ECR TODAY2014 DAILY NEWS FROM EUROPE’S LEADING IMAGING MEETING | SUNDAY, MARCH 9, 2014 5 9 17 25 HIGHLIGHTS CLINICAL CORNER TECHNOLOGY FOCUS COMMUNITY NEWS Parizel takes ECR delegates Experts share strategies PACS providers plot Award-winning author on a cerebral journey of to help radiologists justify routes through a changing delivers honorary lecture discovery and hope their imaging decisions medical landscape at ECR 2014 BY FRANCES RYLANDS-MONK Experts chew the fat on obesity and present novel ways to bolster services for larger patients Ground-breaking applications of in which there is fa y accumulation to diagnosis through a number of functional imaging techniques can plus lobular infl ammation, hepatocyte modalities including ultrasound, help radiologists play their part in ballooning and perisinusoidal fi brosis, CT, MR spectroscopy and the lesser the fi ght against the emerging obe- and which may also lead to cirrhosis, known controlled a enuated param- sity pandemic. In particular, MR elas- according to Prof. Valérie Vilgrain, eter (CAP), a measure of ultrasound tography is showing promise in the chair of imaging at Beaujon Hospital, a enuation on the fi broscan which early detection of disease, a endees Paris, France. correlated with pathological grades were told at Saturday’s State-of-the- Importantly, very recent data sug- of steatosis. Art Symposium. gest that the fi rst cause of hepatocel- “It is much more diffi cult to iden- Obesity-related illness worldwide lular carcinoma (HCC), the primary tify the dangerous subtype, NASH, is having a huge direct impact on liver cancer, is not due any more to defi ned pathologically with infl am- healthcare costs, and indirectly aff ects alcohol intake or viral hepatitis but mation and fi brosis, which are harder individual loss of productivity and to a metabolic syndrome in which to detect on imaging,” she added. its related socio-economic problems obesity plays an important role. Fur- At present, the latest development as many obese patients are deemed thermore, an increasing incidence of in obesity imaging is the application unfi t to work. It presents an obstacle HCC, including those found inciden- of functional quantitative imaging Prof. Valérie Vilgrain from Paris, Dr. Rachel Ba erham from to the population’s physical, mental tally, and benign liver tumours linked to detect infl ammation and fi bro- France. London, United Kingdom. and fi nancial well-being that health- to obesity constituted a challenge for sis. There is growing evidence that care providers can’t aff ord to ignore. radiology and oncology departments. one such new technique, functional One such associated disease is Nevertheless, NAFLD patient surveil- MR elastography, can diff erentiate Already used routinely in Vilgrain’s pared to the general population, there non-alcoholic fatty liver disease lance using imaging techniques would NASH among NAFLD patients. The hospital and in dedicated centres, is also a higher cardiovascular mor- (NAFLD), which ranges from relatively help to detect HCC and hepatocellular technique determines liver stiff ness, there is an argument for implement- tality, and such diff erentiation could benign, simple steatosis – fa y accu- adenomas. as stiff ness increases in early NASH ing MR elastography wherever obese infl uence management strategies at mulation in under 5% of hepatocytes “Now our task as radiologists is to even with no fi brosis and it further patients are managed; not only is an earlier stage. – to a more severe condition called diagnose liver steatosis and quantify increases with the severity of the there a higher liver-specifi c mortal- non-alcoholic steatohepatitis (NASH), it, which is easy,” she said, pointing disease. ity among NASH patients when com- continued on page 3 ECR LIVE QUOTE OF THE DAY FAVOURITE TWEETS ABOUT ECR 2014 “watching from Italy, it’s perfectly working, great cases, “But social media also provides many useful and easy to wonderful atmosphere, thank you!” use solutions for interacting with patients. #ECR2014” Lorenzo Pinelli sm_rad Want to get on the cover of ECR Today? Then get tweeting with #ECR2014. Each day, we’ll publish our favourite tweet right here. #frontpagefame myESR.org ULTRASOUNDULTRASOUND SOLUTIONSSOLUTIONS CLEARLYCLEARLY DEFINED DEFINED A NEW GENERATION ULTRASOUND SYSTEM Keen to experience this innovation in ultrasound? Come and visit us @ Booth 322, Expo C or @ www.hitachi-medical-systems.eu , Switzerland www.hitachi-medical-systems.com ECR TODAY | SUNDAY, MARCH 9, 2014 HIGHLIGHTS 3 BY PHILIP WARD Tread cautiously when it comes to MR-guided prostate biopsies, warns ECR 2015 President MR-guided biopsies of the prostate should only be performed in selected patients, and it’s vital to keep aware of false-negative results. Also, an urgent need exists for robust multicentre trials of targe- ted biopsies of the prostate, ECR delegates learned during a Special Focus session on Saturday. On the plus side, an MR-guided how good are we?” noted Hamm, who at the Medical University of Vienna, biopsy (MRGB) is more effi cient than will be President of ECR 2015. where he also did his medical train- a systematic transrectal ultrasound Overall, multi-parametric MRI ing. Another huge challenge is the (TRUS) biopsy, the detection rate in enables detection of signifi cant can- accuracy of negative sampling, and Prof. Bernd Hamm from Berlin, Prof. Bob Djavan from Vienna, TRUS-negative patients is between cers, and is an accepted tool, espe- imaging has a role here too. Germany. Austria. 40 and 50%, an MRGB yields longer cially in patients in whom there is “We have a problem identifying core cancer length than a TRUS a negative TRUS biopsy. An MRGB insignifi cant cancers,” he said. “Today, biopsy, an MRGB detects more sig- has high cancer detection rates, inde- active surveillance is a very popu- It’s not time to trash biopsies, but There is a great need to rationally nifi cant and fewer insignifi cant can- pendent from numbers of previous lar tool in urology. We don’t operate it’s time to change how biopsies are approach prostate cancer with new cers, fewer cores per patient are nec- TRUS-biopsies. on every cancer today, and many performed, he continued. “Just doing tools, according to session modera- essary, and an MRGB performs be er Importantly, there is also a trend patients go on to active surveillance, more biopsy and lateral is not the tor Dr. Joan Vilanova, from Clínica than a cognitive biopsy, according to in the literature and in daily routine which means we don’t treat them, solution. We need to add imaging Girona, Hospital Santa Caterina, Prof. Bernd Hamm, director of the away from in-bore MR-guided pro- we wait and we do biopsies and PSA information, specifi cally multi-par- University of Girona, Spain. Imaging Institute of Radiology at the Charité, cedures and toward MR/ultrasound (prostate-specifi c antigen). If the PSA ametric MRI, and we need to learn must come fi rst, with biopsy last, and Berlin, Germany. fusion biopsies. rises, then we operate.” how to do a good fusion.” MRI should play an important role in Conversely, an MRGB is time-con- Strategies to improve TRUS biop- Urologists need the imaging Suitable fusion technology is not improving prostate cancer detection, suming and expensive. Moreover, sies include obtaining more biopsy information that can help to reduce yet available, according to Djavan. said Vilanova, who strongly urged only limited data exist, and there cores, tackling the increased risk of unnecessary biopsies, increase It is not helpful to be able to have all ECR a endees to a end the 4th is li le or no evidence in favour infectious complications with every the detection rate, and predict the great parametric MRI exams that European Society of Urogenital Radi- of MRGBs, he explained. Whereas additional biopsy, and increasing the Gleason grade and cancer volume. look wonderful in a lecture but do not ology Teaching Course on prostate studies on MRGBs typically have biopsy cu ing length, depth, and The fusion of a TRUS and a mul- help clinically when no fusion exists. MRI, which begins in Girona on been single-centre trials involving number of cores. ti-parametric MRI is essential for “The future will not be radical June 6, 2014. between 10 and 100 patients, those From a urologist’s perspective, the this purpose, he said. prostatectomy – it pays my personal “I cannot promise you a table at on TRUS have been multi-centre prime goal is adequate detection of “Fusion means not only fusion of bills, and I’m very happy about that, El Celler de Can Roca, recently voted studies involving 1,000 or more signifi cant cancers, which is why technologies but fusion of two spe- but the future will be about not the best restaurant in the world, but patients. MRI and multi-parametric MRI is cialities: urology and radiology. We doing surgery in so many patients,” I can promise you two excellent days “Most of the studies have a poor so important, according to Prof. Bob need to work together,” urged Dja- he said. “I always say to urologists: a of learning about prostate MRI,” said adherence to standards in report- Djavan, director of the department of van. “Biopsies should be a two-de- fool with a tool is still a fool. I’m very Vilanova, who is the course director ing diagnostic accuracy. This is a urology at VA Hospital in New York partmental ma er in which imaging self-critical. If you give me an MRI, for the event. concern, giving rise to the question: University and professor of urology and urology work together.” I’m still an idiot!” continued from page 1 “We are not going to solve the prob- with Body Mass Index (BMI), waist cir- employment are also compounded lem with just morphological imaging,” cumference and other measurements.