Postgraduate Educational Programme - myESR.org

Postgraduate Educational Programmeof irradiated rectal cancer is 47%-54%. The major cause of overstaging is diffusehypointense tissue infiltration into the mesorectal fat, related to marked fibrosis ofthe bowel wall and desmoplastic reaction. Replacement by fibrotic scar tissue withan island of residual adenocarcinoma can make it difficult to identify viable tumouron MR images, causing understaging. Imaging after CRT is not sufficiently accuratefor identifying complete responders, with PPVs ranging from 17 to 50%. In mostcases, a hypointense scar replaces the site of disease, and the major componentof error on MRI is overstaging due to its limited capability to differentiate betweenviable tumour, residual fibrotic tissue, and desmoplastic reaction. DWI in additionto standard MRI significantly improves the performance of radiologists to selectcomplete responders.Learning Objectives:1. To learn the rationale for following-up on patients after neoadjuvant chemoradiation.2. To understand conventional imaging criteria for assessing tumour response.3. To learn about new techniques for assessing response, including diffusionMRI and PET/CT.A-010 16:55C. Assessment of anal cancer responseV.J. Goh; London/UK (vicky.goh@kcl.ac.uk)Anal cancer is an uncommon cancer, accounting for 1.5% of all gastrointestinalcancers, but is increasing in incidence. Anal cancer is predominantly a loco-regionaldisease; less than 5% of patients have disease outside the pelvis at presentation.Definitive chemoradiation, combining radiotherapy with concomitant 5-fluorouraciland mitomycin C, is recognised to be the optimal treatment modality for squamouscell cancers of the anal canal and margin, offering good loco-regional control andsurvival rates similar to surgery. Traditionally clinical examination and proctoscopyhave been the main tools for locoregional tumour assessment, however, in recentyears, imaging has become the method of choice for assessing tumour regressionfollowing chemoradiation. The advantage and limitations of the different imagingtechniques in assessing response will be described. The complications of treatmentand imaging appearances will also be discussed.Learning Objectives:1. To learn the rationale for restaging after therapy.2. To know how to assess the tumour response with conventional imaging criteria.3. To learn about new techniques for assessing response in anal cancer, includingdiffusion MRI and PET/CT.Panel discussion:What clinicians expect from us in rectal and anal cancer staging andrestaging? How should we image patients? 17:1516:00 - 17:30 Room D2CardiacRC 303Cardiac imaging: the cutting edgeModerator:E. Di Cesare; L’Aquila/ITA-011 16:00A. Cardiac MRI: do we need more than 1.5 T?B.J. Wintersperger; Toronto, ON/CA (Bernd.Wintersperger@uhn.ca)1.5 T cardiac MR imaging is a main stay of cross-sectional imaging of various cardiacdiseases and has proven high accuracies and new insights into diseases. Basedon its success, diagnostic approaches have changed and also risk assessmentfor some cardiac diseases has become possible. Based on continuous technicaldevelopments though higher field strength have become available in recentyears with clinical use of 3 T and research use of 7 T. However, specific changesthat come along with the increase in B0 have to be incorporated in most aspectsof a cardiovascular MR imaging procedures; from patient screening to imagingtechnique details. Basic changes at higher B0 are: B0 proportional increase ofSNR, substantial increase in RF deposition, changes in magnetic tissue propertiesand B0/B1 inhomogeneities. While most of these changes affect all aspectsof cardiac imaging at 3 T, some may only affect certain applications (e.g. assessmentof myocardial iron). CE MRA benefit from SNR increase at higher B0 (e.g.3 T) and improved background suppression based on short TR and prolonged T1values. While some applications at higher B0 have not yet been proven to impactdiagnosis signal starving applications at 1.5 T (e.g. myocardial perfusion), alsosubstantially benefit from the B0 increase. The work horse of cardiac MRI, cineSSFP is affected by off-resonance artifacts at higher B0, with proper adjustments(shimming, frequency scouting) though diagnostic image quality can be maintained.Most importantly, in daily routine also the safety aspect of the patient with potentialdevices has to be taken into account.Learning Objectives:1. To learn about the differences between 1.5 T and 3 T cardiac MRI.2. To understand the clinical applications of high-field cardiac MRI.3. To become familiar with the problems of using high-field cardiac MRI in dailyroutine.Author Disclosure:B. J. Wintersperger: Speaker; Siemens Healthcare, Bayer Healthcare.A-012 16:30B. Cardiac CT: technique in 2020; where to next?K. Nikolaou; Munich/DE (konstantin.nikolaou@med.uni‐muenchen.de)In recent years, technical advances and improvements in cardiac computedtomography (CT) have provoked increasing interest in the potential clinical roleof this technique in the non-invasive work-up of patients with various cardiacdiseases - most importantly in patients with suspected coronary artery disease(CAD). Within the next years, several trends are foreseeable: from a researchstandpoint, the strengthening of clinical evidence by larger, randomised, clinicalmulticentre trials for cardiac-CT indications can be expected. From a technicalstandpoint, there are two main fields of interest and technical developments to beexpected: further optimising radiation dose and image quality, by techniques suchas high-pitch scanning, iterative reconstruction algorithms, wide detectors withsingle heart beat acquisitions and digital detector technology. On the other hand,introduction of new applications and protocols, such as the combined assessmentof cardiac morphology, function, and viability/perfusion, will broaden the clinicalapplicability of cardiac-CT.Learning Objectives:1. To learn about the latest technical developments in state-of-the-art cardiacCT.2. To explore what new developments will influence cardiac CT over the nextfew years.3. To understand if what you need is a lot of rows, tubes or both for optimalcardiac CT.A-013 17:00C. Cardiac hybrid imaging: “One-Stop-Shop”P.A. Kaufmann; Zurich/CH″Abstract Not Submitted″Learning Objectives:1. To understand the principles of cardiac hybrid imaging.2. To learn about the diagnostic value of hybrid imaging.3. To know about possible indications for performing hybrid imaging.16:00 - 17:30 Room E1Molecular ImagingRC 306Molecular imaging in oncologyModerator:O. Clément; Paris/FRA-014 16:00A. New PET-tracers for oncologyP.L. Choyke; Bethesda, MD/US (pchoyke@nih.gov)PET tracers represent an exciting development in the imaging of cancers. Becauseof the sensitivity of PET (nano-pico molar sensitivity vs. micromolar for MRI), it ispossible to image cell membrane-based receptors responsible for the abnormalgrowth associated with cancers and detect subtle changes in the integrity of cancercells. FDG-PET /CT has been the trailblazer agent, demonstrating unique sensitivityfor cancers, however, while FDG uptake does reflect glycolysis, it is relativelynon-specific and, to date, has not dictated the choice of therapies. The promiseof new PET agents is that they will aid clinicians in adding or deleting therapiesdepending on the pharmacodynamics of the imaging biomarker. For instance,classes of agents have been developed to investigate angiogenesis, proliferation,S8AB C D E F G