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Scientific and Educational Exhibits 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 ...................................................... 502 331 EECR07-C-SciEduc-FIN.inddCR07-C-SciEduc-FIN.indd 1 112.02.20072.02.2007 117:02:547:02:54 Scientific and Educational Exhibits 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
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