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ECR TODAY 2013 DAILY NEWS FROM EUROPE’S LEADING IMAGING CONGRESS Sunday 10 March 2013 CT cardiothoracic PACS developers put Accomplished imaging enters renewed emphasis professor to become an exciting phase on patient empowerment editor-in-chief of of evolution and safety European Radiology Page 9 Page 17 Page 25 MR-PET demonstrates ever greater potential for detecting multifocal cancers By Becky McCall “MR-PET is the only thing that picomolar range, the most sensitive can approach imaging the dimen- level available.” MR-PET allows superior early sions of tumour heterogeneity at this By way of example, he said there detection and evolution of cancers time,” he told ECR Today. “I think were some new developments in as they disseminate around the body. this is an enormously promising prostate cancer, such as the novel That was the key message of Prof. area and this evolving concept of [68Ga]Gallium-labelled PSMA Heinz-Peter Schlemmer in his talk cancer cells having their own ecol- tracer. This is a prostate specific at yesterday’s New Horizons Session. ogy that adapts to the surroundings membrane antigen tracer that tar- Taking the two sources of infor- can only be displayed by a multi- gets the tumour and provides a pre- mation together provides insight dimensional approach.” cise location of the tumour, thereby into both the biology and location “The same tumour in different improving diagnostic accuracy. “It of the tumour or metastases inside places at different points in time should also help with prognostic the body, according to Schlemmer, behaves differently and needs to stratification and biopsy planning professor of oncologic radiology at be treated differently. I think this and needle guidance.” the University of Heidelberg, Ger- new technology is the only way I The radiotracer used also helps many, and chair of radiology at the can imagine to get a handle on the determine whether to image simul- German Cancer Research Center. many dimensions,” he added. taneously or sequentially, according Combined MR-PET can help radi- Schlemmer pointed out that if to Schlemmer. If the radiotracer is ologists to detect cancer early and tumour cells have their metabo- slowly taken up, then it’s feasible characterise its biological behav- lism blocked in one place, then to inject the tracer and image with Heinz-Peter Schlemmer from Heidelberg, Osman Ratib from Geneva, Switzerland. iour. Also, it’s important to con- they move elsewhere. “Also, there PET followed by MRI, and later fuse Germany. sider the heterogeneity of tumours, are indications that when you irradi- the images. However, he noted that which are an evolving structure that ate a tumour, it starts to metastasise if the tracer is rapidly taken up or their disease, especially with cancer logic radiologists is that we see the started on one side of the organ and and the reason is that initially the if, for example, there are moving is becoming a chronic disease. He scope and applications.” disseminated. blood flow decreases and then the organs [such as lung or liver] then cited the example of a patient with He stressed that people need to “Different tumours in different cell realises it would be better off if there were often difficulties. prostate cancer needing repeated remember how to assess costs asso- parts of the body vary in their behav- it moved.” “When you conduct a PET and imaging to monitor progression or ciated with using MR-PET. “Imag- iour and we need to assess these dif- He acknowledged that he had seen then transfer the patient to the MR treatment evaluation. ing is expensive, but therapy is also ferences and adapt the therapy to this in prostate cancer commonly scanner there is often a misrepre- “In this situation you want to expensive. If you give the wrong the patient accordingly,” he noted. and that it was visible with MR-PET. sentation due to blurring without minimise use of ionising radiation therapy then it is also very expen- “We also need to monitor therapy However, he tempered his enthu- precise overlap,” he said, noting that to reduce harm and further cancer. sive for the patient too,” he said. “We to evaluate the intervention across siasm by stressing that MR-PET this had implications for tumour We anticipate that MR-PET use in need to weigh up everything relating the body. MR-PET will help us to is only as good as the radiotracer biopsy or tailoring radiotherapy to these cases would reduce radiation to clinical benefit and then conclude individualise and stratify therapies available. a precise location. “For these types exposure in these patients,” he said. whether it is cost effective or not. to the patient.” “Without the right radiotracer it of tumour, the combined MR-PET However, it is still early days, and This can only be answered when it is Commenting on this point, Prof. is only an MRI,” he said, adding that is more suitable.” Schlemmer remarked that to date, integrated into the whole diagnostic Herbert Kressel, from Harvard the radiotracer makes the molecules Schlemmer highlighted that the clinical benefit has not been fully and therapeutic process in oncologic Medical School in Boston, U.S., who and pathways visible. “This allows MR-PET also had implications in established. “We can only guess at imaging. We need to move beyond attended the presentation, said he the radiologist to see metabolism the treatment of oncologic patients this stage. There are no large mul- believed that heterogeneity was the and molecules distributed on the who usually require many repeat ticentre trials providing evidence. sweet-spot for this technology. cell surface with sensitivity in the studies throughout the course of However our experience as onco- continued on page 3 myESR.org | #ECR2013 @myESR A91SY-9258-A1-7600 The device is pending 510 (k) clearance, and is commercially not yet available in the United States. www.siemens.com/ecr Answers, visualized. syngo.via: Enhancing productivity across the radiological workflows Whether you are facing day-to-day or functionality and guides you through challenging cases, time is of the the entire workflow. Allowing you to essence. That’s why you need a 3D focus on your core task: caring for Hall Extension routine and advanced reading patients. Expo A software that drives efficiency – and With syngo.via, you don’t just read Austria Center, syngo.via1 does just that. Offering a images – you get the full picture. Vienna wide range of applications, this solution helps to accelerate processes across all modalities. It is incredibly Read the QR code with QR code flexible: modular licensing models are reader in your mobile! available, and you can customize applications and layouts to suit your 1 syngo.via can be used as a standalone device requirements. And above all, it is or together with a variety of syngo.via-based intelligent. The software delivers software options, which are medical devices in powerful quantitative reading their own rights. Answers for life. Sunday 10 March 2013 Highlights ECR Today 2013 3 Gastrointestinal radiologists prepare to enter new era of personalised medicine By Philip Ward therapeutic response. His advice to The main benefits of MRI fluor- ECR delegates was to embrace the oscopy are its multiplanar imaging Gastrointestinal (GI) imaging looks new responsibilities in the era of capability, the full view of soft tissue poised to make another quantum personalised medicine. structures (not just the lumen), and leap forward in the years ahead, “Technological advances have the lack of ionising radiation, which as fluoroscopic techniques are led to a revolution in GI imaging, is of particular value for repeat stud- left behind and the field develops but very importantly, all these tech- ies. The drawbacks are that its tem- beyond simply anatomical imaging, niques are complimentary,” he said. poral resolution is up to 10 times embracing increasingly functional “Clinical applications are changing, less than standard fluoroscopy, the and quantitative techniques, accord- and as radiologists, we’ve got to requirement for the patient to be in a ing to speakers at yesterday’s Special understand the strengths and limi- supine position, lack of fine intralu- Focus Session on GI imaging. tations of each diagnostic technique minal detail, and the fact that it takes Over the past decade or so, and where they sit within the clinical 20–30 minutes, according to Taylor. there have been major advances management of patients.” Gastric motility can be broadly in abdominal imaging in CT, MRI MRI fluoroscopy can replace con- divided into changes in gastric vol- and PET-CT. Given the emphasis ventional techniques in swallowing ume, for which the gold standard is on dose reduction, radiation-free and gastric emptying, and also it can the barostat device, and measure- modalities are now taking centre replace conventional methods and ment of peristaltic activity/empty- stage as radiology goes increasingly increase understanding of a patient’s ing rate, for which the gold standard mobile. condition in the case of both gas- is scintigraphy, he stated. Stuart Taylor from London, U.K. Simon Jackson from Plymouth, U.K. “As well as the functional tech- tric emptying and the small bowel, Assessment of small bowel motil- niques, we’re moving into quantita- said Dr. Stuart Taylor, who heads ity using MRI can be of particular tive techniques with which we can the development of functional MRI value, he continued. Usually it Motility information can shed follow-up of patients,” he said. “MRI look at cellularity, perfusion and in oncology and GI diseases at Uni- is vital to distend the bowel, as is light on conditions such as diabetic assessment of gastric emptying is inflammation,” said session mod- versity College London Hospitals done for MR enterography, e.g., neuropathy, pseudo-obstruction, now established as a clinical and erator Dr.

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