programma & abstracts - Nederlandse Vereniging voor Radiologie

16 

29 en 30 september 2011 

radio 

logen 

dagen 

m e c c , m a a s t r i c h t 

Nederlandse Vereniging voor Radiologie 

Radiological Society of the Netherlands 

programma & abstracts

programma voorwoord & abstracts 

Kwaliteit 

Dames en heren, geachte leden van de Nederlandse Vereniging voor Radiologie, 

Welkom in Maastricht op de Radiologendagen 2011! Het thema dit lustrumjaar is Kwaliteit. 

Kwaliteitseisen in de gezondheidszorg worden steeds meer opgelegd en zijn belangrijk voor een goede praktijkvoering. Dit 

geldt uiteraard ook voor de radiologie, dan bij voorkeur door ons als vereniging zelf de eisen opgesteld en in goede samenwerking 

met onze klinische collega’s. 

Voor de hand liggend is het om kwalitatief beter te worden door te leren van eigen fouten. Het programma begint donderdagochtend 

daarom met ‘Deze misser maak je maar 1 keer’. 

In de tweede plenaire sessie op donderdag ‘Setting standards in healthcare – many ways, no return’ zal het onderwerp 

kwaliteit belicht worden door gastsprekers Dr. M-J Vrancken Peeters (chirurg, NKI-AvL) en Prof. Dr. D. Rubin (radioloog, 

Stanford University, USA). 

Op vrijdag zal er door een drietal pro-con koppels worden gedebatteerd over het hanteren van kwaliteitsnormen: ‘Pro-con: 

setting standards in healthcare – which way to go?’. 

Nieuw onderwerp bij de parallelsessies is de Educatieve Voordracht. Dit is bedoeld om onderwerpen welke direct toepasbaar 

zijn in uw praktijk, maar (nog) niet zijn verworden tot een wetenschappelijk artikel. 

Bij alle wetenschappelijke abstract sessies zijn hierbij passende keynote lectures gezocht. 

De ‘Research Corner’ uit 2009 is gestoken in een nieuw jasje. Acht UMC’s presenteren niet alleen hun spraakmakende 

wetenschappelijke onderzoeken, maar steken ook de hand naar elkaar uit, om samen beter te worden. 

De Refresher Courses op beide dagen worden deels verzorgd door toonaangevende gastsprekers uit het buitenland. Aan de 

hand van de verstrekte leerdoelen kunt u beter schatten of een onderwerp uw belangstelling heeft. 

Wij zijn buitengewoon verheugd een aantal van u ook een workshop te kunnen aanbieden. De geluksvogels onder u gaan 

statistisch gezien herboren naar huis en met bouwstenen voor een robuuste teachingfile (millennium proof). Lees voor details 

het volledige programma. 

Dit jaar is er een andere formule gekozen voor de verschillende prijzen. Naast de bekende Philipsprijs en Radiologendagen 

prijs zal er een toelichting op en uitreiking van de NVvR Travel Grant plaatsvinden. 

Bent u dit jaar niet in de prijzen gevallen dan bent u niet minder welkom in feestelijke kleding op het Diner & Galafeest met 

als thema ‘Dress to impress’. Op een prachtige locatie in Maastricht wordt u op zuidelijke wijze verwend. 

De radiologendagen kunnen mede mogelijk worden gemaakt door sponsoring van de industrie, u wordt dan ook van harte 

uitgenodigd om met de industrie in contact te komen op de expositie. 

Onze dank gaat uit naar de inzet van velen, zichtbaar in het programma boekje. Namen noemen is ontoereikend, enthousiaste 

deelnemers is uw verdienste. 

Veel plezier op de radiologendagen 2011! 

Bert-Jan de Bondt, voorzitter 

Vincent Cappendijk 

Marion Smits 

Bart Wiarda 

Henk-Jan van der Woude

16 E RADIOLOGENDAGEN 2011 

Organisatie 

Organisatie Comité 

Bert-Jan de Bondt, voorzitter 

Vincent Cappendijk 

Marion Smits 

Bart Wiarda 

Henk-Jan van der Woude 

WETENSCHAPPELIJK COMITÉ 

Henk Jan Baarslag 

Ludo Beenen 

Marc Engelbrecht 

Nanko de Graaf 

Jan-Cees de Groot 

Ieneke Hartmann 

Mechli Imhof-Tas 

Simone Jap-a-Joe 

Viola Koen 

Martin Kraai 

Krijn van Lienden 

Ruud Pijnappel 

Stefan Steens 

Joachim Wilberger 

CONGRESSECRETARIAAT 

Postbus 2428 

5202 CK ‘s-Hertogenbosch 

Tel 073 700 3500 

Fax 073 700 3505 

info@congresscompany.com 

www.congresscompany.com 

1 6 E R A D I O L O G E N D A G E N - 2 9 e n 3 0 S E P T E M B E R 2 0 1 1 1

programma & abstracts 

programma 

Donderdag 29 september 2011 

Tijdstip 

Onderwerp 

TRAJECTUM 

10.00 - 10.40 Ontvangst & registratie 

AUDITORIUM 2 

10.40 - 10.45 Opening door voorzitter 

Dr. R.B.J. de Bondt, Isala klinieken, Zwolle 

AUDITORIUM 2 

10.45 - 12.00 Plenaire sessie: Deze misser maak je maar één keer 

Voorzitter: Mw. Drs. V.H. Koen, Kennemer Gasthuis, Haarlem 

Dr. K.P. van Lienden, AMC, Amsterdam 

Mw. Dr. C.S.P. van Rijswijk, LUMC, Leiden 

Dr. M.W. de Haan, MUMC, Maastricht 

EXPOFOYER 

12.00 - 13.00 Lunch 

EXPOFOYER 

12.15 - 12.45 Postersessie 

AUDITORIUM 2 

13.00 - 14.00 Plenaire sessie: Setting standards in healthcare - many ways, no return 

Kwaliteitseisen opgelegd door de zorgverzekeraar, maar ook die van de heelkundige beroepsvereniging 

zijn opmerkelijk in het nieuws geweest. Onvermijdelijk dat de radiologie hiermee te maken krijgt. Van 

buitenaf opgelegd dan wel zelf opgesteld. In deze sessie schetst dr. M-J. Vrancken Peeters, chirurg en 

woordvoerster van de NVvH, de aanloop tot -en achtergrond van de recent gepubliceerde kwaliteitseisen 

voor oncologische chirurgie. Vervolgens stelt dr. D. Rubin een ambitieuze maar praktische manier 

voor om de kwaliteit van het radiologisch werk te verbeteren. 

Inleiding door: Prof. dr. J.S. Laméris, AMC, Amsterdam 

Gastsprekers: 

Dr. M-J. Vrancken Peeters, chirurg, NKI-AvL, Amsterdam 

Prof. D. Rubin, Stanford University, USA 

14.05 - 15.35 Parallelsessies vrije voordrachten 

Voorafgaand aan de wetenschappelijke voordrachten zal iedere sessie aanvangen met een keynote lecture. 

ZAAL 2.1 COLORADO 

Sessie 1: Abdominale radiologie 1 

Voorzitters: Dr. R.F.A. Vliegen, Atrium MC, Heerlen & Drs. J.E. van den Bergh, AMC, Amsterdam 

PET-MRI: tool or toy 

Dr. J. Buscombe, Addenbrooke’s Hospital, Cambridge, UK 

Learning objectives: 

Understand technical issues of PET/MR 

Look at possible indications for PET/MR 

Understand some of the issues for nuclear medicine staff 

The first PET/MR machines are now on the market for €2 million. However there are significant 

technical issues including just trying to acquire images. What compromises are made in terms of image 

quality for both PET and MR. How can attenuation correction be applied? Once these technical issues 

have been resolved is PET/MR just a technique looking for an indication? 

ZAAL 0.8 ROME 

Sessie 2: Abdominale radiologie / Acute radiologie / Diversen 

Voorzitters: Mw. M.A. Stam, Medisch Centrum Alkmaar & L.F.M. Beenen, AMC, Amsterdam 

Alternatieve diagnoses bij MRI appendicitis 

Mw. M.A. Stam, Medisch Centrum Alkmaar, Alkmaar 

ZAAL 0.5 PARIS 

Sessie 3: Cardiovasculaire radiologie 

Voorzitters: Dr. H.J. Lamb, LUMC, Leiden & H.C.M. van den Bosch, Catharina Ziekenhuis, Eindhoven 

MRI bij diabetes en metabool syndroom 

Dr. H.J. Lamb, LUMC, Leiden 

ZAAL 0.9 ATHENS 

Sessie 4: Mammadiagnostiek 1 

Voorzitters: Dr. M.J.C.M. Rutten, Jeroen Bosch Ziekenhuis & Mw. K.M. Duvivier, UMC Utrecht, Utrecht 

3D echografie van de mamma; een poor mans MRI? 

Dr. M.J.C.M. Rutten, Jeroen Bosch Ziekenhuis, ‘s-Hertogenbosch 

ZAAL 0.4 BRUSSELS 

Sessie 5: Interventieradiologie / Cardiovasculaire radiologie 

Voorzitters: Dr. M.W. de Haan, MUMC, Maastricht & L.W. Kaufmann, Spaarne Ziekenhuis, Hoofddorp 

Update abdominale endoprothesen 

Dr. M.W. de Haan, MUMC, Maastricht 

AUDITORIUM 2 

Research Corner 

Voorzitters: Mw. Prof. dr. R.G.H. Beets-Tan, MUMC, Maastricht & Prof. dr. J.S. Laméris, AMC, Amsterdam 

Tijdens deze parallelsessie zullen de 8 UMC’s de gelegenheid hebben een presentatie te geven van een 

hoogstaand en origineel onderzoeksproject. Van het project wordt een kort overzicht gegeven. Duidelijk 

zal worden wat de positie van het onderzoek is ten opzichte van andere groepen in Nederland en daarbuiten, 

en wat het perspectief van het onderzoek is in 5 a 10 jaar van nu. Tot slot wordt aangegeven 

met welke additionele (externe?) kennis, men dit perspectief verwacht eerder te kunnen halen. 

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Tijdstip 

Onderwerp 


EXPOFOYER 

15.35 - 16.00 Theepauze 

LUMC: Toepassingen van ultrahoogveld MRI bij patientenpopulaties 

Prof. dr. M.A. van Buchem 

Erasmus MC: Population Imaging 

Prof. dr. A. van der Lugt 

UMC Groningen: Screening for Coronary Artery Disease by Non-invasive Imaging in Patients with 

known Extra-cardiac Atherosclerotic Disease: the GROUND-2 study 

Mw. Dr. R. Vliegenthart 

VUMC: Pseudo-continuous arterial spin-labeling at 3T in Alzheimer’s disease 

Drs. M.A.A. Binnewijzend 

UMC St Radboud: MR gestuurde prostaat interventies; klaar voor de praktijk? 

Dr. J.J. Fütterer 

MUMC: Wait and See in rectal cancer patients: selection by imaging and outcome 

Mw. Drs. M. Maas & Mw. Prof. dr. R.G.H. Beets-Tan 

AMC: Neurotransmitters in de MRI 

Mw. Dr. L. Reneman, neuroradioloog 

UMC Utrecht: MRI-guided High Intensity Focused Ultrasound: The future of tumor ablation? 

Dr. M.A.A.J. van den Bosch 

16.00 - 17.15 Refresher courses 


Chronische thrombo-embolische pulmonale hypertensie 

Voorzitter: Dr. H.W. van Es, St. Antonius Ziekenhuis, Nieuwegein 

Het klinisch gezichtspunt 

L. van den Toorn, Erasmus MC, Rotterdam 

Leerdoelen: 

* De patient met pulmonale hypertensie bestaat (niet)? 

* Work-up van patiënten met (vermoeden) pulmonale hypertensie 

* Wat zijn de verschillende behandelingen (medicamenteus en chirurgisch). 

CT beeldvorming 

Mw. Dr. W. van Lankeren, Erasmus MC, Rotterdam 

Leerdoelen: 

* Welk protocol bij analyse pulmonale hypertensie? 

* Wat zijn de direct en indirecte kenmerken CTEPH op CT? 

* Wat zijn de pitfalls? 

MRI beeldvorming 

Prof. dr. A. Vonk-Noordegraaf, VUMC, Amsterdam 

Leerdoelen: 

* Welk protocol bij analyse pulmonale hypertensie? 

* Wat zijn de direct en indirecte kenmerken CTEPH op CT? 

* Toegevoegde waarde van functionele informatie? 

Chirurgie 

Dr. W.J. Morshuis, St. Antonius Ziekenhuis, Nieuwegein 

Leerdoelen: 

* Wat zijn de operatie-indicaties 

* Wat houdt CTEPH chirurgie in? 

* Post-operatief beloop: succes gegarandeerd? 

Paneldiscussie 

Leerdoel: 

Kunnen MRI en CT angiografie vervangen? 

ZAAL 0.8 ROME 

Beeldvorming bij groei- en puberteitsstoornissen 

Voorzitter: Drs. N. de Graaf, Erasmus MC, Rotterdam 

Beeldvorming 

Mw. A.M.J.B. Smets, AMC, Amsterdam 

What the clinician wants to know! 

Drs. N. Zwaveling-Soonawala, kinderarts-endocrinoloog, EKZ-AMC, Amsterdam 

Leerdoelen: 

Beeldvorming bij groei- en puberteitsstoornissen 

Beeldvorming is een essentieel onderdeel in de work-up van een slecht of juist te snel groeiend kind, 

van een puberteit die te lang op zich laat wachten of juist te vroeg begint. 

Beeldvormers beschikken over een palet aan technieken om de kinderarts te ondersteunen in 

de diagnostiek van deze problemen. Na deze refresher course, weet u meer over de achtergrond van 

groei- en puberteitsstoornissen, beheerst u welke radiologische onderzoeken sleutels kunnen zijn in 

het oplossen van een endocrinologisch probleem bij kinderen en hoe u deze modaliteiten optimaal kunt 

inzetten. 


What is the best imaging modality for ‘aseptic/low grade infection/infectious 

loosening of joint prostheses?’ 

Chairman: Dr. A. Ginai, AMC, Amsterdam & Erasmus MC, Rotterdam 

Imaging of Total Hip Replacement and Complications 

Dr. A. Ginai, AMC, Amsterdam & Erasmus MC, Rotterdam 


* Various types of hip prostheses and their radiological appearances. 

* Recognition of postoperative complications. 

* Role of imaging in diagnosis of prosthetic loosening. 

* Recommendations and an algorithm for imaging in ‘a patient with painful total hip arthroplasty or THP’ 



Tijdstip 

Onderwerp 

Radionuclide imaging of the problematical prosthetic hip 

Dr. J. Buscombe, Addenbrooke’s Hospital, Cambridge, UK 


Understand the role of multiphase scintigraphy in the painful hip prosthesis 

Understand advantages and problems of labelled leucocyte imaging in the painful hip prosthesis 

Understand the interaction of nuclear medicine and other investigations. 

Whilst many areas of clinical practice has been lost to nuclear medicine the assessment of the painful 

hip prosthesis remains a common indication. The incidence of infected hip prosthesis is less than that 

for the knee (1% vs4%) but hip replacements remain more common. In many cases pain in a hip 

prosthesis is not due to infection or loosening but the advantage of nuclear medicine techniques is their 

high negative predictive value. However care must be taken when using various scintigraphic 

techniques to ensure an accurate final diagnosis is established. 

AUDITORIUM 2 

Respons monitoring made sexy 

Chairman: Dr. B. Brans, nucleair geneeskundige, MUMC, Maastricht 

Accurate respons monitoring is crucial for the patient 

Prof. dr. H.C. Schouten, hemato-oncologist, MUMC, Maastricht 


Refresh knowledge about respons workhorses RECIST and HOVON 

Advantages and disadvantages of these workhorses 

What does the oncologist do with the (standardized) radiology report? 

Learn about the impact of respons monitoring on survival, management, and complications 

Respons monitoring, State of the art 

Prof. Dr. V. Vandecaveye, UZ Leuven, Belgium 


Overview of methods of respons monitoring of the near future (automatic volume measurements, DWI, 

dynamic postcontrast imaging, PETCT/PETMRI, other?) 

Work out of 1 or 2 of these techniques; how do I, interpretation, reporting (with emphasize on daily 

practice) 

Information technology solutions for practical implementation of these new techniques 

Prof. D. Rubin, Stanford University, USA 


* Learn about IT developments which can accelerate introduction of new techniques in daily practice 

* Learn about IT developments which can accelerate introduction of quantitative imaging in daily practice 

* Learn about basic IT concepts to achieve your optimal workflow -learn about who can do this for you 


Neuroanatomie voor dummies 

Voorzitter: Prof. dr. F.A. Barkhof, VUMC, Amsterdam 

Oppervlakte en diepte anatomie - chirurgische landmarks 

Prof. dr. F.A. Barkhof, VUMC, Amsterdam 

Functionele anatomie - toepassingen fMRI en tractografie 

Prof. dr. S. Sunaert, UZ Leuven, België 

Vasculaire anatomie - arteriële en veneuze territoirs 

Dr. G.J. Lycklama à Nijeholt, MCH Westeinde, Den Haag 

Leerdoelen: 

Kennis van anatomie vormt de basis van elke radiologische interpretatie. Gezien de complexiteit van de 

hersenanatomie geldt dat zeker ook voor de Neuroradiologie. Toenemende scankwaliteit en geavanceerde 

beeldvormingstechnieken zoals fMRI en DTI maken het mogelijk steeds meer descriptieve en 

functionele anatomie af te beelden van zowel cortex als subcorticale structuren. Kennis hiervan is van 

belang voor goede diagnostiek en planning van therapie. Deze ‘refresher course’ behandelt aan de hand 

van state-of-the-art MRI beelden de descriptieve en functionele anatomie van de cortex, diepe kernen, 

vezelbanen en vasculaire territoria en reikt praktische tips aan voor een klinisch relevante beschrijving 

van afwijkingen van deze structuren. Het volgen van deze cursus zal hopelijk leiden tot een verbetering 

van uw neuroradiologische verslagen. Verder kan de verworven kennis uw inzicht in ziekteprocessen 

vergroten, en zullen uw diagnostisch arsenaal en didactische vaardigheden toenemen. 

ZAAL 0.2 BERLIN 

Workshop “Interpretatie van radiologisch wetenschappelijk onderzoek” 

Mw. Dr. S. Spronk, klinisch epidemioloog, Erasmus MC, Rotterdam 

Leerdoelen: 

* Het toepassen van risicomaten zoals incidentiecijfer en cumulatieve incidentie, en de effectmaten 

zoals relatief risico, (populatie-)attributief risico 

* Het beoordelen van een studie op validiteit en precisie en daarbij de volgende begrippen leren 

gebruiken: selectiebias, informatiebias, confounding bias, effectmodificatie, verification bias, 

regressie naar het gemiddelde 

* Berekenen van sensitiviteit en specificiteit op basis van onderzoeksgegevens en werken met de regel 

van Bayes 

* Onderzoeksdesign kunnen herkennen: follow-up onderzoek (retrospectief, prospectief); patientcontrole 

onderzoek; experimenteel onderzoek; non-expirimentele evaluatie van therapie; meta-analyse. 

ZAAL 0.3 COPENHAGEN 

Emeritus programma (parallel aan het algemene programma) 

Voorzitters: Prof. dr. G. Rosenbusch en J.F.M. Panhuysen 

11.20 - 12.00 Een bijzondere tentoonstelling in 1929: Invloed van de Russische kunst op de kinderboek 

illustratie in het westen vóór de 2e wereldoorlog 

Dr. A. Lemmens 

4 




Tijdstip 

Onderwerp 

14.05 - 14.35 Opwekking van röntgenstraling m.b.v. het teruggevonden toestel van Hoffmans uit januari 

1896 te Maastricht 

Prof. dr. J. van Engelshoven en Dr. G. Kemerink 

14.35 - 15.15 De eerste Wereldoorlog in België, Radiologie in ‘Trench Coat’ 

Dr. R. van Tiggelen 

16.00 - 16.35 “Koorts en Honger” ofwel geneeskunde op het platteland in de afgelopen eeuwen 

J.A.C. van den Broek 

16.35 - 17.15 De gang van J.S. Bach naar Nederland 

Prof. dr. M. Oudkerk, UMC Groningen, Groningen 

AUDITORIUM 2 

17.15 - 18.45 Uitreiking prestigieuze WSS penning aan Prof. dr. J.O. Barentsz met aansluitend de ALV NVvR 

& Juniorsectie 

EXPOFOYER 

18.15 Industrieborrel: exclusief aangeboden door 

Vrijdag 30 september 2011 

Tijdstip 

Onderwerp 

8.30 - 9.00 Ontvangst & registratie 

9.00 - 10.15 Refresher courses 


Buiktrauma, waar gaat het nou eigenlijk om 

Voorzitter: L.F.M. Beenen, AMC, Amsterdam 

Classificaties van orgaanletsels, lever en milt 

L.F.M. Beenen, AMC, Amsterdam 

Classificaties van orgaanletsels, overige organen 

Mw. D.R. Kool, Jeroen Bosch Ziekenhuis, ‘s-Hertogenbosch 

Interventieradiologie bij buiktrauma 

Dr. O.M. van Delden, AMC, Amsterdam 

Leerdoelen: 

* Inzicht in wat wel en wat niet van belang is bij buiktrauma’s 

* Inzicht achter de ratio van de verschillende chirurgische en radiologische classificaties 

* Rol van de interventieradiologie in de behandeling van buiktrauma’s 


Acute pijn op de borst: Stand van zaken 

Voorzitter: Prof. dr. M. Oudkerk, UMC Groningen, Groningen 

Acute Chest Pain: The clinical perspective 

Dr. S.C.A.M. Bekkers, MUMC, Maastricht 

* To understand the challenges for the clinical assessment of pulmonary embolism, acute aortic 

pathologies and coronary artery disease 

* To define the in- and exclusion criteria for imaging in patients with acute chest pain 

Acute Chest Pain: The imaging perspective 

Prof. dr. J.E. Wildberger, MUMC, Maastricht 

* To summarize the technical prerequisites for advanced cross-sectional imaging 

* To define the role of CT and MR in the assessment of pulmonary embolism, acute aortic pathologies 

and coronary artery disease 

* To understand the potential clinical impact of imaging in the emergency setting, also in the 

perspective of logistics and cost-effectiveness 

Acute Chest Pain: Statement of the European Society of Cardiac Radiology 

Prof. dr. M. Oudkerk, UMC Groningen, Groningen 

* To summarize current clinical concepts and guidelines for acute chest pain 

* To learn about the specific role of different imaging modalities (CT, MR, Ultrasound, QCA) in this context 

Differentiated examination protocols even for the emergency setting have become technically feasible 

due to ongoing advances especially in non-invasive imaging techniques. The aim of this refresher 

course is to provide an overview on the rationale, the opportunities and current concepts for the 

work-up in patients with acute chest pain. 

ZAAL 0.8 ROME 

De knie: Niet standaard MRI bevindingen en de postoperatieve knie 

Voorzitter: Mw. Dr. M.P. Terra, AMC, Amsterdam 

De postoperatieve knie (MRI) 

Dr. P. Van Dyck, UZ Antwerpen, België 

De postoperatieve knie 

Mw. Dr. G.A. Meins, orthopedisch chirurg, ZGT, Almelo-Hengelo / clubarts FC Twente 

Niet standaard MRI bevindingen in en rond de knie 

Dr. P. Van Dyck, UZ Antwerpen, België 


Opleiden anno 2011 

Voorzitter: Dr. H.J. Baarslag, Meander MC, Amersfoort 

AIOS als “active learner” 

Mw. Drs. J.A. Baane, AMC, Amsterdam 



Tijdstip 

Onderwerp 

EXPOFOYER 

10.15 - 10.45 Koffiepauze 

Intervisie voor opleiders 

Prof. dr. O.R.C. Busch, chirurg, AMC, Amsterdam 

Optimalisatie radiologie bespreking 

Dr. M. Maas, AMC, Amsterdam & Drs. B.M. Wiarda, MCA, Alkmaar 

Leerdoelen: 

De HORA heeft veel veranderd en verbeterd in opleidingsland. Maar daarmee zijn we er nog niet. Met 

betrekking tot het opleiden anno 2011 is een nog actievere instelling mogelijk, die zowel de AIOS, de 

opleider als ook de gehele opleidingsstaf stimuleert. Alle 3 genoemde groepen komen zowel individueel 

als interactief aan bod bij deze refreshercourse onderwijs. 


Veneuze interventies 

Voorzitters: Dr. K.P. van Lienden, AMC, Amsterdam & Mw. Dr. C.S.P. van Rijswijk, LUMC, Leiden 

Pelvic congestion syndroom 

Dr. J.H.B. Boomsma 

Behandeling veneuze trombose 

Dr. J.A. Vos, St. Antonius Ziekenhuis, Nieuwegein 

Rol van cava filters 

Prof. dr. J.A. Reekers, AMC, Amsterdam 

Veneuze toegang; PICCs, Dialyse catheters en andere CVCs 

Dr. H. van Overhagen, HagaZiekenhuis, Den Haag 

ZAAL 0.1 LONDON 

Workshop / hands-on: To make Radlex more familiar. 

Using IHE TCE for export of PACS data to an MIRC teaching file 

E. Sanders, Amphia Ziekenhuis, Breda 

P. van Ooijen, UMC Groningen, Groningen 

10.45 - 12.15 Parallelsessies vrije voordrachten 

Voorafgaand aan de wetenschappelijke voordrachten zal iedere sessie aanvangen met een keynote lecture. 


Sessie 6: Abdominale radiologie 2 

Voorzitters: Prof. dr. A.A.M. Masclee, MUMC, Maastricht & Dr. R.E. van Gelder, AMC, Amsterdam 

Endoscopie vs CTC 

Prof. dr. A.A.M. Masclee, MUMC, Maastricht 

ZAAL 0.8 ROME 

Sessie 7: Kinderradiologie / Diversen 

Voorzitters: Dr. R.A.J. Nievelstein, UMC Utrecht, Utrecht & N. de Graaf, Erasmus MC, Rotterdam 

Huidige status en toekomstperspectief 

Dr. R.A.J. Nievelstein, UMC Utrecht, Utrecht 


Sessie 8: Mammadiagnostiek 2 & Uitreiking Jan Hendriksprijs 

Voorzitters: Drs. R.D.M. Mus, UMC St Radboud, Nijmegen & Mw. M.W. Imhof-Tas, UMC St Radboud, Nijmegen 

MRI van de mamma in 2 minuten? 

Drs. R.D.M. Mus, UMC St Radboud, Nijmegen 


Sessie 9: Neuro-Hoofdhals radiologie 

Voorzitters: Dr. J.C. de Groot, UMC Groningen, Groningen & Dr. S.C.A. Steens, UMC St Radboud, 

Nijmegen 

Vasculaire evaluatie van het brein in stroomversnelling 

Dr. J.C. de Groot, UMC Groningen, Groningen 


Sessie 10: MSK / Thorax / Diversen 

Voorzitters: Mw. Dr. M. Reijnierse, LUMC, Leiden & Dr. P.J.W. Wensing, ZGT Almelo/Hengelo 

Postop infection around metals: CT/Mri techniques 

Mw. Dr. M. Reijnierse, LUMC, Leiden 

AUDITORIUM 2 

De educatieve voordracht 

Voorzitters: Dr. C.J. van Rooden, HagaZiekenhuis & Dr. R. Ouwendijk, Erasmus MC, Rotterdam 

In deze gloednieuwe sessie tijdens de Radiologendagen komt een groot scala aan klinisch georiënteerde 

onderwerpen voorbij, van echogeleide bijnierpunctie tot beeldvorming van atherosclerose. Voor het 

eerst konden dit jaar, naast wetenschappelijke, ook educatieve abstracts ingestuurd worden. 

De kwaliteit van de inzendingen was hoog, dus deze primeur belooft een erg interessante, gevarieerde 

en vooral ook leuke sessie te worden, voorgezeten door twee top-radiologen! 

Future clinical applications of high resolution anatomical imaging of the brain at 7.0 Tesla MRI 

A.G. van der Kolk, UMC Utrecht, Utrecht 

Is beeldvorming van atherosclerose klaar voor de dagelijkse praktijk? 

Mw. S. Gerretsen, MUMC, Maastricht 

Lung perfusion defects on dual-energy Computed Tomography (DECT): review of morphology 

and differential diagnosis 

Mw. Dr. A.E. Odink, Erasmus MC, Rotterdam 

Value of computed tomography coronary angiography in failed conventional coronary angiography 

A.S. Thijssen, Erasmus MC, Rotterdam 

Pseudotumoren bij metaal op metaal totale heup artroplastiek 

M.F. Boomsma, Isala klinieken, Zwolle 

6 



Tijdstip 

Onderwerp 


EXPOFOYER 

12.15 - 13.15 Lunch 

EXPOFOYER 


De vergrote bijnier: Endosonografische FNA van de linker-bijnier 

R. de Ridder, MDL-arts, MUMC, Maastricht 

Long-term follow-up features on rectal MRI during a wait-and-see approach after a clinical 

complete response in rectal cancer patients treated with chemoradiotherapy 

D.M.J. Lambregts, MUMC, Maastricht 

Implementatie van virtuele colonoscopie in de dagelijkse radiologische praktijk 

M.T. de Witte, VieCuri Medisch Centrum, Venlo / UMC St Radboud, Nijmegen 

Mw. Dr. P.C.G. Simons, VieCuri Medisch Centrum, Venlo 

ZAAL 0.2 BERLIN 

Workshop “Interpretatie van radiologisch wetenschappelijk onderzoek” 

Mw. Dr. S. Spronk, klinisch epidemioloog, Erasmus MC, Rotterdam 

Leerdoelen: 

* Het toepassen van risicomaten zoals incidentiecijfer en cumulatieve incidentie, en de effectmaten 

zoals relatief risico, (populatie-)attributief risico 

* Het beoordelen van een studie op validiteit en precisie en daarbij de volgende begrippen leren 

gebruiken: selectiebias, informatiebias, confounding bias, effectmodificatie, verification bias, 

regressie naar het gemiddelde 

* Berekenen van sensitiviteit en specificiteit op basis van onderzoeksgegevens en werken met de regel 

van Bayes 

* Onderzoeksdesign kunnen herkennen: follow-up onderzoek (retrospectief, prospectief); patient-controle 

onderzoek; experimenteel onderzoek; non-expirimentele evaluatie van therapie; meta-analyse. 

AUDITORIUM 2 

13.15 - 13.30 Wetenschappelijk beleid NvvR voor academische -en niet academische centra 

Mw. Prof. dr. R.G.H. Beets-Tan, MUMC, Maastricht 

AUDITORIUM 2 

Plenaire sessie 

13.30 - 14.30 Pro-con: Setting standards in healthcare - Which way to go? 

Ook voor de radiologie zullen kwaliteitsnormen steeds belangrijker worden. Wat vinden de debaters, 

maar ook: Wat vindt U! Drie onderwerpen zullen U raken. Drie pro-con koppels testen uw dekking. 

Fair play is de regel, maar neem uw bokshandschoenen mee. 

Voorzitter: Dr. J.A. Vos, St. Antonius Ziekenhuis, Nieuwegein 

De kwaliteitseisen voor de radiologie zijn autonoom op te stellen 

Pro: Dr. C. Holt, Isala klinieken, Zwolle 

Con: J.W.A.P. van Hoogstraten, Deventer Ziekenhuis, Deventer 

Hoog complex, (laag volume) diagnostiek moet alleen door experts worden uitgevoerd 

Pro: Prof. dr. J. Stoker, AMC, Amsterdam 

Con: Mw. L.F.I.J. Oudenhoven, ZGT Almelo, Almelo 

Information technology in radiology - Yes, it helps! 

Pro: Prof. D. Rubin, Stanford University, USA 

Con: R.H.M. Smithuis, Rijnland Ziekenhuis, Leiderdorp 

14.30 - 15.15 Richtlijnen sessie 

Voorzitter: Drs. B.M. Wiarda, Medisch Centrum Alkmaar, Alkmaar 

Licht traumatisch hoofd/hersenletsel 

Mw. D.R. Kool, Jeroen Bosch Ziekenhuis, ‘s-Hertogenbosch 

Distale Radius Fracturen 

Mw. S. Kolkman, AMC, Amsterdam 

Acuut lateraal enkelletsel en Interne indicatoren Acuut lateraal enkelbandletsel 

J.W.A.P. van Hoogstraten, Deventer Ziekenhuis, Deventer 

Oesofaguscarcinoom 

Prof. dr. E.J. van der Jagt, UMC Groningen, Groningen 

EXPOFOYER 

15.15 - 15.45 Theepauze 

AUDITORIUM 2 

15.45 - 16.25 Uitreiking Philipsprijs, gevolgd door bekendmaking en presentatie van achtereenvolgens de 

Posterprijs, Radiologendagen prijs, NVvR Travel Grant en Fellowshipdiploma’s 

AUDITORIUM 2 

16.25 - 17.15 Quiz 

Door de maatschap radiologie van het Albert Schweitzer ziekenhuis 

AUDITORIUM 2 

17.15 - 17.20 Afsluiting door voorzitter 

Dr. R.B.J. de Bondt, Isala klinieken, Zwolle 

Vanaf 20.00 

Diner & Galafeest 

Amrâth Grand Hotel De L’Empereur Maastricht 


programma genomineerden & abstracts 

Genomineerde abstracts voor 

de Radiologendagenprijs 2011 

O1.7 ASSESSMENT OF A COMPLETE RESPONSE OF RECTAL CANCER TO 

PREOPERATIVE CHEMORADIATION THERAPY: A COMPARISON 

BETWEEN MR VOLUMETRY AND DIFFUSION-WEIGHTED MRI 

D.M.J. Lambregts 1 , L. Curvo-Semedo 2 , M. Maas 1 , T. Thywissen 1 , G. Lammering 1 , G.L. Beets 1 , 

F. Caseiro-Alves 2 , R.G.H. Beets-Tan 1 

1 

Maastricht Universitair Medisch Centrum, Maastricht 

2 

Radiology University Clinic, Coimbra University Hospital, Coimbra, Portugal 

O4.3 LESION DETECTION AND BI-RADS CLASSIFICATION IN 3D-US AUTO- 

MATED BREAST VOLUME SCANS (ABVS): CORRELATION WITH BREAST MRI 

T.A. Fassaert, I.J.M. Dubelaar, M.D.F. de Jong, M.C.J.M. Rutten 

Jeroen Bosch Ziekenhuis, Den Bosch 

O5.8 1 JAAR NA EVAR BESTAAT NOG ONGEVEER EENDERDE DEEL VAn de 

ANEURYSMAZAK UIT ONGEORGANISEERDE THROMBUS BIJ PATIENTEN 

MET EN ZONDER AANTOONBAAR ENDOLEAK 

S.A.P. Cornelissen 1 , E.P.A. Vonken 1 , H.J. Verhagen 2 , F.L. Moll 1 , L.W. Bartels 3 

1 

Universitair Medisch Centrum Utrecht, Utrecht 

2 

Erasmus Medisch Centrum, Rotterdam 

3 

Image Sciences Institute, Universitair Medisch Centrum Utrecht, Utrecht 

O9.1 ARTERIAL CALCIFICATION IN RELATION TO COGNITION AND 

STRUCTURAL BRAIN CHANGES 

D. Bos, M.W. Vernooij, S.E. Elias-Smale, G.P. Krestin, A. Hofman, W.J. Niessen, J.C.M. Witteman, 

A. van der Lugt, M.A. Ikram 


O10.5 IMPACT ON DIAGNOSTIC PERFORMANCE AND READING TIME OF A 

COMPUTER AIDED DETECTION ALGORITHM FOR THE DETECTION OF 

ACUTE PE: SECOND READING VERSUS CONCURRENT READING 

R. Wittenberg 1 , J.F. Peters 2 , I.A.H. Van den Berk 3 , N.J.M. Freling 3 , R.J. Lely 4 , B. de Hoop 5 , K. Horsthuis 3 , 

C.J. Ravesloot 5 , M. Prokop 6 , C.M. Schaefer-Prokop 7 

1 


2 

Philips Healthcare, Best 

3 

Academisch Medisch Centrum, Amsterdam 

4 

VU Medisch Centrum, Amsterdam 

5 


6 

Universitair Medisch Centrum St Radboud, Nijmegen 

7 

Meander Medisch Centrum, Amersfoort 

8 




Genomineerde abstracts voor 

de NVvR Travel Grant 2011 

O2.3 MRI FEATURES ASSOCIATED WITH ACUTE APPENDICITIS 

M.M.N. Leeuwenburgh 1 , B.M. Wiarda 2 , A. Spilt 3 , P.M.M. Bossuyt 1 , M.A. Boermeester 1 , 

J. Stoker 1 , OPTIMAP Studiegroep 

1 


2 

Medisch Centrum Alkmaar, Alkmaar 

3 

Kennemer Gasthuis, Haarlem 

O2.4 OPTIMAL STRATEGY IN PATIENTS WITH SUSPECTED ACUTE APPENDICITIS, 

CAN MRI REPLACE CT? 

M.M.N. Leeuwenburgh 1 , H.W. van Es 2 , J.W.C. Gratama 3 , P.M.M. Bossuyt 1 , M.A. Boermeester 1 , 

J. Stoker 1 , OPTIMAP Studiegroep 

1 


2 

St. Antonius Ziekenhuis, Nieuwegein 

3 

Gelre ziekenhuizen, Apeldoorn 

O2.7 MR EVALUATION OF URETHRAL DIVERTICULA AND DIFFERENTIAL 

DIAGNOSIS IN SYMPTOMATIC FEMALE PATIENTS 

S.I. Verschuuren, R.S. Dwarkasing, W. Dinkelaar, W.C.J. Hop, G.R. Dohle, G.P. Krestin 


O5.7 CAROTID ATHEROSCLEROTIC PLAQUE PROGRESSION AND CHANGE 

IN PLAQUE COMPOSITION OVER TIME; A PROSPECTIVE IN VIVO SERIAL CT 

ANGIOGRAPHY STUDY 

M.J. van Gils, D. Vukadinovic, D.W.J. Dippel, W.J. Niessen, A. van der Lugt 


O6.4 PERCEIVED BURDEN OF SCREENING BY COLONOSCOPY OR 

CT-COLONOGRAPHY IN THE DETECTION OF ADVANCED NEOPLASIA: 

A RANDOMIZED CONTROLLED TRIAL 

M.C. de Haan 1 , T.R. de Wijkerslooth 1 , E. Stoop 2 , P.M. Bossuyt 1 , M. Thomeer 2 , 

M.L. Essink-Bot 1 , M.E. van Leerdam 2 , P. Fockens 1 , E.J. Kuipers 2 , E. Dekker 1 , J. Stoker 1 

1 


2 


O7.2 MINIMALLY INVASIVE MRI BY OMITTING INTRAVENOUS CONTRAST 

INJECTION; DOES IT CHANGE THE RADIOLOGIC ASSESSMENT OF KNEE 

JOINT PATHOLOGIES IN JIA? 

R. Hemke, M.A.J. van Rossum, M. van Veenendaal, T.W. Kuijpers, M. Maas 



programma genomineerden & abstracts 

Vervolg 

O7.3 ULTRASOUND TO PREDICT SIGNIFICANT HEPATIC STEATOSIS IN OBESE 

ADOLESCENTS: POOR POST-TEST PROBABILITY DESPITE ACCEPTABLE 

SENSITIVITY AND SPECIFICITY 

A.E. Bohte 1 , B.G. Koot 1 , A.J. Nederveen 1 , O.H. van der Baan-Slootweg 2 , S. Bipat 1 , T.H. Pels Rijcken 3 , 

P.L.M. Jansen 1 , M.A. Benninga 1 , J. Stoker 1 

1 


2 

Heideheuvel Kliniek, Hilversum 

3 

Tergooiziekenhuizen, Hilversum 

O9.1 ARTERIAL CALCIFICATION IN RELATION TO COGNITION AND STRUCTURAL 

BRAIN CHANGES 

D. Bos, M.W. Vernooij, S.E. Elias-Smale, G.P. Krestin, A. Hofman, W.J. Niessen, 

J.C.M. Witteman, A. van der Lugt, M.A. Ikram 


O9.2 TIA AND STROKE PATIENTS WITH CAROTID STENOSIS: PRESENCE 

OF COMPLICATED PLAQUE FEATURES AT MRI IS ASSOCIATED WITH 

RECURRENT EVENTS 

R.M. Kwee 1 , R.J. van Oostenbrugge 1 , W.H. Mess 1 , M.H. Prins 1 , R.J. van der Geest 2 , J.W.M. ter Berg 3 , 

C.L. Franke 4 , A.G.G.C. Korten 5 , B.J. Meems 6 , J.M.A. van Engelshoven 1 , J.E. Wildberger 1 , M.E. Kooi 1 

1 


2 

Leids Universitair Medisch Centrum, Leiden 

3 

Orbis Medisch Centrum, Sittard 

4 

Atrium Medisch Centrum Parkstad, Heerlen 

5 

Laurentius Ziekenhuis, Roermond 

6 

VieCuri Medisch Centrum, Venlo 

O10.6 DEVELOPMENT AND VALIDATION OF A DIAGNOSTIC MODEL FOR 

AIRFLOW LIMITATION IN HEAVY SMOKERS BY USING QUANTITATIVE 

COMPUTED TOMOGRAPHY 

O.M. Mets 1 , C.M.F. Buckens 1 , P. Zanen 1 , I. Isgum 1 , M. Prokop 2 , P.A. de Jong 1 

1 


2 


P02 

AUTOMATED BREAST VOLUME SCANNER: 3D-ULTRASOUND 

OF BREAST LESIONS 

T.A. Fassaert, M.D.F. de Jong, I.J.M. Dubelaar, M.C.J.M. Rutten 

Jeroen Bosch Ziekenhuis, ‘s-Hertogenbosch 

10 



Auteursindex 


AUTEUR 

abstract 

Aalten, S.M. van O6.7 

Adam, J. O1.8 

Adams, A. O8.7 

Adriaanse, S.M. O9.6 

Akkerman, E.M. O1.8 

Amstel, J.D. van O8.10 

Aquarius, R. O5.2 

Baan-Slootweg, O.H. van der O7.3 

Backes, W.H. O1.3 

Backx, F.J.G. O3.7 

Bakers, F.C.H. E02, O1.3 

Bakker, C.J. O5.4 

Ballegooijen, M. van O6.3 

Barkhof, F.A. O9.5, O9.6 

Bartels, L.W. O3.2, O5.8 

Bechan, M.A.H. 

P03 

Beek, F.J.A. O1.8, O7.4 

Beek, H. van O10.8 

Beenen, L.F.M. O2.5 

Beerman, H. O10.8 

Beets, G.L. E02, O1.1, O1.2, O1.3, 

O1.6, O1.7, P14 

Beets-Tan, R.G.H. E02, O1.1, O1.2, 

O1.3, O1.6, O1.7, O2.2, 

O4.1, O6.8, P14 

Benedictus, M.R. O9.5 

Benninga, M.A. O7.3 

Bentohami, A. O7.5 

Berckel, B.N.M. van O9.6 

Berg, A.S. van den O5.1 

Berg, R. van den O9.5, P09, P12, P13 

Berk, I.A.H. van den O10.5 

Berkhof, M. O1.1 

Bernsen, M.R. O7.7, O7.8 

Beumer, D. O9.5 

Beute, G.N. O9.8 

Bierings, M.B. O1.8 

Biermann, K. O6.3 

Biessels, G.J. O3.8 

Bijlsma, T.S. O7.5 

Binnewijzend, M.A.A. O9.6 

Bipat, S. O2.1, O5.3, O5.5, O6.1, 

O6.5, O7.1, O7.3 

Bisschops, R.H.C. O8.6 

Bluekens, A.M.J. O8.4 

Boelens, J.J. O7.4 

Boellaard, T.N. O6.2, O6.5 

Boer, E. de O6.6 

Boer, R. de O9.4 

Boermeester, M.A. O2.3, O2.4 

Boersma, E.H. O3.1 

Boetes, C. † O4.1 

Bohté, A.E. O7.3 

Boiten, J. O5.6, O9.5 

Bokkers, R.P.H. 

P05, P06 

Bonenkamp, J. 

P04 

Booij, R. 

E06 

Boomsma, M.F. 

E08 

Borst, G.J. de 

P05 

Bos, D. O9.1 

Bosch, M.A.A.J. van den O4.4, 

O5.4, O8.5, O8.10 

Bosker, B.H. 

E08 

Bosker, R.J.I. O1.4 

Bosscha, K. 

P10 

Bossuyt, P.M.M. O2.3, O2.4, O6.1, 

O6.2, O6.3, O6.4 

Bot, J. O9.5 

Bouwhuijsen, Q.J.A. van den O9.3 

Breest Smallenburg, V. van O4.3 

Brink, R.B.A. van den O3.6 

Broeder, A.A. den O10.4 

Broeders, M.J.M. O8.4 

Bron, E. O10.1 

Bruijnes, V. O4.5 

Brundel, M. O3.8 

Buckens, C.M.F. O10.6 

Budde, R.P.J. O3.2, O3.4, O3.5, O3.6 

Buijsen, J. O1.2 

Caan, M.W.A. O2.1, O7.1 

Cappendijk, V.C. E01, E02, E05, 

O1.3, O2.2 

Carli, D.F.M. O9.8 

Caseiro-Alves, F. O1.7 

Chamuleau, S.A.J. O3.6 

Cleutjens, J. O4.1 

Cornelissen, S.A.P. O5.8 

Cramer, M.J.M. O3.7 

Cremers, P.T.J. O1.5 

Cremers, S.E.H. O1.5 

Curvo-Semedo, L. O1.7 

Dalen, T. van O4.4 

Damoiseaux, J.S. O9.6 

Das, M. 

E05 

Dekker, E. O6.3, O6.4 

Dekker, H.M. O2.6 

Dharampal, A.S. O3.1, O3.3 

Diepstraten, S.C.E. O4.4 

Diest, P.J. van O4.4, O8.10 

Dijk, R.A.J.M. van O1.4, O4.6, O8.3 

Dijkman, B.A. van O7.5 

Dinkelaar, W. O2.7 

Dippel, D.W.J. O5.7, O9.5, P08 

Doeswijk, G. O7.7, O7.8 

Dohle, G.R. O2.7 

Doorn, M.M.A.C. van O2.5, O9.5 

Douwes, D.C.E. O2.2 

Dubelaar, I.J.M. O4.2, O8.1, P02 

P04, P07 

Duijm, L.E.M. O4.3, O8.2, 08.9 

Duvivier, K.M. O4.4 

Dwarkasing, R.S. O2.7, O6.1, O6.7 

Eddes, E.H. O1.4 

Eeftinck Schattenkerk, M. O1.4 

Elias, S.G. O8.7 

Elias-Smale, S.E. O9.1 

Elschot, M. O5.4 

Engelen, S.M.E. O1.2 

Engelshoven, J.M.A. van E05, O9.2 

Ernst, M. 

P10 

Es, H.W. van O2.4 

Essink-Bot, M.L. O6.4 

Ettema, H.B. 

E08 

Fassaert, T.A. O4.2, O8.1, P02 

Fernandez-Gallardo, M.A. O4.4 

Feyter, P.J. de O3.1, O3.3 

Fijnheer, R. O1.8 

Flier, W.M. van der O9.5, O9.6 

Flucke, U. 

P04 

Fockens, P. O6.3, O6.4 

Folbert, E.C. O10.3 

Franke, C.L. O9.2 

Frans, F.A. O5.3, O5.5 

Fransen, P.S. O9.5 

Freling, N.J.M. O10.5 

Frotscher, C. O4.1 

Geelen, L.M.H. O9.7 

Geerdes, M. O5.2 

Geest, R.J. van der O9.2 

Gerretsen, S.C. 

E05 

Gilhuijs, K.G.A. O4.5 

Gillissen, F. O1.2 

Gils, M.J. van 

O5.7, P08 

Gorp, T. van O6.8 

Goslings, J.C. O7.5 

Gratama, J.W.C. O2.4 

Gryspeerdt, S. O1.5 

Guenoun, J. O7.7, O7.8 


programma index & abstracts 

Haan, M.C. de O6.1, O6.3, O6.4 

Habets, J. O3.4, O3.5, O3.6 

Hartkamp, N.S. 

P05, P06 

Hartmann, I.J.C. E06, O10.7 

Hauptmann, M. O7.6 

Havinga, M.E. O5.2 

Heer, L.M. de O3.2 

Heeten, G.J. den O8.4 

Hegeman, J.H. O10.3 

Heijde, D.M.F.M. van der O10.4, 

P12, P13 

Helle, M. 

P06 

Hellemondt, F.J. van O3.7 

Hemke, R. O7.2 

Hendrikse, J. 

E04, O3.8, 

P05, P06 

Hendriks-Roelofs, F. O10.4 

Hensen, J.J. O8.8, O10.8 

Herk, M. van O7.6 

Herwerden, L.A. van O3.2 

Hobbelink, M. O8.10 

Hoeberigs, M.C. O9.7 

Hofman, A. O9.1 

Hofman, P.A.M. O9.7 

Holland, R. O8.4 

Homburg, P.J. 

P08 

Hoop, B. de O10.5 

Hop, W.C.J. O2.7 

Horsthuis, K. O10.5 

Houterman, S. O1.5 

Huizinga, T.W.J. 

P12, P13 

Hummel, T.Z. O7.1 

IJzermans, J.N.M. O6.7 

Ikram, M.A. O9.1, O9.3, O9.4 

Imholz, A.L.T. O4.6, O8.3 

Isgum, I. O10.6 

Jager, G.J. 

O8.1, P10 

Jansen, F.H. O4.3, 08.9 

Jansen, P.L.M. O7.3 

Jansen, R.J. O6.1 

Jasperse, B. O9.4 

Jens, S. O5.5 

Jeukens, C.R.L.P.N O1.6 

Jong, H.W. de O5.4 

Jong, M.D.F. de O4.3, O8.1, 

P02, P10 

Jong, P.A. de O7.4, O10.6 

Kallen, B.F.W. van der O5.6, O9.5 

Karssemeijer, N. O8.4 

Kate, F.J.W. ten O6.6 

Kauffman, D. O6.1 

Kersten, M.J. O1.8 

Kessel, C.S. van O6.6 

Keymeulen, K. O4.1 

Kindermann, A. O7.1 

Klein, S. O10.1 

Klein, W.M. 

P01 

Klerk, J.M.H. de O1.8 

Klieverik, S.J. 

P14 

Klomp, D.W. O8.5 

Kluin, J. O3.2 

Kluza, E. 

O1.6, P14 

Koek, M. O9.4 

Koelemay, M.J.W. O5.3, O5.5 

Kolk, A.G. van der E04, O3.8 

Kollen, B.J. 

E08 

Koning, G.A. O7.7, O7.8 

Kooi, M.E. E05, O9.2 

Koot, B.G. O7.3 

Korten, A.G.G.C. O9.2 

Korteweg, M.A. O8.5, O8.10 

Koster, K. O1.4 

Kotek, G. O10.1 

Kraai, M. O10.3 

Kraal, K.J. O8.8 

Kreb, D. 

P10 

Krestin, G.P. E07, O2.7, O3.1, O3.3 

O7.7, O7.8, O9.1, O9.3 

O10.1, O10.2 

Kruitwagen, R. O6.8 

Kruse, A. O6.8 

Kuijer, J.P.A. O9.5 

Kuijpers, T.W. O7.2 

Kuipers, E.J. O6.3, O6.4 

Kwee, R.M. E05, O9.2 

Kwee, T.C. O1.8 

Lahaye, J. O1.2, O4.1 

Lalisang, R. O6.8 

Lalji, U.C. O2.8 

Lam, M.G.E.H. O5.4 

Lambregts, D. 

E02, O1.1, 

O1.2, O1.3, O1.6, 

O1.7, O6.8, P14 

Laméris, J.S. O7.6 

Lammering, G. E02, O1.7 

Lavini, C. O2.1, O7.1 

Ledeboer, M. O1.4 

Leerdam, M.E. van O6.3, O6.4 

Leeuwen, M.S. van O1.8, O6.6 

Leeuwenburgh, M.M.N. O2.3, O2.4 

Lefere, P. O1.5 

Legemate, D.A. O5.3 

Leij, C. van der O6.1 

Leiner, T. E05, O3.4 

Lely, R.J. O10.5 

Liedenbaum, M.H. O6.1 

Lijn, F. van der O9.4 

Lijster, M.S. de O6.1 

Lima Passos, V. O4.1 

Linden, H. van der 

P10 

Linden, E. van der O5.6 

Lobbes, M.B.I. E05, O4.1 

Loeffen, D.V. O2.2 

Loo, C. O4.5 

Looij, B.G. 

P10 

Ludwig, I. O1.8 

Lugt, A. van der O5.7, O9.1, O9.3, 

O9.4, O9.5, P08 

Luijkx, T. O3.7 

Luijten, P.R. E04, O3.8, O8.5 

Lute, C.C. O6.1 

Lutgens, L. O6.8 

Lycklama à Nijeholt, G.J. O5.6, O9.5 

Maas, M. 

E02, O1.1, O1.2, 

O1.3, O1.6, O1.7, P14 

Maas, M. E08, O7.2, O7.5 

Maat, G.H. van de O5.4 

Majoie, C.B.L.M. O9.5, P09 

Mali, W.P.Th.M. O3.2, O3.4, O3.6, 

O3.7, O4.4, 

O8.5, O8.7, O8.10 

Man, R.A. de O6.7 

Marcelis, C. 

P01 

Meems, B.J. O9.2 

Meijer, F.A. 

P07 

Mendez, C.P. 

P03 

Mess, W.H. O9.2 

Met, R. O5.3 

Mets, O.M. O10.6 

Mol, B.A.J.M. de O3.4, O3.5 

Moll, F.L. O5.8 

Mollet, N.R.A. E07, O3.1, O3.3 

Mongula, J.E. O6.8 

Mourik, J.E.M. O8.7 

Nederend, J. O8.9 

Nederkoorn, P.J. O9.5 

Nederveen, A.J. O2.1, O6.5, O7.1, O7.3 

Neefjes, L. O3.1, O3.3 

Nieman, K. O3.1, O3.3 

Niessen, W.J. O5.7, O9.1, O9.3, O9.4 

Nievelstein, R.A.J. O1.8, O7.6 

Niezen, R.A. O8.8, O10.8 

Nijman, J. O8.8 

12 




Nijsen, J.F.W. O5.4 

Nio, C.Y. O6.2, O6.3 

Nunspeet, L. van O1.4 

Odink, A.E. E06, O10.7 

Odink, H. O5.1 

Oei, E.H.G. O10.1, O10.2 

Oostenbrugge, R.J. van O9.2, O9.5 

Osch, M.J.P. van 

P06 

Paardt, M.P. van der O6.1, O6.5 

Pels Rijcken, T.H. O7.3 

Pengel, K. O4.5 

Pennings, J.P. O8.6 

Peters, J.F. O10.5 

Plas, G.J.J. 

P08 

Ponsioen, C.Y. O2.1 

Prakken, N.H.J. O3.7 

Prehn, J. van O3.2 

Prins, M.H. O9.2 

Prokop, M. O3.5, O10.5, O10.6, P04 

Quarles van Ufford, H.M.E. O1.8 

Ravesloot, C.J. O10.5 

Reekers, J.A. O5.3, O5.5 

Reijnierse, M. O10.4, P12, P13 

Riedl, R.G. O1.3 

Ridder, R. de 

E01 

Ronckers, C.M. O7.6 

Rooij, W.J.J. van O9.8 

Roos, Y.B. O9.5 

Rooy, J.W.J. de 

P04 

Rooy, T.D. de O5.6 

Rossi, A. O3.1, O3.3 

Rossius, M. E06, O10.7 

Rossum, M.A.J. van O7.2 

Rozendaal, R. O8.6 

Ruggiero, A.R. O7.8 

Rutten, I.J.G. O1.3 

Rutten, M.J.C.M. O4.2, O8.1 

P02, P10 

Sandt-Koenderman, W.M.E. van de 

P03 

Sanz-Arigita, E. O9.6 

Schaefer-Prokop, C.M. E06, O10.5, 

O10.7 

Scheltens, P. O9.5, O9.6 

Schep, N.W.L O7.5 

Schepers-Bok, R. O5.2 

Schip, A.D. van het O5.4 

Schoonheim, M.M. O9.6 

Seevinck, P.R. O5.4 

Senden, P.J. O3.7 

Setz-Pels, W. O4.3, O8.2 

Siebelt, M. O10.2 

Sijbrandij, L. 

E08 

Sikkenk, A.C. O8.8 

Simons, P.C.G. 

E03 

Slaar, A. O7.5 

Slangen, B.F. O6.8 

Slooter, G. O1.5 

Sluzewski, M.S. O9.8 

Smets, A.M. O7.1, O7.6 

Smit, H. O10.1 

Smit, R.S. O10.3 

Smits, M. 

O9.4, P03 

Smits, M.L.J. O5.4 

Spijkerboer, A.M. O2.1, O3.6 

Spilt, A. O2.3 

Sprengers, M.E. O9.5 

Stehouwer, B.L. O8.5, O8.10 

Stoker, J. O1.8, O2.1, O2.3, O2.4 

O6.1, O6.2, O6.3, O6.4 

O6.5, O7.1, O7.3 

Stokkers, P. O2.1 

Stoop, E. O6.3, O6.4 

Storm, R. O8.6 

Straten, M. van O10.2 

Symersky, P. O3.4, O3.5 

Tanghe, H.L.J. 

P08 

Ter Berg, J.W.M. O9.2 

Terkivatan, T. O6.7 

Thijssen, A.S. 

E07 

Thomeer, M.G.J. O6.1, O6.3, 

O6.4, O6.7 

Thywissen, T. O1.7 

Tiel, J. van O10.1, O10.2 

Tilborg, G.F.A.J.B. van 

E07 

Tolboom, N. O9.6 

Tran, V.H.P. O8.3 

Uijlings, R. O3.6 

Uiterwaal, C.S.P. O1.8 

Vandenbussche, F. 

P01 

Veenendaal, M. van O7.2 

Velde, D. van der O10.3 

Veldhuis, W.B. O8.5, O8.10 

Velthuis, B.K. O3.7 

Vente, M.A.D. O5.4 

Verhagen, H.J. O5.8 

Verheij, J. O6.7 

Verhulst, M.L. O1.5 

Verkooijen, H.M. O4.4 

Vermeule, W. O10.7 

Vermoolen, M.A. O1.8 

Vernooij, M.W. O9.1, O9.3, O9.4 

Verreyen, C.C.C.M. 

E08 

Verschuuren, S.I. O2.7 

Versluys, A.B. O7.4 

Vijver, M.J. van de O6.3 

Vincken, K.L. O3.2 

Visch-Brink, E.G. 

P03 

Visser, R.N. de 

E07 

Visser, F. E04, O3.8 

Visser, P.J. O9.5 

Vliegen, R. O6.8 

Vlies, M. van der 

P09 

Volmerink, M.H.M. O4.6, O8.3 

Vonken, E.P.A. O5.8 

Voogd, A.C. O8.2 

Voort, M. van der O8.7 

Vossen, M.H.E. O10.4, P12, P13 

Vroegindeweij, D. O8.8, O10.8 

Vrooman, H.A. O9.4 

Vukadinovic, D. O5.7 

Waarsing, J.H. O10.2 

Walenkamp, M.W. O7.5 

Wattjes, M.P. O9.5 

Weerink, L.B.M. O10.3 

Weinans, H. O10.1, O10.2 

Wensing, P.J.W. dr. O5.2 

Weustink, A.C. E07, O3.1, O3.3 

Wiarda, B.M. O2.3 

Wielopolski, P.A. O7.7 

Wiersma, H.W. O1.4 

Wijkerslooth, T.R. de O6.3, O6.4 

Wildberger, J.E. E05, O4.1, O9.2 

Wilde, J.C.H. O7.5 

Wink, A.M. O9.6 

Winkens, B. O5.1 

Witkamp, A.J. O4.4, O8.10 

Witte, M.T. de 

E03 

Witteman, J.C.M. O9.1, O9.3 

Wittenberg, R. O10.5 

Worp, H.B. van der 

P05 

Ypma, Y.F.R. O10.8 

Zagers, M.B. O5.5 

Zanen, P. O10.6 

Ziech, M.L.W. O2.1, O7.1 

Zijlstra, I.J.A. O6.1 

Zijta, F.M. O6.5 

Zonnenberg, B.A. O5.4 

Zsiros, J. O1.8 

Zwam, W. van O9.5 

Zwanenburg, J.J.M. E04, O3.8 


RCprogramma abstracts 

& abstracts 

Samenvattingen 

‘Research Corner’ 

Donderdag 29 september, 14.05 - 15.35 uur 

LUMC 

TOEPASSINGEN VAN ULTRAHOOGVELD 

MRI BIJ PATIENTENPOPULATIES 

M.A. van Buchem 

Enkele jaren geleden zijn MRI-systemen ontwikkeld met een 

zeer hoge veldsterkte die geschikt zijn voor onderzoek bij 

mensen. Recent zijn twee van zulke systemen, functionerend 

bij een veldsterkte van het magnetisch veld van 7Tesla, in 

Nederland geplaatst, respectievelijk in het LUMC en het 

UMCU. Inmiddels zijn een groot aantal patiënten op deze 

systemen onderzocht. In deze presentatie zal een indruk 

geschetst worden van de eerste ervaringen die daarbij 

opgedaan zijn. 

Erasmus MC 

POPULATION IMAGING 

A. van der Lugt, M. Vernooij, M. Smits, W. Niessen, 

G.P. Krestin 

Introductie: Beeldvormende technieken worden in toenemende 

mate gebruikt in epidemiologische studies. 

Het gaat hier niet meer alleen om de relatief goedkopere 

technieken zoals conventionele Röntgenonderzoeken of 

echografie, maar ook om state-of-the-art CT en MRI. In 

grote populatiestudies met langdurige follow-up wordt 

onderzoek gedaan naar 1) determinanten van ziekten, 

gericht op 1a) inzicht in de pathofysiologie van ziekte en 1b) 

de mogelijkheid tot preventie door middel van interventie; 

2) vroegtijdige detectie van ziekte; 3) vaststellen van hoog 

risico groepen. 

Gezien het jarenlange subklinische beloop van ziekten 

zoals aderverkalking en neurodegeneratieve afwijkingen 

(dementie) waarvan de afwijkingen (mogelijk) al vroeg in 

het ziekte proces zichtbaar te maken zijn, kan beeldvorming 

een belangrijke rol spelen in deze onderzoeksprogramma’s. 

Beeldvorming en met name seriële beeldvorming kan surrogaat 

eindpunten leveren voor ziekte waardoor het onderzoek 

naar determinanten kan verbeteren en meer inzicht 

kan worden verkregen in de pathofysiologie van ziekte. 

Beeldvorming kan bijdrage aan vroege detectie van ziekte 

waardoor een tijdige interventie ook binnen handbereik 

komt. 

Project: De afdeling Radiologie van het Erasmus MC 

is partner in twee grote lopende populatie studies: de 

Rotterdam Studie en Generation R. In beide studies wordt 

(seriële) MRI verricht bij alle deelnemers in de studie 

(>1000). Het onderzoek richt zich op hersenen, bloedvaten, 

hart en skelet. In de presentatie wordt aangegeven wat 

de meerwaarde is van de radiologische bijdrage in het 

beantwoorden van de studie vraagstellingen. Tevens wordt 

ingegaan op de specifieke radiologische problemen zoals 

kwaliteitscontrole, dataopslag, data analyse en toevalsbevindingen. 

Bijzonder: Beeldvorming in populatie studies heeft een 

andere oogpunt dan de klinische radiologie waarbij men 

gericht is op het oplossen van een specifiek klinisch probleem 

en de radioloog met een differentiaal diagnose een 

bijdrage levert aan de zorg van de individuele patiënt. In 

populaties studies gaat het om grote aantallen deelnemers 

waarbij voornamelijk wordt gekeken naar “normale afwijkingen” 

die geleidelijk optreden bij veroudering en waarbij 

afwijking van de norm relevant is. Grote datasets zijn 

nodig voor het vaststellen van determinanten (waaronder 

genetische variaties) en het voorspellen van ziekte. (Semi)- 

automatische kwantitatieve evaluatie van afwijkingen is 

noodzakelijk gezien de omvang van de datasets en de subtiliteit 

van de afwijkingen. 

Perspectief: Door de inbreng van de radiologie worden de 

nieuwste technieken direct toegepast in wetenschappelijk 

onderzoek. Andersom kan de klinische radiologie leren van 

de manier waarop consistente data acquisitie plaats vindt, 

wat het belang is van standaardisatie en kwantificatie 

van data. Ontwikkelde kwantificatiesoftware kan gebruikt 

worden in de kliniek. Tot slot verschaffen deze studies normaal 

waarden waartegen klinische pathologie kan worden 

uitgezet. 

14 



RC 

research naam corner sessie 1 

UMC Groningen 

SCREENING FOR CORONARY ARTERY 

DISEASE BY NON-INVASIVE IMAGING 

IN PATIENTS WITH KNOWN EXTRA- 

CARDIAC ATHEROSCLEROTIC DISEASE: THE 

GROUND-2 STUDY 

R. Vliegenthart 1 , M. Oudkerk 1 , M.A.M. Dekker 1 , 

J.J.A.M. van den Dungen 2 , R.A. Tio 3 , W.P.Th.M. Mali 4 , 

M.M.J.J.R. Jaspers 5 

1 

Center for Medical Imaging – North East Netherlands 

(CMINEN), Dept of Radiology, University Medical Center 

Groningen/University of Groningen, Groningen 

2 

Dept of Surgery, University Medical Center Groningen/ 

University of Groningen, Groningen 

3 

Dept of Cardiology, University Medical Center Groningen/ 

University of Groningen, Groningen 

4 

Dept of Radiology, University Medical Center Utrecht, 

Utrecht 

5 

Dept of Radiology, Deventer Hospital, Deventer 

Patients with extra-cardiac atherosclerosis, like claudication, 

carotid stenosis or aortic aneurysm, have an increased risk 

of coronary heart disease. The purpose of the GROUND-2 

study is to non-invasively evaluate the presence of asymptomatic 

coronary artery disease (CAD) by CT calcium scoring, 

coronary CT angiography (CTA) and adenosine perfusion cardiac 

magnetic resonance imaging (APMR) in case of known 

extra-cardiac atherosclerosis. 

This study is designed as a prospective multicenter study. 

Patients aged 50 and over, diagnosed with extra-coronary 

atherosclerosis, either stenotic or aneurysmatic, are eligible 

to participate. Exclusion criteria are a history of symptomatic 

cardiac disease, severe arterial hypertension and contraindications 

to the used imaging modalities. All patients will 

non-contrast CT scanning to evaluate the coronary calcium 

score. In case of a zero calcium score, patients will be followed. 

In all other cases, CTA will be performed to evaluate 

the coronary arteries for significant stenoses. In case of a 

calcium score above 1000, the CTA is bypassed. 

Next, APMR will be used to assess perfusion defects of the 

myocardium. If there is a left main stenosis or equivalent on 

CTA or a perfusion defect on APMR, the patient will be referred 

to a cardiologist for further evaluation and treatment. 

All patients will be followed for 5 years for the occurrence 

of events. 

In this multicenter study, at least 1030 patients will be 

included. Inclusion has started in December 2009. This study 

will provide insight into the prevalence of silent severe 

CAD, detected by non-invasive cardiac imaging, in patients 

with known extra-cardiac atherosclerosis. Radiological 

screening for asymptomatic CAD may improve survival in 

these patients. Preliminary results indicate that significant 

coronary atherosclerosis is prevalent in patient with known 

extracoronary atherosclerosis. 

VUMC 

PSEUDO-CONTINUOUS ARTERIAL SPIN 

LABELING AT 3T IN ALZHEIMER’S DISEASE - 

INITIAL EXPERIENCE IN A MEMORY CLINIC 

M.A.A. Binnewijzend, J.P.A. Kuijer, M.R. Benedictus, 

P.J. Visser, W.M. van der Flier, M.P. Wattjes, P. Scheltens, 

F.A. Barkhof 

3D pseudo-continuous arterial spin labeling (PCASL) is a 

non-invasive scan technique that measures cerebral blood 

flow (CBF). We aimed to compare CBF of subjects with 

Alzheimer’s disease (AD), mild cognitive impairment (MCI) 

and subjective memory complaints (SMC). 

MRI scans, including MPRAGE and 3D-PCASL (post-label 

delay 2.0s, 3D-FSE, TR=4.8s, TE=4.7ms, spiral readout 8 

arms x 512 samples; 36x5.0mm axial slices; total scan time 

4min) were acquired on a 3T GE HDxt scanner in 76 consecutive 

subjects (33 AD, 15 MCI, 28 SMC) that visited our 

memory clinic. Partial volume estimates were obtained from 

MPRAGE images (using the FAST algorithm, part of FSL) to 

create CBF maps corrected for partial volume effects. Gray 

matter (GM) CBF-values were compared using analyses-ofvariance. 

Correlations with cognition (MMSE-scores) and 

vascular white matter lesions (WML) were investigated 

using linear regression analyses, correcting for age and 

gender. 

Four subjects (1 AD, 2 MCI, 1 SMC) were excluded from 

further analyses because of poor scan quality. Compared 

to SMC subjects, GM-CBF was decreased in both MCI 

(43±7 vs. 50±8 ml/100g/min; p

RC 

programma abstracts & abstracts 

Figure 1: Whole brain CBF map. 

Figure 2: Partial volume corrected gray matter CBF map. 

Figure 3: Boxplot of gray matter CBF in SMC, MCI and AD. 

UMC St Radboud 

MR GESTUURDE PROSTAAT INTERVENTIES; 

KLAAR VOOR DE PRAKTIJK? 

J.J. Fütterer 

Next to digital rectal examination and PSA level, biopsy of 

the prostate is an essential procedure for determining optimal 

treatment. Systematic TRUSBx is the gold standard, but 

it fails to detect numerous tumors. This systematic approach 

is characterized by low sensitivity (39–52%) and high specificity 

(81–82%). 

Using diagnostic MRimages during an MR-directed biopsy 

procedure improves quality of the biopsy. In open MR scanners, 

the prebiopsy MR images often must be registered to 

the real-time biopsy images because open MR scanners do 

not provide optimal tissue contrast; thus, the patient must 

first be examined in a closed MR scanner and then biopsied 

in an open scanner. The advantage of open MR over closed 

MR is that the physician has easy patient access. Closed 

MR scanners can be used for the prebiopsy scan as well as 

for the biopsy procedure. Because operating room is limited 

within the closed MR scanner, manipulators are used to perform 

the biopsy. The MR detection rates after one negative 

biopsy round using MR-guided biopsy ranges between 38% 

and 55.5%. 

The clinical value of MR-guided prostate biopsy lies in 

the fact that a high percentage of prostate cancers can be 

depicted using an targeted biopsy technique, eliminating 

unnecessary systematic prostate biopsies for patients with 

elevated PSA levels and repeated tumor-negative TRUSBx. 

Extensive clinical studies are still essential to review the 

value of MR-guided biopsy. One of the largest challenges 

in taking biopsiesof the prostate is the correction for movements 

of the prostate tissue during the biopsy procedure. 

In conclusion the combination of a diagnostic MR examination 

and MR-guided biopsy is a promising tool and may be 

used in patients with previous negative TRUSBx. 

MUMC 

WAIT AND SEE IN RECTAL CANCER 

PATIENTS: SELECTION BY IMAGING AND 

OUTCOME 

M. Maas, R.G.H. Beets-Tan 

Locally advanced rectal cancer is treated with neoadjuvant 

chemoradiation. In approximately 20% of the patients the 

tumor and the involved lymph nodes disappear or become 

sterilized due to this chemoradiation: a complete response. 

With a combination of T2-weighted MRI, diffusion-weighted 

MRI, gadofosveset-enhanced MRI and endoscopy these 

patients can be selected for a ‘wait-and-see policy’, in which 

surgery is omitted and patients undergo intensive follow-up. 

Maastricht University Medical Centre is the only Dutch 

centre that currently performs a study to evaluate this waitand-see 

policy with MRI-based selection and follow-up. The 

preliminary results are very encouraging and for the future 

we expect to be able to offer this wait-and-see policy safely 

to complete responders after neoadjuvant chemoradiation. 

16 



esearch naam corner sessie 

RC 

AMC 

NEUROTRANSMITTERS IN DE MRI 

L. Reneman 

Kinderen krijgen steeds vaker medicijnen voorgeschreven, 

terwijl niet duidelijk is òf en hoe dit hun hersenontwikkeling 

beïnvloedt. Onderzoek is er nauwelijks. Niet naar de 

bijwerkingen en zelfs niet naar de effectiviteit. Toch stijgt het 

gebruik fors, want ze kunnen er baat bij hebben. Er is weinig 

bekend over bijwerkingen bij kinderen omdat deze medicijnen 

altijd zijn getest in volwassen dieren en mensen. Het meerendeel 

van de medicijnen dat wordt voorgeschreven is zelfs 

niet geregistreerd voor gebruik in kinderen. Ze worden off 

label en off license voorgeschreven. Uit proefdieronderzoek 

weten we dat medicijnen de ontwikkeling van het brein langdurig 

kunnen beïnvloeden en daardoor een tegenovergesteld 

effect kunnen hebben van wat je zou verwachten. Onderzoek 

naar eventuele bijwerkingen van medicijnen bij kinderen is 

vooral belangrijk voor geneesmiddelen die hun invloed uitoefenen 

op de hersenen, zoals middelen tegen depressie en 

ADHD. Want niet alleen wijkt de stofwisseling van kinderen 

af van dan die van volwassenen, hun brein is nog in ontwikkeling 

tot aan de jong volwassenheid. Medicijnen zouden die 

ontwikkeling kunnen verstoren. In Nederland hebben 8.500 

kinderen in de leeftijd van 0 t/m 20 jaar in de eerste helft van 

2008 een antidepressivum via de apotheek gekregen. Echter, 

de sterkste stijging de afgelopen tien jaar zijn medicijnen 

voor attention deficit hyperactivity disorder (ADHD). Werden 

in 2008 ongeveer 500.00 recepten uitgeschreven, was dit 

in 1999 nog maar 132.000 keer. De oorzaak van de forse 

stijging zijn de verbeterde diagnostiek en de steeds sterkere 

behoefte van ouders en artsen aan verlichting van klachten. 

De afdeling Radiologie van het AMC heeft door de jaren 

heen een sterke reputatie opgebouwd in het bestuderen 

van effecten van middelen (misbruik) op de hersenen. Zowel 

nationaal als internationaal vervult het AMC hierin een 

pioniersfunctie en wordt baanbrekend onderzoek verricht. 

In een groot multidisciplinair project onderzoeken we nu de 

zogeheten neurologische imprinting van geneesmiddelen. 

Bijvoorbeeld, rond 2004 kwamen aanwijzingen dat bij 

jongvolwassenen het percentage zelfmoordgevallen juist 

toenam onder invloed van serotonine heropname remmers 

(SSRIs), waardoor dit medicijn een tijdje gecontraindiceerd 

is geweest in deze populatie. Wij onderzoeken hoe dat komt 

en wat de werking is van andere geneesmiddelen op de 

hersenontwikkeling. Kleven er risico’s aan het gebruik op 

jonge leeftijd, of misschien juist onverwachte voordelen? 

We visualiseren de veranderingen die medicijnen kunnen 

aanbrengen in de hersenontwikkeling met behulp van farmacologsiche 

magnetic resonance imaging (phMRI). Hierbij 

kijken we vooral naar hersensystemen die werken op basis 

van de neurotransmitters serotonine - waarop medicijnen 

tegen depressie aangrijpen - en dopamine - voor medicijnen 

tegen ADHD. Ook kijken we naar het functioneren van de 

hersenen met behulp van neuropsychologisch onderzoek. 

Wij denken dat hoe jonger kinderen medicijnen krijgen, hoe 

meer ze ingrijpen op de normale uitrijping van de hersenen. 

Alle artsen willen het beste voor kinderen, maar dan moet 

wel duidelijk zijn of je meer goed dan kwaad doet. Ons 

onderzoek stelt artsen en ouders in staat de eventuele 

risico’s van bijwerkingen af te wegen tegen de voordelen 

van een medicamenteuze behandeling. 

UMC Utrecht 

MRI-GUIDED HIGH INTENSITY FOCUSED 

ULTRASOUND: THE FUTURE OF TUMOR 

ABLATION? 

M.A.A.J. van den Bosch 

MR-HIFU is an innovative, noninvasive tumor ablation technique. 

MR-imaging and focused ultrasound is combined allowing 

real-time anatomic guidance and temperature mapping 

during treatment. Recently, the volumetric ablation approach 

has been introduced in order to reduce treatment length and 

more homogenous tumor ablation. 

A MR-HIFU system has been installed at the department of 

Radiology UMC Utrecht in 2009. From the beginning a successful 

program for MR-HIFU treatment of uterine fibroids 

has been started. Currently one patient a week is treated in 

clinical practice, and a phase2 efficacy study is running. 

The first step for treatment of malignant tumors with 

MR-HIFU has been made in patients with painful bone 

metastases. Palliative treatment of painful bone metastases 

is applied in clinical practice since the beginning of this 

year. It is expected that besides bone, the first breast cancer 

patients will be treated in the beginning of 2012. 

Several issues need to be further investigated for successful 

cancer treatment with MR-HIFU, including patient selection 

criteria, definition of treatment margins and optimal 

transducer technology. For this we have a multidisciplinary 

MR-HIFU team in UMC Utrecht consisting of interventional 

radiologists, radiotherapists, physicists, postdocs and PhDstudents. 

1 6 E R A D I O L O G E N D A G E N - 2 9 e n 3 0 S E P T E M B E R 2 0 1 1 

17

1 programma Abstracts & abstracts 

Sessie 1 

Abdominale radiologie 1 


O1.1 

RESTAGING NODAL STATUS AFTER CHEMO- 

RADIATION FOR LOCALLY ADVANCED 

RECTAL CANCER: PREDICTIVE FACTORS 

M. Maas, D.M.J. Lambregts, M. Berkhof, G.L. Beets, 

R.G.H. Beets-Tan 


Purpose: Restaging N-stage after CRT for rectal cancer is 

more accurate than N-stage prediction at primary staging 

of rectal cancer. The aim was to identify predictive factors 

which can help a radiologist in predicting the yN-stage. 

Methods: 39 patients with locally advanced rectal cancer 

underwent MRI before and after CRT. All visible nodes in 

the mesorectum were measured and recorded before and 

after CRT on a 3DT1W GRE-sequence with 1mm3 voxels. 

Baseline characteristics were collected and compared between 

patients with and without nodal involvement at pathology 

with t-tests and χ2. With regression analyses predictive 

factors for nodal involvement after CRT were identified. 

Based on the regression analyses a predictive model for yNstage 

was constructed and ROC curves were constructed for 

this predictive model. 

Results: 895 nodes were identified, of which 392 (44%) 

disappeared after CRT. Patients with ypN+ had larger nodes 

than ypN0-patients: mean 6.3 vs 3.6mm before CRT and 4.5 

vs 2.3mm after CRT, respectively (both p

Abdominale radiologie 1 1 

MRI is used for EMR identification and thus for identification 

of patients who need CRT on the obturator areas, patients 

can be spared an extensive resection with associated morbidity. 

O1.3 

GADOFOSVESET-ENHANCED MRI FOR 

NODAL STAGING IN RECTAL CANCER: 

PREDICTIVE CRITERIA 

D.M.J. Lambregts, M. Maas, I.J.G. Rutten, W.H. Backes, 

R.G. Riedl, F.C.H. Bakers, V.C. Cappendijk, G.L. Beets, 

R.G.H. Beets-Tan 


Purpose: Recently, we showed that MRI using a new 

lymph-node contrast (gadofosveset) can significantly 

improve accuracy for staging of rectal cancer nodes. Aim 

of the present study was to determine the most accurate 

predictive imaging criteria for lymph node assessment using 

gadofosveset-MRI. 

On gadofosveset-MRI, SI was significantly higher in the 

benign nodes (p

1 

programma Abstracts & abstracts 

in 10 en respectievelijk 8 tumoren. Op MRI 3 tumoren op 

niveau omslagplooi: peroperatief 2 rectumtumoren en 1 

sigmoïdtumor. 

De PS-lijn heeft geen onderscheidend vermogen tussen rectum- 

en sigmoïdtumor. Ondanks de matige zichtbaarheid van 

de omslagplooi correleert MRI in 18 van de 23 tumoren met 

peroperatieve bevindingen. De afstand omslagplooi tot anus 

(MRI) benadert het 15cm-criterium (endoscopie). 

O1.5 

CHRONIC DIVERTICULITIS VERSUS 

COLORECTAL CANCER: FINDINGS ON CT 

COLONOGRAPHY 

S.E.H. Cremers 1 , S. Gryspeerdt 2 , P. Lefere 2 , S. Houterman 3 , 

G. Slooter 3 , M.L. Verhulst 3 , P.T.J. Cremers 3 

1 

Albert Schweitzer ziekenhuis, Dordrecht 

2 

Virtual Colonoscopy Teaching Centre (VCTC), Hooglede 

3 

Máxima Medisch Centrum, Veldhoven 

Purpose: In CT colonography chronic diverticulitis (CD) can 

mimic colorectal cancer (CRC) masses. In order to distinguish 

these two entities several findings were analysed. 

Methods: 525 symptomatic patients consecutively underwent 

CT colonography between June 2008 and February 

2011. All patients with pathologic confirmation of CD (13) 

and CRC (30) on surgical specimens were included. The 

images were analysed in retrospect by a consensus of 

two reviewers. Length of the mass, diverticula included in 

the mass, growth pattern, luminal narrowing, presence of 

perilesional lymph nodes and mesenteric fat stranding were 

evaluated. Statistical analysis was performed using Mann- 

Whitney and Chi-Square tests. 

Results: There was a significant difference in median 

length of the mass between CD and CRC, 100 and 49 mm 

respectively ( p


Figure 1: A) T1-weighted images (T1W) acquired before, 30 s and 60 s after contrast agent (CA) administration, obtained for a patient with 

rectal cancer during primary staging. Red line indicates the tumor boundaries. White arrows indicate different tissue components of the rectum. 

T2W tumor image is shown as an image inset (upper left). B) Average signal enhancement-time curves obtained for the tumor (black line), rectal 

muscle (red line), mucosa (green line) and mesorectal fat (blue line) in three patients. In patient 3, the delineation of ROIs in rectal muscle and 

mucosa was not possible. 

O1.7 

ASSESSMENT OF A COMPLETE RESPONSE 

OF RECTAL CANCER TO PREOPERATIVE 

CHEMORADIATION THERAPY: A 

COMPARISON BETWEEN MR VOLUMETRY 

AND DIFFUSION-WEIGHTED MRI 

D.M.J. Lambregts 1 , L. Curvo-Semedo 2 , M. Maas 1 , 

T. Thywissen 1 , G. Lammering 1 , G.L. Beets 1 , F. Caseiro-Alves 2 , 

R.G.H. Beets-Tan 1 

1 


2 

Radiology University Clinic, Coimbra University Hospital, 

Coimbra, Portugal 

Purpose: To determine the performance of diffusion-weighted 

MRI (DWI) in assessing a complete tumor response (CR) after 

chemoradiation (CRT) in patients with locally advanced rectal 

cancer (LARC) by means of [1] volumetric signal intensity and 

[2] apparent diffusion coefficient (ADC) measurements, and to 

compare its performance with volumetry on T2W-MRI. 

Methods: Fifty LARC patients underwent standard T2W-FSE 

and DWI (b0,500,1000) pre- and post-CRT. Two independent 

readers retrospectively placed free-hand ROIs in each tumorslice 

on both datasets to determine pre-CRT and post-CRT 

tumor volumes and the tumor volume reduction (∆volume). 

ROIs were copied to an ADC-map to calculate mean tumor 

ADCs. Histology (ypT0) was the standard reference. ROCcurves 

were generated to compare the performance of T2Wvolumetry, 

DWI-volumetry and ADC in assessing a CR. The 

intraclass correlation coefficient (ICC) was used to evaluate 

interobserver variability and the correlation between T2Wvolumetry 

and DWI-volumetry. 

Results: Areas under the ROC-curve (AUC) for identification 

of a CR based on pre-volume / post-volume / ∆volume were 

0.57 / 0.70 / 0.84 for T2W-volumetry versus 0.63 / 0.93 / 0.92 

for DWI-volumetry (p=0.15 / 0.02 / 0.42). For ADC, AUCs were 

0.55, 0.54 and 0.51. Interobserver agreement was excellent for 

all pre-CRT measurements (ICC 0.91-0.96) versus good (0.61- 

0.79) post-CRT. The ICC between T2W- and DWI-volumetry 

was excellent (0.97) pre-CRT versus fair (0.25) post-CRT. 

Conclusion: Post-CRT DWI-volumetry provided a high diagnostic 

performance is assessing a CR and was significantly 

more accurate than T2W-volumetry. Post-CRT DWI was 

equally accurate as ∆volume of both T2W-MRI and DWI. Pretreatment 

volumetry and ADC were not reliable. 


1 

programma Abstracts & abstracts 

Figure 1: ROC-curves for assessment of a CR. 

O1.8 

WHOLE-BODY MRI, INCLUDING DIFFUSION- 

WEIGHTED IMAGING, FOR STAGING NEWLY 

DIAGNOSED LYMPHOMA: COMPARISON 

TO COMPUTED TOMOGRAPHY IN 101 

PATIENTS 

T.C. Kwee 1 , M.A. Vermoolen 1 , E.M. Akkerman 2 , 

M.J. Kersten 2 , R. Fijnheer 3 , I. Ludwig 1 , F.J. Beek 1 , 

M.S. van Leeuwen 1 , M.B. Bierings 1 , J. Zsiros 2 , 

H.M.E. Quarles van Ufford 1 , J.M.H. de Klerk 3 , J. Adam 2 , 

J. Stoker 2 , C.S.P. Uiterwaal 1 , R.A.J. Nievelstein 1 

1 


2 


3 


Purpose: To compare whole-body magnetic resonance 

imaging (MRI), including diffusion-weighted imaging (DWI), 

to computed tomography (CT) for staging newly diagnosed 

lymphoma. 

30.7% (31/101), and lower in 4.0% (4/101) of patients, with 

correct/incorrect/unresolved overstaging and incorrect/ 

unresolved understaging relative to CT in 13/12/6 and 3/1 

patient(s), respectively. Staging results of whole-body MRI 

with DWI were equal to those of CT in 62.5% (60/96), 

higher in 32.3% (31/96), and lower in 5.2% (5/96) of 

patients, with correct/incorrect/unresolved overstaging and 

incorrect/unresolved understaging relative to CT in 18/10/3 

and 4/1 patient(s), respectively. 

Conclusion: Staging of newly diagnosed lymphoma using 

whole-body MRI (without and with DWI) equals staging 

using CT in the majority of patients. Disagreements between 

whole-body MRI and CT are mostly caused by overstaging of 

the former relative to the latter, with the number of correctly 

and incorrectly overstaged cases being approximately equal. 

The potential advantage of DWI is still unproven. 

Materials and methods: One hundred and one consecutive 

patients with newly diagnosed lymphoma prospectively 

underwent whole-body MRI (T1-weighted and T2-weighted 

short inversion time inversion recovery [n=101], and DWI 

[n=96]) and CT. Ann Arbor stages were assigned according 

to whole-body MRI and CT findings. Disagreements in 

staging between whole-body MRI (without and with DWI) 

and CT were resolved using bone marrow biopsy, 18F-fluoro- 

2-deoxyglucose positron emission tomography (FDG-PET), 

and follow-up FDG-PET, CT, and whole-body MRI studies as 

reference standard. 

Results: Staging results of whole-body MRI without DWI 

were equal to those of CT in 65.4% (66/101), higher in 

22 



Sessie 2 

Abdominale radiologie/ 

Acute radiologie/Diversen 

2 




O2.1 

DYNAMIC CONTRAST ENHANCED MRI FOR 

THE EVALUATION OF PERIANAL FISTULAS 

IN PATIENTS WITH CROHN’S DISEASE 

M.L.W. Ziech, C. Lavini, C.Y. Ponsioen, M.W.A. Caan, 

S. Bipat, A.M. Spijkerboer, P. Stokkers, A.J. Nederveen, 

J. Stoker 


Purpose: To determine if dynamic contrast enhanced MRI 

(DCE-MRI) can evaluate disease activity in patients with 

perianal fistulizing Crohn’s disease. 

Methods and materials: Patients with perianal fistulizing 

Crohn’s disease, underwent DCE-MRI. The van Assche 

MRI-based score and perianal disease activity index (PDAI) 

were determined. Transversal DCE-MRI was performed at 3T 

during intravenous contrast injection (TE 2.3, TR 5.1, FA 30, 

15 slices, total duration of dynamic scan 5.05 min, 70 scans 

per slice, temporal resolution 4.2 sec per volume). 

The qualitative parameters Maximum Enhancement (ME), 

slope of the enhancement curve (SoE) and curve shape type 

(as by Lavini et al), as well as the quantitative parameters 

Ktrans, Vep, Kep as in the Tofts model were calculated 

(using a measured arterial input function) on a pixel by pixel 

basis, and then averaged of over an ROI drawn around the 

fistula. Spearman correlations between DCE-MRI parameters 

and PDAI and MRI-based score were calculated. 

Results: Sixteen patients (7 males) were included, mean 

age 37 (range 18-63). PDAI correlated with ME (r=0.669, 

p=0.005), SoE (r=0.582, p=0.018), ROI volume (r=0.786, 

p

2 


Figure 1 

Figure 2 

O2.3 

MRI FEATURES ASSOCIATED WITH ACUTE 

APPENDICITIS 

M.M.N. Leeuwenburgh 1 , B.M. Wiarda 2 , A. Spilt 3 , 

P.M.M. Bossuyt 1 , M.A. Boermeester 1 , J. Stoker 1 , OPTIMAP 

Studiegroep 

1 


2 

Medisch Centrum Alkmaar, Alkmaar 

3 

Kennemer Gasthuis, Haarlem 

Purpose: To identify MRI features associated with appendicitis. 

Methods: Signs expected to be associated with appendicitis 

were recorded by two expert radiologists in 223 abdominal 

MRI scans of patients with suspected appendicitis 

(HASTE, HASTE SPAIR, DWI). The investigated features 

were: 

(1) Diameter >6mm; 

(2) Appendicolith; 

(3) Peri-appendiceal fat infiltration; 

(4) Peri-appendiceal fluid; 

(5) Absence of gas in the appendix; 

(6) Destruction of the appendiceal wall structure; 

(7) Restricted diffusion of the appendiceal wall; 

(8) Restricted diffusion of the appendiceal lumen; 

(9) Restricted diffusion of focal fluid collections 

An expert panel assigned acute appendicitis as final diagnosis 

in 117 of 223 patients based on histopathology and 

follow-up after 3 months. Associations between imaging 

features and appendicitis were evaluated with multivariable 

logistic regression analysis. 

Results: In 210 of 223 scans the appendix could be visualised. 

All 9 investigated MRI features were significantly 

associated with appendicitis in univariate analysis. Presence 

of two of these features had a probability of appendicitis 

between 85%(95%CI: 78-91%) and 100%(95%CI: 86-100%). 

If no features were identified in the MRI appendicitis was 

present in 0%(95%CI: 0%-8%) of patients. In multivariable 

Table 1 

24 





2 

analysis only peri-appendiceal fat infiltration and restricted 

diffusion of the appendiceal wall had a significant association 

with appendicitis. The probability of appendicitis was 

96%(95%CI: 90-98%) in presence of both features, and 

5%(95%CI: 2-11%) in their absence. 

Conclusion: In MRI, peri-appendiceal fat infiltration and 

restricted diffusion of the appendiceal wall are strongly 

associated with appendicitis. Presence of both features in a 

MRI examination leads to a high probability of appendicitis, 

whereas their absence almost rules appendicitis out. 

O2.4 

OPTIMAL STRATEGY IN PATIENTS WITH 

SUSPECTED ACUTE APPENDICITIS, CAN MRI 

REPLACE CT? 

M.M.N. Leeuwenburgh 1 , H.W. van Es 2 , J.W.C. Gratama 3 , 

P.M.M. Bossuyt 1 , M.A. Boermeester 1 , J. Stoker 1 , OPTIMAP 

Studiegroep 

1 


2 

St. Antonius Ziekenhuis, Nieuwegein 

3 

Gelre ziekenhuizen, Apeldoorn 

Purpose: To identify the optimal imaging strategy in adult 

patients with suspected appendicitis. 

Methods: We included consecutive patients with suspected 

appendicitis in six hospitals. Patients underwent initial 

US, followed by CT in case of non-diagnostic US results. 

Additionally, all patients underwent MRI (HASTE, HASTE 

SPAIR, DWI), with the MRI reader blinded for the results of 

the other imaging methods. An expert panel assigned a final 

diagnosis based on histopathology and clinical follow up 

after 3 months. We evaluated the sensitivity and specificity 

of the following scenarios: (1) US only;(2) US in all patients 

followed by CT after a non-diagnostic US;(3) US followed by 

MRI after a non-diagnostic US;(4) MRI only. 

Results: We performed 229 US, 126 CT and 223 MRI examinations 

in 230 patients (mean age 38 years, 41% male). 

Acute appendicitis was assigned as final diagnosis in 118 

patients (51%). Sensitivity of US only was 0.76(95%CI: 

0.68-0.83); specificity 0.94(95%CI: 0.88-0.97). Conditional 

imaging strategies with CT or MR after a non-diagnostic US 

resulted in a significantly increased sensitivity (p

2 


O2.5 

IS TRAUMA SIMULATIE NUTTIG BIJ 

TRAINING VAN RADIOLOGEN IN 

OPLEIDING? 

M.M.A.C. van Doorn, L.F.M. Beenen 


Doelstelling: Evalueren van het effect van simulatie van 

polytrauma Total Body CT scans. 

Achtergrond: In grote traumacentra kan het voorkomen dat 

er meerdere traumata tegelijk moeten worden opgevangen. 

Van al deze patiënten wordt beeldvorming verricht, waarbij 

er steeds vaker een Total Body CT scan (TBCT) wordt uitgevoerd. 

Dit genereert een grote druk bij arts-assistenten, 

die in korte tijd uit >1000 beelden per patiënt, allereerst de 

klinisch meest relevante afwijkingen moeten vaststellen. 

Beschrijving: In een prospectieve setting zijn 3 simulaties 

uitgevoerd. Per simulatie werd een groot ongeval aangekondigd 

met betrokkenheid van 5 slachtoffers, waarbij om de 

10 minuten een TBCT scan werd vervaardigd. Elke arts-assistent 

kreeg de uitdrukkelijke opdracht binnen 10 minuten de 

levensbedreigende letsels op te sporen. De dataset betrof 

alleen axiale coupes, reconstructies konden naar eigen 

inzicht worden uitgevoerd op het PACS-station. De simulatie 

is 3 maal herhaald, met enkele maanden tussenpoos. 

Bij de eerste simulatie werd een blanco invulformulier 

gebruikt, bij de tweede en derde simulatie een checklist. 

Een Likert-scale van 5 werd gebruikt als confidence-score. 

Een webbased-enquête werd opgesteld om achteraf de 

ervaringen te evalueren. 

Resultaten: 19 van de 31 arts-assistenten hebben minimaal 

2 simulaties meegedaan. 

Het merendeel van de arts-assistenten vindt de simulatie 

reëel met betrekking tot tijdsdruk (20/23) en pathologie 

(23/23), en goede voorbereiding op een ramp(21/22). Bij 

8/19 van de arts-assistenten is er een toename van de 

confidence-score. 

Conclusie: Simulatie is een eenvoudige methode, die het 

vertrouwen van arts-assistenten zowel objectief als subjectief 

vergroot. 

Met behulp van een checklist verloopt de beoordeling meer 

gestructureerd. 

O2.6 

SIMULTANE INTRODUCTIE VAN EEN 

NIEUWE PREVENTIE RICHTLIJN VOOR 

CONTRASTNEFROPATHIE IN COMBINATIE 

MET EEN AANGEPAST RADIOLOGISCH 

AANVRAAGFORMULIER: 1 JAAR ERVARING 

H.M. Dekker 


Doel: De evaluatie van de toepassing van een aangepast 

radiologisch aanvraagformulier. 

Methoden: Ziekenhuisbreed is een nieuwe richtlijn 

geïntroduceerd om contrastnefropathie(CN) te voorkomen. 

Deze richtlijn adviseert om bij alle patiënten de 

serumcreatinineconcentratie te bepalen en de eGFR te 

schatten met de MDRD formule en om patiënten met hoog 

risico te identificeren en voorzorgsmaatregelen te nemen. 

Hoog-risicopatiënten zijn gedefinieerd als eGFR1 risicofactor (risicofactoren: hartfalen, perifeer 

vaatlijden, dehydratie, >75 jaar, anemie, symptomatische 

hypotensie, >150 ml contrastmiddel, nefrotoxische 

medicatie) of ziekte van Kahler/Waldenström met lichte 

ketens in de urine. Op het aangepaste aanvraagformulier 

dienen de MDRD en risicofactoren verplicht te worden aangegeven. 

Hoog-risicopatiënten werden verwezen naar een 

CN-polikliniek. Gedurende 1 jaar werden gegevens 

verzameld van alle poliklinisch geplande urologische patiënten 

van ≥18 jaar, gepland voor CT met iv contrast. 

Resultaten: Er waren 622 patiënten, met een gemiddelde 

leeftijd van 56 jaar. Bij 99% was een serumcreatinineconcentratie 

bekend. In 23% was de eGFR



2 

O2.7 

MR EVALUATION OF URETHRAL 

DIVERTICULA AND DIFFERENTIAL 

DIAGNOSIS IN SYMPTOMATIC FEMALE 

PATIENTS 

S.I. Verschuuren, R.S. Dwarkasing, W. Dinkelaar, W.C.J. Hop, 

G.R. Dohle, G.P. Krestin 


Objective: The purpose of this study was to evaluate the 

role of MRI in the diagnosis and differential diagnosis of 

urethral diverticula (UD) in symptomatic female patients. 

Materials and methods: Female patients referred for MRI 

at a single institution with suspicion of UD were included 

retrospectively. All MRI examinations were independently 

evaluated by two radiologists and compared with patients’ 

follow-up data. Sensitivity and specificity of MRI for UD was 

calculated using surgery and clinical confirmation as the 

reference standard. Image quality of the urethra and 

periurethral region performed with the endoluminal coil was 

compared with the pelvic phased array coil. 

Results: From a study group of 60 patients (mean age, 44 

years), 20 patients (33 %) had UD, 28 (47 %) had an alternative 

diagnosis, of which 13 (46 %) were demonstrated with 

MRI. In the remaining 12 patients (20 %) no abnormalities 

were found. For UD, MRI had a sensitivity and specificity of 

both 100 %. Twenty patients had a total of 27 diverticula; 

these were mostly locally round (n=12) with sharp margins 

(n=25) and high (n=19), homogeneous (n=16) signal intensity 

on T2- weighted sequences. The ostium of UD was identified 

in 23 (85 %) diverticula by both readers. Agreement was 

93 % with a kappa value of 0.72. Endoluminal coil in the 

vagina demonstrated the best image quality of the urethra 

and periurethral region. 

Conclusion: Dedicated MRI is an excellent imaging 

modality for UD, furthermore, MRI will show the alternative 

diagnosis in almost half of the remaining patients. 

O2.8 

WAARDE VAN METOCLOPRAMIDE BIJ MRI 

ENTEROGRAFIE 

U.C. Lalji 


Vraagstelling: Is metoclopramide nuttig bij MR-enterografie voor 

het diagnostiseren van Crohn met betrekking tot darmdistentie. 

maag of beoordeelbaarheid van het onderzoek. 

Metoclopramide interfereerde niet met de acquisitie van de beelden 

na toediening van buscopan. 

Discussie: Metoclopramide lijkt geen toegevoegde waarde te 

hebben bij MR-enterografie. 

Methode: In de periode van 1 mei 2010 tot 30 juni 2010 

werden 24 patienten geincludeerd met de vraagstelling Crohn. 

Hiervoor ondergingen ze een MRI van de dunne darm volgens 

ons MR-enterografie protocol waarbij er 1 liter water met hierin 

opgelost metamucil 1 uur voor het onderzoek moest worden 

gedronken. Van deze 24 patienten kregen 10 patiënten 3 uur voor 

aanvang van het onderzoek 10 mg metoclopramide per os. Ook 

moesten zij een vragenlijst invullen m.b.t. bijwerkingen en vragen 

over het onderzoek zelf. 

De overige 14 patiënten kregen geen metoclopramide maar volgden 

wel de rest van het protocol. 

2 abdominale radiologen scoorden de onderzoeken op de volgende 

punten: 

Distentie proximale dunne darm, distentie distale dunne darm, 

distensie terminale ilium, maagresidu en beoordeelbaarheid 

onderzoek. 

De radiologen waren hierbij niet op de hoogte welke patiënten 

metoclopramide hadden gekregen. 

Resultaten: De onderzoeken waren over het algemeen goed te 

beoordelen. Vergeleken met de groep zonder metoclopramide liet 

de groep met metoclopramide geen significante verschillen zien in 

mate van distentie van de delen van de dunne darm, residu in de 


27

3 programma abstracts & abstracts 

Sessie 3 

Cardiovasculaire radiologie 


O3.1 

DIAGNOSTIC ACCURACY OF COMPUTED 

TOMOGRAPHY CORONARY ANGIOGRAPHY 

(CTCA) IN WOMEN WITH LOW, 

INTERMEDIATE AND HIGH RISK FOR 

CORONARY ARTERY DISEASE (CAD) 

A.S. Dharampal, A. Rossi, A.C. Weustink, L. Neefjes, 

K. Nieman, N.R.A. Mollet, E.H. Boersma, G.P. Krestin, 

P.J. de Feyter 


Purpose: To determine the diagnostic accuracy of CTCA 

in women with low, intermediate and high risk of having 

significant CAD. 

Materials and methods: Retrospective study including 

symptomatic women without prior history of coronary 

revascularization who underwent both CTCA and invasive 

coronary angiography between 2004 and 2009. The pre-test 

probability for significant CAD was estimated using the 

Duke Clinical Score and were grouped in low (≤20%), intermediate 

(21-80%), and high risk (≥81% probability) groups. 

The diagnostic accuracy of CTCA to detect significant CAD 

(≥50% lumen diameter narrowing) was assessed in the dif 

ferent risk groups on a per patient level. 

Results: Two-hundred-and-seventy-five women were included 

and stratified in low (n=50), intermediate (n=183) and 

high (n=42) risk group. The pre-test probability in the low, 

intermediate and high risk groups were 12%, 49% and 89% 

with a prevalence of 38%, 66%, and 83%, respectively. 

In the low risk group the sensitivity, specificity, PPV and NPV 

were 100%(95%CI: 83-100%), 74%(57-86%), 70%(52-84%) 

and 100%(85-100%). 

In the intermediate risk group the sensitivity, specificity, PPV 

and NPV were 98%(94-100%), 78%(66-86%), 89%(83-94%) 

and 96%(87-99%). 

In the high risk group the sensitivity, specificity, PPV and 

NPV were 100%(90-100%), 57%(25-84%), 92%(81-97%) 

and 100%(51-100%). 

Conclusion: The prevalence of CAD in women is underestimated 

in low and intermediate risk groups. 

CTCA can accurately rule out significant CAD in women with 

all risk groups. 

The post-test probability for detecting significant CAD is not 

depended on the pre-test probability of disease. 

O3.2 

ANALYSIS OF AORTIC VALVE ANNULUS 

PULSATILE DISTENSION IN PATIENTS 

WITHOUT AORTIC VALVE DISEASE BY 

ECG-GATED MULTISLICE COMPUTED 

TOMOGRAPHY (MSCT) 

L.M. de Heer, L.W. Bartels, L.A. van Herwerden, 

W.P.Th.M. Mali, K.L. Vincken, J. van Prehn, J. Kluin, 

R.P.J. Budde 


Objective: A key element of successful transcatheter 

aortic valve (AV) implantation is adequate prosthesis sizing. 

Cardiac output and aortic compliance result in aortic shape 

changes throughout the cardiac cycle. This may result in 

inadequate prosthesis sizing. To understand the dynamic 

changes in stenotic AV, the healthy aorta has to be studied 

first. We assessed the dynamic changes of the AV annulus 

using ECG-gated MSCT. 

Methods: Fifteen patients without AV disease who had 

undergone cardiac MSCT were identified. 3D datasets were 

reconstructed at each 10% of the ECG-interval. Per phase a 

cross-section in-plane with the AV annulus was reconstructed. 

The annulus area was segmented and analysed using 

in-home developed software (Dynamix, ISI) (figure). Radius 

changes were measured over 360 degrees from the center 

of mass per phase and plotted. The complete annulus shape 

change in all directions was depicted by fitting an ellipse 

over the data obtained in 360 degrees and described by 

radius changes over the major and minor axis. The asymmetry 

ratio was calculated by dividing the major by the minor 

axis. In addition area change was determined. 

28 



Cardiovasculaire radiologie 3 

Results: In all patients distension of the AV annulus was 

asymmetric (ratio 1.3±0.2). Diameter and area changes 

were significant in all patients. Mean diameter change was 

20±4%. Mean area change was 28±7%. 

Conclusions: The healthy AV annulus diameter and area 

show over 20% change during the cardiac cycle and these 

changes are asymmetrical. Quantification of dynamic morphological 

changes may aid prosthesis sizing and it may 

have implications for ultimate clinical success. 

Figure 1: Aortic segmentation (pink) by thresholding 

O3.3 

DIAGNOSTIC PERFORMANCE OF 128- 

SLICE DUAL SOURCE CT CORONARY 

ANGIOGRAPHY IN PATIENTS WITH 

VARIOUS HEART RATES USING 3 DIFFERENT 

SCAN PROTOCOLS: A RANDOMIZED STUDY 

L.A. Neefjes, A. Rossi, A.S. Dharampal, K. Nieman, 

A.C. Weustink, P.J. de Feyter, G.P. Krestin, N.R. Mollet 


Purpose: To compare radiation dose and diagnostic performance 

of 3 CT coronary angiography (CTCA) protocols using 

a 128-slice Dual Source CT scanner (Siemens): a prospective 

high pitch spiral (HPS), a prospective step-and-shoot (SAS), 

and a retrospective (RS) scan protocol. 

Materials and methods: We prospectively included 459 

symptomatic patients with a regular heart rate (HR). Patients 

with a pre-scan HR

3 


on a 64 detector-row scanner. Diastolic and systolic images 

were reconstructed with FBP (high and low-dose) and the 

IR algorithm (low-dose only). Hypo- and hyperdense artifact 

volumes were determined using two threshold filters (≤-50 

HU and ≥175 HU, respectively). Image noise was measured. 

Results: Mean image noise was 16.3±1.6 HU (high-dose 

FBP), 23.2±2.3 HU (low-dose FBP) and 16.5±1.7 (low-dose 

IR). Low-dose IR reconstructions had similar image noise 

compared to high-dose FBP (16.5±1.7 vs. 16.3±1.6, mean 

± SD). Mean hypo- and hyperdense artifact volumes (mm 3 ) 

were 1235/5346 (high-dose FBP); 2405/6877 (low-dose FBP) 

and 1218/5333 (low-dose IR). For all PHV types, hypodense 

and hyperdense artifact volumes were similar for the highdose 

scans reconstructed with FBP when compared to lowdose 

scans reconstructed with IR. 

Conclusion: Iterative reconstruction allows ECG-gated PHV 

imaging with similar image noise and PHV artifacts at 50% 

less dose compared to FBP in an in vitro pulsatile model. 

Figure 1 

O3.5 

RADIATION DOSE AND ARTIFACTS 

ARE REDUCED BY PROSPECTIVE ECG- 

TRIGGERING RELATIVE TO RETROSPECTIVE 

ECG-GATING FOR IMAGING OF PROSTHETIC 

HEART VALVES WITH 256-SLICE CTS 

P. Symersky 1 , J. Habets 2 , B.A.J.M. de Mol 1 , M. Prokop 3 , 

R.P.J. Budde 2 

1 


2 

Universitair Medisch Centrum, Utrecht 

3 

Radboud University Nijmegen Medical Center, Nijmegen 

Introduction: Multislice CT imaging has complementary 

diagnostic value in the evaluation of prosthetic heart valve 

(PHV) dysfunction. For PHV imaging, modified coronary protocols 

with retrospective ECG-gating have been used at 

considerable radiation exposure. We compared image noise, 

radiation dose and artifacts with prospective triggering to 

retrospective gating for PHV evaluation. 

Methods: Two mechanical PHVs (St Jude bileaflet and 

Medtronic Hall tilting disc) were scanned using a pulsatile 

in vitro model. Image acquisition was performed with a 

256-slice scanner with either a retrospectively gated helical 

scan (120kV, 600mAs, CTDI vol 

39.8mGy) or a prospectively 

triggered axial scan (120kV, 200mAs, CTDI vol 

13.3mGy), rotation 

time 0.27sec. Hypo- and hyperdense artifact volumes 

were quantified using thresholds of -45 and 175HU. Image 

noise and artifacts were compared between protocols. 

Additionally, mean image noise and radiation dose were 

compared between 6 patients with mechanical PHVs 

scanned with a prospectively triggered protocol and 20 

30 




patients scanned with retrospective gating. 

Results: In vitro, prospective triggering reduced valve-induced 

hypo- and hyperdense artifacts by 35 and 26%, respectively 

(p

3 


aortic (n=59), mitral (n=17), pulmonary (n=1) and tricuspid 

(n=1) position. In addition, seven annuloplasty rings were 

present. PHV artifacts prohibiting assessment of at least one 

coronary segment were present in 12/70 patients (17%). 

Artifacts were located in the RCA, LCX and LAD: in 9/70 

patients (13%) (mainly from PHVs in the aortic position), in 

7/70 patients (10%) and in 3/70 patients (4%) (both mainly 

from PHVs in mitral position), respectively, and never in the 

left main coronary artery. Biological PHVs (0/17), annuloplasty 

rings (0/7), Carbomedics bileaflet (0/20), ON-X bileaflet 

(0/7) and Medtronic Hall tilting disc (1/11) PHVs caused no 

artifacts precluding coronary artery assessment. However, 

coronary artery assessment was hampered by PHV artifacts 

in the Bileaflet Saint Jude (3/11) and Duromedics (1/1) PHVs 

as well as Sorin (5/7) and Björk Shiley (4/4) tilting disc PHVs. 

Conclusions: MSCT imaging is a suitable technique to 

assess coronary artery segments in most patients with 

PHVs. Björk-Shiley and Sorin tilting disc PHVs prohibit diagnostic 

assessment due to PHV artifacts. 

Figure 1: PHV artifact in the RCA. 

O3.7 

MORE NON-COMPACTED MYOCARDIUM IN 

BLACK FOOTBALLERS ON CARDIAC MRI 

T. Luijkx 1 , B.K. Velthuis 1 , F.J. van Hellemondt 2 , P.J. Senden 2 , 

N.H.J. Prakken 1 , F.J.G. Backx 1 , W.P.T.M. Mali 1 , 

M.J.M. Cramer 1 

1 


2 


Purpose: Electro- and echocardiographic (e.g. septal wall 

thickness, SWT) characteristics are known to differ between 

athletes of black and white ethnic descent. We used cardiac 

MRI (CMR) to study differences between elite black and 

white football (soccer) players. 

Methods: 38 healthy elite male football players aged 19-34 

years (mean age 23±4 years) underwent CMR: 28 of white 

and 10 of black ethnic descent. Blinded observers used a 

reproducible contour tracing protocol to assess ventricular 

volumes, function and wall mass. Maximum SWT and the 

ratio of non-compacted to compacted (NC/C ratio) myocardium 

was determined on a standardized apical-to-mid-ventricular 

CMR short axis slice at six positions recommended 

by the American Heart Association. 

Results: Black athletes showed slightly lower end-diastolic 

volumes and higher end-systolic volumes in both ventricles, 

resulting in lower ejection fractions. SWT was larger in 

black athletes. Myocardial NC was more widely present and 

more pronounced in black athletes with both a higher peak 

(white/black mean 1.81/2.30, range 1.13-2.42/1.14-3.66) and 

average (white/black mean 1.02/1.40, range 0.42-1.66/0.69- 

2.08) NC/C ratio. 

Conclusions: In this small sample footballers of black ethnicity 

show decreased ventricular systolic function at rest, 

which may be related to more pronounced myocardial noncompaction. 

The NC/C ratio frequently exceeds the clinically 

used CMR cut-off value of 2.3. 

Table 1 

32 




O3.8 

INTRACRANIAL VESSEL WALL IMAGING AT 

7.0 TESLA MRI IN ISCHEMIC STROKE AND 

TIA PATIENTS 

A.G. van der Kolk, J.J.M. Zwanenburg, M. Brundel, 

G.J. Biessels, F. Visser, P.R. Luijten, J. Hendrikse 


Background & purpose: Conventional imaging methods 

cannot depict the vessel wall of intracranial arteries at 

sufficient resolution. This hampers the evaluation of intracranial 

arterial disease. The aim of the present study was to 

develop a high-resolution MRI method to image intracranial 

vessel wall. 

Methods: We developed a volumetric (3D) turbo spin 

echo (TSE) sequence for intracranial vessel wall imaging 

at 7.0 Tesla MRI. Inversion Recovery (IR) was used to null 

cerebrospinal fluid to increase contrast with the vessel wall. 

Magnetization preparation (MP) was applied prior to inversion 

to improve signal-to-noise ratio (SNR). 35 patients 

with ischemic stroke or TIA (Transient Ischemic Attack) of 

various causes were imaged to test the MPIR-TSE sequence. 

Gadolinium-based contrast agent (Gadobutrol, 0.1mL/kg) 

was administered to assess possible lesion enhancement in 

the patients. 

Results: The walls of intracranial arterial vessels could be 

visualized in all volunteers and patients with good contrast 

between wall, blood and cerebrospinal fluid. The quality of 

the vessel wall depiction was independent of the vessel 

orientation relative to the plane of acquisition. In 21 of the 

35 patients a total number of 52 intracranial vessel wall 

lesions were identified. Eleven of the 52 lesions showed 

enhancement after contrast administration. Only 14 of the 

52 lesions resulted in a stenosis of the arterial lumen. 

Conclusions: Intracranial vessel wall and its pathology can 

be depicted with the MPIR-TSE sequence at 7.0 Tesla. The 

MPIR-TSE sequence will make it possible to study the role 

of intracranial arterial wall pathology in ischemic stroke. 

Figure 1: Example of wall lesion on 7T MPIR-TSE & TOF-MRA 


33


Sessie 4 

Mammadiagnostiek 1 


O4.1 

VISUELE VERSUS SEMI-AUTOMATISCHE 

BEOORDELING VAN MAMMADENSITEIT 

IN STANDAARD MAMMOGRAFISCH 

ONDERZOEK 

M.B.I. Lobbes 1 , J. Cleutjens 1 , V. Lima Passos 2 , 

K. Keymeulen 1 , R.G. Beets-Tan 1 , C. Frotscher 1 , M.J. Lahaye 1 , 

J. Wildberger 1 , C. Boetes † 

1 


2 

Universiteit Maastricht, Maastricht 

Doel: BI-RADS richtlijnen adviseren analyse van de klierweefseldensiteit 

op mammografisch onderzoek als deel van 

de mammografische evaluatie. Over het algemeen wordt 

visuele inspectie gebruikt om de densiteit van het klierweefsel 

in te schatten. Vergelijking tussen visuele en semi-automatische 

beoordeling van de klierdensiteit nog niet eerder 

onderzocht met een zogenaamde ‘threshold techniek’. 

Methoden: Klierdensiteit werd beoordeeld door een 

ervaren en onervaren radioloog in 200 mammografieën. 

Klierdensiteit werd ook gemeten met een softwareprogramma 

dat gebruik maakt van een zogenaamde ‘threshold 

technique’ (figuur 1). Klierdensiteit werd gescoord volgens de 

richtlijnen van het BI-RADS classificatiesysteem. De correlatie 

tussen klierdensiteit van beide radiologen, alsook de correlatie 

tussen hun beoordeling versus de semi-automatische 

methode, werd uitgedrukt in de gewogen Kappa-waarde. 

Resultaten: Klierdensiteitmetingen van beide mammae en 

in beide projectierichtingen waren uitstekend en hoog significant 

(intraclass correlation coefficients >0.9, alle p

Mammadiagnostiek 1 4 

tly be visualized for evaluation in most patients. 

To date, 50 patients are evaluated: 3D-US evaluation of the 

breast shows a sensitivity of 88% and specificity of 97%, 

compared to MR imaging findings (and histology). In coming 

months all 201 patients will be evaluated. 

Conclusion: In our study so far, 3D-US shows high sensitivity 

and specificity in the detection of suspicious lesions compared 

to MRI. Automated breast volume scanning seems a promising 

new ultrasound technique in breast evaluation. 

O4.3 

MEDICOLEGAL CLAIMS FOLLOWING 

SCREENING MAMMOGRAPHY IN THE 

NETHERLANDS 

V. van Breest Smallenburg, W. Setz-Pels, F.H. Jansen, 

L.E.M. Duijm 

Catharina Ziekenhuis, Eindhoven 

Purpose: To determine the type and frequency of medicolegal 

claims at a Dutch breast cancer screening programme. 

Materials and methods: The study population consisted of 

all 80019 women who underwent screening mammography 

at a southern breast screening region of the Netherlands 

between January 1997 and July 2007 (301139 screens). We 

included all medicolegal claims that had been recorded at the 

central screening department within 3 years following screening 

mammography. During 2-year follow-up, we collected the 

biopsy results and surgery reports of all referred women. Two 

screening radiologists reviewed the screening mammograms 

of all screen detected cancers (SDC) and interval cancers (IC) 

and determined whether the cancer had been missed at the 

previous screen (in case of SDC) or latest screen (in case of 

IC). The radiologists were blinded to each others review; discrepant 

readings were followed by consensus reading. 

Results: Just 3 medicolegal claims had been reported, 

all of them related to financial compensation following a 

diagnosis of IC. The verdicts of these cases still have to be 

finalized. Excisional biopsy had been performed in 10.7% 

(234/2183) of false positive referrals. Review showed that 

20.8% (261/1254) of SDC had been missed at the previous 

screen and 23.6% (139/588) of IC should have been detected 

at the latest screen. 

Conclusions: Medicolegal claims were very rare, although 

a substantial proportion of false positive referred women 

had been confronted with excision biopsy and over 20% of 

cancers had been missed at the previous screen or latest 

screen, respectively. 

O4.4 

RADIOFREQUENCY-ASSISTED INTACT 

SPECIMEN BIOPSY OF BREAST TUMORS: 

AN EVALUATION ACCORDING TO THE 

IDEAL GUIDELINES 

S.C.E. Diepstraten 1 , H.M. Verkooijen 1 , P.J. van Diest 1 , 

M.A. Fernandez-Gallardo 1 , K.M. Duvivier 1 , A.J. Witkamp 1 , 

T. van Dalen 2 , W.P.Th.M. Mali 1 , M.A.A.J. van den Bosch 1 

1 


2 

Diakonessenhuis, Utrecht 

Purpose: Radiofrequency-assisted intact specimen biopsy 

(RFIB) has been introduced for percutaneous biopsy or 

removal of breast tumors. Using radiofrequency cutting, 

the system enables the interventional radiologist to obtain 

an intact sample of the target lesion. According to IDEAL 

guidelines, we performed a critical evaluation of our initial 

experience with RFIB. 

Methods: Between June and November of 2010, X-ray guided 

RFIB was performed in 19 female patients. All patients 

presented with suspicious microcalcifications (BI-RADS 

III-V) on mammography. Biopsy specimen integrity, thermal 

damage and histological diagnosis were assessed by an 

expert breast pathologist. Data on technical success, 

diagnostic and therapeutic accuracy and peri-procedural 

complications were collected and analyzed according to the 

IDEAL guidelines. 

Results: Median age was 59 years. Median lesion diameter 

on mammography was 8 mm (range 2-76 mm). The procedure 

was successful in 17/19 (89%) patients and unsuccessful 

in 2/19 (11%) patients (1 nonrepresentative sample, 

1 sample with extensive thermal damage). Histological 

analysis of the RFIB specimen revealed 12/19 (63%) benign 

lesions and 7/19 (37%) malignancies (4 DCIS lesions and 3 

invasive ductal carcinomas). In 1 patient a DCIS lesion was 

completely removed with RFIB. Overall, 3 peri-procedural 

complications occurred (1 wound leakage, 1 arterial hemorrhage 

and 1 infection requiring oral antibiotics). 

Conclusion: Tissue sampling of suspicious breast lesions 

can be performed successfully with RFIB. In 1 patient DCIS 

was radically excised with RFIB, which illustrates its potential 

as a minimally invasive therapeutic procedure for removal 

of small breast tumors. This is an interesting focus for 

further research when larger probe sizes become available. 


35

4 


O4.5 

CAN COMPUTER-AIDED ANALYSIS OF 

BREAST MRI PREDICT THE NOTTINGHAM 

PROGNOSTIC INDEX OF PATIENT SURVIVAL? 

K.G.A. Gilhuijs 1 , K. Pengel 2 , V. Bruijnes 2 , C. Loo 2 

1 


2 

NKI-AvL, Amsterdam 

Purpose: The aim of this study is to identify imaging biomarkers 

from contrast-enhanced breast MRI that predict the 

Nottingham prognostic index (NPI) prior to surgery. 

Methods: Patients with invasive breast cancer and eligible 

for breast-conserving therapy on the basis of conventional 

breast imaging and clinical examination received additional 

preoperative breast MRI in a prospective study. Temporal and 

morphological features of contrast uptake were automatically 

analyzed by a custom-build workstation. The size and grade 

of the tumor as well as the number of positive lymph nodes 

were assessed at histopathology. From their combination, the 

NPI was calculated. Based on NPI, patients were stratified in 

subgroups with expected 5-year survival rates larger or equal 

to 93% and subgroups with lower survival rates. Multivariate 

analyses were performed to identify correlations between 

computer-extracted MRI features and NPI. Bonferroni correction 

and receiver-operating characteristics were employed. 

Results: Five-hundred-and-forty-nine patients were included 

between 2000 and 2007. The mean patient age was 57 

years, the mean tumor size was 1.6 cm. A total of 224/549 

patients had one or more positive lymph nodes. The mean 

NPI was 3.1 (range 1.2 - 36.2), 304 patients were at or 

above the expected 93% 5-year survival threshold, 245 were 

below. From 20 computer-extracted features, the largest 

diameter of the washout in the enhancing lesion was most 

predictive to discriminate between the two groups, yielding 

an area under the curve of 0.74. 

Discussion and conclusion: Computer-aided analysis 

of breast MRI shows potential to estimate the NPI prior to 

surgery, and may thus ultimately provide complementary 

information to select neoadjuvant or minimally invasive 

treatment strategies. 

O4.6 

MRI RESPONSE MONITORING IN 

NEOADJUVANTLY TREATED 

MAMMACARCINOMA: ADVANTAGE OF 

TWO- AND THREE-DIMENSIONAL OVER 

ONE DIMENSIONAL MEASUREMENTS? 

M.H.M. Volmerink, A.L.T. Imholz, R.A.J.M. van Dijk 

Deventer Ziekenhuis, Deventer 

Aim: to investigate the associations of (changes in) MRI 

tumoursize in one, two and three dimensions with specimen 

pathology of neoadjuvantly treated mammacarcinoma. 

Methods: In this retrospective study, in 35 patients dynamic 

contrast-enhanced MRI was performed before, during and 

after chemotherapy. Tumoursize was measured by RECIST, 

cross-section area (2D), volume (3D; all at early (70s) and 

late (450s) enhancement) and by RECIST washout 

. Change in 

tumoursize from MRI 1 to 2, and tumoursize at MRI3 were 

correlated with pathology by logistic regression. 

Results: decrease in tumoursize measured by 2D late 

(ß=4,1 

p=0,03), RECIST early 

(ß=2,5 p=0,01) and RECIST washout 

(ß=3,4 

p

Interventieradiologie/ 


Sessie 5 

5 




O5.1 

CRURAL PTA FOR CRITICAL LIMB ISCHEMIA; 

TECHNICAL AND CLINICAL LONG-TERM 

RESULTS 

A.S. van den Berg 1 , H. Odink 1 , B. Winkens 2 

1 

Atrium Medisch Centrum, Heerlen 

2 


Purpose: To evaluate the technical and clinical long-term 

effectiveness of angioplasty of the crural arteries to preserve 

the leg. 

Materials and methods: In a 5½ year period a retrospective 

study was performed with 109 crural PTA’s of consecutive 

patients (47 men and 62 women; median age 79 years; SD 

= 9) with critical limb ischemia. Analysis of the clinical longterm 

effectiveness of angioplasty of the lower leg arteries 

in time (limb salvage rate = LSR), was performed using the 

Kaplan-Meier life-table analysis. 

Results: PTA included 29 stenoses (mean grade of stenosis 

= 90%; SD = 6%, mean length = 5 cm; SD = 12 cm) and 80 

occlusions (mean length = 15 cm; SD = 10 cm). Total technical 

failures were 16 (TF = 15%) and 93 procedures were 

successful (TS = 85%). The procedure-related mortality rate 

was 4%. 

Of 109 limbs 90 procedures were a PTA of a de novo lesion 

(83%). In the group of de novo lesions the LSR after 3 years 

was 78% (SD = 4.8). For the 80 technically successful procedures 

only the LSR after 3 years was 87% (SD = 4.1). 

Conclusion: PTA of the crural arteries appears to be an 

effective treatment for patients suffering from critical limb 

ischemia. 

Figure 1: Kaplan-Meier survival curves of PTA . 


37

5 


O5.2 

CLINICAL PERFORMANCE OF A NOVEL 

BIOACTIVE COMPOSITE IN THE TREATMENT 

OF VERTEBRAL COMPRESSION FRACTURES 

R. Schepers-Bok 1 , M. Geerdes 1 , M.E. Havinga 1 , R. Aquarius 2 , 

P.J.W. Wensing 1 

1 

Ziekenhuisgroep Twente, Hengelo 

2 

Radboud University Nijmegen Medical Centre, Nijmegen 

Objective: To analyse the outcome of percutaneous vertebroplasty 

with CortossTM in patients with vertebral compression 

fractures. 

Methods: Between 2005 and 2010, 221 vertebral compression 

fractures were treated with percutaneous vertebroplasty 

in 132 patients. Inclusion criteria were: compression fractures 

due to osteoporosis, trauma or malignancy, invalidating 

back pain due to compression fracture, no improvement 

to standard conservative therapy for minimal 6 weeks, 

Numerical Rating Scale (NRS) score of at least 7 and bone 

marrow edema on MRI scan. 

NRS score was obtained before, and two and six weeks 

after vertebroplasty. Primary outcome was pain reduction 

measured by NRS score. Clinically significant pain relief 

was defined as a decrease in NRS score of at least 3 points. 

Secondary outcome were new vertebral fractures, injected 

volume and complications. 

Results: Two weeks after vertebroplasty, 84,7% of the 

patients showed a decrease of at least three points on NRS 

score. This increased to 86,8% after six weeks. 34 new fractures 

occurred in 22 patients (17,4%).No embolisms occurred. 

Mean injected volume of Cortoss was 1,54 mL. 

Conclusion: In a group of patients with vertebral compression 

fractures percutaneous vertebroplasty with Cortoss is 

an effective and safe treatment option. PVP leads to a significant, 

rapid decrease in pain. Our results are comparable 

to results of other studies which used PMMA. These good 

clinical results, together with advantages of Cortoss, such 

as the low cement volume needed, and the mix-on-demand 

delivery system, make it a strong candidate to be a standard 

material in vertebral augmentation. 

Figure 1: Distribution of Cortoss: trabecular pattern. 

Table 1: Patient characteristics. 

38 





5 

Table 2: Mean NRS before and after vertebroplasty. 

O5.3 

INTERVENTIES BIJ PATIËNTEN MET KRITIEKE 

ISCHEMIE EN KWALITEIT VAN LEVEN 

F.A. Frans, R. Met, S. Bipat, M.J.W. Koelemay, 

D.A. Legemate, J.A. Reekers 


De keuze van de behandeling bij patiënten met kritieke 

ischemie (CLI) van het onderbeen is maatwerk. Behoud van 

het been en Kwaliteit van Leven (Qol) zijn belangrijke uitkomstmaten 

bij de behandeling. Doel van dit onderzoek was 

het inventariseren van de behandelingen en het vervolgen 

van de Qol bij patiënten met CLI. 

In deze prospectieve cohort studie werden alle opeenvolgende 

patiënten met CLI die zich presenteerden in ons 

ziekenhuis geïncludeerd. De ziektespecifieke VascuQol 

vragenlijst werd ingevuld bij presentatie (baseline) en na 

6 maanden. Verschillen in scores werden getoetst met de 

Wilcoxon-Signed Ranks test. 

Van mei 2007 t/m mei 2010 presenteerden zich 218 patiënten 

met CLI. Hiervan konden 150 patiënten worden geïncludeerd 

in de studie. De uiteindelijke studiepopulatie bestond na 6 

maanden uit 127 patiënten. Primaire behandeling was een 

PTA (79;62%), chirurgisch (32;25%), conservatief (12;10%) of 

een amputatie (4;3%). Bij 43 patiënten (34%) was binnen 6 

maanden opnieuw een interventie nodig. De hele groep liet 

een toename zien in Qol na 6 maanden in de somscore en op 

alle individuele domeinen van de VascuQol (p

5 


Methods: five patients with liver metastases were treated 

with 166 Ho-radioembolization. In order to assess microsphere 

biodistribution, pre and post treatment multi-gradient echo 

T 2 

*-weighted MR images and post treatment SPECT images 

were acquired. R 2 

* (R 2 

*=1/ T 2 

*) maps were constructed, 

since increases in R 2 

* are known to linearly relate to the 

166 

Ho-MS concentration. R 2 

*-maps were compared with 

SPECT images. Couinaud’s liver segments and up to 5 index 

lesions per patient were selected in volumes of interest 

(VOI) using anatomical MR images. VOIs were projected 

over the SPECT images and R 2 

*-maps and the intensity per 

VOI was expressed in percentage of total liver intensity. 

From the 5 patients a total of 61 VOIs from R 2 

*-maps and 

SPECT were compared. 

Results: Presence of 166 Ho-MS in the human liver was clearly 

visible with both modalities. In certain cases, the higher 

resolution of MR-acquired R2*-maps provided additional 

information to the SPECT images with regard to the microsphere 

biodistribution within a tumor. Biodistribution measurements 

showed a high correlation between SPECT and MRI 

for liver segments (r 2 0.92) and index lesions (r 2 0.83). 

Conclusion: The intrahepatic biodistribution of 166 Ho- 

MS can be clearly visualized with both SPECT and MRI. 

Biodistribution measurements based on MRI and based on 

SPECT show a very good correlation. 

Figure 2: Percentage of total liver intensity in each VOI. 

Figure 1: 166Ho microspheres visualised on 

R2*-map and SPECT. 

O5.5 

COMPARISON OF SELF REPORTED WALKING 

DISTANCE, TREADMILL TEST PERFORMANCE 

AND WALKING ABILITY IN PATIENTS WITH 

INTERMITTENT CLAUDICATION 

M.B. Zagers, F.A. Frans, S. Bipat, J.A. Reekers, S. Jens, 

M.J.W. Koelemay 


Objectives: Decisions regarding treatment of patients with 

intermittent claudication (IC) are guided by the patient’s perceived 

disability due to limited pain free (PWD) and 

maximum walking distance (MWD), and objective assessment 

of PWD and MWD on a treadmill. There are few data 

on the relationship between treadmill test, daily life and 

patient reporting regarding the outcomes, PWD and MWD. 

Our objective was to determine correlations between these 

assessments. 

Methods: All consecutive outpatients with IC who gave 

informed consent were included in this prospective study. 

Assessments included PWD and MWD during a standardized 

treadmill test (3,0 km/h, 8% incline), and on a walking 

track on the corridor at the patient’s own pace. All patients 

40 





5 

also estimated their Subjective (S)PWD and (S)MWD. 

Differences and correlations between the assessments 

were determined with the Wilcoxon-Signed Ranks test and 

Spearman’s rank test, respectively. 

Results: 35 patients (71% men, mean age 64 years) were 

included. Mean PWD and MWD at corridor were significantly 

higher (115 and 265 meters) compared to the distances 

on the treadmill (62 and 128 meters) (P

5 


Figure 2: Opname na thrombectomie (C) zonder thrombolytica. 

O5.7 

CAROTID ATHEROSCLEROTIC PLAQUE 

PROGRESSION AND CHANGE IN PLAQUE 

COMPOSITION OVER TIME; A PROSPECTIVE 

IN VIVO SERIAL CT ANGIOGRAPHY STUDY 

M.J. van Gils, D. Vukadinovic, D.W.J. Dippel, W.J. Niessen, 

A. van der Lugt 


Purpose: Serial in vivo imaging would improve our understanding 

of atherosclerotic plaque progression and would be 

useful in assessing cardiovascular risk and monitoring treatment 

efficacy. Purpose of this prospective study is to quantify 

changes in atherosclerotic carotid plaque volume and 

plaque composition over time with CT angiography (CTA). 

Results: Thirty out of 222 arteries were excluded (local 

treatment, occlusion or poor image quality). Mean follow-up 

was 63±8 months. Intra-observer reproducibility of all volume 

measurements was good (ICC=0.90-1.00), except for lipid 

(ICC=0.79). Wall volume decreased in 30% and increased 

in 70% of vessels (range -6.8-10.9%/year). Baseline lumen 

volume was 1479±632 mm 3 , wall volume was 1089±461 

mm 3 . On average, volumes of vessel, lumen and wall increased 

0.6%, 0.5% and 1.2% per year (p≤0.001, oneway 

t-test). Plaque composition changed significantly from 

baseline (fibrous 66.3%, lipid 29.0%, calcifications 4.7%): 

fibrous tissue decreased with 1.1% (p



5 

O5.8 

1 JAAR NA EVAR BESTAAT NOG ONGEVEER 

EENDERDE DEEL VAN DE ANEURYSMAZAK 

UIT ONGEORGANISEERDE THROMBUS 

BIJ PATIENTEN MET EN ZONDER 

AANTOONBAAR ENDOLEAK 

S.A.P. Cornelissen 1 , E.P.A. Vonken 1 , H.J. Verhagen 2 , 

F.L. Moll 1 , L.W. Bartels 3 

1 


2 


3 

Image Sciences Institute, Universitair Medisch Centrum 

Utrecht, Utrecht 

Doel: Doel van dit onderzoek was om de veranderende 

organisatiegraad van de aneurysmazak gedurende het eerste 

jaar na EVAR af te beelden met MRI. 

Methoden: In deze METC-goedgekeurde studie ondergingen 

30 patiënten MRI-onderzoeken pre-operatief, < 6 weken 

postoperatief, 6 maanden en 1 jaar na EVAR. Er werden 

pre-contrast T1- en T2- en postcontrast T1-gewogen beelden 

gemaakt. De aneurysmazak werd met speciaal hiervoor ontwikkelde 

software door een ervaren radioloog uitgesplitst 

in gebieden met endoleak, ongeorganiseerde en georganiseerde 

thrombus aan de hand van de signaalintensiteit op 

de verschillende beelden. 

Resultaten: Het gemiddelde ongeorganiseerde thrombusvolume 

pre-operatief was 23 ml(95%CI 16-30ml), postoperatief 

51 ml(95%CI 41-61 ml), na 6 maanden 39 ml(95%CI 

29-48ml), na 1 jaar 32 ml(23-41ml), zie figuur 1. Er was een 

significante toename in ongeorganiseerde thrombusvolume 

postoperatief t.o.v. pre-operatief (gepaarde t-test, p

6 


Sessie 6 


Vrijdag 30 september, 10.45 - 12.15 uur 

O6.1 

EVALUATION OF A STANDARDIZED CT 

COLONOGRAPHY TRAINING PROGRAM IN 

NOVICE READER 

M.H. Liedenbaum 1 , S. Bipat 1 , P.M.M. Bossuyt 1 , 

R.S. Dwarkasing 2 , M.C. de Haan 1 , R.J. Jansen 1 , 

D. Kauffman 1 , C. van der Leij 1 , M.S. de Lijster 1 , C.C. Lute 1 , 

M.P. van der Paardt 1 , M.G. Thomeer 2 , I.J.A. Zijlstra 1 , 

J. Stoker 1 

1 


2 


Purpose: To determine how many CT colonography (CTC) training 

examinations have to be evaluated by novice readers to 

obtain an adequate level of competence in polyp detection. 

Methods: Informed consent was obtained from all participants. 

Six physicians (one radiologist, three radiology 

residents, two researchers) and three technicians completed 

a CTC training program. 200 CTC’s with colonoscopic verification 

were selected from a research database, with 100 

CTC’s with at least one polyp ≥6mm. After a lecture session 

and an individual hands-on training, CTC reading was done 

individually with immediate feedback of the colonoscopy 

outcome. The increase in per-polyp sensitivity was calculated 

for four sets of 50 CTC’s for lesions ≥6mm. Using logistic 

regression analyses, the number of CTC’s to reach 90% 

sensitivity for lesions ≥6mm was estimated. Reading times 

were registered. 

Results: The average per-polyp sensitivity for lesions 

≥6mm was 76% (207/270) in the first set of 50 CTC’s, 

77% (262/342) in the second set (p=0.96 vs. first set), 80% 

(310/387) in the third set (p=0.67 vs. first set) and 91% 

(261/288) in the fourth set (p=0.018). The estimated number 

of CTC’s to be evaluated to reach a sufficient sensitivity for 

lesions ≥6mm was 164. Six of the nine readers reached 

this level of competence within 175 CTC’s. Reading times 

decreased significantly from the first 50 CTC’s to the second 

50 CTC’s for 6 readers. 

Conclusions: Novice CT colonography readers obtained a 

sensitivity equal to that of experienced readers after practicing 

on average 164 CTC studies. 

O6.2 

THE FEASIBILITY OF TRAINING 

RADIOLOGIC TECHNOLOGISTS IN 

TRIAGING CT-COLONOGRAPHY FOR 

EXTRACOLONIC FINDINGS 

T.N. Boellaard, C.Y. Nio, P.M. Bossuyt, J. Stoker 


Purpose: Cost-effectiveness is important for the implementation 

of CT-colonography as a screening tool for colorectal 

cancer. Radiologists’ reading time contributes substantially 

to CT-colonography costs. Therefore we evaluate the 

feasibility of radiologic technologists in triaging screening 

CT-colonography for extracolonic findings. 

Method and materials: Eight technologists participated in 

a training program and subsequently reported extracolonic 

findings in 280 CT-colonography exams. The dataset 

contained 86 possibly (E3) and 30 probably important (E4) 

findings (C-RADS). The first and last 40 cases were identical 

examination cases. Feedback was given after each case 

from reference standard (the consensus read by two radiologists), 

except for the examination cases. Technologists 

reported lesion location and characteristics, C-RADS classification, 

need for a radiologist’s read and reading time. 

We constructed learning curves for correct scan and lesion 

triaging using a moving average technique. 

Results: For the final exam 70% of scans with E3 or E4 

findings were correctly triaged, while 30.5% of scans 

without E3 or E4 findings were incorrectly triaged. For the 

final exam technologists correctly identified and classified 

64.4%(67/104) of E3 and 67.5%(27/40) of E4 findings. 

This is an improvement, compared to the first exam, of 

33.6%(p0.05). The learning curve for 

E3 and E4 findings combined did not reach a plateau after 

280 cases. The technologists’ average reading time decreased 

from 11:51 to 4:13 minutes(p


6 

Conclusion: A training program for radiologic technologists 

leads to an increased capability of triaging extracolonic findings 

at CT-colonography. The number of cases was too low 

to reach a sufficient competence. 

O6.3 

A RANDOMIZED CONTROLLED TRIAL 

COMPARING PARTICIPATION AND 

DIAGNOSTIC YIELD IN COLONOSCOPY AND 

CT-COLONOGRAPHY FOR POPULATION 

BASED COLORECTAL CANCER SCREENING 

(COCOS TRIAL) 

M.C. de Haan 1 , E. Stoop 2 , T.R. de Wijkerslooth 1 , P.M. Bossuyt 1 , 

M. van Ballegooijen 2 , Y. Nio 1 , M.J. van de Vijver 1 , K. Biermann 2 , 

M. Thomeer 2 , M.E. van Leerdam 2 , P. Fockens 1 , J. Stoker 1 , 

E.J. Kuipers 2 , E. Dekker 1 

1 


2 


Purpose: To compare participation rate and diagnostic yield 

of colonoscopy and CT-colonography screening in a RCT trial. 

Methods: A random selection of the Dutch population, aged 

50-75 years, was 2:1 randomized to colonoscopy or CTC 

for primary CRC screening. Participation rate was defined 

as number of invitees undergoing the examination divided 

by the total number of invitees. Colonoscopy was positive 

when advanced neoplasia (adenomas with a diameter ≥10 

mm, a ≥25% villous component, or high grade dysplasia or 

CRC) was detected; CTC when a lesion >5mm was found. 

Individuals with ≥1 lesions 6-9mm at CTC were offered 

surveillance CTC and colonoscopy was offered for lesions 

≥10mm. Diagnostic yield was calculated as number of 

advanced neoplasia per 100 invitees. 

Results: 1,276 of 5,923 colonoscopy invitees participated 

(22%) compared to 982 of 2,919 CTC invitees (34%) 

(p

6 


O6.5 

MR-COLONOGRAPHY WITH IODINE- 

TAGGED LIMITED BOWEL PREPARATION 

AND AUTOMATED CARBON DIOXIDE 

INSUFFLATION FOR COLONIC DISTENSION 

M.P. van der Paardt, F.M. Zijta, T.N. Boellaard, S. Bipat, 

A.J. Nederveen, J. Stoker 


Introduction: To prospectively evaluate image quality and 

diagnostic accuracy of 3.0Tesla MR-colonography using 

iodine-tagged preparation and CO2 for bowel distension. 

Methods: 40 patients at increased risk for colorectal carcinoma 

underwent 3.0Tesla MR-colonography using iodinetagged 

bowel preparation and automated CO2 insufflation. 

Coronal FS 3D-T1-weighted SPGR were acquired in supine 

and prone position, 2D-T2-weighted SSFSE in supine 

position. Five parameters (Table) were assessed by two 

observers for 6 colon segments (240 segments/observer, 

480 segments/sequence). Wilcoxon-signed-rank test was 

used for comparison. MR-colonography results were compared 

with colonoscopy and sensitivity/specificity were 

assessed. 

Results: The amount of fecal residue was rated ‘0-25% 

of lumen filled’ in 66.9%(321/480) of the images. Overall, 

the consistency of the residue was scored ‘liquid’; 

93.3%(448/480). 

Supine distension was ‘adequate’ to ‘optimal’ in 

89.2%(428/480) segments on T1-weighted images 

and 90.4%(427/472; 8 missing values) on T2-weighted 

series. In the T1-weighted series distension was better in 

supine compared to prone position: 89.2%(428/480) versus 

74.1%(347/468; 12 missing values), p


cases, Gd-EOB-DTPA (Primovist®) can be used, which is 

taken up by hepatocytes, if they are connected to biliary 

ducts, leading to hyperintensity in the hepatobiliary phase. 

However, thus far specific enhancement patterns of FNH 

have not been reported. 

Material and Methods: Retrospective evaluation was 

performed of 29 FNH lesions, imaged with MRI precontrast 

and after Gd-EOB-DTPA. MR examination consisted 

of precontrast T1 sequences, in and out of phase T1 

sequences, T1-weighted dynamic sequences after 

Gd-EOB-DTPA injection, T2-weighted sequences, Diffusion 

weighted imaging and T1 hepatobiliary phase after 10 

and 20 minutes. 

Results: Evaluation of 29 FNH lesions during the hepatobiliary 

phase yielded four types of enhancement: homogenous 

hyperintense 12/29 (41,4%), heterogeneous 3/29 (10,3%), 

hypointense with peripheral rim enhancement 5/29 (17,3%) 

and isointens to liver parenchyma 9/29 (31,0%). In all cases, 

enhancement patterns observed at 5 minutes persisted 

during 10 and 20 minutes post injection. Pathological examination 

demonstrated correlation of observed enhancement 

patterns with specific vascular and biliary duct distribution. 

Conclusion: In the hepatobiliary phase of the Gd-EOB-DTPA 

four different enhancement patterns were recognized in 

FNH. Pathological correlation suggests specific subtypes of 

FNH lesions. 

Figure 1: Four different enhancement patterns FNH. 


47

6 


O6.7 

MAGNETIC RESONANCE IMAGING 

FINDINGS CORRELATES WITH 

PATHOLOGICAL SUBTYPE CLASSIFICATION 

OF HEPATOCELLULAR ADENOMAS 

S.M. van Aalten, M.G.J. Thomeer, T. Terkivatan, 

R.S. Dwarkasing, J. Verheij, R.A. de Man, J.N.M. IJzermans 


Purpose: To investigate the correlation between magnetic 

resonance imaging (MRI) findings and pathological subtype 

classification of hepatocellular adenoma (HCA) and to propose 

guidelines for follow-up and management. 

Methods: This retrospective study was approved by the 

institutional review board and the requirement for informed 

consent was waived. Seventy-one resected tumours previously 

diagnosed as HCA were classified based on pathological 

findings and immunohistochemical analysis: liver-fatty 

acid binding protein (L-FABP) negative HCA, inflammatory 

HCA, β-catenin positive HCA and unclassified HCA. The 

available MRI scans of 61 lesions (48 patients, median age 

36 years) were independently reviewed by two radiologists, 

thereafter consensus was obtained. Chi-square and Fishers’ 

exact tests were performed for statistical analysis. 

Results: MRI signs of diffuse intratumoral fat deposition 

were present in 7 of 9 L-FABP-negative HCA compared to 

5 of 29 inflammatory HCA (P = 0.001). Steatosis within the 

non-tumoral liver was present in 11 of 29 inflammatory 

HCA compared to none L-FABP-negative HCA (P = 0.038). A 

characteristic ‘atoll’ sign was only seen in the inflammatory 

group (P = 0.027). Presence of a typical vaguely defined type 

of scar was seen in 5 of 7 β-catenin positive HCA 

(P = 0.003). No specific MRI features were identified for the 

unclassified cases. 

Conclusions: L-FABP-negative HCA, inflammatory HCA and 

β-catenin positive HCA were related to MRI signs of diffuse 

intratumoral fat deposition, an ‘atoll’ sign, and a typical 

vagely defined scar, respectively. Since β-catenin positive 

HCA are considered premalignant, closer follow-up with 

MRI or resection may be preferred. 

O6.8 

MAGNETIC RESONACE IMAGING FOR 

PREDICTING RESIDUAL DISEASE AFTER 

RADIOTHERAPY IN LOCALLY ADVANCED 

CERVICAL CANCER 

J.E. Mongula 1 , D. Lambregts 1 , R. Kruitwagen 2 , T. van Gorp 2 , 

A .Kruse 2 , L. Lutgens 3 , R. Lalisang 2 , R. Vliegen 4 , 

B.F. Slangen 2 , R. Beets-Tan 1 

1 


2 

GROW, School for Oncology and Developmental Biology, 

Maastricht 

3 

Maastro clinic, Maastricht 

4 

Atrium Medisch Centrum, Heerlen 

Objective: To assess whether MRI is valuable for evaluating 

the presence of residual tumor after RT and which 

imaging criteria are the best predictors of response. 

Methods: 40 patients with histologically proven primary 

cervical cancer FIGO ≥1b were retrospective included, to 

date 20 out of 40 have been analyzed. Patients underwent 

MRI (standard T2-weighted FSE in 3 planes at 1.5T) before 

and 2-3 months after RT. An experienced gynaecologic radiologist 

scored the likelihood of residual tumor on post-RT MRI 

using a 5-point confidence level score based on assessment 

of isointens residual mass, hypointens fibrotic mass, border 

irregularity and nodular shape. The standard reference 

consisted of gynecological examination with biopsy and/or 

clinical follow-up. ROC curve analyses were performed to 

determine the performance for assessing residual tumor. The 

value of each imaging criterion was assessed. 

Results: 3/20 patients had residual disease. AUC for identification 

of residual tumor based on visual interpretation 

was 0,94; sensitivity 100%, specificity 88%. The individual 

imaging criteria resulted in AUCs of 0,94 (isointense mass), 

0,50 (hypointense mass), 0,67 (irregular border) and 0,70 

(nodular shape). The combination of an isointens nodular 

mass resulted in a AUC of 0,98, sensitivity 100%, specificity 

88%. Adding an irregular border in AUC of 1,00, sensitivity 

100%, specificity 100% 

Discussion: MRI can provide high accuracy for the assessment 

of residual tumor after RT in patients with locally 

advanced cervical carcinoma. The best imaging criteria to 

predict residual disease are the presence of an isointense 

residual mass with nodular shape and irregular borders. 

Use of these criteria could benefit the MR assessment of 

residual disease in daily clinical practice. 

48 



Sessie 7 

Kinderradiologie/Diversen 7 

Kinderradiologie/Diversen 


O7.1 

THE ROLE OF DYNAMIC CONTRAST 

ENHANCED MR ENTEROGRAPHY AS 

COMPARED TO ABDOMINAL ULTRASOUND 

IN DIAGNOSING INFLAMMATORY BOWEL 

DISEASE IN CHILDREN 

M.L.W. Ziech, T.Z. Hummel, A.M. Smets, C. Lavini, 

A. Kindermann, S. Bipat, A.J. Nederveen, M.W.A. Caan, 

J. Stoker 


Purpose: Our purpose was to assess if dynamic contrast 

enhanced magnetic resonance imaging is useful as compared 

to ultrasound in diagnosing inflammatory bowel disease 

(IBD) in children. 

Method and materials: Consecutive consenting pediatric 

patients with suspected IBD were included. All patients 

underwent diagnostic work-up including ileo-colonoscopy 

and esophagogastroduodenoscopy under general anesthesia, 

MR enterography (800 ml sorbitol ingested in 3 hours 

as an small bowel and colonic intraluminal contrast agent, 

3T coronal dynamic contrast enhanced 3D T1-weighted 

sequence, temporal resolution 0.8 seconds) and 

abdominal ultrasound (including Doppler measurements of 

the superior and inferior mesenteric artery). At MRI maximum 

enhancement (ME) was calculated in a region of interest 

representing the terminal ileum, ascending, transverse 

and descending colon. Statistical analysis was performed 

with the Kruskall-Wallis test. 

Results: Eighteen paediatric patients were included (9 

males, 50%; mean age 14, range 10-18 years). Seven were 

diagnosed with ulcerative colitis (39%) and eight with 

Crohn’s disease (44%). Three patients had no IBD (17%). 

Fifteen patients underwent all modalities, three did not 

undergo ultrasound. Patients with Crohn’s disease had significantly 

larger wall thickness of the terminal ileum (p=0.037) 

measured with abdominal ultrasound. There were no differences 

between groups for all other segments and flow 

velocities. Mean ME at DCE-MRI did not differ significantly 

between the three groups (p=0.202). 

Conclusion: Wall thickness of the terminal ileum on abdominal 

ultrasound can be used for the diagnosing Crohn’s 

disease, but not for ulcerative colitis. There seems to be no 

role for DCE-MRI in children with suspected IBD. 

O7.2 

MINIMALLY INVASIVE MRI BY OMITTING 

INTRAVENOUS CONTRAST INJECTION; 

DOES IT CHANGE THE RADIOLOGIC 

ASSESSMENT OF KNEE JOINT PATHOLOGIES 

IN JIA? 

R. Hemke, M.A.J. van Rossum, M. van Veenendaal, 

T.W. Kuijpers, M. Maas 


Purpose: MRI is the most preferred imaging modality in 

detecting joint pathologies in Juvenile Idiopathic Arthritis 

(JIA), despite practical limitations. Gadolinium (Gd) contrast 

use prolongs examination time, increases invasiveness and 

patient discomfort, and thereby reduces feasibility of MRI 

in JIA patients. Therefore, our objective is to evaluate if JIA 

joint pathologies can be reliably assessed by MRI 

without Gd injection compared with Gd-enhanced MRI as 

the reference. 

Methods: Data-sets (open-bore, 1.0T) of 46 JIA patients 

(mean age 12 years [range 4-18]) were prospectively scored 

twice by two experienced readers for the presence of knee 

joint pathologies. MRI features were evaluated using a 

literature-based assessment score, comprising synovial 

hypertrophy, bone marrow edema (BME), cartilage lesions 

and bone erosions. The first reading included unenhanced 

images (-Gd), whereas complete image sets were available 

for the second reading (+Gd). 

Results: Using +Gd MRI as the reference, sensitivity and 

specificity of -Gd MRI in the detection of BME (89%, 99%), 

cartilage lesions (73%, 100%) and erosions (100%, 99%) 

were high. Good -Gd and +Gd interreader agreements (ICC) 


49

7 


were found regarding BME (0.87, 0.88), cartilage lesion 

(1.00, 0.97) and bone erosion scores (0.90, 0.93). Regarding 

synovial hypertrophy scores, the specificity of -Gd MRI was 

98%, though the sensitivity was 60%. ICC for +Gd MRI was 

0.88, however omitting post-Gd acquisitions increased interreader 

variation (ICC=0.76). 

Conclusion: Omitting intravenous contrast is unimportant 

in the assessment of bone marrow edema, cartilage lesion 

and bone erosion scores in knees of JIA patients, but decreases 

the reliability of synovial hypertrophy scores. 

O7.3 

ULTRASOUND TO PREDICT SIGNIFICANT 

HEPATIC STEATOSIS IN OBESE 

ADOLESCENTS: POOR POST-TEST 

PROBABILITY DESPITE ACCEPTABLE 

SENSITIVITY AND SPECIFICITY 

A.E. Bohté 1 , B.G. Koot 1 , A.J. Nederveen 1 , 

O.H. van der Baan-Slootweg 2 , S. Bipat 1 , T.H. Pels Rijcken 3 , 

P.L.M. Jansen 1 , M.A. Benninga 1 , J. Stoker 1 

1 


2 

Heideheuvel Kliniek, Hilversum 

3 

Tergooiziekenhuizen, Hilversum 

Purpose: to evaluate the post-test probability of ultrasound 

(US) for the prediction of hepatic steatosis (HS) in a severely 

obese adolescent population with 1 H-MRS as reference 

standard. 

Methods: HS was prospectively evaluated in 113 obese 

adolescents with US and 1 H-MRS. For US, HS was 

graded semi-quantitatively as 0:none, 1:mild, 2:moderate, 

3:severe). 1 H-MR spectra were acquired with a PRESS 

sequence in a voxel of 8cm3 at 3T. The fat fraction (FF) was 

calculated as: total fat peak area/reference water peak area. 

HS was defined as a FF>1.8% and US score ≥1. Moderate/ 

severe HS as a FF>7.7% and US score ≥2. Sensitivity and 

specificity for both thresholds were calculated. Based on 

these values the negative and positive post-test probabilities 

were determined and plotted against the prevalence of HS. 

Results: Mean age was 14.1y; mean BMI was 38.3 kg/m2. 

The overall prevalence of HS was 0.45 (95%CI:0.36-0.54) 

with a sensitivity of 0.84 (0.78-0.91) and a specificity of 0.55 

(0.46-0.64) for US grade ≥1. The prevalence of moderate/ 

severe HS was 0.14 (0.08-0.21) with a sensitivity of 0.75 

(0.67-0.83) and a specificity of 0.87(0.80-0.93) for US grade 

≥2. The positive and negative post-test probabilities are 

plotted in fig.1 for both threshold values. The positive posttest 

probabilities were low: 0.61 for US grade ≥1 and 0.48 

for grade ≥2. Negative post-test probabilities (1-NPV) were 

adequate: 0.19 and 0.05 respectively. 

Discussion: The positive post-test probability of US for HS 

was poor. This implies that the applicability of US to predict 

HS in the individual obese adolescent is limited. 

Figure 1 

50 




O7.4 

RESPIRATORY DISEASE IN PAEDIATRIC 

ALLOGENEIC HEMATOPOIETIC STEM 

CELL TRANSPLANT (HSCT) RECIPIENTS: 

COULD A HIGH-RESOLUTION COMPUTED 

TOMOGRAPHY (HRCT) SCORE AID IN 

DIAGNOSIS? 

P.A. de Jong, A.B. Versluys, J.J. Boelens, F.J.A. Beek 


Background: HSCT can be complicated by a variety of 

live-threatening infectious and non-infectious pulmonary 

complications, but much overlap appears to be present in 

HRCT features of these complications. 

Aims: To assess observer agreement of a HRCT-score for 

typical post-HSCT abnormalities and to determine whether 

this HRCT-score can differentiate between infectious and 

non-infectious diseases. 

Methods: Following protocol paediatric HSCT-recipients 

undergo HRCT when respiratory symptoms occur or when 

infection is suspected for which chest radiography demonstrates 

no obvious cause. Forty-five consecutive disease 

episodes in 45 children were studied. HRCT were scored for 

severity per lobe (maximum score 18) by two blinded independent 

radiologists for various airway and parenchyma/ 

interstitial abnormalities. Clinical diagnosis was established 

by an expert HSCT-physician based on all available information 

including follow-up. Possible diagnoses were; pulmonary 

infection, early alloimmune lung disease (0.80) 

for consolidation and composite 

HRCT-score and moderate (intraclass-correlation 0.60-0.79) 

for bronchiectasis, tree-in-bud, nodules, ground glass and 

expiratory air trapping. The prevalence of abnormalities 

largely overlapped between infectious and non-infectious 

complications, but alloimmune lung disease was associated 

with significantly higher composite HRCT-score (both early 

and late), ground glass HRCT-score (early) and air trapping 

HRCT-score (late, Figure 1) when compared to infectious 

disease. 

Conclusion: Our data suggest that the severity of certain 

HRCT abnormalities aids in the differentiation between 

infectious and non-infectious complications in pediatric 

HSCT recipients. The role of the HRCT-score in HSCTrecipients 

needs confirmation in an independent study. 

Figure 1: Two patients with alloimmune lung disease. 

O7.5 

OVERCONSUMPTIE VAN RÖNTGEN- 

DIAGNOSTIEK BIJ KINDEREN NA 

POLSTRAUMA; DE NOODZAAK VAN EEN 

KLINISCHE BESLISREGEL 

A. Slaar 1 , A. Bentohami 1 , M.W. Walenkamp 1 , 

B.A. van Dijkman 2 , T.S. Bijlsma 3 , M. Maas 1 , J.C.H. Wilde 1 , 

N.W.L. Schep 1 , J.C. Goslings 1 

1 


2 

Flevoziekenhuis, Almere 

3 

Spaarne Ziekenhuis, Hoofddorp 

Acuut polsletsel bij kinderen is een van de meest voorkomende 

redenen van een bezoek aan de spoedeisende hulp. 

In de meeste ziekenhuizen wordt routinematig een 

Röntgenfoto gemaakt van de pols. Echter, een groot aantal 

van de Röntgenfoto’s laat geen afwijkingen zien. 

Doel: onderzoeken welk percentage van de aangevraagde 

röntgenfoto’s met de vraagstelling fractuur ook daadwerkelijk 

een fractuur liet zien bij kinderen met polsletsel. 

Gegevens van de kinderen (3 tot en met 16 jaar oud) die zich 

van 1 september 2009 tot 1 september 2010 presenteerden 

op de spoedeisende hulp van een ziekenhuis, waarvan een 

röntgenfoto van de pols werd gemaakt met de vraagstelling 

polsfractuur, werden geanalyseerd. Van deze patiënten werden 

de demografische gegevens, het traumamechanisme, 

aanwezigheid van een fractuur en fractuurtype verzameld. 

309 patiënten konden worden geanalyseerd. De gemiddelde 

leeftijd bedroeg 11.20 (SD=3.1); 153 waren jongens. 77% 


51

7 


van de patiënten was gevallen, 33% van de kinderen waren 

gevallen tijdens spelen. 

Slechts 50 % van de röntgenfoto’s liet een polsfractuur zien. 

Bij 34% van deze patiënten bedroeg het een torus fractuur, 

17% een radius fractuur, 13% een greenstick fractuur, 15% 

een antebrachii fractuur, bij 19% een Salter Harris type 2 

fractuur, resterende fracturen 2%. 

Conclusie: De helft van de röntgenfoto’s van kinderen na 

een polstrauma liet geen fractuur gezien. Deze overconsumptie 

van röntgendiagnostiek leidt tot onnodige wachttijden, 

onnodige stralenbelasting bij kinderen, en onnodige 

kosten. 

Derhalve is er behoefte aan een klinische beslisregel analoog 

aan de Ottowa Ankle rules. Deze Amsterdam Wrist 

Rules zijn op dit moment in ontwikkeling. 

O7.6 

STRALING DOOR CT SCANS BIJ KINDEREN 

EN HET RISICO OP KANKER: EEN 

EPIDEMIOLOGISCHE STUDIE 

M. Hauptmann 1 , A.M. Smets 2 , M. van Herk 1 , 

R.A.J. Nievelstein 3 , J.S. Laméris 2 , C.M. Ronckers 2,4 

1 

Nederlands Kanker Instituut, Amsterdam 

2 


3 


4 

Stichting Kinderoncologie Nederland, Den Haag 

Computer tomografie (CT) scans gaan gepaard met hogere 

stralingsdoses dan conventionele beeldvormende technieken. 

Omdat het gebruik van CT gestaag stijgt is het van 

belang ongewenste neveneffecten goed in kaart te brengen, 

in het bijzonder het ontstaan van kanker. Kinderen vormen 

een extra kwetsbare groep omdat zij gevoeliger zijn dan 

volwassenen voor de schadelijke gevolgen van ioniserende 

straling en omdat zij een lange levensverwachting hebben 

waardoor er een grotere kans is dat negatieve bijwerkingen 

tot uiting kunnen komen. Er is op dit moment echter geen 

direct empirisch bewijs voor een verband tussen CT scans 

en kanker. 

Wij beschrijven de opzet van een Nederlands retrospectief 

cohortonderzoek als onderdeel van een groot multinationaal 

samenwerkingsverband. Het onderzoek heeft als doel om 

(1) het gebruik van CT scans bij kinderen in Nederland te 

beschrijven en (2) het verband tussen CTgerelateerde stralingsdosis 

en het risico op kanker (voornamelijk leukemie) te 

kwantificeren. De methoden van dataverzameling zijn getest 

in een pilot-studie en geoptimaliseerd. De beoogde studie 

betreft circa 100.000 mensen die in de periode 1999-2010 

op kinderleeftijd (0-17 jaar) één of meerdere CT scans hebben 

gehad in Nederland. De cohortleden worden geïdentificeerd 

en de dosis zal worden geschat op basis van elektronische 

archieven (RIS, PACS) van de afdelingen (kinder) 

radiologie van deelnemende ziekenhuizen. Follow-up voor 

incidente gevallen van kanker zal via de Nederlandse Kanker 

Registratie (NKR) gaan. Voorbereidingen voor de dataverzameling 

zijn dit voorjaar van start gegaan, in nauwe samenwerking 

met de Nederlandse Vereniging voor Radiologie en 

de radiologie afdelingen van Nederlandse ziekenhuizen. 

O7.7 

LONGITUDINAL IN VIVO IMAGING OF 

GD-LABELED MSCS AND OPTIMIZATION OF 

LABELING STRATEGY 

J. Guenoun, G.A. Koning, P.A. Wielopolski, G. Doeswijk, 

G.P. Krestin, M.R. Bernsen 


Purpose: Optimizing the labeling of mesenchymal stem 

cells with Gd-liposomes for sensitive, longitudinal cell tracking 

in vivo. 

Materials and methods: Gd-DTPA was incorporated 

in liposomes. Rat mesenchymal stem cells were labeled 

with liposomes containing various Gd-dosages, for various 

labeling times. Cellular Gd load, cellular toxicity, cell proliferation 

rate and cell differentiation were then determined 

for the different conditions. Intracellular retention of Gd 

was assessed (20d). Intracellular fate of Gd-liposomes was 

imaged with confocal microscopy, using intraliposomal fluorescent 

dyes. MRI of MSCs was performed on a 1.5T 

and 3.0T clinical scanner. Cells were transplanted in rat 

skeletal muscle and imaged for 3 weeks in vivo. At several 

time-points histology was performed to correlate to MRI 

findings. Statistical tests: one-way ANOVA, with Bonferroni 

post-hoc test. 

Results: Labeling for 4h with 125 µM lipid is most 

preferred, combining time-efficiency with sufficient cellular 

Gd uptake (30±2.5 pg Gd cell-1), lacking significant 

effects on cell viability, proliferation and differentiation. 

Gd-liposomes were well retained intracellularly in endosomes. 

Gd-liposome labeled MSCs were visualized at 1.5T and 

3.0T both in vitro and in vivo. At least 10.000 Gd-MSCs were 

detected. Histology showed cellular incorporated liposomes 

at the site of injection. Prolonged in vivo imaging of 500,000 

Gd-labeled cells was possible for at least two weeks (3.0T). 

Conclusion: Gd-loaded liposomes are suitable for cell 

labeling, without detrimental effects on cell viability, proliferation 

and differentiation allowing sensitive and longitudinal 

visualization by MRI. 

52 




Figure 1 

O7.8 

CELLULAR IMAGING: IN VIVO ASSESSMENT 

OF GD- OR SPIO-LABELED CELL GRAFT 

VIABILITY, COMBINING MRI AND 

BIOLUMINESCENCE IMAGING 

J. Guenoun, A.R. Ruggiero, G. Doeswijk, G.A. Koning, 

G.P. Krestin, M.R. Bernsen 


Purpose: Using MRI mapping techniques to determine 

possible differences in R1, R2 or R2* relaxation rate of 

viable and non-viable transplanted rMSCs, labeled with Gd 

or SPIO . 

Using bioluminescence imaging to link changes in R1, R2 or 

R2* to cell viability. 

Materials and methods: Study type: experimental longitudinal 

follow up. 

Gd-DTPA was intraliposomal incorporated. Rat mesenchymal 

stem cells (rMSCs), expressing firefly luciferase, were labeled 

with SPIO or Gd-liposomes. Cells were divided in a viable 

and non-viable fraction (non-viable cells were acquired 

by repeated freeze-thawing). For in vivo studies, 5x105 

viable or non viable rMSCs were injected intramuscular and 

imaged with MRI and BLI at days 2, 5, 10, 15. T1, T2 and 

T2* mapping was performed on 3T. At end-point animals 

were sacrificed for immunofluorescent staining. 

Results: Irrelevant MRI signal from non-viable Gd-MSCs 

disappeared quickly (

7 


Figure 1 

54 



Sessie 8 


Mammadiagnostiek 2 


O8.1 

EVALUATIE IN TIJD EN ACCURATESSE 

VAN CORONALE BEOORDELING VERSUS 

CORONALE, SAGITTALE EN AXIALE 

VLAKKEN BIJ AUTOMATED BREAST 

VOLUME SCANNING 

M.D.F. de Jong, G.J. Jager, I.J.M. Dubelaar, T.A. Fassaert, 

M.J.C.M. Rutten 


Doel: Borstkankerscreening middels mammografie is een 

effectieve manier van screenen om de sterfte aan boorstkanker 

te verlagen. Echter de sensitiviteit wordt lager naarmate 

densiteit van het borstweefsel toeneemt. Automated breast 

volume scanning (ABVS) kan worden ingezet als toegevoegde 

screeningsmodaliteit. Voorafgaand hieraan zullen de testeigenschappen 

(hoge sensitiviteit en laag aantal fout negatieven) 

geëvalueerd moeten worden. Voordat implementatie in 

een screeningsprogramma mogelijk is, zal ook het gebruiksgemak 

en beoordelingstijd geëvalueerd moeten worden. 

Materiaal & methode: Van 50 ABVS scans werden eerst 

de coronale reconstructies beoordeeld volgens de BI-RADS 

criteria. Ieder onderzoek betrof 3 a 5 scans per borst. Aantal 

en locatie van elke laesie en beoordelingstijd werd genoteerd. 

Daarna werden de drie richting scans beoordeeld en 

vergeleken met de coronale. 

Resultaten: Als proof of principal werden 9 patiënten 

beoordeeld tot nu, resulterend in 59 scans van 17 borsten. 

Er was geen verschil in BI-RADS classificatie en de 

drie vlakken beoordeling detecteerde vier extra cysten. 

Beoordelingstijd bedroeg bij de coronale evaluatie 28,1 

seconden in vergelijking met 96,0 seconden met drie vlakken, 

hetgeen een factor 3,4 bedraagt. 

Conclusie: Voorlopige resultaten tonen een goede overeenkomst 

tussen de twee manieren van beoordelen, waarbij er 

aanzienlijke tijdwinst te behalen valt met de coronale scan 

beoordeling. Dit kan belangrijk zijn als ABVS als screeningsmodaliteit 

ingezet gaat worden. 

O8.2 

OPBRENGST VAN HERHAALDE VERWIJZING 

NA EEN EERDERE FOUT POSITIEVE 

SCREENINGSMAMMOGRAFIE 

W. Setz-Pels 1 , L.E. Duijm 1 , A.C. Voogd 2 

1 


2 


Doel: Bepaling van de screeningsuitkomsten van vrouwen 

die opnieuw zijn verwezen voor een laesie welke na een 

eerdere verwijzing als fout positief is afgegeven. 

Methoden: We includeerden alle 424703 screeningsonderzoeken, 

welke van 1995 t/m 2009 bij 2 screeningseenheden 

waren gemaakt. Van alle 5676 verwijzingen werd na 1 jaar, 

middels de verslagen van radiologische, chirurgische en 

PA-bevindingen in het natraject, vastgesteld of er al dan niet 

sprake was van borstkanker. Bij 61 van de 147 vrouwen, die 

na een eerdere fout-positieve verwijzing voor een tweede 

keer waren verwezen, werd middels de screeningsfoto’s 

en notities van de screeningsradiologen vastgesteld dat de 

reden voor herhaalde verwijzing dezelfde laesie betrof. 

Resultaten: Bij 2180 verwezen vrouwen was sprake van 

borstkanker (5,1 borstkankers per 1000 screens, positief 

voorspellende waarde van verwijzing (PVW): 38,4%, 95% 

betrouwbaarheids-interval 37,1%-39,7%). Bij 22 van de 

61 vrouwen, opnieuw verwezen voor dezelfde laesie 

na een eerdere fout positieve screen, werd borstkanker 

vastgesteld (PVW 36,1%, 95% betrouwbaarheids-interval 

23,7%-48,5%). Bij 4 van deze 22 borstkankers betrof het 

een advanced cancer (invasief carcinoom >20 mm en/of 

lymfkliermetastasen). De vertraging in borstkanker diagnose 

varieerde van 21 tot 92 maanden (gemiddeld 42,5 maanden) 

en 9 vrouwen (40.9%) waren tenminste 1 keer gescreend 

(en niet verwezen) tussen de eerste, ten onrechte fout positieve 

verwijzing, en de tweede verwijzing. 

Discussie: Bij een belangrijk percentage vrouwen die 

opnieuw wordt verwezen voor dezelfde laesie, is sprake 

van borstkanker. Verder onderzoek is vereist om te bepalen 

welke factoren in het natraject en in de screening leiden tot 

een vertraging in de diagnose borstkanker. 


55

8 


O8.3 

RESPONSE EVALUATION OF NEOADJUVANT 

CHEMOTHERAPY IN MAMMACARCINOMA: 

ASSOCIATION OF CHANGES IN MRI 

DYNAMIC GADOLINEUM ENHANCEMENT 

AND DIFFUSION WEIGHTED IMAGING (DWI) 

V.H.P. Tran, M.H.M. Volmerink, A.L.T. Imholz, 

R.A.J.M. van Dijk 

Deventer Ziekenhuis, Deventer 

Background: Monitoring tumour response in neoadjuvant 

chemotherapy in mammacarcinoma is based on MRI dynamic 

gadolineum enhancement. However, the role of DWI in 

tumour response monitoring remains to be established. 

Methods: In this retrospective study, (changes in) apparent 

diffusion coefficient (ADC) after three cycles of neoadjuvant 

chemotherapy in 29 consecutive patients treated in our hospital 

between 2006 and 2010 were compared to changes 

in tumour size measured by RECIST, cross sectional area of 

tumour (both early enhancement), and diameter of gadolineum 

washout. 

Results: Following chemotherapy, ADC increased from 

1,44*10 -3 mm 2 /sec (SD0,37*10 -3 ) to 1,69*10 -3 mm 2 /sec 

(SD0,40*10 -3 ; Student’s t-test p


MRI was performed on a 7T whole-body scanner (Philips 

Health Care, Cleveland, USA) using a two-channel doubletuned 

unilateral RF breast coil. The protocol included a dynamic 

series consisting of 7 consecutive 3D T1-weighted Turbo 

Field Echo scans with fat suppression by means of selective 

water excitation [TR/TE 5.0/2.0ms, binominal FA 20˚, FOV 

160x160x160mm 3 , acquired resolution 

1mm isotropic, temporal resolution of 63seconds]; and a 

high resolution T1-weighted 3D Fast Field Echo Spectral 

Selection Attenuated Inversion Recovery sequence [acquired 

resolution 0.45x0.57x0.45mm 3 ]. After the 1st dynamic scan 

0.1mmol/kg Gadobutrol was injected. 

Lesions were assessed according to ACR BI-RADS-MRI criteria. 

Results were compared to histopathology. 

Results: The exams were technically successful. Lipid suppressed 

sequences showed good lesion-and-fibroglandulartissue 

to fat contrast. All lesions were masses of irregular 

shape. Margins were spiculated in 4 and irregular in 1. 

Enhancement was heterogeneous in 3, homogeneous in 

1 and rim type in 1. In 4 lesions the kinetic curve showed 

rapid-rise, followed by wash-out: type-3 curve. 1 lesion showed 

rapid-rise followed by a plateau-phase: type-2 curve. 

All lesions were categorized BI-RADS V. Histopathology 

showed 3 ductulolobular and 2 ductal carcinomas. 

Conclusion: CE Breast MRI at 7T is technically feasible. 

The exams were amenable to BI-RADS-MRI conform analysis, 

allowing for future intra-individual comparison between 

7T and 3T. 

Figure 1: X-ray mammography and 7T CE-MRI results 

obtained from a 62 year old patient. 

a) X-ray mammography (Cranio-Caudal view, rotated to correspond 

to the MRI orientation), showed a BI-RADS V lesion (circle). 

b) Pre-contract T1 weighted MRI (voxel size 1x1x2mm3) showed a 

irregular mass. 

c) After administration of contrast agent the mass showed heterogeneous 

enhancement (T1w imaging, voxel size 1x1x2mm3) 

d) High resolution T1w SPAIR (voxel size 0.45x0.45x0.57mm3) showed 

good fat suppression and fine morphological details. 

e) The most malignant curve (squares) shoed a rapid initial rise, followed 

by a plateau in the delayed phase. The average curve showed 

a similar “tpe-2” pattern (triangles). 

O8.6 

DE INVLOED VAN MRI OP HET BELEID EN 

DE UITKOMST VAN PATIËNTEN MET EEN 

INVASIEF LOBULAIR MAMMACARCINOOM 

J.P. Pennings, R. Storm, R. Rozendaal, R.H.C. Bisschops 

Albert Schweitzer ziekenhuis, Dordrecht 

Doel: Preoperatieve MRI is een onderdeel van de 

EU-richtlijnen bij het beleid van het invasieve lobulaire carcinoom 

(ILC), vanwege de permeatieve groei, frequent gerapporteerd 

multifocaal en multicentrisch voorkomen (32%) en 

contralaterale laesies (7%). In deze retrospectieve studie 

is gekeken of er verschil is in de chirurgische behandeling 

sinds het invoeren van een preoperatieve MRI. 

Methode: Tussen januari 2007 en maart 2011 werden 117 

patiënten met een histologisch bewezen ILC geïncludeerd. 

49 (42%) patiënten onderging sinds het invoeren van de 

richtlijn in 2008 een MRI, van wie 5 postoperatief. Alle 

patiënten werden behandeld conform de geldende richtlijnen. 

De volgende primaire uitkomstmaten werden vergeleken: 

contralaterale bevindingen, chirurgische behandeling, 

irradicaliteit en heroperaties. 

Resultaten: Tussen de patiënten met (n= 49) en zonder 

(n=68) een MR mammografie zijn geen significant verschillen 

in patiëntkarakteristieken, bevindingen op X-mammagram 

of echografie. In beide groepen werd één contralaterale 

tumor gevonden, echter geen ILC maar een ductaal adeno- 


57

8 


carcinoom. In de MRI groep toonde 14 (28%) patiënten een 

multifocale of een multicentrische laesie. Bij acht patiënten 

werd een additionele benigne contralaterale laesie gevonden 

met de MRI. Er is geen significant verschil in chirurgische 

behandeling tussen de twee groepen, 19 (39%) patiënten 

met MRI en 18 (27%) patiënten zonder MRI ondergingen 

een lumpectomie. Er zijn ook geen significante verschillen 

tussen de MRI groep en de niet-MRI groep in irradicaliteit 

(18% vs. 12%) en het aantal heroperaties (14% vs. 4%). 

Discussie: Er werd geen contralaterale ILC gevonden. 

Preoperatieve MRI liet geen significant verschil zien in chirurgische 

behandeling in de door ons onderzochte populatie. 

O8.7 

MOLECULAR OPTICAL IMAGING USING 

AN ORGANIC FLUOROPHORE AND A 

CLINICAL FLUORESCENCE DIFFUSE OPTICAL 

TOMOGRAPHY SYSTEM - EXTENSIVE 

PHANTOM EXPERIMENTS 

A. Adams 1 , J.E.M. Mourik 2 , M. van der Voort 3 , 

W.P.Th.M. Mali 1 , S.G. Elias 1 

1 


2 


3 

Philips Research, Eindhoven 

Purpose: Fluorescence Diffuse Optical Tomography (FDOT) 

is an emerging clinical breast imaging modality. To estimate 

Limits of Detection (LOD) of a clinical FDOT breast system 

(Philips, The Netherlands), phantoms filled with the clinical 

grade available near-infrared organic fluorophore IRDye800CW 

(Licor, Lincoln, NE) were scanned in various situations. 

Methods: Phantoms (0.9cm 3 , 2.1cm 3 ) were filled with 

IRDye800CW and suspended in optical matching fluid (with 

optical properties of average breast tissue) at a center and 

an edge position in a medium sized breast cup (±500cm 3 ). 

Relative (1-120:0, 1-6:1) and absolute (2-20nM) phantom-tobackground 

concentration differences were assessed. Threedimensional 

fluorescence images (excitation: 730nm; filters: 

>750nm) were obtained twice on different days. Average 

signal intensities were determined on reconstructed images 

for volumes matching the sizes and locations of the phantoms. 

Regression lines were fitted and LOD were estimated 

(LOD=(s B 

/β)*k n 

; s B 

: standard deviation of measurements of 

blanks; β: slope of regression line; kn: coverage factor (3.13 

for duplicate measurements and five measurements of 

blanks to reach a type-1 error of 1%)). Pearson’s correlationcoefficients 

and between-day reproducibility were calculated. 

Results: The LOD ranged from 0.1nM to 2.3nM for the different 

situations. The fluorescent signal was very well linearly 

correlated with concentration differences (R 2 : 0.95-1.00); between-day 

reproducibility was excellent (intraclass-correlation: 

0.93-0.99). Differences in regression line slopes were observed 

for the two phantoms and locations but did not affect the LOD. 

Conclusion: Limits of Detection of the Fluorescence Diffuse 

Optical Tomography system for IRDye800CW are in the lownanomolar 

range for relevant situations. Upcoming clinical 

studies with this system and this fluorophore are feasible. 

This research was supported by the Center for Translational 

Molecular Medicine (MAMMOTH). 

Figure 1: The clinical Fluorescence Diffuse Optical Tomography 

(FDOT) breast imaging system. (Philips, The Netherlands) 

Table 1 

58 




Figure 2 

O8.8 

CORRELATIE VAN GEBIOPTEERDE 

MICROCALCIFICATIES IN DE MAMMAE MET 

DE INITIËLE BI-RADS CODERING; ANALYSE 

EN HERBEOORDELING VAN BI-RADS 3 

CALCIFICATIES 

K.J. Kraal, J.J. Hensen, A.C. Sikkenk, J. Nijman, R.A. Niezen, 

D. Vroegindeweij 

Maasstad Ziekenhuis, Rotterdam 

Doel: evaluatie en justificatie van stereotactisch gebiopteerde 

microcalcificaties in de mammae en vergelijking van 

de initiële en gereviseerde BI-RADS codering. 

Methode: retrospectieve analyse van de in de periode 

2007-2009 stereotactisch gebiopteerde microcalcificaties. 

Per mammabiopt werd de oorspronkelijke BI-RADS codering 

vergeleken met de PA-uitslag. 

De BI-RADS 3 groep (42 biopten) werd voor herbeoordeling 

voorgelegd aan een ervaren mammaradioloog (A) en een 

ouderejaars assistent (B), zonder kennis van de oorspronkelijke 

codering maar met kennis van de oorspronkelijke klinische 

informatie en ondergane stereotaxie. Maligne werd 

gedefinieerd als BIRADS 4 en 5. 

Bij herevaluatie van de oorspronkelijke BI-RADS 3 codering, 

ivm te hoog percentage maligniteit, ontstond een spreiding 

naar andere coderingen waarbij 44% een BI-RADS code 2 

of 3 en 56% code 4 of 5 kregen. Beoordelaar A en B bereikten 

een sensitiviteit van 86%, resp. 57 % en een positief 

voorspellende waarde van 25%, resp. 17 % voor de maligne 

microcalcificaties. 

Conclusie: van de stereotactische biopten in verband met 

microcalcificaties bleek 26% maligne. De oorspronkelijke 

codering laat een te hoog percentage maligne microcalcificaties 

met oorspronkelijke BI-RADS 3 codering zien. 

Bij herbeoordeling ontstaat een significante verschuiving van 

code 3 naar een hogere codering en een betere correlatie 

met de PA. 

De meest ervaren beoordelaar haalt bij herbeoordeling de 

hoogste sensitiviteit en PVW voor maligne microcalcificaties. 

Resultaten: van 236 biopten bleek 74% benigne en 26% 

maligne. Respectievelijk 0% van de BI-RADS 2-, 16% van de 

BI-RADS 3-, 26% van de BI-RADS 4- en 88% van de BIRADS 

5 gecodeerde microcalcificaties waren maligne. 


59

8 


O8.9 

TRENDS IN INCIDENCE AND DETECTION 

OF ADVANCED BREAST CANCERS AT 

BIENNIAL SCREENING MAMMOGRAPHY: 

A POPULATION BASED COHORT STUDY 

J. Nederend, F.H. Jansen, L.E.M. Duijm 


Purpose: To determine trends in incidence of advanced 

breast cancer (ABC) at screening mammography and determine 

the potential of reducing ABC at screening. 

Methods and Materials: We included all 351,009 biennial 

screening mammograms obtained in a Dutch breast 

cancer screening region between 1997-2009. Two screening 

radiologists reviewed screening mammograms of all advanced 

screen detected cancers (SDCs) and advanced interval 

cancers (ICs) and determined whether the ABC (defined as 

>T2-tumour and/or axillary lymph node positive tumour) had 

been visible at the previous screen (SDC) or latest screen 

(IC). Outcome measures were the proportions of ABCs 

among SDCs and ICs through the years and the potential of 

detecting SDCs and ICs at an earlier stage. 

Results: The incidence of ABC did not decline through the 

years and fluctuated annually from 28.7% to 35.4% (mean 

32.2%, 571/1773 among SDCs and from 52.0% to 68.1 

% (mean 63.4%, 424/669) among ICs. Of the 571 screen 

detected ABCs, 106 (18.6%) were detected at the initial 

screen, respectively 266 (46.6%) and 88 (15.4%) were either 

not visible or showed a minimal sign at the previous screen 

and 111 (19.4%) had been missed at the previous screen. 

Advanced ICs were either not visible at the latest screen or 

showed a minimal sign in respectively 50.9% (216/424) and 

24.3% (103/424) of cases, whereas 25.1% (105/394) had 

been missed at screening. 

Conclusions: No decline in ABC was observed during 12 

years of biennial screening mammography. A majority of 

ABCs cannot be prevented through earlier breast cancer 

detection at screening. 

O8.10 

THE VALUE OF BLUE DYE FOR DETECTING 

THE SENTINEL LYMPH NODE IN BREAST 

CANCER PATIENTS IN ADDITION TO 

LYMPHOSCINTIGRAPHY 

M.A. Korteweg, J.D. van Amstel, M. Hobbelink, 

B.L. Stehouwer, M.A.A.J. van den Bosch, A.J. Witkamp, 

P.J. van Diest, W.P.Th.M. Mali, W.B. Veldhuis 


Background: Sentinel lymph node biopsy (SLNB) is 

performed for axillary staging of breast cancer patients by 

blue dye injection, lymphoscintigraphy or combining both 

techniques. This study assesses the added value of blue dye 

for sentinel lymph node (SLN) detection in comparison to 

lymphoscintigraphy. 

Materials & methods: Patients with invasive breast 

cancer who underwent a SLNB following both lymphoscintigraphy 

(figure1) and blue dye injection between January 

2007 and August 2010, were included. The outcome was 

recorded. Sensitivity, specificity, positive and negative predictive 

value (PPV, NPV) were determined. 

Results: 256 SLNs were harvested of 151 patients who 

received 153 SLNB procedures. 68 (26%) nodes contained 

metastases. Lymphoscintigraphy was unsuccessful in 5 procedures 

(3%), of which in 1 case (1/5; 20%) blue dye detected 

the SLN (table1). The added overall value of blue dye is 

0.7% (1/153). Blue dye was unsuccessful in 55 procedures 

(36%), of which lymphoscintigraphy was successful in 

51 procedures (51/55; 93%). Of the 4 procedures both techniques 

failed, an axillary nodal dissection was performed 

in 3 cases and in 1 case the SLN was found by palpability. 

Sensitivity, specificity, PPV and NPV for blue dye and for 

lymphoscintigraphy were respectively 68%, 50%, 33%, 

81% and 97%, 12%, 40%, 92%. Combining both techniques 

resulted in values of 99%, 5%, 27% and 90%. 

Conclusion: Blue dye injection, as adjunct to lymphoscintigraphy 

resulted in 0.7% additional SLN detection. Blue 

dye detected the SLN in 20% of failed lymphoscintigraphy 

procedures. This implies that blue dye should only be used 

when lymphoscintigraphy is unsuccessful. 

60 




Figure 1: Anterior(A) and lateral(B) scintigraphic imaging in a 59-year old female patient with breast cancer, two hours after injection of technetium-99 

nanocolloid. The largest spot is the injection site of technetium-99-nanocolloid. The nannocolloid was injected peri-tumorally in the 

breast. The lateral image also depicts two axillary lymph nodes (arrows) which have taken up the nanocolloid. These nodes are sentinel lymph 

nodes as they are assumed to also be the first nodes to accumulate metastases. 

# Age Breast Cancer Type Metastatic Node Blue Node 

1 69 Ductal None No 

2 83 Lobular None No 

3 64 Mixed ductal-lobular Macro No 

4 73 Mixed ductal-lobular Macro No 

5 79 Ductal Macro Yes 

Table 1: Patient characteristics of the patients with an unsuccessful lymphoscintigraphy procedure: Patients 1-3 received an axillary lymph node 

dissection. Patient number 4 and 5 received a sentinel lymph node biopsy as in patient 4 the node was palpable and in patient 5 the sentinel node 

dyed blue. 


61


Sessie 9 

Neuro- en Hoofdhals radiologie 


O9.1 

ARTERIAL CALCIFICATION IN RELATION 

TO COGNITION AND STRUCTURAL BRAIN 

CHANGES 

D. Bos, M.W. Vernooij, S.E. Elias-Smale, G.P. Krestin, 

A. Hofman, W.J. Niessen, J.C.M. Witteman, A. van der Lugt, 

M.A. Ikram 


Purpose: Atherosclerosis plays an important role in the 

pathogenesis of cognitive decline and dementia. Calcified 

plaque measured with CT is a marker of atherosclerosis. 

This study investigates associations between CT-measured 

arterial calcifications measured at four locations, with cognition 

and macro- and microstructural brain changes. 

Method and materials: From the general population, 2437 

participants underwent CT of the coronary arteries, aortic 

arch, extracranial and intracranial carotid arteries to quantify 

calcification volume. Cognitive function was assessed in the 

following domains: memory, executive function, information 

processing speed and motor speed. In a random subgroup of 

844 participants brain MRI was performed to obtain measures 

of brain atrophy. Automated quantification of brain MRI 

scans yielded tissue-specific brain volumes. Furthermore, 

microstructural integrity of white matter was quantified 

using diffusion tensor imaging (DTI). Associations between 

arterial calcification and cognition, brain tissue volumes and 

DTI-measures were assessed with linear regression, adjusted 

for relevant confounders. 

Results: Larger calcification load was associated with 

worse cognitive scores in all domains. Calcification in all 

vessel beds was also associated with smaller total brain 

volume. Specifically, coronary calcification was associated 

with smaller grey matter volume, whilst both extra- and 

intracranial carotid artery calcification was associated with 

smaller white matter volume. Calcification in all vessel beds 

was associated with worse microstructural integrity of white 

matter. 

Conclusion: Arterial calcification load is associated with 

worse cognitive performance. Moreover, larger calcification 

load is associated with smaller brain tissue volumes and 

with worse white matter microstructural quality, elucidating 

possible mechanisms through which atherosclerosis leads to 

poorer cognition. 

O9.2 

TIA AND STROKE PATIENTS WITH CAROTID 

STENOSIS: PRESENCE OF COMPLICATED 

PLAQUE FEATURES AT MRI IS ASSOCIATED 

WITH RECURRENT EVENTS 

R.M. Kwee 1 , R.J. van Oostenbrugge 1 , W.H. Mess 1 , 

M.H. Prins 1 , R.J. van der Geest 2 , J.W.M. ter Berg 3 , 

C.L. Franke 4 , A.G.G.C. Korten 5 , B.J. Meems 6 , 

J.M.A. van Engelshoven 1 , J.E. Wildberger 1 , M.E. Kooi 1 

1 


2 


3 

Orbis Medisch Centrum, Sittard 

4 

Atrium Medisch Centrum Parkstad, Heerlen 

5 

Laurentius Ziekenhuis, Roermond 

6 


Purpose: There is a need for improved risk stratification of 

TIA and stroke patients with carotid atherosclerosis. The 

purpose of the present study was to prospectively investigate 

whether certain MRI-based carotid plaque characteristics 

are associated with recurrent ischemic events. 

Materials and Methods: One hundred TIA/stroke patients 

with ipsilateral 30-69% carotid stenosis underwent multisequence 

MRI, including contrast-enhanced images, of the 

carotid plaque within 32.7±19.9 days after the initial event. 

For each plaque, vessel wall volume and volumes of lipidrich 

necrotic core (LRNC), calcifications, and fibrous tissue 

were assessed. Maximum vessel wall thickness, minimum 

lumen area, fibrous cap status, and intraplaque hemorrhage 

(IPH) were also assessed. Patients were followed by structured 

interviews and chart review to determine the recurrence 

of ipsilateral TIA and/or ischemic stroke within one year. 

62 



Neuro- en Hoofdhals radiologie 9 

Results: Ten of hundred included patients suffered from 

recurrent ipsilateral clinical ischemic events (9 TIAs and 1 

ischemic stroke). The presence of IPH was associated with 

recurrence (Pearson Chi-Square= 7.373, P=0.007). Patients 

with recurrent events also had plaques with larger LRNC 

volume and larger maximum vessel wall thickness, although 

these findings were borderline significant (P=0.032 and 

P=0.055, respectively). Other MRI-based parameters were 

not related to recurrent ischemic events. 

Conclusion: The results of this study indicate that the 

presence of IPH, larger LRNC volume, and larger maximum 

vessel wall thickness of carotid plaques are associated with 

recurrent TIA and ischemic stroke. Assessment of carotid 

plaque characteristics by MRI may help identifying high-risk 

patients, which could improve patient selection for carotid 

endarterectomy or stenting. 

O9.3 

CAROTID PLAQUE MORPHOLOGY AND 

ISCHEMIC VASCULAR BRAIN DISEASE ON 

MRI 

Q.J.A. van den Bouwhuijsen, M.W. Vernooij, W.J. Niessen, 

G.P. Krestin, M.A. Ikram, J.C.M. Witteman, A. van der Lugt 


Purpose: Vulnerable plaque components in carotid arteries 

can be detected non-invasively with magnetic resonance 

imaging (MRI). In asymptomatic persons, the relation between 

carotid plaque composition and vascular brain disease 

is not well studied. We studied the association between 

carotid atherosclerotic plaque characteristics and ischemic 

brain disease on MRI. 

Methods: From the population-based Rotterdam Study, 952 

participants with carotid wall thickening on ultrasound >2.5 

mm underwent both carotid MRI and brain MRI. Maximum 

carotid wall thickening, degree of stenosis and presence of 

intraplaque hemorrhage, lipid core and calcification were 

assessed in both carotid arteries. Associations between 

plaque characteristics and white matter lesions (WMLs), 

lacunar and cortical infarcts were investigated per 

participant and additionally per carotid artery. Analysis were 

adjusted for cardiovascular risk factors. 

Results: Carotid stenosis (OR per 10% stenosis increase 

1.2 95% confidence interval (1.0-1.4), maximum carotid 

wall thickness (per mm increase 1.3,1.1-1.6) en presence of 

intraplaque hemorrhage (1.9,1.1-3.3), were all found to be 

significantly associated with presence of cortical infarcts, 

both in the participant based analysis and in the carotid 

artery based analysis. There were no associations between 

any plaque characteristics and presence of lacunar infarcts. 

In the subject based analysis maximum plaque thickness, 

presence of intraplaque hemorrhage and calcification were 

associated with WML-volume. In the artery based analysis 

only the association for calcifications remained. 

Conclusion: Presence of carotid intraplaque hemorrhage 

and measures of carotid plaque size are independently associated 

with cortical infarcts, but not with lacunar infarcts. 

Plaque calcification, but not vulnerable plaque components, 

is related to WML volume. 

Clinical relevance: This MRI study gives insight into the 

importance of atherosclerotic plaque composition, also in 

small plaques, for development of ischemic brain disease. 

O9.4 

A COMPUTER BASED DIAGNOSTIC 

SYSTEM TO FACILITATE THE EARLY AND 

DIFFERENTIAL DIAGNOSIS OF DEMENTIA 

B. Jasperse, H.A. Vrooman, M. Koek, M.W. Vernooij, 

R. de Boer, F. van der Lijn, M.A. Ikram, M. Smits, 

W. Niessen, A. van der Lugt 


Purpose: Patterns of brain atrophy, hippocampal atrophy and 

vascular changes, as visualized on brain-MRI, play an important 

role in determining the underlying cause of dementia 

syndromes. The visual interpretation of these pathological 

changes can be very challenging due to intercurrent agerelated 

brain changes.To facilitate the distinction between 

abnormal and ‘normal age-related’ brain changes, we 

developed an automated system that provides individualspecific 

lobar brain volumes, hippocampal volumes and white 

matter lesion volume taking into account age- and sex-specific 

reference data from a ‘healthy’ aging population. 

Methods and Materials: Automated brain tissue segmentation 

and atlas-based registration is performed on T1, T2 

and FLAIR MR-images, generating lobar brain volumes, hippocampal 

volumes and white matter lesion volume. For each 

resulting volume, reference curves are used to generate 

age- and sex-specific percentile values. The results are then 

presented in an on-line viewer to interpret the quality of tissue 

and structure segmentation and the quantitative results. 

Reference curves are generated from 867 healthy aging 

individuals (age-range (years): 61-91, Male/female-ratio (N): 

425/422). 


63

9 


Results/conclusion: An example of segmentation results 

and percentile plots (colored lines represent percentile-lines) 

for a 69 year old male patient with suspected dementia 

is provided in figure 1. Visual inspection suggests parietal 

atrophy, which might be attributed to global cortical atrophy. 

The automated analysis results show that overall brain 

volume is appropriate for age (75th to 95th percentile), with 

a strikingly low parietal lobe volume (37th percentile), confirming 

the initially suspected parietal lobe atrophy. 

A system prototype is currently under evaluation at our 

radiology department. Future work aims to incorporate 

automated analysis of microbleeds, shape of individual 

brain structures and microstructural integrity using diffusionweighted 

MRI sequences. 

Figure 1: Results for a patient with suspected dementia. 

O9.5 

MECHANICAL THROMBECTOMY WITH 

THE TREVO STENT DEVICE IN PROXIMAL 

INTRACRANIAL ARTERIAL OCCLUSIONS 

M.M.A.C. van Doorn 1 , R. van den Berg 1 , B. van der Kallen 2 , 

G.J. Lycklama à Nijeholt 2 , W. van Zwam 3 , Y.B. Roos 1 , P.J. 

Nederkoorn 1 , M.E. Sprengers 1 , J. Bot 1 , J. Boiten 3 , R. van 

Oostenbrugge 3 , A. van der Lugt 4 , D. Beumer 4 , P.S. Fransen 4 , 

D.W.J. Dippel 4 , C.B.L.M. Majoie 1 

1 


2 

Medisch Centrum Haaglanden, Den Haag 

3 


4 


Background and Purpose: To evaluate the safety and 

effectiveness of a self-expanding and fully retrievable stent 

(Trevo; Concentric Medical Inc, Mountain View, CA, USA) in 

revascularization of patients with acute ischemic stroke. 

Methods: Prospective multicenter case series of 22 patients 

with an acute ischemic stroke caused by a proximal intracranial 

arterial occlusion treated with a fully retrievable stent 

within the first 8 hours from symptom onset (median NIHSS 

21 [range 13-28]). Thrombectomy was used as rescue therapy 

in patients who were refractory to, had contraindications 

for or were to late for IV rtPA. The occlusion site was the 

middle cerebral artery in 7, terminus internal carotid artery 

in 2, cervical internal carotid artery/middle cerebral artery in 

4 and basilar artery in 9 patients. Complications related to 

the procedure and outcome at 3-6 months were assessed. 

Results: Stent placement was feasible in all procedures 

and successful recanalization defined as thrombosis in cerebral 

ischemia (TICI) grade 2b or 3 was achieved in 18 of 22 

treated vessels (82%). The mean number of passes for maximal 

recanalization was 2 (range 1-5). The median time from 

groin puncture to recanalization was 110 minutes (range 

26 – 199). One significant procedural event occurred (carotid 

artery occlusion after stent removal). 33% of all patients had 

a good outcome (mRS 0-2), 0% moderate outcome (mRS 3), 

67% poor outcome (mRS 4-6). 

Conclusions: These results suggest that with the Trevo 

device, clots can be safely and effectively removed from 

intracranial large vessel occlusions in acute ischemic stroke. 

64 




O9.6 

RESTING-STATE FUNCTIONAL MRI CHANGES 

IN ALZHEIMER’S DISEASE AND MILD 

COGNITIVE IMPAIRMENT 

M.A.A. Binnewijzend 1 , M.M. Schoonheim 1 , E. Sanz-Arigita 2 , 

A.M. Wink 1 , W.M. van der Flier 1 , N. Tolboom 1 , 

J.S. Damoiseaux 3 , S.M. Adriaanse 1 , P. Scheltens 1 , 

B.N.M. van Berckel 1 , F.A. Barkhof 1 

1 

VU medisch centrum, Amsterdam 

2 

Foundation CITA-AD, San Sebastian, Spain 

3 

Stanford University School of Medicine, Palo Alto, Cal, USA 

Alzheimer’s disease (AD) features distinct structural and functional 

brain changes. With the prospect of disease-modifying 

therapies it is desirable to detect signs of neurodegeneration 

before it is detectable on structural MRI as atrophy. In this 

study we used resting-state functional MRI (rs-fMRI) to 

compare regional functional connectivity of patients with AD, 

mild cognitive impairment (MCI) and healthy elderly controls 

(HC). MRI scans and neuropsychological assessments were 

acquired of 39 AD patients, 23 MCI patients and 43 HC. After 

a mean follow-up of 2.8±1.9 years seven MCI patients 

converted to AD, while 14 patients remained cognitively stable. 

Rs-fMRI scans were non-linearly registered to standard 

space and analyzed using independent component analysis 

(ICA), followed by a “dual-regression”technique to create 

and compare subject-specific maps of each spatio-temporal 

independent component, correcting for age, gender and additionally 

for gray matter atrophy. AD patients displayed decreased 

functional connectivity within the default-mode network 

(DMN) in the precuneus and posterior cingulate cortex compared 

to HC, which survived correction for gray matter atrophy. 

Within these regions, decreased functional connectivity was 

found in converting MCI as well, while no differences were 

found between stable MCI patients and HC. Correlation with 

cognitive dysfunctions demonstrated the clinical relevance of 

functional connectivity changes within the DMN. In conclusion, 

a clinically relevant decrease in functional connectivity 

was observed within the DMN in AD, independent of cortical 

atrophy. Similar decreases were present in MCI patients 

before conversion to AD. Rs-fMRI is a promising technique 

that can identify functional impairment in early AD. 

Figure 1: Differences in DMN FC between HC and AD patients. 


65


Figure 2: Boxplots of regional FC mean z-values. 

O9.7 

COMPUTER-AIDED DIAGNOSIS OF 

CORTICAL LESIONS IN EPILEPSY PATIENTS 

M.C. Hoeberigs 1 , L.M.H. Geelen 1 , P.A.M. Hofman 2 

1 


2 

Kempenhaeghe Epilepsiecentrum, Heeze 

About 30% of epilepsy patients with partial seizures have 

intractable epilepsy. MRI detection of an epileptogenic lesion 

is of clinical importance because focal resection may be the 

only viable therapeutic option. In up to 74% of patients with 

partial seizures, MRI shows no abnormalities, although it is 

assumed that the majority of these patients have a small cortical 

dysplasia. In some of these cases the lesion is visible on 

the MRI study, but not detected by the neuroradiologist. 

We investigated the additional value of a computer-aided 

diagnostic technique, by retrospectively analyzing all scans 

from patients with partial seizures acquired between 

December 2008 and December 2009. The scan protocol on 

a 3T scanner included a 3D-T1 weighted scan, which was 

used for the post-processing. The other sequences were 

axial TSE-T2, FFE-T2 and FLAIR, coronal FLAIR and IR. 

MRI post-processing was a fully-automated voxel-based 3D 

MRI analysis within SPM5 (normalization, segmentation, 

results compared to normal database): feature maps of cortical 

thickness, gray-white junction and gray matter extension 

were generated. These maps were visually evaluated and 

correlated with the full exam. Only when the detected 

cortical lesion was also visible on the original scans it was 

considered a true cortical lesion. 

A total of 289 MRIs were evaluated. Based on visual 

assessment, a cortical lesion was described in 45/289. In 

28/45 positive scans and in 5 out of the initially negative 

244 patients a cortical lesion was detected by computeraided 

technique. 

Computer-aided postprocessing can increase the diagnostic 

yield, but not replace visual assessment. 

66 




O9.8 

COMPLICATIONS OF PARTICLE 

EMBOLIZATION OF MENINGIOMAS: 

FREQUENCY, RISK FACTORS, AND 

OUTCOME 

D.F.M. Carli, M.S. Sluzewski, G.N. Beute, W.J.J. van Rooij 

St. Elisabeth Ziekenhuis, Tilburg 

Purpose: We assessed the frequency and outcome of 

complications of embolization of meningiomas and tried to 

identify risk factors. 

Methods: Between 1994 and 2009, a total of 198 patients 

with 201 meningiomas underwent embolization. Indication 

for embolization was preoperative in 165 meningiomas 

and adjunctive to radiosurgery in 8. In the remaining 28 

meningiomas, embolization was initially offered as a sole 

therapy. There were 128 women and 70 men with a mean 

age of 54.4 years (median age, 54 years; range, 15-90 

years). Complications were defined as any neurologic deficit 

or death that occurred during or after embolization. Logistic 

regression was used to identify the following possible risk 

factors: age above median, female sex, tumor size above 

median, meningioma location in 5 categories, use of small 

particle size (45-150 microm), the presence of major peritumoral 

edema, and arterial supply in 3 categories. 

Results: Complications occurred in 11 patients (5.6%; 95% 

confidence interval [CI], 3.0%-9.8%). Ten complications 

were hemorrhagic, and 1 was ischemic. Six of 10 patients 

with hemorrhagic complications underwent emergency 

surgery with removal of the hematoma and meningioma. 

Complications of embolization resulted in death in 2 and 

dependency in 5 patients (7/198, 3.5%; 95% CI, 1.6%-2.0%). 

The use of small particles (45-150 mum) was the only risk 

factor for complications (odds ratio [OR], 10.21; CI, 1.3-80.7; 

P = .028). 

Conclusions: In this series, particle embolization of meningiomas 

had a complication rate of 5.6%. We believe that 

the use of small polyvinyl alcohol (PVA) particles (45-150 

microm) should be discouraged. 


67

10 


Sessie 10 

MSK/Thorax/Diversen 


O10.1 

REPRODUCIBILITY OF 3D DELAYED 

GADOLINIUM ENHANCED MRI OF 

CARTILAGE OF THE KNEE AT 3.0 TESLA 

IN PATIENTS WITH EARLY-STAGE 

OSTEOARTHRITIS 

J. van Tiel, G. Kotek, H. Smit, E. Bron, S. Klein, G.P. Krestin, 

H. Weinans, E.H.G. Oei 


Purpose: To assess the reproducibility of 3D delayed 

Gadolinium Enhanced MRI of Cartilage (dGEMRIC) of the 

knee at 3.0Tesla in patients with early-stage osteoarthritis 

(OA). 

Methods: In three early-stage knee OA patients (Kellgren 

and Lawrence grade I or II) dGEMRIC was performed twice 

with an interval of seven days using a 3.0Tesla MRI-scanner 

and a custom-made open design knee coil. This coil was 

specifically developed to enable imaging of OA patients who 

would not fit in the commercially available knee coil. The 

new coil has a higher signal-to-noise ratio in the weightbearing 

cartilage compared to the regular knee 

coil. The dGEMRIC consisted of an Inversion Recovery Fast 

Spoiled Gradient Echo sequence with five different inversion 

times. Using Matlab, three regions of interest (ROIs) in the 

medial and lateral cartilage (weight-bearing condyle and 

plateau and non weight-bearing condyle) were drawn on 

three consecutive slices. Mean T1GD relaxation time per 

ROI per slice was calculated and compared between the 

two dGEMRIC scans using a paired t-test and an intraclass 

correlation coefficient (ICC) to assess reproducibility of the 

measurements. 

Results: In all ROIs of all slices mean T1GD relaxation 

time was not significantly different between the two 

examinations (p=0.1-0.5). The ICCs of mean T1GD relaxation 

times of all ROIs were good to excellent (ICC:0.64- 

0.99;p=0.004-0.0001). 

Conclusions: These preliminary results suggest that 3D 

dGEMRIC of the knee at 3.0Tesla is a reproducible measure 

of cartilage quality in early-stage OA patients. Therefore, 

it is a valuable tool to assess cartilage quality over time in 

longitudinal studies. 

Figure 1 

68 



MSK/Thorax/Diversen 10 

O10.2 

CT-ARTHROGRAPHY TO MEASURE 

CARTILAGE QUALITY: INFLUENCE OF 

SULPHATED GLYCOSAMINOGLYCAN 

CONTENT AND STRUCTURAL 

COMPOSITION OF EXTRACELLULAR 

MATRIX ON CONTRAST AGENT DIFFUSION 

INTO CARTILAGE 

J. van Tiel, M. Siebelt, J.H. Waarsing, M. van Straten, 

G.P. Krestin, H. Weinans, E.H.G. Oei 


Purpose: To assess the potential of CT-arthrography to 

evaluate cartilage quality in terms of sulphated glycosaminoglycan 

content (sGAG) and structural composition of the 

extra-cellular matrix (ECM). 

Methods: Eleven human cadaveric knee joints were 

scanned on a second generation dual source spiral CT scanner 

before and after intra-articular injection of a negatively 

charged contrast agent. Mean X-ray attenuation values of 

both scans were calculated in seven regions of interest 

(ROIs) of the cartilage (weight-bearing condyles and plateaus, 

non weight-bearing condyles and patella). Next, all 

ROIs were rescanned with contrast-enhanced 

micro-CT (μCT), which served as reference standard because 

it accurately measures sGAG content and hence quality 

of cartilage. Correlation between mean X-ray attenuation 

values of CT-arthrography and μCT was analyzed with linear 

regression. Additionally, residual values from the linear fit 

between unenhanced CT and μCT were used as a covariate 

measure to identify the influence of structural composition 

of cartilage ECM, i.e. without influence of sGAG, on contrast 

diffusion into cartilage. 

Results: Mean X-ray attenuation of cartilage was 

significantly higher for CT-arthrography compared to 

unenhanced CT in all ROIs. Furthermore, CT-arthrography 

attenuation values correlated excellently with reference 

μCT values representing sGAG content of cartilage 

(R=0.86;R2=0.73;p

10programma abstracts & abstracts 

O10.3 

FRACTUREN VAN DE THORACALE EN 

LUMBALE WERVELKOLOM IN HET CENTRUM 

VOOR GERIATRISCHE TRAUMATOLOGIE: 

VASTSTELLEN VAN SCHADE AAN DE MIDDEL- 

STE PIJLER NIET VAN BELANG VOOR BELEID 

L.B.M. Weerink, M. Kraai, E.C. Folbert, R.S. Smit, 

J.H Hegeman, D. van der Velde 

Ziekenhuisgroep Twente, Almelo 

Over de behandeling van ouderen met een wervelfractuur 

door de middelste pijler is geen consensus. De relevantie 

van de CT-scan in de diagnostiek staat hiermee ook ter 

discussie. Doel van dit onderzoek is de meerwaarde van de 

CT-scan bij ouderen met een wervelfractuur te bepalen. 

Voor dit onderzoek werden 106 patiënten in het Centrum 

voor Geriatrische Traumatologie met een fractuur ter hoogte 

van de thocacolumbale wervelkolom geïncludeerd. Er werden 

retrospectief gegevens verzameld over radiologische 

parameters zoals betrokkenheid van de middelste pijler en 

diameter van het spinale kanaal. Algemene patiëntengegevens 

en gegevens over het functioneren na 6 weken en 

3 maanden werden geregistreerd. 

In onze populatie is er geen relatie is tussen betrokkenheid 

van de middelste pijler, compressie van het spinale kanaal 

en andere radiologische parameters met het functioneel 

eindresultaat. 

In tegenstelling tot de literatuur werd bij patiënten met een 

fractuur door voorste en middelste pijler het beleid in 83,3% 

(45 patiënten) gewijzigd naar snelle mobilisatie. Het functioneel 

eindresultaat in beide groepen is vergelijkbaar. 

Conclusie: In onze studie hebben radiologische kenmerken 

van een wervelfractuur geen relatie met het functioneringsniveau 

na 6 weken en 3 maanden. De toepassing van snelle 

mobilisatie in plaats van strikte bedrust bij een fractuur met 

betrokkenheid van de middelste pijler is een veilige optie. 

Het vaststellen van de betrokkenheid van de middelste pijler 

door middel van een CT-scan lijkt met deze conclusies minder 

relevant voor het te volgen beleid. De rol van de CT-scan 

bij de diagnostiek van ouderen met een wervelfractuur staat 

hiermee ter discussie. 

O10.4 

IMPROVING DEPLOYMENT OF MR-SI IN 

PATIENTS SUSPECTED FOR SPONDYLO- 

ARTHRITIS IN A LARGE CLINICAL PRACTICE, 

USING A TARGETED INTERVENTION 

M.H.E. Vossen 1 , A.A. den Broeder 2 , F. Hendriks-Roelofs 2 , 

D.M.F.M. van der Heijde 1 , M. Reijnierse 1 

1 

Leiden Universitair Medisch Centrum, Leiden 

2 

Sint Maartenskliniek, Nijmegen 

Background: Diagnosing axial spondyloarthritis (SpA) can 

be difficult: sacroiliac (SI) joint radiographs are often normal. 

Magnetic Resonance (MR) exam of SI joints (MR-SI) may 

reduce diagnostic uncertainty. Optimal deployment requires 

pretest chance of approximately 50%. Otherwise, increased 

numbers of MR-SI requests, false positives, excessive 

patient burden and costs will result. 

Objective: To examine characteristics of deployment of 

MR-SI in patients with suspected SpA before and after 

targeted intervention. 

An introduction on effect of pretest chance on predictive 

value, patient burden, costs was given. Alternative behavioral 

strategy was offered through a simple diagnostic 

algorithm. 

Results: 198 MR-SI (148 females / 50 males; mean age 36 

± 9.8yrs) were performed between April 1st, 2004 and April 

17th, 2007. 166 MR-SI (84%) were normal, 5 (2.5%) suspicious 

and 27 (13.5%) positive. 

After intervention, MR-SI number dropped to 58 (41 females 

/ 17 males; mean age 35. ± 9.8 years). Corrected for total 

number of patients seen (mean increase 12%), this is 

decrease of 79% with almost doubling of positive MR-SI: 44 

normal (76%), 0 suspicious and 14 (24%) positive. 

Conclusion: A simple, three stage feedback intervention 

resulted in 79% reduction of MR-SI requests with increase 

in number of positive MR-SI. This approach may benefit 

future research in areas with diagnostic uncertainty. 

Methods: MR-SI from April 1st, 2004 to December 31st, 

2010 were retrospectively collected. Inclusion criteria: MR-SI 

ordered by rheumatologist, suspicion of axial SpA, complete 

patient data. MR-SI reports were graded ‘normal’, ‘suspected 

sacroiliitis’ and ‘sacroiliitis’. Descriptive statistics were 

mean ± standard deviation (SD) or median (25-p75). In April 

2007, an intervention was done to improve deployment. 

Review data on requesting behavior, patient characteristics, 

outcomes were presented to rheumatologists. 

70 




Figure 1: Diagnostic algorithm by Rudwaleit, M. et al. 

O10.5 

IMPACT ON DIAGNOSTIC PERFORMANCE 

AND READING TIME OF A COMPUTER 

AIDED DETECTION ALGORITHM FOR 

THE DETECTION OF ACUTE PE: SECOND 

READING VERSUS CONCURRENT READING 

R. Wittenberg 1 , J.F. Peters 2 , I.A.H. Van den Berk 3 , 

N.J.M. Freling 3 , R.J. Lely 4 , B. de Hoop 5 , K. Horsthuis 3 , 

C.J. Ravesloot 5 , M. Prokop 6 , C.M. Schaefer-Prokop 7 

1 


2 

Philips Healthcare, Best 

3 


4 

VU Medisch Centrum, Amsterdam 

5 


6 


7 


Purpose: Evaluation of a CTPA study for the detection of 

pulmonary embolism (PE) represents a time consuming and 

tiring reading process. Computer-aided detection (CAD), 

when used as second reader, was found to improve reader 

performance for the detection of small emboli but inevitably 

at the expense of a substantial increase of reading time. We 

hypothesised that CAD may be used more advantageously 

when used as concurrent reading tool. 

Methods and materials: In this retrospective study, six 

observers of varying experience evaluated 157 negative and 

39 positive 64-slice consecutively acquired CTPA. With a 

time interval of 6 weeks, all cases were read twice in different 

order using CAD as second and as concurrent reader, 

respectively. Per patient, observers were asked to determine 

the presence of PE using a 5 point confidence scale and 

to document their reading time with and without CAD. 

Sensitivity and specificity were calculated by comparing the 

reader data with an independent consensus standard. 

Results: Baseline performance without CAD was high with 

a mean sensitivity of 91 % and increased further to 95 % 

with CAD as second reader and 94 % with CAD as concurrent 

reader. Mean specificity decreased with CAD as second 

reader (96%, 94 % and 96 %, respectively). The mean 

reading time with CAD as concurrent reader significantly 

decreased (108 s, 136 s and 91s, respectively). 

Conclusions: CAD used as concurrent reader has the 

potential to achieve the same high sensitivities without 

loss of specificity at the advantage of a significantly shorter 

reading time. 


71

10programma abstracts & abstracts 

O10.6 

DEVELOPMENT AND VALIDATION OF 

A DIAGNOSTIC MODEL FOR AIRFLOW 

LIMITATION IN HEAVY SMOKERS BY USING 

QUANTITATIVE COMPUTED TOMOGRAPHY 

O.M. Mets 1 , C.M.F. Buckens 1 , P. Zanen 1 , I. Isgum 1 , 

M. Prokop 2 , P.A. de Jong 1 

1 


2 


Purpose: To develop a CT based diagnostic model for the 

presence of airflow limitation in smokers participating in a 

lung cancer screening study. 

Materials and methods: In 1173 screening participants, 

we analyzed inspiratory and expiratory chest computed 

tomography (CT) scans, patient characteristics, smoking history 

and prebronchodilator spirometry obtained at the same 

day as the CT scan. Scan parameters were: 120kVp (≤80kg) 

or 140kVp (>80kg) at 30mAs for inspiratory scans, and 90kVp 

(≤80kg) or 120kVp (>80kg) at 20mAs for expiratory scans. 

Axial slices of 1mm at 0.7mm increment were reconstructed. 

CT emphysema was defined as percentage of voxels


O10.8 

ANALYSE RESULTATEN CYTOLOGISCH EN 

HISTOLOGISCHE PUNCTIES;CORRELATIE 

AAN PA-DIAGNOSE EN UITVOERDER 

Y.F.R. Ypma, J.J. Hensen, D. Vroegindeweij, H. van Beek, 

R.A Niezen, H. Beerman 

Maasstad Ziekenhuis, Rotterdam 

Doel: Evaluatie hoe frequent een CT, echografisch of stereotactisch 

geleide cytologische en histologische punctie 

resulteerde in een PA diagnose. Tevens werd het verschil 

in materiaal opbrengst tussen radioloog en arts-assistent 

geanalyseerd. 

Methode: Retrospectief werden alle cytologische en histologische 

puncties van 2009 en 2010 geincludeerd geanalyseerd. 

Het verschil tussen cytologische en histologische 

punctie werd geanalyseerd alsmede de methode hoe het PA 

materiaal werd verkregen en door wie de punctie werd verricht 

(radioloog versus assistent). 

Daarnaast werden alle puncties gecorreleerd aan de PA 

diagnose. 

Resultaten: In 2009 en 2010 werden 814 histologische 

biopten en 1260 cytologische puncties verricht. 

Radiologen verrichtten in deze periode 1056 puncties, 

waarvan 407 histologisch en 649 cytologisch. Assistenten 

verrichtten 1018 puncties, waarvan 407 histologisch en 611 

cytologisch. 

Van alle puncties (cytologisch en histologisch) waren er 67 

CT geleid, 1820 echogeleid en 175 stereotactisch. 

Cytologische puncties gaven in 88,5% (1116/1260) een 

PA diagnose en histologie in 95,3% (776/814). Van deze 

histologische biopten resulteerde het stereotactische biopt 

in de hoogste opbrengst, 96% (168/175), gevolgd door het 

echogeleide biopt, 95% (554/581). De laagste opbrengst gaf 

het CT geleide biopt, 93 % (62/67). 

Radiologen verkregen in 91,1% (962/1056) van de puncties 

representatief materiaal, assistenten in 91,3% (930/1018). 

Conclusie: Het stereotactisch geleide histologische biopt 

resulteerde in de hoogste PA score. Zowel cytologische 

puncties als histologische biopten resulteerden in vrijwel 

alle gevallen in een juiste PA diagnose. Er was geen significant 

verschil tussen de verschillende uitvoerders van de 

puncties. 


73

E programma abstracts & abstracts 


‘De educatieve voordracht’ 


E01 

DE VERGROTE BIJNIER: 

ENDOSONOGRAFISCHE FNA VAN DE 

INKER BIJNIER 

R.J.J. de Ridder 1 , V.C. Cappendijk 2 

1 

Maag-, darm-, leverziekten, Maastricht Universitair 

Medisch Centrum, Maastricht 

2 

Radiologie, Maastricht Universitair Medisch Centrum, 

Maastricht 

Incidentalomen van de bijnier worden door toenemend 

gebruik van beeldvormende technieken vaker gevonden. 

Driekwart van deze afwijkingen wordt gevonden bij personen 

welke beeldvorming ondergaan voor de stadiering van een 

maligniteit. Vaak kan door beeldvorming, eventueel aangevuld 

met endocrinologisch onderzoek, vastgesteld worden dat het 

om een (niet-functioneel) bijnieradenoom gaat. Bij twijfel over 

een primaire dan wel secundaire maligniteit, en indien relevant 

in de klinische context, is nader onderzoek aangewezen. 

Percutane CT- of echo geleide FNA van de bijnier heeft een 

sensitiviteit voor het aantonen van een maligniteit van 93%. In 

studies bedraagt het aantal niet diagnostische puncties echter 

19-24% [1,2] Belangrijke complicaties ontstaan in 3-8% van 

de patiënten aansluitend aan een percutane punctie.[3,4] De 

belangrijkste complicaties zijn pneumothorax, bloeding, hematoom 

en het risico op entmetastase. 

Referenties: 

1. Harisinghani MG, Maher MM, Pinkney PF et al. Predictive value 

of benign percutaneous adrenal biopsies in oncology patients. 

Clin Radiol 2002;57: 898-901 

2. Gilliams A, Roberts CM, Shaw P. et al. The value of CT scanning 

and percutaneous fine needle aspiration of adrenal masses in 

biopsy-proven lung cancer. Clin Radiol 1992;46: 18-22 

3. Mody MK, Kazerooni EA, Korobkin M et al. Pecutaneous CT-guided 

biopsy of adrenal masses: immediate and delayed complications. 

J Comput Assist Tomogr 1995;19:434-439 

4. Welch TJ, Sheedy PF, Stephens DH et al. Pecutaneous adrenal 

biopsy: review of 10-year experience. Radiology 1994;193:341-4 

5. Dietrich CF, WehrmannT, Hoffmann C et al, Detection of the 

adrenal gland by endoscopic or transabdominal ultrasound. 

Endoscopy 1997;29:859-864 

6. Schuurbiers OCJ, Tournoy KG, Schoppers et al. EUS-FNA for the 

detection of left adrenal metastasis in patients with lung cancer; 

Lung Cancer, in press 

7. DeWitt J, Alsatie M, LeBlanc J et al, Endoscopic ultrasoundguided 

fine-needle aspiration of left adrenal gland masses, 

Endoscopy 2007;39:65-71 

Transgastrische endosonografie (onder sedatie middels midazolam) 

is een beproefde methode voor afbeelding van met name 

de linker bijnier. De linker bijnier kan in 98% van de patiënten 

middels EUS in beeld worden gebracht, de rechter in 30% van 

de gevallen. Transabdomiale echo kan in 69% van de gevallen 

de linker bijnier visualiseren.[5] 

De sensitiviteit voor het aantonen van een maligniteit middels 

EUS met FNA bedraagt 86%. Niet diagnostische puncties 

variëren sterk tussen studies van 5.9-24%.[6,7] In de literatuur 

is slechts een casus van een post-procudurele bloeding 

beschreven na EUS-FNA. 

De procedure wordt door patiënten goed getolereerd en duurt 

ca. 10 minuten. 

EUS-FNA is een veilige en weinig belastende procedure voor 

het verkrijgen van een weefsel diagnose indien er bij een vergrote 

linkerbijnier de verdenking bestaat op een maligniteit. 

74 



Educatieve abstracts 

E 

E02 

LONG-TERM FOLLOW-UP FEATURES ON 

RECTAL MRI DURING A WAIT-AND-SEE 

APPROACH AFTER A CLINICAL COMPLETE 

RESPONSE IN RECTAL CANCER PATIENTS 

TREATED WITH CHEMORADIOTHERAPY 

D.M.J. Lambregts, M. Maas, F.C.H. Bakers, V.C. Cappendijk, 

G. Lammering, G.L. Beets, R.G.H. Beets-Tan 


Background: Surgical resection is the standard treatment 

for patients with locally advanced rectal cancer who have 

undergone preoperative chemoradiation (CRT). There is now, 

however, a trend towards a conservative wait-and-see policy 

for patients with a complete tumor regression. It is not clear 

how patients should be monitored once they are managed 

non-operatively and whether follow-up by MRI has any role. 

As part of an observational study, a series of 19 carefully 

selected patients with a clinical complete response was 

managed with a wait-and-see policy and followed regularly 

by rectal MRI. 

Purpose: To study the short-term and long-term morphological 

MRI-features of rectal cancer patients with a complete 

tumor response undergoing a wait-and-see policy with regular 

MR follow-up after CRT. 

MR-imaging features: Shortly (6-8 weeks) after CRT, 

patients with a complete tumor response showed either 

a normalised rectal wall (26%) or a hypointense fibrotic 

remnant (74%). Three patterns of fibrosis could be classified, 

the aspects of which were dependent on the initial tumor 

morphology at primary MR staging (figure 1). The aspect of 

the normalised wall or fibrosis remained entirely consistent 

during long-term follow-up (median 20, range 9-57 months). 

During the first months after CRT, varying degrees of postradiation 

edema were observed in 26% of patients, which 

gradually disappeared during longer follow-up (figure 2). 

Conclusion: The morphological MR patterns observed in 

these patients may be used as a reference for the follow-up 

of rectal cancer patients with a complete tumor response 

after CRT, managed with a ‘wait and see policy’. 

Figure 1: Patterns of post-CRT fibrosis (d-f) and the corresponding types of primary tumors (a-c). Small polypoid tumors (a) typically resulted in 

a minimal fibrotic residue (d). Larger, bulky tumors (b) mostly resulted in a ’full thickness’ fibrosis (e). Spicular tumors (c) resulted in a similarly 

spicular fibrosis. 

Figure 2: Small primary tumor (a). Six weeks after CRT there is an edematous wall thickening (b), visible as a three layered rectal wall consisting 

of an inner mucosa (arrowhead), a hyperintense submucosa (*) and a hypointense outer muscular wall (arrow). During long-term follow-up 

the edema gradually decreases untill a normalised two-layered rectal wall (d) becomes visible. 


e 


E03 

IMPLEMENTATIE VAN VIRTUELE 

COLONOSCOPIE IN DE DAGELIJKSE 

RADIOLOGISCHE PRAKTIJK 

M.T. de Witte 1,2 , P.C.G. Simons 1 

1 


2 

UMC St Radboud, Nijmegen 

Colorectaal carcinoom is 2 e kankergerelateerde doodsoorzaak 

in Nederland en de Westerse landen. De incidentie zal naar 

verwachting nog stijgen. De adenomateuze poliep wordt 

gezien als voorloper van het CRC, de zogenaamde “adenomacarcinoma 

sequence”. Het vroegtijdig opsporen en verwijderen 

van deze benige voorloper voorkomt het uitgroeien tot CRC(1). 

Virtuele colonoscopie werd voor het eerst beschreven door 

David Vining in 1994 (2). Initieel gestart als 2D techniek, 

werd al snel ook de 3D “virtuele endoscopie” ontwikkeld. 

De segmentatie van darmsegmenten moest aanvankelijk 

handmatig gebeuren, een tijdrovende en arbeidsintensieve 

procedure. Inmiddels is Virtuele Colonoscopie volgroeid tot 

een volautomatische software tool met snelle segmentatie 

van darmsegmenten, panoramische weergave, automatische 

poliepdetectie (CAD), en elektronische cleansing. 

Officieel geaccepteerde indicaties voor Virtuele Colonoscopie 

zijn onvolledige optische coloscopie voor beoordeling van het 

proximale colon, verhoogd complicatie risico door hoge leeftijd 

en / of comorbiditeit en patientenweigering (3). 

In onze ervaring is deze techniek echter breder toepasbaar. 

Uit initieel onderzoek blijkt dat bij goede patientenselectie 

optische coloscopie in ruim 85% van de gevallen kan 

worden voorkomen (4). Een recente en interessante ontwikkeling 

is korte termijn VC follow-up bij 1-2 kleine poliepen. 

Door de zeer accurate anatomische lokalisatie van afwijkingen 

middels VC blijkt deze techniek bij uitstek geschikt 

voor follow up van deze poliepen(5). Dit lijkt een geschikt 

alternatief voor de huidige richtlijnen waarbij excisie van 

poliepen ongeacht de grootte wordt geadviseerd (6).  Nu 

besloten is om in Nederland vanaf 2012 een landelijk screeningsprogramma 

naar CRC middels i-FOBT op te starten, zal 

het aantal coloscopieen en dus ook het aantal onvolledige 

procedures toenemen. Hierdoor zal de vraag naar VC zeker 

toenemen.   VC is een betrouwbare en robuuste techniek 

met een grote toekomst. Deze techniek dient dan ook geimplemeteerd 

te worden op elke radiologische afdeling. 

Referenties: 

1. J. Stoker. CT colografie en bevolkingsonderzoek voor colorectaal 

carcinoom. Memorad 13 (4), 2008; 13-18.  

2. DJ Vining, DW Gelfand, RE Bechtold et al. Technical feasibility of 

colon imaging with helical CT and virtual reality. AJR Am J Roentgenol 

1994; 162:Suppl: 104 abstract. 

3. EG MacFarland, JG Fletcher, PJ Pickhardt et al. ACR Colon Cancer 

Committee White Paper: Status of CT Colonography 2009. J Am 

Coll Radiol. 2009; 6: 756-772.  

4. CT-colografie als eerstelijnsdiagnosticum bij patienten met darmklachten. 

JS Peulen. MT de Witte, P Friederich et. al. Ned Tijdschr 

Geneeskd 2010; 154: A1681.  

5. The natural history of small polyps at CT colonography. PJ Pickhardt, 

DH kim et al. Annual meeting for the Soceity of Gastrointestinal 

Radiologsts 2008; Rancho Mirage, CA.  

6. Coloncarcinoom. Landelijke richtlijn versie 2.0, 09-01-08, Landelijke 

Werkgroep Gastro Intestinale Tumoren. 

E04 

FUTURE CLINICAL APPLICATIONS OF HIGH 

RESOLUTION ANATOMICAL IMAGING OF 

THE BRAIN AT 7.0 TESLA MRI 

A.G. van der Kolk, J.J.M. Zwanenburg, F. Visser, P.R. Luijten, 

J. Hendrikse 


Purpose: To show the clinical potential of anatomically highly 

detailed images of the brain obtained with 7.0 Tesla MRI. 

Background: Although not widely used clinically, an 

increasing number of sites worldwide have the availability 

of an MRI scanner with a field strength of 7.0 Tesla. There is 

active debate if and when it may become the field strength 

of choice for certain clinical applications. Specifically, 

high resolution anatomical brain imaging at 7.0 Tesla with 

sequences such as FLAIR, T1- and T2*-weighted imaging 

and MR angiography may be the potential area where 7.0 

Tesla MRI provides additional diagnostic information not 

found on lower field strengths. 

Materials & Methods: Apart from a review of the current 

literature regarding anatomical brain MRI at 7.0 Tesla, the 

focus will be on clinical patient examples where 7.0 Tesla 

MRI gives additional diagnostic information or a better delineation 

of pathology than lower field strengths. Also, normal 

findings and anatomical variants not seen on 1.5 or 3.0 Tesla 

will be shown. When possible, comparison with 3.0 Tesla or 

1.5 Tesla MR images will be given (figure 1) to further illustrate 

the additional information which can be gained with 

7.0 Tesla scanning compared to lower field strength. 

Conclusion: High resolution anatomical brain imaging at 

7.0 Tesla MRI can give additional information about pathology 

and normal anatomical variations and will be able to 

contribute to faster and more accurate diagnosing. 

76 




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Figuur 1: White matter lesions at 1.5T as compared to 7.0T. 

E05 

IS BEELDVORMING VAN ATHEROSCLEROSE 

KLAAR VOOR DE DAGELIJKSE PRAKTIJK? 

S.C. Gerretsen 1 , V.C. Cappendijk 1 , R.M. Kwee 1 , 

M.B.I. Lobbes 1 , M. Das 1 , T. Leiner 2 , J.M.A. van Engelshoven 1 , 

M.E. Kooi 1 , J.E. Wildberger 1 

1 


2 


Doelstelling: Het bieden van een overzicht van de huidige 

mogelijkheden voor het detecteren en karakteriseren van 

atherosclerotische plaques. 

Beschrijving: In deze presentatie wordt een overzicht gegeven 

van de routine- en geavanceerde technieken die kunnen 

worden gebruikt voor beeldvorming van atherosclerose. Er 

wordt getoond hoe verschillende stadia van atherosclerose 

kunnen worden gedetecteerd, hoe stabiele atherosclerotische 

plaques van instabiele plaques onderscheiden kunnen worden 

en hoe plaques in symptomatische en asymptomatische 

patiënten kunnen verschillen. Tenslotte zal uitgelegd worden 

welke studies er nodig zijn om het afbeelden van een atherosclerotische 

plaques klinisch toepasbaar te maken. 

Conclusie: Niet-invasieve beeldvorming is geschikt voor de 

detectie en karakterisatie van atherosclerotische plaques. 

Deze presentatie beoogt de radioloog bewust te maken van 

het belang van detectie en rapportage van atherosclerose. 

Dit is een belangrijke stap om beeldvorming van atherosclerose 

klinisch toepasbaar te maken. 

Achtergrond: Atherosclerose is een chronische aandoening 

van de arteriële vaatwand die vaatvernauwingen en 

thrombo-emboliën kan veroorzaken hetgeen kan leiden tot 

een hersen- of hartinfarct. Ondanks vooruitgang in diagnostiek 

en behandeling blijft atherosclerose één van de belangrijkste 

doodsoorzaken in de westerse wereld. Geavanceerde 

technieken hebben aangetoond dat het mogelijk is om op 

niet-invasieve wijze de arteriële vaatwand af te beelden. 

Hierbij kunnen verschillende stadia van atherosclerose in 

beeld gebracht worden en zijn er verschillen waargenomen 

in plaques tussen symptomatische en asymptomatische personen. 

Echter ook op routine-onderzoeken is veel informatie 

over de aanwezigheid en mate van atherosclerose te verkrijgen. 

Gezien de mogelijke complicaties van atherosclerose is 

vroege detectie en rapportage van atherosclerose belangrijk. 


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E06 

LUNG PERFUSION DEFECTS ON DUAL- 

ENERGY COMPUTED TOMOGRAPHY 

(DECT): REVIEW OF MORPHOLOGY AND 

DIFFERENTIAL DIAGNOSIS? 

A.E. Odink 1 , M. Rossius 1 , R. Booij 1 , C.M. Schaefer-Prokop 2 , 

I.J.C. Hartmann 1 

1 


2 


Purpose: To present insight on the basic principles of DECT 

and provide a pictorial review of the range of morphology 

of lung perfusion with diagnostic clues for differentiating 

pulmonary embolism from other underlying diseases. 

Content organization: The classic presentation on a 

DECT perfusion map of acute pulmonary embolism (PE) is a 

peripheral, wedge shaped defect. However, other underlying 

parenchymal diseases such as emphysema, lung cysts, fibrosis 

or pneumonia also cause perfusion defects. Location, 

distribution and configuration of perfusion defects together 

with findings in lung window settings provide the necessary 

information for correct differential diagnosis. Also artifacts 

caused by beam hardening or pulsation cause perfusion 

inhomogeneities that occur in typical locations and are 

mostly easy to dismiss. 

The exhibit provides an overview of the spectrum of perfusion 

map findings to be encountered in a group of unselected 

patients undergoing evaluation for suspected PE and 

with known or unknown concomitant lung diseases. Typical 

and atypical perfusion defects caused by artifacts, focal or 

diffuse lung parenchymal diseases will be presented together 

with some guidelines for correct interpretation. 

Conclusion: Especially in an unselected group of patients 

with accompanying lung disease, knowledge of pitfalls and 

artifacts is important for correct interpretation of the spectrum 

of lung perfusion defects seen in DECT. 

E07 

VALUE OF COMPUTED TOMOGRAPHY 

CORONARY ANGIOGRAPHY IN 

FAILED CONVENTIONAL CORONARY 

ANGIOGRAPHY 

A.S. Thijssen 1 , R.N. de Visser 2 , G.F.A.J.B van Tilborg 2 , 

A.C. Weustink 1 , G.P. Krestin 1 , N.R.A. Mollet 1 

1 


2 

St. Elisabeth Ziekenhuis, Tilburg 

Purpose/aim: If conventional X-ray coronary angiography 

(CCA) fails, computed tomography coronary angiography 

(CTCA) has the potential to provide the desired diagnostical 

information concerning coronary patency but may also 

demonstrate the cause of failing CCA exams. 

Content organization: CTCA has proved its usefulness in 

ruling out significant coronary artery stenosis in patients 

with an intermediate risk of having coronary artery disease. 

Although CCA is superior for this purpose, the exam cannot 

always be successfully completed. 

We will present a series of cases in which CCA could not be 

successfully completed and where CTCA revealed the cause 

of the failed exam. The presentation will feature several 

images from CTCA studies (multiplanar reformations and 3D 

renderings). 

Summary: Although CTCA is primarily reserved for patients 

with an intermediate risk of coronary artery disease, it can 

be employed to image the coronary tree in cases where CCA 

fails. In several instances, CTCA will reveal the cause of 

failed CCA. CTCA data may also provide useful information 

for planning interventional procedures or surgery in patients 

with a failed CCA exam. 

Figure 1 Figure 2 Figure 3 

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E08 

PSEUDOTUMOREN BIJ METAAL OP METAAL 

TOTALE HEUP ARTROPLASTIEK 

M.F. Boomsma 1 , L. Sijbrandij 1 , B.H. Bosker 2 , H.B. Ettema 2 , 

C.C.C.M. Verreyen 2 , B.J. Kollen 3 , M. Maas 4 

1 

Radiologie, Isala klieken, Zwolle 

2 

Orthopedie Isala klieken, Zwolle 

3 

Faculteit Medische wetenschappen, Universitair Medisch 

Centrum Groningen, Groningen 

4 

Radiologie, Academisch Medisch Centrum, Amsterdam 

Na het ondergaan van een totale heupartroplastiek is 

bekend dat er als complicatie pseudotumoren kunnen 

optreden. Recente vermoedens van verhoogde incidentie 

van klachten, gepaard gaande met pseudotumorvorming bij 

metaal op metaal totale heup artroplastiek (MoM THA), hebben 

geleid tot veel media-aandacht. Inmiddels zijn meerdere 

Nederlandse ziekenhuizen overgegaan tot het oproepen van 

patiënten die een MoM THA hebben ondergaan. 

In een recent uitgevoerd prospectief single center cohort 

studie is aangetoond dat de incidentie van pseudotumoren bij 

deze groep patiënten 36% is. Dit heeft inmiddels geleid tot 

revisie tot een polyethyleen acetabulum component van de 

MoM THA in 28% van de patiënten met een pseudotumor.[1] 

In deze presentatie zal de beeldvorming van de normale en 

postoperatieve heup in het kader van de THA worden besproken. 

Tevens wordt een overzicht gegeven van de verschillende 

uitingsvormen van pseudotumoren bij de MoM THA. 

Ervaringen van auteurs hebben geleid tot een “recall imaging” 

strategie, welke zal worden besproken. Een belangrijk 

item hieruit is het gebruik van CT bevindingen en de verhouding 

hiervan ten opzichte van een gangbare MR classificatie 

van pseudotumoren bij MoM THA patiënten.[2] 

Referenties: 

1. Risk assessment for pseudotumor after metal-on-metal largediameter 

femoral head total hip arthroplasty: a prospective cohort 

study. Bosker BH, Ettema HB, Boomsma MF, Kollen BJ, Wagemakers 

B and Verheyen CCPM. (Submitted) 

2. Grading the severity of soft tissue changes associated with metalon-metal 

hip replacements: reliability of an MR grading system. 

Anderson H, Toms AP Cahir JG, Goodwin RW, Wimhurst J and 

Nolan JF. Skeletal Radiol (2011) 40:303–307 


P 

programma posterpresentaties & abstracts 


Posterpresentaties 

P01 

FOETALE POSTMORTEM 

RADIOLOGIE 

W.M. Klein, C. Marcelis, F. Vandenbussche 


Doel: verbetering radiologie congenitale afwijkingen bij 

overleden foetussen. 

Achtergrond: Met de komst van de 20-wekenecho neemt 

het aantal gevonden congenitale afwijkingen sterk toe, en 

hiermee ook het aantal zwangerschapsafbrekingen. Toch 

daalt het aantal autopsieen (gouden standaard). Postmortem 

MRI en CT kunnen, zonder het kind te beschadigen, aanvullende 

informatie geven. 

Discussie & conclusie: Postmortem foetale MRI en CT 

kunnen belangrijke bevestiging en additionele informatie. 

Dit is van grote waarde voor de verwerking door ouders en 

voor genetic counseling ten behoeve van volgende kinderen. 

Zeker bij een dalend aantal autopsieen is dit van groot 

belang. 

Een prospectieve studie in samenwerking met pathologie, 

radiologie, klinische genetica en gynaecologie zal de diagnostische 

waarde moeten aantonen. 

Techniek en casuistiek: Postmortem radiologische diagnostiek 

(

posterpresentaties 

P 

Figuur 2: Thanatofore dysplasie. 

Figuur 3: Tubureuze sclerose astrocytoom. 

P02 

AUTOMATED BREAST VOLUME SCANNER: 

3D-ULTRASOUND OF BREAST LESIONS 

T.A. Fassaert, M.D.F. de Jong, I.J.M. Dubelaar, 

M.C.J.M. Rutten 


Purpose: Familiarize the reader with the imaging characteristics 

of benign and malignant findings in 3-dimensional 

breast ultrasound (3D-US) obtained with an automated 

breast volume scanner (ABVS). Emphasis is put on the 

added value of the new coronal plane (surgeon view) and 

the multiplanar correlation. 

Content: From a study of 200 consecutive patients, who 

underwent breast MRI and ABVS, we demonstrate 3D-US 

findings in a selection of illustrative cases with benign and 

malignant breast lesions. The illustrated cases are correlated 

with digital mammography, handheld 2D ultrasound, 

MRI and histopathological findings. 

Summary: ABVS provides high-resolution 3D-US images of 

breast lesions. The new coronal view and multiplanar correlation 

facilitate the sonographic assessment of benign and 

malignant breast lesions. 

Figuur 1: 3D-UScorrelation necrotic focus after RFA. 


81

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Figuur 2: 3D-US correlation of lymph node & vascular bundle. 

Figuur 3: 3D-US correlation of a stellate lesion. 

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P03 

BRAIN PLASTICITY IN APHASIC PATIENTS 

AFTER MELODIC INTONATION THERAPY 

ASSESSED WITH FUNCTIONAL MAGNETIC 

RESONANCE IMAGING (FMRI) 

M.A.H. Bechan 1 , W.M.E. van de Sandt-Koenderman 2 , 

C.P. Mendez 1 , E.G. Visch-Brink 1 , M. Smits 1 

1 


2 

Rijndam revalidatiecentrum, Rotterdam 

Purpose: Certain aphasic patients are treated with Melodic 

Intonation Therapy (MIT), which uses musical elements of 

speech to initiate language production. The purpose of this 

study is to visualize neuronal reorganizational processes in 

the brain in response to MIT using fMRI. 

Methods and materials: Four patients with chronic and 

two with acute aphasia (22-67 years; 4 males; 5 righthanded) 

were scanned at 3T before and after six weeks of 

MIT, which consisted of naming, repeating and spontaneous 

speech. To visualize language processing a block design 

task, consisting of listening to stories versus reverse speech, 

was used. Language performance was measured using the 

Sabadel story telling task. Imaging data were analyzed 

using Statistical Parametric Mapping 8 (London, UK). After 

preprocessing individual statistical t-contrast maps were 

calculated for pre- and post-therapy datasets. Lateralization 

indices (LI) were calculated using the number of significantly 

(p

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P04 

DESMOID-TYPE FIBROMATOSIS: 

A COMPREHENSIVE REVIEW OF 

MULTIMODALITY IMAGING FINDINGS 

IN PRIMARY, RECURRENT AND 

DEDIFFERENTIATED DISEASE WITH 

HISTOPATHOLOGIC CORRELATION 

I.J.M. Dubelaar 1 , U. Flucke 2 , J. Bonenkamp 2 , M. Prokop 2 , 

J.W.J. de Rooy 2 

1 


2 


Summary: Desmoid-type fibromatoses are rare, locally 

aggressive, non-metastazing soft tissue tumors with high 

tendency towards local recurrence. 

This exhibition will review: 

1. the various types and the multimodality imaging features 

of primary, recurrent and dedifferentiated disease with 

histopathological correlation 

2. The role of imaging in the management of these types of 

soft tissue tumors 

3. Current treatment options 

Content organization: 

1. Desmoid-type fibromatosis review; - epidemiology, aetiology, 

localization and clinical features of different types 

- multimodality imaging features of primary, recurrent/ 

dedifferentiated disease and post- therapy changes 

2. Histopathologic morphology and genetics 

3. Treatment options: - local excision - radiotherapy - 

systemic therapy 

P05 

REPEATED PHASE-CONTRAST MAGNETIC 

RESONANCE ANGIOGRAPHY TO ASSESS 

CEREBROVASCULAR REACTIVITY IN 

PATIENTS WITH CAROTID ARTERY STENOSIS 

N.S. Hartkamp, J. Hendrikse, H.B. van der Worp, 

G.J. de Borst, R.P.H. Bokkers 


Purpose: To assess the cerebrovascular reactivity in 

patients with internal carotid artery (ICA) stenosis and 

identify the optimal timing for reactivity measurements with 

acetazolamide as vasodilatory challenge medication. 

Methods: Twenty-one patients with a symptomatic ICA 

stenosis and 18 healthy control subjects underwent twodimensional 

phase-contrast magnetic resonance angiography 

to repeatedly measure the blood flow (ml/min) in the 

ICAs at baseline and in 5 minute intervals for 30 minutes 

after intravenous administration of 12 gram acetazolamide 

per kilogram body weight. 

Results: The blood flow during the exam was significantly 

lower in the stenosed ICA of patients (figure 1, indicated 

with the star) than in the contralateral ICA (light gray) 

and than in the ICAs of healthy controls (white). The 

absolute increase of blood flow after 15 minutes was as 

well significantly lower in the stenosed ICA than in the 

contralateral ICA and than in the healthy ICAs (respectively 

74.6±12, 122±18, and 137±15 ml/min), whereas the relative 

increase was not (respectively 46.9±6.7%, 56.0±9.4%, and 

58.2±7.2%). The vasodilatory effect in the stenosed ICAs 

Figure 1: Blood flow after acetazolamide administration. 

Figure 2: Time to peak after acetazolamide 

administration. 

84 




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was maximal after 15 minutes (figure 2, indicated with the 

star) and decreased after 20 minutes (figure 1), which was 

significantly later than in the contralateral ICA (light gray) 

and healthy ICAs (white). 

Conclusion: Patients with ICA stenosis have a reduced 

absolute increase in blood flow with preserved relative 

increase after a vasodilatory challenge with acetazolamide. 

The time to maximum vasodilatation was also longer in 

the stenosed ICA of patients. The optimal timing for single 

reactivity measurements using acetazolamide is between 15 

to 20 minutes after administration. 

P06 

MIXED CEREBRAL PERFUSION TERRITORIES 

IN THE POSTERIOR CIRCULATION 

INVESTIGATED USING SUPER-SELECTIVE 

ARTERIAL SPIN LABELING MRI 

N.S. Hartkamp 1 , M. Helle 2 , R.P.H. Bokkers 1 , J. Hendrikse 1 , 

M.J.P. Van Osch 3 

1 


2 

Institute of Neuroradiology, Christian-Albrechts-Universität, 

Kiel, Germany 

3 

Leiden Universitair Medisch Centrum, Leiden 

Purpose: The posterior circulation is supplied with blood by 

the vertebral arteries (VA) that fuse into the basilar artery 

(BA). We aim to investigate to which extent blood mixes in 

the BA before it arrives in cerebral hemispheres. 

Methods: Five healthy volunteers were investigated on a 3T 

MRI scanner with super-selective pseudo-continuous arterial 

spin labeling (ASL) perfusion imaging, which allows separate 

labeling of the VAs. The contribution to the perfusion 

of each individual VAs was calculated for the left and right 

hemisphere of the cerebellum and cerebrum. 

Results: The relative amount of ASL-signal from each VA 

to either hemisphere of the cerebellum and cerebrum are 

summarized in table 1. The posterior circulation of subject 1 

was almost exclusively supplied by one VA due to a variant 

anatomy. The perfusion images of both the left and right VA 

from subject 5 shown in figure 1. Examination of the perfusion 

images reveals areas in the cerebellum exclusively supplied 

by either the left or the right VA (also shown in figure 

1). The perfusion images show increasing overlap in the 

cerebrum. Both in the cerebellum and in the cerebrum most 

of the ASL-signal is observed ipsilateral from the labeled 

VA, although significant signal is also observed contralaterally, 

especially in the cerebrum. 

Conclusion: The results show that although most ASLsignal 

in the posterior flow territory originates from the 

ipsilateral VA, a considerable amount of ASL-signal stems 

from the contralateral VA, indicating mixing of blood or at 

least exchange of magnetization between blood streams in 

the BA. Mixing in the BA however does not produce a completely 

homogeneous blood supply to the cerebral posterior 

circulation in our subjects. 

Figure 1: Perfusion images of the left and right VA. 

Table 1: Relative contributions of the left and right VA. 


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P07 

MALFORMATIE VAN DE VENE 

VAN GALENI 

I.J.M. Dubelaar 1 , F.A. Meijer 2 

1 


2 


Purpose: To inform the reader of the rare congenital 

aneurysmal malformation of the vein of Galen. To illustrate 

the appearance, therapy options and various outcome in a 

pictorial review. 

Content organization: Aneurysmal malformation of the 

vein of Galen is a rare congenital vascular malformation, 

resulting in developmental delay, congestive heart failure, 

hydrocephalus, brain damage and/or death in childhood. 

In a pictorial review, we illustrate the best outcome 

(spontaneous thrombosis), the worst outcome (melting 

brain) and therapy options (endovascular embolization). 

Pathophysiology, clinical presentation and therapy options 

will be briefly discussed. 

Summary: Vein of Galen malformation and resulting 

aneurysm is a rare, often fatal congenital disorder. Various 

outcome is illustrated and therapy options discussed. 

P08 

SUBSEQUENT ISCHEMIC STROKE IN 

VASCULAR TERRITORIES AFFECTED BY 

INTRACRANIAL ARTERIAL STENOSIS IN 

PATIENTS WITH TRANSIENT ISCHEMIC 

ATTACK AND ISCHEMIC STROKE 

P.J. Homburg, M.J. van Gils, G.J.J. Plas, H.L.J. Tanghe, 

D.W.J. Dippel, A. van der Lugt 


Background and purpose: Compared to extracranial carotid 

artery atherosclerosis, intracranial arterial stenosis (ICAS) 

has received little attention as a cause of cortical ischemic 

stroke. We evaluated the stroke recurrence risk of ICAS per 

arterial territory in a large cohort of patients with a transient 

ischemic attack (TIA) or ischemic stroke. 

Methods: Consecutive patients (n=786) were prospectively 

evaluated for the presence and distribution of ICAS (≥30% 

stenosis) using CT angiography. Multivariable Cox 

proportional hazards models were used to identify risk 

factors associated with subsequent ischemic stroke and to 

analyze the stroke recurrence risk for ICAS per territory (left 

carotid territory, right carotid territory and posterior territory). 

Results: In 178/786 patients (23%), 288 ICAS were 

observed. Subsequent ischemic stroke occurred in 49 

patients (6%), of which 15/49 (31%) occurred in a territory 

affected by ICAS. After adjustment for age, sex, hypertension, 

diabetes mellitus and extracranial artery stenosis ≥50%, 

ischemic stroke risks in territories affected by ICAS were HR 

4.34 (95%CI 1.36-13.87) for the left carotid territory, HR 8.09 

(95%CI 2.53-25.92) for the right carotid territory and HR 6.94 

(95%CI 1.93-25.04) for the posterior territory. 

Conclusions: Ischemic stroke and TIA patients with ICAS 

have a particularly high risk of subsequent ischemic stroke 

in the affected arterial territory. This finding warrants more 

research in the pathophysiology of ICAS and modified treatment 

for patients with ICAS. 

P09 

PROSPECTIVE QUALITATIVE COMPARISON 

OF 4D RADIAL ACQUISITION CONTRAST- 

ENHANCED MR ANGIOGRAPHY VERSUS 

DIGITAL SUBTRACTION ANGIOGRAPHY 

IN CHARACTERIZING INTRACRANIAL 

ARTERIOVENOUS MALFORMATIONS 

M. van der Vlies 1, 2 , R. van den Berg 1 , C.B.L.M. Majoie 1 

1 


2 

Onze Lieve Vrouwe Gasthuis, Amsterdam 

Introduction: Digital subtraction angiography (DSA) is 

the gold-standard procedure for diagnosis and follow-up 

of cerebral AVM because of its high temporal and spatial 

resolution. However, alternative time-resolved techniques 

such as TRICKS (GE Healthcare), TWIST (Siemens) and 4D 

TRAK (Philips Healthcare) are now widely available 

to allow dynamic MR imaging for the appreciation of 

contrast kinetics. We hypothesized that in agreement with 

other studies, 4D radial acquisition contrast enhanced 

MRA (4D rCE-MRA) compared to DSA, approximates 

vascular architecture and flow dynamics of AVMs, furthermore 

implying a reduction in risk exposure and in 

procedural risks. 

Methods: A total of 21 consecutive patients were assessed 

prospectively, 7 had AVM, 7 had AV-fistula and 2 had a DVA. 

4D rCE-MRA and DSA were performed. The 4D rCE-MRA 

images were assessed regarding vascular architecture and 

dynamic flow characteristics. 

Results: 4D rCE-MRA correctly depicted location, nidal 

size, venous drainage pattern and prominent arterial feeders 

in almost all cases of AVMs and AV-fistulas. There 

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was good agreement (approximately 90%) between DSA 

and 4D rCE-MRA images. 

Conclusion: 4D rCE-MRA is a good alternative imaging 

modality tool approximating the imaging gold standard of 

DSA and furthermore proving to be a reliable minimal invasive 

imaging tool that avoids the risks associated with DSA. 

Figure 1: 4D MRA arterial phase. 

Figure 2: 4D MRA venous phase. 

Figure 3: 4D MRA late venous phase, showing cerebellar AVM. 

P10 

RADIOFREQUENTE ABLATIE VAN OUDERE 

PATIENTEN MET T1 MAMMACARCINOOM 

DIE NIET IN AANMERKING KOMEN VOOR 

CHIRURGIE 

M.D.F. de Jong, M.J.C.M. Rutten, D. Kreb, B.G. Looij, 

K. Bosscha, M. Ernst, H. van der Linden, G.J. Jager 


Doel: Radiofrequente ablatie (RFA) kan een alternatieve en 

effectieve behandeling vormen bij patiënten met T1 borstkanker, 

welke niet geschikt zijn voor chirurgisch ingrijpen. 

Doel is te bepalen of RFA technisch haalbaar en veilig is 

en of lokale tumorcontrole verkregen kan worden. Daarbij 

wordt geëvalueerd hoe de behandeling door patiënten wordt 

ervaren. 

Methode: Patiënten >70 jaar met een oestrogeen positief 

mammacarcinoom < 2 cm worden gevraagd deel te nemen 

aan deze studie. De respons na de aanvullende RFA therapie 

(naast hormonale therapie) zal geëvalueerd worden, middels 

mammografie, echografie en MRI na 1, 6 en 12 maanden. 

Tevens zal een echogeleid vacuümbiopt volgen van het 

RFA-gebied voor histologische analyse volgen na een jaar. 


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Ervaringen van patiënten voor, tijdens en na de behandeling 

worden geëvalueerd. 

Resultaten: In totaal hebben vijf patiënten RFA ondergaan, 

waarbij er geen aanwijzingen waren op lokaal recidief 

of residu weefsel na een jaar follow-up. De geableerde 

gebieden vertoonden afname van grootte en ringaankleuring 

gedurende follow-up. Bij één patiënte is interval follow-up 

niet verricht in verband met een CVA. Patiënten vonden 

RFA-behandeling verdraagbaar en er was afname van één 

punt op een zeven puntsschaal ter analyse van de kwaliteit 

van leven. 

Conclusie: RFA kan technisch veilig worden uitgevoerd bij 

inoperabele, oudere patiënten met een solitaire borsttumor, 

met minimale afname op de kwaliteit van leven. 

Figuur 1: bewezen maligne laesie linker mamma. 

Figuur 2: controle na 1 maand toont ringaankleuring. 

Figuur 3: na 1 jaar afname aankleuring, geen recidief. 

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P12 

PROPOSAL FOR AN ADAPTATION OF THE 

BERLIN ALGORITHM FOR DIAGNOSING 

SPA: RESULTS OF THE SPONDYLOARTHRITIS 

CAUGHT EARLY (SPACE)-COHORT 

R. van den Berg, M.H.E. Vossen, M. Reijnierse, 

T.W.J. Huizinga, D.M.F.M. van der Heijde 


Background: The Berlin algorithm assists clinicians in diagnosing 

early axial SpA. 

Objectives: Validate the Berlin algorithm in the 

SPondyloArthritis Caught Early (SPACE)-cohort. 

Methods: The SPACE-cohort is set-up in our hospital to 

early diagnose and treat (axial) spondyloarthritis (SpA)- 

patients. Patients with back pain (>3 months, < 2 years; 

onset 80% probability. In patients 

(n=65) not diagnosed with axial SpA, 14 (21.5%) patients 

fulfilled ASAS axial SpA criteria and 7 (10.8%) had >80% 

probability; the majority did not have IBP. 

The modified Berlin algorithm, with IBP as additional SpAfeature, 

resulted in three entry groups; requirement of ≥4, 

2-3, and 0-1 SpA-features. According to this modified algorithm, 

57 patients (50%) has axial SpA; 45 (78.9%) fulfilled 

ASAS axial SpA criteria and 55 (96.5%) had >80% probability. 

Of the 57 patients not diagnosed as SpA, six (10.5%) 

fulfilled ASAS axial SpA criteria. 15 additional patients 

could now be diagnosed as axial SpA by the modified Berlin 

algorithm and no single patient with a probability >80% was 

excluded. 

Conclusions: We propose a slightly modified Berlin algorithm 

excluding IBP as entry criterion that is better in accordance 

with the new ASAS axial SpA criteria. 

Results: In 4/114 patients no MRI was made and were analyzed 

as MRI-. According to the Berlin algorithm 49 patients 

Figure 1: The Berlin algorithm. 


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Figure 2: The modified Berlin algorithm. 

P13 

DIFFERENCE IN CLINICAL PRESENTATION OF 

PATIENTS WITH SPONDYLOARTHRITIS WITH 

A POSITIVE MRI OF THE SI JOINTS AND/OR 

HLA-B27 POSITIVITY 

R. van den Berg, M.H.E. Vossen, M. Reijnierse, 

T.W.J. Huizinga, D.M.F.M. van der Heijde 


Background: The SPondyloArthritis Caught Early (SPACE)- 

cohort is set-up in our hospital to early diagnose and treat 

(axial) spondyloarthritis (SpA)-patients. The new ASAS axial 

and peripheral SpA criteria rely on the presence of active 

sacroiliitis on MRI and on HLA-B27 positivity. 

Objective: Investigate the difference in presentation of 

patients with sacroiliitis vs. non-sacroiliitis on MRI and presence 

vs. absence of HLA-B27. 

Methods: Patients with back pain (>3 months, < 2 years; 

onset


P 

Table 1: Presence and distribution of SpA-features. 

P14 

FEASIBILITY OF FUNCTIONAL IMAGING, 

INCLUDING DYNAMIC CONSTRAST- 

ENHANCED MRI AND PERFUSION CT, 

FOR POST-CHEMORADIOTHERAPEUTIC 

RESTAGING IN RECTAL CANCER PATIENTS 

S.J. Klieverik, E. Kluza, M. Maas, R.G.H. Beets-Tan, G. Beets, 

D.M.J. Lambregts 


Aim: The aim of this study was to perform a review of the 

literature to determine whether 1) the current literature 

reports correlations between functional imaging and clinicopathological 

markers in rectal cancer patients and 2) if 

functional imaging is sensitive to chemoradiotherapy (CRT)- 

induced changes in rectal cancer. 

Methods: The literature of interest was searched using 

Pubmed. Studies were included when correlations between 

functional and clinicopathological markers and differences 

in functional parameters between pre- and post-CRT were 

reported. 

Results: Five studies used dynamic constrast-enhanced MRI 

(DCE-MRI) and two studies used perfusion CT (p-CT) to 

investigate the correlation between functional and clinicopathological 

markers. Two studies compared functional parameters 

from DCE-MRI in CRT responders vs. non-responders. 

Studies correlating DCE-MRI parameters with clinicopathological 

markers showed that higher endothelial transfer 

coefficient (Ktrans) and perfusion index (PI; a measure of 

both perfusion and cappilary permeability surface product) 

were significantly correlated with more advanced cancer 

stages (e.g. TNM stage) and that these functional parameters 

were significantly higher before treatment in patients 

with a good response to CRT than in non-responders. Two 

studies evaluated the correlation between p-CT parameters 

and clinicopathological parameters. Results showed that 

significantly higher blood volume, blood flow and mean 

transit time were found in groups with poor prognosis (e.g. 

high MVD, existence of lympathic metastasis). There were 

no studies comparing p-CT parameter in a pre vs. post-CRT 

setting. 

Conclusion: The reviewed literature shows that functional 

imaging parameters, especially Ktrans in DCE-MRI and 

BV and BF in p-CT, correlate with clinical and pathological 

markers. Therefore, both DCE-MRI and p-CT are of great 

potentional as non-invasive therapy-monitoring or therapypredicting 

methods in rectal cancer. 


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0-niveau 

0.4 0.5 

Brussels 

Paris 

Naar Expo Foyer 

Copenhagen 

0.3 

Lobby 

0.6 

0.7 

0.2 

0.9 0.8 

Berlin 

Athens 

Rome 

0.1 

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Naar hotel 

K1 

K2 

K3 

0.14 0.12 

0.13 

0.11 

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1-niveau 

Forum Passage 

Registratiebalie 

Trajectum 

Entree 

Naar hotel 

Expo Foyer 

Auditorium 1 

Slide preview > 

1.3 

1.2 

Podium 

Auditorium 2 


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programma PLATTEGRONDen En programma & abstracts 

2-niveau 

2.7 2.8 2.9 2.10 

Promenade 

2.11 

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2.6 

2.5 

Auditorium 1 

2.14 

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2.3 

Podium 

2.1 

Colorado 

Auditorium 2 

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Donderdag 29 september 2011 

Expofoyer Auditorium 2 Zaal 0.2 Berlin Zaal 0.3 Copenhagen Zaal 0.4 Brussels Zaal 0.5 Paris Zaal 0.8 Rome Zaal 0.9 Athens Zaal 2.1 Colorado 

10.00 - 10.45 Ontvangst 

10.45 - 12.00 Plenaire sessie: Emeritus programma 

Deze misser maak je (start vanaf 11.20 uur) 

maar één keer 

12.00 - 13.00 Lunch 


13.00 - 14.00 Plenaire sessie: 

Setting standards in 

healthcare - 

many ways, no return 

14.05 - 15.35 Research corner Vervolg Parallelsessie: Parallelsessie: Parallelsessie: Parallelsessie: Parallelsessie: 

Emeritus programma Interventieradiologie / Cardiovasculaire Abdominale radiologie / Mammadiagnostiek 1 Abdominale 

Cardiovasculaire radiologie radiologie Acute radiologie / Diversen radiologie 1 

15.35 - 16.00 Theepauze 

16.00 - 17.15 Refresher course: Workshop: Vervolg Refresher course: refresher course: Refresher course: refresher course: 

Respons monitoring “Interpretatie van radiologisch Emeritus programma Chronische thrombo- Neuranatomie Beeldvorming bij groei- What is the best imaging 

made sexy wetenschappelijk onderzoek” embolische pulmonale voor dummies en puberteitsstoornissen modality for “aseptic/low 

hypertensie grade infection/infectious 

loosening of joint prostheses?” 

17.15 - 17.30 Uitreiking WSS penning 

17.30 - 18.45 ALV NVvR & Juniorsectie 

18.15 Industrieborrel: 

excl. aangeboden door 

Vrijdag 30 september 2011 

Expofoyer Auditorium 2 Zaal 0.1 London Zaal 0.2 Berlin Zaal 0.4 Brussels Zaal 0.5 Paris Zaal 0.8 Rome Zaal 0.9 Athens Zaal 2.1 Colorado 

08.30 - 09.00 Ontvangst 

09.00 - 10.15 Workshop/hands-on: Workshop: refresher course: refresher course: Refresher course: refresher course: refresher course: 

To make Radlex more familiar. “Interpretatie van Buiktrauma, waar gaat Acute pijn op de borst: De knie: Niet standaard Opleiden anno 2011 Veneuze 

Using IHE TCE for radiologisch het nou eigenlijk om Stand van zaken MRI bevindingen en interventies 

export of PACS data to wetenschappelijk de postoperatieve knie 

an MIRC teaching file onderzoek” 

10.15 - 10.45 Koffiepauze 

10.45 - 12.15 Parallelsessie: Parallelsessie: Parallelsessie: Parallelsessie: Parallelsessie: Parallelsessie: 

De educatieve Abdominale Mammadiagnostiek 2 Kinderradiologie / MSK / Thorax / Neuro-Hoofdhals 

voordracht radiologie 2 & Uitreiking Diversen Diversen radiologie 

Jan Hendriksprijs 

12.15 - 13.15 Lunch 


13.15 - 13.30 Wetenschappelijk beleid 

NVvR voor academischeen 

niet academische centra 

13.30 - 14.30 Plenaire sessie: 

Pro-con: Setting standards in 

healthcare - which way to go? 

14.30 - 15.15 Richtlijnen sessie 

15.15 - 15.45 Theepauze 

15.45 - 16.25 Prijsuitreiking: 

Philipsprijs, Posterprijs, 

Radiologendagenprijs, 

NVvR Travel Grant en 

Fellowshipdiploma’s 

16.25 - 17.15 Quiz 

Vanaf 20.00 Diner & galafeest in Amrâth Grand Hotel De L’Empereur, Maastricht 

Het uitgebreide programma en de leerdoelen vindt 

u vooraan in dit programma- en abstractboek: 

Donderdag 29 september 2011: bladzijde 2 t/m 5 

Vrijdag 30 september 2011: bladzijde 5 t/m 7

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programma & abstracts - Nederlandse Vereniging voor Radiologie

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