STIR and was done in 5 of them. Diagnosis was made by imaging features and laboratory TrueFISP coronal whole body in fi ve stations, STIR axial- whole body, T2 sagittal- studies and verifi ed by pathologic study wherever feasible. spine, dynamic post contrast multi-phase VIBE-upper abdomen, magnetization Results: Echinococcal cysts were identifi ed in the spleen (5), kidneys (7), abdominal transfer prepared axial-brain and T1W fat saturated imaging-whole body. cavity (3), heart (2), thigh musculature (1), spinal canal (3), seminal vesicles (3), tes- Conclusion: Whole body MRI can be used effectively for metastases screening. It tis (1) and ribs (2). Abdominal HD was manifested with symptoms of hydatidemesis also helps in characterization of co-existing non-cancerous pathologies. Contrast in a case of a solitary left subdiaphragmatic calcifi ed cyst with gastro-cystic fi stula enhanced imaging increases the senisitivity and specifi city of whole body MRI for while abdominal obstruction was the fi rst sign of a disseminated intraperitoneal metastatic work up. disease. Cysts were calcifi ed in 18 (65 %) while cyst diameter ranged from 2 to 13 cm. Primary disease was evident in 12 while abdominal HD was disseminated in 2. IV administered contrast media was given in 9, while typical confi guration of C-078 HD was identifi ed in 12 cases. Surgical excision was undertaken in 7 cases. The role of post contrast CT examination in evaluation of splenic trauma: Conclusion: Although liver and pulmonary HD is the most common form of the Correlation with ultrasound examination disease, uncommon locations do exist with low incidence. Imaging studies are of W. Wawrzynek, A. Siemianowicz, R. Majer, S. Kasprowska, B. Koczy, A. Koczy, great value in depicting the nature, extend and possible complications of HD. MRI M. Trzepaczynski; Piekary Slaskie/PL is valuable in musculoskeletal forms, while CT in abdominal disease. Purpose: To evaluate the role and usefulness of post contrast CT examination in detecting splenic trauma in comparison with ultrasound examination. C-081 Methods and Materials: 32 patients, aged 13-66 years; 29 men and 3 women, Focal splenic lesions: Role of US, CT and MR imaging in their detection after traffi c accidents. In all cases, the USG and CT examinations were performed and characterisation in Radiology Department of Trauma Surgery Hospital in Piekary Slaskie. The fol- I. Delgado, J. Puig, A. Malet, A. Darnell, D. Gil-Bello, J. Martin; Sabadell/ES lowing ultrasound scanners were used: 1) LOGIQ 100, 2) LOGIQ 200, 3) Sonoline ([email protected]) Antares. The following Helical CT scanners and examination conditions were used: 1) HiSpeed CT\e GE Medical System; slice thickness 7-10 mm; automatic Learning Objectives: To illustrate the spectrum of non-traumatic spleen abnor- mAs selection, 2) 8-slice CT scanner Light Speed Ultra GE Medical System; slice malities. To describe the imaging workup for the most common splenic diseases. thickness 2.5-7.5 mm; automatic mAs selection. Examinations were performed To determine the current role of US, CT and MR imaging in the detection and after nonionic contrast medium administration. In some cases, multiplanar recon- characterization of focal spleen lesions. structions were performed. Background: Spleen abnormalities have received little attention in the scientifi c Results: In all cases, traumatic lesions of spleen were visible in CT examination. literature. However, recent US, CT and MR imaging advances open new possibili- In 6 cases, USG gave false negative results. In these patients, USG showed no ties in the study of splenic diseases. signs of splenic traumatic lesions which were visible and diagnosed in CT. In few Procedure Details: For educational purposes, we can classify focal splenic lesions cases, USG did not show all existing pathology. Traumatic lesions of spleen were into vascular disorders (infarcts), infectious diseases (granulomas, abscesse, and so classifi ed according to AAST scale. Type I was observed in 10 patients, type II 12 on), benign tumours (cysts, hemangioma, hamartom,and so on), malignant tumours in patients, type III in 5 patients, type IV in 2 patients, type V in 3 patients. (metastases, lymphoma and sarcoma), and other hematologic and metabolic disor- Conclusion: Application of contrast-enhanced CT of the abdomen is necessary in ders (haemochromatosis, Gamna-Gandy bodies, extramedullary haematopoiesis). multitrauma patients with suspicion of splenic lesions. CT extends the possibilities Conclusion: Although most splenic lesions are detected as incidental fi ndings and of quick and precise radiological diagnosis of splenic trauma, especially in cases have a non-specifi c appearance, the combined use of current imaging tools can with false negative ultrasound examination. often reach the correct diagnosis. US, CT and MR imaging all play an important role in the detection and characterization of focal splenic lesions, and with suffi cient C-079 clinical information, they enable the differential diagnosis of these lesions. Effect of diffusion-weighted image quality on abdominal apparent diffusion coeffi cient measurements C-082 T. Yoshikawa, Y. Ohno, H. Kawamitsu, M. Fujii, K. Sugimura; Kobe/JP Parallel imaging techniques for accelerated volumetric interpolated breath- hold examination (VIBE) magnetic resonance imaging of the upper abdomen Purpose: To assess the effect of diffusion-weighted image (DWI) quality on ab- D.Y.H. Huang, R. Fernando, D. Svasti-Salee, J. Dark, N. Jeyadevan; London/UK dominal apparent diffusion coeffi cient (ADC) measurements and the usefulness ([email protected]) of anisotropic images. Methods and Materials: Twenty-six patients (10 men and 16 women; mean, 58.1 Learning Objectives: To illustrate the concept of parallel imaging. To describe the years) who underwent DWI and were diagnosed not to have any abdominal dis- use and indications of parallel-imaging accelerated VIBE in upper abdominal MR eases were analyzed. Single-shot spin-echo echo-planar DWI was performed and study based on a series of 38 patients.
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2 7 0 0 2 mm . 2 ) with -3 349 2 0 . 2 112.02.2007 17:03:45 G cient (ADC) measurements C nding (10/12, 83.3%). The typical CT nding (10/12, 83.3%). BDEF ([email protected]) ([email protected]) A ([email protected]) ([email protected])
We had retrospectively reviewed 12 cases of abdominal reviewed had retrospectively We Single-shot echo-planar diffusion-weighted MR imaging Single-shot echo-planar diffusion-weighted Manisa/TR CT fi ndings of abdominal tuberculosis may mimic various diseases. diseases. mimic various ndings of abdominal tuberculosis may CT fi The majority of SHs evaluated with CEUS presented an isoechoic with CEUS presented The majority of SHs evaluated Evaluation of ADC can give further be used as a of ADC can give and may information Evaluation Thessaloniki/GR ll-in in the arterialhypoechoic isoechoic (n=2) and appeared but phase, Lateral arcuate ligaments (LAL) are ocasionally observed anatomic Lateral To elucidate the features and assess the clinical signifi cance of CT and assess the clinical signifi elucidate the features To To evaluate the use of apparent diffusion coeffi evaluate To (1) Abdominal tuberculosis occurred in younger patients more frequently (1) Abdominal tuberculosis occurred in younger The mean ADC value of two patients with GIST was 1.51 (x10 patients with GIST was of two The mean ADC value ); in 4 patients with tumor recurrences (2 colon and 2 ovary cancers) it was cancers) it was in 4 patients with tumor recurrences (2 colon and 2 ovary ); -1 vascular phase, whereas 1/17 SH was isoechoic in the arterial was whereas 1/17 SH phase, became phase but vascular and a rapid SHs showed 4/17 phases. in portal-venous and delayed hypoechoic complete fi peripheral hyperechoic 2/17 SHs showed respectively. phase (n=2) in delayed 2/17 hem- ll-in. centripetal fi progressive by nodules in the arterial followed phase, in all phases. lesion angiomas appeared as hypoechoic Conclusion: cases contrast-en- in some showing phase, the vascular throughout appearance hancement patterns similar to that of liver. examination in the diagnosis of abdominal tuberculosis. in examination Methods and Materials: All cases were 2004. 1996 and August June between tuberculosis investigated All had pre- and post-contrast abdominal tuberculosis histopathologically. proven All WS). enhancement CT scanning (helical CT/i, GE medical system, Milwaukee 36.6 years) mean age: 20-66 years, age range: of the images (6 men and 6 women; of the disease. ne the location and extent to defi reviewed were Results: 10/12 from outlying places. (2) Nine of 12 patients (75%) were 36.6). (mean age: The most (3) night-sweat. fever, (83.3%) patients had symptoms with low-grade mesenteric in- by lymphadenectasis (n=10), followed nding was common CT fi (n=4), thickening wall loculated), bowel (n=5), ascites (n=4, all were volvement (n=1). uid (n=2), and pancreatic involvement fl (n=3), pleural omental thickening lymphadenectasis (mainly the menteric and peripancreatic lymph Tuberculous (4) associated fi the most common nodes) was enhancement, enlarged lymph nodes with peripheral or multilocular nding was fi and some enlarged lymph nodes with caseous necrosis, related with which was cations. or calcifi ecked fl multiple Conclusion: to can contribute Characteristic manifestations symptoms combined with the CT it from other neoplastic and differentiate early diagnosis of abdominal tuberculosis, ammatory diseases. and infl C-086 of abdominal tuberculosis CT features Shanghai/CN Peng; W. Wang, X.-H. Purpose: C-087 at and variations Prevalance ligaments of the diaphragm: Lateral arcuate abdominal spiral computed tomography Hallac; N. Pekindil, G. Purpose: and extend- surface diaphragmatic the lateral abutting of the diaphragm variations There is scans. ing in to the posterior space on computed tomographic pararenal C-085 of the MR imaging in routine imaging Implementation of diffusion-weighted abdomen Kalpakidis, V. Pilavaki, M. Petridis, A. Fotiadou, A. Thomaidis, R. Gerukis, T. Palladas; P. Purpose: abdomen lesions. (histologically proven) in the study of variable Methods and Materials: T MR unit with a 1.5 MR examination added to the routine abdomen was (DWI) (0, 500, 1000 s/mm obtained in 3 b-values Images were in 41 patients. 1.56; in 1 pancreatic cancer patient it was 1.45; in 1 adrenal metastasis from renal 1.45; in 1 pancreatic cancer patient it was 1.56; in 4 hepatocellular 2.04; in 1 patient with desmoid tumor it was 1.32; cancer it was in all occasions The mean ADC of malignant lesions was carcinomas it was1.47. than that of the benign lesions. lower Conclusion: sequences and techniques) in successful tool (in adjunction to the other available believe and we abdominal organs, characterization of malignant lesions in different Further experi- accumulative clinical practice. its place in everyday take that it must of pathologic in each occasion. ne the ranges ence is needed to defi sec generation of ADC maps. Quantitative analysis of ADC was made by region-of- made by analysis of ADC was Quantitative of ADC maps. generation abdominal interest measurements in normal and pathologic tissue of different 1, 2, bladder 4, ovaries 3, adrenal 4, bowel 22, pancreas 2, kidney organs (liver peritoneum 3 patients). Results:
ndings Palermo/IT culty in breath-holding, ndings of complications of these nding during an abdominal scan imaging modalitiesndings of various Scientific and Educational Exhibits Scientific and Educational -enhanced US of 17 patients (10 men, 7 women; -enhanced US of 17 patients (10 men, 7 women; ® ammatory etiology character- disorders of unknown ndings of autoimmune diseases of liver, biliary diseases of liver, ndings of autoimmune ndings and include autoimmune hepatitis, primary hepatitis, ndings and include autoimmune biliary To illustrate the enhancement patterns illustrate of splenic heman- To To be familiar with pathogenesis, pathology, clinical features, clinical features, pathology, with pathogenesis, be familiar To Two experienced radiologists retrospectively reviewed by by reviewed retrospectively radiologists experienced Two Thirty-eight consective patients referred for abdominal MR for Thirty-eight patients referred consective This pictorial assay demonstrates relevant imaging fi relevant demonstrates This pictorial assay 9 1
d d Hemangioma, although infrequent, is the most common primary The VIBE is an established sequence which permits sequence VIBE is an established imag- abdominal The Autoimmune diseases of liver, biliary recog- system and pancreas are diseases of liver, Autoimmune We demonstrated the feasibility of parallel-imaging accelerated accelerated of parallel-imaging the feasibility demonstrated We n Although autoimmune diseases of liver, biliary system and pancreas diseases of liver, Although autoimmune i . N I F - c u d E i c S - mean age: 59.5 years) with 17 SHs (mean size: 2.5 cm) - confi rmed splenec- by cm) - confi 2.5 with 17 SHs (mean size: 59.5 years) mean age: baseline echogenicity and (n=2), CT (n=16) and/or MRI (n=10) - evaluating tomy dynamic enhancement pattern of each lesion, in comparison with adjacent spleen throughout the an isoechoic appearance 8/17 SHs showed At CEUS, parenchyma. conensus baseline and SonoVue conducted for other reasons and more frequently observed in adults with age range other reasons and more frequently observed in adults with age range conducted for Some studies with equal frequency among men and women. from 30 to 50 years, hemangiomas. that CEUS is helpful in diagnosing liver demonstrated have Details: Procedure C-084 Role of contrast-enhanced ultrasound in the assessment of spleen hemangiomas Midiri; La Grutta, M. Malizia, L. Galia, G. M. Taibbi, Bartolotta, A. T.V. (CEUS). enhanced ultrasound with contrast giomas (SHs) evaluated Background: from 0.3% to 14% at ranging benign neoplasm of the spleen, with a prevalence as incidental fi SH is often discovered autopsy. ([email protected]) ([email protected]) Learning Objectives: system and pancreas Jaschke; W. Vogel, W. Unsinn, K.M. Tzankov, A. Graziadei, I. Freund, M.C. Innsbruck/AT Learning Objectives: C-083 fi Spectrum of imaging and management of autoimmune diseases of liver, biliary system and pancreas rel- diseases of liver, and management of autoimmune with typical fi be familiar To to the radiologist. evant resulting in improved image quality. resulting in improved Conclusion: imag- The application of parallel VIBE sequence in upper abdominal MR imaging. culty in diffi be useful in patients who have ing minimises scanning time and may breath-holding. as complications and differential ERCP) as well MRI, MRCP, MDCT, (sonography, biliary system and pancreas. diseases of liver, diagnosis of autoimmune Background: primarycirrhosis, pancreatitis. and autoimmune sclerosing cholangitis, Findings: Imaging nized as chronic progressive infl as chronic progressive nized ing in a single breath-hold. Parallel imaging is a novel technique whereby parallel parallel whereby technique is a novel imaging Parallel breath-hold. ing in a single coils permit of conventional of signal independent spatial localisation more rapid has previ- It shorteningThis allows acquisition time. of image spatial acquisition. Reports on sequences that had high intrinsicously been used largely with signal. signal to noise such as the imaging with sequences with low the use of parallel imaging are limited. VIBE sequence in abdominal Findings: Imaging MR study that included abdominal All patients underwent included. imaging were In addition, patients underwent VIBE. sequences with dynamic post gadolinium to minimise imaging optimised parallel VIBE sequences with further accelerated and conventional The images obtained with accelerated 20s). scanning time (13s vs. The accelerated radiologists. experienced two by reviewed VIBE sequences were clini- VIBE sequence in providing conventional to comparable VIBE sequence was observed In addition, less motion artifacts in the were images. cally acceptable of patients who had diffi in the sub-group images accelerated circulating autoantibodies e.g. features, and autoimmunologic immunologic by ized These diseases are associated with characteristic and hypergammaglobulinemia. clinical and histologic fi Background: with emphasis on typical patterns for early diseases of with emphasis on typical patterns recognition of autoimmune for Also imaging fi biliary system and pancreas. liver, hepatocellular carcinoma, types of cirrhosis, various e.g. diseases are shown, cholangiocellular and cholangiocarcinoma, biliary cholan- strictures, cholestasis, cross-sectional imaging by diagnosis displayed cholelithiasis and differential gitis, percutaneous image- Also, disease. mentioned autoimmune modalities peculiar for cholangiography transhepatic including biopsy, guided procedures will be shown for as endoscopic procedures including ERCP and drainage as well and drainage diagnosis and therapy. Conclusion: early diagnosis with recognition of typical patternsare rare, the can help avert disease and unnecessary surgery. consequences of progressive C - 7 0 R C EECR07-C-SciEduc-FIN.indd 19 Scientific and Educational Exhibits
only one report decsribing conventional CT fi ndings of a small group. In this initial Breast study, we review prevalance and anatomic variations of LAL in a more larger group using spiral CT. Biopsy Methods and Materials: Abdominal single-slice spiral CT images of consecutive 571 cases were retrospectively reviewed. The presence of LAL, side, extention level in respect to kidney, thickness and morphological characteristics were noted. C-088 Collimation and pitch were 5-10 mm and 1.5, respectively. Analysis of 416 microcalcifi cation cases BI-RADS 4B with negative core- Results: The incidence of LAL was 5.25% (28/571). There were 13 women and needle biopsy: Management and false negatives 15 men aged between 25-79 years old (mean 48 years). LALs located on right A. Almenar, C. Romero, C. Varela, P. Calvo, R. Sánchez, I. García-Hidalgo; side in 23 cases, on the left side in 2 cases and bilateral in 3 cases. The thickness Toledo/ES ([email protected]) of LALs ranged between 0.3-1.4 cm (mean: 0.68 cm). The LALs were extended to upper pole of pararenal fat in 11 cases, mid level in 18 cases and lower pole in 1 Purpose: To evaluate the appropriate management of BI-RADS 4B microcalcifi ca- case. Morphological appearances of LALs were nodular, linear and mixed types tions lesions with negative core-needle biopsy. in 8, 21, and 1 cases respectively. Methods and Materials: From January 1999 to December 2005, 416 microcal- Conclusion: Our results show that LAL are more frequently located on right dia- cifi cation cases reported as BI-RADS 4B had a negative biopsy. All cases were phragm and the prevalance is 5%. Recognition of various appearances of LALs histologically confi rmed using Stereotactic Vacuum-Assisted Breast Biopsy (SVABB) may help to avoid misinterpretation of abdominal CT scans. performed with an 11-gauge needle. Biopsy was repeated twice and lesions were classifi ed as concordant or discordant based on histology results. Concordant cases were followed up at 6, 12, 24, and 36 months. Surgical biopsy was performed for lesions with confl icting SVABB results. Results: The most common anatomopathology fi nding corresponded to fi brocystic disease with microcalcifi cations (45%). There were 49 (12%) cases with opposite results at biopsy. Surgical biopsy was performed for those cases resulting in two false negatives (FNs) (4%), a ductal carcinoma in situ and an invasive ductal carcinoma (IDC) grade I. Among the concordant cases, there were 8 (2%) fi ndings that changed showing an increase in the number of microcalcifi cations and excisional biopsy performed. Changes were detected at 6 months for 1 case, at 1 year for 4 cases, and at 2 years for 3 cases. There was only one FN that was an IDC (0.2%) at 35 months follow-up. 3-year follow-up was completed for 86% of the cases. Conclusion: SVABB is a correct alternative technique to surgical biopsy for microcalcifi cations reported as BI-RADS 4B. To warrant benignancy, surveillance periods of microcalcifi cation cases should last at least three years. However, for mass lesions a 2-year surveillance period is appropriate. C-089 BI-RADS lexicon for calcifi cations diagnosed with needle-localized open breast biopsy: Application and pitfalls H. Shin1, H. Kim1, S. Kim1, H. Yang1, J.-H. Sohn1, K. Kim1, E. Cha2, H. Kim1; 1Seoul/KR, 2Suwon/KR ([email protected])
Learning Objectives: To learn the BI-RADS descriptor such as morphology and distribution for calcifi cations. To learn subcategories 4a, 4b, and 4c of the new BI-RADS for calcifi cations. To know the pitfalls of BI-RADS categorization for calcifi cations. Background: The Breast Imaging Reporting and Data System (BI-RADS) has stan- dardized the assessment and reporting of breast lesions identifi ed on mammograms. Both lesion description and management recommendations have become more consistent with use of BI-RADS. By making auditing easier, BI-RADS categorization of reports has also facilitated quality assurance practice. Needle-localized open breast biopsy (NLOBB) is an indispensable therapeutic or diagnostic tool. A total of 396 NLOBBs for calcifi cations performed in 384 women aged 31-78 years (mean age, 52 years) were reviewed. The purpose of this exhibit is to learn the BI-RADS descriptor and categorization for calcifi cations. Imaging Findings: Of 396 NLOBBs, 142 (36%) had malignant results and 254 (64%) had benign results. PPVs of BI-RADS category 4 and 5 assignments were as follows: category 4a, 27 (11%) of 245; category 4b, 33 (54%) of 61; category 4c, 52 (90%) of 58; and category 5, 31 (97%) of 32, respectively. Conclusion: BI-RADS descriptor and categorization of calcifi cations is useful in predicting the likelihood of malignancy. To standardize the description of calcifi ca- tions based on BI-RADS lexicon can avoid a false-positive or false-negative inter- pretation. Optimizing the description of calcifi cations based on BI-RADS lexicon can increase the cancer detection.
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G Aichi/JP, Aichi/JP, 0.139×10 1 ed only on repeated ; ± 2 Fukuoka/JP cantly correlated to features of cantly correlated to features , T. Mitake , T. 1 ([email protected]) ([email protected])
C cation of enhancing incidental lesions. cation of enhancing incidental lesions. BDEF , K. Ohno , K. 1 Leeds/UK A exible surface coil) and RVS were analyzed for 35 for analyzed were coil) and RVS surface exible ndings of each lesion, including cellular density, the ndings of each lesion, including cellular density, cient in invasive breast carcinoma: Correlation breast carcinoma: cient in invasive Dynamic MR images and diffusion-weighted images Dynamic MR images and diffusion-weighted Results of sonography, contrast-enhanced MRI (1.5- MRI contrast-enhanced Results of sonography, (p=0.0377) and the E/D cantly correlated to ADC values , T. Fukutomi , T. 1 This review illustrates the spectrum illustrates of morphology and This review broadenoma, n=4; small breast cancer, n=1) were not seen not seen n=1) were small breast cancer, broadenoma, n=4; ILC presents a diagnostic challenge because of its often subtle presen- The fi ndings suggest that the enhancement ratios on dynamic MRI ndings suggest that the enhancement ratios The fi city of MRI, we have tried on to re-identify enhancing incidental lesions have city of MRI, we The RVS system could project MRI information onto a body surface cor- onto a body surface MRI information system could project The RVS ect the growth patterns including cellular density and of carcinomas, growth ect the , M. Takasugi , M. ([email protected]) ([email protected]) 1 Contrast-enhanced magnetic resonance imaging (MRI) is the most most magnetic resonance imaging (MRI) is the Contrast-enhanced
To investigate the correlations between ADC values in invasive breast in invasive ADC values the correlations between investigate To The mean ADC value of carcinomas was 0.895 of carcinomas was The mean ADC value Analysis included 39 malignant foci in 38 cancerous breasts, of which 17 in 38 cancerous breasts, Analysis included 39 malignant foci Chiba/JP Purpose: Because of the breast cancer. invasive detecting imaging method for sensitive limited specifi recently developed We the aim of assessing lesions immediately. with sonography with Hitachi Medical system in cooperation (RVS) a real-time virtual sonography and contrast-en- both breast sonography enabling Japan), Corporation (Tokyo, The in real time. images of the same site to be displayed hanced MRI cutaway of the RVS value and clinical to assess the accuracy of this study was objective imaging. breast system for Methods and Materials: 3-dimensional flash T1-weighted dynamic gadolinium-enhanced T scanner, supine position, fl sequence, correlated with The results were breast cancer. with invasive women consecutive ndings. histopathological fi Results: 89% for Sensitivity was 7-54 range, 14 mm). (median size, mm; palpable were foci Enhancing incidental lesions system. the RVS MRI and 94% for 94% for sonography, present in 5 cases (fi 3 could be identifi Of these, techniques. using conventional system. ed using the RVS identifi all 5 incidental lesions could be but sonography, Conclusion: The present results suggest that the RVS image. form sonography rectly while checking identifi for accuracy excellent system offers Cellular density was signifi Cellular density was also signifi were The E/D ratios (p=0.0157). ratios p=0.0346). p=0.0145, delicate to narrow: the stroma (broad to delicate: Conclusion: seem to refl of stroma, and might be closely correlated to ADC values. features architectural Learning Objectives: enhancement patterns seen on MRI. Background: MRI of the breast is a useful adjunct to mammography tation clinically and on imaging. If ILC both in making the diagnosis and in delineating tumour extent. and ultrasound, MRI as part offer we is planned, is diagnosed at core biopsy and a wide local excision C-094 Apparent diffusion coeffi and contrast-enhanced MR images with the enhancement ratio on dynamic detailed histologic features Muranaka; T. Yasumori, Adachi, K. A. Matsubayashi, R.N. ([email protected]) Purpose: C-095 of the carcinoma lobular MRI appearances of invasive Pictorial review: breast (ILC) Dall; B.J.G. Manuel, Sharma, D.D. N. Breast Resonance Magnetic C-093 of the lesions on contrast-enhanced MR imaging Detection of enhancing Fusion of MR and sonographic breast using real-time virtual sonography: data imaging Nakano S. 2 MRI and on dynamic contrast-enhanced carcinomas and enhancement ratios detailed histologic features. Methods and Materials: In each patient, in 20 women. reviewed breast carcinomas were of invasive (DWI) the ADC Based on the DWI, obtained. T1WI and dynamic images were T2WI, DWI, calculated with were ADC values measured. were of all 20 carcinomas values the ADC Correlation between of 0, 1000 s/mm² using echoplanar DWI. b-factors on dynamic E/D ratio) phase: (early ratios and enhancement delayed to values MRI and detailed histologic fi and delicate) of the (broad, narrow features of cancer nests and architectural size examined. cancer nests were stroma between Results: lter eld cations cations de- cations Frankfurt/DE lter combina- lter Frankfurt/DE cations in cations eld digital eld lter combination. eld digital eld cations in specimen 0.00001). < cations was found. In FFDM found. cations was ([email protected])
cations, which were referred for for referred which were cations, cantly better (p=0.000002) using a cations was detected using a Mo/Mo detected using a cations was 0.00001, p < the CAD- correctly by marked cations were Scientific and Educational Exhibits Scientific and Educational cations in FFDM in this specimen study was uence of anode/fi lter combinations on de- uence of anode/fi Toronto, ON/CA Toronto, cance applying a Wilcoxon-matched-pairs test. Wilcoxon-matched-pairs cance applying a lm mammography mammography lm ndings included 54 malignant lesions. We considered We 54 malignant lesions. ndings included cations was evaluated separately for both, digitally and for separately evaluated cations was The retrospective review of breast biopsies database review The retrospective lter combination. Thus, the detectability of microcalcifi Thus, lter combination. cations were marked at 1 of the standard views. Dense at 1 of the standard views. marked cations were Radiograms of 27 specimen of BIRADS IV/V lesions were specimen of BIRADS IV/V lesions were of 27 Radiograms Radiograms of 32 specimen of BIRADS IV/V lesions were Radiograms cations was evaluated separately for both anode/fi for separately evaluated cations was on detected microcalcifi lter combinations ned as BI-RADS category 3 and 4 densities. eld digital mammography system (FFDM) to a conventional system (FFDM) to a conventional eld digital mammography 1 2
d lter combination compared to using a W/Rh anode fi lter combination compared to using a d The sensitivity of CAD-FFDM system for the detection of malignant the detection of malignant The sensitivity of CAD-FFDM system for n In order to get optimal results in specimen radiograms the Mo/Mo In order to get optimal results in specimen radiograms i . The detectability of microcalcifi N I ndings were tested on signifi ndings were The study compares the detectability of microcalcifi of computed-assisted detection in full-fi the performance evaluate To The study compares the infl The study compares In SFM a mean number of 40.81 microcalcifi of 40.81 In SFM a mean number F A mean number of 20.719 microcalcifi A mean number - Fifty of 54 (93%) of malignant microcalcifi W/Rh combination and should be chosen lter combination is superior to the c lter combination compared to a mean number of 16.125 microcalcifi to a mean number lter combination compared u d eld digital mammography E i uence of anode/fi c S - tected using a W/Rh anode fi tected using a in specimen radiograms was assessed to be signifi was in specimen radiograms Mo/Mo anode/ fi anode/fi Conclusion: anode/fi dose is not important. when radiation radiograms of a full-fi of radiograms system (SFM). lm mammography state-of-the-art screen fi Methods and Materials: and SFM (Siemens DR) obtained using FFDM (Siemens Mammomat Novation a with 23 acquired were kV tube voltage, All radiograms Mammomat 3000 Nova). The lter combination and automatic exposure. anode/fi molybdenum/molybdenum detectability of microcalcifi glass in SFM and performing using a magnifying obtained images, conventionally A with and without means of digital post processing in FFDM. reading softcopy ndings. the fi carried out to evaluate was Wilcoxon-matched-pairs-test Results: counted when using softcopy cations was of 44.33 microcalcifi a mean number additionally the When using all means of digital post processing reading alone. The amounts of microcalci- ndings could be increased to 49.19. of fi mean number The detection cantly (p=0.01). signifi cations detected in FFDM and SFM differed fi cantly better than in SFM signifi reading was using all kind of digital softcopy rate reading alone (p and when using softcopy Conclusion: tected microcalcifi cations in full-fi eld digital mammography (FFDM). eld digital mammography cations in full-fi tected microcalcifi Methods and Materials: Results: better results. The use of digital post processing methods lead to even superior to SFM. obtained using FFDM (Siemens Mammomat Novation DR) with two different anode/fi different DR) with two Mammomat Novation obtained using FFDM (Siemens All (Mo/Mo) and tungsten/rhodium (W/Rh)). combinations (molybdenum/molybdenum The control. and automatic exposure tube voltage kV with 25 acquired were radiograms detectability of microcalcifi The fi tions. C-092 of computed-assisted detection in full-fi Clinical performance microcalcifi cations in dense breasts is higher than previously reported. The The reported. cations in dense breasts is higher than previously microcalcifi better in the CC view. of CAD-FFDM was performance Purpose: (CAD-FFDM) mammography Bukhanov; Crystal, K. P. Scaranelo, A.M. Purpose: cations. (CAD-FFDM) in detecting malignant microcalcifi digital mammography Methods and Materials: cancer-detection Overall (42 of 54). MLO view and 78% in the FFDM system on the CC view The CAD-FFDM systems detected all cancers in dense breast with 96% (52 of 54). was rate or and 97% (28 of 29) using only MLO view a sensitivity of 100% (29 of 29) in at least 1 view and (23 of 25) in at least 1 view 92% was the sensitivity breasts, In non-dense only CC view. 84% (21 of 25) in the CC view. and dropped to 64% (16 of 25) in the MLO view Conclusion: revealed 175 digital mammograms with microcalcifi 175 digital mammograms revealed defi breast tissue was Results: Purpose: C-091 with full-fi Comparison of specimen radiograms obtained and screen-fi mammography Vogl; J. T. Kaufmann, M. Thalhammer, A. Jacobi, V. Solbach, Diebold, C. T. mass or asymmetriccations associated with tissue were breast Microcalcifi biopsy. fi The pathology excluded. if the calcifi CAD positive full-fi Vogl; T.J. Kaufmann, M. Thalhammer, A. Jacobi, V. Solbach, C. Diebold, T. Infl Digital Mammography Digital Mammography C-090 Breast C - 7 0 R C EECR07-C-SciEduc-FIN.indd 21 Scientific and Educational Exhibits
of the preoperative assessment. This is a retrospective review of 62 patients. C-098 Imaging Findings: ILC is subdivided on MRI into masses and areas of enhance- Role of diffusion-weighted MR imaging for characterization and ment. The mass lesions are clearly seen on both the high-resolution T2 pre-contrast differentiation of breast lesions images and the post-contrast subtraction images. The areas of enhancement are F. Pediconi, E. Moriconi, F. Altomari, A. Roselli, S. Padula, V. Dominelli, only seen on the post-contrast subtraction images. 74% presented as a mass and C. Catalano, R. Passariello; Rome/IT ([email protected]) 24% as an area of enhancement; one case was MRI occult. ILC presenting as a mass was subdivided as follows: (a) focal mass - spiculate (26%), smooth (3%); Purpose: To evaluate the role of diffusion-weighted MR imaging for the character- (b) mass with adjacent satellites (14%); (c) multifocal mass - multinodular (8%), ization and differentiation of breast lesions. dentritic (10%), mixed (8%) and multicentric (5%). ILC presenting as an area of Methods and Materials: Thirty consecutive women (age range: 35-70 years) with enhancement was subdivided into subtle (8%) or overt (16%). The enhancement 43 histologically confi rmed benign and malignant breast lesions were prospectively profi les are as follows: 47% had a malignant curve, 33% had a suspicious curve evaluated. All patients were examined at 1.5 T using a dedicated bilateral breast and 20% had a benign curve. coil. The MR imaging protocol included axial FSE T2-weighted sequences with Conclusion: The morphology is variable and the enhancement profi le can be fat-suppression, axial EPI sequences sensitised to diffusion along 3 orthogonal deceptively benign. The MRI scan must be interpreted in conjunction with the directions, and pre- and post-contrast axial 3D GRE T1-weighted sequences mammography and ultrsaound to optimise its benefi t. (gadobenate dimeglumine, Gd-BOPTA; 0.1 mmol/kg). The average apparent dif- fusion coeffi cient (ADC) value along the 3 orthogonal directions was calculated for C-096 all lesions. Differences in main diffusivity (MD) among the lesions were evaluated by means of a non-parametric two-tailed Mann-Whitney test. Increased specifi city for detection of invasive breast cancer using Results: The 43 lesions evaluated comprised 6 fi broadenomas, 4 cysts, 13 invasive combined high-resolution 3.0 T MRI and vascular mapping of the breast ductal carcinomas (IDC), 12 invasive lobular carcinomas (ILC), 6 ductal carcinomas in A.C. Schmitz1, W.P.T.M. Mali1, R. van Hillegersberg1, M.A.A.J. Van den Bosch2; situ (DCIS) and 2 papilloma. The MD was signifi cantly higher for cysts than for benign 1Utrecht/NL, 2Stanford, CA/US ([email protected]) fi broadenomas (p < 0.0002) or malignant lesions (p < 0.0002). Furthermore, the MD Purpose: To assess the diagnostic accuracy of 3.0 T Magnetic Resonance Imag- was signifi cantly lower in malignant respect to benign lesions (p < 0.0004). ing (MRI) of the breast. Conclusion: Diffusion-weighted MR imaging is an inexpensive quantitative pro- Methods and Materials: Fifty-four patients suspected of having breast cancer cedure that can potentially serve as a corollary to established MR techniques for were prospectively enrolled in the study and underwent 3.0 T MRI of the breast. characterization of breast lesions. Based on diffusion properties, MD maps provide MR images were evaluated according to the MRI-BIRADS lexicon criteria. Lesions valuable information for the characterization and differentiation of breast lesions. size, number of lesions and localization in the breast were systematically assessed. High resolution contrast-enhanced fat-saturated T1-weighted images were used C-099 to obtain maximum intensity projections (MIPS). Breast vascularization (number The effect of magnetic resonance mammography (MRM) on the clinical and size of vessels) was assessed according to the method of Sardanelli. Finally, management of 512 women with suspected lesions during X-ray the diagnostic accuracy of 3.0 T MRI of the breast was calculated by comparing mammography or ultrasound MRI to histopathology. F. Pediconi, S. Padula, F. Altomari, A. Roselli, V. Dominelli, E. Moriconi, Results: Histopathologic analysis of 54 lesions revealed 24 (44%) malignant le- C. Catalano, R. Passariello; Rome/IT ([email protected]) sions and 30 (56%) benign lesions. Correlation with the MRI-BIRADS classifi cation revealed all 23 (100%) BIRADS 2 lesions were benign; 6/7 (86%) of the BIRADS Purpose: To assess the impact of bilateral breast magnetic resonance mammog- 3 lesions were benign and 1/7 (14%) was malignant; 1/6 (17%) of the BIRADS 4 raphy (MRM) on the clinical management of patients with suspected lesions during lesions was benign and 5/6 (83%) were malignant; and all 18 (100%) BIRADS 5 X-ray mammography or ultrasound. lesions were malignant. Based on morphologic and kinetic data MRI had a sensitivity Methods and Materials: 512 consecutive patients with suspected lesions dur- of 100% (24/24) and a specifi city of 76% (23/30). The use of the vascular score as an ing X-ray mammography or ultrasound were evaluated with contrast-enhanced adjunct to MRI upgraded the specifi city to 86% without affecting the sensitivity. bilateral MRM between October 2002 and February 2005. Indications of MRM Conclusion: Combined analysis of lesion morphology and enhancement kinetics included pre-operative staging (n=296; group 1), undetermined or suspected together with vascular mapping of the breast ultimately improved the specifi city of lesions (n=143; group 2), evaluation of mammarian prosthesis (n=52; group 3), breast MR imaging to 86%, without affecting sensitivity that was 100%. and cancer screening in patients with familial risk (n=21; group 4). MRM, X-ray mammograms, sonograms, and histology were compared to determine the effect C-097 of MRM on clinical management in each group. Results: MRM determined changes in clinical management in 72/296 (24.3%) pa- Can we refi ne our use of MRI in the management of breast cancer patients tients in group 1. The altered management was due to a greater lesion size in 22/72 undergoing neoadjuvant chemotherapy? cases, multifocality or multicentricity in 15/72 cases, multifocality/multicentricity and B.J.G. Dall, S. Kumar, K. Franks; Leeds/UK ([email protected]) greater lesion size in 5/72 cases, contralateral foci in 28/72 cases, and suspected Purpose: To review and refi ne the use of MRI in breast cancer patients undergoing pectoral muscle infi ltration in 2/72 cases. In group 2, MRM confi rmed possible neoadjuvant chemotherapy. benign lesion in 71/143 patients,suspected malignant lesion in 38/143 patients, Methods and Materials: We performed a retrospective audit of 78 patients. and no lesion in 34/143 patients. In group 3, MRM confi rmed a suspected broken Everyone had a pre-treatment MRI scan, a second scan following 2 or 3 cycles prosthesis in 40/52 patients and confi rmed an intact prosthesis in 12/52 patients. of chemotherapy and a third scan at the end of treatment. The volume, extent and In group 4, breast MRM identifi ed an occult tumor in 8/21 women. activity of the disease was assessed and the response to chemotherapy scored (- Conclusion: MRM demonstrates high sensitivity for the detection and character- 1=Progressed; 0=No Response; 1=Minimal Response; 2=Partial; 3=Almost Complete; ization of suspected lesions. MRM can determine important changes in clinical 4= Complete). The third MRI scan was compared to the histology at surgery. management and can provide accurate guidance for per-surgical treatment. Results: Extent of disease (fi rst MRI): MRI matched mammography and ultrasound in 62 patients (79%) and identifi ed additional disease in 17 patients (21%). Sixteen C-100 of these patients had multifocal disease. Breast MR imaging: Accuracy in the detection of residual cancer after Response to chemotherapy (second MRI): 10 patients who had a complete patho- neoadjuvant chemotherapy logical response scored 2 or 3 on the second scan. I. Pecharroman de las Heras, A. Izco Aso, E. Garcia Casado, A. Vicente Bartulos, Extent of residual disease (third MRI): size at MRI equalled size at histology in 46 pa- I. Mota Goitia, M. Moreno Barrero; Madrid/ES ([email protected]) tients (61%), MRI
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7 0
, 0 1 2 . 2 353 0 . 2 112.02.2007 17:03:45 G ed the surgical , E. Moriconi , E. Barcelona/ES 1 , S. Padula , S. Barcelona/ES 1 ([email protected]) ([email protected])
rmed observed suspicious lesions C , F. Altomari , F. 2 BDEF Latina/IT 2 A Rome/IT, Rome/IT, 1 ; Retrospective review was performed of 903 breast MR performed was review Retrospective , L. Carotenuto , L. 1 Fifty women with proven breast cancer at pathology who breast with proven Fifty women We studied 77 women with breast cancer, diagnosed be- diagnosed with breast cancer, studied 77 women We 1 broadenoma were evaluated. The standard display evalua- display The standard evaluated. broadenoma were automated software with ndings with color-coded Our experience reveals that MR mammography is a powerful tool in is a powerful that MR mammography reveals Our experience In our series, the surgical attitude was changed in 8 of 54 cases changed In our series, the surgical attitude was , C. Catalano , C. 1 , R. Passariello , R. To study the use of MR in the preoperative detection of multifocal, mul- detection of multifocal, preoperative study the use of MR in the To To investigate the value of a new color-coded automated signal intensity- of a new the value investigate To Evaluation of MR imaging results in patients with suspected malignancies Evaluation 1 In 25 patients, with about 4% malignant lesions, MR breast imaging with about 4% malignant lesions, In 25 patients, At pathology, 11 ductal carcinoma in situ (DCIS), 6 lobular carcinoma 11 ductal carcinoma in situ (DCIS), 6 lobular At pathology, We have a correlation between MRI and surgery MRI and between a correlation patients with in 54 of 77 have We Purpose: magnetic resonance mammography contrast-enhanced for package curve software (CE-MRM) in determinationperipheral of tumor diameter and in enhancement with breast cancer. women Methods and Materials: at 1.5 performed CE-MRM was evaluated. CE-MRM were preoperative underwent T2-weighted (axial before performed Imaging was coil. surface T using a bilateral GRE images) and after (dynamic 2D T1-weighted STIR images and 2D Flash min) administration GRE images acquired at 2, 4, 6, 8 and 10 T1-weighted Flash analysed were Images mmol/kg gadobenate dimeglumine (Gd-BOPTA). of 0.1 interactive means of a new method and by using a standard display separately used were package the software by maps generated False-color package. software Comparisons in the assessment of tumor diameter and peripheral enhancement. made with histo-pathological results. were Results: carcinoma lobular ductal carcinoma (IDC), 12 invasive in situ (LCIS), 16 invasive 2 lobular papilloma, 3 ductal hyperplasia, (ILC), 2 medullar carcinoma, 3 intra-ductal hyperplasia and 6 fi A. Roselli A. decision of prosthetic change. Conclusion: to change up to 8% of therapeutic. and it is able diagnosing suspicious lesions, C-105 Correlation of contrast- enhancement in breast lesions: Peripheral enhanced MRI fi and tumor angiogenesis histologic features Pediconi F. C-103 in breast cancer lesions and multicentrical of multifocal MRI detection Olsina; G. Oliva, L. Sanchís, E. Sanchez-Laforga, A. Risueño, N. C-104 therapeutic management for A useful tool Breast MR mammography: Mundt, E. Conde, M. Llaverias, Martinez, Bertomeu, S. A. Montull, M. C. Mauri; E. Basilio, E. Segade, Gallart, A. Querol, A. V. Purpose: in posterior management. treatment Methods and Materials: with suspicious lesions, 2006.Patients 2001 to August January from examinations those cases in in order to evaluate reviewed occult or not, were mammographically results of compared the management, and we which MR had changed therapeutic kinetic and lesion diameter, Number, and US imaging. MR imaging mammography resection specimens and histological results correlated with surgical shape were considered as well. were Results: 2% of women, In nearly 1. or both. bilaterality, multifocality, had demonstrated wall or the thoracic of tumour the real size demonstrated MR mammography MR confi In about 2% of the cases, ltration. infi and an could be re-evaluated so that they and US, mammography in conventional to 0.5% of malig- could be performed.Up or MR -guided biopsy ultrasound-guided and in patients with ultrasound MR mammography by diagnosed nant lesions were MR modifi In 0.7% of the cases, results. negative mammography ([email protected]) Purpose: ticentric disease in breast cancer. and bilateral Methods and Materials: of review a retrospective could make we cases, In 54 of these 2005. 2004 and tween The study sequences used the MR 1.5 T Siemens Symphony. We MRI and histology. We T1 of gadolinium. and after administration TSE and FLASH-3D before T2-WI were reconstructions. dynamic-enhanced MRI, 3D and multiplanar evaluated Results: 12 patients 15 patients, in Surgery detected more than one focus breast cancer. MRI detected more than one 3 false-negatives. MRI with by also detected were The rest are now biopsy (22.2%). by demonstrated were Twelve in 18 patients. focus to mastectomy changed from lumpectomy Surgical attitude was being followed-up. MRI and biopsy. in 8 of these 12 cases detected by Conclusion: perform always in our centre we That is why (14.8%) after MRI study and histology. MRI in all breast cancers. local staging by a preoperative /s 2 broglan- 0.35 (-3) mm 0.35 (-3) ± 0.001). < Rome/IT ndings were assessed as follows: (1) assessed as follows: ndings were Scientific and Educational Exhibits Scientific and Educational /s. We confi rmthreshold less than 1.4 a confi We /s. 2 nding was related to the increased cellularity of the nding was Twenty-nine patients with bloody discharge underwent underwent discharge patients with bloody Twenty-nine We retrospectively analysed 87 Patients with breast can- analysed 87 Patients retrospectively We 0.12 x 10 (-3) mm ndings with abnormality 14 malignant tumors on MRI were ([email protected]) ([email protected]) ±
ve patients (26%). Overall, the Pearson’s correlation between correlation between the Pearson’s Overall, patients (26%). ve 3 2
ow rate. Their MR imaging fi Their rate. ow d d MRI provides a high correlation between measurements of re- measurements a high correlation between MRI provides n DWI would be an effective parameter in distinguishing malignant in distinguishing malignant parameter be an effective would DWI MRM is useful in evaluating the extent of abnormal lesions in pa- the extent MRM is useful in evaluating i . N I To assess the usefulness of MR mammography (MRM) in patients with assess the usefulness of MR mammography To To investigate the role of diffusion-weighted imaging (DWI) sequences imaging (DWI) the role of diffusion-weighted investigate To (1) Abnormality in MRI: 26 patients (89.7%); (2) abnormality on T1- (2) abnormality on 26 patients (89.7%); (1) Abnormality in MRI: F Pathological results revealed 78 invasive cancers and 9 in situ cancers. In cancers and 9 in situ cancers. 78 invasive results revealed Pathological Takatsuki/JP The average tumor size predicted by MRI after chemotherapy was 1.88 was MRI after chemotherapy predicted by cm tumor size The average - c u d E i c S - Conclusion: chemotherapy. undergoing pre-operative in women sidual disease with pathology be considered useful in monitoring tumor response in MRI may breast Therefore, chemotherapy. neoadjuvant Purpose: discharge compared to pathology. bloody Methods and Materials: Axial fat-sup- coil. using a breast array magnet T superconductive MRI with a 1.5 acquired in and dynamic 3D-FSPGR coronal images were T2-weighted pressed (0.2 mmol/ of Gd-DTPA and 90, 210, 420 s after administration each patient before kg) at a 3 ml/s fl C-102 discharge with bloody in women of MR mammography Value Narabayashi, I. Tanikake, M. Tatsugami, Nakai, F. Matsuki, G. M. Inada, Y. Tsuji; M. (7 invasive cancers; 7 predominantly DCIS or DCIS) and 12 benign lesions (5 cancers; (7 invasive 3 patients There were 1 abscess). 1 mastitis; 5 mastopathy; papillomas; intraductal 1 DCIS and 2 mastopathy. without abnormality: Conclusion: biopsy or surgery, discharge and helpful in deciding regions for tients with bloody lesions. especially in the non-palpable weighted images: 7 patients (26.9%); (3) number of patients with mass and of patients with mass and (3) number 7 patients (26.9%); images: weighted patients with mass lesions (4) and 14 (53.8%); 12 (46.2%) non-mass lesions: of and (5) distributions 11 patients (91.7%); enhanced malignant pattern: showing 3 diffuse 14 regional; 7 segmental; abnormality in patients with non-mass lesions: fi Pathological patterns. absence/presence of abnormality in MRI; (2) absence/presence of abnormality on absence/presence of abnormality in MRI; (4) pattern of enhancement in lesions; (3) mass/non-mass images; T1-weighted A comparison of abnormality and (5) distribution lesions. in non-mass mass lesions; conducted. ndings was with pathological fi Results: cer who underwent pre-operative MRI. MRI was performed with a 1.5 T unit (Signa with a 1.5 performed MRI was MRI. pre-operative cer who underwent with performed was Isotropic DWI USA). GE Medical System, Milwakee Advantage; calculated for was ADC value a single-shot echo-planar imaging sequence and compared to pathological results. were ADC values each lesion. Results: 1.027 x 10 of breast cancer was value the mean ADC our study, C-101 cancer evaluation in breast Diffusion-weighted imaging Bonomo; L. Masetti, Costantini, R. Magistrelli, M. Belli, A. P. Purpose: in characterizing breast lesions. Methods and Materials: (median: 0.8; range: 0.13), compared with 2.4 cm (median: 1.5; range: 0.13) at range: 1.5; cm (median: with 2.4 0.13), compared range: 0.8; (median: to have found were 3 women chemotherapy, neoadjuvant After receiving histology. in the breast), with (no residual disease found a complete pathologic response complete response patients showed Four on MRI. complete response also shown by MRI underestimated tumor size at pathology. on MRI and had residual disease more than 1 cm in fi 0.92, p high (r = and pathology was post-treatment MRI size the abnormally enhancing lesion was measured. Histologic measurement of tumor Histologic measurement of the abnormally measured. enhancing lesion was measurements compared with tumor and was used as the gold standard was size treatment. from MRI after Results: x 10 (-3) mm/s to discriminate malignant lesions from normal breast tissue. Conclusion: lesions from normal breast tissue. It supports diagnosis of breast masses and lesions from normal breast tissue. permits the lesions including tumour about information the acquisition of more early showing can anticipate diagnosis DWI cellularity pattern. and histological potential application in monitoring early re- molecular changes and could have sponse to chemotherapy. The mean ADC value of the breast cancer was statistically lower than that of the lower statistically of the breast cancer was The mean ADC value normal breast tissue and this fi carcinoma was invasive for value the ADC In our experience, malignant lesions. of the normal fi The mean ADC value forms. than that of non invasive lower 1.66 dular tissue was C - 7 0 R C EECR07-C-SciEduc-FIN.indd 23 Scientific and Educational Exhibits
tion revealed an overestimation of lesion diameter compared to the pathological Breast specimens. Conversely, better agreement with histo-pathological specimens was seen when tumor diameter and peripheral enhancement were evaluated using the Ultrasound interactive software package. Conclusion: The color-coded software package permits correct determination of breast lesion size. False-color maps permit better depiction of lesion peripheral C-106 enhancement, thereby differentiating peripheral angiogenesis from tumor mass. Diagnostic usefulness and interobserver variability of BI-RADS ultrasound descriptors J.M. Santana, R. Fuentes, P. Aleman, A. Gomez, J.M. Limiñana, A. Jorrin; Las Palmas/ES ([email protected])
Purpose: To evaluate diagnostic usefulness of BI-RADS ultrasound descriptors to classify solid breast nodules and interobserver variability. Methods and Materials: All breast sonograms performed in our hospital during the last 3 years were retrospectively analyzed. All examinations were performed and evaluated by 1 of the 3 radiologists who participated in our study and independently reviewed by the reamining two, who were blinded to clinical and mammographic facts. In all lesions, pathologic diagnosis was obtained. Kappa coeffi cient was used to calculate interobserver variability; logistic regression was used to assess the descriptors that have an independent correlation with the likelihood of malignancy and sensitivity, specifi city, positive predictive value; and ROC curve analysis was used to evaluate diagnostic usefulness. Results: A total of 601 solid nodules were found, of which 184 were malignant. Among all BI-RADS ultrasound descriptors, 4 were independently related with malignancy by the 3 readers combined: Nonparallel orientation, microlobulated margins, spiculated margins and clustered microcalcifi cations. Overall sensitivity was 70, 68 and 73%, specifi city 93, 92 and 92%, positive predictive value 82, 79 and 80% and area under ROC curve of 0.90, 0.90 and 0.92 for each radiologist, respectively. Kappa varied between 0.49 and 0.70 for those descriptors. Kappa value for fi nal BI-RADS ultrasound category was 0.64 (0.68, 0.59 and 0.77 for BI-RADS ultrasound categories 3, 4 and 5, respectively). Conclusion: Diagnostic usefulness according to BI-RADS ultrasound descriptors to classify solid breast nodules was excellent, whereas interobserver variability ranged from moderate to good. C-107 Synchronous position-display system in breast ultrasound M. Machida, N. Uchiyama, N. Moriyama; Tokyo/JP ([email protected])
Purpose: Currently, body marks in ultrasonography are only displayed manually and do not represent the probe position accurately. Especially in breast ultrasonog- raphy, it is diffi cult to acknowledge the location only by images compared to other organs such as the abdomen and neck. The purpose of this research is to develop a novel system that can display and record the precise position and orientation synchronously in breast ultrasound. Methods and Materials: We have created a system that has a magnetic sensor, and a PC with novel software was attached to the ultrasound equipment. First, the magnetic sensor that was attached to the probe detected the position and the orientation relative to the nipple. Secondly, the information with regard to the probe position was received and transferred to the PC. The images were recorded on the PC and the software analyzed the information and displayed the breast body mark synchronously. In addition, the contact area can be traced to confi rm that the entire area has been scanned. We also evaluated the accuracy of position detection of this system. A plate was set in space to simulate breast examination. Plotting paper was fi xed on the plate and 20-mm grid positions in space were measured from the simulated nipple position (reference position). Results: Errors at 231 points were evaluated. The mean errors were 16.3 mm in the X direction and 0.8 mm in the Y direction. Conclusion: Synchronous position-display system in breast ultrasound is expected to be clinically useful. C-108 Relation of breast cancer vascularization pattern depicted by ultrasound to axillary nodes’ status F. Todua, T. Changelia, T. Daraselia, L. Jvarsheishvili; Tbilisi/GE ([email protected])
Purpose: The aim of the study was to assess possible correlation between power Doppler sonographic data concerning vascularization pattern of the tumor and histopathology results after lymphadenectomy in case of breast cancer. Methods and Materials: 105 females with breast cancer were studied preop- eratively by power Doppler sonography. Tumor size and number of tumor arteries were correlated with axillary nodal status. Sonographic fi ndings were compared with tumor arteries with a diameter larger than 350 µm and with the density and
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7 0 5 0 ed > 2 . 2 355 0 . 2 112.02.2007 17:03:46 ed as IDC ve irregular ve G ), mammographic, ), mammographic, … cations, surrounding cations, ed DS, a score of ed DS, ([email protected]) ([email protected]) C BDEF A performed, (seroma) were ne needle aspiration cance of masses within the pectoralis muscle de- muscle cance of masses within the pectoralis We examined preoperative ultrasonography in 206 pa- ultrasonography preoperative examined We 110 patients with 128 biopsies performed in the Depart- 110 patients with 128 biopsies performed From May 2000 to September 2005, 10,389 routine breast 2000 to September 2005, May From Suwon/KR Suwon/KR rming the validity of the simple diagnostic model. rming validity the ed diagnostic score with the form DS = 5 + 18C + 17T + 10M ed diagnostic score with the form ltrating ductal carcinomas (including the intrapectoral seroma), the intrapectoral ductal carcinomas (including ltrating ed the sonographic features into three types: type I: single mass; single mass; type I: three types: into features ed the sonographic ([email protected]) ([email protected])
Masses within the pectoralis muscle are extremely rare. A biopsy rare. are extremely muscle Masses within the pectoralis A combination of US features may be used to predict malignancy, be used to predict malignancy, may A combination of US features the pectoralis muscle masses within cance of ultrasound detected To describe the sonographic features according to proportions features describe of intra- the sonographic To Breast ultrasonography (US) is a useful adjunct to mammography in (US) is a useful adjunct to mammography Breast ultrasonography To assess the signifi To Eight patients (0.07 %) had eight intramuscular masses (mean age (mean age masses %) had eight intramuscular Eight patients (0.07 The most frequent sonographic features were type I in 72% of pure IDC, type I in 72% of pure IDC, were features The most frequent sonographic The training set comprisedThe training benign and 30 (23%) malignant 98 (77%) ltrating ductal carcinomas and one Hodgkin´s lymphoma). Two cases were cases were Two carcinomas and one Hodgkin´s lymphoma). ductal ltrating ultrasonographic and pathologic fi ndings were studied. ndings were fi and pathologic ultrasonographic Results: diagnosis (seven malignant All patients had a previous 32-78). range yrs; 60.3 breast infi depicted fi Ultrasound normal were in all cases. Mammograms palpable. Seven well-circumscribedmasses and one seroma. two ill-circumscribed masses, 14G needle core biopsies and one fi consistent with results were Pathology and no complications. with good tolerance metastatic infi ve fi necrosis and one schwannoma. one lymphoma, one fat Conclusion: es- of malignancy, in these cases because of the high rate should be performed history of a malignant tumor. pecially if the patient has a previous tected on routine breast ultrasound studies and the diagnostic management with tected on routine breast ultrasound percutaneous procedures. Methods and Materials: retrospectively cases were These at our institution. performed scans were ultrasound that muscle detected masses within the pectoralis ultrasound searching for reviewed ne biopsy and fi with percutaneous procedures (14G needle core diagnosed were surgery previous palpation, (age, Clinical needle aspiration). Purpose: to comparable set were considered to be malignant.Results of the validation was set, confi the training Conclusion: than biopsy in 27% of lesions in our validation rather follow-up potentially allowing set in this preliminary study. C-114 of to proportions of breast cancer according Sonographic features intraductal component Yim; Kim, H. T. Kang, D. Purpose: ductal component in patients with breast carcinoma, and then identify sonographic ductal carcinoma. and non-invasive of invasive differences Methods and Materials: tients and classifi On non-mass lesion. type III: abnormality; dominant mass with surrounding type II: categories based on into four grouped the tumors were histopathologic analysis, ductal carcinoma (IDC); 1- pure invasive the proportions component: of intraductal 3 - IDC with an extensive component (MIC); 2 - IDC with a marginal intraductal Sonographic 4 - pure ductal carcinoma in situ (DCIS). component (EIC); intraductal ndings. fi correlated with histopathologic of breast cancer were features Results: and type III in 63% of type II in 53% of IDC with MIC and in 39% of IDC with EIC, identifi were percent of cases with type II feature Eighty-two pure DCIS. C-112 The signifi Zudaire; Zornoza, B. Pina, G. L. Herraiz, M. Pons, M. Alonso-Burgos, Diaz, A. M. Pamplona/ES C-113 breast for of tumour descriptors Multiple logistic regression analysis on ultrasonography nodules diagnosed Singapore/SG Gupta; N. Hee, S.-W. Ho, J.T.S. Purpose: a simplifi and validate set out to develop We characterising solid breast masses. diagnostic score from multiple logistic regression of US features to determine the of US features logistic regression diagnostic score from multiple a solid mass. of malignancy of likelihood Methods and Materials: from October 2003 Singapore, ment of Oncologic Imaging, National Cancer Centre, in reviewed Images were set. included in the study as a training 2004 were to June Another group results of the biopsy. to the blinded radiologists two consensus by 2003 in the same centre was biopsied from Aprilof 26 lesions that were to July shape, The categories of the tumour descriptors were: set. used as a validation calcifi sound transmission, echogenicity, margin, echo texture, tissue and ductal extension. Results: The simplifi nodules. value of 0 and a maximum value minimum + 6ET + 3S + EG - 5ST with a possible curve from the simplifi Based on the ROC used. of 60 was
ndings. ndings. Genoa/IT broadenoma, papilloma, broadenoma, Scientific and Educational Exhibits Scientific and Educational 0.001) and tumor size (P = 0.012) was was (P = 0.012) 0.001) and tumor size < Twenty patients (24 implants) with marked symptoms patients (24 implants) with marked Twenty To describe and illustrate the sonographic appearances of appearances describe the sonographic and illustrate To The sonographic appearance of the normal appearance male breast is The sonographic 5 ([email protected]) ([email protected]) 2
d d A majority of male breast lesions are benign, with gynecomastia n Sonography has been shown to aid in distinguishing benign from to aid in distinguishing benign from has been shown Sonography The ultrasound guide allows a safe injection of Triamcinolone in the Triamcinolone injection of a safe guide allows The ultrasound The number of arteries in invasive breast carcinoma detected with of arteriesThe number in invasive i . N I To evaluate the effectiveness and the tolerability of ultrasound-guided of ultrasound-guided and the tolerability the effectiveness evaluate To c disease entities are reviewed. Benign entities include gynecomastia, in- c disease entities are reviewed. F The average thickness of the capsule was 2 mm. After 3 months, in 10 After 3 months, mm. 2 of the capsule was thickness The average Good correlation of ultrasonographic and histopathology results regarding and of ultrasonographic Good correlation - c u d E i c S - observed. Multivariate analysis showed an independent relationship between prob- an independent relationship between showed analysis Multivariate observed. ability of axillary of tumor arteries number metastasis, (P = 0.016), and sonographic The model of axillary developed. A predictive status was (P = 0.035). tumor size used to determine characteristic curve was operating 0.2324 as the score receiver high sensitivity (93.1 %), low This score indicated to classify axillary nodal status. (96.1%). value predictive %), and high negative city (49.4 specifi Conclusion: the independent predic- is tumor size and sonographic Doppler sonography power prediction of to reliable could contribute these variables tor of axillary nodal status; model. on the basis of a mathematic absence of axillary involvement C-111 with A pictorial review Sonographic appearances of male breast disease: pathologic correlation Cangiarella; J. Oken, S.M. Toth, H.K. Moy, L. Singer, C.I. Mercado, C.L. NY/US York, New various benign and malignant lesions encountered in the male breast, correlate themvarious management. and determinendings, recommendations for with the pathologic fi Background: Male breast cancer represents less than 1% of being the predominant pathology. breast imaging in a male The most common indication for all male breast disease. is often in addition to mammography, Sonography, mass. patient is a palpable of these lesions. the evaluation for performed Findings: Imaging and male breast lesions are illustrated of various features Sonographic reviewed. the specifi and benign masses (lipoma, fi (abscess formation), fection Learning Objectives: sebaceous cyst). Malignant entities include primary breast carcinoma (invasive Malignant entities include primary breast carcinoma (invasive sebaceous cyst). and mammo- The sonographic papillary carcinoma) and lymphoma. ductal cancer, with the pathologic fi and correlated are reviewed imaging features graphic disease entities are discussed along with their management. The various Conclusion: of appearance with the sonographic Familiarity malignant male breast lesions. breast lesions is essential in the prompt diagnosis and management of various diseases of the male breast. C-109 the capsule reduce Triamcinolone injection of Can the ultrasound-guided of contracted breast implants? Neumaier; Cicchetti, C.E. Adami, S. M. Murolo, C. enza, Sconfi L.M. (io@lucasconfi enza.it) (io@lucasconfi Purpose: breast implants acetonide in the capsule of contracted Triamcinolone injection of III-IV) in reconstructed and augmented patients. (Baker Methods and Materials: number the of tumor arteriesnumber (k= 0.66, P sixteen breast assessed: were III/IV capsular contracture grade and established an underwent They reconstructions augmentations (8 implants). and 4 bilateral 40 acetonide (Kenacort® injection of 1 mg/mlultrasound-guided Triamcinolone cc of of evaluation Ultrasound ml of saline solution. diluted in 10 Squibb) Bristol-Myers to assess the effective- postoperatively repeated 3 months was capsular thickness 1 year. assessed after Stability of the treatment was ness of the treatment. Results: and the and contracture observed a reduction of the capsular thickness we cases, In the 5 cases left, where the symptoms were of the symptoms. disappearance One injection was Triamcinolone. a second injection of performed still strong, we In one patient, who had just augmentation. needed in the 4 patients with bilateral a sudden lysis of the capsule had oc- undergone a cycle of chemoradiotherapy, The the whole implant. to remove an urgent operation curred, so she underwent in all the patients. did not change after 1 year capsular thickness Conclusion: the risk of perforation avoiding little space around the implants, area of microvascularization. Results: C - 7 0 R C EECR07-C-SciEduc-FIN.indd 25 Scientific and Educational Exhibits
containing any amount of intraductal component. Forty-three percent of cases with Breast type III feature were pure DCIS, whereas none of thepure IDC showed type III feature. The accuracy of ultrasonography for differentiation between invasive and Miscellaneous non-invasive ductal carcinoma was 82%. Conclusion: The predominant sonographic features were "single mass" in pure IDC, "dominant mass with surrounding abnormality" in IDC containing MIC or EIC, C-116 and "non-mass lesion" in pure DCIS. Ultrasonography is valuable in depicting the Male breast cancer: Spectrum of imaging fi ndings intraductal component of breast cancer, and differentiating invasive carcinoma O. Catalano, M.R. Rubulotta, T. Petrosino, A. Nunziata, F. Avino, G. D’Aiuto, from non-invasive carcinoma. A. Petrillo, A. Siani; Naples/IT ([email protected])
Learning Objectives: To illustrate typical and atypical fi ndings in male subjects with C-115 breast cancer. To report the imaging fi ndings with a large spectrum of diagnostic Ultrasonographic fi ndings of absorbable mesh implant in the breast after modalities. To highlight the clues to diagnosis and features allowing differentiation conserving surgery: Preliminary report between benign and malignant lesions. S. Hur, Y. Lee, H. Kwag, S.-H. Kook; Seoul/KR ([email protected]) Background: Male breast cancer represents a rare but possible occurrence, with its own diffi culties in assessment and management in comparison with female Purpose: The aim of this study was to present the ultrasonographic fi ndings of the tumour. The purpose of this exhibit is to offer a detailed pictorial review of carci- implanted absorbable mesh in patients who underwent breast-conserving surgery. noma arising in male breast as shown by a wide spectrum of imaging modalities Methods and Materials: From August 2005 to March 2006, 15 patients who had including mammography, US, color-Doppler, power-Doppler, contrast-enhanced undergone absorbable mesh implantation in the breast-conserving operation were US, and MRI. This exhibit also intends to discuss the related diagnostic diffi culties included. Initial ultrasonography was taken 3 months after surgery in 12 patients and differential diagnosis. (12/15) and follow-up examination was done in 7 patients (7/12) at 6 (5/7) or 9 (2/7) Procedure Details: We discuss the epidemiological, histological, clinical, and months after operation. Three of 15 patients had taken initial ultrasound before three imaging aspects of breast cancer in males. Findings on mammography, US, CDUS, months and in 1 patient it was taken at two and six months. We retrospectively PDUS, and CEUS are illustrated. These lesions frequently show an appearance reviewed ultrasonographic fi ndings of the absorbable mesh implant, focusing on different from the typical one encountered in case of female carcinoma. Cancer- the presence of encapsulation, the internal content, presence of vascularity in the ous infi ltration of retroareolar region should be differentiated from infl ammatory power Doppler scan, and the sequential changes of implant. or post-traumatic thickening of this area; vascularity assessment can be helpful. Results: Six out of 12 patients revealed a well-encapsulated cyst and 5 showed Palpable masses arising outside the areolar region can be underestimated by both a well-encapsulated cyst with internal echogeinc nodule. One patient showed an the patient and the physician as resembling benign lesion. Hence, locally advanced echogenic nodule without cystic content. In power Doppler image, all patients had cases, including patients with axillary lymph node metastasis, are not uncommon. no signifi cant vasculrity in and around the implant. In the follow-up examinations, We also show cases developing peripherally, within the etherotopic glandular areas. size of the implant decreased. In one patient, an echogenic nodule newly appeared We also illustrate a bilateral case. in the center of the well-encapsulated cyst. Conclusion: By viewing this exhibit, radiologists will obtain a detailed essay of clini- Conclusion: The sonographic fi ndings of the implanted absorbable mesh on the cal and imaging aspects of male breast carcinoma, thereby increasing confi dence operation site after the breast-conserving surgery revealed a well-encapsulated in mammographic and US differential diagnosis. cyst with or without internal echogenic nodule. Power Doppler image revealed no vascularity of the implant. The size of the implant decreased in the follow-up examinations. C-117 Pectoral and sternalis muscle insertion mimicking a malignant breast lesion E. Gómez1, M. Campo1, E. Operé1, A.C. Vela2, L. Oleaga1, D. Grande1; 1Bilbao/ES, 2Zaragoza/ES ([email protected])
Learning Objectives: To review the normal anatomic variants of chest wall mus- culature (sternalis muscle and pectoral muscle). To evaluate the radiological clues to differentiate the normal chest wall muscles from breast malignant lesions. Background: The goal of accurate mammographic interpretation is to identify malignancy of the breast and distinguish between normal and abnormal breast tissue. This is accomplished by the use of characteristic radiologic signs and aided by familiarity with normal anatomic structures. When an artefact is produced that mimics malignant disease, it is important to recognize its appearance. In this ex- hibit, we show 13 cases of anatomic variants of chest wall musculature mimicking carcinoma on mammography. Imaging Findings: Ten cases of sternalis muscle and 3 cases of sternal insertion of the pectoral muscle were observed. To our knowledge, it represents the largest group published in the literature. The sternalis muscle was present on the right in all cases. The sternal pectoral muscle insertion shown on the mammography in one case was on the left side, in the second case on the right and in the third case it was bilateral. In all cases, at least, bilateral cranio-caudal and lateral oblique projections were obtained. The study was completed with CT (12 cases) or MR imaging (1 case) to confi rm the diagnosis. Conclusion: The knowledge of the different anatomic variants of chest wall mus- culature and their appearance on mammography, CT and MR imaging can avoid confusion with a malignant lesion. C-118 Radiofrequency ablation of invasive breast carcinomas L. Apesteguía, L. Miranda, E. Arteche, F. Domínguez-Cunchillos, C. De Miguel, R. Trujillo, B. Repáraz, M. Sanz; Pamplona/ES ([email protected])
Purpose: To evaluate the safety and accuracy of offi ce-based radiofrequency ablation (RFA), under local anaesthesia and ultrasonographic (US) guidance, as local therapy for primary invasive breast carcinomas (PIBC). Methods and Materials: Prospective study of 19 PIBC smaller than 20 mm., diagnosed by US-guided needle core biopsy and then treated with RFA. Exclusion criteria: Mammographic features suggesting intraductal component; multifocality;
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7 0 0 2 . 2 357 0 . 2 112.02.2007 17:03:46 G nally when to nding. However, However, nding. cantly higher and cantly broadenomas that were broadenomas that were C cation, displaying suspicious or unusual suspicious or unusual cation, displaying BDEF A broadenomas broadenomas ndings and even associated malignancies. associated malignancies. ndings and even ([email protected]) ([email protected])
broadenomas are easily diagnosed by a typical clinical broadenomas are easily diagnosed by 73 female patients (24-89 years) with histologically proven with histologically proven patients (24-89 years) 73 female ([email protected]) ([email protected])
To illustrate the broad range of sonographic presentations of sonographic range the broad illustrate To To orient radiologists to the mammographic and ultrasono- orient to the mammographic radiologists To Three mammographic appearances of gynaecomastia have of gynaecomastia have appearances Three mammographic Review of our database found 443 fi of our database found Review Cairo/EG ([email protected]) ([email protected])
Fibroadenomas are among the most common breast lesions in Fibroadenomas are among Gynaecomastia is the most important disease of the male breast; Gynaecomastia is the most important disease of the male breast; While most fi While T1-DCE model-independent perfusion analysis of the A pixelwise ow (TBF) and the tumor volume of distribution (TVD) were calculated (TVD) were of distribution (TBF) and the tumor volume ow Brussels/BE To evaluate the usefulness of the regional perfusion parameters obtained of the regional perfusion parameters the usefulness evaluate To 0.05). Final diagnosis included: 20 benign and 53 malignant lesions. In all the 20 benign and 53 malignant lesions. Final diagnosis included: < ask for FNB in gynaecomastia. ask for Background: about 85% the male breast, accounting for affecting it is the commonest problem of breast masses. Findings: Imaging Nodular gynaecomastia denderitic and diffuse patterns. nodular, been described: Learning Objectives: of gynaecomastia, patterns appearance of gynaecomastia and diagnosis graphic patterns mammographic to the the different The relation between procedures. and the ultrasonographic the mammographic and the correlation between duration to the histopathological types of gynaecomastia, and fi appearance C-123 of gynecomastia Sono-mammographic diagnosis Abdel Razek; N.M. C-121 facets of breast fi The multiple Dufresne; M.P. Mesurolle, B. Kadoche, Khetani, L. K. El-Khoury, M. Rakheja, R. Montreal, QC/CA Learning Objectives: broadenomas. ndings of fi pathological fi and associated uncommon Background: freely oval, typically present as palpable, Fibroadenomas pre-menopausal women. a well-circumscribed, On ultrasound, rubbery women. mobile, masses in young mass is the most common fi homogenous hypoechoic oval-shaped, 2001 and March 2006 September and biopsied between assessed sonographically their localiza- atypical either by Fibroadenomas can be considered in our institution. tion, occurrence in accessory their sonographic by breast tissue in the axilla, or to the BI-RADS classifi according features with unusual Fibroadenomas can also be associated appearance. sonographic ductal carcinoma in situ, atypical lobular pathologic components including extensive These cases ductal carcinoma. invasive hyperplasia, ductal carcinoma in situ or even features and presented with special emphasis on their unusual will be illustrated with pathological correlations. Conclusion: possibility of of the should be aware the radiologist presentation, and sonographic fi ultrasound presentations, rare C-122 for Potential of breast tumors: Model independent perfusion parameters pathological characterization Luypaert, Sourbron, R. Stadnik, S. T. Dujardin, M. Dewilde, V. Makkat, S. De Mey; J. Purpose: dynamic contrast T1-weighted with a model-independent analysis of second bolus of breast tumors. diagnosis the differential (T1-DCE) data in enhanced -weighted Methods and Materials: protocol which included the routine MR mammography breast tumors underwent A second suppressed sequences. T1-DCE and high-resolution fat whole breast ash Turbofl injected and a dynamic single slice was bolus of 0.1 mmol/kg Gd-DTPA resolution of 400 images with a temporal 4.9/2.4/50/196, acquisition (TR/TE/FA/TI The rela- at the slice where the lesion enhanced maximally. performed 0.3s) was by pixelwise deconvolved signal changes of the second bolus sequence were tive The Response Function (IRF). a model independent method to yield the Impulse fl tumor blood and the mean transit of the IRF respectively and the time integral as the maximum compared were of these parameters Mean values TVD/TBF. time (MTT) as the ratio benign and malignant groups. between Results: the parametric maps clearlymalignant lesions, delineated tumors from the sur- signifi were TVD values TBF and Mean rounding breast tissue. in the malignant tumors compared to the benign lower were mean MTT values ones (p Conclusion: These perfusion TVD and MTT. TBF, of parameters data of breast tumors provides diagnosis of breast tumors. the differential the potential for have parameters clinical presentation and sonographic appearance can be highly variable, while can be highly variable, appearance sonographic clinical presentation and accompanying unusual can very seldom demonstrate pathologic examination such as carcinoma. pathological entities, Findings: Imaging ndings ndings that ndings of intra- ndings (mammography, (mammography, ndings lling defect in 93% (26/28). in 93% lling defect ([email protected]) ([email protected]) ([email protected]) ndings. US may reveal a well- reveal US may ndings.
lling defect. Doppler Sonography Doppler Sonography lling defect. cant complications were observed. cant complications were Scientific and Educational Exhibits Scientific and Educational 6.3). Tumour sizes: Between 4 and 14 mm. mm. 4 and 14 Between sizes: Tumour 6.3). ndings should suggest a diagnosis when Madrid/ES Madrid/ES ± 1. To evaluate the mammographic, ultrasound and MRI ultrasound the mammographic, evaluate To 1. 1) Review the spectrum of imaging fi 1) Review The mammographic, ultrasound and MRI features are de- and MRI features ultrasound The mammographic, ndings. 2. To learn fi the clinical and radiological To 2. ndings. We have retrospectively reviewed the imaging fi reviewed retrospectively have We 7 2
d d Papillomas are generally solitary are generally tumors of the mammary Papillomas ducts Mucinous carcinoma of the breast is a rare breast neoplasm that Mucinous carcinoma of the breast is a rare n Offi ce-based RFA under local anaesthesia is a safe, feasible and feasible is a safe, under local anaesthesia ce-based RFA Offi It is important for radiologists to be familiar with a variety of imaging with a variety It is important to be familiar radiologists for Intraductal papilloma has a wide spectrum of imaging manifestations papilloma has a wide spectrum Intraductal of imaging manifestations i . N I F Ages: From 44 to 72 years (X:64 44 to 72 years From Ages: - c 2.8). Complete ablation with negative NADH-diaphorase test was achieved in 17 achieved test was NADH-diaphorase with negative Complete ablation 2.8). u ± ndings with pathologic correlation d E i c S - (X:8.5 component the intraductal case, In another test. a slightly positive One case showed cases. No signifi ring. effect out of the RFA found was Conclusion: Wider mm. in 90% of the PIBC smaller than 20 accurate procedure, comfortable to be Additional studies have the technique. series are necessary to evaluate surgery. alone versus of RFA recurrence taxes directed to compare local Mucinous carcinoma of the breast: Mammographic, ultrasonographic and Mammographic, of the breast: Mucinous carcinoma MRI fi Alonso Roca, S. Goldaracena, Oliver J. Domínguez-Franjo, E. Fernandez; Peña E. Arguelles Pinto, M. help the Radiologist to make the correct diagnosis approach. the correct diagnosis approach. help the Radiologist to make C-120 Learning Objectives: breast carcinoma and to correlate the imaging features of mucinous appearance with the histologic fi prognosis. can forecast Background: among are more commonly found They 1-7% of all breast carcinomas. accounts for mucinous Histologically, is strongly age related. Its prevalence elderly women. carcinoma depending on and mixed carcinoma can be divided into pure mucinous carcinoma has better prognosis Pure mucinous mucin. of extracellular the volume incidence of metastases. and lower Findings: Imaging ultrasonographic and The most common mammographic scribed and illustrated. mass with very high signal intensity on microlobulated or lobular is an oval feature and such imaging fi images, T2-weighted present in an elderly patient. Conclusion: our shows This exhibit carcinoma and their histologic type. of mucinous features 1.Clinical and imaging character- on: carcinoma focused with mucinous experience The mammographic, 2. carcinoma. istics that should suggest diagnosis of mucinous carcinoma that can predict prognosis. of mucinous and MRI features ultrasound depending on their hystologic subtype. We visualize them as intraductal lesions in them as intraductal visualize We subtype. depending on their hystologic of the typical imaging fi Ackowledgment and usually in US. galactography Learning Objectives: correlate To 2) papillomas. of the intraductal Doppler and ductography) ultrasound, of the effectiveness analyze To 3) with the histological result. the imaging features lesions diagnosis. the core-needle biopsy in the intraductal Background: typically report nipple Patients epithelium and are usually located near the nipple. of papillary pathol- neoplasms correlate to the gross Imaging features discharge. nd fi may we Occasionally, US are frequently normal. and Mammograms ogy. cations, calcifi gross cations, cluster of suspicious microcalcifi in mammography benign-appearingmass or a combination of these fi cystic lesion with or a smooth-walled, mass hypoechoic ned, smooth-walled, defi a fi usually shows Galactography solid components. ow. arterial demonstrate may fl Findings: Imaging mam- patients, Out of a total of 55 ductal papillomas from our pathology database. Core-needle biopsy in 28. in 53, US in 51 and ductography performed was mography Intraductal papilloma. intraductal result for with a positive in 20 cases performed was lesion was A solid intraductal in 58% (31/53). silent in mammography papilloma was a fi showed Ductography 36% (18/51). in US in found Conclusion: C-119 of the breast The one-hundred faces of the intraductal papilloma Pérez, S. Torres, M. Domínguez, E. Alonso, S. Oliver, J.M. Rebollo, M. López; J. Peña, García, E. R. Baeva, M. pregnancy; patients with previous breast surgery, radiotherapy or chemotherapy; or chemotherapy; radiotherapy breast surgery, patients with previous pregnancy; consent Informed less than 10 tumours located wall. thoracic to the skin or mm next The carried local anaesthesia. was out under RFA subjects. obtained from all was All of the lesion under US guidance. placed in the centre electrode probe was Complete after RFA. 2-4 weeks surgical therapy conservative patients underwent done when axillary was demonstrated. node metastases were limphadenectomy study included Pathologic cases. done in the remaining Sentinel node biopsy was c NADH-diaphorase stein and the specifi haematoxylin-eosin the conventional specimen. study in a freezed Results: C - 7 0 R C EECR07-C-SciEduc-FIN.indd 27 Scientific and Educational Exhibits
appears as a focal retroareolar density. Denderitic gynaecomastia appears as a C-126 retroareolar density with prominent extensions that radiate into the deeper adipose Quantitative refraction-based computed tomography with high resolution tissue. Diffuse glandular gynaecomastia has a mammographic appearance similar using synchrotron radiation to heterogenosly dense female breast; the glandular densities are either limited to E. Hashimoto1, A. Maksimenko1, S. Ichihara2, Y. Arai3, H. Sugiyama1, K. Hirano1, the subareolar region or scattered throughout the whole breast. By ultrasonography, D. Shimao4, K. Hyodo1, T. Yuasa5, T. Endo2, M. Ando1; 1Tsukuba/JP, 2Nagoya/JP, gynaecomastia has either focal hypoechic retroareolar lesion or diffuse echogenic 3Shiojiri/JP, 4Inashiki/JP, 5Yonezawa/JP ([email protected]) hyper-refl ective parenchyma with or without prominent ducts, indicating develop- ment of the TLDU. It was found that the denderitic type correlates with fi brous Purpose: The ability of refraction-based contrast CT to depict breast cancer nest gynaecomastia and the nodular type correlates with fl orid type. These fi ndings are was tested by observing breast cancer of the human with synchrotron X-rays. directly proportionate to the duration. FNB is reserved only in suspicious cases. Reconstructed images of breast cancer show much detail that is noted in absorp- Conclusion: Sono-mammography has provided satisfactory results in diagnosing tion-based CT. gynecomastia as the commonest cause of breast lump in males. Moreover, it cor- Methods and Materials: Recently, we have developed a new Computed Tomog- relates well with the radiographic fi ndings of different histological patterns. raphy algorithm for refraction contrast that uses the optics of diffraction-enhanced imaging. We applied this new method to visualize soft tissue, which is not visualized C-124 by the absorption contrast. The meaning of the contrast that appears in refraction- contrast X-ray CT images must be clarifi ed from a biologicEPOS or anatomic point of Rare breast tumors: Imaging fi ndings and radiologic - pathologic view. It has been reported that the contrast is made with the specifi c gravity map correlation with a range of approximately 10 µarc sec. The relationship between the contrast C. Martínez Lara, B. Arenas García, T. Zamora Martínez, M. Baizán García, and biologic or anatomic fi ndings has not been investigated. We compared refrac- J. Sevillano Sánchez; Zamora/ES ([email protected]) tion-contrast X-ray CT images with microscopic X-ray images, and we evaluated Learning Objectives: To illustrate the imaging fi ndings on mammography and refractive indexes of pathologic lesions on phase-contrast X-ray CT images. sonography of rare breast tumors. We add a radiologic - pathologic correlation Results: We focusedNo our Material attenuation Submitted of breast cancer to as samples. X-ray refrac- of each entity. tion-based Computed Tomography appeared to be the pathological ability to Background: The uncommon breast lesions cause a diagnostic dilemma and need depict the boundary between cancer nest and normal tissue, and inner structure a triple approach encompassing clinical, radiological and histological features. An of the disease. exact diagnosis is crucial for the adequate management of the patient. Conclusion: The properties of the refraction contrast provide certain advantages Procedure Details: Retrospective review was performed of 626 breast lesions over other contrasts such as absorption and phase-shift. The refraction contrast diagnosed in our department between January 2004 and June 2006. All patients can show tiny details of the inner structure, which are invisible in other types of underwent diagnostic mammography or mammography and breast sonography. X-ray imaging techniques. Another advantage of the contrast is the sensitivity to The accurate diagnosis was made by core needle biopsy. We present the imaging the low Z materials. fi ndings and radiologic - pathologic correlation of 18 selected cases of uncommon breast tumors: Six benign tumors (2 hamartoma, 1 granular cell tumor, 1 phyllodes C-127 tumor, 1 lactating adenoma and 1 intracystic papilloma) and twelve malignant tumors Percutaneous treatment of nipple discharge with Mammotome biopsy (4 mucinous carcinoma, 2 medullary carcinoma, 2 primary non-Hodgkin lymphoma, under ultrasound guidance 1 invasive papillary carcinoma, 1 malignant phyllodes tumor, 1 carcinosarcoma and M. Torres-Tabanera1, P. Alonso-Bartolomé2, A. Vega-Bolivar2, 1 metastases from carcinoid tumor). S.M. Sánchez-Gómez2, E. Lag-Asturiano3, M. Sainz-Miranda3, Conclusion: The radiologist must know the imaging fi ndings of these unusual P. Martínez-Miravete3, M. Ruiz-Díaz3, F. Garijo-Ayensa2; 1Alcorcon/ES, breast tumors and take them into account to make a correct differential diagnosis, 2Santander/ES, 3Logroño/ES ([email protected]) which has a great impact on therapeutic strategies. Purpose: To show our experience in the treatment of pathological nipple discharge by C-125 removal of intraductal papillary lesions with ultrasound-guided Mammotome biopsy. Methods and Materials: We carried out a multi-institutional study of 45 intraductal Diagnostic accuracy of dynamic multidetector row CT to evaluate axillary lesions identifi ed by ultrasound in patients with nipple discharge, from January 2003 lymph node in patients with breast cancer to July 2006. Imaging studies included mammography, ultrasound, galactography D. Kang, J. Kim, Y. Jung; Suwon/KR and ultrasound re-evaluation directed to the identifi cation of galactographic fi lling Purpose: To investigate the usefulness of dynamic multidetector row CT (MDCT) defect. All biopsy procedures were performed with 11G Mammotome under ultra- in the detection of axillary lymph node (LN) metastasis using morphologic criteria sound guidance. We applied a radial approach oriented to place the needle under and quantitative analysis. the lesion, following the longitudinal axis of the duct. Removal was considered Methods and Materials: Fifty-nine patients with breast cancer underwent MDCT complete when no lesion was identifi ed on ultrasound. preoperatively. 16-slice dynamic MDCT was performed before, and 90sec and 5 min Results: Histopathologic results were intraductal papilloma in 30 lesions, ductal after an administration of nonionic contrast material. The morphologic features papillary projections in 11, ductal ectasis in 1 and benign non-specifi c in 3. Removal and contrast enhancement of the axillary LN were evaluated using multiplanar was considered complete in 91%. Surgical excision was recommended in 4 lesions: reformation and three-dimensional maximum-intensity projection. Short diameter 3 due to incomplete removal and 1 with atypical hyperplasia (fi nal result was benign). of LN, S/L (short diameter/long diameter) ratio and cortical change were evalu- Nipple discharge persisted in six patients: 4 due to residual lesions and 2 related ated as morphologic features of LN. Contrast enhancement was quantitatively to second lesions. Four were successfully re-excised with Mammotome and 2 sent analyzed using a region-of-interest method to evaluate the enhancement rate and to surgical removal (percutaneous re-excision was non intended). Percutaneous time-density pattern. removal avoided surgical excision in 86.7% of lesions and complete resolution of Results: The hilar obliteration and eccentric cortical thickening was the most nipple discharge was achieved in 95% of cases treated with Mammotome. sensitive predictor for metastatic LN. The density values at each scanning time Conclusion: Percutaneous removal of papillary lesions with Mammotome under were signifi cantly different for metastatic and non-metastatic LN. The sensitivity, ultrasound-guidance is an effective therapeutic technique in the treatment of specifi city, positive predictive value (PPV), negative predictive value (NPV), and patients with nipple discharge and should be considered as an alternative to accuracy of MDCT to detect metastatic LN using morphologic criteria were 81%, surgical excision. 82%, 83%, 79% and 81%, respectively, and the corresponding performances using quantitative analysis were 61%, 71%, 70%, 63% and 66%, respectively. In C-128 combined analysis of morphologic criteria and quantitative analysis, the overall FDG PET-CT in the detection and evaluation of breast diseases: sensitivity, specifi city, PPV, NPV, and accuracy were 65%, 93%, 91%, 70% and Usefulness and common pitfalls 78%, respectively. H. Lim1, Y. Jeong1, H. Kang1, J. Kim2, J. Park2, H. Bom1; 1Jeollanam-do/KR, Conclusion: Morphologic features detected on MDCT help distinguish metastatic 2Gwang Ju/KR ([email protected]) LN from non-metastatic, and was a more valuable diagnostic criteria than that of quantitative analysis. The quantitative analysis of axillary LN improved the overall Learning Objectives: To show various clinical settings in which FDG PET/CT can specifi city and positive predictive value. aid in detecting breast disease. To discuss the role of FDG PET/CT in patients with known breast cancer. To discuss the limitations and pitfalls of FDG PET/CT in the evaluation of breast disease.
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2 rmed 359 0 . ; 2 1 112.02.2007 17:03:47 ; 1 G Madrid/ES , Y. Ogawa , Y. 1 , C.R. Chatwin , C.R. 1 , A. Nishioka , A. C 1 , R.C.D. Young , R.C.D. 1 BDEF A ndings of these conditions. , K. Nakatani , K. 2 , K.A. Miles , K.A. 2 ltration to highlight image features at different spatial at different image features to highlight ltration ([email protected]) ([email protected])
assessment and b) and 2.5 (coarse features), ne detail) ([email protected]) ([email protected]) Forty-two female patients with breast cancer enrolled in Forty-two female and non-intrinsic brohisticitoma and malignant phyllodes) Mammographic series depicting focal abnormalities series were depicting focal Mammographic
ed as feeding arteryed as feeding all tumors located in the medial for To illustrate the radiologic features of uncommon and rare of uncommon and rare features the radiologic illustrate To , J. Hitomi , J. 1 We retrospectively reviewed all uncommon and rare breast all uncommon and rare reviewed retrospectively We Susaki/JP Most radiologists are familiar with the more common forms of breast with the more common forms are familiar Most radiologists , O. Strukowska , O. 2 Worthing/UK lter ratio 0.5/1.5; p=0.046 for 0.5/2.0). This difference was enhanced was This difference 0.5/2.0). p=0.046 for 0.5/1.5; lter ratio 1 , S. Itoh , S. Texture analysis could potentially make a useful adjunct to computer- could potentially make analysis Texture Knowledge of imaging features with pathological correlation can help of imaging features Knowledge 2 1 This pilot study investigates the potential for computerised analysis of the potential for investigates This pilot study In our department, intra-arterial often administrate we chemotherapy Texture was signifi cantly different between lesions with and without IC between cantly different signifi was Texture ITA was identifi was ITA cation of tumor-feeding artery using CT angiography (CTA) for for artery (CTA) using CT angiography cation of tumor-feeding Nankoku/JP, Nankoku/JP, Falmer/UK, Falmer/UK, randomly selected from an image archive. Pathological examination had confi examination Pathological from an image archive. selected randomly Purpose: within mammographic and receptor status invasion to predict cancer image texture abnormalities. Methods and Materials: (IC) in 2, cancer alone in 5, DCIS with invasive ductal carcinoma in situ (DCIS) manually assessed in regions of interest (ROIs) was Texture and IC alone in 4. analysis com- Texture a dedicated breast radiologist. the lesion by constructed over a) band-pass image fi prised: 0.5 (fi frequencies between spatial different at two features made to the image by contributions of the relative 0.5/2.5). (e.g. lter ratios as fi expressed frequencies, Results: fi (p=0.036 for cor- Texture 0.5/1.5). ratio from the analysis (p=0.016 for axial views omitting by 0.5/1.5, axial view (p=0.0056; of invasion related with the presence and extent and progesterone receptor 0.5/2.5) omitted), oestrogen receptor status (p=0.010; 2.0/2.5). status (p=0.016; Conclusion: in mammographic pathological features identifying adverse assisted diagnosis by sentinel treatment planning and selection for assist in may This knowledge lesions. node biopsy. C-133 Identifi breast cancer patients Yamanishi T. 1 C-131 from and receptor status cancer invasion Predicting breast mammographic texture Ganeshan B. 1 C-132 Radiologic - pathologic Uncommon and rare malignant breast disease: correlation Cazorla; A. Pastor, P. Tomás, Gutierrez, M. Miró, B. Benitez, C. O. ([email protected]) ([email protected]) Learning Objectives: malignant breast disease with histopathologic correlation. Background: often pose a diagnostic challenge. malignant diseases rare However, cancer. Details: Procedure Patients 1991 and 2006. malignant diseases diagnosed at our institution between diagnosis was nitive The defi and/or breast sonography. mammography underwent carcinoma, epithelial tumors (tubular include rare We biopsy. core needle made by ammatory medullary carcinoma, apocrine carcinoma, infl carcinoma, metaplastic carcinoma papillarycarcinoma, intracystic patterns rare carcinoma), of invasive carcinoma), breast disease and intracystic Paget’s (malignant myoepithelioma, sarcomas (liposarcoma, fi describe We and metastases). angiosarcoma breast tumors (lymphoma, leukemia, and pathological fi the radiological Conclusion: which diseases, diagnosis of these uncommon and rare the differential narrowing can pose a diagnostic challenge. the study. Their mean age was 49.8 years (age range: 32-67). Concerning tumor 32-67). range: (age 49.8 years Their mean age was the study. and another 6 T2 tumor, 28 patients had T1 tumor, cation, 8 patients had classifi angiography digital subtraction selective these patients, For T3 tumor. patients had artery and subclavian internal (SA). artery thoracic for performed (DSA) was (ITA) each patient. administered for was CTA the procedure, following Just Results: Purpose: systemic neoadjuvant breast cancer patients whose tumors are resistant for for In intra-arterial in terms of intensifying local tumor control. (NAC), chemotherapy We artery to identify feeding it is essential of the tumor accurately. chemotherapy, artery site and tumor-feeding breast tumor the relationship between evaluated duringusing CT performed intra-arterial material injection of iodine contrast (CT CTA). Angiography: Methods and Materials:
rmed F-FDG broad- 18 ndings of ndings was was ndings Toledo/ES
uorodeoxyglucose uorodeoxyglucose EPOS ndings of primary breast lym- ([email protected]) ([email protected])
Scientific and Educational Exhibits Scientific and Educational c, the diagnosis can possibly be excluded be excluded the diagnosis can possibly c, ndings of the primary breast lymphoma ndings (BI-RADS 4) Seoul/KR PT with hypercellularity broadenoma (84%) and one We collected 70 lesions reportedWe as BI-RADS 4 and
To determine the mammographic and sonographic charac- determine and sonographic the mammographic To No Material Submitted to period in 3,211 a 2-year for FDG PET/CT studies performed Submitted Material No We reviewed 12 primary lymphoma of breast to determine reviewed the We 9 2
d broadenoma using image guided core-needle biopsy (CNB). Cases Cases broadenoma using image guided core-needle biopsy (CNB). d The breast is an uncommon site of development for malignant malignant for The breast is an uncommon site of development Positron emission tomography (PET) with [18 emission tomography F]fl Positron Most of the primary breast lymphomas presented as a single, n FDG PET/CT is useful in patients with known breast cancer in the patients with known FDG PET/CT is useful in ACR recommends a 6-month follow-up BI-RADS 4 lesions confi BI-RADS 4 lesions recommends a 6-month follow-up ACR i . ed as concordant or discordant based on its mammographic appear- or discordant based on its mammographic ed as concordant N I To evaluate the potential use of immunohistochemical methods for fi for methods the potential use of immunohistochemical evaluate To F There were 64 concordant (91%) and 6 discordant (8.5%) cases. Six 64 concordant (91%) and 6 discordant (8.5%) cases. There were - c u d E i c S - broadenoma and one (17%) was a PT. Retrospective immunohistochemistry results Retrospective a PT. broadenoma and one (17%) was in some benign cases can be confused with malignant disease. be confused with malignant disease. in some benign cases can S. Yang, C. Lyou, B. Lee, K. Kim; Kim; K. Lee, B. Lyou, C. Yang, S. teristics of primary breast lymphoma. Background: of primary frequency non-Hodgkin despite the relative lymphomas, extranodal articles about imaging fi There are few lymphomas. Mammographic and sonographic fi ([email protected]) Purpose: C-130 Learning Objectives: of appearance The data about the sonographic literature. phoma in the radiology its mammographic more limited than those on primary breast lymphoma are even appearance. Details: Procedure The mam- disease. characteristics of this rare and sonographic mammographic and the imaging radiologists, two by reviewed were and the sonography mograms Description of imaging fi determined consensus. were appearances by made according to BI-RADS lexicon. Conclusion: primary breast lymphoma are nonspecifi oval-shaped, high-density mass on mammography and a hypoechoic mass with and a hypoechoic high-density mass on mammography oval-shaped, Although the imaging fi margin on US. circumscribed or microlobulated concordant cases (9.37%) showed an increase in size (period of 6-25 months size an increase in concordant cases (9.37%) showed (83%) were Five performed. surgical biopsy was 14) and therefore, with average fi found. breast cancer was detection for false-negative Any MIB-1. and positive Conclusion: are present. cations or desmoplastic reactions if calcifi ance and histology results. One year follow-up was recommended for concordant recommended for was follow-up One year ance and histology results. Immunochemistry tech- biopsy. sent to excisional cases were Discordant cases. diagnosis between to determine applied a differential retrospectively niques were tumor (PT). broadenoma and Phyllodes fi Results: higher than 50% and 2, including the PT, that all had a cellular proliferation showed 93% Of the remaining 58 concordant cases in surveillance, MIB-1. had a positive the results for Excisional biopsy follow-up. change after 3-year any not shown have 6 discordant cases yielded 5 fi enoma lesions reported management. as BI-RADS 4 to determine its follow-up Methods and Materials: diagnosed as fi classifi were Potential use of immunohistochemical methods to determine management management methods to determine use of immunohistochemical Potential fi of suspicious mammography Sánchez; R. Fandiño, E. Calvo, P. Varela, C. Almenar, A. Romero, C. C-129 Background: (FDG) in combination with computed tomography (CT) is rapidly gaining a critical gaining (CT) is rapidly with computed tomography (FDG) in combination the staging and evaluate of patients with cancer for evaluation role in the clinical health examination. increasingly being used for of treatment and also is effect are described of PET CT in breast diseases pitfalls The usefulness and common and illustrated. Details: Procedure consecutive patients with various malignant diseases and for health examination health examination malignant diseases and for patients with various consecutive in which PET/CT can clinical settings The various reviewed. retrospectively were breast of PET/CT in patients with known the role aid to detect breast disease, patients with other additional breast cancer in of unexpected and detection cancer, of PET/CT describe And also we and pitfalls limitations malignancies are illustrated. of breast disease. in the evaluation Conclusion: staging and monitoring response to therapy. However, high accumulation of high accumulation However, staging and monitoring to therapy. response as fi broadenoma using CNB; however, our results show that those lesions with that results show our however, broadenoma using CNB; as fi and 1-year and MIB-1 can be managed conservatively hypercellularity negative to reduce surgical biopsy should be considered Otherwise, is appropriate. follow-up or PT. the risk of growth C - 7 0 R C EECR07-C-SciEduc-FIN.indd 29 Scientific and Educational Exhibits
region (A and B region) (n=9). In contrast to the result, feeding artery of the tumor C-136 located in the lateral region (C and D region) or multiple regions, such as ACE, Pregnancy-associated breast lesions: Radiological fi ndings and patient was either ITA or SA, or both of them (n=33). Though tumor stain by the contrast management material was visualized in only 50% (n=21) of the patients by the DSA method, it P. Belli, M. Costantini, C. Malaspina, S. Magno, R. Masetti, L. Bonomo; Rome/IT was visualized in all the patients of CTA (p < 0.05 by chi-square test). Conclusion: CTA is considered as the most promising procedure in terms of Learning Objectives: To describe pathophysiology, clinical presentation, diagnostic identifying tumor-feeding artery for breast cancer patients. imaging and therapeutic approach to breast lesions in pregnant women. To illustrate the most important radiological fi ndings to differentiate benign from malignant C-134 masses and to clarify the role of biopsy. Background: Various breast lesions were detected during pregnancy including Small HER-2 positive versus HER-2 negative non-palpable breast cancers: breast cancer, mastitis and abscesses, lactating adenoma, galactoceles, lobular Do they differ on admission in terms of mammographic characteristics, hyperplasia and fi broadenomas. Clinical diagnosis of breast masses in pregnant axillary nodal or other histopathological factors? women is diffi cult. A thorough breast examination at the fi rst antenatal visit, before A. Koskela, M. Berg, V. Kataja, M. Sudah, V. Karja, R. Vanninen; Kuopio/FI the physiologic changes in breast parenchyma obscure possible masses, is es- (anna.koskela@kuh.fi ) sential. The work-up of masses detected during pregnancy should not be postponed Purpose: Human epidermal growth factor receptor (HER-2) over-expression in until after delivery. breast cancer has been shown to be associated with aggressive disease, poor Imaging Finding: Breast ultrasound could be an excellent imaging modality for prognosis and response to trastuzumab anticancer therapy. By now trastuzumab differentiation between benign and malignant lesions. When the imaging results has been used for advanced disease, but ongoing trials use trastuzumab as adju- are suspicious, a biopsy should be performed to obtain a pathologic diagnosis. vant treatment for early breast cancer with excellent preliminary results. The aim Mammography has a very low level of radiation and should not be delayed if of the present study was to assess whether in small, non-palpable breast cancers deemed necessary. the mammographic and other tumour characteristics on admission differ in HER-2 Conclusion: Vigilant monthly breast self-exams and clinical breast exams during positive vs HER-2 negative tumours. pregnancy and lactation can help prevent the delayed diagnosis of breast cancer Methods and Materials: Altogether 197 concecutive patients (mean age 56 yrs, and enable optimal treatment. Ultrasound and biopsy are the only signifi cant range 32-88) with 205 mammographically detected non-palpable breat lesions examinations. underwent stereotactic 14G core needle biopsy. Cores of 41 invasive cancers were prospectively studied for HER-2 over-expression by immunohistichemistry, C-137 and further confi rmed by chromogenic in situ hybridisation to detect HER-2 gene Can chest MDCT play a role in preoperative assessment of breast cancer? amplifi cation. No Material Submitted to EPOS A comparison with mammography, ultrasonography and MR imaging Results: Altogether 6/41 (15%) of the cancers were HER-2 positive. Between HER- Y.-W. Chang1, K.H. Kwon1, J.-H. Hwang1, H.-J. No1, H.-K. Lee2, D.-H. Kim3; 2 positive and negative cases, no difference was noted in patient age (p=0.615), 1Seoul/KR, 2Bucheon/KR, 3Kwang Ju/KR ([email protected]) lesion size (p=0.288), tumour grade (p=0.133), BI-RADS classifi cation or frequency of metastatic axillary nodes (p=0.575). Four of the HER-2 positive cancers appeared Learning Objectives: 1. Recognize the characteristic appearance of breast cancer as mass lesions (1 stellate, 3 oval/round) and two as microcalcifi cations (1 casting, on Chest MDCT and correlate with mammography, ultrasonography and MR imag- 1 powderish). Estrogen reseptors were equal (p=0.402), but progesterone reseptors ing. 2. Describe the imaging features on Chest MDCT of breast cancer of various were signifi cantly lower in HER-2-positive lesions (p=0.040). pathologies. 3. Discuss the clinical manifestations that have a role in staging breast Conclusion: Exact histopathologic HER-2 assessment is essential for treatment de- cancer on chest MDCT. cisions in early breast cancer while mammographic characteristics or tumour grade Background: To evaluate the effi cacy of chest multidetector-row helical computed to- do not give any clue for HER-2 status in small, non-palpable breast cancers. moraphy (MDCT) in detecting breast cancer in preoperative metastasis work-ups, and to assess the accuracy of MDCT compared with magnetic resonance imaging (MRI). C-135 Procedure Details: We retrospectively reviewed the chest MDCT images of breast cancer for margin, shape, mass enhancement pattern and the enhancing distri- Is there an increase of circulating epithelial cells after mammographical bution of non-mass lesions. MDCT fi ndings were compared with mammography, examination due to compression? ultrasonography and MR imaging. D.M. Renz, J. Böttcher, K. Pachmann, M. Facius, W.A. Kaiser; Conclusion: The diagnostic value of chest MDCT for preoperative staging is com- Jena/DE ([email protected]) parable with MR imaging for the detection and extension of lesions. Furthermore, Purpose: The aim of this prospective study was to detect circulating epithelial chest MDCT of breast cancer can add to information about lymph node status or cells (CEC) in the peripheral blood in a sample of women obtaining diagnostic distant metastasis compared with mammography or ultrasonography. So, chest mammography and to monitor these cells before and after mammographical ex- MDCT of breast cancer is a useful method of preoperative assessment for cancer amination. The further objective was to investigate if the quantity of cells increases staging and limitational condition of MR imaging. after compression. Methods and Materials: CEC can be often be found in high numbers in patients C-138 suffering from an epithelial tumour, like breast cancer. In general, lower levels of Variability and accuracy in the interpretation of screening mammography cells are detected in healthy individuals. In some cases, CEC seem to have a me- (VILMA project) tastasing potential. For cell quantifi cation, the FITC-conjugated mouse anti-human M. Maristany, F. Ferrer, I. Vollmer, J. Sanchez, X. Castells, J. Royo, J. Martinez, epithelial antibody (HEA, Germany) and the Lasing Scanning Cytometer (Com- A. Solano; Barcelona/ES ([email protected]) pucyte Corporation, USA) were used. This method, termed MAINTRAC analysis, enables relocation of CEC for visual examination and quantifi cation. Blood samples Purpose: The aim of this study is to evaluate the accuracy and the agreement in the were taken from 28 women immediately before mammographical examination and interpretation of screening mammography, as well as the impact when assessing afterwards in the following time periods: 10 minutes, 1 hour, 3 days. the effectiveness of mammographic double reading. Results: In 9 of 28 women (32.1%), the quantity of CEC increased after com- Methods and Materials: Twenty-eight screening radiologists from Catalonia read a pression > 10%. In 19 cases (67.9%), the numbers remained at the same level kit of 150 mammographies (Mx). The Mx were an oportunistic sample of Mx of 50-69- (deviation between +10% and -10%). In these 19 women, a higher quantity of CEC year-old participating women in a breast cancer screenning program in, at least, two was measured before mammographical examination compared to the rest of the consecutive rounds. The proportion of cancers was oversampled. Both the difference sample and healthy individuals (p < 0.05). in accuracy between simple and double reading and the agreement among radiolo- Conclusion: CEC seem to be mobilized by compression in one third of the cases. gists were evaluated. The result of the Mx was assessed by the BI-RADS. Further studies should examine the impact of epithelial cell accumulation in the Results: Using the BI-RADS assessments for 56.700 possible pairwise compari- peripheral blood in patients with verifi ed breast cancer and consecutively the risk sons, 60% of the radiologists agreed. Among women with cancer, 41.4% of pairs of mammography due to compression. agreed, and in those without cancer, 62.6% agreed. Using the variable ‘positive assessment or not’, the percentages among possible pairwise radiologists for women with cancer were: a 70.4% of agreement in a correct diagnosis, a 6.4% of agreement in a wrong diagnosis, and a 22.5% of disagreement. When cancer was not present: agreement in a correct diagnosis: 50.5%; agreement in a wrong
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EECR07-C-SciEduc-FIN.inddCR07-C-SciEduc-FIN.indd 3300 112.02.20072.02.2007 17:03:4717:03:47 7 4 : 3
Breast 0 : 7 1
7 0 0 2 . 2 361 0 . 2 112.02.2007 17:03:47 cial lesions G , 1 , F. Noack , F. 2 Luebeck/DE, Luebeck/DE, 1 ; 1 , I. Rudolf , I. 1 C BDEF ndings is made observing solid nodules A , T.K. Helmberger , T.K. 1 RFA in a lactating and a non-lactating bovine udder was udder was in a lactating and a non-lactating bovine RFA ed as invasive carcinomas. Correlation between the differ- Correlation between carcinomas. ed as invasive ([email protected]) ([email protected])
Mammography and ultrasound (including Doppler) were Doppler) were (including ultrasound and Mammography , C.U. Bergmann-Koester , C.U. 1 , A. Lubienski , A. 1 Acknowledgement of mammography and sonography features in features and sonography of mammography Acknowledgement There is little conduction of heat in bovine breast tissue. Sharp de- breast tissue. There is little conduction of heat in bovine To evaluate the conduction of heat in radiofrequency ablation (RFA) (RFA) ablation of heat in radiofrequency the conduction evaluate To In the non-lactating tissue, there is a direct correlation of the temperature the temperature there is a direct correlation of In the non-lactating tissue, Birmingham, AL/US Purpose: in superfi Especially breast tissue. udder as a model for in the bovine S. Kapsimalakou S. tissue is conduction and demarcation of the ablated heat near the skin surface, an important issue. Methods and Materials: The tempera- guidance. under ultrasound deployed The needle was performed. 60 and 100ºC and maintained for between steps applied in 10-degree ture was three times for repeated was The experiment 15 prongs. at the tips of the minutes Histopathologic in the lactating and non-lactating tissue. step each temperature The diameter of the ablation made. assessment of the resected specimens was margin against the surrounding tissue tissue and demarcation of the ablated zone measured. applied was with respect to the temperature Results: 1.27 in diameter was ablation The maximum and diameter of the necrosis zone. a sharpThere was cm in the lactating tissue. the non-lactating tissue and 1.30 The transition cm in the non-lactating tissue. 0.2 0.1 and demarcation between between ranging 80ºC, below visualized not well in the lactating tissue was zone 0 and 0.2 cm. Conclusion: ideal control of the heat, hence, suggests accurate zone marcation of the ablation in human breast tissue. RFA conditions for prognosis than other breast carcinomas because of their usual slower growth. slower because of their usual other breast carcinomas prognosis than Findings: Imaging of lesions with both Evaluation in our series. in all of the 34 patients performed most of the lesions as suspicious of malignity us to consider techniques allowed MRI classifying them as 4 or 5 BI-RADS categories. (76.4% or 26 of 34 cases), 38% Histologically, in order to reject multicentricity in 10 patients. performed was classifi (13 of 34) was the imaging fi ent histological types and also review We carcinoma than cystic lesions. invasive more often associated with series aspects in our such as age of presentation, location, size other different and clinical signs. Conclusion: In our experience, papillary to suspect carcinoma. the radiologist allows lesions solid papillary frequently associated with histological invasion carcinomas are more than cystic papillary carcinomas. C-142 for study Experimental in breast tissue: ablation Radiofrequency udder of heat conduction in the bovine evaluation Stoeckelhuber B.M. 2 city (kssunny1106@ ndings with ndings ([email protected]) ([email protected])
ndings of BI-RADS category 3 ([email protected]) ([email protected])
Scientific and Educational Exhibits Scientific and Educational Madrid/ES Valencia/ES The project involved two groups of patients. First, a of patients. groups two The project involved Of 3,207 cases of US-guided core needle biopsy for 4 for Of 3,207 cases of US-guided core needle biopsy Our purpose is to make a retrospective review of the of the review Our purpose a retrospective is to make per thousand). There were 29 (13.1%) intraductal carcinomas. 29 (13.1%) intraductal There were per thousand).
1 3
d d Papillary carcinomas represent 1-2% of breast carcinomas. Histologi- carcinomas represent 1-2% of breast carcinomas. Papillary n In our on-demand program, an increase in detection was obtained an increase in detection was In our on-demand program, By considering the results of the radiologists in the double reading, By considering in the double the results of the radiologists Despite the retrospective nonblinded evaluation of mammography and of mammography evaluation nonblinded Despite the retrospective i . cation: 2; hyperdense mass: 2), and 4 (44.5%) were suspicious on US 2), and 4 (44.5%) were mass: hyperdense 2; cation: N I To analyze the clinical and imaging fi analyze To Screening programs based on mammograph examinations in the asymp- examinations based on mammograph Screening programs F Of the 18 malignant lesions that were palpable in 12 (67%) and nonpal- palpable Of the 18 malignant lesions that were - In the population program, the total number of cancers was 349 (4.6 per thousand). 349 (4.6 per thousand). of cancers was the total number In the population program, c u d E i c S - C-141 fi Spectrum of imaging of the breast: carcinoma Papillary pathologic correlation Sanz, A. Borrego, J. Oliver, J.M. Alonso, S. Grande, M. Rebollo, M. Blanco, J.A. Olmedilla; Hernández, P. S. Cámara, N. Learning Objectives: imaging findings of the papillary carcinoma of the breast, and to correlate them with the histological results. Background: cally, they can be divided into in situ carcinomas, including intracystic and intraductal and intraductal including intracystic can be divided into in situ carcinomas, they cally, better are considered to have they As a group, carcinomas. and invasive types, There were 75 (21.4%) intraductal carcinomas. In the on-demand program, 221 cancers In the on-demand program, carcinomas. 75 (21.4%) intraductal There were diagnosed (6.04 were mammographic and BI-RADS category 3 breast lesions by as malignancy diagnosed ultrasonographic assessment ultimately Seoul/KR Choe; Y. Kim, Shin, S. J. Ko, Han, E. Kang, B.-K. S. C-140 Purpose: increased early decreased mortality detection and tomatic population have from the show We screening arouses controversy. population However, breast cancer. results of our series during a period of 8 years. Methods and Materials: within the screening program years of 45-69 women for population-based program in which women Second, an on-demand program Community. Valencian of the pathology in the breasts or as presenting whether for requested an examination, no limitation on age or place of resi- There was result of a control examination. obtained from 43,955 were mammography of 111,719 studies by A total dence. and 16,973 in the program 26,982 in the population-based in eight years: women on-demand program. Results: Conclusion: On the other hand, the detection of intra- against the population-based program. 45 below The incidence in women higher in the last group. ductal carcinoma was years) with more than two series of age (28.6% in our on-demand program years of the age at which to begin population should perhaps prompt the reappraisal women. especially in young screening and the frequency of exams, hanmail.net) Purpose: (US) assessment ultimately and ultrasonographic mammographic breast lesions by diagnosed as malignancy in retrospect Methods and Materials: and sonographic based on mammographic after biopsy, category given 3 was years, and 637 composed of 462 palpable in 1,099 lesions (41.7%) that were evaluation, malignancy in 18 lesions (1.6%). nal pathology was The fi lesions. nonpalpable and US described using BI-RADS mammographic retrospectively Each lesion was with category compatible assessed whether the lesions were and it was lexicons, ndings suggested malignancy. 3, and if not, which fi Results: with category compatible 3 both on mammography in 6 (33%), 9 lesions were pable Of 9 lesions improperly categorized as category 3, in retrospect. even and on US, suspicious on mammography lesions (44.5%) were Four palpable. 8 (89%) were alone (calcifi hypervascularity: 1; skin retraction: 2; mass: or nonparallel alone (microlobulated suspicious on both examinations. 1) and 1 (12%) was Conclusion: BI-RADS category 3 lesions Palpable cases are placed in category many 3. US, biopsy. managed by should be more carefully assessed and should be safely C-139 and Results of on-demand program of breast cancer: detection Early of 8 years from in a breast cancer centre population-based program 1998-2005 experience, Cervera; J. Olmos, T. Morales, F.J. diagnosis: 23.1%; disagreement: 25.9%. A 94% sensitivity and a 50% specifi A 94% sensitivity and a 25.9%. disagreement: 23.1%; diagnosis: was obtained through the double reading, whereas, in average, 82% sensitivity 82% in average, whereas, reading, the double obtained through was individual radiologists. obtained for city was and 64% specifi Conclusion: city decrease of 14%. of 12% and a specifi there is a sensitivity increase C - 7 0 R C EECR07-C-SciEduc-FIN.indd 31 Scientific and Educational Exhibits
Cardiac logically measure the extent of myocardial injury on P846-enhanced T1-weighted spin-echo imaging (T1-SE). MRI Methods and Materials: In this experimental study, rats were subjected to either of the following myocardial injuries: 30 min LAD occlusion followed by 2.5 h re- perfusion (n=8) to produce non-transmural infarction, or complete LAD occlusion C-143 (n=8) to produce transmural infarction. MR imaging was performed before and after Impact of physiological bradycardia on myocardial high-energy phosphate administration of 0.05 mmol/kg P846. IR-EPI and T1-SE sequences were repeat-
metabolites measured by 31-P 2D CSI edly acquired to measure T1 and injury extent. Histopathology was performed to C. Wolf1, G. Klug2, M. Faulhaber1, T. Trieb1, M. Frick1, B. Metzler1, W. Jaschke1, measure true infarcted size. M. Schocke1; 1Innsbruck/AT, 2 Würzburg/DE ([email protected]) Results: After administration of P846, reperfused infarct showed immediate enhancement on the T1-SE images. This fi nding was confi rmed by the sequential Purpose: 31-P-Magnetic-Resonance-Spectroscopy (31P-MRS) is a unique tool measurement of T1 in the infarcted and peri-infarcted zones. In contrast, occlusive to investigate in vivo high-energy phosphates (HEP) in human heart. We intended infarcts appeared as hypo-enhanced core surrounded by an enhanced rim after to evaluate the impact of low-heart rates on myocardial high-energy phosphates contrast administration. The slow wash-in and wash-out of P846 from myocardium (HEPs). Furthermore, we aimed at comparing training induced. provided differentiation between occlusive and reperfused myocardial injury for Methods and Materials: Twenty-one male volunteers (mean age 46 ± 11 years) 60 min. The T1 values in the occlusive infarcted gradually increased in the 50-min with a physiological heart rate (HR) below 55 bpm were compared to a group of 37 observation period, but it did not reach those values that were obtained in the age-matched normofrequent volunteers (HR > 60 bpm). All volunteers underwent reperfused infarct. 31-Phosphorous 2-dimensional Chemical Shift Imaging (31P-2D-CSI) and cine Conclusion: P846 provides prolonged window of discrimination between occlusive MR images in short and long-axis acquired using breathhold ECG-triggered cine and reperfused myocardial injury. P846 provided persistent (60 min) enhancement bright blood sequences to assess their myocardial HEP metabolism by determin- of peri-infarcted and infarcted myocardium. ing phosphocreatinine to beta-ATP ratios (PCr/b-ATP) on the one side and heart morphology and function on the other side using a 1.5 Tesla scanner. Results: All volunteers were free of known cardiovascular disease. The detailed results C-146 of heart function (ventricular wall thickness, ventricular mass, volume of heart chambers, MRI of cardiac and paracardiac masses: A pictorial review ejection fraction, stroke volume a.s.o). will be presented. In the spectroscopic evalua- G.K. Schneider, P. Fries, M. Boehm, H.-J. Schaefers, I. Kindermann; tion, volunteers with a HR< 50 bpm showed signifi cantly higher PCr/b-ATP ratios than Homburg a.d. Saar/DE ([email protected]) volunteers with a HR> 60 bpm (2.46±0.37 vs. 1.65±0.33, **: p < 0.0001). Learning Objectives: The purpose of this exhibit is to present MRI fi ndings in both Conclusion: In this study, we observed a difference in myocardial HEP metabolism benign and malignant cardiac tumors as well as tumor-like lesions. When helpful between volunteers with bradycardia and normofrequent volunteers. To further de- CT imaging, catheter angiography and echocardiography as well as histologic termine the effects of endurance training or drug-induced bradycardia on myocardial specimens are presented, important fi ndings for diagnosis, staging and therapy HEP metabolism, 31P-MRS might be of clinical importance since PCr/b-ATP is a planning will be highlighted. prognostic marker in patients with structural heart failure. Background: Although cardiac masses are most frequently detected on echo- cardiography, MRI is the method of choice to accurately evaluate and further C-144 characterize cardiac tumors. High-resolution myocardial perfusion imaging at 3.0 T: Comparison to Imaging Findings: An overview of imaging techniques in cardiac MRI together with standard 1.5 T perfusion studies and diagnostic accuracy in patients with proposed protocols to evaluate cardiac masses will be presented. Based on MRI suspected CAD fi ndings and other clinical data, algorithms that give the reader a large spectrum C. Meyer, K. Strach, D. Thomas, M. Hackenbroch, U. Schwenger, H. Schild, of information to characterize cardiac and paracardiac masses will be presented. T. Sommer; Bonn/DE ([email protected]) Case studies include common and rare benign and malignant as well as tumor-like lesions, with typical and atypical manifestation, and these will be correlated with Purpose: To evaluate high resolution myocardial rest perfusion (HRRP) in healthy histology and surgical images. volunteers at 3.0 T in comparison to 1.5 T and the technical feasibility and diagnostic Conclusion: MRI is a valuable tool in the evaluation of cardiac and paracardiac accuracy of 3.0 T high resolution myocardial stress perfusion (HRSP) in patients masses. The maximum information is gained if all clinical information together with with suspected CAD. results of other imaging modalities are taken into consideration. The minimal MR Methods and Materials: All perfusion studies were performed using a T1-TFE-sequence. protocols to characterize a lesion should be understood to add important informa- Seventeen healthy volunteers underwent a HRRP at 3.0 T (pixel size: 3.78 mm2) and tion in the work-up of cardiac and paracardiac masses. 1.5 T (pixel size: 9.86 mm2). Myocardial signal intensity (SI) increase was assessed for 3.0 T and 1.5 T. Image quality was evaluated on a four-point grading scale (4: excellent, 1: non-diagnostic) with respect to homogeneity of myocardial enhancement, blurring and C-147 presence of artifacts. Nineteen patients with suspected CAD HRSP was qualitatively as- Safety of CMR adenosine stress perfusion imaging in patients with sessed for stress-induced hypoperfusion. Hemodynamically signifi cant CAD was defi ned coronary artery disease as stenosis > 70% in conventional coronary angiography. D. Piotrowska, L. Kownacki, O. Rowinski, M. Golebiowski, G. Opolski, L. Krolicki; Results: SI increase in HRRP at 3.0 T was not signifi cantly different from that at Warsaw/PL ([email protected]) 1.5 T (207% ± 43 vs. 199% ± 52, p> 0.05). Image quality was signifi cantly improved Purpose: The aim of this study was to assess safety of stress perfusion CMR at 3.0 T (3.1 ± 0.7 vs. 2.2 ± 0.4, p < 0.01). Mean score of image quality was 2.7 ± 0.7. imaging during adenosine infusion in high risk patients with three vessel coronary The mean SI increase was 170% ± 30. Sensitivity and specifi city of HRSP studies at artery disease and early after acute myocardial infarction. 3.0 T for the detection of signifi cant CAD was 90% and 78%, respectively. Methods and Materials: 126 examination reports of high risk patients who un- Conclusion: HRRP at 3.0 T permits signifi cantly improved spatial resolution and derwent CMR in stress condition during adenosine infusion (140 ug/kg b.w./ min, provides signifi cantly improved image quality in comparison to a standard approach over 4.5 min) were included in the study. 95 of studied patients had stable three at 1.5 T. 3.0 T HRSP is feasible in patients yielding promising results for the detec- vessel coronary artery disease and 31 patients were scanned within one week after tion of signifi cant CAD. acute myocardial infarction. We analyzed response pattern to adenosine infusion and frequency of adverse events. C-145 Results: Adverse events during infusion of the adenosine were observed in 56 P846, a new diffusion/convection MR contrast media, allows differentiation patients (44%). The frequency of adverse events ranged from 16 % for warm feeling, between reperfused and occlusive myocardial infarction using inversion 12 % for dyspnea and 8% for chest pain/discomfort to 7% for temporary atrio-ven- recovery echo-planar and spin-echo MR imaging tricular block. All adverse events disappeared quickly without treatment. Signifi cant A. Jacquier, M. Bucknor, L. Do, C.B. Higgins, M. Saeed; San Francisco, CA/US systolic blood pressure drop (more than 20 mmHg) was seen only in patients with ([email protected]) tree vessel disease and occurred mostly in fourth minute of adenosine infusion. Only in 2 cases stress perfusion was not performed because of pressure drop. Purpose: (1) To determine the usefulness of a new diffusion/convection (medium Conclusion: Stress CMR perfusion using 4.5 minutes adenosine infusion protocol size) MR contrast media P846 in defi ning reperfusion after myocardial ischemia; (2) is safe in patients with advanced coronary artery disease as well as early after to compare the kinetics of P846 in occlusive and reperfused ischemically injured acute myocardial infarction. myocardium using inversion recovery echo-planar imaging (IR-EPI), 3) to chrono-
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7 0 0 2 . 2 363 29 ml, 0 . ± 2 ow voids voids ow 112.02.2007 17:03:47 G 0.05), as well well as 0.05), < 26 to 73 cantly reduced San Francisco, San Francisco, ± 0.05). In chronic 0.05). cantly correlated < 0.05). < and disturbancies ow ([email protected]) 1.1, p
± a reduction was 0.05), but ow voids. In fast-GRE with In fast-GRE voids. ow < 10%; p 10%; ± 30 ml and 80 ± vector c adeno-associated viral Rome/IT 10%; p 10%; C ± 15 ml, respectively; p respectively; 15 ml, ± 8% to 24 33 to 95 ± ± 1.0 versus 2.2 1.0 versus BDEF ± consequent fl disturbances and ow 18 to 52 12% to 38 A ± ± ow evaluation. ow evaluation. MRI was performed in swine at 3 days and 8 weeks and 8 weeks at 3 days in swine performed MRI was Forty-one patients who underwent LACA for symptomatic for LACA Forty-one patients who underwent To understand relationships between fl relationships between understand To 19 ml and 58 and 19 ml ± In 15 patients with mitral or aortic compared In 15 patients with mitral we valvulopathies 0.05) after ablation. No changes were appreciated in LA EF in No changes were 0.05) after ablation. < ([email protected]) ([email protected])
Valvular diseases cause fl Valvular Tagging MRI is useful for assessment of pericardial adhesion and MRI is useful for Tagging Turbulence jets assessment with fast sequences allows rapid semi- rapid sequences allows with fast jets assessment Turbulence LA inverse remodeling was present in all patients submitted to LACA, present in all patients submitted to LACA, remodeling was LA inverse 19 to 85 ± 0.05) and Adhesion Score in chronic phase was signifi in chronic phase was 0.05) and Adhesion Score The purpose of this study is to evaluate the effect of left atrial circumfer- the effect The purpose study is to evaluate of this To determine the effects of cardiac-specifi determine the effects To < GRE cine sequences with 12-14 msec TEs display well the turbulence the turbulence well TEs display msec GRE cine sequences with 12-14 Pre-procedural LAmax and LAmin were smaller and LA EF was higher in smaller and LA EF was LAmax and LAmin were Pre-procedural ([email protected]) ([email protected])
brillation Conclusion: regardless of the clinical outcome. phase, compared with acute phase, pericardial thickness was reduced and new reduced and new was pericardial thickness compared with acute phase, phase, not found. lesion of pericardial adhesion was Conclusion: after cardiac surgerythe image obtained one month can predict pericardial adhe- years. sion in a few noted in patients with AF recurrences (33 as in those patients with relapsed AF (117 respectively; p respectively; (40 patients with successful LACA on GRE images depending on a variety of factors, especially echo time. especially echo time. of factors, on a variety on GRE images depending Details: Procedure (11 and jets using fast-GRE of turbulence grading area, length and subjective gating) and SSFP cine or retrospective bandwidth, prospective kHz receiving 31 as gold standard. sequences with Echocardiography Results: breathing artefacts. by scanning times and are often degraded require long jets but to a minimum TE is forced breath-hold acquisition but sequences allow Fast-GRE with consequent impaired detection of fl value, default gating, reduction of receiving bandwidth to 11-15 prospective 8-11 kHz allows msec gating allows with retrospective fast-GRE jets; turbulence with more marked TEs, least 20 phases resolution (at TE coupled with a higher temporal the choice of any turbulence with variable T2/T1 ratio is due to signal In SSFP blood are required). mapping data and velocity Good correlation with echocardiography jets evidence. cine sequences. gated fast-GRE retrospective has been obtained for Conclusion: function identifying patients needing velocity of valvular evaluation quantitative sensitivities mainly different showed techniques Fast-GRE mapping measurements. SSFP assessment. ow fl for suitable generally are but depending on echo time, fl techniques are not adequate for compared with that in acute phase (1.3 compared with Purpose: treatment in left atrial AF (LA) volumes. for (LACA) ential ablation Methods and Materials: in only when patients were performed MRI was drug refractory included. AF were (LAmax), LA maximal volume and 4-6 months after it. LACA before rhythm sinus compared. (LA EF) were and LA ejection fraction (LAmin) LA minimal volume Results: There recurrences during the follow-up. the 30 patients (73%) with no arrhythmia in the entire and LA EF after LACA cant reduction of LAmax, LAmin a signifi was sinus LAmax and LAmin reduction occurred in those patients with recovered group. (97 rhythm Purpose: (VEGF) on regional myocardial factor endothelial growth vascular for encoding (AAV) resorption using magnetic resonance imaging (MRI). perfusion and infarct Methods and Materials: injected 1h after reperfusion into the was AAV-VEGF after reperfused infarction. (r=0.6, p C-152 atrial for ablation Left atrial remodeling after left atrial circumferential fi Salvador; Sanchez, R. Mont, M. L. Tamborero, D. de Caralt, T.M. Perea, R.J. Barcelona/ES C-153 VEGF injection of adeno-associated viral vector encoding Intramyocardial measurements of resonance magnetic cardiovascular gene improves resorption perfusion and infarct Saeed; M. Higgins, C.B. Do, Martin, L. A. Saloner, D. Jacquier, A. CA/US sion Scores between acute and chronic phases were also signifi were acute and chronic phases sion Scores between C-151 heart diseases of valvular evaluation Cine sequences for Fast Bonomo; L. Lombardo, Meduri, A. A. Natale, L. Learning Objectives: different cine-MRI techniques. different Background:
,16.5 ms), … 0.05). Adhe- 0.05). eld measure- eld < Nicosia/CY =2.5.4.5, 8 Seoul/KR
2
,TE … , cant difference between T2 between cant difference 2 cient (r=0.4 p ,TE 1 Sendai/JP t liver and, particularly, heart iron and, particularly, t liver Scientific and Educational Exhibits Scientific and Educational Seong-Nam/KR, 1 ; 2 ,96 ms) and a breathold multi-echo, k-space ms) and a breathold multi-echo, ,96 … =6, 12, cant correlation between Adhesion Scores by two two Adhesion Scores by cant correlation between 16 , J.-H. Park , J.-H. 2 We performed tagging MRI in consecutive 33 patients 33 patients tagging MRI in consecutive performed We T2 and T2* proton relaxation measurements in the heartT2* proton relaxation measurements T2 and ,TE … To learn the merit and the potential role of cardiac MRI in To , 2 We will illustrate the various MR techniques such as delayed en- MR techniques such as delayed various the will illustrate We , W. Lee , W. 3 1 3 ,TE
1
d d The cardiomyopathies include a variety of diseases where the primary of diseases include a variety The cardiomyopathies Familiarity with MRI techniques and features of various cardio- of various with MRI techniques and features Familiarity n The use of 3.0 T seems to benefi The use of 3.0 i . N I Assessment of pericardial adhesion after cardiac surgery is very impor- Tissue iron overload in b-thalassaemic patients is routinely assessed Tissue iron overload F There was a signifi There was The increased SNR at 3.0 T can be used to increase in-plane spatial The increased SNR at 3.0 , S.I. Choi , S.I. - 1 c u d E i c S - segmented, gradient-echo sequence (TR= 22 TE segmented, gradient-echo ms, ([email protected]) ([email protected]) Learning Objectives: cardiomyopathies. of various the evaluation Background: increas- is proving Cardiac MR (CMR) the myocardium. pathology directly involves in these conditions. cation and management in the identifi ingly valuable Details: Procedure and MRI, cine MRI, tagged MRI using HARP software, hancement, stress perfusion in patients with cardiomyoaphty. of diastolic function) the evaluation VENC-MRI (for dilated, restrictive ischemic, ndings of the characteristic will present MR fi we Also, LV cardiomayoapthy, dysplasia, constrictive arrythmogenic RV cardiomyopathy, non-compaction, and myocarditis diverticulum, stress-induced cardiomyopahty, on the basis of our experiences. Conclusion: diagnosis and proper the accurate is considered to be helpful for myopathies management. C-150 tagging surgery by adhesion after cardiac Assessment of pericardial resonance imaging magnetic Takahashi; S. Takase, K. Yoshioka, I. Ichinose, A. ([email protected]) ([email protected]) Purpose: tant in the conduct of repeat surgery or prediction of right-sided cardiac function. imaging (MRI) is that tagging magnetic resonance hypothesized we In this study, assessment of pericardial adhesion. useful for Methods and Materials: cardiac surgerywho underwent one month ago (acute phase) and repeated the Pericardial (chronic phase). in 12 of them after more than 2 years examination adhe- (0=no adhesion, 1= mild adhesion, 2= severe visually scored adhesion was sites (post sternal one radiologist sion) at two bone site and right site) by ventricular sites The sum of scores at two surgeon independently. and one cardiovascular readers or between two obtained and compared between (Adhesion Score) was acute and chronic phases. Results: readers using Spearman order correlation coeffi rank ([email protected]) ([email protected]) Purpose: of high and advantages the differences on workThis focuses T. with MRI at 1.5 eld measurements. fi Methods and Materials: Evaluation of tissue iron overload in b-thalassaemia patients: in b-thalassaemia patients: overload of tissue iron Evaluation T T and 1.5 between 3.0 A comparative study Posporis; T. Kokkis, S. Eracleous, E. Economides, C. Seimenis, I. C-149 using T, T and 3.0 obtained at 1.5 b-thalassaemic patients were of twelve and liver spin-echo sequence Carr-Purcell-Meiboom-Gill a respiratory-triggered multi-echo, TE (TR=2000 ms, The role of MR imaging in various cardiomyopathies cardiomyopathies in various imaging of MR The role Chun E. C-148 respectively. Both sequences were electrocardiographically gated and prescribed electrocardiographically Both sequences were respectively. pursued for sequence optimization was Moreover, along the short cardiac axis. 3.0 T measurements. Results: Since the delineation. myocardium resolution, which is important accurate for high fi suppression is suggested for fat is larger at 3.0 T, water-fat-shift no signifi studied, there was In the patient group ments. cation (low, classifi in terms of iron overload T, T and 1.5 measured at 3.0 values obtained at T2* determination,T2* values heart regard to With medium or high). T shorter obtained at 1.5 considerably values than the corresponding T were 3.0 at to the increased susceptibility effects be attributed This may subjects. ve in fi and haemo- in ferritin assessing iron distribution for suggest a tool and may T, 3.0 system on the gradient performance the advanced Additionally, siderin deposits. T2* which are necessaryTEs, for the use of submillisecond T system allows 3.0 iron overload. myocardial determination in severe Conclusion: determination in b-thalassaemic patients. level C - 7 0 R C EECR07-C-SciEduc-FIN.indd 33 Scientific and Educational Exhibits
infarcted and peri-infarcted myocardium (n=6), the other 6 pigs served as control. Mean age at reoperation was 27 years and the average time between the corrective Cine sequences (tr/te=8/5 ms, 16 phases), Gd-DOTA fi rst pass perfusion (SR-GRE: repair and reoperation was 19 years. tr/te=3/1.5 ms) and delayed contrast enhancement (IR-GRE: tr/te=4.4/2.1 ms, Conclusion: CMR is a diagnostic imaging modality to indicate reoperation in all TI=270-325 ms) were performed to measure LV function, area at risk (AAR) and our patients with repaired TOF. However, we still need new techniques for a bet- infarct size. At postmortem, the hearts were stained with histochemical TTC, ter interpretation of CMR parameters in order to determine the right moment for Masson’s trichrome and isolectine B4 to characterize myocardium. reoperation. Results: AAV-VEGF prevented the deterioration of LV ejection fraction in treated animals at 8 weeks. AAV-VEGF animals showed greater reduction in the AAR C-156 (39±2% at 3 days to 20±2% LV at 8 weeks) versus control animals (41±2% to Cardiac MRI in patients with previously treated congenital heart disease: 33±2%, p < 0.01). AAV-VEGF improves the reduction in extent of hyperenhanced Long term follow-up results myocardium in treated (19±2% at 3 days to 10±3% LV at 8 weeks) versus control A. Sias, A. Balestrieri, C. Politi, G. Mallarini; Cagliari/IT animals (18%±2% to 15±2%LV, p < 0.01). TTC infarct size was smaller in treated ([email protected]) (10±1% of LV) compared with control animals (14±3% of LV, p < 0.001). Histology showed increase in thin-walled arterioles (38±2/mm² in treated versus 6±2/mm² in Purpose: The purpose of this study is to display the fi ndings of cardiac MR ex- control) and capillaries (1065±78/mm² in treated versus 576±50/mm² in control) aminations performed on a group of patients treated for congenital heart disease in the injection sites. when infants or children, after a period of relative well being which lasted for Conclusion: Intramyocardial injection of AAV-VEGF signifi cantly improved MRI several years. measurements of myocardial function and perfusion. The therapy also increases Methods and Materials: Among a Sardinian population of about 1,200 patients infarct resorption by promoting angiogenesis. surgically treated for congenital heart disease on an average of 15 years before we randomly selected 120 of them and examined with standard cardiac MR to C-154 evaluate the heart morphology, and whether they had any abnormalities which Role of cardiac magnetic resonance imaging (MRI) in the follow-up could have gone undetected with other follow-up examinations to which they had assessment of tetralogy of Fallot (TOF) repair been routinely subjected. P. Serrano Gotarredona, S. Navarro Herrero, L. Aguilar Sánchez, Results: We discovered a number of pathological fi ndings which were not noted, or L. Garcia Camacho, I. Gutierrez Jarrín; Sevilla/ES underevaluated with other imaging examinations and/or clinical examinations. ([email protected]) Conclusion: Follow-up cardiac MR examinations in patients with congenital heart disease surgically treated, even after a long term interval after the intervention, can Purpose: To assess the value of cardiovascular MRI in the follow-up of Tetralogy be useful in defi ning the evolution of cardiac morphology and the development of of Fallot after complete reparative surgery. iatrogenic or surgery related abnormalities, which might go undetected by standard Methods and Materials: We include all the patients who were survivors of TOF follow-up examinations. surgical repair and were explored by MRI in our institution during the last two years. The protocol included 3D MR angiography (MRA) to delineate pulmonary arteries anatomy; spin-echo and gradient echo sequences to delineate right ventricular C-157 Aortic coarctation: Evaluation with cardiovascular magnetic resonance outfl ow tract (RVOT); balanced steady state free precession (b-SSFP) cine-imaging angiography using time-resolved imaging of contrast kinetics (TRICKS) to quantify ventricular function; and phase-contrast velocity mapping (VEC-MR) to R. Sasdelli Neto, I.M.F. Pinto, W.Y. Ishikawa, I.B. Jatene, L.C.B. Souza, quantify pulmonary regurgitation (PR). A.D. Jatene; São Paulo/BR ([email protected]) Results: We studied 16 patients aged between 4 and 34, 11 of them older than eighteen years. The estimated value of ejection fraction of the right ventricle was Learning Objectives: To evaluate aortic coarctation by Magnetic Resonance over 50% in eight subjects, and under 40% in fi ve. Up to thirteen had PR. VEC- Angiography with Time-Resolved Imaging Of Contrast Kinetics (TRICKS). MR sequences concluded regurgitation fraction equal or over 50% in three cases, Background: Cardiac Magnetic Resonance (CMR) in children may be limited between 40 and 50% in two, between 27 and 40% in other seven. The last one in unravelling all details concerning the heart and great vessels. CMR is very at- had a PR of 10%. 3D MRA showed pulmonary artery branches stenosis in seven tractive, however, for it allows an optimal anatomical and functional analysis and cases. It was severe at the level of the anastomoses a case of prosthetic conduit does not require iodine nor radiation exposure. Standard 3D Magnetic Resonance placement because of RVOT re-stenosis. b-SSFP sequences showed residual Angiography (3D-MRA) series may not reveal all anatomical abnormalities because ventricular septal defect in two patients. of incorrect timing of peak enhancement. For a better display of the cardiovascular Conclusion: Cardiac MRI is a valuable method to evaluate and follow-up TOF fi ndings, it would be desirable if one could reconstruct such structures at different patients who had undergone complete surgical repair. It not only provides valu- contrast transit times. The 3D-MRA with TRICKS, available in GE MR scanners, able anatomic information about RVOT and pulmonary arteries, but also quantifi es furnishes sequential MRA Gadolinium-enhanced series and allows the selection of ventricular function and pulmonary regurgitation. the best contrast-enhanced series to study a particular vessel. It would, therefore, be very useful in the evaluation of Aortic Coarctation. C-155 Imaging Findings: Patients’ mean age was 1.2 years (0-12) and they were re- Cardiovascular magnetic resonance in the follow-up of adults with ferred to either diagnose aortic disease or to post-treatment follow-up. All images corrected tetralogy of Fallot: A useful tool to indicate reoperation? underwent extensive time-resolved reconstructions at dedicated workstations and F. Baudraxler, M. Bret-Zurita, E. Cuesta, A. Aroca, J. Oliver, A. Sánchez-Recalde; 3DVR data sets were reconstructed in order to unravel the anatomy of the aorta Madrid/ES ([email protected]) and its main branches. Conclusion: TRICKS is a powerful tool in the evaluation of Aortic Coarctation for Purpose: To demonstrate that CMR can be a useful imaging modality to indicate it allows precise identifi cation of the aorta disease and of additional cardiovascu- reliably a re-operation in patients with repaired tetralogy of Fallot (TOF). To show lar malformations, such as PDA. This was the fi rst MRA technique to provide 3D the indications for reoperation in our patients. temporal display of the fl ow-abnormalities. Methods and Materials: Seventy-six CMR imaging studies of patients with repaired TOF performed between January 2004 and September 2006 were reviewed. A 1.5 T Signa LX 9.1 Echo-Speed GE MR system, body or cardiac array coils were used. C-158 Evaluation by MRI of left ventricular remodelling and global functional SE T1 ECG-gated, FIESTA, PC Flow sequences and MR-Angiography 3D with MPR recovery in patients treated with granulocyte-colony stimulating factor (G- and VRT reconstructions were employed. Morphology and size of cardiac cavities CSF) after acute myocardial infarction (AMI) and aneurysms of the right ventricular outfl ow tract (RVOT), right ventricular ED L. Natale, A. Bernardini, A. Meduri, A. Leone, F. Crea, L. Bonomo; Rome/IT and ES volume, stroke volume, cardiac output, ejection fraction (EF), pulmonary ([email protected]) blood fl ow, and morphology of the pulmonary tree were analyzed. Results: Parameters provided by CMR which indicated reoperation were the Purpose: To assess by MRI the effect of i.v. administration of G-CSF on global following: right ventricular ED volume> 190 ml, EF less than 30%; regurgitation myocardial function after AMI. Recent data suggest better outcome and functional fraction more than 50% and aneurysm of RVOT > 5-6 cm. Forty-six reoperations recovery in patients with AMI treated with stem cells therapy, both with intracoronary were performed in 39 patients. The most common indications referred to aortic root delivery or hematopoietic precursor mobilization by G-CSF. and valve (n=10), right ventricle to pulmonary artery (RV-PA) conduit obstruction Methods and Materials: Eight patients with anterior AMI, treated with primary (n= 9), and enlargement of the RVOT inserting a pulmonary valve prothesis (n=8). PTCA (TIMI 3) and i.v. administration of G-CSF (5 µg/kg for 5 days), were studied
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7 c 0 0 2 3.18 . 2 ± 365 0.05). 0.05). 0 . > 2 112.02.2007 17:03:48 400. The 400. > ed plaques ed G 6.97 mGy and ± ed plaques (FCP) 4.33 vs. 30.05 4.33 vs. ± Chiba/JP ([email protected])
C Beijing/CN Moscow/RU BDEF c bowties can reduce X-ray dose for CT dose for can reduce X-ray c bowties cation adjoining non calcifi c cardiac bowtie on VCT reduced the overall VCT reduced the overall on c cardiac bowtie A cance of focal coronary calcifi cance of focal The data from previously published studies (indexed in studies (indexed published previously The data from 422 subjects underwent MSCT (Lightspeed Ultra 16). We We 16). MSCT (Lightspeed Ultra 422 subjects underwent ed plaques evaluated by multislice computed multislice by ed plaques evaluated To demonstrate the potential of using an application-specifi demonstrate To 0.29, respectively, with no statistical difference (p with no statistical difference 0.29, respectively, ± Thirty cardiac patients in each group with similar sex, age, age, Thirty with similar sex, cardiac patients in each group uence of individual studies on the pooled relative risk allowed risk allowed of individual studies on the pooled relative uence Using application-specifi The application-specifi The results of the meta-analysis demonstrate that relative risk of CVD that relative The results of the meta-analysis demonstrate cantly increased with higher CAC scores. We conclude that CAC score conclude that CAC We scores. cantly increased with higher CAC To determine the signifi To To defi ne predictive value of coronary of value arteryne predictive scoring in calcium (CAC) defi To Our meta-analysis included 8 studies. The studies were very heteroge- The studies were Our meta-analysis included 8 studies. 7.60 mGy, respectively, with t-test of p=0.0015 indicating statistically sig- respectively, mGy, 7.60 cance of focal coronary calcifi coronary cance of focal 0.34 and 3.72 ± ± with p=0.025). Conclusion: impact on other clini- dosage to cardiac patients and image noise without adverse parameters. cally relevant adjoining non calcifi ed plaques (NCP) or exclusive NCP using MSCT. ed plaques (NCP) or exclusive adjoining non calcifi Methods and Materials: (2) with (1) with FCP adjoining NCP, groups: ed subjects into the following classifi or exclusive non calcifi or exclusive tomography Komuro; Shiina, I. Y. Mikami, Y. Uehara, Funabashi, M. N. Purpose: analysis of the infl identifying the outlying studies. Conclusion: signifi events risks were relative since the pooled independent of CVD events, is the risk factor studies on the pooled of outlying The effect risk traditional factors. adjusted for blinded representation of genders, the different by be explained estimates may and longer follow-up. and registrations, endpoint validations nifi cant lower dosage with cardiac bowtie. In addition, the noise measurements for In addition, the noise measurements for dosage with cardiac bowtie. cant lower nifi than those of LB (27.80 statistically lower was the CB group 83.97 C-161 and reduce quality image to improve bowtie The use of a CT cardiac patient dosage Li; N. Wang, Dai, G. Li, R. J. Sun, X. Gao, J. ([email protected]) Learning Objectives: C-162 Signifi Cardiac Cardiac CT (MDCT) Multidetector C-160 calcium score as a predictor of atherosclerotic Coronary Meta-analysis: in asymptomatic patients disease events cardiovascular Morozov; Sinitsyn, S.P. V.E. Ternovoy, S.K. Purpose: patients at higher riskidentifying asymptomatic of atherosclerotic cardiovascular coronary and coro- death, infarction, myocardial (non-fatal disease (CVD) events nary revascularization). Methods and Materials: The studies should have the meta-analysis. for extracted PubMed Medline) were in order to be events of CVD registration reported scores and prospective CAC risk traditional factors) risk (adjusted for Relative included in the meta-analysis. of patients. subgroups score in 3 CAC CVD events used as a meta-meter for was and analyzed heterogeneity, applied Q-test for bias, publication for tested data We of the studies. individual weights Results: The pooled of follow-up. duration and race, sex, age, neous in terms of patients’ CAC 2.1 for was model risk effects random calculated on the basis of relative scores CAC and 9.3 for scores 100-400; CAC 5.0 for scores 1-100; cardiac image quality and reduce patient dose. to improve bowtie Background: ux fl X-ray (CB) that redistributes a cardiac bowtie VCT provides GE imaging. the dose-reduction potential evaluates This study on the heart. to concentrate (LB) using comparing large bowtie it to the use of traditional by of such bowtie patient scan data. Findings: Imaging respec- and heartheight, weight scanned with LB and CB, were distributions rate the image quality blindly evaluated quantitatively radiologists experienced Two tively. edge sharpness ed, vessel and in terms of coronary of the number arteries identifi 4 being the highest. using scores of 1-4, with agent claritycontrast in the vessel measured and statistically sets were the two and image noises for CTDIw values were the CB and LB groups The image quality scores for using t-test. analyzed 3.73 However, the CTDIw values for groups CB and LB were 77.66 CB and LB were groups for the CTDIw values However, cance 37.37 ml; 37.37 ml; ammation ± ammation. ammation. MRI cance regarding cance ndings with the presence ammation in myocardial biopsies ammation in myocardial 41.54 ml; FU-ESV= -25.13 ml; 41.54 ± Scientific and Educational Exhibits Scientific and Educational cant difference. Myocardial infl Myocardial cant difference. Twenty-two patients with DCM underwent ceMRI after patients with DCM underwent Twenty-two 5 3 10.07). The effect of G-CSF approached statistical signifi The effect 10.07).
±
d d n The presence of delayed enhancement does not correlate to myocar- The presence of delayed We found a positive trend with partial a positive statistical signifi found We i . N I Dilated cardiomyopathy (DCM) is a frequent cause of heart failure. Some (DCM) is a frequent cause of heart failure. Dilated cardiomyopathy LR showed signifi cant correlation between DE-score and follow-up follow-up DE-score and cant correlation between signifi LR showed F The most abundant pattern of DE was a stripe-like lesion in the midwall pattern lesion in the midwall a stripe-like The most abundant of DE was - c u d E i c S - was performed on a 1.5 T MRI scanner. Images for DE were acquired 20 acquired 20 DE were minutes Images for T MRI scanner. on a 1.5 performed was categorized This was DE. for visually assessed and were after injection of Gd-DTPA pattern. and the distribution regarding the location in the myocardium Results: cardiac pa- DE and the cant correlation for no signifi There was portion of the IVS. Three genomes (31.8%). viral for positive biopsies were myocardial Seven rameters. 4 of the 15 virus-negative DE versus (42.9%) showed patients of the 7 virus-positive patients (26.7%), with no statistically signifi C-159 is unrelated in patients with dilated cardiomyopathy enhancement Delayed or the presence of infl to virus persistence from the right part ventricular taken Biopsies were of the inter- biopsy. myocardial genomes and infl viral for septum (IVS) and analyzed ventricular FU-EF= +5.43% FU-ESV (p=0.06). only for Conclusion: These data, G-CSF after AMI. treated with i.v. in patients global functional recovery rmed larger series. in a confi need to be however, Hosten; Staudt, N. Hegenscheidt, A. Ruppert, K. J. Langner, S. ([email protected]) Greifswald/DE Purpose: of DE in the ceMRI of DCM patients. Methods and Materials: present in 3 of these patients (25%) DE was detected in 12 patients (54.5%). was cant difference. signifi and in 4 of the remaining 10 patients (40%), with no Conclusion: patients show delayed enhancement (DE) in contrast-enhanced MRI (ceMRI). The (ceMRI). MRI enhancement (DE) in contrast-enhanced delayed patients show Virus and myocardial persistence in DCM. pathologic surrogate of DE is unknown proportion biopsies of in a considerable of myocardial ammation can be shown infl The study compares the histological fi patients with DCM. ammation in myocardial infl dial viruspersistence or to the presence of myocardial biopsies of patients with DCM. EDV (FU-EDV), ESV (FU-ESV), and EF (FU-EF). No signifi cant linear correlation cant linear correlation No signifi ESV (FU-ESV), and EF (FU-EF). (FU-EDV), EDV trend in G-CSF a positive showed and ANCOVA MLR found. with FP-Score was of G-CSF, in DE (effect differences accounting for all functional indexes, for group -22.19 FU-EDV= as LS-Means: expressed by 1.5 T MRI within 7 days and after 3-5 months. Functional, perfusion (FP) and perfusion (FP) and Functional, 3-5 months. and after 7 days T MRI within 1.5 by with eight compared were Values obtained. (DE) studies were enhancement delayed basing on scored FP and DE were (anteriorcontrol patients AMI, primary PTCA). Correlation of FP and extension. and on transmural involved of segments number accounting groups, the two between and differences DE with functional outcome Linear (LR) and Multivariate with Univariate assessed were FP and DE extent, for Analysis (ANCOVA). and Covariance (MLR) Regression Results: C - 7 0 R C EECR07-C-SciEduc-FIN.indd 35 Scientific and Educational Exhibits
exclusive NCP without any calcifi ed plaques (CP) or with NCP separate from CP, C-165 (3) with CP without NCP, and (4) with neither NCP nor CP. Groups were compared Initial experiences of ‘SnapShot Cine’ - low dose prospective as to age, sex, coronary risk factors (CRFs). electrocardiograph (ECG)- triggering coronary 64-slice CT angiography (CTA) Results: The 4 groups had 81.43,147, and 77 subjects, respectively. The incidence M. Kiguchi1, J. Horiguchi1, K. Ito1, K. Marukawa1, C. Fujioka1, M. Ishifuro1, of hypertension and diabetes mellitus (DM) were higher in Group (1) (69% and T. Furukawa1, Y. Shen2, F. Watanabe2; 1Hiroshima/JP, 36%) than in (4) (34% and 12%). The incidence of CRFs, number of males, DM, 2Tokyo/JP ([email protected]) hyperlipidemia (HL), and smoking were signifi cantly higher in (1) than in (2). In logistic models, HL and obesity (relative risks 2.40 and 2.52) were associated Learning Objectives: To demonstrate low radiation dose in 64-slice coronary CTA with incidence of FCP adjoining NCPs. Furthermore we divided group (2) into two using prospective ECG-triggering. To demonstrate reduction of banding and cone groups: (2 A) with exclusive NCP without any CP or (2B) with NCP separate from beam artifacts by 3D back projection (3DBP) algorithm. CP. CRFs were 2.6 (2B) and 1.5 (2 A) and that of (2 A) was similar to (4). Background: Diagnostic capability of 64-slice CTA for coronary artery disease Conclusion: CRFs were more frequent in subjects with FCP adjoining NCP than has been already accepted and become a widely spread use. The major draw- in other groups. FCP adjoining NCP may indicate the advanced arteriosclerosis. back of the technology is the high radiation dose caused by data acquisition with Conversely, CRFs were less frequent in subjects with exclusive NCP than in other retrospective-ECG gating on which the raw data includes cardiac phases not groups with any NCP and/or CP but similar in subjects with neither NCP nor CP contributing in image reconstruction. Advancement of ECG-modulated retrospec- and presence of exclusive NCP may indicate early staged arteriosclerosis. tive-ECG gating technique and prospective ECG-triggering scan are strongly desired to overcome this problem. C-163 Procedure Details: A 64-row x 0.625 mm-collimation confi guration (40 mm) (GE Healthcare) is used for data acquisition with prospective ECG-triggering. Three or Presence of focal fatty infi ltration of the right ventricular wall in asymptomatic 4 X-ray exposures per examination with 5 mm overlapping cover 11 cm or 14.5 cm patients undergoing screening coronary calcium scoring on EBCT in z-axis. Banding artifacts, which are caused by misregistration of data and have J. Kirsch, E.E. Williamson, J. Glockner; Rochester, MN/US been observed so far on retrospective-ECG gating scan, are reduced. Conebeam Purpose: Macroscopic focal fat deposition along the free wall of the right ventricle artifacts seen on multi-slice CT technology are also reduced by 3DBP algorithm. We (RV) has been historically associated with arrhythmogenic right ventricular dyspla- present initial experiences of this software as to dose saving and image quality. The sia. Recently, it has been shown that this fi nding can be seen in patients without image quality was assessed on motion artifacts and data continuity (occurrence of ARVD. In this investigation, we assess the incidence of fatty infi ltration of the RV banding artifacts), with relation to the scanning time and heart rate. in a cohort of patients without clinical evidence of ARVD. Conclusion: ‘SnapShot Cine’ 64-slice coronary CTA using prospective ECG-trig- Methods and Materials: 120 consecutive patients undergoing non-contrast ECG- gering, with signifi cantly reduced dose, has a potential to replace retrospective- gated EBCT for coronary calcium scoring comprised the study group. Images were ECG gating CTA. evaluated for the presence or absence of RV fatty infi ltration as well as additional fatty proliferation in the mediastinum, lipomatous hypertrophy of the interatrial C-166 septum, and changes of thoracic surgery. Medical records were assessed to obtain Cardiac CT for the stratifi cation of cardiovascular risk in patients age, gender, body-mass index, and arrhythmias detected on ECGs obtained within undergoing major non-cardiac surgery: Background, rationale and 6 months of imaging. Patients with surgical changes were excluded to avoid false- possible diagnostic algorithm negatives secondary to artifact. Images were evaluated, by consensus, by 2 of 3 L. Damiani, A.L. La Fata, E. Maffei, A.A. Palumbo, F. Notarangelo, A. Aldrovandi, dedicated cardiac radiologists. F. Cademartiri; Parma/IT ([email protected]) Results: Of the 120 patients, 12 were excluded due to lack of required information in the medical records and/or surgical changes. 12/108 (11%) patients had fatty Learning Objectives: To provide current methods and guidelines for stratifi cation of deposition along the RV wall. cardiovascular risk in patients undergoing major non-cardiac surgery. To understand Conclusion: Focal fatty infi ltration of the RV is a fairly common fi nding in the patient the rationale for stratifi cation of cardiovascular regarding different implications of population, and should not be considered as defi nitive evidence of ARVD. inducible myocardial ischemia in the surgical theatre. To provide an algorithm for stratifi cation of cardiovascular risk in patients undergoing major non-cardiac surgery C-164 that includes Cardiac-CT. Background: In daily clinical practice, patients undergoing major non-cardiac Three-dimensional CT angiography of various anomalous pulmonary surgery need a stratifi cation of their cardiovascular risk. This is performed by venous return: From pathophysiology to post-operative evaluation means of scoring methods and diagnostic tests (i.e. ECG, stress-ECG). However, S. Jun, W. Lee, J.-E. Cheon, W.-S. Kim, I.O. Kim, K.-M. Yeon; Seoul/KR these tests are sub-optimal and because of their low sensitivity and specifi city may ([email protected]) under/over-estimate the potential risk. Conventional coronary angiography, which Learning Objectives: To describe the wide spectrum of the anomalous pulmonary is the diagnostic gold standard, cannot be performed in all patients since it is inva- venous return. To understand pathophysiology and radiologic features of this entity sive and the prevalence of signifi cant disease is intermediate or low. Cardiac-CT and diverse post-operative anatomical and hemodynamic changes. To evaluate is a non-invasive method for assessment of signifi cant coronary artery disease the utility of three-dimensional CT angiography in the diagnosis and management characterized by a high sensitivity and negative predictive value. In addition, it can of this entity. provide the coronary atherosclerotic plaque burden and the type of lesions associ- Background: Anomalous pulmonary venous return shows diverse anatomical and ated with an individual patient undergoing surgery. These additional informations hemodynamic spectrum, which range from isolated incidental fi ndings to compo- can change surgical and anaesthesiological management. nents of more complex anomalies, most often congenital heart disease. Correct Procedure Details: 1. Description of current scoring methods and guidelines diagnosis with CT angiography affects the patient’s treatment and allows avoiding for pre-operative cardiovascular risk assessment. 2. Description of cardiac-CT unnecessary invasive studies. features that may improve stratifi cation of cardiovascular risk. 3. Description of a Procedure Details: We retrospectively reviewed CT angiography with 3D recon- diagnostic algorithm for patients undergoing major non-cardiac surgery including struction images of 41 consecutive patients with anomalous pulmonary venous cardiac-CT. return (16 PAPVR and 25 TAPVR) from June 2002 to March 2006. Twenty-nine Conclusion: Cardiac-CT may become in the future a standard diagnostic pre-operative CT angiography were available and 21 post-operative CT angiography method for the stratifi cation of cardiovascular risk in patients undergoing major were available; among them, both pre-and post-operative CT angiography were non-cardiac surgery. available in 9 cases. We will show the diverse spectrum of anomalous pulmonary venous return and remind the check points in imaging interpretation to provide C-167 critical information for surgical planning and post-operative evaluation. Thrombi in the left cardiac appendix with state-of-the-art multislice CT: Conclusion: Three-dimensional CT angiography provides precise and excellent A reason for discussion between radiologists and cardiologists? overview of the diverse spectrum of anomalous pulmonary venous return, nonin- A.L. La Fata1, L. Damiani1, E. Maffei1, A.A. Palumbo1, G. Runza2, F. Cademartiri1; vasively. In addition, it allows in assessing other anomalies involving the bronchial 1Parma/IT, 2Palermo/IT ([email protected]) tree or visceral organs. This exhibit will help you to understand the characteristic imaging features and diverse post-operative anatomical and hemodynamic changes Learning Objectives: 1. To describe the main clinical techniques used for the of this entity, and to remind the information critical for surgical planning and post- detection of thrombi in the left atrium (Trans-thoracic and Trans-Esophageal operative evaluation. Echocardiography; TTE and TEE) and the potential of Multislice CT in this diag-
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7 0 0 2 . 2 367 0 . 2 112.02.2007 17:03:48 ed plaques G ed plaques and a m voxel size (MicroCT) and 0.6 size mm m voxel µ C plaques and plaque rupturesed were BDEF A ndings from MicroCT and histopathology may ndings from MicroCT and histopathology may culties using routine diagnostic techniques. Applica- culties using routine diagnostic techniques. ([email protected]) ([email protected])
Eleven autopsy specimens of human coronary vessels Eleven ndings show that current clinical CT is mainly limited by that current clinical CT is mainly limited by ndings show To present the usefulness of ECG-gated multislice computed of ECG-gated multislice present the usefulness To ed spots found by histopathology were detected by DSCT, DSCT, detected by histopathology were by ed spots found cations and vessel wall thickening. A lower density structure, A lower thickening. wall cations and vessel Examinations of 30 adult patients with variable cardiovascular cardiovascular Examinations of 30 adult patients with variable rst experience with CT for percutaneous defect closure of the closure percutaneous defect with CT for rst experience The prevalence of congenital heart 1% of diseases is approximately The prevalence MSCT allows precise diagnosis of complex cardiovascular mal- cardiovascular precise diagnosis of complex MSCT allows This fi DSCT tends to overestimate medium and large calcifi medium DSCT tends to overestimate Groningen/NL To compare visualization of atherosclerotic plaques by Dual Source compare visualization of atherosclerotic plaques by To Some calcifi distance between atrial defect and aortic root and inferior vena cava is measured cava and aortic atrial vena distance between defect and inferior root are compared in and closure devices Atrial defects in CT and echocardiography. after closure procedure. and before 3D visualization, Conclusion: atrium seems promising. were scanned with MicroCT (Siemens MicroCATII, Siemens Molecular Imaging, scanned with MicroCT (Siemens MicroCATII, were ni- Defi agent and with DSCT (SOMATOM without contrast Tennessee) Knoxville, agent (mean Germany) with contrast Forchheim, tion, Siemens Medical Solutions, reconstructedThe images were at 48 250 HU). C-171 artery on coronary plaque analysis autopsy Morphological atherosclerotic computed micro computed tomography, specimens using dual source and histopathology tomography, Willems, T.P. Greuter, M.J.W. Ooijen, van P.M.A. Dikkers, R. Kristanto, W. Oudkerk; M. Purpose: (MicroCT) Tomography (DSCT), Micro Computed Tomography Computed and histopathology. Methods and Materials: C-170 shunts in adults: with intra and extracardiac malformations Cardiovascular in diagnosis spiral computed tomography The possibilities of multislice examinations and postoperative follow-up Drop; A. Tomaszewski, A. Staskiewicz, Uhlig, G.J. S. Czekajska-Chehab, E. Lublin/PL Learning Objectives: of examinations follow-up and postoperative (MSCT) in diagnosis tomography and limita- the advantages understand To malformations. cardiovascular complex of hearttions of MSCT in imaging as well anomalies with atrial and septal defects as with discordant ventriculoarterial returns. connections and anomalous venous congenital heart diseases with shunts. review To Background: vessels’ with great Detection of some of them, especially when combined all births. cause some diffi may anomalies, cardiac imaging is increasing and becoming more precise along tion of MSCT for both accurate That enables in modern scanners. with higher resolutions achieved circulatoryvisualization of central system and adjacent anatomical structures. Findings: Imaging group Selected processed. scanner were and 64-row with 8-row performed defects patent ductus arteriosus, heart univentricular with transposi- VSD, ASD, contained: left tetralogy, arteries,tion of great arteries, of great corrected transposition Fallot’s and right sided partial anomalous pulmonary returns and persistent left venous after surgical corrections of some In addition, CT examinations cava. superior vena Multiplanar and 3D reconstructions acquired were presented. were of the defects with respect to educational purpose. and shown Conclusion: imaging even tool for being a valuable evaluation, and postoperative formations Moreover, circulatorycomplicated and infrequent anomalies of central system. visualization of congenital heart as allow and 3D reformations multiplanar defects ideal educational material. slice thickness (DSCT). Histopathology analysis was performed afterwards for for afterwards performed Histopathology analysis was (DSCT). slice thickness the morphology the reconstructed images, of the plaques was From reference. compared to the histopathological results. Results: histopathology Some soft plaques observed by in size. overestimated were but Smaller calcifi DSCT. by shown vaguely were MicroCT clearly could not be detected on DSCT. but histopathology, observed by small calcifi showed observed inside one of the large calcifi suspected as lipid pool, was possible plaque rupture was also observed plaque rupture in one of the specimens on MicroCT. was possible Conclusion: whereas it misses the small ones. Soft plaques are shown but vaguely. MicroCT vaguely. but Soft plaques are shown whereas it misses the small ones. its high by as can be expected on plaque morphology, more details much shows Our fi spatial resolution. Analysis of the fi spatial resolution. CT data. help interpret the clinically available , 1 , D. Ardissino , D. , 1 1
, A. Aldrovandi , A. , A. Aldrovandi , A. 2 2 Palermo/IT 2 Scientific and Educational Exhibits Scientific and Educational ([email protected])
, L. La Fata , L. 2 , L. Damiani , L. 2 Parma/IT, Parma/IT, 1 ; 1 Palermo/IT 2 , L. La Fata , L. , L. Damiani , L. 1 1 1. To briefl y introduce clinical manifestation related to related to y introduce clinical manifestation briefl To 1. 1. To provide ECG fundamentals for correct CT setting. 2. 2. correct CT setting. ECG fundamentals for provide To 1. Drawings for the explanation of ECG basics are presented. ECG basics are presented. of the explanation for Drawings 64-slice CT allows a motion-free 3D images of ASD and PFO. a motion-free 3D images of ASD and PFO. 64-slice CT allows 1. Description of TTE and TEE and the diagnosis of left appen- and TTE Description of 1. 7 3
Parma/IT, Parma/IT,
1 , F. Cademartiri , F. d ; 1 , E. Maffei , E. , E. Maffei , E. d 1 TTE is not an optimal technique for the examination of the left ap- the examination optimal technique for TTE is not an Atrial septal defects (ASD) and patent foramen ovale (PFO) are one ovale and patent foramen (ASD) Atrial septal defects 1 1 ECG and physical examination are the primary evaluations performed are the primary examination evaluations ECG and physical n Left appendix thrombi are easily displayed and several discrepan- and several easily displayed Left appendix thrombi are i In clinical practice, patients with coronary heart disease may have irregu- patients with coronary In clinical practice, heart have may disease . 65 bpm, no premature beats) minimizes image motion artifacts and beats) minimizes bpm, no premature 65 N < I F - c u d E i c S - Several examples of heart of examples beats abnormalities and improvement are shown Several A correct placement of image quality is reported after ECG editing. and before It is described to get how artifacts: signal ECG electrodes is mandatory to avoid the best ECG signal. Conclusion: irregular heart will be not considered as an In the near future, rhythm lar heart rates. CT of the heart criteria for exclusion and ECG-editing will become routine in enhancing CT. cardiac the inclusion of more patients for the image quality and allowing ([email protected]) Learning Objectives: tips give To of coronary 3. and CT appearance ECG traces correlate arteries. To good image quality in patients with ECG post-processing editing for for and tricks irregular heart rates. Background: to radiolo- of ECG is becoming familiar The knowledge heartto overview conditions. demonstrated studies have Several cardiac imaging. in non invasive gists involved rhythm, sinus (i.e. ECG track that the synchronization of the scan with an optimal heart rate patients with coronary In clinical practice, cantly increases image quality. signifi CT-CA for irregular heartartery upgrades and software rates have disease may bigeminism, irregular heart premature beats, to handle can help the radiologists abnormalities. and other rhythms Details: Procedure F. Cademartiri F. C-169 Role of 64-slice closure: defect planning of percutaneous Non-invasive CT cardiac Palumbo A.A. C-168 What radiologists need to know CT of the heart: Basics of ECG for Palumbo A.A. pendix. TEE is the current clinical gold standard but it is invasive and operator and operator it is invasive but TEE is the current clinical gold standard pendix. de- a non operator modality providing 64-slice CT is a non invasive dependent. of Multislice current generation The cardiac chambers. pendent assessment of the sub-millimiter spatial resolution and good temporal CT scanners uses ECG-gating, It also assessment of coronary increasingly accurate resolution to provide artery. detection. the allows Details: Procedure 3. Description the diagnosis of left appendix thrombi. of CT (64-slice) 2. dix thrombi. the discrepancy for Gallery of examples 4. all techniques. Gallery for of examples a resume of providing Table both techniques. for and the sources of mis-diagnosis the limitations. each technique and ndings for the fi Conclusion: thrombi from other CT can also differentiate TTE and CT are found. cies between clinical gold soon become a new all these reasons may cardiac masses and for assessment of cardiac chambers. the standard for nostic set-up. 2. To provide examples of discrepancy between those techniques those techniques between of discrepancy examples provide To 2. nostic set-up. the possible explain To 3. and viceversa). and CT negative positive (Ultrasound this discrepancy. reasons for Background: Learning Objectives: and (PFO) with drawings ovale and patent foramen (ASD) atrial septal defects the role of cardiac CT in the planning of percutaneous defect show To 2. schemes. modalities of 3D visualization of different examples several provide To 3. closure. means of CT. by Background: ischemia predispone to cerebral They of the most common cardiac abnormalities. right-to-left shunting under condi- thromboembolism by as a result of paradoxical maneuver). right that raise atrial pressure (valsalva maneuvers tions or physiologic depic- a decade and it needs an accurate for closure is reliable defect Percutaneous trans-esophagel Since now, a correct surgical planning. for tion of atrial anatomy Cardiac the anatomical and functional informations. has provided echocardiography a better reproducibility of thanks to an higher spatial resolution, a non-invasivity, CT, helping to correctly images of atrial anatomy, excellent measurements can provide choose the best occluder device. Details: Procedure are measured in systole (during All dimensions of tissue surrounding the defect In particular, (during systole). ventricular and in dyastole dyastole) ventricular F. Notarangelo F. C - 7 0 R C EECR07-C-SciEduc-FIN.indd 37 Scientific and Educational Exhibits
C-173 presence of associated cardiovascular and cerebrovascular disease in the PVD group were obtained from the patient’s medical record. Why do we misinterpret lesions on cardiac CT while compared with Results: Age and sex distribution were similar in both groups. Prevalence of risk fac- catheter coronary angiography? A critical review series collaborated tors in both groups was as follows (CAD/PVD): 77%/68% hyperlipidaemia, 55%/61% with cardiologists hypertension, 47%/69% smoking, 39%/44% positive family history and 17%/36% T. Lee, I.-C. Tsai, W.-L. Lee, C.-T. Ting, M.-C. Chen, W.-C. Liao; Taichung/TW diabetes. In the PVD group, 42% and 23% had symptomatic CAD and cerebrovascular ([email protected]) disease, respectively. In the CAD group, 12% had symptomatic cerebrovascular disease. Learning Objectives: To understand the limitations and artifacts of CT coronary Coronary disease on investigation was more severe than in comparable studies angiography. To understand when, how and why we misdiagnose in CT coronary Conclusion: This study has shown that the prevalence of risk factors and associated angiography. To understand the possible reasons for the discrepancy between CT co-morbidity are either comparable or higher than studies carried out elsewhere. Higher and catheter coronary angiography. prevalence of smoking and diabetes was noted in the PVD group. Findings of the coro- Background: CT coronary angiography is recently a hot topic. With the advent nary and peripheral angiograms and the resulting treatment will be discussed. of MDCT, this technique is gradually integrated into the clinical practice. But this technique is so new that the standards of training, interpretation and clinical practice C-176 are not established yet. What are the basic requirements of an ‘interpretable’ scan? Utility of 64-DAS MSCT for accurate measurement of coronary calcium When and why do we misinterpret? Are the misinterpretations avoidable? These score using a pulsation mock-vessel considering pulsating rate, tube are important questions we will try to answer by this review series. current and reconstruction methods Procedure Details: We retrospectively review 72 cases that underwent both the N. Funabashi1, N. Mizuno1, K. Suzuki2, M. Terao2, K. Nakamura1, F. Maeda2, 40-detector row CT coronary angiography and catheter coronary angiography. All M. Uehara1, I. Komuro1; 1Chiba/JP, 2Tateyama/JP initial reports and images are critically reviewed by collaboration of two cardiac radiologists and a senior interventional cardiologist. Using catheter coronary Purpose: To evaluate 64-DAS MSCT (Light Speed VCT, GE) with 0.625 mm slice- angiography as reference, all the misinterpretations are critically discussed. All thickness, 0.35s/rotation, tube 120KV and max tube current 800 mA, ECG-gated. the lessons learned are summarized with consensus. About the CT aspect, the We used pulsating calcifi ed mock-vessels and measured total calcium score (CS) discussed topics include respiratory motion, heart rate, heart rate stability, arrhyth- based on Agatston, and evaluated high tube current and suitable reconstruction mia, image noise, interpretation skill, post-processing technique, reconstruction methods especially for higher pulsation rates. phase selection and window settings. Some misinterpretations of catheter coronary Methods and Materials: Four calcifi ed mock-vessels (200-400 HU) were made angiography are also found during the review process and will be demonstrated to pulsate at a rate of 50-110/min. MSCT (Light Speed VCT, GE) scanning with and discussed in the exhibit. 0.625 mm slice-thickness, tube-volt 120KV, and tube-current 600 mA was performed Conclusion: Most misinterpretations in CT coronary angiography are related to ten times per pulsation rate. For comparison, the same scanning except tube-cur- the techniques in interpretation, image acquisition and processing. Most of them rent 300 mA was performed. Suitable reconstruction methods were selected, and are potentially avoidable. total CS was measured at most static phase. Results: At 600 mA, CS were 345±2.6,350±10.9,354±19.6,329±28.6, 201±68, C-174 254±41.9,289±16.4, and 286±39.4, respectively, at 0, 50~110 beat/min using segmented method, 345±2.6,350±10.9,354±19.6,329±28.6,340±34,341±41.9, Multidetector CT in the anatomic evaluation of left atrium and pulmonary 292±33.6, and 289±13.2, respectively, at 0, 50~70beat/min reconstruction segment, veins in atrial fi brillation patients: A pictorial assay 80~110beat/min reconstruction burst. At 300 mA, CS were 343±3.4,304±49.5,363 M. Centonze, M. Del Greco, M. Marini, G. Nollo, F. Ravelli, V. Manera, ±14.2,331±24.8,213±15.2,268±16.3, 295±39.6, and 272±12.6, respectively, at 0, F. Dalla Palma; Trento/IT ([email protected]) 50~110 beat/min using segment method, 343±3.4,304±49.5,363±14.2,331±24.8 Purpose: To show typical anatomic pattern and variance of the left atrium-pulmo- ,351±15.2,347±16.3,336±39.6, and 289±12.6, respectively, at 0, 50~70beat/min nary veins complex (LA-PV) studied by 16 slices Multidetector CT (MDCT) in atrial reconstruction segment, 80~110 beat/min reconstruction burst. Total CS at 50-110 fi brillation (AF) patients candidated to percutaneous ablation. The exact knowledge beat/min, relative to the static state was 102, 103, 95, 58, 74, 84, and 83% at tube of this anatomic region is extremely important to increase the effi ciency and effi cacy current 600 mA, and 89, 106, 97, 62, 78, 86, and 79% at 300 mA, reconstructed of the procedure, and to reduce the related complications. by the segment method. But at a higher rate, at 600 mA, this was improved to 99, Methods and Materials: In the last three years, 65 AF patients (15 females, 50 99, 85, and 84% reconstructed by burst methods at 80-110beat/min. males) underwent MDCT cardiac examination using retrospective gating and dose Conclusion: High tube-current is more precise for evaluating CS, especially at modulation with reconstruction of 75% of RR ECG interval. lower rates. At higher rates of > 80beat/min, the burst method may further improve Results: In the patient population, we identifi ed 141 right PV, 11 of which were the accuracy of calcium measurement. suprannumerary; 112 left PV, 19 of which common trunk and 1 suprannumerary. In 60% of patients, the anatomic pattern was typical (2 right and left PV) and in the C-177 remaining 40% atypical (23% 2 right PV and left common trunk; 2% 3 right PV and 3 Evaluation of coronary artery calcifi cation with multi-slice computer left PV; 6% 3 right PV and left common trunk). In the defi nition of branching, MDCT tomography in chronic kidney disease stages 3 and 4 identifi ed 55 branchings of the right inferior PV, 41 of the right superior PV, 4 of the K.S. Pointon, A. Stavroulopoulos, C.J. Porter, D.J. Hosking, S.D. Roe, left superior PV, 6 of the left inferior PV and 2 of the suprannumerary veins. M.J.D. Cassidy; Nottingham/UK ([email protected]) Conclusion: MDCT represents a fundamental diagnostic imaging tool in the anatomic defi nition of the PV that is characterized by great variability. Radiologists Purpose: To describe the prevalence and extent of coronary artery calcifi cation must be familiar with anatomic variants and understand the importance of these (CAC) in chronic kidney disease (CKD) stage 3 and 4 patients comparing those variants to the refering cardiac interventional electrophysiologist. with and without diabetes. To determine if presence of peripheral artery calcifi cation (PAC) would assist in identifying patients positive for CAC. C-175 Methods and Materials: CAC was detected by multi-slice computed tomography on a General Electric Medical Systems Lightspeed 16 scanner, and PAC by plain Correlation of prevalence of risk factors in cardiovascular and peripheral foot radiography. Study population was 112 patients, 58 without and 54 with dia- vascular disease betes, asymptomatic for heart disease. Demographic and laboratory data were P. Chaturvedi1, H. Jones2, M.R. Rees3; 1Bangor/UK, 2Cardiff/UK, 3Gwynedd/UK collected and analysed. ([email protected]) Results: Prevalence of CAC was 76% and 46.5% in CKD patients with and without Purpose: To analyze and correlate the prevalence of risk factors and associated co- diabetes, respectively. In the multivariate analysis model for the whole group, age, morbidity in symptomatic coronary artery and peripheral vascular disease patients. diabetes and obesity were the major predictors of CAC. Patients with diabetes had Methods and Materials: The study was conducted at Gwynedd hospital, Bangor, higher CAC scores with more vessels affected, and in the presence of diabetes men North Wales, a 550-bed district general hospital. All patients who were referred for and women had the same risk for CAC. Severity of renal dysfunction was a predictor of coronary or peripheral angiograms between January 2004 and May 2005 were CAC in the patients without diabetes, but not when diabetes was present. Phosphate included in the study. A total of 168 patients of the CAD group and 160 patients of levels were predictive of CAC in patients without diabetes, and parathyroid hormone the PVD group were included. Data on age, sex, and risk factors were recorded. levels were associated with the extent of CAC in patients without diabetes and when Data was also collected on the extent of coronary artery disease (CAD), peripheral all CKD patients were considered. PAC detected by foot radiography was not an vascular disease (PVD), and the treatment given to that patient. Data regarding adequate alternative-screening marker for identifying patients with CAC.
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7 c 0 0 ca- 2 . 2 369 0 . 2 112.02.2007 17:03:49 ndings. ndings. ndings in G C ets. Systolic diameters of ascending Systolic ets. BDEF rst time the diagnosis was made. Thirteen made. rst time the diagnosis was ([email protected]) ([email protected]) A
brosis in hypertrophic obstructive cardiomyopathy), cardiomyopathy), brosis in hypertrophic obstructive ([email protected])
To review MDCT fi ndings of oncology related cardiac ndings of oncology related cardiac MDCT fi review To Presented herein are cardiac CTA protocols optimised for protocols optimised for Presented herein are cardiac CTA Pamplona/ES Detailed 16- and 64-row slice protocols from the major CT Detailed 16- and 64-row MDCT images from patients with breast cancer, lymphoma, MDCT images from patients with breast cancer, MDCT is commonly used for the evaluation and follow-up of of and follow-up the evaluation MDCT is commonly used for The number of coronary CTA examinations has increased dramati- examinations of coronaryThe number CTA Optimised protocols for cardiac MDCT require an understanding Optimised protocols for ECG-CT enables reliable evaluation of aortic valve’s morphology of aortic valve’s evaluation reliable ECG-CT enables Boston, MA/US Appropriate knowledge of tumoral and non-tumoral related MDCT features and non-tumoral Appropriate of tumoral knowledge BAV was detected in 1.61% of examinations, e.g. 24 patients (age: 22-72, 24 patients (age: e.g. detected in 1.61% of examinations, was BAV pathology in oncologic patients ndings of cardiac eld of view for imaging native coronaries and bypass grafts, effective mAs, kV, and kV, mAs, effective grafts, coronaries and bypass imaging native for eld of view methods of postprocessing in end-diastolic and end-systolic phases were used. In used. were and end-systolic phases in end-diastolic methods of postprocessing addition, morphology diameters of aorta ventricle, and function of left at 4 specifi analyzed. pathologies were and other cardiovascular levels Results: the fi it was In 16 cases, mean 37.6). of left arterialpatients had pathological changes 2 stenosis, ostium (8 regurgitations, plane to aortic parallel End-systolic reformation valve 3 regurgitation and stenosis). of aortic leafl evaluation optimal for most was aorta 16-59 18-60 were 36.2 38.4), diastolic: Dilatation mm (mean: mm (mean: mm). 65-326 was of left ventricle ml EDV of ascending aorta cases. diagnosed in 12 was abnormal EF was in 7 cases. enlarged in 12 cases. was 175 ml), ventricle (mean: coarctation of aorta, tetralogy, Fallot’s ASD, VSD, such as: Concommitant defects ed. and coronary identifi anomalies were arteries’ PAPVR Conclusion: et variant. giving opportunity leafl of its two of diagnosis oncological patients. Background: and tumoral different of patients, in this group Incidentally, oncological patients. non-tumor-related heart involvement, such as metastatic disorders can be found, non-tumor related heart cardiac disorders, and chemo- paraneoplastic disorders, a role in the MDCT plays related cardiac side effects. and radiotherapy therapy detection of these entities. Findings: Imaging melanoma bronchogenic carcinoma, pheochromocytoma, and carcinoid will be (1) epicardial metastatic groups: divided into four was Cardiac affection discussed. exten- and caval cardiac invasion direct tumoral metastases, myocardial disease, (carcinoid cardiac syndrome); cardiac involvement (2) non-metastatic tumoral sion; be misdiagnosed as car- that may (3) non-oncological related cardiac affection fi diac metastasis (myocardial rupture) or vascular myocardial pericardial implants (surgical changes following and secondary formation (4) radiotherapy (thrombus to port reservoir); invasion coronary and pericardial drugs calcifi induced changes (infarcts, chemotherapy Learning Objectives: to diagnose and report radiologists encourage cardiac fi To disorders. pericardial effusion, cardiomyopathy). tions, Conclusion: of oncological patients with ancillary cardiac fi a complete evaluation allows C-182 MDCT fi Hernandez, C. Villanueva, Bastarrika, A. G. Alonso-Burgos, Diaz, A. M. Garcia del Barrio; L. C-181 CT multidetector coronary for Optimised contrast-enhanced protocols angiography Rybicki; F.J. Learning Objectives: MDCT 16- and 64-row for illustrated acquisition and high spatial resolution, rapid images obtained from 16- and coronary between CTA Differences technology. 64-slice scanners are illustrated. Background: (MDCT) tomography computed multi-detector cally with the introduction of faster (total injection parameters contrast relationships between Understanding scanners. of injection, and dual injection) duration rate, ow fl iodine concentration, volume, has become important to optimise protocols. Details: Procedure bolus tracking, test bolus vs. highlighted include: Parameters are presented. vendors fi and reconstruction Optimal acquisition vary parameters reconstruction parameters. the principles delivery generally of contrast however, across scanner manufacturers; media with a higher iodine The use of contrast remain constant across scanners. (370-400 concentration superior arterial MDCT enables mgI/mL) with 16- or 64-row and total iodine dose. volume enhancement with a smaller total contrast Conclusion: medium with a higher iodine Use of a contrast important parameters. of several while minimizing the total the iodine delivery rate helps maximize concentration media volume. administered contrast , 2 Monza/IT, Monza/IT, 1 ; 1 , L. La Grutta , L. 1 Rotterdam/NL, , S. Sironi , S. 1 1 ; 1 , N. Mollet , N. 1 , T. Khouri , T. 2 Scientific and Educational Exhibits Scientific and Educational , F. Pugliese , F. , F. Cademartiri , F. 1 1 , S. Seitun , S. 3 , R. Malagó , R. 1 , P. de Feyter , P. ECG-CT examinations and clinical data of 1488 patients ECG-CT examinations 1 ([email protected]) ([email protected]) , M. Inserra , M. 1. To modify the standard protocol of coronary imaging To 1. To discuss the acquisition protocol and reconstruction discuss the acquisition al- To
2 A 64-MSCT scanner (LightSpeed VCT, General Electric, Electric, General VCT, A 64-MSCT scanner (LightSpeed In this exhibit, we provide examples of DSCT coronary an- examples provide we In this exhibit, 9 3
d d Regional kinesis alteration of IVS is associated with different cardiac IVS is associated with different of Regional kinesis alteration , A. Weustink , A. , G. Krestin , G. The recently introduced DSCT scanner permitsThe recently introduced coronary imaging with n DSCT allows high-resolution scanning of the entire thorax within a high-resolution scanning of the entire thorax DSCT allows CAC is common in CKD stages 3 and 4 patients, especially in those especially in those 3 and 4 patients, is common in CKD stages CAC 64-MSCT is an effective imaging modality in depicting IVS contrac- 64-MSCT is an effective 1 1 i , E. Giglio , E. (fi [email protected]) (fi . Catania/IT 1
3 N I Bicuspid aortic valve (BAV) occurs with incidence of 0.9-2%. The defect The defect occurs with incidence of 0.9-2%. (BAV) Bicuspid aortic valve F - c u d E i c S Genoa/IT, Genoa/IT, Palermo/IT - single breath hold. We demonstrate image quality of DSCT coronary angiography coronary image quality of DSCT demonstrate angiography We single breath hold. discuss the acquisition We heart surgery. in patients with various after bypass rates protocol and reconstruction of both optimal image quality algorithm, which provide coronary CABG and native arteries. Learning Objectives: high resolution (83 image quality in patients with higher improved provides ms), which the entire heart Moreover heart when compared to earlier rates scanner generations. within a single breath-hold of 8 to 12s. course can be acquired and graft Details: Procedure of normal grafts. and diseased and occluded bypass in the evaluation giography shown. surgery examples bypass techniques are discussed and various Different ce indicators, artifacts orifi originating address possible from graft In addition, we of both bypass in the evaluation surgical clips and sternal discuss pitfalls and wires, coronary and native arteries.grafts Conclusion: gorithm which provide optimal image quality of bypass grafts and native coronary and native grafts optimal image quality of bypass gorithm which provide address artifacts for and interpretative strategy To arteries with Dual-Source CT. surgery. after bypass in patients CT coronary angiography Background: W. Meijboom W. ECG - gated computed tomography (ECG-CT) in diagnosis of the of the (ECG-CT) in diagnosis ECG - gated computed tomography bicuspid aortic valve Drop; A. Staskiewicz, Uhlig, G.J. S. Tomaszewski, A. Czekajska-Chehab, E. Lublin/PL Purpose: heartcan be associated with different anomalies and usually predisposes to serious Authors rare. detection in CT are extremally Reports of BAV’s clinical complications. diagnosis. in application of ECG-CT in BAV present their experience Methods and Materials: Standard scanner). 476 with 64-row 8-row, with (1012 performed analyzed were 10% of R-R reconstructions and typical 2D and 3D cardiac CT protocol with every C-180 2 C-179 of (64-MSCT) in the evaluation computed tomography 64-multislice interventricular septum (IVS) contraction anomalies Spagnolo P. Dual-source computed tomography (DSCT) angiography for the for (DSCT) angiography computed tomography Dual-source artery (CABG) grafts visualisation of coronary bypass Alberghina F. 2 with diabetes. Prevention and treatment of the reversible risk factors may affect affect may risk factors reversible and treatment of the Prevention with diabetes. history. its natural C-178 Conclusion: tion anomalies. tion anomalies. Milwaukee) was employed, using the following parameters: 64x0.625 collimation, parameters: using the following employed, was Milwaukee) agent was iodinate contrast pitch 0.24, 680 rotation time 350 i.v. mA, 120 msec.; kV, 80 20 by phase injection : cc at 5 with a double cc at administrated cc/sec followed 65 beats administered to patients with heart were above rate 4 Beta-blockers cc/sec. then reconstructed phases covering Axial images were at multiple (bpm). per minute After 0% and 95%. the cardiac cycle in increments of 5% of the R-R interval between to a workstation, contiguous multiphase transferred images were the reformatted short-axis using semiautomated interactive generated and long-axis images were 4.2, CardIQ III function, GE Healthcare). Windows (Advantage software Conclusion: Learning Objectives: kinesis different recognize To 2. studies in order to depict IVS and right ventricle. pattern cardiac diseases. of IVS related to various Background: meanings of which both pathological and physiological have conditions which may determine that may block branch a) left bundle the most important are the following: represent an independent predictor of and may asynchrony ventricular intra-left b) pulmonary increase embolism that in heart patients; failure cardiac events severe cardiomyopathies; d) restrictive pericarditis; c) constrictive right pressure; ventricle cardiac surgery. e) post-operative Details: Procedure C - 7 0 R C EECR07-C-SciEduc-FIN.indd 39 Scientific and Educational Exhibits
C-183 nodular pericardial thickening was found in 5 (29.4%) and 1 (4.8%), diffuse thicken- ing in 7 (41.2%) and 7 (33.3%), and associated pleural effusion in 13 (76.5%) and Imaging of the myocardium and pericardium with contrast-enhanced 16- 13 (61.9%), respectively, without statistically signifi cant differences. The amount and 64-slice CT: Spectrum of disease of pericardial effusion was not different between malignant and benign pericardial R. Salgado, B. Shivalkar, B. Op de Beeck, P.M. Parizel, C. Vrints; Edegem/BE effusion. Diagnostic performances including sensitivity, specifi city, positive predictive ([email protected]) value (PPV), and negative predictive value (NPV) of nodular pericardial thicken- Learning Objectives: To understand normal imaging characteristics of contrast- ing to diagnose malignancy were 29.4%, 95.2%, 83.3%, and 62.5%, respectively. enhanced CT images of myocardium and pericardium, together with a great variety Diagnostic performances of diffuse pericardial thickening (41.2%, 66.7%, 50%, of common and more rare pathologic conditions involving these structures. and 58.3%) and associated pleural effusion (76.5%, 38.1%, 50%, and 66.7%) Background: Since the introduction of 16- and especially 64-slice, CT radiolo- were relatively low. One case of tuberculous pericardial effusion showed a nodular gists are increasingly involved in the execution and interpretation of CT images of pattern of pericardial thickening. the heart and coronary arteries. While there is extensive literature on the imaging Conclusion: Although CT features of malignant and benign pericardial effusion of the coronary arteries, CT imaging features of the myo- and pericardium have are nonspecifi c, nodular pattern of pericardial thickening has a high specifi city to been scarcely reported. diagnose malignant pericardial effusion. Imaging Findings: It is the aim of this pictorial review to familiarize the radiolo- gist with the common presentation on CT examinations of myo- and pericardium, C-186 including normal anatomy variations. Furthermore, a wide variety of diseases like The infl uence of heart rate fl uctuation on cardiac image quality and the myocardium infarctions of different ages, congenital entities like non-compaction improvement by combining varispeed scan technique (VST) and multi cardiomyopathy, pericardial cysts and other pathologies are reviewed. The images sector reconstruction algorithm (MSR) are collected from more than 3000 16- and 64-slice cardiac CT examinations J. Liao1, Y. Shen1, X. Ge2, S. Wu2, J. Li1, J. Qi2; 1Beijing/CN, 2Tianjing/CN gathered between 2003-2006. ([email protected]) Conclusion: Pathology in the myocardium and pericardium is frequently encoun- tered during CT examination of the heart and coronary arteries. Solid knowledge Purpose: To determine the infl uence of heart rate (HR) fl uctuation on cardiac of both normal and abnormal presentation of these structures will increase the image quality. To evaluate the improvement by using Varispeed Scan Technique diagnostic accuracy of the radiologist, as such limiting errors of interpretation. (VST) and Multi Sector Reconstruction (MSR). Methods and Materials: A novel cardiac phantom was used to simulate the C-184 volume change of heart and coronary arteries. The phantom was set at 3 base HR (60, 85, 105 bpm) with a shift of 0, 2.5, 5, 10, 15 bpm and underwent a 16-row Densitometry of coronary artery plaque: Measurement of accuracy by MDCT (GE LightSpeed 16) with the slice thickness 0.625 mm and pitch 0.275:1. 64-slice CT For each pulsating mode, VST was used (0.5 s/r and 0.6 s/r). All scan data was C. Fujioka1, J. Horiguchi1, K. Ito1, M. Kiguchi1, M. Ishifuro1, T. Furukawa1, Y. Shen2; reconstructed with 2 algorithms [Cardiac Half Reconstruction (CHR), Multi Sector 1Hiroshima/JP, 2Tokyo/JP ([email protected]) Reconstruction (MSR)]. Then VR and MPR images were reformatted to display Purpose: Less-invasive detection and characterization of coronary artery plaque the stenosis. A fi ve-grade standard was made based on the image quality. Three by CT coronary angiography is challenging. In previous studies, CT densities were doctors evaluated the image and calculated the mean score. different between soft and intermediate plaques. A recent study using 16-slice CT, Results: 1. At each base HR, the image quality degraded signifi cantly with the however, reported that there was a considerable overlap. The purpose of this study increase of fl uctuation range (p < 0.05). 2. At 60 and 105 bpm, the image quality is to validate the accuracy of 64-slice CT densitometry of soft and intermediate with 0.5 s/r was better than the one with 0.6 s/r. But at 85 bpm, the image qual- plaque using a pulsating cardiac phantom. ity with 0.6 s/r was better than the one with 0.5 s/r. 3. At the higher HR (85 bpm, Methods and Materials: Acrylonitrile-butadiene-styrene resin (35 HU) and acryl 105 bpm) and wider HR fl uctuation range, MSR could improve the image quality (100 HU), which are used for simulation of soft and intermediate plaques, were signifi cantly (p < 0.05). used in the coronary artery models (diameters: 3 mm and 4 mm, respectively). Conclusion: HR fl uctuation is an important reason that degrades the image quality. Variable parameters included heart rate, cardiac reconstruction algorithm, coronary VST could optimize the matching of rotation speed and HR to improve image quality. arterial enhancement (150 HU, 250 HU, 350 HU and 450 HU), CT densitometry MSR could provide the better temporal resolution and it is effective in reducing the site, plaque shape and the stenosis (25%, 50% and 75%). infl uence of HR fl uctuation. Results: For soft plaque, CT densitometry was accurate in low heart rate (50 bpm) with half reconstruction algorithm (p < 0.01) and on intracoronary enhancement C-187 of 250 HU (p < 0.01). For both soft and intermediate plaques, the densitometry MDCT-CA volume rendering/auto track vs. MPR/MIP analysis to assess near the arterial lumen was overestimated and higher than those at the center coronary artery stenosis (p < 0.01). For plaque sizes of 50% of the arterial diameter or more, accurate CT V. Alaimo1, G. Runza1, L. La Grutta1, M. Galia1, G.F. Lo Re1, T.V. Bartolotta1, densitometry was possible in every case. F. Cademartiri2, M. Midiri1; 1Palermo/IT, 2Parma/IT ([email protected]) Conclusion: Coronary artery enhancement has a signifi cant impact on 64-slice CT densitometry of coronary artery plaquea, especially soft ones. A large plaque Learning Objectives: To display as a correct approach to detect coronary artery size, densitometry not near the arterial lumen, intracoronary enhancement of disease is based on a careful evaluation of coronary tree by using manual track vessel 250 HU and a low heart rate are factors for precise measurement. In clinical analysis and MPR/MIP reconstructing approach. To demonstrate as the degree of practice, accurate CT densitometry of the plaque seems to be diffi cult, except in coronary arteries stenosis is infl uenced by different post-processing techniques. favorable situations. Background: Cardiac MDCT is a non-invasive technique to recognize presence of coronary disease, thanks to the capability to identify vessels remodelling and coro- C-185 nary stenosis. In this exhibit, we will describe the use of different post-processing techniques for the assessment of coronary artery stenosis, such as VR/Auto track CT fi ndings of pericardial effusion: Differential diagnosis between approach and MPR/MIP conventional assessment, which are compared. malignant and benign diseases Imaging Findings: Post-processing procedures were performed using auto-cage J. Sun, K. Park; Suwon/KR ([email protected]) bone removal/auto track and MPR-MIP/manual track vessels analysis. Images Purpose: To clarify the CT fi ndings useful for differentiating between malignant obtained with the methods were compaired. and benign pericardial effusion. Conclusion: VR images of LAD, CRX and RCA, clearly show the non-calcifi ed Methods and Materials: From May 2003 to June 2006, a total of 45 patients (27 stenotic tract of the vessels, but often overstimate the degree of stenosis compared men and 18 women; mean age: 54.3 years) with pericardial effusion detected on with MPR/MIP assessment. Stenosis of the marginal and diagonal arteries with a CT scans underwent pericardiocentesis (N=45) or pericardial biopsy (N=14) in small diameter are diffi cult to assess with VR and Auto track analysis. The correct our institution. Pathologic studies confi rmed malignant pericardial effusion in 17 approach for an accurate and complete evaluation of coronary tree cannot exclude cases. Twenty-one other cases were confi rmed as benign by pathologic results and the vessels analysis by MPR/MIP reconstruction. follow-up studies. CT images were analyzed, determining the pattern of pericardial thickening, the amount of pericardial effusion, the presence of pleural effusion, and other associated fi ndings. Results: In patients with malignant (N=17) and benign (N=21) pericardial effusion,
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EECR07-C-SciEduc-FIN.inddCR07-C-SciEduc-FIN.indd 4400 112.02.20072.02.2007 17:03:4917:03:49 9 4 : 3
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7 0 0 2 . 24%, 2 371 ± 0.01), cantly 0 ciently . < 2 112.02.2007 17:03:49 cant positive cant positive G cantly different 40.4 ml, and -21 Chiba/JP cients between CT and CT cients between ± 24.5%, respectively. ± at second-scan). The averages of The averages at second-scan). 2 0.05). cantly decreased to 96 mg/ml at the C < 0.05). There was a signifi There was 0.05). 126.7 ml, 25.8 < ± BDEF A =0.1514, P 2 ed portions, measured under the manually were 36.7 ml, and -20.5 rst and 12.6 rst and 12.6 mm ± ([email protected])
rst-scan and 62 HU at second-scan and the mean of rst-scan and 62 rst scan and signifi 21 asymptomatic subjects (16males, median 69 years) median 69 years) 21 asymptomatic subjects (16males, Twenty-nine patients with valvular heart patients with valvular diseases under- Twenty-nine 2SD of the differences of EDV, ESV, and EF between CT and and EF between ESV, of EDV, 2SD of the differences Seoul/KR 0.05). The mean areas of NCP were not signifi areas of NCP were The mean 0.05). ± < 54.1 ml, 28.5 ± In all subjects, estimates of EDV, ESV, and EF were signifi EF were and ESV, estimates of EDV, In all subjects, Atorvastatin may decrease area of NCP if LDL levels are suffi decrease area of NCP if LDL levels Atorvastatin may Volume rendered virtual CT angioscopy is useful in the evaluation of rendered virtual is useful in the evaluation CT angioscopy Volume cations, shape of the valves, valve thickening, pannus at the mechanical pannus thickening, valve shape of the valves, cations, To evaluate the usefulness of virtual in patients with CT angioscopy evaluate To To quantitate the annual effect of Atorvastatin on size and content of non-calci- of Atorvastatin size on effect quantitate the annual To 21 NCP (18 LAD, 2L Cx, and 1RCA) were evaluated. The mean LDL The mean LDL evaluated. 2L Cx, and 1RCA) were 21 NCP (18 LAD, provided VCTA 2-5). 3.78 (range, quality was VCTA of grade Average ed plaques of coronary arteries following atorvastatin treatment by treatment by atorvastatin arteriesed plaques of coronary following ed coronary and comparing plaques (NCP) using MSCT LDL cholesterol levels. correlated between CT and ILVG, but CT tended to underestimate EF. In subjects CT tended to underestimate EF. but CT and ILVG, correlated between and estimates of EF were and ESV, EDV with OMI, CT tended to overestimate These discrepancies with OMI. in subjects CT and ILVG less correlated between asynergy 3-dimensionally more wall LV be due to capability of CT to estimate may ILVG. than accurately Conclusion: ILVG were 8.0 were ILVG respectively. In 37 subjects with OMI, the correlation coeffi In 37 subjects with respectively. (all P 0.79, 0.84, and 0.60, respectively and EF were ESV, EDV, for ILVG and the averages and EF between CT and ILVG were 0.3 were CT and ILVG and EF between Conclusion: between both scans (11.8 at fi between which could suggest a change in NCP increase CT values, decreased and may Further in a larger population studies are needed using 64-MSCT components. cient decreases in LDL levels. with suffi C-193 of virtual in the evaluation CT angioscopy Usefulness of volume-rendered heart diseases valvular Choe; Y. Jeon, M. Purpose: C-192 on size of non- and content of atorvastatin effect Quantitative annual calcifi CT multislice Komuro; Shiina, I. Y. Mikami, Y. Uehara, M. Funabashi, N. Purpose: fi Methods and Materials: given all were LDL measurements, Following enrolled. MSCT were with NCP by re- were and MSCT and LDL measurements 1-year, mg of Atorvastatin for 10 The area and CT selected in each subject. NCP was One remarkable peated. calcifi excluding of NCP, values same conditions. Results: 122 was mg/dl at the fi level heartvalvular diseases. Methods and Materials: 2 pulmonary diseases, valve 6 mitral diseases, 40-slice MDCT (24 aorticwent valve The diseases). 4 aortic diseases, valve and mitral 1 tricuspid valve diseases, valve with Advantage generated were virtual (VCTA) volume-rendered CT angioscopy compared virtual radiologists Two 4.1, GE Medical systems). workstation (Version quality VCTA images (MPR). reformatted CT angioscopic images with multiplanar of the regarding to the distribution CT images evaluated We in 5 scales. graded was calcifi valve areas. and valve vegetations, valve, Results: of the 8 patients VCTA to that of MPR in 16 patients (55%). similar information In 5 patients (17%), MPR provide than MPR. more information (28%) provide valve shape of the valve, cations, calcifi of the valve Distribution more information. better visualized were and vegetations at the mechanical valve, pannus thickening, homogeneously enhanced. was cavity when left ventricle on virtual CT angioscopy, than on VCTA on overestimated stenosis was of aortic the degree valve However, MPR image. Conclusion: on the architecture of the more realistic information It offers heartvalvular disease. and vegetations. and soft tissue lesions such as pannus valves CT values were 55 HU at fi 55 were CT values HU at second-scan and both were rst and 45 HU at fi 40 were SDs of CT values cantly higher in the second scan (P signifi correlation between the ratios (%) of annual change in area to baseline area at change in area to baseline (%) of annual the ratios correlation between of Atorvastatin (x) after one year cholesterol levels rst scan of NCP (y) and LDL fi treatment (y=0.0106x-0.7265, R second scan (P , , 1 2 ex artery, and artery, ex , F. Maeda , F. 1 , M. Uehara , M. 2 y-through is 80 (32-107) mm , M. Terao , M. 2 , K. Nakamura , K. 2 ([email protected]) ([email protected])
2SD of the differences of EDV, ESV, ESV, of EDV, 2SD of the differences Scientific and Educational Exhibits Scientific and Educational ± , K. Suzuki , K. 2 , M. Terao , M. 2 ([email protected]) ([email protected])
Tateyama/JP Tateyama/JP 2 Groningen/NL 80 beat/min, an appropriate reconstruction method , F. Maeda , F. cient in most patients. The introduction of dual source cient in most patients. 1 > , K. Suzuki , K. 1 61 subjects (45 male, mean 65 year old) who underwent old) who underwent mean 65 year 61 subjects (45 male, Chiba/JP, Chiba/JP, Twenty patients were scanned using a dual source MDCT patients were Twenty A pulsating device (AZ-631N, Anzai Medical) with contrast with contrast (AZ-631N, Anzai Medical) A pulsating device 1 Tateyama/JP ; 2 1 0.01). 0.01). The averages < 1 4
d d , K. Nakamura , K. , N. Mizuno , N. 1 1 n This 64-DAS MSCT can measure EDV even at high beat rates (up to at high beat rates even MSCT can measure EDV This 64-DAS Dual source MDCT allows for high quality visualization of the coronary for Dual source MDCT allows i Chiba/JP, Chiba/JP, . 1 y-through or virtual angioscopy using dual source MDCT data MDCT or virtual using dual source y-through angioscopy , I. Komuro , I. N 1 ; I To determine whether CT is useful to evaluate cardiac volume and func- cardiac volume determine whether CT is useful to evaluate To Coronary fl y-through, or virtual angioscopy (VA), has been studied ever has been studied ever y-through, or virtual (VA), angioscopy Coronary fl To evaluate 64-DAS MSCT (Light Speed VCT, GE) at 0.625 mm slice- GE) at 0.625 VCT, MSCT (Light Speed 64-DAS evaluate To 1 F For all subjects, averages of EDV, ESV and EF were 119 ml, 57 ml and ml, 57 119 ESV and EF were of EDV, averages all subjects, For VA could be performed in every patient for each of the major coronary patient for in every could be performed VA The mean EDV and ESV were 98, 97, 97 96, 95, 94, and 101% and 98, 97, 97 96, 95, 94, and and ESV were The mean EDV - c u d E i c S - (the burst method) may further improve the accuracy of EF measurement. of EF measurement. the accuracy further method) may improve (the burst Purpose: CT to measure using 64-multislice (LVG) ventriculography left performed tion, we (EF) of the (ESV) and ejection fraction end-systolic volume end-diastolic (EDV), (ILVG). LVG compared with invasive 3-dimensionally, (LV) left ventricle Methods and Materials: recruited were within 1week VCT) and ILVG enhanced ECG-gated CT (Lightspeed [OMI]). infarction (37 with old myocardial Results: The correlation coef- respectively. 54% in CT and 119 ml, 31 ml and 75% in ILVG, 0.34, 0.83, and 0.67, and EF were ESV, EDV, for CT and ILVG cients between fi (all P respectively I. Komuro I. M. Uehara M. C-191 left with invasive compared computed tomography Utility of 64-multislice of left analysis quantitative 4-dimensional volumetric ventriculogram for ventricle Funabashi N. P.M.A. van Ooijen, M. Oudkerk; Oudkerk; Ooijen, M. van P.M.A. C-190 fl Coronary MDCT could prove to enable VA in all patients. VA to enable MDCT could prove Methods and Materials: Purpose: limited because of the its application was However, in 2000. since its invention Recent an optimal CT scan and time consuming post-processing. requirements for until but VA easy construction of facilitate in post-processing software advances insuffi image quality was now, Germany) using a standard coronary Forchheim, artery Siemens, nition, (Defi (TeraRecon, on an AquariusWorkstation performed was Post-processing protocol. recorded in mm together was per major branch Length travelled CA). San Mateo, with the time required in minutes. Results: length of the automated fl The mean (range) arteries. the left circumfl the left anterior 75 (21-116) mm for descending, for Utility of multislice computed tomography with a 64-data acquisition with a 64-data acquisition computed tomography Utility of multislice a pulsating using analysis volumetric four-dimensional system for pulsation rate and reconstruction methods phantom and considering Funabashi N. C-189 arteries because scanning with this machine is independent of the patient in every the successful virtual in all patients. by This is clearly shown angioscopy heart rate. should be determined in the near future. VA of the clinical value Potential 109 (21-190) mm for the right coronary artery. Calcifi cations and stenoses are Calcifi the right coronary109 (21-190) mm for artery. LAD, 3 required was Mean time min for most side branches. as as well visualized, the RCA. for LCx, and 2 minutes 2.5 min for Conclusion: Purpose: 4-D volumetric ECG-gated for mA, tube 120KV at 400 0.35s/rotation, thickness, and end- to measure end-diastolic (EDV) used pulsating phantoms we analysis, (EF) to assess reconstruction fraction and ejection methods systolic (ESV) volume higher pulsation rates. especially for Methods and Materials: material (300 at 40-110 to-and-fro move- moved 10x with saline was mgI/dl) diluted and The EDV rate. x5 per pulsation performed ECG-gated MSCT was ments/min. using workstation measured Aze). (VirtualESV were Plus, Place Advance Results: compared to the static 145, 143, 142, 144, 145, 149, 156 and 160%, respectively, 76% at 40-110 pulsations/min, when 80, 81, 81, 80, 79, 77, 73, and EF was state. to 82, 83, 85, and 84% improved was the segmented method, but reconstructed by The latter is therefore method. the burst at 80-110 beat/min when reconstructed by higher rates. more appropriate for Conclusion: ESV tended to be over- Because compared to the static state. 110 beats per minute) EF tended to with the static state, 140-160% compared approximately estimated by How- static state. 73-81% compared with the approximately be underestimated by of at higher beat rates ever, C - 7 0 R C EECR07-C-SciEduc-FIN.indd 41 Scientific and Educational Exhibits
C-194 diagnostic spin-off of CT coronary angiography relates to its capability of showing any thoracic fi nding and therefore several different fi ndings, such as non coronary New acquisition method to exclusively enhance the left side of the heart causes of chest pain, may arise (i.e. pulmonary embolism, aortic dissection, pul- by a small amount of contrast material achieved by 64-slice computed monary artery fi stula, coronary fi stula, bronchogenic cyst, pericarditis, oesophageal tomography disease, pulmonary sequestrum, mediastinal masses, etc). N. Funabashi1, K. Nakamura1, F. Maeda2, K. Suzuki2, M. Terao2, N. Mizuno1, Imaging Findings: This exhibit will overview all causes of cardio-thoracic syndrome M. Uehara1, I. Komuro1; 1Chiba/JP, 2Tateyama/JP mimicking coronary artery disease. Examples will be provided with patho-physi- Purpose: To exclusively enhance the left side heart by a small amount of contrast ological explanation. material (CM) using rapid acquisition of MSCT (Light Speed VCT, GE) with a 64- Conclusion: CT coronary angiography applied to cardio-thoracic syndromes is able data acquisition system (DAS) and 0.625 mm slice thickness, we measured the to detect all major non-coronary causes of chest pain. For this reason, it is becoming mean and standard deviations (SD) of the CT values at each site. the gold standard for chest pain assessment especially in ER settings. Methods and Materials: 110 consecutive subjects underwent ECG-gated MSCT. Dependent upon transit time, total volume of CM was determined, ranging from C-197 45 to 60 ml. Transit time plus 3 seconds after injection of CM at a rate of 4 ml/sec Coronary artery anomalies at 64-slice coronary CT angiography followed by saline (Dual Shot, Nemoto), scanning was performed with retrospec- C. Thilo, P. Costello, U.J. Schoepf; Charleston, SC/US ([email protected]) tive ECG-gated reconstruction, and end-diastole volume data were transferred to a workstation (Virtual Place Advance Plus, Aze). Learning Objectives: The aim of this exhibit is: 1) To review the classifi cation of Results: The mean of the CT values of the right atrium (RA), right ventricle (RV), coronary artery anomalies. 2) To differentiate clinically signifi cant and insignifi cant left atrium, left ventricle, aorta, right coronary artery, left main, left anterior descend- variations. 3) To illustrate coronary anomalies based on 64-slice coronary CT ing and left circumfl ex branch were 225±76, 251±72, 353±55, 355±51, 352±34, angiography (cCTA). 4) To emphasize small vessel anatomic variations. 312±65, 296±57, 285±55, and 267±60 HU, respectively. The SD of the CT values Background: The increased use of cardiac CT leads to more frequent detection of those were 39±22, 37±16, 32±7, 31±8 HU, 25±5, 36±15, 31±13, 36±23, and of coronary anomalies. Improved temporal and spatial resolution of 64-slice CT 40±18 HU, respectively. enables visualization of small anomalies, which have been insuffi ciently described Conclusion: The mean of CT values of the RA and RV were signifi cantly lower to date. than the left side heart (P < 0.01) with excellent SD. We could easily obtain coronary Imaging Findings: The following imaging fi ndings will be reviewed and discussed: arteries without artifact due to high CT values of the RA and RV. We successfully Coronary anomalies: Frequency and clinical signifi cance - Normal variants - Benign obtained exclusive enhancement of the left heart using a small amount of CM. coronary anomalies - Malignant coronary anomalies - Coronary artery fi stulas - Small vessels of the heart: Anatomy and variants of the sinus node artery, conus C-195 branch, septal perforators, etc. Conclusion: 1) Coronary artery anomalies are more frequently detected since Patency of coronary arteries surrounded by drug-eluting stent by 64-slice the introduction of cCTA. 2) cCTA with 64-slices enhances our knowledge on multislice computed tomography: Comparison with bare metal stents small vascular anatomy and small vessel variation. 3) In most cases, congenital N. Funabashi1, K. Nakamura1, F. Maeda2, K. Suzuki2, M. Terao2, M. Uehara1, anomalies are asymptomatic and incidentally detected. 4) In symptomatic patients I. Komuro1; 1Chiba/JP, 2Tateyama/JP with suspicion of coronary artery anomalies, cCTA is emerging as the diagnostic Purpose: To evaluate the patency of coronary arteries surrounded by drug-eluting modality of choice. stents (DES) compared with bare metal stents (BMS), we performed 64-slice MSCT. Methods and Materials: Thirty-fi ve consecutive subjects, with a total of 63 stents C-198 (10DES, 53BMS) (25LAD, 12LCx, and 26RCA), underwent enhanced ECG-gated Comparison between iodine and gadolinium-enhanced multidetector CT MSCT (Light Speed VCT, GE) performed with 0.625 mm slice thickness, 0.35sec coronary angiography: Preliminary report per rotation, 120kv tube volt, and tube current increased up to 750 mA only in 35- P. Carrascosa1, C. Capuñay1, M. Bettinotti2, A. Goldsmit2, J. Carrascosa1, 80% of the R-to-R interval of ECG. The patency was confi rmed in all 10DES by R. Pissinis1; 1San Isidro/AR, 2Capital Federal/AR conventional coronary angiogram. ([email protected]) Results: Patency was confi rmed in 70% DES (83, 50 and 50% with 3.5, 3, and 2.5 mm diameters, respectively), and in 87%BMS (100, 88, 95 and 69% with 4, Purpose: To determine the sensitivity (S) and specifi city (Sp) of gadolinium-en- 3.5, 3, and 2.5 mm diameters, respectively). Patency of 30% DES (17, 50, and hanced CT angiography (Gd-CTA) and iodine-enhanced MDCT (I-CTA) for the 50% with 3.5, 3, and 2.5 mm diameters, respectively) and 13% BMS (0, 12, 5, and detection of signifi cant coronary stenosis compared to digital angiography (DA). 31% with 4, 3, 5, 3, and 2.5 mm diameters, respectively) could not be confi rmed Methods and Materials: Eighteen patients with known coronary artery disease because of partial volume effects due to small size. 6% BMS revealed a low CT underwent Gd-CTA, I-CTA and DA. CTs were performed with a 16-row CT scanner. area inside the stents (1 each with 4, 3.5, and 3 mm diameters). 4% BMS revealed For Gd-CTA, a volume of 0.4 mmol/kg of body weight of gadolinium was adminis- total occlusion (1 each with 3.5 and 3 mm diameters). tered. For the I-CTA, a volume of 100 ml of contrast material containing 350 mg/ml Conclusion: 64-slice MSCT is a non-invasive diagnostic modality with the potential of iodine was administrated. The axial images and reconstructions of the coronary for evaluating patency of DES with a low incidence of restenosis, especially DES tree of both acquisitions were reviewed independently and directly compared. The with 3.5 mm diameter. However, due to partial volume effects, it remains diffi cult if degree of enhancement, the capability of an adequate delimitation of the coronary the lumen is 3 or 2.5 mm. BMS had a thinner slice thickness and bigger lumens, tree and the detection of coronary artery disease were evaluated. Both acquisitions and their patency was easier to evaluate by MSCT. determined the presence of plaques and measured the coronary stenosis. Those equal or above 50% where considered as positive fi ndings. C-196 Results: Gd-MDCT angiography was successfully completed for evaluation in all patients. Axial and multiplanar reconstruction images showed adequate visualiza- Unusual causes of cardio-thoracic syndromes on cardiac CT mimicking tion of the main coronary artery. The mean peak attenuation during I-CTA was coronary artery disease 253.65 HU, whereas during Gd-CTA it was 135.20 HU. A total of 310/312 segments A.L. La Fata1, L. Damiani1, E. Maffei1, A.A. Palumbo1, G. Runza2, F. Cademartiri1; were evaluated for both Gd-CTA and I-CTA. Gd-CTA showed S of 89%, Sp of 96%, 1Parma/IT, 2Palermo/IT ([email protected]) whereas I-CTA showed S of 84% and Sp of 95%. Learning Objectives: 1. To overview the causes of cardio-thoracic syndromes. To Conclusion: Gd-CTA showed similar results when compared to I-CTA in the patients provide examples of non coronary fi ndings identifi ed on CT coronary angiography analyzed. It can be considered as an alternative way to perform coronary angiograpy in patients with cardio-thoracic syndromes. in patients who have contraindications to iodinated contrast material. Background: Within the patients with chest pain and overt coronary artery disease, there are a large number of negative fi ndings. A small niche of these patients present with chest pain that mimics coronary artery disease and they may carry unusual fi ndings. In these patients, the diagnostic challenge may be diffi cult using the conventional diagnostic tools (i.e. history, physical examination, ECG, biomarkers, chest X-ray). CT coronary angiography is increasingly applied in the ER settings for the assessment of patients with atypical chest pain because of its high negative predictive value in populations with low-to-intermediate prevalence of disease. A
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7 0 0 2 23.0 . 2 ± 373 0 . 2 112.02.2007 17:03:50 50.0 16 mg/dl), uence the ; ± 1 → G 181 16.0 Nankoku City/JP, City/JP, Nankoku → 1 ± ; 1 25 ± , S. Sironi , S. eld units) in 9 patients 1 , Y. Ogawa , Y. 1 , T. Khouri , T. 60 Hounsfi 60 3 < C change (42.0 cant BDEF , A. Nishioka , A. 1 , M. Inserra , M. 2 A ([email protected]) ([email protected])
, Y. Murata , Y. 2 Thirteen soft plaques ( 18 years old) were detected in an initial scan using 40- old) were 18 years Catania/IT ± , M. Romano , M. The role of 64-MSCT in the diagnosis of cardiomyopathies in the diagnosis of cardiomyopathies The role of 64-MSCT 3 2 A 64-MSCT scanner (LightSpeed VCT, General Electric, Electric, General VCT, A 64-MSCT scanner (LightSpeed 14%). ± Cardiomyopathies (CM) are chronic, progressive myocardial diseases myocardial progressive chronic, (CM) are Cardiomyopathies There may be some relationship between FR in the RVM and con- and FR in the RVM relationship between be some There may A decrease in the soft plaque CT value is associated with an improve- A decrease in the soft plaque CT value , T. Okamura , T. , E. Giglio , E. 64-MSCT is an appropriate imaging study for CM in diagnosing ischemic 64-MSCT is an appropriate imaging study for 1 Genoa/IT, Genoa/IT, 1 2 52.6 To use 40-slice computed tomography to evaluate whether there are whether there are to evaluate use 40-slice computed tomography To → Although the average cholesterol was reduced (196 cholesterol was Although the average 14 ± Kochi City/JP Kochi Monza/IT, Monza/IT, Conclusion: by cause plaque regression may therapy Lipid lowering ment of coronary stenosis. mechanisms other than a reduction in plasma lipid levels. Hounsfi eld units). In the group that showed a reduced CT value, the reduction was the reduction was a reduced CT value, that showed In the group eld units). Hounsfi lipoprotein cholesterol not correlated with the reduction in cholesterol, low-density of stenosis degree a reduction in the average or triglycerides, although there was (61.6 the average plaque CT value showed no signifi showed plaque CT value the average slice MDCT (Philips Brilliance 40), and were evaluated in a follow-up scan after in a follow-up slice MDCT (Philips Brilliance evaluated and were 40), compared the reduction of cholesterol, We therapy. 5-11months of lipid-lowering lipoprotein cholesterol and triglyceride low-density with changes in the CT value of stenosis. and the degree Results: (male; 8, female; 1, 62 8, female; (male; Purpose: changes in coronary therapy. soft plaques in response to lipid-lowering Methods and Materials: Learning Objectives: and cardiac function tools. (CM) using both coronary angiography Background: with distinct patterns changes. of morphological, functional, and electrophysiological in particular ruling of coronary out the presence aetiology, Determining the exact is important and patient prognosis. directly treatment disease, because it affects t from revascularization, benefi in ischemic disease may management Patient whereas patients pharmacotherapy, and secondary preventive aneurysmectomy, Determining better response to beta-blockade. have with non-ischemic CM may imaging available cult using currently can be diffi however, aetiology, the exact coronary or X-ray imaging radionuclide such as echocardiography, techniques, cardiomyopathies among different overlapping since imaging feature angiography, be encountered. may Details: Procedure 64x0.625 collimation, parameters: using the following employed, was Milwaukee) agent: contrast iodinate i.v. msec; rotation time 350 kV, mA, 120 pitch 0.24, 680 administered to patients with heart were Beta-blockers 5 cc/sec. ow-rate: fl 100 cc; reconstructed were data at the end- Raw (bpm). 65 beats per minute above rate diastolic and end-systolic periods of the heart cycle. Conclusion: CM that is associated with shorter CM. to non-ischemic mean survival relative in 21 subjects, 31% of whom received anti arrhythmia drugs for VPB and among drugs for anti arrhythmia received 31% of whom in 21 subjects, the untreated subjects, Among them. without FR, 25% received the 15 subjects subjects with FR, and 218 1786 in 11 VPB on Holter ECG was of number average in 9 subjects without FR. Conclusion: still infl may FR in the RVM VPB. duction system abnormalities causing occurrence of VPB. VPB. occurrence of C-203 as assessed cause regression of soft plaques may therapy Lipid-lowering 40-MDCT by Tadokoro M. 2 C-202 and non-ischemic ischemic between diagnosis Differential (64-MSCT) tomography computed 64-multislice using cardiomyopathies Spagnolo P. 1
ve beats ve 60 BPM; BPM; 60 < Chiba/JP rst fi , 2
Shenyang/CN 2 36.14; for FP it was FP it was for 36.14; ± ed plaques. The S was The S was ed plaques. rst fi ve beats after the CM ve rst fi , A. Palacios , A. 2 of MDCT in the detec- city (Sp) city in differentiating the different the different city in differentiating Shanghai/CN, 1 ; Capital Federal/AR 2 2 Scientific and Educational Exhibits Scientific and Educational 123. Fifty-nine of 70 plaques (84%) were Fifty-nine of 70 plaques (84%) were 123. , M. Bettinotti , M. 2 ± , Z. Hao , Z. 1 uctuation of heart increased after CM rate 70 BPM. The ECG data of the three groups The ECG data of the three groups 70 BPM. > San Isidro/AR, 1 , Y. Shen , Y. ; 1 1 Forty-fi ve patients scheduled for conventional angiog- conventional scheduled for patients ve Forty-fi , A. Goldsmit , A. 140 cases that underwent 16-slice CTCA were included 16-slice CTCA were 140 cases that underwent 36 consecutive subjects (28 males, 35-79 years old) who 35-79 years (28 males, subjects 36 consecutive 2 3 4 ed the plaques into three groups: SoP, FP and CP. The density FP and CP. SoP, plaques into three groups: ed the
, K.M. Chen , K.M. d 1 , P. Kantor , P. d 1 n MDCT is a non-invasive modality to evaluate patients with coronary modality to evaluate MDCT is a non-invasive Though the mean heart rate after CM injection was a little lower Though the mean heart a little lower after CM injection was rate i , J. Carrascosa , J. . 1 ed into three groups according to their heart rate: Group 1: Group 1: according to their heart ed into three groups rate: N I To evaluate the effects of contrast medium (CM) injection on the heart medium (CM) injection of contrast the effects evaluate To Arrhythmogenic right ventricular cardiomyopathy (ARVC) has been diag- (ARVC) right cardiomyopathy ventricular Arrhythmogenic To determine the sensitivity (S) and specifi To F 239 ECG were included in total, in which 107 ECG were before CM before included in total, in which 107 ECG were 239 ECG were A total of 196 segments were evaluated in 43 vessels. For group SoP: S SoP: group For in 43 vessels. evaluated A total of 196 segments were In 36 subjects with MSCT and Holter ECG, FR of the RVM was detected was In 36 subjects with MSCT and Holter ECG, FR of the RVM 35 and for CP it was 400 HU 400 CP it was 35 and for - ± c u , X.Z. Lin , X.Z. 1 d E i c S uctuation in the 16-slice CT coronary angiography angiography uctuation in the 16-slice CT coronary - types of plaques in comparison with IVUS. types of plaques in comparison with IVUS. correctly differentiated between SoP and FP. For the group of CP versus non-calci- of CP versus the group For SoP and FP. between correctly differentiated 122 of 129 plaques (94%) were HU, of 199.72 using a cut-off value ed plaques, fi ed plaques. ed as CP or non-calcifi correctly classifi Conclusion: artery high sensitivity and specifi disease showing 128 HU were compared statistically. ECG data of all the heartbeats and the fi compared statistically. were also compared. after the CM injection were Results: CM injection 1, 2 and 3 before The mean BPM of groups injection and 132 after. 55.26, 64.71 and 56.01, 65.13 and 76.47 BPM and after CM injection were were CM injection were 1, 2 and 3 before Mean D-HR of groups 76.24, respectively. 3.42, 4.28 and 6.47, were 3.06, 3.27 and 5.52 BPM and after the CM injection they Mean D-HR of all the heartbeats and the fi respectively. 4.44 and 2.76 BPM, respectively. injection were Conclusion: CM injection, the fl than that before Shortening decrease the scanning time may injection during the 16-slice CTCA. uctuation of heart rate. the fl ([email protected]) Purpose: CP). FP, ed plaques (SoP, brous and calcifi tion and characterization of soft, fi Methods and Materials: done with a 16-row were CTs studied with CA, IVUS and MDCT. (CA) were raphy correlated, MDCT and IVUS images were carried IVUS were out after DA. scanner. IVUS performed. Plaque characterization was 10 considering every mm segment. and MDCT classifi each type of plaque were The mean and SD for calculated. of each plaque was analysis determined adequate discrimination ROC between if there was calculated. of plaques. the HU of each group Results: 93.2%, Sp=95.1%. S was CP: For =98%; 94%, S S was FP: For 94%, Sp=92; was as non-calcifi in the same group analyzed SoP and FP were HU 43.04 SoP were The mean and SD for 93%, Sp=95.7%. nosed by fat deposits in the right ventricular (RV) wall. But we frequently observe fat frequently observe fat But we wall. deposits in the right (RV) ventricular fat nosed by therefore We (RVM). myocardium of the RV replacement (FR) of the anterior wall CT (MSCT) determined multislice by the relationship of FR of the RVM evaluated premature beats (VPB). with ventricular Methods and Materials: ([email protected]) ([email protected]) Purpose: 16, GE) and Holter ECG at the ECG-gated MSCT (Light Speed Ultra underwent FR of the RVM. for analyzed same period retrospectively were Results: C-201 of fat replacement of the right ventricular myocardium Clinical roles Relationship of those with the occurrence of CT: multislice determined by ventricular arrhythmia Komuro; I. Uehara, M. Nakamura, Ueda, K. Hori, M. Y. Funabashi, N. C-200 materials on the heart of injection of contrast The effects rate and its fl Y. Liu Y. Role of multislice CT in the characterization of coronary plaques: plaques: of coronary CT in the characterization Role of multislice ultrasound Comparison with intravascular Carrascosa P. C-199 C. Capuñay C. in the study. During calcium scoring and CTCA, waves of electrocardiogram (ECG) of electrocardiogram During calcium scoring and CTCA, waves in the study. of heart recorded, and the were rate Values disks. oppy fl recorded in two were All cases the sequential heart between calculated. beats (D-HR) were differences classifi were ([email protected]) ([email protected]) Purpose: (CTCA). uctuation in 16-slice CT coronary angiography and its fl rate Methods and Materials: group 2: 60-70 BPM; and group 3: 3: and group 60-70 BPM; 2: group C - 7 0 R C EECR07-C-SciEduc-FIN.indd 43 Scientific and Educational Exhibits
Cardiac Background: Although echocardiography is a useful method, ECG-gated MDCT and MRI are speculated to provide additional information for the evaluation of Miscellaneous aortic stenosis. Procedure Details: We illustrate the ECG-gated MDCT and MRI features of aortic stenosis with an emphasis on echocardiographic and surgical correlation including C-204 aortiv valve morphology (tri-bi-, unicuspid valve), quantifi cation of aortic valve area To assess the incidence of pulmonary vein stenosis in patients submitted to and fl ow, measurement of ascending aorta, and evaluation of cardiac function. atrial fi brillation ablation and to increase awareness of this clinical syndrome Conclusion: Familiarity with MDCT and MRI features of aortic stenosis will be A. Bajaj, D.T.D. Barnes, P.A. Vlachou, T. Siva, J.J. Entwisle; Leicester/UK (amrita. helpful for the accurate diagnosis and proper management. [email protected])
Purpose: To assess the incidence of pulmonary vein stenosis in patients submitted C-207 to atrial fi brillation ablation and to increase awareness of this clinical syndrome. Tips and tricks for CT and MR imaging in major congenital heart diseases Methods and Materials: 174 consecutive cases had catheter ablation for atrial D. Mandry, L. Mainard-Simard, S. Tissier, F. Marcon, L. Mace, P.-Y. Marie, fi brillation over a period of two years 2004-2005. These were retrospectively re- D. Regent, M. Claudon; Vandoeuvre les Nancy/FR ([email protected]) viewed on the radiology information system to look for any cross-sectional imaging Learning Objectives: 1) To remind of the major features of the most frequent of the thorax (multi-detector row CT/MR) performed within 6 months following the congenital heart diseases (CHD), including atrial septal defect (ASD), ventricular ablation. The images were then retrospectively reviewed to look for pulmonary septal defect (VSD), tetralogy of Fallot (TOF), transposition of the great arteries vein stenosis. (TGA) and coarctation of the aorta. 2) To expose CT and MR advantages and limits Results: Eighteen of the 174 patients had CT/MR within 6 months of the procedure. in these indications. 3) To give radiologists clues to better understand clinicians’ Six of the 18 cases queried pulmonary vein stenosis on the initial request. Six of questions and therefore to answer them better. the cases were done to evaluate the anatomy for redo procedure. Of the remaining Background: Because life expectancy of patients with a congenital heart disease 6, 4 queried pulmonary embolism, 1 queried bronchiectasis and 1 was unclear. (CHD) has improved, thanks to better medical and surgical managements, and Five patients presented with haemoptysis on the initial request. In 5 patients, the thanks too to great improvements in CT and MR imaging, radiologists are more and history of ablation was not stated on the radiology request. Six (3.4%) patients had more faced with these particular conditions. Moreover, as surgical techniques have pulmonary stenosis. Left superior pulmonary vein was the most commonly involved. become more sophisticated and complicated, the need for a precise anatomical Remaining important radiological fi ndings also seen in the cases of pulmonary vein description and for functional analyses has become crucial. CT and MRI have these stenosis were consolidation and lung nodule. abilities and are complementary. But they also have some drawbacks. Conclusion: Pulmonary vein stenosis after catheter ablation is an important Procedure Details: We will illustrate this topic using numerous cases taken from complication associated with signifi cant morbidity. Our series showed a complica- our experience as a CHD care center. All CT exams were performed on a multislice tion rate of 3.8%, with severe stenosis in a still smaller percentage. The reported CT, either a 4 or a 64 detectors, whereas MR were performed on a 1.5 T magnet. incidence ranges from 3% to 42%. Radiologist and clinicians should be aware of CT and MR protocols varied, depending upon the congenital heart disease. this condition in patients presenting acutely following ablation. Conclusion: CT and MRI are powerful tools for the non-invasive evaluation of CHD. Anyone performing these exams has to understand their advantages and limits in C-205 order to be able to answer clinicians’ questions. Role of cardiac sympathetic I123-MIBG scintigraphy in parkinsonian syndromes patients with non-conclusive mr and 123-Iofl upane imaging C-208 P. Sullo, E.M. Covelli, G. Mazzarella, G.E. Vitale, G. Belfi ore; Caserta/IT (eugenio. Diagnostic utility of tissue tracking echocardiography for the evaluation [email protected]) of left ventricular global systolic function Purpose: Both Magnetic Resonance (MR) and I123-Iofl upane (DatScan) imaging M.N. Alekhin, G.E. Gogin, O.V. Menshikova; Moscow/RU ([email protected]) are recently proposed to investigate Parkinson’s disease (PD) but its diagnostic Purpose: To evaluate the ability of tissue tracking for the assessment of left value is not certain at early and bilateral disease. I123-MIBG scintigraphy is a ventricular global systolic function by determination of the systolic mitral annular noninvasive tool to assess cardiac sympathetic denervation detected in PD. We displacement. Tissue tracking displays the integral of tissue longitudinal velocity aimed to evaluate the cardiac innervation by I123-MIBG scintigraphy in patients during systole of myocardial segments in apical views by a graded color display. with parkinsonian symptoms and inconclusive MR and DatScan imaging in order Methods and Materials: We studied 114 patients (62 males, age 65±14 years) with to differentiate between idiopathic PD and parkinsonian syndromes. good acoustic window, sinus rhythm and different left ventricular function. Systolic Methods and Materials: Thirteen patients (8 F, 5M; mean age 58 years) with PD mitral annular displacement was determined by tissue tracking and was assessed symptoms underwent DatScan tomography. MR was performed to exclude cerebro- in all patients. Only medial and lateral sites from apical four-chamber views were vascular disease (CD). Cardiac I123-MIBG scintigraphy was carried out only in pa- used to determine the mitral annular displacement. Left ventricular ejection fraction tients showing inconclusive MR and DatScan imaging. Cardiac images were acquired was determined by two-dimensional echocardiography using Simpson's rule. 4 hours after MIBG injection. Semiquantitative analysis was performed calculating Results: Mean mitral annular displacement correlated closely with left ventricular heart to mediastinum count-ratio (H/M) by ROIs over the mediastinum and heart. ejection fraction (r=0.76, P < 0.001). Left ventricular ejection fraction ≤40% (n=30) Results: All patients showed negative-MR for CD. Four (31%) patients presented could be predicted with a sensitivity of 87% and a specifi city of 92%, using a cut-off asymmetric monolateral reduced I123-Iofl upane uptake suggestive of idiopathic value of 8 mm for the mitral annular displacement determined by tissue tracking. In PD and nine (69%) showed symmetric bilateral reduced uptake inconclusive to PD. patients with calcifi cation of the mitral annular, correlation between the mean mitral Cardiac I123-MIBG scintigraphy showed normal uptake (H/M: 1.89±0.16) in three annular displacement and left ventricular ejection fraction was lower. of these patients than diagnosed as having parkinsonian syndromes and reduced Conclusion: Tissue tracking imaging is feasible and evaluates global systolic left cardiac tracer accumulation (H/M: 1.31±0.22, p < 0.05) in remaining 6 patients with ventricular myocardial function by assessment of systolic mitral annular displace- idiopathic PD diagnosis and subsequentely positive L-Dopa response. ment with high diagnostic accuracy compared with two-dimensional echocar- Conclusion: Decrease of cardiac MIBG accumulation indicating degeneration of diography. myocardial sympathetic neurons was detected in idiopathic PD. Therefore, cardiac I123-MIBG scintigraphy may be useful in the diagnosis of PD, expecially when cerebral MR and DatScan imaging is not conclusive. C-209 I-123 metaiodobenzylguanidine cardiac scintigraphy in neurodegenerative disease C-206 Y. Tanabe, M. Ishibashi, S. Sugihara, T. Ogawa; Yonago/JP Aortic stenosis: Evaluation with multidetector row coronary CT angiography and MR imaging Learning Objectives: To describe the cellular transport mechanism of I-123 E. Chun1, S.I. Choi1, W. Lee2, J.-H. Park2; 1Seong-Nam/KR, 2Seoul/KR metaiodobenzylguanidine (MIBG) at sympathetic nerve endings and the method ([email protected]) for the quantitative evaluation of cardiac sympathetic function by use of I-123 MIBG. To demonstrate the value of I-123 MIBG cardiac scintigraphy in neuro- Learning Objectives: To know the various features of aortic stenosis and how to evaluate degenerative disease. on electrocardiographic (ECG)-gated multidetector row computed tomography (ECG- Background: MIBG is a physiological analog of norepinephrine analog that traces gated MDCT) and magnetic resonance imaging (MRI) features of aortic stenosis.
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7 0 0 2 . 2 375 0 . 2 112.02.2007 17:03:50 G c component c le, therefore, is le, therefore, uent parenchymal parenchymal uent ndings in immunologic lung ndings in immunologic C 15) were imaged by CT before and 25 CT before imaged by 15) were and radiological cation, and their clinical ± BDEF le part will be the central ndings of the diseases A SD, 60 SD, ± cations of immunologic lung diseases other than of immunologic cations 130 peak HU at un-enhanced CT. > ndings will be correlated with pathological specimens, To describe those intratumoral components in lung neo- describe those intratumoral To To familiarize radiologists with immunologic lung diseases with immunologic radiologists familiarize To ([email protected]) ([email protected]) Seventy lung masses (4-8 cm in diameter) in 70 patients (44 lung masses (4-8 Seventy The CT imaging fi
cation), and two observers identifi ed in consensus those intratu- observers identifi cation), and two Different intratumoral components in lung neoplasms, which were which were components in lung neoplasms, intratumoral Different Immunologic lung diseases other than asthma and collagen-vascular lung diseases other than asthma and collagen-vascular Immunologic Different intratumoral components in lung neoplasms are depicted intratumoral Different In the appropriate clinical setting, CT fi ([email protected])
Trieste/IT brotic component in adenocarcinomas (n=5) manifested as peripheral strands; (3) as peripheral strands; brotic component in adenocarcinomas (n=5) manifested Conclusion: CT images. by seconds after intravenous injection of iodinated contrast agent (iodine 300 injection of iodinated contrast mg/mL; seconds after intravenous analysed by Surgical/bioptic/autoptic specimens were bolus injection). 150 i.v. mL; and eosin staining, macroscopic and microscopic/histologic analysis (hematoxylin x20-x40 magnifi components: Macroscopic CT images. depicted by components that were moral necrosis in squamous cell carcinomas (n=30) appeared (1) internal colliquative (2) injection; and without enhancement after contrast at un-enhanced CT, hypodense fi (n=2) presented as diffuse/confl carcinomas bronchiolo-alveolar necrotic and haemorrhagic changes in small cells (4) coagulative consolidations; hypodense (n=15) and anaplastic carcinomas (n=10), which appeared, respectively, and without enhancement after contrast at un-enhanced CT, and hyperdense component in hamartomas with (5) fat (n=8) appeared hypodense administration; (a) cellular component Microscopic components: HU at un-enhanced CT. -20/-50 (b) stroma; in the extracellular enhancement due to neovessels with diffuse contrast (c) calcifi absent enhancement; stroma revealing brotic extracellular fi with appearing hyperdense diseases other than asthma and collagen-vascular disorders are suggestive of the disorders are suggestive diseases other than asthma and collagen-vascular making the correct diagnosis with a reasonable in underlying and allow disorders dence. of confi level Learning Objectives: C-211 and macroscopic Radiologic-pathologic correlations between intratumoral in lung neoplasms components microscopic Quaia; E. Chest Lung C-210 collagen-vascular lung diseases other than asthma and Immunologic fi teaching An electronic disorders: Bankier; Müller-Mang, A.A. C. Stiebellehner, L. Koller, A. Grosse, Plank, C. C.M. Vienna/AT classical pat- elaborate To disorders. other than asthma and collagen-vascular these disorders. of features and radiological terns clinical history, of presentation, approach based on clinical and radiological propose a systematic diagnostic To ndings. fi Background: Churg-Strauss granulomatosis, (Wegener’s 1) Lung vasculitides disorders include: 3) Eo- 2) Diffuse pulmonary hemorrhage; vasculitis); hypersensitivity syndrome, pneumonia, drug-inducedsinophilic lung disease (acute and chronic eosinophilic these Although and 5) Amyloidosis. 4) Extrinsic allergic alveolitis; lung disease); their of their etiology, common, there is little awareness diseases are relatively classifi their underlying pathomechanisms, The purpose proposed electronic teaching fi of the manifestations. diagnostic approach based on combined clinical a comprehensive to elaborate ndings. and imaging fi Findings: Imaging The CT fi of our presentation. structure overall The and combined to typical clinical histories and presentations. most recent classifi will follow of the electronic teaching The format disorders. asthma and collagen-vascular an integrative and provide through the information easy navigation le will allow fi approach. comprehensive Conclusion: Learning Objectives: imaging. plasms that are depicted by Background: in un-en- be recognized may at macroscopic and/or microscopic analysis, evident (CT) images. hanced and contrast-material-enhanced computed tomography Findings: Imaging mean age 26 females, males, nding Scientific and Educational Exhibits Scientific and Educational The heart-to-mediastinum obtained (H/M ratios) count ratios 5 4
d d n While the early and delayed H/M ratios reduced and the WR increased reduced and the H/M ratios While the early and delayed i . N I F - c u d E i c S - and clinical usefulness of I-123 MIBG cardiac scintigraphy in neurodegenerative in neurodegenerative I-123 MIBG cardiac scintigraphy and clinical usefulness of in are demonstrated syndrome and dementia, including Parkinsonian diseases, this presentation. Details: Procedure chest planar images and (at 4 hours) and delayed minutes) from the early (at 30 calculated. the 2 images (WR) were between rate the cardiac washout Conclusion: syn- the other Parkinsonian disease, in Parkinson’s with the disease progression corticobasal and progres- degeneration, system atrophy, such as multiple dromes, Dementia normal only mildly disturbed results. showed or palsy, supranuclear sive WR, and this H/Ms and increased decreased bodies (DLB) also showed with Lewy cardiac I-123 MIBG disease. from that of Alzheimer distinctly different nding was fi for disease and of Parkinson’s the diagnosis clinically useful for was scintigraphy of DLB from Alzheimer disease. the differentiation the uptake and transport of norepinephrine in presynaptic nerve terminals. I-123 transport and the uptake of norepinephrine nerve in presynaptic terminals. in- of the cardiac sympathetic the assessment allows scintigraphy MIBG cardiac sympathetic function in various the cardiac nervation used to evaluate and has been fi The technique, heart disease. in neurodegenerative diseases and recently C - 7 0 R C EECR07-C-SciEduc-FIN.indd 45 Scientific and Educational Exhibits
C-212 C-215 CT imaging of the spectrum of diseases causing air trapping The many faces of bronchioloalveolar carcinoma: A radiologic-pathologic J. Euathrongchit1, N. Thoongsuwan2, J.P. Kanne3, E.J. Stern4; 1Chiang Mai/TH, pictorial review 2Bangkok/TH, 3Cleveland, OH/US, 4Seattle, WA/US ([email protected]) D. Chourmouzi, E. Papadopoulou, K. Xinou, T. Zaraboukas, A. Drevelegas; Thessaloniki/GR ([email protected]) Learning Objectives: To systemically review the CT imaging spectrum of diseases causing air trapping. Learning Objectives: To describe the pathologic and radiologic types of Bron- Background: Pulmonary air trapping is abnormal retention of gas within regions chioloalveolar carcinoma (BAC). To present the imaging features of each type of of the lung, most evident during or after expiration. It is most readily diagnosed by BAC. To outline the main differential diagnosis. To emphasise the role of imaging demonstrating focal areas of abnormally lucenct lung parenchyma on exhalation evaluation in treatment and follow-up. CT scans, typically with little or no change in cross-sectional area. The appearance Background: Bronchioloalveolar carcinoma (BAC) is classifi ed as a subset of lung can be very similar to that caused by pulmonary vascular diseases and subsequent adenocarcinoma but has a distinct clinical presentation, tumor biology, response mosaic perfusion. Air trapping is shown in the multiple conditions and disease, not to therapy, and prognosis compared with other subtypes of non-small-cell lung only small airway diseases but also large airway disease, vascular diseases, post carcinoma (NSCLC). It is characterized by growth along alveolar septae without surgical changes, biomechanical abnormalities, etc. Using CT scanning, we review the evidence of stromal, vascular, or pleural invasion. Nonmucinous bronchioloalveolar spectrum of air trapping diseases, which can be divided into the following categories: carcinoma tends to be more localized and has a lower frequency of bronchogenic 1. Air trapping from the airway disease. 2. Air trapping from the lung parenchymal spread than mucinous bronchioloalveolar carcinoma. BAC has received increasing disease. 3. Air trapping from the cardiovascular disease. 4. Miscellaneous. attention in recent years due to its increasing incidence and its rate of sensitivity to Procedure Details: This educational computer exhibit reviews the spectrum of air epidermal growth factor-tyrosine kinase inhibitors (EGFR-TKIs). trapping from these conditions. Imaging Findings: At computed tomography (CT), the single nodular form ap- Conclusion: With the advantage of the mutidetector CT scanning, the multiplanar pears as a peripheral nodule or localized ground-glass attenuation with or without and the 3D reconstruction images allow a deeper understanding of the complexity consolidation, frequently associated with bubble like areas of low attenuation and and interrelation of each cause of air trapping. open bronchus signs. The lobar consolidative form may demonstrate the CT an- giogram and open bronchus signs. The diffuse nodular form appears as multiple nodules or areas of ground-glass attenuation or consolidation. C-213 Conclusion: Understanding the radiologic fi ndings of bronchioloalveolar carcinoma Air-leak syndromes in hematopoietic stem cell transplant recipients with on the basis of various morphologic and growing patterns is essential in the initial chronic GVHD-related bronchiolitis obliterans: Thin-section CT fi ndings evaluation of patients with BAC. High-resolution lung CT-scan is necessary to E. Granell, R. Guerrero, T. Franquet, A. Giménez, A. Hidalgo, F. Plancarte; evaluate pulmonary involvement. Imaging evaluation is also essential to assess Barcelona/ES ([email protected]) therapeutic response and follow-up. Purpose: To determine the incidence and the thin-section CT fi ndings of air-leak syndromes in a large group of hematopoietic stem cell (HSC) transplant recipients with C-216 chronic graft-versus host disease (cGVHD) related bronchiolitis obliterans (BO). Pattern recognition in lobar collapse: Can you read the signs? Methods and Materials: A retrospective review of the medical records and imaging E. Sonnex, R.A. Coulden; Leicester/UK ([email protected]) fi ndings identifi ed 158 allogeneic HSC transplant recipients with a proven diagno- sis of cGVHD between January 1999 and December 2004. Of the 158 transplant Learning Objectives: To understand plain fi lm appearances and recognise the recipients, 9 had air-leak syndrome and proven cGVHD. The patients were 8 men patterns of lobar collapse. These fi ndings are fully explained and corroborated by and 1 woman ranging in age from 19 to 45 years (mean age, 28 years). The thin- a 3-dimensional CT reconstruction. section CT scans were retrospectively reviewed by two thoracic radiologists for the Background: The diagnosis of lobar collapse is the ‘bread and butter’ of chest presence, appearance, and distribution of abnormalities. radiology but as 3-D imaging takes over, plain fi lm reporting skills are being lost. Results: All cases were allogeneic HSC transplant recipients with cGVHD who Procedure Details: We describe the classic patterns of lobar collapse on the acquired new respiratory symptoms and/or radiologic abnormalities. Nine cases of plain chest radiograph with the aid of CT correlation to explain the appearances air-leak syndrome occurred during the analyzed study period, for a 2-year estimated of: Collapse and why it looks the way it does; How to use the silhouette sign; The cumulative incidence of 2.1%, whereas its prevalence was 5.7%. Among all the causes of collapse; The features of collapse. patients, pneumomediastinum (n=6) and pneumothorax (n=6) accounted for the Conclusion: Accurate diagnosis is based on recognised patterns. This presenta- majority of air-leak syndromes in our series; the remainder were due to subcutane- tion uses 3-D CT images to explain the recognised patterns of collapse in plain ous emphysema (n=3) and pulmonary interstitial emphysema (n=2). A combination chest radiographs. of different air-leak syndromes was observed in 6 cases. In all cases there existed an association between air-leak syndromes and cGVHD-related BO. Conclusion: Air-leak syndromes represent an uncommon late complication in C-217 The impact of MDCT in the study of diffuse cystic and cavitary diseases of HSC transplant recipients related to cGVHD and BO. the lung F. Zuccarino1, O. Perciva2, A. Roque2, D. Varona2, E. Pallisa2, A. Jordi2, C-214 J. Cáceres2; 1Genoa/IT, 2Barcelona/ES (fl [email protected]) Cystic and cavitary lung disease revisited: A MDCT pictorial review S.M. Dias, C. Pina Vaz; Porto/PT Learning Objectives: To illustrate the spectrum of usual and unusual cystic diseases involving the lung, focusing on the fi ndings with MDCT. To outline the Learning Objectives: To list the fi ndings of the main cystic and cavitary lung le- advantages of this technique. sions in multidetector computerized tomography (MDCT), outlining the importance Background: High-resolution computed tomography (HRCT) has been widely of high-resolution CT (HRCT) for diagnosis. To describe the main criteria useful for accepted as the imaging standard of reference for assessing diffuse lung disease. narrowing the differential diagnosis. A drawback is that only about 10% of the lung parenchyma is scanned, whereas Background: Lung cysts and cavities are commonly encountered in daily multidetector row CT (MDCT) allows evaluation of whole lung parenchyma with practice and can become a diagnostic challenge as there is a broad spectrum an easier detection of disease. of congenital and acquired diseases that can cause them, namely hystiocytosis Procedure Details: We retrospectively reviewed the imaging fi ndings of patients X, lymphangioleiomyomatosis, carcinoma, pulmonary fi brosis, infection, trauma, with diffuse cystic lesions from our database of thoracic pathology. Examinations among others. were performed with 64 and 16 MDCT. We did MPR reconstruction, MPVR and VR Procedure Details: The authors review the most important MDCT fi ndings useful for every patient. Multiplanar reconstruction (MPR) helped us to fi nd the planes in for narrowing the differential diagnosis, such as presence/absence of wall and its which key features are displayed and to identify the main pattern of diffuse lung thickness and morphology, inner wall contour, nature of content, number and pattern disease. Minimum intensity projection (MinIP) is especially useful: a better visual- of distribution of the lesions, and coexistent lung parenchyma abnormalities. Most ization of the airways is fundamental in the diagnosis of cystic bronchiectasis and common etiological entities are presented and illustrated thoroughly. in the evaluation of distortion in pulmonary fi brosis. Maximum intensity projection Conclusion: HRCT of the cystic and cavitary lung lesions help to defi ne morpholog- (MIP) allows detection of associated micronodules (for example, in Langherans ic features that may be used as important clues for defi ning their etiology. Volumetric cell histiocytosis) and a better visualization of centrilobular artery (centrilobular CT should complement HRCT to assess extent and distribution of disease. emphysema). Volume-rendered (VR) images resemble the macropathologic view;
376 A BDEFC G
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112.02.2007 17:03:51 ndings. The ndings. G Hull/UK ndings of ndings nding of HP can be in nition of granuloma cation with lower lobe cation with lower cardiac cant increase in Vancouver, BC/CA, Vancouver, 2 C ndings of the most common granulo- BDEF ne nodules and diffuse alveolar consoli- ne nodules and diffuse alveolar Barcelona/ES, Barcelona/ES, 1 ; 3 A , T.V. Colby , T.V. 2 To illustrate HRCT fi illustrate To To illustrate Pathogenesis of hypersensitivity pneuomonitis of hypersensitivity Pathogenesis illustrate To ([email protected]) ([email protected]) Depending on the anatomic location and histologic charac- ammation; more recently the term has been restricted to cases ammation; We will be reviewing the radiographic and the HRCT fi and the HRCT the radiographic will be reviewing We
Acute Lung Injury presents radiological and CT challenges. The Acute Lung Injury and CT challenges. presents radiological Diffuse granulomatous lung diseases are a group of lung diseases lung diseases are a group Diffuse granulomatous Pathological pattern of the ARDS is the diffuse alveolar damage that patternthe diffuse alveolar of the ARDS is Pathological ndings ndings Hypersensitivity pneuomonitis, also known as extrinsic allergic alveolitis, allergic alveolitis, as extrinsic also known Hypersensitivity pneuomonitis, The cyto/histological patterns of different ALI stages explain the ALI stages explain The cyto/histological patterns of different This review presents an approach to the differential diagnosis of presents an approach to the differential This review The defi nitive diagnosis of HP relies on a constellation of clinical, diagnosis of HP relies nitive The defi , N.L. Müller , N.L. 1 ammatory lung disease in which inhalation of certain organic antigens repeat- Scottsdale, AZ/US Scottsdale, Learning Objectives: diagnosis based matous disorders of the lung, and to present a working differential correlation. on pathologic - radiologic Background: are an importantin which granulomas component of the histologic fi term granuloma has been used historically for all reactions rich in histiocytes and has been used historicallyterm for granuloma cell infl mononuclear with associated giant cells epithelioid histiocyte clusters usually cohesive showing use the more restricted defi We granulomas). sarcoid-like (i.e. which the term granuloma completeness entities for also include for but this review, has been used historically. Findings: Imaging result in lung diseases may teristics of the abnormalities, diffuse granulomatous c) than 1 b) small nodules, a) nodules greater CT patterns: cm in diameter, several pattern), lines (tree-in-bud d) bronchiolocentric nodules and branching centrilobular and opacities and consolidation, and f) low-attenuation e) ground-glass ltrates, infi mosaic perfusion. Conclusion: and compares pulmonary disorders based on their HRCT features granulomatous ndings. the HRCT with the pathologic fi chest X-ray demonstrates bilateral infi without signifi ltrates infi bilateral demonstrates chest X-ray and eosinophilia, acute pulmonary oedema and upper airway obstruction from and eosinophilia, acute pulmonary oedema and upper airway ALI, such as valproic Some drugs can also induce severe laryngeal oedema. or haemorrage epilepsy that can induce alveolar acid in treatment of neurological breast cancer. gemcitabine during treatment for Findings: Imaging (a hazy increase glass attenuation ground CT demonstrates pedicle. or vascular size margins) in the with preservation bronchial and vascular of in the lung attenuation that obscures the (increase in lung attenuation middle regions and consolidation sign can be present). the bronchogram but margins, broncho vascular Conclusion: imaging features. air-space opacifi 1) Acute phase: the clinical subtypes of HP. C-222 High-resolution CT and lung diseases: Diffuse granulomatous pathologic fi Franquet T. 3 acute lung injury) drug and other related diseases. Background: An phase. membrane and hyaline exudative phases such as different recognize biopsy transbronchial (BAL) or lavage with a bronchoalveolar urgent bronchoscopy related acute TRALI, the transfusion damage (DAD). a diffuse alveolar can show typically lung injury transfusion blood is an uncommon complication of allogenic in and hypotension, fever oedema, dyspnea, hypoxemia, bilateral by manifested The main patterns pulmonary are infi presence of a normal cardiac function. C-221 Radiographic and high resolution CT fi dust: The organic pneuomonitis hypersensitivity Kennan; N. Avery, G. Viswanathan, C. Lavakumar, Khaleel, R. Z. ([email protected]) Learning Objectives: ne and defi To ndings in HP. fi history the natural demonstrate and physical To (HP). of HP. and HRCT appearances the radiographic review Background: is an infl tissue formation. mediated reaction with granulamtous edly induces immunologically The targeted lung structures are the distal bronchioles and the alveoli. Findings: Imaging and the fi predominance on radiographs patternne reticulonodular on radiographs fi 2) Subacute Phase: dation on HRCT. 3) Chronic Phase: on HRCT. nodules centrilobular glass opacities with and ground and intraseptal on radiographs coarse reticulation with upper lobes predominance bronchioectasis on HRCT. and traction honeycombing and interseptal thickening, Conclusion: Although the imaging fi ndings. and laboratoryradiological, fi nonspecifi c, certainc, pattern particularly strongly suggest the on HRCT would nonspecifi prompt management of the disease. diagnosis and facilitate , 0.05) 1 0.05). 0.05). < < , 3
Forchheim/DE Forchheim/DE Terni/IT 3 3 , R.F. Grasso , R.F. 2 , C. Thierfelder , C. 2 Forlì/IT, Forlì/IT, Kiel/DE, 2 2 Seoul/KR , S. Tomassetti , S. 2 Rome/IT, Rome/IT, 1 , B. Hoffmann , B. ; Scientific and Educational Exhibits Scientific and Educational 2 1 0.05). Heidelberg/DE, 1 < ; 1 , H. Bolte , H. 1 , M. Romagnoli , M. 1 Five porcine lungs were infl ated inside a dedicated ated inside a dedicated infl porcine lungs were Five From 2002 to 2006, a total of 83 nodular GGOs were were 2002 to 2006, a total of 83 nodular GGOs From 1. To show the underlying pathological changes of ALI. 2. 2. the underlying pathological changes of ALI. show To 1. , T. Welzel , T. 0.05). The pathological results of multiple GGOs were focal focal GGOs were multiple The pathological results of 0.05). 1 , B. Beomonte Zobel , B. , H.U. Kauczor , H.U. 2 < 2 7 rmed in 57 patients (M:F=26:31, mean age 58.2); 43 lesions rmed mean age 58.2); in 57 patients (M:F=26:31, (n=9) and adenocarcinoma with (n=10), AAH (n=2), BAC brosis 4
brosis more frequently in patients with solitarybrosis more frequently in patients with GGO (p
d d n Clinical, pathological and radiological features of multiple nodular of multiple features Clinical, pathological and radiological The realistic ex-vivo study with direct comparison of retrospectively study with direct comparison of retrospectively The realistic ex-vivo MDCT offers a new approach to the study of diffuse lung cystic dis- approach to the study of a new MDCT offers i , C.C. Quattrocchi , C.C. . 1 N , V. Poletti , V. I To compare clinical, pathological, and thin-section CT features be- features compare clinical, pathological, and thin-section CT To 3 To analyze the image quality of retrospectively gated helical CT based gated helical the image quality of retrospectively analyze To , M. Heller , M. , J. Biederer , J. F Partial projection effects were only present in the dynamic scans (aver- were Partial projection effects All the patients with multiple GGOs (M:F=3:14, mean age 59.1) and 25 GGOs (M:F=3:14, mean age 59.1) All the patients with multiple 1 1 - c u d E i c S (AAH) (n=15), bronchioloalveolar brosis (n=3), atypical adenomatous hyperplasia - Conclusion: from those of solitary nodule GGO. GGOs are different ([email protected]) ([email protected]) Learning Objectives: identify the pattern of early and late stage of ALI at CR and CT with clinical To related TRALI (transfusion of ALI, including forms different show To 3. correlation. chest phantom and prepared with 8-14 nodules of ~1 cm. A water-fi lled diaphragm A water-fi with 8-14 nodules of ~1 chest phantom and prepared cm. acquired in a dy- Images were at a frequency of 8/min. contractions simulated 0.1 (slice collimation 24x1.2 namic mode with a pitch of slice mm, rotation time 1s, inspiration Static scans at 0/25/50/75/100% mm). mm, increment 1 1.5 thickness The visual without respiratory motion. but obtained with the same protocol, were of the 3D-data reformations based on multiplanar of image quality was evaluation partial Stepladder-artifacts, judged semi- projection artifacts and noise were sets. parts lower middle and the upper, independent observers for two by quantitatively absent, minimal, large and diagnostically for given Scores of 0-3 were of the lung. artifacts. relevant Results: prominent in dynamic series Stepladder artifacts were 1.33). age artifact scores: less prominent in end-in- and artifacts Both were on static scans. also visible but Image noise predominated close to and predominated close to the. end-expiration 9 given A score of 3 was from the dynamic condition. independently the diaphragm the region close to the diaphragm. artifacts), all for kymographic times (7/9 for Conclusion: respiratory artifacts gating of retrospective tolerable gated and static scans shows rms the high quality of 4D-CT. and confi Purpose: on a comparison with static scans. Methods and Materials: J. Debus J. in the future could help the quantifi cation of these disorders. cation of these could help the quantifi in the future Conclusion: characterization a better an easier visualization of the lesions and It allows ease. of the cysts. of the regional distribution None had lymph node metastasis. CT type was signifi cantly different between between cantly different signifi CT type was None had lymph node metastasis. GGOs and solitarymultiple GGO (p and nonsmokers (p and nonsmokers fi Solitary (n=14). subtype (n=11) and adenocarcinoma with mixed carcinoma (BAC) fi focal GGOs were in patients with multiple more frequently found AAH were subtype (n=19). mixed fi GGO and focal The acute lung injury (ALI): A clinico-radiological correlation A clinico-radiological The acute lung injury (ALI): Piciucchi S. C-220 Clinical, pathological and thin-section CT features of multiple nodular of multiple pathological and thin-section CT features Clinical, glass opacity with solitary glass opacities compared nodular ground ground Im; Chun, J.-G. E. Lee, C. Lee, H. Goo, J. Park, C. pathologically confi GGO and 40 patients had solitary in 17 patients with multiple lesion. found were ed into type1 to 5 according to Morphology classifi was of each nodule on CT pathologic results and CT type of The clinical records, cation. classifi Suzuki’s compared with those of solitary GGOs were multiple GGO using Chi-square and test. Fisher exact Results: among 40 patients with solitary non- 57.7) were GGO (M:F=23:17, mean age, (p Multiple nodular GGOs occurred more frequently in female smokers. C-219 ([email protected]) ([email protected]) Purpose: glass opacities (GGOs) and those of solitary nodular ground multiple tween nodular GGO. Methods and Materials: C-218 of Comparison helical CT of the lung: multislice Four-dimensional system ex-vivo in an images gated and static retrospectively Dinkel J. A. Carloni A. C - 7 0 R C EECR07-C-SciEduc-FIN.indd 47 Scientific and Educational Exhibits
C-223 of pulmonary lymphoma, its rare cavitating form, highlighting its presentation, radiological features, and progression, and distinguishing aspects from other Respiratory complications of connective tissue disease: A pictorial review cavitating lung pathologies. A. Varghese, C. Vandervelde, D. D’Cruz, W. Jan; London/UK ([email protected]) C-226 Learning Objectives: 1) To demonstrate the imaging appearances of the respira- Idiopathic interstitial lung disease: An analysis of the main radiological fi ndings. tory complications of rheumatoid arthritis, systemic lupus erythematosus, mixed An integrated clinical, radiologic and histologic approach to diagnosis connective tissue disease, progressive systemic sclerosis, dermatomyositis, poly- M. Prieto del Rey, X. Gallardo Cistare, E. Castaner Gonzalez, J. Mata Duaso, myositits and Sjogren’s syndrome. 2) To discuss the imaging features suggestive I. Delgado Alvarez, S. Perez Aguilera; Barcelona/ES ([email protected]) of each of the above conditions and the diagnostic pitfalls. Background: The connective tissue diseases are autoimmune multisystem conditions Learning Objectives: To describe and illustrate the principal radiological and histological that can affect the lungs. All components of the respiratory system including pleura, fi ndings for idiopathic interstitial lung diseases. To explain a strategy for the diagnosis of dif- alveoli, interstitium, lymphatics, airways and vasculature can be involved. Although ferent types of idiopathic interstitial disease and determining their severity and prognosis. there is a great deal of overlap between the imaging fi ndings in these conditions, there Background: We review the radiological fi ndings for idiopathic interstitial lung diseases, are features that can point the radiologist towards a particular diagnosis. grouped according to the American Thoracic Society/European Respiratory Society Imaging Findings: Patterns of respiratory involvement include pleural effusion or International Multidisciplinary Consensus Classifi cation (ATS/ERS IMCC) of 2001 into: thickening, organising pneumonia, usual interstitial pneumonia (UIP), nonspecifi c usual interstitial pneumonia, non-specifi c interstitial pneumonia, desquamative intersti- interstitial pneumonia (NSIP), bronchiectasis, lymphoid interstitial pneumonia, lym- tial pneumonia, respiratory bronchiolitis interstitial lung disease, cryptogenic organizing phoma, obliterative bronchiolitis and nodules. Acute pathologies such as alveolar pneumonia, acute interstitial pneumonia, and lymphocytic interstitial pneumonia. haemorrhage and pulmonary embolism are also seen. These and others are shown Imaging Findings: We present representative cases of each of the seven ATS/ERS on plain radiographs and CT images. IMCC categories, describing the clinical, radiological and histologic fi ndings. We Conclusion: The purpose of this exhibit is to show the wide spectrum of pleuro- provide high-resolution CT images showing the most characteristic fi ndings for pulmonary manifestations of connective tissue disease, and to point the radiologist each entity and discuss the differential diagnosis. towards a more specifi c diagnosis based on the imaging fi ndings. Conclusion: Careful and thorough evaluation of the distribution, extension, and evolution of the radiological fi ndings together with the relevant clinical information C-224 enables a strategy to orient the diagnosis of the different types of idiopathic inter- stitial disease, their severity, and clinical prognosis. The diagnosis of interstitial lung Paraquat poisoning of the lung: Initial and follow-up thin-section CT diseases requires an integrated, dynamic evaluation of the clinical, radiological, fi ndings in relation to ingestion amount of the paraquat and histological fi ndings. High-resolution CT is an important tool in the diagnostic M. Park1, S. Song1, S. Park2; 1Uijeongbu/KR, 2Seoul/KR work-up of diseases that affect the pulmonary interstitium. ([email protected]) Purpose: To evaluate the patterns, distribution, and extent in relation to the inges- C-227 tion amount of paraquat poisoning and evaluate the temporal lung changes on CT scan fi ndings in fungal pneumonia in immunocompromised patients thin-section CT (HRCT) scans. M. Heckmann, M. Uder, W. Bautz, M. Heinrich; Erlangen/DE Methods and Materials: The study included 15 patients with urine-positive paraquat ([email protected]) kit and pulmonary abnormalities in HRCT scans. Scans after hemodialysis were assessed for the presence, extent, and distribution of pulmonary abnormalities. Six Learning Objectives: This poster should give an overview about the CT scan of the 15 patients, underwent follow-up CT scanning 5-20 days after initial CT. fi ndings and differential diagnosis of diverse pulmonary fungal infections in im- Results: The abnormal fi ndings on the initial HRCT scan consisted of ground-glass munocompromised patients. Pneumonias caused by aspergillus, cryptococcus, attenuations (n=9), consolidations (n=9), irregular lines (n=9), nodules (n=2), traction candida, histoplasma, mucor and geotrichum capitatum are illustrated. bronchiectasis (n=2), pleural effusion (n=4), and pneumothorax (n=1). The most com- Background: The importance of pulmonary fungal infections has increased substan- mon predominant fi nding that has the largest extent was ground-glass attenuation tially during the last decades, occurring in patients with neutropenia caused by malig- (n=7). On initial CT scan, the lesions showed bilateral (n=9), lower (n=6) and sub- nancies, solid organ or stem-cell-transplantation, chemotherapy, corticosteroid-therapy pleural (n=6) zonal predominancy. The extent of lung involvement was well correlated or HIV-infection. Because of unspecifi c clinical symptoms and the high morbidity and to the amount of paraquat ingestion. The follow-up CT was performed in six patients. mortality of these infections, an early and non-invasive diagnose is very important. The ground-glass attenuation might be improved in extent (n=2) or progressed to con- Imaging Findings: Pulmonary aspergillosis comprises a broad spectrum of disor- solidation (n=2). The new parenchymal abnormalities such as traction bronchiectasis ders. Allergic broncho-pulmonary aspergillosis (ABPA) is typically associated with and architectural distortion developed in the remaining two patients. upper lobe consolidations, mucous-plugging and central bronchiectasis. Semi-in- Conclusion: In paraquat poisoning, the most predominant fi nding at initial presentation was vasive aspergillosis is characterized by progressive upper lobe consolidation that ground-glass attenuation and it was bilateral, lower and subpleural in distribution. The extent may cavitate and harbor mycetomas. The CT halo-sign and, later in the disease, of lung involvement was well correlated to the amount of paraquat ingestion. On follow-up the air crescent sign are characteristic fi ndings of invasive aspergillosis. Cryptococ- CT, fi brosis such as traction bronchiectasis and architectural distortion might develop. cosis may manifest as a solitary lung mass, as multiple nodules or as segmental or lobular consolidations. In patients with candidiasis, air-space consolidation is C-225 most commonly seen with a lower lobe distribution. Histoplasmosis presents with diffuse nodules, small linear opacities or focal or patchy areas of consolidation. Radiological features of cavitating pulmonary lymphoma: A review The radiological manifestations of mucor mycosis can mimic those of invasive as- C.G. Cronin, E. Delappe, M. Murray, C. Roche, J. Murphy; Galway/IE pergillosis. Geotrichum capitatum can present with bilateral non-cavitated nodules, ([email protected]) consolidations and ground-glass-opacity. Learning Objectives: To review the radiological fi ndings with clinico-pathological Conclusion: The CT fi ndings of fungal diseases may overlap. However, the knowl- correlation of pulmonary Hodgkin’s and non-Hodgkin’s lymphoma, particularly edge of the various radiological appearances of fungal infections in combination with focusing on its cavitating pulmonary form. Outline the distinguishing features of the patient’s immunologic status allows narrowing of the differential diagnosis. cavitating lymphoma from other cavitating lung lesions. Background: Lymphomatous involvement of the lung is often asymptomatic or C-228 has non-specifi c symptomatology, thereby making diagnosis diffi cult. Cavitating Pulmonary melioidosis: Clinical and radiological correlation pulmonary lymphoma is a rare entity in both primary and secondary pulmonary A. Md Ralib, M. Abd Rashid, S. How, J. Abd Rahman, A. Che Ahmad; Kuantan, lymphoma. Diagnosis if also often hindered as infection (including superimposed Pahang/MY ([email protected]) infection), granulomatous disease, primary and secondary carcinomas, and drug reactions may have similar radiological fi ndings. Purpose: Melioidosis is endemic in Southeast Asia and associated with high Imaging Findings: From our experience with a number of cavitating pulmonary mortality. We would like to correlate the chest radiograph fi ndings with the clinical lymphoma patients and a review of literature, we will provide a diverse review of its presentations of patients with pulmonary melioidosis. pathophysiology, clinical and radiological presentations (location, distribution), and Methods and Materials: We reviewed the chest radiographs of 39 cases of positive blood appearances (wall features, progression, and response to treatment). cultures of Burkholderia psuedomallei in a 4-year period, from 2003 to 2006. The chest Conclusion: This exhibit will provide an informative thorough guide and review radiograph fi ndings were correlated with the clinical presentations on admission.
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Chest 0 : 7 1
7 0 0 2 . bro- 2 379 cantly 0 . 1.93 vs ndings, ndings, 2
± 112.02.2007 17:03:51 , 2 are used lms G 0.22, p=0.00). 0.22, p=0.00). ± ndings of pulmo- , K. Inoue , K. 1 ndings Gyeonggi-do/KR ndings of parenchimal fi 0.16 vs 2.55 cantly improved in EOA after after in EOA cantly improved ± , M. Kinjho , M. 1 ([email protected]) ([email protected])
ndings of asbestos-related disease 0.11, p=0.02). Extent of air trapping Extent of air trapping 0.11, p=0.02). signifi 0.05), while FEV1 was cantly more thickened in EOA than in EOA cantly more thickened ndings with clinical parameters and ndings with clinical parameters C ± < BDEF lung benign masses and malignant brosis, ndings for the differential diagnosis. the differential ndings for ndings with a patient’s clinical background clinical background ndings with a patient’s Cadiz/ES , T. Nakayama , T. A 2 0.05). However, FEF25-75% was not improved not improved FEF25-75% was However, 0.05). < 0.04 vs 0.68 ± ndings in patients with early-onset and late-onset Kitakyushu-City/JP 2 We arbitrarily designated EOA (n=26) and LOA (n=22) as (n=26) and LOA arbitrarily designated EOA We , I. Sakino , I. brotic sheets. 1 1. To demonstrate miscellaneous HRCT fi demonstrate To 1. To illustrate radiological fi radiological illustrate To ARD comprises from pleural effusion and pleural plaques to ARD comprises effusion and pleural from pleural ndings in actual cases. 3. To understand those noninfectious understand those noninfectious To 3. ndings in actual cases. ndings Fukuoka/JP, Fukuoka/JP, 1 Therapeutic advances for hematologic and solid organ malignancies, hematologic and solid organ malignancies, for advances Therapeutic Asbestos has been recognised as a potential hazard since the 1940s. as a potential hazard since the 1940s. Asbestos has been recognised In conclusion, the results of our study may suggest that LOA can be suggest that LOA In conclusion, the results of our study may Rates of ARD remain high in our population due to past occupational Rates of ARD remain high in our population due to ; 1 , K. Yasumori , K. To compare HRCT fi To 1 Mean age of the patients was signifi cantly older in LOA (70.50 LOA cantly older in signifi Mean age of the patients was c diagnosis to determine benign and malignat lung masses, and will focus diagnosis to determinec and will focus benign and malignat lung masses, 2.80, p=0.00). Bronchial wall was signifi was Bronchial wall 2.80, p=0.00). ± improved after treatment. improved Conclusion: from EOA. phenotypically different Severity of bronchial wall thickening and extent of air trapping were signifi cantly signifi were of air trapping and extent thickening of bronchial wall Severity correlated with age onset of asthma (r=-0.33, p=0.03, r=0.34, p=0.02, respectively). signifi were FEV1 and FEF25-75% PFT, In follow-up, (p inhaled corticosteroid therapy (p after inhaled corticosteroidin LOA therapy asthma and to evaluate correlation of HRCT fi asthma and to evaluate of asthma. PFT according to the grouping Methods and Materials: clinical fi and evaluated reviewed retrospectively We age criteria of 55 years. air trapping, thickening, of bronchial wall the severity ndings on HRCT for fi PFT, thickening. and centrilobular Results: 43.76 0.96 (mean HRCT score in LOA (1.96 than in EOA in LOA cantly larger signifi was Background: regimens and high-dose corticosteroids, the frequent use of immunosuppressive have organ transplantation in hemodialysis techniques and and improvements causing increasing in number, been patients have meant that immunocompromised The purpose of this exhibit an increase in miscellaneous opportunistic infections. and to assess the HRCT images of pulmonary varied is to demonstrate infections such patients. CT for of updated diagnostic value Learning Objectives: patients with AIDS excluded We patients. nary in immunocompromised infections HRCT fi correlate To 2. from this study. and pathological fi fi mimic radiological disorders that may T. Muranaka T. Learning Objectives: C-234 Spectrum of high- patients: in immunocompromised Pulmonaryinfections resolution CT fi Furuya K. C-231 review A pictorial disease: Asbestos-related Reina Cubero, R. Garcia Benitez, Rodriguez Castilla, J. Diaz, M. Escobar I. Trujillo; Garcia I. Cordero, Payares J. conventional with chest radiographs, and lung parenchyma pleura (ARD) involving differentia- enabling diagnostic features emphasize To CT and High Resolution CT. lung masses associated with asbestos exposure. tion from benign and malignant Background: had a Our population with a long latency period. ARD is an occupational disease A long-term-follow-up this dust. in contact with workers of shipyard number great is necessary. of these workers Details: Procedure termasbestosis, reserved to interstitial fi fi Plain and bronchogenic carcinoma. masses including mesothelioma disease. and lung of asbestos related pleural extension to identify presence and than chest radiographs more sensitive to be much CT has been shown Conventional and can also identify fi these changes in demonstrating reticulation parenchimal bands, sis such as pulmonary lines, subpleural arcades, and interlobular thickened In addition, HRCT can demonstrate and honeycombing. will highlight typical characteristics that allows this review Finally, lines. intralobular a specifi pleural ssural fi on spectrum lesions including round atelectasis, of pseudotumor fi plaques and mass-like Conclusion: of ARD are described, imaging features Typical long latency period. and exposure masses. with special attention to lesions that can mimic neoplastic C-232 High-resolution CT fi and late-onset asthma: Early-onset S.-A. Choi, J.-S. Park, N.-M. Choi, S.-H. Paik; Bucheon, Paik; Choi, S.-H. N.-M. Park, Choi, J.-S. S.-A. ([email protected]) Purpose: am-
ammatory Miyazaki/JP Miyazaki/JP , 2 2 Rome/IT ndings of infl ndings were correlated ndings were ltrates, 4 patients (10%) ltrates, ndings. Only 10 patients ndings. ned mass or nodule was seen ned mass or nodule was , K. Nabeshima , K. 1 San Diego, CA/US, CA/US, San Diego, 1 c diagnosis. c diagnosis. cant correlation can be made with the cant correlation ; Scientific and Educational Exhibits Scientific and Educational 1 B80 vs B60 and B80 vs B30 while cant between , Y. Kakitsubata , Y. 1 broblastic tumor of the lung is a rare, benign pseudo- lung is a rare, tumor of the broblastic , P.J. Friedman , P.J. 2 CT images were obtained in 8 patients submitted to our obtained in 8 patients CT images were 25 patients with different clinical indications underwent a clinical indications underwent 25 patients with different broblastic tumor of the lung: CT - pathology correlation tumor of the lung: broblastic 9 4
, D.J. Theodorou , D.J. d ltrates and 8 (20%) patients with mixed fi 8 (20%) patients with mixed and ltrates , S. Tamura , S. 1 2 d n Because of variable imaging features, myofi broblastic tumor of the broblastic myofi imaging features, Because of variable Chest radiograph fi ndings in patients with melioidosis are very vari- fi Chest radiograph CT reconstruction algorithm may strongly affect functional lung volume functional lung volume strongly affect CT reconstruction algorithm may ammatory myofi ammatory i . nding on chest radiographs. Histopathologic fi nding on chest radiographs. brous histiocytoma type was noted in all cases. brous histiocytoma type was N I Infl To evaluate the effects of 3 different reconstruction algorithms on quantita- of 3 different the effects evaluate To F Results for volumetric assessment according to the three algorithms for assessment according to the three algorithms volumetric for Results for There were 27 patients (70%) with alveolar infi patients (70%) with alveolar 27 were There On radiographs and CT images, an ill-defi and CT images, On radiographs cant between B60 and B30. Comparison between volumetric results and Comparison volumetric between B60 and B30. cant between - c u d E i ammatory myofi ammatory c S - in 5 patients (6 lesions), and a well-defi ned lesion was present in 3 patients (3 le- ned lesion was in 5 patients (6 lesions), and a well-defi 5 During CT, located. centrally peripheral, and 2 were lesions were Seven sions). Increased homogeneous. and 4 were attenuation, of heterogeneous lesions were peribronchial infl by caused abnormalities, which were perilesional parenchymal The predominant histopathologic feature seen in 3 cases. were ltrates, matory infi lymphoplasmacytic type in 3 cases, organizing pneumonia type in 3 cases, was Variable type in 2 cases. and both organizing pneumonia and lymphoplasmacytic of fi degree Conclusion: lung is often misdiagnosed as lung cancer. CT fi ndings combined with certainndings combined CT fi lung is often misdiagnosed as lung cancer. can suggest specifi histopathologic features ([email protected]) ([email protected]) Purpose: semi automatic software. using a dedicated from MDCT by measures derived tive Methods and Materials: C-230 reconstruction algorithms of different Effect Functional lung parenchyma: quantitative measures imaging on 64-detector computed tomography Passariello; R. Catalano, Mennini, C. Bertoletti, M. L. Fraioli, F. chest 64-DCT (collimation 64 x 1.2 mm). Image data sets were reconstructed Image data sets were with 3 chest 64-DCT (collimation 64 x 1.2 mm). Density mask and volume sharp (B80), standard (B60), and smooth (B30). algorithms: algorithmmeasurements from the alternative compared with standard data sets were of density with a threshold segmented in subranges Each lung was algorithm data set. represent the functional these ranges HU; -500-1024 and -910-1024 of -500-910; the emphisematous zones. the total air contained in the lung and lung parenchyma, calculated algorithm from the three alternative measurement sets was Lung volume with vital capacity (VC). and compared with the software Results: [500-910] (B80) range:690-1174 (B60):range:923 cc; cc- as follows: each lung were cc; [500-1024] (B80) range:2300-2920 cc; cc-1535 (B30):range:1130 cc; 1368 cc-3145 cc; (B60):range:2554 cc-3335 cc; (B30):range:2830 [910-1024] (B80) cc. cc-1935 (B30):range:1430 cc-1752 cc; (B60):range:1345 cc; range:1257-1690 statistically signifi were Differences not signifi and the best correlation with B60 algorithm while an overstimation VC showed respectively. with B30 and B80 algorithms, found understimation was Conclusion: measurement. These differences are important when follow-up are requested: it are requested: are importantThese differences when follow-up measurement. use the same reconstruction algorithmis mandatory in the evaluation to always of chest exams. C-229 Infl S.J. Theodorou S.J. Results: with nodular infi with nodular Purpose: S. Kakitsubata S. The purpose to describe the CT fi of this study was tumor. myofi broblastic tumor of the lung with histopathologic correlation. broblastic myofi Methods and Materials: with patients, 5 male and 3 female There were period. a 9-year institution over The presenting symptoms (mean age of 55 years). of 22-73 years an age range an tumor was broblastic myofi 6 cases, For chest pain and cough in 2 cases. were incidental fi ndings in all cases. with the imaging fi Results: (26%) were noted to have associated cavitations. Apical involvement was only seen only was Apical involvement associated cavitations. noted to have (26%) were Seven- 5 patients (13%). only seen in effusion was Pleural in 16 patients (41%). lobe the rest had multiple and single lobe involvement teen patients (22%) had 50% had the right upper lobe In patients with single lobe involvement, involvement. 39% had all the lobes involved. lobe involvement, with multiple In patients involved. a very high mortality; was There seen in 16 patients (41%). was Apical involvement No signifi survive. 21 patients (54%) did not of symptoms. and the outcome and duration ndings fi chest radiograph Conclusion: and apical involvement, not frequently associated with cavitations It is also able. ndings The fi frequently seen in patients with pulmonarywhich were tuberculosis. mimic other pulmonary infections. may C - 7 0 R C EECR07-C-SciEduc-FIN.indd 49 Scientific and Educational Exhibits
Imaging Findings: Pulmonary infections presented are bacterial infections: Chest streptococcus, MRSA, klebsiella, pseudomonas aeruginosa, and legionella, fun- gus; aspergillus, candida, cryptococcus, pneumocystis carinii, cytomegalovirus, Pathology tuberculosis, and nontuberculous mycobacteriosis. All patients included in the study were in an immunocompromised state. HRCT fi ndings of these infections are demonstrated. Noninfectious disorders that present with similar imaging fi ndings C-235 are also shown to enable a differential diagnoses. Malignant mesothelioma: Pictorial review of radiological-pathological Conclusion: Pulmonary infections in immunocompromised patients present a correlation wide variety of radiological fi ndings and sometimes demonstrate imaging fi ndings S. Narayanaswamy, P. Rao, A. George; Plymouth/UK ([email protected]) mimicking those of noninfectious pulmonary disorders that make correct diagnosis diffi cult. Awareness of the various HRCT manifestations and imaging pitfalls will Learning Objectives: To illustrate the spectrum of imaging and histological appear- help in correct diagnosis and urgent treatment for such patients. ances, and to discuss the advantages and limitations of these investigations in the diagnosis and follow-up of patients with malignant mesothelioma. Background: Malignant mesothelioma is a highly aggressive tumour with an inci- dence progressively increasing with time. Malignant mesothelioma has got a grim prognosis attributable to the late detection of the disease. The diagnosis is based on a combination of clinical history, radiological appearances and histology. Despite all these modalities, diagnosis remains a challenging task to the medical profession as symptoms, imaging and the histological features often mimic other pathologies. Imaging Findings: Computed tomography, magnetic resonance imaging, PET and histology play an important role in the diagnosis and staging of malignant mesothelioma. The spectra of radiological abnormalities noted are pleural effusion, plerual thickening, calcifi ed pleural plaques, interlobar fi ssural thickening, contracted ipsilateral hemithorax, evidence of local and distant metastasis. Histologically, it is divided in to 3 distinct types, 1) Epitheliod (60%), 2) Sarcomatoid (15%) and 3) Biphasic (25%). We present a pictorial review of all these distinct radiological and histological appearances, and also discuss briefl y the importance of these features in the diagnosis and staging of malignant mesothelioma. Conclusion: A good understanding of the radiological and histological appearances is important as this will simplify and fasten the process of diagnosing malignant mesothelioma, enabling a larger number of patients to be diagnosed in the initial stages and undertake more successful treatment options. C-236 Feasibility of micro-computed tomography in quantifi cation of murine bleomycin-induced lung fi brosis in in-vivo and postmortem conditions: Correlation with pathologic score H. Lee, J. Goo, J.-G. Im, K.-R. Son, C. Lee, C. Park, E. Chun; Seoul/KR ([email protected])
Purpose: Bleomycin-induced lung fi brosis (BILF) is an animal model of pulmo- nary fi brosis. The aims of this study were: (1) to quantify BILF using micro-CT in in-vivo and postmortem conditions and (2) to correlate the micro-CT scores with pathologic ones. Methods and Materials: After intratracheal instillation of bleomycin in eight mice, in-vivo baseline and 2 weeks (2w) (n=3), 4 weeks (4w) (n=3), or 8 weeks (8w) (n=2) follow-up micro-CT (SkyScan 1076; SkyScan, Belgium) in in-vivo and immediate postmortem state were performed with 35 µm spatial resolution. On micro-CT, ground-glass opacities, consolidation, reticular opacities, honeycombing, and bronchial dilatation were scored. Pathologic scores including infl ammation, parenchymal fi brosis, and airway fi brosis were obtained. Spearman’s correlation analysis to correlate micro-CT and pathology, Kruskal Wallis with Duncan test to compare the 2w, 4w, and 8w groups, and Wilcoxon signed rank test to compare in-vivo and postmortem micro-CT were performed. Results: Consolidation score in both of in-vivo (rho=0.44, p=0.01) and postmortem (rho=0.45, p=0.01) showed correlation with infl ammation score. Score of bronchial dilatation in in-vivo (rho=0.49, p=0.02) and postmortem (rho=0.56, p=0.001) showed correlation with airway fi brosis score. In 2w group, consolidation score was higher than in 4w or 8w (p=0.03). In 4w and 8w groups, score of bronchial dilatation was higher than in 2w (p=0.02). Only consolidation score of micro-CT was higher in in-vivo than in postmortem (p=0.04), and other scores showed no difference. Conclusion: The scores of micro-CT and pathology were well correlated. The results of quantitative assessment in in-vivo and postmortem state were nearly comparable. C-237 Imaging fi ndings of blunt diaphragmatic rupture and delayed complications: A pictorial review E. Parlorio, E. Girela, M. Chans, J.R. Olalla, J.A. López-Corbalán, A. Moreno-Egea; Murcia/ES ([email protected])
Learning Objectives: To describe the anatomy of the diaphragm. To illustrate the spectrum of chest radiographic and helical CT fi ndings in blunt diaphragmatic rupture (DR). To emphasize the signifi cance of an early diagnosis and surgical repair to avoid delayed complications.
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Chest 0 : 7 1
7
0 0 2 . 2 381 0 ndings . 2 112.02.2007 17:03:52 ndings in eld of view, eld of view, ation (n=3), ation , G Sabadell/ES 1 2
hyperintensity nding was Alzira/ES, Alzira/ES, 1 ; 1 lms, CT and MR fi lms, culty to obtain quality images Leicester/UK , A.J. Revert-Ventura , A.J. 2 C rming thoracic fetal anomalies when rming fetal thoracic ndings and endoscopic correlation BDEF ation. The key MRI fi The key ation. , E. Mollá-Olmos , E. rming US fi ndings. rming fi US 1 ndings. A To illustrate the anatomy of the retrocaridac space. To To of the retrocaridac space. the anatomy illustrate To ([email protected]) ([email protected]) To familiarize with fetal thoracic MRI in order to be able to MRI in order to be able thoracic with fetal familiarize To
, E. Castañer-Gonzalez , E. To describe the characteristic imaging fi and illustrate To 1 ation in 10 of these. Five patients were studied with a 4-row studied with a 4-row patients were Five ation in 10 of these. We present our experience in fetal thoracic MRI describing thoracic in fetal present our experience We Chest X-ray fi ndings were branching tubular opacity (n=7), tubular branching ndings were fi Chest X-ray , A. Caño-Gomez , A. 1 lled bronchocele on T2-weighted images. Bronchoscopy guided by guided by Bronchoscopy images. T2-weighted lled bronchocele on We retrospectively studied12 patients (7 m and 5 f; mean age: mean age: studied12 patients (7 m and 5 f; retrospectively We Ultrasonography is the primary prenatal as- imaging modality for Ultrasonography A retrospective reviewed of the plain fi reviewed A retrospective CBA is a rare congenital anomaly in which one segmental bronchus congenital CBA is a rare MRI is the best choice for confi MRI is the best choice for 36.7 yrs). All patients underwent chest X-ray and CT and 3 also underwent MRI. MRI. and CT and 3 also underwent chest X-ray All patients underwent yrs). 36.7 clinical follow-up. and bronchoscopy All patients underwent Findings: Imaging hyperinfl nodular opacity (n=3), consolidation (n=3), distal parenchymal plug in all cases (n=12), a mucous CT showed (n=8). translucency and parenchymal stenosis of a segmental bronchus (n=11) with with (n=3) or without air (n=9), severe surrounding hyperinfl Intensity Projection (MIP), Minimum Maximum In these cases, CT. multidetector Intensity Projection (MinIP) and Multiplanar Reconstruction very helpful, (MPR) were morphology bronchus plug, the atresic segmental the tubular of the mucous showing and the surrounding hyperinfl affected, of the mucous-fi 2 patients. the atresic bronchus in all but ndings showed the CT fi Conclusion: CT scan, can suggest the diagnosis. features Radiographic is atresic or stenotic. characterization, localization, allows MinIP and MPR, MDCT with MIP, preferably diagnosis of the lesion, helping to ensure accurate and study of the distribution maneuvers. aggressive and obviating of this rare entity and provide guidelines for its diagnosis. To show the correlation show To its diagnosis. guidelines for entity and provide of this rare and endoscopic fi imaging between Background: ([email protected]) Learning Objectives: Learning Objectives: To normal abnormalities. recognize lung images and the most common thoracic abnormalities. thoracic the diagnosis of fetal the MR indications for know Background: Limitations of US include restricted fi abnormalities. sessment of fetal and the diffi dependence on the skills of the operator In Spain, prenatal US is usually per- due to maternal obesity or oligohydramnios. is scarce. and our experience than radiologists, gynaecologists rather by formed options should be considered, anomaly is detected, different When a pulmonary fetal early neonatal surgery abortion, or therapeutic such as in utero surgery, depending It is hospital. of a specialized of the abnormality and the availability on the severity a precise antenatal diagnosis and the cases where US fundamental to establish imaging modal- other reliable by be solved must and doubts arise, is inconclusive T2-weighted of ultrarapid and the development during pregnancy, MR is safe ity. confi for it suitable sequences makes Findings: Imaging of the normal abnor- thoracic lung and the the characteristic imaging features hernia congenital diaphragmatic congenital cystic adeno- (4), malities studied: (3), pulmonarymatoid malformation (2) and situs ambiguous with sequestration asplenia (1). Conclusion: with its use and with the be familiar must we As radiologists, US is not conclusive. of these pathologies. basic imaging features C-241 thoracic abnormalities of fetal MR imaging Amador; Rosselló, E. C. Jofre, Roldán, M. Rodriguez, J. M. Reynes, C. Palmer, J. de Mallorca/ES Palma C-242 masses of retrocardiac A pictorial review Behind the heart: Entwisle; Bajaj, J.J. Obaid, A. Vlachou, H. P.A. C-240 fi Imaging atresia: Congenital bronchial Pallardó-Calatayud Y. ([email protected]) Learning Objectives: Radiologists with a broad spectrumoc- of disease processes that can familiarize of of a wide range appearances the radiological demonstrate To cur in this region. the further the role of MDCT for assessment of evaluate To retrocaridac masses. diagnosis. accurate these conditions in order to establish Background: J. Camps-Herrero J. chest radiograph, with other techniques also it is useful, e.g. MRI (evaluation of MRI (evaluation also it is useful, e.g. with other techniques chest radiograph, planning for in selected cases value (of considerable CT or multislice wall) thoracic surgical procedures). cult am- ndings ndings on CT, including ndings on CT, ltrated the mediastinum in 5 the mediastinum ltrated brosing mediastinitis frequently brosing mediastinitis frequently London/UK Scientific and Educational Exhibits Scientific and Educational ammatory/infectious, tumour or extra- ammatory/infectious, brosing mediastinitis obtained from our database ([email protected]) ([email protected])
ndings and several CT signs indicative of DR, such as CT signs indicative ndings and several To illustrate the spectrum of CT fi ndings of fi brosing brosing ndings of fi the spectrum illustrate of CT fi To 1) Recognize the normal of the ribs 1) Recognize appearance in various We retrospectively reviewed the clinical, pathological and reviewed retrospectively We We present a cohort present We of patients with rib disease assessed in We reviewed chest radiographs and helical CT scans of 10 radiographs chest reviewed We 1 5
d d Fibrosing mediastinitis is a rare condition characterised by exces- condition characterised by Fibrosing mediastinitis is a rare In daily practice, conventional chest radiograph offers an excellent an excellent offers chest radiograph conventional In daily practice, DR occurs in approximately 5-6% of blunt thoracoabdominal trau- thoracoabdominal of blunt 5-6% approximately DR occurs in n DR usually requires prompt surgical repair to avoid delayed com- delayed surgical repair to avoid DR usually requires prompt Obstruction fi structures of vital by An assessment of the ribs is of primary importance in the conventional i . Barcelona/ES N I ndings on 12 cases of fi F - c u d E i c c chest radiographic fi c chest radiographic S ndings - intrathoracic herniation sign, sign, collar intrathoracic content, dependent viscera of abdominal thickening. diaphragmatic sign, and diaphragm absent of the diaphragm, discontinuity 2 complications: of them with severe presentation, 3 delayed patients showed Five colonic strangulation/obstruction. 1 transverse gastric volvulus, intrathoracic Conclusion: of Familiarity and helical CT. Diagnostic tools include chest radiograph plications. of DR is required to guide and radiology anatomy with diaphragmatic radiologists patient. the management of polytraumatized Learning Objectives: the radiological 2) Illustrate particularlyimaging techniques, the chest radiograph. particularly imaging techniques, the various 3) Know the ndings of rib diseases. fi CT and reconstructionapplication of multislice techniques. Background: opportunity assesing the ribs and detecting potentially undiagnosed disease. for classify these lesions into three We the ribs. that affect diseases There are many congenital, infl main pathological entities: Do not forget the ribs: Pathology, imaging techniques and radiological techniques imaging Pathology, the ribs: Do not forget fi Andreu Soriano, Morenza, J. Persiva Roque Pérez, O. A. Porres, Varona D. Cáceres; J. C-239 pulmonary lesions. Findings: Imaging chest radiograph, imaging techniques (conventional our hospital using different CT, can be studied with multislice group The congenital CT). MRI or multislice The infl useful reconstruction techniques in case of surgery. using extremely diseases are presented, is heterogeneous and various group matory/infectious In adulthood, the cyst. tuberculosis or hydatid cell histiocytosis, Langerhans’ e.g. Primary tumours most common rib myeloma. lesions are metastasis and multiple the most frequent are chondroid tumours (chondroma of the ribs are uncommon; Extra-pulmonary lesions (neurogenic tumours and pleural and chondrosarcoma). the ribs. erode or invade lesions) may or extra-pleural Conclusion: Fibrosing mediastinitis - the spectrum of contrast-enhanced CT fi mediastinitis - Fibrosing C-238 patients with surgically proved blunt DR. 100% were left-sided. We describe spe- We left-sided. 100% were DR. blunt patients with surgically proved cifi because DR may be overlooked due to associated thoracoabdominal lesions. If the lesions. due to associated thoracoabdominal be overlooked because DR may Sub- occur. herniationdiagnosis is missed, intrathoracic may of abdominal organs a mortality of up to rate sequent gastrointestinal strangulation/obstruction will have trauma. screening tool after blunt remains the initial Supine chest radiograph 50%. analysis more accurate particularly allows scanners, multidetector-row Helical CT, in diagnosis. with the subsequent improvement of the diaphragm, Findings: Imaging Padley; Nicholson, S. n, A.G. Griffi N. Devaraj, A. Learning Objectives: mediastinitis. Background: Fibrosing medisatinits diffusely infi from 1992 to 2006. of mediastinal of 12 cases had narrowing Eleven in 7. localized patients and was structures, including 5 with pulmonary artery with bronchial (41.6%), 4 narrowing of (25%) and one with narrowing narrowing (33.3%), 3 with tracheal narrowing often associated with The presenting complaint was the pulmonary (8.3%). vein considered The disease was mediastinal structure. compression of a relevant (41.6%). aetiology in 5 cases idiopathic in 7 cases (58.3%) with a demonstrable Eight out of 12 patients (66.6%) had additional pulmonary fi aetiology. all patients with a known Conclusion: sive fi brous tissue deposition within the mediastinum. It may present as either as either present It may mediastinum. brous tissue deposition within the fi sive underlyingan idiopathic condition or as a consequence of an process such as TB or histoplamosis. Details: Procedure imaging fi Background: Left-sided injuries aspect of diaphragm are more frequent, the posterolateral mas. diagnosis is often diffi The preoperative common site of rupture. being the most gives rise to complications and is accurately illustrated by contrast-enhanced CT. CT. contrast-enhanced by rise illustrated to complications and is accurately gives in particularndings, when There is a high incidence of concomitant pulmonary fi aetiology is present. able an identifi C - 7 0 R C EECR07-C-SciEduc-FIN.indd 51 Scientific and Educational Exhibits
patients presented with retrocardiac lesions in a University Teaching Hospital over C-245 the last 10 years. Data was collected from Computerized Radiology Information Tubes, lines, and catheters in plain chest fi lms: An abc guide for the System and Medical notes were reviewed if necessary. Images were reviewed on assessment of normal and pathological fi ndings PACS. CT scans were performed by using 16 Multislice scanners. Images were D.D. Cokkinos, G. Giannakopoulou, E. Daskalaki, M. Avlianos, A. Bouga, reported by Chest Radiologists. A. Kontogiannis, N. Gavalas; Athens/GR ([email protected]) Imaging Findings: The pictorial review will illustrate conditions including pulmonary sequestration, hiatus hernia, lung tumour, para-esophageal varices, neurogenic Learning Objectives: To illustrate the essentiality of evaluating the position of tumours (such as neurofi broma, medulloblastoma and schwannoma), lobar col- tubes, lines and catheters in chest X-rays. lapse, aortic aneurysm, pericardial and bronchogenic cysts, pleural masses, chest Background: Tubes, lines and catheters are common fi ndings on everyday radio- wall lesions and paraspinal masses (like extramedullary hematopoiesis, abscess graphs, especially chest studies. It is essential to evaluate the placement and posi- and metastases). tion of tubes and lines, such as central venous and arterial catheters, endotracheal Conclusion: Retrocardiac masses are not uncommon but are often missed. Cross- and nasogastric tubes, thorax drains, and cardiac pacemakers. Unfortunately, lack sectional imaging plays an important role in the diagnosis of retrocaridac tumours. of familiarity with these devices leads to misjudgement of proper positioning, and Radiologists should be aware of the imaging fi ndings of lesions situated behind the therefore immediate or delayed complications. heart in order to lead to accurate diagnosis. Procedure Details: We inspected retrospectively chest radiographs from 65 patients (neonates, children, and adults) and concentrated on identifying all C-243 tubes, lines and extraneous devices. We reviewed the fi lms with respect to normal positioning and malpositioning. We also looked out for complications associated Watch the diaphragm: Practical MR imaging of the thoracoabdominal junction with inappropriate positioning or malfunctioning devices, such as pneumothorax, M.C. Saborido, J. Mañas, M. Rodriguez, M. Arias, A. Iglesias, J. Leon; Vigo/ES air embolism, perforation and bleeding. In addition, we assessed the device’s ([email protected]) integrity and alignment, receiving valuable information for the patient’s general Learning Objectives: 1. To review the diaphragm embriolgy and anatomy. 2. To health or lack thereof. review the Diaphragmatic and paradiaphragmatic pathology. 3. To review the imaging Conclusion: Familiarisation with normal and abnormal fi ndings of tubes, lines features of normal and pathologic diaphragmatic and paradiaphragmatic processes. and catheters is essential and leads to proper management and treatment of 4. To review the advantages of MRI in evaluating the thoracoabdominal junction. the patients. Background: The diaphragm is a musculotendinous structure that separates the thoracic and abdominal cavities. MRI offers multiplanar capabilities and good tissues C-246 contrast resolution. Review the anatomy and diaphragmatic and paradiaphragmatic Molecular targeted anti-cancer therapeutic agents for non-small cell lung processes and its appearances in MRI. Emphasis will be placed on diaphragmatic cancer: Mode of action, current results, and radiologic fi ndings after hernia and traumatic pathology. treatment using these agents Imaging Findings: To assess hernias and their contents is the most common C. Park, J. Goo, H. Lee, C. Lee, J.-G. Im, E. Chun; Seoul/KR indication for diaphragmatic MRI and coronal and sagital. T1-Weighted offers an ([email protected]) optimal visualisation of the hypointense diaphragm to evaluate the anatomy. MRI also provides tissues characterization of the hernia contents. MRI can be useful Learning Objectives: 1. To review the mode of action of various molecular targeted in evaluating for transdiaphragmatic extension of disease, primary or metastatic anti-cancer agents used for non-small cell lung cancer (NSCLC). 2. To review the diaphragmatic or juxtadiaphragmatic tumors. selection of proper patients from whom we can expect reasonable therapeutic re- Conclusion: MRI of the diaphragm permitted to evaluate small lesion or hernia sponse from each targeted agent. 3. To present the imaging fi ndings of the NSCLC anatomy and it can answer clinical diagnostic questions with important management after the chemotherapy using these kinds of anti-cancer agents. implications that others studies of imaging cannot. Knowing normal and abnormal Procedure Details: 1. Mode of action of various molecular targeted agents: A. processes allows for the best diagnosis. Epidermal growth factor receptor (EGFR) targeted agents, B. Anti-angiogenic agents and C. Other mechanisms. 2. Patients selection and predictive biomarkers of each C-244 molecular targeted agents. 3. Current results of various molecular targeted agents. 4. Review of imaging fi ndings after treatment using these agents: A. Computed Assessment of diaphragmatic motion after lung resection using magnetic tomography including un-enhanced image and post-contrast image and B. Positron resonance imaging emission tomography. R. Takazakura, M. Takahashi, N. Nitta, K. Murata, N. Tezuka, S. Sawai, S. Fujino; Conclusion: 1. NSCLC benefi ts from the molecular targeted agents including Otsu/JP ([email protected]) EGFR targeted agents and anti-angiogenic agents, which have led to a new era in Purpose: To quantitatively assess the impairment of diaphragmatic motion after the treatment of NSCLC. 2. Patient selection is mandatory to ensure the treatment lung resection using magnetic resonance imaging. effi cacy and decrease the occurrence of the treatment-related complications. 3. The Methods and Materials: In 44 patients (29 males and 15 females, mean age: knowledge about molecular targeted anti-cancer agents and familiarity with the im- 62.2 years) with lung cancer, diaphragmatic motion was measured during maximal ages of the patients treated with these agents will be mandatory for the radiologists deep slow breathing using a spoiled gradient-recalled-echo sequence before and to determine the accurate tumor-response to the molecular targeted agents. after lung resection. The study group consisted of 34 patients who were examined using a 1.5-T unit in the supine position and 10 patients using a vertically open C-247 0.5-T unit in both the sitting and supine positions. The infl uence of surgery sites The spectrum of diseases causing airway mucoid impaction and postures of the patients on the diaphragmatic motion after lung resection was J. Euathrongchit1, N. Thoongsuwan2, J.P. Kanne3, E.J. Stern4; 1Chiang Mai/TH, investigated. The protocol of this study was approved by the Institutional Review 2Bangkok/TH, 3Cleveland, OH/US, 4Seattle, WA/US ([email protected]) Board. We received written informed consent from all subjects. Results: In all cases after the lung resection, the diaphragmatic motion of the Learning Objectives: To systemically review the imaging aspects of the spectrum operated side signifi cantly decreased (p < 0.001) and that of the non-operated of diseases causing mucoid impaction of the airways. side increased signifi cantly (p = 0.045). After left upper lobectomy and right bi- Background: Mucoid impaction, mucus plugs, and bronchial mucocele are similar lobectomy, the diaphragmatic motion of the operated side decreased signifi cantly conditions resulting from accumulation of inspissated secretions such as mucus/ (p < 0.001), and that of the other side increased signifi cantly (p < 0.001). After pus/ infl ammatory products within the bronchi, whichto EPOSare usually dilated. Mecha- right middle lobectomy, the diaphragmatic motion had not changed signifi cantly. nisms resulting in this condition are abnormal mucociliary transport, excessive produc- The diaphragmatic motion of the operated side was impaired signifi cantly more (p tion of mucus, and collected mucous in bronchi distal to an airway obstruction. = 0.035) in the supine position than in the sitting position. Procedure Details: In this exhibit, we follow the above mechanisms to display the Conclusion: Our results indicated that magnetic resonance imaging (MRI) was variety and spectrum of presentations of mucoid impaction. useful for quantifying the impairment of the diaphragmatic motion after lung Conclusion: This educational computer exhibit reviews the spectrum of the radio- resection. graphic features of mucoidNo Material impaction Submitted on chest radiographs, CT and MRI and the underlying mechanisms responsible.
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7 0 0 2 . 2 383 brosis 0 . 2 112.02.2007 17:03:52 G c radiological radiological c
percent- c diagnosis in a great ([email protected]) ([email protected])
London/UK C bromatosis; fusiform tumour in neural tumour in neural fusiform bromatosis; BDEF ed into 5 subtypes (0-4). Subtype 1 may Subtype 1 may ed into 5 subtypes (0-4). A Toronto, ON/CA Toronto, cans neurofi cans CT studies were reviewed for 14 consecutive patients re- 14 consecutive for reviewed CT studies were To illustrate the spectrum of thoracic pathology seen in sickle the spectrum pathology seen in sickle illustrate of thoracic To We will illustrate the common and uncommon manifestations of manifestations the common and uncommon will illustrate We a specifi us to establish ndings allow Sickle cell disease (SCD) is a hemoglobinopathy characterized by by characterized is a hemoglobinopathy cell disease (SCD) Sickle In patients with suspected CCAM, preoperative CT may suggest the CT may In patients with suspected CCAM, preoperative The knowledge of pathologic processes that affect the chest wall and the chest wall of pathologic processes that affect The knowledge Thoracic disease due to sickle cell anemia has many different manifes- different many cell anemia has disease due to sickle Thoracic cation: myositis ossifi myositis cation: Congenital cystic adenomatoid malformations (CCAMs) are rare con- (CCAMs) are rare Congenital cystic adenomatoid malformations Median age at the time of resection was 3.2 years (range:1.2-23.4). Five Five (range:1.2-23.4). 3.2 years Median age at the time of resection was behaviour, imaging techniques provide a strategy in the workup of an accurate in the workup of an accurate a strategy provide imaging techniques behaviour, the surgical approach. biopsy and for and is a useful guide for diagnosis, subescapular, fusiform soft tissue and fat lesion: elastofi broma dorsi; cystic tumour cystic tumour broma dorsi; elastofi lesion: soft tissue and fat fusiform subescapular, ground-glass expansive, bone cystic lymphangioma; cervico-thoracic junction: talas- the diagnosis: settings that help to precise Clinic brous dysplasia. fi matrix: hematopoiesis; extramedullary bone density anomaly: masses; paraspinal emia; antecedent; abscess traumatic density: low central ring uptake, context; infectious calcifi gross sarcoma. radio-induced radiotherapy; previous tumour; neurogenic territory: Conclusion: fi its radiological a non-specifi lesions show when chest wall However, age of the cases. C-252 Is CT a useful predictor of malformation: adenomatoid Congenital cystic histological type? Padley; Nicholson, S. A. Deveraj, n, A. Griffi N. C-251 disease in children cell of sickle Thoracic manifestations Parkin; P. Babyn, Helm, P.S. E.J. Learning Objectives: CT and MRI plain radiography, by cell anemia as demonstrated Background: The lung and heart are major target organs in changes in all major organ systems. of pulmonary disease include the acute chest c manifestations Specifi this disease. include manifestations Cardiovascular chronic lung disease. syndrome and sickle ischemia and pulmonary hypertension, chamber dilatation, myocardial multiple manifestations disease is frequently associated with other severe Thoracic infarction. as neurological disease and bone infarction. cell anemia such of sickle Findings: Imaging lung disease and pulmonary chronic SCD including acute chest syndrome, hyper- A be subtle or absent. ndings may lm fi plain fi In the acute chest syndrome, tension. occur. picture may consolidation and an ARDS type to multifocal progression rapid and better depicts glass shadowing ground and hypoperfusion demonstrate CT may lung disease include fi sickle ndings in chronic lm fi Plain fi early changes. [email protected]) (nyreegriffi Purpose: genital lung lesions recently reclassifi type-4 CCAMs between There is also overlap undergo malignant transformation. to determineThe aim of this study was if and type-1 pleuropulmonary blastomas. aid characteristic changes on CT that may pathological subtypes 1, 2 and 4 show diagnosis preoperative Methods and Materials: postnatally with the histological diagnosis of CCAM on surgical resection. ferred Results: type-2 CCAM; 6 were patients had type-1 histology; Five females. patients were CT review encountered. No type-0 or type-3 lesions were type-4 CCAM. and 3 were and Lesion size lobes (11). in the lower Most lesions were indicated the following: 40 cysts), and did not depend on histo- (from 1 to over variable were cyst number cyst diameter with maximum ned cysts, lesions had well-defi Type-1 logical type. cyst with maximum lesions had cystic change in 5 cases, Type-2 4 cm. exceeding also seen were Areas of reduced attenuation diameter measuring less than 2 cm. either microcystic (1) or macrocystic change (2), with showed lesions Type-4 (5). mediastinal shift seen and contralateral cases, in all 3 demonstrated mass effect nodules. One patient also had pleural in 2 cases. Conclusion: regarding malignant potential. information histological subtype and thus provides and cor pulmonale. CT changes include interlobular septal thickening, reticular septal thickening, CT changes include interlobular and cor pulmonale. ndings of fi Echocardiographic loss. lobar volume tags and abnormalities, pleural reported. extensively been chamber dilatation and pulmonary hypertension have ndings of ischemia or infarction. furtherSPECT imaging can demonstrate fi Conclusion: assessment, been used for has traditionally Although the chest radiograph tations. importantother imaging modalities frequently add additional information. ndings ndings
Hull/UK c tumour. To show To c tumour. Alzira/ES ndings of reservoir associ- ndings based on a series of lms, US, and CT) of the different and CT) of the different US, lms, Scientific and Educational Exhibits Scientific and Educational lms, ultrasound and CT are useful for the and CT are useful for ultrasound lms, cation: development anomalies; iatrogenic anomalies; development cation: ndings of the complications that may occur ndings of the complications that may ndings (plain fi ndings that may establish an accurate diagnosis: fat fat diagnosis: an accurate establish ndings that may To describe the radiological features (chest X-ray, CT and (chest X-ray, describe features radiological the To To establish an imaging algorithm in order to approach the establish To To review and illustrate the imaging spectrumand illustrate of Asbestos- review To bres than the pleurae, asbestosis is a well-recognised sequel asbestosis is a well-recognised bres than the pleurae, ndings Benign pleural disease is the commonest encountered mani- disease is the commonest encountered Benign pleural Imaging fi 3 Normal imaging fi 5
d ([email protected]) ([email protected]) d Chest ports an important play role in the management of oncology Asbestos fi bres inhalation is known to induce a range of pleural of pleural to induce a range bres inhalation is known Asbestos fi
Chest wall disorders classifi Chest wall n Appropriate knowledge of the normal Appropriate and radiologi- knowledge CR appearance Owing to the accuracy of imaging in asbestos-related disease and Owing to the accuracy i . N I F - c u d E i c S - C-250 and its pathological techniques Role of the image Chest wall disorders: correlation Navarro-Hervás, M. Ferrer-Ripolles, P. Pallardo-Calatayud, Y. Jornet-Fayos; J. Forment-Navarro, M. Revert-Ventura, A.J. the characteristic imaging fi show To lesions. characterization of chest wall ([email protected]) Learning Objectives: of a certain the establishment that allow diagnosis of a specifi imaging and histological fi the correlation between 72 patients. Background: density: lipoma; high density: hematoma; phleboliths and vascular enhancement: enhancement: phleboliths and vascular hematoma; high density: lipoma; density: cortical continuity tumour; chondral cations: rings and arcs calcifi hemangioma; broma; neurofi appearance: target-like osteochondroma; and medullary bone: Learning Objectives: admin- US) of chest ports chemotherapy and reservoirs (CR) commonly used for describe fi the radiological To istration. with these devices. Background: intravenous and other chemotherapy products, patients who need frequent blood Chest port arise during their placement, removal related complications may drugs. cases of catheter-induced Many be asymptomatic. may or the meantime and they the incidence of pulmonary but embolism in thrombosis go unrecognized, central Plain fi be as high as 12%. may this group secondary involve- neoplasms: pseudotumours; infections; lesions; and traumatic primary myeloma, tumours. ment, metastasis, Findings: Imaging C-249 portsSpectrum of radiological appearance of chest and catheters: non-interventional radiologists for An exhibit Alonso-Burgos; A. del Pozo, J. Noguera, Bastarrika, J. G. Villanueva, Diaz, A. M. Pamplona/ES prompt diagnosis of these complications. General and oncology radiologists rather rather radiologists and oncology General prompt diagnosis of these complications. an important play than interventional role in their detection. radiologists Findings: Imaging ports such as thrombus and reservoirs and some common interpretation pitfalls, Radiological fi are described. inside a vein, formation and catheter related and infection ated complications such as rotation, thrombosis, displacement, breakage, thrombosis, tip and sleeve complications such as mural, are discussed. and infection migration Conclusion: ndings of CR related complications is important a prompt in order to facilitate cal fi to consider the CR are encouraged radiologists General diagnosis. and effective as an area of interest when interpreting imaging studies. Pleuropulmonary manifestations of asbestos-related disease: Computed Computed disease: of asbestos-related manifestations Pleuropulmonary (CT) fi tomography C-248 Avery; G. Kennan, N. Lavakumar, R. Viswanathan, C. Khaleel, Z. ([email protected]) ([email protected]) Learning Objectives: related disease of the lungs and the pleura with emphasis on computed tomography with emphasis on computed tomography and the pleura related disease of the lungs ndings. (CT) fi Background: been gradually have of asbestos exposure High levels and pulmonary disorders. of this disorder is still Prevalence countries. in many prohibited since the 1970s this is secondary or longer) period to the long latency (20 years however, rising; of the disease. and development exposure initial between Findings: Imaging rounded atelactasis and plaques, effusion, pleural and includes pleural festation is thought to be less sensitive Although lung parenchyma thickening. diffuse pleural of the fi to the effects include bonchogenic Malignant manifestations to prolonged asbestos inhalation. carcinoma and malignant mesothelioma. Conclusion: role a pivotal plays the radiologist the medicolegal implications of the diagnosis, of the CT/HRCT fi aim to present a review We in the disease management. of this debilitating illness. of this debilitating illness. C - 7 0 R C EECR07-C-SciEduc-FIN.indd 53 Scientific and Educational Exhibits
C-253 Conclusion: Normal variants and congenital thoracic anomalies in adults may be a diagnostic challenge in normal practice because of their CXR aspect or because Imaging of lung scedosporiosis of their unusual presentation at that age. CT is a known helpful technique to get R. Pellón, E. Marco de Lucas, J. Arnáiz, M. López-Duarte, G. Blanco, T. Piedra, the fi nal correct diagnosis. A. Ortiz, J. Jordá, E. Ruiz, M. Torres, J. Izquierdo, A. Fernández Flórez, A. Bermúdez, F. Marco de Lucas; Santander/ES ([email protected]) C-256 Learning Objectives: To describe the main imaging fi ndings of Scedosporium Cryoablation for the treatment of malignant lung tumors: Correlation with prolifi cans infections in deep immunocompromised patients. sequential CT fi ndings Background: Scedosporium prolifi cans and pseudallescheria are emerging S.-Y. Ham, S. Cho, S. Lee, K. Kim, Y.-H. Kim; Seoul/KR ([email protected]) opportunistic fungal agents encountered in severely neutropenic patients during treatment of haematologic malignancies. A major part of the cases described Purpose: To present our results of CT guided cryoablation for primary and meta- have been found in northern Spain and France, and Australia, with an increas- statses and evaluate role of cryoablation in palliation of primary and metastases. ing number of cases published. Between January 1997 and December 2005, 17 Methods and Materials: Total 23 patients (male:female: 19:4) with mean 61 patients with lung scedosporiosis were studied in our hospital, all of them with year old (37-74 years old) were included. 28 cases were analyzed. The ratio of pulmonary infections. primary and metastases was 17:6. Mean tumor dimension is 37.9 mm. Pathology Imaging Findings: Imaging fi ndings are based on chest radiography and computed were squamous cell ca (8), adenocarcinma (9), metastases (hepatocelluar ca (2), tomography. Most frequent fi ndings in pulmonary infections are patchy, bilateral renal cell carcinoma (2), colon cancer (1), soft tissueEPOS sarcoma (1)). CT guided and rapidly progressive condensations associated with severe respiratory failure. cryoablation was performed under the local anesthesia by guidance of CT. Mean In addition, 8 patients had brain lesions secondary to embolic dissemination. Imag- ablation is 2.4 per patient. Sequential CT was acquired on 1, 3, 6 mo. CT fi ndings ing fi ndings are fairly similar to those encountered in disseminated aspergillosis; were analyzed (maximal dimension, mean attenuation). We analyzed sequential however, all these patients had a fatal and rapid evolution, because this fungus is changes of volume and mean ROI. Nine of them were correlated with PET-CT for resistant to all anti-fungal therapies known. Autopsy demonstrated necrosis and evaluation of viable component. hyphae proliferation inside the thoracic and brain lesions. Results: Major symptoms (cough, dyspnea, and hemoptysis) were assessed Conclusion: Scedosporium prolifi cans must be included in the differential diagno- and showed improvementNo Material in symptoms. Submitted Mean admission to was less than 1 week. sis of rapid lung infi ltrates in deep immunocmpromised patients in some western Complications were pneumothorax (6), hemothorax (1), hemoptysis (10), pleural regions of Europe and Australia. effusion (6). Patients were followed for a mean period of 11 months (4-23 months). In metastases, perilesional necrosis was more prominent in immediate CT (within C-254 1 week). Six cases were increased dimension. Necrosis was shown in fi ve cases. Five have increased CT attenuation than initial CT. Non pulmonary primary thoracic malignancies: A radio- pathological Conclusion: Cyoablation plays an important role in palliation of advanced cancer, correlation post operative recurrence, or metastases. Our study suggests that adequate pal- A. Donuru1, V. Kandula1, A. Barbieri2, J.J. Entwisle1; 1Leicester/UK, liation may be achieved by cryoablation applied to advanced cases. 2Northampton/UK
Learning Objectives: The purpose of this exhibit is to describe the radiological fi ndings of various non-pulmonary primary thoracic malignancies. All the cases illustrated are pathologically proven. Background: Thoracic cancer comprises many different types of cancer that strike the thorax. Some types are common, such as lung cancer and esophageal cancer. Some are rare. Imaging Findings: The pathologies included are lymphoma (Hodgkin’s and Non Hodgkin’s), breast cancer, oesophageal cancer, mesothelioma, sarcoma, thy- moma, angiosarcoma, leiomyosarcoma, chondrosarcoma, ganglioneuroblastoma, malignant fi brous histiocytoma, rhabdomyosarcoma, haemangioendothelioma, plasmacytoma and neurilemmoma. Conclusion: It is important for the radiologists to have an awareness of the imaging fi ndings of the above mentioned thoracic malignancies. When the diagnosis is not clear on a chest radiograph or on computed tomography it is strongly recommended that a biopsy is performed for pathologic confi rmation. C-255 Normal variants-congenital thoracic anomalies in adults F. Fernandez1, M. Villarreal1, V. Muñoz1, E. Lopez1, A. Torramilans1, O. Pozuelo1, E. Andia2; 1Viladecans/ES, 2Hospitalet de Llobregat/ES ([email protected])
Learning Objectives: To present normal variants-congenital thoracic anomalies diagnosed in adults in a county hospital. Background: Normal variants and specially congenital thoracic anomalies are usually diagnosed during childhood. Asymptomatic lesions may be diagnosed in early adulthood. Most of them are easily depicted because they are relatively frequent, but others can be misdiagnosed because of their bizarre radiological aspect or because of their unusual presentation in the adult life. Imaging Findings: We will show CXR and CT of different normal variants-congeni- tal anomalies affecting mediastinal vessels (aorta and its branches, inferior vena cava), pulmonary vessels (pulmonary atresia and pulmonary anomalous pulmonary venous return including two cases of combined venous anomalous drainage from RUL and RML to superior vena cava and one case of venous anomalous drainage from RLL associated with intrahepatic inferior vena cava agenesis), pericardium (two cases of congenital absence of pericardium, one of them associated with congenital diaphragmatic hernia), and bronchial tree (bronchial atresia, bronquial atresia with broncocele, accessory cardiac bronchus and aberrant origin of seg- mental posterior LUL bronchus from LUL bronchus with associated vein coursing partially trough the mediastinum).
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7 0 0 rst- 2 . cant 2 385 0 . 2 112.02.2007 17:03:52 nal patho- nal ndings were were ndings rmed patho- G ne needle aspiration needle ne rmation of nodal status
cacy of PET-CT and chest cacy of PET-CT to EPOS to culties in accurate staging. culties in accurate Seoul/KR ([email protected]) C
BDEF rmation disease. of nodal or distant A ed 71 patients as neoplastic. Twenty-seven cor- Twenty-seven as neoplastic. ed 71 patients Gwangju/KR This study enrolled 33 patients with lung cancer who had Retrospectively reviewed CT scan, PET-CT, and histology CT scan, PET-CT, reviewed Retrospectively
c histopathology for non small cell cancer. Higher level SUV Higher level non small cell cancer. c histopathology for No Material Submitted Submitted Material No PET-CT and chest CT showed similar results in staging of lung similar results in staging of lung and chest CT showed PET-CT Our initial results indicate that 18 FDG PET-CT may be useful as fi may that 18 Our initial results indicate FDG PET-CT PET SUV, independent of size, is a marker of biologic aggression that of biologic aggression is a marker independent of size, PET SUV, ndings mimicking true fi ndings. true fi ndings mimicking To evaluate the SUV in the primary inde- nodes, lesion and metastatic evaluate To The goals of this study are to estimate the effi PET-CT correctly classifi PET-CT Agreement in PET-CT for staging of lung cancer is 21.2% (7 cases). staging of lung cancer is 21.2% (7 cases). for in PET-CT Agreement The 37 of squamous cell ca and 31 of adenocarcinoma. was Pathology were obtained in all cases and served obtained in all cases of reference. as standard were Results: 14 to squamous-cell carcinoma, 25 to large-cell responded to adenocarcinoma, false- remaining 8 patients were The carcinoma. carcinoma and 5 to small-cell 3 processes (3 abscesses, ammatory-infectious corresponding to infl positives and the The sensibility lung cancer. that simulate tuberculosis and 2 neumonia) all the patients, In 100 and 89.87%, respectively. were value positive predictive modalities such as contrast- of other imaging the performance avoided PET-CT scintigraphy. enhanced body CT and bone Conclusion: with suspected lung cancer and help in avoiding line imaging modality in patients other diagnostic procedures. intravenous contrast, and water as oral contrast. Biopsy and/or fi Biopsy contrast. as oral and water contrast, intravenous Results: seen in 12 cases (36.3%) and was PET-CT cancer by lung stage for Overestimated In 6 cases interpreted were %) to be in an underestimated stage. 8 cases (24.2 fi Diseases causing false-positive not proved. (18.2%), malignancy was such as ammations and infl lymphadenopathy, reactive ammatory granuloma, infl Small cancer or small malignant lymph nodes pneumonia, lymphoma. pneumonitis, ndings. PET fi false-negative showed Conclusion: the proper for Also, studies represented high conditional dependency. Two cancer. false the various PET-CT, interpretation diagnosis of lung cancer by and accurate understood. should be ndings of PET-CT fi ([email protected]) Purpose: correlates with presence of nodal or distant metastases at the time pendent of size, of presentation and correlate pathologic types of non-small cell lung cancers. Methods and Materials: Patients 2003 and 2006. population between of patients in our lung cancer referral with primary non-small-cell lung cancer and pathologic confi We analysis. included for or accepted non-PET proof of distant metastases were = (SUV RI (Retention Index) acquired the percent change of SUV according to this; compared with fi staging were CT and PET-CT 1h-SUV2h)x100/SUV 1h. Sixty-eight patients (M:F = 51:17, mean 63.1 yr old) had complete logic staging. and confi PET, including CT, results, Results: There is a signifi and 5 IV. 14 IIIA, 11 IIIB, 9 IIA, 12 IIB, 6 IA, 11 IB, stages were SUV of primarycorrelation between nodal or distant metasta- lesion and presence of higher than squamous cell carcinoma than adenocarcinoma. were ses and RI value is The RI ratio is 16.1:5.6 (squamous:adenocarcinoma). Mean SUV of each group similar The SUV of the lymph nodes were 20.5:12.5 (squamous:adenocarcinoma). pattern RI to the primary mass. Conclusion: can predict the specifi squamous cell carcinoma than adenocarcinoma. of primary mass favors logically. The correlation of tumor stages by PET-CT or chest CT, and both studies CT, or chest PET-CT The correlation of tumor stages by logically. ndings of fi or false-negative false-positive various Also, evaluated. combined were causing diffi thereby demonstrated, were PET-CT C-261 of non-small cell lung cancer in the differentiation Dual time point PET-CT Kim; Y.-H. Choe, Kim, J. Oh, S. Y.-W. Ham, S.-Y. C-260 in lung cancer staging for CT and chest The comparison of PET-CT Kim; Y. Byun, J. Yang, Kim, J. D. Purpose: or (positive false various and combined, in tumor staging and to exhibit alone CT, fi negative) Methods and Materials: patients is of the consecutive The age range and chest CT. undertaken PET-CT Two done within 27.1days. Both studies were 60.8 years). (mean age: 35-81 years solved obtained from each test, and discrepancies were independent readings were lung biopsy was Bronchoscopic biopsy or percutaneous transthoracic consensus. by confi All cases were and one physician. one radiologist by performed ndings 0.001). 0.001). < ndings were ndings were ed according ed ects the clinical rst-line imaging ed as follows: 12 ed as follows:
cantly higher than that cantly higher ndings. between cant differences cation refl cation cation. It is believed that the It is believed cation. 0.05). The other fi 0.05). Shizuoka/JP < ([email protected]) ([email protected])
= 0.002) p correlated with SUV (p cantly Scientific and Educational Exhibits Scientific and Educational Fukuoka/JP ecting the malignancy of the tumor; it is useful ecting the malignancy of the tumor; rst-line imaging modality for lung cancer for modality imaging rst-line ndings cation and to determine the possibility of differentiat- ([email protected]) ([email protected])
Between January 2004 and March 2006, our center has Between The subjects were 29 patients (16 males and 13 females; 13 females; 29 patients (16 males and The subjects were PET/CT studies of 223 patients with histologically proved PET/CT studies of 223 patients with histologically proved Mean SUVmax of lesions with spiculation and without 0.01). = 0.009, high vs. cancer: cancer: = 0.009, high vs. < p 5 5
cacy of FDG-PET to differentiate thymic epithelial tumors epithelial tumors thymic differentiate of FDG-PET to cacy Madrid/ES
d d n A low FDG uptake of lung lesions in small size, with low CT density with low of lung lesions in small size, FDG uptake A low It was recently reported that the WHO classifi WHO recently reported It was that the i . N I To evaluate the feasibility of PET/CT for diagnosis of lung cancer by diagnosis of lung cancer by of PET/CT for the feasibility evaluate To To assess the FDG-PET of thymic epithelial tumors classifi of thymic assess the FDG-PET To F According to the WHO system, the tumors were classifi WHO system, the tumors were According to the Tumor size and density were signifi and density were size Tumor - c u d E i c S - features of and is one of the prognostic factors for thymic epithelial tumors. FDG- epithelial tumors. thymic for is one of the prognostic factors of and features also refl accumulation, PET exhibits WHO classifi diagnosis according to the in differential epithelial tumors. role in the diagnosis of thymic a key procedure plays not signifi cantly correlated with SUV. not signifi Conclusion: FDG a low In contrast, lung cancer. ndings to deny fi or spiculation are not reliable suggest nding or high CT density may fi of the lesion with lobulation-like uptake the lesion benign. spiculation were 4.2 and 7.5, respectively and SUV of lesions with spiculation was and SUV of lesions with spiculation was 4.2 and 7.5, respectively spiculation were than that without spiculation (p cantly lower signifi low-risk thymoma (2: type A; 6: type AB; 4: type B1); 8 high-risk thymoma (3: type (3: 8 high-risk thymoma type B1); 4: type AB; 6: type A; (2: low-risk thymoma Upon visual inspection, all tumors carcinomas. and 9 thymic type B3); B2 and 5: 2.73 (1.52-4.68), 4.18 (2.60- were T/M ratios and the indicated FDG accumulation with signifi 6.64), and 7.33 (4.27-10.69), in ascending order, high: vs. them (low Conclusion: Mean SUV of lesions with lobulation and without lobulation were 8.4 and 5.9, were and without lobulation Mean SUV of lesions with lobulation signifi was of lesions with lobulation and SUV respectively (p without lobulation to the WHO histologic classifi to the ing malignancy. Methods and Materials: average age: 60.0 years) with a diagnosis of thymic epithelial tumor between epithelial tumor between a diagnosis of thymic with 60.0 years) age: average WHO ed according to the 2004 classifi All were October 2002 and April 2006. administered MBq was FDG 150-250 the PET examination, For cation. classifi of and the computed ratio Visual evaluation startedlming was 1 hour later. and fi against contrasted (T/M) were the peak SUV of the tumor and mediastinal SUV cation. the WHO classifi Results: C-259 as fi of 18 FDG PET-CT Value Initial experience diagnosis: Marín, Pinilla, D. I. Sánchez-Almaraz, C. Torres, M. Gómez-Patiño, J. Gómez-León; N. Methods and Materials: lung cancer (adenocarcinoma; n=137, squamous cell; n=52, lung metastasis; n=14, n=52, lung metastasis; n=137, squamous cell; lung cancer (adenocarcinoma; n=2, carcinoid; n=3, large cell; n=3, sarcoma; n=10, adenosquamous; small cell; mm thin-section CT 1.2 in consensus. radiologists two by reviewed n=2) were margin, marginal border shape, density, about the size, evaluated ndings were fi setting of ROI measured by The density was spiculation and lobulation. irregularity, of FDG was The uptake short-axis of a maximum in size diameter of the lesion. These CT fi (SUV). value uptake standardized represented as maximum as fi a diagnostic protocol of lung cancer with PET-CT developed Purpose: F FDG with thin-section CT fi of 18 correlating the uptake Methods and Materials: statistically compared. and SUV were Results: suspi- for referred mean age 62 years) 69M; patients (10 F, Seventy-nine modality. Patients studied. ndings were fi cious of lung cancer based on chest radiography with performed Image acquisition was excluded. diagnostic CT were with previous in-line system from head to mid-thigh, 50 after intra- minutes a combined PET-CT of 370 administration venous MBq 18 of iodinated and with administration F-FDG, N. Ogasawara, A. Kanou, Y. Honma; Honma; Y. Kanou, A. Ogasawara, N. C-258 Correlation lung cancer: of integrated PET/CT for value Diagnostic between FDG PET and CT fi ([email protected]) ([email protected]) Purpose: Study on the effi on Study PET C-257 Nakamura, Y. Kondo, H. Okumura, T. Ode, Y. Nakagawa, K. Endo, M. Yamamoto; N. Takahashi, T. Asai, G. Murakami, H. Chest C - 7 0 R C EECR07-C-SciEduc-FIN.indd 55 Scientific and Educational Exhibits
Chest Background: PH is a complex life-threatening condition with numerous aetiologies. Symp- toms such as breathlessness on exertion, fatigue and chest pain are non-specifi c and are Vascular often attributed to more common disorders such as asthma delaying diagnosis. Treatment has a profound impact on outcome. A specifi c diagnosis is important as therapeutic options range from surgical intervention to targeted medical therapy. C-262 Since biopsy may be hazardous in this patient population, imaging plays a central Perforating branches of the internal thoracic artery: An anatomical study role in establishing a diagnosis and guiding therapy. using MDCT angiography Imaging Findings: Imaging features in PH can be divided into those that are K. Nakatani, H. Maeda, N. Hamada, T. Yamanishi, K. Miyatake, A. Nishioka, common to all aetiologies and those that are disease specifi c. An understanding Y. Ogawa; Nankoku/JP ([email protected]) of the pathophysiology and classifi cation of the PH aids diagnosis. We will present imaging data from patients presenting to a national centre for PH and pulmonary Purpose: Breast reconstruction is a crucial technique for patients after breast- thromboendarterectomy with pathologic correlation in specifi c cases. conserving surgery. Breast reconstruction with consideration of the breast blood Conclusion: The radiologist plays a central role in the diagnosis of PH. It is supply offers the potential of avoiding complications such as breast scleroses and important to be aware of the general and more specifi c imaging features in the adiponecrosis. The present study aimed to determine the locations, courses and spectrum of diseases associated with PH as early diagnosis and targeted therapies distributions of perforating branches of the internal thoracic artery (ITA), the major can improve the outcome. artery infl ow to breast tissue from the inner side, using multi-detector row-computed tomography (MDCT) angiography. Methods and Materials: Subjects in this prospective study comprised 39 women C-265 with suspected breast cancer who underwent MDCT angiography between April The importance of looking at the heart when interpreting standard thoracic CT 2004 and December 2005. Perforating branches of the ITA were identifi ed on a E. Castaner1, Y. Pallardó2, X. Gallardo1, M. Prieto del Rey1, S. Perez Aguilera1, dedicated workstation using transverse sections and 3-dimensional images. Distri- J. Mata1; 1Sabadell/ES, 2Alzira/ES ([email protected]) butions of the identifi ed perforating branches were investigated. Depth of perforating Learning Objectives: To familiarize viewers with the normal anatomic structures branches was measured and analyzed using simple regression analysis. of the heart and pericardium to avoid mistaking them for pathologic processes. To Results: A total of 48 perforating branches were found, with 27 branches (56.3%) explain the signifi cance of some incidental fi ndings. To emphasize the importance originating in the second intercostal space and 7 branches (14.6%) originating in of looking at the heart when interpreting a thoracic CT study, especially in some the third intercostal space. Most branches from the second intercostal space turned particular clinical settings. horizontally after running cranially. Most branches from the third intercostal space ran Background: Important information concerning the heart can be obtained on horizontally. A strong correlation was identifi ed between distance from skin to branches both un-enhanced and contrast-enhanced CT of the thorax. Cardiac disorders and adipose thickness at the shallowest and deepest points (P < 0.001). can often complicate or coexist with extracardiac thoracic disease, and may often Conclusion: We succeeded in detailing the course, length and distribution of ITA remain unsuspected or underevaluated. Correct analysis of images of the heart and perforating branches using MDCT angiography. These results for distribution and surrounding structures depends on a thorough understanding of cardiac anatomy depth of ITA-perforating branches will prove helpful in performing immediate breast and on the ability to recognize the normal and abnormal appearances of the heart reconstruction following breast-conserving surgery. commonly observed on CT. Imaging Findings: We show anatomic structures that can be misinterpreted C-263 (crista terminalis, eustachian valve, fossa ovalis, coronary sinus, valves, pericardial And the aortic arch, where is it? recesses, paracardiac structures); some incidental fi ndings and their clinical value J. Roldan Busto, J. Palmer Sancho, M. Rodríguez Romero, M. Palmer Sans, (calcifi cations, dilatations, fat deposition, increased or decreased myocardial den- M. Jofre Guasch, M.L. Noje; Palma de Mallorca/ES ([email protected]) sity) classifi ed considering the structure involved: valves, chambers, pericardium. We comment on some clinical situations with possible cardiac repercussion: pulmonary Learning Objectives: To review the embryologic features of the aortic arch hypertension, pulmonary embolism, neoplasms, and chest wall disorders. specially focussed on right-sided aortic arch development. To describe the most Conclusion: Knowledge of cardiac anatomy is essential to avoid mistaking normal relevant fi ndings of the right arch, great vessels and associated anomalies to aid anatomic structures for pathologic processes. It is important to know the clinical potential surgical procedure. relevance of some incidental fi ndings and which of them will require further exami- Background: The right-sided aortic arch is an uncommon congenital defect of the nations. Radiologists need to know conditions that may have an important effect aorta. It is present in 0.05% to 0.1% in radiological series. Deletion in chromosome on cardiac structure and function. 22q11 is associated in 24% of isolated anomalies of laterality of branching of the aortic arch. Using Edward´ s hypothesis, three types are described: type 1, with mirror-image branching of the major arteries; type 2, with an aberrant subclavian C-266 artery; and type 3, with isolation of the subclavian artery. Congenital heart anoma- MSCT and MRI of the pulmonary veins: Anatomy, anatomic variations and lies are usually present in types 1 and 3. The initial fi ndings by the chest-x ray and anomalous pulmonary venous drainage barium swallow suggest the anomaly. However, CTA or MRA should be performed A. Alonso - Burgos, L. Diaz, J. Noguera, E. De Luis, A. Villanueva, J. Larrache, to confi rm the defi nitive diagnosis. G. Bastarrika; Pamplona/ES ([email protected]) Imaging Findings: MRI and CT with post-processing images were analyzed. Learning Objectives: To describe MSCT and MRI features of the normal anatomy, We review 13 right aortic arches, 8 in adulthood, only one symptomatic, result- anatomical variations, and anomalous returns of the pulmonary venous system. ing in a Kommerell´ s aneurysm with oesophageal fi stula. The other four cases To emphasize the capability of MSCT and MRI to non-invasively map pulmonary were paediatric patients with associated cardiac and vascular anomalies: aortic venous and left atrial anatomy before the percutaneous ablation. coarctation and hypoplastic aortic arch, pulmonary stenosis and Tetralogy of Fal- Background: Assessment of pulmonary venous and left atrial anatomy has become lot-Corvisart´s disease. a hot topic among cardiac electrophysiologists, as radiofrequency catheter ablation Conclusion: Both MRI and CTA are excellent techniques for diagnosis and follow-up is being increasingly used for atrial fi brillation. Both MSCT and MRI provide detailed of aortic arch anomalies. Right aortic arch with aberrant left subclavian artery is and accurate anatomic information about the pulmonary veins and additional the most common type. Recognition of associated malformations is important for anomalies that are commonly associated with the development of atrial fi brillation. surgical management. Axial images and especially volume-rendered reconstructions allow to precisely determine the anatomy, anatomic variations, anomalous returns, and total number C-264 of pulmonary veins, thereby facilitating the interventional procedure. Imaging in pulmonary hypertension: A pictorial review Imaging Findings: In this exhibit, normal pulmonary venous MSCT and MRI anatomy and E.P. Smith, S.K.B. Agrawal, J. Suntharalingham, D. Rassl, N.J. Screaton, anatomical variations will be discussed. Anomalous pulmonary venous returns as well as D. Gopalan; Cambridge/UK ([email protected]) associated anomalies will also be illustrated. The role of MSCT and MRI to non-invasively depict pulmonary venous and left atrial anatomy before the ablation will be emphasized. Learning Objectives: 1. Describe the normal pulmonary circulation. 2. Describe Conclusion: MSCT and MRI allow a rapid non-invasive assessment of normal the classifi cation and pathophysiology of pulmonary hypertension (PH). 3. Illustrate pulmonary venous anatomy and associated anomalies. Preprocedural exact the spectrum of diseases associated with PH, highlighting the more specifi c ra- delineation of these structures might facilitate the percutaneous intervention in diologic fi ndings.4. Familiarise the practicing radiologist with the optimal multislice patients with atrial fi brillation. CT techniques.
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7 0 0 2 . 2 387 0 . 2 112.02.2007 17:03:53 5 ml/100 ml ± G 0.05). Relevant Relevant 0.05). < 0.01 ml/100 ml/min. The 0.01 ml/100 ml/min. ± C 1.0 ml/100 ml tissue and 38 and tissue 1.0 ml/100 ml ± BDEF 2.0 ml/100 ml. ± A 2.0 ml/100 ml/min and 0.24 and 2.0 ml/100 ml/min ± cation of segmental arteriescation computed in multislice was 10.0 was as well as PS from ED and LD were not found. from ED and LD were as PS as well PA IDT To review the normal anatomy of branches of pulmonary the normal of branches anatomy review To Each pulmonary sub- considered a separate segment was ([email protected]) ([email protected])
cult. Therefore, an attempt of a clear and short of explanation Therefore, cult. values showed signifi cant correlation (r=0.58, p signifi showed values from ED and LD were 10.1 LD were from ED and IDT Pulmonary arteries are very well visusalised with MSCTPA. At fi rst, At fi Pulmonary arteries MSCTPA. visusalised with are very well MSCTPA allows detailed visualistion of segmental arteries. Appro- of segmental arteries. detailed visualistion allows MSCTPA PA Our results supportstatement that rBV and PS measurements are the rBV Lublin/PL and rBV PA Results: correlation between rBV correlation between C-270 in multislice of pulmonary arteriesShortest evaluated guide to anatomy angiography computed tomography Maciejewski, R. Torres, Uhlig, K. S. Czekajska-Chehab, E. Staskiewicz, G.J. Drop; A. Learning Objectives: particularly identifi artery, for remind the main pulmonary To (MSCTPA). pulmonary angiography tomography scores) according to anatomical Quanadli and Mastora obstruction (Miller, scores structures evaluated. Background: understood it becomes a well with proper training, however, it seems very complex is useful in all chest of segmental anatomy Detailed knowledge part of anatomy. in patients suspected examination particularly but imaging modalities, in MSCTPA of pulmonary embolism, as assessment of pulmonary obstruction score becomes In contact with clinicians who understand its feasibility. commonly requested by of of anatomy that the knowledge the authors realized radiology, in trainees new segmental arteries it residents is limited, and, which is worse, among the young is considered diffi made. was segmental anatomy Findings: Imaging intensity and maximum Rendering, reformations multiplanar Volume structure. visualisation of arteriesprojections useful for of particular pulmonary segment are of segmental arteries Most common variants are presented. shown. Conclusion: of all pulmonary is useful in evaluation priate of segmental anatomy knowledge methods particularlyconditions, Postprocessing in suspected pulmonary embolism. of segmental arteries, anatomy the complex useful in explaining are extremely readers. in-training especially for Conclusion: Further not be calculated using late data sets. may time-dependent and probably the determination of the appropriateresearch is needed for time of data acquisition. and the qualitative study protocol could improve The optimization of the DCE-CT could serve These parameters assessment of functional tumor data. quantitative studies. follow-up be used for or may as prognostic factors tissue, respectively. rBV respectively. tissue, PS from ED and LD were 23.5 LD were PS from ED and rBV ca-
from ED Dresden/ IDT 1 ; and PS were and PS were 1 Madrid/ES ow PA , N. Abolmaali , N. 2 ndings for RV pressure load and RV ndings for cients between CT obstruction index CT obstructioncients between index Scientific and Educational Exhibits Scientific and Educational , U. Haberland , U. 1 cients of CT obstruction index, RV wall thick- wall RV cients of CT obstruction index, , A. Koch , A. 1 18 patients (7 men, average 56 year old) with proven old) with proven 56 year 18 patients (7 men, average Fifteen patients (median 67 years) with non-small cell Fifteen patients (median 67 years) 1) To show the normal anatomy of thoracic veins. 2) To pres- To 2) veins. the normal of thoracic show anatomy To 1) Chiba/JP We employed 16 slice MDCT for study of all chest on a single 16 slice MDCT for employed We 0.05) and 0.42 (P=0.16), respectively. 7 < 5
d d Central venous catheters and other devices are routinely used in the catheters and other devices venous Central , V. Hietschold , V. ow parameters using the Indicator Dilution Theory (IDT) and Patlak Theory (IDT) and Patlak using the Indicator Dilution parameters ow n MDCT angiography is the most reliable method in the non-invasive method in the non-invasive reliable is the most MDCT angiography 1 We can derive both CT obstruction index and indicators of RV pressure and indicators of RV both CT obstruction can derive index We i . N I To analyze the time-dependence of data acquisition for the quantifi of data acquisition for the time-dependence analyze To To quantify chronic pulmonary thromboembolism (CPTE) and morpho- To F In 18 subjects, the correlation coeffi In 18 subjects, - c u d Forchheim/DE ([email protected]) ([email protected]) Forchheim/DE 2 E i c S - was calculated on the basis of IDT. was Purpose: tion of blood fl tion of blood Analysis (PA). Methods and Materials: 16, Siemens) (Biograph DCE-CT using PET-CT lung cancer (NSCLC) underwent DCE-CT study of 100 administration at 4 ml Ultravist ml/sec. intravenous following rotation: 30 scans through 60 sec with time per consisted of early Dynamics (ED): interscan interval-30 480 sec, 8 scans through and late Dynamics (LD): 0.5 sec, rBV sec starting administration. at 90 sec after beginning of contrast DE, separately derived from ED and LD by means of PA. Additionally rBV means of PA. from ED and LD by derived separately Comparative analysis of methods for determination of blood fl determination of blood of methods for Comparative analysis C-269 ([email protected]) Learning Objectives: lung cancer in non-small-cell parameters Abramyuk A. ent most common thoracic venous variants and abnormalities, such as persistence variants venous ent most common thoracic accessory pulmonary anomalous vein, hemiazygos cava, of the left superior vena the usefulness of emphasize To 3) occlusions and thrombosis. drainage, venous anatomy. venous in the study of the thoracic 16-slice MDCT angiography Background: MDCT angiography of thoracic venous anatomy: Normal appearance, main Normal appearance, venous anatomy: of thoracic MDCT angiography and congenital anomalies variants Polat, Batiray Marco Sanz, A. Sanz, A. Alvarez C. Gamo, M. Sanchez Cordon; B. Moreno, Fraile E. Garcia del Salto Lorente, L. venous of the thoracic this reason, the correct knowledge for practice; hospitable method to describe it, is the best non-invasive MDCT angiography is basic. anatomy disorders that could be im- venous us the possibility to diagnose thoracic and it offers iatrogenic complications. to avoid portant placing catheters and, consequently, for Details: Procedure C-268 of 5 mm per rotation, and a reconstruction increment feed A table section helical. of 1.25 100 mm are used. material contrast mL of non-ionic is injected at 4 mL/sec- mL of saline solution at the same injection of 30-40 by ond, immediately followed At the workstation, we acquires at 20 seconds. The images were injection rate. reconstructions. multiplanar performed Conclusion: disorders. venous diagnosis of thoracic CPTE underwent enhanced ECG-gated MSCT (Light Speed Ultra-16). CT images (Light Speed Ultra-16). enhanced ECG-gated MSCT CPTE underwent the 18 patients, Of reconstructedwere end-systole (ES) and end-diastole (ED). at 12 had CT and right heart catheterization within 18 months of each other performed CT fi In these 12 patients, condition. during stable Qanadli, and pulmonary by artery advocated CT obstruction index pres- systolic thickness Wall 1) ed: quantifi We catheter could be compared. sure measured by short to left ventricle axis diameter and 2) Ratio of RV in ED, myocardium of RV diameter) in ES. of RV/LV (ratio Results: Quantitative evaluation of chronic pulmonary thromboembolism pulmonary thromboembolism of chronic evaluation Quantitative by ventricular pressure load evaluated and its relationship to right CT multislice electrocardiogram-gated Uehara, M. Kuriyama, T. Tanabe, N. Fujikawa, Shiina, A. Y. Funabashi, N. Komuro; Mikami, I. Y. Purpose: MSCT and ECG-gated performed pressure load, we logical right (RV) ventricular compared with pulmonary factors, these two the relationship between evaluated right heart pressure measurements obtained by catheterization. artery (PA) Methods and Materials: C-267 Conclusion: of RV/LV conclude that the ratio we and MSCT, using ECG-gated load simultaneously systolic pressure. in ED might predict PA thickness wall diameter in ES and RV and RV thickness in ED and the ratio of RV/LV diameter in ES were 0.23 (P=0.36) diameter in ES were of RV/LV in ED and the ratio thickness and RV and 0.34 (P=0.16), respectively. the correlation coeffi In 12 subjects, 0.46 systolic pressure was diameter in ES with PA of RV/LV and ratio ness in ED, (P=0.13), 0.56 (P C - 7 0 R C EECR07-C-SciEduc-FIN.indd 57 Scientific and Educational Exhibits
Chest especially with the post-processing technique, including MPVR, MIP, mIP, volume rendering, provides fast, sensitive, and accurate evaluation of vascular, pulmonary, Technical Aspects airway, skeletal and diaphragmatic injuries. Imaging Findings: 2D reformations provide a panoramic view of all the chest structures, allowing the detection of minor fractures. Curved reformations provide C-271 information of excellent value in case of spine injuries. MIP-MPVR may be used in Computer-aided diagnosis of lung cancer: Defi nition and detection of the evaluation of vessel injuries as and costal cartilage injuries. Mini-IP is useful in ground-glass opacity on high-resolution CT the detection of all lucent lesions, including pneumothorax. pneumomediastinum, T. Okada, S. Iwano, T. Ishigaki, S. Naganawa, T. Kitasaka, Y. Hirano, K. Mori, tracheobronchial ruptures or pulmonary hernia. Volume rendering is particularly Y. Suenaga; Nagoya/JP ([email protected]) helpful in case of thoracic cage trauma. Conclusion: The post-processing techniques used in the diagnosis of chest trauma are Purpose: Radiologists usually recognize ground-glass opacity (GGO) of lung highly informative. A rigorous protocol with optimized use of reconstructions is required. cancer on CT, subjectively. However, no characteristic quantitative value for GGO has been defi ned. The purpose of this study was to defi ne GGO by medical imaging engineering, and to differentiate between GGO (pure or mixed GGO) and solid-type C-274 lung cancer semiautomatically, with computer-aided diagnosis (CAD) scheme. Optimise your technique in the CT-guided pulmonary biopsy: An Methods and Materials: High-resolution CT of 100 pulmonary nodules pathologi- audiovisual tutorial cally diagnosed as peripheral lung cancer were collected from our clinical records. D. Volpe, N. Volpe, A. Saponaro, F. Travaglini, F. Favano, M. Sacco, A. Carriero; First, on these HRCT images, two radiologists traced the contour of nodules on Novara/IT ([email protected]) computer, and separated GGO area from solid area. The CT attenuation value of Learning Objectives: We want to use an audiovisual presentation to review CT- each area was measured. Second, we evaluated whether the CAD could detect guided techniques for performing a pulmonary biopsy. GGO area. Third, we evaluated whether our CAD scheme could differentiate be- Background: Many focal pulmonary lesions are inaccessible by broncoscopy and tween solid-type and GGO-type lung cancer by ROC analysis. a biopsy though the chest wall is required. Percutaneous transthoracic lung biopsy Results: Mean CT attenuation of GGO area was -618.4±212.2 HU, whereas that is a common procedure used mainly to elucidate the nature of pulmonary masses. of solid area was -68.1±230.3 HU. The CAD detected 88.9% of GGO area in 100 It is necessary to collect material from the lesion for microscopic investigation. The nodules. In addition, the CAD could differentiate between solid-type and GGO- results determine the initiation of appropriate treatment. type lung cancer, with a sensitivity of 86.0% and a specifi city of 96.5% when the Procedure Details: Review CT-guided techniques for performing biopsy of pulmo- threshold value was -370 HU. However, four nodules of mixed GGO were incorrectly nary nodules. Demonstrate techniques that minimize procedure-related complica- classifi ed as solid type with CAD. tions. Review indications and contraindications of a pulmonary biopsy. Conclusion: Objective defi nition of GGO by CT attenuation may be feasible. This Conclusion: This tutorial allows in understanding and optimizing the application of method is useful for the semiautomatic differentiation between GGO-type and CT-guided transthoracic needle biopsy in the evaluation of intrathoracic lesios, with solid-type lung cancer with CAD. a focus on improving diagnostic yield and minimizing complications. C-272 C-275 Assessment of a pulmonary angiography 16-row MDCT protocol Computer-aided detection (CAD) in lung cancer screening at chest MDCT: using 100 kVp in comparison to a 120 kVp protocol: A prospective ROC analysis of CAD vs. radiologist performance randomized trial F. Fraioli, L. Bertoletti, M. Mennini, R. Lezoche, C. Catalano, R. Passariello; P. Mohr, S.A. Peters, S.P. Lemburg, V. Nicolas, C.M. Heyer; Rome/IT ([email protected]) Bochum/DE ([email protected]) Purpose: Our aim was to compare the performance of radiologists against a CAD Purpose: To implement a pulmonary angiography MDCT protocol using 100 kVp, algorithm for pulmonary nodule detection on MDCT. and to compare vessel enhancement, SNR, CNR, radiation exposure, and subjec- Methods and Materials: Three radiologists independently analysed 200 scans tive image quality to a protocol using 120 kVp. and assigned each nodule a confi dence score (1-3). CAD was applied to all scans, Methods and Materials: Sixty patients were referred for evaluation of suspected successive readers re-evaluated all fi ndings of the CAD, assigning, in consensus, a pulmonary embolism by CT angiography on a 16-row scanner. Patients were confi dence score (1-3). The reference standard was established by other two expe- randomly assigned to a CT protocol using 100 or 120 kVp, respectively. All other rienced chest radiologists. Results were used to generate an FROC analysis. scan parameters including tube current, collimation, and gantry rotation time Results: The reference standard showed 124 nodules. Sensitivity for readers I- were kept constant. Contrast media was injected using bolus tracking. Based on II-III was: 48, 61, and 36%. A double and triple reading resulted in an increase in density measurements, pulmonary vessel opacifi cation and image noise were sensitivity up to 72%. With CAD, sensitivity was increased to 91, 94, and 92% for quantifi ed and SNR / CNR were calculated. Subjective vessel contrast was as- readers I, II, and III. The area under the FROC curve (Az) was 0.53, 0.69, 0.42, sessed by two radiologists in consensus. Effective dose was calculated based on and 0.80 for readers I, II, III, and the CAD. Differences between all readers and the DLP/CTDI values. Results of both protocols were compared using chi-square-test CAD were signifi cant (P < 0.05). For nodules > 6 mm Az was 0.72, 0.88, 0.64 and and student’s t-test. 0.88 for readers I, II, III, and the CAD. P was signifi cant between reader I and the Results: The 100 kVp protocol showed a non-signifi cant higher mean vessel density CAD and between reader III and the CAD, it was not signifi cant (P=0.9) between than the 120 kVp protocol (387±130 HU to 318±113 HU; p=0.56) and a non-signifi - reader II and the CAD. For nodules < 6 mm, Az was 0.18, 0.19, and 0.17 for read- cant higher image noise (17±6 HU to 14±6 HU; p=0.84), resulting in almost identical ers I-III and 0.63 for the CAD. Differences between all readers and the CAD were SNR (25±12 to 27±15; p=0.37) and CNR (22±11 to 23±13; p=0.51). Furthermore, signifi cant (P < 0.05). subjective image quality showed no signifi cant differences between the two proto- Conclusion: CAD can aid in daily radiological routine detecting a conspicuous cols. Mean effective dose of the 100 kVp protocol was signifi cantly lower compared number of nodules unseen by radiologists. to the 120 kVp protocol (1.37±0.39 mSv to 2.44±0.98 mSv; p < 0.001). Conclusion: Reduction of tube kilovoltage from 120 to 100 kVp resulted in signifi - cant reduction of effective dose in pulmonary 16-row MDCT angiography without C-276 signifi cant loss of objective and subjective image quality. Automatic volumetric assessment of pulmonary nodules enhancement: Correlation with axial measurements to evaluate benign and malignant nodules C-273 F. Fraioli, L. Bertoletti, M. Mennini, C. Catalano, R. Passariello; Rome/IT The post-processing of multi-slice CT in the interpretation of chest traumas ([email protected]) W. Yang1, C. Beigelman-Aubry2, A. Brun2, P.A. Grenier2; 1Shanghai/CN, 2Paris/FR Purpose: To evaluate wash in and wash out densitometric curves of pulmonary Learning Objectives: To outline the indication and advantage of multislice CT nodules (PN) after administration of contrast media, comparing volumetric results post-processing in the interpretation of chest traumas. To demonstrate several with that obtained on a single slice. potential pitfalls in the interpretation and the method of avoiding these pitfalls with Methods and Materials: Thirty patients with known PN underwent a dynamic the post-processing technique. MDCT (Siemens Sensation 64; parameters: 0.6-mm coll., 1-mm interval) before and Background: Chest traumas are responsible for approximately 25% of trauma- after the administration of contrast material (c.m). (5-30-60-90, 120 s e 5 minutes). related deaths. They are associated with high morbidity and mortality rates. CT,
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We Among the vast range of resources of radiological interest on of resources of radiological range Among the vast The healthcare information distribution on CD media is rapidly on CD media is rapidly distribution information The healthcare Information interesting to physicians accounts for a large part accounts for of interesting to physicians Information technologies (ICT) and communication On one hand, information The standardization of the portable media distribution is improving The standardization of the portable is improving media distribution Our aim is to propose a digital guide of free Internet resources for Our aim is to propose a digital guide of free Internet resources for Plano, TX/US Plano, ow through portable media through ow and reconciling medical images through portable CD media. To enhance the portable To through portableand reconciling medical images CD media. health IT documents. non-imaging for ow workfl media distribution Background: operating example, For and networkincreasing and reduces cost dependency. of sharing increase their use images through physicians dental and referral rooms, data of standardization on the health CD data organization and The lack CD media. This it correctly. capability to access the data and display types reduces the client’s proposes a standard solution, based on IHE profi educational exhibit media on interchange imaging information of distribution a reliable to provide IRWF, import, and print. for display Details: Procedure through portable medical images current limitations on distributing demonstrating importing for and reconciling medi- ow workfl CD media, (2) presenting a reliable cal images using IHE profi sharing through portable medical images media, (4) Extend the portable CD media other non-imaging, health IT EHR information. for distribution Conclusion: the patient in improving and sharing,the medical image distribution which is a key cost. operational and reducing healthcare health practices of the human body. the entire sectional anatomy selected in order to cover were a user-friendly inter- built We Anatomica. Terminologia labeled using Images were image series to cine through multi-slice combined with textual which allows face, Learning assessment is provided drawings. 3D models and anatomy information, Learning Objectives: workfl present a reliable To through portable CD media. the IHE profi ciling medical images using "ImportWorkfl Reconciliation radiologists Internet guide for Carriero; A. Saponaro, A. Masiello, N. Volpe, N. Volpe, D. ([email protected]) Learning Objectives: inexpert people to embark basic indications that will encourage on a and provide adapted to their needs and abilities. personal exploration Background: terms. world and qualitative of the Internetthe multimedia in both quantitative are dedicated to imag- sites containing medical information Hundreds of the many and their nature is constantly is constantly growing, their number ing diagnostics, dispersed and often half hidden in a is that the information This means changing. thus making it diffi of site categories range or local resources, vast C-280 sectional anatomy A free interactive atlas of whole body E-anatomy.org: Hoa; Micheau, D. A. Learning Objectives: based on tools, self-study and assessment with interactive of the human body, more than 1500 MR and CT slices. Background: interactive, in learning, giving access to relevant, innovation act as a catalyst for CT) multisection in CT (e.g. On the other hand, improvements high-quality content. highly detailed images of spatial resolution) deliver and MR imaging (improved computer-based content and Flash animations interactive Thus, internal anatomy. to teach sectional anatomy. ways could be used to create new Details: Procedure Computer Applications Computer C-278 distribution of medical images international standardization Towards workfl Avraham; E. C-279 manner. its quality and reliability in an objective Details: Procedure the Internet, propose a classifi we The sites being sought. and directly supply the type of information extent greatest institutional sites, catalogue sites, ideal folders: into seven been grouped have on-line journals, sites offering image databases, radiological specialised sites, teaching material, and discussion forums. Conclusion: radiologists. rmed at Scientific and Educational Exhibits Scientific and Educational rmed. Forty-fi ve (50.6%) of these cancers were (50.6%) of these cancers were ve Forty-fi rmed. We retrospectively reviewed and compared the number and compared the number reviewed retrospectively We 9 5
d d n Volumetric assessment of the wash in and wash out curves appears in and wash assessment of the wash Volumetric The digitization of the ED increased the rate of lung cancers detected The digitization of the ED increased the rate i . ([email protected]) N
I To evaluate the impact of the digitalization of a radiology departmentdigitalization of a radiology the impact of the in evaluate To F In 2003, 112 lung cancers were detected and histologically confi In 2003, 112 lung cancers were An almost perfect agreement was obtained between the two measure- the two obtained between was agreement An almost perfect - c u d E i c S - Impact of the digitalization of a radiology department in the detection of departmentlung cancer in the emergency Pinto; J. Romero, Ruiz, C. C. Varela, C. García Hidalgo, M. Herrera, I. Toledo/ES Purpose: the detection of lung cancer in the emergency department (ED). Methods and Materials: 2003) and (year using conventional of lung cancer cases detected in the ED by department Our radiology became completely chest radiography. 2005) digital (year situation brought the opportunity the images This new of having digital in 2004. of the images acquired the later review time and made possible at any available the role of an expert radiologist analyzed We an expert radiologist. at the ED by images. of previous together with the availability Results: C-277 ments in the diagnosis of benign nodules while a disagreement occurred in 2 PN benign nodules while a disagreement ments in the diagnosis of 25 than greater in enhancement wash a nodules, In those HU histological malignant. and greater out respectively with a wash both measurements but for shown was performed. assessment were single axial or volumetric smaller than 30 HU when Conclusion: of densitometric curves a better evaluation allowing and reproducible more accurate may dedicated software Moreover, slice evaluation. and reducing limits of single time and a semi automatric evaluation analysis with a reduction in the provide results. more comparable reported A radiologist as abnormalcases. 73.3% of those detected at the ED. (66.6%) Twenty-two imaged at our institution. Thirty-three previously (73.3%) were reported of them had the image available and 14 (36.9%) were a radiologist by in digital format. Conclusion: of cases interpreted the an expertThe number radiologist, by at this department. images and reports of previous has also increased due to the digitization availability department. of the radiology Pathological diagnosis was achived by surgery in 25 patients and with a follow-up surgery by and with a follow-up in 25 patients achived was diagnosis Pathological calculated by nodules was of malignant city and accuracy specifi Sensitivity, in 5. Thirty PN out of c.m. in and wash wash Vs total volume considering single slice Diagnostic criteria included in our analysis. were with 18 benign and 12 malignant out and a wash HU in of 25 nodules with a wash of malignancy included those less than 30 HU. Results: our institution. Thirty-eight (33.9%) were detected at the ED. Twenty (52.6%) of them Twenty Thirty-eight at the ED. detected (33.9%) were our institution. radiographs and 24 (63.2%) patients had previous a radiologist detected by were lung cancers were In 2005, 89 available. at our institution although no image was detected and histologically confi C - 7 0 R C EECR07-C-SciEduc-FIN.indd 59 Scientific and Educational Exhibits
by self-tests. All these teaching modules are available on the Internet. Firstly, the airway trees are segmented, and then airway center-lines and bifurcation Conclusion: e-learning and interactive Flash animation combined with the latest points at each generation are acquired with morphological analysis. Then, we can multi-slice CT and MR imaging technologies offer new ways to teach radiological calculate every wall thickness of each generation of the volumetric airway tree by whole body human anatomy. We provide a useful, free, interactive tool for the using a proposed method based on vector analysis with perpendicular plane to radiologist’s everyday use; available online at http://www.e-anatomy.org. airway. Finally, our own software visualizes color-mapped virtual bronchoscopy that refl ects airway wall thickness, fl ying through the inner path of airway. Conclusion: Using CT scans of human cases, we present results showing that C-281 this new approach is convenient, accurate, automatic and well-visual in estimating Integrated supporting tools of screening mammography for breast cancer airway wall thickness. Our proposed method can provide pre-operative planning of Y. Kobayashi, M. Suzuki, S. Yamamoto, H. Fukushima, N. Moriyama; Tokyo/JP the intervention for lung surgery with enhanced functional virtual bronchoscopy as ([email protected]) a complementary tool for clinical diagnosis and several airway diseases. Learning Objectives: 1. To learn the image processing, quality control and effec- tive reading methods for breast cancer screening 2. To learn the how to combine C-284 clinical and physical check in mammography. A statistical model for the geometric correspondence between different- Background: With the westernization of the Japanese diet and way of life, the view breast X-rays taken isochronically from a single breast mortality due to breast cancer continues to increase gradually. Mammography is J. Teubl1, H. Bischof1, M. Blumenthal2; 1Graz/AT, 2Munich/DE the best tool available for screening breast cancer. The committee of Mammography ([email protected]) Quality Standards in Japan has recommended a unique program. We developed the software for breast cancer screening with the QC and the diagnostic supporting Purpose: We investigated the reduction of false-positive detections of a mammo- tools based on the recommendation of the committee. graphic CAD system using a new statistical correspondence model. Procedure Details: Our program was developed under multi-platform design to Methods and Materials: There is no accurate physical model available to solve operate on any standard PC or workstations. MATLAB software (MathWorks Inc. the geometric correspondence problem between two different views of the breast; Massachusetts, USA) was used for writing codes of both mathematical equations therefore, we propose a new statistical model derived from the cases of a large and the graphical user interface. Technical aspect presented by this system can database. Instead of a direct point-to-point correspondence, we infer the corre- provide the 3 parts: (1) image processing and analysis using full-fi eld digital mam- spondence probability using a probability-estimation technique. The crucial point mography, (2) quality control (QC) tools improved the effi ciency of periodic tests, and is the normalisation of point correspondences. In our method, one of the breasts (3) GUI-based checker for clinical breast examination and mammography fi ndings. is arbitrarily chosen as the norm breast. The lesions from all other breasts are Granulometry was implemented in this program with basic imaging fi lter (smoothing, normalised to this norm breast. This approach provides us with a suffi cient number edge-enhancement and adaptive wiener fi lter). Granulometry determines the size of point correspondences in one breast to compute a statistical model. distribution of the region of interest (ROI) in a mammogram. Results: In the fi rst experiment comprising 993 breasts from the DDSM, we com- Conclusion: The software we developed for supporting breast cancer screening pared our statistical model with the recently proposed stripe model. We showed that had a benefi cial effect to improve the effi ciency of QC and the diagnostic work of the statistical model performed better (i.e. using 29% of the breast area as search mammography. space, we fi nd 90% of the lesions using our new method compared to 82% when using the stripe model). In the second experiment comprising a smaller set of 70 breasts, we showed that the geometrical correspondence was useful to reduce C-282 the number of false-positive detections. Virtual colonoscopy: CAR versus non-CAR Conclusion: If the geometric correspondence information is used, a mammographic A. Koshman; Moscow/RU ([email protected]) CAD system can achieve a higher accuracy. The method introduced in this paper Purpose: To compare the results of 3D endoluminal analysis using computer outperforms the recently proposed geometric correspondence models. assisted reading (CAR) with 3D endoluminal analysis non-CAR by experts for colorectal polyps detection. C-285 Methods and Materials: Twenty-eight patients (19 males, 9 females, age range Using DICOM header to improve interventional radiology practice: An 45-68 years) underwent virtual colonoscopy procedure. All of them had under- European consensus initiative gone optical colonoscopy which revealed 52 polyps and was used as a reference E. Vano1, K. Faulkner2, R. Padovani3, S. Kottou4, H. Jarvinen5, H. Bosmans6, standard. Two radiologists read the datasets from virtual colonoscopy: one after A. Schreiner7, C. Maccia8, J. Vassileva9, J.M. Fernandez1, J.I. Ten1, J.M. Ordiales1; the procedure, non-CAR; the other radiologist read the data sets using CAR. 1Madrid/ES, 2Newcastle/UK, 3Udine/IT, 4Athens/GR, 5Helsinki/FI, 6Leuven/BE, Sensitivities were calculated. All reading times and number of false-positive results 7Luxembourg/LU, 8Bourg La Reine/FR, 9Sofi a/BG ([email protected]) were documented. Results: Sensitivities for clinically signifi cant polyps of 5-9 mm and 10 mm or larger Purpose: To present the usefulness of the information contained in the DICOM in diameter were: 64% and 75%, respectively for 3D non-CAR and 77% and 88% header of archived images for patient dosimetry and automatically audit the inter- for 3D CAR (p=0.05). False positive rates (mean) were 4.3 and 1.2 for 3D non-CAR ventional procedures, and to introduce the consensus of the European SENTINEL and 3D CAR, respectively (p=0.05). The average reading time for 3D non-CAR was consortium in this topic. 26.2 minutes (SD±3.8) and 18.3 minutes (SD±3.8) for 3D CAR (p=0.001). Methods and Materials: Information on dose, radiographic techniques, beam ge- Conclusion: Using 3D CAR system provides higher sensitivity, lower false-positive ometry, C-arm angulations, fi ltration, fi eld of view, collimation, acquisition protocols, rate and less time per case than 3D non-CAR. post-processing, number of frames that are included in the DICOM header were analysed using CD-ROMs from different interventional X-ray systems installed in several European hospitals. The usefulness of the different parameters to audit the C-283 clinical procedures is discussed. A novel wall thickness-mapped approach of clinical virtual bronchoscopy Results: When looking at the DICOM header, it is evident that a signifi cant amount S. Park, J. Kim, J. Goo, K. Kim, H. Lee, S. Lee; Seoul/KR ([email protected]) of information for dosimetric purposes is contained in private tags. Their format and Learning Objectives: To understand an algorithm of automated assessment of meaning is unfortunately not easily available and even not well defi ned in the DICOM airway wall thickness in chest CT images. To experience the wall thickness-mapped conformance statement. The dose reports produced by most of the interventional virtual bronchoscopy that visualizes color-mapped wall thickness at each part of X-ray systems are useful documents, which could help in the audit of patient doses airway. To appreciate effi ciency of PC-based application for the virtual bronchoscopy and procedures allowing rough skin dose maps to be calculated retrospectively. through developed-software. Conclusion: The consensus document issued by the SENTINEL group states that Background: Measurements of bronchial tree airway geometry can be used dosimetric, technical and geometric parameters allowing the automatic audit of to evaluate and track the progression of disease affecting the airways, such as patient dose and radiological procedures should be contained in public fi elds of the asthma, COPD and cystic fi brosis, and to assess the effi cacy of new therapeutic DICOM headers. The work in progress started by IEC to standardize the structure approaches. This exhibit demonstrates a new method for wall thickness-mapped of the dose reports will improve the present situation. Development of software virtual bronchoscopy through measurement of airway wall thickness with a pro- facilitating the extraction of DICOM header information for patient dosimetry and posed algorithm. quality control on line should be promoted. Procedure Details: We present an enhanced virtual bronchoscopy that allows assessment of wall thickness during the virtual fl y-through using the steps below.
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EECR07-C-SciEduc-FIN.inddCR07-C-SciEduc-FIN.indd 6600 112.02.20072.02.2007 17:03:5417:03:54 4 5 : 3
Computer Applications 0 : 7 1
7 0 0 2 cul- . 2 391 0 . 2 112.02.2007 17:03:54 , 1 G les ned a small lesion at- , A. Fyrenius , A. 2 Erlangen/DE 2 C ([email protected]) ([email protected]) , G. Petersson , G.
1 BDEF A , C. Silén , C. 1 Kalmar/SE Cleveland, OH/US, OH/US, Cleveland, 2 1 ; 2 To demonstrate the usefulness and pedagogic value of the usefulness and pedagogic value demonstrate To To evaluate the diagnostic help offered by real-time fusion real-time fusion by the diagnostic help offered evaluate To To develop an image annotation and presentation program annotation and presentation program an image develop To , J. Kvist , J. 1 les and presentations in realtime. It is user tailored, easy to les and presentations in realtime. Using a standard clinical workstation (Advantage Windows, Windows, Using a standard clinical workstation (Advantage We developed the multilingual online program Annotate, which Annotate, online program the multilingual developed We CEUS-CT fusion imaging correctly defi Linköping/SE, Nine patients affected by: 1 atypical pancreatic pseudocyst, 5 pancreatic pseudocyst, 5 1 atypical by: Nine patients affected At this time there is no image annotation and presentation program program At this time there is no image annotation and presentation In undergraduate medical teaching, students continue to have diffi to have medical teaching, students continue In undergraduate 1 Annotate (www.annotate.org) is an image annotation and presenta- Annotate (www.annotate.org) The MUOLS system and its architecture are based on four founda- four architecture are based on MUOLS system and its The US-CT fusion imaging offers advantages in terms of cost-effective- advantages US-CT fusion imaging offers ; , S. Wirell , S. 1 , M. Grunewald , M. 1 1 ([email protected]) ([email protected])
es the US position of foreign body in small parts, guiding surgical resection. es the US position of foreign ties with complex 3D anatomy. This project, integrating problem-based learning problem-based and This project, integrating 3D anatomy. ties with complex purposes, teaching attempts to address this problem use of 3D visualizations for to rendering visualizations of CT and MR images accessible making volume by computers. on low-end interactivity maximum that offers students in a way Details: Procedure ([email protected]) ([email protected]) Learning Objectives: teaching annotations for creating interactive for and anywhere, anytime available with tailored, easy to use, user free of charge, les and presentations in realtime, fi necessary. le download fi skills and no additional program no programming Background: ac- is free of charge, annotations in realtime, interactive which creates available computer worldwide and is user tailored. from every cessible Details: Procedure over It is available image annotations and presentations. to create interactive allows computer with internetthe internet worldwide connection. from every and accessible The image edition as experience. programming The author does not need to have the program. as the linking and the source code are created automatically by well The the internet. worldwide over is immediately available The created website time and the changes author can change the annotations and presentations at any The after each change. le transfer a fi There is no need for will be done in realtime. needs. the individual user’s can be tailored for program Conclusion: creating and changing for and anywhere, anytime which is available tion program teaching fi interactive skills and no additional program There are no programming use and free of charge. be enhanced by learning may experience The user’s necessary. le downloads fi of presentation. modes multiple offering Conclusion: Learning in place most successfully takes is inherently social and 1. tional ideas. learning. There is no "right" for pedagogical model 2. of communities. the context Successful online 4. not the manufacturer. is the user, The source of innovation 3. extraordinary provide so) must more (learning communities even communities to participants and administrators. amount of feedback E. Nylander E. Learning Objectives: US (CEUS) and (US) or contrast-enhanced ultrasound imaging based on baseline soft tissue). vascular, elds of application (parenchymal, fi CT in different Background: repaired abdominal aorta bodies retained in endovascularly aneurysms, 3 foreign Two CT and to US-CEUS examination. to multidetector submitted soft tissues were coupled, then correlated US probe position to the volume imaging modalites were pancreatic pseudocyst and In using an electromagnetic tracker. CT, acquired by as well. performed CEUS was grafts, in endovascular Findings: Imaging C-291 learning on low- anatomy for rendering 3D images Interactive volume end computers Smedby Ö. C-289 ultrasound based on in real-time fusion imaging experiences clinical First and CT images Martegani; A. Campi, Rossini, R. Mascheroni, G. F. Ciancio, M. Sopransi, M. Como/IT C-290 annotation and image user tailored and free of charge A web-based, fi interactive presentations and teaching for editing program Talanow R. Learning Objectives: on VR format presented in QuickTime renderings of human anatomy volume computers. low-end Background: tached to cystic wall as "not solid". CEUS-CT fusion imaging provided functional and CEUS-CT fusion imaging provided as "not solid". tached to cystic wall US-CT fusion imaging rapidly morphologic about aortic information endoprostheses. identifi Conclusion: elds of application. fi in different time and diagnostic accuracy ness, , 1
Malaga/ES , A. Kontogiannis , A. 1 ne different kinds of communities, kinds of communities, ne different , V. Nikolaou , V. 1 Scientific and Educational Exhibits Scientific and Educational ([email protected]) ([email protected])
([email protected]) ([email protected]) , J. Tzovara , J.
2 Larissa/GR 2 Cagliari/IT 1. To demonstrate simple and advanced Web searching Web simple and advanced demonstrate To 1. Medical ultrasound open learning Medical ultrasound space (MUOLS) is a new To present a multimedia project focused on training medical on training project focused multimedia present a To MUOLS is a teaching-learning tool based on the. LRN open MUOLS is a teaching-learning tool based on the. The application is a PowerPoint based case collection of dif- based case collection of is a PowerPoint The application In this exhibit, simple and advanced Web searching strategies will searching strategies Web simple and advanced In this exhibit, 1 , G. Tsimitselis , G. 6
1
d d It is well known that the Web or Internet electronic is a richWeb illimitable that the known It is well Internet has become an important in our means of communication E-learning radiology resources are used to be focused on residents E-learningbe focused resources are used to radiology n This exhibit presents the evolution of this project and the actual 3.1 presents the evolution This exhibit Even though there are several ways to search the Web, a strategy map a strategy Web, to search the ways though there are several Even i . Athens/GR, 1 N I ; 1 F - c u d E i c S - Learning Objectives: radiology- and targeted engines for a list of reference provide To 2. strategies. radiologists. resources for Web identify useful To 3. dedicated search. Background: in this unbounded space requires a navigation However, source of information. Three main types of search tools tools named "search engines". of valuable quiver Any metasearch engines and subject directories/guides. search engines, exist: used. search depends on the strategy radiological Details: Procedure to limit or increase results will also be presented combined Methods on how be shown. The technique of automated content-based image retrieval, examples. with various A complimentary list will be also discussed. needed to search into image databases, online databases and targeted engines for resources, with radiological of references the participant. for the most thorough search will be also provided Conclusion: of radiology-focused navigation should be always available so that any radiologist radiologist so that any available should be always navigation of radiology-focused pages. Web of on the least number can get the most information C-288 e-learning medical ultrasound platform open source A new Campisi; Illomei, G. G. Learning Objectives: open-source e-learning platform, easy to use, available free of charge, available available free of charge, open-source e-learning available easy to use, platform, students and professionals. and at all times for multilingually everywhere Background: attention on the Internet there has been much years, During the last few culture. E-learning systems should be simple, as an aid in learning situations. and training open and easy to use. Details: Procedure is being improved, the platform now the MIT, by First developed source platform. t-making LRN under the no-profi efforts, thanks to the open-source community community Its underlying architecture is based on a highly-scalable supervision. suited to support that is ideally framework teaching, research, and administration to defi users and administrators allows ROLS C-287 radiologists guidelines dedicated for Web-navigation Chalazonitis A.N. tools and resources for can be equipped with different where each community consists of a "out-of-the-box" ROLS and investigation. shared work, dialogue, and an applications, portal suite of collaborative robust system, a comprehensive based on open standards. enterprise infrastructure layer ([email protected]) ([email protected]) Learning Objectives: Analysis of nine years of experience with "A walk through radiology" radiology" with "A walk through of experience of nine years Analysis Martínez-Morillo; M. Torales, Ruiz-Gómez, O. M.J. Sendra, F. the experi- images and to review of radiological students in the visual perception 1998. ence in our institution since Background: to medical students or general our project is addressed or specialists training, but lesson about radiology, pretend to be an exhaustive It does not practitioners. visual perception. the user’s to train tool a practical Details: Procedure After seeing in normal organized pathological series. and image modalities, ferent commentar- response screen where several go to the the user must each case, project has Since 1998, this with animated transitions. ies and marks are shown last course of the medical students in a parttaken for activities of the practical of evaluation with computers, Questionnaires about performance our institution. Two been collected during this time. the application and open suggestions have one will in 2000 and 2002 and the next been published editions have CD-ROM The purpose to the editions is to distribute of these appear at the end of 2006. This project has also been adapted to html cost. at low students and professors 3.1 is translated resource and version as a web-based-training to be integrated ash presentations. into fl Conclusion: Ger- which is presented into six languages Spanish, English, French, version, within through Radiology" Walk tryingman, Italian, and Portuguese, to spread "A European Countries. C-286 N. Ptohis N. C - 7 0 R C EECR07-C-SciEduc-FIN.indd 61 Scientific and Educational Exhibits
GE Medical, Milwaukee, WI, USA), volume rendering visualizations of high-resolu- in the present study. The object is associated with a series of prior studies and tion 3D CT datasets have been produced in QuickTime VR format for self-study includes information about scan protocol, scan range and the position of key im- by medical and physiotherapy students. The images can be accessed on any ages in the series. After acquiring a CT localizer in the present study, the operator network-connected computer with the free QuickTime Player installed. As demon- registers the CT localizer to a prior one in the object, in order to fi t the patient’s strated by this exhibit, the user can freely rotate the volume around both vertical position using the anatomical landmarks. This operation enables the operator to and horizontal axes by dragging the mouse in the image. In addition, the user can fi t the scan range and image reconstruction range automatically. The CT scanner easily zoom in and out. The images produced so far include the heart and great creates the new dedicated DICOM objects associated with the present study that vessels as well as parts of the musculoskeletal system. The use of semi-opaque have spatial offset value for comparable images to prior key images. structures facilitate the presentation of, e.g., the relationship between coronaries Results: The acquired images have same scan conditions and same position of and heart chambers or between patella and femur. In preliminary evaluations, the prior images within one slice difference. students give the material high ratings. Conclusion: We developed a CT scanner that makes it easy to acquire compa- Conclusion: Easy access over the Internet and good interaction capabilities on rable images to those of a prior study. A time of additional operation of current low-end computers make this format attractive as an aid for anatomy learning. study does not give much effect for study throughput of the CT system. Now, we are planning to standardize this dedicated object to make interoperability between C-292 different vendors and modalities. A new software platform for interactive vertebra radioanatomy and CT guided interventions learning C-295 S. Aubry, A. Pousse, P. Sarliève, E. Delabrousse, L. Laborie, B. Kastler; Image retake analysis in digital radiography using DICOM header information Besançon/FR ([email protected]) E. Vano, J.I. Ten, C. Prieto, J.M. Fernandez, N. Arevalo, E. Crespo, A.I. Iñiguez, A. Litcheva; Madrid/ES ([email protected]) Learning Objectives: To become familiar with advanced software for 3D interac- tive radio-anatomy learning. To learn about basics in rachidian radio-anatomy. To Purpose: Retake analysis is a key aspect in any quality assurance programme experience fundamentals of simulated CT guided interventions. and a basic tool to avoid unnecessary doses to patients in a radiology department. Background: The range of rachidian CT guided interventions is widening from day A methodology to automatically detect potential retakes using DICOM header to day. This practice requires a perfect vertebra radio-anatomy knowledge and a information is presented. high degree of interventional procedure culture. We present a software platform Methods and Materials: A system called QCONLINE was developed to help in dedicated to vertebra radio-anatomy and CT guided interventions learning. the management of images and patient doses in a digital radiology department. Procedure Details: Based on 3D high resolution modelisation of vertebra segments Images are sent to the PACS and to a dedicated workstation where the QCONLINE and of their vasculonervous environment from multidetector CT acquisitions, the runs. DICOM header information is extracted and transferred to a database. Rel- presented tool simultaneously offers multiplanar reconstruction (MPR), 3D surface evant images can also be archived for inspection. The initial criterion for potential rendering, objects outlining on MPR. OpenGL based development allows interactive retakes was that 2 or more images have the same patient ID, modality, description, shading such as lighting or opacity modifi cations. Furthermore, Virtual 3D objects projection and date. This criterion was applied over the 3,742 abdomen and 4,236 have been inserted in the volume in order to simulate the best of rachidian CT chest images. A sample of the images was assessed to determine the goodness guided interventions (infi ltration, cementoplasty, RF). of the method. Conclusion: This 3D modelisation package has the potential to improve radiologist’s Results: The initial rejection criteria lead to a 15.4% retake rate in the abdomen knowledge of the spine. Radiologists are thus able to virtually practice approaches examinations and a 4.5% for the chest examinations. After a thorough analysis of aimed at safe planning of a variety of CT guided interventions. the supposed repeated images, the need for additional criteria such as orientation of the cassette (landscape/portrait) was demonstrated. The fi nal retake fi gures were roughly 50% of the automatic fi ltering from the database. C-293 Conclusion: Automatic retake analysis is a critical aspect in digital radiology. It Automatic segmentation of the rectal tube in computer-aided detection for allows detecting defi ciencies like wrong identifi cations, positioning errors, wrong virtual colonoscopy radiographic technique, bad image processing, equipment malfunctions, artefacts, P. Boda, S. Agliozzo; Turin/IT ([email protected]) and so on. In addition, retake images fi ltered automatically and collected can be Purpose: Computer-aided detection (CAD) for virtual colonoscopy (VC) is a tool used for continuous training of the staff. that allows to detect polyps from VC exams. During the exam, a rectal tube (RT) is placed in the patient for air insuffl ation. This tube is the origin of false positive C-296 (FP) detections in the CAD system. We present a method for the automatic seg- Feasibility of showing radiologic images on iPOD: Can Pod save the space? mentation of the RT. H. Funatsu, H. Takano, M. Kogure, A. Imamura, T. Kasai; Chiba/JP Methods and Materials: Two types of RTs were used, which differ for their diameter and the plasticity. The fi rst RT (RT1) has a maximum diameter of 14 mm, whereas Purpose: iPOD, a portable media player, is capable of displaying images and mov- the second one (RT2) has a diameter of 8 mm and is more fl exible. Exams were ies. Carrying radiologic images in iPOD would be useful for educating residents, acquired on a multislice helical CT scanner with a tube current of 50 mA at 120 kV, communicating with other radiologists or referring physicians, or informing patients a slice thickness of 1.25 mm and an interval reconstruction of 0.6 mm. Patients at bedside. The purpose of our study is to evaluate lesion conspicuity on iPOD. were scanned in both supine and prone positions, after bowel cleansing and air Methods and Materials: Fifty sets of key images of either computed tomography insuffl ation. We studied 15 cases, for a total of 30 CT scans, four of them with RT1s or magnetic resonance imaging were randomly collected from computerized and the rest with RT2s. database in our department. Any lesions equal or less than 10 mm in diameter Results: The algorithm detected 96% of RTs (29/30) and in all of these cases were excluded while collecting images. These 50 images with any fi ndings and RTs were completely tracked. It failed once for a RT of the second type. The visual 50 images without any fi ndings were installed on iPOD. Size and site of the each inspection of this case showed that the lumen of the RT was almost entirely fi lled lesion were recorded. Five blinded radiologists reviewed the images both on with fecal residus. iPOD and DICOM viewer with a 4-week interval between sessions. Conspicuity Conclusion: We developed a robust automatic method for the segmentation of of the lesions was evaluated by using response receiver operating characteristic two types of RTs for CAD for VC. (ROC) curve analysis. Results: The areas under the ROC curves (95% CI) were 0.97 (0.88-1) for iPOD, 0.99 (0.94-1) for DICOM viewer. Difference between Az value was not C-294 signifi cant (p=0.53). Organic re-circulation of the information on network (ORION): The Conclusion: iPOD may be used for displaying radiologic images of appropriate development of CT scanner reproducing prior key image and evaluable quality as DICOM viewer. T. Masuzawa1, M. Kazuno1, S. Kaminaga1, M. Ozaki1, M. Achiwa2, H. Fukatsu2; 1Otawara-Shi,Tochigi/JP, 2Nagoya-city, Aichi/JP
Purpose: The purpose of this study is to develop a CT scanner system to reproduce key images that are specifi ed in a prior diagnosis. Methods and Materials: The CT scanner retrieves a dedicated DICOM object from an image server and extracts a scan protocol of a previous study for application
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C les and allow the travelling presenter the travelling les and allow BDEF and identify patients ect hepatic physiology Dublin/IE, Dublin/IE, 1 A ; 1 Shanghai/CN To demonstrate that pulmonary demonstrate arterial and phase images To To demonstrate how high quality, large capacity multimedia large capacity multimedia high quality, how demonstrate To , M.S. Molloy , M.S. A multimedia presentation with integrated rehearsed timings presentation with integrated A multimedia 2 After image correction, pulmonary enhancement and bronchial Powerpoint is the default standard for multimedia presentations multimedia standard for is the default Powerpoint Pulmonary supply includes pulmonary blood and systematic circula- Pulmonary phase perfusion and aortic phase perfusion can be iPods now have suffi cient integrated storage and video processing storage cient integrated suffi have now iPods Texture analysis of hepatic CT images obtained during analysis routine clinical Texture , D. Mullan , D. The feasibility study demonstrated that liver texture during the portal texture that liver study demonstrated feasibility The 1 Learning Objectives: using an iPod. presentations can be displayed Background: although other applications can create similar fi surrounding can occasionally run into compatibility problems venues in unfamiliar sound and electrical requirements. cabling, le types, fi media versions, Details: Procedure format, movie 2004 exported to Quicktime created using Microsoft Powerpoint was to connecting the iPod to an audience by and delivered synchronised to an iPod is similar in all respects to one given The presentation given unit. a visual display video and audio. builds, methods encompassing transitions, using traditional Conclusion: ability to accommodate very media rich large fi with a laptop based presentation. a colleague travelling to rehearse on a plane unlike further batteryRecent security reinforced worries measures and exploding have role as an academic aid. the iPod’s Learning Objectives: Windows-based develop To aortic phase images can be acquired with 64 slices CT. perfusion. ed dual phases processing semi-qualifi for software Background: such as COPD. in some diseases, supply imbalance is complex Regional blood tion. pulmonary images, non-contrast arterialWith complicated scanning technique, phase images and aortic acquired in one breath-hold with 64- phase images were was Contrast determined a time-density curve. time was by Delay CT. slices spiral Then, pulmonary arterial phase better enhancement. for saline by pushed forward (DualX 2.0) based software Windows and aortic phase data sets can be acquired. dual phase images with Delphi 9.0. these selective to analyze developed was Details: Procedure Then, pulmonary ratio technique. subtraction enhancement can be calculated by calculated, which is the proportionwas of pulmonary enhancement in total enhance- over these parameters Pseudo-color map also can be rendered to illustrate ment. images. non-contrast Conclusion: separately. evaluated C-301 in radiology educational technologies Evolving and the iPod: Powerpoint Sherif Z. C-300 pulmonary and aortic regional parenchymal to evaluate approach Novel dual phase perfusion with self-developed selectively supply blood software in 64-slices CT Li; Chen, Z. Y. Zhang, G. Xie, X. quantifi cation of liver texture. of liver cation quantifi Results: and survival (r=-0.50, p=0.0074), index with the hepatic perfusion phase correlated tis- in apparently normal liver texture study, evaluation In the (r=0.49, p=0.0095). from patients with no tumour different metastases was sue in patients with hepatic (p=0.026) and arterialrecurrence on unenhanced images (p phase only (p=0.014). disease on unenhanced images from patients with extra-hepatic analysis of portal texture metastases on CT, liver Among patients with no visible disease on PET (p=0.0035) those with extra-hepatic phase images could identify The hepatic phosphorylation of glucose was and impaired survival (p=0.0074). p=0.0062). (r=-0.59, texture biological correlate for ed as a possible identifi Conclusion: that refl biomarkers can provide practice disease and poor survival. with extra-hepatic
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= 85-92 and q t. JPEG shows a little JPEG shows t. JPEG Moscow/RU Falmer/UK ([email protected])
Scientific and Educational Exhibits Scientific and Educational Nagoya/JP 2 at panel detector at-panel detector system (CXDI-40G, CANON ed fl ed ltration at different spatial frequencies, followed by by followed spatial frequencies, at different ltration A feasibility study comprised 27 patients undergoing A feasibility Shizuoka/JP, Shizuoka/JP, Dynamic chest radiographs (1344×1344, 12 bit, 3 fps, 10 (1344×1344, 12 bit, 3 fps, Dynamic chest radiographs 1 Investigation included 40 patients with various pathologies 40 patients with various included Investigation ; 2 3 6
cant differences were found between the known and measured and measured the known between found were cant differences
d d n Dynamic chest radiograph with our computer analysis can clarify Dynamic chest radiograph Compression Ratio cannot be Quantitative Quality Index. In visual Quality Index. Compression Ratio cannot be Quantitative .067). i . , Y. Kodera , Y. 1 N I p= To determine optimal compression settings and parameters for MR determine for settings and parameters optimal compression To To assess the potential for computer analysis of liver texture during CT texture of liver computer analysis assess the potential for To This study was performed to develop a method of using a temporal a method of using a temporal to develop performed This study was F Image Compression Ratio (e.g. 8:1, 10:1 etc). is often used as a term 8:1, 10:1 etc). (e.g. Image Compression Ratio The movement tracks of the nodule could be visualized as a white region of the nodule could be visualized tracks The movement - c u d E i c S - ([email protected]) ([email protected]) Purpose: patients with colorectal cancer and to identify possible for biomarkers to provide features. texture relevant biological correlates for Methods and Materials: group an evaluation by followed CT after primary resection of colorectal cancer, available Hepatic CT perfusion and survival data were of a further 32 patients. in the evalua- PET results accessible uorodeoxyglucose with fl both groups, for constructed assessed within regions of interest manually was Texture tion group. and and fat, vessels major blood whilst excluding apparently normal liver over comprised band-pass image fi C-299 of hepatic CT analysis Texture in colorectal cancer: biomarkers Imaging Chatwin; C.R. Young, R.C.D. Miles, K.A. Ganeshan, B. C-298 temporal subtraction in of nodule kinetics using Quantitative evaluation with a fl radiography chest dynamic Y. Tsuchiya Y. Evaluation of JPEG, JPEG2000, JPEG-LS compression of MR images for for of MR images JPEG-LS compression JPEG2000, JPEG, of Evaluation teleradiology Sinitsyn; V.E. Pianykh, O. Ustyuzhanin, D. Ansheles, A. C-297 ([email protected]) ([email protected]) Purpose: image compression. Methods and Materials: and consisted of mathematical and visual approaches. The mathematical approach and visual approaches. and consisted of mathematical of compressed MR images Quality Index the Quantitative included searching for Ratio), compress- index-Compression quality approved (with analysis of currently performed was image evaluation Visual estimation of coders behavior. ibility tests, images were Test observers. four spine MR images by on nine 12-bit head and (q). quality settings JPEG-LS at various compressed in JPEG, JPEG2000, Results: because the visual quality of im- it is unacceptable, but equal to Image Quality, lossless threshold Visually widely vary. may ages with the same compression ratio quality settings required) resolution the higher depends on resolution (the lower of spine images is better than head images). compressibility (e.g. and body zone q between In our study the visually lossless threshold was sec) were obtained using a modifi sec) were analysis, JPEG-LS provided the best image quality with maximum compression. compression. the best image quality with maximum JPEG-LS provided analysis, JPEG2000 seems high quality. JPEG can be still useful due to good compatibility and resolution and high compression orientation. because of high unacceptable = 82-94 for four observers. JPEG-LS was the best coder for high quality MR im- the best coder for JPEG-LS was observers. four = 82-94 for to be unfi ages compression, while JPEG2000 is concluded result than JPEG-LS. worse Conclusion: Purpose: kinetic function of a lung the quantitative evaluating technique for subtraction the clinical application of and to investigate chest radiography, dynamic nodule by nodule. using a simulated our technique by Methods and Materials: Inc, Tokyo, Japan). For respiratory phase synchronization, analysis of diaphragm For Japan). Tokyo, Inc, phase was in the expiratory subtraction and continuous performed, kinetic was The clinical effective- image as output. to obtain a temporal-subtraction performed (22-54 y/male) volunteers of eight healthy using radiographs investigated ness was of the enhanced region that appeared on the The range nodule. with a simulated kinetic the known between The differences measured. manually output image was cance of difference Signifi calculated as detection error. amount and result were paired t-test. by then evaluated was Results: with 8 nodules was of the radiographs The detection rate on the output image. less than measured was that were of ranges difference The maximum 75% (6/8). 3.69 was of the difference of the absolute value the average 4 mm; statistically signifi amounts ( Conclusion: as a screening examination regarding nodules and is effective kinetic information therapy. or initial planning of radiation checkup for C - 7 0 R C EECR07-C-SciEduc-FIN.indd 63 Scientific and Educational Exhibits
Contrast Media the fi ndings of this imaging modality with those of dynamic magnetic resonance imaging (MRI). Methods and Materials: A total of 27 patients with HCC treated by transarterial C-302 chemoembolization (16), ethanol ablation (10) or radiofrequency ablation (1) were Tumor vessel compression hinders perfusion of ultrasonographic contrast included in the study. All of them were examined with second-generation contrast agents agents ultrasonography (CUS) one month after the last percutaneous treatment. N. Faccioli, M. D’Onofrio, M. Galie’, A. Sbarbati, R. Pozzi Mucelli; Verona/IT Vascular fi ndings at CUS were compared with the results of dynamic MRI. Contrast- ([email protected]) enhanced MRI fi ndings were taken as the gold standard. Tumoral response criteria considered at CUS were: (1) persistence or absence of tumoral enhancement during Purpose: To compare the dynamic information obtained from contrast-enhanced arterial phase, (2) necrotic tumoral size. ultrasonography (CEUS) and contrast-enhanced magnetic resonance (CEMR) on Results: CUS and MRI, performed one month after HCC percutaneous treatment, two experimental tumor models exhibiting notable differences in vessel anatomy. found complete response in 13 of the 27 patients (48%) and no response in 14 Methods and Materials: Six animals subcutaneously injected with a carcinosar- patients (52%), respectively. Comparing both imaging techniques, we obtained an comatoid (A17) cell line and six animals injected with a carcinoma (BB1) cell line agreement of 85% (kappa 0.70), a sensitivity of 85%, a specifi city of 86%, a posi- underwent CEUS and CEMR. CEUS was performed on a Technos (Esaote, Italy) tive predictive value of 85%, a negative predictive value of 86% and an accuracy with a bolus injection (0.01-0.05 ml) of sulphur hexafl uoride microbubbles (SonoVue, of 85%. In 4 cases, CUS and MRI found different results. Bracco, Italy) into a tail vein. The curve of enhancement (time-intensity) obtained Conclusion: CUS is useful to detect residual HCC when compared with dynamic by locating a ROI over the tumor was used to calculate maximal intensity (Mi) and MRI results. Because of its low cost and high disponibility, it may reduce the fre- slope (S). CEMR was performed on a Biospec scanner (Bruker, Germany) by quency of dynamic MRI in the follow-up of treatment response. injecting Gd-DTPA-albumin (Contrast Media Laboratory, University of California, USA). By locating a ROI over the tumor, we calculated fraction plasma volume (fPV) and transendothelial permeability (kPs). All the tumors were removed and C-305 analyzed histologically and immunohistochemically (CD 31). The vascularity of the Contrast-induced nephropathy: A review two different tumor histotypes was comparatively evaluated by immunohistochemi- C. Cronin, K. McCarthy, E. Delappe, J.N. Mhuircheartaigh, D. Reddan, cal, CEMR and CEUS analyses. P.A. McCarthy; Galway/IE ([email protected]) Results: Considering the viable areas of the tumor, the vessels of A17 were Learning Objectives: To provide an educational review of the multifactorial ele- signifi cantly (P < 0.00001) more numerous and smaller than those in BB1 tumors. ments of contrast-induced nephropathy. To review the current literature on etiol- CEMR fPV and kPS parameters were signifi cantly (P=0.00001) higher for the A17 ogy and prevention of contrast-induced nephropathy. To provide evidence-based tumors than for the BB1 tumors. CEUS Mi and S values were smaller in the A17 approach/algorithm when assessing patients undergoing contrast enhanced tumors than in the BB tumors (P=0.002). procedure. To establish a protocol for patient care and follow-up. Conclusion: Our data demonstrate that particular histologic features, such as Background: Contrast-induced nephropathy has become an important cause of collapsed intratumoral vessels, can lead to a mismatch between CEUS and CEMR iatrogenic acute renal impairment and currently ranks as the third most common in studying tumor vascularization. cause of hospital-acquired acute renal failure. Although clinical presentation of CIN is well described, precise mechanisms and management strategies for this C-303 complication continue to be a matter of debate. The incidence of CIN (Contrast Ferumoxtran-10 enhanced MR imaging at 3 T MRI with total imaging Induced Nephrotoxicity) is dependent on both the defi nition of CIN and the patient matrix: State-of-the-art MRI for novel molecular imaging techniques with population investigated. The incidence of nephropathy is low in the general popula- nanoparticles tion, but patients with increased risk (patients with renal impairment and diabetes) S. Takahashi, W. Deserno, R. Heesakkers, J.O. Barentsz; Nijmegen/NL have reported signifi cantly higher frequency (12-50%). ([email protected]) Procedure Details: Through a medline literature search and review of a number of current guidelines, we will establish an algorithm of best practice for all patients Learning Objectives: To discuss the optimisation of acquisition parameters to undergoing contrast-enhanced procedures. We will assess the current evidence maximize the ability of Ferumoxtran-10 enhanced MR imaging (USPIO-MRI) at on potential prophylaxis (prehydration, acetylcysteine, bicarbonate, fenoldopam, 3 Tesla. To demonstrate tips and tricks for evaluating USPIO-MRI in combination discontinuation of nephrotoxic medications prior to contrast-enhanced scans) and with dedicated software for visualizing 3D localisation of LNs. those patients that should be targeted for these treatments. Background: USPIO-MRI is shown to be extremely accurate for assessment of Conclusion: We provide a thorough and concise review of this intricate area, the LN status in prostate cancer patients. Since positive LN smaller than 4 mm can which could be applied in all radiology departments to optimise patient care in a be accurately detected with USPIO-MRI, appropriate high-resolution imaging is practical manner. essential to maximize its clinical usefulness. Clinical 3 T whole-body MR system, which is increasingly becoming available, is expected to enable imaging with a higher spatial resolution. Aids with dedicated computer software are now essential C-306 in evaluation for numerous high spatial resolution images. Effi cacy and safety of meglumine gadoterate (Gd-DOTA) enhanced Imaging Findings: The exhibit is based on our experiences of USPIO-MRI at 3 T magnetic resonance angiography (MRA) compared to non-enhanced time- in years, including 3 T-MRI scanner with total imaging matrix. Positive LNs with 2 of-fl ight (TOF) MRA in the diagnosis of clinically signifi cant non-coronary to 3 mm in diameter can now clearly visualised on USPIO-MRI at 3 T. Thanks to arterial disease multi-channel capability, both T1 and T2*-weighted image can be obtained with D. Shah1, S. Bingham2, S. Wolff3, C. Dubourdieu4; 1Nashville, TN/US, 2Provo, 3DFT-volume data acquisition, which enable to acquire isotropic voxel T2*-weighted UT/US, 3New York, NY/US, 4Paris/FR ([email protected]) images, as well as T1-weighted images. These volume data are evaluated on Purpose: To assess the diagnostic accuracy of Gd-DOTA MRA over TOF MRA for dedicated software for visualizing 3D localisation of LNs. non-coronary arterial disease by comparing the percent agreement at the subject Conclusion: Combination of novel techniques, 3 T-MRI with TIM technique and level of each MRA method with X-ray angiography (defi ned as number of segment USPIO, enable to visualise tiny positive LNs on MRI. Optimisation of the acquisition scores in agreement/ total number of segments evaluated for the subject x100). parameter is essential to maximize the ability of USPIO-MRI. The help of computer Methods and Materials: Multicenter, open-label, fi xed sequence, paired trial in technology is vital in handling numerous data to be evaluated. 100 subjects > 18 years [64 men, 36 women; mean age (±SD) 64.5 ± 13.7 years] with suspected non-coronary arterial disease and scheduled to undergo X-ray C-304 angiography were included and received an iv bolus of Gd-DOTA 0.1 mmol/kg. Second-generation ultrasound contrast agents (SonoVue) to evaluate Results: The regions imaged for arterial disease were: renal (33.0%); aorto-iliac percutaneous treatment response of hepatocellular carcinoma: (31.0%); femoral (15.0%); carotid (12.0%); popliteal (6.0%); and calf (3.0%). There Comparison with dynamic MR imaging was a statistically signifi cantly greater mean (±SD) percent agreement of MRA to L. Atilano, J. Martin, B. Canteli, A. Urresola, A. Aguinaga, A. Barturen, J. Pijoan; X-ray with Gd-DOTA MRA vs TOF MRA [86.0% ± 22.3% vs 79.5% ± 30.5%, re- Barakaldo/ES ([email protected]) spectively; difference 6.6% ± 24.2% (p=0.0210)]. The sensitivity of Gd-DOTA MRA was signifi cantly greater than TOF MRA at the segment level [78.3% vs 58.3%, Purpose: To assess the effi cacy of harmonic gray-scale ultrasonography using respectively (p=0.0196)] and at the patient level [96.6% vs 69.0%, respectively second-generation contrast agents (SonoVue) in evaluating the response of (p=0.0114)]. Similarly, the specifi city of Gd-DOTA MRA was also signifi cantly greater hepatocellular carcinoma (HCC) after percutaneous treatment, and to compare
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Contrast Media 0 : 7 1
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-cells were incubated with iomeprol and cor- incubated with iomeprol and -cells were A 1 65 HU)] and protocol B [50 ml (283 ± cant differences (P=0.5646) in mean CT numbers (P=0.5646) in mean CT numbers cant differences , S. Okumura , S. 1 ndings. 4. To establish a safe and credible procedure procedure and credible a safe establish To 4. ndings. ush injected at 3.0 mL/s. Two protocols that differed protocols that differed Two mL/s. ush injected at 3.0 3D-CTA of the aorta was performed in 78 patients. of the aorta in 78 patients. performed was 3D-CTA LLC-PK Contrast-enhanced ultrasound improves the detectability of the detectability improves ultrasound Contrast-enhanced Bunkyo-ku,Tokyo/JP 2 The interaction between the "bubbles" and the US beam is explained and the US beam is explained the "bubbles" between The interaction , D. Utsunomiya , D. The iomeprol-induced inhibition of MTT-conversion is mostly revers- The iomeprol-induced inhibition of MTT-conversion User-friendly DVD Rom-based visual guide with step-by-step pro- visual guide with step-by-step Rom-based User-friendly DVD 1 To evaluate the mechanisms of cytotoxicity of an iodinated contrast of an iodinated contrast the mechanisms of cytotoxicity evaluate To 64-row multislice CT provides detailed data over a wide range in a short a wide range detailed data over provides CT multislice 64-row There were no signifi There were Iomeprol induced a time- and dose-dependent inhibition of MTT-conversion of MTT-conversion Iomeprol induced a time- and dose-dependent inhibition Kumamoto/JP, Kumamoto/JP, dose of iodinated contrast medium that was needed to obtain acceptable contrast contrast needed to obtain acceptable medium that was dose of iodinated contrast Conclusion: part be due to may The irreversible and is not associated with cell necrosis. ible, apoptosis and decreased proliferation. administer the solution, how to make control adjustments on US machine, and how and how adjustments on US machine, control to make solution, how administer the fi the sonographic to evaluate results. and ensures true-positive complications that minimizes Background: and real-time US videos. with analytical drawings Details: Procedure illus- This medical e-book of increased vascularity. regions revealing pathology by contrast with use of ultrasound exam an ultrasound to perform taken the steps trates to prepare the how agents, A detailed description contrast of ultrasound agents. of the solution, control adjust- to prepare the patient, administration solution, how TGC, detection such as MI, high-analysis contrast ments of US machine to enable agents contrast of ultrasound appearance and sonographic gain, depth and focus step technique is demonstrated The proper in a user-friendly manner. are provided presenta- video presentations included a simultaneous double Educational step. by technique. and the examiner’s exam tion of the real-time ultrasound Conclusion: with ultrasound examination an ultrasound to perform instructionscedural on how agents. contrast C-311 of the aorta using 3D-CTA for contrast protocols of low-dose Evaluation CT multislice 64-row Sakamoto T. 1 C-310 contrast of a nonionic monomeric iodinated of cytotoxicity Mechanisms in vitro cells renal tubular medium on proximal Uder; Bautz, M. W. Heckmann, M. Scheer, Heinrich, M. M. ([email protected]) Purpose: cultures. cell medium on renal tubular Methods and Materials: Purpose: time, and reducing the amount of contrast medium used for 3D-CTA has been at- 3D-CTA medium used for and reducing the amount of contrast time, the optimization of to investigate conducted studies We facilities. tempted at many protocols contrast the usefulness of low-dose enhancement and to evaluate contrast of the aorta, based on clinical data. 3D-CTA for Methods and Materials: fol- mL/s, of 3.0 injected at a rate mgI/mL) was medium (300 Nonionic contrast mL saline fl a 20 by lowed mL (26 patients) and 100 medium injected [protocol A: in the amount of contrast The mean CT and compared. evaluated mL (52 patients)] were 50 protocol B: in the ascending aorta, and SD values numbers descending aorta, pulmonary The aortic iliac artery diaphragm, and external artery, branches, compared. were also was body weight appropriate medium per kilogram dose of iodinated contrast protocol B. for investigated Results: protocol A[100 between ml (291 (64-14%, at 4.69-75 54-41%, at 2-24 h at 18.75 mg I/ml at 24 h; mg I/ml), which was at 24 h, p mannitol (99-47% than that induced by cantly stronger signifi responding mannitol solutions (4.7-75 mg I/ml, 2-24 h). Metabolic activity was Metabolic activity was mg I/ml, 2-24 h). responding mannitol solutions (4.7-75 assessed with 3-(4.5-dimethyl-2-thiazolyl)-2.5-diphenyl-2H-tetrazoliumbromid detect To used to assess cell viability. test was Trypan-blue The (MTT)-assay. the determination in the cell lysate of oligonucleosomes an ELISA for apoptosis, (BrdU)-incorporation 5-Bromo-2’-deoxyuridin was into the DNA performed. was measured to assess proliferation. Results: stronger inhibition of proliferation than mannitol (92% and 68% vs. 99% and 82% than mannitol (92% and 68% vs. stronger inhibition of proliferation h, p 24 at 18.75 and 37.5 mg I/ml, respectively; After 24 h incubation with iomeprol and a recovery time of 2 h after removal of time of 2 h after removal After 24 h incubation with iomeprol and a recovery (96% inhibition of MTT-conversion only a small medium, there was the contrast no signifi There was mg I/ml, respectively). and 89% at 4.7 and 75 8% and 10% after 24 h incubation (8% in control; of necrotic cells in the number p mg I/ml, respectively; with iomeprol at 37.5 and 75 increased signifi of oligonucleosomes the number apoptosis, mg I/ml after 24 h, p to control at 37.5 ush. ush. ow rate of rate ow
uence image quality. uence image quality. cantly greater diagnostic diagnostic cantly greater 102 HU in group 3. Group 102 3. HU in group ve different locations. different ve ([email protected]) ([email protected]) ±
Recife/BR Athens/GR Scientific and Educational Exhibits Scientific and Educational city than non-enhanced MRA in the diagnosis of city than cation of the thoracic aortacation of the thoracic a trend to and showed 83 2 and 277 HU in group ± eld Units (HU) was assessed from the ascending aortaeld Units (HU) was Ninety consecutive patients (53 men, 37 women; mean patients (53 men, 37 women; Ninety consecutive (1) To review the chemical structure, classifi cation and cation and classifi the chemical structure, review To (1) 1. To survey the physics and technology of US contrast and technology of US contrast the physics survey To 1. The purpose of this review is to address some of the main is to address some of the main The purpose of this review 5 ([email protected]) ([email protected])
6
d d Iodinated contrast media (CM) are sterile Iodinated contrast solutions iodine-containing Different contrast medium CT protocols were evaluated and this evaluated medium CT protocols were contrast Different n Although iodinated CM are safe and widely used, adverse events oc- events and widely used, adverse Although iodinated CM are safe Gd-DOTA MRA provided statistically signifi MRA provided Gd-DOTA i . N I Graz/AT To prospectively compare different volumes of contrast medium and dif- of contrast volumes compare different prospectively To F The patients of all the three study groups showed diagnostically acceptable diagnostically acceptable showed The patients of all the three study groups - c u d 54 1, 274 HU in group E ± i c S - 5 ml/s are used. 5 ml/s are used. ferent fl ow rates at 64-detector row CT angiography (CTA) of the thoracic aorta. of the thoracic (CTA) CT angiography at 64-detector row rates ow fl ferent Methods and Materials: 1: in group protocols: to one of three CTA assigned randomly were 57 years) age: ml/s); 4 rate: ow fl mg iodine per milliliter [mgI/ml]; medium (300 ml of contrast 70 and in group ml/s); 4 rate: ow fl mgI/ml; medium (350 ml of contrast 60 2: in group ad- 5 intravenously ml/s) were rate: ow fl 50 medium (350 ml of contrast mgI/ml; 3: 20 by fl ml of saline followed medium applications were All contrast ministered. mean aortic was attenuation The overall aorta. of the thoracic values attenuation 258 Purpose: aorta. of the thoracic in CTA values diagnostic attenuation resulted in acceptable medium reducing the amount of contrast CT allows 64-detector row Therefore, mgI/ml and a fl of 350 ml, when an iodine concentration to 50 down The attenuation in Hounsfi The attenuation of the aortic aortato the thoracic at fi hiatus at the level Results: 1 had the most constant opacifi values and median attenuation higher minimum but mean and maximum, lower attenuation a trend to lower 3 showed 2 and group group 2 and 3; than groups aorta in the distal thoracic 1. values than group Conclusion: The basic procedural knowledge of ultrasound contrast agents: A how-to- of ultrasound contrast agents: knowledge The basic procedural guide teaching Rom-based audiovisual do DVD Tsiakouri, C. Irakleous, E. Tragea, H. Pahou, K. Theotokas, I. Zoumpoulis, P.S. Panteleakou; E. Antsaklis, A. Korantzis, A. C-309 Learning Objectives: targeted organs. the procedure of contrast-enhanced demonstrate To 2. agents. to to prepare the patient, how visual guide on how present a step-by-step To 3. C-308 Comparison aorta: of the thoracic CT angiography row Sixty-four-detector CT-protocols contrast medium of different Quehenberger, F. Reittner, Deutschmann, P. Schoellnast, H.A. H. Fritz, G.A. Tillich; M. clinically signifi cant non-coronary arterial disease. clinically signifi This presentation is use of iodinated CM. concerns that arise with the day-to-day pos- guidelines recommending precautions to prevent It provides topics. divided by consent informed The authors discuss the need for iodinated CM reactions. sible predict that may as the riskand measurement of renal function, as well factors The had a prior reaction. to deal with patients who have and how events, adverse reactions are discussed. types and treatment of adverse Conclusion: Every radiologist and interactions. safety cur and questions remain about their use, with CM. should be intimately familiar used in almost all diagnostic imaging methods. Since their advent in the 1950s, in the 1950s, Since their advent used in almost all diagnostic imaging methods. of CM Although the diagnostic value diagnostic imaging. revolutionized have they also occur. side effects is enormous, other less desirable Details: Procedure accuracy, sensitivity and specifi accuracy, ([email protected]) Learning Objectives: that infl discuss the factors To (2) properties CM. of iodinated reactions, or nonrenal adverse nephrotoxicity the risk of anaphylaxis, evaluate To (3) of the decisions be aware To pre-medication regimen.(4) and to discuss the role of the become acquainted with To (5) injecting iodinated CM. before one has to make discuss special situations To (6) reactions. appropriate treatment of such adverse pregnancy and lactation). metformin, (dialysis, Background: C-307 know radiologist must every What contrast media: The essence of iodinated Helluey, K. Carneiro, C. Cardoso, Correia, S. T. Borba Filho, P. Manzella, A. do O; Zelaquett, I.B. C. Sales, D.C. Kaercher, J.H. than TOF MRA [92.9% vs 88.9%, respectively (p=0.0253)] and [83.7% vs 73.5%, and [83.7% vs (p=0.0253)] respectively MRA [92.9% vs 88.9%, TOF than events 14 adverse (10.0%) experienced patients Ten (p=0.0588)]. respectively and unrelated to Gd-DOTA). (mostly mild Conclusion: C - 7 0 R C EECR07-C-SciEduc-FIN.indd 65 Scientific and Educational Exhibits
enhancement (250 HU) was 200 mgI/kg, with a dose of 250 mgI/kg, which provided Methods and Materials: Double-blind, randomized studies were conducted in 120 a high success rate. patients undergoing cardiac angiography (CA) and 96 patients undergoing periph- Conclusion: The fi ndings of the present study indicate that the appropriate dose eral intra-arterial digital subtraction angiography (IA-DSA). Patients undergoing CA of contrast medium is 250 mgI/kg body weight to ensure optimal contrast enhance- received Iomeprol-350 (n=60) or Iodixanol-320 (n=60). HR and systolic/diastolic ment in aortic 3D-CTA. BP was determined before and after initial injection during left and right CA (LCA and RCA) and left ventriculography (LV). Differential effects were assessed using t-tests. Patients undergoing IA-DSA received Iomeprol-300 (n=49) or Iodixanol-320 C-312 (n=47). HR and systolic/diastolic BP were evaluated before and after the fi rst 4 Evalutation of post-treatment response of hepatocellular carcinoma: injections. Repeated-measures ANOVA and t-tests compared mean HR changes Comparison of ultrasonography with second generation ultrasound across the fi rst 4 injections and after the fi rst injection, respectively. Monitoring for contrast agent and dynamic CT adverse events (AE) was performed in both studies. G. Caruso, G. Salvaggio, A. Campisi, M. Midiri, R. Lagalla; Palermo/IT Results: No signifi cant differences between Iomeprol and Iodixanol were noted in ([email protected]) terms of mean changes in HR during LCA (p=0.8), RCA (p=0.9), and LV (p=0.8). Purpose: To compare the reliability of contrast enhanced ultrasound (CEUS) and In patients undergoing IA-DSA, no differences between CM were noted for effects dynamic CT in evaluating hepatocellular carcinoma (HCC) treated with non surgical on mean HR after the fi rst injection (p=0.6) or across the fi rst 4 injections (p=0.2). treatment [trans-catheter arterial chemoembolisation (TACE) and radiofrequency No differences between CM were noted regarding effects on systolic or diastolic thermo-ablation (RFTA)]. To evaluate the effi cacy of RFTA guided and monitored BP. Possibly-related non-serious AE were more frequent for Iodixanol (CA: 14/60 with contrast-enhanced ultrasound. [23.3%] vs. 10/60 [16.7%]; IA-DSA: 2/47 [4.3%] vs. 1/49 [2%]; Iodixanol vs. Iomep- Methods and Materials: One hundred and thirty-four patients with 148 nodules rol, respectively). of HCC treated with TACE (n. 38) and with RFTA (n.110) were admitted to our Conclusion: Iomeprol and Iodixanol have equally negligible effects on HR and department for follow-up. Nodules treated with RFTA were divided retrospectively systolic/diastolic BP during and after selective CA and peripheral IA-DSA. into two groups: 1) Group 1 (41/110): immediate post-ablation evaluation using CEUS was performed and, when necessary, immediate contrast-enhanced ultrasound-guided targeted re-treat- ment was carried out; and 2) Group 2 (69/110): CEUS was performed only for follow-up. Therapeutic response was evaluated at one month with dynamic CT and CEUS. Sensitivity and specifi city of CEUS and dynamic CT were calculated. Results: After RFTA, complete response was observed in 92.7% (group 1) and in 78.3% (group 2) with dynamic CT and in 92.7% (group 1) and 82.6% (group 2) with CEUS. Sensitivity and specifi city of CEUS were 83% and 100%. After TACE, complete response was observed in 47.4% of nodules with dynamic CT and in 39.5% with CEUS. Sensitivity and specifi city were 87% and 100% for dynamic CT and 100% for CEUS. Conclusion: Contrast-enhanced ultrasound may be a more suitable technique to evaluate intratumoral residual blood fl ow following TACE treatment. Evaluation of the results between the two groups who underwent RFTA showed a signifi cant difference in the ablation success rates. C-313 Is contrast-enhanced ultrasound useful? Principal radiological and clinical applications D. Volpe, N. Volpe, A. Saponaro, N. Masiello, P. Neri, A. Carriero; Novara/IT ([email protected])
Learning Objectives: To show the technical principles underlying ultrasound (US) contrast agents, imaging fi ndings, and principal radiological and clinical applications. Background: The introduction of contrast agents has led to one of the most im- portant advances in ultrasonography. US contrast agents are intravenously injected substances that are distributed by the blood fl ow to all organs, where they modify the characteristics of the tissues by increasing their ultrasonographic refl ectance. Given the different types of vascularization of normal and pathological tissues, they offer a better means of characterizing focal lesions than B-mode echography. Procedure Details: Contrast-enhanced US is more accurate than conventional echography in determining the number and size of focal lesions, and revealing capsular involvement, because it reduces the number of false-negative results. This more precise classifi cation of lesions has a considerable diagnostic and prognostic impact. We provide an overview of its principal radiological and clini- cal applications: focal lesions, trauma of solid abdominal viscera, vescicoureteral refl ux, and vascular diseases. Conclusion: The introduction of second-generation contrast media is changing the diagnostic perspective by giving radiologists an effective product of immediate use that eliminates all interpretative doubts and facilitates diagnosis. C-314 Effects of non-ionic iodinated contrast media (CM) on patient heart rate during intra-cardiac or intra-arterial injection I. Schmid1, D. Didier2, T. Pfammatter3, A. Garachemani1, M. Fleisch1, M.A. Kirchin4, B. Meier1; 1Bern/CH, 2Geneva/CH, 3Zurich/CH, 4Milan/IT ([email protected])
Purpose: To compare heart rate (HR) and systolic/diastolic blood pressure (BP) after intra-cardiac or intra-arterial injection of a non-ionic low-osmolar CM (Iomeprol) and a non-ionic iso-osmolar CM (Iodixanol).
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A ndings, with hyperlinks to more informative and to more informative with hyperlinks ndings, bromas, thecomas, adenofi thecomas, bromas, The program runs on a 700 The program II quad proces- MHz Pentium To review a spectrum of MR features in benign endome- a spectrum of MR features review To Cleveland, OH/US Cleveland, ([email protected]) ([email protected])
Benign endometriomas typically exhibit high intensity on high intensity on Benign endometriomas typically exhibit T2 shorteningT2 observed collagenous tissue was due to dense MR imaging is a useful modality for accurately diagnosing endo- accurately MR imaging is a useful modality for www.CancerStaging.info is a free, web-based, customized tool that customized web-based, is a free, www.CancerStaging.info ow. Furthermore, it offers hyperlinks to more comprehensive websites websites Furthermore, to more comprehensive hyperlinks it offers ow. Hypointensity on T2-WI may usually suggest its benign nature, but some but nature, usually suggest its benign T2-WI may Hypointensity on Kyoto/JP brous tumors such as fi ndings To provide a free, comprehensive, web-based, on-the-fl web-based, comprehensive, a free, provide To This web-based and customized program easily integrates into the into the integrates easily program and customized This web-based Imaging Findings: Imaging in benign fi Learning Objectives: on dif- with emphasis in endometriomas, triomas and malignant transformation of these conditions. ferentiation Background: including of gynecologic problems which causes a variety metriomas of the ovary, Endometriomas acute abdomen due to rupture. menorrhalgia, infertility and rarely secondary commonly clear cell carcinomas be complicated by malignancies, may and müllerianand endometrioid borderline mucinous carcinomas, tumors (MMBT). Ac- neoplasms can arise from endometrial ovarian cysts. various Less frequently, diagnosis of these malignancies is importantcurate since the majority of tumors benign endometrial cysts frequently Meanwhile, malignancies. are high-grade secondary simulate malignancy. of heterogenous intensity that may contain foci MR spectrum illustrates of benign and malignant conditions in The current review ndings. endometriomas in correlation with pathologic fi Findings: Imaging Malignancies arising from endometrioma T2WI. or high intensity on T1WI and low T1WI and present as a solid mass within endometrioma of high intensity on both cell carcinomas and endometrioid Solid component in clear carcinomas T2WI. MMBT typically T2WI, while to intermediate low intensity on frequently exhibits repre- T2WI may intensity on low In benign endometriomas, brightshow intensity. is easy to use and aids in accurate staging of common female pelvis cancers, pelvis cancers, staging of common female is easy to use and aids in accurate ndings. based on imaging fi Methods and Materials: Script languages include PERL, system. sor with Microsoft Server 2003 operating about tumor classifi Information DHTML. Javascript, C-319 in MR spectrum of benign endometriomas and malignant transformation Correlation with pathologic fi endometriomas: Fujii, Saga, S. T. Fujimoto, K. Morisawa, Mikami, N. Y. Tamai, K. Koyama, T. Togashi; K. C-318 A free and customized online tool to facilitate www.CancerStaging.info: based on pelvis cancers of common female and accurate staging quick fi imaging Shah; S. Talanow, R. Purpose: calculating and comparing the information y staging is done by On-the-fl database. the user with the tumor classifi by provided the user’s modes for offered in several the information provide The user may to increase modes in several is also offered Output of information convenience. ow. workfl into the reader’s and better integration exibility fl Results: is fl The interface station. monitor or PACS daily work from any radiologist’s seamlessly incorporating by preferences easily adapts to the individual physician’s into the workfl a particular for and prognostic information malignancy. access to therapeutic for Conclusion: cervical, uterine and ovarian, pelvis cancers (i.e. staging of common female allows endometrial) on imaging fi based which makes user friendly educational program It is an intuitive, in-depth websites. accurate. pelvis malignancies easy and staging of common female tumors, but rarely also observed in malignant tumors such as Krukenberg’s tumors tumors also observed such as Krukenberg’s in malignant tumors rarely but tumors, with neoplastic and malignant carcinoid tumors stromal proliferation with reactive refl contrast-enhancement Intense stromal proliferation. malignant tumors with Rare solid be the diagnostic clue. malignant tumors may materialslled with mucinous necrosis or coagulated fi appearance honey-combing mimic benign fi may tumors or solid clear cell carcinoma such as mucinous internaland reticular contrast-enhanced these tumors. suggest patterns may hemorrhagic clots in malignant germCoagulated necrosis with cell tumors may of specifi and elevation hypointensity, show or viscous proteinous materials cystic tumors, in mucinous Mucinous, diagnosis. in the cystic portions. hypointensity cause with colloid cysts may and struma ovarii cause hypointensity hemorrhage in endometrialRepeated intra-cystic cysts may be observed also in some dermoid cysts may similar appearance as "shading", but abscesses. and tubo-ovarian Conclusion: diagnosis is important. and preoperative hypointensity malignant tumors also show
Latina/IT cult diagnosis. diagnosis. cult
cant decrease of cant as this may be may cant as this Tokushima/JP cant difference between SI of between cant difference San Francisco, CA/US San Francisco, nding of ovarian tumors and form nding of ovarian 0.05). < Scientific and Educational Exhibits Scientific and Educational ow and reduced venous tone, thereby predisposing thereby tone, and reduced venous ow Seventeen female patients referred for gynecological for referred patients female Seventeen We will explain the etiology of round ligament varices (RLV) (RLV) ligament varices the etiology of round will explain We To demonstrate various benign and malignant ovarian pathol- benign and malignant ovarian various demonstrate To Dilatation of the veins of the broad ligament and ovarian plexi plexi of the broad ligament and ovarian Dilatation of the veins 7 6
d d Anatomically the round ligament extends from the lateral uterus from the lateral to Anatomically the round ligament extends nding The true incidence of round ligament varices is unknown but is is but The true is unknown incidence of round ligament varices Hypointensity on T2-WI is an unusual fi T2-WI is an unusual Hypointensity on n Intravenous injection of Sinerem provides a signifi provides injection of Sinerem Intravenous i . N I To evaluate the diagnostic advantages of intravenous USPIO administra- of intravenous the diagnostic advantages evaluate To Qualitative analysis showed a signifi cant decrease of SI of normal a signifi analysis showed Qualitative F - c u d E i c S - Results: leading to a better lesion conspicuity. administration after Sinerem myometrium a statistically signifi analysis showed Quantitative means of Sinerem-enhanced MR images assessed by on plain and myometrium follow- cantly increased lesion and normal signifi C/N between myometrium t-test. Sinerem-enhanced images provided In 13 patients ing Sinerem administration. T staging. leading to more accurate additional information Conclusion: SI of normal myometrium with higher C/N between neoplastic lesion and normalSI of normal with higher C/N between myometrium conspicuity of neoplastic lesions. increasing the myometrium C-317 resonance imaging: T2-weighted magnetic lesions on Hypointense ovarian Radiologic-pathologic correlation Nishitani; H. Uehara, H. Matsuzaki, K. Takeuchi, M. ([email protected]) Learning Objectives: T2-WI with pathologic correlation. masses on ogies presenting as hypointense Background: some histopathologic characteristics, These lesions have a special diagnostic category. diagnosis. differential T2 relaxation time of tissues and help to make which shorten the The ultrasound appearances of round ligament varices in pregnancy in pregnancy ligament varices The ultrasound appearances of round Goldstein; R. Pearl, J.M. Poder, L. McKenna, D.A. C-316 ([email protected]) ([email protected]) Purpose: of uterine carcinoma. T-staging tion on Methods and Materials: ([email protected]) Learning Objectives: a similar clinical picture to an ir- have may they in pregnancy and elucidate why of this condition is clinically signifi Knowledge hernia. reducible misdiagnosed as an obstructed hernia, leading to unnecessary surgical intervention will we (US) is the imaging modality of choice, As ultrasound during pregnancy. diagnosis. an accurate that establish the US features review Background: Pregnancy arteries,the labium majorus lymphatics and nerves. containing veins, fl promotes increased venous and inguinal hernias can be indistinguish- RLV Clinically, patients to varicosities. cough impulses and both positive comparable with similar anatomical sites, able reducibility with positional change. demonstrating Findings: Imaging When cause a clinical entity called the pelvic congestion or pelvic pain syndrome. a more diffi into the round ligament, it becomes this process extends of this condition are unique and and Doppler appearances the ultrasound However, can be easily recognized. Conclusion: suspected to be higher than the small amount of reported cases in the literature that the diagnosis of RSV should be entertained demonstrate we Through our series, should be and ultrasound mass, presenting with a painful groin in pregnant women unnecessary surgical exploration. in such cases to avoid performed Decrease of signal intensity of myometrium after iv USPIO administration: after iv USPIO administration: of myometrium Decrease of signal intensity MR fi A novel Female C-315 Laghi; A. De Cecco, C. Iafrate, F. Ferrari, Laghi, R. A. Paolantonio, P. 11 with corpuscarcinomas, uterine cancer and 6 with cervical carcinoma underwent T2*W sequences (TR/TE/FA/matrix/ GRE T magnet. 1.5 MR scan of the pelvis on a 1800 time: msec/15 acq. msec/30°/230x512/13.51 on multiple acquired min) were of of body weight mg/kg of 2.6 and 24 hours after iv administration planes before consensus by performed Image analysis were France). Sinerem (Guerbet, Paris, analysis of signal and quantitative and it included qualitative radiologists two by and after intensity (SI) of both normal and neoplastic lesions before myometrium T-staging cation of Modifi calculated. S/N and C/N were Sinerem administration. Statistical also evaluated. was in images obtained after Sinerem administration test (p Wilcoxon using performed analysis was Genitourinary C - 7 0 R C EECR07-C-SciEduc-FIN.indd 67 Scientific and Educational Exhibits
sent clots or granulative tissue containing hemosiderin, whereas nodules of high C-322 intensity may represent various metaplasia, endometrial hyperplasia or decidual Malignant transformation of mature cystic teratoma: Analysis of imaging changes. Postcontrast images are generally useful for differentiating benign from fi ndings and clinical data malignant conditions. J. Kim, S. Park, J. Kim, K. Cho; Seoul/KR ([email protected]) Conclusion: Recognition of MR spectrum in endometrioma is benefi cial for ac- curate diagnosis of benign and malignant conditions. Purpose: To evaluate the imaging fi ndings and clinical data predicting malignant transformation of mature cystic teratoma. C-320 Methods and Materials: In 11 patients with histopathologically confi rmed diagnosis, we analyzed the CT and MR fi ndings with regard to the presence of soft tissue Color Doppler US in uterine pathology components, tumor size, the angle between the soft tissue components and the A. Buzzi, J. Lehmann, V. Suárez, A. Frontera, C. Domínguez, M. Lucchesi; inner wall of the cyst (acute or obtuse), and the confi guration of the inner border Ciudad de Buenos Aires/AR ([email protected]) (regular or irregular). Clinical and laboratory data including patient’s age and tumor Learning Objectives: To illustrate the value of color Doppler US as an adjunct marker such as CA-125, CA 19-9, and AFP, were also analyzed. technique in the evaluation of those uterine pathologies in which detection and Results: In the analysis of the imaging fi ndings, nine (82%) of 11 tumors had soft characterization of vascular structures allow an early diagnosis. tissue components and eight (89%) of nine soft-tissue-containing tumors showed Background: Ultrasonography (US) is the initial diagnostic modality in gynecologi- an obtuse angle between the soft tissue components and the inner wall of the cyst. cal assessment. The transvaginal via is recommended, except in contraindicated In nine (82%) patients, the maximum tumor diameter was greater than 10 cm and cases (intact hymen, pregnancy of more than three months, and so on). Color the patient’s age was greater than 45 years. CA-125 was greater than 35 U/ml in Doppler US as an adjunct technique has become an effective tool in the evaluation six (67%) of nine patients and CA 19-9 was greater than 37 U/ml in three (75%) of those uterine pathologies in which detection and characterization of vascular of four patients. structures allow establishing early diagnosis, when the gray-scale ultrasound im- Conclusion: Malignant transformation of cystic teratoma can be preoperatively ages are nonspecifi c or confusing. In this exhibit, we describe the value of color predicted by combination of imaging fi nding and clinical data. Doppler US in the diagnosis of endometrial polyps, the distinction of leiomyomas and adenomyomas, the evaluation of de arteriovenous malformations, and the C-323 diagnosis of aneurysms and pseudoaneurysms. Spectrum of fi ndings of Mullerian duct anomalies at MRI Imaging Findings: Color Doppler US contributes to the diagnosis of endometrial P. Paolantonio, R. Ferrari, F. Iafrate, C. De Cecco, P. Lucchesi, A. Laghi; polyps by the identifi cation of vascular structures in the pedicle; permits the distinc- Latina/IT ([email protected]) tion between leiomyomas and adenomyomas bythe vascular distribution patron; plays an important role in the evaluation of de arteriovenous malformations, allows Learning Objectives: To illustrate some crucial MRI technical features for the distinction from myomas with degenerative changes, and detects the presence evaluation of normal uterine morphology and mullerian duct anomalies. To show of arteriovenous shunting. Color Doppler US also plays an important role in the spectrum of fi ndings of several mullerian duct anomalies at MRI. To illustrate diagnosis of aneurysms and pseudoaneurysms. MRI fi ndings useful in predicting the clinical impact of uterine anomalies in terms Conclusion: Color Doppler US with conventional techniques and power-angio are of infertility or risk of miscarriage. To illustrate MRI fi ndings useful for treatment very useful in early diagnosis and the follow-up of many uterine pathologies. regimens assessment. Background: Since 1988, the American Fertility Society (AFS) established a clas- C-321 sifi cation of uterine malformations. Because mullerian ducts defects are the result of a spectrum of mullerian ducts non-fusion, defi cient development and/or defective Benign cystic ovarian masses with solid components mimicking canalisation of the uterine cavity, the process may become arrested at any point in malignancy: Radiologic-pathologic correlation development. A complete assessment of uterine anatomy is mandatory in order to M. Takeuchi, K. Matsuzaki, H. Uehara, H. Nishitani; Tokushima/JP evaluate the impact of uterine malformation on women fertility and also to plan the ([email protected]) optimal strategy of treatment. Learning Objectives: To demonstrate various benign ovarian pathologies present- Procedure Details: In this exhibit, we describe an optimised MRI protocol including ing as cystic masses with solid components on imaging mimicking malignancy with high resolution T2 weighted TSE sequence acquired on dedicated oblique planes pathologic correlation. for the evaluation of uterine morphology. We describe MR fi ndings of several mul- Background: Solid components of ovarian cystic masses may usually suggest lerian duct anomalies according to the AFS classifi cation with emphasis on different their malignant nature, but some benign pathologies may also show the similar subtypes of septate uterus describing fi ndings useful to predict risk of recurrent appearances mimicking malignancy. miscarriage and to programme histeroscopical surgical treatment. Imaging Findings: Solid fi brous tumors (Brenner tumor and adenofi broma) co- Conclusion: MRI is a safe, non invasive and ionizing free method for diagnosis of existing with cystadenomas show characteristic hypointensity on T2-WI refl ecting uterine anomalies. MRI allows a complete evaluation of uterine morphology useful dense fi brous proliferation. Small tiny cysts within hypointense solid portion (black in surgical approach planning. sponge-like appearance) of adenofi broma are diagnostic. Mural nodules with in- tense contrast-enhancement and very high intensity on diffusion-weighted images C-324 (DWI) may suggest malignancy, but benign dermoid nipple may show surface slight MRI of the pelvis in mullerian duct abnormalities: Is there a role in contrast-enhancement and very high intensity on DWI. Solid portion of struma ovarii selecting patient for histerocopic metroplasty? also show intense contrast-enhancement, and lobular appearance with hypointense P. Paolantonio1, F. Iafrate1, R. Ferrari1, C. De Cecco1, A. Carnevale2, colloid contents on T2-WI is characteristic. Benign cystadenomas may contain small C. De Angelis2, A. Laghi1; 1Latina/IT, 2Rome/IT ([email protected]) papillary vegetations with no or slight contrast-enhancement. Pregnant decidual changes of endometriomas may show broad-based hyperintense mural nodules Purpose: Selection of patient for histeroscopic metroplasty requires a complete on T2-WI. Irregular clots within endometriomas may mimic malignant component, assessment of uterine morphology usually achieved by laparoscopy that represent and the absence of contrast-enhancement on subtraction images is the diagnostic the gold standard in the evaluation of uterine morphology. The aim of our study was clue. Daughter cysts of mucinous cystadenomas, and ovarian parenchyma within to assess the role of MRI in selecting patients with mullerian duct fusion defect for peritoneal retention cysts may mimic solid mural nodules on CT or ultrasonography, hysteroscopic metroplasty. and T2-WI can provide better tissue contrast for the correct diagnosis. Methods and Materials: We prospectively investigate 25 females with known mul- Conclusion: Benign cystic lesions with neoplastic components (Brenner tumors, lerian duct defect assessed at hysteroscopy. Examination were performed using adenofi bromas, teratomas and vegetations), reactive components (decidualized 1.5 T magnet equipped with phased-array coil acquiring high-resolution TSE T2W endometriomas), and non-solid components simulating solid portion (mucinous sequence (TR: 3000 msec/ TEeff 190 msec / ETL: 29/ Matrix 256 x 512) parallel to daughter cysts) should be differentiated from malignancy to avoid excessive the long axis of the uterus. Final diagnosis was assessed in all patients at surgery surgical procedure. using laparoscopy in the assessment of uterine morphology. In 22 patients, hys- teroscopic metroplasty was also performed. Image analysis was performed by two radiologist in a blind consensus fashion. They qualitatively evaluate morphology of both uterus and endometrial cavity. MR fi ndings were compared with laparoscopic and hysteroscopic fi ndings. Results: MRI revealed uterine abnormalities in all patients. In detail, 15 patients
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7 0 0 2 . 2 In the 399 0 . . 2 ndings. 112.02.2007 17:03:56 ndings G cant differences cant differences 30 cc compared broma. The most most The broma. < ammatory disease in ux in cases of female ux in cases of female 0.05). In patients staged with 0.05). < C 30 cc (p ≥ BDEF ([email protected]) ([email protected])
A ([email protected]) ([email protected])
ned. The tumors are biphasic, i.e., it is composed i.e., The tumors are biphasic, ned. ned 3 degrees of OOV: I - one side dilatation of ovary of OOV: ned 3 degrees Tbilisi/GE ndings of the mixed epithelial-mesenchymal tumors of the epithelial-mesenchymal of the mixed ndings TVCD was performed in 136 women with infertility. Age with infertility. in 136 women performed TVCD was Seoul/KR The purpose of this study is to describe the clinical and histo- We describe and exhibit the clinical and histologic appearance the clinical and histologic appearance describe and exhibit We cantly higher in patients with tumor volume higher in patients with tumor volume cantly ux was positive in 53% by Valsalvas maneuver. Valsalvas in 53% by positive ux was broma and adenomyoma. Malignant lesions include adenosarcoma, Malignant lesions include broma and adenomyoma. The mixed epithelial and mesenchymal tumors (MEMT) comprise epithelial and mesenchymal The mixed Regarding the diagnosis of pelvic sidewall invasion, clinical and MR invasion, of pelvic sidewall Regarding the diagnosis Familiarity with these radiologic features of unusual uterine of unusual tumors features with these radiologic Familiarity TVCD is an effective and noninvasive modality in the diagnosis of OVV modality in the diagnosis of OVV and noninvasive TVCD is an effective To study the possible use of Transvaginal Color Doppler (TVCD) in Color Doppler (TVCD) Transvaginal use of study the possible To Patients were staged as I B (n=1), II A (n=2), II B (n=19), III B (n=19) II A (n=2), II B (n=19), staged as I B (n=1), were Patients OVV was revealed in 65 (47.79%) patients. The frequent clinical complaints in 65 (47.79%) patients. revealed was OVV ndings of the mixed epithelial-mesenchymal tumors of uterus and correlate epithelial-mesenchymal ndings of the mixed to the patients with the tumor volume of volume to the patients with the tumor no signifi there were as IIB and IIIB, both clinical and MR imaging lymph node and distant metastases. in local recurrences, Conclusion: ran- staging causes, of false the knowledge For imaging concordance is very low. necessary. ndings are domised clinical trials supported with histopathologic fi assesment of posttreatment local response, concordance of the clinical and MR concordance of the local response, assesment of posttreatment survival and disease-free survival were Overall 88.9%. ndings was imaging fi statistically signifi Results: concordance 84 parametrialareas in 42 patients, For (1) (FIGO) priorIV A to RT. of parametrialndings in diagnosis invasion fi imaging and clinical MR between and 15.8%, respectively 71.0%, 64.7% IIIB were IIB and grade absence, 46%, myoma in 28%, and endometriosis in 26%. In 82% OVV were noted bilater- were In 82% OVV in 28%, and endometriosis in 26%. 46%, myoma Based on the diameter and and in 6% on the right side. in 12% on the left side, ally, defi we location of varicosis, from uterovaginalis venus and dilatation of plexus OVV mm, II - bilateral to 5 vein varicosis. mm in cases of total pelvic veins 10 above mm, III - the dilatation 6 to 10 refl Reno-ovarian Conclusion: In 66%, this pathology with secondary changes in infertility. as a cause of female dishormonal combined with various pathologies. gynecological was ovaries infertility, and to determine the frequency of combination of OVV with other gyne- and to determine the frequency of combination of OVV infertility, cological diseases. Methods and Materials: and in 48 (35.29%) it primary, In 88 (64.71%) cases infertility was 19-45 years. secondary. was Results: a combi- In 66% of cases, pain, disturbance of menstrual abdominal cycle. low were: or polycystic (multicystic noted was with structural changes in ovaries nation of OVV along with ovarian in 46% cases, Also, inanition). the syndrome of ovary ovaries, chronical infl also noted: were structural changes the following C-329 fi MR imaging of uterus: tumors epithelial and mesenchymal Mixed C-328 infertility by in cases of female vein varices of ovarian The diagnosis color Doppler transvaginal Jvarsheishvili; L. Todua, F. Purpose: refl and Reno-ovarian (OVV) varices vein ovarian revealing with histopathologic correlation Kim; S. Cho, J. Jung, D. Learning Objectives: and MR fi logic appearance and the histopathologic fi uterus these MR features and correlate between Background: of clinical and pathological features and the exact of uterine group lesions, a rare these lesions are still being defi genital female stroma and can occur in any of both epithelium and mesenchymal Benign lesions can be subdivided into benign and malignant lesions. They tract. include adenofi mullerian tumor), and carcinofi carcinosarcoma (malignant mixed docu- where both components are malignant, is well MMMT, malignant variant, The broma, is infrequently reported. adenofi The benign biphasic variant, mented. Adenosarcoma contain a malignant and benign neoplasm. phasic variants last two documented, as about 90 containing benign epithelium and malignant stroma is well malignant epithelium by broma, characterized Carcinofi been reported. cases have The most common presenting and benign stroma, has been reported in 4 cases. bleeding. symptom of the MEMT is abnormal vaginal Details: Procedure and MR fi ndings. histopathologic fi and the these MR features between Conclusion: can help ensure correct diagnosis and proper management. years. nd ndings. ndings. 2) To Kyoto/JP Kyoto/JP and 2 st ndings; Aetiopatho- ndings; ([email protected]) ([email protected])
c locations (uterosacral liga- c locations (uterosacral month and 1 th Scientific and Educational Exhibits Scientific and Educational Istanbul/TR rst-line imaging technique for the diagnosis of rst-line imaging technique for on staging and on response to cacy of MR imaging ne an algorithm on TVS, RES, and MR imaging for and MR imaging for RES, TVS, ne an algorithm on This analysis included previously untreated 42 patients This analysis included previously 1) To illustrate MR features of uterine myometrial lesions of uterine myometrial features MR illustrate To 1) 1. To highlight features of pelvic endometriosis on imaging highlight features To 1. ([email protected]) ([email protected])
The major teaching points of this exhibit are: Hemorrhage and are: The major teaching points of this exhibit On DWI, the normal myometrium shows low intensity and the low the normal shows myometrium On DWI, 9 6 Recall clinical fi nition of pelvic endometriosis;
uenced by nuclear-to-cytoplasm ratio and cellular density that may and cellular density that may ratio nuclear-to-cytoplasm uenced by d d DWI can provide tissue contrast based on diffusion motion of water based on diffusion motion of water tissue contrast can provide DWI Defi MRI is a valuable tool in the evaluation of uterine morphology. Its Its of uterine morphology. in the evaluation tool MRI is a valuable n TVS represents the fi DWI and ADC measurements may have a limited role in distinguishing have and ADC measurements may DWI i Paris/FR . N I Assesment of the effi F ndings, to compare the outcome according to clinical and MR imaging to ndings, - c u d E i c S brosis are the main components of ovarian and deep endometriosis, respectively; respectively; and deep endometriosis, brosis are the main components of ovarian - pelvic endometriosis but MRI is the most accurate technique. RES should be only technique. MRI is the most accurate pelvic endometriosis but if intestinal resection is planned. performed Are MR imaging criteria adequate in determination of stage and prognosis and prognosis criteria adequate in determination of stage Are MR imaging in cervical carcinoma? Aslay; Olmez, I. H. Kucucuk, Engin, S. G. C-327 Purpose: C-326 What is new? of pelvic endometriosis: Imaging Daraï, Cortez, E. A. Bornier, C. Combescure, L. Thomassin-Naggara, I. Bazot, M. Marsault; C. the discordance of clinical and MR imaging to evaluate (RT), primary radiotheraphy staging fi staging, lymph node status and tumor volume. Methods and Materials: alone or concomitant chemora- with cervical treated with RT carcinoma who were Clinical and therapy. to all patients before performed MR imaging was diotherapy. been carried out in 6 have MR imaging follow-up fi Learning Objectives: recall the imaging perfor- To 2. diagnosis. an accurate to make studies and how locations of the diagnosis of different RES and MR imaging for TVS, mance of defi To 3. pelvic endometriosis. the diagnosis of pelvic endometriosis. Background: Transrectal sonography, (Transvaginal imaging features Review genetic concepts; of accuracy Describe overall MR imaging); and Rectal endoscopic sonography, Recall limitations of deep pelvic endometriosis; each technique especially for imaging techniques. Details: Procedure lesions in specifi Hypoechoic areas and hypointense of deep endometriosis. intestines) are highly suggestive ments, Conclusion: between benign and malignant myometrial lesions. However, careful interpreta- However, lesions. benign and malignant myometrial between aid in estimating tissue characteristics of uterine T2WI may and tion of both DWI lesions. myometrial Learning Objectives: with pathologic fi in correlation images (DWI) on diffusion-weighted in evaluat- and ADC measurement of DWI and limitations discuss the advantages lesions. ing uterine myometrial Background: calculated ADC values MR sequences. from that of conventional different molecules, are infl from DWI has been Since DWI of malignant tumors. to decreased ADC values be attributed and limitations of its advantages knowledge pelvis, recently applied to the female lesions. myometrial evaluating is necessary for Findings: Imaging majority of ordinary The vast leiomyomas normal intensity. endometrium high shows intensity on low T2WI, also exhibit on intensity low which show and adenomyosis, prominent increased intensity on DWI. uterine In contrast, sarcomas show DWI. adenomyosis and benign lesions such as cellular leiomyomas even However, which on DWI, high intensity ectopic endometrial tissues show with proliferating avoiding T2WI is mandatory for of careful evaluation Thus, can mimic malignancy. lesions are usually of these myometrial Although ADC values misinterpretation. benign and malignant to the normal distinction between myometrium, relative lower overlap. cult because of a considerable be diffi may based on ADC values Conclusion: C-325 lesions with in uterine myometrial imaging Diffusion-weighted MR pathologic correlation Togashi; Fujii, K. S. Fujimoto, K. Morisawa, N. Koyama, T. Tamai, K. were diagnosed as incomplete septate uterus, 5 as complete septate uterus, four four uterus, 5 as complete septate septate uterus, diagnosed as incomplete were ndings were fi MRI uteruspatient as arcuate as bicornuate and one patient uterus. and laparoscopy. rmed hysteroscopy by as confi cases, correct in all Conclusion: hysteor- selecting patients for use will help in sparing patients from laparoscopy, plastic metroplasty. C - 7 0 R C EECR07-C-SciEduc-FIN.indd 69 Scientific and Educational Exhibits
C-330 disease. It has also interest in detection of recurrent disease and in evaluation of treatment effi cacy and associated complications. Patient selection guidelines in MR-guided focused ultrasound surgery of uterine fi broids: Several fi ndings in screening pelvic MRI S.-W. Yoon, S. Kim, J. Cho, S. Cha, C. Lee, M. Lee, Y. Na; Gyunggi-do/KR C-333 ([email protected]) Diagnostic pitfalls in evaluating MR gynecological disorders S. Gispert, R. Domínguez, X. Merino, V. Pineda, S. Roche; Barcelona/ES Learning Objectives: To evaluate several points to meet the patient selection ([email protected]) guidelines in screening pelvic MRI for MR-guided focused ultrasound surgery (MRgFUS) of uterine fi broids. Learning Objectives: To review the possible pitfalls in the evaluation of gyneco- Background: Currently, all treatment options for uterine fi broids are invasive and logical disorders by MR imaging. require several days of hospitalization and a few weeks of recovery. MRgFUS is Background: MR imaging has an increasing role in evaluating female pelvis. The newly developed non-invasive procedure to reduce symptoms of uterine fi broids aim of the exhibit is to review the pitfalls in evaluating gynecological disorders. in an outpatient procedure. It combines MRI to visualize the body organs, plans These pitfalls are roughly divided into physiological conditions that simulate organic and guides the treatment, and monitors the treatment outcome in real time, with lesions, benign conditions that simulate malignancy and malignant diseases that high-intensity focused ultrasound waves, which destroy the tissue. Patients go simulate benign conditions. According to the organ affected, we will show possible home after the procedure and usually return to normal activities within a day or diagnostic pitfalls: uterus (pseudolesions related to uterine contraction that mimic two. Unfortunately, it cannot be applied to every patient with uterine fi broids. The leiomyoma or adenomyosis, adenomyosis that resembles uterine malignancies), decision to perform the MRgFUS in patients with uterine fi broids is made according ovary (appendicular mucocele or peritoneal cysts simulating ovarian tumors, to the patient-selection guidelines in screening pelvic MRI. ovarian atrophy simulating adenopathies), cervix (cervical carcinomas mimicking Imaging Findings: In screening pelvic MRI, several points must be evaluated endometrial carcinomas), fallopian tube (hidrosalpinx resembling cystic masses), carefully to meet the selection guidelines for MRgFUS in uterine fi broids. These and vulva and vagina. include the fi ndings of fi broids itself, obstacles to sonication pathway and relation Conclusion: It is important to know the wide variety of MR pitfalls in gynecological dis- to adjacent structure. orders in order to distinguish possible mimicking lesions from real organic lesions. Conclusion: It must be requisite to know thoroughly the fi ndings in screening pelvic MRI to select suitable patients for MRgFUS in uterine fi broids. C-334 MR in local recurrency of cervical neoplasms: Diagnosis and tumor C-331 response after therapy Abdominal wall endometriosis: Imaging - pathologic correlation R. Manfredi, S. Baltieri, A. Tognolini, C. Cicero, M. Motton, R. Pozzi Mucelli; E. De Lama, L. Aja, R. Llatjos, J.A. Narvaez; Barcelona/ES Verona/IT ([email protected])
Learning Objectives: To review the underlying pathologic changes that create Purpose: To evaluate the capability of MRI in assessing pattern of recurrence three- the imaging appearances of abdominal wall endometriosis at US, CT and MRI. dimensional tumor volume and tumor response in patients with locally recurrent To learn the imaging appearances of abdominal wall endometriomas and to il- uterine cancer treated with concomitant chemo-radiation. lustrate the usefulness of imaging-guide preoperative biopsy. To review the main Methods and Materials: Twenty-four women who had undergone radical hys- differential diagnosis. terectomy and with locally recurrent uterine cancer were enrolled in our study. All Background: Abdominal wall endometriosis occurs in up to 1% all women who patients underwent gynecologic examination and MRI to assess local recurrence. have had cesarean deliveries, and may be diffi cult to diagnose. The recurrences were distinguished based on site: vagina, vaginal vault with or Procedure Details: We will review: 1) Pathologic changes in abdominal wall en- without pelvic wall extension, pelvic side wall. After diagnosis, the patients received dometriomas. 2) US, CT and MRI fi ndings correlated with pathologic changes. 3) concomitant chemo-radiation; then they underwent follow-up MRI 45days after the Usefulness of imaging-guide preoperative biopsy. In addition, differential diagnosis end of treatment and then periodically every six months. Pre- and post-treatment including nonneoplastic conditions, such as suture granuloma, ventral hernia, volumes were calculated by MRI with ellipsoid formula and compared determin- postsurgical hematoma or abscess, and neoplasms, such as a desmoid tumor, ing tumor response: complete, partial, no change, progression of disease. Image sarcoma, lymphoma, or metastasis will be reviewed. analysis: MRI showed 15 patients with central pelvic recurrence, 9 with recurrence Conclusion: Abdominal wall endometriomas are often non suspected clinically, in the pelvic side wall. The mean pre-treatment 3D-volume was 34.96 mm3 (range but should be included in the differential diagnosis of a symptomatic mass in 0.29-302.49 mm3). The mean post-treatment 3D-volume was 14.06 mm3 (range 0- women who had cesarean deliveries. Pathologic characteristics of abdominal wall 302.49 mm3). 13 patients had complete response, 8 partial response, 2 no change, endometriomas (surrounding infl ammatory reaction and fi brosis, degraded blood 1 progression of disease. products) explain most of the imaging features. Results: The site of response was associated to different prognosis; patients with recurrent tumor limited to vagina and vaginal vault showed better loco-regional C-332 control rates compared to patients with recurrence in the pelvic side wall. Recur- rent 3D tumor volumes < 50 mm3 had better diagnosis than larger tumor volumes. MR imaging of uterine cervical carcinoma: Optimization of local staging Furthermore, MRI is an accurate non invasive method of distinguishing tumor and evaluation after therapy from fi brosis. S.M. Dias, A. Ferrão, C. Pina Vaz; Porto/PT Conclusion: MRI permitted a good evaluation of pelvic recurrences and tumor Learning Objectives: To review the spectrum of magnetic resonance (MR) fi ndings response following chemo-radiotherapy. clinically relevant for staging cervical carcinoma. To purpose technical strategies to optimize disease evaluation. To discuss clinical usefulness of MR for differentiation C-335 between recurrent disease and post-treatment complications. Optimization of T2-weighted fast spin-echo sequence for female pelvis at Background: Worldwide, cervical uterine cancer is second only to breast cancer 3 T MR imager as the most common malignancy in incidence and the third cause of death after K. Fujimoto, T. Koyama, K. Tamai, N. Morisawa, Y. Nakamoto, K. Togashi; breast and lung cancers in women. The Féderation Internationale de Gynécologie Kyoto/JP ([email protected]) et Obstétrique (FIGO) classifi cation is the most commonly used staging system but it has recognized limitations that can be overcome with MR Imaging. Purpose: To optimize T2-weighted fast spin-echo sequence for female pelvis at Procedure Details: The authors present the spectrum of MR fi ndings useful for 3 T MR imager. staging and differentiate treatment complications from recurrent disease. Technical Methods and Materials: MRI were obtained at 3 T-imager (Siemens; Trio) using strategies that can optimize local disease evaluation, such as intravaginal gel fi lling, 8ch phased-array coil in eight healthy volunteers. All scans were performed with are discussed. Pitfalls, advantages and limitations of MR when compared to other sagittal section with thickness of 3 mm, interslice gap of 0.9-1.5 mm, FOV of imaging methods, namely MDCT and Positron Emission Tomography (PET), are 260x195 mm without parallel imaging. Scans were performed: 1) before and after listed and illustrated comprehensively. injection of anticholinergic agent (Buscopan), 2) with variable TR (8000, 6400, Conclusion: Magnetic resonance imaging is a powerful tool in the work-up of 4800, 3200), 3) with variable ETL (21, 17, 13) 4) with variable band-width (BW) cervical carcinoma. It optimizes selection of the most suitable therapeutic strategy (175, 205, 235, 260, 300), and 5) with variable TE (79, 107-113, 148) with differ- for each patient, as it provides a more effi cient staging of the disease, evaluating ent types of RF pulse (low SAR vs normal mode). SAR of all scans was recorded. accurately important prognostic factors as tumour volume and presence of lymphatic All images were qualitatively evaluated concerning artifacts, contrasts between
400 A BDEFC G
EECR07-C-SciEduc-FIN.inddCR07-C-SciEduc-FIN.indd 7700 112.02.20072.02.2007 17:03:5617:03:56 6 5 : 3
Genitourinary 0 : 7 1
7 0 0 2 nite . 2 401 0 . 2 112.02.2007 17:03:56 G broid (odds ratio broid (odds ratio cult unless the most with anastomosis and 3 ([email protected]) ([email protected]) nding in the course of imag-
broids at subserosal (33.3%), broids, and multigravida were were and multigravida broids, Aichi/JP rst 3 diagnoses. rst 3 diagnoses. ndings. ndings of teratomas on various on various ndings of teratomas C Athens/GR BDEF ndings, and in the remaining 4 cases, the and in the remaining 4 cases, ndings, broids or adenomyosis were reviewed in reviewed were or adenomyosis broids A Selective uterine arteriography of consecutive 60 patients uterine arteriography of consecutive Selective c features of this pathological entity. c features To illustrate the imaging fi illustrate To 123 cases of pelvic masses were diagnosed as teratomas by by as teratomas diagnosed were 123 cases of pelvic masses Pelvic teratomas is a frequent incidental fi teratomas Pelvic Uteroovarinan anastomosis is often demonstrated during UAE irre- during anastomosis is often demonstrated UAE Uteroovarinan In 119 cases, the imaging diagnosis of teratoma was in complete was the imaging diagnosis of teratoma In 119 cases, without anastomosis (p=0.027). Anastomosis was demonstrated in demonstrated Anastomosis was without anastomosis (p=0.027). 3 To assess the factors in regard to the visualization of uteroovarian anas- in regard to the visualization of uteroovarian assess the factors To Uteroovarian anastomosis was demonstrated in 25 of 60 patients (41.7%) demonstrated anastomosis was Uteroovarian 44.4% of patients with multiple fi broids and 30.4% with solitary fi fi 44.4% of patients with multiple 1.92), and (odds ratio and 31.0% with nullipara 1.82), 46.4% with multigravida 44.4% in patients with a history of abdominal surgery surgery and 35.9% without 1.43). (odds ratio Conclusion: Arterial catheterization is a defi spasm by of type and location of lesion. spective fi multiple Smaller uterine volume, technical factor. of visualization of anastomosis. cant factors considered as signifi C-338 teratomas revisited Pelvic pelvis: female of the The monsters Tsagari; C. Keramopoullos, D. Ghiatas, A. Learning Objectives: C-339 during anastomosis of uteroovarian to the visualization in regard Factors uterine arteriography Kimura, J. Ohno, Katsuda, R. Ohsima, E. Y. Kamei, S. Hagihara, Matsuda, M. J. Ishiguchi; T. Kawamura, T. Ohno, K. Nakamura, A. Purpose: tomosis during uterine uterine artery arteriography for embolization (UAE). Methods and Materials: fi symptomatic for UAE who underwent including arterial Factors arteries. regard to visualization of anastomosis with ovarian and history of abdominal location of lesion, birthspasm, uterine history, volume, surgery analyzed. were Results: (5.0%) with visualiza- 3 patients There were and 34 of 120 uterine arteries (28.3%). tion of anastomosis due to arterial where at the origin spasm of the uterine artery, seen in fi Anastomosis was engaged. the catheter was cant Signifi (42.9%). (43.8%), and adenomyosis submucosal (35.7%), intramural 547.1 cm seen in the mean uterine volume: was difference 1024.0 cm imaging modalities. To discuss the appropriate modalities and selection of imaging To imaging modalities. imaging interpretation pitfalls. to avoid techniques and how Background: Differential pathology unrelated to teratomas. pelvis for of the female ing evaluation be diffi may from other pelvic masses diagnosis of teratomas to are able been selected, which and techniques have optimal imaging modalities the specifi demonstrate Details: Procedure surgery All cases underwent and or a combination of them. MRI or ultrasound, CT, compared to the imaging fi pathology results were Conclusion: the surgical/pathology fi with agreement with the fi in agreement was diagnosis of teratoma ndings ndings as far ndings as far ed according to
to EPOS to c for endometriosis and help to c for Lisbon/PT Scientific and Educational Exhibits Scientific and Educational cation of 1988. ndings with laparoscopic fi Valencia/ES Valencia/ES A prospective study was undertaken from 1999 to 2005. undertaken study was from 1999 to 2005. A prospective To correlate MR fi To
city, positive and negative predictive values are concerned. are concerned. values predictive and negative positive city, No Material Submitted and can mimic are variable (US) features Ultrasonographic Submitted Material No 1 7
d d Endometriosis is an important gynaecologic disorder primarily affect- n The roles of the two modalities are therefore complementary. Knowl- complementary. modalities are therefore The roles of the two Our preliminary data suggest that the optimal parameters of T2WI Our preliminary of data suggest that the optimal parameters This study with noninvasive and cheap technique suggests that the This study with noninvasive i . N I To asses the diagnostic value and the usefulness of three-dimensional asses the diagnostic value To F 517 mullerian duct anomalies were detected in 10,352 patients (4.99%). detected in 10,352 patients (4.99%). 517 mullerian duct anomalies were Scans without Buscopan were considerably degraded by intestinal move- by degraded considerably were Scans without Buscopan - c u d 0.05). ETL=17 provided best images qualitatively. Although lower BW images BW images Although lower best images qualitatively. ETL=17 provided 0.05). E i < c S - ([email protected]) ([email protected]) Learning Objectives: specifi as sensitivity, are more specifi identify which imaging features To describe manifestations the unusual To masses. distinguish it from other adnexal and complications that can be seen with endometriosis. Background: of 2002 and the the beginning Between years. duringing women their reproductive mean 20-48 years; (Age range reviewed. end of 2005, a total of 50 patients were Forty-two and laparoscopic studies. All had MR examinations 36.48 years). age, patients had no gynaecological background. Findings: Imaging Magnetic resonance imaging lesions. those of other benign and malignant ovarian with endometriotic cysts typically appearing with high diagnostic accuracy, improves T2-WI. "shading" on images and demonstrating T1-weighted signal intensity on lapa- therefore, radiologically; evaluated Small implants and adhesions are not well Although MR diagnosis and staging. for remains the standard of reference roscopy imaging is limited in its ability to depict small endometrial implants and adhesions, include the ability to characterize laparoscopy imaging over of MR the advantages contents sites of involvement, extraperitoneal endometriotic lesions and to evaluate dense adhesions. or lesions hidden by of a pelvic mass, Conclusion: of endometriosis of MR imaging appearances and organ involve- edge of the variety ment is important guiding a subsequent laparoscopic examination. for C-337 correlation in 50 patients with laparoscopic MR imaging Endometriosis: Távora; I. Abecasis, M. Mascarenhas, V.V. C-336 Three-dimensional ultrasound fi anomalies: Congenital mullerian M. Belloch Ramos, F. Raga Baixauli, P. Naranjo Romaguera, F. Bonilla Bartret, F. Romaguera, Naranjo Raga Baixauli, P. F. Belloch Ramos, M. da Cruz; Palmero J. Bonilla Musoles, F. ments. Longer TR generally provided better SNR, although TR=8000 images in better SNR, although provided TR generally Longer ments. TR=3200 were motion artifact from small intestine. by degraded subjects were ve fi CNR in the uterine(96-99%) and decreased corpus associated with high SAR (p blurring. associated with greater better SNR, BW=175 images were provided BW=205-260, between difference remarkable did not reveal evaluation Qualitative decreased SNR. TE=148 images had and although BW=300 TE=79-113 images, cance. without statistical signifi better SNR RF pulse provided SAR Low Conclusion: TE=79-113 with RF pulse ETL=17, BW=205-260, TR=4800-6400, T include at 3 essential. of Bustopan is Administration type. SAR of low Purpose: compared with of congenital mullerian in detection anomalies, (3D) ultrasound ultrasound, two-dimensional other diagnostic methods (magnetic resonance, Mullerian anomalies are and hysteroscopy). laparoscopy hysterosalpingography, 3D ultrasound true incidence is unknown. but problems, related to reproductive these anomalies. tool to evaluate represents a useful noninvasive Methods and Materials: ex- were to a routine gynecological revision, who went A total of 10,352 women stored in the hard disk and All studies were ultrasound. 3D transvaginal amined by Mullerian classifi anomalies were three of the authors. by reviewed both inner, outer layer of the myometrium, the endometrium, and those between the myometrium, of outer layer both inner, of these measurement (SNR, CNR) Quantitative cervicalstroma. epithelium and also performed. structures was Results: American Fertility (ASRM) classifi Society Results: uteriArcuate (n=289, 59.8%) and septate (n=95, 18.3%) the most common were bicornuateThe rest of anomalies observed were (n=20, observed. malformations uteri. DES-exposed 3.8%), unicornuate (n=15, 2.9%) uteri and four Conclusion: malformation The most frequent near 4.99%. of these anomalies is prevalence DES drug related a normal like variant. arcuate uterus considered nowadays was uterus today. is rare C - 7 0 R C EECR07-C-SciEduc-FIN.indd 71 Scientific and Educational Exhibits
Genitourinary (PM) of renal mass parenchyma and renal cortex in affected and normal kidney were calculated from ‘Siemens Body PCT (VB20B)’ software. Kidney Results: Renal clear cell carcinoma (RCCC), renal pelvic transitional cell carci- noma (RPTCC) and renal angiomyolipoma (RAML) was pathologically confi rmed in 30, 5 and 11 of 58 subjects, respectively, while the remaining 12 subjects were C-340 with renal simple cyst (RSC). Technical failures were experienced in 1 (1.7%) Use of colour Doppler for early detection of hemorrhage in ultrasound patients. Perfusion parameters of tumor parenchyma were measured as follow: guided renal biopsies RCCC: BF=92.9±26.6, BV=177.0±55.3, PM=110.4±32.9; RPTCC: BF=46.5±22.1, K. Brabrand, A. Günther, P. Bache Marthinsen, A.E. Berstad; Oslo/NO BV=79.7±32.3, PM=63.3±19.4; RAML: BF=50.7±17.6, BV=113.2±47.0, Perme- ([email protected]) ability=60.1±23.9; RSC: BF=7.1±6.1, BV=18.0±10.8, Permeability=16.0±8.8. In all groups, perfusion parameters showed signifi cant differences (P < 0.01) between Purpose: To evaluate the use of colour Doppler (CD) for early detection of hemor- mass parenchyma and renal cortex in normal kidney, while there were no signifi cant rhage after ultrasound guided renal biopsy. difference (P> 0.05) in perfusion parameters between renal cortex in affected and Methods and Materials: A linear CD signal may be observed along the biopsy normal kidney. There were signifi cant differences (P < 0.05) in perfusion param- tract showing blood fl ow out of the kidney into the perirenal tissue immediately eters between parenchyma in any two kinds of renal masses, except for RPTCC after withdrawing the needle indicating a post biopsy hemorrhage. To evaluate the and RAML (P> 0.05). incidence and duration of CD bleeding after renal biopsies, a prospective study was Conclusion: These four kinds of renal masses all have decreased perfusion char- performed using an Acuson Seqouia with a 4V2 transducer (CD frequency 2.5 MHz, acteristics. Perfusion imaging with MSCT has potential clinical application value in scale 0.12m/s). 78 patients were included. There were 90 biopsy procedures in differential diagnosis of renal mass. 83 renal transplants and seven native kidneys with a total number of 243 biopsy needle passes. For each needle pass the presence and duration of CD bleeding were registered. If CD bleeding was seen, CD guided compression was applied. C-343 Results: CD bleeding was seen after 63 needle passes in 42 biopsy procedures. Vascular complications after renal transplantation: US fi ndings The incidence of CD bleeding increased with the number needle passes per I. de la Pedraja, N. Gomez, J. Hernandez, M. Ciudad, E. Vaño; Madrid/ES procedure. The duration of CD bleeding exceeded four minutes in seven patients, Learning Objectives: 1) To illustrate the different types of vascular complications of whom six developed a post biopsy hematoma. Eight of nine of the post biopsy after renal transplantation, with emphasis on their characteristic chronology. 2) To hematomas (mean diameter 2.2 cm) were preceded by CD bleeding. CD guided be familiar with the ultrasound fi ndings that allow us to diagnose vascular compli- compression was applied in 42 biopsy procedures. cations in renal allografts. Conclusion: CD is useful in renal biopsies for early detection of post biopsy Background: Renal transplantation is the treatment of choice for severe end- hemorrhage. The study shows that the duration of CD bleeding correlates with the stage renal failure. Because of this, it is very important for the common radiologist severity of the bleeding. CD guided compression could possibly reduce the duration to know enough about the diagnosis and management of renal grafts complica- and volume of post biopsy bleeding. tions, especially the vascular ones, which are a very frequent and severe reason of early graft failure and reject, and a common request of diagnostic procedures C-341 in the emergency room. Renal tumors: The spectrum of contrast-enhanced sonographic fi ndings Imaging Findings: We illustrate some examples of the different types of vascular and correlation with other imaging modalities and pathology complications associated with renal transplants, including graft artery and recipient H. Moschouris, S. Filaditakis, D. Kalikis, M. Khalili, D. Matsaidonis; Piraeus/GR iliac arterial system stenoses, arterial and venous thromboses, focal and diffuse ([email protected]) infarcts, pseudoaneurysms and arteriovenous fi stulas. Some examples not only of single kidney grafts complications but of "En Bloc" transplants complications are Learning Objectives: To familiarize the radiologist with the fi ndings of contrast- presented. We also discuss the imaging features of vascular complications in gray- enhanced ultrasonography (CEUS) of the commonest primary renal tumors. To scale sonography and Doppler sonography, and, in some cases, the appearance present these fi ndings in the setting of an integrated diagnostic approach. of the subsequent fi ndings in MRI and angiography. In addition, we emphasize the Background: The high frequency of detection of renal lesions and the innovations characteristic chronology of each vascular complication. in their treatment have increased the need for an accurate imaging diagnosis. This Conclusion: Although angiography is still the "gold standard" in the diagnosis of exhibit is based on the study of 68 renal tumors that were scanned before and after vascular complications in renal transplantation, ultrasound is usually the fi rst step i.v. injection of a second-generation ultrasound contrast agent (SonoVue, Bracco). in the diagnostic procedure, and is a valuable technicque that allow the radiologists Representative CEUS images and the corresponding fi ndings of baseline and color to make an early diagnosis of them. Doppler US, CT, MR and DSA are displayed. Microscopic and macroscopic sections of the excised tumors confi rm these fi ndings and establish the fi nal diagnosis. Imaging Findings: Numerous cases of renal cell carcinomas (clear cell, papillary C-345 and cystic varieties), urothelial neoplasms, angiomyolipomas, oncocyttomas (typical Correlation of hemodialysis duration with enthesal site changes of and atypical) and a multilocular cystic nephroma are depicted. Several patterns hemodialysis patients by lower limb ultrasonographic examination of enhancement are described. The increased sensitivity of CEUS in outlining the U. Kerimoglu, M. Hayran, F.B. Ergen, A. Kirkpantur; Ankara/TR pseudocapsule, small cystic areas and heterogeneity in the perfusion of renal ([email protected]) tumors is demonstrated. The tortuous pathologic vessels at the periphery of the Purpose: To evaluate the enthesal site changes of the lower limb of patients on RCCs and the spoke-wheel pattern of the oncocyttoma are displayed. Challenging hemodialysis utilizing Glosgow Ultrasound Enthesitis Scoring System, and to assess cases, such as isoechoic tumors that mimic normal variants and small lesions that the correlation between the duration of hemodialysis and the score of patients. are imperceptible on baseline US, are also included. Methods and Materials: Forty-nine patients who are on hemodialysis for at least Conclusion: Compared to fundamental US of renal tumors, CEUS may provide 2 years were included in the study. The patients were subgrouped according to valuable additional information. CEUS fi ndings correlate well with those of other the duration of hemodialysis; 2 to 5 years (group 1, n=14), 5 to 10 years (group imaging methods and can contribute to an accurate diagnosis. 2, n=15), 10 to 20 years (group 3, n=12) and more than 20 years (group 4, n=8). For each patient, the total score of GUESS, the mean score of GUESS for each C-342 group, total score for enthesophyte and erosion were correlated with the duration Perfusion characteristics of renal mass parenchyma with a 64-slice spiral of hemodialysis. computed tomography Results: The mean of the total GUESS scores (8.8±3.0, 13.5±3.0, 17.9±4.5, H. Sun, Z.Y. Jin, H.D. Xue, W. Liu; Beijing/CN ([email protected]) 23.4±4.6 for groups 1-4, respectively) increased signifi cantly among gropus (p < 0.001, Jonckheere-Terpstra test). There was statistically signifi cant correla- Purpose: To investigate the perfusion characteristics of renal mass parenchyma tion between the duration of hemodialysis and total GUESS scores (p < 0.001, and renal cortex in affected and normal kidney on 64-slice CT. rs=0.81), especially for men. Signifi cant correlation was seen between the duration Methods and Materials: Totally 58 patients with renal mass were enrolled. 64- of hemodialysis and total enthesophyte and erosion scores (p < 0.001). If severe slice spiral CT (Siemens Somatom Sensation 64) was used for renal perfusion enthesitis was to be defi ned as a total GUESS score of more than 18, a receiver- scan that began with a contrast bolus injection of 50 ml (370 mgI/ml) at a rate of operating characteristic curve analysis reveals a cut-off point of 10 years (with 83% 5 ml/s. Surgical and pathological outcomes were collected for comparison. Perfu- sensitivity and 93% specifi city) that results in severe damage (area under the ROC sion characteristics, including blood fl ow (BF), blood volume (BV) and permeability
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7 0 0 2 . cant 2 403 cance 0 . 2 cant dif- 112.02.2007 17:03:57 Singapore/ 1 G ; 1 ow (F). Instead (F). ow ow using ow cant difference between between cant difference , B.C. Goh , B.C. 2 0.05), and no signifi 0.05), and < C , S. Bisdas , S. 1 tting (P BDEF brosis 10% (2/20). Technical success reached Technical brosis 10% (2/20). A ltration rate (GFR) similar to the standard Patlak (GFR) similar to the standard Patlak rate ltration , H. Rumpel , H. fl ltration rate and renal blood 1 Five patients underwent dynamic contrast-enhanced dynamic contrast-enhanced patients underwent Five of clinical additional parameters tting method also provided tting , T.S. Koh , T.S. 1 0.05). The estimated GFR by both techniques range from 70 to both techniques range The estimated GFR by 0.05). < Fine’s model with vascular delay performs as well as the Patlak plot as the Patlak as well performs delay model with vascular Fine’s Core biopsy of the transplant kidney is an essential diagnostic tool is an essential diagnostic kidney Core biopsy of the transplant 3 glomeruli per specimen) was acquired in all cases. Histological exami- in all cases. acquired 3 glomeruli per specimen) was To determine if the use of a physiological model (Fine’s) with vascular with vascular model (Fine’s) determine use of a physiological if the To , C.H. Thng , C.H. Paired t-tests showed that there was no signifi that there was t-tests showed Paired An average of 1 tissue core per biopsy was obtained. Adequate tissue obtained. biopsy was of 1 tissue core per An average 1 ≥ Frankfurt/DE ([email protected]) ([email protected]) Frankfurt/DE 2 194 ml/min. The model fi The 194 ml/min. time and mean transit vascular time, transit minimum such as vascular relevance time. transit mean parenchyma Conclusion: Further studies are required to determine the signifi in calculating GFR and F. from modelling. derived and clinical utility of these additional parameters ference for F (P for ference GFR estimates by Patlak plot and model fi Patlak GFR estimates by of signal change, concentration versus time curves were obtained from regions of time curves were versus concentration of signal change, each of the calculated by GFR and F were interest of aorta and renal parenchyma. to determine performed a signifi t-test was if there was Paired techniques. two Purpose: glomerular can calculate fi delay plot analysis. Methods and Materials: as part assessment of angiogenesis magnetic resonance imaging (DCE MRI) for used for scans included the normal and were kidneys Twelve of a phase I trial. these two the relation between done to explore was derivation Theoretical analysis. fl estimating renal blood for extended plot was Patlak techniques. calculated GFR and F. in the difference Results: nation revealed tubular atrophy 5% (1/20), acute rejection 55% (11/20), chronic 5% (1/20), acute rejection 55% (11/20), atrophy tubular nation revealed segmental tubular necrosis 10% (2/20), focal tubular 15% (3/20), acute nephropathy fi sclerosis 5% (1/20) and interstitial complications. no major post-procedural There were 100%. Conclusion: The and suspicion of rejection. patients with dysfunctional renal transplant for further any uencing in a critical way yield, infl procedure has a high diagnostic targeting the kidney of better the advantage offers CT-guidance management. and hence decreasing loops, superimposed bowel avoiding in the pelvis, allograft the complication rate. was selected. All biopsies were performed using a 20G automated core biopsy 20G automated core biopsy using a performed were All biopsies selected. was performed. was One pass per patient needle. Results: sample ( C-349 fi Measurement of glomerular plot and of Patlak A comparative study contrast-enhanced MRI: dynamic model fi physiological Zhang J. SG, Patras/GR Patras/GR cacy of LC in the man- ndings in renal lymphoma is Scientific and Educational Exhibits Scientific and Educational Seventy-one patients underwent LC for a total of 75 LC for patients underwent Seventy-one During the last 2 years, we performed 20 CT-guided 20 CT-guided performed we During the last 2 years, cacy of CT-guided core biopsies in renal transplant patients core biopsies in renal transplant cacy of CT-guided dence limits: 0.83-1.00). dence limits: 1. To evaluate the role of multislice CT and MRI in primary the role of multislice renal evaluate To 1. CT scans were performed on a multislice CT. Magnetic reso- CT. on a multislice performed CT scans were 3 7
d d Renal lymphoma is most often seen in conjunction with multisystemic, multisystemic, Renal lymphoma is most often seen in conjunction with Athens/GR n Our 5-year medium-term experience suggests that LC is a safe, well well medium-term suggests that LC is a safe, Our 5-year experience Multislice CT is useful in the evaluation of patients with suspected Multislice CT is useful in the evaluation Kidney transplantation performed as early as possible, especially especially as early performed as possible, transplantation Kidney i . N I This study aims to determine the safety and effi to determineThis study aims the safety Renal biopsy is a necessary step in the diagnostic work-up of patients with a F Cryolesions decreased in size by an average of 38% at 1 month, 46% at 3 an average by Cryolesionssize decreased in ([email protected]) -
c u d E i c S - agement of small RCC, and to assess its medium-term MR after 5-year outcome agement of small RCC, imaging follow-up. Methods and Materials: US guidance. administered under laparoscopic were All treatments treated tumors. MR imaging 24 hours and by biochemically, clinically, followed-up were Patients All at 1, 3, 6, 12, 18, 24, 36, 48, and 60 months. and subsequently after surgery, TSE T1w, using GRE T MR system with a 1.5 performed were MR examinations T2w sequences and ce dynamic GRE FS-T1w sequence. Results: MR Post-procedural LC. 64% at 6 months and 80% at 12 months following months, no revealed Follow-up complete ischemia of all cryolesions. ce-T1w images showed showed One patient of local or distant recurrence in 64/71 patients (90%). evidence 1 metachronous nodule 3 patients demonstrated local recurrence at 12 months; 1 2 patients showed respectively; at 12, 18, and 60 months, in the same kidney at 18 and 24 months,respectively; kidney metachronous nodule in the controlateral In 21 cases, pancreatic metastatic nodules at 6 and 12 months. 2 patients showed at 1 and 3 months after surgery. evident a small perilesional haematoma was Conclusion: and MR is an effective small RCC, for therapy and minimally invasive tolerated, of RCC treated with LC. imaging technique in the follow-up with deteriorating renal function and clinical suspicion of transplant rejection. with deteriorating of transplant renal function and clinical suspicion Methods and Materials: The indica- 21-57) years. biopsies in 17 patients (14 male), mean age 37 (range increased serum creatinine 70% (14/20), albuminuria biopsy included: tions for functional decline renal function 10% (2/20) and progressive 15% (3/20), delayed tissue sampling pelvic CT and optimal site for The patients underwent 5% (1/20). renal allograft, presenting with renal dysfunction and suspicion of rejection. We evalu- We of rejection. presenting with renal dysfunction and suspicion renal allograft, and effi ated the safety CT-guided biopsies in patients with renal transplant and suspicion of rejection CT-guided Petsas; T. Tsamandas, A. Zampakis, P. Kraniotis, Kalogeropoulou, P. C. Purpose: C-348 C-347 Primary renal lymphoma Seferos, Sammouti, E. E. Delimpasis, G. Gyftopoulos, A. Protopapa, E. Filis, P. Fousteris; A. Learning Objectives: lymphoma. 2. To become familiar with both typical and atypical manifestations of pri- manifestations with both typical and atypical become familiar To 2. lymphoma. the basic concepts of primary renal lymphoma. review To 3. mary renal lymphoma. Background: scanner. Tesla on a 1.5 performed nance imaging was Conclusion: with the spectrum of fi familiarity renal lymphoma; the recommendation of important diagnosis and, when necessary, accurate for imaging guided percutaneous biopsy. disseminated lymphoma. Reports on primarydisseminated lymphoma. renal lymphoma are scarce in the the most parturological literature, of them being secondary on a lymphomatous Primary as a clinical entity is not renal lymphoma (PRL) of the kidneys. ltration infi Multislice CT is do not contain lymphatic tissue. undisputed because the kidneys of the kidneys evaluation for examination and comprehensive the most sensitive detection it improves In particular, in patients with suspected renal lymphoma. optimising contrast by and characterisation of lymphomatous renal involvement accurate dynamics and data acquisition and is the current modality of choice for reportWe mass the case of three patients with an incidental staging of lymphoma. on review A literature their diagnosis and management are discussed. on the kidney; and atypical Typical will be presented. currently recommended diagnostic practices CT patterns a diagnostic challenge will be discussed. which provide Details: Procedure Purpose: Laparoscopic cryoablation (LC) of small renal cell carcinoma (RCC): Medium- (RCC): carcinoma (LC) of small renal cell cryoablation Laparoscopic follow-up resonance (MR) imaging magnetic term outcome after 5-year Balconi; G. Guazzoni, Mangili, G. Cestari, P. A. Iabichino, C. Cardone, G. Milan/IT Conclusion: enthesitis. severe prevent would 10 years, before C-346 curve: 0.92, 95% confi 0.92, curve: C - 7 0 R C EECR07-C-SciEduc-FIN.indd 73 Scientific and Educational Exhibits
Genitourinary infl ammatory and neoplastic.Ultrasonography is the primary modality for imaging the scrotum. It should be performed with the highest frequency transducer that Male provides adequate penetration. Intratesticular versus extratesticular pathologic conditions can be differentiated with a high sensitivity. Imaging Findings: In this pictorial review, we describe and illustrate cases selected C-350 from our radiology department fi les of non-neoplastic extratesticular disorders in Comparison of sonoelastography guided biopsy with systematic biopsy: adults. The following pathologic entities are included: (1) Fluid collections: hydro- Impact on prostate cancer detection celes, hematoceles and pioceles; (2) Epididymis: acute and chronic epididymitis, L. Pallwein, F. Aigner, E. Pallwein, V. Fischbach, J. Gradl, F. Frauscher; Innsbruck/ cysts, spermatoceles and granulomas; (3) Spermatic chord: hematomas, torsion, AT ([email protected]) lipomatous infi ltration and varicocele; (4) Paratesticular masses: inguinal hernias. Conclusion: The information obtained with gray-scale and color Doppler ultra- Purpose: We performed a prospective study to determine whether a limited biopsy sonography is suffi cient to enable diagnosis in most cases of non-neoplastic approach with sonoelastography (SE) targeted biopsy of the prostate would detect extratesticular disorders in the adult patient. Because physical examination usu- cancer as well as gray scale US guided systematic biopsy with a larger number ally lacks specifi city for scrotal lesions, the radiologist should be in the position of of biopsy cores. making an early and correct diagnosis in order to direct further work-up and avoid Methods and Materials: We examined 230 men (mean age: 62.3) with a total PSA severe complications. of 1.25 ng/ml or greater. First investigator performed 5 or fewer SE targeted biopsies into suspicious (stiffer) regions in the peripheral zone. Hard lesions were considered as malignant. Subsequently, another examiner performed 10 systematic prostate C-353 biopsies. The cancer detection rates of the 2 techniques were compared. Pre-treatment evaluation of prostate cancer with MRI and three- Results: Cancer was detected in 81 of the 230 patients (35%), including 68 (30%) dimensional 1H-magnetic resonance spectroscopy: Our experience by SE targeted biopsy and in 58 (25%) by systematic biopsy. The overall cancer S. Giusti, M. Lazzereschi, F. Francesca, A. Tognetti, D. Caramella, C. Bartolozzi; detection rate by patient was not signifi cantly different for SE targeted and system- Pisa/IT atic biopsy (p = 0.132). The detection rate for SE targeted biopsy cores (12.7% or Purpose: Our aim was to assess the accuracy of 1H-magnetic resonance spec- 135 of 1,109 cores) was signifi cantly better than for systematic biopsy cores (5.6% troscopy (MRS) in patients with high prostate-specifi c antigen (PSA) levels and or 130 of 2,300 cores, p < 0.001). SE targeted biopsy in a patient with cancer was biopsy proven prostate carcinoma, candidate to radical prostatectomy. 2.9-fold more likely to detect prostate cancer than systematic biopsy. Methods and Materials: Twenty-one patients underwent MRI and MRS for the evalua- Conclusion: Sonoelastography targeted biopsy detected as many cancers as tion of tumor location, local extent and aggressiveness of prostate cancer. Our imaging systematic biopsy with fewer than half the number of biopsy cores. Although an protocol included axial, coronal and sagittal T2wi FSE sequences and an axial T1wi FSE increase in cancer detection was achieved by combining targeted and systematic sequence. For MRS, we used 3D chemical shift imaging (CSI) spin-echo sequence. We techniques in this screening population, Sonoelastography targeted biopsy alone divided the prostatic gland into six sextants and sensitivity, specifi city and accuracy of is a reasonable approach for decreasing the number of biopsy cores. biopsy, MRI, MRS, MRI+MRS were calculated with pathological correlation. Results: Pathology identifi ed a total of 69 peripheral zone neoplastic locations. Bi- C-351 opsy correctly detected 46 locations with 23 FN and 20 FP (sens.:67%, spec.:65%, Transrectal ultrasound (TRUS) of prostate cancer (PRCA): Step-by-step acc.:66%, NPV: 62%, PPV:70%); MRI correctly detected 57 locations with 12 FN visual guide of TRUS technique and TRUS-guided biopsies (2006 edition) and 17 FP (sens.:82%, spec.:70%, acc.: 77%, NPV: 77%, PPV: 77%); MRS cor- D. Alexopoulos, K. Pahou, K. Kestis, N. Papantoniou, A. Filippidou, rectly detected 57 locations with 12 FN and 8 FP (sens.:83%, spec.:86%, acc.:84%, S. Prapavessis, D. Leli, E. Tako, P.S. Zoumpoulis; Athens/GR ([email protected]) NPV:80%, PPV: 87%); MRI+MRS correctly detected 60 locations with 9 FN and 18 FP (sens.:87%, spec.:70%, acc.:79%, NPV:81%, PPV:77%). Learning Objectives: 1. To demonstrate the role of TRUS in diagnosing prostate Conclusion: Combined MRI and 3D 1H MRS of the prostate have a diagnostic lesions. 2. To present TRUS prostate echoanatomy, semiology and haemodynam- advantage in tumor location over MRI alone and over biopsy alone. In particular, a ics of PrCa. 3. To reach a sonographic diagnosis using algorithms. 4. To provide negative result at 3D 1H MRS is able to exclude the presence of cancer with high comparison of an US image with images of the database. probability. We are further investigating whether there is a correlation between high Background: Since TRUS is the most effi cient way to detect prostate cancer (PrCa), Gleason score and MRS sensitivity. this e-book aims to teach the TRUS procedure in detection and staging of PrCa and correlate it with the histological fi ndings emphasizing the use and effectiveness of USCA and local anesthesia prior to biopsy sampling. C-354 Procedure Details: This medical e-book is a multimedia DVD Rom-based teach- The usefulness of the apparent diffusion coeffi cients (ADC) by line scan ing fi le featuring 2500 US prostate images, 150 US video demonstrations, 400 diffusion image (LSDI) in normal prostate and prostatic cancer video cases presenting clinical data and detailed description of TRUS techniques, T. Yoshizako, N. Uchida, K. Uchida, A. Wada, H. Kitagaki, M. Ikawa; chapters on prostate anatomy, TRUS technique for the detection and staging of Izumo Shimane/JP PrCa (based on over 10,000 cases), color Doppler, and the technique of US- Purpose: The purpose of this study was to compare the apparent diffusion coeffi cient guided biopsies. The proper TRUS technique is demonstrated step by step. Its (ADC) of single shot echo planner image (SS-EPI) with that of line scan diffusion image educational role is based on video cases and double video presentations. The (LSDI: Gudbjartsson H et al. MRM 1996) in normal prostate and prostatic cancer. latter consists of a simultaneous presentation of the real-time ultrasound exam and Methods and Materials: All studies were performed with a 1.5 T superconducting the examiner’s technique. A database is included in aiding the user to reach the system. Twenty-nine prostatic cancers (> 10 mm) in 34 patients were included. correct diagnosis and to compare his sonographic image to histologically proven Radical prostatectomy was performed in all patients within 2 months after MRI. T2- images of the database. weighted image with fat saturation and ADC map by each method were obtained. Conclusion: User-friendly DVD Rom-based teaching fi le on the prostate with Trace ADC map of the normal prostatic tissue (peripheral zone: PZ and inner gland: chapters on anatomy, pathology, ultrasound physics, sonographic appearance IG) and prostatic cancers were evaluated by each method. of the normal prostate, TRUS morphology, detection and staging of PrCa, local Results: Normal PZ ADC was 1.763 + 0.205 (×10-3 mm2/s) by SS-EPI, 1.496 + anesthesia, USCA and comparative database. 0.939 (×10-3 mm2/s) by LSDI. Normal IG ADC was 1.382 + 0.223 (×10-3 mm2/s) by SS-EPI, 1.258 + 0.866 (×10-3 mm2/s) by LSDI. There was signifi cant difference C-352 between SS-EPI and LSDI by Student’s t-test (p < 0.05). In three normal PZs, Scrotal sonography of non-neoplastic extratesticular disorders in the susceptibility artifacts arose from the air-fi lled rectum. Prostatic cancer ADC was adult patient 0.951 + 0.256 (×10-3 mm2/s) by SS-EPI, and 0.783 + 0.226 (×10-3 mm2/s) by LSDI. V.M. Muley Luelmo, M. Sanchez Cabello, E. Crespo Vallejo, D. Llanos Perez, Two prostatic cancer ADC by SS-EPI were not calculated, because of susceptibility E. Huelga Zapico; Madrid/ES ([email protected]) artifact arising from the air-fi lled rectum. All prostatic cancer ADC by LSDI were calculated without susceptibility artifact arising from the air-fi lled rectum. Learning Objectives: Review the sonographic fi ndings of non-neoplastic pathologic Conclusion: There was signifi cant difference between ADC by SS-EPI and by processes involving the extratesticular structures in the adult patient. LSDI. ADC by LSDI in both prostatic cancer and normal prostate were inherently Background: The scrotum is a fi bromuscular sac divided by a median raphe. It insensitive to susceptibility artifacts. contains the testis, epididymis, spermatic cord, and associated fascial coverings. These structures can be affected by several pathologies including congenital,
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Genitourinary 0 : 7 1
7 0 0 2 nity am- . 2 405 =6.99, 0 t . =0.001). =0.001). 2 112.02.2007 17:03:57 P G =3.78, t 0.001). The value of rMTE of value The 0.001).
< P WI. Then the SI-T curve and PWI WI. * 2 C =0.002) and normal ( ndings of various epididymal masses ndings of various ([email protected]) ([email protected])
=11.79, P t BDEF ([email protected]) ([email protected])
0.001). According to ROC, the rNEI had the According to ROC, 0.001).
< A =3.50, t P Seoul/KR follow-up rmed surgical resection, or radiological by ciency. The optimal threshold was calculated as 6.44 calculated The optimal threshold was ciency. ([email protected])
0.045) according to the Jonckheere-Terpstra test. The test. 0.045) according to the Jonckheere-Terpstra Fifty-three cases were divided into three groups: Group 1 divided into three groups: Fifty-three cases were =10.32, We retrospectively reviewed clinical and pathological data reviewed retrospectively We t La Laguna/ES < To illustrate the sonographic fi ndings of different types of ndings of different fi the sonographic illustrate To 0.001) and normal (
A retrospective review was performed in patients with epididy- in patients performed was review A retrospective < P ndings were included. Biopsy and prostatectomy specimens were specimens were Biopsy and prostatectomy included. ndings were Tianjin/CN masses of epididymal ndings 0.011; 0.011; p Although epididymal lesions are usually benign, it is important Although epididymal lesions to Knowledge of sonographic fi of sonographic Knowledge rNEI is an effective parameter to differentiate PCa from BPH. PCa from BPH. to differentiate parameter rNEI is an effective < To evaluate the diagnosis and differential diagnosis value of PWI for of PWI for diagnosis value differential the diagnosis and evaluate To of a prostate needle-core biopsy specimen can The histologic grade The TRUS fi ndings and the number of cores affected were similar in the were of cores affected ndings and the number fi TRUS The In the peripheral zone (PZ), the value of rNEI of PCa was higher than that of PCa was of rNEI (PZ), the value In the peripheral zone =11.64, t 0.001) and normal (
< may be helpful for differential diagnosis. diagnosis. differential for be helpful may reader to understand the appropriate use of various imaging modalities to provide the appropriatereader to understand modalities to provide imaging use of various of to understand the techniques presentation is also useful The staging. accurate and Dynamic MRI imaging. CT Urography C-360 transrectal ultrasonography extended Comparison of Gleason score from and radical prostatectomy guided biopsy protocol (TRUS) Rodrigo Bello, M. Ramos, Fernández Gonzalez García, J. I. Nieto Morales, M.L. Hernández; Morales M. Purpose: C-358 Sonographic fi Ryu; Jin, C. W. Kim, H. Yang, D. Learning Objectives: epididymal mass. Background: and solid lesions related to infection epididymal complex distinguish between concerning literature epididymal The sonographic and cystic epididymal masses. Our masses is limited to case reports series or small of benign epididymal masses. of epididymal types ndings of the different fi the sonographic to illustrate goal was ammatory masses. malignant, and infl masses including benign, Findings: Imaging confi All cases were mal masses. epididymal ed in various identifi were features of sonographic A variety study. The disease entities include epididymal cyst, spermatocele, spermatic masses. chronic infl abscess, metastases, leiomyoma, tumor, adenomatoid granuloma, C-359 cancer and benign prostatic of PWI in prostate value Diagnostic hyperplasia Bai; R. Zhao, X. Purpose: (BPH). prostate cancer (PCa) and benign prostatic hyperplasia Methods and Materials: enrolled in 8 cases were 2 included 22 BPH cases, included 23 cases of PCa, group Infi Twin-Speed with 1.5 T examined All subjects were 3 as normalgroup control. axial single The sequence of PWI was GE Medical System). with Excite II (Signa; T echo echoplanar imaging recalled shot gradient prosta- radical determine whether a patient with prostate cancer is a candidate for the concordance to illustrate The aim of this study was or another treatment. tectomy prostatectomy. biopsy and radical of Gleason score between Methods and Materials: between prostatectomy biopsy and radical TRUS of 51 patients who underwent 9 men had undergone a nonextended Of the included patients, 2004 and 2005. scheme (type B), and biopsy scheme (type A), 33 patients a 6-10 extended sextant available were Clinical parameters biopsy (type C). 9 patients a 10-14 extended fi and sonography of dif- concordance and the effect of grading The rate the same staff. by reviewed determined. was on the concordance rate biopsy schemes (A,B,C) ferent Results: (p 3 groups mation, and tuberculosis. Conclusion: parameters were obtained. To compare the difference of perfusion-related parameters the difference compare To obtained. were parameters mean time to rMTE (relative enhancement integral), negative including rNE (relative slope of decrease) among three groups. maximum enhance) and rMSD (relative Results: of BPH ( concordance between prostate biopsy and radical prostatectomy Vacurg score Vacurg prostatectomy prostate biopsy and radical concordance between 2/9 cases [A scheme (22.2%)], 22/33 cases [B (66.7%)] and 8/9 cases [C was in 7/9 cases found Biopsy understaging was p=0.000). (88.9%)] (z test -3.793; (z test -3.55) 11/ 35 cases (33.3%) and 1/9 cases (11.1%), respectively, (77.8%); PCa was lower than that of BPH ( lower PCa was best differential diagnosis effi best differential PCa. differentiating with a sensitivity of 91.3% and a speciality of 89.2% for Conclusion: In the central zone (CZ), the value of rNEI of PCa was higher than BPH ( higher than of rNEI of PCa was (CZ), the value zone In the central P ned cation based on cation ndings ([email protected]) ([email protected])
([email protected]) ([email protected])
Vigo/ES Scientific and Educational Exhibits Scientific and Educational Manchester/UK both benign tumours, cation of intra-testicular 1. To understand staging systems and importance of stag- To 1. 1) To review the clinical, pathological and imaging manifes- review To 1) 1. The classifi 1. We study clinical, pathological and imaging manifestations manifestations study clinical, pathological and imaging We 1. Knowledge of the various types of benign and malignant of the various Knowledge 1. The staging system for bladder cancer is discussed. The vari- cancer is discussed. bladder The staging system for 5 7
d d 1. Varity of intra-testicular tumours, with a classifi tumours, of intra-testicular Varity 1. When studying a scrotal mass, the two most important the two When studying a scrotal mass, questions Cystoscopy is the gold standard for evaluating focal tumours confi focal evaluating is the gold standard for Cystoscopy n Ultrasound may effectively ascertain cell type of primary effectively testicular may Ultrasound In order to make a correct diagnosis and to prevent unnecessary diagnosis and to prevent a correct In order to make It is important to provide accurate staging of bladder cancer preopera- It is important staging of bladder accurate to provide i . ([email protected]) ([email protected])
N I F - c u d E i c S rst choice modality for studying these lesions. MRI is seldom needed, but provides provides MRI is seldom needed, but studying these lesions. rst choice modality for - and malignant. 2. The histological features of intra-testicular tumours. 3. The ultra- 3. tumours. of intra-testicular The histological features 2. and malignant. of histology and ultrasound Correlation 4. tumours. of intra-testicular sound features prediction of tissue type on ultrasound. possible for that allow features Background: cell type. 2. Various grey-scale ultrasound features of intra-testicular tumours. 3. 3. tumours. of intra-testicular features ultrasound grey-scale Various 2. cell type. pertinent with histology to allow ultrasound features Correlation of ultrasound demonstrated. to be features Findings: Imaging imaging Understanding the characteristic ultrasound 2. tumours. intra-testicular of the limitations and Knowledge 3. tumours. intra-testicular of the various features cation. in testicular tumour classifi strengths of ultrasound Conclusion: imaging with some certainty. tumours based on grey-scale tively. This presentation gives an update on bladder cancer staging and helps the an update on bladder This presentation gives tively. Learning Objectives: imaging modalities discuss the various To 2. cancers preoperatively. ing bladder cancer. to stage bladder Background: various of upper tracts, evaluation tumours and for more advanced For to bladder. intravenous ultrasound, and transurethral transabdominal imaging modalities like post gado- MRI imaging including 3D dynamic, Urography, CT and CT urography, been used to imaging have linium breath hold sequences and radionucleotide preoperative imaging modalities help in accurate The newer cancers. stage bladder cancers. staging of bladder Findings: Imaging of each modality is and disadvantages ous imaging modalities and advantages and MRI Importance to the technique of CT Urography is given also high lighted. y The role of PET in staging is also briefl MRI imaging. and dynamic post contrast the technique of staging cancer explaining of bladder examples Several discussed. imaging. CT and MRI Ultrasound, using IVU, are given Conclusion: Imaging of bladder cancer of bladder Imaging Taylor; P. Hawnaur, J. Rajashanker, B. C-357 Learning Objectives: Ultrasound appearances of intra-testicular tumours: Gray-scale imaging imaging Gray-scale Ultrasound appearances of intra-testicular tumours: prediction of tissue type to allow with histologic correlation features Sidhu; P.S. Muir, G.H. Pomplun, S. Clarke, J.L. Sellars, M.E.K. Ammar, T. London/UK C-356 R. Prada González, G. Tardáguila de la Fuente, J. Aguilar Arjona, J. de la Fuente, Tardáguila González, G. Prada R. Fernández; G. Rivas, Armentia, Santos C. E. Intra- and extra-testicular cystic lesions: US and MRI fi US and lesions: cystic Intra- and extra-testicular C-355 Learning Objectives: in the the roles of US and MRI demonstrate To 2) tations of scrotal cystic lesions. masses. diagnosis of scrotal cystic Background: and whether it is or extra-testicular, whether the lesion is intra are to be answered solid, are usually benign. both cystic and masses, Extratesticular cystic or solid. and solid masses the prognosis of cystic when the mass is intratesticular, However, should be considered malignant, solid lesions Intratesticular is quite different. although Therefore, benign. cystic lesions are most likely whereas intratesticular its recognition is important, cystic masses are rare, intratesticular in order to avoid unnecessary surgical intervention. Details: Procedure tunica cystic lesions include simple cysts, Intratesticular of scrotal cystic masses. testicular epidermoidthe rete testis, ectasia of cysts (mis- tubular cysts, albuginea infarctions in some cases, named cyst because it is solid lesion), abscess and, varicocele, hematocele, cystic lesions are hydrocele, Extratesticular and teratomas. spermatocele, papillary US is the cystadenoma, spermatic cord cyst and hernia. fi useful information when US results are inconclusive. useful information Conclusion: surgical intervention, it is of the utmost importance to recognize imaging features surgical intervention, it is of the utmost importance imaging features to recognize is the primary Although ultrasound cystic masses. and extra-testicular of intra- to be an useful MRI proves researching testicular lesions, imaging modality for tool when the results of US are unclear. C - 7 0 R C EECR07-C-SciEduc-FIN.indd 75 Scientific and Educational Exhibits
(z test -3.954; p=0.000). Primary Gleason pattern was predicted exactly by biopsy Background: Contrast-enhanced TRUS has shown its ability to detect neovascu- in 3/8 cases (37.5%); 26/35 cases (74.3%) and 9/9 cases (100%), respectively (z larisation, which characterises prostate cancer, and to improve cancer detection test -3.557; p=0.000). rate in an early detection program. Contrast-enhanced MRI and MR spectroscopy Conclusion: Extended needle biopsy signifi cantly increases the accuracy of biopsy are effective tools to locate tumors of signifi cant volume in patients with raising Gleason score for assessing fi nal prostate cancer grade. PSA level and negative biopsies or in patients with a microcarcinoma (< 3 mm of cancer on a single positive biopsy). Procedure Details: Contrast-enhanced TRUS with low mechanical index and C-361 specifi c software sonographic equipment (CPS technique, Acuson, Siemens) is Pre-operative MR imaging in the evaluation of seminal vesicle invasion: performed after IV bolus injection of microbubbles (Sonovue, Bracco) to detect early Pattern analysis of seminal vesicle lesion focal enhancement within the peripheral or transition zone. A 30’ room time MRI D. Jung, H. Lee, S. Kim; Seoul/KR ([email protected]) protocol has been developed including 3 plane FSET2 sequences, spectroscopy Purpose: 1. To investigate the MR imaging features that can predict seminal sequence and dynamic MRI after IV injection of gadolinium. Post-processing is done vesicle invasion (SVI) by means of the pattern analysis of seminal vesicle lesion on the commercially available workstation of the manufacturer (Leonardo, Siemens). (SVL). 2. To evaluate whether pattern analysis of SVL could improve the accuracy Several examples will show how posterior and anterior non-palpable tumors can be for detecting SVI. detected and how only a combination of both MR sequences can achieve a suffi cient Methods and Materials: The MR images of 217 patients who underwent Retropubic degree of accuracy to be recommended to target repeat biopsies. radical prostatectomy due to prostate cancer between Jan. 2004 and Dec. 2005 Conclusion: Contrast-enhanced TRUS optimizes cancer detection rate during were retrospectively analyzed, focusing on SVL on T2WI. The SVL on T2-weighted a fi rst set of biopsies. MRI, a second line tool, detects signifi cant volume tumors sequences was classifi ed as 5 classes. In each class, the results were correlated provided that spectroscopy and contrast sequences are combined. with histopathologic fi ndings. Performance characteristics of pattern analysis for predicting SVI were compared with those of conventional ROC analysis and those C-365 of serum PSA level. Full comprehensive MR protocol for prostate examination with endorectal Results: Fourteen (6.5%) of 217 patients had evidence of SVI and 203 (94%) coil, including dynamic contrast agent and proton spectroscopy had no SVI. 146 (67%) were classifi ed as having no SVL on MR images, and the A. Iozzelli, A. Esseridou, F. Sardanelli; Milan/IT ([email protected]) remaining 71 (33%) had various classes of SVL. Class I was identifi ed in 16 (23%), II in 24 (34%), III in 14 (20%), IV in 10 (14%), and V in 7 (9.9%). The sensitivity Learning Objectives: To become familiar with MR procedures in the examination and specifi city of each class for prediction of SVI were calculated. The overall ac- of prostate with endorectal coil, using the most comprehensive study protocol, curacy of pattern analysis was superior to that of PSA level and of conventional including dynamic study and proton spectroscopy (1H-MRS). ROC analysis (P <.01, McNemar test). Background: MR examination of prostate is performed to detect prostate cancer in Conclusion: The classifi cation of SVL on the basis of their imaging morphologic patients with abnormal PSA serum level and ultrasound, with negative or uncertain features can provide objective standard and simplify the abnormal fi ndings for biopsy results. Moreover, it is used for an accurate local staging of already diag- predicting SVI in prostate cancer. Pattern analysis of SVL on MR imaging improves nosed tumor, in particular for the detection of extracapsular spreading. Endorectal the accuracy of detecting SVI. coil examination show better image quality and better proton spectroscopy data than body or surface coils. T2-weighted imaging can demonstrate hypointense prostate cancers in the peripheral zone. 1H-MRS can detect the presence of C-362 choline or alterated choline/citrate ratio, both signs of prostate cancer presence. Correlating radiological and histopathological staging for prostate cancer Gadolinium-enhanced T1-weighted sequences (dynamic study) can detect suspi- in a general NHS setting: Do fi ndings live up to national standards? cious hypervascular foci. A. Raza, S. Higgins, R. Mason, N. Ryley; Torquay/UK Procedure Details: The protocol consisted in fat-sat fast spin-echo T2 sequences, Purpose: Preoperative MRI staging of prostate cancer is more accurate with Gd-enhanced dynamic study with 3D FLASH sequences (1 before and 5 after gado- higher strength magnets and endorectal coils; however, these are still not widely teridol 0.1 mmol/kg, temporal resolution 35 s), T1-weighted fat-sat fast spin-echo se- available in all UK hospitals. We assessed the degree of accuracy using a 1 Tesla quence and 3D CSI proton spectroscopy. Dynamic sequences were post-processed magnet and a pelvic array coil (a common setup throughout the UK). All patients with image subtraction (enhanced minus unhenanced) and intensity/time curves for subsequently underwent radical prostatectomy, and the results of preoperative MRI targeted regions of interest. Proton spectroscopy data were evaluated generating staging were compared with histological fi ndings. 1H spectra voxel-by-voxel, choline maps and choline/citrate ratio maps. Methods and Materials: Thirty-three patients were identifi ed by the urology re- Conclusion: A complete protocol can be performed in less than 30 minutes, cords from August 2003 to 2005. The imaging was performed with 1 Tesla magnet including morphologic images, dynamic study and 1H-MRS. without endorectal coils. All patients underwent radical prostatectomy. Case notes were retrieved and reviewed in detail along with histopathology. MRI studies were C-366 reviewed in a blinded fashion. Functional MR imaging of prostate cancer Results: 26/33 patients had an MRI done (78.78%). 12/26 patients had MRI and Y. Choi, J. Kim, N. Kim, K.-S. Cho; Seoul/KR ([email protected]) histopathological concordance (46.15%). 14/26 patients were non-concordant with histopathological results (53.84%). Out of these 14 patients, 9 were false -ve Learning Objectives: 1. To introduce basic principle of dynamic-contrast enhanced and 5 were false +ve. MR imaging, diffusion-weighted imaging, MR spectroscopy. 2. To discuss the ad- Conclusion: The Royal College of Radiologists (UK) guidelines for reporting ac- vantages and disadvantages of functional MR imaging for prostate cancer imaging. curacy at MRI range from 66 to 83%. This study using a 1 Tesla magnet without 3. To discuss the incremental value of functional MR imaging in the pretreatment access to endorectal coil had poor staging accuracy and possibly refl ects the cur- work-up of prostate cancer. rent situation in many UK hospitals. Access to endorectal coils or higher strength Background: Endorectal MR imaging has been widely used for pretreatment magnets is a major factor in increasing staging accuracy. This study arguably work-up of prostate cancer. However, undeniable limitations still remain because reports accuracy fi gures more representative of average NHS radiology services, this modality is not highly specifi c for accurate cancer localization. Furthermore, and therefore raises important concerns about the validity of existing national this modality is not useful for detecting cancer tissue in the transitional zone and for standards and guidelines. differentiating cancer tissue from biopsy-related hemorrhage and infl ammation. Procedure Details: In order to overcome limitations of conventional MR imaging, various functional imaging modalities including MR spectroscopy, diffusion-weighted C-364 imaging and dynamic contrast-enhanced MR imaging have been introduced. Localisation of non palpable prostate cancer: Value of contrast-enhanced Conclusion: Various MR imaging techniques including conventional MR imaging, imaging (TRUS and MRI) and MR spectroscopy dynamic contrast-enhanced MR imaging, diffusion-weighted imaging, and MR F. Cornud, F. Préaux, F. Thévenin, A. Chevrot; Paris/FR spectroscopy for prostate cancer detection and localization will be presented and ([email protected]) their advantages and disadvantages will be discussed. Learning Objectives: To show the accuracy of transrectal contrast enhanced imaging (ultrasonography and MR) and MR spectroscopy in the localisation of non-palpable prostate cancer and the consequences it can have on cancer detec- tion rate and treatment option.
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Houston, TX/US Moscow/RU London/UK C cult on cross-sectional imaging. Pelvic Pelvic cult on cross-sectional imaging. BDEF A rst type (including 13 percutaneous nephrolithotomy Two types of operations were studied: 1. Percutaneous Percutaneous 1. studied: were types of operations Two rst type - 4.24 µSv/minute, second type - 3.43 µSv/minute. second type - 3.43 µSv/minute. rst type - 4.24 µSv/minute, 1. To learn of the inguinal canal using cross- the anatomy To 1. To describe the anatomy of the surgical pelvic sidewall with of the surgical pelvic sidewall describe the anatomy To The surgical approach to the pelvic sidewall is based on layers is based on layers The surgical approach to the pelvic sidewall Radiology plays an essential role in the diagnosis, staging, and an essential role in the diagnosis, Radiology plays The assessment and staging of the spread of malignancy within the pel- The importance of understanding the complex anatomy of the pelvis The importance anatomy of understanding the complex The average effective dose level/operation (PCNL) is 5.4 times more dose level/operation effective The average Staff dose levels estimation during estimation endourology operations. Staff dose levels 38 operations of the fi 38 operations C-370 in endourology Occupational exposure Naryshkin; S.A. Teodorovich, Zelikman, O.V. M.I. ([email protected]) Purpose: C-371 of common and features and imaging Anatomy The inguinal canal: uncommon masses Patnana; M. Gonzales, Szklaruk, M. J. Bhosale, P.R. Genitourinary Miscellaneous C-369 An anatomical depiction with radiological Where is the pelvic sidewall? correlates and surgical Rockall; A. Reznek, R. Sahdev, Suaris, A. T.D. ([email protected]) Learning Objectives: with video illustrate To and CT and MRI correlates. annotated schematic drawings dissec- (PSW) with cadaveric dissection of the pelvic sidewall clip the laparascopic views. and laparascopic and compare the radiological tion of the pelvic sidewall, of anatomical borders with reference imaging the alteration with demonstrate To surgical changes, post changes, post radiotherapy disease, primary invasive to: the pelvic malignancies invading of examples demonstrate To recurrent disease. PSW to varying degrees. Background: However, of the pelvis. of the structures and anatomy vis require detailed knowledge delineation of the PSW can be diffi the exact recurrent gynaecological centrally for procedure performed is a salvage exenteration The surgery resection of all pelvic structures. en bloc The procedure involves cancers. in these PSW involvement of complication. and associated with high-rates is complex surgery. or exenterative to radical patients is a contraindication Findings: Imaging approach, CT and MRI images of the PSW Understanding this from deep to lateral. Imaging will demonstrate of the pelvic wall. the layers will be annotated to revise nerves and vessels obturator structures, neurovascular of ureters, the involvement internusand obturator and piriformis muscles. Conclusion: correct interpretationon cross-sectional imaging allows of pelvic pathology. Methods and Materials: perfomed were Measurements operations. ureteral Retrograde and 2. operations, the thermo- using estimated by were Dose levels during 2006. March - September surgeon and assistant on bothluminescence dosemeters (LiF) which are worn by and on apron, on genitals under apron, and under protective on chest above eyes, and under apron, under apron on on chest above on forehead, By the nurse: wrists. The surgeon and the assistant located under the table. tube was The X-ray genitals. 0.35 mm Pb. the nurse, 0.5 mm Pb, with lead equivalent aprons used protective Results: fl General performed. of the second type were (PCNL)), and 30 operations 175.5 time was Specifi (96 minutes PCNL) and 61.6 minutes accordingly. minutes fi of an irradiation: values - 5.8 µSv. retrograde PCNL - 31.4 µSv, per operation: dose level effective Average a crystalline lens the surgeon (PCNL) for for doses/operation equivalent Average 74µSv and 222 µSv accordingly. and hands: Conclusion: of doses is measured on the eye level The greatest operations. than of retrograde of the The right hand dose level source. which is located more closely to the X-ray surgeon is 1.5 and left hand is 2.7 times more than those of the assistant (PCNL). ([email protected]) Learning Objectives: of learn the imaging features To 2. sectional CT and MRI images of the pelvis. common and uncommon masses located in the inguinal canal Background: (CT) and magnetic Computed tomography surveillance of oncological patients. for resonance imaging (MRI) are the most common imaging modalities utilized While interpreting often encounter masses radiologists pelvic images, staging. un- Common masses in the inguinal canal include: the inguinal canal. occupying H-MR 1 c antigen
Gliwice/PL ed - Scrotolite, Albugineal Albugineal ed - Scrotolite, ([email protected]) ([email protected])
Scientific and Educational Exhibits Scientific and Educational Santander/ES Combined endorectal MR imaging and MR spectroscopy Combined endorectal MR imaging and MR spectroscopy 1. To review the anatomy, development and normal scrotal development the anatomy, review To 1. We show the normal anatomy and development of the scrotal normal the and development show anatomy We 7 7
d d Scrotal wall patology is rare and presents a wide range of lesions. of lesions. and presents a wide range patology is rare Scrotal wall Increased value of (Cho+Cr)/Cit ratio may be found (appear) in (appear) in be found may of (Cho+Cr)/Cit ratio Increased value n The scrotal wall presents a wide range of lesions. The phisician should of lesions. presents a wide range The scrotal wall i . N I To evaluate prostate MR spectroscopy after radiation therapy in patients therapy after radiation prostate MR spectroscopy evaluate To F Voxels with a (Cho+Cr)/Cit ratio of 1 or more were found in 4/12 patients found of 1 or more were ratio with a (Cho+Cr)/Cit Voxels - c u d E i c S - ([email protected]) ([email protected]) Purpose: with complete biochemical remission. Methods and Materials: within 3 months No increase of PSA rate chosen. 1 ng/ml were below (PSA) level radiation external-beam 8/12 patients underwent observed. was post examination and prostate therapy radiation external-beam 3/12 patients underwent therapy, 74Gy. dose was The mean radiation prior to our study. brachytherapy MR with 1.5T Siemens Avanto performed endocoil) was (Medrad MR spectroscopy ms) three-dimensional (TE=120 used for was Siemens software scanner. in 12 patients after radiation therapy of prostate cancer without biochemical signs of prostate cancer therapy in 12 patients after radiation the prostate-specifi with Patients performed. was recurrent disease for C-368 - initial experience after radiation therapy MR spectroscopy cancer: Prostate Senczenko; W. Bobek-Billewicz, B. Rembak-Szynkiewicz, J. Ultrasonography of scrotal wall pathology: Pictorial review Pictorial review wall pathology: of scrotal Ultrasonography Lastra, P. Piedra, T. Pelaz, M. Blanco, Martín G. Cuesta, L. Pellón, Arnaiz, R. J. Calabia; A. López Rasines, G. C-367 Learning Objectives: wall appearance. 2. To illustrate the ultrasonography features of scrotal wall pathol- of scrotal wall features the ultrasonography illustrate To 2. appearance. wall pathology. wall diagnosis of scrotal understand the differential To 3. ogy. Background: is not any There in scrotum imaging. is the choice diagnostic tool Ultrasonography in the literature. wall of scrotal review Findings: Imaging wall. We show a revision of cases of scrotal wall pathology from 2001 to 2006. We We from 2001 to 2006. pathology of cases of scrotal wall a revision show We wall. edema, - edema, acute scrotal of the scrotal wall (A) Diffuse lesions found: have emphy- subcutaneous within the scrotal wall, veins varicose hematoma, abscess, (B) Circumscribed lesions of the scrotal wall: purpura; sema, Schoenlein Henoch (2) Solid - Fibrous cyst; Albugineal Pyocele, Hematocele, (1) Cystic - Hydrocele, Lipoma, Angiolipoma, Sebaceous cyst, Adenomatoid tumor, Pseudotumor, (3) Calcifi Hernia, Rhabdomiosarcoma, Liposarcoma; calcifi cation. calcifi Conclusion: in appearance and its ultrasonography pathologic conditions the different know examination. an scrotal ultrasonography correctly order to evaluate spectroscopic data acquisition and processing. The metabolite (Cho, Cr and Cit) The metabolite (Cho, spectroscopic data acquisition and processing. calculated. was considered and (Cho+Cr)/Cit peaks were Results: of 1 and less of a (Cho+Cr)/Cit ratio with value Voxels in prostate peripheral zone. with a (Cho+Cr)/Cit Voxels in 8/12 patients. found were in prostate peripheral zone furthermore, zone; in 9/12 patients in prostate central found of 1 or more were ratio zone. 1 in prostate central equal or below was in 3/12 patients this ratio Conclusion: months post after several patients with complete biochemical remission even That can represent a presence of neoplasmatic cells in prostate therapy. radiation of biochemical and clinical evidences despite lack therapy months after radiation of disease. C - 7 0 R C EECR07-C-SciEduc-FIN.indd 77 Scientific and Educational Exhibits
descended testes, herniated bowel, and varicoceles. Uncommon masses include tion, pitch 7). Contrast material (100 mL, 300 mgI/mL) was injected at a rate of liposarcomas, testicular tumors, lymphoma, and neurofi brosarcomas. Familiarity 3.5 mL/sec. Axial slices of 1-mm thickness were evaluated. The following points with the normal anatomy as well as the imaging characteristics of these masses were evaluated regarding the RAV: The rate of visualization, the relationship to an is essential for correct image interpretation. accessory hepatic vein, the anatomy, including the location of the orifi ce in relation Imaging Findings: Via CT and MRI images, this exhibit will review the embryology, to the IVC, direction from the IVC, length and diameter. male and female anatomy of the normal structures associated with the inguinal Results: The RAV was detected in 79 (76%) of 104 patients. The RAV formed a canal. We will also present the imaging features and the clinico-pathological back- common trunk with an accessory hepatic vein in 8%. The RAV joined in the right ground of common and uncommon masses located in the inguinal canal. posterior wall of the IVC in 97% and in the left posterior in 3%. The direction of the Conclusion: On completion of this exhibit, the attendee will become familiar with RAV from the IVC was posterior and rightward in 77%, posterior and leftward in the anatomy, pathology, embryology and imaging characteristics of the common 23%, caudal in 89% and cranial in 11%. The length and diameter averaged 3.8 mm and uncommon masses in the inguinal canal. and 1.7 mm, respectively. Conclusion: MDCT enabled identifying the RAV and delineating its anatomy, C-372 including the position and relationship to the IVC in most patients. Intravenous urography: Still a useful imaging modality for the urinary tract J. Ni Mhuircheartaigh, M. Browne, E. DeLappe, C. Cronin, P. McCarthy; C-375 Galway/IE ([email protected]) Color Doppler ultrasonography for diagnosis of mid-ureteral stones J. Kim, S. Kim; Jinju/KR ([email protected]) Learning Objectives: To illustrate the spectrum of diagnoses which can be obtained from traditional intravenous urography, an imaging modality which has lost favour Purpose: Ultrasonography (US) has been known to be diffi cult for evaluation of in recent years with the advent of CT urography. ureteral stones, especially of mid-ureteral stones. However, color Doppler twinkling Background: The intravenous urogram aids in the diagnosis of many urinary patholo- artifact (CDTA) frequently found in the urinary stones during the examination of color gies including calculi, malignancy, obstruction and anatomical variants. Although the Doppler US (CDU) could be very useful for diagnosis. We evaluated the usefulness role of intravenous urography as a primary investigation for many of these indications of CDU in diagnosing mid-ureteral stones. has been diminished recently, it is still the examination of choice where there is a Methods and Materials: We prospectively examined CDU with gray scale US need to visualize the entire urinary system. During the authors’ initial fi ve weeks (GSU) in 562 consecutive subjects presenting with renal colic to diagnose ureteral performing intravenous urograms, we encountered a diverse range of abnormalities stones. The fi nal diagnosis was confi rmed by additional imaging, clinical follow-up, which highlighted, for us, the utility of this undervalued investigation. or urological intervention. Mann-Whitney U test was used for statistical analysis. Imaging Findings: Abnormalities demonstrated during this period included pyelo- Results: CDU with GSU demonstrated ureteral stones in 437 of 562 subjects that ureteritis cystica, renal scarring, pelvico-ureteric junction stenosis, extravasation were all confi rmed as having stones. Out of the 437 patients, 41, 133, and 263 of contrast, mega-ureter, duplex ureter and a number of calculi causing varying showed stones at the mid, upper, and lower ureters, respectively. Of the remaining degress of obstruction. 125 subjects, seven with ureteroliths (1, 4, and 2 with stones at the mid, upper, and Conclusion: While intravenous urography is somewhat out of vogue at present, lower ureters, respectively) were missed. Therefore, there was a total of 42 patients this series elegantly demonstates that a great deal of relevant information can be with mid-ureteral stones. US revealed stones in 41 patients. But 1 case without obtained from this relatively straighforward study. hydronephrosis failed to show. CDTA was seen in 39 of the 41 cases (95.1%) and it was not related with size or calcifi cation of stones (p> 0.05). CDU was able to differentiate ureteral stones from stone-like echogenic structures and ureters from C-373 vessels. Sensitivity and specifi city of CDU with GSU for diagnosis of mid-ureteral Urogenital tuberculosis stones were 97.6% and 100%, respectively. L. Graña, M.J. Ciudad, J. Barrera, Y. Martínez, E. Vañó, A. Litcheva; Madrid/ES Conclusion: CDU was very useful for the diagnosis of mid-ureteral stones. ([email protected]) Learning Objectives: 1. To illustrate the spectrum of imaging features of tuberculo- C-376 sis of the genitourinary tract. 2. To review the differential diagnosis of genitourinary MR urography in the diagnosis of obstructive uropathy in selected tuberculosis. clinical groups Background: Tuberculosis is the most common cause of mortality from infectious J. Zielonko, M. Markuszewski, M. Studniarek; Gdansk/PL diseases worldwide. The prevalence of this infection has increased over the past decade in most developed countries and extrapulmonary tuberculosis represents Purpose: To evaluate the role of MRU in the diagnosis of obstructive uropathy in a a progressively greater proportion of the new cases. Genitourinary tuberculosis selected clinical groups. is an important but uncommon form of TB, although it is the second most common Methods and Materials: Sixty patients with obstructive uropathy underwent form of extrapulmonary tuberculosis. Diagnosis is often diffi cult and delayed because static fl uid MRU (sMRU), conventional MR sequences, and excretory MRU (12 TB can mimic many other diseases. Radiologic examinations are very useful to cases). The degree of the urinary tract dilatation, level and type of obstruction determine the presence of tuberculosis and to monitor de therapeutic effi cacy. were estimated. Four groups of pathologies were distinguished: calculi, strictures Imaging Findings: This pictorial review illustrates the radiological features of of ureteropelvic junction (UPJ), benign and malignancy-induced ureterostenosis. genitourinary tuberculosis. It shows intravenous urography, retrograde pyelography, The results were compared with IVU, CT, US, clinical, and histopathological data. US, CT and MR images of differents stages of tuberculosis affecting the kidney, For estimation of the agreement between sMRU and other techniques, Cohen’s ureter, bladder and genital tract. kappa statistic was applied. Conclusion: Diagnosis of genitourinary tuberculosis is often diffi cult and delayed, Results: In patients with urolithiasis, sMRU correctly depicted the degree of as there are many pathologic conditions that can mimic this entity. Although defi nitive ureterohydronephrosis in 85%, in cases of UPJ stenosis and malignancy-induced diagnosis is established by cultive or histologic examination, radiologic examina- ureterostenosis the depiction was 100% and in the group of benign ureterostenosis tions are useful in suggesting the presence of the disease and it is important for it was 91%. Determination of obstruction level was adequate in 92% of stones and the radiologist to be familiarized with the fi ndings of genitourinary TB. in 100 % of non-calculous ureteral strictures. Completed with conventional MR sequences, sMRU depicted tumour or infi ltration in 83% cases of malignancy-in- duced ureterostenosis. In the remaining groups, neoplasm was excluded in 91%. C-374 Filling defects were verifi ed with IVU/CT to exclude tumours. For evaluation of the Demonstration of the anatomy of the right adrenal vein with multi- agreement between sMRU and other modalities, kappa values were calculated detector row CT concerning: (a) the degree of ureterohydronephrosis - 0.97/0.91 for right/left-sided T. Matsuura, K. Takase, T. Yamada, A. Sato, S. Takahashi; Sendai/JP pathologies, (b) obstruction level - 0.97/0.96, (c) type of obstruction - 0.93. Purpose: Adrenal venous sampling is essential for an accurate diagnosis of pri- Conclusion: MRU is a useful technique in the assessment of obstructive uropathy, mary aldosteronism. Information about the anatomy of the right adrenal vein (RAV) especially that of non-calculous origin. Among different clinical applications, MRU obtained by CT would be useful in planning adrenal venous sampling. The purpose is superior in the evaluation of dilated urinary tract in altered anatomical conditions of our study is to determine how frequently the RAV could be identifi ed on MDCT (e.g. ileal neobladder). and what spectrum of anatomic variations was seen among the RAV. Methods and Materials: Post-contrast MDCT were retrospectively reviewed in104 patients. CT scan was performed with a MDCT (8-row) scanner (1 mm collima-
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7 0 0 2 . 2 409 0 . 2 112.02.2007 17:03:58 , 1 G ed in various groin groin ed in various ([email protected]) nding is discussed.
, M. Ferreira , M. 1 0.001). 0.001). < C ([email protected]) ([email protected])
([email protected]) ([email protected])
BDEF , J.C. Fernandes , J.C. 2 ndings, the differential diagnosis of the groin diagnosis of the groin the differential ndings, A cance as it changes the surgical management. cance as it changes the surgical management. Angra do Heroísmo/PT Angra 2 Seoul/KR New Dehli/IN New , M. Lima , M. stula. They are also used to help decrease the likeli- are also used to help decrease the They stula. 1 To assess the role of multidetector computed tomogra- assess the role of multidetector To To illustrate the sonographic fi ndings of the different types ndings of the different fi the sonographic illustrate To To describe the major complications associated with ureteral To cult or impossible. Therefore, imaging modality such as so- imaging modality such Therefore, cult or impossible. MDCT was done on 16-row MDCT scanner. A plain scan was was A plain scan MDCT scanner. done on 16-row MDCT was A retrospective review was performed in patients with groin in patients with groin performed was review A retrospective In our presentation, we divide the complications associated with In our presentation, we rmed at surgery. rmed at surgery. Coimbra/PT, Coimbra/PT, , J. Costa , J. 1 1 ; 1 masses ndings of groin Double-J catheters have been in use since 1967 in the treatment catheters have Double-J An accessory renal artery of patients crosses the UPJ in only 11-39% Groin complaints can be caused by various diseases having a similar diseases having various Groin complaints can be caused by MDCT angiography was superior was to color Doppler and DSA and MDCT angiography HR-T2WI is only slightly more accurate than T2WI in overall local T2WI in overall than more accurate HR-T2WI is only slightly Imaging techniques are useful in monitoring the placement of a ureteral , J. Brito , J. 1 F. Caseiro-Alves F. pathology may be diffi pathology may The an important play role in the assessment of the correct diagnosis. may nography fi masses on the sonographic groin of various appearance Findings: Imaging rmed surgical resection, biopsy or radiological by confi All cases were masses. identifi were features of sonographic A variety study. follow-up aneurysm,The disease entities include hernia, false testis, undescended masses. were correctly assessed by T2WI (86%) and all cases (100%) with HR-T2WI. The with HR-T2WI. (86%) and all cases (100%) T2WI correctly assessed by were As HR-T2WI (p=0.001). MRI and (79%) by T2WI (74%) by was accuracy overall (sensitivity had equal accuracy T2WI and HR-T2WI node staging, regards to lymph 93%). accuracy city 97% and overall 85.7%, specifi Conclusion: stages, In invasive in lymph node staging. equal accuracy staging (p=0.003) and has (p accurate cantly more is signifi HR-T2WI however, C-381 placement Complications associated with double-J Graca B. C-382 Sonographic fi Ryu; Jin, C. W. Kim, H. Yang, D. Learning Objectives: masses. of groin Background: On the clinical fi clinical presentation. C-380 preoperative assessment of ureteropelvic CT in of multidetector Value junction obstruction Bhaktarahalli; J.N. Mishra, A. Learning Objectives: as the cause for (CRV) of crossing renal vessel (MDCT) in the evaluation phy outline its To obstructionureteropelvic junction (UPJ) and to describe its technique. (DSA). angiography and digital subtraction color Doppler imaging over advantages Background: are usually located anterior to the UPJ and its preopera- CRV with UPJ obstruction. cation is of utmost signifi identifi tive color over describe we MDCT and its advantages the usefulness of In this exhibit, Doppler imaging and catheter angiography. Details: Procedure to identify the renal poles with a 10 collimation through the kidneys performed mm. injected intravenously mg of injection Furosemide was 40 and aortic bifurcation. from the level performed a helical CT scan was later, minutes 8-10 as a diuretic. till the aorticof the upper pole of the left kidney bifurcation with an intravenous (350 injection of 80 of 4 mg Iodine/mL) at a rate cc of injection Iohexol mL/second speed mm, table a collimation of 0.625 of 15-20 seconds, with a scanning delay of 11 rotation periodmm/sec and tube of 0.7 seconds during a single breath-hold. reconstruction, projection and volume Curved multiplanar maximum-intensity also were Color Doppler imaging and DSA rendering algorithms applied. were all the patients. for performed Conclusion: UPJ it as the cause for and establishing in detecting CRV 100% accuracy showed obstruction as confi Learning Objectives: imaging techniques. from different with examples a Double-j, catheterization by Background: obstructionof ureteral and fi Double-J lithotripsy. wave hood of sepsis or obstruction shock after extracorporeal method of upper urinary catheterization tract constitutes a simple and effective clinical situations. used in the most variable drainage Details: Procedure cient positioning or migration b) defi a) infections; placement in 5 groups: Double-J and e) functionality; d) loss of anti-obstructive lesions; c) traumatic of the stent; of these lesions, examples several provide We of the stent. structural alterations approach. in a multimodality Conclusion: allowing thereby associated complications, eventual can demonstrate stent, as they with subsequent reduction of the morbidity. diagnosis, and effective quicker
rm other Nijmegen/NL 2 ndings according to the ([email protected]) ([email protected])
Mansoura/EG , Mansoura/EG 1 ; 1 ndings of genitourinaryndings of pathology in Scientific and Educational Exhibits Scientific and Educational Nottingham/UK , T.A. El-Diasty , T.A. ciency and trauma, among others. During the last among others. ciency and trauma, 2 220 patients with histologically proven urinary 220 patients with histologically proven bladder To review imaging fi review To To illustrate the use of additional series following unenhanced series the use of additional illustrate following To The detected pathology was classifi ed, fundamentally, in in- ed, fundamentally, classifi The detected pathology was From our cohort of unenhanced CT scans, we illustrate how our cohort how illustrate we of unenhanced CT scans, From 9 7
, J.O. Barentsz , J.O. 1 d ([email protected]) ([email protected]) d Patients with genitourinary Patients disease represent an important volume Unenhanced CT is widely accepted as the primary investigation for for accepted as the primary Unenhanced CT is widely investigation
n The radiologist must be aware of the wide variety and high prevalence and high prevalence of the wide variety be aware must The radiologist Additional series were required in 12% of cases following unenhanced Additional series required in 12% of cases following were i . N I To compare the accuracy of T2w-imaging (T2WI) and high-resolution T2w- T2w-imaging (T2WI) and high-resolution of compare the accuracy To F 60/220 (26.7%) cases had muscular invasion (stages T2 and T3a). Com- T3a). T2 and (stages invasion 60/220 (26.7%) cases had muscular rm as characterize malignancy as well the diagnosis of renal or urothelial - c u d E i c S - T2WI vs HR-T2WI in assessment of urinary bladder carcinoma carcinoma T2WI vs HR-T2WI in assessment of urinary bladder Abou Bieh E.A. C-379 fectious/infl ammatory conditions, obstructive disorders, trauma and complications trauma ammatory disorders, obstructive conditions, fectious/infl or other interventional or surgical procedures. associated with renal transplantation urography Intravenous and CT. mainly ultrasonography Imaging techniques were role in had also a therapeutic Interventional radiology less frequently used. was selected cases. Conclusion: of emergency genitourinary pathology and its imaging fi Genitourinary tract disease in the emergency room: A pictorial review A pictorial review room: Genitourinary tract disease in the emergency Carreño Garcia, E. Montoya, Mora P. Pons, Barranco Martinez de la Haza, R. D. Guma Martinez; Hernandez Gañan, A. Ortiz, J. Valdivielso Aguila, A. Vera P.A. Barcelona/ES Learning Objectives: diagnostic hospital according to available the emergency room in a third level and urography intravenous computed tomography, imaging methods (ultrasound, interventional radiology). Background: in the in emergency services of consultations of the total number and, therefore, consultation in The more frequent reasons for on call. daily work of the radiologist hematuria, syndrome, anurythese patients include lumbar or genital pain, febrile acute renal insuffi or oligoanury, and 4300 6500 emergency sonography 2006), over 2005-June 18 months (January in Genitourinary involved pathology was our center. at performed were CT exams The spectrum either suspected or not. 20% of these examinations, approximately during this period. ndings in these conditions has been reviewed of fi Findings: Imaging of the possibilities of inter- be aware He also must imaging techniques. available approach in selected patients. as a therapeutic radiology ventional C-378 Learning Objectives: important diagnoses such as urological malignancy and non-urological pathology, both of which can mimic the presentation of renal colic. Unenhanced CT for suspected renal colic: The importanceThe of additional colic: suspected renal CT for Unenhanced certainty diagnostic series to improve Lloyd; J.E. Au-Yong, Ali, I.T.H. S.A. diagnostic certainty and to both improve renal colic, suspected for CT performed rm other important diagnoses. confi Background: cell carcinoma may and transitional Renal cell carcinoma suspected renal colic. mimic or haematuriaboth present with loin pain pathology may and non-urological series that additional In a cohort found we of cases from our institution, renal colic. our knowledge, To diagnostic certainty. in 12% of cases to improve required were in the literature. of this subject has not been published a review Findings: Imaging distinguish a Prone scanning can additional series clarify an uncertain diagnosis. may CT urography junction. calculus from a calculus at the uretero-vesical bladder enhancement contrast Parenchymal from a ureteric a phlebolith calculus. differentiate can confi C-377 additional also provide enhancement may Contrast renal cysts. incidental complex important of non-urological pathologies. in a range diagnostic information Conclusion: diagnostic certainty and confi renal colic to improve suspected CT for ([email protected]) ([email protected]) Purpose: imaging (HR-T2WI) in local and nodal staging of urinary carcinoma (UBC). bladder Methods and Materials: T2WI and axial HR-T2WI of MR imaging axial preoperative carcinoma underwent These Electric General Medical System). LX echo speed; T (Signa horizon at 1.5 local tumor histopathology regarding compared with postoperative results were staging and nodal staging. Results: correctly assessed were 36/60 (60%) cases pared to histopathological examination, the most frequent staging was Over HR-T2WI. and 40/60 (67%) cases by T2WI by T2WI and correctly assessed by 100/132 (76%) cases were T3b, In stage problem. 24 cases present in 28 cases, T4a was Stage HR-T2WI. 104/132 (79%) cases by C - 7 0 R C EECR07-C-SciEduc-FIN.indd 79 Scientific and Educational Exhibits
lipoma, epidermoid cyst, lymph nodes, liposarcoma, lymphoma, metastases, chronic GI Tract infl ammation, abscess, and hematoma. Conclusion: Knowledge of sonographic fi ndings of various groin masses may be Colon helpful for differential diagnosis. C-383 C-385 The role of ultrasound in infl ammatory bowel disease A review of the clinical use of low-dose CT KUB at Derriford Hospital, N. Bharwani, N. Stephens, J. Pilcher; London/UK Plymouth, UK S. Narayanaswamy, N. Venkatanarasimha, N. Manghat, S. Freeman, A. George; Learning Objectives: 1. Discussion of the role of bowel ultrasound in infl am- Plymouth/UK ([email protected]) matory bowel disease. 2. Pictorial demonstration of typical ultrasound fi ndings. 3. Advantages and disadvantages of ultrasound in IBD compared with other Purpose: Ureteric calculi are the main consideration in the majority of patients imaging modalities. presenting with acute fl ank pain. Unenhanced spiral CT has become the imaging Background: High-resolution ultrasound has recently become a recognised tool in modality of choice in these patients not only because of its unrivalled ability to the evaluation of infl ammatory bowel disease (IBD). With advances in ultrasound identify ureteric stones, but also because of its potential to identify other renal and equipment and novel imaging techniques, this modality is increasingly being used non-renal pathologies. We report our experience with the use of CT KUB and the to diagnose patients at initial presentation, assess disease activity, identify com- clinical incidence of non-calculus renal and non-renal pathology in patients present- plications, and monitor response to therapy. ing with acute fl ank pain with a provisional clinical diagnosis of ureteric colic. Imaging Findings: This pictorial review will highlight the features seen in IBD on Methods and Materials: We retrospectively reviewed 242 patients who underwent high-resolution ultrasound, both in and outside the bowel wall. We will outline the CT KUB from Jan 2005 to Dec 2005 for suspected renal colic. We excluded patients role of spectral Doppler in assessing the mesenteric circulation and that of power with a known renal disease or previously diagnosed renal stones. Doppler in the monitoring of patients. The latter half of the discussion will focus Results: 178 patients were included in the study after applying the exclusion criteria. on more recent techniques beginning to be employed in the assessment of IBD. Incidence of stone disease identifi ed by CT KUB was 45%. The majority of stones This includes the application of microbubble contrast agents using both power (44%) were found in the distal ureter and VUJ. Stone size of ≥5 mm was found in Doppler and harmonic imaging modes to try and measure mural infl ammation, 34% of cases. Secondary signs were reported in nearly 65% of patients with stone and the role of non-absorbable, anechoic, oral contrast agents in distinguishing disease. Alternative pathologies were identifi ed in 27 cases (15%). small-bowel strictures. Barium studies, CT, and MRI correlation will be provided, Conclusion: Unenhanced CT is an excellent modality for imaging patients with where appropriate. acute fl ank pain. Non-calculus renal and non-renal pathologies can often be identi- Conclusion: High-resolution ultrasound is an evolving modality in the management fi ed on unenhanced low-dose CT performed for suspected renal colic. A careful of infl ammatory bowel disease. It can effectively be used to evaluate patients with search for these alternative diagnoses should be made in all cases and particularly clinically suspected IBD at fi rst presentation, and also to monitor known patients when the examination does not identify a ureteric calculus. with regard to disease activity, luminal and mesenteric complications. C-384 Imaging in urogenital emergencies C-386 Advanced evaluation and visualization techniques for CT colonography N.A. Al-Nakshabandi; Riyadh/SA ([email protected]) M.S. Juchems1, S. Virmani2, S. Pohlman2, A.J. Aschoff1; 1Ulm/DE, Learning Objectives: 1) Familiarize the audience with the most urgent radiological 2Highland Hights, OH/US ([email protected]) emergencies in the urogenital system. 2) Learn the most appropriate approach for Learning Objectives: 1. To demonstrate the use of new 3D visualization techniques these emergencies and how to reach an appropriate differential diagnosis. 3) Learn for CT colonography (CTC). 2. To discuss the benefi ts and drawbacks of electronic the use of the appropriate modality. 4) Identify the radiological signs associated colon cleansing (ECC). 3. To demonstrate the utility of the translucency-view as with each of these emergencies. a new diagnostic tool. 4. To discuss the role of colon computer-assisted reading Background: The use of imaging in urological emergencies is important to learn (CAR) in the detection and quantifi cation of polyps. and manage. Careful attention to the urogenital involvement in emergency conditions Background: Various studies in the past have proved CT colonography as a viable is a very essential step in the radiological evaluation of these conditions option for colorectal cancer screening. There are challenges and pitfalls in CTC Imaging Findings: Flank pain/ureteral colic is experienced by 2-3% of the popula- study review that include low sensitivity and specifi city due to the inability to assess tion, with a 40-50% recurrence rate at 5 years. CT plays a valuable role in detect- the entire colonic surface, poor patient preparation and inability to differentiate ing the location of the stone and the presence of obstruction. Urosepsis occurs between stool residuals and polypoid lesions. secondary to pyelonephritis, cystitis, prostatitis, or any other cause of obstruction. Procedure Details: In this exhibit, we demonstrate major advances in 3D visu- Ultrasound plays a valuable role in its diagnosis and intervention by placing a alization techniques, interpretation tools and computer-assisted reading for CTC percutaneous nephrostomy catheter. Ultrasound is utilized in acute renal failure to that might overcome the CTC-related challenges mentioned above: 1. Perspec- assess’ renal size, parenchymal thickness and presence of obstruction. CT with tive fi let view - unfolded and unobstructed 3D view of the colon to increase the or with out cystogram is optimal for blunt abdominal trauma when kidney, ureter or colonic surface visualization. 2. Electronic colon cleansing - improved sensitivity, bladder injury is suspected. Retrograde urethrogram can be done when a urethral specifi city and better reading experience. 3. Translucency view - investigation of injury is suspected. Ultrasound can easily differentiate orchitis from testicular torsion. polyps, facilitates differentiation between polyps and false positives. 4.Colon CAR It is also valuable in confi rming the diagnosis of testicular rupture. - automatic detection and quantifi cation of polyps. Conclusion: The use of imaging in urogenital emergencies is of outmost impor- Conclusion: 1. CT colonoscopy can become a valuable screening technique with tance. Examples of imaging and management will be given. better visualization techniques that result in higher sensitivity and specifi city for polyp detection. 2. ECC may decrease the amount of patient preparation needed for CT colonoscopy. 3. CAR might help readers with less experience to improve their sensitivity for polyp detection. C-387 CT colonography (virtual colonoscopy) for post-surgical evaluation of colorectal cancer: A pictorial review Y. Choi, S. Park, S. Lee, A. Kim, H. Ha; Seoul/KR ([email protected])
Learning Objectives: 1. To have a comprehensive pictorial review of CT colo- nography (CTC) fi ndings. 2. To discuss the role of CTC in post-surgical patients with colorectal cancer. Background: Approximately three hundred post-surgical patients of colorectal can- cer underwent CTC in the authors’ institution over a year period. We categorized the CTC fi ndings into: 1) normal anatomy, 2) insignifi cant lesions including a protruded suture material and a suture granuloma in anastomosis, and 3) signifi cant lesions
410 A BDEFC G
EECR07-C-SciEduc-FIN.inddCR07-C-SciEduc-FIN.indd 8800 112.02.20072.02.2007 17:03:5817:03:58 8 5 : 3
GI Tract 0 : 7 1
7 0 0 2 . 2 411 cantly 0 . 2 eld 112.02.2007 17:03:58 cult at times. cult at times. G ed as T1, 3 as ed as T2 and 15/16 T3). N T3). T2 and 15/16 < Koyang, Kyunggi/KR, Kyunggi/KR, Koyang, 1
; 1 ned to the bowel wall in ab- wall ned to the bowel city of 100%, a positive predictive predictive city of 100%, a positive C , J.-A. Ryu , J.-A. 1 ([email protected]) ([email protected]) ed: 1 lesion was classifi 1 lesion was ed:
BDEF , N. Park , N. A 1 Bristol/UK into adjacent organs in which radio-tracer ltrating ed and localized on PET/CT images. FDG-PET/CT on PET/CT images. ed and localized Twenty patients with diagnosis of colorectal cancer cancer patients with diagnosis of colorectal Twenty , E. Lee , E. 1 103 polyps, size from 3 to 10 mm, were created on the created on mm, were from 3 to 10 size 103 polyps, Appendicitis is one of the most common causes for an Appendicitis is one of the most common causes for , C. Park , C. 2 ed T stage in 18 of 20 (90%) patients (3/4 ed Appendicitis is a great mimicker of disease, not just clinically but also not just clinically but of disease, mimicker Appendicitis is a great FDG-PET/CT is a useful diagnostic tool in evaluating T and N T and N FDG-PET/CT is a useful diagnostic tool in evaluating MRC with bFFE using a water-Gd. enema provided the greater the greater enema provided MRC with bFFE using a water-Gd. ([email protected]) ([email protected])
To evaluate FDG-PET/CT as a diagnostic tool in the assessment as a diagnostic tool in the assessment FDG-PET/CT evaluate To To evaluate different combinations of magnetic resonance (MR) colono- combinations of magnetic resonance (MR) different evaluate To T2 lesions were defi ned as tumours confi defi T2 lesions were The bFFE using the water-Gd. enema showed greater diagnostic per- greater enema showed The bFFE using the water-Gd. 20 adenocarcinomas were identifi 20 adenocarcinomas were < , C. Park , C. 1 eld echo (bFFE), using either the air enema or water-Gd. enema. We evaluated evaluated We enema. the air enema or water-Gd. eld echo (bFFE), using either Seoul/KR better at enhancing polyp conspicuity compared to the air enema. better at enhancing polyp conspicuity compared to Conclusion: diagnostic performance. with excellent conspicuity, Purpose: agents. contrast sequences and intraluminal graphic Methods and Materials: larger than mm or smaller and 54 were 5 Forty-nine polyps were porcine colon. T1-high resolu- with the three-dimensional performed was 5 MR colonography mm. balanced two-dimensional or multislice (THRIVE) excitation tion isotropic volume fast fi of each polyp in the MRC compared to the simulated the presence or absence agent combi- MR sequence-contrast of each performance The diagnostic polyps. enemas, compare air and water-Gd. To detecting polyps. assessed for nation was scale under bFFE sequence. a four-point using evaluated polyp conspicuity was test. signed ranks Wilcoxon’s using analyzed The results were Results: It had a sensitivity of 95.9%, a specifi formance. polyps (NPV) of 81.8% for value predictive (PPV) of 100%, and a negative value polyps and NPV of 100% for PPV, city, specifi of 5 and a sensitivity, or smaller; mm also signifi enema was using the water-Gd. The bFFE mm. larger than 5 C-392 of did I miss appendicitis on abdominal CT? A pictorial review Why appendix pathology on CT Young; R. Shukla, R. Hanif, M.A. appendix along in the position, length and location of the vermiform Variations and clinical presentations fat in the amount of intra-abdominal with the differences Criteria the diagnosis of for dilemma. to this seemingly simple diagnostic contribute into account the take They documented in the literature. appendicitis on CT are well C-390 T1-high Comparison between resonance colonography: Magnetic fast fi (THRIVE) and balanced excitation volume resolution isotropic 2 C-391 of colorectal cancer Role of FDG-PET/CT in the local staging Salvatore; M. Pace, Storto, L. G. Camera, L. Avitabile, Mainenti, G. P.P. Selva, E. Napoli/IT Purpose: of primary (T) and lymph node metastases (N) in patients with tumor extent colorectal cancer. Methods and Materials: on evaluated were T and N parameters surgery. FDG-PET/CT before underwent images. T3 lesions as tumours with spiculated uptake; parietal radio-tracer sence of extra radio-tracer edges showing outer contour or with rounded or nodular advancing T4 lesions as tumours infi uptake; each less than in a cluster of three nodes N1 as FDG uptake present; was uptake N2 as FDG uptake or in a single node measuringcm in diameter cm; 1 at least 1 T and N PET/CT staging was in more than three nodes regardless of their size. compared to histopathology. Results: Learning Objectives: We the resident on call. acute abdomen, which can be missed on CT abdomen by appendiceal patholo- of different aim to present this poster as a pictorial review leading to This will help us analyse the factors gies with atypical presentations. results on CT. false-negative Background: The diagnosis of acute appendicitis - especially in the adult patient. radiologically to be diffi of the abdomen can prove (CT) on computed tomography echo (bFFE) using a water-gadolinium enema or air enema enema or air using a water-gadolinium (bFFE) echo Kim M. T2, 16 as T3; lymph-nodal involvement was present in 9 cases (5 N1 and 4 N2). present in 9 cases (5 N1 and 4 N2). was lymph-nodal involvement T3; T2, 16 as correctly identifi All lesions were correctly identifi appropriately determinedstage was patients (9/11 N0, 4/5 N1 in 17 of 20 (85%) and 4/4 N2). Conclusion: in patients with colorectal cancer despite the absence of iv contrast parameters medium on CT scan. nding in Latina/IT, Latina/IT, 1 ; 2 cant lesions. Polypoid Polypoid lesions. cant , S. Morini , S. 1 cant with protruded suture materials due to arterio-venous-typelling veins , F. Iafrate , F. Scientific and Educational Exhibits Scientific and Educational 2 of ectatic and include accumulation ndings , F. Taggi , F. 1 cial and noninvasive surveillance method for post-sur- surveillance method for and noninvasive cial Screening strategies were compared by using computer compared by were Screening strategies To describe the MDCT techniques used to evaluate patients describe the MDCT techniques used to evaluate To , R. Ferrari , R. 2 We retrospectively reviewed 27 cases of colonic angiodys- reviewed retrospectively We Barcelona/ES A colonic anastomosis typically presents as a web-like structure presents as a web-like A colonic anastomosis typically 1 8
d ndings at CTC will help increase the role of CTC in post-surgical will help increase the role of CTC in post-surgical ndings at CTC d Lower gastrointestinal bleeding is a cause of considerable morbidity. morbidity. is a cause of considerable gastrointestinal bleeding Lower n MDCT is a useful tool for the diagnosis of colonic angiodysplasia MDCT is a useful tool for CTC screening allows a more rational use of endoscopic procedures, use of endoscopic procedures, a more rational CTC screening allows CTC is a benefi i . N I ([email protected]) It has been estimated that the endoscopic manpower is insuffi cient to is insuffi It has been estimated that the endoscopic manpower
F , C. Hassan , C. The number of colonoscopies was 175.911 in the colonoscopy simulation simulation in the colonoscopy 175.911 was of colonoscopies The number - 1 c u d E i c S Rome/IT - Purpose: The impact of CT US. in the with colonoscopy population screening a general cover stud- since different demand is still unclear, (CTC) on colonoscopy colonography of to compare the number The aim of this analysis was ies reach opposite results. a population colonoscopies required when simulating diagnostic and therapeutic screening with CTC or colonoscopy. Methods and Materials: population of 100 000 persons process in which a hypothetical models of a Markov decade. every of age undergoes CTC or colonoscopy 50 years Results: of diagnostic colonoscopies was The number and 61.849 (-65%) in the CTC group. cor- to 38.478 in the CTC group, group 134.158 in the colonoscopy reduced by at positive due to false 15.201 (39%) were Of the latter, responding to a 70% drop. 41.763 to 23.371, reduced by colonoscopies was of therapeutic The number CTC. colonoscopies of therapeutic the number However, corresponding to a 44% drop. (1.989 vs 2.006), groups simulated similar in the two polyps was advanced for higher in the colonoscopy much polyps was of not advanced removal whilst that for (39.774 vs 21.365). group Conclusion: substantially reducing the number of negative endoscopies and selecting mainly of negative substantially reducing the number polypectomy. pathology - for the high-risk patients - those with advanced 2 C-389 polyps of diminutive with and without removal Impact of CT colonography demand on colonoscopy Laghi A. abdominal vascular studies. The MDCT fi studies. abdominal vascular earlytortuous fi the colonic wall, within vessels enlarged arteries area, and intraluminal of the target development, malformation bleeding. of active in cases materialcontrast extravastion Conclusion: to fails colonoscopy when GI bleeeding especially in elderly patients with lower catheter angiography. need of invasive the avoiding the diagnosis, establish C-388 MDCT diagnosis Colonic angiodysplasia: de la Presa, Boyé R. Saperas, E. Pérez Lafuente, Sebastià, M. Quiroga, C. S. Alvarez-Castells; A. Learning Objectives: describe the and illustrate To with acute or chronic gastrointestinal hemorrhage. the diagnosis of colonic angiodysplasia. ndings that allow MDCT fi Background: as a common source of Colonic angiodysplasia has been increasingly recognized up to 50% of cases accounting for in elderly patients, acute and chronic bleeding assesment of gastro- imaging Currently, of obscure gastrointestinal hemorrhage. or such as endoscopy procedures lesions relies on invasive intestinal vascular technique as a minimally invasive MDCT has gained acceptance but angiography, system. the vascular imaging of for Details: Procedure was the examination In 24 cases, MDCT during past 5 years. plasia diagnosed by to failed when colonoscopy due to acute or chronic recurrent bleeding performed incidental fi an colonic angiodysplasia was In 3 cases, the cause. show including metachronous adenomatous polyp and cancer and recurred/metastatic polyp and cancer and recurred/metastatic adenomatous including metachronous each category and are presented selected were cases for Representative cancer. correlation. with optical colonoscopic Findings: Imaging Distortion of the normal shape of an anastomotic with a smooth and sharp border. lesions and signifi cant both insignifi ring can be caused by lesions at anastomotic ring are typically insignifi Irregularitiesof the anas- most common etiology. being the and suture granulomas represent anastomotic may tomotic ring or elevation such as irregular depression morphology the usually polyp or a of a lesions have Metachronous recurrences. perianastomotic clearly CTC recur- shows in the colon. mass at CTC elsewhere detected at also be metastatic implant may Peritoneal rence or distant metastasis. the lesion. compression by noting an extrinsic y-through of CTC by endoluminal fl Conclusion: gical colorectal cancer. Knowledge of and familiarity with the normal of and familiarity and abnormal Knowledge gical colorectal cancer. post-surgical fi cancer. of colorectal follow-up C - 7 0 R C EECR07-C-SciEduc-FIN.indd 81 Scientific and Educational Exhibits
diameter of the imaged appendix, the presence or absence of free fl uid, stranding of technique in patients with infl ammatory bowel disease (IBD). surrounding fat and the presence of defi nite complications of appendicitis. Despite Methods and Materials: Eighteen patients with suspected or known IBD under- this, appendicitis still remains a diffi cult diagnosis to be certain about. went MRC at 1.5 T-device (Magnetom Symphony, Siemens). Fecal tagging was Procedure Details: Image data bank from a large teaching hospital; Siemens performed by oral administration of dense barium-sulfate (200 ml) at major meals somatom 4 slice CT scanner. starting 2 days before MRI. Patients were instructed not to eat fi ber-rich and Conclusion: Careful analysis of the CT image with respect to the possible pre- high manganese containing food. After water enema (2000 ml), MR protocol fi rst sentations of acute appendicitis can reduce the number of false-negative results included HASTE and true-FISP sequences. Coronal T1w 3D VIBE (2.0 mm thick) and enable a more accurate diagnosis. was obtained before and 60 seconds after intravenous administration of Gd-chelate. MR images were evaluated in conference by two observers by seeking for bowel abnormalities and were correlated with conventional colonoscopy (CC) in all cases C-393 and with surgery in 7/18 patients. Gangrenous appendicitis: An emergency surgical condition, preoperative Results: MRC could be successfully performed in all cases, whereas CC was evaluation with helical CT incomplete in 5/18 patients. MRC correctly defi ned bowel wall thickening, stenosis P. Antonopoulos, K. Tavernaraki, F. Constantinidis, E. Kalikatzaros, and extension of the infl amed colon in 4/5 patients with ulcerative colitis. In 10/12 G. Charalampopoulos, A. Petroulakis; Marousi/GR ([email protected]) patients with Crohn disease, involvement of both large and small bowel was dem- Learning Objectives: To demonstrate specifi c CT fi ndings, the combination of onstrated; perianal abscesses (n=2) and fi stulas (n=2) were also identifi ed. In one which provides a safe diagnosis of gangrenous appendicitis. remaining case, no abnormality was found at MRC and fi nal histological diagnosis Background: Gangrenous appendicitis is the result of appendiceal lumen ob- was not surely diagnostic for IBD. struction, which if left untreated, leads to perforation of the appendiceal wall and Conclusion: MRC with fecal tagging technique is a promising, minimally invasive peritonitis. Thus, it is of crucial importance to promptly diagnose and surgically technique for evaluation of the bowel in patients with suspected IBD. It can be used treat this emergency condition. In a three year period, 65 patients (mean age 48 for the assessment of disease’s extension, especially for those who cannot have years, age range 16-80) with clinical and laboratory fi ndings suggestive of acute CC due to severe pain and fecal residua. appendicitis were evaluated with Helical CT. Diagnosis of gangrenous appendicitis was based on a combination of specifi c imaging fi ndings, which were surgically C-396 anf pathologically confi rmed. Abnormal masses of the right iliac fossa: Spectrum of imaging fi ndings Imaging Findings: Five different combinations of specifi c CT fi ndings suggestive A.E. Mahfouz, H. Sherif, N. Morad; Doha/QA ([email protected]) of gangrenous appendicitis were observed in our study. Enlargement of the appendix was visualised in all patients accompanied by: 1. Learning Objectives: To learn the differential diagnosis of abnormal masses of Intraluminal appendicolith and air bubbles (30.8%). 2. Infl ammatory involvement of the right iliac fossa and to illustrate the peculiar imaging features of each of these caecum and terminal ileum (18.5%). 3. Intraluminal appendicolith and infl ammatory different masses with histopathological correlation. involvement of caecum and terminal ileum (16.9%). 4. Intraluminal air bubbles (15.4%). Background: Diagnosis of patients with symptoms related to the right iliac fossa 5. Intraluminal appendicolith and diffuse peritonitis (13.8%). In three patients (4.6%), may be diffi cult due to the wide variety of pathological processes which may involve the diagnosis of gangrenous appendicitis was made surgically and pathologically, the right iliac fossa. Imaging may be helpful in diagnosis. since none of the above combinations of CT fi ndings were observed. Imaging Findings: Abnormal masses of the right iliac fossa illustrated in this Conclusion: Our study suugests fi ve different combinations of specifi c CT fi ndings, educational exhibit include appendicitis, appendicular abscess, mucinous ad- which can provide a safe diagnosis of gangrenous appendicitis, thus resulting in enocarcinoma of the appendix, Cecal carcinoma, typhlitis, omental strangulation, prompt surgical treatment, before rupture of the appendix and other serious as- infl ammatory bowel disease, ileocecal tuberculosis, and ileocolic intussusception as sociated complications occur. well as abnormalitis outside the gastrointestinal tract, which may be considered in the differential diagnosis. Peculiar imaging features on different imaging modalities including ultrasonography, multidetector CT, scintigraphy, barium studies, and MR C-394 imaging with their pathological correlation will be presented. CT-colonography (CTC): Which are the right scanner parameters to use? Conclusion: Modern imaging modalities are helpful for the correct diagnosis of of P. Paolantonio, F. Iafrate, R. Ferrari, M. Rengo, F. Vecchietti, A. Laghi; Latina/IT patients with symptoms related to the right iliac fossa. ([email protected]) Learning Objectives: To describe acquisition parameters of CT-colonography C-397 protocols using different scanners generations moving from single slice spiral Ct The role of MDCT-colonography in the pre-surgical staging and restaging to the 64-MDCT. of rectal cancer, treated with preoperative neoadjuvant therapy Background: Nowadays, the "panorama" of technical approaches for CTC is ex- J.M. Pienkowska, E. Szurowska, J. Wierzbowski, A. Bianek-Bodzak, G. Rompa, panding offering a wide spectrum of different possibilities. As technology continues M. Czarnowska-Cubała, M. Studniarek; Gdansk/PL ([email protected]) to advance, there will be a continuing need to reassess the relative tradeoffs between scan width, image noise, patient dose, image artefacts, breath-hold times, and the Purpose: Preoperative radiotherapy with or without chemotherapy in the manage- number of reconstructed images to be viewed and archived. ment of patients with locally advanced rectal cancer allows to decrease tumor size Procedure Details: We will discuss the relationship between collimation, tube and stage, improves sphincter preservation and the ability to perform a curative current settings, patient dose exposure and accuracy in polyp detection of various resection. The aim of this study was the estimation of the role of MDCT-colonography CTC protocols valid for different scanner generations. We will offer some practical in the pre-surgical staging and restaging of rectal cancer, treated with pre-operative guidelines for CTC technique based on evidences of literature and on our personal neoadjuvant therapy. experience of more than 800 CTC examinations performed on different scanners Methods and Materials: Twenty-eight selected patients with histologically proven generation including a 64-MDCT (VCT; GE). rectal cancer with initial stage T3/4, N+ and M0 were studied. All patients under- Conclusion: A single scanning protocol with identical parameters for all scanners went MDCT-colonography with use of a standard protocol for preoperative staging and patients cannot be recommended due to technological differences as well as before and 2-4 weeks after radio/radiochemotherapy. Pre-operative TNM staging different clinical indications to CTC. What is possible is to offer general guidelines was correlated with surgical/histological fi ndings. according to the consensus statement on CTC. Collimation should not be larger Results: Histopathological evaluation of the resected tumor revealed complete than 5 mm for SSCT and no larger than 3 mm for MDCT. With the advent of 64- response in one patient, partial response in 18 and stable disease in 9. Reduction slice MDCT, sub-millimeter collimation will be mandatory, although clinical benefi ts in tumors size was signifi cantly greater in responders than in non-responders and are still unclear. indicated a good reaction to therapy. 67% patients showed tumor downstaging and only 7% nodal downstaging after TNM restaging. MDCT correctly staged T in 22 (78.5%) cases, T was overstaged in 6 (21.5%) due to peritumoral post-therapeu- C-395 tic fi brosis. MDCT correctly staged N in 21 (75%), overstaged in 5 (17.8%) and MR colonography with fecal tagging technique: Findings in patients with understaged in 2 (7.2%) cases. infl ammatory bowel disease Conclusion: MDCT-colonography is an accurate procedure for pre-operative staging F. Donati, P. Boraschi, R. Gigoni, A. Costa, A. Volpi, S. Spallanzani, F. Falaschi, and restaging TNM classifi cation in patients with rectal cancer treated with neoad- C. Bartolozzi; Pisa/IT ([email protected]) juvant therapy and can be used for treatment planning. The greatest diffi culty was Purpose: To evaluate the usefulness of MR colonography (MRC) with fecal tagging distinction between T2 and T3 stage due to peritumoral post-therapeutic fi brosis.
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G ammation and Coimbra/PT 50%. We We established adjuvant 50%. ± ux, hernia, or motility disorders are C ndings: 1029 LNs were dissected and 1029 LNs were ndings: BDEF ndings: In a total of 421LNs, 14% of type In a total of 421LNs, ndings: A Clinical evaluation: Fifty-three consecutive patients who Fifty-three consecutive Clinical evaluation: ed into 3 types prior to CRT; solid type (type S): isodensity solid type (type S): ed into 3 types prior to CRT; To demonstrate the capacities of single contrast esophagog- contrast the capacities of single demonstrate To stulas with pleural or bronchial communication and vascular and vascular or bronchial communication stulas with pleural We made a retrospective review of barium at studies performed review made a retrospective We 0.0001). We established adjuvant criteria with the results as follows: criteria adjuvant with the results as follows: established We 0.0001). Chiba/JP Despite the current focus on cross-sectional imaging studies such Despite the current focus < Digital cineradiography is a suitable technique for evaluating the evaluating technique for is a suitable Digital cineradiography Single contrast esophagography is an available, rapid, cost-effective cost-effective rapid, is an available, esophagography Single contrast Using these adjuvant CT criteria, the diagnostic value of CT may CT criteria, of CT may Using these adjuvant the diagnostic value To evaluate the enhancement pattern of metastatic mediastinal lymph evaluate To In all patients, the evaluation of oesophageal motility disorder was pos- disorder was of oesophageal motility the evaluation In all patients, Clinical metastasis and CT fi ned as metastatic with change in size over over ned as metastatic with change in size ([email protected]) ([email protected]) Learning Objectives: in the diagnosis and characterization of esophageal benign diseases. raphy Background: continues barium examination and Magnetic Resonance, as computed tomography of patients with clinical to be the primary the evaluation modality for radiologic ndings of esophageal disease. fi Details: Procedure in patients with complains of dysphagia, odynophagia our institution in the last year with a 50% w/v barium after 6 hours of fasting, done Studies are always or pyrosis. Exams suspect. was discontinuity when wall contrast suspension or iodated oral uoroscopic control, and images are obtained in upright left under fl are performed Decubitus positioning and and rightposterior position. posterior oblique oblique manoeuvres are usually triedpostural when refl trac- of Zenker’s, present a pictorial we review our iconography, With suspected. of cricopharygeus failure varices, rings, webs, tion and epiphrenic diverticulums, relaxation, achalasia, diffuse esophageal spasm, hernias with and without asso- giant esophagitis, candida caustic or peptic stenosis, ciation with gastric volvulus, fi polyp, brovascular fi compressions. extrinsic Conclusion: which permits a good representation of esophagus innocuous exam, and relatively distensibility and contractility. morphology, oesophagus and oesophagogastric junction were also examined. The water siphon The water and oesophagogastricoesophagus also examined. junction were of the procedure. at the end performed test was Results: high and barium retention in of the disorder was of them, the grade In 18 sible. of liquid barium Owing to the stagnation in the also detected. the oesophagus was possible of oesophagogastric junction was terminal the evaluation oesophagus, presented a hiatus hernia 7 Of these patients, and 8 a gastro- only in 10 patients. ux. oesophageal refl Conclusion: Sclerodermia. by functional abnormalities of the oesophagus in patients affected evaluated histologically. When the criteria 84% the sensitivity was applied, were histologically. evaluated 98%. city was and the specifi Conclusion: reports compared to previous of poor sensitivity due to infl improve anthracosis. C-402 cancer node of esophageal Enhancement pattern of metastatic lymph using thin-section MDCT Ochiai, T. Sato, Narushima, A. K. Aoyagi, T. Hayano, Okazumi, K. S. Shuto, K. Yanagawa; N. Purpose: Adjuvant type R. type I, or any mm, round-shaped 10 round-shaped type S over CT criteria in comparison with histological fi C-401 of the diagnosis for of single contrast esophagography Contribution diseases benign esophageal Ilharco; J. Donato, P. Oliveira, Belo P. Rodrigues, H.M.V.F. adjuvant nodes (LN) of esophageal cancer using thin-section MDCT to establish metastasis. CT criteria for Methods and Materials: mm MDCT with 1.25 enrolled. were (CRT) therapy chemoradiation underwent The enhancement pat- prior after CRT. performed to and 3 weeks was thickness tern classifi of LNs were mosaic enhancement with spicular or with regular margin, irregular type (type I): LNs with peripheral enhancement. hypodensity unclear margin, rim type (type R): defi were another 50 Histological Evaluation: enhancement pattern. CT criteria evaluating with lymphadenectomy. esophagectomy radical underwent patients consecutive assessed priorLNs were to surgery based on the CT criteria, compared with and ndings subsequently. histological fi Results: assessed as metastatic with statistical 67% of type I and 91% of type R were S, (P difference ow
/s vs 1.756 2 /s vs 0.830 x 2 mm ow volume and volume ow -3 Zagreb/HR mm . We evaluated the evaluated We . -3 2 ([email protected]) ([email protected])
Chiba/JP Scientific and Educational Exhibits Scientific and Educational Transabdominal Doppler US and endoscopy were were endoscopy Doppler US and Transabdominal From June 2004 to February 2006, 30 patients (12 male; 2004 to February 2006, 30 patients (12 male; June From Thirteen consecutive patients with advanced esophageal esophageal Thirteen patients with advanced consecutive ([email protected]) ([email protected])
3 cantly different among groups of patients with different variceal variceal of patients with different among groups cantly different 8 ow velocity did not depend on the presence of red signs and velocity ow
0.0001). The mean ADC value of the responder group was sig- was of the responder group The mean ADC value 0.0001).
< d d cantly higher, while PPG was lower in patients with, than in patients in patients with, than lower while PPG was cantly higher, n According to our results, transabdominal Doppler US might be of transabdominal According to our results, This non-invasive modality could be a valid clinical diagnostic modality modality could be a valid This non-invasive i . N /s, p /s, I The aim of the study was to evaluate the role of Doppler ultrasonography the role of Doppler ultrasonography to evaluate The aim of the study was 2 The aim of the study was to determineThe aim of the study was the oesophageal functional abnor- To evaluate the effect of chemoradiation therapy for advanced esophageal advanced for therapy of chemoradiation the effect evaluate To Palermo/IT F Values of portal diameter, cross-sectional area, blood fl cross-sectional area, blood of portal diameter, Values Eight patients were responder and 5 were non-responder. All tumors non-responder. responder and 5 were Eight patients were /s, p=0.0054). /s, - 2 c u mm d -3 mm E i -3 c S - without variceal red signs. Only diameter, cross-sectional area, and blood fl and blood cross-sectional area, Only diameter, red signs. without variceal CI were signifi CI were signifi were volume sizes. The blood fl The blood sizes. - of signifi did not reach level In addition, recorded US parameters size. variceal The sensitivities, Child-Pugh score. of patients with different groups cance between were US parameters curves of the analyzed and areas under ROC cities, specifi 62.5-82%, 47.2-79.8%, and 0.79-0.89, respectively. Conclusion: value in non-invasive assessment of the risk of esophageal variceal bleeding in assessment of the risk bleeding of esophageal variceal in non-invasive value cirrhosis. patients with liver x 10 18 female, mean age 43) with Sclerodermia were examined. A digital cineradiog- mean age 43) with Sclerodermia examined. were 18 female, in all patients using bolus performed was acquisition with 6 frames/second raphy In 10 patients standing in the left barium. ml of liquid (60% weight/volume) of 30 right position and prone in the posterior position, the posterior oblique oblique C-400 sclerodermia by in patients affected cineradiography Esophageal Lo Greco, V. D’Agostino, T. Runza, G. Taibbi, Bartolotta, A. T. Galia, M. Lo Re, G. Midiri; M. Purpose: examination. malities in patients with Sclerodermia using a digital cineradiography Methods and Materials: C-399 of Doppler ultrasonography The role bleeding: variceal Risk of esophageal Potocki; Plestina, K. S. Stern-Padovan, Plestina, R. S. Kralik, M. performed in 38 patients (26 male, 12 female, mean age 54.8 years) with liver with liver mean age 54.8 years) 12 female, in 38 patients (26 male, performed and the presence of red signs size The variceal cirrhosis and esophageal varices. of the portal US parameters were vein Following determined endoscopy. were by ow fl and blood velocity ow fl diameter and cross-sectional area, blood recorded: Child-Pugh (CI). (PPG), and congestion index perfusion pressure gradient volume, compared were The US parameters also determined. function was score of liver risk. to the endoscopic signs of esophageal bleeding Results: (US) of the portal vein in assessing the risk of esophageal variceal bleeding in (US) of the portal in assessing the risk bleeding variceal of esophageal vein cirrhosis. patients with liver Methods and Materials: Purpose: ([email protected]) Purpose: Evaluation of chemoradiation effect for advanced esophageal cancer using esophageal advanced for effect of chemoradiation Evaluation A pilot study resonance imaging: diffusion-weighted magnetic Narushima, K. Hayano, Mochizuki, K. R. Shuto, Okazumi, K. S. Aoyagi, T. Yanagawa; Ochiai, N. T. Saitoh, H. Satoh, A. measuring resonance imaging (DWI) magnetic cancer using diffusion-weighted cient (ADC) value. coeffi tumor apparent diffusion Methods and Materials: Esophagus Esophagus C-398 participated esophagus squamous cell cancer of thoracic study. in this prospective using a performed was DWI (CRT). therapy chemoradiation All patients underwent A single-shot body coil. T whole body scanner equipped with a phased-array 1.5 in the diffusion weighting spin-echo type of echo-planar sequence that provided b- The corresponding images. used to obtain DW direction of slice selection was b=1000 s/mm were to the diffusion sensitizing gradients value GI Tract GI Tract Conclusion: to predict the outcome of CRT of advanced esophageal cancer. esophageal cancer. of advanced to predict the outcome of CRT 10 DW images measuring the ADC value of the tumor and compared it with the effect it with the effect of the tumor and compared images measuring the ADC value DW WHO criteria, using assessed according to the was effect The therapeutic of CRT. after the treatment. 4 weeks MDCT and esophagography contrast-enhanced Results: of the tumor was The mean ADC value 100%). (accuracy DWI detected by were than that of the normal esophagus (1.004 x 10 cantly lower signifi x 10 (1.187 cantly higher than that of non-responder group nifi C - 7 0 R C EECR07-C-SciEduc-FIN.indd 83 Scientific and Educational Exhibits
C-403 GI Tract Pictorial review of achalasia and pseudoachalasia: A diagnostic conundrum N.K.K. Venkatanarasimha1, B. Drake1, V. Raju2, N. Manghat1, S.A. Jackson1; Rectum 1Plymouth/UK, 2Torquay/UK ([email protected])
Learning Objectives: To present a pictorial review of the radiological appearances C-405 of Achalasia and Pseudoachalasia with emphasis on endoscopic correlation. Does radiotherapy have an effect on the accuracy of TRUS in patients with Background: Barium swallow remains a valuable imaging modality in patients rectal cancer? presenting with dysphagia. Pathologies such as achalasia and pseudoachalasia S.R. Rafaelsen, T. Sørensen, A. Jakobsen, C. Bisgaard, J. Lindebjerg; Vejle/DK can be diffi cult to distinguish on barium swallow as typical fi ndings may not always ([email protected]) be apparent. Recognising the various radiographic appearances by the radiologist Purpose: To evaluate the effect of radiotherapy on the accuracy of preoperative is critical for prompt and accurate patient management. transrectal ultrasound (TRUS) in patients with rectal cancer. Imaging Findings: We present a case series of achalasia and pseudoachalasia on Methods and Materials: The study included 218 consecutive patients with biopsy- barium swallow encountered at our institution. We emphasise the differences between proven rectal cancer: Male:female, 128:90; age range, 38-89 (mean 67.2) years. A the two pathologies both on imaging and on text as a learning experience. We also 6.5 MHz transrectal transducer (Siemens) with tissue harmonic imaging was used. provide a review of the existing literature with reference to our experience. 134 patients were treated with surgery alone and 84 patients (29 with 5x5 Gy and Conclusion: Barium swallow is an established method for evaluating patients 55 with 60 Gy) were treated with preoperative pelvic radiotherapy. A complete with dysphagia. However achalasia and pseudoachalasia still remain diffi cult to EPOS postoperative histopathological examination was used as the gold standard. distinguish; so awareness of the potential pitfalls with endoscopic correlation in all Results: In pathology 73 of 218 (33%) tumors were classifi ed as T0-T2, and 145 cases is emphasised to avoid radiological misdiagnosis. (67%) were classifi ed as T3-T4. TRUS had an accuracy of 90% in detecting penetra- tion of the rectal wall in the 134 patients treated with surgery alone. The accuracy C-404 of TRUS in patients treated with 5x5 Gy was 82.3% (NS), and in patients treated Late evaluation of the swallowing function in patients with maxillofacial with 60 Gy, the accuracy was 55.2 % (p < 0.001). A high sensitivity was noted in all gunshot injuries by multimodality radiologic and complementary methods groups; however, theNo specifi Material city of TRUS Submitted rapidly decreased to to zero with increased Z.U. Coskun1, S. Ozturk2; 1Bilkent, Ankara/TR, 2Etlik, Ankara/TR pelvic radiotherapy intensity, as the false-positives increased because of tumour ([email protected]) shrinkage. This change in accuracy was not seen to the same extent with regard to lymph node metastases. Purpose: Maxillofacial (MF) gunshot wounds having a tract between the mouth Conclusion: TRUS has a high accuracy in patients treated with surgery alone. fl oor and the naso-orbital region may result in long-term swallowing disorders. Here, The T-staging accuracy of TRUS is low in patients receiving high-dose pelvic we aimed to show late functional outcomes of the primary surgical treatments by radiotherapy due to down staging. using objective radiologic and complementary studies. Methods and Materials: 20 patients were included in the study. The mean age was 21±3. Free osteocutaneous fi bula fl aps, iliac or calvarial bone grafts were used C-406 with fasciacutaneous fl aps. Dento-palatal restorations were accomplished with Usefulness of perfusion CT for assessing pathological features of rectal dental and prostetic obturator implants. Functional outcomes were assessed by: cancer Videofl uoroscopy, Cine-MRI, Submental USG, Fiberoptic endoscopic swallowing K. Hayano, S. Okazumi, K. Shuto, R. Mochizuki, T. Aoyagi, K. Narushima, study (FEES), Functional EMG. The results were compared to the control group A. Sato, H. Saito, N. Yanagawa, T. Ochiai; Chiba/JP (N:10) statistically. ([email protected]) Results: Videofl uoroscopic studies showed pooling in vallecula and pyriform si- Purpose: The purpose of this study is to evaluate perfusion CT in assessing nuses (n:16), delayed pharyngeal (n:12) and oral transit times (n:12), spilling out pathological features of rectal cancer before surgery. due to oral incompetence (n:10), nasal regurgitation (n:8), sublingual pooling (n:4), Methods and Materials: Forty consecutive patients (23 men, 17 women; median multiple swallowing action (n:3), and aspiration (n:2). Cine-MRI revealed reduced la- age 62.8 years) with rectal cancer underwent perfusion CT, using the commercially ryngeal elevation (15.4 mm) and epiglottic angle (10.5o). Discordance and impaired available CT Perfusion 3 software (GE Medical Systems, Milwaukee, WI). All pa- oral fl oor muscles were observed. Submental USG showed insuffi cient tongue tients were followed by surgery, and we retrospectively investigated the correlations movement resulting in bolus formation and transit impairment (n:8), restricted hyoid between perfusion parameters and pathological features (wall invasion, histological elevation (n:12), and submental muscle defects (n:12). FEES revealed pooling in differentiation, lymph node metastasis, Dukes’ classifi cation). Statistical analysis vallecula and pyriform sinuses (n:16), delayed epiglot closure (n:12) and impaired was performed with Mann-Whitney U test for comparison of two data sets, and swallowing apnea (n:2). Functional EMG showed lower amplitude of submental Kruskal-Wallis test for comparison of multiple data sets. P < 0.05 was considered and pharyngeal constrictors (n:12). to indicate a statistically signifi cant difference. Conclusion: Clinically, knowing the radiopathologic fi ndings in such patients may Results: There were no correlations between perfusion parameters and wall in- help the clinician in determining an algorithm to manage the secondary deformi- vasion. Well-differentiated tumors showed signifi cantly higher blood fl ow than the ties as well as adding new surgical techniques such as replacement of submental moderately-differentiated tumors (P = 0.03). There was a signifi cant tendency for muscles by functional muscle fl aps during primary surgery. the tumor with low blood fl ow, low blood volume or long mean transit time to show lymph node metastasis (P = 0.006, 0.01, 0.001, respectively). And there was a signifi cant correlation between Dukes’ classifi cation and blood fl ow (P < 0.0001), blood volume (P = 0.002), mean transit time (P = 0.001), and permeability surface area product (P = 0.004). Conclusion: In the near future, perfusion CT may help to assess pathological features of rectal cancer before surgery. C-407 Which are the most important predictive criteria for USPIO MRI in nodal staging of patients with primary rectal cancer? M.J. Lahaye1, S. Engelen1, A.G.H. Kessels1, A.P. de Bruïne1, M.F. von Meyenfeldt1, J.M.A. van Engelshoven1, C.J.H. van de Velde2, G.L. Beets1, R.G.H. Beets-Tan1; 1Maastricht/NL, 2Leiden/NL
Purpose: To determine the most important predictive factors for USPIO MRI in nodal staging in rectal cancer patients. Methods and Materials: Twenty-eight patients were included for the study. Se- quences used were 2DT2WFSE, 3DT1WGRE and 3DT2*. Gold standard was histology. A MR radiologist, blinded for histological results, evaluated each node on T2*-weighted images for: border and estimated ratio of the area of white region
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7 0 0 ng 2 . 2 415 0 . 2 112.02.2007 17:03:59 Paris/FR Paris/FR G C oor manoveurs by MRI T2-weighted T2-weighted MRI by oor manoveurs BDEF ltrative behaviour. Villous tumors are large behaviour. ltrative A can be helpful in c CT and MR imaging features oor excursion and the involvement of the middle of and the involvement oor excursion ed as epidermoid dermoid enteric cysts, cysts ac- cysts, To review the MDCT and pelvic MRI features of unusual of unusual the MDCT and pelvic MRI features review To To review the MR imaging features of the spectrum of cystic imaging features the MR review To To report retrospectively our series of 20 female incontinence report our series of 20 female retrospectively To Mucinous anorectal adenocarcinomas are characterised by a Mucinous anorectal adenocarcinomas are characterised by Dynamic MRI and Colpocystodefecography assessed 20 peri- Dynamic MRI and Colpocystodefecography Although adenocarcinoma is the most frequently encountered rectal Although adenocarcinoma is the most frequently encountered In patients with incontinence disturbances, dynamic MRI and Colpo- disturbances, In patients with incontinence Developmental cysts are the most common retrorectal cystic lesions Developmental Compared to Colpocystodefecography, Dynamic MRI of Pelvic Floor Dynamic MRI of Pelvic Compared to Colpocystodefecography, Identifying key specifi Identifying key ([email protected]) ([email protected])
lling the rectal lumen and displaying frondlike projections. Anorectal stromal projections. frondlike displaying lling the rectal lumen and oor involvement in incontinence disorders. Dynamic MRI was carried out Dynamic MRI was disorders. in incontinence oor involvement diseases involving the presacral area in adults. the presacral diseases involving of these lesions. the current role of MRI in the evaluation review To Background: are classifi They in adults. present with symptoms or with a may They cording to their histopathologic features. diagnosis differential Their degeneration. or malignant complication such as infection C-412 Spectrum of lesions in adults: High-resolution MRI of presacral cystic disease Tubiana; Arrivé, J.-M. L. Mourra, N. Lewin, alo-Hazan, M. Afl V. Hoeffel, C. ([email protected]) Paris/FR Learning Objectives: C-410 (LAM) ani muscle and levator of incontinence disorders Assessment (MRI) and colpocystodefecography MR imaging dynamic by features Nunziata; A. De Feo, P. Montemarano, E. Cavallo, G. Nocera, V. Salzano, A. Naples/IT Learning Objectives: the evaluating Dynamic MRI and Colpocystodefecography, by patients examined of rectum, the pelvic fl evacuation emptying of bladder the addition, the study of the LAM activity, In pelvic organs. the mechanism of this pathology. and anorectum to better understand Background: organs and the features to study both the statics of pelvic allow cystodefecography and the advantages illustrate we Besides, and function of LAM. of MRI anatomy in studiyng in comparisonthe role of Dynamic MRI to Colpocystodefecography pelvic fl pelvic fl different with the supine patient in scans in Breathe Hold. Findings: Imaging 5 prolapses, 10 rectal wall 13 cistoceles, 12 rectoceles, neal descent syndromes, MRI enlargement of LAM hiatus as a wide cone appeared rectal intussusceptions. At signal in 3 cases. thin in 6 cases and with MRI alterated LAM was in 19 cases; larger in 15 patients with a the anal canal caliber was Colpocystodefecography, 18-33 mm). mean diameter of 27 mm (range Conclusion: of the the evaluation for investigation useful and rapid represents a non-invasive, detect perineal Dynamic MRI can accurately the clinical incontinence subjects. the surgeon important giving to disorder and the descent syndrome, both fecal the therapy. ndings for and urinary MRI fi C-411 and their mimickers rectal tumors of unusual CT and MR features Tubiana; Arrivé, J.-M. L. Lewin, M. Mourra, N. Raynal, M. Hoeffel, C. ([email protected]) Learning Objectives: illustrate To features. anorectal tumors correlated with their clinical and pathological the current role of CT and MRI review To diagnosis. and differential their mimickers in their evaluation. Background: of less common anorectal cross-sectional imaging features with the familiarity tumor, diagnosis is important as of their differential because their prognosis tumors as well will describe we the CT and MRI features In this exhibit, and treatment are different. of such lesions based on a series of 30 patients treated in our department since 2003 with a pathologic correlation. Details: Procedure an enhancing solid compo- images, T2-weighted content on hyperintense markedly nent within the mass and their highly infi masses fi peri- and lack the rectal wall masses expanding well-marginated tumors are large, engulfi concentric thickening marked wall display Lymphomas rectal adenopathy. the rectum, with luminal restriction but minor obstruction and adenopathies. Linitis minor obstructionthe rectum, with luminal restriction and adenopathies. but a over of the rectal wall thickening a circumferential and rectal metastases display melanoma, anal Other uncommon tumors include carcinoid tumor, long segment. diffuse rectal angiomatosis, diagnosis include Crohn disease, Differential condyloma. diverticulitis. rectal endometriosis, changes after radiotherapy, Conclusion: suggesting a diagnosis. MRI is a modality of choice to evaluate unusual anorectal unusual MRI is a modality of choice to evaluate suggesting a diagnosis. neoplasms. 3 (66.7%, 2
(71.4%,10/14), T 2 Aviano/IT it still has but ltration, in found cient r = -0.6) was Shanghai/CN city 100%, sensitivity 71%) (58.8%, 10/17), N 1 uorouracil or Raltitrexed-based or Raltitrexed-based uorouracil Scientific and Educational Exhibits Scientific and Educational (52.2%, 12/23), N 0 city, positive predictive value, and negative predic- and negative value, predictive positive city, 80% and TRG values of 1 and 2 (no residual disease or of 1 and TRG values 80% and Fifty-six patients with histologically proved rectal carci- Fifty-six patients with histologically proved Twenty-three patients with advanced rectal cancer (T3-T4) rectal cancer patients with advanced Twenty-three > cant correlation was found between T measurement with MRI between found cant correlation was 5 8
d d While PET provides reliable metabolic information about tumour about metabolic information reliable PET provides While n High-spatial-resolution MR imaging accurately indicates the tumor High-spatial-resolution MR imaging accurately The estimated ratio of white area within the node and the measured Ra- of white area within the node The estimated ratio i . N I To compare the diagnostic performance of PET and MRI in correctly compare the diagnostic performance To To evaluate the accuracy of high-spatial-resolution MR imaging in pre- of high-spatial-resolution the accuracy evaluate To F A lesion-by-lesion analysis of 228 lymph nodes was feasible. The area feasible. analysis of 228 lymph nodes was A lesion-by-lesion Strong correlation (Spearman correlation coeffi The accuracy of the MRI T staging was 83.9%(47/56): T 83.9%(47/56): T staging was of the MRI The accuracy - 75.5%, 3/4). Sensitivity, specifi city, positive predictive value, and negative and negative value, predictive positive city, specifi Sensitivity, 75.5%, 3/4). c 3 ( u d E i c S - microscopic active disease). Strong correlation (specifi disease). microscopic active was found between CRM measurement with MRI and on the surgical specimen. measurement with MRI and on the surgical specimen. CRM between found was No statistically signifi and on the surgical specimen. Conclusion: response to therapy, MRI provides reliable measurement of CRM. Both modalities measurement of CRM. reliable MRI provides response to therapy, surgery. to correctly restage patients before be performed must ([email protected]) ([email protected]) Purpose: radio- with neo-adjuvant rectal cancer treated restage patients with advanced surgery. before chemotherapy Methods and Materials: were studied with PET and MRI before and after 5-fl studied with PET and MRI before were chemotherapy and 45-50 Gy of radiation therapy. Pre-surgical scanning was per- Pre-surgical scanning was therapy. and 45-50 Gy of radiation chemotherapy compared the results were after the end of the chemoradiation; 6 to 8 weeks formed considered tumour response was PET, Particularly for to the surgical specimen. (SUV) percentage decrease related to Value Uptake Standardized evaluating MRI, tumour response was For (TRG) at pathology. Grading Regression Tumour TNM system. according to the and size (1) tumour extension considered evaluating: Resection Margin (CRM) measurement assessing the distance (2) Circumferential tumour and mesorectal fascia. extramural between Results: SUV decrease between predictive value of MRI in detecting lymph node invasion were 63.3% (19/30), were of MRI in detecting lymph node invasion value predictive 52.2%(12/23), 65.5%(19/29), and 52.5% (12/23), respectively. Conclusion: tumor infi staging of rectal carcinoma and depth of extramural a low accuracy rate for detecting metastatic lymph node. detecting metastatic lymph node. for rate accuracy a low (86.8%,33/38). Sensitivity, specifi Sensitivity, (86.8%,33/38). tive value of MRI in detecting invasion through the bowel wall were 87.8%(36/41), were wall through the bowel of MRI in detecting invasion value tive of MRI The accuracy 73.3%(11/15), 90.0%(36/40), and 68.6%(11/16), respectively. N 67.9%(36/53): N staging was C-409 on high-spatial-resolution MR of rectal carcinoma Preoperative staging Li; X.Q. Mao, J. Tang, Cai, F. S.J. Peng, W.J. Zhang, S. Purpose: staging of rectal carcinoma operative Methods and Materials: staged preopera- high-spatial-resolution MR imaging and were noma underwent TNM staging system. done according to the The rectal carcinoma staging was tively. histopathologic MRI staging of rectal carcinoma and postoperative Preoperative T staging and N staging were of the MRI The accuracy compared. staging were calculated. Results: C-408 (PET) and emission tomography with positron evaluation Pre-surgical rectal advanced (MRI) of patients with locally resonance imaging magnetic radio-chemotherapy cancer treated with neo-adjuvant Morassut; Cimitan, S. M. Talamini, Borsatti, R. Balestreri, E. L. tioA were very accurate for distinguishing between malignant and benign nodes. nodes. malignant and benign distinguishing between for very accurate tioA were under the ROC curve (AUC) of border, short long axis of the total node were and of border, curve (AUC) under the ROC percentage and mea- the estimated for The AUC 0.66, 0.65 and 0.72. respectively The 0.95, respectively. 0.93 and within the node were sured RatioA of white region of the ratios: The AUC in 207 lymph nodes. be positioned could accurately ROI 0.76 and 0.90. respectively SIwhite/SIdark were and SITN/SImuscle Conclusion: within the node versus the size of the total node, categorized as 50%. This ratio was was This ratio 50%. as categorized total node, of the the size versus within the node and short the long calculated (RatioA) by axis diameter measurements objectively Regions of inter- node and the total node. of white region within the of both the area (SImuscle), the signal intensity (SI) within muscle used to measure were est (ROI) These and darktotal node (SITN), white (SIwhite) (SIdark) node. region within the SIwhite/SIdark SITN/SImuscle. and used to calculate the ratios: measurements were performed. was analysis characteristic (ROC) operating A receiver Results: 6/9), N C - 7 0 R C EECR07-C-SciEduc-FIN.indd 85 Scientific and Educational Exhibits
is varied. We review the MR imaging fi ndings with pathologic correlation of presacral C-415 cystic masses based on a series of 25 patients treated in our department. Diagnosis and follow-up of anoperineal fi stuals with phased-array MRI: A Imaging Findings: Developmental cysts, among which tailgut cysts are the most pictorial review frequent are characterized by well-defi ned, multilocular cysts with "daughter cysts". F. González, G. Blanco, C. Juanco, N. Valle, M. Lopez, M. Silvan; Santander/ES Their wall is usually thin unless they are complicated. An enhancing wall with peri cystic infl ammation suggests infl ammation and additional internal enhancement Learning Objectives: To describe the anatomy and imaging features of acquired evokes malignant degeneration. Their signal intensity is variable, usually homoge- anorectal fi stulas. To identify the MRI fi ndings in the various types of anorectal fi s- neous, either isointense to muscle on T1-weighted images and isointense to fat on tulas. To review the role of MRI in the assessment of acquired anorectal fi stulas. T2-weighted images or hyperintense on T1/hyperintense on T2 depending on their Background: The most commonly encountered and known anorectal fi stulas are content. Differential diagnosis includes anterior sacral meningocele, recurrence of anorectoperineal fi stulas occuring in Crohns disease. However, there is a variety mucinous rectal adenocarcinoma, cystic lymphangioma, necrotic sacral chordoma of less common fi stulas involving the anorectum. TheirEPOS causes include infection, or leiomyoma, pyogenic abscess, schwannoma, peritoneal pseudocyst. infl ammation, neoplasms, trauma and iatrogenic injury. Pelvic MRI assessment Conclusion: Most lesions of the retrorectal space are developmental cysts but the has proved useful in the evaluation of fi stulas and has become an important part differential diagnosis must be known. Knowledge of the key imaging features of of diagnostic work-up before proper case management. the retrorectal cystic lesions may help suggest the diagnosis and the information Imaging Findings: We illustrate the MR fi ndings in fi stulas involving the rectum or needed to plan treatment. anal canal or ileal or colonic pouch (in case of previous surgery) and the vagina, uterus, prostate, urethra, bladder, and ileum. We also present the features of com- C-413 plex anoperineal fi stulas.No Material The current Submitted role of MRI is to discussed. We emphasize the role of MRI in the follow-up after medical or surgical treatment. Preoperative N staging of rectal cancer evaluating from morphological Conclusion: Phased-array pelvic MRI is an accurate technique for the identifi cation feature using magnetic resonance imaging of acquired anorectal fi stulas and their complications. MRI exam is a noninvasive T. Sazuka, S. Okazumi, K. Shuto, T. Aoyagi, H. Makino, R. Mochizuki, T. Ochiai, diagnosis method that allows us an accurate diagnosis and follow-up in patients N. Yanagawa; Chiba/JP with anoperineal fi stulas. Purpose: The purpose of this study is to evaluate the accuracy of magnetic resonance imaging (MRI) in N staging of rectal cancer and to compare histological fi ndings. Methods and Materials: Eighty-six patients of rectal cancer were enrolled in this study. All of the patients underwent surgery and proved histologically. Prior to treatment, MRI was performed with T2-weighted fast spin echo sequences using a 1.5 T whole body scanner equipped with a phased-array body coil. Following fi lling the rectum with air of 200-250 ml from a placed tube, images were acquired with a slice thickness of 8 mm. Every reconstruct axial, coronal and sagittal images of each node was evaluated. We classifi ed lymph nodes over 5 mm by 3 morphological features as follows: solitary/ confl uent, margin clear/ spicular, shaped fl at/ round. And we assessed those features in comparison with histological fi ndings. Results: A total of 313 nodules were evaluated. All of confl uent nodules (N=11) were histologically metastatic (PPV 100%, specifi city 100%). When we defi ne metastatic node as any features of confl uent nodule, irregular margin or round shaped, the sensitivity was 91% and the specifi city 91%, PPV 78% and NPV 97% in comparison with histological fi ndings. Conclusion: This diagnostic method classifying by morphological features is noninvasive and may be valid with an acceptable detectability by no means inferior to enhanced or radiological modality. C-414 Dynamic magnetic resonance imaging (MRI) evaluation of levator ani muscle (LAM) in patients with wall prolapse and intussusception pathologies of the rectum A. Salzano, V. Nocera, G. Cavallo, E. Montemarano, P. De Feo, A. Nunziata; Naples/IT ([email protected])
Learning Objectives: To describe MRI dynamic appearance of LAM in patients with rectal wall prolapse and intussusception, outlining the role and the advantages of dynamic MRI for the assessment of anatomic and functional study of LAM and evacuation disorders. Background: Dynamic MRI allows to evaluate morphology and pathomorpho- logic changes of the LAM during defecation. Defecography well assesses rectal prolapses, but does not provide imaging of muscles of pelvic fl oor except indirect signs. Dynamic MRI provides a whole and direct visualization both anatomical and functional of LAM and rectal prolapses. We illustrate a study of 23 female subjects (mean age of 61 years; range 47-74 years) previously investigated by Defecography in order to obstructed evacuation. Imaging Findings: Dynamic MRI was carried out in different dynamic phases of pelvic fl oor, in Breathe Hold using T2-weighted scans. We diagnosed 16 rectal wall prolapses and 8 intussusceptions; all patients had rectocele and perineal descent syndrome. LAM had reducted thickness in 16 cases and alterated signal in 4 cases. Levator hiatus was large in 19 cases in the coronal plane with a typical shape of large cone. We focused a relationship between hiatal area, movements of rectal walls and descent of pelvic fl oor. Conclusion: Dynamic MRI is considered a novel noninvasive imaging method of investigation in comparison to Defecography, to understand the dynamics of LAM and the pelvic fl oor descent disorders. MRI provides better the relationship of rectal intussusception and wall prolapse related to pelvic organ mobility and dynamic shape changes of LAM.
416 A BDEFC G
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7 0 0 2 . cient 2 417 0 . 2 112.02.2007 17:04:00 G ed from Assche ed from Assche ed as the following ed as the following
stulas due to Crohn´s disease stulas due to Crohn´s disease Rome/IT C BDEF A We prospectively studied 52 patients who underwent studied 52 patients who underwent prospectively We Patients with perianal fi Patients In 15 patients with known Peutz-Jeghers polyposis in the Peutz-Jeghers In 15 patients with known iximab is an effective treatment for patients with perianal treatment for iximab is an effective stulizing Crohn´s disease patients. To compare clinical and To Crohn´s disease patients. stulizing stulous pathology. We use a 1.5 T system (Magnetom Avanto T system (Magnetom Avanto use a 1.5 We stulous pathology. ([email protected])
Oral Infl Oral MDCT virtual enteroscopy in Peutz-Jeghers syndrome showed a high syndrome showed MDCT virtual in Peutz-Jeghers enteroscopy The purpose of this study is to evaluate the diagnostic accuracy of multi- the diagnostic accuracy The purpose of this study is to evaluate Hamartomas in the case are usually considered histologically benign, but Twelve patients were included in our study. Six (50%) achieved complete Six (50%) achieved included in our study. patients were Twelve Good small bowel distension was obtained in 13 cases, and suffi obtained in 13 cases, distension was Good small bowel The radiological prevalent subtype was the active subtype. The sensitivity, The sensitivity, subtype. the active subtype was prevalent The radiological ndings in these patients, using the perianal Crohn´s disease activity index the perianal using disease activity index Crohn´s patients, ndings in these therapy in perianal fi therapy MRI fi the evaluate To score (MRS). resonance imaging-based and magnetic (PCDAI) of this pathology. diagnosis and follow-up cacy of MRI in the effi Methods and Materials: with pelvic MR previ- evaluated and were study, into a prospective enrolled were to observe in order of 24 months, a long-termous to treatment and after follow-up of fi the evolution applied the MRS modifi We coil. Siemens®) with a phased-array to the images obtained. The clinical response was evaluated with the PCDAI with the PCDAI evaluated The clinical response was to the images obtained. Irvine.described by Results: no changes showed (41.6%) Five and MRS. ed with both PCDAI verifi responses, no response in and 1 (8.3%) showed in MRS with partial response in the PCDAI both MRS and PCDAI. Conclusion: the diagnosis of the method for MR is a good to Crohn´s disease. stulas due fi of the treatment and evaluation the follow-up perianal and for Crohn´s disease be of the results in clinical and MR scores may The differences of these patients. and the ¨placebo¨effect in PCDAI that are evaluated index due to the subjective of the treatment. Purpose: We there are reports patients, of malignant changes in the polyps. of Peutz-Jeghers assessment of Peutz- the tried usefulness of virtual to assess the for enteroscopy to reach a good distension in Our goal was Jeghers polyposis in the small bowel. virtual by enteroscopy. the small bowel Methods and Materials: examined were Patients performed. stomach and colon, CT virtual was enteroscopy slice 1 mm, with overlap parameters: CT scanner using the following with a 16-row administered was agent contrast reconstruction 120 intervalscans, 0.5 ml i.v. mm. mural thickening, mural evaluated We of 50 s. of 3 at a rate with a scan delay ml/s The results of MDCT enteroscopy dilatation. praestenotic enhancement, stenosis, enterography Selective and surgery. enterography compared with selective were and surgery considered the gold standard. were Results: polypoid contrast-enhancing 45 i.v. MDCT virtual showed enteroscopy in 2 cases. mm and 12 were Thirty-three than 10 smaller lesions were lesions in 8 patients. enterography Selective polyps caused intussusception. Two mm. larger than 10 MDCT virtual mm. mm, and 12 larger than 10 than 10 36 polyps smaller showed lesions smaller than per-lesion sensitivity of 91.6% for had an overall enteroscopy lesions larger than 10 mm. 10 mm, and 100% for Conclusion: sensitivity in detecting polyps smaller than 10 mm. C-420 disease: Crohn in patients with suspected small bowel CT enteroclysis with methylcellulose barium enteroclysis A comparison with conventional Bonomo; L. Poloni, G. Vecchioli, Minordi, A. L.M. C-419 detecting Peutz-Jeghers method for an acceptable Is virtual enteroscopy poliposis in the small bowel? Takács; Szilvássyné Á. Komezei, Á. Szeidl, Tóth, K. G. Turupoli, E. Budapest/HU ([email protected]) Purpose: barium enteroclysis with methylcellulose versus (MDCT-E) detector-CT-enteroclysis disease. (BE) in clinically selected patients with suspected small bowel Methods and Materials: after (16 rows), multidetector-CT-enteroclysis unenhanced and contrast-enhanced performed BE was naso-jejunal tube. by of 2-2.5 L of methylcellulose administration (1-2 L). ml) and methylcellulose of bariumafter administration 60% w/v (200-250 classifi disease were of Crohn’s signs with radiological Patients or regenerative reparative stulizing/perforating, fi brostenotic, fi active, subtypes: endoscopy. patients also underwent Twenty-eight subtypes. Results: 83%, 100% and BE was versus of MDCT-E diagnostic accuracy city and specifi CT cases due to early Crohn’s negative 5 false BE showed 89%, respectively. 1 showed cases of the CT and the BE, but rmed positive confi endoscopy disease; and BE permitted the diagnosis MDCT-E Together, case of the BE. negative false adhesions in 1 patient, lymphoma in 2 patients disease in 30 patients, of Crohn’s ; 2 iximab ndings, have have ndings, , J.M. Murphy , J.M. 2 ammatory bowel cacy of oral infl cacy of oral ([email protected]) ([email protected]) cient method to investi-
uoroscopic guidance. Dif- uoroscopic guidance. , C.J. Roche , C.J. 2 Naples/IT ammatory and neoplastic disease ed and subsequently histologically ed and Scientific and Educational Exhibits Scientific and Educational , P.A. McCarthy , P.A. 2 response in perianal iximab therapy ([email protected]) ([email protected])
([email protected]) , D. Mc Kenna , D. To illustrate the spectrum illustrate of MDCT enteroclysis techniques To Madrid/ES
ndings (i.e.parietal thickening, endoluminal or extraparietal endoluminal or extraparietal ndings (i.e.parietal thickening, 1. Understanding the different histological types of lymphoma histological types of Understanding the different 1. 2 ltrating borders causing thickening of the walls and narrowing and narrowing of the walls borders causing thickening ltrating All examinations have been performed used a 16-detector been performed have All examinations Small-bowel lymphomas are presented in wide spectrum of ap- Small-bowel 7 8
d stulas) are provided. Discussion on limitation and reliability of each stulas) are provided. d Small bowel investigation represents a diagnostic challenge for represents a diagnostic challenge for investigation Small bowel The gastrointestinal tract is the most common site of extra-nodal common site of extra-nodal is the most tract The gastrointestinal n MDCT-Enteroclysis can be considered an effi MDCT-Enteroclysis MR imaging of the small bowel has moved in the recent years and in the recent years has moved MR imaging of the small bowel rmed by this examination as well as by clinical/surgical fi as by as well rmed this examination by i . Galway/IE 2 , C. Cronin , C. N 1 I To evaluate using magnetic resonance the effi evaluate To F - c u d E i c S Dublin/IE, Dublin/IE, disease stulizing Crohn's - Learning Objectives: of each meth- limits and advantages and to outline the various of the small bowel results in infl describe different the To odology. on a selected series of 122 cases. based on experience Background: method to study seems to be a reliable (MDCT-E) MDCT-enteroclysis radiologists. techniques can be used to perform some different however, the small intestine; records and chartsThe imaging 122 patients submitted to of the examination. suspected small bowel 2006 for from January 2004 and July MDCT-enteroclysis confi disease, are described indications and results achieved The techniques, been reviewed. and illustrated. Details: Procedure after positioning of a naso-jejunal tube under fl CT, row been used, depending from clinical suspicion: enteric media have contrast ferent contrast (37 patients), iodinated water-soluble (35 patients), water methylcellulose on a dedicated worksta- been reviewed have All examinations solution (18), air (32). description of the and illustration Focused reconstructions. tion, using multiplanar pathological fi different fi lesional mass, method is extensively treated. method is extensively Conclusion: C-418 of oral infl MRI in the evaluation fi M. Casares Santiago; Casares Santiago; M. gate small bowel. Knowledge of all the different techniques in which the examina- of all the different Knowledge gate small bowel. to choose the most indicated one help the radiologist may tion can be performed depending on the clinical suspicion. Purpose: C-417 to do it? Comparison How of the small bowel: MDCT-enteroclysis optimisation and results in IBD and feasibility, of methodologies, neoplastic disease Romano; L. Grassi, R. Lombardo, P. Romano, S. Small bowel lymphoma typical appearance patterns at MR small bowel appearance patterns at MR small bowel typical lymphoma Small bowel (MR SBFT) through follow Alhajeri A. 1 Small Bowel Small Bowel C-416 GI Tract GI Tract Learning Objectives: that is of relevant importance in GI study. 2. Provide a detailed radiological analysis a detailed radiological Provide 2. importance in GI study. that is of relevant histological subtypes in various and characteristics are of particular which relevance small by provided and disadvantages Describe the advantages 3. of lymphoma. lymphoma. (MR SBFT) in studying bowel MRI follow-through bowel Background: 30% of primary lymphomas account for gastrointestinal Small-bowel lymphoma. It has reported association with long-standing populations. Western lymphomas in SLE, infl ciency syndrome, acquired immunodefi celiac disease, pearances included aneurismal dilatation, intra luminal polypoidal mass, mesenteric included aneurismal luminal polypoidal mass, pearances dilatation, intra mass with irregular infi disease, and post-organ transplantation. disease, Findings: Imaging of thickening mural present just as diffuse circumferential of the lumen and it may of the advantage MR SBFT offers lumen. with irregular narrowed walls the bowel and absence of imaging capabilities and multiplanar contrast soft-tissue excellent Over lymphoma. other modalities in studying small bowel over ionizing radiation of small evidence for 260 MR SBFT examinations period, reviewed we a 4-year identifi In all, 14 cases were lymphoma. bowel of these of the appearances review a detailed radiological provide We rmed. confi tumors at MR SBFT. Conclusion: lymphoma may of small bowel of the typical MR SBFT appearance the knowledge to suggest the diagnosis. aid the radiologist C - 7 0 R C EECR07-C-SciEduc-FIN.indd 87 Scientific and Educational Exhibits
and carcinoid tumors in 2 patients. C-423 Conclusion: MDCT-E permits good representation of pathological patterns. Early Utility of MDCT enteroclysis in the evaluation of gastro-intestinal bleeding stages of Crohn’s disease is better evaluated by BE. in small bowel diverticulosis: A pictorial review G. Tóth, L. Tóth, P. Magyar, E. Turupoli, K. Hüttl; Budapest/HU C-421 ([email protected]) Coeliac disease - incidence and radiological fi ndings of associated Learning Objectives: While small bowel diverticulosis is a rare entity and usu- malignancy ally asymptomatic, it may cause acute or chronic symptoms and complications. E. DeLappe, C. Cronin, C. Meehan, C. Roche, J. Murphy; Galway/IE Because of its rarity, diagnosis is often delayed, resulting in unnecessary morbid- Purpose: Enteropathic-associated T-cell and B-cell lymphomas are recognised ity and mortality. Nowadays, the diagnosis of small bowel diseases is frequently associations of coeliac disease; however, the exact prevalence is unknown. The made by MDCT enteroclysis. We present and discuss the typical fi ndings of MDCT purpose of this study was to determine the prevalence of associated gastrointestinal enteroclysis in 6 cases. lymphoma or other malignancy in patients with chronic gluten-sensitive enteropathy. Background: Small bowel diverticulosis is a rare disorder found in 0.2-3% of We describe the radiological features and distribution of these malignancies in our the adult population. Most small bowel diverticula remain asymptomatic and are subject population. detected as an incidental fi nding, but they can also present a wide spectrum of Methods and Materials: We retrospectively reviewed the radiological and patho- complications, such as acute diverticulitis, hemorrhage, intestinal obstruction, logical fi ndings of gastrointestinal tract malignancies in a total of 363 patients with perforation, malabsoption, and present as diffi cult diagnostic challenge. Acquired coeliac disease referred to our institution over a fi ve-year period. Assessment small bowel diverticulosis predominantly involves the proximal jejunum, and is included disease presentation, location (duodenal, jejunum, ileum), stage and located on the mesenteric aspect of the small bowel, while the congenital Meckel radiological features (wall thickening, abnormal mucosal pattern, local nodal diverticulum is located on the antimesenteric aspect of the ileum, 30-60 cm from involvement). We also reviewed the radiological fi ndings and prevalence of extra- the ileocecal valve. gastrointestinal malignancies. Imaging Findings: Between September 2004 and September 2006, MDCT Results: A total of 14 new cancers were diagnosed in the total population sample enteroclysis was performed in 120 patients because of gastro-intestinal bleeding. (3.9%). Of these, 5 had a diagnosis of oesophageal cancer (1.4%) and 3 (0.8%) Collimation was 16x0.75 mm, rec.: 2 mm with overlap scans. We found 5 jejunal had lymphomatous involvement of the gastrointestinal tract. There was a signifi cant diverticulosis and 1 Meckel diverticulum. In all cases, MDCT enteroclysis showed increased risk of both oesophageal cancer and gastrointestinal lymphoma com- different sizes of outpouching of wall. These were fi lled with water and/or with air. pared to that of an age-matched population (p < 0.05). We identifi ed a number of Conclusion: MDCT enteroclysis with MP reconstructions is a good tool to detect other gastrointestinal and extra-gastrointestinal malignancies in the sampled group small bowel diverticulosis and can help to fi nd this rare cause of gastro-intestinal including duodenal, colon, bladder, lung, ovarian, and carcinoid with no statistically bleeding. signifi cant increased risk. Conclusion: Although coeliac disease has been shown to have an association C-424 with gastrointestinal lymphoma, other gastrointestinal malignancies such as oe- Multi-detector CT enterography in small bowel tumors: A comparison with sophageal tumours also occur increasingly in such patients. This possibility must be double contrast small bowel enema, and surgical fi ndings considered when patients with known coeliac disease present with gastrointestinal- G. Tóth, L. Tóth, P. Magyar, E. Turupoli, K. Hüttl; Budapest/HU related symptoms, which are atypical for their primary condition. ([email protected]) C-422 Purpose: To evaluate the diagnostic role and accuracy of MDCT enteroclysis versus small bowel enteroclysis (SBE) in patients with small bowel tumors. Duodenal and paraduodenal lesions: Imaging fi ndings Methods and Materials: Ninety-three patients with suspected small bowel tumor G. Pekindil; Manisa/TR ([email protected]) were examined with a sixteen-row CT scanner (Brilliance Power 16), using the Learning Objectives: To illustrate imaging features of various developmental, following parameters: Coll. 16x0.75 mm with overlap scans, reconstruction interval infl ammatory, neoplastic, traumatic and postsurgical processes that are located 2 mm, after administration of methylcellulose by nasojejunal tube, before and after in or adjacent to duodenum. infusion of 120 ml iv. contrast agent, at the rate of 3.5 ml/s, with a scan delay of Background: Although primary diseases of doudenum are rare, several pri- 50 seconds. In all the cases, multiplanar and curved planer reformatted images mary and secondary processes may involve duodenum due to its both intra and were performed. We evaluated mural thickening, mural enhancement, stenosis, extraperitoneal localization, proximity to pancreas, stomach, hepatobiliary and praestenotic dilatation, perienteric reactions, lymph node enlargement. Results intestinal system. were compared with SBE and surgical fi ndings. Procedure Details: Duplication, annular pancreas, malrotation and transient Results: MDCT detected 26 lesions, and SBE showed 23 pathological lesions. paraduodenal hernias are rarely seen congenital anomalies whereas diverticula The comparison with SBE showed 2 CT false-positive cases due to poor bowel may be seen more frequently. Infl ammatory wall thickening may arise from ulcers, distension. Three SBE false-negative cases were due to the small polipod lesions pancreatitis, Crohn’s disease, Coeliac disease, Henoch-Schonlein purpura. Many (< 10 mm). The fi nal diagnosis was adenocarcinoma in 5 patients, carcinod tumor adjacent infl ammatory pathologies such as appendicitis, pancreatitis, cholecystitis in 3 patients, Peutz -Jeghers poliposis in 1 patient, adenomatous polyps in 3 may also have düodenal wall involvement and may cause "Sentinel loop" apper- patients, lymphoma in 3 patients, leiomyoma in 2 patients, leiomyiosarcoma in 1 ence of dilated duodenum with air-fl uid levels. Duodenal dilatation may arise from patient, CD in 6 patients and adhesions in 2 patients. We found enlarged lymph superior mesenteric artery syndrome. Primary adenocarcinoma, paraganglioma, nodes in 13 patients, and liver metastases in 7 patients. MDCT fi ndings correlated liposarcoma, GIST, lymphoma, Menetrier disease may cause noeplastic involvement well with the surgical fi ndings. of duodenum. Also, metastatic lymphadenopathies of seminoma, mesothelioma, Conclusion: MDCT enterography is a useful and reliable method for the diagnosis lymphoma may locate around duodenum. Walls of duodenum may be thickened of small bowel tumors. from adjacent malignancies such as cholangiocarcinoma, adenocarcinomas of stomach, colon and pancreas. Cystic extrensic compression may arise from cho- C-425 ledococel, intestinal lympangiectatic cysts, choledochal cyst, pseudocysts, policystic Role of multidetector-CT enteroclysis (MSCT-E) in complications of disease. Foreign bodies located in duodenum such as metallic nail and traumatic advanced Crohn’s disease (CD) patients hematoma can be revealed by CT. Chlodecoduodenostomy, Whipple operation and G. Lo Re, M. Galia, M. Midiri, G. Runza, E. Grassedonio, L. La Grutta, A. Taibbi, gastrojejunostomy may cause several changes of duodenum. T. Bartolotta; Palermo/IT ([email protected]) Conclusion: Since several different pathologies may affect or may arise from duo- denum, radiologist should pay attention to duodenum as much as other adjacent Purpose: To evaluate the role of MSCT-E after oral hyperhydration with isotonic organs in the interpretation of many sectional imaging modalities. solution in depict common complications in advanced CD patients. Methods and Materials: From September 2005 to August 2006 patients (28 female; 19 male; mean age 41) referred for advanced CD underwent MSCT-E scan. In all cases, the MSCT-E was performed after oral administration of 2000 mL polyethylene glycol electrolyte balanced solution; before the scan, N-butyl-scopolamine was administered intravenously. All scans were acquired at baseline and 50 seconds after intravenous administration of 110-130 ml non-ionic iodinated contrast medium.
418 A BDEFC G
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7 0 0 2 . 2 419 0 exhibit, exhibit, . 2 112.02.2007 17:04:00 G In this stenoses bowel stulae,
ndings of Crohn’s Disease (CD) ndings of Crohn’s Rome/IT C ndings and classical signs in adult ndings and classical signs in adult reveal the complications. the complications. reveal BDEF A ndings, usually pathognomonic, contemplate: a) "target or a) "target contemplate: usually pathognomonic, ndings, 1) To review MDCT fi MDCT review To 1) To present a spectrum of fi To Between January 2005 and September 2006, 40 patients with Between CT fi stulas in 7% and abscesses in 10% of the same population. MRI of the same population. stulas in 7% and abscesses in 10% Rome/IT ndings in Crohn’s disease illustrated by magnetic magnetic disease illustrated by ndings in Crohn’s Intussusception is rarely seen in adults, accounting for only about only about accounting for seen in adults, Intussusception is rarely Accurate assessment of CD has been a challenge for both clinicians a challenge for assessment of CD has been Accurate stulae and abscesses. We observed two different patterns of enhancement, layered and ho- patterns of enhancement, layered different observed two We Although ultrasound is a useful tool for the diagnosis of intussusception is a useful tool for Although ultrasound C-428 the degree of MDCT in predicting for Is there a role Adult intussusception: A radiologic-pathologic correlation compromise? vascular Catalano, C. Carbone, I. Sandolo, Macrì, F. F. Telesca, Sedati, M. P. Passariello; R. Learning Objectives: 3) the leading point. assess the ability of MDCT in detecting To 2) intussusceptions. compromise. of vascular role of MDCT in predicting the degree the evaluate To Background: among all intussus- of adult disease, The prevalence obstructions. 1% of bowel an organic usually caused by Adult intussusceptions are is only 5-16%. ceptions, Although the leading point is treatment. surgical always lesion, and require almost intussuscep- the diagnosis of technique for preferred seldom detected, CT is the important compromise is especially an optimal of vascular tion, and the degree for surgery. planning before Findings: Imaging enahanced mesenteric surrounded by intussusceptum sign" appearance, eye bull’s intus- the thick-walled all of them circumscribed by fat, and low-attenuating vessels intussusceptum and intussuscipiens between b) Enhanced thin strait, suscipiens. c) Evidences of a medium administration. contrast seen after oral is often walls, is aspects, attenuation malignant mass),with its variable benign or lead-point (ex. loops consequent to the intestinal d) Enlargement of small bowel often observable. obstruction. Conclusion: because it technique in adult patients, MDCT is the preferred especially in children; compromise of vascular leading point and the degree the detection of the enables characteristic CT signs of review We surgery. helping a correct planning before compromise. intussusception with special regard to vascular C-429 Spectrum of fi resonance imaging Piccione, E. Sammarra, M. Grasso, Sansoni, R.F. I. Vescovo, Del R. Beomonte Zobel; B. Caviglia, Della Longa, R. G. ([email protected]) ([email protected]) Learning Objectives: and its complications illustrated by Magnetic Resonance Imaging (MRI). To describe To Magnetic Resonance Imaging (MRI). by and its complications illustrated the best indications and results of the method. Background: to demon- Diagnostic imaging techniques should ideally be able and radiologists. and the severity evaluate strate the extent, due to no radiation clinical applications of MRI in gastrointestinal tract, will show we and the pos- soft tissue contrast excellent superb image quality, patients, for burden abnormalities. and extramural sibility of assess associated luminal, transmural Findings: Imaging in performed was preparation bowel T magnet; MRI on 1.5 CD underwent proven mixture during 30-45 the all patients using a PEG/water the exami- before minutes administered to reduce bowel i.v. were Forty mg of N-butyl-scopolamine nation. and assessment of disease activity The major indication is the evaluation peristalsis. MRI is useful Moreover, patterns enhancement. considering of bowel different two enhancing mesenteric limph-nodes, in detecting increased mesenteric vascularity, fi bowel-bowel peritonealparietal abscesses, microabscess, and perianal fi Conclusion: Increased mesenteric disease. and inactive active indicating respectively mogeneus, patients and enhancing mesenteric limph- in 57% of active present was vascularity nodes in 95%, fi to the diagnostic assessment of small intestinal disease. currently contributes
guration guration is Matosinhos/PT ([email protected]) ([email protected])
stulisation were found in 41 cases, in 41 cases, found stulisation were lead mass is not always cation of the cient distension of the bowel loops cient distension of the bowel Scientific and Educational Exhibits Scientific and Educational stulas, 3 cases of bowel obstruction, 4 3 cases of bowel stulas, Plzen/CZ 100 consecutive patients with suspected or known CD patients with suspected or known 100 consecutive 1) Review the pathophysiology of adult enteric intussuscep- the pathophysiology 1) Review At CT, the presence of a bowel within bowel confi within bowel the presence of a bowel At CT, 9 8
d d Adult small bowel intussusception has been regarded as a condi- intussusception has been regarded Adult small bowel MR enterography with 2.5 mannitol is a safe valuable imaging tool imaging tool valuable is a safe with 2.5 mannitol MR enterography n Incidental enteric intussusceptions are being increasingly diagnosed MSCT-E after oral hyperhydration with isosmotic solution well detected with isosmotic solution well hyperhydration after oral MSCT-E i . N I To assess a clinical value of the magnetic resonance imaging of the assess a clinical value To ndings that help differentiate between transient and lead point enteric transient between help differentiate ndings that F Side effects of the oral application of mannitol were noted in four cases noted in four application of mannitol were of the oral Side effects MSCT-E detected complications in 38 patients (80.8%), in which it al- detected complications in 38 patients (80.8%), MSCT-E - c u d E i c S - Assessment of the Crohn disease with MR-enterography using oral disease with MR-enterography Assessment of the Crohn preparation with mannitol Kreuzberg; B. Kozeluhova, J. Ferda, J. pathognomonic for intussusception, having three different patterns depending on the three different intussusception, having pathognomonic for Intussusceptions without a lead mass of the disease process. and duration severity are due to they Experiments say non-obstructing. small and are usually transient, A lead point observation. disturbances in peristalsis and require only conservative be as- intussusception usually appears as a long abnormal mass that may target-like Identifi obstruction. bowel sociated with proximal be recommended. surgical treatment should once recognized, however, easy; Conclusion: C-427 Purpose: or suspected Crohn’s in patients with known preparation oral with mannitol bowel disease (CD). Methods and Materials: minutes. ml 2.5% mannitol during 60 after drinking 2000 examination underwent Protocol com- Siemens). T system (Avanto, on 1.5 performed Examinations were matrixms, TE 2.6 ms, TR 5.1 trueFISP: posed of bright lumen sequencies (T2 w. and dark lumen sequencies (T1 w. 2 - GRAPPA) iPAT 19 x 1.28 s, TA 312 x 512, 2 iPAT 22.08 s, TA matrixms, 231 x 256, TE 1.4 ms, TR 3.3 VIBE: FLASH 3D - in arterial,ml early and late portal of 7.5 phase after administration - GRAPPA) 1 M contrast. Results: and three cases of mild diarhea), no serious complication (one case of vomiting images with suffi The evaluable present. was enhance- and submucosal - mucosal Signs of activity obtained in 92 cases. were - with or without fi wall bowel ment of thickened colitis in 5 cases (including 4 cases of stenosis), ulcerative CD in 22 non-active nding in 31 cases. enteritiscases, in one case and normal fi Conclusion: posing a new diagnostic and therapeutic problem. Not all this intussusceptions problem. and therapeutic diagnostic posing a new work because most of them are intussusceptions without a require aggressive it is important to know Therefore, of no clinical importance. lead point and therefore the imaging characteristics that permit them to prevent the distinction between therapeutics. unnecessary aggressive and should be used as the prime imaging modality in patients with suspected CD. or known ([email protected]) ([email protected]) Learning Objectives: 2) Discuss the patterns. and different tion, its cross sectional imaging appearance imaging fi intussusception. Background: required surgery reports because up to 90% of the surgical tion that always said use of with the growing However, to be associated with a lead point abnormality. of patients with abdominal complaints, cross-sectional imaging in the evaluation lead point disease has the detection of enteric intussusception without a visible cance and increased, creating a challenge in determining its diagnostic signifi approach. therapeutic Findings: Imaging C-426 what does it mean? does it look, How intussusception: Adult small bowel Salgueiro; A. Ribeiro, C.A. Tavares, M.C.G. Silva, A.C.A. lowed to recognize 2 entero-cutaneous fi to recognize lowed 18 scrictured and 11 strictured 6 abscesses, and dilatated stulas, entero-enteric fi images permitted the axial 26 (68.4%) patients, alternated of small bowel.In tracts possible a correct diagnosis was in 1 (2.6%) patient the complications, to display images were in 11 (28.9%) patients reformatted while only using axial images, assessment. correct necessary for Conclusion: After the axial images evaluation, raw dataset were elaborated in a workstation elaborated dataset were raw images evaluation, After the axial the presence of Rendering algorithmsevaluate to Volume and 3D with MPR, MIP complications. CD common Results: MSCT- Both axial and reformatted patients. CD advanced common complications of an importantin assessment of diagnostic role VR) have E images (MPR, MIP and alternative and effective a safe also can be considered MSCT-E CD complications. CT enema. spiral studies and to small bowel radiographic to conventional C - 7 0 R C EECR07-C-SciEduc-FIN.indd 89 Scientific and Educational Exhibits
GI Tract involvement by histologic examination. The frequency of metastatic involvement was calculated and correlated to lymph node size. Stomach Results: A total of 1253 lymph nodes were present in the 31 specimens examined for this study. A mean number of 40 lymph nodes (range 20-53) were found in each specimen. Of these 1253 nodes, 922 (74%) were tumor-free and 331 (26%) con- C-430 tained metastases. The mean diameter of the lymph nodes free of metastases was Role of perfusion CT in assessing tumor blood fl ow and malignancy level 4.1 mm, whereas that of nodes infi ltrated by metastases was 6.0 mm (p <.0001). Of of gastric cancer: A pilot study the tumor-free lymph nodes, 735 (80%) were less than 5 mm in diameter, whereas A. Satoh, S. Okazumi, K. Shuto, R. Mochizuki, K. Hayano, T. Aoyagi, 182 (55%) nodes containing metastases were less than 5 mm in diameter. Of the 10 K. Narushima, H. Saito, T. Ochiai, N. Yanagawa; Chiba/JP ([email protected]) patients without lymph node metastases, 7 had at least one node that was 10 mm or greater in diameter; similarly, 15 (71%) of the 21 patients with node metastases Purpose: The purpose of this study is to evaluate the correlation between tumor blood had at least one node that was 10 mm or greater in diameter. fl ow calculated with perfusion CT and clinicopathological status of gastric cancer. Conclusion: Lymph node size is not a reliable indicator for lymph node metastasis Methods and Materials: The study enrolled 30 consecutive patients who underwent in patients withgastric cancer. surgery for advanced gastric cancer. Perfusion CT was performed with a 16-row MDCT using an intravenous injection of iodinated contrast material. Sequential dynamic scans were performed on a single level where the tumor was largest in C-433 size. These dynamic images were reconstructed in the workstation to create a An analysis of the physiological FDG uptake in the stomach with water functional image. The new image was analyzed to calculate tumor blood fl ow (BF, gastric distention method ml/min/100 g tissue), using ROI. We compared the BF in each patient and evaluated K. Kamimura, S. Fujita, R. Nishii, H. Wakamatsu, S. Nagamachi, T. Yano, its correlation with the clinicopathological status of the gastric cancer. Y. Umemura, M. Ogita, Y. Fujimoto, S. Tamura, M. Nakajo; Miyazaki/JP Results: No signifi cant correlation was found between the BF level and the tumor ([email protected]) location, diameter, or T-stage. The BF level was higher in the cN0 group than in Purpose: Physiological FDG uptake in the stomach is often seen, especially at the cN1/2 groups, and signifi cantly higher in pStage I/II compared to pStage III/IV. the oral end. Water ingestion just before scanning would make stomach distention Pathological examination revealed the BF level of the undifferentiated-scirrhous and thin the gastric wall, which may lead to apparent reduction of uptake in area of type, often with high-grade malignancy resulting in poor prognosis, to be signifi cantly stomach. In this study, we assessed whether gastric distention using water ingestion lower than that of the differentiated-medullary type. suppressed physiological FDG uptake in the stomach. Conclusion: The BF value of the gastric cancer acquired from perfusion CT may Methods and Materials: Forty patients who had FDG whole-body PET imaging refl ect the histopathological structure of the tumor, including tumor vascularity and for cancer screening followed by gastric endoscopic examination were registered volume of extracellular matrix components of the tumor. This radiological imaging in this study. All patients took 400 mL of water for hydration and were administered procedure is a valid modality to visualize the decreased tumor blood fl ow for as- 185 MBq of FDG intravenously. All patients were randomly divided into two groups sessing the malignancy level of gastric cancer, especially in those with high-grade with or without (additional) water. With water group, 20 patients had additional malignancy. 400 mL of water immediately before PET imaging. The stomach regions were classifi ed into three areas: U (upper)-area, M (middle)-area, L (lower)-area. The C-431 degree of FDG uptakes in these three gastric regions were semi-quantitatively Evaluation of malignant potential of GIST using F18-FDG positron evaluated using SUV. emission tomography Results: Without water group, the mean SUVs in the U-, M-, L-areas was 2.43±0.11, K. Narushima, S. Okazumi, K. Shuto, R. Mochizuki, K. Hayano, T. Aoyagi, 2.31±0.11 and 2.13±0.13 respectively, while in water group, 1.94±0.16, 1.84±0.16 A. Sato, H. Saito, T. Ochiai, N. Yanagawa; Chiba/JP and 1.84±0.18, respectively. With water group, the SUV in the U- and M-area were signifi cantly lower than that of without water group (P <.05). A signifi cant Purpose: The purpose of this study is to evaluate the malignant potential of gastro- difference in FDG uptake was not observed among the three gastric areas in intestinal stromal tumor using FDG-PET in comparison with histological fi ndings. water group (P <.05). Methods and Materials: Twenty-fi ve patients who underwent surgical treatment Conclusion: Additional water-intake immediately before PET imaging suppressed the were enrolled in this study (esophagus 4 cases and stomach 21 cases). Prior to physiological gastric FDG uptake. Therefore, decrease of physiological stomach ac- surgery, PET imaging was performed 1 hour after intravenous injection of 370 MBq cumulation with this method has a possibility of improving diagnosing in this area. of F18-FDG tracer measuring the standardized uptake value (SUV) of the tumor. Histological diagnosis was performed by immunohistological staining of c-kit and CD34 counting mitotic index (MI), which indicates malignant potential. Malignant potential of clinical risk group was assessed based on the NCCN risk assessment classifi cation guideline of GIST. We evaluated the relationship between SUV and risk groups (low-risk group, intermediate-risk and high-risk). Results: The tumor size was 4.9 ± 1.7 cm in diameter. The SUV of all tumors was 4.0 ± 2.5, and the MI was 6.9 ± 6.5 (50 HPF). There was a signifi cantl correlation between SUV and MI (R=0.50, P=0.011). Based on the guideline, SUV of the low-risk group (N=7) was 2.9 ± 1.4, intermediate-risk group (N=8) 2.6 ± 1.6 and low-risk group (N=10) 5.8 ± 2.8. SUV level of high-risk group was higher than that of low group and intermediate group with a statistical difference (P=0.036, 0.007, respectively). When the cut-off SUV level for high-risk group was established as 6.0, the positive predictive value and the accuracy rate was 100% and 85%, respectively. Conclusion: FDG-PET may be an appropriately quantitative modality to distinguish high-risk group with acceptable diagnostic value. C-432 Staging of gastric cancer: CT fi ndings and correlation between lymph node size and metastatic infi ltration A. Gligorievski, K. Gjoreski, A. Karagjozov; Skopje/MK ([email protected])
Purpose: The assessment of lymphatic metastases is an important factor in the staging of gastric cancer. Lymph node size has been used as one criterion for possible nodal metastasis. Methods and Materials: In a prospective morphometric study, the regional lymph nodes from 31 gastrectomy specimens of consecutive patients with primary gas- tric adenocarcinoma were analyzed. The lymph nodes were counted, the largest diameter of each node was measured, and each node was analyzed for metastatic
420 A BDEFC G
EECR07-C-SciEduc-FIN.inddCR07-C-SciEduc-FIN.indd 9900 112.02.20072.02.2007 17:04:0017:04:00 1 0 : 4
GI Tract 0 : 7 1
7 0 0 2 . 2 421 0 . amma- 2 112.02.2007 17:04:01 ltrating ltrating scir- G ndings
amed, thickened amed, pari-thickened Chieti/IT nding of stratifi ed attenuation in ed attenuation of stratifi nding C c, most likely represents non neoplastic most likely c, BDEF ndings of ISIGO is important in making the ndings related to the bowel wall or mesentery wall ndings related to the bowel A brous bands and/or dilated thrombosed veins. The The veins. brous bands and/or dilated thrombosed of the ndings of idiopathic segmental infarction To illustrate multidetector-row CT (MDCT) features of of features CT (MDCT) multidetector-row illustrate To To describe of gastro-intestinal the imaging appearance To All typical imaging features of ISIGO are well recognizable on recognizable of ISIGO are well All typical imaging features The target sign is commonly observed target sign is commonly The infl in idiopathic The landmark of intussusception is a target-like image with aThe landmark of intussusception is a target-like ISIGO is a rare benign and self-limiting disorder, presenting with and self-limiting disorder, benign ISIGO is a rare Intussusception is the herniation gastrointes- of one segment of the Gastrointestinal intussusception has a wide spectrum of clinical To recognize MDCT fi recognize To The target sign may be seen on contrast-enhanced MDCT scans as be seen on contrast-enhanced may The target sign c feature of non neoplastic bowel diseases. Correlation with patient Correlation with diseases. of non neoplastic bowel c feature ([email protected]) ([email protected])
uid and oral contrast material fi lling the bowel lumen or the deposition lling the bowel material contrast fi uid and oral Imaging Findings: Imaging ([email protected]) ([email protected]) Learning Objectives: omentum (ISIGO) with pathologic of the greater idiopathic segmental infarction correlation. Background: The acute abdominal conditions. mimic other clinical symptoms that may c aspecifi it has been postulated that precipitat- cause of ISIGO has been not established; resulting in displacement of the omentum, such as sudden increase ing factors a sudden change in body overexertion, meals, in abdominal pressure after heavy stasis and thrombosis leading cause venous position, coughing or sneezing, may necrosis and extravasation to omental edema and congestion, with hemorrhagic uid. of serosanguineous peritoneal fl Findings: Imaging fatty or cake-like circumscribed, include a well oval they unenhanced CT scans; of soft tissue attenuation containing strands mass with heterogeneous attenuation, fi corresponding to probably mass is usually right sided and most often located deep to the rectus abdominis It appears adherent to infl and anteriormuscle to the colon. amount of free peritonealThere is frequently a small to moderate etal peritoneum. diverticulitis, cholecystitis, diagnoses include appendicitis, Major differential uid. fl primary benign or malignant neoplasms epiploic appendagitis and, less frequently, or metastatic peritoneal seeding. Conclusion: avoid It may with acute abdominal pain. diagnosis in patients correct preoperative intervention. unnecessary surgical explorative tory bowel diseases (ulcerative colitis and mostly Crohn disease) and ischemic and mostly Crohn disease) colitis tory (ulcerative diseases bowel en- infectious hemorrhage, intestinal be present in intramural it may enterocolitis; purpura, (Henoch-Schönlein lupus erythematosus), vasculitis terocolitis, radiation The fi in cirrhosis. edema enterocolitis and bowel although non specifi segment, a thickened occurrence of this sign in infi of the rare with the exception disease, in the diagnosis are pitfalls Potential and colon. rhous carcinoma of the stomach residual fl fat. of submucosal Conclusion: a non specifi clinical history and associated CT fi diagnosis. the differential to narrow allow may C-438 and MRI fi CT, US, X-ray, Intestinal intussusception in adults: C-437 CT fi Multidetector-row greater omentum with pathologic correlation Storto; M.L. Gorgoglione, A. Filippone, Cianci, A. R. Siani; A. Petrillo, De Rosa, A. V. Nunziata, A. Catalano, O. Sandomenico, F. Naples/IT Learning Objectives: a of diagnostic modalities in patients with intussusception with a large range appendicular, jejunal, ileal, ileo-colic, of intussusception locations (gastric, variety make To and causes. transient), chronic, and rectal), presentations (acute, colic, of com- of the clues to a diagnosis and of the imaging features the reader aware plicated intussusception. Background: In adults, distal). more frequently, or, to the former into another (proximal tinal tract levels at different develop intussusception usually has a leading cause and may colour-Doppler, US, all X-ray, illustrate We of clinical presentations. with a variety ndings in adult intussusception of the stomach, the small bowel, and MRI fi CT, reportWe cases of obstructing, subacute, the appendix, and the large bowel. highlight the clues to a diagnosis We intussusception. transient and even chronic, and potential pitfalls. Findings: Imaging due to the invaginated attenuation or an eccentricallycentrally located fat-tissue of the of the target image are due to the wall layers The various mesenteric fold. loop (intussuscipiens). loop (intussusceptum) and of the invaginating invaginated contrast including oral factors, depend on various and attenuation Their appearance be combined with intestinal dilation due Intussusception may medium administration. indicates strangulation. of vascularization Lack to obstruction or can be transient. Conclusion: c nal that
am- ndings, ndings, the Madrid/ES
the bowel, cholecystitis, cholecystitis, the bowel,
non-invasive diagnosis is non-invasive
EPOS ([email protected])
Chieti/IT cance of target sign as seen on CT sign that helps in the evaluation CT sign that helps in the evaluation
Scientific and Educational Exhibits Scientific and Educational for these conditions range from monitoring conditions range these for
Barakaldo/ES nal diagnosis. Correct nal diagnosis. ndings of mesenteric injury: diffuse bowel wall wall diffuse bowel ndings of mesentericinjury: ndings of bowel injury: free intraperitoneal/retro- injury: ndings of bowel rst sight. Once localized it, we describe it, we specifi the localized Once rst sight. ndings in bowel and mesenteric injury include the following: and mesenteric injuryndings in bowel include the following: To understand the signifi To Evaluating the accuracy of CT in the diagnosis and man- of CT the accuracy Evaluating To be aware of the importance of fat stranding in locating the of the importance stranding be aware of fat To
abdominal pain in emergency radiology. It is no patognomonic It is no patognomonic radiology. abdominal pain in emergency
No Material Submitted to Submitted and describing the showing made a pictorial review have We Material No 1 CT fi 9 uid. d. indirect fi d. uid.
d ndings of bowel or mesenteric injury of bowel ndings are the only CT fi d The target sign is a term used to indicate stratifi cation within a The target sign is a term used to indicate stratifi CT plays a crucial role in differentiating the underlying causes of the a crucial role in differentiating CT plays Bowel and mesenteric abdominal injuries Bowel blunt are detected in 5% of ndings of mesenteric injury: intravenous contrast extravasation from extravasation contrast intravenous ndings of mesenteric injury: n Fat stranding is a useful sign to localize the underlying pathology in is a useful sign to localize stranding Fat CT has been shown to be accurate for detecting bowel and mesenteric detecting bowel for accurate to be CT has been shown i . N I include appendicitis, ischemia or perforation of ischemia or perforation include appendicitis,
F ndings of bowel injury: bowel wall disruption and oral contrast extravasa- disruption contrast and oral wall bowel injury: ndings of bowel nding that will lead us to a fi - c u d E i c S - thickened bowel wall that consists of three layers: a inner and outer layer of of a inner and outer layer that consists of three layers: wall bowel thickened and mucosa corresponding to contrast-enhanced respectively high attenuation, of decreased attenuation muscularis propria/serosa, and an intermediate layer to represent hyperemia The target sign is believed corresponding to submucosa. and the muscularis propria,in the mucosa serosa or both and edema or infl ([email protected]) ([email protected]) Learning Objectives: illustrate To CT (MDCT) of the abdomen. multidetector-row contrast-enhanced be observed. diseases in which target sign may bowel various Background: mation in the submucosa. of patients with acute trauma and surgery. trauma Findings: Imaging CT imaging features of the most common abdominal urgent pathology. We try to We of the most common abdominal urgent pathology. CT imaging features on abdominal CT can help us to identify the crucial stranding fat how demonstrate point of the acute abdominal at fi important because treatment approaches C-436 diseases Spectrum of bowel CT: sign on multidetector-row The target Storto; M.L. Gorgoglione, A. Filippone, Cianci, A. R. C-435 with CT and mesenteric trauma of bowel Evaluation Serrano, Lázaro Aja, M. Carreras M. Ibañez Alonso, Arrieta Artieda, S. I. Bejo; Terreros I. Francisco, Alvarez R. Learning Objectives: and CT signs of bowel and mesenteric trauma. agement of patients with bowel mesenteric injury are described and correlated with surgical results. Background: Early diagnosis and treat- occur isolated. and rarely patients at laparotomy trauma CT has become the primary ment are critical to decrease morbidity and mortality. signs can be subtle radiological However, the imaging of these patients. modality for and should be regarded as complementary assessment. to meticulous clinical Findings: Imaging though it warns us where to look at. Fat stranding may arise from many causes arise from many may stranding Fat though it warns us where to look at. Fat stranding on emergency abdominal CT: Where to look at? Where abdominal CT: stranding on emergency Fat Arevalo; Martinez, N. Y. Ciudad, M. Grana, L. Montes, M. Nieto, B. Miscellaneous Miscellaneous C-434 GI Tract GI Tract ([email protected]) ([email protected]) Learning Objectives: abdominal urgent pathology. To be familiar with the differential diagnoses depend- with the differential be familiar To abdominal urgent pathology. the benign entities that resemble differentiate To location. stranding ing of the fat diseases. life-threatening Background: is a stranding Fat symptoms in acute abdomen. should be considered in the differential diagnosis. Acute conditions that cause fat Acute conditions that cause fat diagnosis. should be considered in the differential stranding to surgery. We show some key-facts to help us to differentiate both groups. differentiate to help us to some key-facts show We to surgery. Conclusion: it helps us to reach a fi of CT signs accompanying Knowledge acute abdomen. diagnosis, and therefore a more accurate clinical decision. clinical decision. a more accurate and therefore diagnosis, imaging fi peritoneal air or fl tion. b. direct fi b. tion. a. direct fi a. indirect fi c. mesenteric vessels. injury caused by trauma and is useful in predicting the need for either surgical repair and is useful in predicting the need for injury trauma caused by management. or conservative thickening, diffuse bowel wall enhancement, mesenteric infi ltration or haematoma. or haematoma. ltration enhancement, mesenteric infi wall diffuse bowel thickening, When indirect fi surgical intervention is highly dependent on clinical judgment and can be need for to elucidate necessary hours after the initial evaluation reassessment with CT 6-8 ndings. cance on such fi the signifi Conclusion: C - 7 0 R C EECR07-C-SciEduc-FIN.indd 91 Scientific and Educational Exhibits
presentation, causes, and imaging appearance. This exhibit covers all the various pathologic correlations. possibilities. Conclusion: To carefully evaluate abdominal wall lesions is sometimes a great diagnostic clue. C-439 Spectrum of fi ndings in neuroendocrine tumors with pathologic C-442 correlation: A pictorial review Gastrointestinal stromal tumours: Imaging fi ndings with C. Andreu, T. Presa, G. Fernandez, L. Fresno, L. Del campo; Madrid/ES histopathological correlation S.K. Lapsia, S. Ramachandra, V. Smith, S. Ghai, S. Ghai; Stoke-on-Trent/UK Learning Objectives: To review concepts about neuroendocrine tumors including ([email protected]) their location, histopathology and diagnosis approach. To show clinical and radiologi- cal features of neuroendocrine tumors and correlate them with histology. Learning Objectives: 1. Recognise the spectrum of imaging features of primary Background: An extended distribution of neuroendocrine cells explains an ex- GISTs with histopathological correlation. 2. Discuss the differential diagnosis of tremely diverse tumoral location of this tumoral lineage. There are neuroendocrine GISTs. 3. Review the imaging response to imatinib therapy. cells in adrenal medulla, anterior pituitary, gastroenteric tube, pancreas, aortic and Background: Gastrointestinal stromal tumours (GISTs) are the most common carotid bodies, parathyroid and neural tissue, thyroid, torax and some tumors with mesenchymal neoplasm of the gastrointestinal tract arising from the interstitial cells variable differentiation like prostate and breast. Some of these tumors are associated of Cajal. These cells express a tyrosine kinase growth factor receptor KIT (CD 117), with syndromes such as von-Hippel-Lindau, Neurofi bromatosis or MEN syndromes. which has resulted in the advent of targeted molecular drugs such as imatinib. Some of them are hormonally active, classifi ed as either syndromic (functioning) or Imaging Findings: Computed tomography (CT) is the imaging modality of choice nonsyndromic (nonfunctioning), on the basis of clinical and laboratory fi ndings. for the assessment of GISTs. The majority of GISTs appears as large exophytic, Procedure Details: We reviewed retrospectively the radiological fi ndings in CT heterogeneous enhancing masses on CT because of internal necrosis, haemor- and MRI of neuroendocrine tumors of our data base. The fi ndings were correlated rhage or cystic degeneration. Although, defi nitive diagnosis relies on histopathology, with pathology results in each of the cases. We specially go in depth with the ones imaging can be suggestive of the diagnosis, and plays an important role in the localized in pancreas, digestive tube and adrenal medulla, since they are the most detection of complications and identifi cation of metastases. Differentiation from frequently founded in our centre, but we also go through the radiological fi ndings other primary gastrointestinal tumours can often be made on the basis of these of the ones in unusual locations. specifi c fi ndings. This exhibit will demonstrate the spectrum of imaging features Conclusion: This poster presents the vast spectrum of radiological features of of GISTs, their differential diagnosis on imaging, and their behaviour following neuroendocrine tumors and encloses them in a frame of multiple endocrine neo- treatment with imatinib. plasia and facomatosis, checking over each of their possible anatomical setting Conclusion: In this educational exhibit, the typical imaging fi ndings of GISTs with and their radiological fi ndings. histopathological correlation are illustrated. Differential diagnosis and response to treatment are also reviewed. The importance of imaging in helping to make the diagno- sis of GISTs and in their follow-up after treatment is of increasing importance because C-440 imatinib has dramatically improved the survival rates in patients with GISTs. Autologous bone marrow transplant: A review of gastrointestinal complications E. de Luis, M. Diaz, J. Noguera, G. Bastarrika, A. Benito, A. Villanueva, M. Idoate, C-443 C. Hernandez-Sastre; Pamplona/ES ([email protected]) Normal sonographic anatomy of the inguinal canal G. Rajeswaran, J. Lee, J. Healy; London/UK ([email protected]) Learning Objectives: To know clinical, pathologic and imaging characteristics of gastrointestinal (GI) complications after Autologous Bone Marrow Transplant Learning Objectives: The purpose of this exhibit is to describe the sonographic (ABMT): duodenitis, yeyunitis, ileitis, cholitis, and portal vein gas. To review multislice anatomy of the inguinal canal using ultra-high-frequency sonographic transducers, computed tomography (MSCT) fi ndings of these complications. To emphasize the to aid accurate assessment of disorders involving this region. use of MSCT to promptly diagnose the cause of abdominal pain after ABMT. Background: Disorders involving the inguinal region can often be clinically diffi cult Background: ABMT is a relatively new medical procedure for oncologic diseases to assess. The advent of ultra-high-frequency probes has improved our ability to resistant to conventional treatments. Although it has a high rate of success it has image the inguinal canal. However, a good understanding of the sonographic a wide spectrum of side effects. Major causes of complications are sepsis, graft- anatomy is fi rst required to prevent misdiagnosis. versus-host disease, mucositis and veno-occlusive disease. GI complications may Imaging Findings: In this exhibit, we will document the required sonographic appear as a cause of acute abdomen. technique as well as common pitfalls encountered, followed by a detailed de- Imaging Findings: We describe imaging fi ndings of duodenitis, yeyunitis, ileitis, scription and illustration of the sonographic anatomy of the inguinal canal. The cholitis, pneumatosis intestinalis, portal vein gas and their pathologic correlation. structures described include the superfi cial and deep inguinal rings (and their Conclusion: Prompt recognition of GI complications after ABMT allows an adequate boundaries), the walls of the inguinal canal, the inguinal ligament and the contents management of these patients. MSCT is the recommended imaging technique to of the inguinal canal. diagnose the cause of acute abdominal pain in patients after ABMT. Conclusion: We have described the ultrasound anatomy of the inguinal canal to enable sonography of this area as a dynamic, non-invasive and inexpensive method C-441 of evaluating disorders of this region. Ultrasonography of abdominal wall: The tip of the iceberg Y. Kim1, J.Y. Kim1, S.-Y. Song2, O.-K. Cho2; 1Kuri city/KR, 2Seoul/KR C-444 ([email protected]) The role of ultrasound and helical CT in the diagnosis of primary abdominal mucinous adenocarcinoma Learning Objectives: 1. To learn various fi ndings of abdominal wall lesions in F. Cegarra Navarro, E. Parlorio, M.A. Corral, A. Garcia Jeronimo, F. Lloret, ultrasonography and CT scan. 2. To correlate primary lesions and abdominal wall A. Gimenez Bascuñana; Murcia/ES ([email protected]) lesions. Background: Abdominal wall is a potential source of many pathologic processes. Purpose: To show abdominal mucinous adenocarcinoma (MA) imaging fi ndings, Most of them are secondary to localized or systemic disorders, and primary lesion and to assess ultrasound (US) and helical CT (HCT) diagnostic performance. is uncommon. Thus, most of abdominal wall lesion can be clues to the diagnoses Methods and Materials: We retrospectively reviewed the clinical records and of unknown or recurred underlying diseases. Ultrasonography is a valuable tool in radiological images (abdominal US and HCT) in 73 patients diagnosed with a MA the initial screening and follow-up study after treatment. Therefore, the chances of of abdominal origin in our institution from March 2000 to August 2005. Sex and facing those lesions in US and the importance of recognizing them with a consid- age distribution and radiological fi ndings were determined, focusing the imaging eration of underlying causes are increasing more and more. analysis on tumour origin, local infi ltration, haematogenous and peritoneal spread, Imaging Findings: In this exhibit, US fi ndings of the spectrum of diseases which and associated complications. are classifi ed into: 1) lesion adjacent to umbilicus; metastatic lymph node, urachal Results: Sixty-one patients (27f/34m, mean age: 66.57±14.71) studied by US cyst, umbilical hernia, collateral vessels, 2) lesion associated with surgical inci- (37) and HCT (44) were included. US and HCT established tumour origin in sion; incisional hernia, heterotopic ossifi cation of midline incision, metastasis, 3) 83.8% and 90.9% of cases, respectively. Colon was the most common MA origin infl ammatory lesion; actinomycosis, abscess, necrotizing fasciitis, 4) neoplastic site (67.1%), followed by stomach (11.5%), pancreas (8.2%), ovary (6.6%) and lesion; benign and malignant tumors, 5) others will be illustrated with CT and/or oesophagus (3.3%). HCT was more sensitive (Se) and specifi c (Sp) than US
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ve years in years ve ndings. We We ndings. ned irregular G ndings of the Badalona/ES , H. Won , H. 1 basic ed into three Zagreb/HR ndings of obscure GI , A. Kim , A. 1 ([email protected])
, J. Byun , J. C 1 ammatory, neoplastic, and vascular. The and vascular. neoplastic, ammatory, cantly narrowed. The possible presence The possible cantly narrowed. BDEF Iksan/KR 2 , S. Park , S. 1 A Seoul/KR, 1 , K. Kim , K. 2 ; 1 To present typical appearances of peritoneal, typical appearances present omental To To illustrate radiological manifestations of the causes of manifestations radiological illustrate To The aim of this educational exhibit is to revisit the clinical is to revisit The aim of this educational exhibit cation, distribution and radiological imaging fi and radiological cation, distribution Abdominal and pelvic MDCT was performed with oral and/or with oral performed was Abdominal and pelvic MDCT Using multidetector-row CT scanner, well-designed barium well-designed CT scanner, Using multidetector-row We reviewed all of radiological reports all of radiological in the last fi reviewed We , H. Ha , H. 1 , S. Yoon , S. 1 ndings and imaging appearance, the broad differential diagnosis the broad differential ndings and imaging appearance, cation of lymphoma is complex and still debated. The stage of the and still debated. cation of lymphoma is complex Lymphomas are malignant disorders of lymphoid tissues which are Lymphomas Up to 5% of patients with recurrent gastrointestinal (GI) bleeding (GI) bleeding Up to 5% of patients with recurrent gastrointestinal The causes of peritoneal, mesenteric and omental diseases could be stula and radiation enteritis. Diagnosing these lesions is frequently enteritis. stula and radiation Peritoneum, omentum and mesentery can be affected either by either by omentum and mesentery can be affected Peritoneum, The cause of obscure GI bleeding can be detected in many cases by using cases by can be detected in many The cause of obscure GI bleeding , Y. Shin , Y. 1 , M.-G. Lee , M.-G. 1 ([email protected]) ([email protected]) Learning Objectives: and mesenteric diseases and to narrow the differential diagnosis for each mor- diagnosis for the differential and mesenteric and to narrow diseases phological pattern. Background: infl infectious, groups: major divided into four morphological changes in this anatomical region can be classifi masses (including cystic masses), ill-defi ned solid well-defi patterns: masses and infi ltrative processes of the mesentericand omental fat. ltrative masses and infi Details: Procedure the diaphragmal The area between material. contrast of administration intravenous In each patient, the homogeneity of scanned. was dome and inguinal ligament and enhancement of the intraperitoneal attenuation the presence, abdominal fat, of parietal and enhancement peritoneum, and the presence of the surface mass, analyzed. and ascites were mesenteric lymphadenopathy Conclusion: primary from adjacent or secondary direct extension pathologic conditions, by On the lymphatic and hematogenic dissemination, and peritoneal seeding. organs, basis of clinical fi of diseases in this region could be signifi and/or ascites can make peritoneal thickening of mesenteric lymphadenopathy, ndings more conspicuous. the fi disease is classifi ed according to the Ann Arbor staging system. ed disease is classifi Findings: Imaging the cases with primary selected lymphoma and they We extra-nodal our institution. fi of radiological unaware who were radiologists two by reviewed were lung (7) and Thoracic: encountered 48 cases of primary lymphoma: extra-nodal (6), urologic abdominal viscera (10), gastrointestinal tract Abdominal: (2); pleural (2), skin bone (3), muscle Musculoskeletal: (5), peritoneumand genital tract (1); C-449 review A pictorial lymphoma: of primary extra-nodal features Imaging Oriol; Guasch, A. Roqué, I. Mariscal, C. A. Puyalto, P. Quintero, J. of lymphoma. involvement extra-nodal rare Background: lymphoma. disease and non-Hodgkin’s Hodgkin’s broad groups: subdivided into two may involvement Extra-nodal classically presents in lymph node sites. Lymphoma also be due to regional spread of nodal disease or haematogenous dissemina- The classifi tion. C-447 spectrum MDCT imaging diseases: omental and mesenteric Peritoneal, diagnosis and differential Lusic; Prutki, M. M. Kralik, M. Hrabak, M. Stern Padovan, R. C-448 obscure evaluating CT for The impact of multidetector-row bleeding gastrointestinal Cha E.Y. Kim P. ([email protected]) Learning Objectives: presentation, classifi bleeding caused by splenic artery caused by bleeding pseudoaneurysm, arteriovenous ectopic varices, and angiodysplasia. malformation, Conclusion: and angiography. barium studies, CT, imaging modality such as multislice variable Learning Objectives: diagnosis of GI bleeding. aid the differential To obscure GI bleeding. Background: Gastrointes- and colonoscopy. standard gastroscopy will remain undiagnosed by investigations conventional tinal (GI) hemorrhage is considered obscure when lesions. to detect bleeding fail and colonoscopy) (esophagogastroduodenoscopy small intestinal lesions. have 27% of patients with obscure GI bleeding On average, include Arterio-venous malformation, The causes of obscure GI bleeding vascular peristoma and jejuno-ileal, colonic, (duodenal, angiodysplasia, ectopic varices cholesterol crystal emboli, stromal tumor, bowel lipoma, small small bowel varices), aortoenteric fi to routine endoscopy. tend to be inaccessible cult because they diffi Findings: Imaging fi radiological the various illustrate we and angiography, study, ltration. Peritoneal Peritoneal ltration. rst US exam with acute rst US exam ammatory clinical and US features, ammatory clinical and US features, Scientific and Educational Exhibits Scientific and Educational Thirty-fourun- patients with beginning or relapsed IBD We retrospectively reviewed 3.312 abdominal CT scans reviewed retrospectively We ([email protected]) ([email protected])
3 9
d ammatory bowel disease (IBD): Evaluation by contrast contrast by Evaluation disease (IBD): ammatory bowel d n US and, particularly, CT are useful diagnostic tools when assess- US and, particularly, the most common cause of retroperitoneal air col- far is by Trauma CEUS seems to correlate well with the clinical evaluation and labora- with the clinical evaluation CEUS seems to correlate well i . Athens/GR ([email protected]) ([email protected]) N
I To correlate clinical features with enhancement pattern with enhancement of the intestinal correlate clinical features To To review the etiology of non-traumatic retroperitoneal air collections, a retroperitoneal the etiology of non-traumatic air collections, review To F All the patients showed active disease at the fi active All the patients showed Of the remaining 65 patients, 47 presented severe clinical symptoms 47 presented severe Of the remaining 65 patients, - c u cation and increase of the vascularization at PwDoppler. After the dynamic After the dynamic at PwDoppler. cation and increase of the vascularization d ndings of non traumatic retroperitoneal air collections: A brief review A brief review air collections: retroperitoneal ndings of non traumatic E i c S - symptoms, arranging in 26/34 (76.47%) with elevated values of RCP. At the At the of RCP. values in 26/34 (76.47%) with elevated arranging symptoms, according to the clinical remission features showed 14/40 (35%) exams follow-up, 16/40 (40%) persistence of the infl evaluation, disease at US and clinical symptoms but 10/40 (25%), instead, persistent active normal RCP level. Conclusion: tory tests in the beginning IBD and during the follow-up. C-446 Activity of infl (CEUS) enhanced ultrasonography Tinti; Montermini, R. Chiribau, I. R. Frittoli, B. Fogazzi, Romanini, E. L. Grazioli, L. Brescia/IT Purpose: after CEUS in the patients with IBD. wall Methods and Materials: study with SonoVue, the degree and the pattern of the wall enhancement were and the pattern enhancement were the degree of the wall study with SonoVue, of the illness has been the activity degree the base of these features, On evaluated. compared with data were The ultrasound or remittent. subactive active, ned as: defi All the patients were and clinical symptoms. RCP level the clinical activity index: (baseline and CEUS) in order to evaluate examination up with ultrasound followed (40 examinations). correlated to the clinical features the response to the therapy and of the of the vascularization wall reduction of the thickness In the follow-up, enhancement pattern considered remission features. was Results: derwent US baseline exam and CEUS. Features of pathological bowel segment of pathological bowel Features and CEUS. US baseline exam derwent mm, loss of the echo- more than 3 of the wall thickness were: at baseline exam stratifi CT fi conditions of common and uncommon Makrodimitri, Karzi, P. Antoniadi, E. D. Michalakou, M. Passomenos, D. Serveta; K. dissemination (26%) was displayed as peritoneal nodes and, less frequently, as as peritoneal frequently, nodes and, less displayed (26%) was dissemination malignant peritoneal peritoneal (mucinous pseudomixoma carcinomatosis - MPC). results comparable peritoneal CT and US showed dissemination, evaluating For Sp=100%, and Se=86.7%, NPP=93.5%; (Se=86.7%, Sp=100%, PPV=100%, dissemination (18%) Haematogenous respectively). PPV=100%, NPP=86.7%, only 1 patient Regarding associated complications, common in the liver. most was secondary to MPC. uropathy obstructive showed Conclusion: with reliable the radiologists provide Both imaging techniques ing abdominal MA. and abdominal metastases. ltration about tumour origin,information local infi C-445 Purpose: uncommon entity. relatively Methods and Materials: 2006) in our hospital, and 2005- August in the last 12 months (August performed We the retroperitoneal of air in space. with evidence selected 634 examinations injury, traumatic abdominals CT scans due to history 248 of previous excluded an abdominal procedure (surgical and after performed and 321 examinations interventional techniques). Results: of intestinal perforation Findings minimal clinical signs. while in 18 there were being long-standing %), the most frequent reason noted in 52 patients (80 were in duodenal ulcer perforation not uncommon Retroperitoneal air was diverticulitis. pneumoret- the presence of for also responsible was Renal infection (4 cases). Pancreatitis roperitoneum of abscesses. with or without the formation (5 cases) of abscess or the presence of air in the form in 7 patients for responsible was pancreatitis. emphysematous Conclusion: organ such as of a hollow the second most frequent being perforation lections, also produce Other conditions may colon. ascending or descending duodenum, a into account for to be taken have small amounts of retroperitoneal air and they patients. especially in diabetics or in immunocompromised proper diagnosis, (Se=93.9%, Sp=90.9%, PPV=96.9%, NPP=83.3%; and Se=64.5%, Sp=83.3%, and NPP=83.3%; Sp=90.9%, PPV=96.9%, (Se=93.9%, local infi when evaluating NPP=31.3%, respectively) PPV=95.2%, C - 7 0 R C EECR07-C-SciEduc-FIN.indd 93 Scientific and Educational Exhibits
and subcutaneous tissue (1); Nervous system: brain (5) and spinal cord (1); Other: GI Tract salivary glands (2), breast (2) and thyroid gland (1). Conclusion: Extra-nodal manifestations of lymphoma are greatly diverse and may Peritoneum mimic a variety of both neoplastic and non-neoplastic conditions, depending upon the site of involvement. Familiarity with the broad spectrum of primary extra-nodal lymphoma is important for enhancing lesion detection and improving diagnostic C-450 accuracy. Multimodality imaging plays a critical role in detecting, characterising CT fi ndings of chronic ambulatory peritoneal-dialysis-related conditions and staging the disease. T. Ichikawa, T. Hashimoto, T. Yamashita, J. Koizumi, Y. Imai; Isehara/JP ([email protected])
Learning Objectives: To illustrate the CT fi ndings of sclerosing peritonitis (SP) and other conditions related to chronic ambulatory peritoneal dialysis (CAPD) Background: Sclerosing peritonitis (SP) is a rare but serious complication of CAPD. SP is characterized by thickening of the peritoneum that encloses some or all of the small intestine, which could result in bowel obstruction and necrosis. Imaging Findings: This exhibit illustrates abdominal CT fi ndings of conditions related to CAPD focusing on SP. Other conditions associated with CAPD are also discussed. We retrospectively reviewed abdominal CT of 48 patients on CAPD for more than 7 years. Findings of SP were peritoneal thickening, peritoneal calcifi ca- tion, located fl uid collections, and small bowel abnormalities. The most serious complication of SP was associated with bowel perforation in 1 case. Other conditions such metastatic calcifi cation of soft tissue and joints due to renal osteodystrophy and vascular abnormalities such as atherosclerosis were also well depicted. In addition to axial images, we utilized opitimal multiplanar sections to visualize the entire peritoneal cavity. Conclusion: CT is an important tool in the diagnosis of SP and other condi- tions associated with CAPD. Knowledge of specifi c CT fi ndings of SP will lead to identifi cation of this rare complication of CAPD, and is benefi cial for differential diagnosis of peritoneal disease. Other conditions associated with CAPD are also excellently depicted on CT. C-451 Diseases of the mesentery, omentum and peritoneum G.A. Birjawi1, A. Karam1, R. Khouzami2, M.C. Haddad1, N.J. Khoury1; 1Beirut/LB, 2Zghorta/LB ([email protected])
Learning Objectives: To review the wide range of primary and secondary patho- logic conditions that affect the mesentery, omentum and peritoneum. To describe the CT fi ndings of these conditions and to present some rare processes and their specifi c imaging fi ndings. Background: The peritoneum, mesentery and omentum are important sources of primary pathologic conditions as well as common sites of secondary involvement from various primary processes. Most of these conditions are common, but few others are very rare, and one should be aware of these. Imaging Findings: The described primary diseases include: 1. Infl ammatory: e.g. panniculitis, epiploic appendagitis, sclerosing encapsulating peritonitis (abdominal cocoon). 2. Infection: e.g. tuberculosis. 3. Neoplasms: e.g. lymphoma, CLL, me- sothelioma, sarcomas, primary peritoneal carcinoma, desmoid. 4. Cystic lesions: e.g. mesenteric cyst (cystic lymphangioma). The described secondary diseases include: 1. Infl ammatory diseases: e.g. sarcoidosis, lupus, familial Mediterranean fever, fi brofatty infi ltration secondary to IBD. 2. Infection: e.g. hydatid cyst, appendi- citis, diverticulitis, phlegmon, abscess. 3. Neoplasms:e.g. metastasis from various primary carcinomas, pseudomyxoma peritonii. 4. Miscellaneous: e.g. postoperative complications, omental infarction, heart failure, cirrhosis, loculated ascitis (simulating cyst), mesenteric hematoma, internal and external mesenteric hernias, mesenteric ischemia, GI tract perforation, lithopedion. Conclusion: The mesentery, omentum and peritoneum may be an important source of primary as well as secondary pathologic conditions, both benign and malignant. CT scan is an excellent tool in detecting disease in these anatomic regions and can be specifi c in diagnosing few of these entities. Radiologists should be also aware of very rare conditions affecting these areas. C-452 Peritoneal involvement of various benign and malignant pathologies: Usual, unusual imaging manifestations and pitfalls K. Matsuzaki, M. Takeuchi, H. Uehara, H. Nishitani; Tokushima/JP ([email protected])
Learning Objectives: To demonstrate characteristic imaging manifestations of various benign and malignant pathologies involving peritoneal cavity by using conventional and new imaging techniques such as three dimensional reformations of multi-detector-row CT (MDCT), high b-value diffusion-weighted MR images (DWI), and 18 F-FDG PET-CT. Background: Various benign and malignant pathologies may involve peritoneal
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G uence of muscles’ uence of muscles’ Lodz/PL ([email protected]) ([email protected])
ndings as well as post-surgery as well ndings the latest technicalt the most from C ed to use the eye muscles’ volume to volume muscles’ ed to use the eye lm, CT or MR. To arrange frequently arrange To lm, CT or MR. BDEF Madrid/ES A uence of all structures’ volume on the exophthal- volume uence of all structures’ ndings by categories. To emphasize useful informa- emphasize To categories. ndings by ([email protected]) ([email protected])
Forty-fi ve patients (90 orbits) were the study subjects patients (90 orbits) were ve Forty-fi To illustrate new radiological techniques offering precise offering techniques radiological new illustrate To To outline normal anatomy. To resume the most common To outline normal anatomy. To Normal inner ear anatomy with a 64-detector CT-scan and with and Normal CT-scan with a 64-detector inner ear anatomy cant: in a clinical method using Hertl`s r=0.357, exophtalmometer cant: uence of the muscles’ volume on the exophthalmos degree was was degree on the exophthalmos volume uence of the muscles’ A wide variety of calvarial features are daily evaluated, sometimes are daily evaluated, features of calvarial A wide variety One of the body regions that benefi One of the body regions that Thanks to the radiological imaging studies performed with the latest imaging studies performed Thanks to the radiological NSI technique is a clinically useful application providing objective data objective NSI technique is a clinically useful application providing cant surgical improvements, play an important play in the management role cant surgical improvements, The aim of our study was determinationThe aim of our study was of the infl The infl volume as well as all intraorbital structures’ volume for the exophtalamos extend. the exophtalamos for volume structures’ as all intraorbital as well volume Methods and Materials: in whom the quantity assessment of eye exophthalmos with the clinically proved NSI, the carried out using NSI application. ball was tissue and eye fat ball muscles, that nearly computer software is a new numerical segmentation image technique, on the base of MRI images. structuresautomatically counts the intraorbital volume T scanner using head coil. in 1.5 MRI examination All patients underwent Results: statistically signifi method in comparisonp=0.000552 in a radiological to the interzygomaticus line The infl r=0.511, p=2.59221E-07. 0.492, p = 8.47986E-07. 0.441, p = 1.34334E-05; respectively, was, mos degree Conclusion: It is justifi each orbit. calculated individually for ([email protected]) ([email protected]) Purpose: Determination ophtalmopathy. estimate activity of the pathological processes Graves than clinically. is more objective way in a radiological of the exophtalamos Learning Objectives: encountered during plain fi variants cranial detected pathologic imaging fi report. should include in the radiological tion that radiologists Background: nd- often as incidental fi but mass, or as a palpable neurologic manifestations by Learning Objectives: C-454 segmentation image numerical estimation by The orbit structures volume degree (NSI) in relation to exophtalomos technique Stefanczyk; L. Mlynarczyk, W. Grzelak, Elgal, P. M. Majos, A. C-455 A pictorial What the general radiologist needs to know? The cranial vault: review Pruna; Garriga, X. V. Cuadrado, García, M. Berrocal, D. Marín, L. A. Medrano, S. (Barcelona)/ES Granollers Head and Neck Head and Neck Head C-453 of the most recent MR Contribution pathology: inner-ear around Turning of management and surgical to the diagnosis advances and CT imaging disorders inner-ear Baudraxler, F. Lassaletta, L. Orejas, Royo Martínez A. Schmickrath, M. Ruiz de Gopegui; M. Moreno Anaya, P. of inner ear patholo- examples display To of the inner ear. anatomical information for selecting candidates describe for our imaging protocol To gies in MR and CT. as post-surgery as well complications. the cochlear implant program, Background: new provided have Three-dimensional MR sequences is the inner ear. improvements of the 64-detector the development also, nervous pathology; to evaluate pathways reconstructions and volumetric has permitted with multiplanar a better CT-scan together advances, these radiological Therefore, structures. of its bony evaluation with signifi of these impairingdisorders. Findings: Imaging of pathologies that groups Examples of different RM will be characterized. 1.5-Tesla disorders (geniculate hemangioma, symptomatic vascular like ear, the inner affect vertebral artery neuromas, and facial diseases (acoustic dolichoectasy), tumoural and congenital pathologies (Mondini’s eosinophilic and cholesterol granulomas), ammatory conditions (osseous internal aqueduct syndrome), and infl vestibular imaging proto- Also, otosclerosis) will be illustrated. auditory conduct exostosis, according with our hospital’s cochlear implant candidates will be revised, col for Otoneurology department, describingimaging fi program. ted from this benefi complications in 43 patients that have Conclusion: surgical procedures such combined with new MR and CT technical advances, with inner-ear the management and treatment of patients as cochlear implants, a big improvement. experienced disorders have uid collection in infectious or uid collection in infectious Scientific and Educational Exhibits Scientific and Educational To evaluate primary (mesotheliomas and serous papillary evaluate To 5 9
d d n To differentiate benign tumor-like conditions from malignant peritoneal tumor-like benign differentiate To i . N I F - c u d E i c S - diseases on the basis of imaging features is important for the adequate treatment. is important the adequate treatment. diseases on the basis of imaging features for infl ammatory diseases such as bacterial or tuberculous peritonitis, and infl am- ammatory diseases such as bacterial and infl or tuberculous peritonitis, infl intra-peritoneal and benign tumor-like tumors Some rare matory diseases. bowel peritonei, such as pseudomyxoma conditions with characteristic imaging features and mesenteric panniculitis, tumors, brous fi syndrome with benign ovarian Meigs’ peritoneal cysts with peritoneal retention adhesion are also demonstrated. Conclusion: adenocarcinomas of the peritoneum)adenocarcinomas of the and secondary carcinomatous peritonitis, subtle omental irregularity of MDCT is helpful in demonstrating capability multiplanar locating of peritoneal in accurately walls, to the bowel or small implants adjacent space or regions such as sub-diaphragmatic lesions in anatomically complicated Contrast-enhanced encasement. mesenteric vascular and in evaluating cul-de-sac, small peritoneal demonstrate implants, technique may saturation T1-WI with fat of diseases, the staging for useful information can provide and PET-CT and DWI DWI primaryor detecting unknown with secondary tumors peritoneal involvement. and purulent fl can also detect peritoneal thickening cavity. To recognize the pathways from extra-peritoneal diseases to the peritoneal from extra-peritoneal the pathways recognize To cavity. and intra-peritoneal spreading patterns diseases is important of various for cavity, diagnosis. correct preoperative Findings: Imaging C - 7 0 R C EECR07-C-SciEduc-FIN.indd 95 Scientific and Educational Exhibits
ings in radiologic studies. CT is the method of choice for the assessment of bone C-458 lesions. MRI shows soft tissues and intracranial involvement better. Ultrasound can Volume rendering imaging of the middle-ear ossicular chain with 64-MDCT examine soft tissue and outer table of diploë and helps to evaluate radiographic M.E. Sakarya1, D. Efe2, H. Çetin1, V. Yurttas1, S. Keşkin1, I. Taş1; 1Ankara/TR, diagnostic doubts. Plain radiography still has a value as the fi rst step of imaging 2Konya/TR ([email protected]) modality in the emergency room. Imaging Findings: We have reviewed a wide sample of cranial imaging features Purpose: Three-dimensional (3D) volume rendering is a recently developed tech- and classifi ed them by different educational categories and subcategories: normal nique. The purpose of this study was to demonstrate the usefulness of the role of anatomy and variants (with anatomical drawing schemes and radiological cor- 3D volume rendering to complete the standard CT examination of the middle-ear respondences). Calvarial abormalities divided into different etiological classes: ossicular chain. congenital anomalies / fractures / surgical changes/tumours/systemic disease/thick- Methods and Materials: We studied 16 patients (8 females, 8 males) aged 17-73 ness changes. Each category is represented by plain fi lms, US, CT and/or MRI. A years (mean age: 38.6) for a total of 32 normal middle-ear ossicular chains. All "key summary" is also displayed in each section. examinations were performed on a multidetector CT (MDCT) scanner (Sensation Conclusion: This exhibit illustrates the main calvarial lesions and points up the 64, Siemens, Erlangen, Germany) with axial volumetricEPOS acquisition and completed information to pass in the report. Some of normal variants and benign fi ndings in with 3D volume rendering. MDCT scan parameters for axial acquisition were set calotteal bones are often misdiagnosed or simply not reported. This work could be as follows: 0.6 mm scan collimation, FOV 250 mm, mAs 380, kV 120. Axial images a useful tool to recognize them and, if necessary, include them in the radiological were reconstructed at 0.6 mm thickness and with a reconstruction increment of information reported. 0.1 mm using a high-resolution bone algorithm. Results: We obtained virtual 3D views of middle-ear structures. Volume rendering C-456 provided additional information with respect to standard CT images in all cases. Volume rendering allowedNo Material an identifi Submitted cation of the to anatomy of the ossicles. The Bionic ear imaging elements of the stapedial crura were clearly visualized with volume rendering R. Cerini, N. Faccioli, R. Manfredi, M. Barillari, V. Colletti, R. Pozzi Mucelli; images in all cases. Verona/IT ([email protected]) Conclusion: Volume rendering should not be considered an alternative to the stan- Learning Objectives: To illustrate the different imaging features of middle and dard CT examination, but it can represent a valid integration to provide additional inner ear implants, brainstem implants and inferior colliculus implants. information on visualisation of the middle-ear ossicular chain. This technique may Background: We retrospectively reviewed CT images of 250 patients with con- have an important role in preoperative planning, surgical training, and postoperative genital or acquired transmissive or neurosensorial hearing loss that underwent evaluation in the middle ear. surgery. The implants examined were: 15 Vibrant implants, 5 at the long crus of incus and 10 at round window, 150 cochlear implants, 84 brainstem implants, and C-459 1 implant at inferior colliculus. All patients underwent postoperative CT scan (single Closed globe injuries: CT fi ndings or multislice scanner) or a Dentomaxillofacial X-ray Cone-beam CT scan (DCT) S.V. Setola, A. Di Giacomo, S. Tamburrini, V. Festa, P. D’Alessandro, V. Accattatis, (axial and MPR reconstruction), and x-plan radiography to visualize the correct L.C. Cirillo; Naples/IT ([email protected]) position of the implant. Procedure Details: The DCT scan depicts vibrant site of implant better than x-plan Purpose: To retrospectively (1) identify computed tomography fi ndings in closed radiography, with lower X-ray dose compared to CT. For cochlear implants, a single globe injury and (2) to compare the diagnostic accuracy of non trained and trained x-plan by Stenvers projection can directly visualize the electrodes in the cochlea. radiologists. All patients with brainstem or inferior colliculus implants underwent postoperative Methods and Materials: 104 orbital CT scans of patients (34 women, 70 men, CT scan (12 hours) to exclude complications, and to assess correct implantation. mean age 37 years) with ophthalmologic diagnosis of closed globe injuries were The follow-up of these implants can be done only by x-plan radiography. reviewed by three radiologists in consensus, blinded to clinical fi ndings. Scans were Conclusion: CT and DCT scan could provide a reliable and relatively fast method to reviewed in order to identify post-traumatic alterations of anterior and posterior precisely determine the location of middle ear implants; we prefer DCT in regards to segment structures. CT because of the lesser X-ray dose administered; a single radiography is enough Results: The eye involved was right in 39/104 and left in 65/104 patients. The dif- to visualize and follow-up brainstem or inferior colliculus implants. ference in axial length between the eye involved (M+) and the uninvolved one (M-) ranged between 0 and 1.6 mm (with a prevalence in axial length of M+). 90/104 C-457 patients had soft tissue swelling (M+). In one patient, anterior chamber was shal- low. Lens presented an irregular surface in 2 patients and was dislocated in one. CT and MR imaging of cochlear implant candidates: What the surgeon Hemorrhage was seen in two patients (1 vitreous (< 50%), 1 retina). 5 CTs initially needs to know read negative were read positive in the retrospective review (lamellar lacerations V.G. Katsiva, E. Stavrianou, D. Ziogana, M. Karayanni, D. Xenis, E. Anagnostou; (LL)); in all, a tiny air bubble was recognised in the cornea or at the sclerocorneal Pireus/GR ([email protected]) junction. In one of them, a foreign body was recognised. Prospectively 22 fractures Learning Objectives: To outline the specifi c questions to the radiolgist with regard were diagnosed at CT, retrospectively 1 fracture was not recognised, and 1 was to cochlear implantation. seen only in retrospect. Nine patients with orbital fractures had intraorbital air (5 Background: Cochlear implants are intended for patients with severe to profound extraconal, 2 intraconal, 2 intra and extraconal). sensorineural hearing loss (SNHL). Successful cochlear implantation depends on Conclusion: CT fi ndings in globe trauma are the effect of mechanical impact. a variety of factors, including an intact cochlear nerve and a surgically accessible Radiologists training signifi cantly improved CT accuracy. route for electrode placement. Therefore, imaging evaluation consists a major part of the preoperative assessement. C-460 Procedure Details: Twenty-eight patients, aged from 2 to 72 years who were Superior canal dehiscence: Multidetector-row CT evaluation candidates for cochlear implants were referred for imaging evaluation. All patients G. Palermo Patera1, G. Sparacia1, A. Schiavello1, F. Landino1, A. Iaia2, had severe SNHL of various causes. High-resolution computed tomography M. Texeido2, R. Lagalla1; 1Palermo/IT, 2Newark, NJ/US (HRCT) scans were performed most on single-detector CT scanner using the classic protocol. MRI scans were acquired from a 1.5 and 1 Tesla scanners with Purpose: To present a series of 26 patients, with clinical fi ndings suggestive of an axial high-resolution two-dimensional or three-dimensional (3D) fast spin echo superior canal dehiscence syndrome, who presented to a single otologic practice T2-weighted sequence or 3D gradient echo (Ciss or True FISP). Non-enhanced and to describe the clinical work-up, common fi ndings, surgical and conservative and enhanced T1- weighted images through the temporal bone and axial fl air im- treatment of these patients. ages through the brain were taken as well. Twenty-four patients had both CT and Methods and Materials: Retrospective chart review of 26 patients seen with clinical MR examinations. These were reviewed based on a detailed analysis of known symptoms attributed to superior canal dehiscence confi rmed on high-resolution CT anatomical landmarks and variants related to the procedure. scan of the temporal bone. Along with the CT scan, all patients underwent physical Conclusion: CT is superior ino studying the bony structures of the inner ear and examination, audiogram and vestibular-evoked myogenic potentials. middle ear cavity and the course of the fallopian canal for surgical planning, whereas Results: The charts of 16 females and 10 males (mean age 50) with unilateral MRI is superior in analyzing the soft tissues of the inner ear and the vestibulocochlear otologic symptoms were reviewed. All patients had dehiscence of the superior nerve. Both modalities are equally effective in depicting labyrinth malformations. semicircular canal seen on CT scan of the temporal bone on the ipsilateral side. To date 5 of the 26 patients have undergone transmastoid occlusion of the superior
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A MRI was performed in 20 volunteers without strabis- volunteers in 20 performed MRI was Twelve months after surgery, 20 patients underwent an 20 patients underwent months after surgery, Twelve Beijing/CN To illustrate the anatomical alternatives of the temporal of the temporal the anatomical alternatives illustrate To The found alternatives are: an anterior sigmoid sinus, alterna- an anterior sinus, sigmoid are: alternatives The found This work is based on a second reading by a specialized radiologist radiologist a specialized This work is based on a second reading by Inverted papilloma is a rare benign tumour of nasal cavity and pa- of nasal cavity benign tumour is a rare papilloma Inverted The anatomical alternatives of the temporal bone to announce to of the temporal The anatomical alternatives All ocular motor nerves can be seen in the subarachnoid cisterns All ocular motor nerves can be seen in the subarachnoid ([email protected]) ([email protected]) To display the oculomotor cranial nerves by MRI and to present an nerves by cranial the oculomotor display To
To evaluate the morpho-structural and functional modifi evaluate To Both oculomotor cranial nerves (CN3) were demonstrated well in in well demonstrated nerves (CN3) were Both oculomotor cranial CT showed a solid unilateral tumour (n=19), or bilateral (n=1), developing (n=1), developing or bilateral tumour (n=19), a solid unilateral CT showed Results: to the maxillary sinus and extending sinuses or paranasal cavity with the nasal erosion It is associated with bone (n=5). sphénoïd and frontal sinuses (n=14), and to lobulated a heterogeneous and MRI showed (n=2). (n=12) and bone condensation categorizing patients according to the staging proposed tumour (n=16), and allowed 2, 7 cases of stage 3, and 2 cases of 1 case of stage1, 6 cases of stage Krouse: by Association with epidermoïde noted in only 1 patient. was carcinoma stage 4. Conclusion: CT and MRI assessment can accurately It is locally aggressive. sinuses. ranasal be useful for MRI may staging by Preoperative of the tumour. predict the extent planning an appropriate surgical approach. C-465 3D-FIESTA Visualization of ocular motor cranial nerves by Jiao; Y. Wang, Man, Z. F. C-466 of patients with evaluation resonance (MR) in the post-surgical Magnetic Carriero; A. Stecco, approach A. fractures treated using the trans-parotid condyle mandibular Volpe, D. Travaglini, F. Favano, Armienti, F. F. Saponaro, A. Novara/IT Purpose: with joint and the onset of parotid complications in patients temporo-mandibular reduction with the application of treated by monocondylar fractures extra-capsular approach. a titanium microplate using a trans-parotid Methods and Materials: Turbo T2-weighted joint using coronal of the temporo-mandibular MR examination T2-weighted TSE and T1-weighted and parasagittal Spin Echo (TSE) sequences, C-464 CT assessment of the temporal bone: Anatomical alternatives Rajhi; Salem, H. Mehiri, A. Chammakhi, S. R. Mnif-Megdiche, N. ([email protected]) Learning Objectives: and to insist on the importance the radiologist by of announcing bone to be known them to the surgeon. Background: slices carriedof 200 CT scan of petrous bones with axial and coronal out between 2004 and 2006. Findings: Imaging deep tympani nerve, alternatives of the canal of facial of the jugular vein, tives pre mallear bone blade. septum, anterior epitypanic recess, Korner thick sinus, gathering the radiologist the whole for Other lesions represented images traps a canal of the anatomical structures which can wrongly lend with pathology like confused to a fracture. Conclusion: to constitute an embar- being able are alternatives They the surgeon are not rare. Their or to predispose to surgical incidents. with the initial surgical way rassment adjust and the surgeon to guide and is important the radiologist knowledge for surgical procedure. Purpose: brosis of extraocular fi update on clinical applications of dominant congenital (CFEOM). muscles Methods and Materials: used. A head coil was GE). T MR unit (Twinspeed, and 3 CFEOMs on 1.5 mus obtained in axial plane using three 0.6 gap were slices without interslice mm thick sequence steady state acquisition (FIESTA) imaging employing dimensional fast and observed nerves in oblique-axial Oculomotor were without enhancement. planes acquired with MPR. oblique-sagittal Results: one. planes in 19 normal and oblique-sagittal subjects (95%) except oblique-axial planes. in oblique-sagittal displayed 32 abducens (CN6) of 40 nerves (80%) were hypoplasia degree Different showed. 25 trochlear nerves (CN4) of 40 (62%) were very were all CN6s in CFEOMs: exhibited especially CN6, was of motor nerves, and 4 traced thin, in which 1 nerve could be seen normally coursing, 1 not found, strikingly 4 CN3s were The superiorly CN3. ipsilateral among which 2 coursed to and 2 not. well shown onsets of 4 CN4s were The small and 2 normal. Conclusion: the diagnostic potential exploiting This is a precondition for using 3D-FIESTA. by of MR images in CFEOMs. ammatory disease ammatory ([email protected]) ([email protected])
stula, otosclerosis, hydrops hydrops stula, otosclerosis, to EPOS to Tunis/TN Scientific and Educational Exhibits Scientific and Educational rmed diagnoses evoked clinically, permit- clinically, rmed diagnoses evoked We reviewed 23 patients treated for primitive (n=30) or primitive 23 patients treated for reviewed We ([email protected]) ([email protected]) 100 patients presenting a sino-nasal infl
To show the utility of ultrasound of the eye in patients with of the eye the utility of ultrasound show To No Material Submitted Submitted Material No The authors review the normal eye anatomy by ultrasound, and ultrasound, by anatomy the normal eye The authors review 7 9
d d Ultrasound is an invaluable non-invasive tool in ophthalmology. The tool in ophthalmology. non-invasive is an invaluable Ultrasound n Imaging especially when realized according to a rigorous technique Imaging especially when realized All patients reviewed presented with various complaints of sound- presented with various reviewed All patients Ocular sonography is good method for imaging the eye and intraocular and intraocular imaging the eye is good method for Ocular sonography i . stula repair. stula repair. N I The endoscopic surgery is confronted with two of the frontal sinus To describe the CT and MRI appearances of inverted papillomas allowing papillomas allowing describe of inverted the CT and MRI appearances To ([email protected]) Viladecans/ES F Imaging in these patients confi
- c u d E i c S - were investigated between 2004 and 2006 (complicated acute or chronic sinusitis, chronic sinusitis, 2004 and 2006 (complicated acute or between investigated were endoscopic exam ted all of a sinus benefi They polyposis). sino nasal mucoceles, and coronal, sagittal massif containing an axial study and a scanning of the facial and curvilinear reconstructions in the plan of the fronto-nasal tract. Results: ted the study of complications, notably frontal sinusitis and the exact study of the and the exact frontal sinusitis notably ted the study of complications, Anatomical detailed of drainage. and its ways anatomy fronto-ethmoïdal complex pathological correlations are presented. CT boards and various Conclusion: of the frontal sinusitis tool in the diagnosis of complications is an indispensable surgery. and in the anatomical study before C-463 with CT and MRI Evaluation papilloma: Inverted Ferjaoui; M. Marrakchi, Rajhi, M. Salem, H. A. Ayadi, S. Mnif-Megdiche, N. Tunis/TN age The patient’s 18 men and 14 women. papillomas, recurrent (n=2) inverted in performed CT scan was 52 years). age, (average from 28 to 75 years ranged 20 patients and MRI in 16. Purpose: cartography. a precise preoperative Methods and Materials: C-462 of drainage and its ways sinus of the frontal and variants Radiological anatomy Ben Messaoud, M. Bougamra, Azaiz, I. O. Nouira, K. Boukhris, S. Menif, E. Hachicha; S. Besbes, G. Kharrat, Sahtout, S. S. Purpose: of fronto-ethmoïdal the nearness organs and the complexity of noble culties: diffi The purpose of and variants of this work is to clarify anatomy radiological anatomy. the importance and to show of drainage of imaging and its ways the frontal sinus of this region. in the investigation Methods and Materials: Ocular ultrasound Lopez, E. Fernandez, F. Muñoz, V. Villarreal, M. Pozuelo, O. Torramilans, A. Sedo; S. of the fundus may In the presence of opaque ocular media, a complete view structures. is invaluable. sonography and, in these cases, ophthalmoscopically be impossible or eustachian tube dysfunction. Patients with Superior Canal Dehiscence Syndrome Patients or eustachian tube dysfunction. pa- Few phenomenon and symptomatology. Tullio not present with the classic may Making tients with symptomatic superior canal dehiscence elect surgical treatment. audiologic evaluation, the combination of clinical history, the correct diagnosis with patients properly can save CT scans and high clinical suspicion formatted VEMP, from unnecessary and potentially harmful or such as stapedectomy treatments perilymph fi C-461 the sono- illustrate To or vitreous hemorrhage). opaque ocular media (dense cataract of ocular pathologic conditions in these cases. of a variety appearance graphic Background: accessi- other imaging methods are safety, study over of ultrasound advantages most In spite of this, real time kinetic examination. bility and the ability to perform and diseases depicted sonographi- with ocular anatomy are unfamiliar radiologists has principally been the domain sonography largely because ophthalmologic cally, for allowing internal of the eye, anatomy displays Ultrasound of ophthalmologist. media are obscured by of the posterior pole components when they evaluation vitreous hemorrhage. and such occur with dense cataract opacities, Findings: Imaging entities that can be found of differents present the most common manifestations retinal detachment, choroid in the study of patients with opaque ocular media: vitreous vitreous hemorrhage, detachment, asteroid hyalosis, detachment, hyaloid Advantages, changes. drusen and postoperative masses, intraocular membranes, applications are discussed and illustrated. and clinical pitfalls limitations, Conclusion: induced nausea or vertigo, aural pressure, hyperacusis, autophony generalized generalized autophony hyperacusis, pressure, aural or vertigo, induced nausea to attributable These symptoms can all be easily disequilibrium and hearing loss. such as perilymphother common otologic conditions fi Learning Objectives: semicircular canal with signifi cant improvement in clinical symptoms. cant improvement canal with signifi semicircular Conclusion: C - 7 0 R C EECR07-C-SciEduc-FIN.indd 97 Scientific and Educational Exhibits
Fast Field Echo sequences from the resting position to the position of maximum C-469 oral opening. We evaluated signal intensity and morphology, disc position at various The modern ultrasound diagnosis (US) in the combat injuries of eyes degrees of oral aperture, the morphology of the treated condyle, plate integrity, the V. Troyan, K. Slobodin; Moscow/RU ([email protected]) onset of parotid complications, and the length of the treated mandibular branch in comparison with the healthy side. Purpose: The improvement of clinical-and-radiation diagnosis of structural changes Results: The follow-up examinations revealed, on the treated side, fi ve cases of in eyes and retrobulbar space after combat injuries. anterior dislocations of the disc (25%), one of disc degeneration (5%), one parotid Methods and Materials: 284 cases of radiation examination for eye injuries oc- fi stula (5%), and one case of degenerative condylar osteoarthritis (5%). curred during conduct of military operations were analyzed. The ultrasound diag- Conclusion: The surgical repositioning of the condyles does not always lead to nosis with the help of high-frequency probes by transorbital approach was formed. morphological restoration without late skeletal anomalies. Both trauma and surgical During investigations, the possibilities of color Doppler were used and eye anterior intervention can damage the meniscal capsulo-ligamentous containing apparatus. section was examined with the help of water boluses in different modifi cations. MR allows the identifi cation of complications due to the trauma and/or treatment, Results: US method allowed developing the classifi cation groups of eye combat and the comparative evaluation of the condyles and joint function. injuries, the US diagnostic syndromes and the radiationEPOS examination algorithm. The US high diagnostic informative capacity was noted in differentiation of retinal C-467 detachment; vascular tunic and vitreous body; in visualization and topical diagnosis of any intraocular foreign bodies more than 1 mm in size; in diagnosis of intraocular Use of multiplanar, surface and volume rendering in 3D CT for the evaluation and retrobulbar hemorrhages and their sequelae. It also appeared effective in of complex facial trauma: 2 years of experience on emergency basis diagnosis and prognosis of development of infl ammatory posttraumatic changes C. Iosif, E. Triantafyllou, D. Karakyklas, G. Zois, S. Kawadias, M. Tsouroulas, in the eye based on the analysis of ratio blood fl ow velocity in retinal central ar- C. Drossos; Athens/GR ([email protected]) tery/orbital artery; theNo degree Material of posttraumatic Submitted subatrophy to and its development; Purpose: This is a two-year study of management of complex facial trauma with in lens dislocation and change in its transparence. US is the method of choice in use of multislice CT and various reconstructions. cases of "hydrodynamic" rupture of sclera and orbital osteal walls during eye severe Methods and Materials: We have selected 208 patients mostly presented as traffi c contusion and in stab wounds. or work accidents in a period of 2 years using a 16-row multislice CT. The data were Conclusion: Complex US is a universal method for evaluation of structural changes analyzed by multiplanar reconstruction (MPR), surface shaded display (SSD) and in the eye after combat injuries that can be used for screening, pathologic process volume rendering (VR) occasionally and were read by 2 radiologists. verifi cation under conditions of multi-purpose institution and for dynamic follow-up Results: The 208 patients scanned had complex fractures, 113 of which could of treatment results. be classifi ed as Le Fort type, and 95 complex bone fractures of other types, with or without soft-tissue fi ndings or indirect signs. As far as orbital fractures were C-470 concerned, identifi cation of bone dislocation and fragments were of importance as Radiation dose optimization for 16-detector row CT in patients with well as identifi cation of soft-tissue entrapment and occular muscle trauma, air and suspected chronic sinusitis foreign bodies in the orbit etc. In maxillofacial trauma dislocation of bony structures, M. Gamo Gallego, A. Marco Sanz, I. Salmeron Beliz, D. Jimenez Jurado, minor fractures and condylar injuries were the target. The Le Fort type fractures A. Batiray Polat, L. Garcia del Salto Lorente, B. Sanchez Cordon; Madrid/ES were additionally classifi ed as combined or not combined with other fi ndings. ([email protected]) The reconstruction of these provided valuable information of space relationships, particularly useful for the design of operation. The evaluation of facial nerve was Purpose: Compare image quality of sinonasal cavities scans obtained with attempted in 34 cases (with partial/complete palsy) where coronal oblique MPR standard radiation dose and 50% reduced radiation dose with a 16-detector row reformations were valuable. CT scanner. Conclusion: The use of MPR, SSD and especially VR protocols allows extended Methods and Materials: The study includes forty patients referred to multislice evaluation of minor and complex fractures as well as soft-tissue impairment in CT (MSCT) scan of the sinonasal cavities for suspected chronic sinusits. Twenty relatively small structures such as the occular muscles and the facial nerve. patients underwent MSCT examination at standard dose using the following protocol parameters: 16 x 0.625 mm detector confi guration, 0.562:1 pitch, 150 mAs, 120 kV C-468 and 1.25 mm slice thickness. CT scan were obtained in the other twenty patients with half radiation dose by using a pitch of 1.375:1. In all patients, 1.25 mm axial and Osteonecrosis and osteomyelitis of the jaws associated with i.v. coronal images were reconstructed from raw data. All CT scans were reviewed by a bisphosphonate therapy for multiple myeloma and metastatic bone neuroradiologist who evaluated, with a three-point quality scale, several anatomical cancer: CT fi ndings structures and infl ammatory mucosal changes. The graded differences between A. Lo Casto, F. Ganguzza, G. La Tona, F. Sorrentino, R. Restivo, L. Solazzo; the two protocols were evaluated using a t test. Palermo/IT ([email protected]) Results: Reduced dose scans were performed with a CTDIvol of 23 mGy. No Purpose: The i.v. bisphosphonates are widely used in metastatic bone cancer but signifi cant image quality differences were observed between the two groups of in some patients it lead to osteonecrosis and osteomyelitis of the jaws. Panoramic patients. radiography and CT with dedicated dental software fi ndings of 8 patients treated Conclusion: Dose-reduced MSCT helical examinations of the sinonasal cavities with i.v. bisphosphonate therapy for metastatic bone cancer are described. can be obtained using 1.375:1 pitch and 23 mGy CTDIvol without signifi cant im- Methods and Materials: 8 patients (5 women and 3 men, age range 66-86 years) age quality loss. affected by multiple myeloma (5/8 patients) or metastatic bone cancer (3/8 patients) and treated by i.v. bisphosphonate therapy for 3 months to 1 year were submitted to C-471 panoramic radiography and CT with dedicated dental software for dental pain and MR morphology of alar ligaments in asymptomatic subjects evaluated by jaw swelling. In 2/8 patients, a fi stula in the skin surface of the chin with purulent 1.5 and 3 Tesla drainage was also present. P. Schmidt, P.E. Kullnig, H.P. Burmeister, H.-J. Mentzel, W.A. Kaiser; Results: CT fi ndings in the jaws were: osteolytic area, diffuse hyperdensity of Jena/DE ([email protected]) trabecular bone, bone sequestrum, thinning and erosion of cortical bone, perios- teal bone reaction. In 2/8 patients, a fi stulous tract draining in the skin surface of Purpose: As no data of 3 T MR imaging of alar ligament imaging is yet available, the chin was also observed in the mandible. In 1/8 patient, only the maxilla was the purpose of this study was to assess the magnetic resonance appearance of involved, in 5/8 patients only the mandible was involved and in 2/8 patients both the alar ligaments in asymptomatic individuals and to crossvalidate the fi nding jaws were involved. with 1.5 T imaging. Conclusion: CT with dedicated dental software is useful in the detection of osteo- Methods and Materials: 11 healthy subjects (6 female, 5 male) with a mean age necrosis and osteomyelitis associated with i.v. bisphosphonate therapy, allowing of 29.4 years (range 18-42 years) underwent coronal T2 weighted MR imaging a complete assessment of the diseases including the localization of eventual at 3.0 T scanner (TR 5000, TE 99, Siemens, Trio) and 1.5 Scanner (TR 6360, TE fi stulous tract. 107, Siemens Vison). MR fi ndings were analyzed independently by 4 radiologists, differences were resolved in conference. Results: Alar ligaments could be detetcted in all subjects at both scanners at 3 T as well as at 1.5 T. Asymmetric ligaments were found in the majority of the subjects (73%), one case of known old whiplash injury in the past revealed a partial tear of
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G brous dysplasia brous ndings city was 86.7%, and city was Barcelona/ES brous dysplasia: dysplasia: brous ndings to enable the differential the differential ndings to enable C brous dysplasia on the basis of density, brous dysplasia on the basis of density, BDEF A 100, sensitivity was 85.0%, specifi 100, sensitivity was Sixty-two patients undergoing arthoscopy of the TMJ patients undergoing arthoscopy of the Sixty-two ≥ To establish the key radiologic fi ndings to enable the the ndings to enable fi radiologic the key establish To We reviewed 10 cases of Paget disease and fi 10 cases of Paget reviewed We Paget disease and fi brous dysplasia are 2 bone disorders, with brous dysplasia are 2 bone disorders, disease and fi Paget We determined the key imaging fi determined the key We MR is a good imaging method in the evaluation of disk position, MR is a good imaging method in the evaluation Semiquantitative parameters calculated by VOIClassic including the VOIClassic by calculated parameters Semiquantitative The study was designed to assess the diagnostic accuracy of MR in the of MR designed to assess the diagnostic accuracy The study was Sixty-two MR of the TMJ were studied. Mean age was 35.6 years (range: (range: 35.6 years Mean age was studied. TMJ were MR of the Sixty-two It was possible to distinguish the melanoma from the other orbital tumors to distinguish the melanoma possible It was ([email protected])
with bone involvement on craniofacial CT seen in our hospital. The key features features The key our hospital. CT seen in on craniofacial with bone involvement due to involvement craniofacial between diagnosis to consider in the differential is a) whether or not bone involvement brous dysplasia are: fi disease versus Paget c) the bone pattern,symmetrical, b) whether or not it crosses sutures, and d) the bones. presence or absence of disease in the paranasal Conclusion: disease and fi Paget diagnosis between involvement, and distribution of the lesions. of the lesions. and distribution involvement, ([email protected]) Learning Objectives: disease and of of Paget involvement craniofacial diagnosis between differential brous dysplasia. fi Background: a very important studies play in which imaging involvement, frequent craniofacial Fibrous role in orienting the diagnosis and planning appropriate surgical treatment. mesenchyme of the bone-forming anomaly developmental dysplasia is a skeletal in up to one third involvement with craniofacial people, young that usually affects disease is a bone formation/resorption disorder that normally Paget of the cases. in up to 60% of involvement with craniofacial of age, 40 years people over affects pat- radiologic disease can present different brous dysplasia, Paget fi Like cases. terns in function of the stage of the disease. Findings: Imaging C-476 fi disease versus in Paget Craniofacial involvement diagnosis differential Imaging Zauner Jakubik, M. Gols, Rovira Carvajal Díaz, A. A. Prieto del Rey, M. Araiz; Veintemillas M. Melloni Ribas, P. Pascual, Valls R. C-475 internal derangement of of the of MR in the evaluation Value fi Correlation with arthroscopic joint: temporomandibular E. Santos Armentia, F. Tardaguila Montero, J. Aguilar Arjona, J. Montero, Tardaguila Santos Armentia, F. E. Delgado Sanchez-Gracian; Gonzalez, C. Prada R. de la Fuente, Tardaguila G. Vigo/ES Purpose: evaluation of internal derangements of the temporomandibular joint (TMJ). of internal of the temporomandibular derangements evaluation Methods and Materials: MR was In all patients, evaluated. 2006 were 2004 to 1 January from 1 January Philips) with a surface (Intera, T System surgery or a 1.5 with a 0.5 obtained before coil, with sagittal, coronal and dynamic images. Results: in 33 (53.2%), pain in 45 patients (72.6%), clicks Clinical presentation was 14-70). 15 (24.2%), sub- of opening in in 23 (37.1%), limited range lockings mandibular Only in 38 of the 62 patients luxations in 6 (9.6%) and bruxism in 1 patient (1.6%). Arthroscopy described disk displace- described duringdisk position was surgery. disk displacement in ndings showed MR fi ment in 25 and normal position in 13. specifi 67-93%), 80% (IC 95%: Sentibility was 23 and normal in 38. position 78-98%) 87% (IC 95%: was value predictive positive 63-90%), 77% (IC 95%: was of the test Global value 52-82%). 66% (IC 95%: was value predictive and negative 66-92%). 79% (IC 95%: was Conclusion: the diagnosis of visualizing disk position and making possible of being capable internal derangements. standardized by the fusion software included in Neurostat. The standard ROIs The standard ROIs included in Neurostat. fusion software the by standardized adjusted were then they the orbit, and slices for determinedwere from the several calculated by was The uptake image of the 123I-IMP. SPECT to the standardized tumor were patients with orbital Twenty including the Neurostat system. VOIClassic Retention orbit. side of the of the affected compared the uptake We assessed. ratio-early (delayed Retention Index= correction. with decay calculated was Index x 100 (%). ratio)/early ratio Results: When we of the co-registered MR and SPECT images. without the fusion image at RI set the cut-off level 85.7%. was accuracy Conclusion: the diagnosis of method for an objective and provide Neurostat system are useful orbital malignant melanoma.
ed, cult Moscow/RU
2 nding in symptomatic ed prior to surgery, the ed prior to surgery, Bangor/UK 2 Saint-Petersburg/RU, Saint-Petersburg/RU, 1 ed in CT sinuses. It is very important, ed in CT sinuses. ; Scientific and Educational Exhibits Scientific and Educational 2 Liverpool/UK, 1 ; 1 , A. Vasilyev , A. 1 , N. Moshin , N. 2 First, we obtained the normal First, we MRI image of the brain, MRI was carried out in 6 patients (2 choroidal melanoma, MRI was brovascular tissue progression into porous PTFE spheres tissue progression brovascular To illustrate the various anatomical variants in the lateral wall wall in the lateral anatomical variants the various illustrate To ([email protected]) ([email protected])
One of the commonest anatomical variant that is readily that is readily One of the commonest anatomical variant 9 uoroethylene orbital implant: MR imaging pattern MR imaging orbital implant: uoroethylene 9 brovascularized area at the level of the equator of the partially area at the level brovascularized
d d , V. Nikolaenko , V. There are various anatomical variants seen in the lateral wall of the wall seen in the lateral anatomical variants There are various , C. Barwick , C. 1 n 1 3 Tesla MRI provides better visualization of the alar ligaments com- better visualization MRI provides Tesla 3 Magnetic resonance studies seem to be the best-suited imaging mo- Magnetic resonance studies seem to be the best-suited CT sinuses act as a road map for the ENT surgeons prior to functional act as a road map for CT sinuses i . Tokyo/JP N I The usefulness of 123I-IMP for the diagnosis of orbital malignant mela- The usefulness of 123I-IMP for To evaluate the role of MRI in the study of new orbital implant from porous orbital role of MRI in the study of new the evaluate To uoroethylene (PTFE) used for the treatment of anophthalmos, and to the treatment of anophthalmos, (PTFE) used for uoroethylene F On MR images, PTFE orbital implants represent spherical with formations On MR images, - c u d E i c S - New semiquantitative assessment of 123I-IMP for the diagnosis of orbital the diagnosis semiquantitative assessment of 123I-IMP for New malignant melanoma Kakizaki, Umeda, D. J. Park, J. Shindo, H. Saito, K. Goto, H. Yoshimura, M. Koizumi; K. that the ROI be so faint because the images acquired 24 hours after injection may procedure to semiquantitative a new evaluated We becomes arbitrary. draw we in patients with orbital of 123I-IMP the uptake estimate more easily and objectively malignant melanoma. Methods and Materials: C-474 Purpose: is sometimes diffi the estimation of the uptake but recognized, noma is well Preventing FESS from turning into a mess: Role of the radiologist turning into a mess: FESS from Preventing Ganeshan D. C-473 patients a possible cause of neck pain after whiplash injury. injury. pain after whiplash cause of neck patients a possible C-472 polytetrafl Porous pared to 1.5 Tesla MRI imaging. Asymmetry are common in of the alar ligaments MRI imaging. Tesla pared to 1.5 of this fi This result limits the value asymptomatic individuals. Ratnikov V.A. the right-sided ligament. Though all ligaments were detectable by 1.5 T MRI, all 1.5 by detectable were Though all ligaments the right-sided ligament. and faster resolution and an easier better T MRI offers observers that 3 concluded cation of the alar ligaments. identifi Conclusion: ([email protected]) ([email protected]) Purpose: polytetrafl within the porous PTFE implant. progression ingrowth brovascular the fi evaluate Methods and Materials: with primary mean age 49) at 8-24 months after enucleation 3 glaucoma; 1 trauma, 18−20 MRI studies whose diameter was implantation of porous PTFE sphere, mm. protocol, including FLASH 2D (T1), SE and using a standardized performed were T2, Pd) in the coronal, sagittal and axial planes. TSE (T1, Results: intensity (SI) from The signal precisely equal contours and homogeneous structure. 420-580 Units (U) (T2-WI) was images T2-weighted porous PTFE implants made in - 80-120 U). 110-170 U (normalT1-WI was eye - 620-870 U), and in (normal eye The presence of fi associated with in 5 patients and was porous PTFE sphere is revealed wrapped mm. Depth of germination 1-8 was T2-WI. on the reduction of SI from this zone surrounding to differentiate artifacts that allow PTFE does not create any Porous optic nerve orbital fat. and orbital structures − ocular muscles, Conclusion: assessing the fi dality for failed. has identifying patients in whom vascularization and for after enucleation ([email protected]) Learning Objectives: the importance emphasize of identifying To of nose that can be seen in CT sinuses. complications. post-operative these to prevent Background: can be identifi of these variants Most nose. because if left unidentifi identify these variants, to to be able as radiologists, In this serious complications can arise during surgery. functional endoscopic sinus came across in a series that we describe anatomical variants we various exhibit, of 100 CT sinuses. Findings: Imaging unwary surgeon can easily damage important the optic nerve including structures, and carotid artery with disastrous results. Conclusion: to identify the It is important, to be able as radiologists, surgery. endoscopic sinus so that the surgeon can take of nose, wall in the lateral anatomical variants various complications. necessary precautions to avoid identifi ed is nasal septal deviation. There are various other variants like Agger like other variants There are various ed is nasal septal deviation. identifi aetio-pathogenic role in sinusitis. have which may nasi cells and concha bullosa, It is equally important Haller cell, Onodi cell and sphenoid like to identify variants If these are not identifi septal attachment to carotid artery. C - 7 0 R C EECR07-C-SciEduc-FIN.indd 99 Scientific and Educational Exhibits
C-477 ears, 3 foramina in 2 ears, 4 foramina in 2 ears; Abnormal shape of cochlear nerve foramen was seen in 4 ears, spiral shape disappeared completely in 2 ears, small Post-traumatic orbital hematomas: Classifi cation, imaging hints and round shape was shown in 2 ears. literature review Conclusion: Three dimensional imaging can improve the understanding and F. Armienti, A. Stecco, F. Cravero, M. Brucoli, E. Cignini, A. Benech, A. Carriero; comprehension of IAC fundus. CTVE is useful in showing the normal structures Novara/IT ([email protected]) and pathological changes of IAC fundus. Learning Objectives: To understand the pleomorphic presentation of retrobulbar hematomas, occurring after cranio-facial trauma, the radiologic techniques to investi- C-480 gate them, and the principal features useful to achieve the differential diagnosis. Establishment of normal cochlea measurements on standard HRCT Background: Retrobulbar hemorrhagic lesions can be classifi ed in two groups: images to aid diagnosis of cochlea hypolasia intraorbital hematoma and subperiosteal hematoma. Subperiosteal hematomas G. Wuxian, G. Ruozhen, C. Baoting, W. Min; Jinan/CN ([email protected]) represent a rare but well-defi ned clinical entity; they are more frequently seen in children, due to the loose adhesion of periostium in these patients, which can be Purpose: To establish normal measurements of cochlea on standard position im- easily detached from orbital bones by a hemorrhagic mass, with resultant proptosis ages using MPR of HRCT to aid diagnosis of cochlea hypolasia. and compromise of the optic nerve. Infrequently, this kind of retrobulbar hemorrage Methods and Materials: HRCT scanning of temporal bone was undergone in 50 can be associated to the presence of an extradural intracranial hematoma; and volunteers (100 ears). The images of all cases were postprocessed using MPR. Two this condition is known as a real diagnostic and therapeutic emergency. Diagnosis standard images (position I and II) were reconstructed and 9 structures of cochlea relies on computed tomography (CT) and magnetic resonance (MR). (named A-I) were measured. Statistical analysis was done on different age groups, Imaging Findings: Anatomy and radiologic anatomy; classifi cation; MR and CT male and female groups, left and right groups in SPSS program. Normative data of features; cases series. 9 measurements were established. 9 measurements of cochlea were also done in Conclusion: CT and MR allow a correct classifi cation, and provide critical informa- 42 cases (78 ears) with profoud SNHL and compared with normal group. tion to the surgeon for mandatory treatment. Results: 1. The images of position I and II were all shown on 100 ears using MPR. 2. All measurements of cochlea have no difference in age, male and female, left and C-478 right groups. 3. The normative data of cochlea measurements: A 5.66-6.60 mm, B 4.08-4.90 mm, C 2.44-3.10 mm, D 3.24-4.14 mm, E 3.0-4.9 mm2, F 1.83-2.81 mm, Correlation between multiplanar reconstruction sections and three- G 0.57-1.40 mm, H 8.58-9.56 mm, I 2.02-2.53 mm. 4. 32 ears have abnormal dimensional CT images of the normal temporal bone measurements in SNHL group.The measurements of A B E F H I have manifest N. Fujii, Y. Inui, K. Katada; Toyoake/JP differences with normal people. Learning Objectives: To demonstrate three-dimensional CT (3D-CT) images of the Conclusion: Measurement on standard images of cochlea can ensure the ac- whole temporal bone, the mastoid cavity, the tympanic cavity, the auditory ossicles curacy of result, and standard images can be easily reconstructed using MPR. and the inner ear. To correlate multiplanar reconstruction (MPR) sections in various The establishment of normative cochlea measurements is helpful in identifying angles with 3D-CT images. To identify four specifi c sections of the ossicles, the subtle abnormalities of cochlea and valuable in choosing proper treatment plan in images of which are reconstructed to allow viewing of the ossicular chain. patients with profound SNHL. Background: Recent advances in multislice CT (MSCT) have made it possible to obtain high-resolution isotropic volume data, allowing us to generate 3D-CT images C-481 of the temporal bone, in which small structures and intricately shaped ossicles are Echo-planar diffusion-weighted MR imaging in the detection of depicted clearly. Furthermore, we have been able to reconstruct two-dimensional cholesteatomas (2D) sections of the temporal bone, even the ossicles, from any desired direction T. Kodama, T. Yano, S. Tamura; Miyazaki/JP ([email protected]) with MPR without diffi culty. Therefore, it has become possible to recognise an object that has small and complicated structures with 2D-3D correlation. Purpose: To evaluate a single-shot echo-planar diffusion-weighted magnetic reso- Procedure Details: MPR and 3D-CT source data from a volunteer were acquired nance imaging (MRI) (EPI-DWI) in the diagnosis of cholesteatoma in comparison by a 0.5-mm, 4-row MSCT system, using a unique high-resolution image recon- with a single-shot fast advanced spin-echo sequence (FASE-DWI). struction algorithm. MPR sections showed conventional axial, coronal planes and Methods and Materials: Twenty-one patients with a primary or postoperative four specifi c sections of the ossicles, which we have identifi ed for the purpose of recurrent cholesteatoma were examined by EPI-DWI and FSE-DWI in addition to viewing the ossicular chain. Each structure has been indicated on both MPR and standard MRI such as T1- and T2-weighted imaging. EPI-DWI was performed by 3D-CT images and correlated with each other. using parallel imaging with a reduction factor of two. Because of its higher signal- Conclusion: High-resolution MPR and 3D-CT images with MSCT depict the to-noise ratio (SNR), EPI-DWI was obtained with a thinner slice thickness and a complicated anatomy of the temporal bone. 2D-3D image correlation and recogni- higher spatial resolution than that of FASE-DWI. Image quality of EPI- and FASE- tion helps to deepen understanding of conventional 2D sectional anatomy, and to DWI was judged from: 1) contrast of the lesion, 2) image distortion and abnormal identify the optimal section for observing a given object. signal secondary to susceptibility artifacts, and 3) anatomical correspondence with other images. C-479 Results: A cholesteatoma was correctly identifi ed as an area of obvious hy- perintense signal on EPI-DWI and FASE-DWI in 15/21 (71%) and 18/21 (86%), Observation of foramina hypoplasia within internal auditory canal fundus respectively. Among the six lesions that were missed on EPI-DWI, fi ve lesions were with CT virtual endoscopy smaller than 5 mm. In 15 patients whose cholesteatoma was correctly diagnosed on G. Wuxian, G. Ruozhen, C. Baoting, S. Shanshan; Jinan/CN the EPI- and FASE DWI, SNR of the cholesteatoma and cerebellum, and contrast- ([email protected]) to-noise ratio of the cholesteatoma to the cerebellum was not signifi cantly different Purpose: To observe normal and abnormal fi ndings of foramina within IAC fundus between the both sequences. Image quality of EPI-DWI was judged inferior to that with CTVE. of FASE-DWI in 12 patients mainly because of susceptibility artifacts. Methods and Materials: CT scanning of temporal bone was undergone by 25 Conclusion: To use EPI-DWI sequences for evaluating middle ear cholesteato- volunteers (50 ears) in the normal group, in 8 cases (13 ears) with foramina hypo- mas, susceptibility artifact is still the problem that should be resolved despite the laisa within IAC fundus, which were shown on CT and MRI images. CTVE fi ndings application of parallel imaging. were observed in the normal and abnormal groups.The lower threshold value was 900-1200Hu in CTVE defi nitions. C-482 Results: The structures and positions of foramina within IAC fundus were shown High-resolution computed tomography evaluation of congenital on the CTVE image in all normal cases. The fundus was subdivided by transverse anomalies of the external auditory canal and middle ear crest which divided the fundus into upper and lower compartments. Facial nerve A. Skorokhoda; Kyiv/UA ([email protected]) foramen was lain on the anterior of upper compartment and superior vestibular nerve foramen on posterior. On the lower compartment, the anterior was cochlea Purpose: Congenital anomalies of the external auditory canal are rather common. nerve foramen which had spiral shape, and the posterior was inferior vestibular The degree of congenital deformities runs from total atresia to hypoplasia or stenosis nerve foramen. The position of single foramen is uncertain, usually located on of the EAC, to microtia. Embriological development of the EAC and middle ear is in-posterior of IAC fundus. In abnormal group, 9 ears were shown as IAC fundus linked so dysplasias are usually combined. disorder and foramina absent, only 1 foramen was shown in 1 ear, 2 foramina in 4 Methods and Materials: We present the experience of 36 patients examination
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cation based on clinical, cation Mansoura/EG Mansoura/EG C cation of vascular lesions of the head lesions cation of vascular BDEF A ning their extension, and in choosing their precise ning their extension, cient (ADC) map. Diffusion-weighted MR imaging plays MR imaging plays Diffusion-weighted cient (ADC) map. nition of their extension, localization and relationship to localization nition of their extension, 1) To describe the technique of diffusion-weighted MR describe MR the technique of diffusion-weighted To 1) 1) To review the spectrum of neurogenic tumors of the review To 1) To present the classifi present the To Retrospective reviewing of MR imaging in 63 patients with of MR imaging in 63 patients with reviewing Retrospective Diffusion-weighted MR imaging was done for 132 patients with 132 done for MR imaging was Diffusion-weighted We have revised 44 patients with vascular lesions of the head with vascular 44 patients revised have We ([email protected]) There is a great confusion in the terminology used for these le- these confusion in the terminologyThere is a great used for which has imaging modality, imaging is a new Diffusion-weighted
Diffusion-weighted MR imaging can help in discriminating Diffusion-weighted malignant CT and MR, and sometimes catheter angiography, helps in differ- CT and MR, and sometimes catheter angiography, cation and radiological diagnosis ow malformations, which are arteriovenous fi stula (AVF) and arteriovenous stula (AVF) which are arteriovenous fi malformations, ow neurogenic tumors in different regions of the head and neck. Schwanomas appeared Schwanomas the head and neck. regions of neurogenic tumors in different Learning Objectives: signs that help and those radiological the ISSVA, in 1996 by approved and neck in diagnosis. Background: a classifi (1982) presented and Glowacki Mulliken sions. C-485 neck of head and with tumors of patients Diffusion-weighted MR imaging Elhawarey; G. Samir, S. Abdel Razek, A.A.A.A. ([email protected]) Learning Objectives: MR the application of diffusion-weighted illustrate To 2) imaging of head and neck. the advantages demonstrate To 3) tumors. imaging in patients with head and neck and limitations of this technique. Background: in the head and neck. and, recently, cant role in the brain signifi Details: Procedure tumor using single-shot echo-planar imaging with reconstruction head and neck of apparent diffusion coeffi and helps tumors, benign from malignant head and neck a role in differentiating metastatic from differentiating it can be used for Also, biopsy. to select the site for gives The ADC value nodules. and characterization lymph nodes of thyroid reactive After treatment, an idea about cellularity of the tumor that correlates with prognosis. recurrent tumors from post-treatment changes. differentiating it can be used for Conclusion: characterization of cervi- is used for tumor from benign lesions,and head and neck cancer patients of head and neck it has a role in follow-up Also, cal lymph nodes. after treatment and prediction of outcome. C-486 features MR imaging of the head and neck: tumors Neurogenic Elhawarey; G. Samir, S. Abdel Razek, A.A.A.A. ([email protected]) Learning Objectives: To 3) the common location of neurogenic tumors. illustrate To 2) head and neck. which allows of neurogenic tumors in the head and neck, present the MR features c diagnosis. specifi Findings: Imaging Head and Neck Head and Neck Neck Head and C-484 Clinical the head and neck. of and malformations tumours Vascular classifi Vara, Guerrero R. Torres, Baselga Beltrán, E. Juan de J. Delago, de Juan M. Nadal; Ruscalleda Gomez Anson, J. B. Castaño Duque, C. Mas, Guardia E. Barcelona/ES Lesions in management. which helps history, and natural histological features, are classifi Tumours are divided into tumours and malformations. hemangioendothelioma, tufted hemangioma, congenital hemangioma, kaposiform hemangiopericytoma congenital cell and spindle granuloma, angioma, pyogenic slow are divided into: malformations Vascular hemangiopericytoma, glomangiomas. and forms; lymphatic and mixed venous, which are capillary, malformations, ow fl fl rapid part being associated to other lesions, These entities can be (AVM). malformations CT etc. nevus", "Blue rubber bleb Sturge-Weber, of syndromes such as PHACE, precise defi and MR allow morphological CT characteristics, Location and different the adjacent structures. enhancement help in differential and contrast density and MR signal changes, lesions is manda- Precise diagnosis of these vascular diagnosis of these lesions. tory in choosing the best treatment options. Findings: Imaging fi the characteristic and present clinical and radiological and neck, types. ing the different Conclusion: in defi entiating these lesions, Radiological treatment options include percutaneous puncture and management. embolization. endovascular
Athens/GR brous pseudocapsule. pseudocapsule. brous Scientific and Educational Exhibits Scientific and Educational To demonstrate the US, CT and MRI features in cases of CT and MRI features the US, demonstrate To 1 Ultrasound when performed will reveal a smoothly marginated a smoothly will reveal when performed Ultrasound 0 1
ltrating it. The IV administration of contrast material of contrast causes en- The IV administration it. ltrating
d hemangioma of the orbit ndings in cavernous d OCA is the most common intraorbital tumor in adults, consisting of tumor in adults, OCA is the most common intraorbital n Knowledge of the radiological appearance in cases of OCA is manda- appearance of the radiological Knowledge High-resolution computed tomography is the most important preopera- tomography High-resolution computed i . N I F The study included 6 cases of bilateral atresia (1- bony atresia, 1-mem- atresia (1- bony 6 cases of bilateral The study included - c u d E i c S - orbital cavernous hemangioma (OCA). orbital cavernous Background: fi channels encompassed by dilated, endothelial lined vascular (sofi [email protected]) [email protected]) (sofi Learning Objectives: common" benign neoplasm, study Although it has been described as a "relatively growing, It is a slow that the incidence is not very high. reveals of the literature Usually it is not detected lesion seen more often in middle age females. vascular Although OCA is histologically other reasons. for until an imaging study is performed and cause optic nerve structures, compression benign, it can displace intraorbital proptosis and visual disturbance progressive gradually Painless, or increased IOP. are the main clinical signs. Findings: Imaging with color-Dop- ow lesion with presence of internal fl hypoechoic round or oval, with lesion, intraconal a hyperdense demonstrates Computed tomography pler. Commonly orbital bone expansion enhancement. homogeneous contrast marked In Magnetic Resonance Imaging, the lesion appears cation is rare. Calcifi is seen. It displaces the optic T2W1. on T1W1 and hyperintense on isointense to muscle nervewithout infi hancement of the lesion. Conclusion: optimal treatment. facilitating tory its correct characterization, thus, for C-483 Radiological fi Batakis; N. Kakouri, Lepida, A. N. Ntai, S. Kokkinaki, Mylona, A. S. tive test in patients with congenital aural atresia and evaluation of the changes in of the changes and evaluation atresia test in patients with congenital aural tive nerve facial joint, temporo-mandibular mastoids, ossicles, otic capsule, middle ear, and cosmetic operations. reconstructive providing canal for branous atresia, 4- atresia of external auditory 4- atresia of external atresia, branous and canal with ossicular deformities atresia; EAC bony 1- in 30 cases: found atresia was Unilateral mastoids). hypoplastic deformities 10 cases had ossicular atresia with normal middle ear; sized 5 - EAC and atresia cases had ossicular deformities normal 11 unilateral but mastoids, in 5 cases. found plate and no ossicles was atresic thick mastoids, hypoplastic in displastic condyles were Mandibular in 14 cases. were Small tympanic cavities cases. and 1 bilateral occurred in 1 unilateral Stenosis of EAC cases. 8 unilateral Anteriorly located in 1 case. found was deformity Combined inner ear Mondini noted in 12 cases. nerve was canal descending facial Conclusion: with external auditory canal and middle ear dysplasias from 1 to 12 years. In all auditorywith external 1 to 12 years. ear dysplasias from canal and middle Germany) in Plus 4 (Siemens, CT on Somatom used high-resolution cases we planes. axial and coronal Results: C - 7 0 R C EECR07-C-SciEduc-FIN.indd 101 Scientific and Educational Exhibits
as well-defi ned encapsulated mass. Multiple schwanomas are commonly seen in Background: Vascular lesions of the head and neck region are a clinical emer- neurofi bromatosis (NF) type II. Plexiform neurofi broma is a diffusely infi ltrating mass gency with important morbidity and mortality, and appear frequently in polytrau- that associates with NF type I. Malignant peripheral nerve sheath tumor appears matized patients who are diffi cult to evaluate. A high suspicion index is required as large mass with heterogeneous contrast enhancement. Glomus tumors such and prompt realization of modern imaging studies is critical for an accurate and as jugular, tympanicum and vagale appeared as highly vascular tumors with signal rapid diagnosis. void regions. Neuroblastoma, ganglioneuroblastoma, ganglioneuroma are primitive Imaging Findings: We review the radiologic appearance of the main traumatic neuronal tumors that arise from sympathetic chain in children. vascular lesions: arteriovenous fi stula, occlusion, dissection, pseudoaneurysm, and Conclusion: 1) MR imaging adequately diagnosed benign peripheral nerve sheath transection. We point out the locations where one should search for these lesions. tumors, differentiating from malignant counterparts and suspect neurofi bromatosis. We analyze the results of the different imaging techniques. 2) Signal intensity and location are specifi c for diagnosis of glomus tumors. 3) Conclusion: CT angiography (CTA) and MR angiography (MRA) allow prompt and Neuronal tumors are commonly seen in the paraspinal region. accurate diagnosis of traumatic vascular lesions, which is crucial in the prognosis of these patients and ensures their correct management. Conventional angiography remains the gold standard for the confi rmation of these lesions and enables an en- C-487 dovascular treatment, but is costly and not optimal as a screening technique, and is MR diffusion-weighted imaging (DWI) of malignant melanoma in the head not exempt of serious neurologic complications. The use of non-invasive techniques and neck after accelerated carbon-ion radiotherapy (CTA and MRA) for the initial assessment of vascular lesions is growing rapidly. K. Tanabe, S. Kandatsu, T. Sano, J.-E. Mizoe, R. Kishimoto; Chiba/JP These techniques offer several advantages: they are non-invasive, less resource- ([email protected]) dependent, and allow simultaneous evaluation of extravascular structures. Purpose: To report change of diffusion-weighted imaging (DWI) of malignant melanoma in head and neck after carbon-ion radiotherapy. Methods and Materials: Eighteen patients having malignant melanoma in the head and neck regions undertook carbon-ion radiotherapy at the National Institute of Radiological Sciences, Chiba, Japan. We examined the patients using the DWIBS (diffusion-weighted imaging with background body signal suppression) method before and after the treatment. ADC (apparent diffusion coeffi cient) value was measurable in 9 of 18 cases (mean age: 65 yrs, age range: 56-78, 5 males and 4 females). We compared the ADC value obtained before the treatment with the one obtained after the treatment. Intera Achieva 1.5 T Nova Dual system (Philips Medical) was used for the examination. The EPI-based diffusion-weighted imag- ing sequence with SPIR fat suppression was applied at the settings of 2 b-values, namely 0 and 1000 sec/mm2, respectively. Results: Average ADC value for all clinical cases were 0.897×10-3 (S.D.: 0.142×10-3) at pre-treatment and 1.355×10-3 (S.D.: 0.573×10-3) at post-treatment. ADC values increased in 8 of 9 cases and decreased in 1 case. There was a signifi cant differ- ence in ADC value between pre- and post-treatment (P < 0.028). Conclusion: DWIBS examination for malignant melanoma in the head and neck showed signifi cant increase in ADC value after carbon-ion radiotherapy. The ADC value has the possibility of becoming a criteria when we judge the effect of the carbon-ion radiotherapy in malignant melanoma. C-488 Granulomatous diseases of the head and neck: CT and MR imaging appearance A.A.A.A. Abdel Razek, A. Kandeel; Mansoura/EG ([email protected])
Learning Objectives: 1) To review the spectrum of granulomatous diseases of the head and neck. 2) To illustrate the common location of granulomatous diseases. 3) To demonstrate the CT and MR imaging appearance of granulomatous diseases in different regions of the head and neck. Imaging Findings: Retrospective reviewing of CT and MR imaging of 55 patients with granulomatous diseases of the head and neck. Necrotic cervical nodes are commonly seen in tuberculosis. Scleroma appeared as nasal masses with thickened subglottic region. Actinomycosis affects the cervicofacial region with sinus tract. Aspergilosis appears as localized aspergiloma or invasive form and mucormycosis extends into the orbit. Nasal mass with septal erosion was seen in midline lethal granuloma and Wegeners granulomatosis. Enlarged nodes are seen in sarcoidosis. Pseudotumor showed enhancing tissue with bone destruction. Conclusion: 1) CT scan and MR imaging help in characterization of granulomatous diseases in different regions of the head and neck. 2) Cross-sectional imaging de- tects location, extent and effect on surrounding, which are essential for treatment planning. 3) Key characteristics of granulomatous diseases to be differentiated from neoplastic lesions. C-489 Head and neck traumatic vascular lesions A. Alcala-Galiano, F. Ballenilla, A. Ramos, R. Cano, M. Navallas, E. Zabía, J. Campollo; Madrid/ES ([email protected])
Learning Objectives: To identify those patients who will benefi t a specifi c imag- ing study to rule out vascular lesions in the head and neck region. To describe the radiologic fi ndings and more frequent locations of these traumatic lesions. To establish which are the optimal imaging techniques to confi rm the presence of a vascular lesion and to characterize them.
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7 0 0 2 . 2 433 0 . 2 112.02.2007 17:04:03 G c imaging features, bro-odontoma, calcify- bro-odontoma, c diagnosis to be suggested. c diagnosis to be suggested. San Diego, CA/US San Diego, C London/UK BDEF A manifesta- of the typical radiologic knowledge c, ed tumor matrix CT also and cortical destruction. 1. The anatomy of the parathyroid glands. 2. The embryology 2. glands. of the parathyroid The anatomy 1. To identify the radiologic spectrum lesions mimick- identify the radiologic of various To ndings, patient history, physical examination and histologic and examination physical history, patient ndings, Although the imaging features of many lesions mimicking mimicking lesions of many Although the imaging features 1. Knowledge of the anatomy, embryology and patho-physiology embryology and patho-physiology of the anatomy, Knowledge 1. Radiography, the modality most often used for initial evaluation, initial evaluation, used for the modality most often Radiography, ndings of a lesion within the gnathic bones can narrow the broad ndings of a lesion within the gnathic bones can narrow Odontogenic tumor-mimicker lesions (non-odontogenic lesions lesions (non-odontogenic lesions Odontogenic tumor-mimicker 1. Anatomy and embryology of the parathyroid glands including and embryology of the parathyroid Anatomy 1. Ultrasound is an important assess- Ultrasound imaging tool in the pre-operative Although aggressive lesions are commonly malignant and benign lesions are commonly malignant Although aggressive The morphologic characteristicstumors and other le- of odontogenic brous dysplasia, leukemia, multiple myeloma, maxillary sinus carcinoma, juvenile maxillary carcinoma, juvenile sinus myeloma, multiple brous dysplasia, leukemia, ing odontogenic tumor (Pindborg tumor), odontogenic myxoma, cementoblastoma cementoblastoma odontogenic myxoma, tumor (Pindborg tumor), ing odontogenic The dentigerous cyst. and keratocyst, odontogenic ameloblastoma, (cementoma), because of non-specifi can be tricky diagnosis of these processes with certain of familiarity and lack atypical clinical presentation, abnormalities. Findings: Imaging than sensitive CT is more However, cortical detecting can be helpful for destruction. calcifi detecting for radiography In the lesion, and can guide biopsy. of delineation of the anatomic extent provides addition to imaging fi the correct diagnosis. analysis are required to reach Conclusion: or diagnostic clues regarding the aggressive key provide sions of the gnathic bones presen- radiologic of the Awareness of the disease process. behavior non-aggressive diagnostic choices. tations of abnormalities of the most likely helps formulation including odontoma (compound and complex), ameloblastic fi ameloblastic (compound and complex), including odontoma is important in arriving at a correct diagnosis and guiding the surgeons pre-operatively. is important in arriving at a correct diagnosis and guiding the surgeons pre-operatively. as a systemic as well imaging features Understanding the characteristic ultrasound 2. 3. adenomas. localisation of parathyroid scanning approach will aid pre-operative imaging is important. in parathyroid of the limitations of ultrasound Knowledge Conclusion: disease. ment of the patient with parathyroid C-494 Ultrasound glands: and pathology of the parathyroid anatomy Embryology, and localisation in the surgical characterisation techniques, imaging candidate Sidhu; P.S. Schulte, K.-M. Fernando, R.A. ([email protected]) Learning Objectives: The 4. disease. of parathyroid The patho-physiology 3. glands. of the parathyroid pathology with correlation of parathyroid imaging features characteristic ultrasound with other imaging. Background: disease including differential of parathyroid Patho-physiology 2. normal variants. Ultra- 4. imaging. Summary of imaging modalities used in parathyroid 3. diagnosis. gland, including techniques for sound technique used in imaging the parathyroid features Characteristic ultrasound 5. surgery. localization to aid minimally-invasive gland. of pathology of the parathyroid Details: Procedure C-493 of non-odontogenic lesions features Imaging Gnathic bones (part 3): masquerading as odontogenic tumors Sartoris; Theodorou, D.J. Theodorou, S.J. D.J. Learning Objectives: the imaging features recognize To ing odontogenic tumors of the gnathic bones. To odontogenic tumors and their mimickers. distinction between allow that may pitfalls that might avoid with essential imaging features the radiologists familiarize and errors in diagnosis. Background: In the further may as odontogenic lesions) complicate diagnosis. masquerading tumor, brown disease, of such lesions includes Paget’s a group gnathic bones, dysplasia, cleidocranial bromatosis, fi infantile ammatory aggressive disease, infl fi of these conditions share Although several broma, and metastatic disease. angiofi very different do have they and pathologic characteristics, some clinical, radiologic, treatments and prognoses. Findings: Imaging odontogenic tumors are non-specifi from differentiation their lesions often enables tions of odontogenic tumor-mimicker a specifi and occasionally allows odontogenic tumors, occur with non-malignant may characteristic, an aggressive Osseous expansion, a rim of bone sclerosis around a Similarly, disease. such as Paget’s conditions, is present in circumstances, characteristic that, in rare lesion is a non-aggressive ammation is frequently associated Furthermore, local infl malignant neoplasms. those of that resemble ndings with poorly fi demarcated osteolysis and periostitis, a malignant tumor. Conclusion: of Consideration true. this is not uniformly tumors are commonly non-aggressive, certain imaging fi diagnosis. differential
/sec 2 0.20 ; ± city in 2 mm -3 ndings) were , S. Baeck , S. 1 ndings. city of this method, Odontogenic tumors are 0.17 (n=32), 1.24 1.24 (n=32), 0.17
± , C. Hahm , C. 1 ndings to be in sync with the San Diego, CA/US San Diego, ndings (including CT fi , C. Park , C. cient (ADC) on diffusion-weighted MRcient (ADC) on diffusion-weighted 1 Scientific and Educational Exhibits Scientific and Educational 0.377 for normal parotid glands (n=53). There normal (n=53). parotid glands 0.377 for 0.001). Cut-off value of 1.20 x10 Cut-off value 0.001). , Y. Kim , Y. 1 ± < ([email protected]) ([email protected]) /sec) of pleomorphic adenoma, Warthin tumor, Warthin tumor, /sec) of pleomorphic adenoma,
2 . Mean ADC values were statistically compared were Mean ADC values . 2 mm - 3 in cient on diffusion weighted MR imaging , S. Chung , S. DW MRIs with a 1.5-T MR unit in 53 patients with primary MRIs DW Realtime elastography of 60 enlarged cervical lymph nodes Realtime elastography 1 ([email protected]) ([email protected])
To describe the imaging appearances of tumors involving the describe of tumors involving the imaging appearances To cant difference of ADC values between malignant tumors and between of ADC values cant difference Hiroshima/JP 3 0 1
, S. Kim , S. ed using a 5-pattern system (1-5). Pattern 1: Stiff areas occupying Stiff areas occupying 1: Pattern 5-patterned using a system (1-5). 1 d d In the gnathic bones, odontogenic tumors are reported odontogenic In the gnathic bones, to comprise 0.17 (n=9), with 1.24 n ADC value on DW MRI is a valuable tool for characterizing and dif- tool for is a valuable MRI on DW ADC value Ultrasonic elastography showed excellent performance in the diagno- performance excellent showed elastography Ultrasonic i ± . Daejeon/KR N I 2 Evaluation of ultrasonic elastographic appearance of enlarged cervical appearance elastographic of ultrasonic Evaluation To evaluate apparent diffusion coeffi evaluate To F ADC values (x10 ADC values Sensitivity, specifi city, positive predictive value, negative predictive value value predictive negative value, predictive positive city, specifi Sensitivity, - , J. Heo , J. c 1 u d E i ciency of ultrasonic elastography in the differential diagnosis diagnosis in the differential of ultrasonic elastography ciency c S Guri/KR, - was statistically signifi was pleomorphic between of ADC values the difference So was benign tumors (p=0.001). Warthin tumors (p adenomas and Purpose: parotid gland tumors (pleomorphic adenoma; n=32, Warthin tumor; n=12, muco- Warthin tumor; n=32, parotid gland tumors (pleomorphic adenoma; n=3, malignant B-cell n=5, acinic cell adenocarcinoma; epidermoid carcinoma; measured were ADC values Average reviewed. retrospectively were n=1) lymphoma; parotid gland with diffusion non affected in parotid gland tumor and the contralateral, or 800 sec/mm of 0, 500 factor image (DW MRI) for characterizing and differentiating primary characterizing and differentiating tumors. parotid gland MRI) for image (DW Methods and Materials: C-492 and of odontogenic tumors features Imaging Gnathic bones (part 1): lesions tumor-like Sartoris; Theodorou, D.J. Theodorou, S.J. D.J. Learning Objectives: the imaging fi categorize To odontogenic apparatus. with imaging and clinical criteria the radiologists provide to distin- To WHO grading. of the gnathic bones. odontogenic tumors and unusual guish among the various Background: tumors. 1 in 50,000 of all tumors and 1.3-15% of all oral C-491 Effi cervical(metastatic or reactive) of the enlarged lymphnode Hirai, N. Yasutomi, Fukuda, H. Horiguchi, H. J. Tachikake, T. Naito, Alam, K. F. Ito; K. Marukawa, K. (n=12), 1.25 Purpose: between of the diagnostic reliability in differentiating lymph nodes and exploration cervicalmetastatic and reactive lymphadenopathy. Methods and Materials: 11-85 age range: from 25 patients (16 men, 9 women; 32 reactive) (28 metastatic, All the performed. no malignancies) was 11 having cancer, 14 head-neck years; Then and the percentage of stiff areas. distribution for evaluated lymph nodes were classifi were they the whole or almost whole lymph node (LN) with or without a thin rim of peripheral soft areas. Same as pattern1 relatively with central 2: Pattern soft areas. relatively Stiff areas 4: Pattern more than 50% of the LN. Stiff areas occupying 3: Pattern Small stiff areas scattered into 5: Pattern not more than 50% of the LN. occupying set between metastatic lesions was The cutoff line for the LN. soft area of relatively considered considered malignant and 4 and 5 were 1 to 3 were Patterns 3 and 4. Histopathological results and clinical fi reactive. Apparent diffusion coeffi 1 Neck Neck C-490 gland tumors primary parotid D. Park Head and Neck Head and Neck composed of cellular constituents whose primary purpose teeth or tooth- is to form the gnathic bones, can affect Numerous lesions related structures (odontogenesis). allowed the highest accuracy of 89%, with 67% sensitivity and 97% specifi of the highest accuracy allowed and pleomorphicWarthin discriminating adenoma. Conclusion: primaryferentiating parotid gland tumors. and malignant primary 1.89 x tumor were parotid gland for each 3 group (pleomorphic adenoma, Warthin tumor, malignant parotid gland Warthin tumor, (pleomorphic each 3 group adenoma, for in each tumor group. ADC values curve for tumor), obtaining ROC Results: considered as reference standard for analysis of elastographic fi analysis of elastographic standard for considered as reference Results: 78.6%, 100%, 100%, 84.2% and 90%, respectively. were and accuracy Conclusion: Due to high specifi sis of metastatic cervical lymphadenopathy. result is elastographic procedures might be reduced when ultrasonic invasive lymphnode metastasis. for positive C - 7 0 R C EECR07-C-SciEduc-FIN.indd 103 Scientific and Educational Exhibits
C-495 Imaging Findings: Conventional (anteroposterior, lateral, and oblique), intraoral dental, and panoramic radiographs remain the mainstay in the assessment of Evaluation of radiation damage to the microstructure of the parotid gland osseous lesions involving the gnathic bones. CT and MR imaging provide further using MR microscopy characterization of the intrinsic features of lesions affecting the ganthic bones and T. Kan, K. Kodani, S. Fujii, T. Ogawa; Yonagoshi/JP ([email protected]) allow determination of the extent of involvement of the dentomaxillofacial complex Purpose: Radiotherapy for head and neck cancer traditionally includes large parts of and paranasal sinuses. Principles of imaging interpretation include evaluation of the parotid gland in the radiation fi eld and often leads to distressing oral complaints. the lesion location within the maxilla or mandible, shape, size, and rate of growth, The aim of this study is to elucidate the radiation damage to the microstructure of pattern of bone destruction, demarcation, tumor matrix, septation, osseous expan- the parotid gland using MR microscopy. sion, cortical erosion, periosteal reaction, relationship of lesion to the adjacent tooth Methods and Materials: This study comprised 20 normal subjects without parotid structures and sinuses, associated soft tissue mass, and marrow edema. disease and 20 patients treated with radiotherapy for head and neck cancer. Mean Conclusion: Recognition of the key imaging fi ndings of non-odontogenic tumors dose to the parotid glands included in the radiation fi eld was 11.1 to 38.6 Gy (me- and tumor-like lesions affecting the maxilla and mandible, combined with clinical dian: 22.3Gy). MR imaging was performed using a 40 mm microscopy coil before evaluation and results from histopathology suffi ce for correct diagnosis. Estab- and after radiotherapy. Axial fat-suppressed T2-TSE images were obtained with a lishment of defi nitive diagnosis can help the surgeon avoid undue extensive or 1.5 T scanner. We assessed the radiation damage to the parotid parenchyma and unnecessary surgery. duct using ImageJ (version 1.36 software program). Results: The thickness of the parotid duct wall in the normal group was 0.31 to C-498 0.62 mm (mean: 0.46 mm). In irradiated patients, thickening of the duct wall was Many faces of pleomorphic adenoma of the parotid gland: A pictorial essay observed (0.63-1.24 mm, mean: 0.93 mm) after radiotherapy. The difference of G. Chen, A. Magalhaes, J. Feng, M. Al-Abbadi, I. Zak, K. Kish; Detroit, MI/US the wall thickness was statistically signifi cant (p < 0.001). In normal subjects, ([email protected]) reticular pattern refl ecting the microstructure in the gland parenchyma could be clearly visualized, while thickening of the reticular pattern and atrophy of the gland Learning Objectives: To illustrate the variable imaging appearances of parotid parenchyma were observed in the radiotherapy group. gland pleomorphic adenoma. Conclusion: MR microscopy allows us to evaluate not only the volume reduction and Background: Pleomorphic adenomas are the most common tumor of the parotid signal intensity changes of the parotid gland, but also the microstructure of the gland gland, generally presenting as a painless palpable mass. There is variability in the parenchyma, thereby refl ecting the histopathological changes following radiotherapy. size, heterogeneity, enhancement, and encapsulation of thisEPOS benign mass. Ultrasound, CT, and MRI are utilized to localize, characterize, and biopsy parotid masses. C-496 Procedure Details: From a series of 105 parotid masses biopsied over a 3-year- period (01/03-12/05) at Detroit Medical Center/Wayne State University, 30 lesions Multi-slice computed tomography angiography and color Doppler were pathologically proven to be pleomorphic adenomas. The wide range of imaging sonography in the evaluation of neck tumor vascular pattern fi ndings will be discussed. F. Todua, D. Miminoshvili, L. Gzirishvili, G. Tsivtsivadze; Tbilisi/GE Conclusion: All palpable tumors in this series were greater than 10 mm on ([email protected]) presentation and mostNo of Material tumors were Submitted unilateral and to involved the superfi cial lobe Purpose: To determine the value of Multi-slice CT angiography and color Doppler of the parotid (over 90%). Although pleomorphic adenomas had a wide range of sonography in assessing neck tumor neovascular pattern, its relationship to the size, heterogeneity, and enhancement characteristics, most tumors demonstrated carotid arteries and jugular veins (invasion, compression, dislocation) and planning a capsule with circumscribed borders. Recognizing the pleomorphic adenoma may of adequate surgical treatment tactics. avoid unnecessary surgery. Methods and Materials: Between 2000 and 2006, Multi-slice CT angiography (3D image reconstructions using post-processing algorithms - MPR, SSD, MIP) and CDS C-499 were used in 77 patients with morphologically proved tumors (paraganglioma-40, Modifi cation of an US-FNAB technique of the thyroid gland and material schwannoma-18, neurofi broma-12 and neurogenic sarcoma-7). The age range processing with ThinPrep® diminishes the proportion of inadequate smears was 22-63 years; females-44, males-33. M. Diaz, A. Alonso-Burgos, A. Villanueva, J. Larrache, D. Lozano, G. Bastarrika; Results: On both MCTA and color Duplex imaging, carotid body paraganglioma Pamplona/ES ([email protected]) was characterized as highly hypervascular lesions, with anteromedial dislocation of the external carotid artery in 33 cases and posterolateral dislocation of the internal Purpose: To evaluate the effect of a modifi ed thyroid US-FNAB technique with jugular vein in 7 cases. The duplex spectrum in the contributing external and internal ThinPrep® processing (Cytyc, Boxborough, MA) in reducing the number of un- carotid arteries showed a high fl ow and low-resistance pattern. In schwannomas satisfactory smears. and neurophibromas, vessel invasion had not been identifi ed, but close ring en- Methods and Materials: Two groups with different thyroid US-FNAB technique hancement was revealed. On CDS, tumor was revealed as hypovascular lesion with and smear preparation were analysed. Group A included a retrospective (2000-04) high-resistance pattern. Neurogenic sarcomas were characterized as hypervascular evaluation of 322 punctures in which US guidance was used for needle placement. tumors with invasion in internal jugular vein in four cases, while the distal part of the Group B included a prospective (2005-06) evaluation of 111 punctures in which US common carotid artery and its bifurcation could not been identifi ed in three cases. guidance was performed for both needle placement and aspiration. Conventional In all cases, Intralesional fl ow and tumor relationship with adjacent vessels detected smear cytopreparatory technique and ThinPrep® process was used for groups A by CDS and SCTA correlated well with the intraoperative fi ndings. and B, respectively. Radiological and pathological reports were reviewed. Nodule Conclusion: MCTA and CDS are an accurate diagnostic method for the precise size and appearance, number of punctures, procedural complications and cytol- evaluation of neck tumors. The methods provide valuable preoperative information ogy and histology results were analysed. Specimens were classifi ed as adequate regarding tumor vascularity and neck vessel compression or invasion. (benign/malignant), indeterminate (follicular proliferation), or inadequate. Results: No signifi cant differences in the proportion of nodule size, cystic or solid C-497 components and number of punctures were observed. Group A had 109 (33.9%) cases of inadequate smears, 206 (64%) cases of adequate specimen (60.9% Gnathic bones (part 2): Imaging features of non-odontogenic tumors and benign cytology; 3.1% malignant cytology), and 7 (2.2%) indeterminate. Group B tumor-like lesions showed 6 (5.4%) cases of inadequate smears, 102 (91.9%) cases of adequate D.J. Theodorou, S.J. Theodorou, D.J. Sartoris; San Diego, CA/US specimen (89.2% benign; 2.7% malignant lesions), and 7 (2.2%) indeterminate. Learning Objectives: To review the imaging characteristics of non-odontogenic Differences in the proportion of inadequate smears, benign cytology and adequate tumors and tumor-like lesions affecting the maxilla and mandible. To acquaint radi- smears were statistically signifi cant. No signifi cant differences in the proportion of ologists with the unusual gnathic lesions. To provide helpful differential diagnostic indeterminate smears and malignant cytology were detected. features suggestive of individual abnormalities. Conclusion: Use of US guidance for needle tip location and aspiration in com- Background: Although non-odontogenic tumors of the gnathic bones typically bination with ThinPrep® for material processing diminishes the proportion of involve the same basic tumorigenic processes as bone tumors in other parts of the inadequate smears. skeleton, the former may exhibit unique imaging features owing to their proximity to the teeth. Included among non-odontogenic tumors of the gnathic bones are osteoma, ossifying fi broma, osteosarcoma, chondrosarcoma, fi brosarcoma, giant cell tumor, haemangioma, lymphangioma, and aneurysmal bone cyst.
434 A BDEFC G
EECR07-C-SciEduc-FIN.inddCR07-C-SciEduc-FIN.indd 110404 112.02.20072.02.2007 17:04:0317:04:03 4 0 : 4
Head and Neck 0 : 7 1
7 0
0 2 . 2 435 0 . 2 112.02.2007 17:04:04 ne needle G Pamplona/ES ne needle aspiration and biopsy ne needle aspiration PET ne needle aspiration and C city values results were 78% and 25%, 78% and results were city values BDEF ndings in thyroid cancer and related ndings in thyroid cient material in 23.9% of the aspirates. cient material in 23.9% of the aspirates. ([email protected]) ([email protected])
case resulted while 1 cases, ed the lesion in 8 A Rome/IT We selected 154 patients who underwent neck high neck 154 patients who underwent selected We Between 2000 and 2006, 2224 US-guided fi 2000 and 2006, 2224 US-guided Between To illustrate the color-Doppler (CD) and power-Doppler (PD) the color-Doppler (CD) and power-Doppler illustrate To Multidetector CT is an accurate second-level diagnostic technique in diagnostic second-level Multidetector CT is an accurate US guided fi ne needle aspiration is a useful method for characterisa- is a useful method for ne needle aspiration US guided fi es- lymph nodes enlargements, of neck evidence The ultrasound ([email protected]) ([email protected]) To establish the guidelines for the management of patients with inciden- the management the guidelines for establish To lymph nodes enlarge- jugular and paratracheal pretracheal, evaluate To
On US-FNA, there was insuffi On US-FNA, there was A group: 27% showed antibody titers (IV°) and sonographic characteristics antibody titers (IV°) and sonographic 27% showed A group: while in 1 case surgical exploration resulted to be negative. In 9/15 cases with In 9/15 to be negative. resulted surgical exploration while in 1 case surgeryndings, identifi CT fi negative and specifi The sensitivity to be negative. of 73%. a diagnostic accuracy with respectively, Conclusion: entire cervical of the the exploration lesion, allowing the detection of a parathyroid and mediastinal regions. C-504 in patients with thyroiditis of cervical lymphadenopathy Sonographic evaluation La Barbera, L. Tomei, Martinelli, A. M. Fanelli, G.P. Francioso, Flecca, A. D. Giovagnorio; F. Ravazzolo, N. Purpose: C-505 fi imaging and power-Doppler Colour- C-503 between fi Radiologic-pathologic correlation studies of the thyroid Valero; M. Larrache, J. Villanueva, A. Alonso-Burgos, Diaz, A. M. ([email protected]) Purpose: (PET) tomography lesions on position emission uptaking thyroid positive tally found nodules. describe non-uptaking thyroid the cytology and histology of To studies. Methods and Materials: obtained from samples were Two performed. nodules were of thyroid aspirations 47 females. 63 patients (16 males, evaluated We each 23-G needle aspiration. Forty-nine of them PET studies. 20-76, x=55) who also underwent Age range: origin history and 14 of non-thyroid of malignant disease previous had a known biopsy. thyroid underwent Results: 2 disease. benign cytologies and 10.8% malignant 60.8% of patients showed 54% of On PET studies, proliferation). indeterminatecases (4.3%) were (follicular an uptake Since there was 1.7-19). (Suv max: uptake positive the lesions showed uptake all lesions with positive lesions, benign and malignant between overlap Three out of 7 cases with fi US-FNA. underwent Nineteen benign lesions showed PET studies. malignancies had negative proven In our series, the incidence of primary 10). Suv max: (highest value uptake positive history 26% and for of malignancy was in patients with previous cancer thyroid 54%. breast cancer patients it was Conclusion: does not The absence of uptake PET result. lesions with a positive tion of thyroid specially breast tumours, malignancies, with previous Patients malignancy. exclude malignancy. incidence of thyroid greater PET results have with positive phase. in active occult or chronic thyroiditis by ment at US in patients affected Methods and Materials: A divided into 3 groups: were Patients and color Doppler. resolution sonography B group: phase; in active of chronic thyroiditis 64 patients (42%) suspected group: 20 patients (13%) C group: 70 patients (45%) with clinical history of thyroiditis; the thyroid considered In addiction, we pathology. of thyroid familiarity with positive normal high (I°), low of gravity: levels hormones classifying four and antibody titers, (II°), high (III°), more high (IV°). Results: jugular (59%), and (70%), with pretracheal phase, in active of cronic thyroiditis antibody titers 15% showed enlargement. (35%) lymph nodes reactive paratracheal enlargement at US. (13%) and jugular (2%) lymph nodes (III°) and only pretracheal chronic thyroiditis all patients had antibody titers (II°-III°) and sonographics B group: (25%) lymph (81%), jugular (63%) e paratracheal with pretracheal characteristics, from clinical-strumental negative 9% was C group: nodes lipomatous enlargements. (13%) while 4% had antibody titers (I°-II°) and and only pretracheal point of view, enlargement at US. and jugular (2%) lymph nodes reactive Conclusion: appears to be a very useful US sign of subacute or chronic pecially pretracheal, thyroiditis. metastases neck Siani; Gallipoli, A. A. Vallone, P. Chiofalo, Nunziata, M.G. A. Catalano, O. Naples/IT Learning Objectives: provide To gland cancer and related metastases in the neck. ndings in thyroid fi
rmed rmed ndings ed 39 lesions Palermo/IT
ndings in 21 cases. ndings in 21 cases. . Baseline echogenicity and the Baseline . ® ([email protected]) ([email protected])
, malignant nodules showed absent , malignant nodules showed Stoke-on-Trent/UK ® Scientific and Educational Exhibits Scientific and Educational Pisa/IT ndings in 26 cases; negative scintigraphic scintigraphic negative ndings in 26 cases; 0.001) and should be the primary diagnostic < fi ndings in 20 cases and positive One hundred and ninety nine consecutive patients patients One hundred and ninety nine consecutive The study included 60 patients affected by primary by The study included 60 patients affected Eighteen patients affected by solitary thyroid nodules solitary by thyroid Eighteen patients affected ne needle aspiration (FNA) during a two year period (July period (July (FNA) during year ne needle aspiration a two 5 0 1
d d n Obtaining cytology by an ultrasound guided method is statistically an ultrasound Obtaining cytology by i CEUS of thyroid gland is a feasible technique but overlapping fi overlapping but technique gland is a feasible CEUS of thyroid . 0.001). N < I To assess the feasibility of contrast-enhanced ultrasound (CEUS) of ultrasound of contrast-enhanced assess the feasibility To To evaluate the accuracy of multidetector CT in detecting parathyroid CT in detecting parathyroid of multidetector the accuracy evaluate To Despite the risk stratifi cation provided by ultrasound and nuclear medi- and nuclear ultrasound by cation provided Despite the risk stratifi After administration of SonoVue After administration F CT examination resulted positive in 35 cases, negative in 15 cases and negative in 35 cases, resulted positive CT examination Diagnostic samples were obtained in 77% (154/199) of patients. This obtained in 77% (154/199) of patients. Diagnostic samples were - c u d ndings in 34 cases, doubtful US fi ndings in 34 cases, E i c S ne needle aspiration of thyroid nodules ne needle aspiration of thyroid doubtful fi ndings in 19 cases, - CT scans were obtained before and after the contrast medium administration (delay (delay medium administration and after the contrast obtained before CT scans were mm, and a reconstruction interval of of 2.5 of 30 and 80 sec), with a thickness compared to surgical results. ndings were CT fi 1.25 mm. Results: surgery surgery: identifi 40/60 patients underwent doubtful in 10 cases. while in in 2 cases surgery 2 primary negative, (37 adenomas, was hyperplasia); Surgery confi gland. 8 cases the lesions interested an ectopic parathyroid surgery in 8/10 doubtful cases, confi cases; in 23/35 positive CT evaluation in 2 cases the lesions resulted to be ectopic, the location of the lesion in 5 cases, fi ([email protected]) ([email protected]) Purpose: characterising solitary the potential of this method for gland and to evaluate thyroid nodules. thyroid Methods and Materials: rmed surgery by (nine papillary carci- 1.8 cm) confi mean: 0.6-3.6 cm; range: (size and adenoma one follicular hyperplasias, three carcinomas, follicular four nomas, (0.06-0.08) M.I. US at low Pulse Inversion adenoma) underwent one Plummer’s mL bolus of SonoVue injection of a 2.4 after i.v. in diagnosis. a delay technique in avoiding Purpose: primary by hyperparathyroidism. lesions in patients affected Methods and Materials: negative revealed examinations rst-level fi the preoperative hyperparathyroidism; US fi C-502 lesions in patients with primary Multidetector CT in detecting parathyroid hyperparathyroidism Giannini, A. Forasassi, Bertini, F. Cappelli, R. Belcari, C. A. Mazzeo, S. Bartolozzi; Caproni, C. Battaglia, G. V. The comparative diagnostic yield of freehand versus ultrasound guided yield of freehand versus The comparative diagnostic fi ([email protected]) Purpose: nodules. histology is the only discriminator of benign from malignant thyroid cine, both freehand and ultrasound The method of obtaining cytology locally is hybrid, to determine aim of this study was The which is the most successful at guided. an early diagnosis. providing Methods and Materials: C-501 Oxtoby; Britton, J. Rogerson, I. M. Davis, R. undergoing thyroid fi undergoing thyroid ed classifi Cytology was review. included in a retrospective 2006) were 2004-July accounted for Freehand a cytologist. (1) diagnostic or (2) non-diagnostic by as: obtained by whilst the remaining 71% (141/199) were 29% (58/199) of samples, guidance. ultrasound Results: in the freehand FNA group corresponds to a diagnostic yield of 62% (36/58) Comparison guided FNA group. compared with 84% (118/141) in the ultrasound with a chi-squared statistic performed was observed events of predicted versus of 9.78 (p Conclusion: cantly more successful (p signifi (4/13), faint dotted (4/13) and diffuse contrast-enhancement (5/13); in this latter in this latter (5/13); dotted (4/13) and diffuse contrast-enhancement (4/13), faint Benign nodules showed (1/5). case inhomogeneous (4/5 cases) or homogeneous ed pre- both homogeneous (3/5) or heterogeneous (2/5). diffuse contrast-enhancement, modifi CEUS never ndings but fi rmed subjective data confi Quantitative analysis. contrast Conclusion: nodules. seem to limit the potential of this technique in the characterization of thyroid Qualitative and quantitative evaluation of solitary thyroid nodules with nodules of solitary thyroid quantitative evaluation Qualitative and Initial results contrast-enhanced ultrasound: Midiri; M. Lo Re, Runza, G. Galia, G. M. Taibbi, Bartolotta, A. T.V. C-500 dynamic enhancement pattern of each nodule in comparison with adjacent thyroid also images were on gray-scale Signal intensity values assessed. were parenchyma administration. 60 s and 120 s after SonoVue® 30 s, calculated at baseline, Results: C - 7 0 R C EECR07-C-SciEduc-FIN.indd 105 Scientific and Educational Exhibits
histological and surgical correlation. To show the practical value of Doppler tech- C-508 niques in disease detection, differentiation, and follow-up. Preoperative localization of hyperfunctioning parathyroid glands using Background: Sonography is the main imaging tool in the assessment of patients C-11 methionine PET: A comparison with 18F-FDG PET and 99mTc-MIBI with thyroid nodules. Malignant thyroid nodules show a variety of Doppler patterns scintigraphy that should be known in order to prompt further evaluation (cytology). H. Wakamatsu1, S. Nagamachi1, S. Fujita2, K. Kamimura2, R. Nishii1, S. Futami1, Procedure Details: Malignant nodules usually appear hypervascular, although S. Tamura1; 1Kiyotake-cho/JP, 2Miyakonojo/JP hypervascularity is not specifi c for malignancy. Conversely, absence of vascular signal is highly predictive of benign nature. A complete vascular halo around a Purpose: Preoperative localization of hyperfunctioning parathyroid glands in nodule is highly predictive of its benign nature. Absent vascular halo and intra- patients with hyperparathyroidism (HPT) is important. Previously, we reported a nodular vascularity are not specifi c for malignancy, but a combination of absent direct comparison study using 99mTc-sestamibi (MIBI), 99mTc-tetrofosmin, and 201Tl. halo, microcalcifi cations, and intense fl ow is signifi cantly specifi c for its malignant In our previous study, 99mTc-MIBI and 99mTc-tetrofosmin were equally useful and nature (although insensitive). Spectral analysis has a limited practical value. Lymph they were more useful than 201Tl. Recent reports have shown the usefulness of 11C- nodes, node-to-vessel relationship, and jugular vein thrombosis can be evaluated. methionine positron emission tomography (PET), but the role of 11C-methionine is Lymph nodes usually demonstrate peripheral vascularization with irregular signal not well known. We directly compared the detectability for localization of abnormal distribution and alternated hypervascular and hypovascular intranodular areas. parathyroid glands using 11C-methionine PET, 18F-fl uorodeoxyglucose (FDG) PET Conclusion: CD and PD imaging has a signifi cant additional role in the US as- and dual-phase 99mTc-sestamibi (MIBI) scintigraphy to clarify the usefulness of sessment of thyroid cancer and of metastatic cervical lymph nodes. 11C-methionine PET. Methods and Materials: Seven patients (3 men and 4 women), 6 primary HPT C-506 and 1 secondary HPT, were evaluated. We performed 11C-methionine PET, 18F-FDG PET, and dual-phase 99mTc-MIBI scintigraphy on all patients and directly compared Troisier sign (left-sided supraclavicular metastatic lymph node): An old but the detectability. They were operated and confi rmed histologically. still possible presentation sign of chest and abdomen tumours Results: In 6 patients with primary HPT (6 adenomas), 5 patients (83.3%) were F. Sandomenico, O. Catalano, C. Sandomenico, G. Iodice, A. Nunziata, A. Siani; correctly localized by 11C-methionine and dual-phase 99mTc-MIBI scintigraphy. But Naples/IT ([email protected]) 18F-FDG PET could detect only 1 of the 6 patients (16.7%). In 1 patient with second- Learning Objective: To illustrate the clinical and imaging fi ndings in patients with left ary HPT, 11C-methionine PET and dual-phase 99mTc-MIBI scintigraphy could detect supraclavicular lymph node metastasis secondary to thoraco-abdominal tumours. 2 of the 4 abnormal hyperplastic parathyroid glands (50%), but 18F-FDG PET could To highlight how, even nowadays, this site of nodal colonisation can represent the not detect abnormal parathyroid glands. fi rst clinical presentation of an advanced thoracic or abdominal tumour. Conclusion: In our preliminary study, 11C-methionine PET and dual-phase 99mTc- Background: In 1886, the French pathologist Troisier described the palpable MIBI scintigraphy are equally useful for localization of hyperfunctioning parathyroid metastatic involvement of left supraclavicular lymph nodes as an "early" sign of glands, but 18F-FDG PET is not satisfactory for the localization of hyperfunctioning gastric cancer. Tumor cells spread along the thoracic duct till its venous injection parathyroid glands. and colonised the supraclavicular nodes. Procedure Details: We illustrate the clinical and imaging (USy, CT, MRI, and/or C-509 PET) fi ndings in patients with thoraco-abdominal tumours and left supraclavicular Ultrasonography of peripheral lymph nodes: Shape and Doppler-US features lymphatic spread. The exams of patients with advanced tumours of breast, lung, A. Cuñat, E. Belloch, A. Julve, V. Perez, E. Ponce, M. Pina; Valencia/ES thymus, stomach, colon, and ovary are shown. In all these cases, subsequent imag- ([email protected]) ing assessment demonstrated concomitant, although clinically silent, locations in other sites such as liver, lungs, and mediastinal or abdominal lymph nodes. One Purpose: We study peripheral lymph (cervical, axillary and inguinal) nodes features in patient had coexistent papillary thyroid carcinoma and supraclavicular metastasis order to differentiate malignant adenomegalies from hypertrophic-reactive nodes. as isolated site of recurrence from operated colonic carcinoma. Methods and Materials: We practised high resolution ultrasonography with 7.5- Conclusion: Surprisingly, even in the current age of "early diagnosis", we can 13 MHz lineal probes in 100 patients (56 women and 44 men). The ages ranged seldom have a palpable left-sided lymphadenopathy as the fi rst sign of a tho- from 7-78 years (mean age 51.4 years). raco-abdominal tumour. Both physician and radiologist should be aware of this Results: 300 nodes were observed, with 181 benign and 119 malignant nodes. 130 uncommon occurrence. benign nodes (71.8%) had oval shape (Vasallo index ≥1.8) and echogenic centre. 21 benign nodes (11.6%) were oval, without central refringence. 20 nodes (11%) C-507 had kidney-like shape with echogenic centre. 98 benign nodes (54.1%) showed central arterial signal associated with intranodal vascular branching. 67 nodes MR microscopy of the parotid gland tumor and facial nerve using 3 Tesla (37%) showed central vascular signal alone. In 139 nodes (76.8%) there was low MRI resistance (IR< 0.75) arterial signals and 19 nodes (10.5%) showed high resistance M. Ishibashi, S. Fujii, J. Nakanishi, E. Matsusue, S. Sugihara, T. Ogawa; Doppler signals (IR ≥or 0.75). 77 malignant lymph nodes (64.7%) appeared rounded Yonago-city/JP (Vasallo index < 1.8) without central echoes, heterogeneous and hypoecoic. 12 Purpose: To investigate the usefulness of MR microscopy using 3 Tesla MRI for nodes (10.1%) were kidney-shaped, hypoechoic. 27 nodes (22.7%) were rounded, the evaluation of the parotid gland tumor and intraparotid facial nerve. with eccentric echoes. 82 malignant nodes (68.9%) showed lateral vascular signals Methods and Materials: From May 2005 to August 2006, 27 patients with parotid without central vascular signals; in 16 nodes (13.4%) a central vascular signal was gland tumors underwent MR microscopy using a 70-mm surface coil and 3 Tesla recorded. 67 malignant nodes (56.3%) showed high resistance vascular signals. In MRI. All parotid gland tumors were histologocally confi rmed: 13 pleomorphic ad- 28 adenopathies (23.5%) the arterial signals were of low resistance. There was no enomas, 7 Warthin’s tumors, 2 lymphoepithelial cysts, 1 schwannoma, 1 adenoid Doppler signal in 13 malignant nodes (10.9%). 10 neoplastic nodes (8.4%) showed cystic carcinoma, 1 small cell carcinoma, 1 salivary duct carcinoma with pleo- vascular intranodal branching. morphic adenoma, and 1 myoepitheial carcinoma. We obtained axial and coronal Conclusion: We can combine morphologic and vascular nodal features to differenti- T1-weighted, T2-weighted and Gd-T1-weighted images. We tried to evaluate pro- ate accurately between malignant lymph nodes and hypertrophic-reactive nodes. spectively tissue characterization of the parotid gland tumors and also to analyze the relationship of the tumors to the facial nerve. After the surgical resection of the C-510 tumors, we performed MR-pathologic correlation and confi rmed the relationship US fi ndings in loco-regional metastasis from malignant melanoma of the tumors to the facial nerve. A. Cuñat, E. Ponce, A. Julve, M. Pina, V. Perez, E. Belloch; Valencia/ES Results: From the MR-pathologic correlation, we could perform tissue character- ([email protected]) ization of the tumors. This information was useful for the differentiation of parotid tumors. In all cases, except for a few patients with large tumors, primary branches Purpose: We describe the US fi ndings in lesions secondary to malignant melanoma. of intraparotid facial nerve were clearly identifi ed. The lesions were located near the place of excision of the primary melanoma or Conclusion: High-resolution MR images obtained by MR microscopy using 3 in the fi rst lymphatic region. Tesla MRI is quite useful for differentiating parotid gland tumors and preoperative Methods and Materials: 10 patients were included from March ‘05 to March ‘06. planning of surgical approaches for parotid gland tumors. The ages ranged between 47-79 years (mean age 65 years). All the patients had their malignant melanoma resected 6-24 months before the US exam. We practised high-resolution US with 7.5-13 MHz probes.
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7 0 0 2 . 2 437 0.05). 0.05). 0.01); 0.01); 0 . > < 2 112.02.2007 17:04:04 G
Adana/TR 60), 3) duration of hemodialysis of hemodialysis 60), 3) duration Gumi/KR ≥ 2 C BDEF 60 or uoroscopic and sonographic guidance in and sonographic uoroscopic < cantly reduced after embolization (p Seoul/KR, A 1 ; 1 Between November 1997 and May 2006, percutaneous 1997 and May November Between Sixteen large white adult intact male pigs were random- Sixteen large white adult intact male pigs were forty-seven pediatric patients (22 males and 25 females) pediatric patients (22 males and 25 females) forty-seven , D. Goo , D. 2 , S. Yang , S. 1 In pediatric patients, implantation of subcutaneous venous chest venous In pediatric implantation of subcutaneous patients, Transarterial embolization of the prostate is technically feasible and embolization of the prostate is technically feasible Transarterial ([email protected]) ([email protected])
To analyse factors related to restenosis after percutaneous angioplasty related to restenosis after percutaneous angioplasty analyse factors To We aimed to analyse retrospectively the outcomes of subcutaneously aimed to analyse retrospectively We of transarterial and safety embolization technical feasibility evaluate To Technical succes was 100%. There was no complication, except for com- for except no complication, There was 100%. succes was Technical emboliza- obtained in all animals that received success was Technical , Y. Kim , Y. 1 Pathological study suggested that particles arterioles of embosphere occluded Pathological partial normalinside the prostate; arterioles the occluded gland structure nearby of lymphocytes. ltration and infi disappeared with glandular atrophy Conclusion: of the prostate reduce the size The embolization may intact pigs. in the healthy safe function. without compromising the normal sexual no difference on sexual function was noticed between the 2 groups (p the 2 groups noticed between function was on sexual no difference Purpose: stenosis in patients of hemodialysis. AVF native for Methods and Materials: attempted in 2736 patients undergoning stenosis was AVF native angioplasty for proportional with cox AVF native for related to patency The factors hemodialysis. ( 2) age 1) sex, hazard model were: C-512 prostatic the treatment of benign embolization for Transarterial in pigs safety and feasibility on technical A preliminary study hyperplasia: Maynar; M. Usón, Lima Rodríguez, J. J.R. Crisóstomo, V. Sánchez, Sun, F.M. F. Caceres/ES Purpose: C-513 angioplasty after percutaneous related to restenosis of factors Analysis stenosis in patients of hemodialysis native AVF for Jang J. Interventional Radiology Vascular C-511 port chest implantation in pediatric patients Venous Aksungur; Colak, E. D. Korur, Balli, K. T. Akgul, E. ([email protected]) Purpose: chest portsimplanted venous under fl pediatric patients. Methods and Materials: chest ports in- venous 2006 were 2004 and who underwent between placement 4.5 (mean age: 6 months and 12 years between Ages ranged cluded in the study. under IV sedation interventional radiologist by performed Procedures were years). inserted catheter was Port into the right in internal jugular vein and local anesthesia. sonographic in 1 (2.1%) patient under vein 46 (97.9%) patients and right subclavian in 39 (82.9%) patients, Indication of port chemotherapy was placement guidance. in 8 (17.1%) patients. medication and intravenous Results: catheter Total mon carotid artery puncture during the procedure in 1 (2.1%) patient. Six (12.8%) 7 and 697 days. between 190) and ranged (mean: 8923 days time was period, complications In the follow-up patients died while ports still being used. were of because In 1 patient, port extracted was encountered in 4 (8.5%) patients. were resawn was incision of port In another patient, pocket fourth in the month. infection the needles could not be inserted In 2 patients, into ports because of separation. the ports In these patients, were because the port turned base was upside down. rotated to normal manually. position Conclusion: experienced an placed under imaging guidance by ports should be preferably because of the higher technical success and lower interventional radiologist complication rates. in pigs. of prostrate Methods and Materials: anesthesia, Under general embolization (n = 8), control (n = 8). into 2 groups: ized In animals of the group on both sides. angiography selective all animals underwent the prostatic used to embolize embolization, embosphere (500-700 µm) was one from group except the animals in both groups, Three months later, branches. function by on sexual evaluated were embolization with lameness of a hind limb, subjectively function of the male pigs was Sexual pigs. breeding with adult female the sex ced following sacrifi were The animals assigning 0-3 points. by evaluated pathological study. for removed test and the prostates were Results: Compared with those in the group observed. no associated complication was tion; signifi was control, the prostate size ow. The remaining ow. uid-fi lled nodules. 17 nodules. lled uid-fi rst lymph node station should Scientific and Educational Exhibits Scientific and Educational 7 0 1
d d n US examination of the surgical scar and fi of the surgical scar US examination i . N I F We observed 18 rounded-oval, solid lesions and 2 fl solid lesions observed 18 rounded-oval, We - c u d E i c S - lesions were hypoechoic and one had muscle-like refringence. 12 (60%) lesions 12 (60%) lesions refringence. had muscle-like and one hypoechoic lesions were at a distance 20- the surgical scar or over fat located inside subcutaneous were from 3-13 of the lesions ranged The diameter mm 40 mm from the scar (8 nodes). 60%), and 6.5-81 nodes (12 lesions, ones the non-palpable the palpable for mm for Doppler signals, irregular vascular showed lesions (20%) Four 40%). (8 nodes, located in the periphery with arterial two of the nodes, spectra, low-resistance one with high resistance arterial fl one with venous and spectra signals. vascular nodules did not showed Conclusion: melanoma metastasis in patients with malignant for be included in the screening are easily detected. lesions The non-palpable excised. Results: C - 7 0 R C EECR07-C-SciEduc-FIN.indd 107 Scientific and Educational Exhibits
(< 5year or ≥5year), 4)duration of AVF (< 5year or ≥5year), 5) hypertension, 6) of patients. smoking, 7)diabetes mellitus, 8) type of AVF, 9) location of stenosis, 10) degree of Methods and Materials: Thirty-fi ve patients with acute severe pancreatitis have stenosis (< 90% or ≥90%), 11) length of stenosis (< 1 cm or ≥1 cm), 12)degree of undergone on initiation of continuous regional arterial infusion (CRAI) protease dilatation (< 90% or≥90%), 13) thrombus, 14) use of stent, and 15) type of balloon inhibitor, nafamostat mesilate, or gabexate mesilate, and antibiotics, IPM/CS, and in- (conventional balloon or cutting balloon). travenous administration of those. We retrospectively reviewed the day after disease Results: There are fi ve factors related to restenosis after percutaneous angioplasty onset, cumulative dose of intraarterial, and intravenous administrated these drugs for native AVF stenosis in patients of hemodialysis patency, which are: 1) duration of at that time. Cumulative intraarterial administrated doses, intravenous administrated, AVF, 2) use of stent, 3) type of AVF, 4)location of stenosis, and 5) length of stenosis. and total administrated doses were calculated. These factors were compared with Longer duration of AVF and use of stent in the treatment of native AVF stenosis outcomes that included mortality rate, periods of admission of the hospital and demonstrated higher patency rate. Also, cephalic arch of AVF, brachio-cephalic the intensive care unit (ICU), periods that individual laboratory indexes indicated stenosis, and longer length of stenosis were demonstrated higher patency rate. abnormal level. Spearman rank correlation was used for statistical analysis. Conclusion: Factors related to restenosis after percutaneous angioplasty for native Results: Each CRAI was started within 72 hours after the onset on thirty-three AVF stenosis in patients of hemodialysis were included duration of AVF, location patients (91%). The mortality rate was 2.4%. Cumulative intraarterial administrated of stenosis, use of stent, length of stenosis. doses of nafamostat mesilate for the early stage had signifi cant correlation with normalization of CRP (p=.033) and periods of admission of ICU (p=.035). Cumula- tive intraarterial administrated doses of IPM/CS for the early stage had signifi cant C-514 correlation with normalization of CRP (p=.042). There was no correlation between Budd Chiari syndrome: Imaging and intervention other parameters and outcomes. P. Rajiah1, A. Al Muslim2, M. Sylven2, M. Al Moaiqel2, G. Mohhmmad Syed2, Conclusion: These results suggest that increased dosage of intraarterial admin- A.N. Khan2; 1Manchester/UK, 2Riyadh/SA ([email protected]) istration of nafamostat mesilate, and IPM/Cs at the early stage may reduce the Learning Objectives: 1. To discuss the causes, clinical presentations and patho- period of high risked condition of acute severe pancreatitis. physiology of Budd chiari syndrome. 2. To review the appearances of Budd Chiari syndrome in ultrasound, Doppler, CT and MRI. 3. To review the indications and C-518 techniques of hepatic venoplasty and transjugular intrahepatic portasystemic shunts TIPS in budd-chiari syndrome: Effi cacy of 8 mm expanded- in treatment of Budd Chiari syndrome. polytetrafl uoroethylene (PTFE) covered stent Background: Budd Chiari syndrome is an uncommon condition induced by throm- A. Nicolini, S. Crespi, L. Martinetti, M. Primignani, F. Fabris, P. Fasani, botic or non thrombotic obstruction to hepatic venous outfl ow. It usually occurs in P.R. Biondetti; Milan/IT ([email protected]) patients with underlying thrombotic diathesis including myeloproliferative diseases, polycythemia rubra vera, hemoglobinuria, pregnancy, tumours, infl ammatory dis- Purpose: TIPS with bare-stents in patients with Budd-Chiari syndrome (BCS) eases, etc. Imaging plays a vital role in diagnosis and treatment of this condition. has a very high incidence of shunt dysfunction (stenosis and occlusion) and the Imaging Findings: The pictorial review illustrates the imaging appearances of Budd placement of 10 mm stents have a high incidence (43% according to literature) Chiari syndrome in conventional ultrasound, Doppler, CT, MRI and contrast studies. of encephalopathy. We assessed the medium-term response after placement of Benign regenerative nodules are a feature of chronic Budd chiari syndrome. The 8 mm PTFE-covered stents. procedures of hepatic venoplasty and TIPSS are discussed in detail. Methods and Materials: In 2005, 9 patients (6 Child-Pugh B, 3 C) underwent TIPS Conclusion: Ultrasound, Doppler, CT and MRI are important in the diagnosis of with PTFE-covered stents (VIATORR, Gore, USA, 8 mm in diameter). Long-term Budd Chiari syndrome. Contrast enhancement patterns in CT and MRI are often anticoagulation therapy was promptly instituted. 5 patients had a myeloproliferative the only fi ndings to make the diagnosis. Fan shaped enhancement in triple phase disorder, 1 genetic thrombophilia, 3 with unknown etiology. 7 patients had ascites, CT is a specifi c fi nding in the diagnosis. Hepatic venoplasty and TIPSS are useful non-responding to diuretic therapy, 1 had bleeding due to portal hypertension, 1 interventional procedures when conventional treatment fails. had hepatorenal syndrome. HVPG before and after the procedure was measured. All patients underwent color-Doppler and laboratory exams after 48 hours and 1, 3, 6 months. After 6 months an angiography was performed. C-515 Results: In 9 procedures, 19 stents were placed. In 4 patients, a transcaval punc- Which caval fi lter to use: Retrievable or permanent? ture was needed. HVPG reduced from 24+6 mmHg to 11+2 mmHg (p < 0.001). A.N. Keeling, S. Looby, A. Geoghegan, M. Given, M.J. Lee; Dublin/IE After a medium follow-up of 15 months, 8 patients are alive, 1 dead 3 days after ([email protected]) the emergency TIPS procedure. 2/8 patients had an early occlusion, resolved with Learning Objectives: At the end of this presentation, the reader will have knowl- thrombolytic therapy. 7/8 shunts are still open at color-Doppler and angiographic edge of: 1. The current changing indications for retrievable/permanent fi lter use. 2. study; all these patients had clinical and biochemical improvement. Only 2 patients The advantages/disadvantages of current approved retrievable fi lters. 3. Tips to aid (22%) developed a transitory encephalopathy. fi lter retrieval. 4. Follow-up requirements for IVC fi lters. 5. Clinical issue with regard Conclusion: TIPS with 8 mm PTFE-covered stents obtained a good technical, clini- to anticoagulation and fi lter use. cal and hemodynamic success, at a medium term follow-up, with a lower incidence Background: Since its inception in 1967, caval fi lters have undergone many of transitory encephalopathy compared to 10 mm stents. advances. "Optional" fi lters are now the most commonly used. These allow either permanent or retrievable fi ltration and have expanded the indications for IVC fi lters. C-519 There are three new FDA approved optional fi lters (Recovery Filter/Bard, Günther- Arterial infusion chemotherapy for oral cavity cancer: Comparison Tulip Filter/Cook and OptEase Filter/Cordis Coperation (Johnson & Johnson)). between two different anticancer drug regimens Advantages/disadvantages of each will be outlined. Y. Baba, S. Hayashi, K. Ueno, M. Nakajo; Kagoshima/JP Procedure Details: Based on a large experience of over 200 optional fi lter place- ([email protected]) ments, technical issues with regard to placement of optional fi lters and complica- tions encountered will be discussed. Issues with regard to anticoagulation will Purpose: We evaluated the effi cacy of arterial infusion chemotherapy (AIC) for also be discussed. the treatment of oral cavity cancer and compared the results between two different Conclusion: Optional fi lters are now the fi lters of choice for IVC fi ltration. Retrieval anticancer drug regimens. intervals differ between fi lter types, making the choice of fi lter important if retrieval Methods and Materials: Seventy-two patients with cancer of the oral cavity (clini- is planned. cal stage I, 6 cases; stage II, 29 cases; stage III, 22 cases; stage IV, 15 cases) were treated by AIC. Superselective catheterization was performed using a coaxial system microcatheter. After injection of the indigocarmine dye into the vessels, the C-516 tumor feeding vessels were identifi ed by the staining of the cancer. The regimens Continuous regional arterial infusion therapy for acute severe pancreatitis: were carboplatin (300-400 mg/m2) and low-dose cisplatin (30-40 mg/m2). Fifty-six Between cumulative dosage of intraarterial administrated drug for the patients received carboplatin and 16 patients received low-dose cisplatin. The early stage and outcomes of patients survival rates were compared between the two treatment regimens with Kaplan- A. Ishii1, I. Ikushima1, M. Onaga1, K. Seguchi1, S. Higashi1, Y. Yamashita2; Meier methods. 1Miyakonojo/JP, 2Kumamoto/JP ([email protected]) Results: Overall, 24 (33%) of 72 patients had a complete response and 44 (61%) Purpose: To evaluate the correlation between cumulative dose of intraarterial of 72 patients had a partial response after AIC. Fourteen (25%) of 56 patients had administrated drug for the early stage of acute severe pancreatitis and outcomes a complete response and 39 (70%) of 56 patients had a partial response in the
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7 0 0 2 . 2 439 0 cult or . 2 112.02.2007 17:04:05 G and its rst branches cant increase in serum exible shaft which are devised for for shaft which are devised exible C BDEF A ow. We analyse our experience with trans-renal with trans-renal experience analyse our We ow. ([email protected]) ([email protected])
cacy of a selective obliteration technique using a obliteration cacy of a selective cant symptomatic improvement in leg swelling fol- in leg swelling cant symptomatic improvement Galway/IE Galway/IE We review 6 patients with intra-abdominal malignancy 6 patients with intra-abdominal review We A coaxial balloon catheter system consists of 9 F guid- A coaxial balloon catheter system consists of 9 Portocaval shunts were created using a single percutane- shunts were Portocaval Oita/JP ([email protected]) ([email protected])
Direct portocaval shunt creation using sonographic single transhe- shunt creation using sonographic Direct portocaval IVC stenting for the treatment of lower limb swelling due to malignancy limb swelling the treatment of lower IVC stenting for Modena/IT Severe symptomatic lower limb swelling is a recognised complication of limb swelling symptomatic lower Severe the effi evaluate To To describe a new approach to transjugular intrahepatic portal intrahepatic approach to transjugular describe shunt a new To The portocaval shunts were successful in all patients. There were no There were successful in all patients. shunts were The portocaval a signifi There was cult TIPS: Percutaneous ultrasound-guided simultaneous puncture of simultaneous ultrasound-guided Percutaneous TIPS: cult plane the left or righted on a single portal or one of their fi vein cessful PTA) can exclude the patient from a new transplantation. Technical success Technical transplantation. a new the patient from can exclude cessful PTA) with clinical improvement. correlate does not always Early experience with stenting of IVC occlusion: Does stenting across the Does stenting across with stenting of IVC occlusion: experience Early renal function? renal veins compromise Kelliher, O’Riordan, E. Ni Mhuircheartaigh, C. Cronin, J. C. DeLappe, E. O’Sullivan; G. Browne, M. Purpose: C-525 coaxial balloon catheter using a double technique Selective obliteration the treatment of gastric varices system for Ueda, S. Okahara, M. Tanoue, S. Kondo, Y. Kiyosue, H. Maruno, M. Mori; H. Matsumoto, S. Purpose: C-523 Diffi veins the portal and sovrahepatic Caporali, Colopi, C. S. Morandi, C. Foresti, M. Di Chiacchio, G. De santis, M. Torricelli; P. Purpose: with technique in patients transhepatic-transjugular (TIPS) using percutaneous the standard for unsuitable portal was anatomy hypertension, whose hepatic venous procedure. Methods and Materials: identi- we guidance, Under sonographic needle pass in 5 patients. ous transhepatic fi then punctured were Both vessels or rightcorrespondent aligned left hepatic vein. advanced was A 0.021 inch guidewire cm Chiba needle. 15-20 with a 20-gauge, and removed was then the needle cava, vena through the needle into the inferior a 0.035 Subsequently, into the IVC. the guidewire placed over sheath was a 5 Fr and withdrawn cava snared into the superior vena was guidewire inch hydrophilic completed in the The rest of the procedure was sheath. through the transjugular standard fashion. Results: 1 month OLT One patient underwent major complications during the procedures. One patient patent at 6-12 month follow-up. the shunts were In 3 patients, later. 1 month after the procedure. failure died due to liver Conclusion: when standard procedures are diffi patic needle pass is a good alternative or abnormal anatomy anatomic relationship venous due to inadequate impossible the portal and hepatic veins. between branches vein C-524 Symptomatic malignancy. intra-abdominal IVC by of the compression or invasion means of IVC stenting has been described as an effective relief of symptoms by has been a reluctance to place stents across the origin there However, palliation. a sug- function by due to the possibility of compromising renal of the renal veins fl gested reduction in renal blood IVC stenting and determine on renal function. is a deleterious if there effect Methods and Materials: limb oedema that had compression of the IVC and associated symptomatic lower CT or contrast-enhanced made using Diagnosis was nodes or tumour mass. by the IVC adjacent All 6 patients had disease involving gadolinium-enhanced MRI. used to stents were self-expanding Using standard techniques, to the renal veins. monitored post-procedure with ultrasound were All patients the stenosis. traverse to ensure the renal func- patency and regular serum creatinine levels to establish tion did not deteriorate. Results: no imaging demonstrated Follow-up stenting in all of the treated patients. lowing no signifi There was enhancement. in renal contrast delay creatinine levels. Conclusion: limb oedema due to method of reducing symptomatic lower palliative is an effective carried out without concern be safely malignancy and can probably intra-abdominal Further are warranted. studies renal function compromise. for the treatment of gastric varices. coaxial balloon catheter system for Methods and Materials: ing balloon and 5 F coaxial balloon with highly fl April 2004 to From vein. further via femoral advancing retrogradely to the varices Turin/IT Turin/IT Scientific and Educational Exhibits Scientific and Educational We illustrate our experience in the percu- our experience illustrate We Ten patients with acute basilar artery embolism were Ten From January 1991 to August 2006, 1542 liver trans- 2006, 1542 liver January 1991 to August From To review and illustrate percutaneous use of thrombin in the and illustrate review To 9 0 1
d d ([email protected]) n Percutaneous thrombin injection to treat pseudoaneurysms is effec- Percutaneous Arterial infusion chemotherapy may be suitable for oral cancer and cancer and oral for be suitable Arterial may infusion chemotherapy in distal that remote thromboaspiration This small pilot study showed Hepatic venous (very uncommon complications in recipients of piggy- Hepatic venous i
. Munich/DE ([email protected]) Munich/DE ([email protected]) N I Intra-arterial fi brinolysis has lowered the death rate in patients with in patients with the death rate brinolysis has lowered Intra-arterial fi To evaluate the role of angiographic procedures in the management of the role of angiographic evaluate To F Interventional procedures obtained technical success in all the cases. Interventional procedures obtained technical success in all the cases. Complete recanalisation of the basilar artery was achieved in all cases. in all cases. Complete recanalisation of the basilar artery achieved was - c u d E i c S - Purpose: complications. vascular OLT-related Methods and Materials: Eighteen Turin. Battista Hospital of Giovanni plantations had been carried out in S. (2 grafts in 13 patients with 15 liver performed were examinations angiographic + stenting of 6 PTA and hepatic veins, cava vena of the inferior 10 PTA re-OLT): + stenting of the portal 1 PTA TIPS, 1 and hepatic veins, cava vena the inferior clinical (refractory procedures were ascites) radiological The indications for vein. ndings and manometric fi phlebographic in 5/18 (28%) cases and based on US, in 13/18 (72%). Results: In 1 patient, a surgical repair in 10/15 (67%) OLT. achieved Clinical resolution was in the right atrium. an accidental stent migration following performed was Conclusion: technique) and portalback anastomotic stenoses can be successfully treated with In case of incidence of major complications. with a low interventional procedures, unsuc- stent placement (necessary after several involvement, cava vena inferior Radiological treatment of venous stenoses after "piggy-back" technique technique Radiological treatment of venous stenoses after "piggy-back" liver transplantation (OLT) Gandini; Bartoli, G. G. Boffano, C. Gazzera, C. C-522 taneous thrombin treatment of pseudoaneurysm with a review of all cases treated of all cases treated taneous thrombin treatment of pseudoaneurysm with a review pseudoaneurysms Most of the patients had located in our centre with this method. We and splenic artery. tibial anterior artery, artery, humeral artery, in the femoral include also one case of an aortic endoleak post-endoluminal treatment treated and ultrasonographic angiographic, show We with percutaneous thrombin injection. during, and post-procedure. CT images before, Conclusion: and currently the treatment of choice in most of these cases. and safe, fast tive, Learning Objectives: treatment of pseudoaneurysms in different arterialtreatment of pseudoaneurysms in different territories. Details: and Procedure Background C-521 arterial treatment of pseudoaneurysms in different thrombin Percutaneous Pictorial review territories: Bermudez; P. Branera, J. Fortuño, J. Falco, J. Perendreu, Lüttich, J. A. Sabadell/ES C-520 Bilateral vertebral of basilar artery aspiration to enhance retrieval artery embolism Mayer; T.E. there was no different effi cacy between carboplatin and cisplatin regimens. carboplatin and cisplatin regimens. cacy between effi no different there was Purpose: the time-consuming procedure recanalisation failures, but brobasilar thrombosis, are still major limitations of this therapy. and haemorrhagic complications itself, not satisfac- still but under investigation, are now of retrievers variety a Therefore, Therefore, only reach 50%. alone the retrievers by since recanalizazion rates tory, bilateral mechanical recanalisation technique - remote a novel evaluated we in of retrievers - to enhance the effect vertebral thromboaspiration simultaneous distal basilar artery embolism. Methods and Materials: of or in case of occlusion or hypoplasia treated with bilateral were They evaluated. during thromboaspiration proximal unilateral vertebral arterythe contralateral (VA) without the use of a retriever. or even retrievers the use of different Results: The clinical Eight patients survived. seen. No procedure-related complications were outcome will be reported. Conclusion: and might be useful successful alone, It can be basilar artery safe. embolism is studies Larger and randomized devices. in combination with mechanical retriever are needed. carboplatin regimen group. Ten (63%) of 16 patients had a complete response had a complete response (63%) of 16 patients Ten group. carboplatin regimen of 16 patients had a partialand 5 (31%) group. in the cisplatin regimen response the two between in the clinical tumor response no statistical difference There was (P=.7770) survival rates in overall also no statistical difference was There groups. groups. the two between Conclusion: C - 7 0 R C EECR07-C-SciEduc-FIN.indd 109 Scientific and Educational Exhibits
February 2006, 15 patients with high risk or ruptured gastric varices were treated C-528 by selective obliteration technique using the double coaxial balloon catheter sys- Effects of continuous regional arterial infusion therapy for acute severe tem in our institution. Technical success rate, use of additional technique of coil pancreatitis: Correlation of pre-treatment disease severity and outcomes embolization of abundant collateral drainage, and amount of sclerosant, complica- of patients tions were assessed and compared with a control group of 72 cases who were A. Ishii1, I. Ikushima1, M. Onaga1, K. Seguchi1, S. Higashi1, Y. Yamashita2; previously treated by balloon-occluded retrograde transvenous obliteration using 1Miyakonojo/JP, 2Kumamoto/JP ([email protected]) standard catheters. Results: Technical success was obtained in all 15 patients; in control group, Purpose: To assess the correlation between severity parameters on initiation of technical success rate was 86%. Coil embolization of collaterals was needed in 4 continuous regional arterial infusion (CRAI) and outcomes of patients. (26%) of 15 patients, which were signifi cantly lower than that in control group (47%) Methods and Materials: Thirty-fi ve patients with acute severe pancreatitis have (P < 0.05). Mean amount of sclerosant used was 15.0 ml, and was signifi cantly undergone CRAI and intravenous administration of protease inhibitor and antibiot- lesser than in control group (21.7 ml) (p < 0.05). One patient showed transient asci- ics. We reviewed severity parameters in these patients that included pre-treatment tes for a few days after treatment, but no major complications were encountered. APACH-II score, CT severity index, laboratory indexes and the periods between Conclusion: The selective obliteration technique using a coaxial balloon catheter disease onset and CRAI. These factors were compared with outcomes that included system would reduce the necessity of coil embolization procedure of abundant col- mortality rate, periods of admission of the hospital and the intensive care unit (ICU), lateral veins, and can also reduce the amount of sclerosant. This catheter system periods that individual laboratory indexes indicated abnormal level. Spearman rank can simplify the technique for the treatment of gastric varices. correlation was used for statistical analysis. Results: Thirty-three patients (91%) had undergone CRAI within 72 hours after C-526 the onset. Among all patients, APACH-II score was 10.4 ± 4.8 (mean ± SD), CT severity index was 5.4 ± 1.9. Despite disease severity, the mortality rate was The possibilities of intervention radiology of adrenal in complex treatment extremely low (2.4%). There was no correlation between parameters of disease of arterial hypertension severity and other outcomes. T. Dautov; Astana/KZ ([email protected]) Conclusion: These results suggest that disease severity may not directly refl ect out- Purpose: The present study aims to present the possibilities of interventional comes of patients when CRAI is performed in early stage of acute pancreatitis. radiology of adrenal in complex treatment of some forms of arterial hypertension. Methods and Materials: Interventional radiological methods of adrenal treat- C-529 ment were performed in 206 patients with different kinds of arterial hypertension Biomechanical infl uences for intravascular stent fractures (84 males and 122 females, aged from 27 to 65 years). 46 patients who suffered R. Suri, E. Sprague, D. Marton; San Antonio, TX/US ([email protected]) from arterial hypertension with signs of the second hyperaldosteronism underwent roentgen endovascular occlusion of the central vein adrenalsEPOS injection of 3%-ed Learning Objectives: 1. To understand the signifi cance of stent fractures. 2. To solution of thrombovar. 154 patients with arterial hypertension underwent roentgen evaluate the individual and synergistic role of vessel deformation, biological proper- endovascular electro-coagulation of the central vein adrenals. The 6 patients with ties and biochemical factors that could play role in the disruption of the long term adrenal cysts underwent transcutaneous puncture aspiration of cystic content with integrity of implanted intravascular stents. the following sclerosing rest cavity under control of CT. For the sclerosing therapy, Background: Though percutaneous interventional treatment of stenotic vascular used 3%-ed solution of thrombovar taken into account the calculations 10% from disease has been revolutionized with stent placement, SIROCCO trials and recent the volume of cystic content, which developed total contact with epithelial integu- studies are reporting increasing incidence of stent fractures. The etiology and No Material Submitted to EPOS ment of cyst and caused an aseptic infl ammation of cyst walls. Some patients after incidence of stent fractures is still unclear. interventional radiology treatment were prescribed slight forms of antihypertensional Imaging Findings: 1. Incidence and clinical signifi cance of intravascular stent medicines according to individual. fractures. 2. Arterial deformation due to respiration and motion as an implicating Results: Among 206 patients, recovery with stable course of arterial hypertension factor for stent fractures. 3. Physical and chemical factors (including ion leaching) was reached in 115 cases (56%). Improvement has been observed in 85 cases and biological factors (including infl ammation) at the stent surface which could (41.5%). In 6 (2.5%) cases, this treatment turned out to be ineffective. precipitate stent corrosion. 4. Role of scanning electron microscopy (SEM), atomic force microscopy (AFM)No Materialand Secondary Submitted Ion mass to spectroscopy (SIMS) in the in C-527 vitro evaluation of the stent surface. Conclusion: Various biological, chemical, physical and dynamic factors may play a Review of intra-arterial thrombolysis as a causative treatment of potential role either alone or synergistically on the integrity of intravascular stents. hyperacute cerebral ischemic stroke This exhibit aims to evaluate these individual causative factors for stent fractures C. Iosif, M. Papathanasiou, A. Gouliamos; Athens/GR ([email protected]) and to demonstrate the potential role of in vitro evaluation of the stent surface in Learning Objectives: To review the current imaging and interventional protocols, predicting corrosion and stent fractures. the indications and requirements for the performance of intra-arterial thrombolysis as a causative treatment of hyperacute ischemic stroke. To describe the methodol- C-530 ogy and results worldwide of the last 15 years. To discuss the conventions and Acceleration of primary liver tumor growth rate in embolized hepatic lobe ideal conditions of function of the stroke units in accordance with the international after portal vein embolization experience of stroke units of excellence on the fi eld. S. Hayashi, Y. Baba, R. Higashi, T. Yoneyama, M. Nakajo; Kagoshima-shi/JP Background: Cerebral ischemic stroke is the 3rd leading cause of death and the 1st ([email protected]) cause of disability in the developed countries (Europe 650.000 deaths/year, EUSI 2003) with a heavy fi nancial and social cost. The establishment of an effective Purpose: Portal vein embolization (PVE) is now widely accepted as a useful treatment is a very important medical and social issue. preoperative procedure in selected patients undergoing major hepatic resection. Procedure Details: Intraarterial thrombolysis is effective when there is still viable The purpose of this study was to retrospectively evaluate the effects of PVE on brain tissue. Patient selection is based on the therapeutic window since the symp- the growth of liver tumors in the embolized lobe. toms onset, on the lack of clinical and imaging exclusion criteria and on the imag- Methods and Materials: We studied 8 patients (aged 48-79 years, mean age 70 ing confi rmation of occlusion of cerebral artery. The imaging protocols with CT-CT years), of whom 6 had hepatocellular carcinoma (HCC) and 2 had cholangiocellular perfusion mad MR diffusion-perfusion are discussed, as well as the modifi cation carcinoma (CCC) primary liver tumors. PVE was performed for each segmental of the time window according to the imaging fi ndings. The therapeutic approach portal branch using fl uoroscopy. The growth rates of the tumors in the embolized is either intraarterial, with the use of thrombolytic medicine, either combined with lobe and non-embolized liver parenchyma were calculated using the CT volume intravenous infusion (i.v. glucoprotein inhibitor ΙΙb/IIIa). values at the time of tumor identifi cation, and before and after PVE. The recanalisation rate is up to 70% considering the anterior circulation. Results: The mean tumor growth rate was 1.59±2.13 cm3/day before PVE and Major complication is hemorrhagic transformation. 3.11±3.06 cm3/day after PVE (p=0.011). The rate of tumor growth acceleration Conclusion: Intraarterial thrombolysis when performed in specialized centers is ranged from 1.50 to 7.62 (3.58±2.55) in the 6 HCCs and from 1.04 to 1.26 in the 2 an effective etiological treatment of ischemic stroke and has a low complication CCCs. There was no apparent correlation between the tumor growth rate after PVE rate when the inclusion criteria are kept. and the growth rate of non-embolized liver parenchyma (6.53±3.68 cm3/day). Conclusion: These results suggest that the rate of liver tumor growth in an em- bolized lobe accelerates after PVE, especially in cases with HCCs; thus, caution
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7 0 0 2 . 2 441 0 . 2 112.02.2007 17:04:05 G brinolytic therapy brinolytic therapy ed pigtail catheter brinolytic therapy 16. 16. brinolytic therapy ow void is another specifi c is another specifi void ow C brinolytic therapy therapy brinolytic BDEF A ([email protected]) ([email protected])
Within a period of 5 years, 45 patients with severe 45 patients with severe Within a period of 5 years, A total of 39 bronchial artery per- were embolizations Tokyo/JP To learn two different methods of partial learn different splenic embolisa- two To ([email protected]) ([email protected])
MRI and MR angiography are the main investigative modalities modalities are the main investigative angiography MRI and MR Hybrid interventional treatment appears to be a rapid and safe im- Hybrid and safe interventional treatment appears to be a rapid The cessation of hemoptysis was achieved by BAE in all cases, al- all cases, BAE in by achieved The cessation of hemoptysis was To evaluate the effi cacy and safety of a hybrid treatment for severe severe for treatment of a hybrid cacy and safety the effi evaluate To To illustrate various arteries various illustrate encountered during bronchial artery embo- To bromas. Salt and pepper appearance due to fl Salt and pepper appearance bromas. Trans-femoral interventional radiological therapy was achieved in 42 in 42 achieved was therapy interventional radiological Trans-femoral The causes for hemoptysis in 21 patients were: pulmonary tuberculosis hemoptysis in 21 patients were: The causes for Isehara/JP Isehara/JP Seoul/KR carotid body tumours is also discussed and illustrated. Follow-up and clinical outcomes and clinical Follow-up illustrated. is also discussed and carotid body tumours of literature. with brief embolisation is discussed of carotid body review Conclusion: Widening of carotid bifurcation is an body tumours. used in diagnosis of carotid important body tumour from other masses such that distinguishes carotid feature as neurofi surgical removal before Embolisation is used to reduce tumour vascularity, feature. of carotid tumours. Purpose: mechanical thrombectomy, clot aspiration, combining thrombosis by deep-venous brinolytic therapy. and local fi Methods and Materials: After interventional procedures. treated with hybrid were thrombosis deep venous guiding with a PTCA thrombo-aspiration lter, fi insertion cava of a temporary vena ed rotating pigtail or modifi with OASIS catheter and/or mechanical thrombectomy local fi continuous Additionally, performed. catheter system were The primary endpoint was if needed. performed, were and balloon PTA/stenting Systemic thrombolysis and antico- extraction. ndings of thrombus fi venographic followed. agulation therapy Results: in 20 cases. in 22 cases and contra-lateral ipsi-lateral The approach was patients. throm- 37,OASIS clot aspiration manual as follows: Interventional techniques were using a modifi fragmentation 13, mechanical thrombus bectomy local catheter fi 3, stenting 4, and continuous 3, balloon PTA C-535 Clot aspirarion, deep-vein thrombosis: Hybrid intervention of severe and local fi thrombectomy, mechanical Sato, H. Onozawa, Fukunaga, S. T. Nakazawa, K. Murata, S. Tajima, H. Machida; M. Tateno, N. A tempo- in 37 of 42 patients. achieved recanalization was Successful venographic after the insertion 9.2 days in 37 patients. easily removed lter was fi cava rary vena haemo-thorax Complications: days. 3,440,000I.U./6 dose of urokinase was Total 1, retroperitoneal hematoma 1, and puncture site hematoma 3. Conclusion: be treatment may This hybrid thrombosis. in patients with deep-venous provement thrombosis. deep-venous option in patients presenting severe a therapeutic C-536 Hashimoto, splenic embolization under the MRXO system Partial T. Kawawa, Y. Tajima, Horie, R. T. Matsumae, M. Muro, I. Koizumi, J. Imai; Y. Learning Objectives: (MR) magnetic resonance tion (PSE) under the combined system of angiography, room (MRXO). (CT) and an operation imaging, computed tomography C-534 case Experience with variable artery embolization: Bronchial Kim; J. Purpose: with hemoptysis. lization (BAE) in patients Methods and Materials: Embolic materials used from March 2003 to March 2006. in 21 patients formed not were coil and gelfoam (n=2) and coil (n=1), but (n=37), gelfoam included PVA artery name of each emoblized and The number during BAE were used alone. Cessation and recur- each patient. of BAEs for recorded in addition to the number also documented. BAE were rence of hemoptysis following Results: Em- bronchiectasis (n=2) and lung cancer (n=1). brosis (n=2), (n=16), anthracofi arteriesbolized included bronchial (n=55), intercostals (n=25), internal mammary (n=2) arteries thoracic phrenic (n=4), subscapular (n=1), lateral (n=5), inferior and costocervical artery trunk off the subclavian some minor (n=2) in addition to Those arteries arteries off the subclavian were (n=7). off the subclavian branches Cessation in the apical area. thickening pleural when there was usually affected (n=24, 61.5%), whereas either with a single BAE achieved of hemoptysis was after However, observed or recurring after 15 BAEs. continuing hemoptysis was all hemoptysis stopped. repeated BAEs, Conclusion: a successful BAE, it is important For repeated BAEs. by achieved though some were arteries of various to understand the knowledge causing hemoptysis. Manchester/UK, 1 ; 2 ([email protected])
([email protected]) ([email protected])
, A.N. Khan , A.N. 2 Coimbatore/IN Scientific and Educational Exhibits Scientific and Educational Coimbatore/IN , M. Al Moaiqel , M. 2 ed as 1. Active bleeding 2. Pseudoaneurysm and 2. bleeding Active as 1. ed Patients with ulcer or gangrene were excluded from the excluded were with ulcer or gangrene Patients 16 patients with recurrent massive epistaxis (more than massive 16 patients with recurrent 1. To review the pathophysiology of carotid body tumours. of carotid body tumours. the pathophysiology review To 1. , M. Sylven , M. 1 2 The review discusses the normal anatomy and physiology of discusses the normal and physiology anatomy The review 1 1
d d Carotid body tumours occur at the bifurcation of the common carotid n Infrapopliteal PTA is feasible and safe. Appropriate patient selection, and safe. is feasible PTA Infrapopliteal Exploratory angiography and therapeutic embolization is an excellent embolization is an excellent and therapeutic Exploratory angiography i . ([email protected]) ([email protected])
N I To study the feasibility of infrapopliteal percutaneous transluminal percutaneous transluminal of infrapopliteal study the feasibility To To study the role of therapeutic arterial role of therapeutic study the embolization in the management To , M. Otaibi , M. F There was no technical failure. All the limbs showed clinical improvement clinical improvement All the limbs showed no technical failure. There was 12 of the patients had abnormalities in the internal maxillary artery. Of 12 of the patients had abnormalities in the internal maxillary artery. 1 - c u d E i c S Riyadh/SA - carotid body. The pictorial reiew illustrates the imaging appearances of carotid tumour the imaging appearances illustrates The pictorial reiew carotid body. and MRI, MR angiography CT angiography, CT, multislice Doppler, in ultrasound, treatment of The techniques of interventional procedures for somatostain scintigraphy. 2. To discuss the role of various imaging modalities in diagnosis of carotid body discuss the role of various To 2. optimal review To 4. diagnosis. the common differential evaluate To 3. tumours. the role and explain To 5. imaging techniques in assessment of carotid tumours. techniques of interventional procedures in management of carotid body tumours. Background: Ca- artery tumours arising and are glomus from normal tissue of the carotid body. with clusters and the tumours are highly vascularised, rotid body is a paraganglia dense network of capillary vessels. of tumour cells surrounded by calibre blood these tumours. a vital role in diagnosis and treatment of Imaging plays Findings: Imaging Learning Objectives: 2 C-533 and intervention Imaging tumours: body Carotid Rajiah P. C-532 transluminal angioplasty (PTA) Infrapopliteal percutaneous Hedgire, S. Jayesh, S.R. Kalyanpur, T. Gupta, Raja, P. Mehta, D. Cherian, P. M. Madhavram; B. Sekhar, N. Ilayaraja, V. Purpose: infrapopliteal the outcome of 125 consecutive and to review angioplasty (PTA) procedure and post patient selection, guidelines for and evolve procedures PTA care. procedural Methods and Materials: and intermittent rest pain in 105 was claudication PTA indication for The study. The patients smokers. diabetics and 75 of them were All the patients were in 20. All the good. was when distal run off in at least one vessel PTA selected for were at least 48 mg OD for 75 mg BD or Clopidogrel Ticlopidine 250 on patients were 6 months post procedure. for continued hours prior to the procedure and it was 24 hours post procedure. for given heparin was Intravenous Results: maintained at 6 months in 115 (92%). was 24 hrs and this improvement in pain by 105 patients with critical limb ischemia for at 1 year rate The actual limb salvage 90%. was Conclusion: are important good results. premedication and wound-care for modality in the control of post-traumatic epistaxis. epistaxis. modality in the control of post-traumatic Purpose: epistaxis. of post-traumatic Methods and Materials: to our department referred are included in our who were trauma 100 ml) following Each patient had therapy. to conventional All the patients did not respond study. the internal which included the study of (ICA) and external angiography, exploratory carotid arteries of the branches injections in the with selective (ECA) on both sides classifi ndings were The fi ECA. embolized. were The abnormal vessels Others. 3. Results: Other into the ethmoidal sinuses. bleeding active three patients showed these, In all pseudoaneurysms closely related to a sinus. nine showed in the distal branch One patient had active particles. with PVA embolized was the vessel these cases, artery from the ophthalmic bleeding carotid artery since the external ligated at was from was In another patient, bleeding an other center and could not be embolized. a pseudoaneurysm by embolized arising which was the internal from carotid artery, normal was and both the internal In one patient, the angiogram occluding the ICA. patients None of the embolized maxillary arteries with Gelfoam. embolized were had recurrent epistaxis. Conclusion: C-531 of post-traumatic the management Therapeutic arterial for embolization epistaxis Hedgire, S. Madhavram, B. Jayesh, S.R. Gupta, Mehta, P. Cherian, P. M. Raja; D. Kalyanpur, T. Ilayaraja, V. Sekhar, N. is required. Transcatheter arterial chemoembolization for an HCC before PVE may PVE may arterial HCC before an for chemoembolization Transcatheter is required. the tumor growth. option to suppress be a reasonable C - 7 0 R C EECR07-C-SciEduc-FIN.indd 111 Scientific and Educational Exhibits
Background: For hypersplenism, portal hypertension, or hematologic disorders, Conclusion: The TACE-PVO method may be a safe and useful therapy for selected PSE is often performed. However, severe complications such as splenic abscess, patients with unresectable HCC and marked AP-shunts. gastritis, or pancreatitis may limit the indication. In order to reduce these risks, two different methods of PSE were introduced using the MRXO. Procedure Details: Prior to PSE, diffusion- weighted images (DWI) including C-539 Exploratory angiography and simultaneous embolization of abnormal blood oxygenation level dependent (BOLD) images were performed for the splenic bronchial and non-bronchial systemic vessels in haemoptysis with volumetry using a 1.5 Tesla MR machine. After the celiac and superior mesenteric polyvinyl alcohol (PVA) sponge particles: Long term results arteriography, splenic arterio (SpA) CT was obtained to evaluate the splenic or pan- M. Cherian, P. Mehta, P. Gupta, B. Madhavram, N. Sekhar, S.R. Jayesh, creatic branches. Segmental PSE (s-PSE) using microcoils with gelfoam particles or S. Hedgire, V. Ilayaraja, T. Kalyanpur, D. Raja; Coimbatore/IN Lp-NBCA, or peripheral PSE (p-PSE) using microspheres were performed following ([email protected]) the exclusion of gastric and pancreatic branches. Splenic ischemic range was evalu- ated on BOLD images during the procedures and pursued up to 60-70%. Purpose: To study the role of exploratory angiography and simultaneous embo- Conclusion: A control splenic volumetry was semiautomatically obtained using a lization of all abnormal vessels with polyvinyl alcohol (PVA) sponge particles in workstation based on DWI. SpA-CT allowed easy recognition of gastric and pancreatic haemoptysis. branches and the exclusion before PSE. The ischemic foci shown on BOLD images Methods and Materials: Exploratory digital subtraction angiography was performed immediately after the procedures corresponded well to the non- enhanced area on in 250 patients presenting with hemoptysis. The study included aortography, bron- CT one week later. Although p-PSE produced multifocal infarctions and may theoreti- chial, intercostal, and subclavian angiography with selective injection into internal cally disturb abscess formation, the volumetry of ischemic (infracted) tissue is better mammary arteries. Embolization of all abnormal vessels was performed with PVA evaluated on s-PSE than p-PSE. The MRXO is useful for safe and effective PSE. sponge particles of 500-700 microns and 700-1000 microns. The recurrence of haemoptysis was assessed at 24 hrs, 1 month and 1 year. All the patients had C-537 chest radiograph prior to angiography. HRCT of the lungs was performed if the Carcinoids: Spectrum of imaging fi ndings and the role of intervention radiograph was normal. Bronchoscopy was performed when the radiograph did K. Burney1, G.S. Karnati2, E. Loveday2, M.J. Thornton2, L. Jones2; not show a defi nite evidence of tuberculosis. 1Southampton/UK, 2Bristol/UK ([email protected]) Results: Single vessel was abnormal in 53% and multiple vessels in 47%. On an average, 3.5 vessels were abnormal in the latter group with a range of 2-6 vessels. The Learning Objectives: To review the unusual presentations of primary gastrointes- commonest vessel to be involved was the bronchial artery (78%) followed by internal tinal carcinoid tumours. To illustrate the spectrum of uncommon imaging fi ndings mammary (38%), the intercostal artery (27%) and the thyrocervical trunk (17%). 25 and highlight the role of intervention. (10%) cases had recurrence of haemoptysis in the fi rst 24 hrs, 22 (8.8%) of these Background: Carcinoid tumours are one of the more frequently encountered patients had an additional vessel, which was missed initially. 3% of the patients had endocrine tumours of the gastrointestinal tract, and can have a wide spectrum normal arteriography and continued to have haemoptysis. An overall recurrence of 6% of presentations. The radiological appearance of carcinoids varies depending on was seen at 1 year follow-up. their size, location, and on their variable biological behaviour, and can often be Conclusion: If an area of pathology has multi-vessel involvement, embolization of all very diffi cult to diagnose. the vessels with 500-700-1000 microns PVA particles gives good long term results. Imaging Findings: We retrospectively reviewed the imaging of histologically proven carcinoid tumours in our institutions for the last fi ve years. The clinical symptoms are varied and the diagnosis can be made biochemically or histologically. Imaging C-540 Embolic protection during carotid interventions: Pictorial essay and is playing an ever-increasing role not only just in the diagnosis, but also in the classifi cation of device related intraprocedural complications treatment using percutaneous techniques. Cases highlighted include carcinoids R. Suri, M. Wholey, B. Toursarkissian, R. Hagino, D. Postoak, M. Cura; presenting as acute gastrointestinal bleeding and multifocal intra-abdominal masses. San Antonio, TX/US ([email protected]) Endovascular treatment appearances such as transarterial chemoembolisation (TACE) with CT correlation pre- and post-procedure are also presented. Learning Objectives: 1. Compare and contrast various embolic protection devices. Conclusion: Carcinoid tumours can have variable and unusual clinical and imag- 2. Pictorially depict and classify procedural adverse events due to embolic protec- ing presentations. Familiarity with their appearance on imaging can be helpful for tion devices during carotid interventions. 3. Understand techniques to avoid and radiologists to avoid misdiagnosis and for initiation of proper treatment. Interven- appropriately manage these adverse events. tional procedures have an increasing role in both diagnosis and treatment, leading Background: Outfl ow embolic protection devices are used during carotid interven- not only to effective control of symptoms, but may also help prevent potentially tions, though their role is still controversial. They enjoy the benefi t of preventing dangerous complications. neuroembolic complications; however, the use of these devices increases procedural time with associated increased risk of adverse events. C-538 Imaging Findings: Procedural adverse events specifito EPOS c to embolic protection Management of unresectable hepatocellular carcinoma with marked arterio- devices may be classifi ed into: (I) minor adverse events (resolve with appropriate portal shunts: Effectiveness of transcatheter arterial chemoembolization management), and (II) major adverse events (persist despite appropriate man- under balloon occlusion of the corresponding portal vein agement and cause morbidity). Minor adverse events may occur during device S. Murata, H. Tajima, S. Onozawa; Tokyo/JP ([email protected]) deployment (technical failure, or use of adjunctive procedures), stent/PTA (device migration, pseudo-occlusion, arterial spasm responsive to nitroglycerine, transient Purpose: To assess the clinical effects of transcatheter arterial chemoembolization neurological defi cits),No or Materialdevice retrieval. Submitted Major adverse events maybe related to (TACE) under corresponding portal vein occlusion (TACE-PVO) for patients with intraprocedural events (proximal device migration, arterial spasm refractory to hepatocellular carcinoma (HCC) and marked arterio-portal shunts (AP-shunts). nitroglycerine, fl ow-limiting dissection, persistent neurological defi cits) or device Methods and Materials: The study subjects were 14 patients with unresect- retrieval. Knowledge of techniques to avoid and appropriately manage these able HCC and marked AP-shunts who underwent embolization of the AP-shunts adverse events is essential. with coils and/or gelatin sponge particles (group A: n=7) or TACE-PVO (group B: Conclusion: The aim of this exhibit is to compare and contrast embolic protection n=7). Our primary aim was to assess the effi cacy of TACE-PVO for patients with devices, clarify their role with evidence based literature, classify device related unresectable HCC and marked AP-shunts, and our secondary aim was to assess adverse events, and present a pictorial essay of these potential complications with differences in therapeutic effects between groups A and B. their appropriate management. Results: No major complication resulting directly from the procedures was seen in either group. There was also no inter-group difference in the effectiveness of treatment for the AP-shunts. Subsequent TACE therapy was possible in 2 patients C-541 Endovascular stent-graft repair in lesions of the descending aorta of group A and 6 of group B after treatment of the AP-shunts. A favorable response O. Rowinski, M.D. Wojtaszek, M. Januszewicz, Z. Galazka, J. Szmidt; in terms of tumor necrosis exceeding 50% was seen in 28.6% of patients in group Warsaw/PL ([email protected]) A, and in 100% of patients in group B (including 4 cases of complete tumor necro- sis). The 1- and 2-year survival rates in group A were 28.6% and 0%, respectively, Purpose: Aneurysmal diseases of the thoracic aorta are life-threatening condi- whereas the 1-, 2- and 3-year survival rates in group B were 85.7%, 85.7% and tions. Endovascular treatment of aortic disease has emerged as an alternative 42.9%, respectively. There was signifi cant difference (p=.038) of survival rates mode of treatment, particularly attractive for patients with severe comorbidities. between group A and B. Although endoluminal interventions are minimally invasive, they are associated
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7 0 0 2 . 2 443 0 . 2 112.02.2007 17:04:05 G insuffl ation was also was ation insuffl ndings. The ndings. ablation 2
ber inserted within the nidus. ber inserted within the nidus. Chicago, IL/US Chicago, insuffl ation has been described by ation has been described by insuffl 2 C ([email protected]) ([email protected])
insuffl ation. The risk of bleeding was not was The risk of bleeding ation. insuffl BDEF 2 Alzira (Valencia)/ES Alzira A insuffl ation model, and provides a safe and effective and effective a safe ation model, and provides insuffl 2 Strasbourg/FR A balloon catheter was placed above the level of the the level placed above A balloon catheter was Between February placed Between 2006, we 2000 and January From 1994 to 2006, 155 patients aged 2-51 years (mean, 1994 to 2006, 155 patients aged 2-51 years From We anticipated that TearLeader stent placement is more comfortable is more comfortable stent placement TearLeader anticipated that We Our model of using a balloon catheter as a protective device has sev- device Our model of using a balloon catheter as a protective insuffl ation. We offer a new approach in using a balloon catheter as a a new offer We ation. insuffl 2 To evaluate results of image guided laser ablation in a large series of results of image guided laser ablation evaluate To To compare the clinical effectiveness and the patency of a Song stent and the patency compare the clinical effectiveness To Percutaneous RFA of liver tumors has been extensively described and tumors has been extensively of liver RFA Percutaneous The balloon catheter provides a protective barrier that is more stable in barrier that is more stable a protective The balloon catheter provides Painful procedure was referred by 55% of patients in group A and by 10% A and by 55% of patients in group by referred procedure was Painful ([email protected]) ([email protected]) Purpose: stent (PBN). TearLeader (Cook) with that of Methods and Materials: stents TearLeader A) and 98 83 polyurethane Song stents (group 181 stents, the studied we scheduled, and were examinations Follow-up B). (group Wacrees Kaplan-Meier survival curves were phone-opinion survey. by clinical improvement the 2 groups. between rate patency used to compare the cumulative Results: dacriocystitis episodes appeared in 8.4% clinical study showed: Follow-up in B. rmed in complete resolution of epiphora confi A, we In group in A and 18.9% in B. during the B migrated stents in group Ten B. 67%, and in 77% of patients in group of stent of the outcome rate satisfaction revealed Opinion survey period. follow-up in A and 366 days Median survival time was in B. A and 60.8% in 53% in group patency after stent placement; 1 year was: patency rate Cumulative in B. 490 days 0.23 in A and 0.31 in B and after it was after 2 years 0.55 in A and 0.51 in B, was 0.17 in A and 0.22 in B. it was 3 years Conclusion: more but 2 years, long-term for patency rate and this stent has a more favourable been demonstrated. have episodes of dacryocystitis and stent migration Raman et al. as a way to manipulate intraabominal organs to gain safe access organs to gain safe to manipulate intraabominal as a way Raman et al. includ- to this technique, drawbacks these authors stressed several However, routes. and inherent guidance, limited role of ultrasound bleeding, increased ing possible risks in CO increased because the point of probe entry remained closely apposed into the liver acidosis associated with CO Potential to the abdominal wall. Purpose: osteoid osteomas. Methods and Materials: The osteoid osteoma in our department. for laser ablation underwent 22 years) clinical and imaging fi based on unequivocal diagnosis was with a diode laser using an optical fi performed was at wave to the lesion using a continuous delivered 1200 joules were On average, 6 to 144 months (mean, 98 months). up for followed were Patients power. a 2 watts diaphragmatic protective device. protective diaphragmatic Methods and Materials: C-546 and results Long term follow-up of osteoid osteoma: Laser ablation of 155 cases evaluation Gangi; A. Buy, X. Moser, T. Interventional Radiology Non-Vascular C-544 song stent obstruction with a polyuretane of nasolacrimal duct Treatment Long-term results tearleader stent: versus Jornet-Fayos, Aparisi-Gómez, J. Esteban-Hernández, P. E. Ferrer-Puchol, M. Ferragud-Girbes; Sanfélix-Micó, S. P. C-545 using balloons as a diaphragmatic of liver tumors ablation Radiofrequency in an animal model device protective Funaki; B. Straus, Ha, C. Van T.G. Knuttinen, M.-G. ([email protected]) Purpose: CO Targeted and effective. is considered safe 50-70 ablations Approximately anesthesia. hepatic dome in eight pigs under general Fourteen control lesions device. balloon as a protective with the performed were Thermal injury was to the adjacent diaphragm without the balloon. performed were to determine depth of injury. examined Results: position than with saline infusion or CO never a concern. never Conclusion: the CO over advantages eral way of expanding the use of percutaneous radiofrequency ablation of liver tumors of liver ablation the use of percutaneous radiofrequency of expanding way method may this novel Additionally, of the diaphragm. that are in the undersurface be used in the protection of other organs adjacent to areas being ablated. , 2 ow eld cient in cient , F. Maisano , F. 1 , L. Damiani , L. 1 stula in 1 case with CCF. The with CCF. stula in 1 case ([email protected]) ([email protected]) exible enough to pass the tortu- exible
([email protected]) ([email protected])
ciency (sinoplasty): The role of The role (sinoplasty): ciency Scientific and Educational Exhibits Scientific and Educational , A.L. La Fata , A.L. 1 Milan/IT 2 culty. The lesion locations where the covered The lesion locations where the covered culty. Shanghai/CN cency is mainly treated with surgery or edge (graft exibility of the covered stent specially designed for stent specially designed for of the covered exibility t as conventional open surgical repair continues to open surgical repair continues t as conventional Parma/IT, Parma/IT, 1 Between April Between 82 patients and December 2005, 2000 Twelve patients with CICA lesion (3 giant pseudoaneu- Twelve ; , A. Aldrovandi , A. 1 1 To describe anatomical features of the mitral valve as seen valve of the mitral describe anatomical features To ciency. The design of these devices is undergoing and will be The design of these devices ciency. 3 This exhibit will provide a anatomical and pathophysiological a anatomical and pathophysiological will provide This exhibit 1 1
d d Mitral valve insuffi valve Mitral n The intracranial covered stents are fl stents covered The intracranial There is much enthusiasm for the use of endovascular devices, espe- devices, the use of endovascular enthusiasm for There is much Percutaneous mitral valve repair is becoming a new experimental fi experimental repair is becoming a new valve mitral Percutaneous i . N I To investigate the fl investigate To , A.A. Palumbo , A.A. , F. Cademartiri , F. All patients underwent endovascular repair using straight-tube com- repair using straight-tube endovascular All patients underwent F BOT was negative in all 12 cases. The covered stents all reached their The covered in all 12 cases. negative was BOT 1 1 - c u d E i c S - in cardiology and new devices are under development. CT can provide anatomical CT can provide are under development. devices in cardiology and new is theThis information the planning of the procedure. useful for extremely information the individual patients. for the design and the sizing of the devices benchmark for stents were released were C3-C4 in 3 cases, C4-C5 in 4, C6-C7 in 5. The immedi- C4-C5 in 4, C6-C7 in 5. C3-C4 in 3 cases, released were stents were that aneurysm ofter procedure showed disappeared in angiography ate cerebral fi slight endoleak in 2, and greatly-reduced 8 cases, remaining 1 case of pseudoaneurysm only slight low-fl with concurrent CCF had rysms, 4 giant aneurysm, 1 giant pseudoan- 3 small aneurysms with wide necks, stent. covered using the intracranial treated by and 1 CCF) were eurysm with CCF, 3-24 months after the procedure. performed was follow-up Angiographic Results: destinations through CICA without diffi cranial internalcranial artery carotid stent (CICA), the occluding capacity of the covered lesion of CICA. the vascular for Methods and Materials: stula after isolation of the pseudoaneurysm from parent artery the intracranial by fi patency of the parent artery DSA demonstrated Follow-up in all 12 stent. covered 12 cases had no complications related to the occlusion of the branching All cases. arteries at the parent artery at follow-up. Conclusion: lesion and are very effi vascular ous CICA and reach the area of intracranial of long-term of the CICA patency The evaluation managing the CICA aneurysms. stnets needs long-term follow-up. with covered Learning Objectives: valve percutaneous mitral and the technique for describe the devices To on CT. the design and planning of the role of 64-slice CT for show To repair (sinoplasty). repair. valve percutaneous mitral Background: to been developed have some percutaneous devices Recently, to edge technique). insuffi valve treat mitral based on non invasive imaging (i.e. CT and/or MRI). 64-slice CT offers extremely extremely 64-slice CT offers CT and/or MRI). imaging (i.e. based on non invasive the design of both for high spatial resolution in cardiac imaging and can be platform the pre-interventional assessment of the individual patient. and for these devices Findings: Imaging overview of mitral valve insuffi ciency as well as a pictorial essay of mitral valve valve of mitral as a pictorialciency as well essay insuffi valve of mitral overview technique used for and the The percutaneous devices disease as seen on CT. The role of CT in the geometrical as- and described. the treatment will be shown and in the the planning of the percutaneous procedure valve sessment of mitral will be exploited. Conclusion: O. Alfi eri Alfi O. C-543 insuffi repair of mitral valve Percutaneous 64-slice CT in the design and treatment planning Maffei E. Preliminary clinic application of intracranial covered stent in the lesion stent in the lesion of intracranial covered application Preliminary clinic of cranial ICA Gao; B. Fang, C. Wang, Y. Li, M.-H. C-542 Purpose: with complications, as are surgical methods. with complications, Materials: Methods and underwent endovascular repair for lesions of the descending thoracic aorta thoracic lesions of the descending out of for repair endovascular underwent aneurismalwhich 56 presented with or chronic disease and 26 with either acute admitted and 4 were trauma admitted after acute were patients Two dissections. 19 and 75 years. between age ranged Patient TAA. with a diagnosed ruptured and tomography computed through spiral performed diagnosis was Preoperative angiography. in some cases digital subtraction Results: 34 was Mean follow-up (64), Zenith (17) and Gore (1). Talent - mercial stentgrafts in 81 achieved successful implantation was Technically months (8-84 months). because procedure type III dissection required a hybrid On patient with a patients. observed on were late migrations Two of his aneurysm. growth of the continued endoleaks (20.7%) Seventeen additional intervention. which required follow-up, present in dissections on the base of observed of which 12 (46.2%) were were lumen. the false into ow fl retrograde Conclusion: potential indeed hold the it may for aneurysms; the treatment of thoracic cially for patient benefi the greatest for offer serious morbidity and mortality rates. serious morbidity and mortalityoffer rates. C - 7 0 R C EECR07-C-SciEduc-FIN.indd 113 Scientific and Educational Exhibits
Results were classifi ed as primary success when complete pain relief was obtained C-549 after a single ablation session, secondary success when two or three sessions A new challenge for radiologists: Ultrasound guidance in regional were performed and failure when persistence of pain required another therapy. anesthesia Complications were also recorded. L. García del Salto, M. Ruiz Castro, A. Marco, M. Gamo, A. Batiray, Results: Osteoid osteomas located in nearly every part of the skeleton including B. Sánchez Cordón, J. Hernández Salván, E. Fraile; Alcalá de Henares/ES the spine were managed with this technique. Primary success was obtained in 145 ([email protected]) cases (94%), secondary success in 8 cases (5%), and failure in 2 cases (1%). In 2 cases, the procedure was complicated by secondary algodystrophy. Learning Objectives: To review the equipment and practical use of ultrasound Conclusion: Laser ablation is a safe and effective technique which could represent relevant to the practice of regional anesthesia. To show the sonographic anatomy the mainstay therapy for osteoid osteoma. of the areas most frequently involved in regional anesthesia, and to become famil- iar with the imaging appearance of nervous structures. To describe and illustrate C-547 the sonographic appearance of peripheral nerves. To discuss the advantages of ultrasound-guided plexus and nerve blocks. An investigation of brightness changes in ultrasound images due to Background: The ultrasound guidance for nerve block was fi rst reported by La variations of temperature in liver tissue during ex vivo and in vivo Grange et al in 1978, but the interest has increased in the last 10 years due to radiofrequency ablation the technological advances experienced in ultrasound and regional anesthesia. A. Montaseri, M. Mokhtari Dizaji, S. Akhlaghpour, M. Alinaghizadeh; Tehran/IR An optimal distribution of local anesthetic around the nerve structures is the key ([email protected]) requirement for successful regional blocks, and ultrasound allows direct visualization Purpose: A minimally invasive method for the treatment of liver malignancies is in real time. Ultrasound-guided regional blocks improve the quality (faster onset radiofrequency ablation, after which disease recurrence is probable, partially due to and duration), reduce the performance time and complications, and minimize the inadequate capability of temperature monitoring of the target tissue. The goal of this amount of local anaesthetic used. work was to study the possibility of real-time temperature monitoring of liver tissue Procedure Details: It is essential to know the specifi c anatomy and the sono- undergoing RFA. For this purpose, variations of brightness in ultrasonic images graphic correlation of the areas usually involved in the regional blocks of the upper acquired from ex vivo and in vivo experiments were investigated. (interscalene, infraclavicular, axillar, and peripheral blocks) and lower extremities Methods and Materials: In our ex vivo experiments, pieces of fresh bovine liver (femoral, sciatic, popliteal blocks). We describe and illustrate the technique used underwent RFA using active and passive needle electrodes and a microther- in our hospital by the department of anesthesia in collaboration with the radiology mometer, which were inserted into the tissue using ultrasonography guidance. department. Tissue samples were heated up to 70 °C and corresponding to each centigrade Conclusion: Utilization of ultrasound guidance for regional blocks is on the rise of temperature increase, ultrasonic images were acquired and delivered to a PC. and has demonstrated to be an alternative to traditional methods of regional Variations of image brightness were investigated. In our in vivo experiments, the anesthesia. It enables quality nerve blocks, avoiding complications by optimal changes of brightness were studied in the ultrasonic images acquired during the needle positioning. RFA of liver malignancies of three patients. Temperature increase was monitored using thermocouples at the tip of the RF electrode prongs. C-550 Results: The ex vivo study showed that during tissue warm-up from 22 °C to 50 °C, Radiological-endoscopic combined treatment of the transection of the brightness in ultrasound images increases linearly. As temperature rises from 50 °C biliary ducts: Mean and long follow-up results to 70 °C, variation of brightness shows a non-linear behavior due to microbubble M. Corona, F. Fanelli, F.M. Salvatori, G. Orgera, P. Nardis, E. Boatta, A. Pucci, formation. The in vivo investigations showed good consistency with ex vivo results R. Passariello; Rome/IT ([email protected]) in the 40-60 °C interval. Conclusion: It appears that changes of brightness in ultrasound images can be Purpose: To describe the technique and to evaluate the results of a radiological- used for real-time thermal monitoring during RFA. endoscopic combined approach in patients with biliary ducts iatrogenic damage. Methods and Materials: Eighteen patients with complete biliary ducts transec- C-548 tion underwent a radiological-endoscopic rendez-vous. The damage of the biliary ducts was due to trauma in 1 case and to videolaparoscopic colecistectomy in 17 FDG-microPET and diffusion-weighted MR image evaluation of early cases. The procedure consists in re-establishing the continuity of the biliary ducts therapeutic effects of radiofrequency ablation on implanted VX2 rabbit with a combined radiological-endoscopic approach, dilation, and placement of two tumor in the back muscle percutaneous biliary drainages. After 4-6 weeks, the drainages are replaced with T. Ohira, T. Matsuoka, T. Okuma, Y. Wada, K. Koyama, K. Nakamura, 3-6 endoscopic plastic endoprosthesis that are left for 12-14 months. Y. Watanabe, Y. Inoue; Osaka/JP Results: The rendez-vous technique was performed successfully in all cases Purpose: To evaluate the early therapeutic effects of radiofrequency ablation with fast resolution of the symptoms. Two patients underwent surgery, while in (RFA) on implanted VX2 rabbit tumor in the back muscle using FDG-microPET 16 patients the biliary drainages were substituted with plastic endoprosthesis. and MR image. After the removal of the endoprosthesis, 9 patients are asymptomatic after 3-18 Methods and Materials: The bilateral back muscles of 7 rabbits were implanted months. Seven patients are still in treatment with biliary endoprosthesis and are with VX2. A week after tumor implantation, a LeVeen needle electrode was per- asymptomatic after 3-18 months follow-up. cutaneously inserted under CT guidance and radiofrequency was applied until Conclusion: The radiological-endoscopic combined approach represents the maximum impedance. The other side of the VX2 remained as the control tumor. only approach in patients with complete biliary duct transaction to delay or avoid MR imaging was performed with a clinical 1.5 T instrument using a knee coil 2 the surgery. days after RFA. Spin-echo T1-weighted images (T1WI), fast-spin-echo T2-weighted images (T2WI), Gd-enhanced T1-weighted images (CE-T1WI) and echo-planar-im- C-551 aging-diffusion-weighted images (DWI) (b=50, 500, 1000 sec/mm2) were obtained. "Seeing the needle": Tips for improving visualisation of needles during Apparent diffusion coeffi cients (ADC) of ablated lesions and VX2 were measured. ultrasound guided procedures FDG-microPET was obtained 3 days after RFA. Emission data were acquired M.G. Prentice, J.M. Searle, R.E. Hopkins, G.M. McGann; Cheltenham/UK 40-60 min after intravenous 18F-FDG injection. RFA lesion-to-muscle (RF/M) and ([email protected]) tumor-to-muscle (T/M) ratios were calculated. Results: VX2 without RFA showed ring-shaped FDG accumulation and hyper- Learning Objectives: To explain what factors affect needle visualisation during intensity on T1WI, T2WI, CE-T1WI, and DWI, while ablated lesions showed less ultrasound guided interventions and describe techniques for improving visibility accumulation and hypointensity on all sequences. ADC values and T/M ratios of when struggling. VX2 without RFA were 1.69±0.35 × 10-3 mm2/sec and 11.6±3.2, respectively. After Background: Ultrasound is increasingly being used to guide biopsies, drainages RFA, ADC values and RF/M ratios were 1.30±0.27 × 10-3 mm2/sec and 0.5±0.3, and also insertion of central lines. Visualisation of the needle during procedures is respectively. ADC values and RF/M ratios were signifi cantly lower than the VX2 notoriously diffi cult to the inexperienced practitioner. However, seeing the needle without ablation (P < 0.05). Histology showed coagulative necrosis and no viable from skin to target ensures accurate placement and minimises potentially life on ablated lesions. threatening complications. Conclusion: Both FDG-microPET and MR images may be useful for evaluating Procedure Details: We answer the following questions, illustrating key points with early therapeutic effects of RFA. high quality ultrasound images: Why do we see the needle Tip/shaft refl ection;
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7 0 0 2 and . ® 2 445 0 . 2 112.02.2007 17:04:06 ; G 2 , G. Meloni , G. 3
, S. Profi li Profi , S. ([email protected]) 2 C
Liverpool/UK BDEF ([email protected]) ([email protected])
liver biopsies versus of plugged cacy , F. Meloni , F. A 2 , C. Urigo , C. Tempio Pausania/IT Tempio Twelve patients (mean age of 64 years) with unresectable with unresectable patients (mean age of 64 years) Twelve Pamplona/ES 1 3 cient enough to guarantee high levels of safety and quality of safety high levels to guarantee cient enough To establish whether percutaneous plugged liver biopsy percutaneous plugged liver whether establish To 1. To present an overview of pharmacokinetics and pharma- present an overview To 1. We present the basic pharmacokinetics and pharmacodynam-We Hundred patients receiving liver biopsy received TJLB or PPLB biopsy received Hundred patients receiving liver Liver biopsy is important Liver disorders of the in the diagnosis of various Nowadays, there are a high number of diagnostic and therapeutic of diagnostic and therapeutic there are a high number Nowadays, , G. Podda , G. Percutaneous plugged liver biopsy is a feasible alternative to the alternative biopsy is a feasible plugged liver Percutaneous In order for radiologists to perform sedation procedures, it is of utmost sedation procedures, to perform radiologists In order for Sassari/IT, Sassari/IT, 1 2 To verify the feasibility and safety of radiofrequency thermal of radiofrequency ablation and safety the feasibility verify To Cagliari/IT, Cagliari/IT, entropy) the different consciousness levels are exposed. Finally, the main safety the main safety Finally, are exposed. consciousness levels the different entropy) rules of the American Society of Anesthesiologists about this issue are detailed. Conclusion: importance them to be acquainted with the basic pharmacology of the drugs for each procedure. for options available their indications and different employed, the with the management of the airway, it is necessary become familiar to Similarly, cardiopulmonary and basic and advanced resuscitation. devices safety Learning Objectives: be acquainted with their To 2. sedation. used drugscodynamics of most widely for regulations the basic safety explain To 3. principal indications and contraindications. during a sedation procedure. to follow Background: Because of sedation, analgesia or immobilisation. procedures conducted under It is the often carry themselves. radiologists this, out the sedation procedures by departments and anaesthesia responsibility of the radiology to hospital of every so that every implement a working pattern among their staff, based on collaboration profi becomes radiologist during a sedation procedure. Details: Procedure and ketamine etomidate, midazolam, ics of the drugs most widely used (propofol, as their indications and reactions and treatment as well their adverse and fentanile), The basic notions necessary (BIS to recognise and verify contraindications. C-556 of the pulmonary ablation and radiofrequency percutaneous CT-guided adjacent to the heart vessels tumors and large mediastinal unresectable Pusceddu C. 1 C-554 anesthesiologist’s The interventionalSedation in radiology procedures: point of view Martinez-Cuesta, A. De Luis, E. Alonso-Burgos, Gomez, A. M. Noguera, J.J. Bilbao Jaureguizar; J.-I. C-555 A comparison of the risks and effi transjugular liver biopsies Gould; D. Evans, J. Withers, D. Nwosu, A. ([email protected]) Learning Objectives: biopsy (TJLB). liver to transjugular cacious alternative and effi (PPLB) is a safe Background: in patients and percutaneous plugged approaches are favoured Transjugular liver. in high-risk patients, biopsy is safe liver Transjugular riskat a greater of bleeding. consuming and is reported time to yield smaller histological is more expensive, but of both techniques in a aims to compare the performance This exhibit samples. The indications, series in relation to local and national guidelines. of 100 patients biop- types of liver of the different complications and contraindications technique, sies are illustrated. Details: Procedure Seventy-seven period. a 5-year Hospital over Liverpool University at the Royal that histological Our results show PPLB. whilst 23 underwent TJLB, underwent compared TJLB group, 75 patients (97.4%) from the adequate for samples were TJLB Eight patients (13.8%) from the to 23 patients (100%) from the PPLB group. complications compared to 1 patient (5.6%) from the PPLB experienced group (26%) died within 3 months of the TJLB group patients from the Twenty group. biopsy compared to 5 patients (21.7%) from the PPLB group. Conclusion: biopsy is not appropriate liver especially when transjugular biopsy, liver transjugular coagulation defects. to severe in patients with moderate Purpose: under CT guidance in the treatment of malignant neoplasm adjacent to the (RFA) heart and large vessels. Methods and Materials: primary and secondary 1 invasive pulmonary and mediastinal tumors (3 NSCLC, CT-guided treated by 1 mesothelial sarcoma and 7 metastases) were thymoma, adjacent to the aorta and 9 of the lung, were 3 of the mediastinum The tumors, RFA. (7 cases), pulmonary artery (4 cases) or heart (3 cases) with potential thermal dam- expandable with a multitined performed were All ablations age of these structures. Vital signs of the patients electrode under conscious sedation and local anesthesia. ed by cits of patients treated ective shafts/ tips, vibrating vibrating shafts/ tips, ective cult task can be simplifi cult task can cient contrast media application cient contrast Scientific and Educational Exhibits Scientific and Educational ciency of image-guided injection proce- ([email protected]) ([email protected])
uid); Special needles (refl uid); ection at steep angles, good refl ection and therefore ection and therefore good refl at steep angles, ection To demonstrate a technique for parapedicular access to parapedicular a technique for demonstrate To To explain the indications, contraindications and procedure and procedure contraindications the indications, explain To 5 Accurate patient selection is mandatory. After patient place- patient selection is mandatory. Accurate The parapedicular approach does not have the risk of pedicular approach does not have The parapedicular 1 1
d d The thoracic and lumbar vertebral bodies and pedicles differ in and lumbar vertebral bodies and pedicles differ The thoracic Studies have shown the effi shown Studies have n For ultrasound guided procedures to be carried guided procedures ultrasound out successfully and For CT guidance helps in avoiding puncture of vessels by direct visualiza- direct by puncture of vessels CT guidance helps in avoiding We present a technique for parapedicular access to the vertebral body parapedicular present a technique for We i . N Oklahoma City, OK/US Oklahoma City, I F - c u d uoroscopic guidance have made a critical review of these procedures manda- made a critical review guidance have uoroscopic E i c S - tion, thus enhancing safety. A multidisciplinary patient management improves results A multidisciplinary patient management improves tion, thus enhancing safety. approach" will introduce the reader A "how-to-do concerning pain and quality of life. interventional pain management of the cervical spine. to CT-guided dures of the cervical spine in helping avoid surgery. Different case reports Different about surgery. dures of the cervical spine in helping avoid or transitory neurological defi death, permanent invalidity with fl and thereby a better visualisation of anatomic structures, allows CT-guidance tory. of the procedure. enhances the safety Details: Procedure Axial is performed. topogram ment in a supine position on the CT scan, a lateral Step-to-step insertion of interest are obtained. images at the intervertebral level of the needle and application of drugs after suffi are performed. Conclusion: C-553 epidural and Transforaminal, treatments of the cervical spine: CT-guided cervical of image-guided A comprehensive review facet-joint procedures. spine treatments Groenemeyer; D.H.W. Pohl, M. Gevargez-Zoubalan, A. Maratos, Y.K. Bochum/DE ([email protected]) Learning Objectives: pitfalls of CT-guided treatments of the cervical spine in a pictorial essay. To show show To treatments of the cervical spine in a pictorial essay. of CT-guided pitfalls and disadvantages depict the advantages To the importance of patient selection. as a targeting modality. uoroscopy of CT and fl Background: C-552 vertebralparapedicular access to the thoracic and lumbar Percutaneous bodies Beall; D.P. Learning Objectives: and of the spine as it relates to a safe present the anatomy To the vertebral body. accessing the vertebral method of percutaneously body. reproducible Background: the neuro- with this approach, but and the needle is more easily redirected fracture The needle is placed in at the structures are importantvascular to identify and avoid. pedicle-body junction along the superior half of the pedicle and is directed toward not of the pedicle must The medial wall vertebral endplate. inferior the contralateral prior to enteringbe transgressed posterior the portion of the vertebral body. Conclusion: size and shape according to level. The method of accessing the vertebral bodies and shape according to level. size biopsy and for management of vertebral percutaneous compression fractures for and the spine approach in the thoracic has typically been via the parapedicular approach While the transpedicular spine. approach in the lumbar transpedicular the ability to redirect the needle is limited, and there is a risk and effective, is safe of fracturing the pedicle itself. Details: Procedure is approach to vertebral body, and aneural avascular a relatively that will provide a consistent unilateral and will allow and lumbar spine, in the thoracic reproducible approach to the center of the vertebral body. Reverberation artefact; What affects needle visibility? Needle size; Ultrasound Ultrasound size; visibility? Needle needle affects What artefact; Reverberation the needle Medium through which focus); (depth, gain, frequency, machine settings fl gas, tissue, (soft is travelling needles, effervescent shafts). How do you improve needle visibility when strug- improve do you How shafts). effervescent needles, small amounts of air; introducing bevel, rotating the - of stylette, gling? Movement beam slice; in the plane of the ultrasound remain must Slice concept- the needle Angle of needle - poor refl tips. some simple and following considering some applied physics visualisation at shallow angles. This can be achieved by "heel toeing" the probe "heel by This can be achieved angles. visualisation at shallow and Machine settings- Adjusting depth, focus and choosing point of entry carefully; gain plus using an appropriate frequency probe. Conclusion: This diffi require visualisation of the needle. safely C - 7 0 R C EECR07-C-SciEduc-FIN.indd 115 Scientific and Educational Exhibits
were non-invasively monitored continuously. The therapeutic outcomes were evalu- C-559 ated by contrast-enhanced CT after 1 month; the absence of tumor enhancement CT-guided transthoracic needle biopsy of the lung: Risk factors infl uencing CT image was considered to indicate complete tumor necrosis. Two patients were chest tube placement re-treated. In a patient, an electrode is penetrated in the pericardium. S. Koyama, T. Yoshizako, N. Okada, M. Nakamura, T. Katsube, N. Uchida, Results: In all cases, the procedure was technically successful. No intraprocedural H. Kitagaki; Izumo/JP ([email protected]) arrhythmia occurred. Morbidity existed in 3 cases of pneumothorax and 1 case of asymptomatic thickening of the pericardium. In the control CT after 1 month, there was Purpose: To determine risk factors for chest tube placement among patients with complete necrosis in 7 cases and partial (from 70 to 90%) in the remaining 5 cases. pneumothorax, associated with computed tomography (CT) guided transthoracic Conclusion: RFA of mediastinal and lung tumors adjacent to the heart and large needle biopsy of the lung. vessels is feasible and safe because the blood fl ow causes a "heat-sink" effect Methods and Materials: 134 CT-guided transthoracic needle biopsies of the lung adjacent to such structures and prevents undesired thermal damage. were performed in 128 patients. Core biopsy samples for histology were collected. For a group of pneumothorax, patient age, patient position during biopsy, presence C-557 of emphysema, lesion size, lesion depth, lesion location, needle size, number of pleural passes, and pleural puncture angle were analyzed as single and multiple New needle guidance system to reduce ultrasound-guided biopsy dependent variables for chest tube placement. operator dependence Results: Pneumothorax occurred in 83 of 134 procedures (61.9%), and chest A. Shaikh, N. Bluvol, A. Kornecki, A. Fenster; London, ON/CA tube placement was required in 10 cases (7.5% of all biopsies, 12.0% of all pneu- ([email protected]) mothoraces). Among patients with pneumothorax, patient position during biopsy Purpose: The speed of accurate ultrasound (US) guided biopsy is dependent on was the most signifi cant factor of chest tube placement (P=0.038). Patient age, operator experience. We developed a needle guidance system (NGS) to increase presence of emphysema, lesion size, lesion depth, lesion location, needle size, the speed and accuracy of biopsy procedures using US. This system is composed number of pleural passes, and pleural puncture angle were not associated with of a passive articulated mechanical arm attached to an US transducer, providing chest tube placement. real-time projected needle pathway overlay guidance. This NGS coupled to a CNB Conclusion: Patient position during biopsy correlated with chest tube placement needle will result in accurate biopsy with shorter procedure time than those of free- in patients with pneumothorax undergoing CT-guided transthoracic needle biopsy. hand technique, thus potentially limiting the US biopsy operator dependence. Once pneumothorax occurred, supine position during biopsy might increase the Methods and Materials: Biopsy targets composed of 2.5 mm blue PVAC lesions chest tube placement rate. were implanted within chicken tissue test phantoms. Two radiologists experienced with US-guided biopsy and 3 inexperienced radiology residents performed biopsy C-560 of these lesions using both the free-hand technique and NGS (45 lesions per A model experiment for preparing gastroenteric anastomosis with new technique per participant). Participants were alternately assigned to start with 1 minimally invasive technique using rare-earth-metal magnets of the 2 biopsy methods, which were video recorded and analyzed for procedure P. Bata, P. Lukovich, A. Jónás, B. Kádár, K. Tari; Budapest/HU time. Biopsy samples were examined for the presence of blue color, which was indicative of a successful biopsy. Purpose: Experimenting for a new minimally invasive technique on domestic pig Results: Biopsy procedure time using the NGS was signifi cantly lower than the gastroenteric model. Gathering experience for further developments on tools and free-hand technique (p < 0.001). The average procedure time was shorter among techniques for future experiments on living animals. experienced participants than among inexperienced participants when using the Methods and Materials: A biosynthetic model was developed to imitate the upper free-hand technique (p=0.037). Equivalence in procedure time was found when digestive tract. The magnet-insertion procedure was performed under endoscopic physicians, both experienced and inexperienced with free-hand US biopsy, per- and fl uoroscopic guidance. Two coated rare-earth-metal (NdFeBr) magnets (Br = formed biopsy using the NGS (p=0.734). 1200 Gauss, d = 10 mm, central hole d = 6 mm) were inserted by guide-wire and Conclusion: Our needle guidance system is increasing procedural effi ciency duodenal probe into the model. The fi rst magnet was pushed into the fi rst jejunal loop, by improving the rates of successful biopsy and reducing the required physician the second one was placed into the stomach inversely. After reaching the adequate experience to perform biopsy. positions, the magnets were pushed down from the guide-wire to let them cohere. Results: The exact positioning was possible; the magnets cohered across the C-558 gastric and jejunal walls successfully. Expectedly, the pressure between the magnets leads to ischaemia and necrosis of the cohered gastric and jejunal walls, Complications of percutaneous RF ablation of primary and secondary liver while reparing the granulation process along the magnets’ edges yields adhesion tumours: Report of a single center study between them, and fi nally an anastomosis will develop. P. Sedati, F. Macrì, M. Telesca, G. Pelle, L. Paciucci, M. Bezzi, R. Passariello; Conclusion: The experiment was executable even with common tools in a short Rome/IT ([email protected]) period of time in an exact way. Further developments are necessary regarding Purpose: To report complications of radio-frequency (RF) ablation in patients size, material and form of the magnets. With some slight technical corrections, the with liver tumours. method seems to be suitable for animal experiments. Methods and Materials: Between October 1999 and June 2006, 210 patients with 262 lesions were treated with RF: 210 for hepatocellular carcinoma (HCC) and 52 C-561 for metastases. Complications were classifi ed according to the guidelines of the Percutaneous alcohol ablation and catheter drainage for the treatment of Society of Interventional Radiology. Data were analyzed to determine whether the large hydatid cysts in liver complication rate was related to tumor size, tumor location, number of ablation S.K. Puri, A. Dev, S. Ghuman, A. Agarwal, A.S. Puri, P.K. Mishra, S.K. Sarin; sessions, electrode type, or Child’s class in cirrhotic patients. New Delhi/IN ([email protected]) Results: Major complications rate was 2.8%. Death was observed in one patient due to peritonitis after colon perforation (0.5%). Other complications included Purpose: To evaluate the safety and effi cacy of percutaneous alcohol ablation one cutaneous tumour seeding (0.5%), four subcapsular hematomas (2.4%), two using a catheter and subsequent drainage of the cavity in large, > 8 cm hydatid asymptomatic central biliary strictures (1%), and one necrosis of the left lobe of cysts in liver. the liver (0.5%). Methods and Materials: Sixteen patients (6 men and 10 women, aged 22 to 52 A higher rate of major complications was related to an increased number of RF years) with 18 hydatid cysts were subjected to alcohol ablation and catheter drain- sessions and to the Child’s class C (p <.01), but not to tumor size or electrode type. age. All cysts were of Gharbi type I and II and the size ranged from 8 to 14 cm. The Tumor location determined termal damage of adjacent organs and bile ducts. Minor procedure was performed under US guidance (n=12) or CT guidance (n=4) using complications were observed in 6% of patients. light sedation and local anesthesia. Initial needle puncture and aspiration of fl uid Conclusion: The results of our series demonstrate that RF ablation is a relatively were done to examine scoleces and rule out any biliary communication. Catheter- low-risk procedure for the treatment of liver tumors. ization was done by Seldinger technique using 8 F to 14 F pigtail catheters. 95% w/v alcohol was used as scolicidal agent. Follow-up was initially done at monthly intervals for 3 months, and thereafter at 3-month intervals. Results: Fourteen cysts (77.8%) in 13 patients were successfully treated with follow-up ranging from 8 to 18 months. All showed more than 60% volume reduction and solidifi cation of cyst contents. Three patients with failure required surgery. No
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7 - 3 *- 0 2 β 0 ν 2 . α 2 447 0 . 2 112.02.2007 17:04:06 - and T - and 3 nm were 3 nm were 2 ± 41 ms) was was 41 ms) ± G /s was used as /s was c USPIO c 2 0.05) more after < 0.1%). ± -specifi 3 β -specifi c USPIO can dis- -specifi ν 3 α cantly (p cantly β ν α 0.4%/0.3 0.5%) were found than in the found 0.5%) were ± ± Heidelberg/DE C 0.01) higher area fractions of CD31 0.01) higher area fractions < ([email protected]) ([email protected]) ([email protected]) ([email protected])
BDEF ed 71 pathologic nodal lesions, while PET 71 pathologic nodal lesions, ed 8 ms). In line with the MR results, histological In line with the MR results, 8 ms). A ± using le in tumors Beijing/CN Beijing/CN -relaxometry were performed 6 h after injection. Tumor Tumor -relaxometry 6 h after injection. performed were 2 integrin positive vessels were determined. were vessels integrin positive 8 patients (6 Non-Hodgkin lymphomas, 2 Hodgkin 2 Hodgkin lymphomas, 8 patients (6 Non-Hodgkin 3 1) Prescan procedure of STIR-DWEPI was modifi ed modifi was 1) Prescan procedure of STIR-DWEPI APTMS-coated USPIO with diameters of 10 integrin area fraction: 0.9 integrin area fraction: β 3 ν β α ν -relaxation times decreased signifi 2 α integrin positive vessels (1.0 vessels integrin positive 3 β rmed by histopathology, but were not detected by PET. not detected by were but rmed histopathology, by -relaxation time in HaCaT-ras-A-5RT3 tumors (28 -relaxation time in HaCaT-ras-A-5RT3 ν 2 α *-weighted images, a strong heterogeneous decrease in signal images, *-weighted 2 Molecular MRI of angiogenesis using Compared with PET, WB-DWI was more sensitive in the detection more sensitive was WB-DWI Compared with PET, To evaluate the diagnostic accuracy of whole body diffusion weighted of whole body diffusion weighted diagnostic accuracy the evaluate To imaging the free breathing whole body diffusion weighted optimize To Angiogenesis is essential for tumor growth and spread. In this study, In this study, and spread. tumor growth Angiogenesis is essential for On T On In 8 cases WB-DWI identifi WB-DWI In 8 cases 1.1%) and ± Conclusion: (1.9 A431 tumors (CD31/ stronger than in A431 tumors (14 tumors a heterogeneous vascularization in HaCaT-ras-A-5RT3 shows evaluation in A431 Contrarily, density and large mature vessels. with areas of high vessel Furthermore, in small and homogeneously distributed. were the vessels tumors, cantly (p signifi tumors, HaCaT-ras-A-5RT3 C. Zhang, M. Jugold, E.C. Woenne, T. Lammers, M.M. Mueller, H. Zentgraf, Zentgraf, H. Mueller, M.M. Lammers, T. Woenne, E.C. Jugold, Zhang, M. C. Kiessling; F. Semmler, W. Eisenhut, M. Bock, M. ([email protected]) Purpose: C-565 resonance in tumor imaging: diffusion weighted magnetic Whole body and preliminary results improvement Technical Jin; Z.Y. Xue, Sun, H.D. F. Li, S. Purpose: Molecular Imaging Imaging Molecular C-563 compared with (WB-DWI) diffusion weighted MR imaging Whole body staging malignant lymphoma (PET) for emission tomography positron Jin; Sun, Z.Y. F. Xue, Li, H.D. S. Purpose: staging of lymphoma patients in comparison to positron for MR imaging (WB-DWI) (PET). emission tomography Methods and Materials: weeks. and PET within two WB-DWI tumor staging by lymphomas) underwent diffusion recovery TI inversion free breathing short by performed was WB-DWI 30 for minutes scan time was Total in body coil. sequence and build EPI weighted WB-DWI 3D MIP images of High resolution from head to thigh. 5 stations covering scales in order to compare with PET. gray inverted by and displayed obtained were than 1.2 mm image with ADC lower DWI intensity in inverted Low C-564 angiogenic profi differentiate To echo diffusion weighted recovery TI inversion using short protocol by (WB-DWI) High resolution in body coil. sequence and build planar imaging (STIR-DWEPI) obtained intensity projection (MIP) images were three-dimensional (3D) maximum evaluated. in tumor patient screening was and the feasibility Methods and Materials: center an optimized During each exam, under the data from thirty scan. volunteers scan station. the slice offsets in the consecutive minimize used to frequency was intensity was found in HaCaT-ras-A-5RT3 tumors, while signal changes in A431 while signal changes tumors, in HaCaT-ras-A-5RT3 found intensity was Both in HaCaT-ras-A-5RT3 more homogeneous and less pronounced. tumors were T and in A431 tumors, malignancy marker. Results: PET occurred in 6 and WB-DWI Concordance between 62 lesions. demonstrated than 5 greater All pathologic lymph nodes with a diameter mm of 8 patients (75%). In one patient, 2 lesions in the WB-DWI. by could be visualized PET detected by another In WB-DWI. on not clearly were visible PET, by revealed mediastinum by found were and 7 in the inguinal groove patient, 4 nodal lesions in the neck and confi WB-DWI Conclusion: will be a WB-DWI and the inguinal groove. of pathologic lymph nodes in the neck staging of patients with malignant lymphoma. imaging modality for valuable tinguish tumors with different angiogenic profi les in vivo. les in vivo. profi angiogenic tinguish tumors with different conjugated with RGD-peptides. RGD-USPIO or plain particles into injected were conjugated with RGD-peptides. T xenografts. and A431-tumor mice bearingnude HaCaT-ras-A-5RT3 specifi c ultrasmall superparamagnetic iron oxide (USPIO) was generated and its generated was (USPIO) superparamagneticc ultrasmall iron oxide specifi investigated. le was angiogenic profi potential to distinguish tumors with different Methods and Materials: weighted MR imaging and T MR imaging and weighted Results: tissues were immunostained against CD61 and counterstained against CD31. Area against CD61 and counterstained against CD31. immunostained tissues were of CD31 and fractions the injection of RGD-USPIO than after the injection of plain particles. In addition, the injection of RGD-USPIO than after the injection of plain particles. T the decrease in ned Scientific and Educational Exhibits Scientific and Educational ([email protected]) ([email protected])
To present a retrospective analysis of the technical and present a retrospective To 7 Nine patients with osteoid osteomas underwent CT-guided local- CT-guided Nine patients with osteoid osteomas underwent 1 1
Bilbao/ES
d d Osteoid osteoma is a painful benign tumor most frequently observed Osteoid osteoma is a painful Initial technical success was achieved in all cases. Eight of nine in all cases. achieved Initial technical success was n Percutaneous alcohol ablation and catheter drainage is a safe and a safe is catheter drainage and alcohol ablation Percutaneous i . N I F - c rst three decades of life. Treatment of choice used to be complete surgical of choice used to be Treatment rst three decades of life. u d E i c S - ization of osteoid osteomas. Outpatient percutaneous therapy (10 procedures) was (10 procedures) was Outpatient percutaneous therapy ization of osteoid osteomas. All localization of the nidus. anesthesia after image-guided under general performed defi A good response was months of clinical follow-up. patients had at least two excision. In this exhibit, we describe the use of radiofrequency (RF) ablation for for describe (RF) ablation we the use of radiofrequency In this exhibit, excision. 2006, nine patients January 2004 and Juny Between of osteoid osteoma. therapy treated in our department.were Details: Procedure Learning Objectives: percutaneous of CT-guided and clinical follow-up complications, clinical successes, of osteoid osteomas. ablation radiofrequency Background: in the fi and attributed at presentation manifested that were of symptoms as disappearance within 1 prior performed to discharge; Clinical assessment was to osteoid osteoma. and at 2, 6 and and 12 months follow-up. after the procedure; week Conclusion: No major patients had a good response after one thermocoagulation session. observed. complications were immediate or delayed C-562 A prevailing of osteoid osteoma: ablation radiofrequency CT-guided technique Dolado Llorente, Garmendia, Saez A. F. Sarnago, Peña J. de Otalora, Diaz A. Bilbao; Larrea L. effective (success rate 77.8%) method to treat large hydatid cysts in the liver. in the liver. cysts to treat large hydatid 77.8%) method (success rate effective major untoward reaction was encountered. Urticaria each in one and cyst infection, encountered. was reaction major untoward period 5 to 28 days. from Drainage ranged managed conservatively. patient, were Conclusion: C - 7 0 R C EECR07-C-SciEduc-FIN.indd 117 Scientific and Educational Exhibits
Prescan time was also reduced from 50 seconds to 20 seconds with even better C-568 station profi le. Total scan time is 30 minutes for 5 stations 1.2m coverage; 2) Thirty Conjugation of single-chain antibody against human γ-seminoprotein to patients with histological proven malignant disease were scanned under the fi nal iron oxide and its in vitro identifi cation protocol by build in body coil for feasibility evaluation. The image quality and the Y.D. Han1, Y.G. Zhang1, Y. Ji1, D.X. Cui2, J.Q. Xu1, Y.L. Liu1; 1Xi’an/CN, 2Shanghai/ degree of background body signal suppression were also assessed. CN (Hanyuedong@ 126.com) Results: Free breathing WB-DWI is 100% successfully performed in this patients’ group, without slice misregistration, fat contamination, signifi cant distortion or non- Purpose: To synthesize the conjugate of single-chain Fv (scFv) iron oxide against uniformity. The acquired 3D-MIP images were adequate in depicting the malignant human γ-seminoprotein, and identify its biological activity in vitro. lesions on the total 30 patients with high sensitivity and accuracy, compared with Methods and Materials: E4B7 scFv gene was amplifi ed by PCR and then PET or SPECT results. expressed by the rapid translation system. The product was studied by immuno- Conclusion: High resolution images of WB-DWI can be obtained with these techni- precipitation, western blotting, and immunofl uorescent staining, and subsequently cal improvements. WB-DWI has a great clinical application value in the detection conjugated with magnetic nanoparticles (MNP) 8 nm in diameter, which were of primary and metastasis lesions of malignancies in the whole body. It has great further coated with aminosilane and PAMAM dendrimer. The conjugated and the potential in diagnosis and therapeutic assessment of tumors. unconjugated MNP were separately incubated with theEPOS prostate cancer LNCaP cells and then observed via transmission electrical microscopy (TEM). C-566 Results: The E4B7 scFv gene was successfully amplifi ed and expressed. The result of immunoprecipitation and western blotting showed that the expressed peptide Changes in the transferrin-receptor expression of rat mesenchymal stem was completely absorbed by the soluble cytoplasmic fraction and cell membrane cells after labeling with superparamagnetic iron oxide of LNCaP cells, which is highly consistent with the result of immunofl uorescent R. Kehlbach, R. Schaefer, R. Bantleon, J. Pintaske, C.D. Claussen, J. Wiskirchen; staining. TEM showed that the conjugate entered into the cytoplasm within 15 min, Tuebingen/DE ([email protected]) and the amount increasedNo Material over time, Submittedunlike unconjugated to MNP in the control group, Purpose: To evaluate the infl uence of small or ultrasmall particles of iron oxide in which the amount inside the cells was markedly less than that of the conjugate (U)SPIO (Resovist/Resovist C) on the expression of the transferrin receptor (TfR) at the same time point, although they also entered into the cytoplasm. and on the plasticity of mesenchymal stem cells. Conclusion: The scFv peptide against human γ-seminoprotein, and the conjugate Methods and Materials: Adult MSC were isolated from the bone marrow of rats. of scFv-MNP were successfully fabricated, with the latter being uptaken by LNCaP Adult MSC were labeled with 200 µg/ml (U)SPIO or with 60 µg/ml (U)SPIO in cells. Our studies indicate that this targeted probe can be developed for further combination with the transfection agents (TAs) Dosper® or jetPEI™. MSC were molecular MR imaging. characterised by in vitro differentiation; surface receptor expression was analysed by FACS. Spectrophotometrical quantifi cation of the cellular iron content and C-569 determination of cellular viability were performed additionally. Effect of labeling with (U)SPIO on the migration and colony formation of Results: Labeling of aMSC with (U)SPIO was feasible without affecting cell viability adult human mesenchymal stem cells or their adipogenic, osteogenic or chondrogenic differentiation potential. (U)SPIO R. Kehlbach, R. Schaefer, R. Bantleon, B. Maurer, C.D. Claussen, J. Wiskirchen; labeled aMSC without TA showed an enhanced expression of CD71 (the transfer- Tuebingen/DE ([email protected]) rin receptor) in contrary to (U)SPIO labeled aMSC with TA and control cells. TAs augmented the iron content of the cells, especially jetPEI was very effective. Purpose: Labeling of cells with MR contrast agents is feasible without interfer- Conclusion: (U)SPIO labeling without TA does have a biological impact on aMSC ing the viability and proliferative capacity. Monitoring the migratory ability and by up-regulating TfR. The plasticity of the cells, however, is not affected. the colony-forming potential of labeled cells will be another step in the direction towards in vivo application. C-567 Methods and Materials: Human MSC were labeled for 4 h or 15 h with 200 µg/ml Resovist® or Resovist C® (R/RC) or for 4 h with 60 µg/ml R/RC in combination PET/CT in lymphoma: A prospective study of full-dose enhanced PET/CT with the transfection reagents PULSin™ or jetPEI™ (Pul/jP). Directly after the versus low-dose unenhanced PET/CT labeling procedure, migration assays were conducted in culture-well inserts with F. Guerra-Gutiérrez, E. Fernández-Canabal, B. Rodriguez-Vigil, I. Pinilla, J. Coya, 8 µm pores and colony formation assays. N. Gómez-León; Madrid/ES (fl [email protected]) Results: Incubation with Resovist increased the number of migrated cells compared Purpose: To prospectively compare the agreement between low-dose unenhanced to the unlabeled cells (42±2.9 SEM per mm²). The highest migratory ability was PET/CT and full-dose enhanced PET/CT in lesion detection and staging of Hodgkin seen after 4 h incubation (75±4.0), followed by the combinations PulR (60±5.2) disease and non-Hodgkin lymphoma. and jPR (50±4.1). 15 h R resulted in an unaltered count (41±4.5). Compared to R, Methods and Materials: Seventy-two biopsy-proved lymphoma patients underwent RC diminished the migration ability of hMSC after the different labeling conditions, 18 FDG PET/CT that included a low dose unenhanced CT and a full-dose enhanced except for the 15 h value (55±4.0). Data for RC 4 h, jPRC and PulRC were 41±2.3, CT for initial staging. Every patient had both PET/CT studies, and each one was 35±2.7 and 22±2.1, respectively. The clonogenic activity showed only slight differ- evaluated by one pair of experienced physicians, a radiologist and a nuclear phy- ences between controls and combinations with transfection reagents, revealing sician. Both pairs were blinded to the other technique. Lesion detection, number again a small benefi t for R compared to RC. Incubation with higher Fe amounts of sites affected in each anatomical region, and disease stage were assessed for 4 and 15 h reduced the colony-forming ability. with both imaging modalities. Agreement among techniques was determined by Conclusion: The combination of transfection reagents and Resovist® is a promis- kappa statistics, and discordances studied by McNemar’s test. Clinical, analytical, ing approach for the in vivo monitoring of labeled cells. The clonogenic activity is histopathologic, diagnostic enhanced-CT, PET, and follow-up data constituted the not reduced and the migratory ability is even enhanced. reference standard. Results: For region-based analysis, no signifi cant differences were found between C-570 low-dose PET/CT and full-dose PET/CT, although full-dose PET/CT showed fewer 18 F-FDG small-animal PET and MR imaging of rabbit VX2 tumor model indeterminate fi ndings and higher number of extranodal sites affected. Agreement implanted in the back muscle between both modalities of PET/CT was almost perfect for disease stage (k =0.92, T. Okuma, T. Matsuoka, T. Ohira, Y. Wada, K. Koyama, K. Nakamura, p < 0.001). Y. Watanabe, Y. Inoue; Osaka/JP ([email protected]) Conclusion: No statistically signifi cant differences were found between both modalities of PET/CT in the initial staging of patients with lymphoma, although Purpose: To compare FDG-PET imaging using microPET P4 and MR imaging full-dose enhanced PET/CT detected a larger number of anatomic sites affected, including diffusion-weighted image (DWI) with a clinical 1.5-T MR imager in the especially in extranodal regions, and provided fewer indeterminate fi ndings than implanted VX2 tumor. low-dose unenhanced PET/CT. Methods and Materials: VX2 were implanted into the bilateral back muscle of 21 rabbits. FDG-microPET and MR imaging were performed 1 and 2 weeks after implantation. For the PET study, emission data was reconstructed at 40-60 min. and tumor-to-muscle (T/M) ratios were calculated. For MR imaging, T1-weighted- SE, T2-weighted-FSE, echo-planner-imaging-DWI, and Gd-enhanced-T1-weighted image were obtained using a knee coil. The apparent diffusion coeffi cient (ADC) of each tumor was reconstructed on the basis of DWI obtained with gradient b values
448 A BDEFC G
EECR07-C-SciEduc-FIN.inddCR07-C-SciEduc-FIN.indd 111818 112.02.20072.02.2007 17:04:0717:04:07 7 0 : 4
Molecular Imaging 0 : 7 1
7 0 0 2 . 2 449 0
. 2 112.02.2007 17:04:07 G Verona/IT C BDEF A Forty-two MR exams were executed with intravascular with intravascular executed were Forty-two MR exams DCE-MRI permits the non-invasive evaluation of tumoral microcir- of tumoral evaluation DCE-MRI permits the non-invasive
To evaluate the applications of Magnetic Resonance and in particular the of evaluate To
In all the examined animal models, the DCE-MRI shows that the en- the DCE-MRI shows animal models, In all the examined culation, and in particular, of its size, dynamic characteristics and vascular grade grade dynamic characteristics and vascular of its size, culation, and in particular, antiangiogenic treatment. and after before Dynamic Contrast Enhancement Magnetic Resonance Imaging (DCE MRI) in the Enhancement Magnetic Resonance Dynamic Contrast evaluated models, tumoral means of animal microcirculation by study of tumoral and after antiangiogenic treatment. before Methods and Materials: the subcutaneous induced by were tumors in 7 rats, in 21 rats: media contrast mammaryby adenocarcinoma and in 14 rats cells, injection of colon carcinoma and permeability of the implanted tumors were parameters Perfusional cells. to depict media (B22956/1 and Gd-DTPA37-albumin) contrast with two evaluated antiangiogenic different of two response after administration better the tumoral histological and By means of these parameters and SU6668). drugs (Tamoxifen to obtain a map of the microcirculation. possible was it examination, Results: After the area. in the peripheralcentral area than in the hancement is greater of permeabilityantiangiogenic drug and perfusion the mean values administration, The response to the treatment is decreased to 51% and 59%, respectively. were a different media allow contrast Different each antiangiogenic drug. for different the microcircle. capability to visualize Conclusion: C-573 of tumor evaluation in the experimental animal models Pathological resonance with magnetic microvasculature Mucelli; Pozzi R. D’Onofrio, Boschi, M. F. Marzola, P. Faccioli, N. ([email protected]) Purpose: and -3 0.05). 0.05). < rmed by 0.2 cm and 0.5x10 ± ± ) were imaged ) were rst correlation 6 Gifu/JP, Gifu/JP, 1 ; 1 , 1.51 -3 rmed invasive ductal invasive rmed 2.9, respectively. The 2.9, respectively. ± 0.4x10 ± , Y. Kinosada , Y. cytotoxic T-lymphocyte (CTL) (CTL) T-lymphocyte cytotoxic 1 + Cr-release-assay. Iron uptake was was Iron uptake Cr-release-assay. , 1.90 2.6, and 4.0 51 -3 0.05). c for the dextran-coating of Resovist. of Resovist. the dextran-coating c for ± < Scientific and Educational Exhibits Scientific and Educational , S. Era , S. 2 cantly higher than at 2 weeks (P cantly higher than at 2 weeks 0.4x10 . The Winroof software was used to analyze used to analyze was Winroof software The . ± ed by a ed by 2.7, 3.3 2 ± -relaxivity. Resovist-uptake was confi was Resovist-uptake -relaxivity. * , F. Sasaki , F. cant difference was obtained in the ECR values of obtained in the ECR values was cant difference 2 3.7, 7.6 ). ± 2 A CMV-specifi c CD8 A CMV-specifi cally with anti-CD3. After three days, CTLs were labelled CTLs were After three days, cally with anti-CD3. Fifteen patients with histologically confi 9 /s), respectively. The ADC values of the rim at 1 week were of the rim were at 1 week The ADC values /s), respectively. 1 2 1
0.001). Both numerical values are present on the fi Both numerical values 0.001). , H. Nishiofuku , H. d 1 < SD), respectively. The FDG-microPET image shows ring-shaped image shows The FDG-microPET SD), respectively. d (mm Munich/DE ([email protected]) Munich/DE ([email protected]) In the axillary lymph node, ECR value related to the number of of related to the number In the axillary ECR value lymph node, eld from the water resonance. The ECR value was defi ned as the defi was The ECR value resonance. eld from the water n Our preliminary and MR image study suggests that FDG-microPET ± Labelling of human CTLs can be achieved by incubation with Resovist incubation with Resovist by Labelling of human CTLs can be achieved i -3 ([email protected]) .
-relaxation times was observed which diminished substantially after 7 -relaxation times was * N I Equivalent cross-relaxation rate (ECR) imaging (ECRI) is a measure- rate cross-relaxation Equivalent To develop a method for labelling human cytotoxic T-lymphocytes with T-lymphocytes labelling human cytotoxic a method for develop To Resovist-labelling of CTLs was most effi cient using Resovist (100µg cient using Resovist most effi of CTLs was Resovist-labelling F Tumor size at 1 and 2 weeks after implantation was 1.6 implantation was after at 1 and 2 weeks size Tumor The normal organization showed that there were many cells and a higher many that there were The normal showed organization uorescence using an antibody specifi - c u 0.5x10 d 0.2 cm ( ± E i ± c S Nagoya/JP - Conclusion: VX2 tumor. the can be used to characterize ment method that can be used to quantitatively evaluate a change in the structural evaluate ment method that can be used to quantitatively the to evaluate The aim of this study was MRI. organization of lymph nodes by utility of ECRI as molecular imaging. Methods and Material: adopted the off-resonance technique We studied. carcinomas of the breast were the ECR values. of the immobile protons to evaluate saturation preferential for at the frequency employed pulse frequency was transfer The single saturation 5 ppm downfi The images. and saturated the unsaturated percentage of signal loss between had The 50 ROIs constructed on the basis of the percentage of ECR. ECRI was a rectangle-sampling area of 0.3 mm Purpose: 1.9 of the tumor rimT/M ratios at 1 and 2 weeks, The in the tumors. accumulation 11.6 and tumor core were T/M ratio of the rim at 1 week was signifi of the rim was T/M ratio at 1 week Results: MR imaging shows a slightly hyperintense tumor on T1WI, hyperintense on T2WI on T1WI, hyperintense tumor on a slightly hyperintense MR imaging shows rim of the at 1 ADC values The enhancement on Gd-T1WI. and ring-like and DWI, 1.60 and the core were and 2 weeks, at 1.5 T (Philips Intera) 0, 2, 7 and 14 days after labelling using a fast multi-echo multi-echo after labelling using a fast 0, 2, 7 and 14 days T (Philips Intera) at 1.5 T2 readout sequence to determine C-572 relaxation rate cross equivalent node by of axillary lymph Molecular imaging Matsushima S. 2 superparamagnetic iron oxide particles subsequent depiction with a superparamagnetic iron oxide (SPIOs) for T MR scanner. 1.5 conventional Methods and Materials: C-571 with T-lymphocytes labelling of human cytotoxic In vitro particles oxide iron superparamagnetic Rummeny, E.J. Settles, Piontek, M. G. Neudorfer, J. Holzapfel, K. Beer, A.J. Bernhard; H. Purpose: (b= 50, 500, 1000 sec/mm (b= 50, 500, the number of cells. the number Results: cells and few that there were The lymph nodes with metastases showed ECR value. cells and the lowest very few In the adipose tissue there were ECR value. a lower A statistically signifi ECR value. each tissue (p Fe/ml) and Lipofectin. On days 0 and 2 after labelling, pronounced shortening 0 and 2 after labelling, On days of and Lipofectin. Fe/ml) T2 T2- and measured by atomic emission spectrometry atomic emission measured by (AES). Results: 1.58 future application could be the monitoring of CTLs after A possible and Lipofectin. cell transfer. an adoptive and 14 days. The mean iron concentration per cell was 0.9 and 0.8pg at 0 and 2 per cell was mean iron concentration The and 14 days. of the c cytotoxicity ty and specifi Specifi and 0.1pg at 7 days. after incubation days the labelling procedure. not altered by cells was Conclusion: clone was expanded in the presence of feeder cells, Interleukin(IL)-2 and IL-15 cells, of feeder in the presence expanded clone was unspecifi and stimulated (20µg/ml) at and Lipofectin or with Resovist with Resovist incubation either by Cells (2x10 with an incubation time of 4 hours. 100 or 200µg Fe/ml signifi cantly lower than those at 2 weeks (P those at 2 weeks than lower cantly signifi immunofl Specifi determined staining with a CD8-antibody and CMV-multi- ty of CTLs was by Specifi quantifi was cytotoxicity c Specifi mers. line (correlation coeffi cient = 0.92). line (correlation coeffi Conclusion: molecular imaging in the ECRI is a potentially useful method for Therefore, cells. lymph node. C - 7 0 R C EECR07-C-SciEduc-FIN.indd 119 Scientific and Educational Exhibits
Musculoskeletal skeletal involvement in patients with GD based on MRI, scintigraphy or dual-energy X-ray adsorptiometry (DEXA). Bone Methods and Materials: Thirty-one patients with type-1 GD underwent MRI, 99mTc-sestamibi scintigraphy and DEXA. MRI was performed with 1.5 T scanner; protocol included T1 and T2w TSE sequences of lumbar spine and femora. All im- C-574 ages were analysed by 2 radiologists and bone marrow changes were classifi ed Eosinophilic granuloma on a 16-point semi-quantitative scoring system. 99mTc-sestamibi scintigraphy was B. Graca, J. Brito, A. Canelas, P. Belo-Oliveira, C. Marques, F. Caseiro-Alves; semiquantitatively scored; DEXA of the lumbar spine and femoral neck yielded the Coimbra/PT ([email protected]) Z- and T-scores. The relationship between MRI, scintigraphic and DEXA scores and different disease parameters (bone pain, skeletal complications, hepatomegaly, Learning Objectives: To provide an educational and pictorial review of the ra- splenomegaly, platelet count, haemoglobin level, and plasma chitrotriosidase) was diological imaging features (plain radiography/ bone scintigraphy/CT/MRI) and evaluated by the Spearman’s rank correlation test. distribution of eosinophilic granuloma (EG). To illustrate the clinical features and Results: A statistically signifi cant correlation was found between MRI and scin- peculiar radiological appearances of eosinophilic granuloma. To discuss differential tigraphic scores (r = 0.694; P = 0.0001). Moreover, both imaging scores were diagnoses, in particular in differentiating eosinophilic granuloma from other primary statistically signifi cantly correlated with several clinical parameters including platelet bone tumours, metastases or osteomyelitis. count, hepatomegaly, splenomegaly, haemoglobin level and presence of skeletal Background: Langerhans cell histiocytosis is a pathological entity characterized complications. On the contrary, the DEXA-derived parameters were not correlated predominantly by proliferation of a specifi c histiocyte (Langerhans cells). The with any clinical and/or imaging scores. etiology and pathogenesis is still unknown. Eosinophilic granuloma is the unifocal Conclusion: Our preliminary data indicate that both MRI and 99mTc-sestamibi unisystem form of Langerhans cell histiocytosis, typically characterized by bone scintigraphy are reliable tools for assessing the severity of bone marrow involve- involvement, usually in a monostotic pattern. Nonetheless, it is important to be ment in patients with GD. able to recognize this lesion and exclude diffuse involvement, particulary of the bone marrow, lungs, heart, liver, kidney and gastrointestinal tract, conferring an adverse prognosis. EG must be differentiated from neoplastic, infl ammatory and C-577 metabolic lesions, which have variable approaches in terms of prognosis and Imaging fi ndings of osseus tumours that contain giant cells with radiologic treatment. Eosinophilic granuloma may resolve spontaneously. There are good - pathologic correlation results with intralesional injection of methylprednisolone. Surgery, chemotherapy M. Navallas Irujo, E. Alvarez Moreno, E. Sanz Garcia, P. Manjon Luengo, and radiotherapy are reserved for disseminated or complicated cases, which is F. Martinez Tello, S. Montes Moreno; Madrid/ES ([email protected]) rarely the case of EG. Learning Objectives: To describe the clinical, pathological and radiological fea- Imaging Findings: We divide our presentation by anatomical location, showing tures of osseus tumours that contain osteoclast-like giant cells. To understand the lesions of the calvarium, mandible, ribs, vertebra, and long bones, emphasizing the pathologic basis of the radiologic features of these lesions. To realize the problems most important aspects in differential diagnosis, in different imaging modalities. and pitfalls in the pathology assessment and discuss the clinical and radiological Conclusion: Awareness and early identifi cation of eosinophilic granuloma allow features that may allow differential diagnosis. appropriate management. We provide a review of the background, clinical presenta- Background: Differential diagnosis of bone lesions that contain giant cells requires tion and radiological feature of eosinophilic granuloma. the pathologist to consider an important number of possibilities. Each lesion should be analyzed as a clinicopathologic entity and, therefore, the pathologist C-575 should be aware of the relevant clinical information and the radiologic evaluation Whole body diffusion-weighted image: A novel technique to evaluate of the lesions. patients with diffuse bone disease Procedure Details: We have divided these lesions into two groups. The fi rst one J.C. Vilanova, E. Balliu, J. Barceló, I. Peláez, M. Boada, P. Galofré, M. Villalón, includes lesions that can be mistaken for a benign giant cell tumor (BGCT) because N. Ruscalleda, S. Pedraza; Girona/ES ([email protected]) of its histologic similarity or its location in long bones extremities (chondroblastoma, giant cell reparative granuloma, cherubism, brown tumor of hyperparathyroidism and Learning Objectives: To illustrate and evaluate the diagnostic value of a novel intraosseus nodular synovitis). The other group consists of lesions that also contain technique using whole body diffusion-weighted image (WBDWI) for patients with giant multinucleated cells but are histopathologically very different from BGCT diffuse bone pathology. (osteosarcoma, osteoblastoma, osteoid osteoma, fi brous dysplasia, condromixoid Background: Whole body MR imaging has evolved as a potential technique to fi broma, cemento-ossifying fi broma, aneurysmal bone cyst, fi brous histiocytoma, evaluate the entire body. Whole body MRI can be applied not only in oncology, but eosinophilic granuloma and Paget disease) also other non-oncologic applications can be performed such as diffuse benign Conclusion: The radiologist’s role is essential to diagnose and treat osseus tumours disease. Recently, a diffusion-weighted MR technique has been developed with that contain osteoclast-like giant cells, because it allows differentiation between them PET-like image contrast to evaluate the whole body in a short time acquisition. and informs about its biologic potential. Periostic reaction, borders, soft tissue mass Procedure Details: The WBDWI technique was performed on SE-EPI sequence and calcifi ed matrix are the best radiological features that are helpful in differential 2 (b=600 s/mm ) in the axial plane, fi ve stations from the head to the calf. High-resolution diagnosis. Location and patient age are the best clinical clues. multi-planar reformat and MIP were performed from the data set to display the whole body coronal image with PET-like image contrast. Coronal-sagittal STIR and FSE T1 of the whole body were also acquired. We compare and illustrate in the exhibit C-578 the WB-MRI and bone scintigraphy fi ndings for bone metastases, spondylodiscitis, Interobserver reliability of a CT classifi cation system in the calcaneus fracture myeloma and diffuse benign pathology from our series of 68 patients between October P. Jiménez Villares1, F. Ruiz Santiago2, A. Peralta Silva1; 1Cádiz/ES, 2005 and September 2006. WBDWI technique showed all the bone lesions, including 2Granada/ES ([email protected]) the affected ribs, except for the osteoblastic lesions. WBDWI demonstrated all the Purpose: This study was designed to determine the interobserver reliability of a extra-skeletal lesions: liver, lung and lymph node metastases calcaneus fracture classifi cation scheme. For a fracture classifi cation to be use- Conclusion: Whole body MR imaging with the addition of a diffusion-weighted ful, it must provide prognostic signifi cance and intraobserver reproducibility. Most sequence of the entire body is an effective method to evaluate patients with sus- studies have found reliability and reproducibility to be poor for fracture classifi ca- pected diffuse bone disease. WBDWI is a helpful technique for whole body MR tion schemes. imaging with additional information on non-bone related lesions. Methods and Materials: Eighty-nine cases were selected that had an appropriate study of CT image from a trauma hospital center. Two radiologists from the mus- C-576 culoeskeletar department reviewed all these studies. On each viewing, observers Quantifi cation of skeletal involvement in Gaucher disease: MRI, 99mTc- were asked to classify the fractures according to both the Sanders and Crosby- sestamibi scintigraphy or bone densitometry Fitzgibbons and Zwipp systems. Interobserver reliability and reproducibility were S. Ortori, V. Zampa, M. Perri, S. Spallanzani, P. Erba, G. Mariani, C. Bartolozzi; assessed with computer-generated kappa statistics. Pisa/IT ([email protected]) Results: Sander classifi cation: The mean kappa value for interobserver reliability for fracture types I-IV was 0.852. Crosby classifi cation: The mean kappa value for Purpose: MRI, radionuclide imaging and bone densitometry have been used for interobserver reliability for fracture types was 0.903. Zwipp classifi cation: The mean quantifying skeletal involvement in patients with Gaucher disease (GD). In this kappa value for interobserver reliability for fracture types I-VI was 0.833. Duparc study, we compared different quantitative/semiquantitative methods for assessing
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7 0 0 2 . 2 451 0.05), 0.05), 0 . < < 2 112.02.2007 17:04:07 G rmed. Patients with Patients rmed. nding associated with a ([email protected])
C 0.05) and soft tissue abscess (13/20 < ([email protected]) ([email protected])
BDEF Athens/GR ne typical patterns for each location. ne typical patterns for brous dysplasia, sclerosing osteomyelitis, brous dysplasia, sclerosing osteomyelitis, A Strasbourg/FR Gray-scale and Color Doppler Sonography (CDUS) (CDUS) Doppler Sonography and Color Gray-scale A search in our database was performed to identify all performed A search in our database was uid with extraarticular extension (11/20 vs 3/18, p extension uid with extraarticular 1. Describe the variety of diseases that shows diffuse bone Describe of diseases that shows the variety 1. ndings. Additionally most cases underwent image guided image guided Additionally most cases underwent ndings. rmed infection: juxtacortical fl uid (17/20 vs 4/18, p juxtacortical fl rmed infection: Diffuse bone sclerosis can be caused by vascular, neoplastic, neoplastic, vascular, Diffuse bone sclerosis can be caused by Diffuse bone sclerosis is a radiographic fi Diffuse bone sclerosis is a radiographic Diffuse bone sclerosis can be the manifestation of several dis- several of Diffuse bone sclerosis can be the manifestation Ultrasonography can be of help in detecting reactivation of bone can be of help in detecting reactivation Ultrasonography Recognition of typical imaging patterns a more in most bones allows ([email protected])
We aim at describing the ultrasonographic appearance of reactivated of reactivated appearance aim at describing the ultrasonographic We To analyze imaging features of osteoid osteoma in a large series of osteoid of cases imaging features analyze To Based on the fi nal diagnosis, 20 patients had bone/implant infection had bone/implant infection 20 patients nal diagnosis, Based on the fi A total of 158 osteoid osteomas were included in our analysis. Distribution Distribution included in our analysis. A total of 158 osteoid osteomas were vs 9/18). Sinus tracts extending to bone cortex were seen in all patients with bone to bone cortex were extending tracts Sinus vs 9/18). CDUS revealed infection. in none of the patients without (20/20), but implant infection within periosteum/ bone cortexow in 19/20 patients and resistance arteriallow fl whereas respectively, infection around the metallic implant in 4/20 patients with bone patient without infection. detected in any no Doppler signal was Conclusion: implants. and metallic osteomyelitis with posttraumatic in patients infection myriad of clinical and pathological entities, usually with a systemic involvement, usually with a systemic involvement, myriad of clinical and pathological entities, Engelmann- osteopetrosis, disease, Erdheim-Chester’s renal osteodistrofy, like: fi disease, Paget’s disease, Camurati’s of The imaging features metabolic and metastatic disease. disease, Gaucher’s in the diagnosis of these diseases. lesions are of particularskeletal relevance Details: Procedure In our pharmacologicalcongenital, metabolic, and miscellaneous mechanisms. the clinical and this etiological systematization, reviewing follow presentation, we and emphasizing the utility diagnosis, the differential for relevant imaging features imaging techniques. and indication of different Conclusion: lesions of these various of the imaging features Awareness eases or conditions. sclerosis. 2. Identify the most common imaging features of these lesions. 3. Discuss 3. of these lesions. Identify the most common imaging features 2. sclerosis. ndings. fi the importance clinical and radiologic of differentiating Background: Purpose: C-583 A pictorial review Diffuse bone sclerosis: Caseiro-Alves; F. Marques, C. Rodrigues, H. Canelas, A. Brito, J. Graca, B. Coimbra/PT Learning Objectives: C-581 in patients with bone infection of reactivated evaluation Ultrasonographic orthopedic devices Baltas, C. Kelekis, A. Kontopoulou, C. Papakonstantinou, O. Balanika, A. Gouliamos; A. Kelekis, N. Brountzos, E. in patients with metal implants. osteomyelitis post-traumatic Methods and Materials: of reactivated in 38 patients with a clinical suspicion performed perspectively were Affected after orthopedicbone infection surgery and induction of metallic implants. (10 patients), knee (6 patients), and hip femur areas included tibia (9 patients), tract; and sinus included soft tissue abscess evaluated Parameters (13 patients). of pseudocapsule distension uid; juxtacortical intaarticular, and extraarticular fl established was nal diagnosis The fi cortical/periostealand peri-implant vascularity. and cytologic examination. on aspiration Results: not confi was whereas in 18 patients bone/implant involvement ndings compared to fi more frequently the following exhibited bone infection active patients without confi increased intaarticular fl pseudocapsule distension (16/20 vs 5/18, p C-582 skeletal parts patterns in various imaging Typical Osteoid osteoma: Gangi; A. Buy, X. Moser, T. Purpose: and to defi the whole skeleton involving Methods and Materials: based on typical Diagnosis of osteoid osteoma was cases of osteoid osteomas. clinical and imaging fi in our department biopsy results and long termablation follow-up and therefore in our analysis when at least CT scan included Cases were also accessible. were distribu- precised the exact we each case, For review. for available images were epiphyseal, and within the bone both longitudinally (e.g. tion within the skeleton, cortical, subperiosteal). cancellous, (e.g. and transversally diaphyseal) metaphyseal, location. each ned for A typical imaging pattern defi was Results: (63 upper limb (21 cases), spine (21 cases), femur as follows: was in the skeleton able were We limb (25 cases). cases), tibia (28 cases), and remaining of the lower ne at least one typical imaging pattern in all major bones. to defi Conclusion: dent diagnosis of osteoid osteoma with CT scan. confi ve les cation ) and all fi 5 -L 3 uenced perfusion uenced Athens/GR, 1 ; 1 ), lower (L ), lower 2 -L 1 ([email protected]) ([email protected])
0.05) as compared with sex. < 0.05). Multiple regression analysis Multiple regression 0.05). < Scientific and Educational Exhibits Scientific and Educational , L. Moulopoulos , L. 1 Madrid/ES les of healthy adults with dynamic adults with dynamic les of healthy 0.32, p ndings and radiological features are essential features ndings and radiological < r < cation system based on interpretation of a single uence of age, sex and spinal level on contrast profi on contrast and spinal level sex uence of age, , L. Vlachos , L. les of potentially abnormal marrow are assessed. les of potentially abnormal are assessed. marrow 2 We studied 90 healthy adults with d-MRI of the lumbar studied 90 healthy We To describe the radiologic features of vascular bone tumours. bone tumours. of vascular describe features radiologic the To Among a wide sample of vascular bone tumours from our Among a wide sample of vascular 1 2 0.05). Individuals younger than 50 years showed signifi cantly signifi showed than 50 years Individuals younger 0.05). 1 <
, T.G. Maris , T.G. 1 d c imaging features that may simulate malign neoplasms. In addition, malign neoplasms. simulate that may c imaging features d Some vascular lesions of bone are relatively commonly encountered by of bone are relatively lesions Some vascular n Although intraobserver kappa values reached substantial levels and and levels reached substantial kappa values Although intraobserver After interacting with this exhibit, the radiologist will have an enhanced will have the radiologist with this exhibit, After interacting Our results indicate increased perfusion of the upper lumbar spine of Our results indicate increased perfusion of the upper ([email protected]) ([email protected]) i ned CT image was good in all the systems and better in the Crosby all the systems and better in the Crosby good in image was ned CT .
N I ndings of vascular bone tumours with radiologic-pathologic with bone tumours ndings of vascular To investigate the infl investigate To F Perfusion of the upper lumbar spine was signifi cantly higher compared to signifi of the upper lumbar spine was Perfusion - c u ) vertebrae and wash-in and wash-out rates, time to maximum slope and time to maximum rates, wash-out and ) vertebrae and wash-in d 5 E i -L c 1 S Iraklion/GR - younger adults compared to older ones for both spinal levels. Sex infl Sex both spinal levels. for adults compared to older ones younger Conclusion: in spinal perfusion is of such differences Knowledge in the upper lumbar spine only. important profi when contrast spine. ROIs were placed on each lumbar vertebral body, and mean signal intensity and mean signal intensity placed on each lumbar vertebral body, were ROIs spine. upper (L for generated to time (SIT) curves were of lumbar bone marrow of healthy adults obtained with d-MRI. of healthy of lumbar bone marrow Methods and Materials: revealed age as the most signifi cant factor (p cant factor age as the most signifi revealed Purpose: (L Learning Objectives: To of these lesions. features understand the pathologic basis of the radiologic To highlight that anatomopathological fi to reach a correct diagnosis. Background: can present with dif- Patients pathologists. are uncommonly seen by but radiologists, as clearly benign, others symptoms and signs and while some tumours manifest ferent non-specifi have benign and malign lesions. between sometimes pathology cannot easily differentiate Findings: Imaging pathologic and radiologic database, the most representative examples have been have examples the most representative database, pathologic and radiologic Each and pathological characteristics. their main radiological selected to illustrate benign or tumour has been described groups: of the two and assigned to one been chosen from vari- diagnostic images have The most illustrative malignant. CT and MR) and their subsequent X-ray, ous imaging techniques (in particular, are: been reviewed The benign tumours that have anatomopathological images. The ma- disease. tumor and Gorham’s glomus hemangioma, cystic angiomatosis, hemangioendotelioma, ephitheloid are: been analyzed lignant tumours that have hemangioendothelioma and angiosarcoma. Conclusion: understanding of vascular bone tumors, including the histopathologic and radiologic including the histopathologic and radiologic bone tumors, understanding of vascular Both diagnostic tools are crucialto allow to distinguish these lesions and features. their proper management. Imaging fi Imaging correlation Manjon Luengo, Ortiz P. de Mendívil Arrate, A. Irujo, Navallas Ibáñez Sanz, M. L. Montes Moreno; S. Tello, Martínez F. C-580 2 scheme. The results indicate that in a carefully controlled paradigm, the interob- indicate that in a carefully controlled paradigm, The results scheme. server reliability with a classifi carefully defi C-579 contrast profi Spinal bone marrow (d-MRI) contrast-enhanced MRI Savvopoulou V. classifi cation. cation. classifi the Crosby-Fitzgibbons system generally showed greater agreement, we were were we agreement, greater showed generally system the Crosby-Fitzgibbons interobserver reliability with either classifi excellent to demonstrate unable classifi cation: The mean kappa value for interobserver reliability for fracture types fracture interobserver for reliability for kappa value The mean cation: classifi 0.63. I-V was Conclusion: time to peak values were obtained. Patient population was stratifi ed into men and ed into men and stratifi population was Patient obtained. were time to peak values compared among and SIT curves were or older than 50 years, younger women to investigate performed analysis of data was Multiple regression these subgroups. and sex. of age the effect Results: (p level the lower demon- Women both spinal levels. higher perfusion compared to older ones for age in the cantly increased perfusion compared to men of the same signifi strated a moderate time to peak showed except All parameters upper lumbar spine only. linear correlation with age (0.22 C - 7 0 R C EECR07-C-SciEduc-FIN.indd 121 Scientific and Educational Exhibits
may improve the likelihood of obtaining the correct diagnosis and appropriate tumor infi ltration. patient management. Methods and Materials: Fifty-four patients with clinically suspected bone marrow pathology underwent both conventional and DW MR imaging of the spine with ADC maps generation and quantitative ADC analysis. Of these, 15 suffered from C-584 multiple myeloma, 14 had a known primary tumor, 2 suffered from lymphoma and Myeloma staging with the aid of whole-body unenhanced low-dose 23 presented with acute back pain without medical history. MDCT (WBLD-MDCT) and correlation with haematological parameters: Results: In patients with multiple myeloma, quantitative analysis was able to Preliminary results differentiate between active disease (mean ADC 0.62) and response to therapy M. Horger, J. Fritz, M. Vogel, H. Brodoefel, P. Pereira, C.D. Claussen; (1.25). In 4 patients without medical history, the evaluation of the ADC maps led Tuebingen/DE ([email protected]) to an investigation for a primary tumor. In 10 patients with a known primary tumor, Purpose: We aimed at establishing the role of WBLD-MDCT in the assessment of the ADC fi ndings were attributed to metastases (mean ADC 0.61), while in 4 of medullary, extramedullary and osteolytic lesions in multiple myeloma (MM) patients them an osteoporotic fracture was found (1.65). In 10 patients out of 54, quantita- referred for primary evaluation. tive analysis added critical information that changed the therapeutic strategy. ADC Methods and Materials: Fifty consecutive patients with untreated stage I (nI = values were not signifi cantly lower in tumor infi ltration (0.62±0.21) than in normal 11), II (nII = 10) and III (nIII = 29) MM underwent WBLD-MDCT for staging. The bone marrow (0.77±0.35). number and size of osteolysis, as well as number, size and density of medullary and Conclusion: DWI with ADC calculation, a method that studies bone marrow pathol- extramedullary myeloma involvement, were assessed and related to established ogy on the basis of altered water-proton mobility, has been proved to be a useful hematologic prognostic parameters. tool (in adjunction to the other available conventional sequences) for differentiat- Results: Medullary lesions were found in 2/11 (18%) stage I, 6/10 (60%) stage II ing between benign and malignant processes of the spine, and may increase the and 20/29 (69%) stage III myeloma patients. Patients with medullary lesions had diagnostic potential of MR imaging in the assessment of spinal lesions. higher levels of IgA (median, 4730 mg/dl vs. 1520 mg/dl), Bence-Jones protein- uria (median, 690 mg/dl vs. 214 mg/dl) and IgG paraprotein (median, 3270 mg/dl C-587 vs. 2610 mg/dl) compared to patients without medullary lesions. In patients with The skeletal manifestations of sickle cell anaemia medullary infi ltrates, levels of serum ß2-microglobulin were signifi cantly higher than U. Shaikh, R. Yaddavali, S. Kumar, H. Aniq; Liverpool/UK in patients without detectable marrow infi ltrates (median, 4.3 mg/dl vs. 2.4 mg/dl, ([email protected]) p=0.0015). Extramedullary lesions were exclusively found in stage III myeloma. Conclusion: WBLD-MDCT represents a reliable diagnostic tool for the assessment Learning Objectives: To describe the various skeletal presentations of sickle cell of multiple myeloma, allowing not only the detection of typical lytic bone lesions, anaemia, highlighting imaging fi ndings on conventional radiography and on MRI. but also of both medullary and extra-medullary myeloma involvement. Medullary Background: Sickle cell anaemia (SCA) is the most common inherited haemo- involvement was encountered in all stages of the disease, including patients without globinopathy. This haemolytic anaemia is characterized by abnormally shaped red osteolysis, and was associated with signifi cantly elevated levels of ß2-microglobulin, blood cells (RBCs), which are removed from the circulation and destroyed by the a prospective prognostic marker. Therefore, we suggest the inclusion of WBMD-CT reticuloendothelial system, leading to anaemia. However, more signifi cantly, the into the diagnostic workup of MM patients. sickled RBCs cause vascular occlusion, leading to tissue ischaemia and infarc- tion. Patients with SCA are at an increased risk of infection due to abnormalities in host defences and functional asplenia. SCA affects multiple organs, with the C-585 clinical manifestations of SCA being predominantly due to anaemia, vaso-occlu- Whole-body low-dose nonenhanced multidetector computer tomography sion and infection. survey of both osteolysis and medullary involvement in patients with Imaging Findings: The fundamental skeletal abnormalities consist of marrow multiple myeloma referred for therapy response monitoring receiving hyperplasia, which leads to osteopaenia with a coarse trabecular pattern. In bisphosphonates severe cases, medullary cavities are obliterated giving the appearance of general- M. Horger, H. Brodoefel, M. Vogel, J. Fritz, B. Denecke, C.D. Claussen; ized increased bone density. Bone infarction secondary to vaso-occlusion is the Tuebingen/DE ([email protected]) hallmark of SCA. In adults, it affects the ends of long bones, the central portions Purpose: The goal of this study was to establish the role of direct assessment of vertebral bodies with typical ‘H’ shaped vertebrae and the femoral and humeral of medullary involvement by myeloma using whole-body low-dose multidetector heads, resulting in avascular necrosis. In older children, the diaphyses of long bones computer tomography (WBLD-MDCT) compared with the sole interpretation of are the site of predilection. Areas of bone necrosis are susceptible to superadded the course of lytic bone lesions or even together with established hematological infection, especially from salmonella. parameters in patients receiving long-term bisposphonates. Conclusion: Radiologists play a pivotal role in the clinical management of these Methods and Materials: Between June 2002 and December 2005, WBLD-MD CT patients and they should familiarize themselves with the various skeletal manifesta- scans using a standardized protocol were obtained in 131 consecutive patients with tions and complications of sickle cell anaemia, which we present in this pictorial MM, resulting in a total of 439 investigations. Osteolysis, as well focal, or diffuse review. medullary lesions were registered. The results were then and at follow-up related to current laboratory tests. Validation was achieved by combined reading of both C-588 hematologic and radiologic parameters at follow-up in analogy to standard therapy Determination of bone mineral density in children and adolescents on response criteria of the Eastern Cooperative Oncology Group. images containing initial clarifi cation of a fracture after adequate trauma Results: The course of osteolysis showed little agreement with that of medullary A. Malich1, A. Ulrich1, J. Feger1, J. Boettcher2; 1Nordhausen/DE, lesions when PD, R-PR or R-CR were present. Thus, a progress of osteolysis was 2Jena/DE ([email protected]) observed by WBLD-MDCT in only 21/101 (21%) of examinations with validated PD, although in 91/101 WBLD-MDCT was capable to visualize disease progres- Purpose: To verify the bone mineral density in children and adolescents having sion by progress of medullary involvement. In 1/2 patients presenting with R-CR, fractures of the forearm and hand compared to children and adolescents without osteolysis showed no changes at the given time point, while of 39 patients with a fracture after similar adequate traumatic injuries. R-PR, progress of osteolysis was noted in 4 (10.3 %). Methods and Materials: 100 X-ray examinations of the hand or forearm proving Conclusion: Evaluation of the course of medullary lesions at follow-up was es- a fracture of children and adolescents after adequate trauma underwent a BMD sential, proving to be even more accurate than a combined evaluation of laboratory calculation using digital radiogrammetry. All children and adolescents had to fi ll parameters and osteolytic lesions. in a questionnaire regarding potential infl uencing factors of bone mineral density (drug intake, diseases, sportive activity, nutrition). BMD-Z-score calculation used regional normative data of children and adolescents, which were obtained from C-586 images performed to exclude a fracture after adequate trauma. Bone marrow quantitative diffusion MR imaging Results: 80/100 images could be analyzed by DXR technology. 34/80 patients T. Gerukis, M. Tsoukala, A. Fotiadou, S. Koptopoulos, V. Kalpakidis, P. Palladas; with fractures had a Z-score of -1 (20/34 with a Z-score of less than -2SD). Mean Thessaloniki/GR BMD was -0.7 for both males and females. Analysis was possible starting with Purpose: Magnetic Resonance (MR) imaging offers direct visualization of bone 6 years of age. Similar results were obtained for MCI values. Main reasons of marrow composition and distribution. Diffusion Weighted (DW) imaging with cal- BMD loss according to the questionnaire were defi cit of sportive activity and false culation of Apparent Diffusion Coeffi cient (ADC) allows estimation of bone marrow nutritional intake (fast food). Diseases and drug intake were without relevance
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7 0 0 2 eld- 0.55 . ed 2 ± 453 0 . 2 112.02.2007 17:04:08 G 0.65, 3.39 ± 0.52, respectively. 0.52, respectively. ± ([email protected]) 0.60. For delineation For 0.60.
± ed 1024-matrix images cacy of the intra-articular le, together with a literature together with a literature le, 0.67 vs. 2.34 0.67 vs. ([email protected]) ([email protected]) Novara/IT
± 0.47 vs. 2.31 0.47 vs. ± ndings. These were independently These were ndings. C bers of the anterior cruciate ligament Tokyo/JP 0.61 (SD) vs. 2.39 (SD) vs. 0.61 BDEF ± A 0.60, and 3.69 ± cance. cial to the medial collateral ligament (MCL), deep cial to the medial collateral Medical records of 100 consecutive patients who un- Medical records of 100 consecutive ([email protected]) ([email protected])
Sagittal proton-density-weighted and coronal T2*-weight- and coronal Sagittal proton-density-weighted Shoulder magnetic resonance (MR) arthrography depends (MR) arthrography Shoulder magnetic resonance a) Anatomy of the shoulder joint; b) Radiological and MR of the shoulder joint; a) Anatomy 0.55 vs. 2.38 0.55 vs. ± Although the role of glenohumeral MR arthrography is a matter of MR arthrography Although the role of glenohumeral The techniques for multi-modality gadolinium solution injection in the multi-modality The techniques for With the use of 8-channel knee coil, magnifi Antwerp/BE To determine MR accuracy for diagnosing meniscal tears and to discuss determine for MR accuracy To To indicate how powerful the high-resolution MR imaging is by using the high-resolution MR imaging is by powerful indicate how To cacious intra-articular injection. The aim of this exhibit is to compare all is to compare The aim of this exhibit cacious intra-articularinjection. 0.64, 3.06 For delineation of iACL, mean values of qualitative evaluation of the 1024- evaluation of qualitative mean values delineation of iACL, For MR accuracy was 88% for the medial and 85% for the lateral meniscus. Of meniscus. the lateral the medial and 85% for for 88% was MR accuracy ± delineated more detailed structures of the knee than that of 512-matrix. delineated more detailed structures of the knee than that of 512-matrix. injection, which may be guided by palpation or imaging, and performed anteriorly palpation or imaging, and performed be guided by injection, which may or posteriorly depending on the clinical indications. Details: Procedure palpation; C1: of intra-articular access: Techniques c) of the shoulder joint. anatomy d) computed tomography); C3c: uoroscopy; fl C2b: ultrasound; imaging (C2a: C2: E) Case gallery. Limitations and tips; Conclusion: teaching fi in a practical shoulder joint are reviewed and a complete tips and tricks, techniques, indications, provides The exhibit review. each technique. case gallery for Purpose: MR and arthroscopy. causes of discrepancy between various Methods and Materials: retrospectively MR and arthroscopyderwent of the knee at our institution were patients Twenty-three prior patients underwent meniscal surgery. Twelve reviewed. MR and surgical fi had 27 discrepancies between fashion. blinded in a double radiologists musculoskeletal additional two by reviewed interpretation Original categorized as either unavoidable, incorrect diagnoses were meniscal tear. for error or equivocal Results: equivocal 10 (37%) were unavoidable, 12 (44%) were 27 incorrect MR diagnoses, Learning Objectives: on an effi each step. examining techniques by of the available Background: of choice examination it is becoming increasingly apparent that it is the debate, the of the rotator cuffs, the undersurface complex, the capsulolabral evaluating for Cap- shoulders. the rotator cuff interval, and postoperative ligaments, glenohumeral improving to distinguish individual structures by it possible sular distension makes the intra-articular separating material, contrast physically and soft tissue contrast material of contrast in and around an analysis of the distribution thus allowing depends on the effi Shoulder MR athrography the joint. knee coil using 8-channel by 1024-matrix view Sakamoto; T. Moriya, S. Sato, Niitsu, J. M. Purpose: 3.59 were dMCL, pMM, and aLM, the values of FP, as superior structures, the 1024-matrix rated to images were all the evaluated For 512-matrix, with statistical signifi Conclusion: C-593 of menisci of the knee evaluation in the MR imaging of errors Analysis Dyck; Van P. Musculoskeletal Musculoskeletal Joints C-591 anterior and palpation - and imaging-guided for tips and tricks Techniques, MR arthrography posterior injections in shoulder Carriero; A. Stecco, A. Fornara, P. Volpe, N. Volpe, D. C-592 Magnifi examination: in routine of the knee High-resolution MR imaging 8-channel coil in delineation of individual fi plane (FP) superfi fascial (iACL), of the MCL (dMCL), posterior root of the medial meniscus (pMM), and anterior layer meniscus (aLM). root of the lateral Methods and Materials: ed MR images with 1024×1024 matrix, 3 and 150 mm section-thickness, mm fi using a dedicated 8-channel knee coil on a 1.5 by obtained T scanner. were of-view comparison, 512-matrix also obtained with identical sequences. For images were paired images with 1024- and 512- structures, on the above-mentioned Focusing image analysis was Qualitative ed in a same scale on viewers. matrix magnifi were signed-rank Wilcoxon and 4, excellent, 1, poor; scale: using a four-point performed evaluated. A total of 42 cases were used. test was Results: 512-matrix 3.52 were matrix images vs. vs. 2.14 vs. ndings 26 0.05 chi- squared). < cance lms and MR imaging will be cit of BMD during growth. cit of BMD duringgrowth. ([email protected]) ([email protected])
Scientific and Educational Exhibits Scientific and Educational location of tumors make ndings or unusual 20.1[S.D.]) presenting with a suspected bone presenting with 20.1[S.D.]) ± London/UK signifi uid- diagnostic A retrospective analysis was performed in 2658 patients performed analysis was A retrospective ([email protected]) ([email protected])
To review the radiographic appearances in various cartilagi- in various appearances radiographic the review To The cases presented include enchondroma, enchondroma The cases presented 3 2 1
d ed, but can be expected from the defi can be expected ed, but d Cartilaginous tumor is the most common bone tumor in the hand. Cartilaginousthe most common bone tumor in the hand. tumor is Suwon/KR n All FFLs showed non-specifi cally high/low signal on T2/STIR. A sig- T2/STIR. signal on cally high/low non-specifi All FFLs showed Bone mineralization in childhood and adolescence is disturbed in a sig- in childhood and adolescence Bone mineralization i Examples of each entity as seen as plain fi . N I To describe the diagnostic relevance of relative signal intensity of the of relative describe relevance the diagnostic To F 207/2658 (7.8%) cases had FFLs and of these 148 had images available had images available 207/2658 (7.8%) cases had FFLs and of these 148 - c uid levels in bone neoplasms: Relative signal intensity of the in bone neoplasms: uid levels u d E i c cant number of children due to wrong nutritional intake and lack of sportive activity. of sportive activity. and lack of children due to wrong nutritional intake cant number S - presented. Differential diagnosis in patients with chondroid tumors will be discussed. patients with chondroid tumors will be discussed. diagnosis in Differential presented. tumour over an 8-year period. All underwent MRI and diagnosis by biopsy/surgical MRI and diagnosis by All underwent period. an 8-year tumour over The patients ndings. resection or on the basis of clinical/characteristic imaging fi (absent/present) and histology (benign/ divided according to presence of FFLs were signal intensity the relative sub-categorised Cases with FFLs were by malignant). T2W/STIR T1W and on or low/high as high/low layer of the superior-to-inferior imaging, respectively. Results: All tumours showed review. for T2W/STIR sequences available 133 had review. for benign and 42/133 (35.6%) 91/133 (64.4%) were signal on this sequence. high/low malignant. were 5/41 (12.2%) signal. low/high 41 showed review. for T1W available 67 patients had benign (p were malignant tumours and 36/41 (87.8%) were Osteosarcomas, malignant tumours (9 11/26 (42.3%) were signal. high/low showed 1 Malignant Fibrosis Histocytoma, 1 Pleomorphic 15/26 (57.7%) were Sarcoma) and 3 Giant benign tumours (7 Aneurysmal bone Cysts (ABC), 3 Chondroblastomas, 1 Lipoma, 1 Fibrosis Dysplasia). Tumours, Cell Conclusion: T1W compared signal on cant proportion low/high of benign tumours showed nifi occured in both benign T1W imaging signal on high/low Conversely, to malignant. and malignant diseases most frequently in ABC and osteosarcomas. superior and inferior layer of fl layer superior and inferior Purpose: of bone tumours on MRI. in FFLs found layer superior to inferior Methods and Materials: mean age 43.6 years (1057 females, Fluid/fl C-590 F. Alyas, A. Saifuddin, D. Connell; Connell; Saifuddin, D. A. Alyas, F. C-589 fi imaging Plain radiographic and MR in the hand: Cartilaginous tumors chondroma, extraskeletal disease, intracorticalprotuberans, chondroma, Ollier’s chondrosarcoma. osteochondroma with chondrosarcoma, and synovial Conclusion: nous tumors occurringthe hand. in Background: fi imaging unusual occasionally However, these cartilaginouscult to diagnose tumors. it diffi Details: Procedure in our population. Conclusion: nifi on peak bone mass Effects during growth. even rate, This causes a higher fracture verifi are not yet Y. An, J. Kim; Kim; An, J. Y. Learning Objectives: C - 7 0 R C EECR07-C-SciEduc-FIN.indd 123 Scientific and Educational Exhibits
and 5 (19%) were interpretation errors. Of the 67 medial meniscal tears, 12 (18%) debate, the main controversy being whether MRI or MR arthrography is the best were missed. Eight (67%) of these 12 were categorized as equivocal, including 3 means of answering diagnostic questions. Published data and clinical experience postoperative menisci. Of the 30 lateral tears, 12 (40%) were missed, 7 (58%) of show that conventional MRI is effective in assessing full-thickness lesions, but less which were categorized as unavoidable. Of these 12, 11 (92%) showed fraying of capable of differentiating partial lesions and normal fi ndings after surgery. the inner edge, which led to minimal resection (n=7) or had minimal tear treated Procedure Details: A number of factors may decrease the accuracy of MRI in evalu- conservatively (n=4). There were 3 false-positive diagnoses, all occuring in the ating post-operative shoulders, including iatrogenic artefacts, surgical distortions of lateral meniscus, 2 of which were unavoidable and 1was an interpretation error. native anatomy, changes in the signal intensity of tissues, and image degradation Conclusion: Of all missed lateral meniscal tears, most are unavoidable and related caused by metallic artefacts. We show the key points for optimizing post-operative to confusion between what represents fraying and what represents a tear. Unavoid- shoulder MRI protocols and try to identify the best technical parameter among the able false-positive diagnoses are infrequent and may be related to incomplete most widely used pulse sequences. arthroscopic evaluation. Subtle equivocal fi ndings still make MR diagnosis diffi cult, Conclusion: When interpreting post-operative shoulder MR images, radiologists even for experienced radiologists. must be familiar with all possible pitfalls in order to avoid diagnostic errors. C-594 C-597 Imaging variants of the knee: A pictorial review Dynamic gadolinium-enhanced MR imaging in characterization of growth A. Snoeckx, F.M.H.M. Vanhoenacker, J.L. Gielen, P. Van Dyck, P.M. Parizel; cartilage perfusion with epiphyseal vascular occlusion Antwerp/BE ([email protected]) X. Li, L. Xia, H. Zheng; Wuhan/CN ([email protected])
Learning Objectives: To illustrate the anatomical variants encountered during Purpose: To determine the contribution of metaphyseal vascularity to epiphyseal imaging examinations of the knee, with emphasis on magnetic resonance imaging and physeal perfusion with epiphyseal vascular occlusion by using dynamic Gd- and clinically important variants. enhanced MR imaging. Background: Magnetic resonance imaging has become the imaging modality of Methods and Materials: Twelve 2-week-old piglets were randomly assigned into choice for evaluation of internal derangement of the knee. Normal variants are either control or abduction group (12 proximal femurs in each group of 6 piglets). often an incidental fi nding on these examinations. Proximal femoral epiphyseal vascular occlusion was induced by maximal bilateral Imaging Findings: 1092 MR examinations of the knee, performed during the hip abduction for 2 hours. Dynamic Gd-enhanced MR imaging was performed in period May 2005-August 2006, were reviewed for normal variants. The frequency normal and abduction hips. For dynamic Gd-enhanced imaging, spoiled gradient- was 23.4%. Variants may affect different anatomical structures, such as plicae, recalled echo images with a temporal resolution of 3.0s were performed, and a tendons, ligaments, muscles and menisci. Of clinical importance are those variants total of 96 images were obtained. The enhancement ratios (ER) in various regions that may become symptomatic or are prone to pathology and normal variants that of femoral heads were evaluated and correlated with histological fi ndings. may simulate disease. The commonest variants are mediopatellar and suprapatellar Results: In normal hips, we found no signifi cant differences in the ER and the timing plicae, which are found in 13.3% of patients. Other variants encountered during of enhancement between physeal cartilage and metaphyseal spongiosa (P> 0.1). review of the MR studies include various amounts of red bone marrow in the distal However, in abduction hips, the ER of physeal cartilage was lower than that of femur and proximal tibia, multipartite patella that may become symptomatic, variants metaphyseal spongiosa and enhanced more slowly than metaphyseal spongiosa of patellar shape and position, accessory gastrocnemius muscles, discoid menisci, (P < 0.05). Meanwhile, the ER of epiphyseal cartilage remained lower and enhanced osseous pseudolesions such as dorsal patellar defect, cortical "avulsive" irregularity more slowly than physeal cartilage (P < 0.001). The ER of physeal and epiphyseal and a number of ligamentous variants that may simulate meniscal tears. cartilage in abduction was lower and enhanced more slowly than those in the normal Conclusion: 1. Normal variants of the knee are not such an uncommon fi nding. (P < 0.001). More transphyseal vessels in abduction were found histologically than 2. Familiarity with variants and its possible pathologic nature is mandatory for an those in the normal (P < 0.005). accurate interpretation. Conclusion: With epiphyseal vascular occlusion, enhancement seems to advance from the metaphysis into the physis and epiphysis, the metaphyseal vascularity might contribute to epiphyseal and physeal perfusion. This research is supported C-595 by NSFC (30370430). Total hip replacement imaging F.S.R. Thevenin, R. Campagna, A. Feydy, H. Guerini, J.-L. Drapé, D. Richarme, A. Chevrot; Paris/FR ([email protected]) C-598 Imaging the complications of total hip replacement Learning Objectives: Evaluate the imaging contribution in total hip replacement J.M. Moriarty, J. Kerr, C. Shortt, J. O’Byrne, S. Eustace; Dublin/IE (THR) management. Background: Digital or plain fi lm imaging permits the diagnosis of a majority of THR Learning Objectives: The objectives of this exhibit are to describe the anatomic complications. CT scan and MRI, usually less useful, are becoming better adapted basis behind the complications of total hip replacement, the radiologic features due to the performance of the latest machines and specialized software. that describe these complications and the new innovations in diagnostic imaging Imaging Findings: Main local complications are acute, consisting of implant of these features. fractures, joint dislocation and neighbouring bone fatigue fracture. Chronic com- Background: Of the 600,000 total hip replacements performed worldwide each plications include soft tissue new bone formation, periarticular tendonitis, bursitis, year, it is estimated that 5% fail at some stage. The type of surgical approach used, recurent dislocation and, above all, device loosening without infection due to prosthesis inserted and method of fi xation employed all have a role in the prevalence granulomatous reaction or with intercurrent infection. In case of recurrent disloca- and form of complication that can ensue. The role of radiography, arthrography, CT, tion, X-ray or CT scan can be used to evaluate the actual position of the devices and MRI in the diagnosis of these complications is rapidly evolving, particularly the and the possible wear. use of metal artefact reduction techniques in MRI. Conclusion: Hip replacement surgery has been one of the most common elective Imaging Findings: This exhibit presents a pictorial review of components, methods and semi-elective orthopedic operations for the past 25 years. Radiography remains of fi xation and complications of total hip replacement. The exhibit reviews the role the mainstay of imaging evaluation of hip replacements. The various types of hip of radiography, scintigraphy, computed tomography, ultrasound, arthrography and replacements can be recognized on radiographs, and many complications have MRI in the assessment of common complications including loosening, infection, specifi c appearances that the radiologist should be familiar with. heterotrophic bone formation, muscular avulsions, and prosthesis impingement. Furthermore, a detailed review of the use of MRI with artefact reduction techniques in the evaluation of deep seated infection, iliopsoas bursitis and abductor avulsion C-596 will be presented. Pitfalls in post-surgical shoulder MRI evaluations Conclusion: The diverse imaging modalities that may be employed in the evaluation P. Pastore, D. Volpe, N. Volpe, F. Murgante, A. Stecco, A. Carriero; Novara/IT of the myriad complications of total hip replacement is being constantly updated, ([email protected]) re-evaluated and added to. In particular, the increasing sensitivity of certain MRI Learning Objectives: To describe and recognize magnetic resonance imaging sequences in the setting of metallic prostheses has led to the routine use of MRI (MRI) fi ndings that can be confused with pathological abnormalities in post-op- as a problem solving tool. erative shoulder; to maximize the accuracy of MRI imaging by providing the most appropriate pulse sequences. Background: Imaging post-operative shoulders has always been a matter of
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1 455 0 . 2 112.02.2007 17:04:08 G Novara/IT , N. Ravazzolo , N. 1 lls the articular space ([email protected]) ([email protected])
, A. Tomei , A. 1 C Latina/IT 2 BDEF , D. Flecca , D. 1 A Rome/IT, Rome/IT, 1 ; 2 Forty patients with shoulder dislocation-translation Forty patients with shoulder dislocation-translation ed, corresponding to the center of the different density ed, corresponding to the center of the different We studied using US 100 wrist joints (50 healthy persons), using US 100 wrist studied joints (50 healthy We , A. Francioso , A. virtual arthroscopy may be useful in diagnostic accuracy, virtual be useful in diagnostic accuracy, arthroscopy may 2
Our intent is to correlate virtual arthroscopy images with MR arthrographic sequences (SE T1w and GRE T1 FAT SAT) SAT) T1 T1w and GRE FAT MR arthrographic sequences (SE Shoulder MR arthrography (MRA) is now a well-assessed technique a well-assessed (MRA) is now Shoulder MR arthrography Virtual technique that has the potential to arthroscopy is a new gallery an image means of virtual and to show by ndings, arthroscopic With its direct multiplanar imaging capabilities, excellent soft tissue soft tissue excellent imaging capabilities, With its direct multiplanar Shoulder , F. Giovagnorio , F. cial linear US transducer of high resolution (10 MHz). We measured We of high resolution (10 MHz). linear US transducer cial Chios/GR 1 , M. D’erme , M. 1 The ultrasound (US) study of scapho-lunate ligament and scapho- (US) study The ultrasound To assess the value of virtual assess the value arthroscopy of the shoulder. To MDCT arthrography diagnosed 20 Bankart MDCT arthrography 5 Bankart lesions, osseous uoroscopic control, administering 20 cc of room air. The data were down- The data were uoroscopic control, administering 20 cc of room air. nds its way between the rotator cuff (RC) and the gleno-humeral ligaments. In ligaments. gleno-humeral the rotator cuff (RC) and the between nds its way both as an adjunct to clinical and surgical planning, as well as an interactive tool as an interactive as well both as an adjunct to clinical and surgical planning, learning arthroscopicfor and pathology. anatomy assessment of a cartilageassessment Electric MRI General used Signa we repair procedure, with cartilage-sensitive coronal and sagittal planes T with axial, Horizon LX 1.5 density- spin-echo/proton fast T2-weighted such as fat-suppressed sequences, the of plugs, the number evaluated We sequences. echo gradient or 3D weighted cartilage congruence of the and bone, the adjacent hyaline to integration graft donor site as of the graft the status adjacent bone marrow, the articular surface, complications. as associated well Conclusion: non-invasive for resolution, MRI could be the method of choice and spatial contrast mosaicplasty. of patients after follow-up Purpose: Methods and Materials: and 64 slices MDCT arthrography and/or clinical signs of instability underwent virtual using 64-detector row performed All scans were arthroscopic reconstruction. 0.6 mm; thickness 40 mA; 200 Kv; parameters: helical CT scanners with following preparation matrix x 512; 512 mm; reconstruction 0.6 increment collimation 0.6; in supine positions with examined The patients were and acquisition time 10 min. intra-articular posteriorly, performed injection was position; the shoulder in neutral without fl loaded to a workstation and virtual arthroscopy using a PC-based 3D performed producing for rendering employed algorithm was A surface reconstruction program. renderingvirtual algorithm, Prior a to applying the surface arthroscopic images. specifi was threshold value models then were Surface and soft tissue. (the brightest tissue pixel) bony between an imaginary light source employing calculated and displayed Results: Virtual ar- lesions and 2 SLAP lesions. 15 Hill-Sachs 5 cuff-rotator tears, lesions, a further it provides all lesions above-mentioned; detected and visualized throscopy orthopaedic of shoulder joint which is useful for surgeons planning point of view in the teaching of also serve as a simulation it may arthroscopyor arthrotomy; orthopaedic trainees. Conclusion: of CT arthrography. enhance the diagnostic performance M. Martinelli M. Purpose: lunate distance. Methods and Materials: with a superfi C-604 virtual CT in shoulder instability arthroscopy 64 slices multidetector Fanelli G.P. C-605 by Study The scapho-lunate joint and the scapho-lunate ligament: ultrasonography Giannopoulos, T. Kastania, M. Setakis, G. Foteinos, A. Michaelides, A.R. Chalkias; S. C-603 Image gallery Shoulder virtual in glenohumeral instability: arthroscopy correlation with arthroscopy Carriero; A. Stecco, A. Fornara, P. Masiello, N. Volpe, N. Volpe, D. medium solution, which fi based on the injection of contrast and fi pathology or partial case of gleno-labral use an additional sequence we RC tears, obtaining virtualthat allows the MR to complete arthroscopy post-processed views of shoulder pathology. evaluation Details: Procedure T Signa and the supplemental sequence is a 3D Spoiled with a GE 0.5 are provided Virtual means of arthroscopy by is performed T1w positioned in coronal plane. GE loaded on a work-station. a dedicated software Conclusion: ([email protected]) ([email protected]) Learning Objectives: arthroscopic fi images of main shoulder pathologies. Background: gura- nding guration guration Basle/CH Seoul/KR 0.0001]. The talar radius was larger was The talar radius 0.0001]. cant difference in talar height. cant difference < Scientific and Educational Exhibits Scientific and Educational on ndings of anterior cruciate ligament (ACL) ndings are of importance, that ankle showing nding of ACL was seen in 9 of 138 knees (6.5%). Cor- seen in 9 of 138 knees (6.5%). was nding of ACL coronal MR images and oblique on sagittal nding of ACL One hundred thirty-eight of the knee in MR images Fifty-two patients [18 males, 34 females, 39 (16-66) years] 39 (16-66) years] 34 females, patients [18 males, Fifty-two ([email protected]) To illustrate the appearance and outcome of the articular and outcome of the appearance illustrate To
5 There were 22 patients with focal chondral lesion (19 of the lesion (19 chondral focal 22 patients with There were brous scar in 2 C-P-C and one I-P-C. 2 1
0.0001]. There was no signifi There was 0.0001]. d < d Articular cartilage damage is extremely common in today’s society. Os- society. Articular cartilage common in today’s damage is extremely n A larger radius of the talus and a smaller tibio-talar sector contrib- A larger radius A discordant fi i . Toledo/ES N I Some patients suffer from recurrent ankle sprains even after operative after operative even from recurrent ankle sprains Some patients suffer To analyze the discordant fi analyze To F A discordant MR fi The tibio-talar sector was smaller in patients with instability [80.0° (72-95°)] The tibio-talar sector was - c u d E i c S - instability may depend not only on competence of collateral ligaments but also on ligaments but depend not only on competence of collateral instability may guration. osseous joint confi in patients with instability [21.2 (17-26 mm [18.6 in the control group mm)] than mm (13-26 mm), p Conclusion: These fi ute to osseous instability. was the following: C-P-P in 3, P-I-I in 2, C-I-I in one, C-P-C in 2, and I-P-C in one C-P-C in 2, and C-P-P in 3, P-I-I in 2, C-I-I in one, the following: was with partly total rupture of ant-med bundle post-lat bundle intact At arthroscopy, case. tissue in intercondylar notch and fat by displaced ACL observed in 3 C-P-P; was adhesion in 2 ligamentum mucosum torn course by deformed meniscal fragment, fi P-I-I and one C-I-I; Conclusion: displaced course, to remained post-lat bundle, not frequent, and attributed was Interpertation coronal image seems more on oblique of ACL and presence of scar. than on sagittal images. accurate relation of ACL status on sagittal, oblique coronal images with arthroscopic status on sagittal, oblique fi relation of ACL Learning Objectives: knee and 3 of the ankle) treated with mosaicplasty. Clinical examination, X-ray X-ray Clinical examination, knee and 3 of the ankle) treated with mosaicplasty. The mosaicplasties surgery. on each patient before performed and MRI were normallywere autologous bone from the done with arthoscopic and transferred the for After the surgery, donor site to the recipient site into the cartilage defect. cartilage autologous osteo- patology with multiple after treatment of osteochondral plugs (mosaicplasty) using magnetic resonance imaging (MRI). chondral Background: is a surgical technique that is being used increasingly autotransplantation teochondral With more defect. or osteochondral chondral in the treatment of symptomatic focal such mosaicplasty, defects, surgical procedures being used to repair chondral new these procedures. to evaluate radiologists there is an increasing demand for Details: Procedure C-602 of articular cartilage evaluation after resonance imaging Magnetic grafting autologous osteochondral Calvo, P. Céspedes, M. Herrero, Y. Fernández-Zapardiel, S. Herrera, I. Fandiño; E. C-601 instability ankle Osseous criteria for Ledermann; Hintermann, H. B. Frigg, Magerkurth, A. O. Purpose: joint confi One reason could be a disadvantageous ligament reconstruction. of the ankle joint that could determine stability. Methods and Material: than in the control group [88.1° (74-111°), p than in the control group who suffered at least three occurrences of ankle sprains were included in the study. in the study. included were least three occurrences of ankle sprains at who suffered admitted to our emergency department 100 patients, consisted of The control group In the control 41 (16-96 years)]. 37 females, [63 males, sprain ankle pain without for osteoarthritis (43 fracture, excluded or luxation were patients with a previous group, osteoarthritis, fracture, due to outer force, sprain with instability, Patients patients). (17 surgery excluded tendon dysfunction were and prevoius deformity, hindfoot used A DICOM application was included. were Only strictly views lateral patients). and sector. the talar height, radius to evaluate Results: Purpose: and correlate with arthroscopic of the knee, coronal MR images sagittal and oblique ndings as the standard. fi Methods and Materials: of the osseous confi those parameters purposeThe to evaluate was tion. Discordant interpretation of ACL on sagittal and oblique coronal MR coronal oblique and on sagittal of ACL interpretation Discordant correlation with arthroscopic Analysis images: Chung; E. Hur, S. Kwag, Hong, H. H. Chung, H. Lee, M. internalpatients with suspected underwent who subsequently derangement of clinical details, unaware radiologists, Two arthroscopic surgery included. were images initially and proton density-weighted T2, on sagittal ACL jointly evaluated as intact determined the status of ACL Reviewers coronal images. then on oblique status When interpretation of ACL (I), partialor complete tear (C) respectively. (P), as discordant categorized cases were both imaging planes, between different was and correlated with arthroscopic results. Results: C-599 C - 7 0 R C EECR07-C-SciEduc-FIN.indd 125 Scientific and Educational Exhibits
the distance between the scaphoid and lunate bones in (a) neutral position, (b) C-608 radial deviation, (c) ulnar deviation; and characterized the visualization of the Direct and indirect MR arthrography: Advantages and disadvantages scapho-lunate ligament in the palmar and dorsal surfaces. The visualization of T.A.A. Macedo1, L.P. Souza2, L. Farage2; 1São Paulo/BR, 2Uberlândia/BR the scapho-lunate ligament was characterized as completely visualized, partially ([email protected]) visualized and non-visualized. Results: The scapho-lunate distance was measured between 2.0 mm and 6.6 mm, Learning Objectives: To demonstrate the pros and cons of direct and indirect with a mean diameter of 4.5 mm. The difference in this distance between left and magnetic resonance arthrography (MRA). right arm did not exceed 2.4 mm. There was no signifi cant change in the scapho- Background: Direct MRA (dMRA) with injection of gadolinium (Gd) diluted in saline lunate distance during ulnar and radial deviation. The scapho-lunate ligament was solution can be useful for evaluating certain pathologic conditions in the joints. It is completely visualized in 52/100 cases, and partially visualized in 23/100 cases, most helpful in the shoulder; especially for outlining labral-ligamentous abnormalities all being studied dorsally. The scapho-lunate ligament was better visualized by and distinguishing partial-thickness from full-thickness tears in the rotator cuff; but ultrasound in the dorsal surface compared to the palmar one. it can be also useful in other joints, demonstrating labral tears in the hip, showing Conclusion: The scapho-lunate ligament is partially or completely visualized tears of the collateral ligament of the elbow, identifying residual or recurrent tears in 75% of wrist joints studied and this fi nding could help exclude scapho-lunate in the knee following meniscectomy, and assessing the stability of osteochondral dislocation or subluxation. lesions in the articular surface of joints. Indirect MRA (iMRA) can be done when dMRA is inconvenient, or not logistically feasible. In this case, the MR images are C-606 acquired after an intravenous administration of Gd-contrast media. Between April 2005 and August 2006, we performed 29 dMRA and 44 iMRA in our institution. Imaging patellar complications after knee arthroplasty Procedure Details: The direct arthrographies were perfomed using fl uoroscopy P. Melloni, R. Valls, M. Veintemillas, S. Pérez, I. Delgado, M. Prieto; Sabadell/ES and ultrasound guidance and about 12-15 ml Gd-diluted solution was injected in the Learning Objectives: To illustrate and describe complications affecting the patella shoulder. Indirect MRA was done after 10 ml (0.5 mmol/mL) intravenous injection in patients with total or partial knee arthroplasty. of Gd-contrast media (Dotaren®,Guerbet Laboratories). All the examinations were Background: We retrospectively reviewed 937 consecutive patients treated with performed in patients with rotator cuff, labral or SLAP lesions. total or partial knee arthroplasty in the last two years; 34 (1.42%) patients (22 Conclusion: Although iMRA is unable to fi ll the joint cavity, it does not require direct women and 12 men) presented patellar complications. Mean patient age was 74 Gd-contrast media injection and it is superior to conventional MR imaging when years (range: 59-90 years). All underwent plain-fi lm radiography periodically. In there is minimal joint fl uid. In addition, intravenous injection allows demonstrating determinate cases according to the clinical symptoms, patients underwent US. vascularized or infl amed tissue. Imaging Findings: The most common patellar complications after total or partial knee arthroplasty were: fracture (n=9), instability (n=13), dislocation or luxation C-609 (n=4), osteonecrosis (n=5), infection (n=2), erosion (n=2), impingement on the Evaluation of anterior cruciate ligament (ACL) autografts and allografts prosthesis (n=3), patellar or quadriceps tendon tear (n=3), and loosening or rupture with magnetic resonance imaging (MRI) of the patellar prosthetic button (n=5). The mean interval from total knee replacement I. Tsifountoudis, I. Kalaitzoglou, A. Haritandi, I. Economou, A.S. Dimitriadis; to patellar complication was 5 years and 7 months (range: 5 months-14 years). Thessaloniki/GR ([email protected]) Conclusion: Patellar complications following knee arthroplasties are generally uncommon but often of potential clinical signifi cance. Plain fi lms are essential Learning Objectives: Arthroscopic reconstruction of ACL is being performed for the evaluation of patellar complications after surgery and should be the initial with increasing frequency. Although the procedure is performed with good suc- imaging study performed. Careful attention to initial prosthesis placement and cess rates, early and late complications have been documented. Our purpose is comparison of follow-up images will allow subtle abnormalities to be detected in to demonstrate the normal appearance of the reconstructed ACL with MRI and to patellar complications. US may have a special role in the evaluation of soft-tissue illustrate the diagnostic pitfalls and the postoperative complications. structures around the patella. Background: Sixty-fi ve patients (58 males and 7 females; age range: 17-59) who had undergone ACL reconstruction using either autografts or allografts were C-607 referred to knee MRI (1.5 T) for ACL graft control, between July 2004 and Sep- tember 2006. The imaging protocol included T1-weighted, proton density-weighted Superfi cial cartilage defects of medial femoral condyle: Diagnosis with fat- and T2-weighted fast spin-echo images and STIR images in all planes. If the graft suppressed three-dimensional spoiled gradient-echo MR imaging was not optimally visualized, oblique sagittal T2-weighted images were obtained S. Lee, W.-H. Jee, Y.-S. Kim, J.-M. Kim; Seoul/KR ([email protected]) along the course of the graft. Finally, gadolinium was administered intravenously Purpose: Fat-suppressed three-dimensional (3D) spoiled gradient-echo (SPGR) in 7 cases. MR imaging has been described to be accurate for detecting 50% or greater car- Imaging Findings: Intact graft was depicted in 37 patients with continuous, tilage defects. The purpose of this study was to determine the accuracy of sagittal homogeneous and low signal intensity. Signs of roof impingement were found in fat-suppressed 3D SPGR imaging for detecting superfi cial cartilage defects of the 10 patients. The graft fi bers were absent due to rupture in 18 cases. Localized medial femoral condyle. arthrofi brosis (Cyclops lesion) was detected in 8 patients. Postoperative infection Methods and Materials: Fifty patients who had arthroscopically confi rmed carti- was diagnosed in 3 patients, migration of the interference screws in 3 cases and lage defects by an arthroscopist and had MR imaging were included in this study. cystic degeneration of the graft was depicted in 2 patients. Thickening of the har- Sagittal fat-suppressed 3D SPGR MR images were retrospectively reviewed by a vested patellar tendon was seen in 3 patients and "regeneration" of the hamstring radiologist. Cartilage thickness was graded: Grade 0, normal; grade 1, abnormal tendons in 18 patients. signal without a contour defect; grade 2, less than 50% reduction of cartilage Conclusion: The knowledge of the normal MR appearance of ACL grafts and the thickness; grade 3, 50% or greater reduction of cartilage thickness; and grade 4, recognition of their complications are crucial for the appropriate management of full-thickness cartilage defect. symptomatic patients. Results: After arthroscopy, there were 68 cartilage defects in the medial femoral condyles: grade 2 (n = 21), grade 3 (n = 37), and grade 4 (n = 10). After fat-sup- C-610 pressed 3D SPGR imaging, cartilage defects in the medial femoral condyles were Magnetic resonance imaging in chronic ulnar-sided wrist pain: Pictorial review graded as follows: grade 2 (n = 26), grade 3 (n = 33), and grade 4 (n = 9). Sensitiv- J.S. Sawhney, A. Bajaj, R. Bhatt, K. Jeyapalan; Leicester/UK ity, specifi city, and accuracy for grade 2 cartilage defects were 90% (19/21), 85% ([email protected]) (40/47), and 87% (59/68), respectively. Cartilage grading showed a signifi cant correlation between fat-suppressed 3D SPGR imaging and arthroscopy (r =.80, Purpose: Chronic ulnar-sided wrist pain management can be intimidating and P <. 001, Spearman's correlation). confusing because of its vague and intermittent nature, complex anatomy and Conclusion: Sagittal fat-suppressed 3D SPGR MR imaging is accurate for diag- pathology and frustration that it induces in the patient and the doctor. This picto- nosing superfi cial cartilage defects. Thus, it is helpful for planning treatment that rial review attempts to present a spectrum of cases illustrating the anatomy and could be different between early and advanced cartilage defects. pathologies of this complex region as seen on MRI. Methods and Materials: MRI was done for 71 patients over a period of 3 years with chronic pain on ulnar side of wrist. 1.5 T scanner was used. Sequences used were T1 axial and coronal, PD Fat Sat axial and coronal, T2 sagittal and STIR sagittal. The abnormalities are categorised into osseous (bony and degenerative),
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2 lms and 112.02.2007 17:04:09 G ed according to Barcelona/ES Chiba/JP ([email protected]) ([email protected]) C BDEF exion-extension at the same rhythm as a the same rhythm at exion-extension ndings by arthroscopy. arthroscopy. ndings by A ed in 50% of the patients (meniscopathy, femoro- ed in 50% of the patients (meniscopathy, Forty-nine symptomatic patients (52 hips) underwent Forty-nine (52 hips) underwent symptomatic patients In this prospective study, we performed a WB-MR per- a performed we study, In this prospective To describe the technique and illustrate a wide range of describe a wide range the technique and illustrate To Double or triple compartment Double under is performed arthrography ne the role of the Whole-Body MR (WB-MR) in the assessment ne the role of the ndings Traumatic injuries of the wrist are extremely common. They can result They common. injuries of the wrist are extremely Traumatic The WB-MR is a new useful imaging technique for the estadifi useful imaging technique for WB-MR is a new The 4D arthrography of the AL applying motion-gated MSCT can reveal of the AL applying motion-gated MSCT can reveal 4D arthrography The hemophilic artropathy (HA) is a progressive osteoarticularThe hemophilic artropathy (HA) is a progressive disease To analyze the kinesis and morphology labrum analyze (AL) of the acetabular To In one third of the patients, the WB-MR detected HA in other joints not WB-MR detected HA in other joints the In one third of the patients, Of 46 hips with adequate images, 15, 11, and 20 revealed stabilized, stabilized, 15, 11, and 20 revealed Of 46 hips with adequate images, ([email protected]) ([email protected]) Purpose: The aim of presumed to result from intra-articular and periarticular hemorrhage. this study is to defi of the HA. and follow-up of joint involvement, degree of extension, Methods and Materials: MR protocol included treatment. in 35 patients with HA and prophylactic formed The coils. planes using several T1-SE, STIR, and GRE-T2 in the coronal and axial of the important (shoulders, joints 1) involvement were: evaluated parameters (muscular involvement ankles), 2) bone or muscle-tendinous knees, hips, elbows, haematoma, pseudotumor), and 3) other osteoarticular muscular lesions atrophy, classifi of HE were and degree The extension not related to HA. the European Score. Results: One third hemosiderin deposits or early artropathy. as synovitis, detected clinically, of the patients with clinical history of hemarthrosis articular of repetition did not show pathologies Other musculoskeletal MR. or hemosiderin deposits by involvement identifi not related to HA were brous defects), fi necrosis, avascular impingement, labrum disease, acetabular diagnoses. being important differential in order to stablish Conclusion: of the response to the prophilaxis the evaluation It allows of HA. and follow-up diagnosis with the differential for It is also helpful and treatment of the disease. intercurrent osteoarticular pathologies. abnormalities involving ligaments, cartilage, ligaments, and bone. abnormalities involving Background: imaging Different pain and incapability when neglected or left undiagnosed. in severe the assessment of the wrist joint, but extensive been proposed for techniques have has been only poorlyinterest of MDCT arthrography underlined. Details: Procedure mgI/ml iodixanol ml of 270 4 uoroscopic guidance with injection of an average fl on a 64 detec- is performed MDCT arthrography Amersham Health). (Visipaque, C-615 optimisation and Technique of the traumatic wrist: MDCT arthrography spectrum of fi Strasbourg/FR Gangi; A. Buy, Dosch, X. J.-C. Moser, T. Learning Objectives: C-613 labrum applying of the acetabular arthrography Utility of four-dimensional Comparison with computed tomography: motion-gated multislice and Harris hip score arthroscopy Komuro; I. Moriya, H. Harada, Y. Kishida, S. Funabashi, N. Purpose: motion-gated with (4D) arthrography applied four-dimensional we non-invasively, results with arthoscopyMSCT and compared the Harris and hip score (HHS). Methods and Materials: The hip joint. injected into the material CT acquisition, contrast was Before MSCT. reciprocating hip fl subject performed that is ECG-gating, mimic retrospective performed Then we pulsation simulator. into 10 reconstructed and were "motion-gated", acquisition to divide one movement on 4D fi and morphologyThe kinematics evaluated of AL were segments. and eccentric irregular, stabilized, ed into three groups: classifi ndings were the fi ed classifi were lesions Labral in 34 hips. performed Hip arthroscopy was motion. and detached). tear, (intact, fray, according to morphologic groups features into four also calculated depend upon patient state at the examination. HHS was Results: AL on ar- 16 without adhesive Of and eccentric motion, respectively. irregular, and 4 had eccentric 48 HHS) motion (average 6 had irregular (average throscopy, 58 HHS) and HHS tend to be higher in the eccentric than in the irregular group on 4D CT. groups Conclusion: both kinetic and morphological further changes of AL and can perform stratifi of Orthopaedicin subjects with the American Academy Surgeons class 0, or 1 or without "detached" morphological fi C-614 of and follow-up MR in the assesment of extension Impact of whole-body hemophilic artropathy Pineda; V. Merino, Gispert, X. Altisent, S. Domínguez, C. R.
rmed ndings as
Nagasaki/JP 2 Vigo/ES ndings in the patellar ten- guration type III of Wiberg type III of guration Tokushima/JP, Tokushima/JP, 1 ; 2 brocartilage and {tear (9) complex Scientific and Educational Exhibits Scientific and Educational cation of changes in patients with patellar cation of changes in patients , M. Uetani , M. 2 cant difference was seen statistically in the was cant difference Infl ammation and erosions (3) related to Rheumatoid ammation and erosions Infl
ammatory and miscellaneous. neurologic We evaluated 44 patellofemoral joints (43 patients) with 44 patellofemoral evaluated We group includes Ganglia (4) and Neuroma (1). No abnor- Ganglia (4) and Neuroma (1). includes group
, T. Yamaguchi , T. 1) To describe the MR imaging fi To 1) 1 processes such as entrapment of the ulnar nerve in Guyon’s of the ulnar nerve in Guyon’s processes such as entrapment 7
Retrospective review of MR images in 51 knees (48 patients) of MR images in 51 knees (48 patients) review Retrospective 2 1
d d Patellar tendon-lateral femoral condyle friction syndrome is a rare femoral tendon-lateral Patellar This preliminary study indicated that high-resolution MR imaging n MRI extends the possibilities of evaluating chronic ulnar wrist pain. wrist chronic ulnar pain. the possibilities of evaluating MRI extends MR imaging allows identifi MR imaging allows i . N I MR imaging using a microscopy coil provides high-resolution images, high-resolution images, coil provides MR imaging using a microscopy , H. Nishitani , H. F In 528 parts using a microscopy of cartilage, of MR grading accuracy Fracture non-unions of the hook of Hamate (1), ulnar styloid process (1), ulnar styloid process (1), the hook of Hamate (1), non-unions of Fracture midcarpal (triquetrohamate) articulation joint {insta- (2), distal radioulnar 1 -
cance lies in the non-invasive examination of various intraosseous as well as well intraosseous of various examination lies in the non-invasive cance c u d E i c S ndings - bility (4) and synovitis (2)}. Ulnar impaction syndrome (7). Ligamentous injuries Ligamentous Ulnar impaction syndrome (7). (2)}. bility (4) and synovitis fi Triangular TFCC, included Scapholunate (6). degeneration (3)}. Tendinopathies and tensosynovitis noted in E4-E6 compartment and tensosynovitis Tendinopathies (3)}. degeneration (5), FCU (1) and Diffuse (3). mality was found in 13 patients. found mality was Conclusion: Its signifi as soft tissue abnormalities. ([email protected]) ([email protected]) Purpose: purposeThe early which can be useful in demonstrating cartilage abnormalities. of patellofemoral in evaluation its diagnostic accuracy of this study is to evaluate joint cartilage abnormalities. Methods and Materials: im- T2-weighted coil; knee coil and a microscopy MR imaging using a conventional respectively. acquired images were proton-density-weighted ages and fat-saturated Retropatellar cartilage cartilage divided into 9 parts was and femoral into 3 parts, where the status of cartilage into 0 (normal) injury). graded to 4 (full thickness was using surgical or arthroscopic analyzed was fi The diagnostic accuracy ssures cial fi soft indentation and/or superfi cial lesions, cartilage lesion (superfi coil and in 3 with a correct in 9 with a microscopy were grading MR and cracks), no signifi However, coil. conventional of both techniques. accuracy Conclusion: coil could be useful in detecting early cartilageusing a microscopy abnormalities. cant result. Further study is required to obtain a statistically signifi a standard of reference. Results: when grade 0.924 and 0.915, respectively, knee coil were coil and a conventional when grade and 0.990 and 0.994, respectively, considered to be positive, 1-4 was In 31 parts surgically confi with grade-1 considered to be positive. 2-4 was with antero-lateral knee pain and a focal area of abnormal signal intensity in the knee pain and a focal with antero-lateral with a Patients performed. joint was aspect of the patellofemoral inferolateral as the these facts to exclude meniscal tear or ligamentous injury retrieved were in 28 knees. Abnormal demonstrated patellar alignment was cause of knee pain. confi Patellar noted in 8 cases. tendinitis was Patellar don-lateral femoral condyle friction syndrome. 2) To consider the patellar tendon- To 2) condyle friction syndrome. femoral don-lateral diagnosis of patients condyle friction syndrome in the differential femoral lateral condyle femoral identify the patellar tendon-lateral To 3) with anterior knee pain. treatment. a correct friction syndrome in order to make Background: pad impingement. cause of anterior knee pain related to the clinical entity of fat the soft tissue edema in the showing identify this entity, MR imaging can reliable joint. aspect of the patellofemoral body in the anterolateral fat infrapatellar Findings: Imaging in 22 knees. found was Conclusion: ([email protected]) ([email protected]) Learning Objectives: C-612 imaging MR syndrome: friction condyle tendon-lateral femoral Patellar fi A. Iglesias Castañón, M. Arias González, J. Mañas Uxó, M. Saborido Ávila, Mañas Uxó, M. Arias González, J. Iglesias Castañón, M. A. Villaravitz; Herreros M. Leon Alonso, J. Rodríguez Álvarez, M. C-611 joint cartilage of patellofemoral imaging at high-resolution MR Evaluation MR imaging Comparison with conventional coil: using a microscopy Takao S. Results: processes at pisotriquetral Degenerative (2). (1), Lunate AVN Hamate contusion joint (4), ligamentous, tendinous, infl tendinous, ligamentous, canal (1). Miscellaneous canal (1). disease. Neurologic disease. tendon-lateral femoral condyle friction syndrome that should be distinguished from femoral tendon-lateral other causes of anterior knee pain. or lateral C - 7 0 R C EECR07-C-SciEduc-FIN.indd 127 Scientific and Educational Exhibits
tor rows scanner (Aquilion 64, Toshiba Medical Systems) using 100 kV, 100 mAs, Musculoskeletal 0.5 mm collimation and 0.2 mm reconstruction interval. Images are reformatted in transversal, coronal, and sagittal planes and analyzed on a workstation (Vitrea, Soft Tissue Vital Images). Exquisite depiction of bone, articular cartilage, and ligaments allows detection of subtle traumatic lesions. Conclusion: MDCT arthrography is a versatile modality for assessment of the C-616 traumatic wrist. Assessment of sodium homeostasis in skeletal muscles with 23Na MRI M.-A. Weber1, F. Lehmann-Horn2, S. Nielles-Vallespin3, M. Essig1, K. Jurkat-Rott2, H.U. Kauczor1; 1Heidelberg/DE, 2Ulm/DE, 3Erlangen/DE ([email protected])
Learning Objectives: To learn about the possibilities of sodium (23Na) MRI for visualization and quantifi cation of skeletal muscle sodium content based on a series of 20 healthy volunteers and 73 patients with various myopathies, especially muscular channelopathies. Technique and examination protocol are presented and clinical indications are discussed. Background: Functional imaging might increase the role of imaging in muscular dis- eases, since sole assessment of muscle morphology reveals non-disease-specifi c results. Intact sodium homeostasis is crucial for tissue viability. Pathological changes of sodium homeostasis can be found in various clinical diseases, such as infarc- tion, infl ammation, neoplasia, and muscular channelopathies. The implemented three-dimensional radial 23Na MRI technique detected validly the tissue’s sodium content. The acquisition time of 10 minutes and direct reconstruction of images and archiving them in PACS enabled a clinically feasible examination protocol. Imaging Findings: 23Na MRI delivers reproducible data on sodium content within skeletal muscles. In various sodium channelopathies, 23Na MRI detects intracellular sodium accumulation that is associated with muscle weakness and stiffness. Also, the benefi cial effects of blocking the pathologic sodium channels by a dedicated medication can be quantifi ed. Results of 23Na MRI in vivo correlate signifi cantly to both electrophysiological in-vitro data of muscle fi bers derived from biopsies and muscle weakness in patients with sodium channelopathies. Furthermore, 23Na MRI detects altered myocellular sodium content in other ion channelopathies and dystrophic myopathies, as well as altered muscular sodium signal in acute autoimmune myositis. Conclusion: 23Na MRI can quantify skeletal muscle sodium homeostasis and is a promising functional imaging method, especially for muscular channelopathies. C-617 The correlation between sonography and disease severity in carpal tunnel syndrome E. Alimoglu, H. Ozcanli, S. Dogan Bayraktar, A. Apaydin, S. Tuzuner, E. Luleci; Antalya/TR ([email protected])
Purpose: To investigate the correlation between sonographic fi ndings and severity of carpal tunnel syndrome (CTS). Methods and Materials: 118 wrists of patients with CTS symptoms were included in our study. After clinical examination and electrodiagnostic study (ENMG), sonogra- phy was performed in patients by a radiologist unaware of the physical examination and ENMG results. The wrists showing both positive clinical fi ndings and ENMG results were diagnosed as CTS. The cross-sectional area of median nerve was measured at the level of the psiforme bone in sonography and the measurements over 10 mm² were accepted in favor of CTS. The disease was categorized into three groups according to ENMG Results: mild, moderate and severe. The differ- ence between the mean sonographic area values of the three severity groups was investigated to estimate disease severity. Results: Fifty-four wrists had positive clinical examination and ENMG results. The mean area was 14.9±5.7 in these cases. The median nerve area was measured under 10 mm² in 7 cases. The sensitivity of sonography in the diagnosis of CTS was 87%. The mean area of the median nerves was 11.1±3.4 mm², 14.4±4.5 mm², and 19.2±5.9 mm² in mild, moderate and severe groups, respectively, and the difference between them was statistically signifi cant (p=0.000, Kruskal-Wallis analysis). Conclusion: The diagnostic usefulness of sonography in CTS has been clearly shown previously. However, little attention has been paid to the correlation between sonographic fi ndings and severity of disease. In addition to its high sensitivity in the diagnosis of CTS, sonography may also be helpful in estimating disease severity. C-618 Can we use the MRI signal of aggressive fi bromatosis to predict its behavior? G. Castellazzi, D. Vanel, S. Bonvalot, C. Le Péchoux, R.C. Sigal, H. Caillet, A. Le Cesne; Villejuif/FR
Purpose: Aggressive fi bromatosis is an invasive non-metastasing soft-tissue tumor. Until recently, the standard treatment combined surgery and radiation therapy, but new studies report that conservative strategies could be the best management.
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7 0 0 2 . 2 459 0 . 2 112.02.2007 17:04:09 G Cagliari/IT cial musculature; musculature; cial ; 1 , E. Carreño , E. ed from the pathology database ed from the pathology 1 ([email protected]) ([email protected])
C BDEF , R. Mast , R. 1 ndings of eleven patients. ndings of eleven A Durham, NC/US 2 , J. Narváez , J. 2 To analyze the mathematical concept to obtain VR images VR images the mathematical concept to obtain analyze To Hibernoma is a rare benign soft-tissue tumour of brown fat fat Hibernoma benign soft-tissue tumour of brown is a rare To give a comprehensive accurate guide of US, CT and MRI guide of US, accurate a comprehensive give To ndings described diagnosis should lead to consider this rare We studied 12 patients by using a multi-detector-row CT CT using a multi-detector-row studied 12 patients by We The lesions illustrated are identifi ed with relative ease on ed with relative identifi are The lesions illustrated Patient group consisted of seven females and four males, with males, and four females consisted of seven group Patient ne body musculature and to identify pathological alterations. and to identify pathological alterations. ne body musculature Cases were retrospectively identifi retrospectively Cases were Multi-detector-row CT, by using fast scanning and thin collimation using fast by CT, Multi-detector-row Soft tissue tumours with prevailing fat tissue areas are lipomas, lipo- tissue areas are lipomas, fat Soft tissue tumours with prevailing The knowledge of the pathological and surgical substrate of the lipo- of the pathological and surgical substrate The knowledge The MR fi , S. Martínez , S. MDCT can obtain excellent visualization of the superfi MDCT can obtain excellent 1 ([email protected]) ([email protected])
Hospitalet de Llobregat/ES, Hospitalet de Llobregat/ES, Learning Objectives: describe the MR imaging fi We cells. Background: of symptoms were and duration sex age, Patient tertiaryof two hospitals. referral patients with histologi- MRI of eleven the reviewed retrospectively We recorded. hibernoma. cally proven Findings: Imaging located in the Six lesions were 25-63 years). (range age of 35 years an average intramus- Six of the lesions were in the upper limb. thigh, one in the chest and four The located in the subcutaneous fat. intermuscular were three were and two cular, ned, heterogeneous ndings of a well-defi majority MR fi demonstrated of the cases with prominent thin low to subcutaneous fat, slightly or clearly hypointense mass, on STIR or to suppress fully The lesions failed W SE images. T1 signal bands on studies evidenced post-contrast Six of the seven images. T2-weighted fat-saturated cant enhancement within the lesion. signifi Conclusion: mass on MRI. in the assessment of an atypical fatty C-623 of the extremities Radiologic-pathologic correlation in fat tissue tumours Siani; Nunziata, A. A. De Chiara, A.R. Fazioli, F. Catalano, O. Sandomenico, F. Naples/IT Learning Objectives: C-621 techniques rendering using volume by CT of the muscles Multi-detector-row Mallarini; G. Ribuffo, D. Corrias, F. Atzeni, M. Caddeo, G. Saba, L. Learning Objectives: learn as to be used, as well the CT technical parameter To ne the muscles. to defi understand the current indications To increment, mAs and kVs. the slice thickness, underlining study of the muscles CT radiation multi-detector-row performing for cacy effi cost and diagnostic exposure, Background: Moreover, image detail. producing an excellent voxels, can obtain near-isotropic im- to obtain volumetric procedures it is possible with the use of post-processing With the use of images). visual impact (dissection-like ages with an impressive Rendering (VR) reconstruction, Volume using in particular by correct techniques, to defi it is possible to obtain a cor- it is possible is to describe how exhibit The aim of this education that rendered images volume and to show muscles rect visualization of the body to obtain. are possible Details: Procedure Rendered Volume obtained we re-processed and Data obtained were (MDCT). VR reconstructed images in order multiple generated each patient, we For Images. types of muscles. different to evaluate ne the better strategies to defi Conclusion: C-622 patients in eleven the MRI imaging Review Hibernoma: de Albert M. 1 with types of soft tissue lipomatous tumours of the extremity, ndings in various fi pathologic correlations during and after surgery. Background: is the second most common Liposarcoma hibernomablastoma, and liposarcoma. Its histological subtypes are categorised as: type of soft tissue sarcoma (10-35%). type. allomorphic myxoid, and mixed dedifferentiated, differentiated, well Details: Procedure can however, Lipomas, CT and MRI, due to the typical density/signal of the fat. In in these cases vigilance is necessary. density/signal areas; small non-fat reveal In the diagnosis. areas that allow one can usually detect fatty malignant lesions, up on which the biopsy is to be directed, are picked areas, the non-fat these cases, on the density/signal intensity in Special attention should be focused with imaging. some particularity Myxoid liposarcomas have such tumour nodules and septation. position, pseudocystic aspect with peripheral enhancement, small as intramuscular or septa containing fat. solid nodules, Conclusion: the diagnostic soft tissues constitutes the base for matous tumours of the extremity optimal patient management. imaging assessment and is fundamental for in particular, it defi nes with accuracy normal anatomy. normalnes with accuracy anatomy. it defi in particular, c am- ndings of mus- cation of skeletal culties and differential culties and differential Heidelberg/DE Scientific and Educational Exhibits Scientific and Educational perfusion based muscle of skeletal cation cation of perfusion is achieved by analyzing by cation of perfusion is achieved per tissue and time unit including capillaryow (fl [email protected]) (fl
cantly to capillarization in biopsies from these muscles. cantly to capillarization in biopsies from these muscles. Between March 1985 and December 2005, 27 patients December 2005, 27 patients March 1985 and Between bromatosis with its behaviour. bromatosis To illustrate the wide spectrum illustrate of causes of subcutaneous To To learn ultra- possibilities of contrast-enhanced about the To 9 Madrid/ES Gas in soft tissue was found associated to traumatic, iatro- associated to traumatic, found Gas in soft tissue was Contrast-enhanced ultrasound delivers reproducible perfusion reproducible delivers ultrasound Contrast-enhanced 2 1
d d Functional imaging might increase the role of imaging in muscular in muscular Functional imaging might increase the role of imaging Gas in soft tissue is a relatively common sign at the emergency room. common sign at the emergency room. Gas in soft tissue is a relatively n Fibromatoses are a group of soft-tissue tumors with variable charac- of soft-tissue tumors with variable Fibromatoses are a group Radiologists must be aware of anomalous gas in soft tissue, because of anomalous gas in soft tissue, be aware Radiologists must i Contrast-enhanced ultrasound allows valid quantifi valid allows ultrasound Contrast-enhanced . N I F Seventy-nine per cent of lesions in the treated group and 82% in the and 82% in the per cent of lesions in the treated group Seventy-nine - c u d E i c c results. Perfusion, i.e. the blood fl the blood i.e. Perfusion, c results. S ow, is an important functional parameter. Pathological changes of skeletal muscle muscle changes of skeletal Pathological is an important functional parameter. ow, - cle perfusion and is a promising functional imaging method for various myopathies. myopathies. various cle perfusion and is a promising functional imaging method for fi nding - is evidenced by MRI. Moreover, the effects of muscle degeneration on degeneration of muscle the effects Moreover, MRI. by nding - is evidenced fi microcirculation can be assessed. Conclusion: replenishment kinetics of the contrast agent. Also, the effects of training schemes of training the effects Also, agent. replenishment kinetics of the contrast groups. muscle separate for microcirculation can be assessed on muscle Findings: Imaging Furthermore, acute CEUS detects increased microcirculation in histologically proven increases as MRI and additionally accuracy with comparable myositis autoimmune edema - as such a non-specifi when a muscle diagnosis of myositis city in specifi room in the emergency clue Diagnostic Gas in soft tissue: Valbuena, E. Gomez-Patiño, J. Parrón, M. Baudraxler, F. Guerra-Gutiérrez, F. Martí de Gracia; M. data in volunteers. CEUS visualizes exercise-induced hyperperfusion and can exercise-induced CEUS visualizes data in volunteers. perfusion CEUS-derived subjects. subjects from un-trained well-trained separate correlate signifi results in vivo C-620 matory myopathies. Contrast-enhanced ultrasound allows for a sensitive detection a sensitive for allows ultrasound Contrast-enhanced matory myopathies. Quantifi in real-time. of microvascularity Learning Objectives: on a series of 35 healthy volunteers and 35 patients with myopathies. Technique Technique and 35 patients with myopathies. volunteers on a series of 35 healthy imaging using CEUS are presented and protocol of microvascular and examination are discussed. clinical indications possible Background: non-disease-spe- morphology since sole assessment of muscle diseases, reveals cifi fl or infl such as degenerative clinical diseases, in various perfusion can be found CT and plain ndings on fi the key show To in the emergency room. emphysema diagnoses. discuss the differential To radiograph. Background: some of them totally benign, importanceIt has a great due to its broad casualty, the imaging fi reviewed retrospectively We others potentially lethal. but ([email protected]) ([email protected]) Learning Objectives: visualization and quantifi sound (CEUS) for from our database of emergency pathol- patients with subcutaneous emphysema analysed the origins and the associated features. We ogy. Findings: Imaging causes (necrotizing fasciitis, injection), or infectious genic (surgical procedures, pathology caus- associated with thoracic found It also was gangrene). Fournier and abdominal pathology related and pneumomediastinum, ing pneumothorax Diagnostic diffi to intraperitoneal and retroperitoneal gas. diagnoses are emphasized. Conclusion: it may be the main or even unique sign to lead us to search the underlying pathol- be the main or even it may which can be lethal. ogy, C-619 with contrast- in skeletal muscles Assessment of microcirculation enhanced ultrasound Delorme; S. Kauczor, Krix, H.-U. M. Weber, M.-A. The aim of this study is to analyze and correlate the size and MR imaging signal the size and correlate study is to analyze The aim of this fi of aggressive features Methods and Materials: Methods and and no surgery therapy or radiation MRI examinations consecutive with at least two of 47 lesions, 107 MRI examinations underwent They recorded. were in between any 18 did not receive medically treated, while the remaining of which 29 were in time and signal changes size studied by Each lesion was drug administration. used the RECIST we size, For sequences. T1-weighted T2-injected and/or on established and then we the signal in six increasing classes, ed classifi We criteria. in the time. the related variations Results: or increase The initial signal of stable stability. maintained size not-treated group stability of signal a high rate There was most frequently high. of lesions was in size changes were The size changes were. signal and size the initial whatever in time, 3 decreases in group, Only in the treated MR signal. not correlated with the initial observed. with signal decrease were associated size Conclusion: from MRI signal. behaviour to predict their it is not possible teristics on MRI, but C - 7 0 R C EECR07-C-SciEduc-FIN.indd 129 Scientific and Educational Exhibits
C-624 a sacral foramen with marginal sclerosis (1 in each group). 7 patients underwent MRI, T2WI showed hyperintense cystic areas and solid areas of mixed intensity. The role of ultrasonography in patients with radial nerve pathology: On CT or MRI contrast-enhanced images, peripheral enhancement was apparent Comparison with magnetic resonance and surgery in 7 of 11 neurilemomas, whereas irregular enhancement was evident in 4 of 5 C. Bertocchi, S. Colopi, R. Adani, P. Torricelli; Modena/IT neurofi bromas. ([email protected]) Conclusion: Both pelvic neurilemomas and neurofi bromas are typically round, Purpose: To evaluate Ultrasonography (US) accuracy in identifying radial nerve (RN) large, well-circumscribed, heterogeneous tumors that are located in the presacral morphology and related pathologies compared to Magnetic Resonance (MR). space. They can occasionally cause bony changes in the sacrum, but do not invade Methods and Materials: Fifteen patients with NR paralysis (6 had expansive and adjacent structures. Centrally massive necrosis or peripheral enhancement favors 9 traumatic pathology) were examined with radiography, electromyography, US the diagnosis of a neurilemoma. (Siemens-Sequoia; linear probe 10-15 MHz) and MR (Philips Intera 1.5 Tesla). Surgical evaluation was performed in 10 patients. US and MR parameters evaluated were: identifi cation, thickness, integrity and structure of the RN. Results: Five patients had a spontaneous recovery of RN paralysis. In the remain- ing 10, US identifi ed correctly RN morphology, thickness, structure and anatomical relationship, compared to surgical evaluation. RM was unable to identify the RN in 5 cases because of the metallic material artefacts. In traumatic and expansive pathologies, mean RN thickness was 4.4 mm and 1.4 mm, respectively; the ecographic structure was ipoechoic with loss of the fascicolated normal pattern in traumatic lesions while normal in expansive ones. Conclusion: US and MR are both useful for the diagnosis of RN pathologies. US is a dynamic, comparative and brief examination, useful when metallic material obstacles are used in MR evaluation. US, therefore, is also useful in planning surgery and in the follow-up. C-625 Radiological fi ndings in giant cell tumor of tendon sheath of the hand R. Guerrero, E. Granell, J. Llauger, D. Martins-Romêo, F. Plancarte, C. García, S. Valverde; Barcelona/ES ([email protected])
Learning Objectives: To describe the radiologic features observed in 26 cases of giant cell tumor of tendon sheath (GCTTS), with special emphasis on the most characteristic fi ndings by MRI. Background: GCTTS is part of a group of benign proliferative lesions of the sinovium of the joint, bursa and tendon sheath. It represents the most common of this group of lesions, both in its localized and its diffuse form. Procedure Details: We studied retrospectively 24 patients with GCTTS localized in hands (23 had a single tumor and the remaining patient had a multifocal involve- ment). Diagnosis was made by means of excisional biopsy. In all cases, plain fi lms and MRI were performed. Size, shape, localization and osseus involvement were analysed, as well as MRI characteristics such as signal intensity and contrast enhancement. Cases of relapse after surgery were also recorded. Regarding MRI, in T1 weighted images all tumors were homogeneous and isointense, but they were more heterogeneous and predominantly hipointense in T2. After intravenous paramagnetic contrast administration, a homogeneous enhancement was demonstrated. In all cases, gradient echo sequences showed very low intensity areas. Surgery was performed in every patient. In 6 of them, local relapse was detected. Conclusion: GCTTS is one of the most frequent soft tissue masses of the hand, second in frequency only to ganglion. We are obliged to suspect it in every case of hand tumor, specially if it is localized in the fi ngers. MRI is useful in the diagnosis due to the characteristic fi ndings of the tumor. C-626 Benign peripheral nerve sheath tumors in the pelvis: CT and MR fi ndings Z. Jiang, W. Peng, T. Yang; Shanghai/CN ([email protected])
Purpose: Benign peripheral nerve sheath tumors (BPNSTs), which include neu- rilemomas and neurofi bromas, arise in the pelvic space are relatively uncommon. The purpose of our study was to characterize the CT and MR fi ndings of pelvic BPNSTs. Methods and Materials: CT and MR images of 16 patients with a pathologically proven pelvic BPNST (11 neurilemomas and 5 neurofi bromas) were retrospectively reviewed. The following morphologic characteristics were evaluated according to tumor shape, size, position, margin, homogeneity and invasion into adjacent structures. When MRI had been performed, signal intensity and the pattern of enhancement were also assessed. Results: All 16 pelvic BPNSTs were round in shape, with well-defi ned margins; the mean diameter was 8.2 cm (4-13 cm); they were usually located in the presacral region (12/16). Tumors were typically heterogeneous with cystic change (11/16), but centrally massive cystic attenuation was more common in neurilemomas than in neurofi bromas (8/11 vs 0/5). In 2 cases, there was smooth expansion of
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7 0 0 2 . 2 461 0 . 2 112.02.2007 17:04:09 exion/exten- G 0.6° and global ±
cant change in local CT cant exion/extension postures were postures were exion/extension Belfast/UK exion/extension movement of the movement exion/extension C BDEF exion/extension mobility of the exion/extension ndings varied widely in both groups. 73% widely in both groups. ndings varied A cant and relevant problem to accurately measure to accurately problem and relevant cant Milan/IT 10 healthy people participated in the experimental setup. people participated setup. 10 healthy in the experimental To recognise the difference in beam hardening artefact, recognise the difference To Steel and titanium pedicle screws were positioned in a "dry were Steel and titanium pedicle screws Steel and titanium metals are commonly used in spinal surgery Steel and titanium metals are commonly used in 3.5°. These data are very good with respect to the traditional methodsThese data are very good with respect to the traditional 3.5°. This biomechanical model estimates well the lumbar fl This biomechanical model estimates well A signifi cant difference was measured between steel and titanium measured between was cant difference A signifi The authors conclude that active participation that active The authors conclude in sports does not have ± cant impact on post-operative CT image quality. The artefact is due to CT image quality. cant impact on post-operative Skin-based measures obtained through optoelectronic system maybe a Skin-based measures obtained through optoelectronic system maybe The prevalence of pathologic fi The prevalence This biomechanical model shows a metameric error of 2.7° This biomechanical model shows cant immediate impact on spine degeneration in adolescents. However, However, in adolescents. degeneration cant immediate impact on spine 1.5 T MRI scanner (Somatom Sonata, Siemens, Germany). Sagittal PD, T1, T2 and T2 T1, Sagittal PD, Germany). Siemens, (Somatom Sonata, T MRI scanner 1.5 evaluated radiologists Two obtained. T2 images were and transverse TIRM images designed checklist. a previously the images using Results: protrusions. by affected of the comparisonof the athletes and 70% were group Decreased 20%). spondylarthrosis27.9% of the athletes showed (non-athletes: athletes in 30.6% of the found TIRM images was signal intensity of vertebral discs on no cases of nerveor spinal compression. root There were 30%). (non-athletes: cant no signifi There were evaluation. statistical used for The chi-square test was concerning disc (protrusions, signs the most common degeneration differences and spondylarthrosis).degeneration Conclusion: a signifi of sports further the long-time effect on the spine, follow-up in order to evaluate studies are necessary. Purpose: soft tissue However, good technique to assess the functionality of the lumbar spine. be a signifi may artifacts (STA) to be considered. had the mobility of the spine and so they Methods and Materials: attached onto the skin in corre- (pills of oil E vitamin) were markers Twenty-four Six static fl points. spondence to vertebral reference Then a fl acquired through a vertical MRI (vMRI). The estimation of the acquired through an optoelectronic system. lumbar spine was of STA position of vertebral with the knowledge Center of Rotation (CoR) together biomechanical of a new the development studies) allowed (obtained from previous validated Finally these data were model to assess the mobility of the lumbar spine. comparing (vertebral the results of the biomechanical model with a gold standard mobility through vMRI). Results: error of 9.1° assessing the lumbar spine mobility with a mean error reduction of about 50%. Conclusion: sion mobility startingfrom 3D kinematic data acquired through an optoelectronic (previously system, some anthropometrical the relations of STA characteristics, be a useful instrumentation to So it may and the CoR (here estimated). found) assess the functionality of the lumbar spine. C-631 model to assess the fl Biomechanical Consideration of soft tissue artifacts lumbar spine: Andreoni, G. Santambrogio, G.C. Ciavarro, G.L. Perona, Curti, F. A. Cornalba; Castellazzi, G. G. C-630 Pictorial essay Multi-slice CT of spinal metal implants: Winder; Archbold, R.J. Elliott, P. Cairns, J.M. H.R. ([email protected]) Learning Objectives: computed spiral on multi-detector and titanium spinal implants, steel produced by on acquisition parameters of data appreciate the effect To (MDCT). tomography reconstruction kernels of 3 different appreciate the effect To of artefact. the degree learn of to reduce the degree how To titanium metal artefact. of on the appearance alteringartefact MDCT scanning and reconstruction by parameters. Background: with signifi The streaking artefact can seriously our ability to visualise detract values. number nerve root irritation, instance, remaining to the implant, for pathology in proximity bone/disc protrusion. Details: Procedure scanned The model was immersed in water. This was bone" lumbar spine model. obtained data sets were Twelve in a Siemens (Erlangen) 16-slice MDCT scanner. (1.5, 0.75, 0.75 head protocol, and 0.6 using combinations of slice thickness mm) Artefact in each data set and reconstruction kernels (smooth, medium and sharp). assessed at the CT workstation and personalised workstation, identical using was le technique. and a line profi CT numbers settings, window Conclusion: that beam-hard- demonstrated The images presented have artefact. pedicle screw ening artefact of slice collimation can be reduced depending on the combination and kernel setting. beam hardening and it appears as streaking with signifi beam hardening and it appears as streaking with in -1 cient rm the sec cations. cations. 2 in osteopo- mm -1 -3 sec ndings that help 2 0.23) x 10 ± 0.47) x 10-3 mm ± ([email protected]) ([email protected]) Scientific and Educational Exhibits Scientific and Educational A total of 51 acute vertebral body compression frac- The lumbar spines of 111 adolescent elite athletes (56m, To illustrate the spectrum of typical imaging fi ndings of ndings of the spectrum illustrate imaging fi of typical To 1 Plain fi lms, CT and MRI with gadolinium injection are useful. gadolinium injection are useful. CT and MRI with lms, Plain fi 3 1
d d Neuropathic arthropathy of the spine is a rare destructive condi- destructive Neuropathic arthropathy of the spine is a rare n Diffusion-weighted MR imaging with quantitative evaluation of ADC evaluation MR imaging with quantitative Diffusion-weighted Background and imaging are suggestive of the diagnosis. Closed of the diagnosis. imaging are suggestive and Background i . N I Degenerative spine abnormalities start developing early in life and are spine abnormalities early in life start Degenerative developing The spine is the most common location of bone metastases in patients F Benign acute vertebral fractures were hypointense and malignant acute and malignant acute hypointense were Benign acute vertebral fractures - c u d E i c S - rotic acute vertebral fractures. These values were signifi cantly different. cantly signifi were These values rotic acute vertebral fractures. Conclusion: the distinction of benign from metastatic vertebral compression allows values and we information, additional valuable It is a procedure that provides fractures. clinical practice. its place in everyday take that it must believe MRI presents no immediate impact on lumbar spine degeneration in non-athletes adolescent elite athletes versus Aikele; P. Laniado, M. Günther, K.-P. Reuter, U. Platzek, I. Hoff, H. Dresden/DE ([email protected]) Purpose: of sports The effects on lumbar degeneration among adolescents. frequent even The aim of this yet. evaluated not been comprehensively in adolescents have in adolescent of spine degeneration to compare the degree study was prospective athletes and non-athletes. Methods and Materials: mean age:15.0 years) and 20 non-athletes (10m, 10f; 15.4 years) mean age: 55f; with a performed was The lumbar spine examination using MRI. examined were C-629 differentiate neuropathic spine from other processes. neuropathic differentiate Conclusion: confi nally biopsies are often necessary open surgical to fi needle and even infection. spine and exclude Charcot’s (ADC) measurements. Methods and Materials: with primary malignancy, and also of benign osteoporotic fractures, especially in the and also of benign osteoporotic fractures, with primary malignancy, imaging Conventional long-termelderly steroid therapy. who receive and in those Those can benign from malignant lesions. differentiate techniques cannot always diffusion coeffi be better distinguished with the addition of tissue-apparent due to in 19 patients were fractures Twenty-eight in 35 patients. found tures were in 16 patients were whereas 23 fractures osteoporosis (due to age or therapy), T1-weighted, Signal intensities on malignancy. to be due to histologically proven compared. images were (STIR) and diffusion-weighted recovery short tau inversion of normal and abnormalADC values calculated. vertebral bodies were Results: with respect to normal on hyperintense bone marrow were vertebral fractures 0.51 ( was Mean ADC value images. diffusion-weighted C-628 and with conventional Spontaneous vertebral fracture - investigation diffusion MR imaging Palladas; P. Kalpakidis, V. Vafeiadis, E. Fotiadou, Tsoukala, A. M. Gerukis, T. Thessaloniki/GR Purpose: However, solid epidural masses are typically lacking. The presence of vertebral masses are typically lacking. solid epidural However, are furtherbody sclerosis and osseous fragmentation imaging fi Learning Objectives: diagnoses such as infectious and to discuss the main differential spine Charcot’s spondylodiscitis. Background: which is secondary proprioceptive tion of the spine, to the loss of the protective diagnosis in case differential be considered as a possible must Infection exes. refl lesions. with destructive spine of a Charcot’s Findings: Imaging the vertebral bodies and the facet the disc space, process involves This destructive junction and lumbar spine are most frequently affected, The thoracolumbar joints. may Sclerosis or osteolysis involved. be and one or more vertebral segments may verte- and the spinal changes are often initially thought to be due to predominate, the beyond typically extend Osseous fragments or metastasis. osteomyelitis bral and the spinal canal. nes of the vertebral body margins into the musculature confi mass containing calcifi result in a paraspinous Bone debris and effusion may Imaging of neuropathic (charcot’s) arthropathy of the spine of the spine arthropathy (charcot’s) of neuropathic Imaging Richarme, D. Thévenin, Campagna, F. Guerini, R. H. Carlier, R. Feydy, A. Paris/FR Chevrot; A. Vallée, C. Drapé, J.-L. Spine C-627 Musculoskeletal Musculoskeletal metastatic acute vertebral fractures and 1.33 ( metastatic acute vertebral fractures C - 7 0 R C EECR07-C-SciEduc-FIN.indd 131 Scientific and Educational Exhibits
C-632 Musculoskeletal Imaging of craniocervical junction injuries A. Leone, A.M. Costantini, M. Cirillo, N. Magarelli, L. Bonomo; Rome/IT Miscellaneous ([email protected])
Learning Objectives: 1) Discuss morphology, diagnosis and treatment of craniocer- C-634 vical junction injuries. 2) Illustrate imaging algorithm for clearing the craniocervical Ultrasound-guided interventional procedures in the foot and ankle junction. 3) Understand how MDCT is the primary imaging technique for evaluation M. Vlychou, J. Teh; Oxford/UK ([email protected]) of trauma in the emergency room. Learning Objectives: This pictorial illustration of ultrasound-guided interventional Background: The upper cervical spine includes the articulations of the occiput procedures of the foot and ankle will review the indications, technique and pos- with atlas and the atlas with the axis, as well as the bony structures of the base sible complications. of the skull, axis, and atlas. The unique anatomy of the upper cervical spine and Background: Foot and ankle pain, both acute and chronic, are common indications the typical mechanisms of injury yield a predictable variety of injury patterns. We for clinical investigation due to degenerative, infl ammatory or osseous pathology reviewed the spine imaging of 77 patients with craniocervical junction injuries from and sport injuries. Ultrasound is an imaging modality that can be applied not only our scientifi c fi les. All patients underwent Radiography and CT examinations. MRI for the detection of the underlying cause of the problem, but also more importantly was performed in 46 patients as a means of therapeutic and diagnostic intervention. Procedure Details: We summarize epidemiology, pertinent anatomy and clas- Procedure Details: An ultrasound machine with high-resolution linear-array trans- sifi cation systems of craniocervical junction injuries as well as the importance ducers (8-15 MHz) probes is essential in imaging the superfi cial structures of the of MDCT for detection and current treatment options. Cases are presented in a foot and ankle. The use of Doppler may help differentiate solid from cystic lesions, didactic form (occipital condylar and C1/C2 complex fractures, torticollis, acute and also help the operator avoid vessels during interventional procedures. The post-traumatic atlantoaxial rotary dissociation and acute traumatic rupture of the use of extended fi eld-of-view images may be helpful in displaying the relationship transverse atlantal ligament). of adjacent structures. All procedures should take place under sterile conditions, Conclusion: Axial CT with sagittal and coronal reformations and 3D reconstruc- and informed consent should be taken from the patient. Major indications include tions allow the clear depiction of the spatial relationships of the complex anatomy biopsies, aspirations and therapeutic injections with corticosteroid. Injections of the and traumatic pathology of the craniocervical junction. plantar fascia, joints and Morton’s neuromas and biopsy techniques are specifi cally discussed. Potential complications are pain, bleeding, tendon rupture, infection, fat necrosis and allergy. Conclusion: Most interventional procedures in the foot and ankle are simple and relatively safe, with few complications. Aspirations and biopsies under ultrasound guidance may have a role in routine clinical practice, and therapeutic injections should be part of a rehabilitation programme. C-635 Misinterpretation of radiographs by emergency physicians: How big is the problem? Y. Thian, M. Mateo, S. Tay; Singapore/SG ([email protected])
Purpose: To evaluate the rate of discrepancies in radiographic interpretation be- tween emergency physicians and radiologists. The pattern of commonly missed radiographs and the nature of clinically signifi cant interpretation discrepancies leading to a change in management or adverse outcome were also studied. Methods and Materials: All radiographs obtained in our emergency department from January through February 2006 were fi rst interpreted by ED physicians and compared with the formal radiology reports. Discrepant interpretations were marked for further study and classifi ed into one of four categories: false-negative interpretation by ED physicians, false-positive interpretation by ED physicians, false-negative interpretation by radiologists and false-positive interpretation by radiologists. Discrepancies that necessitated intervention and adverse outcomes were also recorded from the clinical summaries. Results: Of the 7309 radiographic examinations generated during the study period, there were 152 (2.1%) false-negative misreads by the ED physicians and 115 (1.6%) overreads. Only 22 examinations (0.3%) necessitated an alteration in clinical management as a result of the misreads. Three adverse events were recorded during the study period as a result of radiographic misinterpretation, all of which were cervical spine radiographs. The most frequent type of false-negative interpretation was the chest radiograph. Conclusion: Only a small portion of radiographic misinterpretations by ED physi- cians necessitated a change in management. C-636 Ultrasonography of brachial plexus: An advanced technique in upper limb block J.J. Noguera, M. Gomez, M.L. Diaz, A. Alonso-Burgos, E. De Luis, J.D. Aquerreta; Pamplona/ES ([email protected])
Learning Objectives: 1. Give an overview of the anatomy of the brachial plexus and its distal branches. 2. Correlate the topographic anatomy of brachial plexus with its ultrasonographic appearance. 3. Explain the technique for the localization of the brachial plexus by ultrasound (US). 4. Give the advantages of US-guided techniques versus neurostimulation. Background: Nowadays, neurostimulation is still the most extended technique to localize the brachial plexus. Nevertheless, it is a technique based upon external ana- tomical references alone. US constitutes an improvement in the technique of plexus
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7 0 0 ed 2 . 2 463 ed by 0 . 2 lms. lms. 112.02.2007 17:04:10 G ndings, ndings, aber- Geneva/CH, Geneva/CH, rm the diagnostic 1 ; lms were identifi lms were 4 lms by radiologists? radiologists? lms by lms? ([email protected])
cant majority. With these cant majority. ([email protected]) ([email protected]) lms), trauma juniors and/or trauma lms),
, H. Bard , H. 1 c musculoskeletal disease. c musculoskeletal cant proportionthe reporting of on patients admitted via the lms cance of appropriate transducer ed and any fi lms where there was lms where there was fi ed and any C Athens/GR Birmingham/UK , X. Montet , X. BDEF 3 A ndings with specifi ([email protected]) ([email protected]) c joint pathology. Relevant Doppler fi Relevant c joint pathology.
Retrospective analysis was made of all patients who analysis was Retrospective , X. Demondion , X. 2 Paris/FR 1. To outline basic US physics and US technology. 2. To present To 2. and US technology. outline basic US physics To 1. To learn the normal and ultrasound anatomy of the median nerve. learn of the median nerve. the normal anatomy and ultrasound To 4 Individual topics include the fundamentals of US physics and Individual topics include the fundamentals of US physics les are used to demonstrate the correct technique through the les are used to demonstrate lm reporting a signifi up still makes Modern high-resolution sonography is increasingly employed in in employed is increasingly Modern high-resolution sonography Disorders of the median nerve (MN) are common in the outpatient Sonography is a valuable modality for musculoskeletal imaging, imaging, musculoskeletal for modality is a valuable Sonography Although A&E doctors have a high standard of reporting, with a low Although A&E doctors have Lille/FR, 3 , C. Martinoli , C. 1 Plain fi Sixty-four percent of the radiographs were agreed to be normal, agreed were 18% of the radiographs percent Sixty-four Genoa/IT, Genoa/IT, fi lms being looked at by radiographers (red dotting fi radiographers by at being looked lms fi and the report compared with the consultant the clinician was in the notes made by identifi were Discrepancies report. radiologist Purpose: fi extremity Trauma departments. work in radiology accident and emergency department the signifi constitute reporting is there still a necessity for of these fi senior doctors, as that junior doctors reported shown as few studies have published Previous correctly. lms 32% of fi Methods and Materials: and emergency departmentpresented through the accident Hospital, at Sandwell Extremity fi periods. one-week separate two Birmingham over a "gold reported to provide consultant radiologist another double discord were by standard" report. Results: abnormal, abnormal to be 18% were identifi agreed which were were but reporting, After double of 12%, with A&E had an error rate only one department. present) of 23% and where none was (identifying a fracture rate positive a false of present) radiologically where one was (missing a fracture rate negative a false Radiology and ankle X-rays. elbows with the shoulders, greatest Errors were 5%. of 5%. had an error rate Conclusion: to report radiology fi all trauma there is still a need for rate, negative false rations during dynamic scanning and common artifacts are also discussed. Em- duringrations artifacts dynamic scanning and common are also discussed. phasis has been placed on delineating the signifi C-641 of technique Normal anatomy, Ultrasound of the median nerve: pathological changes and normal ultrasound anatomy, examination Bianchi S. 2 C-639 need to reportDo radiologists fi A&E trauma extremity Ahmed; A. Farrell, L. Heron, Hussain, J. S. C-640 Rom-based DVD A how-to-do system: of the musculoskeletal Sonography guide audiovisual Plagou, A. Bechrakis, I. Faitaki, S. Michailidis, Chatzimihail, A. K. Delimpasis, G. Zoumpoulis; P.S. Pahou, K. Adamakis, G. Learning Objectives: the main illustrate To 3. system. technique of the musculoskeletal the examination present normal and echoanatomy To 4. indications and limitations of the modality. correlate abnormal fi sonographic Background: Rom is The present DVD injury and disease. the diagnosis of musculoskeletal and incorporates training on facilitating based on a series of lectures focused of normal and diseased with features technical aspects of proper US examination echostructure joints. of the Details: Procedure (with particular study of the shoulder on rotator cuff pathology), focus technology, of the wrist as examination as well and carpal knee, tunnel syndrome, elbow, disease. pediatric musculoskeletal patient and US applications in non-traumatic ed and juxtaposed to abnormal are identifi Normal appearances sonographic associated with specifi features diagnostic results. manipulation and selection of machine settings so as to optimize "Real-time" video fi positioning and obtained US images. of transducer screen display simultaneous Furthermore, the merits these "hands-on" sessions elucidate scanning. of dynamic complementing the main Greek text A bilingual approach has been carried out by with English subtitles. Conclusion: it is implemented meticulously. provided Learning Objectives: To of the median nerve. examination ultrasound learn an accurate to perform how To of median nerve disorders. of a wide variety appearance the ultrasound recognize Background: functional impairment. and deserve earlyclinical practice diagnosis to prevent studies remain the cor- and electrophysiological Although the clinical evaluation assessment of MN, imaging techniques can confi nerstone for 0.001). < ecting free water proton ecting free water ([email protected]) ([email protected])
Scientific and Educational Exhibits Scientific and Educational brous hystiocytomas [n=5]), benign soft brous hystiocytomas broadipose tissue, [n=2]) were examined examined [n=2]) were broadipose tissue, London/UK cacy of diffusion-weighted "reversed fast imaging with fast "reversed cacy of diffusion-weighted Fifteen patients with benign bone tumours (enchondroma, ([email protected]) ([email protected])
To demonstrate normal sonographic anatomy of the foot of the foot normal anatomy demonstrate sonographic To In this exhibit, we show the topographic anatomy of the of the anatomy topographic the show we In this exhibit, ed as hypointense, isointense or hyperintense. Results were Results were isointense or hyperintense. ed as hypointense, 3 The sonographic technique to dynamically image foot liga- technique to dynamically image foot The sonographic 3 1
nal diagnosis established by pathologic examination (n= 5). Sta- (n= 5). pathologic examination by nal diagnosis established d d The oblique orientation of the foot ligaments and tendons can result orientation of the foot The oblique PSIF sequence may allow differentiation of malign and benign of malign and benign differentiation allow PSIF sequence may n Sonography offers high resolution imaging of the tendons and liga- offers Sonography Brachial plexus punctures allow the locoregional blockade of several of several blockade the locoregional allow punctures plexus Brachial i Ankara/TR . N I To evaluate the effi evaluate To F Benign bone tumours and soft tissue lesions were iso- to hypointense to iso- to hypointense Benign bone tumours and soft tissue lesions were - c u d culty identifying them on MR imaging. However, many of these structures can many However, culty identifying them on MR imaging. E i c S - musculoskeletal lesions. Malign tumours show hyperintensity, probably owing to owing probably hyperintensity, Malign tumours show lesions. musculoskeletal infection except Benign lesions, proton mobility in neoplastic tissue. altered water refl hypointensity, show and aseptic necrosis of the bone, Conclusion: amma- to infl be attributed may hyperintensity processes, In infectious mobility. in the tory fraction and proteineous matrix mucoid free water decreasing cells, interstitial space. be identifi ed using high frequency sonography transducers. ed using high frequency sonography be identifi Findings: Imaging structures of the dorsal and plantar The following ments and tendons is described. 1 Extensor Dorsal Surface: on sonography: are demonstrated of the foot surfaces and Talonavicular 3 Tibialis anterior insertion. 2 muscle/tendon. Digitorum brevis 1 Plantar surface: 4 Extensor hood mechanism; talocalcaneal bifurcate ligaments. 3 2 Short and long plantar ligaments. (spring) ligament. Plantar calcaneonavicular 5 Metatar- intermetatarsal ligament. 4 Deep transverse longus insertion. Peroneus layers muscle The four 6 ligaments. cllateral sophalangeal/ interphalangeal joint’s of the sole of the foot. Conclusion: with emphasis on short foot ligaments using schematic drawings and MR imaging with emphasis on short ligaments using schematic drawings foot correlation. for Background: in diffi widely inexpensive, relatively is quick, In addition, sonography ments of the foot. of structures which can be easily clini- dynamic evaluation for and allows available dependent is operator sonography However, cally correlated at the time of scanning. and optimal assessment can only be made with intimate comprehension of the normal anatomy. sonographic Learning Objectives: C-638 with MRI correlation of the foot Normal sonographic anatomy Lee; J.C. Healy, J.C. Ansede, G. adjacent normal bone marrow. Malign bone and soft tissue tumours and benign adjacent normal marrow. bone to normal hyperintense and aseptic necrosis were bone lesions including infection ratios, contrast positive processes had tumours and infectious Malign bone marrow. (p values tumours had negative whereas benign musculoskeletal tistical analysis was performed with Student’s t-test. with Student’s performed tistical analysis was Results: with PSIF sequence. Signal intensity characteristics were analyzed qualitatively. qualitatively. analyzed Signal intensity characteristics were with PSIF sequence. classifi Lesions were compared with fi PSIF sequence in differentiating between benign and malignant between PSIF sequence in differentiating lesions musculoskeletal Ustunsoz, B. Tayfun, C. Kocaoglu, Bulakbasi, M. N. Yildirim, D. Sanal, H.T. Somuncu; I. C-637 Purpose: benign from malignant steady-state precession" (PSIF) sequence in distinguishing lesions. musculoskeletal Methods and Materials: lymphoma, osteosarcoma, lipoma, [n=2]), malign bone tumours (non-Hodgkin aseptic [n=4]), benign bone lesions (infection, parosteal osteosarcoma, metastasis, bro- fi tumour, [n=2]), malign soft tissue tumours (malign mesenchymal necrosis, malign fi two sarcoma, leiomyosarcoma, ammed fi infl necrosis, tissue lesions (fat block, as it allows a safer and more accurate puncture during accurate and more real-time vision. a safer as it allows block, Details: Procedure brachial plexus and its distal branches, with special attention to its anatomical special attention to with and its distal branches, plexus brachial There are three anatomical appearance. relationships and its ultrasonographic region, b) infraclavicular a) supraclavicular plexus: regions to approach the brachial show We or anterior c) axilar region or root of the arm. region of the shoulder and puncture and the different of each of these three regions, anatomy the topographic each area. for techniques recommended Conclusion: safety, with great to guide the puncture US enables regions of the upper limb. nerve such as lesion or and undesired side effects, diminishing complication rates injection of local anesthetic drugs. the intravascular C - 7 0 R C EECR07-C-SciEduc-FIN.indd 133 Scientific and Educational Exhibits
suspicion and add useful additional information. Direct imaging of peripheral nerves C-644 is possible using cross-sectional modalities, such as ultrasound (US), computed Is it necessary to review all casualty radiographs? tomography and magnetic resonance imaging (MRI). In experienced hands, US S. Nayak, M. Chandramohan, C. Groves; Leeds, West Yorkshire/UK provides an economic, fast, noninvasive and accurate evaluation of the MN from ([email protected]) the axilla to the distal branches. Imaging Findings: In this article, we will fi rst present the normal anatomy of the Purpose: To check for any discrepancies in the plain fi lm reporting by the A&E MN through schematic drawing and selected images from cadaveric dissections. doctors when rechecked by a radiologist. To look into the incidence of signifi cant Then, the technique of US examination and the normal US appearance will be misses that altered the patient management. illustrated. In the last part, representative US images with MRI correlations and Methods and Materials: The duration of the study was 30 days. A retrospective schematic drawings will be presented to illustrate a wide spectrum of the patho- study was conducted at the Bradford Teaching Hospitals, looking at all the casualty logic conditions. radiographs that were double reported by the radiologists. Conclusion: US can effi ciently assess the normal MN and diagnose a wide variety Results: A total of 1122 A&E fi lms were reviewed by the radiologists. 1002 (89%) of disorders. Accurate knowledge of the US anatomy and scanning technique is of them were agreed upon by the radiologists in correlation to the A&E diagnosis. an essential prerequisite. 120 (11%) of the total were disagreed by the radiologists. 36 (3.2%) of these were considered as signifi cant misses. Out of 120 disagreed fi lms, 60 letters were sent C-642 by A&E to the GP. Of these, 18 needed further investigations 18 were recalled to the fracture clinic. The radiologists’ reports on radiographs of the chest, face, skull, and Tumors and tumor-like lesions of the scapula and periscapular region wrist had the greatest effect on patient management. Reports on the radiographs of N. Cañete, D. Martins-Romêo, J. Llauger, J. Palmer, S. Valverde, S. Bagué, fi ngers, hands, shoulders, long bones, and toes seldom altered treatment. R. Guerrero; Barcelona/ES ([email protected]) Conclusion: Errors occurred by A&E doctors in reporting plain fi lms. 3.2% of these Learning Objectives: 1. To have an overview of the imaging fi ndings of tumors and were signifi cant misses. Hence, it is recommended to continue double reporting tumor-like lesions of the scapula and periscapular region in adults. 2. To recognize by A&E and radiologists. the specifi c imaging features of some of these tumors. 3. To correlate imaging features with pathologic fi ndings. Background: We describe neoplasms and tumor-like lesions that develop in or around the scapula. Specifi c neoplasms addressed include, among others, benign (osteoid osteoma, osteochondroma, chondroblastoma, aneurysmal bone cyst) and malignant tumors (osteosarcoma, chondrosarcoma, Ewing’s sarcoma, metastases, multiple myeloma). An unusual case of scapular meningioma is also presented. Tumor-like lesions include ganglia and synovial cysts, Paget and elastofi broma. Imaging Findings: Retrospective review of imaging and pathologic studies of patients with scapular and periscapular lesions including radiographs, CT, and MR examinations. Conclusion: The incidence of scapular tumors is low. Bone tumors involv- ing the scapula as the sole site constitute an uncommon fi nding, with few cases reported. Both benign and malignant neoplasms can be found. Since early diagnosis is crucial for prompt therapy, imaging plays an essential role. Plain radiograph is the primary modality in the diagnosis approach. However, computed tomography (CT) and magnetic resonance (MR) play a major role in establishing diagnosis and staging. C-643 Extended fi eld-of-view sonography: Does this technique provide additional information to conventional B-mode images? F. Eksert, C. Yucel, S. Ozhan Oktar, N. Kadioglu, H. Ozdemir; Ankara/TR ([email protected])
Purpose: To compare the imaging fi ndings of lesions examined with B-mode and extended fi eld-of-view (EFOV) sonography and to demonstrate if EFOV technique provides additional information. Methods and Materials: Sixty patients (32 males, 28 females) (age range:1- 83 years, mean age: 47±18.3 years) with 61 lesions were involved in the study. 21/61 (34%) of the lesions were localized in the musculoskeletal system, 19/61 (31%) were in the neck area, 15/61 (26%) were in the anterior abdominal wall, 2/61 (3%) were in the peritoneal cavity, 1/61 (2%) was in the scrotum and 1/61 (2%) originated from the brachial artery. All lesions were examined with both the conventional B-mode and EFOV sonography. The fi ndings were evaluated in- dependently by two radiologists. Sonographic images obtained with each technique were scored for lesion characterization, and for simultaneous demonstration of the lesions and their relationships with surrounding tissues. Wilcoxon signed rank test was used for statistical analysis. Kappa scores were calculated to assess inter-observer agreement. Results: Wilcoxon test revealed that EFOV sonography was superior to B-mode imaging for both lesion characterization and for the determination of its relationships with neighboring structures (p=0.000). Kappa scores refl ected moderate to good inter-observer correlation (0.186-0.454). Conclusion: EFOV sonography is a practical and easily applied technique. This technique overcomes the problem of limited fi eld-of-view, which is one of the most important disadvantages of B-mode sonography. The simultaneous visualization of the lesions and surrounding structures in larger fi eld-of-views makes EFOV images more apprehensible compared with conventional B-mode images.
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Neuro 0 : 7 1
7 0 0 ; 2 2 . bers 2 465 0 . 2 52.3 HU, 52.3 HU, 112.02.2007 17:04:10 .05). A CT .05). ush). The ush). ± < p G cant differences differences cant
, A. Tanigichi , A. 2 .05). Protocol C is .05). < p 400 HU) and compared and 400 HU) ≥ , K. Anami , K. ([email protected]) ([email protected]) 1
Detroit, MI/US cation of neurosurgery. 70.16 HU, 70.16 HU, ± C t from it? To describe cor- a practical To t from it? ip angle: 90º, TR: 2020, TE:68, NSA:6)TE:68, 2020, TR: 90º, ip angle: BDEF , T. Nishiharu , T. 1 Santander/ES ([email protected]) ([email protected])
A cantly increased (protocol A: 324.1 cantly increased (protocol A: , J. Urata , J. 1 The subjects were 158 patients who underwent cerebral cerebral 158 patients who underwent The subjects were bers are easy to map, whereas the visualization of pre- bers are easy to map, To resume the key facts of this new diagnostic technique of this new facts resume the key To Cerebral radiation necrosis (CRN) is an undesired but often necrosis (CRN) is an undesired but radiation Cerebral All the studies were performed on a 1.5 T MR unit by using a T MR unit by on a 1.5 performed All the studies were This technique provides different parameters including fractional parameters different This technique provides 65.93 HU, protocol C: 402.8 protocol C: HU, 65.93 software. We get 2D and 3D color maps from the VP. 3D color maps from the get 2D and We software. ± 300 HU, group II: 300-400 HU, group III: 300-400 III: 300 group II: group HU, HU, /sec. This protocol was modifi ed in 3 patients in order to obtain a ed modifi This protocol was /sec. Bunkyo-ku,Tokyo/JP 2 ≤ 2 Diffusion tensor imaging provides functional images of the brain, functional images of the brain, Diffusion tensor imaging provides ed into 3 items: 1) Diseases that lead to atrophy of the VP (ocular of the Diseases that lead to atrophy 1) into 3 items: ed , D. Utsunomiya , D. Diffusion tensor imaging is a new technique to be included in brain in brain technique to be included Diffusion tensor imaging is a new DTI is a useful technique to study the normal DTI is a useful technique and pathological visual A CT number of 300 A CT number HU or more permits to branches the penetrating 1 In cerebral 3D-CTA, visualization of the penetrating branches near aneu- branches visualization of the penetrating 3D-CTA, In cerebral CT numbers were signifi were CT numbers =800 mm b Philips PRIDE Kumamoto/JP, Kumamoto/JP, recommended for obtaining stable contrast enhancement in patients weighing 80 in patients weighing enhancement contrast obtaining stable recommended for kg near the aneurysm the enhancement of vessels increases, the contrast As or less. signifi Additionally, is improved. branches visualization of penetrating I and III ( groups I and II and between groups observed between were branches. visualizing the penetrating for of 300 HU or more is required number Conclusion: is important Such information when clipping aneurysms. be visualized. protocol B: 362.6 protocol B: better visualization of the pathology (TR: 8474, TE: 68, NSA: 6). We also acquired also acquired We 6). 68, NSA: TE: 8474, pathology (TR: better visualization of the made in a workstation using was Post-processing an anatomical imaging 3D/DTI. the Conclusion: fi Post-thalamic pathway. c DTI acquisition protocol. with a specifi is possible bers thalamic fi caused by entities with associated mass effect (tumors); 3) Infi ltrating lesions of ltrating Infi 3) (tumors); entities with associated mass effect caused by plaques). demyelinitation pseudodotumoral VP (neoplasms, the Details: Procedure sequence (fl single-shot echo-planar imaging compared to the results in normal subjects, the pathological features in patients in patients the results in normalcompared to features the pathological subjects, can be classifi of the fi 2) Displacement hypovitaminosis); sclerosis, multiple globe enucleation, with with an easy point of view, analyzing the different parameters obtained. What do obtained. parameters analyzing the different with an easy point of view, DTI and what can I benefi I need to perform and functional DTI images. anatomy relation between Background: matter. and grey of white matter tracts anisotropy between differences demonstrating role in This technique has been included recently in daily clinical studies with a key in planifi tumors and, especially, diagnosis of brain Findings: Imaging present We and color-coded maps of orientation of white matter tracts. anisotropy and clinical main technical parameters including basic physics, an easy overview role in is included where DTI has a key clinical cases of several A review applications. about its usefulness In addition, a brief show the diagnostic management of patients. in neurosurgery including reconstruction is demonstrated with tractography. Conclusion: interesting both very useful functional information, MR studies because it provides and neurosurgeons. radiologists for C-650 cerebral radiation necrosis of histopathology proven features MR imaging Patel; S. Rogers, Scarpace, L. L. Jain, R. Ellika, S. ([email protected]) Learning Objectives: C-649 dummies DTI for Pelaz, M. Pellón, Martin Cuesta, R. L. Marco de Lucas, E. Blanco, G. Bañales, I. Valle, N. González Mandly, Gutiérrez, A. Díez, A. Sánchez, C. E. Torres; Arnáiz, M. Ruiz, J. Jordá, E. J. Learning Objectives: C-648 (3D- in cerebral 3D-CT angiography branches Depiction of penetrating and visualization contrast protocols Relationships between low-dose CTA): Sakamoto T. 1 CT numbers near the penetrating branches (AchA, LSA, TPA) were divided into3 were TPA) (AchA, LSA, branches near the penetrating CT numbers I: (group groups Purpose: contrast low-dose rysms In this study, is very important when clipping aneurysms. CT multislice a 64-row using branches visualizing the penetrating protocols for evaluated. and then visually and quantitatively developed, system were Methods and Materials: and SDs The CT numbers medium. using 50 mL of 300 mgI/mL contrast 3D-CTA The relation- (MCA, ICA, BA). vessels blood measured in the major cerebral were 3.0 A: studied (protocol were and body weight mL/s, the injection rate ships between mL saline fl a 20 by followed mL/s, 5.0 protocol C: mL/s, 4.0 protocol B: (CT numbers). scale) and quantitatively visually (4-grade Results:
elds cation assumes 0 ber ed Rankin scale St. Petersburg/RU St. ([email protected]) ([email protected])
the 3-month outcome of pa-
([email protected]) ([email protected])
Madrid/ES Scientific and Educational Exhibits Scientific and Educational Berne/CH The present study compares the long-termThe present study outcome of In eight healthy volunteers (18-30 years old), conventional old), conventional (18-30 years volunteers In eight healthy MRI Diffusion Tensor Imaging (DTI) was performed in 7 performed Imaging (DTI) was Tensor MRI Diffusion 5 3 1
d elds number 7, 9 and 37. When a patient must choose the preferred choose the preferred When a patient must 37. 7, 9 and elds number d Diffusion Weighted Imaging (DWI) is a useful technique to obtain Imaging (DWI) Weighted Diffusion n The present study provides evidence for a sustained effect of IAT of IAT a sustained effect for evidence The present study provides Thus, "complex" stimulus causes additional activation in the parietal causes additional activation stimulus "complex" Thus, i . N I Thrombolysis has been shown to improve has been shown Thrombolysis The aim of our work was to localize cortical areas involved in the process- cortical to localize The aim of our work was areas involved One hundred forty-four patients treated with IAT and 147 patients 147 patients and patients treated with IAT One hundred forty-four F "Complex" stimuli in comparison with "simple" stimuli caused activation in comparison caused activation stimuli with "simple" stimuli "Complex" - c u d E i c S - tracking study study tracking Villoria Lebiedziejewski, Guzmán de Muñoz Almazán, J. L. Bravo, Paniagua A. Crespo San José; J. Seoane, Medrano G. C-647 A DTI-fi of the normal and pathological visual pathways: Anatomy Learning Objectives: Our (VP). individuals in order to study the visual pathway patients and 3 healthy as the pathological changes in purpose its normal as well to show anatomy was it. some diseases that involve Background: on the assessment of Our study is focused maps from the white matter tracts. brain When VP. parts different the of the maps to visualize DWI VP after performing the C-646 of the "central executive in localization of the work of functional MRI The role complexities of different stimuli in recognition of the visual mechanism" Sevostyanov; Shelepin, A.V. Y.E. Trufanov, G.E. Fokin, V.A. ([email protected]) ([email protected]) Purpose: using fMRI. complexities with different ing of the visual stimuli Methods and Materials: used echo-planar We T MR scanner. on 1.5 performed anatomical and fMRI were Gabor used matrix we from 10x10 Gabor elements. visual stimulation, For imaging. fi which corresponds to receptive under Gauss law, fading element is a sinusoid Purpose: preferred most elements have In "simple" stimulus, of primary visual cortex cells. preferred only a part stimulus, of the elements have In case of "complex" orientation. were brightness of the stimuli and contrast The size, or verticalhorizontal orientation. (1) calculating includes: Post-processing chaotic and ordered patterns. identical for H statistical map with t-student criterion of more than 4, where hypothesis Long-term effect of intra-arterial thrombolytic therapy in acute stroke in acute stroke therapy of intra-arterialLong-term effect thrombolytic Remonda, L. Brekenfeld, C. Haefeli, T. Arnold, M. Fischer, U. Nedeltchev, K. Schroth; G. Mattle, H.P. Kappeler, L. Brain C-645 Neuro tients with ischemic stroke, but knowledge of the long-term effect of thrombolysis of thrombolysis of the long-term knowledge effect but tients with ischemic stroke, is limited. Methods and Materials: using uroki- treated with intra-arterial patients who were stroke (IAT) thrombolysis modifi The patients treated with aspirin. nase with the outcome of treated patients seventy-three One hundred used to assess the outcome. (mRS) was and 261 patients treated with aspirin from the Bernese Bank Data Stroke with IAT age A matching algorithminto account the patients’ taking the study. for eligible were the National Institute of Health on admission (as measured by severity and stroke and an aspirin group. an IAT used to assemble NIHSS) was Scale, Stroke Results: analysis. treated with aspirin could be matched and included in the comparative 56% of the patients At 2 years, 14 in each group. The median NIHSS score was functional and 42% of the patients treated with aspirin achieved treated with IAT (mRS 0 to excellent Clinical outcome was P = 0.037). independence (mRS 0 to 2; Mortality was and in 24% of the aspirin patients (P = 0.008). 1) in 40% of the IAT 23% and 24%, respectively. Conclusion: the stroke. after when assessed 2 years that MR-signal intensity in rest is equal to activation intensity; (2) for the identifi (2) for intensity; that MR-signal intensity in rest is equal to activation fused with the anatomical image the resulting maps were of anatomical structures, Talairach. to space of atlas transformed and then both images were Results: on Brodmann fi of the mouse to discriminate the left or right button click orientation of elements, in the causes activation "simple" stimulus and "simple" stimuli; "complex" between 9/10). elds number middle frontal gyros (Brodmann fi Conclusion: locus in an additional activation observation demonstrate Cases of active lobes. executive ects the work of the "central refl the prefrontal cortex, which presumably, mechanism". C - 7 0 R C EECR07-C-SciEduc-FIN.indd 135 Scientific and Educational Exhibits
unavoidable effect of brain radiation. We reviewed fi ndings of routine MRI in 41 C-653 cases of pathologically proven CRN. Neuroradiologic fi ndings in children with mitochondrial disorder: Background: It is imperative to distinguish CRN from recurrent tumor in order to Correlation with mitochondrial respiratory chain defects avoid unnecessary antineoplastic therapy and to administer therapy appropriate M. Lee, J. Kim, E. Kim, S.-K. Lee, D. Kim, Y.-M. Lee, H. Kim; Seoul/KR for the CRN. There is no defi nitive imaging method to distinguish these conditions. ([email protected]) We retrospectively reviewed all clinical cases of CRN identifi ed histologically at surgery from HFH in the past 15 years. Learning Objectives: 1. To review pathophysiology and diagnostic criteria Imaging Findings: Treated tumors included 34 gliomas, 5 metastases, 1 PNET and of mitochondrial disorder. 2. To investigate various neuroradiologic fi ndings in 1 ependymoma. Central necrosis (37) and cysts (24) were common. T1 hyperintensity children with mitochondrial disorder and, particularly, unspecifi ed mitochondrial without contrast administration was seen in 17 cases. The most common pattern of encephalomyopathies. enhancement seen in 35 patients included ill-defi ned borders, lack of a nodular com- Background: Mitochondrial disorders are a heterogeneous group of clinical syn- ponent, and a central "swiss cheese" appearance. Subependymal enhancement was dromes associated with abnormalities of mitochondrial energy metabolism. The present in 25 cases and corpus callosum enhancement was seen in 16. A pattern of impaired energy production results from the overall dysfunction of mitochondrial enhancement in two adjacent lobes separated by the dura was seen in three cases. respiratory chain, composed of 5 enzymatic complexes embedded in the inner Brain atrophy was present in 29 and leukoencephalopathy in 19 patients. mitochondrial membrane. We investigated the various neuroradiologic fi ndings in Conclusion: A "swiss-cheese" and ill-defi ned, non-nodular pattern of enhancement 40 children with mitochondrial disorder, and correlated them with the biochemical was most common. The high frequency of involvement of the corpus callosum and defect in the mitochondrial respiratory chain complex. subependyma was unexpected, as these fi ndings are traditionally reported with Imaging Findings: Children with mitochondrial disorder showed different patterns tumor infi ltration. A pattern of enhancement in adjacent lobes separated by the dura of brain MR imaging abnormalities. Rapid progression of atrophy involving all is uncommon, but may be pathognomonic of CRN when the imaging changes are structures of the brain with variable involvement of white matter were found in 29 consistent with the radiation fi eld dosimetry. patients, and the patients with complex I defi ciency showed more severe changes in serial scans; T2 prolongation of basal ganglia, thalami, brain stem and cerebel- C-651 lum in 18 patients with complex I or IV defi ciency; predominant cerebellar volume loss in 3 patients with complex I or IV defi ciency; and encephalomalacia of globi Dural lesions mimicking meningiomas: A pictorial review pallidi in 2 patients with complex I defi ciency. D. Chourmouzi, G. Boulogianni, K. Manolakaki, K. Drevelegas, T. Zaraboukas, Conclusion: Children with mitochondrial disorder showed different features on A. Drevelegas; Thessaloniki/GR ([email protected]) brain MR imaging from a combination of various defects of mitochondrial respira- Learning Objectives: To describe a number of neoplastic and nonneoplastic tory chain complex. Defects of different parts of the mitochondrial enzyme could entities that radiographically and clinically mimic meningiomas. To outline the result in the same abnormality on brain MR imaging, whereas identical biochemical pathological and imaging characteristics of these entities. defects could cause different imaging manifestations. Background: Intracranial dural-based lesions can be due to benign or malignant processes. Imaging characteristics cannot always discern between different pathologic C-654 conditions. A thorough clinical evaluation may reveal likely diagnostic possibilities. Role of diffusion-weighted MR imaging (DWI) and ADC values in Procedure Details: An overview of the MRI characteristics of dural lesions is pre- differential diagnosis of intracranial ring-enhancing lesions sented. There is also presentation of some pathologically proven lesions including C. Mueller-Mang, T.G. Mang, C. Plank, C.J. Herold, M.M. Thurnher; Vienna/AT solitary fi brous tumor, gliosarcoma, hemangiopericytoma, melanocytoma, Hodgkin’s ([email protected]) disease, plasmacytoma, infl ammatory pseudotumor, plasma cell granuloma, Ro- sai-Dorfman disease as well as metastatic carcinoma. The role of the advanced Learning Objectives: 1. To illustrate the wide spectrum of intracranial lesions with magnetic resonance techniques such as spectroscopy, diffusion and perfusion ring enhancement on MRI. 2. To categorize these lesions according to imaging fi nd- MR imaging is discussed. ings on DWI and calculated ADC values. 3. To provide an easy-to-follow algorithm Conclusion: The differential diagnosis of dural-based lesions in the brain varies from for the differential diagnosis of intracranial ring-enhancing lesions. incidental and benign to symptomatic and malignant. Careful vigilance in patient’s Background: Ring enhancement is an unspecifi c MR fi nding occurring with a history is essential. Awareness that such lesions involve the dura may facilitate pre- variety of aetiologies. It is most frequently encountered in neoplastic and infectious operative recognition and, in some cases, preclude unnecessary surgery. disorders, such as metastases, gliomas, and abscesses, but is also observed in vascular pathologies, such as resolving haematomas and infarcts. Because of C-652 the variable clinical course and prognosis of these diseases, an early and correct diagnosis is necessary for choosing the appropriate therapy. MR spectroscopy in dementia and mild cognitive impairment Procedure Details: We present the broad spectrum of intracranial lesions with ring J.M. Garcia Santos, D. Gavrila, D. Salmerón, C. Antúnez, M. Tormo, enhancement on MRI with emphasis on the diagnostic impact of diffusion-weighted S. Torres del Río, C. Navarro, L. Fortuna; Murcia/ES ([email protected]) sequences and ADC values. Additionally, MR features that could be possibly helpful Purpose: To evaluate 1H Magnetic Resonance Spectroscopy (MRS) in patients with in distinguishing ring-enhancing brain lesions are discussed. low MMSE score identifi ed during a community-based study of dementia. Conclusion: DWI has recently shown promise in differentiating ring-enhancing Methods and Materials: A sample of 1493 individuals (> 64 y-o), stratifi ed by age, lesions such as brain abscesses and malignant neoplasms. Combining the infor- gender and residence, was randomly selected. 215 (MMSE≤24) were sent to a mation of conventional MRI and DWI with ADC calculations, the correct diagnosis dementia unit and sorted in clinical groups (Dementia-D, Alzheimer’s Disease-AD, of ring-enhancing lesions can be achieved in a majority of cases. mild cognitive impairment-MCI, and normal-N) according to DMS IV and NINCDS- ADRDA criteria. Only 56 could be fully analyzed with both MRI and MRS. Two C-655 single voxel PRESS sequences (TR 1500 ms, TE 35/144 ms) were carried out in The dynamic study of CSF circulation in hydrocephalic patients by means the posterior cingulate gyrus. Mean ratios NAA/Cr, Cho/Cr, mI/Cr, NAA/mI, and of magnetic resonance (MR): Semeiotic technique and case gallery NAA/Cho were compared (ANOVA and Kruskal-Wallis non-parametric test). The L. Fortunelli1, V. Annibale1, F. Favano1, P. Car1, P. Spagnolo2, A. Stecco1, ability of MRS to distinguish clinical groups was assessed by ROC analysis. A. Carriero1; 1Novara/IT, 2Monza/IT ([email protected]) Results: Regardless of the TE, NAA/Cr, and NAA/Cho were signifi cantly lower in D or AD compared with MCI and N (p < 0.01). In D vs non-D analysis, NAA/Cr- Learning Objectives: To describe the methodological aspects and advances of TE35 ms and NAA/Cho-TE35-144 ms showed an area under the curve-AUC the CINE PC technique for studying CSF. To present a case gallery for each type 83.1%, 82.5%, 84.8%. NAA/Cr-TE35 ms and NAA/Cho-TE35 AUC were 83.7% of hydrocephalus. To describe the MR semeiotics of this technique. and 80.1%, respectively, when confronting AD and N. For MCI and N, AUC was Background: CSF fl ow was previously studied by means of CT, a lumbar puncture NAA/Cr-TE35 ms 86.1% and NAA/Cho-TE35-144 ms 80%, 83.9%. MRS ratios were (tap test) or ventriculocisternography. Dynamic MR investigations are based on not helpful in MCI and N comparison. To differentiate AD and N, NAA/Cr 35 ms phase contrast sequence that provides quantitative and qualitative measurements showed sensitivity 77.8%, specifi city 91.2%, positive predictive value 70.1% and of fl ow velocity and direction. The automatic planning of acquisition planes has negative predictive value 94.0% at a cut-off point of 1.40. recently become available. The indications for this examination are to characterise Conclusion: NAA/Cr and NAA/Cho were the most useful ratios for clinical normotensive hydrocephalus and treated hydrocephalus. groups grading, especially for distinguish D and AD from MCI and N, but not Imaging Findings: Thirty-fi ve examinations were carried out using 1.5 Tesla MR for MCI vs N comparison. with an eight-channel phased array coil and cardiac trigger, and post-processing
466 A BDEFC G
EECR07-C-SciEduc-FIN.inddCR07-C-SciEduc-FIN.indd 113636 112.02.20072.02.2007 17:04:1017:04:10 1 1 : 4
Neuro 0 : 7 1
7 0 0 2 . 2 467 0 .
2 112.02.2007 17:04:11 ndings of
G ndings. However, However, ndings. Madrid/ES
Gliwice/PL EPOS C ltrate’s regression. The changes in other regression. ltrate’s BDEF cult to differentiate from meningiomas, not from meningiomas, cult to differentiate A We followed 19 patients who received an external radiation an external 19 patients who received followed We
1. To show unusual features of intracraneal meningiomas of intracraneal features unusual show To 1. Nine patients had lesions bilateral and simetrics, hyperintense hyperintense and simetrics, bilateral Nine patients had lesions to Submitted Material No Unusual imaging features of meningiomas are shown, such of meningiomas are shown, imaging features Unusual H-MR spectroscopy has the capability of detecting early meta- H-MR spectroscopy tting: Naa, Cho, Cr, Lac, Lip0.9/1.3, Glu+Gln, Ins. The spectra The spectra Lip0.9/1.3, Glu+Gln, Ins. Lac, Cr, Naa, Cho, tting: 1 Meningiomas are the most common nonglial primary tumors of Proton spectroscopy is a useful investigational tool in the study of is a useful investigational Proton spectroscopy The Meningiomas account for 14-20% of intracranial tumors. The diagnosis tumors. 14-20% of intracranial Meningiomas account for H-MRS) changes in tumor bed, during radiation therapy, in patients in patients H-MRS) changes in tumor bed, during therapy, radiation 1 To observe the time course of the proton magnetic resonance spec- To After the completion of radiotherapy, we observed the increase in the we After the completion of radiotherapy, electron transport cascade. Although mitochondrial dysfunction manifests over a over Although mitochondrial dysfunction manifests electron transport cascade. where and brain, the muscle it most often affects of clinical expressions, wide range The most common clinical metabolism is highest. energy on oxidative dependence of neurologic lactic acidosis and a broad range weakness, are muscle features fi MR and proton spectroscopy will analyse we In this exhibit, cits. defi January 1996 Between primary to mitochondrial lactic acidosis related disease. 11 patients with of MR and proton spectroscopy analyzed and January 2006, we suspected of mitochondriallactic acidodsis and clinically disease. Details: Procedure images in T1-weighted on and hypointense images T2-weighted on Flair and Proton too. Three of them had thalamic involvement basal ganglia. stem and brain and a N-acetylaspartate lactate reduction, both elevated revealed spectroscopy normal proton was MR but In 2 of 11 patients, in areas that appeared damaged. ndings. similar fi showed spectroscopy Conclusion: mitochondrial to that of conventional information diseases as it supplies additional brain in areas of the metabolic anormaliesimaging, because it documents even that appeared to be normal. tumour bed after the completion of radiotherapy. bolic changes in the irradiated can be concentrations The increase of Naa and decrease of Cho and Glu+Gln the result of the residual neoplasmatic infi cant. not signifi were occurred, but metabolite concentrations ([email protected]) ([email protected]) Purpose: C-660 in meningioma features Atypical imaging Saiz; A. Nieto, Ciudad, B. M. Litcheva, Gomez, A. N. Graña, L. C-659 MR in tumour bed with proton of metabolic changes Observation in patients with primary therapy gliomas during radiation spectroscopy Idasiak; A. Senczenko, W. Bobek-Billewicz, Zarudzki, B. L. ( troscopy hemangiopericytoma, melanocytic lesions, tumors, (mesenchymal only tumoral dermoid lesions (aneurysms; also non-tumoral metastases), but dural shwannomas, and epidermoid cyst) Conclusion: fi easy when the tumor has characteristic radiological is relatively in order to sug- of the less frequent imaging features be aware must the radiologist Most meningiomas are gest the diagnosis in cases that meningiomas are atypical. that (1-3%) variants there are also atypical (5-7%) and malignant benign (90%), but ([email protected]) ([email protected]) Learning Objectives: 2. and perfusion sequences. including diffusion-weighted on CT and MR images, meningiomas. diagnosis of intracranial Differential Background: They neoplasms. nervous system and the most commom extra-axial the central enhancing markedly homogeneous, characteristic imaging features: usually have or region in the parasagittal convexity, the cerebral mass situated over extra-axial characteristics unusual show meningiomas may However in the sphenoid wing. on CT and MR. Findings: Imaging degeneration; cystic or fatty intraosseu); as infrequent locations (intraventricular, We permeability. and increased values low-ADC ring enhancement; large edema; be diffi cases that may will also show with primary gliomas. Methods and Materials: All 49.5 days). median: 51 days; primary (mean: 6-9 weeks for gliomas for therapy The patients received surgery brain patients underwent prior to the radiotherapy. single Each patient underwent lesion area. doses of 54 or 60 Gy in the fractioned and just after the completion of TE=30) before TE=135; (SVS spectroscopy voxel chosen in the tumour bed, over- of interest were The voxels therapy. the radiation metabolite concentrations, The following (PTV). lying the planning target volume the areas of the by evaluated were their ratios and normalized concentrations peaks after peak fi ed with LCModel. verifi were Results: and the decrease in the normal- and Naa/Cr ratio normalized NAA concentrations and Cho/Naa ratio. concentrations Glu+Gln, Lip[0.9] Cho, ized Conclusion: ndings eni.org.ar) 0.4 mmol/l and one patient ± 3.0 mmol/l for at least 10 min, at least 10 mmol/l for 3.0 < 10 min) does not induce visible min) does not induce visible 10 < (rsalvatico@fl
uence of cerebral diffusion could be uence of cerebral Scientific and Educational Exhibits Scientific and Educational ([email protected]) ([email protected])
Capital Federal/AR Seven volunteers received an i.v. bolus of 0.15 U per kg an i.v. received volunteers Seven 2.0 mmol/l or the subject wished to abandon the trial due Doha/QA < To introduce the technique of virtual magnetic resonance To To illustrate the spectrum of MR and proton spectroscopy the spectrum illustrate proton spectroscopy of MR and To 7 Three-dimensionally acquired images of the brain have been have Three-dimensionally acquired images of the brain 3 1
ow. The post-processing analyses included the quantitative and analyses included the quantitative The post-processing ow. d d Mitochondrial diseases constitute a complex and heterogeneous Mitochondrial diseases constitute a complex The recent advances in three-dimensionally acquired and displayed in three-dimensionally acquired and displayed The recent advances n Short-time severe hypoglycemia ( hypoglycemia Short-time severe The technique was feasible in 100% of cases, all of which showed of which showed all of cases, in 100% feasible The technique was Virtual MR ventriculoscopy of the brain is a new technique of imaging new is a of the brain Virtual MR ventriculoscopy i . N I Severe cerebral hypoglycemia with onset of neurological symptoms is with onset of neurological symptoms hypoglycemia cerebral Severe ([email protected]) F All subjects revealed a hypocglycemia a hypocglycemia All subjects revealed
- c u d E i c S - Learning Objectives: To ndings in primary lactic acidosis related to mitochondrial diseases in brain. fi evaluation. of proton MR spectroscopy describe the advantages Background: abnormalities heritable of the respiratory of metabolic disorders caused by group R.M. Salvatico, N.M. Hatamleh, M. Aguilar, M. Massaro, G. De Pino, F. Meli, F. De Pino, G. Massaro, M. Aguilar, Hatamleh, M. N.M. Salvatico, R.M. Romero; C.A. Lambre, H.E. C-658 fi spectroscopy MR and proton Primary lactic acidosis encephalophaty: mean serum glucose level decreased down to 1.94 decreased down mean serum glucose level In the MRI diffu- symtpoms. mmol/l due to vegetative at 2.6 stopped examination pointing at an infl no alterations sion images, observed in all individuals. Conclusion: the maybe changes in MRI diffusion imaging, suggesting long-time hypoglycemia diffusion disturbance in MR imaging. observed reversible cause for relevant to vegetative symptoms. Images were independently analyzed by two radiologist. two by independently analyzed Images were symptoms. to vegetative Results: C-657 insulin-induced monitoring of the brain during severe Continuously MR imaging diffusion-weightened by hypoglycemia Kaiser; W.A. Mueller, U.E. Mentzel, Saemann, H.-J. A. Boettcher, Schmidt, J. P. Jena/DE frequently associated with reversible diffusion disturbances, which could be visual- diffusion disturbances, frequently associated with reversible imaging particular brain diffusion weightened in the lesions by as hyperintense ized of on the evaluation This study is focused region. splenium and the corona radiata of insulin-induced especially with regard to the severity pathogenesis, hypoglycemic hypoglycemia. reversible Methods and Materials: short individuals were while the body weight acting insulin inducing hypoglycemia, Diffusion-weightened T scanner (Siemens Sonata). a 1.5 by evaluated continuously obtained without interruption. TR/TE) were echo planar sequences (4500/107 using monitored also continuously were glucose levels serum blood Additionally, later further sampled for specimen were Glucostix test strips; more serum blood stopped as soon as serum glucose Examination was laboratory measurements. diminished to was level Purpose: (MR) ventriculoscopy of the brain and to illustrate the ventriculoscopic appearance appearance the ventriculoscopic and to illustrate of the brain (MR) ventriculoscopy diseases in normal ventricles of the cerebral persons and in patients with different ventricles. the cerebral which involve of the brain, Background: MR images and the use of virtual processing have endoscopic technique in image The present ventricles. virtual of the cerebral enabled endoscopic examination third, and of the normal of the lateral, the appearance illustrates anatomy exhibit ventricles of lesions related to the cerebral fourth and the appearance ventricles from an endoscopic viewpoint. Details: Procedure shot) turbo-FLASH (fast-low-angle T1-weighted 3D fat-saturated by performed virtual been reconstructed by Images have the whole brain. sequence covering Erlangen, Germany).Wizard, Siemens, endoscopic technique (Colon, Conclusion: of be useful in three dimensional evaluation which may ventricles, of the cerebral congenital and acquired abnormalities as abnormal as well masses related to the ventricles. cerebral C-656 Virtual the brain of MR ventriculoscopy Mahfouz; A.E. Sherif, H. Learning Objectives: concordance between the CINE PC images and clinical symptoms. The automatic clinical symptoms. the CINE PC images and concordance between the technique easier to perform. planning method makes software for quantitative analyses. Axial FLAIR and sagittal CSF DRIVE sequences CSF DRIVE sequences Axial FLAIR and sagittal analyses. quantitative for software spin-echo and axial CSF QF (fast aqueduct of Silvius, used to localise the were to used a sagittal PC angiography CSF PCA is analyses. the quantitative 2D) for visualise CSF fl that visualises the CSF circulation. data, with the creation of a CINE-RM qualitative using "smartbrain".The technique is optimised Conclusion: C - 7 0 R C EECR07-C-SciEduc-FIN.indd 137 Scientific and Educational Exhibits
have specifi c histopathological characteristics. These meningiomas show unusual and failed recanalization, respectively. In retrograde type, 1 (14%), 2 (40%), and 5 imaging fi ndings more frequently. The distinction between atypical and typical (36%) territories had cortical infarctions in complete, partial, and failed, respectively. meningiomas is clinically relevant, because benign tumors recur in about 7-20% In stasis type, 6 (100%) territories had cortical infarctions regardless of degree of of cases, where as atypical variants recur in 29-41%. Furthermore, the treatment recanalization. The degree of recanalization is signifi cantly correlated with follow-up is different in both cases. CT fi ndings in only antegrade type. Conclusion: Flow-pattern on superselective MCA angiography has signifi cant relationship with brain tissue recovery. Cases with antegrade fl ow-pattern would C-661 be a good indication for LRT. Epileptogenic structural disorders in pediatric patients: MR imaging characteristics A. Mallouhi, T. Gotwald, E. Haberlandt, G. Feuchtner, E. Trinka, S. Felber, C-664 D. Zur Nedden; Innsbruck/AT ([email protected]) Imaging spectrum of so-called meningeal disorders: MR imaging and pathophysiology of meningeal thickening Learning Objectives: 1. To provide an MR imaging overview of epileptogenic M. Hiratsuka, A. Kunimatsu, I. Anno, T. Ueda, M. Minami; structural disorders in pediatric patients. 2. To familiarize with the key MR fi ndings Tsukuba city Ibaraki-ken/JP ([email protected]) necessary to assist in rendering a diagnosis. Background: Epilepsy is a chronic condition that results from abnormal excessive Learning Objectives: To demonstrate the spectrum of variable meningeal abnormal activity of a population of cerebral neurons. Several brain structural disorders have fi ndings in MR imaging. To review traditional aspects of anatomy of extra-axial space been implicated in epilepsy in pediatric patients. and pathophysiology of meningeal thickening. To clarify enhanced pattern in MR Imaging Findings: In this exhibit, we illustrate a spectrum of brain structural imaging, any cases show dura-arachnoid pattern, others show pia-subarachnoid disorders encountered in MR imaging of pediatric patients with intractable epi- space pattern and any cases show both patterns. lepsy and their implications on treatment planning including cortical development Background: We frequently face variable meningeal abnormal fi ndings. In a lot abnormalities (focal cortical dysplasia, schizencephaly, heterotopia, polymicrogyria), of cases, we could detect only which locate in the extra-axial spaces. So we col- hippocampal sclerosis, vascular malformations, post-traumatic lesions, infections, lected some meningeal disorders locating focally or diffuse and showing abnormal tumors, neurocutaneousNo Material disorders (neurofiSubmitted bromatosis to EPOS I, tuberous sclerosis), and enhanced pattern in MR imaging. Some of which are characteristic and the others mitochondrial disorders. are extremely rare cases. Conclusion: Magnetic resonance imaging is the radiological method of choice Procedure Details:1. Anatomy of meninges 2. Pathophysiology of meningeal for the detection and characterization of parenchymal abnormalities that provoke thickening 3. Pictorial review of meningeal disorders : neoplasms, infection, infl am- epileptic seizures. Conventional and high-resolution MR signal characteristics assist mation, cerebrovascular diseases and miscellaneous changes. Case presentations in determining a specifi c diagnosis. include leukemia, meningeal carcinomatosis, skull metastasis, neurofi bromatosis, anaplastic meningioma, atypical oligodendroglioma, subdural empyema, bacterial meningitis, cryptococcal leptomeningitis, Erdheim-Chester disease infi ltrating to C-662 the subdural space, Letterer-Siwe disease, sinus thrombosis, post subarachnoidal Diffusion tensor imaging in the early stages of stroke can predict hemorrhage, post therapeutic states, CSF hypovolemia syndrome, etc. dysphage outcome Conclusion: Many of meningeal thickening are attributable to cell infi ltration, X. Wei, J. Dai, H. Shen, J. Ma, L. Ai, S. Li, X. Zhang; Beijing/CN some material collection and neoplastic changes. MR imaging enhanced pattern ([email protected]) sometimes suggests what the case is. To diagnose is diffi cult but MR imaging Purpose: To determine whether the degree of impairment of diffusion tensor imag- enhanced pattern shows many clues to the diagnosis, which bring us one step ing in the early stages of a stroke can predict the dysphage outcome. closer to the diagnosis. Methods and Materials: Twenty-fi ve unilateral hemispheric EPOS stroke patients were enrolled to this study. Diffusion anisotropy was measured by determining fractional C-665 anisotropy (FA) in the ROIs (region of interests) placed in the bilateral posterior limb Intraventricular brain tumors: A pictorial review of internal capsule (IC) during the early stages of stoke (average 7.3 days after stroke J. Sanchez1, P. Puyalto2, C. Majos1, C. Aguilera1, L. Aja1, J. Acebes1; onset) and compared with dysphage outcome 3 months after stroke onset. 1L'Hospitalet de Llobregat-Barcelona, 2Badalona/ES ([email protected]) Results: Seventeen patients with complete recovery were assigned to group one and 8 patients with persistent dysphage were assigned to group two. No signifi cant Learning Objectives: To describe the characteristic radiological features of intraven- difference in FA betweenNo Material the bilateral Submitted posterior limb to of IC in group one (p> 0.05). tricular tumours that may allow their appropriate recognition and precise diagnosis. However, FA of the bilateral posterior limb of IC in effect side was lower than that Background: Intraventricular neoplasms are uncommon; they represent only the of the intact side in group two (p < 0.05). 10% of all intracranial tumours. Due to their deep location within the brain, they Conclusion: The degree of impairment in diffusion anisotropy during the early usually have diffi cult surgical access and consequently more potential risks of stages of stroke appears to have the potential to predict dysphage outcome. complications and consequently imaging assessment previous to surgery is es- sential to evaluate the extension and location of these tumours. Imaging Findings: Imaging features of 173 patients with intraventricular tumours C-663 were retrospectively reviewed. They showed a wide spectrum of radiological appear- Flow-pattern on superselective middle cerebral artery (MCA) angiography ances that were non-specifi c, in many cases, making its differentiation diffi cult. The can predict tissue recovery after local recanalization treatment for location of the mass within the ventricular system and the patient’s age provided hyperacute MCA occlusion the most useful information, but other radiological features (calcifi cations, cysts, Y. Hori, H. Kiyosue, H. Mori, J. Kashiwagi, H. Nagatomi, Y. Sagara, S. Tanoue, bleeding or enhancement) were helpful too. MR is the best technique to assess M. Okahara, T. Asano, R. Shimada; Oita/JP ([email protected]) location and extent of the disease but in certain cases CT provides complementary Purpose: In hyperacute middle cerebral artery (MCA) occlusion, viability of brain evaluation of aspects such as calcifi cations or bleeding. tissue depends on the residual blood fl ow which could affect the outcome after Conclusion: Based on patient’s age, location of the tumour within the ventricles local recanalization treatment (LRT). The purpose of this study is to investigate and specifi c radiological features on MR, an accurate diagnosis can be made. whether superselective MCA angiography obtained prior to LRT could predict the recovery of ischemic brain tissue. C-666 Methods and Materials: Thirty-six patients having hyperacute MCA occlusion Regional gray and white matter volume abnormality in obsessive- (32 patients of M1 occlusion, 4 patients of M2 occlusion) without signs of cerebral compulsive disorder: A voxel-based morphometry study infarction on early CT underwent LRT. Pretreatment superselective MCA angiog- O. Togao, T. Yoshiura, F. Mihara, T. Noguchi, A. Hiwatashi, K. Yamashita, raphy via the microcatheter placed just distal to the occlusion site was executed to T. Nakao, M. Nabeyama, H. Honda; Fukuoka/JP ([email protected]) evaluate the fl ow-pattern in 60 (31 anterior trunks, 29 posterior trunks) of 68 trunks. The fl ow-patterns were classifi ed into three types: antegrade (n=28), retrograde Purpose: Several MRI studies have demonstrated gray matter (GM) volume (n=26), or stasis (n=6). The relationship between the degree of recanalization and abnormality in frontal-striatal-thalamic circuits in obsessive-compulsive disorder follow-up CT fi ndings in each fl ow-pattern was investigated. (OCD). No studies were found that showed white matter (WM) abnormality. The Results: Cortical infarction occurred in 28 of 60 trunk territories. In antegrade type, 3 purpose of this study was to assess both GM and WM volume abnormality in OCD (21%), 8 (73%), and 3 (100%) territories had cortical infarctions in complete, partial, patients using voxel-based morphometry (VBM).
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cant decrease of total choline and inositol cant decrease of total choline A Beijing/CN Twelve normal subjects were scanned with a 1.5 T MR normal scanned with a 1.5 subjects were Twelve We followed 18 patients receiving an external radiation radiation patients receiving an external 18 followed We Twenty normal lobe subjects and 11 patients with temporal Twenty It is possible to detect and to evaluate in vivo early metabolic effects early metabolic effects in vivo to evaluate to detect and It is possible The inferior and middle frontal gyrus may be related with semantic and middle frontal gyrus may The inferior To observe the time course of changes in the proton magnetic observe in the proton magnetic the time course of changes To The processing of Chinese may be different from alphabetic languages be different The processing of Chinese may Mapping of language and hand motor brain areas has become an impor- Mapping of language and hand motor brain There was a statiscally signifi a There was motor fMRI. min for language and 13 min for under 20 time was Table Bilateral superior temporal gyrus, left inferior and middle frontal gyrus superior gyrus, left inferior Bilateral temporal ([email protected]) ([email protected]) Purpose: in normal during therapy radiation (1H-MRS) values resonance spectroscopy tissue. human brain Methods and Materials: surgery brain underwent All of the patients primary 2 months. for gliomas for therapy bed and 20-50 54 or 60 Gy in tumour The patients received prior to the radiotherapy. single underwent Each patient normal hemisphere. Gy in the contralateral brain and just after the completion TE=30) before TE=135; (SVS, spectroscopy voxel chosen in the contralateral of interest were The voxels therapy. of the radiation normal and 50% isodose lines 30% hemisphere to meet an area between brain N-acetylaspartate (NAA), The metabolite concentrations: plan. in the radiotherapy lipids (Lip), inositol (Ins), choline compounds (Cho), creatine (Cr), lactate (Lac), and normalized concentrations glutamate and glutamine (Glu+Gln), their ratios ed with LCModel. verifi were The spectra calculated. were Results: The Ins/Cr ratios. and Cho/Cr, their normalized concentrations concentrations, not signifi were changes in the other metabolite concentrations Conclusion: in the normal tissue with the proton magnetic brain human therapy of radiation The cause of the observed changes is unclear and might resonance spectroscopy. composition related to the radiotherapy. of membrane be due to the alterations C-671 and hand motor areas with Whole brain real-time fMRI of language (PACE) movements acquisition correction for prospective Hosten; Domin, N. M. Kuehn, J. Langner, Zimmermann, S. C. ([email protected]) Greifswald/DE Purpose: assessed the We tant clinical application of fMRI in neurology and neurosurgery. movements acquisition correction for of real-time fMRI with prospective feasibility examinations. in routine clinical (PACE) Methods and Materials: An T (Siemens Symphony). at 1.5 examined tumors were epilepsy or intracerebral TSE and T2 T1 GRE, acquisition of anatomical used for 8-channel head coil was and letter-matching task alternated A semantic decision an EPI BOLD sequence. nger-tapping task of ten 30-s an alternating was fi paradigm The motor 24 s. every chosen as cut-off. A z-score of 4 was periods of activation. Results: C-669 in normal spectroscopy MR observedMetabolic changes with proton radiation therapy human brain tissue during Idasiak; A. Senczenko, W. Bobek-Billewicz, Zarudzki, B. L. C-670 input modalities different for processing of language Cerebral organization An fMRI study in Chinese: Shu; Xu, H. Y. Li, K. Yang, Y. Purpose: In this mechanism. also in the neural but such as English not only in the behavior the used to investigate imaging (fMRI) was functional magnetic resonance study, processing. mechanism of semantic information neural Methods and Materials: auditory there were modalities, semantic judgment According to different scanner. semantic judgment (WSJ) (ASJ), picture semantic judgment (PSJ), and word a white-black or saw When subjects heard a word in our experiment. involved it is dangerous or not and press decide whether must they picture/word, drawing and the baseline task employed design was A block the corresponding button. The fMRI data were a cross. listening to a pure tone or viewing passively was using the SPM2. analyzed Results: and left inferior occipital regions, Bilateral during the auditory activated were task. and left parietalmiddle frontal gyrus, associated with the processing regions were than task produced no more activation the word However, of all the visual stimuli. the picture task in the prefrontal area or the temporoparietal region, which were reported in similar studies on English. Conclusion: that It is showed regardless of the input modalities. processing of Chinese word mecha- more similar to pictures and the neural are to some extent Chinese words processing is similar to that of pictures. nism of Chinese words cant
cant at a voxel-level of cant at a voxel-level Santander/ES cant reduction of GM volumes in the cant reduction of GM volumes ed as: type A: the vein drains mainly drains the vein type A: ed as: rst evaluation of patients at the Emer- rst evaluation Scientific and Educational Exhibits Scientific and Educational ndings that showed WM volume abnormal- WM volume ndings that showed ([email protected]) ([email protected])
Nis/CS Subjects consisted of 23 outpatients with OCD and 26 of 23 outpatients Subjects consisted In a 5-year prospective study, we compared venograms compared venograms we study, prospective In a 5-year To show CT perfusion applications in CNS infections provid- CT perfusion applications in CNS infections show To 9 We have reviewed 27 studies performed at our department 27 studies performed for reviewed have We 3 dysfunc- studies implicating are consistent with previous ndings 1
d d CT is usually performed in fi CT is usually performed cant increase in GM volume. OCD patients demonstrated a signifi a demonstrated OCD patients cant increase in GM volume. n The BVR is more variable in patients with PNSAH than in those with in patients The BVR is more variable Our fi CT perfusion could be included as a complimentary technique in brain i . N I Etiology of PNSAH has not been determined. Venous source of bleeding of bleeding source Venous Etiology of PNSAH has not been determined. F In patients with PNSAH, we found type A in 28%, type B in 19% and type found In patients with PNSAH, we OCD patients demonstrated a signifi OCD patients demonstrated - c u d 0.05, corrected for multiple comparisons. multiple 0.05, corrected for E i
c < S - gency department as it discards possible lesions like tumors, hemorrhage or hemorrhage or tumors, gency department lesions like as it discards possible complimentary CT perfusion is a new technique frequently used hydrocephalia. technique. It is an easy and available of acute ischaemic stroke. in the evaluation a very importantIn addition, it provides that can be very functional information abscess lesions including cerebral diagnosis of several useful in the differential or herpetic encephalitis. Findings: Imaging abscess, brain 21 patients for of patients with suspected CNS infection. evaluation ring CTP showed abscess. and pyogenic in AIDS patients, Toxoplasma including reduced enhanced CT with oedema in contrast enhancing lesions with vasogenic increased CBV. have Tumors (CBV) in the lesion in CTP. volume blood cerebral In addition, CTP permits a better depiction of residual enhancement of partially virusThree patients of Herpes encephalitis showed Simplex ed lesions. calcifi in the chronic in the acute phase and hypoperfusion regional hyperperfusion are including fungal infections other 3 cases of other CNS infections Also, phase. described in our series. Conclusion: especially useful when useful funcional information, CT studies because it provides patients. noncollaborative or for MRI is not available bilateral medial prefrontal cortex (Brodman’s area [BA] 8/9), right premotor area (BA prefrontal cortex medial (Brodman’s bilateral (BA 46),6), right orbitofrontal cortex (BA 11), right (OFC) prefrontal corex dorsolateral found No region was to middle occipitall gyrus middle temporal (BA 19). and bilateral signifi to show tion of frontal cortex including OFC. Our fi tion of frontal cortex including OFC. anteriority in orbitofrontal region, limb of internal and anterior cingulated capsule, of frontal-striatal circuit. gyrusthe abnormality implicate would in pathways ing complimentary information especially useful for emergent diagnosis. emergent diagnosis. ing complimentary especially useful for information Background: CT perfusion usefulness in infectious diseases of CNS CT perfusion usefulness in infectious Valle, Flórez, N. Fernández A. Izquierdo, J. Marco de Lucas, E. Pellón, R. Blanco, G. Pelaz, Gutiérrez, M. Sánchez, A. E. González Mandly, A. Bañales, I. Torres; Arnáiz, M. Jordá, J. Ruiz, J. Martín-Cuesta, E. L. ([email protected]) Learning Objectives: C-668 C-667 and perimesencephalic nonaneurysmal subarachnoid variations Venous (PNSAH) hemorrhage Bosnjakovic; P. Stojanov, D.A. Purpose: of BVR in the tento- of the BVR with the drainage forms more primitive The ASAH. The in patients with PNSAH. found (type C in 53%) were rial sinuses or other dural found. structures PNSAH and abnormalityrelationship between was in venous has been implicated. Therefore, we examined venous variations in patients with variations venous examined we Therefore, has been implicated. PNSAH and aneurismal SAH (ASAH). Methods and Materials: The main trunk of the BVR could not be seen clearly in 4 C in 53% of venograms. present in with ASAH type A was In patients only unilaterally. found A was Type cases. Unlike VBR could not be seen in 4 patients. 38%, type B in 36%, and type C in 26%. in 24% patients with ASAH. found type A was patients with PNSAH, bilateral Conclusion: of 37 patients with PNSAH and 135 patients with ASAH. We examined possible possible examined We ASAH. of 37 patients with PNSAH and 135 patients with abnormalities structures, particularly in venous of Rosenthal in the basal vein classifi of were Anatomical variants (BVR). anteriorly and posteriorly it drains (uncal vein) (into type B: of Galen; into the vein Both other than the galenic system. into veins it drains type C: the galenic system); assessed. BVRs were Results: age- and sex-matched normal controls. Three-dimensional T1-weighed MR images T1-weighed Three-dimensional normal controls. age- and sex-matched used A statistical parametric was mapping approach obtained in all subjects. were signifi considered Findings were VBM. optimized to perform Methods and Materials: Methods and P Results: increase in WM volumes in the right anteriorWM volumes limb of internal right orbitofrontal capsule, increase in in the left found was reduction WM volume superiorregion, and bilateral frontal gyri. left anterior gyrus, fusiform cingulate gyrus and right cuneus. Conclusion: C - 7 0 R C EECR07-C-SciEduc-FIN.indd 139 Scientific and Educational Exhibits
In 19/20 subjects language lateralization and in 20/20 the hand motor area were high frequency, maybe linked to the consumption of specifi c fruit and derived tea identifi ed. Imaging was diagnostic in all patients. In all 17 right-handed subjects, from the annonaceae family. speech areas were mainly located in the left hemisphere. Two left-handed subjects Methods and Materials: Thirty-four clinical Gd-PSP underwent prospective brain showed different activation: one in the left and the other mainly in the right hemi- MRI studies, from December 2004 to September 2005. MRI evaluation was per- sphere. For the speech paradigm, 10 of the right-handed subjects showed right formed with a 1.5 T MR imaging (Philips intera), in the University Hospital Radiology hemispheric activation of the cerebellum. One of the left-handed subjects had left Department of Pointe-à-Pitre, Guadeloupe (France). The standard protocol included and the other right hemispheric cerebellar activation. 6 sequences: sagittal T1-weighted Turbo Spin-Echo, axial T2w TSE (3 mm slices), Conclusion: Real-time fMRI is a feasible technique for noninvasive mapping of Coronal T2w TSE (3 mm slices), Axial T2 * FFE, axial T2w FLAIR, axial proton- language and hand motor areas in clinical routine, providing reliable feedback of density. On each MRI, brain atrophy (cortical, subcortical, posterior fossa) and activation after 60 s of paradigm runtime. signals abnormalities (hypo or hyper signals on T2w images) of midbrain, pons and basal ganglia were respectively measured and evaluated. Each MRI was reviewed independently by two neuroradiologists. C-672 Results: Eight of 34 Gd-PSP MRI were not reviewable (motion artefacts). On the Susceptibility weighted (phase) imaging: Technique and clinical applications 26 exploitable cases, interobserver concordance of atrophy was good (p < 0.001). A. Rauscher, A. Deistung, H.-J. Mentzel, S. Witoszynskyj, J. Sedlacik, W.A. 80% had midbrain atrophy of which 32% presented a "hummingbird sign" on mid- Kaiser, J.R. Reichenbach; Jena/DE ([email protected]) sagittal T1w images. 75% had frontal atrophy. 19.2% presented an "état criblé" in Learning Objectives: To demonstrate magnetic susceptibility as a means of the basal ganglia, without "hummingbird sign". Two patients presented an unusual contrast in MRI. To describe data-acquisition and post-processing of susceptibility- tegmental T2 hyperintensity. weighted (phase) images (SWI). To recognize artifacts. To demonstrate the tech- Conclusion: Gd-PSP present a comparable or higher rate of midbrain atrophy nique in clinical cases and to compare it with standard MR imaging methods. than other PSP described in literature. The "état criblé" presented by some of these Background: Magnetic susceptibility is a physical property of tissue that infl uences atypical Parkinson’s syndromes may have an associated vascular origin. the MR-signal via the local precession frequency. Different blood-oxygenation lev- els, cerebral iron concentrations and many pathologies produce contrast in both C-676 magnitude and phase of gradient echo images. Correlation of auditory simple reaction time (aSRT) performance with Procedure Details: High resolution 3D fl ow compensated gradient-echo data are fractional anisotropy (FA) acquired at long TE. Matrix=512x256x36, TE/TR/alpha=40/60/25 at 1.5 T, TE/TR/ D. Güllmar1, S. Böhr1, J. Haueisen2, O.W. Witte1, W.A. Kaiser1, alpha=30/40/20 at 3 T. Phase images are unwrapped with either a homodyne fi lter J.R. Reichenbach1; 1Jena/DE, 2Ilmenau/DE ([email protected]) or a region-growing algorithm. The latter produces better results in magnetically inhomogeneous areas. The susceptibility-weighted MR phase images show a Purpose: Inter-individual variations in reaction time measures are barely inves- unique contrast independent of T1 and can be directly assessed and compared to tigated and the reasons and background of this phenomenon are still unclear. the corresponding T1/T2*-weighted magnitude images from the same scan. Mul- Studies propose that inter-individual differences in reaction time are due to tiplying masks computed from the phase with the magnitude produces susceptibil- physiological white matter differences, especially myelination; however, a proof ity-weighted images, which allow assessment of vascular architecture and function is still missing. Therefore, we aimed to fi nd a correlation between inter-individual (if acquired during hypercapnia and normoxia). SWI of Sturge-Weber syndrome, reaction time differences and fractional anisotropy (FA), which is known to show tuberous sclerosis, tumors, arteriovenous malformations etc. provides additional white matter differences. information that is not accessible by conventional imaging. Methods and Materials: Twenty-two healthy students (right-handed, age: 23.1 ± 0.7 Conclusion: Susceptibility-weighted MR (phase) imaging of the brain provides years) underwent an auditory simple reaction task based on the classic Poffen- valuable information at high spatial resolution. It facilitates detection of small le- berger paradigm. 8 blocks of 36 trials were conducted, preceded by 2 blocks of sions which may be missed by conventional methods. At 3 T acquisition time is 36 practice trials with an inter-block pause of 30-60 s. Whole head DTI was per- reduced to 4-5 minutes due to shorter TE and the option to use parallel imaging formed using TRSE-EPI sequence with an isotropic spatial resolution of 2 mm3. because of increased SNR. Voxel-based regression analysis was conducted between fractional anisotropy and inter-individual aSRT results. Results: Signifi cant negative correlation [pFWE (family wise error probability) = C-673 0.032] was found in the right-central cerebellum. Potent signifi cance was detected The effi cacy of fusion three-dimensional-computed tomography (3D-CT) with right-sided stimulus presentation and response. No signifi cant correlation was for following treated cerebral aneurysms by coil embolization observed, neither for left handed response nor left ear stimuli. M. Ishifuro, J. Horiguchi, Y. Kiura, K. Ito, T. Furukawa; Hiroshima/JP Discussion: Our results imply an association between fractional anisotropy in the ([email protected]) right-central cerebellum and aSRT measures. Presumably, the reason for this Purpose: Owing to metallic artifacts, vessels and coils cannot be observed in correlation is an infl uence of handedness on FA and aSRT. Since FA does not patients after coil embolization (CE) by CTA. Thus, the purpose of this study was characterize specifi c tissue properties but represents an index of WM integrity, to examine whether fusion CT could overcome this problem. the micro-structural/physiological basis of these fi ndings requires further research Methods and Materials: Ten patients underwent CE for cerebral aneurysm. CTA from which important insights into the mechanisms of behavioral performance was performed before CE, and plain CT was performed after CE. Two sets of 3D may be obtained. images were constructed with 3D image analyses software (Virtual Place, AZE). Postoperative 3D coil images were fused with preoperative CTA images in order C-677 to reduce artifacts due to the coils. We compared the coil locations on these fusion Axonal damage and infl ammation relationship by 1H-MRSI and T2- CT images to those on postoperative DSA. weighted MRI in early relapsing remitting multiple sclerosis: The effects of Results: All 3D fusion images with CTA and coils were successfully constructed. subcutaneously interferon beta-1a treatment Fusion CT could reveal postoperative fi ndings as accurately as DSA. Also, we could M.C. Martinez-Bisbal1, A.M. Pascual2, B. Martinez-Granados1, C. Valero2, evaluate the cases whose results were classifi ed as neck remnants. F. Coret2, I. Bosca2, L. Martí-Bonmatí2, B. Casanova2, B. Celda1; 1Burjassot, Conclusion: Fusion CT furnished as accurate information for postoperative fi nd- Valencia/ES, 2Valencia/ES ([email protected]) ings as did DSA; hence, it may be useful in predicting whether coil compaction will occur. Purpose: To examine the relationship between axonal damage in NAWM in brain- stem and infl ammatory activity in patients with early relapsing remitting multiple sclerosis (RRMS) and to assess the effects of interferon beta-1a (IFNB1a) on C-675 metabolic brainstem changes and parameters of infl ammation. Brain MRI of Guadeloupean patients suffering from progressive Methods and Materials: Sixteen RRMS patients treated with IFNB1a, twenty supranuclear palsy RRMS patients untreated and ten healthy subjects were prospectively studied for L. Giré1, A. Lannuzel2, D. Ben Salem1, P. Giré1, F. Ricolfi 1; 1Dijon/FR, two years. Relapse rate (RR) was calculated annually. T2-weighted MR and 1H- 2Pointe-à-Pitre/FR ([email protected]) MRSI were acquired at recruitment and at two years follow-up. T2-weighted lesion Purpose: To describe brain MRI features of Guadeloupean progressive supra- volume (T2LV) was measured. NAA, Cr and Cho resonances ratios were calculated nuclear palsy (Gd-PSP). In Guadeloupe, a french territory in West-indies, a cluster for the sum of the volume elements that represented the brainstem. Disability was of progressive supranuclear palsy-like taupathy has been reported with an unusual rated with EDSS and MSFC.
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7 0 0 2 . 2 ; 471 1 0 . ed into 2 112.02.2007 17:04:12 G cation (CCAC) (CCAC) cation , C. Aguilera , C. 1 Kusatsu,Shiga/JP, Kusatsu,Shiga/JP, 1 ; 0.26) and NAA/Cr ratio 0.26) and NAA/Cr ratio 2 ± H MRS) in diagnosis of H MRS) in diagnosis ([email protected]) ([email protected]) cation and the thickness of cation and the thickness 1
cant reduction of the mI/Cr ratio cant reduction of the mI/Cr ratio , R. Barranco , R. 0.1) and no signifi cant changes 0.1) and no signifi 1 ± , K. Murata , K. C 2 0.34 vs. 0.91 0.34 vs. circumference, of carotid wall 90 degrees BDEF ± < Badalona/ES 2 neurometabolic changes in patients with SHE. neurometabolic changes in patients with SHE. H MRS detection of metabolic abnormalities , A. Camins , A. 1 1
A 0.04 vs 0.29 were positioned in: 1)predominantly white matter positioned in: were ± 3 , S. Kitahara , S. 1 H MRS examination was performed using 1.5 T So- 1.5 using performed was H MRS examination in vivo ndings as follows: group 1: no calcifi cation or dot of no calcifi 1: group ndings as follows: 1 cits during standard neurological examination. The cits during examination. standard neurological in vivo We included to study 39 patients with the diagnosis of included to study 39 patients with We , C. Majos , C. Thirty-eight diffusion tensor MR who underwent patients 2 1 mm; group 2: 2: group 1 mm; The aim of this exhibit is to illustrate a wide spectrum is to illustrate of The aim of this exhibit < 0.5). , Y. Nakano , Y. 1 ± ([email protected]) ([email protected])
H MRS) detects ) scanner with SVS PRESS technique (TR=1500 TE=30 256ms, ms, 1 PCNSL is an uncommon aggressive form of extranodal non-Hodgkin of extranodal form PCNSL is an uncommon aggressive , P. Puyalto , P. CCAC could have an association with FA of the brain white matter. DTI white matter. of the brain with FA an association could have CCAC ( 1 .02). ([email protected]) ([email protected]) <
. On an FA map, ROIs were set on bilateral white matter (3 ROIs on each white matter (3 ROIs set on bilateral were ROIs map, On an FA . To evaluate the association between the cavernous carotid artery the cavernous association between the evaluate To SHE is a disorder of cognitive function in patients with liver cirrhosis, cirrhosis, patients with liver function in SHE is a disorder of cognitive cant reduction of mI/Cr ratio suggests an alteration of glial function. of glial function. suggests an alteration cant reduction of mI/Cr ratio < , A. Slowik, I. Ciecko-Michalska, M. Pasowicz, M. Irzyk, A. Szczudlik; Szczudlik; Irzyk, A. M. Pasowicz, M. Ciecko-Michalska, I. Slowik, , A. The number of patients in groups 1, 2, and 3 were 14, 8, and 16, respec- 1, 2, and 3 were of patients in groups The number Patients with SHE presented with signifi Patients , 3 mm section thickness, total: 50 sections. CCAC was classifi was CCAC 50 sections. total: mm section thickness, , 3 , K. Maeda , K. 2 ś 1 0.51 vs. 1.54 0.51 vs. Siemens ± cation, thickness thickness cation, L'Hospitalet de Llobregat-Barcelona, Otsu,Shiga/JP Purpose: white brain of the (FA) anisotropy using CT and fractional cation (CCAC) calcifi T MRI. matter using 3 Methods and Materials: within 1 of the brain T unit and CT examination using a clinical 3 imaging (DTI) by age 62 years; age, mean (23 men, 15 women; reviewed of each other were year echo planar sequence and at single-shot performed DTI was 15-90 years). range, of 1000 a b-factor applied along 15 directions with were motion probing gradients sec/mm calcifi of circumferential degree the by three groups CT fi cation based on the calcifi calcifi nata ( of 8 cm Three voxels acquistion). 1-2 mm thickness; group 3: 90-360 degrees around carotid circumference, 3 mm 3 circumference, around carotid 90-360 degrees 3: group mm thickness; 1-2 thickness calculated. were of each ROIs and FA center level hemisphere) at the semioval compared statistically. were grades and CCAC Mean FA Results: 0.411, 0.385, 0.353, respectively. was of the three groups FA The mean tively. 1 and group cant change between a signifi There was FA. Group 3 had the lowest 3 (p group Conclusion: risk of the white matter degeneration. discussing a relative might be useful for C-682 A pictorial essay system lymphoma: Primary nervous central Sanchez J.J. 1 C-680 artery carotid calcifi between the cavernous The association T MRI using 3 of the brain white matter (FA) on CT and fractional anisotropy Seko A. 2 C-681 ( spectroscopy resonance Quantitative magnetic (SHE) hepatic encephalopaty subclinical Bany R. Kraków/PL Purpose: daily affecting adversely only during neuropsychological examination, detectable defi and without any activity, The aim of the study was cirrhosis. up to 70% of patients with liver disorder affects to assess the usefulness of in brains of patients with SHE. in brains Methods and Materials: repeated spectroscopy In 15 patients with SHE we volunteers. SHE and 40 healthy out of 112 In control group, evaluable. 122 were Out of 140 spectrums, after 1 year. evaluable. 87 were spectrums, in the posteromedial parietal cortex, 2)predominantly gray matter in the posterior in the posteromedial parietal cortex, gray 2)predominantly calculated were Metabolite concentrations pallidus. occipital cortex, and 3) globus (mI), choline (Cho) and from myo-inositol Peaks software. using integral manually normalized with respect to the creatine-total (Cr) (NAA) were N-acetyl-asparatate Cho/Cr and NAA/Cr). peak (mI/Cr, Results: as compared to controls (0.126 The signifi Learning Objectives: of primary manifestations nervous lymphoma system usual and unusual central MR sequences in the accurate (PCNSL) and to highlight the role of CT and different diagnosis of this entity. Background: other of lymphoma in any lymphoma that originates in the CNS without evidence It represents 0.5-2.0% of primary malignant localization at the moment of diagnosis. spinal, and peripheral cranial, meninges, eye, brain, lesions of the CNS and affects Incidence during in immunocom- the last three decades has increased both nerves. between groups in Cho/Cr ratio (0.89 in Cho/Cr ratio groups between (1.46 Conclusion: , 2
cient in 9 years). A 9 years). ± , J. Sanjuan , J. 2 Beijing/CN SD 33
±
ammation. However, However, ammation. to EPOS to ([email protected]) ([email protected])
, L. Martí-Bonmatí , L. 1 Scientific and Educational Exhibits Scientific and Educational ammatory appears not suffi activity Valencia/ES 2 H MRSI one voxel in each hemisphere including H MRSI one voxel ltered voxels to form functional connectivity maps to form ltered voxels 1 MRS studies (1.5 T unit) were performed in 46 male and performed T unit) were MRS studies (1.5 Fourteen right-handed Chinese healthy college students Fourteen right-handed Chinese healthy , M.C. Martínez-Bisbal , M.C. 1
H MRS study in schizophrenic patients with and without in schizophrenic H MRS study No Material Submitted Submitted Material No 1 1 4 H MRSI) with 2 transversal slices (TR/TE 2700/272 ms, with a 2700/272 ms, slices (TR/TE H MRSI) with 2 transversal 1 1
d 11 years) and 22 control subjects (age mean and 22 control subjects 11 years) d ± n The biochemistry of inferior colliculus, involved with auditory path- involved The biochemistry colliculus, of inferior Axonal damage begins and progresses from early progresses Axonal damage begins and stages of MS and We conclude that the default endogenous analgesia functional network endogenous analgesia functional that the default conclude We i . Burjassot, Valencia/ES, Burjassot, Valencia/ES, N 1 I The aim of this work is to study the biochemical changes in inferior col- The aim of this work the biochemical changes in inferior is to study Functional connectivity provides the functionally related and connected Functional connectivity provides ; F The compelling similarity existed in the network of resting state before in the network of resting state before The compelling similarity existed Basal NAA/Cho ratio at brainstem was decreased in RRMS compared in RRMS compared decreased was at brainstem ratio Basal NAA/Cho Colliculus showed signifi cant reduction of the ratio NAA/Cr in both hemi- cant reduction of the ratio signifi Colliculus showed 1 - c SD 41 u ± d E i c S H MRS imaging ( - B. Celda B. 4 female schizophrenic patients (33 hallucinators and 17 not hallucinators, age hallucinators and 17 not hallucinators, patients (33 schizophrenic 4 female mean Purpose: right-handed in chronic schizophrenic in auditory pathway liculus that is involved adult patients with and without auditory hallucinations. Methods and Materials: C-679 in of acupuncture analgesia effect The functional connectivity study human brain Yang; Ai, L. Zhen, L. Z. Chen, Qin, P. W. Tian, Dai, J. Chen, J. H. ([email protected]) Purpose: used functional con- We regions. among interdependence of brain information nectivity MRI analysis to detect if there is a functional network associated with the of endogenous analgesia. effect Methods and Materials: functional MRI two performed were in the age of 22-26 years] [7 male and 7 female a resting state lasting for One was scanner. Trio T Siemens using 3 examinations acupuncture needle minute during performed a 3 and the other was minutes 15 These two steady states scan. minutes 15 by manipulation on the ST36 followed The preprocessed using SPM2. All data were runsminutes. had an interval of 30 cross- The seed timecourse was chosen as the ROI. was area left side amygdala fi correlated with all other low-pass exists in human brain at a low level, and it could be increased to a higher level by by increased to a higher level and it could be level, at a low in human brain exists acupuncture modulation. for each subject. Finally to compare the difference of resting state connectivity Finally to compare the difference each subject. for a paired Student t-test was and the resting state connectivity after acupuncture, implemented across subjects. Results: found networks was the two between The main difference and after acupuncture. and cerebellum. in the limbic system, brainstem Conclusion: region of interest 110x100x23 mm) was localized including the basal ganglia and localized region of interest 110x100x23 mm) was In the analysis of hippocampus. 1 C-678 pathway Auditory reducing neuroaxonal damage in a short-term study. Longer periods of observa- in a short-termreducing neuroaxonal damage study. ndings. rm preliminary these fi tions are needed to confi with controls. After follow-up, there was a decrease in NAA/Cho (-9%) and NAA/Cr (-9%) and NAA/Cr a decrease in NAA/Cho was there After follow-up, with controls. Patients without changes in controls. RRMS, increased (18%) in T2LV (-15%) while NAA/Cho corre- NAA/Cho at follow-up. lower showed with more than one relapse NAA/Cho between found correlation was an inverse At follow-up, lated with EDSS. RR (annual in reducing disease activity effective IFNB1a was (p=0.008). T2LV and metabolic (all RRMS suffered axonal damage in delaying ineffective but T2LV) and decrements). Conclusion: of infl evidence and radiological has been related with clinical Results: the stabilising effect of IFNB1a on infl the stabilising effect the inferior colliculus was selected for quantitative analysis. jMRUI program was was program jMRUI analysis. quantitative selected for colliculus was the inferior among peak areas of NAA, Cr and Cho in Relations multivoxel. used to analyze SPSS 12.0 in each region. groups compared among colliculus were the inferior statistical analysis. used for was program Results: In the compara- patients compared with control subjects. spheres in schizophrenic by of NAA/Cr followed the smallest value showed hallucinators tion among groups The comparison types of schizophrenic of the two not hallucinators and controls. this localtion. in cant differences signifi patients did not show Conclusion: In this patient with auditory could be altered in schizophrenic hallucinations. way, control and schizophrenic between metabolic differences MRS has shown study, among hallucinators cant differences signifi without any patients in these areas, and no hallucinators. auditory hallucinations Martínez-Granados B. C - 7 0 R C EECR07-C-SciEduc-FIN.indd 141 Scientific and Educational Exhibits
promised and immunocompetent hosts between 45-60 years old and has become C-685 the fi rst brain tumour in patients with the acquired immunodefi ciency syndrome. Differentiation of intracranial tumors by using perfusion and diffusion- Imaging Findings: CT and MR show, mostly, an isolated mass involving deep grey weighted MR imaging matter, periventricuar regions and corpus callosum with or without surrounding T. Gerukis, H. Karatziou, K. Koutroumanidis, K. Anastasiadou, V. Kalpakidis, edema. After contrast injection, the tumour may enhance diffusely and densely or P. Palladas; Thessaloniki/GR in its periphery (ring enhancement) if central necrosis is present. If perivascular spaces or meninges enhance as well, the diagnosis of PCNSL should be strongly Purpose: To determine whether perfusion and diffusion-weighted MR imaging considerated. Calcifi cations or bleeding are rarely seen. Surrounding edema and could be useful to differentiate intracranial tumors based on their differences in multifocal lesions are more frequently seen in immunocompromised patients. vascularity and water molecular mobility. Conclusion: Due to new therapeutical strategies, the outcome for patients with Methods and Materials: Thirty-seven patients with a solitary brain tumor underwent PCNSL is rapidly improving in recent years; although the fi nal diagnosis relies on conventional, diffusion-weighted and contrast-enhanced perfusion MR imaging stereotactic biopsy demonstrating lymphomatous cells, the radiologist plays an before being surgically treated or undergoing a stereotactic biopsy. Twenty-one important role in the noninvasive diagnosis of PCNSL thanks to the imaging fi ndings patients presented with gliomas, 11 with metastases and 5 with intracerebral provided by CT and the combination of different MR sequences. localization of haematological malignancies (3 non-Hodgkin lymphomas and 2 acute lymphogenic leukaemias). Calculations were made of the same areas in C-683 the CBV and ADC maps. The paired Student t-test was used to determine if there was a statistically signifi cant difference in CBV and ADC values between gliomas, Prospective study of two imaging protocols in patients with acute stroke in metastases and intracranial lymphomas. a developing country Results: The measured CBVs in the peritumoral region of gliomas and metas- R.D. Langer, H. Obaid Al Kaabi, K.F.W. Neidl van Gorkom, J. Czechowski, tases were 6.93±4.39 (mean±SD) and 2.39±1.18, respectively - the difference is F. Torab, M. Nagi, M. Ashish; Al Ain/Abu Dhabi/AE ([email protected]) attributed to the presence of peritumoral neoplastic cell infi ltration. This difference Purpose: To assess the detection rate of acute stroke in two groups: Group 1 with was statistically signifi cant. There was no statistically signifi cant difference between unenhanced early cranial computed tomography (CCT), prospective group 2 with ADCs (of tumor or peritumoral edema) to distinguish metastases (1.16±0.32 and multimodality CCT with perfusion studies. To compare early CCT with the defi nite 1.47±0.25, respectively) from gliomas (0.91±0.33 and 1.37±0.19, respectively). infarction size on follow-up (FU) CCT. Intracranial lymphomas showed a signifi cantly low CBV (2.63±1.48) compared Methods and Materials: Unenhanced CCT of 50 patients with acute stroke were to other brain tumors. evaluated retrospectively, using the Alberta Stroke Program Early CT Score (AS- Conclusion: Distinction between primary and secondary intracranial tumors, PECT), and compared with the defi nitive infarction size on FU-CCT. Fifty patients as well as differentiation from intracranial lymphomas, could be based also on underwent multimodality CCT< 8 h after clinical onset, including CBF, CBV, MTT. perfusion MR imaging besides the conventional MR imaging. On the contrary, dif- FU-CCT> 48 h served as the 'gold standard', and mNIHSS for clinical assessment. fusion-weighted MR imaging was not proved useful in determining the presence The AAMD Human Research Ethics Committee approved the research project. of peritumoral neoplastic cell infi ltration. Results: Group 1 included 38 males, 21-92 y, and 12 females, 41-80 y, with clinical onset 2-8 h before CCT; mNIHSS was 0-28. Group 2 also included 38 males, 27-81 C-686 y, and 12 females, 25-78 y. Onset of symptoms was 3-8 h before CCT, mNIHSS was Correlation of cerebral blood volume and apparent diffusion coeffi cient 0-28. Sensitivity in group 1 was 58.3%. Detection of small ischemias in the basal values of brain tumors ganglia was particularly poor. Multimodality CCT in group 2 showed true positive T. Gerukis, H. Karatziou, H. Hatzigeorgiou, A. Petridis, V. Kalpakidis, P. Palladas; results in 32 of 50 cases, and false negative in 6 of 50 cases, with a sensitivity of Thessaloniki/GR 84.2%. CT angiography was helpful in selected cases for detection of intracranial stenoses/occlusions, but limited by motion artifacts. Nine occlusions/stenoses of Purpose: To explore the following hypothesis: When the cellularity (tumor) of a tissue the intracranial arteries were diagnosed. is being raised (expressed by a decrease of the ADC value), the neovascularization Conclusion: Multimodality CCT is superior to unenhanced early CCT for detec- of the tumor is also being raised (expressed by the increase of the CBV value). tion of acute cerebral ischemia, and should serve as a basic diagnostic tool for Methods and Materials: Twenty-nine patients with a previously untreated solitary establishing local stroke units. brain tumor underwent conventional and both diffusion-weighted and contrast-en- hanced perfusion MR imaging. Seventeen patients presented with gliomas, 8 with C-684 metastases and 4 with intracerebral localization of haematological malignancies. The average of the ADC and CBV values was calculated and compared in all the Imaging of the central skull base: Anatomic study above-mentioned areas. I. Pérez1, M. Aperribay1, G. Benito1, I. Terreros2, A. Dolado2, J. Mendiola2; Results: The measured mean CBV values of the enhancing portion of gliomas 1Mondragón/ES, 2Baracaldo/ES ([email protected]) and metastases were 12.51 (±7.65) and 9.87 (±6.41), respectively. The mean rCBV Learning Objectives: To review the anatomy of the skull base including the skull- values in the immediate peritumoral area of gliomas and metastases were 6.93 base foramina and their content, the osseus anatomy of the pterygopalatine fossa, (±4.42) and 2.39 (±1.19), respectively. The measured mean ADC values of the and the sutures and boundaries of the skull base. After reading this exhibit, the enhancing portion were 0.91 (±0.33) for gliomas and 1.16 (±0.32) for metastases. reader will be able to understand the complex anatomy of the skull base, to ac- The mean ADC values in the peritumoral area of gliomas and metastases were curately delineate phatologic processes, and to understand the spread pathways 1.37 (±0.19) and 1.47 (±0.25), respectively. of different lesions involving this complex region. Conclusion: Intracranial tumors exhibit a widely inhomogenous appearance. As far as Background: The radiologist requires a thorough knowledge of the normal anatomy it concerns the solid part of the tumor and the immediate peritumoral edema of both and the pathologic spectrum of the skull base. Imaging plays a central role in the gliomas and metastases, although an exact correlation does not exist, an increase of management of skull-base disease, because this region is, in general, inaccessible to about 30% of the CBV value corresponds to a 10% decrease of the ADC. Exception- clinical evaluation. CT is ideal for outlining the bone architecture, whereas MR imaging ally, the lymphomas were found to have low values for both ADC and rCBV. provides soft tissue details. The pterygopalatine fossa represents a major pathway of spread of malignancy and infection from the head and neck into the skull base. C-687 Imaging Findings: A pictorial review of the skull base with foramina and their MR imaging of malformations of cortical development: A pictorial review content (foramen ovale, rotundum, spinosum, lacerum, yugular foramen, and carotid L.B.O. Jans, K. Deblaere, S. Dekeyzer, T. De Groote, V. Meersschaut, canal), the pterygopalatine fossa and its boundaries, and the sutures of the skull E. Achten; Gent/BE ([email protected]) base (occipitomastoid, sphenosquamous, petrosphenoid fi ssure, petrooccipital fi ssure, pterygomaxillary fi ssure) is provided. Learning Objectives: 1) To review the recent classifi cation of malformations of Conclusion: Familiarity with the complex anatomy of the skull base is a prereq- cortical development. 2) To describe and illustrate the MR imaging fi ndings of uisite for the correct diagnosis and accurate delineation of skull-base lesions. CT malformations of cortical development on 1.5 T and 3 T. and MR imaging are complementary modalities and are often used together to Background: Cortical malformations are being increasingly recognized as a sig- demonstrate the full disease extent. nifi cant cause of developmental delay, focal neurological defi cit, refractory epilepsy and mental retardation. Many of these malformations are present in the neonatal period or infancy. Proper diagnosis and rational classifi cation of these disorders are essential for prognosis, genetic testing and counseling, and investigation of
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EECR07-C-SciEduc-FIN.inddCR07-C-SciEduc-FIN.indd 114242 112.02.20072.02.2007 17:04:1217:04:12 2 1 : 4
Neuro 0 : 7 1
7 0 0 ow 2 . 2 473 0 . ndings 2 112.02.2007 17:04:12 G lter was used lter was in the entire brain ow cantly elevated in white cantly elevated to be observed distribution ow .05). There were no signifi cant no signifi There were .05). ([email protected]) ([email protected]) <
C BDEF Seoul/KR .05). After HD, the Cho/Cr ratio was signifi - signifi was the Cho/Cr ratio After HD, .05). < Seoul/KR ([email protected]) Seoul/KR ([email protected]) A Subjects comprised 15 CRF patients undergoing HD and To cover the entire brain, scanning was performed several several performed scanning was the entire brain, cover To cant elevation of the Cho/Cr ratio in gray matter and the in gray of the Cho/Cr ratio cant elevation To demonstrate the various CT and MR imaging fi various the demonstrate To ([email protected]) ([email protected])
The CT and MR images of histologically proven or clinically images of histologically proven The CT and MR Recently, cerebral amyloid angiopathy (CAA) has attracted atten- (CAA) has attracted angiopathy amyloid cerebral Recently, The signifi Three-dimensional CT perfusion permits fl blood The usual presentation of cerebral amyloid angiopathy is spontaneous angiopathy amyloid of cerebral The usual presentation To evaluate cerebral metabolite patterns with proton MR spectroscopy metabolite patterns cerebral with proton MR spectroscopy evaluate To CT perfusion functional evaluation is a promising method for evaluating evaluating is a promising method for CT perfusion functional evaluation In CRF patients, the Cho/Cr ratio and Myo/Cr ratio were signifi cantly signifi were ratio and Myo/Cr the Cho/Cr ratio In CRF patients, Evaluation of this new display method for CT perfusion studies showed that CT perfusion studies showed method for display of this new Evaluation ow in patients with cerebral ischemia. The conventional method suffers from method suffers The conventional ischemia. in patients with cerebral ow ndings such as cortical petechial hemorrhage and subcortical or deep white matter cantly reduced in white matter of CRF patients (p and laboratory each each metabolic ratio data, and between correlation between of HD. and duration metabolite ratio Conclusion: to be evaluated stereoscopically. This method fully exploits the advantages of a the advantages This method fully exploits stereoscopically. to be evaluated to gain widespread acceptance and is expected of CT detector rows larger number method. CT perfusion imaging technique and display as a useful new to minimize the exposure dose. For image processing, several data series were processing, several image For dose. the exposure to minimize of whole- This technique permits display multiplanar into a single series. bundled method. with the conventional which is not possible ow, fl blood brain Results: fl permits blood the cerebral three-dimensional display ischemic areas it easier to visualize This method makes desired direction. from any method. CT perfusion display useful as a new to prove and is expected Conclusion: blood fl blood The present study was is restricted. the limitation that the area that can be evaluated fl of blood the distribution evaluating method for display conducted to assess a new reconstruction. imaging and multiplanar combining whole-brain by in the brain Methods and Materials: reduced from 8 mm to 2 mm, and the number times with the scan slice thickness used in combination to Saline solution was of scan slices increased from 4 to 16. and a quantum denoising fi medium, of contrast reduce the volume Purpose: (CRF) undergoing hemodialysis (HD) and to clarify (MRS) in chronic renal failure of HD. ndings correlate with duration if these fi Methods and Materials: proton MRS and laboratory TE (=32 Shortms) single voxel volunteers. 15 healthy Spectra after HD. HD and one day acquired in CRF patients before data were and white matter of interest positioned in the gray voxels obtained from two were Changes in N-acetylaspartate (NAA), choline (Cho), myoinositol of parietal lobe. and analyzed (Glx) and creatine (Cr) were glutamine/glutamate complex (Myo), and Metabolic ratios with Cr as the reference. the results presented as ratios, each between Correlations compared. and after HD were laboratory before data and dura- and laboratory ratio each metabolic metabolite ratio data, and between evaluated. tion of HD were Results: signifi was ratio matter and the Myo/Cr in gray elevated matter compared with controls (p and pathogenesis of cerebral amyloid angiopathy. amyloid and pathogenesis of cerebral Background: (ICH), ischemic lesions, hemorrhage to cerebral its close relationship tion for Most com- other types of dementia in the elderly. disease (AD), and Alzeheimer’s isolated or multi-compartmental is massive mon presentation of CAA intracranial in association with subacute or chronic edematous found it is also but hemorrhage, with or without CAA-related hemorrhage. lesion of the white matter Details: Procedure describeddiagnosed CAA were or petechial hemorrhage), with regard to type (lobar and presence or absence of white hemorrhage location, and relapse of cerebral with pathogenesis of these lesions. matter change (leukoencephalopathy) Conclusion: especially in those patients more than lobar hemorrhage in the elderly patients, imaging presents various angiopathy amyloid cerebral However, of age. 70 years fi hemorrhage. change with or without cerebral Purpose: C-692 in MR spectroscopy of cerebral metabolite patterns with proton Evaluation Correlation with duration of hemodialysis renal failure patients: chronic Kim; G. Lee, Y. Yu, Baik, H. Kim, H. S.E. C-690 angiopathy amyloid spectrum of cerebral Imaging Kim; B.-S. Jung, Ahn, S. Kim, K. J. Learning Objectives: C-691 Yamana; Whole-brain three-dimensional CT perfusion D. Wada, K. Yoshimoto, Y. Suzuki, K. Ono, K. Yuba, K. Meguro-ku,Tokyo/JP - - cance 0.36×10 0.08×10 ± ± ight MR angiography. ight MR angiography. ndings is essential for ndings is essential for 0.05). Furthermore, an FA map can Furthermore, an FA 0.05). < Scientific and Educational Exhibits Scientific and Educational ([email protected]) ([email protected])
c anatomic variations in CoW may infl uence infl in CoW may c anatomic variations cance (P cance ed by MR imaging. We present a pictorial review of a pictorial present review We imaging. MR by ed 0.05). The distinction of ADC values between tumor tumor between The distinction of ADC values 0.05). cation and the MR imaging fi < /s) and solitary metastases (ADC values, 2.38 /s) and solitary metastases (ADC values, 2 Taiyuan/CN Thirty term MRI with stan- neonates with HIE underwent Twenty-nine patients were enrolled in this study, and they and they enrolled in this study, were patients Twenty-nine mm -3 3 The classifi cation scheme of malformations of cortical scheme of malformations cation devel- The classifi 4 1
London/UK
d d n The presence of specifi Current MR imaging techniques can clearly Current MR imaging techniques the mor- demonstrate The ADC values of the lesion core aid the differentiation between between of the lesion core aid the differentiation The ADC values 0.25×10 i . ± N I To determine the value of diffusion-tensor imaging in differentiating in differentiating determine of diffusion-tensor imaging the value To Hypoxic-ischaemic encephalopathy (HIE) in term neonates is charac- encephalopathy Hypoxic-ischaemic F The CoW was complete in 50% of infants. BGT or WM lesions occurred BGT or complete in 50% of infants. The CoW was Abscesses showed restricted diffusion (low ADC values, 0.76 restricted ADC values, diffusion (low Abscesses showed cation can be identifi cation - uence of the anatomic variations of the Circle of Willis on white of of the Circle uence of the anatomic variations c u /s) showed unrestricted diffusion. Abscess could be diagnosed by the low the low could be diagnosed by Abscess unrestricted diffusion. /s) showed /s) in their lesion core, whereas the central portion whereas the central glioma (ADC /s) in their lesion core, of high-grade d 2 2 0.05). In patients with brain tumors, contrast FA values from perifocal edema from perifocal values FA contrast tumors, In patients with brain 0.05). E i < c S mm mm - dard structural3D time-of-fl sequences and high-resolution The infl lesions in term neonates with hypoxic matter and basal ganglia ischaemic encephalopathy ischaemic Fitzpatrick, J. Allsop, Counsell, J. Malamateniou, S. C. Adams, M.E. Rutherford; M.A. Purpose: (BGT) and white matter (WM). lesions within the basal ganglia, thalami terised by the distribution an association between shown studies in adults have Previous WM Willis (CoW) and the presence of of the Circle of of the anatomic variations to determine of the CoW The aim of this study was whether the anatomy lesions. and location of these lesions. severity uenced the incidence, infl Methods and Materials: The presence completeness and anatomical variations. for examined The CoW was graded were noted and the lesions WM and BGT lesions were of and distribution ned criteria. according to predefi Results: In those in 9 and mild in 5 infants. changes in 7, moderate with severe in 21 infants, incomplete CoW and 5 of these had an absent anterior 6 had changes, with severe in the study with absence of both The only 2 infants artery communicating (A-Com). The anatomy anterior and posterior arteries changes. communicating severe had uence the location of the lesions. of CoW did not infl Conclusion: with in- Infants with HIE. WM or BGT lesions in infants of ischaemic the severity a following perfuse the brain limited ability to adequately have complete CoW may lesions. present with more severe therefore insult and hypoxic-ischemic C-689 comprised high-grade glioma (n=16), abscess (n=5) and solitarycomprised high-grade metastasis (n=8) ring solitary on contrast-en- enhancement which showed with intracranial lesions, a Siemens with performed were All MR examinations images. T1-weighted hanced values Mean ADC and FA of echo-planar imaging. T imager capable Sonata 1.5 edema, and corresponding perifocal the lesion core, from the lesion substance, normal-appearingcontralateral measured. regions were Results: 2.62 values, Purpose: glioma and solitary high-grade metastasis. abscess, Methods and Materials: Diffusion tensor magnetic resonance imaging in ring-enhancing in ring-enhancing resonance imaging Diffusion tensor magnetic cerebral lesions Su; Zhang, J.S. H. Shi, L. C-688 the underlying molecular causes. Findings: Imaging opment is based on whether these disorders are the result of abnormal on whether these disorders opment is based neuronal abnormal or abnormal or apoptosis, neuronal migration, and glial proliferation this system Characteristics with and enforce that correlate cortical organization. of classifi and genetic counseling. therapy prognosis, proper diagnosis, the MR imaging features of malformations of cortical development with 1.5 and of cortical of malformations the MR imaging features development T MR virtopsy imaging. including 3 T MR imaging, 3 Conclusion: The of cortical of malformations and extent development. distribution phology, understanding of the classifi display the detailed relationship between tumors and nearby white matter tract. tumors and nearby relationship between the detailed display Conclusion: Solitary metastases could be distinguished from high-grade tumor and abscess. the maps can display FA edema. from perifocal ADC values their high glioma by white matter tract. nearby tumors and detailed relationship between ADC values in their lesion core, but ADC values were not effective for distinguish- for not effective were ADC values but in their lesion core, ADC values tumor types (P ing different edema regions in solitaryand perifocal metastasis reach statistical signifi (P decreased, the dif- of the normal were the former side, parenchyma with cerebral the statistical signifi attained ference 3 3 C - 7 0 R C EECR07-C-SciEduc-FIN.indd 143 Scientific and Educational Exhibits
Myo/Cr ratio in gray and white matter was found in CRF patients compared with histologic diagnosis of meningioma were studied in our center, 23 (9.3%) were controls. There was no signifi cant correlation between cerebral metabolite ratios atypical and 6 (2.4%) malignant. We reviewed the CT and MRI fi ndings of these and overall time of HD. 29 patients with pathologically confi rmed atypical and malignant meningioma diag- nosed. We illustrate different appearences of atypical and malignant meningioma. Pitfalls, diagnostic diffi culties and differential diagnoses are emphasized. C-693 Conclusion: After interacting with this exhibit the radiologist will improve his or Imaging fi ndings of CNS infections her knowledge of atypical and malignant meningioma, including histopathology B.R. Foerster1, M. Petrou1, P.C. Sundgren1, M.M. Thurnher2; 1Ann Arbor, MI/US, and radiologic features. 2Vienna/AT ([email protected]) Learning Objectives: 1. To describe and depict CNS infections within the dif- C-696 ferent compartments of the brain. 2. To illustrate characteristic imaging fi ndings 11C-sodium butyrate-PET in neurooncology attributable to specifi c pathogens. 3. To demonstrate infectious etiologies specifi c N.A. Kostenikov, L.A. Tyutin, N.P. Fadeev; St. Petersburg/RU ([email protected]) to immunocomprised and HIV patients. Background: Localizing a lesion within the intracranial compartment is the fi rst Purpose: The aim of the study was to determine the potential in diagnosis of pathologi- critical step in constructing a differential diagnosis. Furthermore, certain types of cal volume brain formations (PVBF) by PET with 11C-Sodium Butyrate (11C-SB). infections have certain propensities for different anatomical regions within the brain Methods and Materials: PET was performed in 143 patients (74 men and 69 and can possess certain imaging characteristics. Of course, the imaging fi ndings women, at the age of 18-79 y.o). to identify tumors or to exclude an advance growth must be placed in the context of the clinical setting particularly in immunocomprised of tumors. According to the results of histological data, malignant tumors were and HIV patients. revealed in 77/143 patients, benign tumors in 28, arterial venous malformations Imaging Findings: We present a pictorial review of infections within different (AVM) in 12, stroke diseases (SD) in 4, and cysts in 22. 2D-PET scans of the brain compartments of the brain. Pathology proven infectious cases will be presented in with attenuation correction («Ecat Exact 47 HR+», Siemens) were performed in a both immunocompetent and immunocompromised patients with discussion of the dynamic mode immediately after intravenous administration of 550-650 MBq 11C- characteristic fi ndings of each pathogen and differential diagnosis. SB. We used tumor/normal tissue ratio (T/NT) as an index for semiquantitative data Conclusion: The radiologist plays a crucial role in identifying and narrowing analysis, as well as analysis of activity/time curves. the differential diagnosis of CNS infections. A thorough understanding of the Results: Results of the studies showed PET with 11C-SB proved to be a highly intracranial compartment anatomy and characteristic imaging fi ndings of specifi c sensitive (94.8%) technique in revealing brain tumors and it allowed to visualize pathogens as well incorporating the clinical information is essential to arrive at clearly malignant and hypervascular benign tumors and to differentiate them from the correct diagnosis. non-tumor masses of the brain. Dynamic 11C-SB-PET allows to assess the grade of vascularity, the level of metabolism, the rate of uptake and utilization of fatty acids (FA), and to estimate indirectly the state of tumors oxygenation. C-694 Conclusion: The performed studies showed that dynamic PET with 11C-SB allows to Diagnostic opportunities of H+MRS and SPECT in patients with temporal visualize precisely malignant brain tumors and estimate their morphological state; the epilepsy latter is of prognostic value in order to plan conservative therapy for brain tumors. V.A. Pozdnyakova, A.N. Yalfi mov, V.R. Kasumov, N.E. Ivanova, V.P. Bersnev, A.V. Pozdnyakov; St. Petersburg/RU ([email protected])
+ C-697 Purpose: To reveal the metabolic and vascular disturbances according to H MRS Susceptibility-weighted imaging (SWI) with 3-Tesla in acute ischemic and SPECT data in patients with focal epilepsy. stroke: Preliminary results + Methods and Materials: H MRS and SPECT were carried out in 25 patients (from Y. Kanasaki, S. Fujii, S. Sugihara, E. Matsusue, J. Nakanishi, E. Yamashita, + 17 to 55 years old) with signs of polymorphic epileptic fi ts. H MRS and SPECT T. Tanaka, T. Ogawa; Yonago/JP ([email protected]) results were compared with EEG data. Results: Cholin (Cho), creatin (Cr) and N-acetylaspartate (NAA) concentrations Purpose: To assess the fi ndings of susceptibility-weighted imaging (SWI) with were examined in symmetrical hippocampus. One-side changes of metabolic 3-Tesla in acute ischemic stroke. concentrations were revealed in 14 (56%) patients, bilateral in 6 (24%) patients. Methods and Materials: Twenty patients underwent CT and MR imaging with SWI, These fi ndings correlated with EEG data. In 5 (20%) cases there were no diffusion-weighted imaging (DWI), and 3D-TOF MRA within the fi rst 5 days after abnormalities in H+MRS. The following metabolites concentrations ratio was the onset of acute ischemic stroke. The SWI sequence is a high-resolution three- identifi ed: in epileptic focuses (according to EEG data) - NAA/Cho=0.94±0.14, dimensional (3D) imaging technique with 3-Tesla. The susceptibility changes by the NAA/Cr=0.92±0.12, in contrlateral side - NAA/Cho=1.86±0.47, NAA/Cr=1.26±0.18. intraarterial clots or emboli, hemorrhage, and the enhancement of the regional vein SPECT in 15 (60%) patients revealed areas of hypoperfusion in temporal lobe, in the abnormal perfusion area of the brain were assessed on SWI. asymmetric perfusion of hippocampus. These changes correlated with EEG data Results: The intraarterial susceptibility changes by the fresh clots or emboli were that permitted and clearly locate the epileptic focus. In 8 (32%) cases, there were visible on SWI in 8 cases. SWI showed distal clots or emboli that were invisible on diagnosed aperfused areas with perifocal hypoperfusion. 2 (8%) patients did not both of MRA and fl uid attenuated inversion recovery (FLAIR) images in 6 cases. have any signs of perfusion's changes. The hemorrhagic infarction occurred in 5 cases. The hemorrhage was shown on Conclusion:Our results demonstrate the clear correlation of metabolic and local SWI earlier than on CT image in each case. The enhancement of the regional perfusion changes in medio-basal areas of affected temporal lobe in patients vein in the abnormal perfusion area of the brain was shown in 6 cases on SWI. All with focal epilepsy. of them were within 2 days after the onset of acute ischemic stroke. Five of the 6 cases were embolic infarction cases of the MCA territory. Conclusion: SWI is an effective means that can provide additional information C-695 about the fresh intraarterial clots, hemorrhage, and the perfusion anomaly in the Meningioma: What happened is not typical? A pictorial review brain in acute ischemic stroke. E. Fandiño, P. Calvo, R. Juarez, F.I. Camacho, J.M. García-Benassi, R. González; Toledo/ES ([email protected]) C-698 Learning Objectives: To describe the characteristic imaging appearences of atypi- Spontaneous intracranial hypotension syndrome: MR fi ndings and cal and malignant meningioma with histologically proven diagnosis. To illustrate image gallery radiologic feature of usual and unusual appearence of atypical and malignant P. Pastore, F. Murgante, D. Volpe, A. Stecco, M. Pancari, A. Carriero; Novara/IT meningioma on Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) and histopathologic correlation. Learning Objectives: The purpose of the work is to teach the most common MR Background: Meningiomas are the most common primary intracranial tumors in fi ndings of spontaneous intracranial hypotension and to defi ne the role of myelo-TC adults. They are usually benign neoplasm, with characteristic pathologic and imaging and myelo-MR in the diagnosis of the syndrome. features. However, according to the third edition of the World Health Organization Background: Spontaneous intracranial hypotension (SIH) is a neurologic syndrome (WHO) classifi cation of brain tumors, meningioma can be common (WHO grade of unknown etiology, characterized by features of low cerebral spinal fl uid (CSF) 1), atypical (WHO grade 2) and malignant (WHO grade 3). The grade is important pressure, postural headache and magnetic resonance imaging abnormalities. because of therapeutic and prognostic implications. Non-spontaneous causes are lumbar puncture, cranial tears, craniotomy, paranasal Imaging Findings: Between January 1999 and August 2006, 247 patients with sinuses surgery, fl ogistic or neoplastic bone erosions, traumatic avulsion of spinal
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7 0 0 2 . 2 475 0 . ndings ndings. ndings. 2 ; 112.02.2007 17:04:12 1 ow limita- ow ndings. We We ndings. G Berlin/DE , B.G. Thompson , B.G. 2 ndings in six cases of histo- les as the infective organisms les as the infective C , S. Gandhi , S. 1 BDEF cult. Six patients at our institution have been have Six patients at our institution cult. A , E. Nicol , E. 1 ([email protected]) ([email protected])
Six patients with distal internal Six patients with distal carotid or vertebral- To depict the various infective brain pathologies commonly brain infective depict the various To To illustrate the wide range of MR imaging characteristics of the wide range illustrate To , J. Lassig , J. Pune/IN 1 Bristol/UK 2 We exemplify atypical imaging fi exemplify We exible intracranial Neuroform stent in tortuous Neuroform intracranial dissected seg- exible ndings and histological structure to explain the displayed atypi- the displayed structurendings and histological to explain Gioblastoma multiforme is the most common primary multiforme Gioblastoma malignant Tackling neuro-infections constitute an ever growing challenge to the growing constitute an ever neuro-infections Tackling In certain tortuous cases of dissections affecting and redundant rmed glioblastoma. Imaging features include lack of enhancement of enhancement include lack Imaging features rmed glioblastoma. Atypical glioblastoma should be considered as a differential diagnosis should be considered as a differential Atypical glioblastoma , S. Ansari , S. 1 Endovascular stenting is evolving as the primary as the treatment option for stenting is evolving Endovascular All patients were symptomatic from their dissections. Presenting symp- from their dissections. symptomatic All patients were Ann Arbor, MI/US, MI/US, Ann Arbor, Purpose: cervical arterial in symptomatic patients refractory dissections medical man- to stents into the tortuous or self-expandable of balloon- The tractability agement. is often diffi vasculature intracranial treated using the fl population studied this We and vertebrao-basilarments of the distal carotid arteries. this treatment approach. to evaluate Methods and Materials: of A total stent. Neuroform treated using intracranial basilar dissections were Dissecting aneurysms via treated were in 6 procedures. utilized 10 stents were clinical with imaging and followed were Patients stent assisted coil embolization. technical and clinical Long-term integrity, a mean of 6.2 months. assessment for assessed. outcomes were Results: Spontaneous and SAH. persistent pain, hemispheric infarcts, TIAs, toms included dissections. for responsible (1) etiologies were (2), and iatrogenic (3), traumatic stents. (n=1) Neuroform with single (n=5) or overlapping treated Dissections were One patient required 3 tandem stents to reconstruct a long segment dissection. in all patients (100%) with no residual fl achieved success was Technical from 84% pre-procedure to 26% Dissection related mean stenosis improved tion. no There were imaging respectively. and 9% on post-procedure and follow-up no long term were There hemorrhages. or subarachnoid infarcts, TIAs, recurrent complications. Conclusion: the endovascular option for to be a safe stent appears Neuroform vasculature, management. and histological features of atypical glioblastoma. and histological features Background: of diagnosis is important the establishment Accurate for tumor in adults. brain cult as this entity can diagnosis is often diffi However, and prognosis. therapy imaging characteristics depending upon its histological structure various display pattern. and growth Findings: Imaging ([email protected]) Learning Objectives: techniques MR imaging the role of advanced emphasize To atypical glioblastoma. and perfusion weighted imaging diffusion weighted such as MR spectroscopy, correlate imaging fi To imaging in the diagnosis of atypical glioblastoma. logically confi pattern, growth primarily administration, after contrast cystic or intraventricular PET fi as negative spread as well subependymal and subarachnoidal correlate imaging fi diagnosic to improve how illustrate We cal MR morphology and signal properties. imaging techniques such as MR spectroscopy, with the help of advanced accuracy imaging. imaging and perfusion weighted diffusion weighted Conclusion: clinical and imaging fi with equivocal lesions space occupying in cerebral MR the use of advanced by improved can be Diagnosis of atypical glioblastoma imaging techniques. Learning Objectives: imaging fea- the various illustrate To encountered in the tropical settings in India. tures of these infections. Background: major cause of morbidity to be a continue They alike. and the physician radiologist clinical and imaging profi and mortality with evolving adapt to more and more drug regimes. C-702 of atypical in the diagnosis techniques imaging MR of advanced The role glioblastoma Klingebiel; R. Bohner, G. Kentenich, M. Franiel, T. Siebert, E. C-703 of the brain infections in tropical Imaging Kulkarni; Singh, R. J. C-701 cervical treatment of distal with and intracranial dissections Endovascular stent the neuroform Gandhi D. 1 0.001 < 0.05 and < cance p stimulation. The data stimulation. 2 ([email protected]) ([email protected])
Scientific and Educational Exhibits Scientific and Educational challenge was calculated separately for for calculated separately challenge was 2 city=71.4% and PPV=88.2%. CBVr and tumor obtained between 0.007 was ([email protected]) ([email protected]) <
Nottingham/UK on BOLD response in of vasoreactivity rm the effect 75%. > cant correlation between the BOLD responses to the the BOLD cant correlation between Six patients (age 55-80) with internal carotid artery Forty-seven patients with brain glioma were studied glioma were patients with brain Forty-seven cance p cance pachymeningeal intracranial are diffuse spinal and ndings Sevilla/ES 5 stimulation (Pearson test 0.69, p=0.01). We did not fi nd differ- did not fi We test 0.69, p=0.01). (Pearson stimulation MRI fi 4 2 1 city=57.1% and PPV=81.3%. Statistical signifi city=57.1% and PPV=81.3%.
d d n MTT can be considered as the most reliable perfusion parameter for for perfusion parameter MTT can be considered as the most reliable MRI features are virtually SIH syndrome while radio- MRI features for diagnostic uences the response to motor tasks. We explored further explored the inter- We to motor tasks. uences the response These results confi i . 60%) were investigated with motor task and co investigated 60%) were N I To determine of Magnetic Resonance perfusion imaging to the value To Blood oxygenated level-dependent (BOLD) functional MRI (fMRI) has (BOLD) functional MRI (fMRI) level-dependent Blood oxygenated > F Statistical signifi There was a signifi a There was - c u d E i c S - was obtained between MTT and tumor grade. MTT in low grade tumor was 9.45s tumor was grade MTT in low MTT and tumor grade. obtained between was of 9.95s A cut off value tumor. high grade [8.9s-11.8s] and 13.9s [11.3s-15.4s] for determined sensitivity=90.9%, specifi Conclusion: gliomas. cerebral and high grade low distinguishing between area under ROC curve was curve was area under ROC Results: grade. Mean value of CBVr in low grade tumor was 6.02 [2.33-9.46] (P25-P75). 6.02 [2.33-9.46] (P25-P75). tumor was grade of CBVr in low Mean value grade. of 6.84 had sensi- A value 9.23 [7.11-12.7]. tumor was Mean CBVr in high grade tivity=78.8, specifi motor task and co analysis was performed with FSL software. The mean percentage of signal inten- with FSL software. performed analysis was sity change during the motor task and co Purpose: glioma. brain and high grade low between differentiate Methods and Materials: gadolinium- dynamic susceptibility-weighted by MRI followed with conventional WHO) and 34 were gliomas (I-II Grade Low 14 were enhanced perfusion-MRI. with a 1.5T Philips MR performed Studies were WHO). gliomas (III-IV High Grade areas of the measured in the 5-6 most vascularized Region of Interest was system. each recorded for was (CBV) value Volume Blood Cerebral The maximum tumor. periatrial CBV of the contralateral white matter to obtain the area and divided by in expressed Time (MTT) is an absolute value, Transit Mean CBV (CBVr). relative obtained using were MTT and glioma grade CBVr, Correlations between seconds. considered when p cant association was Signifi U-test. Mann-Whitney C-700 and high grade between low to differentiate of perfusion MR The value brain gliomas la Peña, Piñero Gonzalez de P. Vivancos-García, J. Rodríguez-Romero, R. Monreal-Rodríguez; C. ences in motor BOLD responses between the side of the maximum stenosis and stenosis the side of the maximum ences in motor BOLD responses between hemisphere. the contralateral Conclusion: patients with carotid artery linearly coupling is that neurovascular disease and show emerged be- no difference In the small sample, and strongly correlated with CVR. for be less relevant of stenosis may hemispheres suggesting that the degree tween The observed is important relationship designing for the BOLD response than CVR. from altered vasoreactivity. effects confounding clinical fMRI studies to avoid C-699 linked with the motor cortexBOLD fMRI response in strongly is artery in patients with carotid disease vasoreactivity Auer; D.P. Goode, S. Ojango, C. gadolinium enhancement, generalized sagging of the brain with downward displace- downward with sagging of the brain generalized gadolinium enhancement, I Arnold-Chiari CSF subdural malformation, Type like ment of the cerebellar tonsils spaces and distended extradural spinal abnormalities expanded collections, like plexuses. venous epidural Conclusion: document- for examination the most sensitive is probably isotope cisternography the demonstrate may and myelo-MR Myelo-CT leakage of CSF. ing the eventual stulas. points of CSF fi roots and CSF fi stulas. fi roots and CSF Findings: Imaging Purpose: method is The activation. brain become a widely used technique to investigate coupling, in neurovascular alteration based on haemdynamic changes and any that It has been shown results. to affect is likely or volume ow fl baseline blood and carotid arterystroke reactivity (CVR) and disease reduce cerebrovascular infl this factor relation between the motor task induced signal change and the CVR in patients the motor task relation between with carotid artery disease. Methods and Materials: stenosis ( both motor cortices. Results: C - 7 0 R C EECR07-C-SciEduc-FIN.indd 145 Scientific and Educational Exhibits
Procedure Details: We reviewed and compiled the imaging features of various Neuro commonly encountered brain infections in India. Patients with tuberculosis, neuro- cysticercosis, chickungunya fever, dengue fever, Japanese B encephalitis, Herpes Spine simplex encephalitis, neurobrucellosis and fungal infections were included in the study group. Opportunistic infections in immunocompromised patients were also included in the study group. In this exhibit, we discuss the imaging features and C-706 the differential diagnosis of each of these conditions. Areas of restricted diffusion The correlation between the fractional anisotropy (FA) value and the not confi rming to any vascular territory in patients of chickungunya fever and de- pathologic change at different stages of spinal cord injury in rats myelinating lesions in dengue fever were some uncommon characteristic imaging N. Chen, K. Li; Beijing/CN ([email protected]) features seen in our study group. Conclusion: Imaging plays a crucial role in management of neuro-infections. Purpose: To evaluate the correlation between the fractional anisotropy (FA) value Characteristic clinical and imaging features may obviate the need for further and the pathologic change at different stages of spinal cord injury in rats. investigations in the cost constrained or epidemic settings. Methods and Materials: A total of 32 SD rats were medially divided into 4 groups. Each group (n=8) received a completely transverse injury at the lever of T6. On each group, diffusion tensor imaging was performed by using a 1.5-T MR scanner at 1, C-704 7, 15 and 30 days after injury. FA maps were computed. Regions of interest were Imaging central nervous system lymphoma placed at the injured cord area. Animals were sacrifi ced immediately after the MR P. Rajiah1, Y. Assiri2, I. Turnbull2, H. Al-Jawad2, A. Al-Mulla2, A.N. Khan2; scan. The spinal cords of all animals were analyzed histologically. 1Manchester/UK, 2Riyadh/SA ([email protected]) Results: For the preoperative subjects, the averaged FA values ranged from 0.66×10-3 to 0.75×10-3 mm2/s. The averaged FA values (0.27±0.087) for 1 day after Learning Objectives: 1. To review the imaging features of primary and secondary injury had decreased markedly; the histology showed the neuraxis of white matter lymphomas of the central nervous system. 2. To illustrate the MRI features that cataplasis and myelin disruption. At 7 and 15 days after injury, the averaged FA help in diagnosing cerebral lymphomas. 3. To review the differential diagnosis of values were 0. 41±0.15 and 0.43±0.17, respectively; the histology showed myelin cerebral lymphomas. disaggregation, vacuole reformation and a few gliocyte infi ltration; at 30 days, the Background: Central nervous system involvement with malignant lymphoma, averaged FA value was 0.61±0.15; the histology showed a great quantity of gliocyte whether primary or secondary is an uncommon disease, which is increasingly proliferation. There was a statistically signifi cant difference in the FA between 1 seen in immunocompromised individuals, particularly secondary to HIV or other day and 30 days. haematological malignancies. There is high morbidity and mortality associated Conclusion: Our fi ndings show that the degree of abnormality in measured FA with cerebral lymphomas. Imaging is important in diagnosing lymphomas and values strongly correlates with the axonal pathologic changes of the injured spinal differentiating it from other mimics. CT is often the fi rst imaging modality, but MRI cord. Therefore, FA is a useful tool to refl ect the pathologic change and to judge is the most useful modality. prognosis of spinal cord injury. Imaging Findings: The pictorial review illustrates the spectrum of imaging fi nd- ings seen in primary and secondary cerebral lymphomas seen in different imaging modalities, with particular emphasis in MRI. CT scan shows hyperdense lesion, C-707 predominantly in the subspendymal region. MRI shows solid, enhancing lesions Diffusion-weighted MR imaging and fi ber tracking of the normal human in subspendymal region. Ring enhancement is a feature of lymphomas arising spinal cord in immunocompromised individuals. Differential diagnosis of lymphomas include N. Chen, K. Li; Beijing/CN ([email protected]) other solid tumours, toxoplasmosis, abscesses. The review discusses the salient features of each of these differential diagnosis. Purpose: To determine the feasibility of obtaining in vivo diffusion-weighted images Conclusion: Primary and secondary central nervous system lymphomas have of the human spinal cord, to calculate normal apparent diffusion coeffi cient (ADC) characteristic appearances in CT and MRI scans. B lymphomas are the commonest values, and to assess cord anisotropy. to affect the brain. Lymphomas are commonly seen in the subspendymal region. Methods and Materials: Fifteen healthy volunteers were imaged using a multi- Primary and secondary lymphomas have different features in imaging. Intense shot, navigator-corrected, spin-echo, echo-planar pulse sequence. Axial images enhancement is a feature of Ring enhancement. of the cervical spinal cord were obtained with diffusion gradients applied along three orthogonal axes (6 b values each), and ADC values were calculated for the white and gray matter. C-705 Results: With the diffusion gradients perpendicular to the orientation of the white Radiological spectrum of lesions involving the hippocampus matter tracts, the spinal cord white matter was hyperintense to central gray matter A. Rovira-Cañellas1, A. Rovira-Gols2, C. Auger1, N. Bargalló1, J. Alvarez-Linera3; at all b values. This was also the case at low b values, with the diffusion gradients 1Barcelona/ES, 2Sabadell/ES, 3Madrid/ES ([email protected]) parallel to the white matter tracts; however, at higher b values, the relative signal intensity of gray and white matter reversed. With the diffusion gradients perpendicu- Learning Objectives: To illustrate the radiological fi ndings of several lesions that lar to the spinal cord, mean ADC values ranged from 0.40 to 0.57 3x10-3 mm2/s for predominantly affect the hippocampus. the white and gray matter. With the diffusion gradients parallel to the white matter Background: The hippocampus, which forms a part of the limbic system, has tracts, calculated ADC values were signifi cantly higher. There was a statistically a crucial role in cognition and memory, particularly in the formation of long-term signifi cant difference between the ADCs of white versus gray matter with all three memory. In vivo visualization of the hippocampus became possible with the advent gradient directions. Strong diffusion anisotropy was observed in the spinal cord of MR imaging, which has allowed the identifi cation of a variety of lesions that white matter. mainly affects this formation. Conclusion: Small fi eld-of-view diffusion-weighted images of the human spinal Imaging Findings: Many of the MR imaging examinations performed to identify cord can be obtained with reasonable scan times. Diffusion within spinal cord white structural abnormalities of the hippocampus are obtained in patients with temporal matter is highly anisotropic. lobe epilepsy (medial temporal lobe sclerosis) and several forms of primary neu- rodegenerative dementia, particularly those of the Alzheimer type (hippocampus atrophy). However, hippocampal changes can occur in a broad spectrum of disor- C-708 ders beyond dementia and epilepsy, including ischemic lesions (infarction within Patterns and emerging trends in spinal tuberculosis: An analysis of 200 the posterior cerebral artery territory), primary brain tumours, infl ammatory and consecutive cases infectious diseases (viral and paraneoplastic encephalitis, demyelinating lesions), S. Govindarajan, L. Ranganathan, V. Parthasarathi, A. Krishnamoorthy; vascular malformations (cavernoma, arterio-venous malformation), and focal Chennai, Tamilnadu/IN ([email protected]) cortical dysplasia, as well as several neuropsychiatric disorders (schizophrenia, post-traumatic depression). The hippocampus may also be selectively affected in Purpose: To analyze the patterns and emerging trends in spinal tuberculosis. patients with neurofi bromatosis type I, and in the acute phase of transient global Methods and Materials: 200 consecutive patients (89:111 - M:F) (age 10-74 amnesia and status epilepticus. years) were studied retrospectively from July 2004 to August 2005. The diagnosis Conclusion: The hippocampus can be affected by a variety of processes that may was pathologically proven in all the patients. Institutional review board approval present similar clinical fi ndings. MR imaging establishes the proper differential diag- was not necessary. Imaging was done with a 1.5 T (Siemens, Erlangen, Germany) nosis with a relatively high specifi city when a suitable imaging protocol is used. scanner. Sagittal T2, T1, STIR and Coronal STIR sequences were obtained for the whole spine. The region-of-interest was scanned using T1, T2 and STIR axial sections. As per institutional practice, CT sections were obtained when deemed
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2 . 2 477 0 . ndings 2 112.02.2007 17:04:13 eld imaging eld Rybnik/PL 2 G Brussels/BE ndings may in- ndings may Katowice/PL, Katowice/PL, 1 ; 2 cation of traumatic lesions on cation of traumatic Phoenix, AZ/US 2 C ndings in patients with suspicion of , P. Ulbrych , P. BDEF 2 A , W. Brojacz , W. Kahramanmaras/TR, Kahramanmaras/TR, 1 1 and spatial resolution with high fi eld strength, ndings in these situations and highlights the possible ndings in these situations and highlights the possible ; 2 To describe the normal and varia- anatomy ligamentous To To present CE-MRA fi To To present spinal cord injury abnormal- without radiological To SCIWORA is illustrated in three different situations: young young situations: in three different is illustrated SCIWORA Magnetic resonance images were obtained using 3-T unit with Magnetic resonance images were , J. Baron , J. 1 Spinal AVMs remain a serious cause of progressive neurologic defi remain a serious cause of progressive Spinal AVMs The use of MRI in patients with post-traumatic symptoms of spinal The use of MRI in patients with post-traumatic Advances in MRI technology have improved signal to noise with signal to improved in MRI technology have Advances This exhibit illustrates the variety of clinical and MRI fi ndings in ndings in of clinical and MRI fi the variety illustrates This exhibit This method allows excellent visualization of the normal ligamentous excellent This method allows , J. Heiserman , J. 1 eld of view (FOV) 18 cm, echo train length of eight, bandwidth 32 kHz, length of eight, bandwidth 32 cm, echo train 18 (FOV) eld of view ndings in "SCIWORA" in children and adults in children ndings in "SCIWORA" Learning Objectives: use of high resolution with an the by junction in detail tions of the cranio-vertebral a better to allow Tesla spin echo (FSE) sequence at 3 T2 fast intermediate echo understanding of these structures situations. in trauma Background: fi increasing main magnetic superior articu- visualization of smaller structuresand allow of the craniovertebral the identifi offered have The recent studies lations. normal with anatomic structures Familiarity junction. MR images of craniovertebral misinterpreta- and to prevent lesions the detection of traumatic is necessary for The normal and some anatomy ligamentous of the ligaments. tion of variations of craniocervical describedvariations in detail using junction were and illustrated MR images. 3-Tesla Details: Procedure Imaging protocol as follows: spin echo (FSE) sequence. T2 fast an intermediate echo 512x320 matrix axial and coronal, for 2200/15 msec (TR/TE), 512x224 matrix for sagittal, fi 2 Scan time was slice thickness (0 (NEX). mm interleaved excitations mm skip), four the sagittal plane. coronal and 5:57 min for 3:18 min for axial, 6:36 min for Conclusion: a and provides junction in detail of the cranio-vertebral and variation anatomy rise injuries to instability. that can give evaluating for background ([email protected]) Learning Objectives: technique, ‘gold standard’ Arteriography is a dysfunction. and bowel cits and bladder is time-consuming and connected with the risk of but catheter therapy, enabling can suspicion of AVM in patients with Spinal MR, performed ischemic complications. in present results of 23 CE MRA of spinal canal, performed We myelopathy. reveal T2 and CISS sequences with 1.0T T1, SE/ patients with suspicion of spinal AVM. Flash3D sequences during CM as dynamic, as well performed, MR scanner were Source images and MIP reconstructions were ml/s). 2 ow fl ml, (25 administration spinal vascular malformation in correlation with angiography. in correlation malformation spinal vascular Background: C-713 of spinal vessels with CE angioMR in suspicion of vertebralEvaluation canal AVM Gruszczynska K. C-711 Tesla of the craniocervical junction at 3 resonance imaging Magnetic Yuksel M. C-712 MRI fi Lecouvet; Cosnard, F. Duprez, G. T. Hernalsteen, D. Ghekiere, O. ([email protected]) Learning Objectives: clinical condition, and the different post-traumatic poorly a known ity (SCIWORA), describe the spectrum of MRI fi To be observed. situations in which it may in SCIWORA in children and adults. in children and in SCIWORA Background: or CT abnormality has lead to the recognition of no radiographic cord damage but This entity has been described in early child- isolated lesions of the spinal cord. in the disc disease (DDD) degenerative hood and in elderly patients with severe cervicallower segment. MRI fi shows This exhibit of adult patients with constitutional narrowing in young observation of SCIWORA the spinal canal. Findings: Imaging spinal canal in relation to DDD, of the narrowing child, elderly people with severe MRI fi adults with constitutional spinal canal stenosis. and young clude swelling, high-signal intensity on T2-weighted images (in relation to edema, T2-weighted high-signal intensity on clude swelling, or gliosis), hemorrhagic lesions of the cord, ligament or disc demyelinisation lesions MRI is indicated to rule out compressive hematoma. and epidural injury, spinal demonstrate hematoma), to disk herniation,(post-traumatic compressive of spinal cord and severity the extent showing ne a prognosis by to defi cord injury, history of the natural of the lesion and evaluation Repetition of MRI allows injury. sequellae. of the possible Conclusion: SCIWORA. cant
ndings on MR ndings outside EPOS ([email protected])
Scientific and Educational Exhibits Scientific and Educational eld artifact. The CoCr disc resulted in severe The CoCr disc resulted in severe eld artifact. ([email protected]) ([email protected])
eld distortion and the device dimensions were eld distortion were dimensions and the device Sault Ste. Marie, MI/US Marie, Sault Ste. Sheep lumbar spinal segments were harvested and the Sheep lumbar spinal segments were Doha/QA
ned to the body (thus mimicking secondaries, lymphoma). lymphoma). secondaries, to the body (thus mimicking ned
To describe the wide spectrum of imaging fi To No Material Submitted to Submitted Material No 7 Abnormalities seen outside the spine in patients referred for for Abnormalities spine in patients referred seen outside the 4 1
ned to the body and posterior arch lesion. Lesions sparing disks ned to the body and posterior arch lesion.
d d Occasionally, the prevertebral soft tissue, paravertebral soft tissue, soft tissue, paravertebral soft tissue, the prevertebral Occasionally, n The choice of biomaterial for spinal implants for spinal implants The choice of biomaterial for Spinal tuberculosis has a varied presentation and can mimic any and can mimic any presentation a varied Spinal tuberculosis has Looking outside the spine on MR images originally tailored to the spine i . N I MRI has become a critical diagnostic imaging modality for spinal disor- MRI has become a critical for diagnostic imaging modality F The distortion from polyethylene was the least severe and CoCr was the and CoCr was severe the least was The distortion from polyethylene The dorsolumbar region was commonly affected. In 45 patients, more than In 45 patients, affected. commonly dorsolumbar region was The - c u d E i c S - MRI artifact and biomaterials: A sheep model MRI artifact and biomaterials: Lawson; Duman, K.J. R.J. C-710 the spine in patients referred for MR imaging of the cervical, or lumbo- thoracic, for the spine in patients referred spine. sacral Background: posterior to the vertebral column, posteriorsoft tissue of the back fossa, cranial important show imaging fi and pelvis may sella turcica, skull base, imaging studies originally tailored to the spine. Findings: Imaging Purpose: Spine arthrodesis to result in signifi and arthroplasty are known ders. devices dif- assessed and compared the artifact resulting from four We artifacts on MRI. arthroplasty in clinical biomaterials when encountered in utilized ferent devices the same shape. Methods and Materials: materials then used Circular discs of the various were lumbar discs excised. lower Titanium, and Chrome cobalt Medical Ceramic, Polyethylene, ll the spaces. to fi Electric obtained with a General 1.5 Images were used. discs were (CoCr) alloy the by reviewed The scans were T MRI unit in both sagital and axial sequences. and orthopedist)authors (neuroradiologist and the distortion the between graded The area of fi materials. various MR imaging of the spine range from the incidentally discovered vascular anomalies anomalies vascular from the incidentally discovered MR imaging of the spine range right sided aortic artery, right such as aberrant subclavian arch, absent inferior the explain and retroaortic to serious disease that may left renal vein cava, vena such as malignant diseases of the spine, symptoms thought to be caused by rectum, para-aortic soft and paraspinal lymph nodes, neoplasms of the ovary, of some of these lesions with presentation illustrates The present exhibit tissue. originally together demonstrated pathology was on which the the original images, full demonstration for at a later stage with the detailed imaging studies performed and histopathological correlation. of the lesions, Conclusion: of visual perception Opening-up of the window detect importantmay abnormalities. to lesions and opening-up of the imaging window to detect these of the radiologist detailed MR imaging of these lesions on the same setting of the MRI of perform the early diagnosis of serious disease. be helpful for the spine may also compared. Results: mild with alone was Ceramic on both sagital and axial MRI scans. most severe Titanium causing an intermediate fi C-709 Looking outside the spine Mahfouz; A.E. Sherif, H. Learning Objectives: twice the dimension of resulting in artifactartifact which was MRI image, on the the disc. Conclusion: effect a profound will have design shape, in addition to arthrodesis and arthroplasty, clinical on the magnitude of MRI artifact and on whether MRI images are of any utility after spinal surgical reconstruction. necessary. The images were analyzed for patterns of involvement, frequencies and frequencies and patterns of involvement, for analyzed images were The necessary. diagnosis entertained.differential Results: two regions were involved. Contiguous involvement of adjacent regions was more of adjacent regions was involvement Contiguous involved. regions were two disk-vertebral three patternsThere were of involvement: common than skip lesions. lesion, those confi (40%) were nearly as common as those involving both body and disc (47%). Nearly both body and disc (47%). nearly(40%) were as common as those involving abscesses with paraspinal/epidural associated 90% of disk-vertebral were lesions also Body lesions were at the dorsolumbar junction. or cord compression, especially of One-third (70%) of abscesses and cord compression. associated a high incidence confi these lesions were Isolated posteriro arch involvement occurred in 13 patients. Isolated posteriro arch involvement Conclusion: body and multifocal Isolated pedicle involvement disease of the vertebral column. can closely mimic malignancy. involvement C - 7 0 R C EECR07-C-SciEduc-FIN.indd 147 Scientific and Educational Exhibits
analysed. In 7 patients catheter angiography was performed next. Neuro Imaging Findings: In 7 patients, CE-MRA revealed spinal vascular malformation. Arterial and delayed phases revealed tortuous, pathologic vessels in vertebral canal, Brain and Spine located on the spine surface or inside thoracic spine. In all patients, extension of the AVM was visible. In 3 patients, feeding arteries were visualised, confi rmed in arteriography. In two patients, catheter embolization was performed, and control C-714 MRA studies showed AVM regression. In 70% of patients, CE-MRA was normal. Neurological complications of connective tissue disease and the Conclusion: 1. Spinal CE angioMR helps to confi rm or exclude the presence vasculitides: A pictorial review of spinal AVM, visualise its extension, and indicate the level of arterial supply. 2. C. Vandervelde, A. Varghese, D. D’Cruz, W. Jan; London/UK CE-MRA can be used as the fi rst line modality of vessel’s imaging in the suspicion ([email protected]) of spinal AVM, helping to select patients to catheter angiography, which remains the gold standard. Learning Objectives: 1) To discuss the neurological complications of Systemic Lu- pus Erythematosus (SLE), rheumatoid arthritis, scleroderma, Sjogren’s syndrome, Behcet’s syndrome and the small, medium and large vessel vasculitides including polyarteritis nodosa, Wegener’s granulomatosis, temporal arteritis and Takayasu’s arteritis. 2) To discuss the imaging techniques used to diagnose these complications. 3) To demonstrate imaging examples of these neurological manifestations. Background: The connective tissue diseases and vasculitides are multisystem conditions that affect the central and peripheral nervous system to varying degrees. The range of neurological complications includes seizure disorders, encephalopathy, amaurosis fugax, transient ischaemic attacks, stroke, cranial nerve palsy, pseu- dobulbar palsy, psychosis, dementia, venous sinus thrombosis, cerebral abscess, aseptic meningitis, mononeuritis multiplex, entrapment neuropathy, transverse myelitis and other spinal cord diseases. Modern imaging techniques including CT, MRI, PET and SPECT can demonstrate the various manifestations in patients with neurological involvement with these conditions. Imaging Findings: There is a degree of overlap between the imaging fi ndings in these conditions. However, certain fi ndings are helpful pointers towards the diagnosis of specifi c connective tissue diseases and conditions associated with vasculitis. Examples of spinal cord compression, focal cerebral infarcts, multifocal white matter lesions, venous sinus thrombosis, intracerebral and subarachnoid haemorrhage, aneurysm, cerebral abscess, cytotoxic and vasogenic oedema in such cases are shown on CT and MR images. Conclusion: The purpose of this exhibit is to illustrate the spectrum of neurora- diological imaging fi ndings in connective tissue diseases and vasculitides, and to show features that allow the radiologist to distinguish between the differential diagnoses. C-715 Neuroimaging manifestations in Von Hippel Lindau disease: Emphasis on unusual fi ndings A. Patsalides1, E. Tzatha2, N. Patronas2; 1Washington, DC/US, 2Bethesda, MD/US ([email protected])
Learning Objectives: In this exhibit, we present the neuroimaging manifestations of VHL disease, emphasizing on the unusual fi ndings. Background: Von-Hippel Lindau (VHL) disease is an autosomal dominant disorder with incomplete penetrance. Neuroimaging manifestations include the presence of hemangioblastomas in the retina, brain and spine as well as endolymphatic sac tumors (ELST). Imaging Findings: Common and unusual imaging features of hemangioblastomas in the cerebellum, brainstem and spinal cord are presented and evolution in time is assessed. We show hemangioblastomas in uncommon locations such as the suprasellar area, cerebral hemispheres, internal auditory canals, cauda equina and leptomeninges, mimicking other tumors. We present the imaging abnormalities of ELST and the range of involvement of the petrous bone as well as a variety of retinal hemangioblastomas and their complications. Conclusion: The spectrum of neuroimaging manifestations in patients with VHL disease is wide. Awareness of the variety of imaging fi ndings and evolution in time is important for the complete understanding of this entity. C-716 Lipomas, dermoids and epidermoids of the brain and spine: A pictorial review S.B. Lachanis, A.N. Chalazonitis, J. Pontikis, G. Tsimitselis, N. Ptohis, I. Tzovara; Athens/GR ([email protected])
Learning Objectives: 1. To pictorially review the MR imaging features of CNS lipomas, epidermoids and dermoids with various sequences. 2. To describe their distinguishing imaging features aiding their differential diagnostic approach. 3. To underline potential pitfalls in their differential diagnosis. Background: Lipomas, dermoids and epidermoids of the brain and spine, although rarely encountered, enter in the differential diagnosis of many other CNS tumors. Although their embryology is different, these lesions share a common feature: they represent "tissues at a false place", as mesencymal and cutaneous ectoderm tis-
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0 . 2 112.02.2007 17:04:13 Latina/IT G Rome/IT ed 5 more injuries: 2 hepatic, 1 2 hepatic, ed 5 more injuries: C BDEF A Between January 2003 and December 2005, 103 patients January Between To illustrate major clinical indications for MRI study of the major clinical indications for illustrate To To review MR imaging sequences used for diagnosis of liver diagnosis of liver sequences used for MR imaging review To Small bowel distension was obtained by means of oral admin- means of oral by obtained distension was Small bowel Seventy-seven pediatric patients (48 boys and 29 girls aged pediatric patients (48 boys Seventy-seven ([email protected]) ([email protected])
Diffuse liver disease in pediatric patients may be due to cirrhosis, be due to cirrhosis, disease in pediatric patients may Diffuse liver In this exhibit, we will describe the MRI of the small bowel performed performed will describewe the MRI of the small bowel In this exhibit, CEUS greatly increases visualization and characterization of liver, and characterization increases visualization of liver, CEUS greatly MR studies of the small bowel represent a feasible and valid diagnostic and valid represent a feasible MR studies of the small bowel To evaluate the effectiveness of Contrast-Enhanced Ultrasonography Ultrasonography of Contrast-Enhanced effectiveness the evaluate To In 15/103 patients conventional US identifi ed solid organs injuries: 6 injuries: ed solid organs US identifi In 15/103 patients conventional ed traumatic lesions in 20/103 patients. Solid organ injuries appeared strongly lesions in 20/103 patients. ed traumatic bowel in paediatric patients. To show an overview of some technical issues of MRI an overview show To in paediatric patients. bowel outline the advantages To distension. with emphasis on bowel of the small bowel clinical results based on a seriesand limitations of the technique and to illustrate of 215 paediatric patients. Background: the the results, indications, agent with the most suitable contrast with a biphasic oral 215 paediatric of this technique in a paediatric and the limits population. advantages MR study of disorders underwent patients with clinical suspicious of small bowel The major clinical indication are represented from the work-up of the small bowel. Other clinical indications are mainly represented by children with suspected IBD. MR the work-up intestinal malabsorption. of patients with Celiac disease or other disease and disorders with emphasis on Crohn’s small bowel ndings of several fi Celiac disease will be presented. Details: Procedure MR the examination. of 10 istration ml/kg/BW of PEG solution immediately before T1W FLASH se- and True-FISP T2W HASTE, using performed were examinations on both axial and coronal planes. quences acquired after iv injection of Gd-DTPA Conclusion: also on a paediatric population. the small intestine evaluation tool for C-719 of An overview paediatric patients: of the small intestine in MR imaging results and clinical features technical Laghi; A. De Cecco, C. Rengo, M. Ferrari, R. Iafrate, F. Paolantonio, P. ([email protected]) Learning Objectives: C-720 Characterization of diffuse liver disease in pediatric patients with MR imaging Abdel Gaffar; W. Abdel Rahman, Abdalla, A. A. Abdel Razek, A.A.A.A. Mansoura/EG Learning Objectives: Pediatric Abdominal C-718 abdominal trauma in pediatric blunt Contrast-enhanced ultrasonography Miele; V. Regine, G. Palliola, R. Galluzzo, M. Atzori, Luzietti, M. M. storage of cirrhosis, MR features demonstrate To diseases in pediatric patients. in pediatric diseases patients. and metabolic liver Background: causes. or metabolic diseases and vascular storage Findings: Imaging diffuse hepatic diseases underwent ms-15 ys) with pathologically proven 3 ([email protected]) ([email protected]) Purpose: (CEUS) in diagnosing and characterizing hepato-spleno-renal traumatic injuries characterizing(CEUS) in diagnosing and hepato-spleno-renal traumatic in (US) and Multislice Ultrasonography pediatric patients compared to conventional (MSCT). Computed Tomography Methods and Materials: were (BAT) abdominal trauma with blunt mean age 6 years) 42 females, (61 males, performed was Ultrasonography CEUS and MSCT. US, conventional by examinated contrast bolus injection of 2.4 ultrasonographic ml of intravenous and after before multislice by performed were CT examinations Italy). Bracco, agent (SonoVue, The presence, agent administration. contrast and after intravenous CT before spiral splenic and renal and conspicuity of hepatic, appearance sonographic number, injuries then analyzed. were Results: CEUS identifi 6 splenic and 3 renal injuries. hepatic, CEUS Therefore, US. at conventional not shown splenic and 2 renal injuries that was identifi MSCT regions. with surrounding hyperechoic US, contrast-enhanced at hypoechoic US results. according with ed 20 solid organs injuries patients, in 20 identifi Conclusion: and it has a high cor- US, spleen and renal injuries compared with conventional rst approach in pediatric blunt CEUS should be used as fi relation with MSCT. and MSCT still remains the choice method in severe whereas abdominal trauma, evaluation. traumas multiple
, 1 Antwerp/BE 2 c white matter lesions. In four pa- In four c white matter lesions. ndings are encoutered, especially , H.R. Degryse , H.R. 1 Scientific and Educational Exhibits Scientific and Educational Brasschaat/BE, Brasschaat/BE, 1 ; 2 , H. De Cauwer , H. 1 Nine patients with positive serology for Lyme were in- were Lyme serology for Nine patients with positive 9 In this exhibit, we present a great number of cases of CNS number a great present we In this exhibit, , P.M. Parizel , P.M. 4 2 1
d d Aspecifi c white matter abnormalities are frequently observed in Aspecifi n Lipomas, dermoids, and epidermoids of the CNS have distinguishing dermoids, and epidermoids Lipomas, of the CNS have i . , L. van denHauwe van , L. N I Central and/or peripheral nervous system involvement (neurobor- and/or peripheral nervous involvement system Central 1 F One brain study and the MR examination of the cervical no spine showed study and the MR examination One brain - c u d E i c S - ([email protected]) ([email protected]) Purpose: c Aspecifi rst presentation. disease and is often the fi reliosis) is frequent in Lyme been have images (WI) in neuroborreliosis T2-weighted white matter lesions on frequently observed nerve enhancement was Cranial in the literature. published ndings in 9 present the magnetic resonance (MR) imaging fi We in our series. neuroborreliosis. patients with proven Methods and Materials: 1 of the lumbar spine brain, 8 MR studies of the study. cluded in this retrospective consisted of MR imaging of the brain and 1 of the cervical performed. spine were enhanced (FLAIR) and contrast recovery inversion uid-attenuated T2-WI, fl T1-WI, and after gadolinium T1-WI before as T2-WI, as well Spinal studies included T1-WI. injection. Results: aspecifi studies displayed brain Five abnormalities. 2 oculomotor nerve, nerve, nerve enhancement (3 vestibulocochlear cranial tients, In and 1 glossopharyngeal nerve, observed. nerve) was 2 trigeminal 1 facial nerve, one patient, right hemispheric was cerebellitis and leptomeningeal enhancement of the cauda equina. polyradiculitis MR of the lumbar spine showed described. Conclusion: in endemic regions. patients suspected for neuroborreliosis. Cranial nerve enhancement, cerebellitis, nerve enhancement, cerebellitis, Cranial neuroborreliosis. patients suspected for patients and neu- diagnosis in these the differential narrow may and polyradiculitis considered when these fi be roborreliosis must J.W. Van Goethem Van J.W. C-717 resonance imaging Findings on magnetic Neuroborreliosis: Pelzers E. lipomas, dermoids and epidermoids. All cases have been drawn up from our teach- been drawn cases have All dermoidslipomas, and epidermoids. MR sequences), and newer Imaging characteristics (with all conventional les. ing fi pitfalls Potential are pictorially diagnosis presented. together with their differential also be discussed. diagnosis will in their differential Conclusion: sues within CNS structures. sues within CNS Findings: Imaging By concerning appearance radiological their MRI imaging characteristics. especially age spectrum, of predilection and affected together with their site appreciating these, c diagnosis in a majority of cases. can reach the specifi radiologist any C - 7 0 R C EECR07-C-SciEduc-FIN.indd 149 Scientific and Educational Exhibits
state-of-art MR imaging sequences. Regenerative nodules, lobar or segmental Background: Balloon dilatation of oesophageal strictures is well described in hepatic changes and collaterals were seen in cirrhotic patients. MR may help in the adult literature. However, its role in the paediatric population after repair of characterization of storage disease as steatosis, iron overload disease, glycogen oesophageal anomalies is less well established. Post operative stricture occurs in storage disease, Wilson disease and Gaucher disease. Enlarged caudate lobe with 30-50% of patients with oesophageal atresia. This carries a high risk of malnutrition intra-hepatic collaterals was detected in Budd Chiari syndrome. Other lesions such and aspiration to the lungs. It is the most common post surgical complication and as cystic fi brosis and congenital hepatic fi brosis can be detected. typically occurs at the primary site of anastomosis. At our institute, we have one of Conclusion: We concluded that MR imaging can help in the diagnosis and char- the largest case series of patients undergoing balloon dilatation of strictures after acterization of diffuse liver diseases in pediatric patients. surgical repair of oesophageal atresia. Procedure Details: All procedures were carried out under general anaesthetic. The oesophageal lumen was opacifi ed with water soluble contrast to correctly C-721 identify the location of the stricture. A 4 F catheter and hydrophilic guidewire were High-resolution ultrasound of infl ammatory bowel diseases in children passed through the mouth and manipulated under fl uoroscopic guidance across U. Zaleska-Dorobisz, A. Stawarski, D. Sokolowska, B. Iwańczak, K. Moroń; the stricture and into the stomach. A balloon catheter (15-20 mm in diameter) and Wrocław/PL ([email protected]) 3-6 cm long was passed over the guidewire and positioned across the stricture. The Purpose: To present the usefulness of high-frequency standard and Doppler ul- balloon was slowly infl ated with diluted water soluble contrast under fl uoroscopy trasound in the diagnosis and therapy monitoring of infl ammatory bowel diseases until the waist on the balloon was obliterated. A post procedure oesophagram was (IBD) in children. then performed to check for oesophageal rupture. Methods and Materials: We studied 95 children, with mean age 13.5 years, with Conclusion: Balloon dilatation of strictures following surgical repair of oesopha- infl ammatory bowel diseases: thirty-fi ve with Crohn Disease (CD), 41 with colitis geal atresia is clinically effective, safe, relatively atraumatic and is without high ulcerosa (CU), 19 with other IBD. We performed high-resolution 2D sonography risk of complications. to evaluate the bowel-wall thickness. Intraparietal vascularisation was assessed with color Doppler. Superior or inferior mesenteric arteries fl ow, mean velocity, C-724 RI (resistance index) were measured in all patients. We compared clinical active Infl ammatory bowel disease and bone mass in children disease, ultrasounds and colonoscopy. C.V. Albanese, M. Paganelli, F. Civitelli, S. Cucchiara, R. Passariello; Rome/IT Results: CD predominantly involved the small intestine. The bowel wall was greatly ([email protected]) thickened more than 8-10 mm. Mucosal ulcerations penetrated into the wall in 25 children; in 13 we found fi stulas and peritoneal abscesses. The mesentery and fat Purpose: To evaluate the effect of infl ammation on bone mineral density (BMD) around the bowel was thickened in all children. UC was limited to the left colon. The in children with infl ammatory bowel disease (IBD) and the possible role of areal colon wall was thickened more than 5-11 mm. Mural infl ammation was located in estimation of BMD (aBMD) in interpreting DXA results in such patients. the mucosal surface with superfi cial ulcerations and pseudo polyps (50%). Color Methods and Materials: A total of 84 children were enrolled: 56 with Crohn’s dis- Doppler revealed hyperemia with increased vascular supply of the involved bowel ease (CD) and ulcerative colitis (UC) and 28 healthy siblings as controls. Lumbar wall. The RI was signifi cantly lower in active disease. After treatment, RI values spine BMD was measured by DXA and Z-scores were obtained by comparison with increased signifi cantly (p < 0.005). age-and sex-matched normal values. Bone age was measured in each patient by Conclusion: High-resolution and Doppler sonography can detect bowel-wall ab- the method of Greulich and Pyle and aBMD was calculated again using bone age normalities in most IBD in children. Doppler fl ow parameters in mesenteric arteries instead of chronological age. Multiple regression analysis was used to evaluate correlated strongly with disease activity. Doppler US could be used for monitoring the relationship between IBD and potential risk factors. the treatment effi ciency. Results: Children with CD and UC differed for corticosteroid exposure. Total duration of therapy (p=0.009), cumulative (p=0.03) and daily dose (p=0.004) of prednisone C-722 were signifi cantly higher in patient with UC. No signifi cant difference was found between CD and UC aBMD. Prevalence of low BMD (Z score<-2) was higher for Single-shot MRCP in the evaluation of pancreaticobiliary disease in children IBD patients respect to controls (p=0.026). aBMD Z scores were then calculated S. Fitoz, A. Erden, S. Boruban; Ankara/TR using bone age instead of chronological age and aBMD was found signifi cantly Learning Objectives: To demonstrate the usefulness of MRCP with a single-shot low in UC patients (p < 0.01). fast spin echo (SSFSE) sequence as a noninvasive method to evaluate biliary Conclusion: Children with IBD should be evaluated for BMD and a corret interpreta- system in children. To outline the advantages of the technique. tion of DXA results is important for identifying children at real risk for osteoporosis. Background: Twenty-fi ve MRCP examinations of 23 patients (2 months to 16 Low BMD has a high prevalence in children with IBD, but it has to be assessed years) using SSFSE technique on a 1.0 T MR unit were evaluated. Examinations using bone age instead of chronological age to avoid overestimation. were all performed with a 1.0 T scanner using head or phased-array surface coil, depending on the body size. Patients fasted for 3-5 hours before the examination. C-725 Sedation, for patients 6 years old and younger, was achieved with an oral chlorate Magnetic resonance imaging of small bowel in pediatric patients with hydrate. MRCP was performed in all patients using 20 to 50 mm single-slab imaging idiopathic infl ammatory bowel (IIB) disease using the following parameters: TR/effective TE range: 5109-6323/772-1163; slab D. Loggitsi, E. Alexopoulou, N. Kelekis, O. Papakonstantinou, N. Economopoulos, thickness: 20-30 mm; fi eld of view: 18-36 cm; matrix: 256x256; NEX: 0.5-1. While E. Roma, I. Panagiotou, A. Balanika, A. Gouliamos; Athens/GR all patients had undergone US, 5 patients had also had CT examination. ([email protected]) Imaging Findings: On the basis of surgical (n=5), ERCP (n=4), liver biopsy (n=4), clinical data and follow-up observation, 17 children were found to have pancreati- Purpose: To present an MR imaging protocol for the evaluation of IIB disease and cobiliary abnormalities, including choledochal cyst (type I, IVb and Caroli’s disease to assess its effi cacy in evaluating disease activity. according to Todani classifi cation), biliary system dilatation due to stone or benign Methods and Materials: MR imaging of the small bowel was prospectively strictures, biliary atresia, multiseptated gallbladder, anomalous pancreaticobilary performed in 15 patients (aged 9-15 years) with known or suspected IIB disease. union in patients with choledochal cysts and pancreas divisum, ruptured hydatid 2.5 lt of water solution with herbal fi bers was administered over 4hours through cyst with cystobiliary communication. Additional information was obtained with a nasogastric tube prior to MR examination. Patients were scanned in the prone MRCP and not provided by sonography in 4 patients. position using coronal and axial thin-slice (1.5 mm) 3D T1-weighted GE and Conclusion: MRCP can be used effectively for evaluation of the biliary T2-weighted bFFE fat-suppressed sequences followed by dynamic study after system in children. contrast administration. Quality of imaging, including small bowel distention, wall conspicuity, motion and susceptibility artifacts, was evaluated by two observers in consensus. Disease activity was evaluated by presence and degree of mural C-723 enhancement and edema. Balloon dilatation of oesophageal strictures following surgical repair of Results: The procedure was well tolerated by all patients. Quality of imaging was oesophageal atresia considered excellent (n=10 patients), satisfactory (n=5) and non-satisfactory (n=0). F.A. Kazmi, D. Roebuck; London/UK ([email protected]) Imaging fi ndings included: wall thickening (> 4 mm) of the terminal ileum (n=11), Learning Objectives: We describe and illustrate the technique, indications and jejunum loops (n=5), large bowel (n=3) and stomach (n=1), and luminal narrowing complications of balloon dilatation of oesophageal strictures following surgical (n=2). Seven patients showed early increased wall enhancement, implying active repair of oesophageal atresia based on a series of 30 patients. infl ammation, whereas four patients exhibited delayed mild enhancement of bowel
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G Innsbruck/AT Innsbruck/AT Milan/IT brosis. To correlate the correlate To brosis. cial respirators. cial respirators. ammation) in patients with cystic C ([email protected]) ([email protected])
brosis by volumetric thin-section thin-section volumetric by brosis BDEF A Athens/GR An evaluation of 35 patients between the ages of 15 of 35 patients between An evaluation All patients had proven cystic fi brosis (CF). cystic fi All patients had proven The tree-in-bud sign represents a non-reversible sign in patients sign in patients sign represents a non-reversible The tree-in-bud The pulmonary hyper-expansion obtained with this method enables obtained with this method enables The pulmonary hyper-expansion Evaluation of the diagnostic accuracy of multi-slice spiral CT (MSCT) spiral of multi-slice of the diagnostic accuracy Evaluation of pediatric chest (US) in the evaluation of ultrasonography The value To determine the incidence of tree-in-bud sign (indicating involvement determine (indicating involvement sign the incidence of tree-in-bud To In all the patients examined, the thorax was kept immobile and continually immobile and continually kept was the thorax In all the patients examined, The tree-in-bud sign was seen in 8/40 patients (20%) and occured at higher sign was The tree-in-bud 0.05), at higher level of CT-morphological involvement as measured by Bhalla as measured by involvement of CT-morphological 0.05), at higher level < 0.05). In this patient population, the tree-in-bud sign was never reversible. never sign was In this patient population, the tree-in-bud 0.05). < score and at higher level of functional pulmonary impairment spirometry measured by score and at higher level (p 08.50-22.52 (mGy•cm) resulted an effective of recorded DLP (range) Conversion 0.12-0.33 (mSv). dose (range) Conclusion: indicating involve- with CF occuring in later stage of disease and presumably ment of bronchioles. ([email protected]) ([email protected]) Purpose: the exami- (HRCT) in paediatric patients for high-resolution computed tomography of the lung expansion maintaining continuous nation of the pulmonary parenchyma, through the use of CPAP. (apneac oxygenation) Methods and Materials: examined were Patients conducted using MSCT-HRCT. was and 2 years days using technical parameters with the Siemens Somaton Sensation 16-CT scanner, using an ensured manually was and ventilation doses, to low exposure enabling the child until the end of the preparation the time necessary for "T" tube for Ayres carried were out with and without PEEP, The examinations of the period of apnea. of 1 minute. with a mean duration Results: the differen- facilitating of interpretative errors, the avoidance enabling extended, the types of precision, distinguishing tiation of pulmonary pathology with extreme the evaluation bronchial obstruction and facilitating associated with air trapping The where collapse often occurs. segments of the lung parenchyma, of the lower fur- us, (kV and mAs) enabled cation of some of the technical parameters modifi doses in compliance with the European thermore, at low carry to out examinations standards. radioprotection Conclusion: giving a correct evaluation in paediatric to be performed patients, the MSCT-HRCT of the pulmonary without the use of artifi parenchyma Purpose: The aim of this study is to present the abnormalities documented. has been well structures when studying thoracic and their spectrum provided of the information in the clinical practice. value C-727 of the computed tomography to perform using CPAP Apneac oxygenation thorax in paediatric patients Boioli; F. Del Sante, Battaglia, M. E. Sonvico, U. Tagliaferri, B. C-728 abnormalities in pediatric patients of chest Ultrasound imaging Leontis, M. Papantoniou, Halatsi, P. E. Vakaki, M. Papadaki, M.G. Koumanidou; Hadjigeorgi, C. C. Pediatric Pediatric Lung C-726 fi sign in cystic Detection of tree-in-bud natural historycorrelation to morphologic and Incidence, MDCT: low-dose score and spirometry Freund; M.C. Jaschke, W.R. Eder, J. Ellemunter, Unsinn, H. K.M. Purpose: and infl infection of the peripheral bronchioles by history the natural evaluate To MDCT. low-dose thin-section volumetric brosis by fi sign in patients with cystic fi of tree-in-bud reversibility) (i.e. spirometry. Bhalla score and to by measured sign to CT-morphology tree-in-bud Methods and Materials: CT (MDCT) of the chest spiral (4, 16, or 64) row multidetector low-dose Volumetric without contrast second year every (5-50 years) in 40 patients performed was during in supine position at end-inspiration single breath-hold with administration kV, 120 mm slice thickness/intervall, contiguous 1.25 scan parameters: following algorithm. mA, 0.8 sec rotation time/360°, standard and lung reconstuction 10 all reviewed radiologists Two recorded. Dose-length product (DLP) (mGy•cm) was historyat consensus opinion regarding incidence and natural images and arrived measured to CT-morphology sign with correlation of tree-in-bud reversibility) (i.e. Bhalla score and to spirometry. by Results: age (p Scientific and Educational Exhibits Scientific and Educational 1 5 1
d d n MRI of the small bowel, using the current imaging protocol, is a well- imaging protocol, is a well- using the current MRI of the small bowel, i . N I F - c u d E i c S - tolerable, non-ionising method for evaluating the presence, extent, activity and activity and extent, the presence, evaluating method for non-ionising tolerable, in pediatric of IIB disease patients. manifestations extraluminal wall consistent with inactive disease. Extraluminal manifestations included mesen- included manifestations Extraluminal disease. inactive consistent with wall and (n=6), ascites (n=2) proliferation brofatty perienteric (n=6), teric fi adenopathy (n=2). valve patulous ileocecal Conclusion: C - 7 0 R C EECR07-C-SciEduc-FIN.indd 151 Scientific and Educational Exhibits
Methods and Materials: The study included 112 patients aged 0-14 yrs. We used Pediatric scanners with 3-5 MHz convex, 5-8 MHz microconvex and 5-12 MHz linear array transducers. Conventional radiography preceded all US studies. Neuro Results: Pleural collections were identifi ed in 81patients with pneumonia. Fluid was anechoic in 18 cases, contained debris/septations in 51 patients and had a honeycomb-like appearance in 12 patients. Metastatic disease was confi rmed in 1 C-729 patient. The underlying lung parenchyma was adequately evaluated in 72/82 patients Role of diffusion-weighted MR imaging and proton MR spectroscopy of the and the assessment of air/fl uid bronchogram and parenchymal vascularity allowed brain in pediatric patients with chronic liver disease the diagnosis of atelectasis/consolidation. Hypoechoic parenchymal lesions were A.A.A.A. Abdel Razek, A. Galal; Mansoura/EG ([email protected]) noted in 11patients and abscesses in 3 cases. Mediastinal enlargement was due to thymus in 12 patients and to nodal enlargement in 1 patient. One case of ganglioneu- Purpose: To determine the role of diffusion-weighted MR imaging and proton MR roblastoma and two of neuroblastoma were visualized. A diaphragmatic hernia was spectroscopy of the brain in pediatric patients with chronic liver disease. confi rmed in 1patient. Three vascular malformations, 1 lymphangioma, 1 lipoma, Methods and Materials: Diffusion-weighted MR imaging (DWI) & multivoxel proton 1 chondrosarcoma, 1 fi brosarcoma, 1 Ewing’s sarcoma, 1 neurofi broma and 1 rib MR spectroscopy of the brain were done for 37 pediatric patients (22 m, 15 f, aged fracture were evaluated. One case of extralobar sequestration was depicted. 4-14 ys, mean 9 ys) with chronic liver disease and 20 volunteers as control. Diffu- Conclusion: US can provide valuable information in pediatric patients with pneu- sion-weighted MR imaging was done using a single shot echo planar imaging with 2 monia by demonstrating the extent and the nature of both pleural and parenchymal a diffusion-weighted factor b of 0, 500 and 1000 sec/mm . The apparent diffusion disease. In specifi c cases, it may contribute signifi cantly to the characterization of coeffi cient (ADC) map was reconstructed. Proton MR spectroscopy (multivoxel lesions concerning the mediastinum, diaphragm and chest wall. PRESS technique: TR/TE=1500/135, 1.6×1.6 matrix, FOV=100 mm, 2 averages) was performed at the level of the most signifi cant MR abnormality. Assignment of the resonance peaks of NAA, creatine, choline, glutamate, myionositol, lipid and lactate was determined in the basal ganglion, thalamus, grey and white matter. Results: Restricted diffusion (high SI at high diffusion-weighted images and low SI at ADC maps) within the corticospinal tract in hepatic encephalopathy (n=14), putamen and caudate nucleus in Wilson disease (n=4) and frontal and occipital white matter in Gauchers disease (n=2). MR spectra revealed increased glutamate with decreased myoinositol and choline peaks in hepatic encephalopathy. Wilson disease showed decreased choline & myoinositol that associated with lactate. MR spectra in Gaucher’s disease revealed presence of lipid and lactate. Conclusion: Diffusion-weighted MR imaging and proton MR spectroscopy added valuable information to routine MR imaging of the brain in pediatric patients with chronic liver disease. C-730 Overview of paediatric orbital pathology: A pictorial review S. Nayak, D. Nayak; Leeds, West Yorkshire/UK ([email protected])
The spectrum of ocular and orbital pathology in the paediatric age group is quite different from that of adults. Imaging studies serve an important role in the diagnosis and management of many of these abnormalities. Systemic approach is required to understand the classifi cation and imaging features of orbital pathology. We have described them according to the three orbital compartments, namely, the globe/optic nerve sheath, intraconal and extraconal lesions. This extensive pictorial review outlines the various abnormalities of the paediatric eye and orbit for which imaging studies are often required, including infection, neoplasm, infl ammation and infi ltration, developmental anomalies, and trauma. Imaging included in this review includes the relevant plain radiography, CT, ultrasound and MRI features of various pathologies. Additionally, the pertinent fi ndings are correlated with pictorial description of the relevant histopathology, fundoscopy features and relevant clini- cal ocular photographs. Correlation of the results of imaging studies with pertinent clinical information allows the determination of specifi c diagnoses in most instances of paediatric orbital pathology. C-731 Pediatric anomalies of cerebral vasculature J. Garcia Marco, C. Pack, J. Gallego León, L.A. Concepción Aramendía, F. Ballenilla Marco, J. Vázquez Suárez; Alicante/ES ([email protected])
Learning Objectives: To review our series of cases and choose the cases that best illustrate the radiologic features of the most common anomalies of cerebral vasculature in childhood. To outline the most typical imaging fi ndings of each le- sion. To discuss the advantages and limitation of the different imaging techniques (transcanial US, CT, MR, CTA, MRA, DSA). Background: Pediatric cerebrovascular diseases are uncommon, but involve a large variety of lesions. We review our experience from 1990 to 2006, selecting the cases that best illustrate the radiologic features of each pathology. Imaging Findings: We will provide examples of Vein of Gale malformation, carotid cavernous fi stula, intracerebral malformation, intracranial aneurysms, dural arterio- venous malformation, Moya-moya syndrome, and Stroke syndrome. Conclusion: Pediatric anomalies of cerebral vasculature are a wide variety of lesions, with specifi c radiologic fi ndings that help in their diagnosis.
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7 0 0 2 . 2 483 0 . ndings 2 112.02.2007 17:04:14 G , 2 cant part. There part. cant 0.001). < cation and should lled a bibliographic lled a bibliographic cant relationship be- cant , M. Keil , M. 2
Alexandroupolis/GR, Alexandroupolis/GR, 1 nd ; 2 , K.J. Griffi n Griffi , K.J. Madrid/ES cation was as follows: 28% normal, as follows: cation was 2 C 3 Imaging fi studied. yrs) were eld in the last 10 years: epidemiology eld in the last 10 years: cant developmental impairment. impairment. cant developmental ± BDEF c knowledge of the diagnosis, management, of the diagnosis, c knowledge A , C.A. Stratakis , C.A. 2 , E.H. Oldfi eld Oldfi , E.H. 2 Data were analyzed retrospectively from a series of pa- retrospectively analyzed Data were 16 years. We analyzed the mechanism of trauma, patient the mechanism of trauma, analyzed We 16 years. < To describe the principal location of facial fractures in in fractures describe the principal location of facial To The most common were nasal fractures, succeeded by succeeded by nasal fractures, The most common were , D. Batista , D. ([email protected]) ([email protected]) 1
, N. Patronas , N. 1 Trauma is one of the main causes of morbidity and mortality in the pe- Trauma Contrast enhanced conventional MRI mostly failed to identify ACTH- MRI mostly failed enhanced conventional Contrast Facial fractures in the pediatric age group have special characteristics, special characteristics, in the pediatric have fractures age group Facial Isolated WM lesions are relatively uncommon following hypoxic ischaemic hypoxic following uncommon WM lesions are relatively Isolated ths developmental scales and a structured neurological examination. ths developmental To compare a spoiled gradient-recalled acquisition in the steady-state compare a spoiled gradient-recalled To Twenty-eight patients had microadenomas and two had macroadenomas; had macroadenomas; microadenomas and two patients had Twenty-eight Of the 64 infants, 41% were females and 59% males. The mean gestational and 59% males. females were 41% Of the 64 infants, pituitarycation of adrenocorticotropin-secreting adenomas in ed four and six of the microadenomas, respectively. Postcontrast SPGR-MRI Postcontrast respectively. six of the microadenomas, and ed four SE-MRI whereas postcontrast tumor in 18 of 28 patients, ed the location of the Bethesda, MD/US Conclusion: with Cushing disease. secreting microadenomas in children and adolescents superior to SE-MRI in tumor identifi SPGR-MRI was Postcontrast SE-MRI in the pituitary imaging of children and be used in addition to conventional adolescents with suspected Cushing disease. were compared with surgical and pathological fi ndings in all cases. fi compared with surgical and pathological were Results: SE and SPGR-MRI Precontrast both MRI techniques. ed by identifi the latter were identifi identifi patients (P ve microadenomas in only fi ed demonstrated identifi age and sex, fracture location, and radiologic features. We fulfi We features. location, and radiologic fracture age and sex, and compared our results to those in the literature. revision Findings: Imaging nasoetmoidal, frontal and panfacial Zygomatic, and orbital fractures. mandibular The 1.7:1 (male/female). was ratio The sex to be infrequent. found were fractures crashes, motor-vehicle aggressions, by followed accidental falls, main causes were and sports accidents. Conclusion: require subject-specifi and therefore and follow-up. P.K. Prassopoulos P.K. Purpose: spin echo acquisition (SE) magnetic resonance imag- weighted T-1 (SPGR) with a in children and tumors of ACTH-secreting ing (MRI) in the diagnostic evaluation adolescents with Cushing disease. Methods and Materials: Thirty children and adolescents with Cushing disease (13 7 years. tients seen over males with a mean age of 12 and 17 females magnetic resonance imaging between 1991-2000 in our unit 64 had no evidence of 64 had no evidence 1991-2000 in our unit imaging between magnetic resonance assessed for images were Conventional the study. for eligible were BGT lesions and measured was outcome Neurodevelopmental of lesions. and distribution severity using Griffi Results: obtained outcome was Neurodevelopmental weeks. 36-42) 40.2 (range age was White matter classifi at a mean of 36.4 months. a signifi was There 19% severe. 31% mild, 22% moderate, outcome. WM lesions and both neurological and developmental of severity tween increasing common and increased with was delay developmental Generalised Motor impairments of cerebral in the form (p=0.01). of white matter lesions severity whom had six of palsy, cerebral developed Eight infants common. not palsy were WM changes. severe Conclusion: are associated with signifi but encephalopathy C-736 shall fi Seek and you fractures: facial Pediatric Jiménez Arranz, Martín Pérez, S. Arribas García, M.A. I. Alcala-Galiano, A. Moreno; Montalvo J. Romance, A. Salvador, E. C-735 Identifi SPGR sequence on disease by and adolescents with Cushing children resonance imaging magnetic Courcoutsakis N.A. 2 ([email protected]) Learning Objectives: optimal imaging discuss the To pediatric appearance. patients and their radiologic in children, with emphasis on the important detection of these fractures work-up for in this fi describe our experience To role of CT. and main mechanisms of trauma. Background: in a signifi being accountable fractures craniofacial diatric age group, on literature epidemiologic data and scant radiologic disparityis great in the available is specially challenging in radiographs Interpretationthis important of facial subject. with the be familiarized must we therefore, cases; children, and CT is required in many fractures facial reviewed retrospectively We unique characteristics of these fractures. The total amounted to 320 diagnosed attended in our institution in the last 10 years. in 282 patients fractures - - rmed c neuro- Tehran/IR, Tehran/IR, 1 ; cant difference difference cant 2
cantly smaller in the PVL EPOS , A.A. Zamani , A.A. London/UK 1 0.001), respectively; tegmentum 0.001), respectively;
< P ndings are expected and rise the ndings are expected Kyoto/JP 0.001), respectively; basis diameters 0.001), respectively; 0.001), respectively. When the age- When 0.001), respectively.
< < Scientific and Educational Exhibits Scientific and Educational P P , S. Molaei , S. 1 0.23 mm ( 0.23 mm 0.001), respectively; and the corpus callosum 0.001), respectively; 0.19 (
± 0.76, ( ± < ± P seen among those presented with loss ndings were , H. Ghanaati , H. 0.14 ( 1 Fifty-two brain images of the patients with confi images of brain Fifty-two ± We examined 80 children (43 boys and 37 girls) with PVL 80 children (43 boys examined We In a cohort, 270 infants with HIE who underwent neonatal In a cohort, with HIE who underwent 270 infants ndings and neurodevelopmental outcome ndings and neurodevelopmental
0.20 and 1.36 No Material Submitted to to Submitted Material No 3 ± 0.90 and 5.51 5 ± 1
([email protected]) ([email protected])
0.21 (SD) and 1.87
, T. Zaman , T. ± d 1 d n We proved that pontine diameter in patients suffering PVL is signifi diameter in patients suffering that pontine proved We In addition to ventricular and sulci widening, myelination abnormal- and sulci widening, myelination In addition to ventricular i ndings while few fi ndings while few . 0.10 and 0.51 N I The most common imaging abnormality in neonates with hypoxic The most common imaging abnormality in neonates with hypoxic ± Methylmalonic acidemia (MMA) often presents with nonspecifi Methylmalonic The brainstem in patients with periventricular leukomalacia (PVL) looks in patients with periventricular leukomalacia The brainstem F Fourteen most common patients (26.9%) had normal images.The brain Pontine diameters in all regions were signifi diameters in all regions were Pontine - c u d E i c S Boston, MA/US - were 0.42 were signifi there was examined, were related pontine diameter differences in pontine diameters after 12 months of age. Conclusion: lengths were 5.02 lengths were cation. Treatment with adequate duration may improve or prevent some structural some or prevent improve may with adequate duration Treatment cation. changes in CNS. logical symptoms that leads to different imaging work-ups. Better recognition of Better recognition imaging work-ups. logical symptoms that leads to different suspect to MMA diagnosis in imaging (CT/MRI) helps physicians ndings of brain fi stages of the disease. earlier reversible Methods and Materials: neonatal screening. of consciousness and those detected by Conclusion: some other fi ity and basal ganglia changes, suspicion to MMA including corpus signal stem thinning, callosum thinning, brain putamen calcifi and bright signal in centrum semioval infarct, change due to focal diameters were 1.23 diameters were cantly smaller than normal control. diagnosis of MMA including 47 MR and 5 CT images were reviewed. The clinical The clinical reviewed. were diagnosis of MMA including 47 MR and 5 CT images radiological The frequency of different each patient. also registered for data were and presenting symptom to age,gender,clinical compared according ndings were fi of treatment. duration Results: dilation (32.7%), ventricular (in order of frequency): ndings of the images were fi diffuse cortical periventricular (sulci dilation)(28.8%), change white matter atrophy (15.4%), subcortical white matter lesions (23.1%), corpus callosum thinning Basal ganglia (7.7%). (11.5%), local cortical (7.7%) and cerebellar atrophy atrophy seen in 2 patients both of whom presented clinically in neonacy. cation was calcifi of ventricular on the severity effect an improving seems to have duration Treatment more than the classic treatment for received in those who have dilation (less severity had usually multiple Children who presented with psychomotor delay one year). fi radiological Purpose: White matter lesions in neonates with hypoxic ischaemic encephalopathy: encephalopathy: ischaemic White matter lesions in neonates with hypoxic A comparison of MR fi Rutherford; M.A. Cowan, Bregan, F. T. Adams, M.E. Purpose: (HIE) are lesions within the basal ganglia and thalami ischaemic encephalopathy These are associated with motor impairments palsy. of cerebral in the form (BGT). been no There have A minority of neonates sustain mainly white matter lesions. to categorise the The aim of this study was reports of outcomes in these infants. and to compare with neurodevel- of the white matter lesions in this group severity opmental outcome. Methods and Materials: C-734 2 C-733 acidemia with methylmalonic (CT/MRI) in children Findings of brain imaging Radmanesh A. ([email protected]) ([email protected]) Purpose: it and papers to demonstrate there are only few but smaller on MR imaging (MRI), The purpose the of this study is to verify small. patients is relatively of the number PVL is smaller than normal that the pons in patients suffering control hypothesis with larger series. Methods and Materials: Control 42 girls) and with MRI. children (58 boys and 100 age-matched control normal normal and also showed neurologically and developmentally children were We groups. of corrected age in both from 0 to 5 years performed MRI was MRI. and the tegmentum and basis pontis, of the pons, measured the AP diameter midsagittal image. T1-weighted corpus length using callosum Results: and control diameters in the PVL group Pontine than in the control group. group 1.66 were group Pontine hypoplasia in children suffering periventricular leukomalacia: periventricular leukomalacia: suffering in children hypoplasia Pontine Is it true? Yamori; Y. Kanda, T. Hayakawa, K. Yoshida, S. C-732 C - 7 0 R C EECR07-C-SciEduc-FIN.indd 153 Scientific and Educational Exhibits
C-737 intraventricular haemorrhage. Conclusion: Cross-sectional imaging, along with clinical data, may provide useful Arterial aneurysm in childhood clues in the early diagnosis of CNS-TB, and may helpful in preventing unnecessary J. Garcia Marco, C. Pack, J. Gallego León, G. Alabau, F. Ballenilla Marco, morbidity and mortality. L. Concepción Aramendía, J. Vázquez Suárez; Alicante/ES ([email protected]) C-740 Learning Objectives: To illustrate and discuss the clinical and radiologic fi ndings of Head and neck tumors in the pediatric age group - more than lymph nodes children with intracranial aneurysms. To outline the accuracy of imaging procedures to be found [transcranial US, computed tomography (CT), magnetic resonance imaging (MR), CT G.K. Schneider, K. Altmeyer, P. Fries, A. Massmann, T. Krenn, N. Graf; angiography, MR angiography and digital sustraction angiography (DSA)]. To describe Homburg a.d. Saar/DE ([email protected]) endovascular treatment options and their results on our particular series of cases. Background: Intracranial arterial aneurism in childhood is very rare, ranging from Learning Objectives: This exhibit will present the wide spectrum of head and neck 1 to 2% of all series. Their diagnosis may be diffi cult because of their infrequency masses in children. Special consideration will be given to describe the lesions DDX and confusing clinical presentation, but should be suspected in the work up of brain according to their anatomic localization. haemorrhage. We reviewed our own cases from 1990 to 2006. Background: Masses of the head and neck area are a commonly encountered Procedure Details: Transcranial US, CT, MR, CTA, MRA and DSA were performed. problem in daily practice. The aim of this exhibit is to review DDX of head and neck Clipping and Coiling were used as treatment options. tumors in children with special regard to their anatomic localization. MRI and CT Conclusion: A clinical and non-invasive imaging diagnosis approach is possible, images will demonstrate the range of lesions from infl ammation to lymphoma, soft although DSA is still crucial to plan the treatment. tissue tumors, and vascular abnormalities. Imaging Findings: The exhibit will review the different anatomic spaces to enable C-738 the reader to properly allocate a mass to its compartment. DDX will be explained with regards to their typical localization, imaging fi ndings and their clinical ap- Fetal magnetic resonance imaging (MRI) in oligohydramnios: Detection of pearance. MRI and when it is useful for DDX CT images will be demonstrated pulmonary hypoplasia and clinical outcome in case presentations. A special emphasis will be laid on pitfalls such as vessel A. Pataraia, G. Kasprian, A. Messerschmidt, P. Brugger, H. Helmer, D. Prayer; abnormalities or pseudotumors. Finally, readers will have the opportunity to test Vienna/AT ([email protected]) their knowledge in some quiz cases. Purpose: Prolonged oligo/anhydramnios may lead to pulmonary hypoplasia. In this Conclusion: DDX of masses in the head and neck region of children goes far follow-up study, we used MR volumetry and the assessment of signal intensities beyond simple lymph node enlargement versus lymphoma. Depending on its lo- to detect fetuses with restricted lung development, and correlated our results with calization, cervical cysts or tumors of neural origin may come into focus. Soft tissue the postnatal outcome. or bone tumors, pseudotumors, and abscess formations or vessel abnormalities all Methods and Materials: Twenty-three singleton pregnancies complicated by may present as circumscribed lesions. MRI allows for exact tumor localization, and oligohydramnios underwent MRI between the eighteenth gestational week (GW) together with CT and ceMRA may identify lesions that need to undergo biopsy. and birth (mean 27.8 GW). Fetal lung volumes, body volumes and the amount of amniotic fl uid were measured and compared to the results of 244 measurements C-741 in normal fetuses. Fetal MRI evaluation of anomalies of the neural tube and spine For the follow-up, 4 groups were defi ned: newborns with (1) lethal postnatal course C. Martín, A. Lüttich, C. Escofet, A. Martín, I. Delgado, S. Perez, C. Durán; (2) intensive respiratory care > 6 days and/or pulmonary hypertension (3) intensive Sabadell/ES ([email protected]) respiratory care < 6 days, and (4) no need for additional respiratory support. Results: In fetuses with oligohydramnios, fetal lung volumes were signifi cantly Purpose: To analyze the neural tube and spinal column anomalies detected reduced (p < 0.01). The mean defi cit of lung volumes was 31% compared to nor- prenatally at our centre over the last 10 years and evaluate the impact of fetal mals. Fetuses with a modal defi cit of 58.7% of lung volume deceased postnatally. MRI in the diagnosis. Reduced signal intensity of lung tissue was associated with lethal outcome in 6 of Methods and Materials: Thirty fetuses with anomalies of the neural tube and spine 8 newborns. Differences of lung volumes and signal intensities between the groups were studied. All patients underwent obstetric US examination. Intrauterine MRI 2-4 were less pronounced. Fetuses with a high risk of pulmonary hypoplasia (group was performed in 22 cases; in the remaining 8, MRI was not performed because 2) showed signifi cantly reduced amniotic fl uid volumes, early onset and a long indications went unobserved at US or further examination was considered unneces- persistence of oligohydramnios. sary. MRI was performed on a 1.5 Tesla unit using ultrafast half-Fourier acquisition Conclusion: Fetal MR can reveal the degree of pulmonary hypoplasia in fetuses single-shot turbo spin-echo (HASTE) sequences. Images were analyzed by a with oligohydramnios. Reduction of fetal lung volumes over 50% of the expected pediatric radiologist and the fi ndings were compared to those of US. All anomalies value together with pronounced darkness of lung tissue on T2- weighted MR were confi rmed after birth or at autopsy. sequences is highly conspicuous for lethal outcome. Results: The anomalies observed were acrania (n=3), encephalocele (n=3), iniencephaly (n=1), spina bifi da (n=8), diastomatomyelia (n=1), hemivertebra C-739 (n=3), kyphoscoliosis (n=2), amniotic band syndrome (n=1), osseous dysplasia with spinal involvement (n=3), caudal regression syndrome (n=1), sacrococcy- Magnetic resonance and computed tomography fi ndings in childhood geal teratoma (n=3), and conjoined twins (n=1). Neural tube and spinal column central nervous system tuberculosis anomalies were associated to anomalies in other organs in 17 cases. Fetal MR P. Di Carlo, A. Mazzola, L. Meli, A. Romano, L. Titone, T. Borino, T.V. Bartolotta; provided additional information in 10 (45%) cases, and changed the therapeutic Palermo/IT ([email protected]) approach in 6 (27%). Learning Objectives: To illustrate CT and MR features of Tuberculosis (TB) of Conclusion: Prenatal diagnosis of neural tube and spinal column anomalies central nervous system (CNS-TB) in childhood in order to allow a prompt diagnosis can predict fetal viability, orient the prognosis and management of the newborn, and thus providing an adequate patient management. and has implications for genetic counseling. MR is a noninvasive method of fetal Background: TB still ranks as one of the most important communicable diseases examination that provides additional information to US. and represents a major global health problem. Although pulmonary TB tends to be the most common form of tuberculosis, the highest mortality and morbidity occurs C-742 with TB of central nervous system (CNS TB), which develops in 4% of children with Mild fetal cerebral ventriculomegaly: Association with corpus callosum tuberculosis and has an high fatality rate and causes serious sequelae, especially R. Manfredi, A. Tognolini, S. Baltieri, C. Bruno, C. Cicero, R. Pozzi Mucelli; during childhood. Verona/IT ([email protected]) Imaging Findings: Available imaging CT and MR studies of 18 patients (11 females, 7 males; mean age: 45.72 months) were retrospectively reviewed. All patients Purpose: To determine the capability of MR imaging in evaluating agenesis of fetal showed a basilar enhancement. Other fi ndings were hydrocephalus (61%), intra- corpus callosum in fetuses with mild cerebral ventriculomegaly at US. cranial tuberculomas (17%), and other nodular (11%) and ischemic lesions (11%). Methods and Materials: 29 fetuses (mean gestational week:28.9; range17-37) with Edema, either perilesional or diffuse, was found in 7/18 patients. Severe ventricular US diagnosis of mild ventriculomegaly (mean value11.6; range 10-15) prospectively dilatation was observed in 9/18 cases. Two patients, with fatal involvement, showed underwent MR imaging. The mean US/MR interval was 3.1 weeks. Post-natal refer- severe hydrocephalus associated, respectively, with extended ischemic areas and ences standard was: ultrasonography and clinical evaluation in all cases, autopsy
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7 0 0 for 2 2 . 2
485 0 . 2 112.02.2007 17:04:15 ts include G Madrid/ES cant differences uoroscopy time in time uoroscopy uoroscopy time and number time and number uoroscopy C ndings in MRU and nuclear medicine. and nuclear ndings in MRU BDEF ([email protected]) ([email protected])
cance using the two-tailed Mann-Whitney Mann-Whitney cance using the two-tailed A Toledo/ES ([email protected]) ([email protected])
0.05). There were no statistically signifi There were 0.05). Dose-area product (DAP), fl Dose-area product (DAP), 15 patients with sonographicallly suspected urinary 15 patients with sonographicallly tract < To present the wide spectrum of sonographic patterns present the wide spectrum of sonographic of To Athens/GR It is well-known that the sonographic appearance of the developing of the developing appearance the sonographic that It is well-known ndings with etiology, which should be the basis for the appropriate which should be the basis for ndings with etiology, An important reduction of dose may be achieved with digital VCUG, with digital An important be achieved reduction of dose may MRU provides very high quality images. Additional benefi very images. high quality provides MRU To assess Magnetic Resonance Urography (MRU) in the morphologic (MRU) assess Magnetic Resonance Urography To (1) To compare dose and image quality of two samples of digital pe- and image quality of two compare dose To (1) The medians of the DAP distributions were 12.1 and 3.0 cGy*cm 12.1 and 3.0 were distributions The medians of the DAP The obstruction site and cause were detected in all cases by MR examina- The obstruction detected in all cases by site and cause were in diagnostic information between both samples. Measured dose values for both for Measured dose values both samples. between in diagnostic information factors Detailed technical if compared with the current literature. samples are lower of each equipment are analyzed. Conclusion: diagnostic information) and patient dose can be reduced (without compromising of 5-10 if appropriate with optimised setting procedure protocol is used, in a factor system. the X-ray for the two X-ray systems included in the study, meaning that there is a statistically systems included in the study, X-ray the two (p cant difference signifi Purpose: try to To of suspected urinary and children. obstruction tract in infants evaluation functional fi the correlation between evaluate Methods and Materials: and nuclear urography T), intravenous (1.5 obstruction studied with MRU were mL/kg) and low-dose saline solution (NaCl 9%, 10 Procedure Details: medicine. (heav- furosemide (1 beginning unenhanced MRU administered before mg/kg) were administrated was 0.1 mmol/kg Gd-DTPA After 15 minutes, T2-W sequences). ily (coronal and dynamic enhanced MRU to coincide with the maximal diuretic effect, performed. 3D FRGE sequences) was Results: system (4), normal system (12), duplex includes: Diagnosis of the 30 kidneys tion. junction stenosis (9), ureterocele (3), ureteric ectopia (2), multicystic pyeloureteral (2). kinking (2), horseshoe kidney (1), megaureter (2), ureteral dysplastic kidney of normal and pathologic kidneys of 180 seconds in the excretion Time difference with the diagnosis of obstruction good correlation medicine. in nuclear showed Conclusion: is a non- MRU surgery. planning for renal arteries and preprocedural evaluation both functional and morphologicionizing imaging technique that allows evaluation in the same procedure and could replace other imaging modalities. Learning Objectives: the renal as pathologic conditions that affect as well in physiologic, renal pyramids correlating the role of sonography, emphasize To medulla of pediatric patients. the imaging fi diagnosis. differential Background: the two groups were analysed for signifi analysed for were groups the two rank Wilcoxon-signed means of the compared by Image quality scores were test. analysis of the results is also made. A qualitative test. Results: C-744 of dilated in the functional and morphologic evaluation MR urograhpy upper urinary tract in children Gonzalez, Cristina, S. V. Fernández-Zapardiel, S. Céspedes, M. Arjona; Martín-Crespo, D. R. C-745 The whole spectrum of sonographic patterns of normal and abnormal and childhood in infancy renal pyramids Pitsoulakis, G. Tavernaraki, K. Simopoulos, A. Papadoniou, P. Vakaki, M. Koumanidou; C. Pediatric Pediatric Urogenital C-743 image quality in digital pediatric voiding Optimisation of dose and cystourethrography Soto; Fernandez J. Vano, E. Sanchez Jacob, R. Vano-Galvan, E. ([email protected]) Purpose: the same by performed (VCUG) examinations cystourethrography diatric voiding discuss To (2) and dose settings. systems X-ray different two using radiologist dose and image balance between an optimal techniques that provide radiographic quality (ALARA criteria). Methods and Materials: been systems have digital X-ray different VCUGs from two of images of 192 and 93 (selected in the 0-1 year A sample of 20 procedures from each group registered. scoring image quality using radiologists, two by blindly age band) is evaluated and fl DAP between Differences European and American criteria. Scientific and Educational Exhibits Scientific and Educational 5 5 1
d d n Mild ventriculomegaly associated with corpus Mild ventriculomegaly callosum agenesis oc- i . N I F 19/29 (66%) fetuses showed a normal confi guration of lateral ventricle ventricle of lateral guration normal a confi showed 19/29 (66%) fetuses - c u d E i c S - while 10/29 (34%) fetuses showed parallel confi guration. Corpus callosum was guration. confi parallel showed while 10/29 (34%) fetuses partial showed (14%) agenesis 4/29 (58%) fetuses, completely present in 17/29 imaging (US/MR), 2 Compared to post-natal while 8/29 (28%) total agenesis. partial in one case over- corpus agenesis of the misinterpreted: were callosum ventricle The mean left lateral case underestimated. estimated and in the other 11.8 diameter was 6-19 mm (range diameter mm), the mean right ventricle lateral cortex was of the cerebral The mean thickness mm). 8-17 mm (range 11.5 was 2.13 signal intensity alterations showed 1.8-3 mm (range fetuses None of the mm). of the nervous tissue. Conclusion: 3/29, MR imaging in 2/29patients. MR imaging data were compared to gold standard. to gold standard. compared data were MR imaging in 2/29patients. 3/29, MR imaging (normal/parallel),guration confi ventricular analysis included: image Qualitative corpusagenesis of the (total/partial:1/3.2/3.3/3), callosum changes signal intensity diameter of the trigones included: image analysis Quantitative of the nervous tissue. (left and right) cortexventricles thickness. and cerebral of the lateral Results: agenesis of the corpus detected callosum was Total (46%). curred in 12/26 fetuses whereas partial2/4 patients. agenesis was in all cases; C - 7 0 R C EECR07-C-SciEduc-FIN.indd 155 Scientific and Educational Exhibits
kidney differs from that in adults and changes from birth to adolescence. One of Pediatric the characteristic unique features of the pediatric kidney is the hypoechoic appear- ance of its prominent medullary pyramids. Various conditions modify this normal Vascular appearance. Furthermore, the disease processes that affect the renal medulla in children differ from those in adults. Imaging Findings: The various sonographic patterns of normal and abnormal C-746 renal pyramids are illustrated. Anatomic details, histopathology and suggested The role of MR imaging in the pre-surgical evaluation of pre-sinusoidal pathophysiologic mechanisms of the different causative pathologic entities are hypertension secondary to portal cavernomatous transformation in children presented. These conditions represent a heterogeneous group of disorders and F. Guerra-Gutiérrez, J. Fernández-Cuadrado, J. Gomez-Patiño, A. Alonso-Torres, include the normal transient neonatal renal medullary hyperechogenicity, the severe M. López-Santamaría, N. Leal; Madrid/ES (fl [email protected]) obstructive urinary stasis and intratubular refl ux, polycystic kidney diseases (mainly autosomal recessive polycystic disease), renal candidiasis, sickle cell anemia, the Learning Objectives: To demonstrate the utility of Magnetic Resonance Angiog- various common and rare causes and types of nephrocalcinosis, etc. raphy (MRA) in the pre-surgical evaluation of pre-sinusoidal hypertension due to Conclusion: Renal sonography with state-of-the-art US equipment is very sensitive portal cavernomatous transformation (PHPCT) in children. in the imaging study of renal medullary pyramids in childhood. Knowledge of the Background: Children with PHPCT may be treated by means of programmed specifi c sonographic features of the different pathologies affecting the renal pyramids surgery, and a pre-surgical imaging evaluation is crucial to defi ne the venous supplemented by the necessary clinical information allows the narrowing of the obstructive pattern, and, subsequently, to choose an appropriate surgical strategy. differential diagnosis directing further diagnostic investigation, when necessary. In that purpose, commonly, these children underwent a conventional angiography, which is an invasive technique. Imaging Findings: Twenty-two children with PHPCT were evaluated. They all underwent a MRA previous to programmed surgery in the past 10 years. We describe four major venous patterns: 1) principal portal vein (PPV) obstruction with patent and connected to each other superior mesenteric vein (SMV) and splenic vein (SV) (n=14); 2) PPV obstruction with thrombosis of SMV and patent SV (n=7); 3) generalized hypoplasia of the splachnic venous system (n=1); 4) any of the previous patterns with normal intrahepatic portal vein (n=5). The surgical procedure was chosen as follows: mesenteric-caval shunt with autologous jugular vein graft (n=11) in the case of the fi rst pattern; distal splenorenal shunt (n=5) and proximal splenorenal shunt, both indicated for the second pattern; mesenteric-left portal vein shunt (Rex) for the fi rst pattern in association with the fourth pattern; non-derivative surgery (n=1) in the case of the third pattern. Conclusion: MRA is a useful tool in the pre-surgical evaluation of children with HPCPT. It gives accurate information that helps the surgeon to choose the most suitable surgical procedure. C-747 Subcarinal left pulmonary artery sling in fi ve patients: Assessing anatomical relationship between air-way and left subcarinal pulmonary artery sling and associated with tracheobronchial anomaly K. Choo1, Y. Kim2, M. Lee1; 1Pusan/KR, 2Pucheon, Kyunggi-do/KR
Purpose: The purpose of our study is to assess anatomical relationship between air-way and subcarinal left pulmonary artery sling and associated with tracheo- bronchial anomaly. Methods and Materials: We present chest radiography, CT and echocardiographic fi ndings of subcarinal left pulmonary sling in 5 patients (2 male, 3 female, mean age: 14.8 months). All patients had respiratory symptoms. Echocardiography showed intracardiac anomaly such as VSD, ASD, pulmonary atresia in 4 patients and abnormal coursing left pulmonary artery in all patients. Single, 4-slice and 16 slice MDCT were performed and axial images with 3 dimensional reconstructions were used for evaluation of anatomical relationships of tracheobronchial anomaly associated with subcarinal left pulmonary artery sling in all patients. Results: One of the 5 patients had severe obstruction of left main bronchus by subcarinal left pulmonary sling, resulting in total atelectasis of Lt. lung, with basically normal bronchial branch pattern. Four of the 5 patients had about 50% obstruction of left main bronchus by subcarinal left pulmonary sling with associ- ated bridging bronchus. Conclusion: The subcarinal pulmonary sling could cause obstruction of left main bronchus and be often associated with tracheobronchial anomaly, including bridging bronchus. In addition, the CT scan using axial images and 3 dimensional reconstruc- tions could help to assess anatomical relationship between air-way and subcarinal left pulmonary artery sling and associated with tracheobronchial anomaly. C-748 Advanced imaging and interventional radiological management of hemangiomas and vascular malformations C. Hernandez, M. Diaz, A. Alonso-Burgos, B. Zudaire, G. Bastarrika, A. Martinez de la Cuesta; Pamplona/ES ([email protected])
Learning Objectives: To describe the classifi cation system of vascular anomalies. To explain the imaging techniques and radiological fi ndings in the diagnosis of vascular anomalies and the different therapeutic options. Background: Vascular anomalies have a high incidence at birth. Imaging stud- ies are necessary to orientate and/or confi rm the diagnosis and to establish their
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From 1990 to 2006, 98 patients with "pseudo" cancers, 1990 to 2006, 98 patients with "pseudo" cancers, From During a 7-year period, 159 children, aged 10 days to 14 period, Duringchildren, aged 10 days 159 a 7-year To review a variety of entities that show with physical with physical of entities that show a variety review To Athens/GR Sonography has been shown to be particularly has been shown helpful in confi Sonography Pseudo-malignancies are rare and diffi Pseudo-malignancies are rare culties (3). One patient had two pseudo-malignancies. Thus, 30 lesions Thus, pseudo-malignancies. had two One patient culties (3). Two per cent of the children referred to our cancer center have pseudo- to our cancer center have per cent of the children referred Two To highlight the role of sonography in the diagnostic evaluation of patho- evaluation in the diagnostic highlight the role of sonography To The sonographic examination revealed the presence of supernumerary revealed examination The sonographic Frequent symptoms, variously combined and most frequently associated variously symptoms, Frequent C-751 MR imaging in children: on the buttock Lumps and bumps Enriquez; G. Aso, Dominguez, C. R. Castellote, A. Barber, I. C-750 of 29 cases review A retrospective pediatric pseudo-malignancies: Imaging Dromain; Sigal, C. R.C. Dufour, Couanet, C. D. Vanel, Castellazzi, D. G. ([email protected]) Learning Objectives: Pediatric Pediatric Miscellaneous C-749 wall in of thoracic and abdominal the study in of sonography The role childhood Pitsoulakis, G. Sfakiotaki, Halatsi, R. E. Leodis, Hountala, M. A. Vakaki, M. Koumanidou; C. Purpose: of pediatric patients. and abdominal wall the thoracic logic processes involving ed as congenital, infl These abnormalities, classifi the pediatric radiologist. for represent a diagnostic challenge and vascular Methods and Materials: thoracic/abdomi- painful/painless presentations (palpable clinical with various years, 5-12 Linear MHz transducers examined. sonographically etc) were swelling, nal wall of the examination Doppler sonographic and color/power gray-scale used for were or abdominal wall. thoracic Results: (n=25) and omphalomesentericbreast tissue (n=2), all types of congenital urachal duct (n=12) abnormalities,(n=10), linea alba (n=12) and postsurgical (n=6) umbilical abscesses (n=9), one primary (n=7), wall hernias, sternal umbilical granulomas (n=17), clavicular contusions or hematomas abdominal wall thoracic/ osteomyelitis, bro- bodies (n=4), lipomas (n=9), neurofi or rib (n=6), soft-tissue foreign fractures sarcomas (n=6), one metastatic neuroblastoma, mas (n=4), one lipoblastoma, (n=4), subcutaneous or abdominal cavity from the thoracic invasion direct tumoral ndings fi The sonographic hemangiomas (n=15), and cystic lymphangiomas (n=8). rmed confi All cases were diagnosis is discussed. and differential are illustrated follow-up. or with clinical/sonographic surgically, Conclusion: and optimal treatment abnormalities and abdominal wall of the thoracic evaluating with the embryology should be familiar therefore, radiologists, Pediatric planning. congenital and ac- of various features sonographic as with the as well and anatomy, of children. and abdominal wall the thoracic quired pathologic disorders involving Purpose: and correlate their clinical and to analyze The aim of this study was malignancy. ndings. fi radiological Methods and Materials: had complete imaging Twenty-nine seen. were clinicians, well-trained by referred and clinical history records and the fi The of age. 1 and 17 years between 19 males and 10 females, were There ease. (12), and serologic made through pathology (17), follow-up were nal diagnoses fi analysis (1). Results: (5), a mass (5), adenopathies (5), and pain (17), fever at the beginning, were: diffi walking malignant bone tumor (9), lymphoma diagnoses: studied with the following were (3), soft tissue tumor (4), nervous tissue (3), neuroblastoma (5), nephroblastoma nasopharyngeal neuroendocrine (1), and undifferentiated tumor (4), small bowell There were performed. were examinations radiological 138 various carcinoma (1). 3 congenital lesions, 3 chronic diseases, lesions, 7 traumatic 15 infections, in fact and in 2 cases no disease corresponding to the clinically suspicious symptoms found. was Conclusion: of images of pediatric The aim of the poster is to propose a review teams. trained the reader more to an oncologic hospital, to make pseudo-malignancies referred and diagnosis, an easier and faster allow problems, with those possible familiar unnecessary and sometimes dangerous treatments. avoid centered signal voids ow Scientific and Educational Exhibits Scientific and Educational Hemangiomas are tumours that show diffuse gadolinium diffuse gadolinium that show Hemangiomas are tumours 7 5 1
d d n MR is the fi rst choice imaging technique. It is able, as well as CT, to as CT, well as It is able, rst choice imaging technique. MR is the fi i . N I F - c u d E i c S - extension. Diagnostic imaging techniques include: plain fi lms, Doppler ultrasound, Doppler ultrasound, lms, plain fi techniques include: Diagnostic imaging extension. and angiographic resonance, Angio- magnetic Angio- computerised tomography, phlebography). techniques (arteriography, Findings: Imaging Arteriovenous is seen with Doppler. ow an arterial Sometimes, fl enhancement. enlarged arterial fl on MRI have Malformations and venous about a nidus. Venous malformations have lumena which are characteristically lumena which are seen have malformations Venous about a nidus. T2 high These lesions show with Doppler ultrasound. to enlarge on bipedestation are enhancement is typical and phleboliths Gadolinium signal intensity on MRI. frequent. Conclusion: Doppler ultrasound correlations. and anatomic precision the extension with evaluate is a use- Angiography information. anatomical and hemodinamic offer examinations Each technique has its indications technique. ful diagnostic and also therapeutic it is necessary the type of technique used as Thus, to individualize and limitations. complementary information. techniques offer different C - 7 0 R C EECR07-C-SciEduc-FIN.indd 157 Scientific and Educational Exhibits
anomalies in the backside of children. To review the imaging techniques used in Pediatric the evaluation of these lesions. Background: Lumps and bumps of the buttock in children often pose a diagnostic Musculoskeletal dilemma. A proper diagnosis is of paramount importance, because therapeutic implications can vary signifi cantly. The purpose of our study is to review the dif- ferential diagnosis and to present the MRI fi ndings of a variety of entities that show C-753 with physical anomalies in the backside of children. Muscular magnetic resonance imaging for evaluation of myopathies in children Imaging Findings: A wide spectrum of congenital lesions such as hemangiomas, li- C.M. Heyer, S.P. Lemburg, S.A. Peters, P. Mohr, C.H.L. Rieger, V. Nicolas; pomas (isolated or associated with congenital anomalies of the spine), lipoblastoma, Bochum/DE ([email protected]) sacrococcygeal teratoma and other germ cell tumors, PNET, rabdomyosarcoma, Ewing sarcoma and plexiform neurofi broma are seen. Gluteal fi brosis, subcutane- Purpose: Myopathies present with a broad diagnostic spectrum, which may ulti- ous fat atrophy or traumatic lesions (hematoma, subcutaneous fat necrosis) are mately require muscle biopsy. MRI has been established as a non-invasive method found. Venous and lymphatic malformations (isolated or associated with other in diagnosing adult myopathies; not only does MRI reveal characteristic fi ndings that overgrowth syndromes such as Proteus Syndrome, Klippel-Trenaunay-Weber, point in a diagnostic direction, but it also aids in determining optimal biopsy sites and Parkes-Weber) are seen. controlling therapeutic interventions. Muscle MRI is increasingly fi nding application Conclusion: Children presenting with a lump on the buttock often request radio- in pediatric myopathies, especially dystrophies and myositides. The following exhibit logical evaluation. Radiography and ultrasonography are often the initial screening serves to illustrate the use of MRI using exemplary clinical vignettes. diagnostic tests, followed by MRI. We review the imaging techniques making a stand Methods and Materials: From 1999 to 2006, 180 children with myopathies of un- on surface coil MRI and MR angiography. known aetiology, aged 14 months to 18 years, were examined with a standardised MRI protocol (axial T1-SE and T2-weigted TIRM sequences). The protocol included imaging of the lower extremities, whereas sequences displaying the upper extremi- C-752 ties were only acquired in selected patients. Furthermore, intravenous contrast agent A PDA reference database solution for pediatric plain fi lm radiography was only administered in selected children. M. Paetzel1, R. Talanow2, M. Grunewald3; 1Cleveland Heights, OH/US, Results: All investigations could be performed without sedation due to an examina- 2Cleveland, OH/US, 3Erlangen/DE ([email protected]) tion time of 12-15 minutes. The illustrated cases of limb-girdle muscular dystrophy, Duchenne’s muscular dystrophy, dermatomyositis, pyomyositis, and chronic neu- Learning Objectives: To provide a free program for handheld devices as a refer- rogenic disease with secondary myopathy all showed disease-characteristic MRI ence database in Pediatric Plain Film Radiography which serves the well and less patterns, which substantially helped reach the ultimate diagnosis. experienced pediatric radiologist to differentiate between physiological age-specifi c Conclusion: Muscle MRI is a non-invasive and effective instrument in helping and pathological fi ndings. diagnose pediatric myopathies of unknown aetiology. It may facilitate muscle Background: It is especially diffi cult for the inexperienced radiologist or the resi- biopsy and serves to control therapeutical effects and disease course. Further- dent on-call to differentiate between physiological age-specifi c and pathological more, muscle MRI may be applicable even to children of less than 4 years of age fi ndings due to developmental variations in the growing child. The suitable book is without sedation. often unavailable. To solve this problem, an easy accessible format like handhelds would help in this situation. Procedure Details: Over 450 images in pediatric skeletal radiography can be C-754 displayed in radiographic standard settings on a handheld device. All images Ultrasound imaging after wrist and distal forearm trauma in children with are categorized by body regions, age and gender. The database can be queried no fractures detected on plain fi lms through selection of all three criteria or by choosing each criterion separately. The D.M. Sokolowska, U. Zaleska-Dorobisz, K. Moron; Wroclaw/PL latter offers itself mostly for determination of bone age using the left hand. Each ([email protected]) mode provides the user with at least one reference image according to each body region, age and gender. Learning Objectives: To illustrate the spectrum of ultrasound image fi ndings Conclusion: This program is a free reference database for almost all standard after wrist and distal forearm trauma in children with no fractures detected on images in plain fi lm radiography, from infancy to adulthood. The database serves plain fi lms. the radiologist on-call and the less experienced pediatric radiologist to differentiate Background: Wrist and forearm injuries are common in adolescent and become between physiological age-specifi c and pathological fi ndings. more and more common in younger group of children, mostly due to decreasing age of starting the recreational or professional sport activity. The interpretation of clinical examination in a child is often more challenging than in adults; thus, in the presence of different clinical symptoms (wrist pain, oedema, limited movement) together with normal radiographic examination, the question arises about the nature of the wrist/distal forearm tissue injury. Procedure Details: In 64 children who attended our paediatric admission unit because of wrist/distal forearm trauma and in whom the standard plain fi lms did not reveal any fracture, a wrist ultrasound examination, according to actual ESSR guidelines, was performed. We focused on tendons evaluation (continuity, tears), joint effusion or occult fractures depiction and precise assessment of the extent of soft tissue oedema. We tried to discuss the correlation between the most com- mon ultrasound fi ndings and the patient age, as well as the injury mechanism and clinical symptoms. Conclusion: Wrist ultrasound is a valuable imaging method in children after wrist/distal forearm trauma. It is particularly helpful in cases of an equivocal clinical examination and in the presence of normal radiographic results helps to assess the character of the tissue injury. C-755 Post-traumatic elbow effusions of paediatric patients: Role of ultrasound I. Zuazo1, O. Bonnefoy2, C. Tauzin2, A. Borocco2, A. Lippa2, J.-F. Chateil1; 1Bordeaux/FR, 2Pau/FR ([email protected])
Purpose: This study evaluates the potential role of ultrasonography in pae- diatric patients with a post-traumatic elbow joint effusion without fracture on initial radiographs. Methods and Materials: Twelve consecutive children (age range: 4-15 years), whose post-traumatic elbow radiographs showed an effusion without fracture, underwent an emergency screening (in the fi rst 48 hours) with an ultrasonography
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sm with progressive bow- with progressive sm ciency. One girl developed a One girl developed ciency. of patients ndings in the subgroup C BDEF Al Ain/Abu Dhabi/AE Al Ain/Abu A To illustrate radiological fi radiological illustrate To All children showed congenital dwarfi All children showed cit due to left frontal infarction, which was caused by hypoxia. caused by which was cit due to left frontal infarction, ndings in patients with Stuewe-Wiedemann syndrome syndrome with Stuewe-Wiedemann ndings in patients ed. The prevalence is high in the UAE (0.5/10,000 birth). Most SWS Most SWS (0.5/10,000 birth). in the UAE is high The prevalence ed. SWS is a rare skeletal dysplasia. Mutations responsible have been have Mutations responsible dysplasia. skeletal SWS is a rare While Maroteaux reported a mean survival time of 2 months, several Maroteaux reportedWhile several survival a mean time of 2 months, attening occurred in 4 patients. Metacarpals shortened and metatarsals were and in 4 patients. attening occurred ing of the extremities and demineralization. Three had metaphyseal enlargements had metaphyseal Three and demineralization. ing of the extremities (kypho)-scoliosis and one progressive Three developed with coarse trabeculae. Epiphyseal epiphyses. fragmented Three children showed spontaneous fracture. fl Rips were an osteonecrosis of the talus. One patient developed undertubulated. chest All survivors repeatedly received broadened and osteoporotic with old fractures. patients Two and pneumonias. pulmonary to aspirations, due infections, radiographs died from respiratory insuffi they subsequently; expired neurological defi Conclusion: SWS and are under surveillance. been published, have cases surviving infancy with of the extremities bowing progressive show survivors after the second year abnormalities, and severe metaphyseal a tendency to fractures, osteoporosis, year. are less frequent after the second Pulmonary infections (kypho)-scoliosis. C-758 fi Radiological surviving infancy Raupp; Al-Gazali, P. L. Langer, R.D. Learning Objectives: (SWS), surviving syndrome the second year. with Stuewe-Wiedemann Background: recently identifi 6 survived the second Out of 24 SWS patients, age of 2. the patients die before orthopedic regular admitted due were or All came for and pediatric checkups, year. 1 bone and chest radiographs; follow-up received Patients to respiratory distress. data. published few been compared to ndings have fi Our CCT. underwent Findings: Imaging
London/UK Scientific and Educational Exhibits Scientific and Educational ([email protected])
Nineteen hips with DDH were followed up over 4 years. 4 years. up over followed Nineteen hips with DDH were The purpose of this educational exhibit is to emphasise the The purpose exhibit of this educational Badalona/ES 9 A total of 120 patients who underwent sonographic evaluation evaluation sonographic A total of 120 patients who underwent 5 1
d d US is a powerful diagnostic tool for the evaluation of musculoskeletal of musculoskeletal the evaluation diagnostic tool for US is a powerful US is a rapid, nonionising and very sensitive technique for imag- technique for nonionising and very sensitive US is a rapid, n Post-traumatic elbow joint effusion of paediatric joint effusion patients is not syn- elbow Post-traumatic Although post reduction MRI demonstrates anatomical abnormalities Although post reduction MRI demonstrates i . N I Open or closed reduction is undertaken to facilitate normal hip growth normal Open or closed reduction is undertaken hip growth to facilitate F Statistical analysis found none of the abnormalities on MRI were predictive none of the abnormalities predictive on MRI were Statistical analysis found Five children (5/12 - 42%) had a lipohemarthrosis on ultrasonography, and in children (5/12 - 42%) had a lipohemarthrosis Five ultrasonography, on - c u d E i c S - secondary to DDH, none of these were predictive of long term acetabular dysplasia. of long term dysplasia. secondary acetabular predictive to DDH, none of these were determining long term on MRI,This suggests that the factors outcome are not visible dynamics or a biomolecular abnormality. perhaps due to poor muscle but of persisting acetabular dysplasia in the older child. of persisting acetabular Conclusion: ([email protected]) ([email protected]) Purpose: a proportion of children who undergo hip reduction However, in children with DDH. These children will need to undergo acetabuli. deep well-formed to develop fail reduce risk of head and thereby of the femoral cover to improve pelvic osteotomy premature osteoarthritis. ascertainWe if the presence of abnormalities on MRI immediately after hip reduc- aiding surgical fore-planning tion can predict long term hip dysplasia, therefore, radiographs. follow-up and reducing need for Methods and Materials: ndings of 13 hips where MRI fi All had initial reduction and post-reduction MRI. compared with the 6 hips that un- were age four by dysplasia resolved acetabular Cartilage bony anlage shape, unresolving dysplasia. for pelvic osteotomy derwent displacement due to panniculus, lateral anteversion, acetabular index, acetabular and whether the acetabular ligament thickness, ligamentum teres and transverse analysed and were into the joint were labrum in a normal was position or folded radiologists consultant musculoskeletal two analysed by The scans were compared. to the outcome of each child. blinded who were Results: C-757 predict Can MRI features of the hip in children: dysplasia Developmental oseotomy? surgical the need for Healy; J. Lee, J. Hulme, A. Evans, S. Goutos, Mitchell, I. P. Chew, N. C-756 and in children ultrasound musculoskeletal Clinical applications of and therapeutic relevance diagnosis description, Technique adolescents: Quintero, Barluenga, J.C. E. Perez-Tudela, A. Moragas, J. Jimenez-Lasanta, J.A. Olazabal-Zudaire; A. onymous with fracture. Ultrasonography appears to be a reliable, accurate, available available accurate, reliable, appears to be a Ultrasonography with fracture. onymous The cortical of occult fractures. the evaluation method for effective and low-cost of a lipohemarthrosisdiagnostic clue is the detection in the articular recess. and an MRI. The aim of sonography was to look for a lipohemarthrosis, is which to look for was of sonography The aim and an MRI. to differenti- the reference The MR imaging was with corticalsynonymous fracture. contusions. muscular from bone or ate fractures Results: (7/12 - 58%) the other children Conversely, cortical on MRI. found fractures all cases we and no corticalhad simple hemarthrosis on MRI. fractures on ultrasonography Conclusion: ing musculoskeletal disorders in children and adolescents. It also offers the the It also offers disorders in children and adolescents. ing musculoskeletal diagnostic and or biopsy procedures with aspiration possibility of performing relevance. therapeutic role of diagnostic and/or therapeutic ultrasonography (US) in diverse congenital (US) in diverse ultrasonography role of diagnostic and/or therapeutic diseases in children and adolescents. and acquired musculoskeletal Background: capability and multiplanar non-invasiveness, cost, availability, to low disorders owing The absence of ionizing radiation dynamic imaging. which allow real-time studies, is required proper training and experience is particularly in children, but valuable pathologies. in the pediatric musculoskeletal Details: Procedure US in our tertiary evaluated. retrospectively were center during the last 5 years carried out with a Sequoia 512 or an Aspen (Siemens-Acuson), was examination comparison, contralateral dynamic manouvres, using high resolution technique, function and interventional procedures. FOV extended Doppler, Color and power also were bone scintigraphy Other imaging techniques such as MRI, CT or in- traumatic, Congenital (DHD), unconclusive. when diagnosis was performed infectious arthritis, (transitory sinovitis, pyomyositis, infectious-toxic ammatory, fl lymphadenitis, infectious subperiosteal abscess, disease, cat-scratch bursitis, of bones or soft tissues), neoplastic (benign and malignant tumors osteomyelitis), will be presented with a selection of malformations and vascular bodies, foreign cases. the most representative Conclusion: Learning Objectives: C - 7 0 R C EECR07-C-SciEduc-FIN.indd 159 Scientific and Educational Exhibits
Physics in Radiology velocity of the heart, assuming to be the optimal reconstruction phase for providing motion-free images. Rawdata of 50 patients were used, scanned with a standard CT cardiac protocol, 64 slices of 0.6 mm, 0.33 s rotation time and concurrent ECG recording (Sensation 64, Siemens, Forchheim). We correlated the identifi ed optimal reconstruction phase derived from our approach with the patient’s heart rate to C-759 analyze the dependence of the optimal reconstruction phase on the heart rate. Fine-streak artifact quantifi cation and removal in reconstructed CT images Results: The probability to obtain the best achievable image quality in the systolic O.S. Pianykh, P.M. Boiselle, D. Litmanovich, V. Raptopoulos; Boston, MA/US phase instead of the diastolic phase increased from 0% to 30% with increasing heart ([email protected]) rate. However, individual analysis showed that the optimal reconstruction phase is more patient-specifi c than dependent on the heart rate. Also, the optimal reconstruc- Purpose: Streak artifacts in CT images can originate from a broad range of factors, tion phase in the diastolic phase shows a high variation of 20% over all patients. and often may be controlled with improved scanning protocol parameters and patient Conclusion: A high patient-specifi c dependence of the optimal reconstruction positioning. Therefore, a reliable method is needed to quantify the streak presence phase for cardiac imaging was shown. Only a slight correlation with the heart rate in the images, guiding the improvements in the scanning protocols and settings. was observed. Algorithms detecting the optimal reconstruction phase seem to be Streak-quantifi cation methods can also lead to better streak-removal algorithms. promising and essential. Methods and Materials: Fine streaks, typically originating from the noise and photon starvation, can still be detected numerically in reconstructed CT images. Our approach is primarily based on exploring streak-shape linearity, leading to the C-762 following image processing steps: ;inear image fi ltering to enhance streak-affected CT scan protocol optimization by the study of focal spot size infl uence on pixels; streak-searching methods, locating straight lines of pixels either raised or image quality lowered compared to the surrounding pixel background; weighting detected streak W. Qi, X. Du, J. Li, S. Zhang; Beijing/CN ([email protected]) lines proportionally to their length and severity; building streak "signature" of the Purpose: To optimize CT scan protocols in various applications by analyzing the image, showing streak presence by streak severity. infl uence of focal spot size on image quality. Results: Our method provided high accuracy in locating and measuring streak ar- Methods and Materials: A Catphan500 CT phantom was scanned with large and tifacts. This quantifi cation method naturally extended to a streak-removal algorithm, small focal spots with the same dose by adjusting scan time. Images were recon- which would "raise" or "lower" image streak pixels to eliminate the streaks. structed using both standard and bone-plus kernels. Modulation transfer function Conclusion: The proposed streak quantifi cation and removal algorithm can be suc- (MTF) and slice sensitivity profi le (SSP) were used to evaluate in-plane and Z-axis cessfully used to: (1) quantify fi ne streaks in reconstructed CT data. The quantity of resolutions, respectively. Two radiologists evaluated and scored inner-ear images of image "streakeness" can then be used to improve image scanning parameters and 15 volunteers with large and small spots without knowing the scan techniques. to achieve higher image quality; (2) remove streak artifacts from the reconstructed Results: The MTF values and FWHM values of SSP with small spots were al- CT images without any need for the raw data (generally unavailable). ways 5-10% better than those of large spots. With standard algorithm, the 10% MTF values were 6.94 LP/cm and 7.45 LP/cm for the large and small focal spots, C-760 respectively. For patient inner-ear images reconstructed with bone-plus kernel and Performance characterisitics of Dyna-CT acquired by the three- 10 cm DFOV, small spots outperformed large spots by 29 to 1. However, the visual dimensional angiography system with fl at panel detector advantage of using small spots decreased when the images were reconstructed E. Minota; Kobe/JP ([email protected]) by standard kernel and 25 cm DFOV. Conclusion: The use of small spots improved both in-plane and Z-axis spatial Purpose: The three-dimensional angiograph equipped with fl at panel detector resolutions by 5-10% compared to large spots. The improved resolution translated (FPD) acquires a complete volume set during a single rotation, which can be into clinical diagnostic advantage for small DFOV, high-resolution applications. used to reconstruct tomographic images similar to ordinary CT. We evaluated the However, this advantage decreased when large DFOV and standard reconstruc- performance characteristics of images acquired thus, including image noise, spatial tion algorithm were used, which suggested that one could have balanced usage resolution in the axial plane, section sensitivity profi le in z-plane (SSPz), contrast of focal spots in these applications. noise ratio (CNR), distortion of an acrylic ball, and clinical images. Methods and Materials: We used a biplane C-arm angiograph with 30×40 cm amorphous silicon FPD (AXIOM Artis dBA, Siemens Medical Solutions, Germany). C-764 The SSPz and axial spatial resolution were measured with miniature iron balls of Image reconstruction using a combined algorithm for a translating and 0.18-1.0 mm. The CNR was measured with a phantom containing agar cylinders rotating volume CT (TRVCT) of various diameter and contrast media density. The distortion was evaluated for Y.-R. Kim, S.-W. Park, H.S. Baek, D.-S. Yoo, Y. Yi; Seoul/KR an acrylic ball of 1 cm diameter at various distances from the center. Data acqui- ([email protected]) sition times were 5 sec (133 projections), 10 sec (248 projections), and 20 sec Purpose: We describe a new system, TRVCT (Translating and Rotating Volume (495 projections). Computed Tomography), developed for a computed tomography image of a large Results: The image quality degraded as the object was away from the center or object. It is a simple method and offers a low price. The key point of this new when the data acquisition time was short, probably due to the nature of cone-beam method is that it handles the movement of an object that is translating and rotat- 3D reconstruction and the reduced number of views. Correction fi lters improved the ing simultaneously. image artifacts. The distortion was considered clinically acceptable. Methods and Materials: Using a vertical linear array detector, one tomogram image Conclusion: Although the image quality was lower than the ordinary CT, espe- can be acquired when the object is translating and rotating simultaneously. This cially for low-contrast objects, it was considered clinically useful if appropriate data method is completely different from that of a normal X-ray CT. We used a fan-beam acquisition protocol and fi lters were used. This system is very valuable not only X-ray. The direction axis for the detector and rotating axis are parallel. Because for brain angiography, but also for orthopedics and other fi elds where tomographic a hundred or thousand tomograms with Z-axis are from just one scanning, this images are helpful. system has excellent Z-axis resolution and has the advantage that this technique can improve the resolution in the X-Y plane with changing translating speed and C-761 frequency of data acquisition. The image reconstruction algorithm is composed of Variation of the optimal reconstruction phase for cardiac CT imaging: a modifi ed con-beam CT algorithm and parallel beam CT algorithm. Analysis by a rawdata-based kymogram approach Results: We have achieved a high resolution image of a tire. We are carrying out D. Ertel, T. Pfl ederer, S. Achenbach, M. Kachelrieß, W.A. Kalender; experiments with other objects. There is no ring artifact that occurs frequently in Erlangen/DE ([email protected]) third generation CT. So, as a consequence of not having artifacts, we can have high resolution tomograms from this TRVCT system. Purpose: To analyze the dependence of the optimal reconstruction phase for Conclusion: TRVCT system can be used to acquire an image from a large object cardiac CT imaging on the patient’s heart rate by using a rawdata-based approach such as car, tire, or engine. TRVCT can remove scatter from X-rays of this high and to prove a patient-specifi c dependence. resolution image. Methods and Materials: The rawdata-based synchronization signal (kymogram) is generated by a center-of-mass tracking [Med.Phys., 29 (7)] and provides directly a motion function of the heart. We identify the phase in the cardiac cycle with the lowest variation of the center-of-mass as representing the phase with the lowest
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3 lm, so as to G 0.01]. Mol/BE, 3 < eld. In a hetero- In a eld. 7.66% at Y axis, Y axis, 7.66% at ± Chiba/JP , F. Vanhavere , F. 2 Leuven/BE, Leuven/BE, cantly lower than the doses cantly lower 2 ve positions: the forehead, both the forehead, positions: ve C Jette/BE, 1 , H. Bosmans , H. ; 2 4 BDEF to so as not table lms placed on the patient cantly inversely correlated with body mass correlated cantly inversely 3.76% in the total irradiation fi 3.76% in the total irradiation A ± cation fi cation , K. Smans , K. 1 , F. Malchair , F. 4 We used tough water and Rando phantoms as homo- used tough water We The study includes 12 RF liver ablation procedures per- procedures ablation study includes 12 RF liver The Both angiography (13) and vascular surgery (13) and vascular (4) centres Both angiography 17.92% for the lung. The absolute values of absorbed dose The absolute values lung. the 17.92% for ± , P. Clerinx , P. 1 cult. Therefore, simulation-based methods are often applied to methods are often simulation-based Therefore, cult. , F. Bleeser , F. 4 Despite a high workload (300-500 procedures/year), doses to the Despite a high workload (300-500 procedures/year), Film dosimetry means of measuring dose skin can be a suitable The RTP system may be a simple and useful tool for estimation of absorbed be a simple and useful tool for system may The RTP Absorbed radiation doses on the body surface and inside phantoms can surface doses on the body Absorbed radiation To evaluate extremity doses to the medical staff in Belgian interventional extremity evaluate To Data was collected from a total of 280 procedures. The median dose per collected from a total of 280 procedures. Data was Maximum skin dose (MSD) delivered to patients ranged from 129 mGy from 129 to patients ranged dose (MSD) delivered skin Maximum In a homogeneous phantom, the difference between values measured values between In a homogeneous phantom, the difference , D. Berus , D. 1 17.64% at Z axis, and 1.00 17.64% at Z axis, ± Liège/BE ([email protected]) Liège/BE ([email protected]) Conclusion: during whole-body CT acquisition. doses inside the human body even radiation geneous phantom, the difference between PLD and RTP values was 4.97 was values PLD and RTP between geneous phantom, the difference for the body and -7.05 the body and for The ab- similar to those in the literature. each organ in patients was measured for signifi were solute measurement values (whole body), -0.80 (right [R= -0.69 lung), -0.81 index (left lung), -0.76 (spinal cord), -0.74 (vertebra bone), -0.74 (heart), and -0.79 (esophagus), all P -1.09 Purpose: (IR) centres. radiological Methods and Materials: monitored doses were Individual extremity participated study. in this multi-centre detectors at fi per procedure with highly sensitive assistant, staff members (physician, Doses to up to three hands and both legs. exposure measured during simultaneously a procedure and relevant were nurse) registered. protection) were data (position, patient-DAP-dose, Results: signifi (62 µSv) was eyes procedure to the physician’s to the legs (181 µSv) and hands (193 µSv) as most centres used an under table patient- to strong correlation between A moderate geometry. tube exposure X-ray surgery At vascular centres, observed. was and dose to the physician DAP-dose about three times higher than in angiography staff doses were DAP-normalised normalised observed. doses were workload, elevated In centres with a low centres. dose both annual exceed likely may physicians that two data showed Extrapolated About one third skin of the legs (500 mSv). (150 mSv) and the limits of the eyes consistently from the patient during image themselves removed of the physicians cient working procedure. to be a very effi dose This proved acquisition. Conclusion: mea- protection when adequate radiation interventionalist can remain acceptable sures are applied. correspond optical density to radiation dose. to radiation correspond optical density Results: had Corresponding optical density mGy. of 135 with a median value mGy to 165 of slices had a number Total of 1.26. with a median value of 1.16-1.48, a range found cant correlation was A signifi with a median of 155 slices. of 108-175 range 0.71). dose (r = of slices and radiation number total between Conclusion: is done. that careful calibration provided Methods and Materials: Methods and assessed skin dose was Patient in the CT departmentformed of Agia Olga hospital. X-Omat verifi means of Kodak by tube kilovoltage recorded were: The technical factors with the procedure. interfere of Calibration of slices. and total number thickness (kVp), tube load (mAs), slice done using thermoluminescent lms was to the fi dosimeters attached fi M.-T. Hoornaert M.-T. C-769 study A Belgian multi-centre doses in interventional radiology: Staff extremity Buls N. 4 C-768 measurement of planning system for therapy Application of a radiation CT acquisition during whole-body doses inside the body organ-absorbed cases phantoms and 30 clinical using homogeneous and heterogeneous Komuro; I. Uehara, M. Tanabe, N. Fujibuchi, T. Funabashi, N. ([email protected]) Purpose: measurements inside but be measured using dosimeters during CT examinations, the body are diffi method a new investigated We time-consuming. this is rather but estimate the latter, planning system (RTPS). therapy that uses a radiation Methods and Materials: and measured absorbed respectively, geneous and heterogeneous phantoms, ionization chamber and Photoluminescence Dosimeter (PLD) doses by radiation Furthermore, mul- cases acquired by in 30 clinical estimates. compared to RTPS calculated the absorbed dose using an arc Toshiba), kV CT (Aquilion, tislice 120 beam calculation system. Results: 0.13 were RTP those estimated by ionization chamber and by lm dur- lm uoroscopy uoroscopy
, 5 uoroscopically New Delhi/IN, New 3 , W. Ng , W. 4 Iraklion/GR lms in CT guided radio- Ankara/TR, Ankara/TR, 7 2 Gy, and in 15 (3.8%) it was and in 15 (3.8%) it was 2 Gy, Athens/GR ts of large area radiochromic ts of large area radiochromic Vienna/AT, Vienna/AT, > ed a number of interventional of ed a number 2 , T. Ishiguchi , T. 1 (ii) long fl cient applications, Scientific and Educational Exhibits Scientific and Educational Udine/IT, Udine/IT, Bangkok/TH, Bangkok/TH, 1 6 ; 8 , A. Trianni , A. 3 uoroscopically guided percutaneous guided percutaneous uoroscopically , L. Wagner , L. Examination parameters for renal and aortoiliac for proce- Examination parameters Patient skin dose was measured for 392 interventional measured for skin dose was Patient 7 , K. Pratik , K. 2 1 lters, and (v) over imposition of several beams on the same beams on the imposition of several and (v) over lters, Kuala Lumpur/MY, Lumpur/MY, Kuala 6 5 1 , D. Bor , D. ([email protected]) ([email protected])
6
d d Male patients up to 59 years old are subjected to a signifi cantly old are subjected to a signifi Male patients up to 59 years n This multinational study has identifi This multinational , M. Rehani , M. i . 1 lms used in radiotherapy have been successfully used for some years some years been successfully used for have lms used in radiotherapy N I To estimate radiation dose and associated risks resulting from fl uo- dose and associated risks estimate radiation resulting from fl To Patient dosimetry during Patient CT interventional procedures is a complex To estimate the frequency of high skin doses in a sample of fl estimate the frequency To F Results are presented as doses normalized to dose area product, so that In 62 procedures (15.8%) the MSK was In 62 procedures (15.8%) the MSK was - c u d E i c 4 Gy. The maximum MSK was 6.6 Gy; of the 62 cases, 39 were PTCA, 7 were RF PTCA, 7 were 39 were of the 62 cases, 6.6 Gy; MSK was The maximum 4 Gy. S Nagakute-cho/JP, Nagakute-cho/JP, Houston, TX/US - duration and a large number of cine frames for cardiac procedures, (iv) lack of lack (iv) procedures, cardiac for of cine frames and a large number duration fi use of transparent the benefi The study has demonstrated skin area. skin dose monitors. dosimeters over The study highlights the importance of periodic skin dose evaluation. procedures resulting in patient skin doses exceeding 2 Gy. Most high-dose proce- 2 Gy. procedures resulting in patient skin doses exceeding (i) the use of old associated with: in 2 hospitals and were concentrated dures were modern dose-effi equipment not designed for ablation, 5 were neuro-embolisation and 10 were hepatic interventions. Thirty-nine hepatic interventions. neuro-embolisation and 10 were 5 were ablation, MSK. to underestimate shown The skin dose monitor was occurred in 2 hospitals. Conclusion: > Purpose: KAP and maximum time, Fluoroscopy and hepatic. procedures - neurologial, cardiac, each procedure according to a com- measured for air kerma (MSK) were entrance fi large radiochromic exposing evaluated MSK was methodology. monly agreed guided interventional procedures in 6 centres (Japan, India, Italy, Malaysia, Thailand, Malaysia, Italy, India, guided interventional procedures in 6 centres (Japan, participating research programme. in an IAEA-coordinated Turkey) and Methods and Materials: additionally used. and in one centre skin dose monitors were ing the procedure, Results: A. Krisanachinda A. C-767 procedures skin dose assessment during CT guided ablation Patient Siafas, I. Kottou, S. Tsalafoutas, J. Maniatis, P. Triantopoulou, Tsapaki, C. V. Papailiou; J. Parissis, K. Sakellios, Priniotaki, G. A. ([email protected]) Purpose: task due to the complexity and severity of case, patient’s physical characteristics, characteristics, physical patient’s of case, and severity task due to the complexity Slow experience. cations of CT scanner used and radiologist’s specifi different fi cation verifi dures were derived using data from 80 consecutive procedures performed in our procedures performed using data from 80 consecutive derived dures were procedures endovascular estimated for doses were Organ and effective institute. using the Monte Carlo (MC) transport code and an adult mathematical phantom. Thermoluminescent used in an anthropomorphic dosimeters were phantom to verify and genetic risks Radiation-induced cancer estimated were the MC calculations. cients. using appropriate coeffi Results: unit can be easily calculated for technique and X-ray the patient dose from any from 15 to dose varied effective The average sessions. iliac and renal PTA/stenting Differences of the patient. 24.5 mSv depending on procedure scheme and the sex from MC-calculated data and data derived observed between of up to 17% were thermoluminescent dosimetry. Conclusion: younger for be considerable Radiation-induced cancer risk may cancer risk. fatal angioplasty with stent placement. individuals undergoing transluminal The purpose of dose. in Interventional radiation Cardiology to assess patient skin cation fi verifi suitability of slow to test the this study was transluminal angioplasty and stenting in the abdominal region transluminal angioplasty and stenting in the abdominal Gourtsoyiannis; N. Tsetis, D.K. Damilakis, J. Stratakis, J. ([email protected]) Purpose: angioplasty and stenting in the roscopically guided percutaneous transluminal abdominal region. Methods and Materials: frequency (RF) ablation. Radiation dose and risk from fl Radiation dose and risk from C-766 4 8 Patient skin dose survey in interventional radiology and cardiology in 6 in interventional skin dose survey radiology and cardiology Patient project research countries participatingIAEA-coordinated in an Padovani R. Dose C-765 Physics in Radiology Physics C - 7 0 R C EECR07-C-SciEduc-FIN.indd 161 Scientific and Educational Exhibits
C-770 C-773 The collective dose to the European population from cardiac X-ray procedures Measurement of occupational exposure in a mobile PET unit K. Faulkner; Tyne and Wear/UK ([email protected]) M. De Marco, S. Maggi; Ancona/IT ([email protected])
Purpose: The objectives of this paper were to: 1) Estimate the number and fre- Purpose: The routine handling of unsealed 18F-FDG in a mobile PET unit, that is quency of coronary angiograms, PTCA’s/stent procedures and pacemaker inser- usually not provided with a hot cell, may result in the production of airborne radio- tions across various European countries in 2006 and 2) Use this information to activity. The aim of our study was to quantify the occupational radiation exposure for estimate the population dose from cardiology in these European countries. a technologist working in a mobile PET unit, evaluating both internal contamination Methods and Materials: Published statistical information was used to deduce and external irradiation. the number of coronary angiograms, PTCA’s/stents and pacemaker insertions. A Methods and Materials: Internal exposure: each technologist was issued with a literature review was undertaken to deduce typical dose-area product values and Personal Air Sampler that collects the air that the worker is really breathing. External effective doses for these procedures. exposure: personal dose equivalent Hp (10) has been quantifi ed using electronic Results: The collective effective dose to the 569,000,000 citizens in the 29 Euro- dosimeters. Occupational radiation exposures have been evaluated twice a week pean countries studied was approximately 30,000 man Sv/year, with just over half for six months based upon an operating PET effi ciency of 9 procedures/day. the dose arising from coronary angiograms. Results: The 50-year Committed Effective Dose from inhaled fl uorine-18 fl uoro- Conclusion: The number of PTCA procedures is increasing at 6.7%/year. The deoxyglucose has been calculated from the dose coeffi cients published by the population dose from cardiology is large and rapidly increasing. IAEA. It ranges from (1.95±0.03) to (4.05±0.02) microSv depending on different working activities, while the external dose, daily received by technologist, ranges from (20±1.0) to (29.5±1.0) microSv. C-771 Conclusion: This study calculated the total effective dose including both the exter- Design and development of patient’s absorbed dose estimation software nal dose and the 50-year committed effective dose for a technologist working in a with Monte Carlo algorism in interventional radiology (IVR) mobile PET unit showing that the maximum dose that he may receive is (31.5±1) H. Tachibana1, F. Matsubayashi2, A. Kuramoto1; 1Tokyo/JP, 2Kanagawa/JP µSv/day. The major contribution comes from external exposure. ([email protected]) Learning Objectives: To describe the methods of patient’s absorbed dose with C-774 Monte Carlo algorism in IVR. To outline the advantage of the software. Education and training of health care professionals: Acceptance of Background: Recently, Monte Carlo simulation has focused on radiology treatment. radiation protection courses We tried to use the Monte Carlo simulation to estimate a patient’s absorbed dose in R. Leppek, B. Madsack, K.-J. Klose; Marburg/DE ([email protected]) IVR. We designed and developed software that can estimate a patient’s absorbed dose at skin and other organs using the Monte Carlo simulation. Learning Objectives: To describe the acceptance of radiation proctection courses Procedure Details: First, CT numbers from CT images were converted into mass for health care professionals in Germany by an anonymous survey. density and elemental weights of tissues required as input for dose calculations with Background: Maintaining safe utilization of ionizing radiation and radiation protec- GEANT4, which is a toolkit for the simulation of the passage of particles through tion of staff, public and environment requires high levels of competencies. In 2002, matter. They were set by x-y coordinate, slice location, and slice thickness. They the German Radiation Protection and X-ray Ordinance put health care professionals were exposed to X-ray from the X-ray tube simulator developed by us in GEANT4. employing ionizing radiation under an obligation to recertify theoretical and practical The simulator exposes X-ray of any energy spectrum (tube volt: 60 kV-150 kV), any knowledge. Personnel, i.e. physicians, physicists, radiographers, nurse-praction- expose fi eld, etc. The absorbed doses at skin and at other organs were calculated. ers and specialist staff, have to enrol for an offi cially approved radiation protection The fusion images of CT dose can be displayed by the viewer developed by us. course every 5 years. 8 or 12 hour classes with a multiple choice tests are held by Conclusion: The patient’s absorbed dose at skin can be found correctly using lecturers, radiation protection offi cers and experts in the fi eld. However, a precon- Monte Carlo algorism without TLDs. Doses at skin and at other organs can both ceived opinion across all levels of professionalism declares radiation protection be estimated by the software developed by us. Patients and medical staff can education and training redundant and costly. calculate the patient’s exposure dose distribution by 2D fusion images of CT dose. Procedure Details: Course participants were asked to fi ll in an anonymous ques- 3D fusion images help them for the explanation of side effects from exposure and tionnaire [n=599, radiographers (45%), physicians 44%, including 25% consultants for obtaining informed consent from patients. and 10% medical directors]. The survey itemized age, vocational training, profes- sional group, fi eld of practice, course content, stimulus, practicality and course costs. 80% estimated the theory-practice-performance ratio as balanced. Stimulus (great C-772 many 20%, many 57%, some 20%). The courses came to participants’ expectations A low-density board placed on the couch reduces a patient’s skin doses in (fully 62%, for the most part 33%, partly 4%. Full coverage of the expenses (120-150 interventional procedures Euros) by the employer was reported by 65% of the participants. A. Kawabe, Y. Nakagiri, Y. Takeda; Okayama-city/JP ([email protected]) Conclusion: Although radiation protection is widely considered as a stepchild in health Purpose: In interventional procedures, scattered radiation generated on the care delivery, professionals are aware of adequate education needs and training. interventional couch increases a patient’s skin doses. Here, we assumed that this low-energy scattered radiation is removed by air gaps between the couch and patient. However, it is physically impossible to produce air gaps between the couch and patient. To solve this problem, we have devised a new process. This process involves the use of a low-density polystyrene board, which acts as an air-gap substitute. The purpose of this study was to investigate the air-gap-reproducing effect of the low-density polystyrene board. Methods and Materials: The entrance skin dose (ESD) was measured without interspaces between the couch and phantom (25 cm acrylic block), which was defi ned as a reference ESD. Low-density polystyrene boards (1 to 10 cm) were inserted between the couch and phantom, and ESDs were measured, respectively. These ESDs were compared with the reference ESD. Results: The low-density polystyrene boards with a 6 cm thickness, inserted be- tween the couch and phantom, led to an ESD reduction of about 10%. Conclusion: The low-density polystyrene board simulated air gaps. In interventional procedures, these boards can be implemented easily and inexpensively in a clinical setting, resulting in reductions in a patient’s skin exposure by as much as 10%, without affecting image quality.
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G Alicante/ES ; 1 Vigo/ES showed better sup- showed 2 0.05); and (4) higher CNR 0.05); < 20 s/mm > , P.A. Wielopolski , P.A. 1 C BDEF provided improved volume coverage and coverage volume improved provided 2 A ([email protected]) ([email protected])
, G.P. Krestin , G.P. 2 After institutional review board approval and informed and informed board approval After institutional review 1. To describe the magnetic properties of matter. 2. To To 2. describe the magnetic properties of matter. To 1. 1) To understand the physical bases of fl uid-attenuated uid-attenuated bases of fl understand the physical To 1) . TR was 6600 ms. B-values B-values 6600 ms. TR was . 3 Omaha, NE/US , S.M. Hussain , S.M. 2 1 Many things contribute to the appearance of MR images but image of MR images but to the appearance things contribute Many 0.05). Our study shows that BBEPI can be used for ultrafast, low SAR, low ultrafast, BBEPI can be used for that Our study shows In summary, this poster serves to demonstrate the technical aspects this poster serves to demonstrate In summary, Understanding the magnetic resonance imaging susceptibility effects effects Understanding the magnetic resonance imaging susceptibility < uence on imaging appearance allows the clinical radiologist to make a to make the clinical radiologist allows on imaging appearance uence To evaluate breath-hold diffusion-weighted black-blood echo-planar- black-blood breath-hold diffusion-weighted evaluate To The optimized short- (25 ms) and long-echo (80 ms) BBEPI provided ms) BBEPI provided ms) and long-echo (80 short-The optimized (25 deposition cation detection b) Haemorrhage detection c) Iron and cations Rotterdam/NL, ([email protected]) Learning Objectives: describe magnetic resonance imaging sequences and the magnetic the main cite the magnetic resonance susceptibility of different To 3. susceptibility effects. media agents and their cite the magnetic resonance contrast To 4. products. blood MRI clinical applications: discuss susceptibility weighted To 5. susceptibility effects. a) Calcifi MR perfusion e) Blood oxygen-depen- analysis d) Dynamic susceptibility weighted functional MRI. dent level Background: Magnetic suscep- T2 weighting. T1 and in terms of is mainly explained contrast The purpose of are important often neglected. are tibility effects but contributors them to our advantage to exploit how is to describe them and explain this exhibit in clinical practice. Conclusion: and their infl to minimize of imaging sequences available wise selection among the broad range diagnosis. as limit the differential enhance pathology detection as well artefacts, ([email protected]) ([email protected]) Learning Objectives: and SNR (p Conclusion: T, thin-slice morphologic in a single breath-hold at 3.0 imaging of the entire liver capability. reformatting near-isotropic data with multiplanar providing pressed blood signal, but b=10 s/mm signal, but pressed blood Flair from head to toe Flair from Mañas Uxo, Saborido Ávila, J. Iglesias Castañón, M. Arias González, A. M. Leon Alonso; J. Villaravitz, Herreros M. Rodríguez Álvarez, M. C-779 echo- black-blood of diffusion-weighted Potential T: at 3.0 Liver imaging imaging volumetric large-coverage sequences for planar-imaging denBos Van I.C. 1 C-780 C-778 to basics From resonance imaging: magnetic Susceptibility-weighted applications clinical everyday Feliu; E. Concepción Aramendía, García Espasa, L. Bernabé, C. J. Purpose: spin-echo sequences SAR-intensive for imaging (BBEPI) as potential alternative T. imaging at 3.0 liver for Methods and Materials: using an T, scanned at 3.0 were volunteers obtained, 14 healthy consent were the entire set to cover were Parameters 8-channel cardiac coil. ASSET compatible with interactively varied cm z-axis) in one 25-sec breath-hold, and were (25 liver Images were size. and voxel slice thickness TR, diffusion b-value, TE, regard to (FS-T2w-FSE) for T2w fast-spin-echo and compared to fat-suppressed evaluated geometric delineation, blurring, distortions, liver fat-suppression, image quality, signal, CNR and SNR. suppression of the blood Results: cover- single breath-hold liver with full anatomic, mm slice thickness mm and 4 2 mm 3.1x2.6x2.0 size resulting in voxel respectively), age (100 and 50 slices, and 3.1x2.6x4.0 mm signal consistency. Compared to FS-T2w-FSE, BBEPI provided: (1) comparable (1) comparable Compared to FS-T2w-FSE, BBEPI provided: signal consistency. geometric distortions; (2) acceptable delineation and blurring; liver image quality, (p and blood-signal suppression of fat- (3) improved combining a body coil for radio frequency transmission and an endorectal coil to and an endorectal frequency transmission radio body coil for combining a collected with magnetic were MRI and MRSI data Three-dimensional signal. receive with lipid shimming water by obtained in the selected volume eld homogeneity fi Peripheral resonances. of lipid inversion with selective suppression accomplished data how will review We and air. periprostatic to suppress saturated fat were voxels to interpretis then processed and how a prostate spectrum. Conclusion: aspects of implementation and technical consider- of 3D MRSI including practical principles will understand the basic radiologists MRS of prostate Hopefully, ations. MRSI and clinical possibility of providing realising the feasibility imaging, and by to initiate prostate spectroscopy. will be encouraged ; 1 to ed in order eld, even if only if only eld, even , A. Laghi , A. 1
Galway/IE , C. De Cecco , C. 2 Scientific and Educational Exhibits Scientific and Educational , M. Rengo , M. Berlin/DE 1 , F. Iafrate , F. 1 Updating the MR-radiologist with respect to risks raised by with respect to risks by Updating the MR-radiologist raised To describe principles of k-space sampling. To offer an easy offer To describe principles of k-space sampling. To There is strong evidence that Magnetic Resonance Imaging There is strong evidence ([email protected]) ([email protected]) Neither iron pigments nor larger tattoo areas are required Neither iron pigments nor larger tattoo areas are We show in a step by step form the image generation pro- the image generation step form in a step by show We 3
We explain how images were obtained with a 1.5 Tesla scanner Tesla obtained with a 1.5 images were how explain We 6 1
d , R. Ferrari , R. d 1 The clinical advantages of spectroscopic data in assessing the of spectroscopic data in assessing the The clinical advantages An increased risk for MRI-associated skin burns described has been An increased risk for K-space sampling represents a crucial step in MR image acquisition. a crucial K-space sampling represents step in MR image acquisition. n The knowledge of k-space sampling strategies is crucial for under- is crucial sampling strategies of k-space for The knowledge Permanent Make-up, for medical purposes better adressed as cos- for Make-up, Permanent i . Rome/IT N 2 I F - c u d E i c S Latina/IT, Latina/IT, - Learning Objectives: explanation of k-space physics for radiologist. To describe properties of k-space and To radiologist. for of k-space physics explanation portions different how show To k-space sampling strategies. different to illustrate for the rationale illustrate To nal image appearance. to the fi of k-space contribute and partial spiral elliptic, centric, k-space sampling strategies. Background: mode that is also a a sequential to sample k-space is represented by The easy way be modifi may K-space sampling strategy time consuming procedure. reduce acquisition time. A central or elliptic sampling of k-space is recommended or elliptic sampling of k-space is recommended A central reduce acquisition time. line of k-space in order to collect central contrast-enhanced-MR-angiography for enhancement. during vessel the peak of Details: Procedure k-space will describe how We our attention on k-space sampling. cess focusing Using graphic pulse sequences commercially available. is sampled in several k-space sampling strategies. will describe we different examples, Conclusion: are k-space sampling strategies Several standing MR image acquisition process. Using the appropriate is useful in reducing k-space sampling strategy available. the clinical purpose for acquisition times and in order to optimise image acquisition happens in centric k-space and contrast- or elliptic sampling of of MR-studies like enhanced MR-angiography. ([email protected]) ([email protected]) Learning Objectives: prostate (MRI) and Magnetic Resonance Spectroscopic Imaging (MRSI) can improve Our aim is to present the technique and practicalities cancer tissue characterisation. gland, imaging of the prostate H-1 magnetic resonance spectroscopy of performing sequences. positioning and choice of imaging including patient preparation, Background: enhanced evalua- localisation of cancerous tissue, prostate gland are improved capsular spread and the potential to assess tumour aggressiveness. tion of extra in patients with clinically localised cancer has to M.R.I. The addition of M.R.S.I. in and reduce interobserver variability the accuracy been documented to improve extension. assessing extra-capsular Details: Procedure C-777 we do it How gland: of the prostate Spectroscopy McCarthy; Gough, P.A. N. Tuohy, B. McKenna, D.A. C-776 MR-radiologist care about it? should the Why make-up: Permanent Klingebiel; R. Schmidt, S. Franiel, T. Learning Objectives: This mechanism of locally induced electric lining has been performed. subtle eye skin contain- dysesthesia and burns in patient’s possible for current is responsible A clinical permanent during MRI examination. make-up e.g. ing a cosmetic tattoo, addressing this problem and recommendations for of the literature review example, will be given. in the daily MR practice Conclusion: local damage to the skin during MRI studies even can cause severe metic tattoo, of these risks and should be aware Every MR radiologist if it is free of iron oxides. accordingly. management and staff training direct patient’s to induce burns in these patients. To gain a special colour effect cosmetic tattoos cosmetic gain a special colour effect To to induce burns in these patients. electric current can be Locally, contain metals such as iron, copper and zinc. of these metals in a high-frequency magnetic fi any induced by a new tattoo-like Make-up technique for appropriate consent and patient informed technique for Make-up tattoo-like a new monitoring MRI studies. throughout Background: permanent Not until recently, pictorial tattoos using iron coloured pigments. for has been recognized spreading cosmetic technique, and rapidly a new Make-up, MR imaging. patients at risk putting the of burns by for Details: Procedure Principles of k-space sampling Principles of k-space sampling Paolantonio P. 1 MR C-775 Physics in Radiology Physics C - 7 0 R C EECR07-C-SciEduc-FIN.indd 163 Scientific and Educational Exhibits
inversion recovery (FLAIR) imaging. 2) To explain the utility of FLAIR imaging to determined. With this calibration parameter, unknown concentrations can then be make the diagnosis of "cyst". 3) To show the usefulness of FLAIR imaging technique easily calculated from the measured MR signal and the actual scanner settings. not only in the central nervous system but anywhere (thorax, abdomen, pelvis, Conclusion: Spectroscopic MR signal intensities can vary largely due to different musculoskeletal system, breast, etc). signal amplifi cations for optimal adjustment of the dynamic range. Linear relation- Background: FLAIR imaging has the capacity to null fl uids due to its long inver- ships between signal and voxel size allow reliable and easy measurements of sion time.This sequence has been widely used in MR imaging, proving its value solutions with arbitrary concentrations. in the disgnosis of a broad range of central nervous system diseases. However, there are almost no evidences of its use outside the central nervous system. This exhibit describes and illustrates the FLAIR technique as a reliable and easy way C-783 Can you guess the MR sequence? to differentiate cystic and solid lesions not only in the central nervous system, but C. García Espasa, J. Bernabé, L. Concepción Aramendía, M. Garcia; anywhere (thorax, abdomen, pelvis, musculoskeletal system, breast, etc). without Alicante/ES ([email protected]) contrast media administration (cost savings). Imaging Findings: Drop in signal in cystic lesions with the FLAIR sequence. Le- Learning Objectives: 1. Beware of the fat signal as a sequence identifi er. 2. sion is considered cystic if it looses signal on the FLAIR sequence when compared Recognize magnetic image weighting, beyond fl uid signal. 3. To learn the impor- with the T2-weighted images. tance of recognizing the protocol´s prescriber intention as a way of identifying the Conclusion: FLAIR technique is a reliable and easy way to differentiate cystic sequences. 4. To read and decode technical informationEPOS from MR images. 5. To and solid lesions. FLAIR imaging can prevent contrast media administration (cost recognize different MR sequences artefact fi ngerprints. savings) in some cases. Background: With the continuous advent of new sequences among the magnetic resonance imaging armamentarium, it is hard to keep up with their names and ap- C-781 plications. A few simple tricks however allow to recognize correctly the sequences Absolute quantifi cation of 1H-MR spectra: Comparing water reference employed in most exams. Conclusion: Newcomers to the MR imaging fi eld struggle among the wealth of quantifi cation with metabolic calibration No Material Submitted to R. Rzanny, F. Kalb, A. Gussew, W.A. Kaiser, J.R. Reichenbach; sequences. Making the wrong assumptions regarding sequences used can yield Jena/DE ([email protected]) wrong conclusions, and inadequate sequence selection can make pathology non- visible. This exhibit is designed to help you understand the process of sequence Purpose: To estimate absolute concentrations from MR spectroscopic measure- selection and recognition. ments reference concentrations are required. Commonly, either tissue water con- centration or separate phantom solutions with known concentration are used. The purpose of the study was to acquire brain spectra in volunteers and to compare C-784 Assessment of a fast, 3D MRI pulse sequence for use in polymer gel dosimetry the variability of both methods. I. Seimenis1, P. Baras2, P. Papagiannis2, P. Karaiskos2, A. Angelopoulos2, Methods and Materials: Overall twelve volunteers were investigated by 1H-2D-CSI P. Sandilos2, L. Vlachos2, B. Pantelis2; 1Nicosia/CY, 2Athens/GR (STEAM; TE=20 ms, TR=5000 ms) on a 1.5 T whole-body scanner (Magnetom ([email protected]) Sonata, Siemens) using the standard head coil. For three volunteers measure- ments were performed twice with identical sequence parameters except for the Purpose: The use of MRI as a readout method for polymer gel dosimetry com- water suppression pulse which was switched on only during the fi rst measurement. monly involves long imaging sessions and, therefore, the technique has not been Spectra were evaluated by the LCmodel. yet established in the clinical setting. This work evaluates the effi ciency and Results: Comparison of absolute concentrations of the metabolites NAA, Cho accuracy of a fast, 3D, dual-echo, k-space segmented Turbo Spin Echo (TSE) and Cr obtained with both methods showed stronger differences for voxels located imaging pulse sequence. in border areas of the selected volume. The differences between concentrations Methods and Materials: PABIG polymer gel dosimeters were irradiated with an 192Ir estimated by using NAA and water as a reference were clearly more pronounced High Dose Rate brachytherapy source, the 4 mm and 8 mm collimator helmets of in the parietal region (NAA: 5.4 vs. 7.0 mmol/L; Cr: 3.2 vs. 5.4 mmol/L; Cho1: 0.7 a gamma knife unit and a custom made x-knife collimator of 1 cm diameter. Profi le vs. 1.4 mmol/L) compared to the frontal region (NAA: 6.4 vs. 7.2 mmol/L; Cr: 3.9 and dose distribution measurements derived from TSE data were benchmarked vs. 4.6 mmol/L; Cho: 1.1 vs. 1.2 mmol/L). This refl ects the spatial variations of the against corresponding fi ndings obtained with the commonly used and optimised coil sensitivity. Carr-Purcell-Meiboom-Gill (CPMG) multi-echo CPMG sequence, as well as treat- Conclusion: As technical parameters like coil-sensitivity and load-factor affect ment planning calculations, Monte Carlo simulations, and fi lm and Pinpoint ion measurements with and without water suppression in the same way, corresponding ionization chamber measurements. errors in the estimated absolute intensities can be avoided. Therefore, if time allows Results: The TSE sequence was found to provide dosimetric results of compa- an internal reference should be preferred compared to estimation by a reference rable accuracy with those obtained from CPMG multi-echo acquisitions (within solution without correction of the sensitivity profi le of the coil. one pixel in the MRI gel readout session, i.e. < 1 mm), and to accurately predict treatments planning calculations and conventional dosimeter measurements in C-782 a range of radiotherapy applications that involve very steep dose gradients and Investigations on absolute quantifi cation of 1H-MR spectroscopic stringent dose delivery requirements and which require high spatial resolution in measurements depending on the adjustment parameters all three dimensions. R. Rzanny, F. Kalb, A. Gussew, W.A. Kaiser, J.R. Reichenbach; Conclusion: The signifi cant scan time reduction (64-fold) achieved with the Jena/DE ([email protected]) proposed imaging sequence implies that the polymer gel-MRI readout method could prove to be a useful and practical tool in modern clinical radiation therapy Purpose: MR scanners adjust receiver gain and FFT scaling factors depending on applications involving high doses and steep dose gradients. the signal intensity emitted by the sample. Therefore, no simple linear relationship between signal intensity and voxel volume or sample concentration exists com- monly. To assess the reliability of absolute metabolic concentrations, as determined C-786 MRI of the skin: Preliminary experience in dermatologic diseases by the LC model, single volume, 1H-MR spectroscopy was analysed with different H. Chiavassa, O. Loustau, M.-L. Despeyroux-Ewers, J. Vial, J. Giron, N. Sans, reference substances, concentrations, and voxel volumes. J.J. Railhac; Toulouse/FR ([email protected]) Methods and Materials: Single voxel spectroscopy (PRESS; TE=135 ms, TR=5000 ms) of three different reference solutions (alcohol, acetate and chloroform) Learning Objectives: To describe fi ndings at MRI in various skin disorders and to was conducted at 1.5 T (Magnetom Vision, Siemens) using the standard head visualize the assessment of epidermic, dermic and hypodermic tissues. MRI (1.5 coil. The phantom consisted of two concentric spherical fl asks with an aqueous Tesla), T1 spin echo and Gradient echo (3D Fiesta) with dedicated 3-inch antenna for cupric-sulphate solution in the outer fl ask (500 ml, 1000 ml or 2000 ml) and the study of the skin was obtained in 40 patients with skin pathology. Different pathologic reference solution in the inner fl ask (approx. 40 ml). Measurements were performed groups have been defi ned with dermatologists (tumours, dermatosis, infectious with different receiver and transmitter adjustments. diseases, psoriasis, scleroderma, dermatomyosis, granulomatosis, etc). Results: By dividing the signal intensity by the total receiver gain and multiplying it Background: MRI (1.5 Tesla), T1 spin echo and Gradient echo (3D Fiesta) with with the FFT scaling factor linear relationships were reconstituted when plotted as dedicated 3-inch antenna for study of the skin was obtained in 40 patients with a function of voxel volume or sample concentration. From the known total receiver skin pathology. Different pathologic groups have been defi ned with dermatologists gain, FFT scale and known reference concentrations a calibration parameter p was (tumours, dermatosis, infectious diseases, psoriasis, scleroderma, dermatomyosis,
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Madrid/ES C , M. Heckmann , M. 2 uoroscopy time (R uoroscopy BDEF method is a reliable uorescence microscopy A Erlangen/DE, 1 ; 1 , S. Grudzenski , S. 1 Hakusan, Ishikawa/JP Individual DSBs were visualised by using immuno fl uo- fl using immuno visualised by Individual DSBs were Image quality has been evaluated for both CR systems for Image quality has been evaluated To improve understanding of the following points about of the following understanding improve To , M. Uder , M. 2 Established "Anti-Glare" panel has waffl "Anti-Glare" panel Established irradiation of blood samples was performed (50 mGy) to evaluate mGy) to evaluate (50 performed samples was of blood irradiation As digital mammography has been getting more popular, mono- has been getting more popular, As digital mammography , S. Schwab , S. Resolution performances of both panels were compared by measur- by compared of both panels were Resolution performances 1 Gamma-H2 fl AX immuno ection, but this higher resolution performance can contribute to the can contribute this higher resolution performance ection, but To compare exposure requirements for similar image quality with similar image quality with requirements for compare exposure To DNA double-strand breaks (DSBs) are among the most signifi cant cant breaks (DSBs) are among the most signifi DNA double-strand , M. Löbrich , M. The dose area product (DAP) ranged from 769 to 17587 microGy*m from 769 to 17587 ranged The dose area product (DAP) 1 in vitro Homburg a.d. Saar/DE ([email protected]) Saar/DE ([email protected]) a.d. Homburg Conclusion: to measure the induction and repair of DNA damages caused by ionising radiation ionising radiation to measure the induction and repair of DNA damages caused by applied. if very small doses were even during angiography Purpose: patients are During angiography, ionising radiation. genetic lesions introduced by and a long time with changing tube position, pulsing rate for to X-rays exposed in patients examined was of ionising radiation The biological effect of view. eld fi applied only previously using a method which was undergoing angiography and in computed tomography. Methods and Materials: The method is based on the phosphorylation of the histone rescence microscopy. patients undergoing from twelve taken Blood was H2 of DSBs. AX after formation Ad- during and after the examination. before, procedures angiographic different ditional the individual repair capacity. Results: C-788 ionising induced by lymphocytes in blood Individual DNA damage radiation during angiographic examinations Kuefner M.A. 2 C-789 in radiography storage-phosphor conventional Needle-based versus paediatric radiology Ordiales; J.M. Prieto, C. Vano, E. Fernandez, J.M. Purpose: (CR) systems in paediatric computed radiography needle-based and conventional radiography. Methods and Materials: of acrylic with varying thicknesses to test object covered with a contrast-detail thick- series obtained with two of images were Four clinical conditions. simulate Physics in Radiology Physics Miscellaneous C-787 display of softcopy resolution performance "Glare" LCD panel improves digital mammography for Hashimoto; N. Yoneda, T. Learning Objectives: digital mam- getting more popular for been which have monochrome LCD monitors of resolution performance panel can affect coating of LCD Surface 1. mography: than "Anti-Glare" resolution performance "Glare" panel has better 2. display. softcopy the majority of medical LCD monitors. for panel which is currently used Background: However, radiologists. also been spreading among chrome LCD monitors have the in order to achieve are required performances higher resolution and contrast microcalcifi detecting example for diagnosis of mammograms, accurate with "Glare" panel which monochrome LCD monitor 5M-pixel new developed have resolution performance. improves Findings: Imaging backlight. from the monitor’s But it also diffuses the light ection of ambient light. refl especially on outlines compared to the image is blurred As a result, the displayed On the other hand, "Glare" panel has fl original image. of resolution It means that there is no degradation image. with the displayed blur coating. with surface performance Conclusion: higher MTF than "Glare" panel showed Function). Transfer ing MTF (Modulation of "Glare" panel. the higher resolution performance "Anti-Glare" panel, which proves the ambient light in reading room has to be controlled to decrease the Of course, specular refl diagnosis of mammograms. accurate respectively). Most of DSBs were repaired within 5 hours Most of DSBs were respectively). fl uoroscopy time ranged from 1:20 to 35:09 minutes. In all patients, the irradiation the irradiation In all patients, from 1:20 to 35:09 time ranged minutes. uoroscopy fl 15 found after the of DSBs was minutes Maximum of DSBs. increased the number of DSBs The number from 0.03 to 1.36 foci/cell. and ranged uoroscopy end of fl and fl to DAP a linear correlation showed W. Bautz W. Scientific and Educational Exhibits Scientific and Educational 5 We analysed with high resolution skin disorders in all cases. cases. skin disorders in all analysed with high resolution We 6 1
d d n MR imaging provides global analysis with high resolution of the various global analysis with high resolution MR imaging provides i . N I F - c u d E i c S - granulomatosis, etc). granulomatosis, Details: Procedure studied. and epidermisDermis changes were in such cases, fat, and subcutaneous exten- signal changes, localization, about thickness, informations useful MRI gave as In such cases, surrounding structuression and relationship with of the lesions. therapy. of of the effects evaluation of sclerodermia, MRI allowed phototherapy ammatory in infl diagnosis differential for substantial informations obtained We skin disorders. Conclusion: skin layers down to the hypodermis and the muscular facia. Characterization of lesions facia. and the muscular to the hypodermis down skin layers analysed, lesions are well Skin tumoral with treatment are permitted. and evolution of skin biopsies on certain number MRI is useful to reduce the indications. C - 7 0 R C EECR07-C-SciEduc-FIN.indd 165 Scientific and Educational Exhibits
nesses: 10 and 20 cm, and increasing tube voltages (60, 81, 102 and 125 kVp). scatter-free beam. In clinical situations, detectors are used with X-ray scatter from Images were acquired at 7 exposure levels. An image evaluation software was the patient. The use of a test object including scatter to measure MTF and NPS used to determine the threshold contrast of 15 circular holes with diameters ranging describes the resolution and noise properties of the imaging system with regard from 0.3 to 8.0 mm. Statistical signifi cance of differences between the two digital to scatter from the patient. systems was assessed. Phantom and detector surface air kerma were measured, and correlated with CR exposure levels. Results: A linear relationship was found between the number of detected holes and C-792 The impact of Nikola Tesla on X-rays discovery the logarithm of exposure. On average, the structured phosphor system required M. Hrabak, R. Stern Padovan, M. Prutki, K. Potocki; Zagreb/HR 55% less phantom entrance air kerma than the conventional phosphor plate. Dif- ([email protected]) ferences in exposure requirements were smaller with decreasing thicknesses of simulated tissue thickness and lower tube voltages (74% at 20 cm and 102 kVp, Learning Objectives: To present the role of Nikola Tesla’s (1856-1943) research and 36% at 10 cm and 60 kVp). All differences were statistically signifi cant. in X-rays discovery and invention of modern imaging technologies. Conclusion: Structured CR provides improved low contrast detectability and a Background: Discoveries of Nikola Tesla represent basics of traditional, but also potential for dose reduction compared with conventional CR. The best performance modern imaging techniques. Tesla’s work is present in every radiological depart- was achieved with conditions comparable to those for adult radiography (102 kVp ment, including fl uorescent lights in viewboxes, alternating current (AC) supplying and 20 cm of PMMA). the equipment, Tesla-Knott generator used for X-ray equipment, etc. One of Tesla’s never completed work was experiments with what would later be called X-rays. C-790 Procedure Details: Tesla’s articles published on the topic of X-rays and their biologi- Current practices of MSCT: A descriptive analysis cal hazards in The New York Electrical Review in the years 1896 and 1897, Tesla’s Y.L. O1, J. Geleijns1, C. Alvey2, E. Benjamins1, K. Chlapoutakis3, biography, as well as medical papers mentioning Nikola Tesla were analyzed. E. Fraile Moreno4, J. Hansen5, K.B. Madsen5, S. Meeson2, A. Meijer1, Conclusion: Since April 1887, Tesla began investigations using Crookes tubes, T. Niemann6, R. Patel2, L. Ruiz Lopez7, I. Salmerón Bérliz4, N. Theocharopoulos3, and his own vacuum tube which was a special single-electrode X-ray tube without G. Bongartz6, A. Calzado Cantera7, J. Damilakis3, S. Golding2, A. Jurik5; target electrode. It seems that by 1892, he became aware of what Roentgen 1Leiden/NL, 2Oxford/UK, 3Iraklion/GR, 4Alcala de Henares/ES, identifi ed as X-rays effects three years later. He didn’t publicly declare his fi ndings 5Aarhus/DK, 6Basle/CH, 7Madrid/ES ([email protected]) nor make them widely known, and much of his research was lost in a fi re in his laboratory in New York in 1895. He was also among the fi rst to comment on the Learning Objectives: To provide insight into current practices of clinical applica- biological hazards of working with X-rays with the conclusion that distance was a tions of Multi-slice Computed Tomography (MSCT) using the new generation of CT useful safety factor. systems able to acquire simultaneously at least 16 sections, and to identify specifi c applications that justify the radiation exposure. Background: Rapid technical developments in CT have had a substantial impact on C-793 Count-rate analysis in PET with LSO detectors the applications of this technology. Since CT is already associated with a relatively F. Bonutti, R. Padovani, O. Geatti; Udine/IT ([email protected]) high (collective) patient dose, a review of current practices was performed. Procedure Details: Administrative patient data on diagnostic applications cor- Purpose: The optimisation of the acquisition parameters in PET has the purpose responding to one contiguous year, and CT reports corresponding to 10% of the to improve the quality of the diagnostic images. Optimisation can be done by maxi- annual data have been retrieved from the information systems and referral forms mizing the NECR that in turn depends on the coincidences rate. of six radiology departments in different European countries. Data pre-processing Methods and Materials: For each bed, the scanner (Biograph Duo, Siemens) included coding the medical specialties, the age groups, anatomic regions, and records the coincidences and the singles rates in a log-fi le. For each patient, we most important coding of the diagnoses from medical details mentioned in the fi gure out the functions Trues=T (s), Randoms=R (s), Scatters=S (s) (where s reports. The resulting database includes 70041 CT examinations, of which 54127 = single count rates) by fi tting the NEMA 70 cm phantom count rate curves on were referred by medical specialties concerning 33149 patients. To learn from these the measured clinical points, in order to analytically calculate the personalized data, descriptive analyses have been performed. PseudoNECR (s) curve linked to the NECR curve. Conclusion: CT examinations are predominantly performed on patients in the Results: For central beds, we estimate a missing activity of ~70% to get the mid- and higher age categories. The highest referrals are by oncology; followed PNECR_max, but the improvement in terms of SNR that we could get is around 15%. by surgery, internal medicine, neurology and neurosurgery. A substantial number We also estimated the correlation between the patient weight and the PNECR_max, of patients received more than 6 CT examinations in 1-year, mostly for oncology. in order to fi gure out which should be the scan duration of a single bed in function Most frequent diagnostic categories are neoplasms; followed by diseases of the of the patient weight to acquire the same PNEC. If we normalize the counts at the musculoskeletal system, vascular system, respiratory system, digestive system, PNECR_max for the 70 Kg patient, the bed duration for a 90 kg patient should be urinary tract, and nervous system. 230s, which is ~30 % longer. Conclusion: Although the analysis indicates that the fast electronics implemented C-791 in the scanner allows the use of higher administered activities, we found that this MTF and NPS measurements including X-ray scatter - application in a would involve a poor improvement in terms of NECR. The attention can be instead digital mammography system addressed on the usefulness of higher bed duration for heavier patients. H. Perez-Ponce1, P. Monnin2, F.R. Verdun2, A. Noel1; 1Vandoeuvre-lès-Nancy/FR, 2Lausanne/CH ([email protected]) C-794 Radiology and physics: How to create ‘joint ventures’? Purpose: Detector characterization with modulation transfer function (MTF), noise G. Blanco, D. Rodríguez, J. Marco, I. Díaz Serrano, E. Marco de Lucas, power spectrum (NPS) and detective quantum effi ciency (DQE) inadequately J. Jordá, R. Pellón, J. Arnáiz, T. Piedra, L. Martín, M. Pelaz, M. Torres, predicts image quality when the imaging system includes patient scatter. This E. Ruiz, J. Izquierdo, A. Fernández Flóres, A. González Mandly, A. Gutiérrez, contribution investigates the effect of X-ray scatter on the MTF and NPS in mam- E. Sánchez; Santander/ES ([email protected]) mography for characterizing the system in clinical situations. Methods and Materials: A full-fi eld digital mammography unit was characterized Learning Objectives: To describe our experience in development of ‘joint ventures’ at 28 kV Mo/Mo at two beam qualities with and without X-ray scatter. Pre-sampling between a Radiology Department and a Basic Research Physics department. To MTF and NPS without scatter were measured according to the IEC 62220-2 stan- analyze pros and cons of this collaboration from little initial projects to participation dard. The same imaging parameters were measured again with a mammography in large EU projects. test object that simulates X-ray scatter due to the breast. Background: Clinical Radiologic departments and basic research Physics groups Results: X-ray scatter causes a falloff of MTF [6% at very low spatial frequency live frequently far away in work and mind from each other. However, to create a (0.1 mm-1) and 9.5% for the rest of the spectra] and adds a constant amount of collaboration group between a Radiology department and a Basic Physics research noise (3% from 0.5 to 2 pl/mm, 6% from 2.5 to 4 pl/mm and 8% from 4.5 pl/mm group provides great benefi ts for both institutions. to the Nyquist frequency). This increase in image noise is related to the amount Procedure Details: We describe our experience, projects and lessons learned of scatter integrated by the detector. The reduction of MTF and the increment of about how to begin a ‘joint venture’. We analyze possible benefi ts for a Radiol- noise implies the drop of the DQE at all frequencies. ogy Department from a Physics group including: a) experience from informatics Conclusion: The properties of an image receptor are properly characterized with a management providing different solutions for several problems of our departe-
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ltration up to 7.0 mm up to 7.0 ltration ([email protected]) ([email protected])
ltration level of 2.5 mm, and of 2.5 level ltration cantly. The best image quality cantly. Dublin/IE Dublin/IE Hamamatsu/JP C Copenhagen/DK BDEF A ltration level. TLDs were used to measure entrance used to measure entrance TLDs were level. ltration The ESD was calculated with PEMNET in 29 patients calculated with PEMNET The ESD was Data collected from 21 Danish X-ray departments show Data collected from 21 Danish X-ray Serial AP and lateral lumbar spine radiographs were taken taken were Serial radiographs lumbar spine AP and lateral ltration as a dose reducing tool in AP and lateral cant dose reduction of 60-74 % is achieved in the thyroid gland. gland. of 60-74 cant dose reduction in the thyroid % is achieved This experiment shows that with a certain shows This experiment predetermined parameter Simultaneous ESD monitoring was useful as an alarm ESD monitoring Simultaneous was so that doctors The CEC guidelines (1996) recommend a minimum total fi ltration ltration total fi The CEC guidelines (1996) recommend a minimum Clinical usefulness of simultaneous entrance skin dose (ESD) monitor- entrance Clinical usefulness of simultaneous the possibility of dose The purpose is to examine of this experiment Signifi cant dose reduction was achieved by using PA instead of AP of AP instead using PA by achieved reduction was cant dose Signifi For the AP lumbar spine exposures, the optimal level of total aluminium the optimal level the AP lumbar spine exposures, For The ESD were different among interventional procedures greatly. The ESD interventional among procedures greatly. different The ESD were ltration was 6.5 mm. This provided 34%, 18%, 27% and 19% reductions in entrance 34%, 18%, 27% and 19% This provided 6.5 was ltration mm. C-799 Increased aluminium fi of a phantom lumbar spine images Brennan; Thompson, P. D’Helft, J. C. Kelliher, E. Purpose: This phantom lumbar spine radiography. for of 3.0 mm aluminium equivalent level of increasing aluminium fi the effects based study examined Dose optimization is of added importance dose and image quality. on radiation due of childbearing age, on females is performed when lumbar spine radiography patients and the risk to increased risk of irradiating of cancer induction in young an undiagnosed foetus. Methods and Materials: phantom, beginning at a total fi of a tissue equivalent Radiographers X-ray Conventional C-797 online measurement of patient entrance skin dose with an Evaluation system in interventional neuroradiology Sakahara; H. Nomura, T. Inagawa, S. Takei, Y. C-798 during a cervicalvertebrae Dose-reduction experiment examination Nielsen; M. Muharemovic, O. Pedersen, R. taken were Three exposures mm. mm, up to 7.0 increasing in increments of 0.5 each projection at each fi for Image quality assessment dose. organ dose and fetal reproductive dose, surface using anatomical criteria performed was based analysis. Results: fi ([email protected]) ([email protected]) Purpose: Purpose: ing with PEMNET (Clinical Microsystems Inc., Arlington, VA) in interventional in interventional VA) Microsystems Inc., Arlington,ing with PEMNET (Clinical evaluated. was neuroradiology Methods and Materials: transarterial Among them, 18 underwent 2004. 2000 through October from May and extra- intracranial for and 11 transarterial infusion (TAI) embolization (TAE) diseases. cranial Results: the TAE, In 4 patients with procedure. TAI than with TAE with times greater ve fi was TAE The ESD in loss of hair. transient underwent and they 2 Gy, ESD exceeded It could be due to than in other procedures. diseases counted higher vascular for more to understand the performed were and angiography uoroscopy that fl the fact (AVM). structure malformation such as arterovenus vascular complex Conclusion: technologists on the spot and radiological can reconsider their treatment strategy tube load to reduce the total patient dose. the X-ray reduction during adjusting predetermined cervical a by vertebrae examination quality. image and still maintaining acceptable parameters, Methods and Materials: assess To settings prior in parameter to a cervicala wide variation examination. The uoride) are used. lithium fl TLD (tablet gland, the absorbed dose in the thyroid of the phantom, which corresponds to the thyroid are placed in the area tablets using images of a specially Image quality is assessed gland´s anatomical position. to a human phantom in density phantom, which is equivalent designed plexiglass linear phantom and phantom has a built-in The plexiglass composition. and overall in the images. to measure and assess the contrast one density holes that enable Results: PA By using AEC in AP, resulting in minimal image quality deterioration. exposure, one can reduce the dose signifi 66 with exposure kV, ratio with the However, 12:1. using grid ratio exposure under AP/PA is achieved at the cant dose reduction of up to 74%, but to observe a signifi able were 8:1, we a slight deterioration of image quality. same time there was Conclusion: regulation, a signifi a slight image resolution reduction is observed that does not At the same time, the diagnostic quality of the image. affect le data ection of real ex type digital ex ts for both groups in both groups ts for ow. A fi ne-dispersive ne-dispersive A fi ow. Anjo, Aichi/JP, Aichi/JP, Anjo, 1 ; 2 ections of surrounding light. ections of surrounding light. lled with a suspension of talc , K. Ichikawa , K. 1 Scientific and Educational Exhibits Scientific and Educational , H. Imai , H. 1 The experimental research was carried out. The high- carried out. research was The experimental 21" LCDs (2560 x 2048) with a anti-glare panel and a 21" LCDs (2560 x 2048) with a anti-glare panel and , A. Ishikawa , A. 7 1 6 ([email protected]) ([email protected]) 1
ection of ambient light. However, this also diffuses the light from this also diffuses However, ection of ambient light. d d n Visualization of streams in liquid accumulations is a refl Visualization of streams in liquid accumulations Creation of joint ventures between basic Physics research groups groups research basic Physics between Creation of joint ventures The LCD with a glare panel was excellent in physical characteristics by characteristics by in physical excellent The LCD with a glare panel was ([email protected]) i .
N I Many current LCDs use anti-glare panels, which have a waffl ed surface ed surface a waffl which have current LCDs use anti-glare panels, Many In certain cases, a coloration occurs under ultrasound investigation with In certain investigation occurs under ultrasound a coloration cases, F In the B-mode, displacement of talc elements to a direction opposite displacement In the B-mode, The LCD with a glare panel had better MTF characteristics and displays The LCD with a glare panel had better MTF characteristics and displays - , M. Sawada , M. c 1 u d E i c S Nagoya, Aichi/JP Nagoya, - Purpose: to diffuse the refl image and a bar-pattern A uniform image displayed evaluated. glare panel were a high-resolution single-lens refl measured with on an LCD were cant signifi In order to avoid equipped with a close-up lens. (D70, Nikon) camera noise profi structures, periodic components of the pixel errors caused by the LCD’s backlight. The aim of this study was to compare the spatial resolution aim of this study was The backlight. the LCD’s NPS) of spectrum: and the noise (noise power MTF) function: (modulation transfer digital mammography. for high-resolution LCDs with anti-glare and glare panel Methods and Materials: a sharper image outline. Furthermore,a sharperbetter NPS the LCD with a glare panel had image outline. characteristics than the LCD with an anti-glare panel. Conclusion: The glare digital mammography. comparison LCD with an anti-glare panel for with the with no refl in a dark environment effective panel was was processed by the hanning window. processed by was Results: frequency probe was submerged into a container fi frequency probe was suspension moving in the direction opposite from the probe can be seen. The in the direction opposite from the probe can be seen. suspension moving reasons and properties behind this phenomenon require further investigation. Methods and Materials: performed. was scanning and ultrasound in degassed water, Results: PRF values, In the color Doppler mode with low visualized. from the probe was from corresponding to movement registered as coloration this displacement was under the follow- marked Increase in intensity of the displacement was the probe. of Doppler modes, implementation shift to distant zones; Focus ing conditions: Reduction of movement increase of Doppler frequencies. mode; especially power (at level Reduction of acoustic power cases: in the following registered intensity was 40% quite stopped), increase of liquid viscosity (the suspension of talc in glycerin did not move). practically Conclusion: C-796 under Visualization of acoustic currents in liquid accumulations ultrasound investigation Stenkina; O.V. Sapozhnikov, Kapustin, O.A. V.V. Kubova, S.J. Gromov, A.I. Moscow/RU which is regarded as an artifact of a pseudo-fl color Doppler, Purpose: 2 scientifi c, economic and open-mind views. economic and open-mind views. c, scientifi C-795 panel for of LCD with anti-glare panel and glare Comparative evaluation digital mammography Oda K. and Clinical radiologic departmentsand Clinical radiologic benefi great can provide ment: advice for PACS and workfl ow, creation of an online database of radiologic database of radiologic creation of an online ow, workfl and PACS advice for ment: money european public with management of experience b) teleradiology; cases, Possible with CAD. in our case, research: basic c) performing sources of money; from a different a) lessons from a Radiology group: group a Physics ts for benefi applications in practical developed b) application of basic research point of view In addition, basic research scientists have in the EU. marketing more easy for application of their work, just the opposite practical null frequently a sensation of of our daily clinical work. Conclusion: liquid untwist, which can be explained by the well-known physical phenomenon physical the well-known by liquid untwist, which can be explained us to interpret of this occurrence enables Correct understanding - acoustic current. in pathological cystic formations. some phenomena that are found C - 7 0 R C EECR07-C-SciEduc-FIN.indd 167 Scientific and Educational Exhibits
surface dose, uterine dose, ovary dose and typical effective dose, respectively, Radiographers compared with 3 mm total fi ltration. For right lateral lumbar spine exposures, the optimal level of aluminium fi ltration was 5.5 mm. This provided 35%, 15%, 22%, CT 23% and 14% reductions in surface dose, left ovary, uterine, right ovary and typi- cal effective dose, respectively. There was no statistical difference in image quality between any of the experimental groups. C-801 Conclusion: These results suggest that current recommendations under-utilise Optimization of patient exposure dose in low-dose scanning for CT the optimization potential of aluminium fi ltration. colonography by adjusting dose according to patient weight Y. Hirano, K. Sasaki, H. Matsuya, S. Katsuki, K. Sasaki; Otaru city, C-800 Hokkaidou/JP ([email protected]) Radiation dose optimisation in the chest X-ray of the children Purpose: Reducing patient exposure dose is important in CT colonography. In a A. Kettunen, K. Kylmäniemi; Oulu/FI (anja.kettunen@oamk.fi ) previous study (ECR 2005), we studied laboratory models and found that scanning with an air SD value (standard deviation value in the acrylic part) of approximately Learning Objectives: 1. To understand the importance of radiation protection with 35 or more results in poor visualization. Air SD values vary according to patient children. 2. To understand the optimisation process according to DIMONDIII. size. In the present study, we investigated optimization of the patient exposure dose Background: The most vulnerable period for radiation-induced cancer appears by adjusting the dose according to patient weight. to be the fi rst years of life. Some newborns and young children are exposed quite Methods and Materials: Patients were examined using a 16-row multidetector CT often during there fi rst living years. The age dependence of a radiation-induced scanner and a 3D workstation. Patient weight was measured before CT colonog- risk is observed for the cancers most readily induced by radiation: leukaemia, raphy. Scanning was performed with an extremely low dose of 5 mAs (70 patients) thyroid cancer and breast cancer. The spontaneous risk of childhood leukaemia or 15 mAs (37 patients), and the air SD values in the colon were determined in and cancer is (2-3)*10-3 per Gy and a prenatal radiation exposure of 10 mGy has the upper abdomen and in the pelvic cavity. Scan conditions were 120 kV, 1.0-mm been reported to increase the risk by 0.06%-40%. According to the DIMONDIII scan slice thickness, and 1.0-mm reconstruction slice thickness. project, the optimisation should be done taking account the radiation dose, image Results: A positive correlation was observed between patient weight and air SD quality and diagnosis. values in the colon. The correlation coeffi cients were 0.74 and 0.73 in the upper Procedure Details: CDRAD image quality phantom was used. The image plates used abdomen and 0.69 and 0.72 in the pelvic cavity for extremely low-dose scanning were Fuji MD and Fuji STVI. Both image plates were exposured with 70 kV/0.5 mAs at 5 mAs and 15 mAs, respectively. and 66 kV/0.5 mAs which are (simulating a newborn child’s chest X-ray). Conclusion: Our previous study (ECR 2005) showed that air SD values of ap- Conclusion: The image plates will tested more with the phantom and after that proximately 35 or more result in poor visualization, making it diffi cult to observe the results will be tested with clinical use. The experienced radiology will analyse the tissue surface. The present study has shown that adjusting the dose according the image quality. The results will be introduced. These fi rst tests showed that it is to patient weight is useful for optimizing the patient exposure dose in low-dose possible to optimise the radiation dose and image quality easily according to the scanning while maintaining good visualization. DIMONDIII process. C-802 How versatile is CT-AEC? Radiographic technique considering performance characteristics K.O. Oosawa1, Y.M. Muramatsu2, S.T. Terakawa3, T.M. Mito3, S.N. Nakahira3, Y.H. Hamada3, Y.U. Ueda3, I.F. Fujimura3; 1Sakurai Nara/JP, 2Chiba/JP, 3Osaka/JP ([email protected])
Purpose: CT automatic exposure control (CT-AEC) is a new technique to optimize increasing exposure during CT examination. Because different CT-AEC systems use different operational principles, CT-AEC cannot be expected to be effective when used thoughtlessly. The purpose of this study is to develop a radiographic technique that considers performance characteristics of different CT-AEC systems, pursuing maximum dose reduction while ensuring image quality. Methods and Materials: Two CT-AEC systems from one manufacturer were in- vestigated: (1) SOMATOM Volume Zoom with CARE Dose, and (2) Sensation 64 with CARE Dose4D (Siemens, Germany). The phantoms for evaluation are cone, elliptical, variable-XY and step phantoms (Kyoto Kagaku, Tokyo). Data was collected by changing abdominal CT scan parameters as appropriate. The data was converted to DICOM images; image noise, tube current and absorbed dose (CTDIw) were obtained using a dedicated software program (BioArts, Fukuoka). Results: The relationship between tube current and image noise was compared for CARE Dose and CARE Dose4D. Dose reductions from 10% to 30% were obtained in both AEC systems compared with doses obtained without AEC. While dose reduc- tion depends on phantom size in both systems, the dependence changes with dose correction curves in CARE Dose4D. The dependence of image noise on phantom shape is observed in CARE Dose, but is not conspicuous in CARE Dose4D. Conclusion: A tube current correction table considering phantom size and shape was developed from the results, allowing dose reduction and comparable image quality from the two systems. C-803 Can the isolated distension of the colon be infl uenced by adequate preparation during virtual colonoscopy, or, if needed, can adequate small intestine distension also be achieved? E. Turupoli, K. Szeidl, L. Fehér, Á. Szilvássyné Takács; Budapest/HU ([email protected])
Purpose: To develop a method by which the isolated distension of the colon can be achieved, or if the status of the small bowel is also questionable, to produce the distension of small bowel too. Methods and Materials: We performed 190 virtual colonoscopies. The infl ation
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7 0 0 , 2 2 . 2 499 0 . 2 112.02.2007 17:04:18 24.8 (n=14) ± G =0.045). p , K. Takahashi , K. 1 cient use of isotropic =0.096). However, the paired However, =0.096). p ([email protected]) ([email protected])
29.0 (n=15) for SD15. ANOVA did ANOVA SD15. 29.0 (n=15) for , S. Tsukagoshi , S. ± 1 C BDEF ow was evaluated. was ow Chiba/JP 44.0 were standard deviation 2 ± , H. Sato , H. 2 ow was best correlated when the slice thick- best was ow A Tochugi/JP, Tochugi/JP, Forty-fi ve esophageal cancer patients underwent CT esophageal cancer patients underwent ve Forty-fi Unenhanced and enhanced (arterial-phase and late- 1 ; 2 , R. Sekiguchi , R. This report illustrates a scanning method used to achieve This report method used to achieve a scanning illustrates 2 ([email protected])
For evaluating spatial resolution, a micro globe 0.18 evaluating mm in diam- For ( among the 3 groups cant difference 31.8 (n=15) for SD12, and 33.8 31.8 (n=15) for ± Traditionally, we understand that CT scan images come from tomog- understand that CT scan images we Traditionally, The results of the experiment found that change occurs in the X-Y found The results of the experiment be obtained at 5 scan may In esophageal cancer patients, mm-thick- ([email protected]) ([email protected]) In CT-AEC based on image quality (SD) setting, the SD level selected quality (SD) setting, the SD level based on image In CT-AEC To determine optimal scanning parameters for CT perfusion in patients determine for parameters optimal scanning To , K. Yokohama , K.
2 The prognosis and blood fl The prognosis and blood The mean evaluation values values The mean evaluation , Y. Muramatsu , Y. 1 t-test showed a signifi cant difference between SD12 and SD15 ( between cant difference a signifi t-test showed not show a signifi not show for SD10, 57.1 for Purpose: The purpose dose and image quality. exposure the balance between strongly affects in abdominal to determineof the present study was the optimal SD setting level CT examinations. Methods and Materials: with hepatocellular phase) helical CT images of 24 patients (17 men and 7 women) data, Using this CT raw without CT-AEC. follow-up acquired for carcinoma were (SD10, SD12, SD15) with CT-AEC SD levels images with 3 different simulated Toshiba, (Raw-NASu, reconstructed program were using a computer simulation to blinded who were 5 radiologists by reviewed were The images Nasu, Japan). using the continuous of diagnostic accuracy the degree to evaluate the SD levels the conducted for Statistical analysis was dence judgment method (0 to 100). confi normality. which showed of 3 of the radiologists, values evaluation Results: I. Aizawa I. C-808 in abdominal CT examinations the optimal SD setting level determine To Yagi N. C-806 resolution isotropic students in understanding for helpful Information Asano; K. Sekitani, T. Goto, T. Anzui, M. Uebayashi, Y. Tsujioka, K. Aichi/JP Toyoake-city Learning Objectives: the effi for method that allows isotropic resolution and a display resolution in image diagnosis. Background: slice in helical scanning and multi to recent developments due However, raphy. to from two-dimensional has advanced CT scanning equipment CT technologies, shifted largely CT images have and, similarly, three-dimensional data collection, Iso- one. to three-dimensional observation two-dimensional of a section from a current needs in CT technology. in meeting factor tropic resolution is an essential that the elements composing CT images hold equal, Isotropic resolution means three-dimensional resolutions. Findings: Imaging used a dual resolution, we contrast evaluating For used. eter made of tungsten was artifact. also evaluated We in CT value. a small difference phantom having glove Conclusion: scan- are set for parameters Y axis direction depending on how direction and the consider such characteristics for must we In the actual clinical environment, ning. of the optimization of isotropic resolution for setting and also be aware parameter report As this a description setting serves of parameter to provide CT image display. nd it helpful fi we more complicated in recent years, has grown CT scan, which for with CT operation. are unfamiliar students who for C-807 CT perfusion in patients with for Optimal scanning parameters cancer esophageal Ochiai; T. Okazumi, Fukuchi, S. Kazama, K. T. Syutou, K. Yanagawa, N. Sato, H. Chiba/JP Purpose: with cancer of the esophagus. Methods and Materials: The image- helical CT. row using a multi-detector performed Scans were perfusion. 4x5 120kv. mm collimation, 1.0sec/rotation, the following: were acquisition factors 20 of 5 at a rate injected by was contrast ml ml/sec followed Forty ml of intravenous the start between 5 sec in 33 cases of injection and scanning was The delay saline. set 40, 60, 80, 100, and 120 mA in The tube current was and 10 sec in 14 cases. mm, reconstructedmm, 5 All the data were with 2.5 esophageal cancer patients. and visually evaluated The shape of time density curve (TDC) was mm. and 10 fl the association of prognosis and blood Results: mAs in esophageal bad scanned at 60 TDC was The shape of mm. 5 ness was time of 10 cancer patients with delay In one out of 3 esophageal cancer patients. arterialseconds, enhancement started the scanning. before Conclusion: time of 5 sec. and delay more than 60 mAs, ness, , 2
, M. Midiri , M. 2 , T.V. Bartolotta , T.V. 1 Cyuo-ku,Sapporo/JP Scientific and Educational Exhibits Scientific and Educational ([email protected]) ([email protected])
, A.A. Palumbo , A.A. 1 Palermo/IT 2 , E. Maffei , E. 1 To easily determine the optimal cardiac phases in coronary To 1. To describe the various methods of CT-Enteroclysis (CT-E) (CT-E) describe methods of CT-Enteroclysis the various To 1. The subjects were 40 patients who underwent cardiac CT 40 patients who underwent The subjects were 9 The main variability observed between different protocols protocols different observed between The main variability brillation, the agreement rate was 93%. was brillation, rate the agreement 6 1
Parma/IT, Parma/IT,
1 d ; d 1 Computed Tomography Enteroclysis (CT-E) is a technique for the is a technique for Enteroclysis (CT-E) Tomography Computed In current coronary determining CT studies, the optimal cardiac phases n The optimal cardiac phases for depicting the coronary depicting arteriesThe optimal cardiac phases for can With these two methods, a higher percentage of cases could be suc- a higher percentage methods, With these two CT-E is a novel modality for the assessment of small bowel that may that may the assessment of small bowel modality for is a novel CT-E i . , L. Damiani , L. N 1 I F Distension of the colon was appropriate with both methods. In 140 cases, In 140 cases, appropriate with both methods. Distension of the colon was - c u d E i c S - F. Cademartiri F. C-805 approach A guided step-by-step to" CT-enteroclysis: "How La Fata A. Conclusion: be determined using this cardiac phase image subtraction accuracy with good Not only can the optimal cardiac phase be determined automatically method. coronary CT studies is sub- the time required for but without visual evaluation, stantially reduced. for depicting the coronary depicting the arteriesfor process that is based on visual is a time-consuming eagerly awaited. is therefore method evaluation A quantitative evaluation. Details: Procedure ECG-gated reconstruction, images of cardiac acquired by Using data studies. three planes near LAD for generated to 99% were from 0% phases in the range method, and subtraction delay #6 to #7, RCA #1, and RCA #2 using the relative The in-plane cardiac phases. images in consecutive for repeatedly performed was measured, and the mean SD value images were of the subtraction SD values the between rate The agreement plotted on a graph. in each cardiac phase was and the optimal cardiac phase determined by SD value phase with the minimum Excluding of 5% of the cardiac phase. 83% within the range was visual evaluation patients with atrial fi ([email protected]) ([email protected]) Learning Objectives: the "elements of cardiac motion" in each evaluate quantitatively To CT studies. compare this optimal cardiac phase determination method To cardiac phase. automatically determine the optimal To visual evaluation. against conventional cardiac phases. Background: C-804 using cardiac phase determination method of optimal cardiac Evaluation CT studies subtraction in coronary phase image Urasawa; Satoh, K. Honma, K. N. Yamaguchi, T. we wanted to produce isolated colon distension. It was succesful in 127 cases. In succesful in 127 cases. It was isolated colon distension. to produce wanted we successful in 47 cases. It was too. small bowel to examine wanted we 50 cases, Conclusion: becomes more Virtualand small bowel of the colon colonoscopy cessfully examined. of discomfort unnecessary could be lessened. feeling and the patient’s effective of the colon was carried out with two different methods, depending on which part depending on which methods, carried different out with two of the colon was isolated achieve To Method I: to be examined. meant was tract of the intestinal ml then about 20 30-60 times, ated infl ml of air was the colon, 5-10 distension of scout view felt, If tension around the coecum was pumped 10-15 times. of air was simul- of the colon and small bowel distension achieve To II: Method done. was then about ml of air 25-40 times, startedation was 20 pumping by infl taneously, easily With this method, air can pass times. pumped 10-15 of air was ml 15-20 through the Bauchim valve. Results: Learning Objectives: worldwide experiences different of the an overview give To 2. of the small bowel. CT-E techniques for compare the different To 3. Germany and American). (Italy, dis- of different a pictorial assay provide To 4. and pitfalls. describing advantages appear on CT-E. eases as they Background: distension by after small bowel It is performed assessment of the small bowel. medium via a nasojejunal catheter fol- of contrast of a high volume administration of conventional combines the inherent advantages CT-E CT acquisition. by lowed homogeneous luminal distension resulting from volume barium enteroclysis (i.e. detection of simultaneous challenge) with those of cross-sectional imaging (i.e. it is a challenging However, abnormalities). and extraintestinal mural intraluminal, to be optimised. steps that have technique with several Findings: Imaging regards the choice contrast medium. German investigators use positive contrast contrast use positive German investigators medium. regards the choice contrast mate- iodinated contrast diluted barium sulphate suspension or water agent (i.e. agents contrast intraluminal use neutral rial), American and Italian investigators are also reported Differences in the choice of or 0.5% methylcellulose). water (i.e. techniques), in the use of sedation Maglinte or Rollandi nasojejunal catheter (i.e. each indication will The optimised protocol for of patients. and in the preparation in the exhibit. be provided Conclusion: completely vicariate previously used modalities. used modalities. completely vicariate previously C - 7 0 R C EECR07-C-SciEduc-FIN.indd 169 Scientific and Educational Exhibits
Conclusion: SD12 is the appropriate SD setting level for CT-AEC in abdominal Radiographers CT examinations. MR Imaging C-809 Usefulness and optimal noise (SD) of auto-mA: Survey among radiology technologists using16-slice MDCT and esophageal cancer phantom study C-810 Manual labeling of brain tissues on MR images - a method to assess the N. Yanagawa, H. Satou, T. Kazama, T. Iimori, K. Shutou, S. Okazumi, T. Ochiai; quality of brain tissue volumes by automatic segmentation in a large Chiba/JP ([email protected]) population based study: The age, gene/environment susceptibility Purpose: Image quality and radiation exposure are confl icting factors. Recently, au- (AGES)-Reykjavik study tomatic determination of radiation dose (auto-mA) in CT scans has been developed. B. Oskarsdottir1, S. Sigurdsson1, L. Forsberg2, J. Fredriksson2, O. Kjartansson1, The purpose of this study was to determine optimal noise level at auto-mA. A. Zijdenbos3, G. Eiriksdottir1, L. Launer4, V. Gudnason1; 1Kopavogur/IS, Methods and Materials: Questionnaire was mailed to 99 institutions that have 2Reykjavik/IS, 3Montreal, ON/CA, 4Bethesda, MD/US ([email protected]) 16-slice MDCT. The questions were usage of auto-mA, and the setting of noise level Purpose: Automated segmentation of brain tissue on MR images is critical to ac- when it was used. A basic study was performed with small and large phantoms. complishing analyses of MR scans acquired in large population-based studies, but The small (S)-phantom was a low-contrast phantom and 20 cm in diameter. The manually labeled tissue is needed to check the accuracy of the algorithms. Here we large (L)-phantom was made of the low-contrast phantom rolled with water-polymer describe a method for manual labeling of brain tissues on MR images and assess absorber material. This was 35 cm in diameter. The largest diameter of the lesions the reproducibility of the method. demonstrating more than two-third of their profi le was searched. Methods and Materials: The brain tissues on the MR images were labeled using Results: Fifty-one institutions answered the survey. In 76% institutions, auto-mA "BorderLine", a software drawing tool specially designed for the AGES-Reykjavik was used and the standard deviation (SD) of auto-mA set between 6 and 15, but study. BorderLine uses a Wacom pen tablet as a human interface device for draw- it was set constant in each institution. On phantom study when SD was set at 8, ing and labeling anatomical landmarks. The tablet comes with a computerized pen the largest profi le of lesions in L-phantom was 10 mm, while that in S-phantom interface and a drawing board, allowing the user to label multiple ROIs or tissue was 12.5 mm. When SD was set at 10, the largest profi le of lesions in L-phantom classes based on a multi-modal set of registered brain images. Intra-rater variability was 12.5 mm, while that in S-phantom was 15.0 mm. was assessed based on 2 repeated measures from one observer on 5 pre-defi ned Conclusion: Although SD of auto-mA was set constant in many institutions, phan- slices of the brain for cerebrospinal fl uid (CSF), gray matter (GM), white matter tom study suggested different optimal SDs depending on patients’ body habitus. (WM) and white matter lesions (WML), based on the 4 following MR sequences: 3D SPGR T1, FSE PD/T2, and FLAIR T2. The intra-rater variability was calculated for each tissue class and each slice location individually using kappa statistics describing spatial agreement (Dice Similarity Coeffi cient). Results: Kappa agreement for all tissue classes and all slice locations was excellent (mean k=0.856±0.088 and mean k=0.899±0.009, respectively). Conclusion: A robust, highly reproducible method has been developed for manual labeling of brain tissues. C-811 An evaluation of computer-aided instruction courseware for MRI physics D. Koumarianos, E. Mihalopoulou, L. Costaridou, G. Panayiotakis; Patras/GR ([email protected])
Purpose: The evaluation of a computer-based instructional package designed to interactively teach MRI concepts using media-rich animations. Methods and Materials: Eighteen postgraduate students were prospectively, randomly assigned to receive instruction on the same MRI topic from a textbook and a computer module. Participants were evaluated by a multiple choice test 2 weeks before the lectures, at the end of the lectures and by a retention test after 1 month. They also completed questionnaires to rank their attitudes quantitatively and qualitatively toward the two instructional methods. Mean test scores of the textbook and computer groups were compared by means of analysis of variance. Results: The percentage of correct answers increased from 36.7% on the pretest to 70.3% on the posttest, and then decreased to 49.6% on the retention test ad- ministered 1 month after completion of the MRI course. Computer group students scored signifi cantly higher on their posttest (M=80.5, SD=9.4) when compared with the textbook group (M=61.3, SD=12.5, p=.003), while they seem to appreci- ate multimedia modules more when compared to textbook students (p=.003). The textbook learning group was equally satisfi ed with their method of instruction in comparison to the computer group (p=.230). Students’ rationale for expanding the use of multimedia in physics education seemed to focus on issues concerning motivation, instructional capabilities and content. Conclusion: Interactive animations are a useful and effective aid for teaching MRI principles. The study demonstrated that the inclusion of properly designed multimedia modules enhances conceptual understanding far more than traditional methods do.
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7 0 0 2 . 2 501 0 . 2 112.02.2007 17:04:18 G eld may be profi led by a led by be profi eld may C BDEF A eld, which was named as "the clinical science of named as "the clinical science eld, which was ning the research focus were found to be "clinical radi- to found were the research focus ning nition, and a model was formulated to describe the research formulated nition, and a model was Results suggest that this new academic fi academic new Results suggest that this Concepts defi distinctive research focus, diverging from that of nursing science. Results also sug- Results also science. from that of nursing diverging research focus, distinctive and be named as the clinical science of radiography eld must fi gest that this new theory in further be exploited academic development, may Results radiotherapy. radiotherapy. and and education within radiography development defi ned in radiography. Data were collected in forms of literature, expert interviews literature, of in forms collected were Data radiography. ned in defi and written content analysis. material, analysed with qualitative and Results: "health and "environment", "nursing"), for (substitute and radiotherapy" ography also These concepts were "health"), and "human being". illness" (substitute for provided Each concept was ways. several to be connected to each other in found with a theoretical defi academic fi of this new focus and radiotherapy". radiography Conclusion: ca- eld, especially eld, Budapest/HU, Budapest/HU, 1 ; 1 eld , G. Forrai , G. 1 ) eld has been active. Especially, the Especially, eld has been active. c principles will help radiographers c principles will help radiographers , I. Pap , I. 1 Scientific and Educational Exhibits Scientific and Educational c principles and the practical applications. c principles applications. the practical and ([email protected]) , I. Szikossy , I.
2 Sixteen naturally mummifi ed human individuals and 30 mummifi Sixteen naturally The study was conducted according to the three-phase The study was rst educational institution in Norway, providing a qualifi providing rst educational institution in Norway, (sanna.sorppanen@oulu.fi Gjøvik University College, in collaboration with Innlandet in collaboration College, University Gjøvik
This course will be a part and is time study within 2 years 1 Gjøvik/NO 7 1
, L.A. Kristóf , L.A.
1
d Oulu/FI d Norway experiences a shortage especially in rural experiences of radiologists, Norway n Radiological examination of ancient bones and mummies can help of ancient bones and mummies Radiological examination Through this postgraduate programme in medical ultrasound, Gjøvik Gjøvik in medical ultrasound, programme Through this postgraduate i . N I Radiology is a very useful method in paleopathology, in the diagnosis Radiology is a very method in paleopathology, useful The master’s programme in radiography has been running in Finland since in radiography programme The master’s F In the cases of mummies, the conventional radiography parameters had to parameters radiography the conventional In the cases of mummies, - , E. Riedl , E. c 1 u d r/HU E ö i c S Gy - tion of radiographers as sonographers. as sonographers. tion of radiographers bone remains were examined. The bones were at least thousand years old and at least thousand years The bones were examined. bone remains were in the discovered were The mummies places in Hungary. originated from different 1731 and 1841. between from burials Hungary, Vác, crypts of Dominican Church, CT and spiral views), on phosphor plates (at least two radiographs Conventional CT data, 3D reconstruc- spiral From performed. were mm HRCT examinations 1 also made. tions were Results: Summation was content. lost water 75% because of the body’s about be reduced by CT scans also required special settings. Obtaining and displaying often unavoidable. and trepanation traumas of the bones most frequently revealed The examinations were changes of the spine and the joint surfaces degenerative Many of the skull. leprosa and vertebral facies disease, Signs of rheumatoid arthritis, Paget detected. pulmonary vertebral changes, In the mummies, tuberculosis could be discovered. diagnosed. lesions were and other traumatic fractures tuberculosis, Conclusion: X-ray methods for New to diagnose pathological changes in these human remains. are necessary features. and CT examinations due to the special Purpose: There is not enough reference ancient human remains. of pathological changes of The aim of our examinations. of paleoradiological data about technical parameters describe and examinations the methods of paloradiological to develop study was and ancient human bones. study of mummies and the radiological Methods and Materials: hybrid method of concept analysis, combining the theoretical and empirical ap- method of concept analysis, hybrid were "health" and "human being" "environment", Concepts of "nursing", proach. not clearlyused as the starting are commonly applied but point, because they in comparison science. to nursing Methods and Materials: Clinical science of radiography and radiotherapy: A conceptual analytical A conceptual analytical and radiotherapy: Clinical science of radiography academic fi of a new focus on the research study Sorppanen; S. Purpose: fi academic of this new 1999, and development This dissertation was science has been under discussion. relationship with nursing academic fi purposed of this developing to clarify the research focus C-814 Hospital Trust, has developed a postgraduate programmeq in medical ultrasound for for in medical ultrasound programmeq a postgraduate has developed Trust, Hospital is to educate sonographers The aim of the course (60 ects). in Norway radiographers with an understanding of the scientifi of the scientifi Understanding and knowledge C-813 in Norway radiographers in medical ultrasound for postgraduate program First Stokke; Aabel, R. I. Learning Objectives: com- Clinical in acquiring the skills necessary in practice. to apply this knowledge petency is an important part integral of the programme. Background: selected to perform The purpose of this education is to qualify radiographers areas. examinations. abdominal ultrasound Details: Procedure and levels of ultrasound, physics Module 1: in 4 modules as follows: organized topographic Module 2: sophistication of equipment image recording, and artefacts. gained under guidance clinical practice, Module 3: of abdomen, pathology. anatomy and a written clinical practice project on 4: Module and supervision of radiologist. the European by The course is based on the guidelines developed a set subject. Structured theoreti- in Medicine and Biology. Ultrasound of Societies for Federation competency assessment. by are followed training cal and practical Conclusion: the fi College is University Paleoradiology: Methods and possibilities Methods and possibilities Paleoradiology: Laki A. 2 Miscellaneous Miscellaneous C-812 Radiographers Radiographers C - 7 0 R C EECR07-C-SciEduc-FIN.indd 171 Scientific and Educational Exhibits
Vascular C-819 Renal artery variants at 64-slice MDCT: Prevalence in a series of 152 CT consecutive patients M. Bertolotto, M. Coss, M. Belgrano, V. Cioffi , L. Calderan, M.A. Cova; Trieste/IT C-815 ([email protected]) Aortic intramural hematoma: Prognostic CT fi ndings in the acute onset Purpose: To determine the prevalence of renal artery variants at 64-slice multi- and follow-up detector row CT (MDCT). C. Sebastia, S. Quiroga, H. Cuellar, A. Miranda, R. Boye, A. Alvarez; Methods and Materials: Between March and July 2006, 158 consecutive patients Barcelona/ES ([email protected]) who underwent arterial phase contrast enhanced MDCT scans of the abdomen (Aq- uilion 64, Toshiba Medical System, Japan) were retrospectively evaluated with PACS Purpose: The aim of this exhibit is to review the CT fi ndings of acute type B aortic workstation (DICOMed PACS, ebitAET, Italy). Isotropic data sets of 0.5 mm slices intramural hematoma and to assess the prognostic value of these fi ndings. were available for review and suitable reconstructions using a dedicated graphic Methods and Materials: We evaluated 34 patients with type B (Stanford) aortic workstation (Vitrea 2, Vital Images Inc, USA). Six of these patients were excluded intramural hematoma (IMH) by helical CT at the acute onset and yearly thereafter. because of aortic stent placement, aortic dissection or surgery, renal atrophy. The The series included 33 men and 1 woman, with a mean age of 67 years (range: fi nal study group for review consisted of 152 patients (97 men, 55 women). 49-87). Patients were followed-up for a mean of 5.6 years (range: 2-13 years). The Results: Thirty-eight of the 152 patients (25%) had renal artery variants. There were initial aortic diameter (≥40 mm), IMH thickness (≥10 mm) of the affected areas, IMH 7 right and 6 left superior polar arteries; 15 right and 6 left inferior polar arteries. 33 length, and presence of tiny ulcers at the acute onset were statistically assessed accessory renal arteries arose from the aorta, 1 from the right common iliac artery. and correlated with poor evolution. Six accessory right arteries passed anterior to the inferior vena cava. Two patients Results: Evolution was to healing in 56% of cases and to focal aneurysm formation had double renal artery, 1 right, 1 left. Two patients had precaval dominant right in 44% of cases. There was no correlation between poor evolution and initial aortic renal artery. The overall prevalence of precaval arteries was 5%. diameter (≥40 mm), IMH thickness (≥10 mm), or IMH length. Ten patients had small Conclusion: Renal artery variants are commonly observed during routine MDCT ulcers at the acute onset, and there was a correlation between the presence of these examinations of the abdomen; 64-slice MDCT scanners allow excellent depic- ulcers and aneurysm formation. No differences were found in the outcome (healing tion of these variants along all their course, and evaluation of relationships with or aneurysm formation) between the fi rst and the last yearly control. adjacent structures. Conclusion: The only CT fi ndings in the acute onset of aortic IMH with prognostic value were the presence of tiny ulcers in the affected aorta. In addition, the fi rst-year evolution was predictive of the long-term evolution of this entity. C-820 What is the advantage of angio-CT system equipped with 16-channel MDCT? Detection of feeding artery during transcatheter arterial C-816 chemoembolisation for hepatocellular carcinomas using 3D-CT Emergency abdominal venous system pathology by CT angiography generated from the data set of CT hepatic arteriography V. Muley Luelmo, M. Sanchez Cabello, S. Martin Garre, J. Montilla Lopez-Gay; M. Hirata, T. Kajiwara, T. Tsuda, T. Mochizuki; Toon Ehime/JP Madrid/ES ([email protected]) ([email protected]) Learning Objectives: To check CT fi ndings of the most frequent causes of ab- Learning Objectives: To demonstrate the usefulness of 3D-CT angiography dominal venous system emergency pathology. (3D-CTA) reconstructed from thin-slice data set of CT hepatic arteriography Background: Abdominal venous pathology cases presentation, by CT diagnostica- (CTHA) obtained from 16-channel angio-CT system for detection of the feeding tion, in the radiology department of our hospital in the last two years. artery of hepatocellular carcinomas (HCCs) in comparison with digital subtraction Imaging Findings: We show several cases of: abdominal venous system traumatic angiography (DSA). pathology; aorta-inferior cava vein fi stula, aorta-gonadal vein fi stula; abdominal Background: Selective catheter placement into the feeding artery is important for venous system primary and metastatic disease; septic thrombosis of the splenic effective treatment of HCCs and avoidance of hepatic damage after transcatheter vein, porta, superior and inferior mesenteric veins; acute venous thrombosis of a arterial chemoembolization (TACE). However, it is sometimes diffi cult to recognize renal graft; thrombosis of the inferior cava vein and renal veins after pregnancy. three-dimensional vascular anatomies on two-dimensional DSA alone. 3D-CTA Conclusion: The emergency radiologist should consider the abdominal venous generated from CTHA enables us to identify the exact feeding artery, which is system pathology in the differential diagnosis of the acute abdomen in order to sometimes diffi cult to depict by intravenous CTA, because direct opacifi cation of achieve a premature diagnostic to reduce morbi-mortality. hepatic artery allows us to produce very precise 3D-CTA. Information of the detailed vascular anatomy and bifurcation point of feeding artery is simultaneously available C-817 when we perform TACE. Flat-panel CT as a new perinterventional imaging modality in aortic Procedure Details: Patients were injected with 15 mL of nonionic iodinated contrast stentgraft procedures: Work in progress material at 1.5 mL/sec via a 2.3 or 4 F catheter placed in the common hepatic artery. E. Rabitsch, H. Illiasch, W. Wandschneider, K.A. Hausegger; Klagenfurt/AT CTHA was performed at 10 seconds after the start of injection. 3D-CTA was rapidly ([email protected]) generated on the imaging workstation equipped for angio-CT system. The vascular anatomies and the target artery for chemoembolization could be recognized easily, Learning Objectives: To evaluate the value of fl at-panel CT during aortic stent- especially on the movie display of the 3D-CTA, which gave hints of suitable selection graft procedures. of devices and helped us to make the effi cient strategy for selective TACE. Background: Flat-panel CT was performed in 12 patients immediately after Conclusion: 3D-CTA generated from CTHA is useful for the detection of feeding endovascular treatment of aortic aneurysms (5 TAA, 7 AAA) on the angiographic artery of HCCs during TACE. table. Images were acquired with a rotating C-arm (Axiom Artis; Siemens), ac- quisition time was 20 seconds. During a rotation of 200 degree, 538 projections were acquired. Images were displayed in MIP and VRT mode. Eight patients got C-821 intraarterial contrast medium (CM). Effi ciency of via dorsum pedis 3D-CT venography for varicose veins of Imaging Findings: In all patients, the entire stentgraft was exactly shown and lower extremities alignment of the prothesis along the landing zones was well displayed. The aneu- M. Ishifuro, J. Horiguchi, K. Ito, T. Sueda, K. Sato, M. Kiguchi, T. Furukawa, rismal sack was well shown in 11 patients (1 patient had traumatic rupture). 1 x C. Fujioka; Hiroshima/JP ([email protected]) an endoleak II was detected, 2 x an angiographically verifi ed endoleak I was not Purpose: The opacifi cation of lower extremities in CT venography (CTV) by intrave- detected (1x suboptimal CM timing, 1x no CM administered). Aortic side branches nous injection of contrast media (CM) via an upper extremity vein is often poor for were well shown in all contrast enhanced studies except 1 (suboptimal CM timing). three-dimensional (3D) display. We assessed whether 3D CTV obtained via dorsum In one patient, distal extension was considered due to suspected short stent-graft pedis, using the same scanning protocol as for CT arteriography, was useful for at the distal neck. Flat-panel CT showed suffi cient neck coverage and no exten- understanding the complicated structures of the venous system. sion was inserted. Methods and Materials: In 10 cases, diluted CM (6:1 ratio of water and 300 mgI/ Conclusion: Flat-panel CT is a promising imaging tool during stent-graft procedures mL CM) of a total amount of 140 ml was injected into the dorsum pedis at a rate and may be helpful especially in problematic procedures. of 3.5 ml/sec. Scanning was performed from foot to head after a delay of 35 sec.
502 A BDEFC G
EECR07-C-SciEduc-FIN.inddCR07-C-SciEduc-FIN.indd 117272 112.02.20072.02.2007 17:04:1817:04:18 8 1 : 4
Vascular 0 : 7 1
7 c 0 0 2 . stula 2 503 0 . 2 112.02.2007 17:04:18 ndings and G cient gathering c clinical symptoms, symptoms, clinical c C ([email protected])
BDEF Milan/IT A Between September 2004 and January 2006, 20 hemo- September 2004 and January Between 1. To describe our protocol for studying the thoracic aorta studying the thoracic describe our protocol for To 1. 1. To illustrate basic liver and renal vascular anatomy and anatomy and renal vascular basic liver illustrate To 1. 1) Major vascular anomalies that involve the systemic arterial the anomalies that involve 1) Major vascular ([email protected])
Since January 2004, we have performed an ECG-gated MSCT tech- performed have 2004, we Since January Multi-detector CT (MDCT) is now a standard type of clinical CT scan- a standard type of clinical is now Multi-detector CT (MDCT) MDCT angiography and MPR reconstructions allowed satisfactory and MPR reconstructions allowed MDCT angiography Recognition of abdominal vascular anomalies on imaging is important anomalies on imaging Recognition of abdominal vascular To assess the role of Multi-detector CT Angiography (MDCTA) in non- (MDCTA) assess the role of Multi-detector CT Angiography To ndings and differential diagnostic features that allow for differentiation differentiation for that allow features diagnostic ndings and differential ([email protected]) Attenuation values ranged from 100 to 180 H.U. Eighteen out of 20 from 100 to 180 H.U. ranged values Attenuation
syndromes and other pathologic processes. Major vascular anomalies that involve anomalies that involve Major vascular syndromes and other pathologic processes. on key with emphasis the systemic arterial systems of the abdomen are reviewed imaging fi from other abnormalities. differential diagnostic features that allow for differentiation from other abnormalities. from other abnormalities. differentiation for that allow diagnostic features differential important most important to avoid post processing technique and how 2) Review specifi are related with which of such anatomical variants 3) Understand error. syndromes or are important a correct surgical planning. clinical symptoms, for Conclusion: be associated with specifi may such variants because several of much more information than by just evaluating thin source images. Post-process- thin source images. just evaluating by than more information of much educational purposes. both in clinical situations and for ing techniques are useful hide important use of these techniques may incorrect information. However, Details: Procedure imaging fi on key with emphasis system of the abdomen are reviewed its variation with multiplanar and 3D imaging using 64 detector row CT. 2. To pro- To 2. CT. 3D imaging using 64 detector row and with multiplanar its variation the basic illustrate To 3. anatomy. 3D vide an atlas of normal vascular and variant how principleimaging using 3D workstation and 3D and to explain of multiplanar image quality. to optimize Background: the effi Appropriate post-processing of MDCT images enables ner. Learning Objectives: the advan- with images and videos, demonstrate, 2.To with ECG-gated MSCT. depict To 3. aorta thoracic diseases. studying several tages of this technique for imaging of the ECG-gated technique for artifacts and disadvantages the pitfalls, aorta.the thoracic Background: aorticnique in 27 patients with thoracic disease (9 aneurysms-pseudoaneurysms of the ascending aorta, 3 type A acute aortic 6 chronic aortic dissections, dissec- 2 aortictions, 1 patent ductus arteriosus, ascending coarctations, 3 postoperative Learning Objectives: C-826 spiral CT (MSCT) of ECG-gated multislice and disadvantages Advantages of the thoracic aortain the study Alvarez; A. Boyé, R. Evangelista, Quiroga, A. S. Cuellar, Sebastia, H. C. Barcelona/ES C-824 with 64 3D anatomy arteries. abdominal and variant Atlas of normal multidetector-CT channel Passariello; R. Catalano, Napoli, C. Macrì, A. F. Telesca, M. Pelle, Sedati, G. P. Rome/IT C-825 CT angiography using multi-detector by Detection of active hemorrhage reconstructions and multiplanar Biondetti; P. Lemos, Marchetti, A. L. Purpose: abdominal hemorrhage. patients suspected of having traumatic Methods and Materials: suspected abdominal hemorrhage, for clinically referred patients, dinamically stable USA). Wisconsin, (LighSpeed-G.E. CT angiography multi-detector underwent the arterial phase using bolus fashion: acquired in a multi-phase Images were (Smart-Prep), technique phase after a 70 second delay, tracking the venous and ac- The at 2.5 mm of collimation, 2.5 mm of reconstruction interval, and 6 of pitch. Images were values. detected with mean attenuation sign (AB) was bleeding tive was Image evaluation reconstructed and rendered with MIP and MPR algorithms. fashion, a blinded-end in abdominal radiologists experienced two carried out by obtained. was (Cohen-Test) and inter-observer agreement Results: detected in 10 whereas the AB sign was patients had abdominal hemorrhage, secondary from an intrahepatic It was to spontaneous bleeding out of 20 patients. pseudoaneurysm (n=1), rupture of a splenic artery pseudoaneurym (n=1), rupture from an aorto-duodenalof a giant renal angiomiolypoma (n=1), bleeding fi (n=2), bleeding from gastric ulcer (n=2), and rupture(n=2), bleeding hemangioma of a hepatic readers in the the two obtained between was agreement Almost perfect (n=2). detection of the AB sign (k=0.82, CI=95%). Conclusion: site, the bleeding The AB sign precisely localized hemorrhage. detection of active planning. therapeutic should be considered before and therefore rmed cantly ex iliac ex nding of 0.01), renal arteries (301 vs < Scientific and Educational Exhibits Scientific and Educational ([email protected]) ([email protected]) A prospective parallel-group randomized study of of study randomized parallel-group A prospective
Between March 2000 and Oct 2003, 63 early Between postopera- 0.01), SMA (325 vs 222 p < 3 7 1
Seoul/KR
d d n Sudden developed hematoma as well as extravasation of contrast of contrast as extravasation hematoma as well Sudden developed Three-dimensional CTV via dorsum pedis for lower extremities is is extremities lower CTV via dorsum pedis for Three-dimensional An iodine concentration of 370 mg/ml leads to an higher enhance- mg/ml leads to an of 370 An iodine concentration i . N I The purpose of this exhibit is to discuss the clinical impacts of earlyThe purpose of this exhibit To compare two different concentrations of a non-ionic contrast media of a non-ionic contrast concentrations different compare two To ([email protected]) ([email protected]) F The early postoperative bleedings after LDLT were caused by Inferior Inferior caused by were after LDLT bleedings The early postoperative Concentration of 370 Concentration 4 mg/ml (injection rate ml/sec) led to a signifi Both varicous and deep veins were enhanced over 500 HU in all cases. 500 HU in all cases. enhanced over were and deep veins Both varicous
- 0.01) and iliac arteries (169 vs 113 p=0.01; 167 vs 112 p=0.01). 3 ml/sec 0.01) and iliac arteries 167 vs 112 p=0.01). (169 vs 113 p=0.01; c < u d cant. cant. ndings compared with angiography E i c S - patients showed a lower enhancement but differences were not statistically sig- were differences enhancement but a lower patients showed cant at the same levels. nifi Conclusion: ment and better delineation of abdominal aorta and smaller arteries compared to ml/sec is non statistically of 3 and 4 injection rates between Difference mg/ml. 300 signifi 206 p early postoperative bleeding in posttransplant patients. Careful consideration for for consideration Careful patients. in posttransplant bleeding early postoperative into catastrophic status that requires the progression ndings can prevent these fi surgical management. Purpose: ndings fi ndings or CT angiographic and CT fi after LDLT bleedings postoperative Emphasis is causes. bleeding according to the various compared with angiography arteries bleeding of the possible according location of hematoma laid on evaluation leakage on CT scan. and contrast Methods and Materials: artery (3.2%), and dissection of common hepatic artery (1.6%). Conclusion: CT fi material in the same region on CT scan is thought to be predictive C-823 living donor liver transplantation: following postoperative bleeding Early CT fi Kim; Hong, A. S. tive bleeding in 50 transplants among 478 adult liver transplants were confi were transplants among 478 adult liver in 50 transplants bleeding tive by conventional angiography. All patients underwent twophase multidetector row row multidetector twophase All patients underwent angiography. conventional by angiography. conventional CT scan before Results: phrenic artery (12.7%), rupture of a bleeding branch (23.8%), jenunal bleeding hepatic artery pseudoaneurysm (9.5%), right renal capsular artery (9.5%), bleeding artery thoracic intercostal and lateral after chest tube insertion bleeding site (9.5%), epigastric and superiorInferior epigastric artery (6.3/1.6%), anastomotic bleeding (4.8%), gas- oozing (4.8%), biopsy site bleeding surface site leakage (6.3%), liver (1.6%/3.2%), circumfl troduodenal and pancreatoduodenal arcades bleeding C-822 abdominal concentration on contrast enhancement of of iodine Effect CT scanner aorta with a 64-detector row Simonetti; G. Mastrangeli, Antonelli, R. Di Roma, L. Nisini, M. A. Squillaci, E. Rome/IT CT (MDCT) in the abdominal aorta helical row with a 64 channel multidetector and splancnic arteries. Methods and Materials: the abdominal aorta and splancnic arteries with a MDCT (GE performed was injected was A non-ionic c.m. VCT) in 40 patients divided in 4 groups. Lightspeed 3 injection rate ml; (130 1-2: mg/ml in group of 300 with an iodine concentration ml/sec). 4 3 or injection rate ml; 3-4 (100 mg/ml in group ml/sec) and of 370 or 4 Arterial trunk, (celiac SMA, renal arteries) enhancement of the aorta at 3 levels and of iliac arteries statistical calculated and were measured, mean values was assessed. cance was signifi Results: higher enhancement of the aorta in comparison with 300 of celiac mg/ml at the level trunk p (329 vs 236, Purpose: Superfi cial veins sometimes did not reach 500 HU; however, they were well dem- well were they however, did not reach 500 HU; sometimes veins cial Superfi of the in the ligation therapy The 3D CTV helped surgeons 3D CT. on onstrated saphenous vein. Conclusion: and helps surgeons as a systems, of the venous the delineation a useful tool for therapy. ligation for navigator The total volume of CM was intended to acquire enough enhancement levels in levels to acquire enough enhancement intended was of CM The total volume HU or higher 500 of values tested whether CT was It extremities. the entire lower systems. obtained in the venous were Results: C - 7 0 R C EECR07-C-SciEduc-FIN.indd 173 Scientific and Educational Exhibits
aortas and 3 intramural hematomas of the ascending aorta) with a 16-row MSCT C-829 unit. In all cases, we performed a retrospective ECG-gated technique, followed by The effect of cardiac function on aortic peak time and peak enhancement conventional MSCT study of the thoracic aorta. All cases were reconstructed in during CT angiography: A retrospective study multiplanar, MIP and VR reformations. Dynamic cine-mode imaging of the aortic S. Sakai, T. Okafuji, A. Chishaki, H. Yabuuchi, Y. Matsuo, T. Kamitani, H. Honda; valves and thoracic aorta was also done in all cases. Fukuoka/JP ([email protected]) Imaging Findings: Images of ascending aorta diseases and postoperative changes are depicted without cardiac motion artifacts; the coronary arteries and their re- Purpose: To investigate how cardiac function affects the magnitude and timing of lationship with aortic disease and surgery are assessed. Dynamic studies of the aortic contrast enhancement during CT angiography (CTA). aortic valves and thoracic aorta are presented. Artifacts due to a loss of cardiac Methods and Materials: Twenty-nine patients (21 men, 8 women; mean age: synchronization, breath motion and insuffi cient aortic coverage are shown. 64.4±13.4 years; mean weight: 59.4±10.3 kg) underwent measurement of cardiac Conclusion: ECG-gated MSCT allows precise evaluation of diseases and surgery output within 2 weeks of coronary CTA. During coronary CTA, after a test injection, of the ascending aorta and coronary arteries. Dynamic studies allow evaluation 90 mL of contrast medium was injected at 3 mL/sec and scanning was initiated of the aortic valve, movement of the intimal fl ap, detection of intimal tears and after a delay based on the previously determined contrast transit time. The cardiac visualization of patent ductus arteriosus. output of each patient was measured by the thermodilution technique, and the cardiac index was calculated. Attenuation of the descending aorta was measured C-827 at the workstation every 3 sec with reference to the image acquisition time shown by DICOM header information. Then the aortic peak time and aortic peak enhance- Thirty-two-detector row CT angiography of carotid and cerebral arteries: ment of each patient were calculated. Pearson’s correlation coeffi cient analysis was Comparison of 40 ml and 60 ml of contrast material with a bolus chaser used to investigate the relationships between the cardiac index and aortic peak H. Shinjyo1, N. Takeyama2, Y. Ohgiya1, Y. Takahashi2, M. Obuchi2, T. Kitahara2, time or aortic peak enhancement. S. Matsui2, Y. Kinebuchi2, T. Gokan1, M. Ishikawa2; 1Tokyo/JP, 2Yokohama/JP Results: The ranges of cardiac index, aortic peak time, and aortic peak enhance- ([email protected]) ment were 1.11 to 5.30 (mean: 3.28±1.08) L/min/m2, 25 to 51 (mean: 38.3±7.5) Purpose: To compare the diagnostic performance of MDCT angiography (CTA) of sec, and 273.1 to 598.1 (mean: 390.4±72.1) HU, respectively. With an increase of the brain and neck, using 40 ml and 60 ml of contrast material (CM). the cardiac index, the aortic peak time decreased (r=-0.698, p < 0.0001) and aortic Methods and Materials: CTA was performed using 32-MDCT from the aortic arch peak enhancement also decreased (r=-0.573, p=0.0009). (AA) to the parietal region. Seventy patients were divided into 2 groups on the Conclusion: The aortic peak time and peak enhancement during CTA are closely basis of CM (300 mg/ml) administration protocol: Group1 (n=35) received 40 ml related to cardiac function. of CM with 25 ml of saline fl ushing at 4 ml/sec; group 2 (n=35) received 60 ml of CM in the same fashion. First, time to peak enhancement (Ti) of the internal C-830 carotid artery (ICA) at circle of Willis (cW) was calculated by test bolus method. The role of advanced vessel analysis software to evaluate aortic diameter Next, scan duration (sd) between AA and cW was calculated (collimation 1.25 mm; in patients with ascending aorta dilation pitch 0.969; rotation time 0.4 sec). Scan was started at [(Ti+4)-sd] (sec) in group1, A. Ferraris, F. Caraffo, M. Oggero, S. Rossetti, A. Secinaro, C. Venturi, and [(Ti+9)-sd] (sec) in group 2. Thirteen ROIs were placed from AA to above the M. Martina, G. Gandini; Torino/IT ([email protected]) cW. Mean attenuation of carotid arteries (CaAs) and cerebral arteries (CeAs) were quantitatively analyzed. Venous contamination (VC), and VR and MIP images were Purpose: To evaluate the "vessel analysis" software accuracy and usefulness also visually analyzed. versus direct axial slice measurements to estimate preoperative maximum aortic Results: Although there was a statistically signifi cant difference (p < 0.05) in mean diameter in patients with ascending aorta dilation. attenuation of each artery between both groups, the attenuation of all arteries in Methods and Materials: We performed preoperative Angio-CT with 16-row MDCT group 1 was over 200 HU, and analysis of VC in group 1 was better than that in GE LightSpeed in 39 patients with ascending aorta dilation. Four radiologists with group 2. Visual analysis of CaAs showed no difference, and that of CeAs in group different experience (1-10 yrs) revaluated ascending aorta maximum diameter 2 was better than group 1. with "advanced vessel analysis," an automatic system that is able to generate Conclusion: A 40 ml CM CTA of the brain and neck may provide suffi cient attenu- view true oblique cross sectional vascular images perpendicular to the vessel axis, ation and diagnostic performance. and then evaluated the same patients with simple direct axial measures. Then, we compared the results so obtained to test the interobserver variability with these 2 C-828 measurement methods. Results: The mean of the maximum aortic diameters obtained by advanced ves- A vascular tree is known by MDCT before gastrointestinal surgery sel analysis was 51.19 mm. The mean of the maximum aortic diameters obtained H. Funatsu, H. Takano; Chiba/JP with direct axial measures was 49.68 mm. Interobserver difference was 0.08 mm Learning Objectives: In this exhibit, we illustrate the normal branching pat- with the use of "vessel analysis" software and 2.47 mm with direct axial measure. tern of visceral arteries and their variants in the abdomen with use of volume The maximum difference between the 2 radiologists with respect to the direct axial rendering technique. measurements was 21.01 mm, and while using vessel analysis it was 1.12 mm. Background: Multidetector-row computed tomography (MDCT) has come to be Conclusion: The routine use of "vessel analysis" software allows minimization of recognized as a useful diagnostic tool for preoperative evaluation. For example, the interobserver bias, and increases the accuracy in the preoperative evaluation angiographic images can be easily acquired after administration of IV contrast of ascending aorta dilatation. media. There is a certain kind of vascular variant that can be a potential source of complication during laparoscopic-assisted surgery for its inherent property (e.g. C-831 limited view of the fi eld, loss of three-dimensional depth perception, limited surgi- Carotid artery wall thickness and stroke: Evaluation by using multi- cal manipulation). Therefore, preoperative vascular mapping in each anatomic site detector-row CT angiography would help your colleague. L. Saba, G. Caddeo, R. Sanfi lippo, R. Montisci, G. Mallarini; Cagliari/IT Imaging Findings: Replaced left hepatic artery arising from left gastric artery, common trunk of left gastric artery and common hepatic artery, tortuous course Purpose: The aim of this work is to determine if carotid artery wall thickness (CAWT) of splenic artery were all depicted and relevant to procedures of or complications evaluated by using multi-detector-row CT angiography (MDCTA) is an effective after laparoscopic partial gastrectomy. Resection of left gastric artery from which parameter to consider as predictive of increased risk of stroke. left hepatic artery branches can lead to liver dysfunction. Whether ileocecal artery Methods and Materials: In this retrospective study, we analyzed 154 patients runs anterior to vein or not determines an approaching method for exposure of by using a multi-detector-row CT scanner. In each patient, we measured CAWT superior mesenteric vein during right hemicolectomy. Delineating root of left colic and measurements were made with an internal digital caliper. We divided patients artery would facilitate left colic artery preserving lymph node dissection during into 2 groups: the fi rst group (group A) included patients without stroke (n = 98) laparoscopic low anterior resection. and the second group (group B) included patients with stroke (n = 56), and we Conclusion: With recent widespread use of laparoscopic procedures, more detailed made a statistical analysis by using t-student test to asses the CAWT difference information about relevant anatomy is required. MDCT providing 3D images could in the 2 groups. be an imaging method of choice for the purpose. Results: Measurements of the distal common CAWT varied from 0.1 to 2.2 mm. In group A, average CAWT was 0.8082 mm (0.279 SD) and in group B it was 1.107 mm (0.2 SD). CAWT in group A patients showed statistical difference (p < 0.01) com-
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. 2 505 , 0 2 . 2 112.02.2007 17:04:19 0.01). < G Tokyo/JP cantly smaller cantly 2 , H. Shinjyo , H. 1 45.1 HU, p 45.1 HU, ± 64.1 HU in group 2), visual HU in group 64.1 Yokohama/JP, Yokohama/JP, ± , S. Matsui , S. 1 1 ; 2 C in mean aortofemoral cant difference BDEF , T. Gokan , T. , M. Obuchi , M. cantly better in group B than in group A group B than in better in group cantly 1 1 14.1 HU vs. 61.8 14.1 HU vs. ± 50 kg undergoing both CTA and CTV received and CTV received both CTA kg undergoing 50 A > CTA was performed using 32-MDCT with 1.25 mm col- using 32-MDCT with 1.25 performed was CTA , Y. Kinebuchi , Y. , Y. Takahashi , Y. 1 A total of 97 preoperative patients [60 men and 37 women, patients [60 men and 37 women, A total of 97 preoperative 2 associated with variables cant and consistent independent 41.8 HU in group 1 vs. 331.8 1 vs. HU in group 41.8 ± ush at 4.0 ml/sec was used for CTA. In group 2 (n=20), Ta was was Ta 2 (n=20), In group CTA. used for at 4.0 ml/sec was ush , Y. Ohgiya , Y. CTA depicts the PGA in a high percentage in this study. Preopera- depicts the PGA in a high percentage in this study. CTA Low-volume CM CTA can provide suffi cient aortofemoral contrast contrast cient aortofemoral suffi can provide CM CTA Low-volume Bolus-tracking technique showed relatively small variation in the scan small variation relatively technique showed Bolus-tracking 1 ([email protected]) ([email protected])
, M. Ishikawa , M. 1 The posterior artery (PGA) is one of the important arteries feeder of the To evaluate whether low-volume contrast material contrast (CM) MDCT angi- whether low-volume evaluate To The mean scan delay of CTA was 19 seconds (SD: 3.3; range: 10-31). 10-31). range: 3.3; 19 seconds (SD: was of CTA delay The mean scan The PGA was detected in 84 patients (86.6%). In 83 of the 84, the PGA detected in 84 patients (86.6%). The PGA was Although there was statistically signifi Although there was 0.001) in CTV. Multiple regression analyses revealed that body weight and that body weight analyses revealed Multiple regression 0.001) in CTV. < of which 189 patients underwent subsequent CTV. We administered two different different two administered We subsequent CTV. patients underwent of which 189 of the weight depending on the body medium iodine contrast amounts of nonionic patients with body weight patient: 450 mg I (group B), while other patients received 300 mg I (group A). The enhance- 300 450 A). mg I (group received B), while other patients mg I (group scale and densities were the four-point estimated by subjectively was ment of vessels performed analyses were Multiple regression measured at the predetermined levels. medium, scan contrast weight, sex, and age, variable, with density as the dependent variables. and presence of embolism as independent delay Results: the two between differ did not CTA estimate of enhancement quality in Subjective signifi while it was (p = 0.778), groups (p only signifi the age were medium, body enhancement of the pulmonary On the other hand, contrast arteries. consistently associated with the independent variables were delay and scan weight veins. the enhancement of deep Conclusion: the important as- medium were and contrast body weight factors Age, time. delay and CTV. enhancement in combined CTA sociated with vessel C-836 Visualization of the posterior gastric artery Ogawa; with CT angiography Y. Okabayashi, T. Hamada, N. Yamanishi, T. Nakatani, K. Miyatake, K. Nankoku/JP Purpose: (CT) imaging, with computed tomography Although the PGA is unfamiliar stomach. lymphonode dissection in gastric surgery and/or the PGA branch depends on how the detectability of the PGA with the 16-scanner multi-detector evaluated We run. (CTA). CT angiography row Methods and Materials: The presence and CT angiography. underwent (mean 69.0 years)] 29-94 years readers using multi-planar 2 experienced assessed by of the PGA was feature reconstruction (MPR). Results: In one of the 84, the PGA had branched from the splenic artery. had branched age or sex, seen between were cant differences No signifi from the celiac artery. and visualization of the PGA. Conclusion: planning the of the PGA can be helpful for of anatomical feature information tive surgical strategy. C-835 utilizing aortofemoral contrast material MDCT angiography Low-volume graft compared bolus transit time in patients with abdominal aortic bypass contrast material MDCT angiography volume with standard Takeyama N. ([email protected]) ([email protected]) Purpose: cient suffi can provide time (Taf) bolus transit utilizing aortofemoral (CTA) ography enhancement. contrast Methods and Materials: of abdominal aortic graft aneurysms, After surgical bypass 40 patients limation. acquired from time to was Taf 1 (n=20), In group groups. divided into two were at L1 vertebra and time to arterial enhancement at peak aortic enhancement (Ta) accord- arranged was Scan duration twice-test bolus method. heads by femoral mgI/ml) ml CM (300 A 40 Ta. 4 sec after was and scan delay Taf, ing to individual with 25 ml saline fl speed and table Ta, 9 sec after was Scan delay calculated only at L1 vertebra. Mean aor- in the same fashion. CTA used for ml CM was An 80 mm/sec. 38 was and minimum maximum between and mean differentiation attenuation tofemoral VR and cross-sectional, MIP, and also analyzed, quantitatively were attenuation visually analyzed. images were Results: (309.4 attenuations T. Kitahara T. Conclusion: enhancement. analysis showed no difference between both groups. It is interesting to note that mean both groups. between no difference analysis showed signifi was attenuation and minimum maximum between differentiation 2 (26.2 1 than that in group in group 1 mm. < 1 mm CAWT had stroke had stroke 1 mm CAWT ≥ ([email protected]) ([email protected]) ([email protected]) ([email protected])
Scientific and Educational Exhibits Scientific and Educational Rome/IT Athens/GR Tochigi/JP Twenty patients with known PAOD underwent 64-CTA 64-CTA underwent PAOD patients with known Twenty 242 patients underwent CTA using bolus-tracking technique, using bolus-tracking CTA 242 patients underwent 1. To demonstrate the causes of pulmonary demonstrate embolism (PE) To 1. The patients were examined using 8-detector row CT (GE). CT (GE). using 8-detector row examined The patients were 5 7 1
0.05) different for the two groups. Higher mean HU values and Higher mean HU values groups. the two for 0.05) different
d < 0.0001) for stroke: in fact, patients with patients with fact, in stroke: 0.0001) for d < Computed tomographic pulmonary angiography (CTA) is the modality (CTA) pulmonary Computed tomographic angiography Although CTA is the standard at many institutions for pulmonary institutions for is the standard at many Although CTA n Results of our study suggest that an increased CAWT is an indicator that an increased CAWT Results of our study suggest 64-detector row CT angiography allows high spatial resolution angio- allows CT angiography 64-detector row i . N I To determine the factors associated with contrast enhancement of pul- associated with contrast determine the factors To To prospectively determine the feasibility of two different protocols in different of two determine feasibility prospectively the To In patients with Fontaine II or III, analysis of attenuation values was was values II or III, analysis of attenuation In patients with Fontaine F - c u d E i c S - Purpose: (CTV). and indirect CT venography (CTA) monary CT angiography Methods and Materials: C-834 associated with vessel enhancement in CT pulmonary Factors and indirect CT venography angiography Hiki; T. Kaji, Y. Kohno, T. Arakawa, H. C-833 of pulmonary with CT angiography embolism Pitfalls in diagnosis Filis; P. Gyftopoulos, Protopapa, A. E. of choice at our institution for the evaluation of patients with suspected pulmonary the evaluation of choice at our institution for of this method, Despite the high accuracy embolism because of its high sensitivity. These that cause indeterminate CT pulmonary pitfalls angiography. there are several as respiratory such motion of patient-related factors be a consequence may pitfalls factors Technical artifact, noise and presence of pulmonary image artery catheter. partial artifact settings, include mostly inappropriate and stair-step window volume for Furthermore, are responsible anatomic and pathologic factors various artifact. include partial The anatomic factors volume the poor quality of the examination. pathol- coexisting Finally, bifurcation. in lymph nodes and vascular effect averaging emboli. plug and tumor of diagnosis such as mucus ogy can decrease the value Details: Procedure ml contrast of 150 injection rate ml/sec with 4 performed were The examinations agent and collimation 16x 0.75 mm with a pitch of 1.2 mm. Conclusion: Purpose: using the current gen- patients with peripheral arterial disease (PAOD) occlusive CT scanners. row of 64-detector eration Methods and Materials: different divided into two randomly were Patients Siemens). (Sensation Cardiac, studied us- Group A was symptoms. (A, B) regardless of age or severity groups the base rule material of scan time=contrast (cm) ing a regular CT scan following mL of highly iodinated cm 80 10 patients received thus, duration; administration 20 s and a bolus trigger technique was scan time was mL/s; at 4 mgI/mL) (400 abdominal aorta of the proximal and the acquisition started at the level employed 110 Group B received mL of the same 150 reached soon after the attenuation HU. or patient characteristics) with bolus tracking cm (independently of scan duration scanning started abdominal aorta; infrarenal of the 13 s after positioned at the level arterial 18 segments. divided into Peripheral tree was reached 150 attenuation HU. performed. analysis was and qualitative Quantitative Results: Learning Objectives: with a range become familiar To 2. misdiagnosis with the use of CT angiography. need to determine the quality of a CT highlight the radiologist’s To 3. of pitfalls. pulmonary study. angiographic Background: The radiologist that reduce this ability. factors there are several embolism diagnosis, he should identify the quality of the study and, if it is poor, is requested to evaluate which pulmonary are rendered indeterminate and whether additional vessels imaging is necessary. signifi cantly (p signifi highest quality images were obtained with group B acquisition strategy. For Group For B acquisition strategy. obtained with group highest quality images were resulting in of distal arteries diseased patients, A, attenuation in heavily weak was diagnosis. for poor image quality even Conclusion: graphic assessment of patients with PAOD; cm administration strategy and scan strategy cm administration with PAOD; assessment of patients graphic run out the bolus. ne adaptation to avoid acquisition protocol require fi C-832 of peripheral arteries: angiography tomography computed 64-detector row all about timing - It’s protocols acquisition Comparison of different Di Paolo, P. Lezoche, Marincola, R. Cavallo B. Napoli, A. Calabrese, F.A. Passariello; R. Catalano, Mangia, C. M. pared to group B. By using 1 By observed another statistical mm as the threshold, we B. pared to group correlation (p with an odds ratio 9.8. in comparison with patients with CAWT in comparison CAWT with patients with 9.8. ratio with an odds Conclusion: well- besides other can be used as risk and this parameter factors riskstroke for hypertension, smoking, dyslipidemia. diabetes, ones like known C - 7 0 R C EECR07-C-SciEduc-FIN.indd 175 Scientific and Educational Exhibits
C-837 Conclusion: MDCTA seems to be a feasible technique in the evaluation of endole- aks aetiology. However, selective angiogram with DSA remains the goldstandard Intraindividual comparison among source images, MIP and VRI algorithms to manage endoleaks. in Willis’ circle anatomy and diseases assessment. Case series and literature review F. Favano, A. Saponaro, L. Fortunelli, F. Travaglini, D. Volpe, A. Stecco, C-840 A. Carriero; Novara/IT ([email protected]) Atherosclerotic carotid plaque quantifi cation with multidetector computed tomography angiography Learning Objectives: To compare the anatomic visualisation and disease as- T.T. de Weert, D. Vukadinovic, C. de Monyé, T. van Walsum, W.J. Niessen, sessment of Willis’ circle offered by source images (SIs), volume-rendered images A. van der Lugt; Rotterdam/NL ([email protected]) (VRIs) and maximum intensity projections (MIPs), and to describe the advantages and disadvantages of each algorithm by means of a case gallery and review of Learning Objectives: 1. To describe state-of-the-art multidetector computed the literature. tomography angiography (MDCTA) of atherosclerotic carotid plaque. 2. To demon- Background: Although the assessment of source images provides precise local strate techniques to measure plaque and plaque component volumes in MDCTA information concerning vessel diameter, source and area, it is often diffi cult to images. 3. To discuss clinical applications of MDCTA based plaque volumes. 4. To appreciate their spatial relationships and mentally reconstruct their global morphol- discuss future developments. ogy. MIPs and VRIs are based on post-processing algorithms developed in order Background: Besides carotid stenosis degree, atherosclerotic carotid plaque to improve the rendering of the overall morphology and/or spatial relationships of morphology has shown to be predictive for stroke. Therefore imaging modalities anatomic structures, but in addition to their strengths, they have weaknesses that are challenged to provide not only the severity of stenosis but also information can lead to artefacts and misinterpretations. on plaque morphology. State-of-the-art multidetector computed tomography Procedure Details: MIPs and VRIs are the most widely used means of showing MR angiography (MDCTA) can accurately grade stenosis degree. With a custom angiography data; 3D image displays of vascular anatomy frequently provide excellent made software program, we are now able to assess plaque volume and plaque information. But both types of reconstruction are associated with disadvantages, such component volumes. as the misrepresentation of spatial relationships and failure to detect eccentrically Procedure Details: It will be shown how to perform MDCTA of the carotid arter- located stenoses. A case series is shown to illustrate these aspects. ies with good image quality, low use of contrast material and reduced perivenous Conclusion: Vessels with low-signal intensities that may be partially or completely artifacts. It will be shown how plaque and plaque component volumes can be as- imperceptible on post-processing images can be seen on individual source images. sessed. It will be shown how these plaque volumes can be used to assess stroke In order to improve detection, it is essential to integrate the information coming risk, and what future developments can be awaited. from SIs, VRIs and MIPs. Conclusion: In vivo assessment of atherosclerotic plaque and plaque component volumes in carotid arteries is feasible. Prospective longitudinal studies which ex- C-838 amine the relationship between plaque volume, plaque component volumes, and outcome have the potential to establish MDCTA-based plaque quantifi cation as Normal variations of the iliac veins on CT scanning a stroke risk predictor. Y. Matsuoka, K. Okano, T. Yaita, J. Fukudome, M. Aoki; Nasushiobara-shi, Tochigi/JP ([email protected]) C-841 Purpose: To investigate the types and frequency of the normal variations of the Demonstration of the anterior spinal artery and artery of Adamkiewicz by iliac vein (IV) detected by computed tomography (CT). multi-detector row helical CT Methods and Materials: Two hundred patients (135 men and 65 women, aged 62±15 S. Hantous-Zannad, A. Zidi, I. Ridene, I. Baccouche, I. Mestiri, years) underwent multidetector CT scanning of the abdomen and pelvis after injection K. Ben Miled-M’rad; Tunis/TN ([email protected]) of contrast medium. Multiplanar reconstruction was done in some cases. Results: Sixty patients (42 men and 18 women) had variations of the right internal Purpose: To evaluate the visualization of the artery of Adamkiewicz and the Anterior IV (IIV) (n=39), left IIV (n=10), both IIVs (n=6), left external IV (EIV) (n=3), or left spinal artery (ASA) by using 16-detector row helical CT. common IV (CIV) (n=2). The right /left IIV was single (n=10/4) or double (n=35/12). Methods and Materials: Twenty consecutive patients underwent 16 detector row The right single IIV drained into the left CIV (n=7) or common iliac junction (CIJ) Helical CT of the thorax extended to the lower edge of the liver for broncho-pul- (n=2). One of the right double IIVs drained into the left CIV (n=26), right CIV (n=3), monary neoplasm, aortic aneurysm, or hemoptysis. or right EIV (n=1). Three patients had a high junction of the left single IIV and EIV. The scanning parameters included a detector row confi guration of 16x1.25 mm or One of the left double IIVs drained into the right CIV (n=2), CIJ (n=1), left CIV (n=3), 16x5 mm with retroreconstruction of 1.25 mm. or left EIV (n=1). The bilateral single or double IIVs jointed together and drained into After bolus injection of contrast medial materiel, arterial phase scans were obtained. the left CIV (n=6). The left EIV ran more posteromedially than is typical, and joined Multiplanar and curved planar reformation, parallel to the spinal cord, were evalu- the left IIV at a low position (n=3). The left CIV was double (n=1) or absent (n=1). ated and the detectability of the ASA and the AKA were analyzed. Conclusion: Variations of the IV, especially the right IIV jointing the left CIV, are Results: The ASA was visualized on the scans of all the patients. The AKA was visual- frequent (30%). These variations must be remembered during diagnosis, surgery, ized on the scans of 16 patients (80%), its segmental origin ranged from T8 to T12. or assessment of injuries of the pelvis. Conclusion: 16 detector row helical CT depicts the artery of Adamkiewicz in a high percentage of patients. C-839 MDCTA in the evaluation of endoleaks aetiology after endovascular repair of abdominal aortic aneurysm (AAA) P. Nardis, F. Fanelli, M. Corona, A. Bruni, A. Conchiglia, E. Boatta, R. Passariello; Rome/IT
Purpose: The aim of this study is to evaluate the accuracy of MDCTA in the detec- tion of endoleaks aetiology in patients who have undergone endovascular repair (EVAR) of abdominal aortic aneurysm (AAA). Methods and Materials: 212 patients undergone EVAR for AAA. Follow-up was performed using MDCTA after 1, 6 and 12 months after the procedure and every 12 months. 32 patients with endoleaks detected at MDCTA underwent to DSA to determine endoleaks aetiology. The results of the CTA-based endoleak calssifi ca- tion were compared to DSA. Results: Agreement between MDCTA and DSA was observed in 28 patients (87%). In 2 patients MDCTA classifi ed endoleaks as type 2 while DSA as type 1; in 1 patient classifi ed as type 1 at MDCTA, DSA revealed type 2 endoleak; One patient with type 1 endoleak at DSA was incorrectly classifi ed as type 3 at MDCTA.
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0 2 . 2 507 0 . 2 112.02.2007 17:04:19 G cant at middle Maastricht/NL rst-pass imaging ndings, but not with but ndings,
ow condition with athero- ow EPOS rst-pass with steady-state with steady-state rst-pass C BDEF 1.5 in bipolar renal length on cm difference ([email protected]) ([email protected]) > A ip angle to maximize vessel-to-background contrast. contrast. vessel-to-background ip angle to maximize Six healthy volunteers underwent MR angiography of MR angiography underwent volunteers Six healthy rst-pass and ultra-high spatial resolution steady state MRrst-pass and ultra-high To provide practical guidelines on how to perform blood pool- blood to perform guidelines on how practical provide To
Despite the much lower dose (0.03 mmol/kg vs. 0.3 mmol/ 0.3 vs. mmol/kg dose (0.03 lower Despite the much 40 and ii. high BP and/or chronic renal failure (CRF) with any (CRF) with any renal failure high BP and/or chronic 40 and ii. to Submitted Material No < The recent introduction of the clinically approved blood pool agent blood The recent introduction of the clinically approved A written referral protocol for MRRA can achieve good compliance good can achieve MRRA protocol for A written referral CFD combined with vascular imaging can calculate and visualize imaging can calculate and visualize CFD combined with vascular The major teaching points of this exhibit are: 1) Ultra-high spatial 1) Ultra-high are: The major teaching points of this exhibit To investigate the technique of visualization and quantitation of hemo- the investigate To A largest contiguous region of low velocity occurred at the carotid bulb. The occurred at the carotid bulb. velocity A largest contiguous region of low rst-pass imaging. Because of the increased distribution volume of the agent, there volume Because of the increased distribution rst-pass imaging. results correlated well with clinical suspicion and ultrasound fi ultrasound clinical suspicion and with well results correlated serum measurements. urea, creatinine or renin Conclusion: reducing unnecessary resource, and best use of a limited requests and aiding are proposed: These indications appropriatenon-specialists in selecting patients. BP and age high i. of the following: audible vascular bruit; bruit; vascular audible of the following: with other vascular CRF unexplained pulmonary oedema; unexplained ultrasound; inhibitor. with ACE of renal failure worsening disease; C-846 Optimization of scan protocols, Bloodpool-enhanced MR angiography: fi and combination of conventional evaluation ultra-high spatial resolution imaging Engelshoven; van de Haan, J.M.A. M.W. Planken, R.N. Leiner, T. C-845 CFD combined with MRA: by bifurcation in human carotid Hemodynamics Preliminary results Beijing/CN Lin; Y. Gao, P.-Y. Xue, Y.-J. Purpose: carotid artery at combining computational dynamic variables by in vivo bifurcation imaging. uid dynamics (CFD) and vascular fl Methods and Materials: Siemens). Trio, carotid arteryT whole-body scanner (Magnetom bilateral a 3.0 by calculated and visualized at these carotid bifurcations were Hemodynamic variables and CFD. imaging post-processing combining vascular by Results: observed at bifurcation and outer part was ow of proximal fl eddy current and back internal carotid artery carotid and external of them changed with and the shapes signifi were ow fl current and back The eddy phase of cardiac cycle. of internal along downstream carotid artery out quickly of systolic phase and faded a large region of map revealed shear stress The wall carotid artery. and external in the to the outer wall and extended stress (WSS) at carotid bulb shear wall low Also 0.5 Pa. below was value the lowest internal end of carotid artery, proximal end of ex- in the proximal WSS at the outer wall a small region of low there was ternal carotid artery. Conclusion: It is an interdisciplinary at carotid bifurcation in vivo. the hemodynamic variables method of a new and hemodynamics and provides radiology science of computer, geometry the relationship of vascular and fl investigating sclerotic pathological changes. ([email protected]) ([email protected]) Learning Objectives: enhanced high-quality fi of abdominal and peripheral arteriesangiography using the latest technological develop- diagnostic yield. such studies in order to maximize to evaluate and how ments, Background: in addition to conventional steady state imaging of vasculature enables Vasovist fi with regards to choice of optimal imaging parameters. are major differences Details: Procedure kg person), fi a 75 mL for (9.0 vs 45.0 kg) and injection volume yields equivalent image quality at identical imaging parameters. Ultra-high spatial Ultra-high image quality at identical imaging parameters. yields equivalent TR, resolution equilibrium-phasehand demands increase of imaging on the other decrease of bandwidth and fl as with curved multi- plane as well in the transverse Images are best evaluated planar reformations. Conclusion: of abdominal and run-off arteriesresolution steady state MR angiography is 2) of 100-500 microns. in the order sizes with voxel minutes in several feasible enhancement will no spatial resolution, acquisitions venous When using ultra-high of 3) Because and assessment of disease. with image evaluation longer interfere imaging pool agents enable blood residence time, longer intra-vascular the much of additional arterial territories. ow ow patterns and ow associated with ow ow separation in the separation ow
c stenotic carotid bifurcation bifurcation c stenotic carotid ([email protected]) ([email protected])
Scientific and Educational Exhibits Scientific and Educational ([email protected]) ([email protected]) Stockport/UK uid eddies in the lee of the stenosis. Regions uid eddies in the lee of the stenosis. Mansoura/EG 105 at any age; peripheral vascular disease; abdomi- disease; peripheral vascular age; 105 at any > t from the procedure. Seven patients with carotid atherosclerosis underwent underwent patients with carotid atherosclerosis Seven Provisional guidelines for requesting MRRA were formu- requesting MRRA were guidelines for Provisional uid dynamics and MR angiography and MR angiography uid dynamics To describe MR angiog- the technique of contrast-enhanced To
High-resolution three-dimensional Contrast-Enhanced MR Contrast-Enhanced High-resolution three-dimensional
No Material Submitted to EPOS to Submitted Material No 7 7 1
d ow. d Delineation of arterial usually done of the upper extremity disorders CE-MRA is a non-invasive imaging modality used for pre-operative pre-operative for imaging modality used CE-MRA is a non-invasive n CFD combined with MRI can be used to simulate fl CFD combined with MRI can be used to simulate
i . N I Magnetic Resonance Renal Angiography (MRRA) is now thought the (MRRA) is now Magnetic Resonance Renal Angiography To analyze fl ow pattern and hemodynamic variables in stenotic carotid patternow and hemodynamic variables fl analyze To F As the extent of stenosis were commencing and aggravating, the stronger commencing and aggravating, of stenosis were As the extent There was 92% compliance with the provisional guidelines. 92% of studies guidelines. 92% compliance with the provisional There was - c u d E i c S - were diagnostic, 44% being abnormal, with a change in management in 88%. The 44% being abnormal, diagnostic, with a change in management in 88%. were C-844 in suspected renal angiography resonance magnetic for A protocol disease renovascular Choudhri; A.H. Lewis, Ahmad, P.S. I. serum high serum urea and creatinine and/or low sudden increase in BP; nal bruit; 100 consecutive BP not adequately controlled despite 3 medications. potassium; and the results correlated retrospectively, reviewed MRRA were for patients referred Renin and aldosterone measurements with the indications and patient management. also considered, where available. scans were and renal ultrasound Results: calculate hemodynamic variables in the stenotic carotid bifurcation as well as the stenotic carotid bifurcation as well in calculate hemodynamic variables to the rupture be relative WSS may The abnormal high normal carotid bifurcation. The secondary recirculation fl turbulent, plaque. of vulnerable plaque develop- to favor of stenosis are likely WSS regions on the downward low ment and thrombogenesis. ([email protected]) Purpose: with increasing Disease, assessing Renovascular technique for best non-invasive There being no demand putting pressure on our MR service, a limited resource. to identify which performed MRRA, this study was consensus on indications for best benefi patients would Methods and Materials: diastolic BP lated, including: C-843 in patient-specifi of hemodynamics Analysis using computational fl at the portionjets formed fl and more prominent of narrowing fl retrograde ICA with regions of slow at the portion predicted shear stress (WSS) were wall of stenosis of elevated predicted on the were WSS Areas of low jet. and at the path of the downstream recircula- corresponding with the location of slowly side of the stenosis, leeward fl tion turbulent Conclusion: Y.-J. Xue, P.-Y. Gao, Y. Lin; Beijing/CN Lin; Y. Gao, P.-Y. Xue, Y.-J. Purpose: (CFD) and MR uid dynamics computational fl combining by bifurcation in vivo imaging. angiography Methods and Materials: T SIEMENS 3.0 of carotid bifurcation by MR angiography contrast-enhanced patternsow of the stenotic carotid and fl Hemodynamic variables MR scanner. imaging post- combining vascular by visualized calculated and bifurcation were processing and CFD. Results: Role of contrast-enhanced MR angiography in arterial disorders of the in arterial disorders MR angiography Role of contrast-enhanced upper extremity Saad; E. Abdel Razek, A.A.A.A. MR C-842 Vascular Vascular Learning Objectives: Angiography (CE-MRA) of the upper extremity was performed in 61 patients with performed was (CE-MRA) of the upper extremity Angiography CE-MRA of Gadolinium. disorders after bolus injection clinically suspected vascular which occlusion and collalaterals, of atherosclerosis and degree extent detects level, Raynaud’s disease, Burger’s Emboli, vasculitis, treatment planning. are essential for It creates with this technique. demonstrated disease and steal syndrome are well and manages traumatic malformation mapping to classify vascular pre-operative it can identify aneurysm in malignancy. blush and tumor Also, injury. Conclusion: raphy of the upper extremity. To review the clinical application of high-resolution 3D the clinical application review To of the upper extremity. raphy of the upper extremity. disorders in vascular MR angiography contrast-enhanced Background: used MR imaging was contrast-enhanced Recently, angiography. with conventional disorders of extremity. imaging of vascular for Details: Procedure mapping and treatment planning of vascular disorders of the upper extremity. disorders of the upper extremity. mapping and treatment planning of vascular C - 7 0 R C EECR07-C-SciEduc-FIN.indd 177 Scientific and Educational Exhibits
C-847 Vascular A pictorial review of lower extremities recanalization procedures E. Gomez, L. Oleaga, M. Isusi, M. Gonzalez de garay, A. Lopez, D. Grande; US Bilbao/ES ([email protected])
Learning Objectives: 1. To illustrate the MR angiographic appearance of the dif- C-849 ferent recanalization procedures used to treat ischemia of the lower extremities. 2. Color Doppler sonography before, during and after endovenous To review the complications following surgery including obstruction, stenosis and saphenous laser ablation pseudoaneurysm formation. A. Cina, S. Venturino, C. Di Stasi, A. Fiorentino, G. Cina, L. Bonomo; Rome/IT Background: Three-dimensional contrast-enhanced MR angiography represents ([email protected]) a good alternative to catheter digital subtraction angiography (DSA) to assess Learning Objectives: To describe the principles and technique of endovenous peripheral artery graft patency. MR angiography is safer, faster, and less costly laser treatment of saphenous vein refl ux. To illustrate the color Doppler US (CDS) than DSA. Postoperative graft surveillance is of particular importance, because fl ow criteria for selecting patients suitable for the procedure. To teach how to perform impairment is the major cause of graft failure. It is important to detect early graft CDS during the procedure. To show CDS fi ndings during follow-up and how to stenosis to improve the bypass patency rate. Venous and expanded polytetrafl uo- evaluate the outcome of the procedure. roethylene grafts are used to treat peripheral artery occlusion. Autologous venous Background: The procedure of endovenous laser ablation of the saphenous vein grafts have a primary and secondary graft patency superior to that of expanded is simple and effective, with minimal side effects. CDS is fundamental in selecting polytetrafl uoroethylene grafts. patients for the procedure, during the procedure and to verify the outcome of the Imaging Findings: MR angiography can identify accurately graft stenosis involving treatment at the follow-up. the proximal and distal anastomosis as well as the midportion of the graft course. Procedure Details: Advantages and limits of the procedure. CDS criteria for se- Aneurismal ectatic changes can also be assessed on MR angiography. Metallic clip lecting and excluding patients. CDS data required for the treatment. Echo-guided presence can represent a limitation on MR angiography; the susceptibility artifact puncture of the saphenous vein. Checking the correct positioning of the laser probe. produced by the clips can produce a misinterpretation of the images. Source im- CDS guide for the tumescent local anaesthesia. Ruling out complications on the ages should be evaluated to avoid misinterpretation of clip-induced susceptibility deep venous system. Follow-up: How to evaluate the effectiveness of the treatment. artifacts as stenosis. Tips and tricks of the procedure. Conclusion: We present our experience with MR contrast-enhanced angiography Conclusion: This exhibit will provide the knowledge necessary to perform CDS for the evaluation of different types of vascular grafts used to treat peripheral arterial before, during and after the endovenous treatment. The exhibit will also review stenosis. We show the normal fi ndings, the complications and limitations we have anatomy, technique, CDS inclusion and exclusion criteria for the treatment. found on MR images, using the DSA as a gold standard technique. C-850 Temporal arteritis: Avoidance of unnecessarily performed biopsies after color Doppler US evaluation E. Antypa, A. Baltouka, A. Parlamenti, M. Skilakaki, D. Ziaka, T. Kratimenos, P. Piperopoulos; Athens/GR ([email protected])
Purpose: The management of temporal arthritis is crucial, and the purpose of this study is to demonstrate the value of Color Doppler US (CDUS) in the diagnosis of temporal arthritis and to permit the reduction of unnecessarily performed biopsies. Methods and Materials: CDUS was performed in 32 patients, mean age 72 years, with clinical suggestion of active temporal arthritis. None of the patients was treated with cortical steroids previously. Linear high-frequency transducers, 10-15 MHz, were used. The common temporal artery and its branches, frontal and parietal, were examined in all patients. The main sonographic criterion for a positive diagnosis was visualization of a periluminar hypoechoic halo and the suspicious areas were marked. Biopsy was performed in all patients. Additionally, in patients with positive CDUS fi ndings of temporal arthritis, the biopsy was guided at the indicated suspicious sites. Results: CDUS fi ndings suspicious of temporal arthritis were reported in 14 pa- tients. In all of them, the biopsy results were positive for temporal arteritis.The biopsy results in the remaining 18 patients were negative, as were the CDUS fi ndings. Conclusion: The method of CDUS evaluation of temporal arthritis, using a linear high-frequency transducer and assessing the characteristic sign of periluminal hypoechoic halo, leads to the direct diagnosis of temporal arthritis, and allows a proper medical approach to the disease. Moreover, CDUS guides the biopsy at the indicated areas and, additionally, contributes to avoid surgical biopsy in selected patients with typical sonographic fi ndings. C-851 The use of contrast-enhanced ultrasound in detecting type-II endoleaks after endovascular abdominal aortic aneurysms repair (EVAR) A. Drelich-Zbroja, T. Jargiello, A. Drop, E. Czekajska-Chebab, M. Szczerbo-Trojanowska; Lublin/PL ([email protected])
Purpose: To assess the effi cacy of contrast-enhanced ultrasound in detecting type-II endoleaks in the aneurysmal sac after EVAR. Methods and Materials: During the period 2005-2006, standard and contrast- enhanced ultrasound with the use of SonoVue were performed in 86 patients who underwent EVAR. Ultrasound examinations and spiral CT were done 12 months after EVAR. The evidence of endoleak type II was evaluated. Results: In conventional Doppler study, type-II endoleaks were diagnosed in 3 patients, 2 from lumbar arteries (LA) and 1 from inferior mesenteric artery (IMA). Contrast-enhanced ultrasound examinations revealed type-II endoleaks in 9 patients, 6 from LA and 3 from IMA, and showed different mechanisms of
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7 0 0 ow 2 . ux to 2 rmed 509 0 . 2 ow, ves- ow, 112.02.2007 17:04:20 bromuscular G ow is identifi ed is identifi ow ts, advantages and advantages ts, cantly with a wider caliber ([email protected])
cation of the degree of stenosis cation of the degree ts, advantages and limitations advantages ts, ow. C BDEF ed plaque. Also, fl ow directions are more ow fl Also, ed plaque. Ankara/TR ciency is characterised by a hyper-affl a is characterisedciency by ow in the LGV demonstrated with CDUS is in the LGV demonstrated ow correlated signifi ow A We present 72 female patients with aortomesenteric present 72 female left We ow has been reportedow in the portal mainly associated vein ow sonography has several advantages over color and power color and power over advantages has several sonography ow To describe the indications, clinical benefi describe the indications, To The fi rst diagnostic step when evaluating non-acute celiac- rst diagnostic step when evaluating The fi ebography and renocaval pressure gradient assessment. pressure gradient and renocaval ebography B-fl ow sonography is a relatively new sonographic technique that sonographic new is a relatively sonography ow stula patency and complications; evaluation of pseudoaneurysms of evaluation stula patency and complications; ow sonography for various applications. various for sonography ow B-fl Celiac-mesenteric insuffi B-fl ow technique provides higher resolution and higher sensitivity to technique provides ow B-fl The presence of helical fl The exhibit will review the indications and techniques, and provide and provide the indications and techniques, will review The exhibit ([email protected]) ow derivation in nutcracker syndrome. In our knowledge the helical fl In our knowledge syndrome. in nutcracker derivation ow
The helical fl c pictures characterised by post-prandial pain (angina abdominis), or by or by pain (angina abdominis), post-prandial characterisedc pictures by In 23 patients (31.9%), CDUS show a reverse spontaneous helical fl ow ow spontaneous helical fl a reverse In 23 patients (31.9%), CDUS show ow in the left gonadal vein: A new sign in color Doppler A new in the left gonadal vein: ow ow sonography: Indications, clinical benefi clinical Indications, sonography: ow ow without Doppler artifacts. Further improvements in the technique may overcome overcome Further in the technique may improvements without Doppler artifacts. ow Doppler sonography: The information from both tissue and blood fl from both tissue and blood The information Doppler sonography: in higher resolution and higher frame rates. Angle dependency, overwriting of the overwriting Angle dependency, rates. in higher resolution and higher frame color artifacts are elimi- aliasing and perivascular the color overlay, by walls vessel evaluation and areas of research are as follows: ow B-fl Major indications for nated. of carotid artery evaluation of carotid artery follow-up stents; lesions and stenoses; of hemodialysis fi and abdominal applications lymph node characterization; therapy; and guidance for of the transformation cavernous of portal thrombosis, vein the investigation like The technique has also some limitations portal and Budd-Chiari syndrome. vein such as decreased sensitivity with increasing depth and inability to obtain signals from a structure located deep to a calcifi easily recognized by color Doppler than by B-fl color Doppler than by by easily recognized Conclusion: fl its clinical applications. limitations and expand of the LGV and with a change in the caliber of the LGV in its junction with the left of the LGV and with a change in the caliber of the US and in ed by not identifi was In 20 patients (27.7%), the gonadal vein renal vein. ow. non-helical laminal fl the 29 remaining patients (40.2%) it presented a reverse Conclusion: in It has been demonstrated syndrome. a common indirect sign of the nutcracker ed. identifi was almost half of the patients in whom left gonadal vein Background: means by itself asymptomatically, manifest the celiaco-mesenteric district that may of aspecifi obesity, are The risk factors conditions such as intestinal infarction. means of dramatic such as fi and antomical malformations dyslipidemia, cigarette smoking, dysplasia, a high origin of the arcuate ligament. of the celiac tripod or hypertrophy Details: Procedure the site us to localize which allows is colour Doppler US, ciency mesenteric insuffi show We as% stenosis). (expressed their severity of the stenoses and measure describe and the semeiotic such an examination the technique of performing of the presence the evaluation principles underlying it and B-mode echography: post-stenotic dilatation, and the quantifi of plaque, and the colour Doppler means of the assessment of direct and indirect signs; by acceleration. ow and fl effects Conclusion: and a complete case gallery. the tips and tricks, sel walls and neighbouring tissues. The main imaging parameters are few (sensitivity, (sensitivity, are few The main imaging parameters and neighbouring tissues. sel walls and location) and easy to use. number control, gain control, focus background Findings: Imaging Purpose: portosystemic intrahepatic transjugular transplantation, shunt creation and to liver (LGV) is one of the main routes of left The left gonadal vein portal stenosis. vein fl renal vein C-856 B-fl Ozdemir; H. Ozhan Oktar, S. Yucel, C. Learning Objectives: limitations of B-fl Background: This technique utilizes presentation. echoes in a gray-scale directly depicts blood fl imaging of blood simultaneous digitally encoded US technology and allows C-855 Helical fl ultrasound in the aortomesenteric vein compression syndrome left renal Calero; Zubicoa, R. Leal, S. J. Sánchez, Jiménez, A. S. Delgado, A.B. Madrid/ES We syndrome. in the LGV has not been described associated with the nutcracker (CDUS) ultrasound means of color duplex describe and frequency by its diagnosis mechanism. hemodynamic and its possible Methods and Materials: The 2006. March 2004 and June compression syndrome studied between renal vein CDUS and confi and transabdominal transvaginal by performed diagnosis was fl with left renal vein Results: blue red and or parallel with either alternative in the cephalic region of the LGV, The presence of this helical fl bands. nd- rmed 3
stulas Rome/IT RI cant, could be made between Scientific and Educational Exhibits Scientific and Educational stula preparation; (B) Complications: feeding feeding (B) Complications: stula preparation; ([email protected]) ([email protected])
cant for transplanted patients. transplanted cant for The RI of 81 consecutive patients were measured by Dop- measured by patients were The RI of 81 consecutive fi ndings after Rouen/FR Purposes of this exhibit are: to describe how to perform a a to describe to perform how are: Purposes of this exhibit Indications, principles of execution and semeiotics in the principles Indications, of execution Anatomy and surgical techniques - (1) CDS methodology Anatomy 9 7 1
cation in vascular nephropathies and an elevated RI is currently nephropathies and an elevated cation in vascular
d Surgically created Brescia-Cimino arteriovenous fistulas and Surgically created Brescia-Cimino arteriovenous fistulas and d n In this exhibit, we describe we arteries the role of CDS in selecting In this exhibit, and The use of ultrasound contrast agents increased the diagnostic ef- contrast The use of ultrasound RI is an exclusive non invasive index to diagnose the vascular sclerosis to diagnose the vascular index non invasive RI is an exclusive i . N ([email protected]) ([email protected]) I
The renal resistive index (RI) measured by Doppler US has a well known known Doppler US has a well (RI) measured by index The renal resistive F For patients having a native kidney biopsy, an independent positive qualita- an independent positive biopsy, kidney a native patients having For - c u d E i c S - ings of the more frequent complications. A detailed description of CDS examination A detailed description of CDS examination ings of the more frequent complications. stula creation is reviewed. and after the fi protocol before artery occlusion; anasthomotic stenosis; venous stenosis; venous/graft thrombosis; thrombosis; venous/graft stenosis; venous artery anasthomotic stenosis; occlusion; steal. radial infections; anasthomotic pseudoaneurisms; Conclusion: fi hemodialysis and the sonographic stulas for fi of AV the preparation for veins C-854 of the celiac-mesenteric districts: Colour Doppler ultrasonography indications and semeiotics Technical Carriero; A. Fossaceca, R. Sibilio, L. Volpe, N. Leo, L. Volpe, D. Pollice, S. Novara/IT Learning Objectives: colour Doppler ultrasonography (US) of celiac-mesenteric insuffi ciency. (US) of celiac-mesenteric insuffi colour Doppler ultrasonography prognostic signifi Purpose: is more contro- Its value associated with the diagnosis of nephroangiosclerosis. Our study patients. nephropathies or in renal transplanted in parenchymal versed endarterial sclerosis parameters: correlated the RI with renal intraparenchymal brosis (IF). (ESc) and interstitial fi Methods and Materials: as mean of 3 measurements given RI results were renal biopsy. just before pler US, the diagnosis made for The biopsy was and middle poles. lower at upper, performed A (n=50). allograft decline of renal function of kidney (n=31) or for of nephropathy histomorphological using an automated methodology to performed, analysis was correlated with the cal- were These parameters determine the IF and ESc index. evaluated were Other parameters test). each patient (Mann-Whitney culated RI for (CGFR). rate ltration Glomerular fi especially creatininemia (Cr) and Cockroft Results: statistically signifi correlation and quantitative tive noted with the IF index. No relation was index. decline in CGFR, and ESc and Cr, not signifi Correlations were Histologic correlation with renal resistive index measurement by Doppler US measurement by Histologic correlation with renal resistive index Henry, J. Janvresse, Primard, A. E. Legallicier, B. Soulis, F. Louvel, J.-P. Godin; M. Dacher, J.-N. color Doppler sonography (CDS) examination before the creation of AV fi stulas stulas fi the creation of AV before (CDS) examination color Doppler sonography ndings and complications of AV normal and to show hemodialysis CDS fi for stulas. hemodialysis fi Background: Although hemodialysis. accesses for are common vascular prosthetic loop grafts the standard is now method of imaging, CDS has been the traditional angiography dysfunctional evaluating stula creation and for the fi before technique employed hemodialysis access. Details: Procedure C-853 Conclusion: of poor prognosis renal function RI is a marker and an elevated kidney in native and chronic renal failure. nephropathy in patients having evolution of study; (2) CDS qualitative and quantitative data necessary before the fi stula the fi data necessary and quantitative before (2) CDS qualitative of study; (A) Normal fi preparation; ([email protected]) Learning Objectives: Color Doppler sonography before and after AV haemodialysis fi haemodialysis after AV and before Color Doppler sonography endoleaks from IMA diagnosed with the use of SonoVue and indicated 1 additional with the use of SonoVue endoleaks from IMA diagnosed 5 type-II endoleaks from LA. only showed CT examinations endoleak from IMA. which with the use of SonoVue, 1 more endoleak from LA diagnosed There was detected during not was CT. Conclusion: This examination detecting type-II endoleaks. for cacy of Doppler examinations fi contrast-enhanced but endoleaks, in detecting type-II to CT value is comparable the mechanism of endoleak and the show additionally examinations ultrasound ow. fl of blood direction and velocities C-852 preparation Bonomo; L. Tazza, L. Muto, E. Venturino, Di Stasi, S. C. Cina, A. endoleaks: 2 complex type-II endoleaks and 7 simple endoleaks. All endoleaks All endoleaks and 7 simple endoleaks. type-II endoleaks 2 complex endoleaks: CT cm/s. to 18 cm/s 11 Vmax from with velocities slow by characterized were 4 patients and confi endoleaks from IMA in detected type-II examinations C - 7 0 R C EECR07-C-SciEduc-FIN.indd 179 Scientific and Educational Exhibits
C-857 artery lumen and vein diameter using B-mode and compression ultrasonography. Flow spectra were evaluated with Doppler scan mode and fl ow parameters were Role of ultrasonography and anatomical landmarks in jugular, subclavian calculated for the femoral, popliteal and calf arteries and veins. and axillary veins cannulation Results: HIT was proven by a positive platelet aggregation test in 20 patients J. Noguera, M. Gomez, M.L. Diaz, A. Alonso, J.-I. Bilbao Jaureguizar, (36%), 11 females and 9 male, who suffered lower extremities thromboembolic A. Martinez-Cuesta; Pamplona/ES ([email protected]) complications. Fifteen patients (75%) had arterial thrombosis, most prominent of Learning Objectives: 1. Give an overview of the anatomy of the jugular, sub- the common femoral, superfi cial femoral and posterior/anterior tibial artery. Six clavian and axillary veins. 2. Explain the techniques of cannulation of these subjects (30%) had deep venous thrombosis, most prominent of the common veins, based upon anatomical landmarks, and correlate them with ultrasound femoral and superfi cial femoral vein. (US)-guided approaches. Conclusion: Our study confi rmed the remarkably high incidence of thromboembolic Background: Central line catheterization is a clinically useful tool, performed for complications, mostly arterial, in critically ill patients with HIT. The routine CDUS is invasive monitoring the hemodynamic, respiratory, and fl uid status of patients, as appropriate in these patients since if silent arterial or venous thrombosis is identi- well as for delivery of drugs and nutritive solutions. Classically, techniques based fi ed, it could infl uence the duration of anticoagulant therapy. upon anatomical landmarks have been used, but that may fail if any vascular anatomic variant exists. Moreover, these techniques may cause complications as pneumothorax and hemorrhage after arterial injury. Procedure Details: After giving an overview of the anatomy of neck and shoul- der, with special attention on anatomical relationships of veins, we expose the different catheterization techniques based upon anatomical landmarks. Jugular vein can be catheterized by anterior, medium or posterior approaches, and subclavian vein by infra or supraclavicular approaches. US-guided cannulation technique is correlated with each of these approaches. Finally, advantages and disadvantages of both techniques are summarized. Conclusion: Based on current literature, US can play an important role in the guidance of cannulation of central lines, as it can detect anatomical variations and venous thrombosis prior to the catheterization. Nevertheless, it may reduce complication rates and number of attempts dur- ing catheterization. C-858 Morphologic and hemodynamic study of gastrocnemius medial vein with color duplex ultrasonography in chronic venous insuffi ciency S. Jiménez, A.B. Delgado, A. Sánchez, P. Martín, S. Zubicoa, J. Leal; Madrid/ES ([email protected])
Purpose: To describe the morphologic changes and hemodynamics of the gas- trocnemius vein (GV) in patients with chronic venous insuffi ciency (CVI) with color duplex ultrasound (CDUS). Methods and Materials: The study was performed in 222 lower limbs of 111 pa- tients. 149 lower limbs presented clinical signs of CVI according CEAP classifi cation and 73 lower limbs were normal. We carried out an anatomical study of the GV and muscle, and provided hemodynamic information about the incompetent veins by demonstrating the presence of refl ux. Results: In 30% of limbs, the GV showed no refl ux and connections with super- fi cial varicose veins through May’s perforating veins (Re-entry veins). 14% had GV refl ux associated with superfi cial varicose veins, in 2% the refl ux was due to post-thrombosis syndrome, and in 6% the refl ux was interpreted due to primary incompetence (no superfi cial varicose veins and no evidence of deep venous thrombus). 14% presented mainly GV stasis (enlargement, slow fl ow and symptoms of pain), and 10% displayed asymptomatic dilatation. In 22%, the study was normal (no enlargement and no refl ux), and the remaining 2% showed gastrocnemius muscle atrophy with dysfunction of muscular pump. The GV mean diameters in the CVI group were larger than those of the non-CVI group (0.82 cm vs. 0.53 cm). We also measured the venous fl ow velocities and fl ow-volume after muscular systole in the different groups. Conclusion: CDUS is a non-invasive technique that allows anatomical and func- tional studies of the GV in patients with CVI. It is also useful for physiopathological classifi cation and pre-therapeutic evaluation. C-859 Arterial and venous thromboembolic complications in heparin-induced thrombocytopenia (HIT) patients: Color Doppler sonography evaluation A. Balanika, M. Theodorakopoulou, M. Lignos, C. Baltas, E. Melissari, A. Gouliamos, A. Armaganidis; Athens/GR ([email protected])
Purpose: Heparin-induced Thrombocytopenia (HIT) is estimated to occur in 1-5% of all patients receiving heparin. The purpose of this study was to investigate by color Doppler ultrasonography (CDUS) the incidence of thromboembolic complications in medically critical patients with HIT. Methods and Materials: Over a period of eighteen months, 55 Intensive Care Unit (ICU) patients (aged 39-89) presented with thrombocytopenia were investigated for HIT and underwent arterial and venous CDUS examination of lower limbs. Orthope- dic, surgical and cardiosurgical patients were not included in the study. We evaluated
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2 7 0 0 2 . 2 511 0 comes . 2 2 112.02.2007 17:04:20 G was aspirated aspirated was 2 is colorless and requires 2 C BDEF A at atmospheric pressure and effectively prevents prevents at atmospheric pressure and effectively 2 The problems associated with carbon dioxide: (1) CO associated with carbon dioxide: The problems We demonstrate a simple, safe and inexpensive system that deliv- and inexpensive safe a simple, demonstrate We angiography at our hospital. at angiography
2 Procedure Details: Procedure alternative to standard iodinated contrast angiography. Conventionally available CO available Conventionally angiography. standard iodinated contrast alternative to contamination with room air. air. contamination with room in large cylinders under high pressure and thus the pressure has to be reduced pressure and thus the pressure has to be reduced in large cylinders under high (2) CO it is injected. close to atmospheric pressure before closed circuit to prevent contamination with air. A blood bag was used in the circuit used in was bag A blood air. contamination with closed circuit to prevent to that of the atmosphere and CO to reduce the pressure equal injectors are expensive and require specialized cylinders which are not currently cylinders which are require specialized and expensive injectors are simple plastic bag delivery a system to perform developed We India. in available CO through a three way stop cork into a 50 ml syringe. Angiography was then performed was stop cork into a 50 Angiography through a three way ml syringe. performed angiography Digital subtraction limb arteriesin the lower of 10 patients. in adequate detail in the vessels depicted dioxide with a hand injection of carbon all the patients. Conclusion: of CO volume ers a known 0.05 vs. vs. 0.05 <
cult, and per-
Belgrade/CS ([email protected])
to EPOS to Scientific and Educational Exhibits Scientific and Educational Coimbatore/IN The purpose of the study was to analyze the diagnostic The purpose to analyze of the study was London/UK rmed treatment in all pathohistology after the surgical by Over the last ten years, dulpex ultrasound has become the ultrasound dulpex the last ten years, Over To demonstrate the feasibility of a plastic bag injection system the feasibility demonstrate To
The indications, technique and radiological appearances of appearances technique and radiological The indications, No Material Submitted Submitted Material No 1 8 1
d Iodinated contrast agents are routinely used in procedures to agents are routinely used in procedures to Iodinated contrast d Contrast venography has long been considered the ‘gold standard’ ‘gold standard’ has long been considered the venography Contrast n Venography remains the ‘gold standard’ in the assessment of lower in the assessment of lower ‘gold standard’ remains the Venography Digital subtraction angiography has better sensitivity than computed has better sensitivity angiography Digital subtraction i . N I Insulinoma is a rare functional pancreatic neuroendocrine tumor, usually functional pancreatic neuroendocrine Insulinoma is a rare tumor, F DSA detected insulinoma in 21/28 patients (sensitivity 75%). Computed 75%). DSA detected insulinoma in 21/28 patients (sensitivity - c u d E i 0.05 vs. DSA). In 7 patients in whom DSA failed to detect insulinoma, the In 7 patients in whom DSA failed DSA). 0.05 vs. c < S - C-862 in digital hand injection of carbon dioxide delivery system for A novel subtraction angiography Kalyanpur, T. Jayesh, S.R. Madhavram, Gupta, B. Mehta, P. Cherian, P. M. Raja; D. Hedgire, S. Sekhar, N. Ilayaraja, V. Learning Objectives: angiography. in digital subtraction a hand injection of carbon dioxide for Background: These agents are associated disease. diagnose and treat peripheral vascular To and allergic reactions in some individuals. nephropathy with contrast-induced as an has been developed angiography carbon dioxide these problems, overcome C-861 "gold standard" The forgotten limb venography: Lower Sandhu, C. Salter, Kazmi, R. F. Dourado, R. Goutzios, P. Fotiadis, Saini, N. A. Adam; A. Sabharwal, T. Learning Objectives: primary modality used to assess lower limb venous disease. As a result, the use disease. primary limb venous modality used to assess lower performed. has declined and in some institutions is rarely venography of contrast the aims to review and experience is based on the authors’ This pictorial review lower by demonstrated and pathology as anatomy venous techniques, indications, venography. limb contrast Background: dem- disease and can effectively limb veno-occlusive in the assessment of lower has the ultrasound Since duplex knee veins. within the below thrombus onstrate it is favoured and does not use ionising radiation, non-invasive of being advantages thrombosis. deep vein both clinicians and patients as the initial diagnostic test for by and may available previously the exposure no longer have Radiologists in training of common pathology. with the techniques or the appearances not be familiar Details: Procedure it is since this method is no longer in frequent use, However, disease. limb venous technique with the current indications, remain familiar that radiologists imperative and interpretation of the test. lower limb venography are illustrated. Emphasis is placed on common anatomical are illustrated. limb venography lower The use of ultrasound. routine duplex that are often poorlyvariants recognised by tumour encase- venous malformations, in the assessment of venous venography ment and in the post-phlebitic limb are also discussed. Conclusion: formed by computed tomography, magnetic resonance and selective angiography angiography selective magnetic resonance and computed tomography, by formed (DSA). of the pancreatic arteries angiography digital subtraction by Methods and Materials: resonance in and magnetic assessment of pancreatic DSA, computed tomography The tumors were with insulinoma. 41+8 years) 11 males; 28 patients (21 females, in the pancreatic body in 17/28 patients (60.71%), in the pancreatic tail localized in the head of the pancreas. in10/28 patients (35.71%) and in 1/28 patient (3.57%) confi The diagnosis was Digital subtraction angiography - a method of choice in detection of - a method of choice Digital subtraction angiography and comparison with computed tomography Head-to-head insulinoma. resonance magnetic Belesnin; B. Aleksandar, Saponski, M. J. Aleksandric, S. DSA C-860 vascularized. mm in diameter and well 12-49 The tumors were patients. Results: detected insulinoma in 11/28 patients (sensitivity 39.28%, p tomography Vascular Vascular ([email protected]) Purpose: Diagnosis is highly diffi in the body and tail of the pancreas. localized diagnosis was achieved by computed tomography or magnetic resonance. The or magnetic resonance. computed tomography by achieved diagnosis was of are poor vascularization to detect insulinoma DSA's failure potential causes for gasses in the bowel. the tumor and presence of extra Conclusion: it has a major role in the detec- So, and magnetic resonance imaging. tomography tion of insulinoma. DSA), whereas magnetic resonance detected tumors in 15/28 patients (53.57%, DSA), whereas magnetic resonance detected tumors p C - 7 0 R C EECR07-C-SciEduc-FIN.indd 181 Scientific and Educational Exhibits
Vascular Background: Infl ammatory/infectious conditions of the aorta and its major branches may present with nonspecifi c symptoms and are often missed clinically in the Multimodality workup for fever of unknown origin (FUO). Increased awareness of aortitis would facilitate appropriate management. Imaging Findings: 1. Clinical signifi cance of aortic and major arterial infl ammatory C-863 conditions. 2. CT/MR/angiographic techniques and the role of image post-processing Vascular imaging: An illustrated history for dedicated evaluation of the aorta. 3. Pictoral review of cross sectional imaging A. Buzzi, V. Suárez; Ciudad de Buenos Aires/AR of a wide spectrum of aortitis due to vasculitidis (Takayashu’s arteritis, giant cell ([email protected]) arteritis) and infection (granulomatous and other bacterial) involving the native aorta or after endograft or surgical repair. Learning Objectives: To show the development of vascular imaging. Conclusion: Increased awareness of aortitis and knowledge of the cross sectional Background: The history of the radiographic study of arteries and veins goes imaging appearances helps to establish accurate diagnosis, which facilitates ap- back to January 1896, the month after the announcement of Roentgen’s discovery, propriate medical or surgical management. Early diagnosis with CT and MR avoids when Haschek and Lindenthal injected a contrast material into the blood vessels life-threatening complications, thus, decreasing morbidity and mortality. of an amputated hand. Imaging Findings: In order to achieve an overview of the historical development of vascular imaging, the works of the pioneers in angiography (E. Haschek and C-866 O. Lindenthal, J. Sicard and J. Forestier, J. Berberich and S. Hirsch, B. Brooks, E. A comprehensive pictorial review of anomalies of the superior and Moniz, R. DosSantos, W. Forsmann, S. Seldinger, and so on), vascular US (C. Dop- inferior vena cava pler, P. & J. Curie, P. Langévin, K. Dussik, G. Ludwig, J. Wild & J. Reid, D. Howry, E. Sueyoshi, I. Sakamoto, M. Uetani; Nagasaki/JP G. Posakony and J. Holmes, W. Wright and E. Meyer, and so on), CT (J. Radon, Learning Objectives: To provide a pictorial review of the embryology and anatomy A. Cormak and G. Hounsfi eld, and so on) and MRI (W. Pauli, I. Rabi, F. Block and of the superior and inferior vena cava. To show a detailed overview of cogenital E. Pourcell, R. Damadian, P. Lauterbur, Yong and Clow, P. Mansfi eld, J. Mallard, and acquired diseases demonstrated by CT, MR, and/or angiography. To discuss and so on) were studied and systemized in chronological order. We describe the the importance of careful analysis during the imaging interpretation. To discuss the works of the authors who were pioneers in vascular imaging, and whose works prognosis of patients with these abnormalities. were historical landmarks. Background: Anomalies of superior and inferior vena cava are not rare. These Conclusion: We display the progress that has been made in vascular imaging abnormalities include congenital and acquired abnormalities associated with from conventional angiography to modern MRI angiography. abnormal development, thrombosis, tumor, infl ammation, etc. Procedure Details: We provide a pictorial review of the embryology and anatomy C-864 of the superior and inferior vena cava. We show a detailed overview of congenital Advanced multi-modality imaging of therapeutic angiogenesis and and acquired diseases demonstrated by CT, MR, and/or conventional angiography. arteriogenesis: Experimental in-vivo applications We also discuss the importance of careful analysis during the imaging interpretation K. Katsanos, D. Karnabatidis, A. Diamantopoulos, G.C. Kagadis, P. Kraniotis, and the prognosis of patients with these abnormalities. D. Siablis; Patras/GR ([email protected]) Conclusion: Knowledge of this exhibit may be useful for the diagnosis and prediction of prognosis of patients with abnormality of the superior and inferior Learning Objectives: To familiarise radiologists and research scientists with ad- vena cava. vanced cross-sectional and angiographic in-vivo imaging modalities for the study of experimentally induced therapeutic angiogenesis and arteriogenesis. Background: Therapeutic angiogenesis (new vessel growth) and arteriogenesis C-867 (collateral vessel enlargement) constitute the frontiers of cardiovascular research Interruption or congenital stenosis of the inferior vena cava in the reversal of ischemic myocardial and peripheral arterial diseases. In-vivo Z. Koc, L. Oguzkurt, S. Ulusan; Adana/TR ([email protected]) vascular imaging allows the quantifi cation of the angiogenic process and is nec- Purpose: To present the prevalence, clinical, and imaging fi ndings of interruption essary for the reproducible morphological and functional investigation of novel or congenital stenotic lesions of the inferior vena cava (IVC), associated malforma- proangiogenic agents. tions, and their clinical relevance. Imaging Findings: Experimental models of hindlimb or myocardial ischemia Methods and Materials: Between March 2004 and March 2006, 7972 patients generally involve surgical or endovascular occlusion of the femoral or coronary who had undergone consecutive routine abdominal multidetector row computed arteries in animals. After the endogenous angiogenic response comes at rest, tomography were analysed for interruption or stenotic lesion of the IVC. exogenous proangiogenic growth factors are administered and the evolution of Results: Prevalence of interruption (n = 8) or congenital stenosis (n = 4) of the therapeutic angiogenesis and collateralization is followed-up. Non-contrast and IVC occurred in 12 (0.15%) of 7972 patients. Four patients with interruption and contrast-enhanced cross-sectional studies with computed tomography (CT) and 4 patients with congenital stenosis of the IVC were symptomatic with DVT (n = magnetic resonance (MR) may depict variations in tissue vascularity and enhance- 4), leg swelling (n = 4), leg pain (n = 2), lower extremity varices (n = 2), hepatic ment after administration of contrast media. Multiplanar reformatting along with vein thrombosis (n = 1), and hematochezia (n = 1). All four of the asymptomatic volume-rendered CTA and/or MRA images may accurately display the morphol- patients were from the interruption group, and these patients had interrupted IVC ogy and bridging points of collateral vessels with diameter > 250 µm. Moreover, with well-developed azygos/hemiazygos continuation. Eight symptomatic patients dynamic image acquisitions during contrast administration and corresponding did not have a well-developed azygos/hemiazygos continuation, and drainage of perfusion studies permit the functional assessment of the newly developed collateral lower extremity was mainly from collateral veins. Additional fi ndings in 8 symptomatic vessels. Finally, intra-arterial digital subtraction angiography delineates the newly patients were abdominal venous collaterals (n = 8), venous aneurysm (n = 2), lower formed vessels with great anatomic detail. Recently developed post-processing extremity varices (n = 2), varicocele (n = 2), and pelvic varices (n=1). computerised algorithms provide the capacity of segmentation, visualisation and Conclusion: Interruption or stenosis of the IVC are rare on routine abdominal CT quantifi cation of microvessels with diameters down to 50-100 µm. examinations and may cause different clinical fi ndings depending on the variant Conclusion: Modern applications of cross-sectional and angiographic vascular drainage patterns or collaterals. Interrupted IVC is commonly asymptomatic if as- imaging with advanced post-processing and reformatting algorithms enable in-vivo sociated with well-developed azygos/hemiazygos continuation, whereas commonly morphological and functional experimental studies of therapeutic angiogenesis symptomatic if well-developed azygos/hemiazygos continuation is not present. and arteriogenesis. C-868 C-865 Mycotic aneurysm: Imaging fi ndings in different sites Imaging spectrum of the infectious and infl ammatory etiologies of aortitis A. Diaz de Otalora, I. Perez Arroyuelos, A. Ezquerro Imas, A. Dolado Llorente, R. Suri, C.S. Restrepo, K.N. Chintapalli, S.R. Prasad, D.W. Postoak, L. Larrea Bilbao; Bilbao/ES ([email protected]) B. Toursakissian; San Antonio, TX/US ([email protected]) Purpose: To determine the imaging characteristics (CT and MR features) of infected Learning Objectives: 1. Review the clinical spectrum of infectious and infl amma- aneurysms in different sites: aortic, peripheral and cerebral. tory conditions of the aorta. 2. Highlight the role of cross sectional imaging in the Methods and Materials: Review of records of patients with surgical and/or mi- diagnosis and assessment of the extent of aortitis, thus helping in the management crobiologic proof of infected aneurysm obtained over a 5-year period revealed 18 of these patients.
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Vascular 0 : 7 1
7 0 0 nd- 2 . 2 513 0 ndings . 2 112.02.2007 17:04:21 ammation G C BDEF ([email protected]) ([email protected])
A Izmir/TR eld of cross-sectional imaging have increased the increased have eld of cross-sectional imaging To evaluate the combined use of Doppler US, MRI, MR combined use of Doppler US, the evaluate To Cervical, renal, abdominal and extremity arterial Cervical, renal, abdominal and extremity Doppler US Takayasu arteritis is characterized by granulomatous infl arteritis granulomatous by is characterized Takayasu Combined radiological approach for the diagnosis and follow-up of the diagnosis and follow-up approach for Combined radiological ow and vessel wall. Thoracoabdominal MRI and MR Angiography studies MRI and MR Angiography Thoracoabdominal wall. and vessel ow aid in the evaluation of this disease, familiarity with imaging characteristics with of other familiarity of this disease, aid in the evaluation additional and assess patients and offer to better the radiologist modalities allow options. imaging less invasive Learning Objectives: arteritis. Takayasu of diagnosis and follow-up the DSA for and Angiography Background: However, or DSA. angiography of the aorta at conventional and its major branches in the fi current developments in the early systemic phase without methods even diagnostic capacity of radiological the approach for present the combined radiological We luminal abnormality. any arteritis. Takayasu patients with Details: Procedure about obtaining direct and indirect information for performed were examinations arterial fl fat-sup- T2-weighted Multiplanar T scanner with body coil. on a 1.5 performed were and after administration before recovery inversion blood black T1-weighted pressed, obtained. sequences were enhanced 3D MR angiography and contrast of Gd-DTPA All luminal Image interpretations after post-processing studies. performed were US and MRI fi During the follow-up, compared with DSA results. ndings were fi C-871 of and follow-up the diagnosis for Current radiological approach arteritis Takayasu Celik; T. Gulcu, A. Goktay, A.Y. occlusion and sometimes to stenosis, leads of the arterial which eventually wall diagnosis has been based on characteristic Classical fi aneurysm formation. enhancement of arterial contrast and were thickening wall wall ings about vessel according performed treatments were endovascular If necessary, also evaluated. to the activity of the disease. Conclusion: changes with wall arteritis the vessel of showing has the advantages Takayasu the response to the treatment. luminal abnormalities and evaluating
c lobulated lobulated
=44%), and n for an infected an infected for
included psoas
t of demonstrat- of t
velocity greater than greater velocity
27.7%), femoral artery27.7%), femoral Paraarterial soft-tissue
n= =5.5%), thoracoabdominal n ndings. 55.5%) of 18 aneurysms, and and peripheral middle cerebral and peripheral middle cerebral
n= ([email protected])
ts and shortfalls of angiography, ts and shortfalls of angiography, than 45 highly specifi cm/sec seems
ndings 5.5%), Scientific and Educational Exhibits Scientific and Educational n= 5.5%) aneurysms. calcifi cation in the aortic ( wall calcifi
n= =27.7%), iliac artery ( n Hamilton, ON/CA This study included 13 men and 1 woman (mean age: 70 (mean age: 13 men and 1 woman This study included
fl uid were present in 10 ( uid were fl
To describe the imaging fi ndings of chronic mesenteric describe the imaging fi To To better appreciate the imaging characteristics of Takayasu’s Takayasu’s better appreciate the imaging characteristics of To dently ruled out. In DUS a peak systolic dently ruled out. 3 While angiography is the traditional gold standard for inves- gold standard for is the traditional While angiography Evidence of visceral artery occlusion with noninvasive imag- artery Evidence of visceral occlusion with noninvasive 8 =5.5%), absence of uid in an unusual location are highly suspicious uid in an unusual 1
n edema with rapid aneurysm progression and development was was aneurysmedema with rapid and development progression
=11%). Angiography showed 5 saccular aneurysms showed with Angiography =11%). d n c. Traditionally, angiographic studies have primarily been used to have studies angiographic Traditionally, c. Imaging characteristics play a critical role in the diagnosis of a critical role in the diagnosis of Imaging characteristics play d CMI is an unusual but important but CMI is an unusual cause of abdominal pain and weight Saccular aneurysms with rapid expansion and adjacent mass, Saccular aneurysms expansion with rapid n Although knowledge of angiographic fi ndings of Takayasu’s Arteritis Takayasu’s ndings of fi of angiographic Although knowledge SMA stenosis. Vascular obstructions, stenosis, collateral pathways and pathways collateral stenosis, obstructions, Vascular SMA stenosis. DUS, as the preferred noninvasive screening test for SMA and CA ste- screening test for noninvasive as the preferred DUS,
i 94.5%) and 1 fusiform ( 94.5%) and 1 fusiform . ([email protected]) ([email protected]) N
I 16.6%). Four patients had 2 infected aortic aneurysms.CT revealed 17 aortic patients had 2 infected aneurysms.CT revealed Four 16.6%). n= included aneurysm size, shape, and location; branch involvement; arterial involvement; branch and location; shape, included aneurysm size, gas (
F Aneurysms aorta located in the thoracic were ( - cant =11%), infrarenal aorta=11%), infrarenal ( in 2 (100%) patients with sequential studies. Other fi ndings Other fi studies. in 2 (100%) patients with sequential
abscess ( n= c
One radiologist reviewed 13 computed tomographic (CT) studies, 5 arterio- (CT) studies, computed tomographic 13 reviewed One radiologist
n u d E i 5.5%), tibial-peroneal arterial trunk ( c S n= - muscle aneurysm. aneurysm. present years). early periarterial C-870 pictorial essay A multi-modality arteritis: Takayasu’s Prabhudesai; V. Banerjee, J.P. Learning Objectives: detection and surveil- Arteritis improve modalities and thereby based on various lance of disease activity. Background: Arteritis that both clinical presentation and serological markers given Takayasu’s are non specifi additional employing However, of this disease. effects the vascular demonstrate Takayasu’s a more complete understanding of modalities provide and/or alternative rheumatologic conditions for base Our institution serves as a local referral Arteritis. and the Department of Medical Imaging is routinely consulted in cases of suspected the imaging best illustrates of patients whose selected a group have We vascultitis. The benefi of this clinical entity. salient features and a pictorial essay enhanced CT and MRI are reviewed contrast ultrasonography, ndings using these modalities. fi various to illustrate is offered Findings: Imaging ing changes within the wall. Conclusion: changes in the bowel wall can be depicted on both CTA and MRA. If endovascular If endovascular and MRA. can be depicted on both CTA wall changes in the bowel remains the diagnostic gold standard. treatment is proposed, angiography Conclusion: with alternative a non invasive provides ultrasonography tigation of vasculitides, and operator value predictive of lower albeit at the expense side effects, fewer non means of CT and MRI also offer Cross sectional imaging by dependance. visualization of luminal pathology with the additional benefi invasive ischemia (CMI) on duplex ultrasonography (DUS), and their correlation with com- ultrasonography ischemia (CMI) on duplex (MRA) magnetic resonance angiography (CTA), angiography puted tomography and angiography. Background: of the three main stenosis of at least two resulting from occlusion or severe loss, and circulation, its variants Understanding abdominal visceral splachnic vessels. artery in patients with visceral to that develop stenosis is key pathways collateral Atherosclerosis is the main cause of CMI (95% cases), usually CMI. recognize the ostium of celiac arteryinvolving mesenteric (CA), superior artery or inferior causes are nonatheromatous lesions (dysplastic lesions, Other rarer (SMA or IMA). arteritis…). Takayasu lesions, radiation-induced thromboangitis obliterans, Findings: Imaging of abdominal or MRA could suggest CMI, if other causes CTA ing such as DUS, been confi pain have diagnosis of CMI, the us to make allow MRA or angiography CTA, by followed nosis, arteries. of affected and number severity of extension, as a valuation as well S. Jiménez, A.B. Delgado, A. Sánchez, Y. Revilla, A. Martínez, E. García; García; Martínez, E. A. Revilla, Y. Sánchez, A. Delgado, Jiménez, A.B. S. Madrid/ES Learning Objectives: C-869 fi Imaging mesenteric ischemia: Chronic Conclusion: and/or fl stranding, Results: aorta ( grams, 3 magnetic resonance (MR) studies and one Doppler sonography. Features Features one Doppler sonography. (MR) studies and 3 magnetic resonance grams, evaluated periaortic and gas; and associated fi cation; calcifi wall aneurysms patients. in 14 ( saccular ( artery ( contour in 2 (40%). MR imaging showed 3 saccular aneurysms. MR imaging showed contour in 2 (40%). 275 greater cm/sec or end-diastolic velocity mass, stranding, and/or stranding, mass, periaortic for signifi for C - 7 0 R C EECR07-C-SciEduc-FIN.indd 183 Scientific and Educational Exhibits
Vascular Miscellaneous
C-872 Role of US, MDCT and MRI in the evaluation of deep venous thrombosis S.M. Dias, C. Pina Vaz; Porto/PT
Learning Objectives: To review the spectrum of fi ndings of deep vein thrombosis (DVT) on B-mode and Doppler Ultrasound (US), Multi-Detector Computerised Tomography (MDCT) and Magnetic Resonance Imaging (MRI). To optimize the technical principles of each method in order to avoid potential pitfalls. To list advan- tages/limitations of the different methods in the evaluation of DVT. Background: DVT is a common vascular disease requiring prompt diagnosis and treatment but clinical assessment is often unreliable. D-dimer testing and pre-test probability scoring are used as guides for selection of the most appropriate investi- gation. Vascular imaging remains essential for diagnosis and B-mode and Doppler US, MDCT and MRI play an important role in the work-up of the disease. Procedure Details: The authors discuss advantages and limitations of each method in the evaluation of DVT, illustrating thoroughly the spectrum of fi ndings at US, MDCT and MRI. Technical principles are outlined as fundamental tools to optimise disease detection and avoid potential pitfalls. Conclusion: B-mode and Doppler US is a cost-effi cient and widely available technique for initial evaluation of suspected extremity DVT. MDCT and MRI allow visualisation of affected areas non-accessible to US imaging. MDCT with shorter acquisition times, greater coverage and reduced scan width provides excellent resolution in depiction of the disease, and detection of eventual complications as pulmonary thromboembolism. C-873 Imaging features of the congenital and acquired abnormalities of the SVC and the pulmonary vasculature K. Burney1, H. Young2, P. McCoubrie2, S. Barnard2, M. Darby2; 1Southampton/UK, 2Bristol/UK ([email protected])
Learning Objectives: To illustrate the spectrum of congenital and acquired abnor- malities of the superior vena cava (SVC). To present the congenital anomalies of the pulmonary veins and the associated anomalous drainage patterns seen. Background: A wide range of clinical conditions can affect the SVC. These include both congenital and acquired abnormalities. Similarly, the pulmonary veins can be affected by a number of congenital anomalies, which can occasionally mimic other disorders and be associated with congenital heart disease. Imaging Findings: We retrospectively reviewed the imaging of patients with SVC or pulmonary venous abnormalities treated in our hospital, and present a review of abnormalities as seen on various radiological investigations including CT, MRI and plain fi lms. The congenital abnormalities of the SVC highlighted include left-sided and double SVC. Acquired abnormalities including intra luminal defects caused by line-associated thrombus, SVC stenosis secondary to multiple central line insertions or tumour invasion, extra luminal compression caused by mediastinal tumour and vascular aneurysms are demonstrated. Partial anomalous pulmonary venous return (PAPVR) is a congenital abnormality in which one or more of the pulmonary veins are connected directly to the right atrium or to a systemic vein. We also present various patterns of PAPVR as seen on contrast-enhanced CT, as they may be associated with congenital heart disease. Conclusion: The development of the central systemic veins including the SVC and pulmonary veins is a complex process subject to a number of variations. Knowledge of some of the resulting variations can be of clinical importance.
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